metastatic carcinoma to the ovary - lasop.com · hypercalcemic undiff ca juv. gct lymphoma scc...
TRANSCRIPT
![Page 1: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/1.jpg)
METASTATIC CARCINOMATO THE OVARY
Steven G. Silverberg, M.D.University of Maryland
Baltimore, Maryland, U.S.A.
![Page 2: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/2.jpg)
CLINICAL IMPORTANCE OF METASTASES TO THE OVARY
• 10-20% of all cancers in the ovary are metastatic
• higher proportion of mucinous, ? endometrioid-appearing tumors
• surgical Rx: find metastases/“implants” vs. find the primary (first or second operation)
• chemotherapy: different for ovarian vs. other 1o sites
![Page 3: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/3.jpg)
TIME OF DIAGNOSISOF OVARIAN METASTASES
• after primary• concurrent with primary (?FS of ovarian
tumor)• before primary (most difficult for the
pathologist; 17-38% of cases in the literature
![Page 4: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/4.jpg)
TYPES OF CANCERS METASTASIZING TO THE OVARY
• most commonly adenocarcinomas, but anything is possible (squamous, small cell neuroendocrine, transitional cell, melanoma, sarcomas, etc.
• lymphomas/leukemic infiltrates can be 1o in the ovary or (more often) part of a disseminated process)
• if no residual ovarian tissue is found, R/O a primary parovarian process
![Page 5: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/5.jpg)
MAIN SOURCE OF CARCINOMA METASTATIC TO THE OVARY
• genital (contralateral ovary, corpus, cervix [adeno], fallopian tube)
• extragenital (esp. colorectum, breast, stomach, pancreas, appendix)
• synchronous primaries are an important consideration mostly for genital sites
![Page 6: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/6.jpg)
![Page 7: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/7.jpg)
![Page 8: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/8.jpg)
![Page 9: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/9.jpg)
METASTATIC COLORECTAL ADENOCARCINOMA:CLINICAL FEATURES
• ~ 1/3 or more of all metastatic ovarian cancers
• 2-10% of women with colorectal carcinoma develop ovarian metastases
• up to 45% of metastases are thought clinically to be ovarian 1o
• 3% of women in one series presented with ovarian mass and unsuspected intestinal disease
![Page 10: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/10.jpg)
METASTATIC COLORECTAL ADENOCARCINOMA:
PATHOLOGIC PROBLEMS
• 30-50% may be unilateral• usually smaller than 10 cm, but may be 20-30
cm• ~ 1/3 contain benign-appearing or borderline-
appearing foci (occasionally most or all of the sampled tumor)
• may appear mucinous or endometrioid, rarely clear cell, papillary, signet cell, or adenosquamous
![Page 11: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/11.jpg)
![Page 12: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/12.jpg)
![Page 13: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/13.jpg)
![Page 14: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/14.jpg)
![Page 15: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/15.jpg)
![Page 16: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/16.jpg)
![Page 17: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/17.jpg)
![Page 18: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/18.jpg)
![Page 19: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/19.jpg)
![Page 20: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/20.jpg)
![Page 21: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/21.jpg)
![Page 22: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/22.jpg)
![Page 23: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/23.jpg)
![Page 24: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/24.jpg)
![Page 25: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/25.jpg)
![Page 26: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/26.jpg)
![Page 27: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/27.jpg)
![Page 28: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/28.jpg)
![Page 29: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/29.jpg)
![Page 30: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/30.jpg)
![Page 31: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/31.jpg)
![Page 32: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/32.jpg)
![Page 33: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/33.jpg)
![Page 34: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/34.jpg)
![Page 35: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/35.jpg)
![Page 36: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/36.jpg)
![Page 37: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/37.jpg)
![Page 38: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/38.jpg)
![Page 39: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/39.jpg)
![Page 40: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/40.jpg)
SMALL CELL TUMORS IN THE OVARY:DIFFERENTIAL DIAGNOSIS
Lymphoid markers
Inhibin, calretinin
CK(7)CK, EMANE, TTF-1IHC
SheetsLut., cystsPleo.,? diff.
