Invasive breast carcinoma - IARC

A
B
Fig. 2.131 Krukenberg tumour. A Note the bilateral nodular ovarian masses of solid yellow-white tissue. B Histology shows the typical features of metastatic gastric
carcinoma consisting of signet-ring cells within a fibrous stroma. C Tubular variant. This mucin-secreting adenocarcinoma resembles a primary ovarian clear
cell adenocarcinoma.
C
{951}. In patients with a gastrointestinal
c a n c e r, the ovarian malignant gro w t h
was discovered before, or more frequently,
at the same time as the gastrointestinal
primary {2232}. In 35% of
patients with a Krukenberg tumour, the
diagnosis of the digestive primary preceded
the diagnosis of the ovarian
metastasis {1933,2545}. When a patient
presents with abdominopelvic symptoms
leading to suspicion of an ovarian
tumour, the symptoms are non-specific
and similar to those of ovarian cancer,
i.e. pelvic masses, ascites or bleeding
{1598,2545}. Eighty percent of patients
with a Krukenberg tumour had bilateral
ovarian metastases, and 73% of patients
with ovarian metastases from breast carcinoma
had extraovarian metastases
{951,2545}.
Imaging
Several studies have evaluated radiological
findings in patients with a Krukenberg
tumour {1094,1460}. When imaging feat
u res were compared, patients with a
Krukenberg tumour more frequently had
a solid mass with an intratumour cyst,
w h e reas primary ovarian growths were
p redominantly cystic {1460}. Magnetic
resonance (MR) imaging seems to be
m o re specific than computed tomography
scan. Identification of hypointense
solid components in an ovarian mass on
T2-weighted MR images seems to be
characteristic of a Krukenberg lesion, but
this aspect is not specific {1094}.
Macroscopy
Ovarian metastases are bilateral tumours
in approximately 70% of cases {2605}.
They grow as superficial or parenchymatous
solid nodules or, not uncommonly,
as cysts. The size of ovarian metastases
is variable even from one side to the
other. The ovaries may be only slightly
enlarged or measure 10 cm or more.
Site of origin
The frequencies of various sites of origin
of secondary ovarian tumours diff e r
among different countries according to
the incidence of various cancers therein.
Colonic adenocarcinoma pro b a b l y
accounts for most metastatic ovarian
tumours that cause errors in diagnosis
{1587,2605,3226}. Frequently, the ovarian
metastases and the primary tumour
a re discovered synchro n o u s l y, or the
intestinal tumour has been re s e c t e d
months or years pre v i o u s l y.
Fig. 2.132 Metastatic adenocarcinoma of colon.
Note the solid and cystic mucinous appearance.
Fig. 2.133
tumour.
Metastatic adenocarcinoma of pancreas. Note the resemblance to a mucinous borderline
194 Tumours of the ovary and peritoneum