Metastatic Pancreatic Adenocarcinoma to the Ovary: A Clinicopathologic Review of Twenty Nine Cases
RA Abadeer, A Malpica. The University of Texas M.D. Anderson Cancer Center, Houston, TX
Background: Metastatic pancreatic adenocarcinoma to the ovary (MPAO) can represent a diagnostic dilemma. The number of studies on this topic is limited. In this study, we present the clinicopathologic features of twenty nine such cases seen at our institution.
Design: Twenty-nine cases of MPAO were retrieved from our files of which twenty six cases had available slides. Patient demographic, initial diagnostic impression, serum tumor marker, treatment, and follow-up data were collected along with pathologic parameters including laterality/size of ovarian metastases, pancreatic site/size of primary lesions, and metastatic burden.
Results: Patients' age ranged from 30-77 years (mean 58). Tumors were bilateral in 58.6% (17/29), unilateral to the right ovary in 27.6% (8/29), and unilateral to the left in 13.8% (4/29) of the cases. MPAO size (range 1.5-29, mean 9.0 cm) was generally larger than the pancreatic tumor (range 1.7-11.0, mean 5.6 cm). Primaries were located in distal pancreas in 48.3% (14/29), proximal pancreas in 27.6% (8/29), and mid/body in 24.8 % (7/29) of the cases. Extra-ovarian metastatic disease was widespread; peritoneal metastases were the most common, followed by omentum and liver. Initial clinical impression was that of a pancreatic primary in 51.7% (15/29) and ovarian primary in 44.8% (13/29) of cases. Serum tumor markers were not ordered in all cases: 83.3% (10/12) of CA 19.9, 73.3% (11/15) of CA 125, and 46.2% (6/13) of CEA results were elevated. Microscopically, the majority of MPAO had ovarian surface involvement (18/26) and desmoplasia (18/26). Infiltrative and nodular patterns of invasion were the most commonly encountered (10/26 and 9/26 respectively). MPAO had cytologic atypia ranging from mild to high grade with a predominance of moderate atypia (12/26). Surgery plus gemcitabinebased chemotherapy was the most common treatment. Median survival ranged from 1 day (necropsy diagnosis) to 58 months (median 11 months). 5 of 29 patients are alive with disease after a follow-up period ranging from 3 to 108 months.
Conclusions: 1. MPAO still represents a diagnostic dilemma from the clinical and pathologic standpoints. 2. Up to 41% of the cases can present as a unilateral ovarian mass. 3. MPAOs are usually larger in size than the pancreatic tumor. 4. Although we encountered a constellation of histologic features present in MPAO, there are cases with overlapping histologic features with primary ovarian tumors. In such cases clinicopathologic correlation is of utmost importance to ensure an accurate diagnosis.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 140, Monday Morning