Small/large cellsAzzopardi effect
H&E features
LN/spleenEstrogenPerit. spread
CA++Lung 1oOther clinical features
B/UUBUBLaterality
AllYoungOlderYoungOlderAge
LymphomaJuv. GCTUndiff CAHypercalcemic SCC
Metastatic SCC
![Page 41: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/41.jpg)
METASTASES TO THE OVARY FROM GENITAL TRACT CARCINOMAS
• endometrium• endocervix• contralateral ovary• fallopian tube
![Page 42: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/42.jpg)
METASTASES FROM CONTRALATERAL OVARY
• LOH studies have suggested mets. more common than synchronous primaries
• usual criteria for differential diagnosis (multinodularity, surface and vascular involvement, etc.)
• serous/TCC/undiff. most frequently bilateral• clinically, staging and treatment same for
mets. and synchronous primaries
![Page 43: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/43.jpg)
METASTASES FROM ENDOMETRIAL CARCINOMA VERSUS SEPARATE PRIMARIES
Not monoclonalMonoclonalNo vascular involvementVascular involvement
Primarily deepPrimarily surface involvedUninodularMultinodular
No other metastasesOther metastasesEndometriosisNo endometriosis
Low grade endometrioidType 2/high grade CANo myoinvasionDeep myoinvasion
YoungerOlder
Favor Synchronous PrimariesFavor Metastasis
![Page 44: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/44.jpg)
![Page 45: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/45.jpg)
![Page 46: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/46.jpg)
MUCINOUS TUMORSOF OVARY AND CERVIX
(IJGP 7:99, 1988)
310316(3)Young
(Ob. Gyn. 64:553, 1984)
—145(2)Kaminski
(IJGP 1:391, 1983)
—404(1)LiVolsi
# BOTH# PRIMARY# METASTATIC# OF CASESAUTHORS
(1) 4 of 22 invasive cervical AC(2) 5 of 39 cervical mucinous AC, 6 of 51 endometrioid(3) 10 of 16 were “adenoma malignum”
![Page 47: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/47.jpg)
MUCINOUS TUMORS OF OVARY AND CERVIX: HELPFUL CRITERIA
(Young and Scully, Int J Gynecol Pathol 7: 99, 1988)
CommonLess commonCervical tumor spread
Less commonOccasionalMucinous metaplasia of tube or endometrium
CommonUncommonLVSI in either tumor
DeepSuperficialCervical tumor invasionSimilarDissimilarTumor histology
CommonLess commonOvarian surface implantsBilateralUnilateralLaterality of ovarian tumor
ShortLongDisease-free follow-upShortLongInterval between tumors
MetastaticPrimary
Note: Endometriosis, IHC, and molecular studies not mentioned
![Page 48: METASTATIC CARCINOMA TO THE OVARY - lasop.com · Hypercalcemic Undiff CA Juv. GCT Lymphoma SCC Metastatic SCC. METASTASES TO THE OVARY FROM ... • Ovary first in 2, after cervix](https://reader031.vdocuments.mx/reader031/viewer/2022020319/5d3451f288c99354318bd139/html5/thumbnails/48.jpg)
ADENOCARCINOMAS OF OVARY AND CERVIX(Elishaev et al, AJSP 29:281-294, 2005)
• 10 Cases, all originally thought to be 1o ovarian tumors• Age 28-51• Ovary first in 2, after cervix in 3, simultaneous in 5• Ovarian tumors bilateral in 2 cases, unilateral in 8, 10 cm or
more in 7• 7 Ovarian tumors looked endometrioid, 3 mucinous; only 1 frankly
invasive• Suspicious features were combined endometrioid/mucinous
phenotype, BOT with IEC• Endocervical tumors mostly small (2 considered microinvasive)• 8 of 10 had no other metastases detected• p16 expression and identical HPV types (mostly 16) present in
cervical and ovarian tumors, ER/PR usually negative or weak