Metastatic Endocervical Adenocarcinoma in the Ovary: The MD Anderson Experience
I Aguilera-Barrantes, ED Euscher, A Malpica. MD Anderson, Houston, TX
Background: The ovary is a common location for metastatic adenocarcinoma, particularly colorectal carcinoma. Metastasis from an endocervical adenocarcinoma (EAC), by comparison, is uncommon. Occasionally, such metastases can mimic a primary ovarian mucinous tumor and rarely precede the diagnosis of EAC. The distinction of these two entities has significant therapeutic and prognostic implications. In this study, we present the clinicopathologic features of 36 such cases.
Design: Thirty-six cases of metastatic endocervical adenocarcinoma (MtEC) were retrieved from the files of our institution over a 20 year period. Clinical information was retrieved from patients' (pts) charts. Clinical and pathologic features noted included: patient age, depth of invasion of the EAC, time elapse between diagnosis of endocervical and ovarian tumors, and histologic features of the MtEC.
Results: Pts ranged in age from 22 to 72 years (median 46). Presenting findings included abnormal vaginal bleeding or discharge (9 cases), abdominal pain (5 cases), increased abdominal girth (3 cases), pelvic mass on imaging studies (2 cases), and abnormal Pap smear (2 cases). In 2 pts, MtEC preceded the diagnosis of EAC by 18 and 21 months, respectively. In 25 pts, MtEC was detected at the time of curative surgery. Nine pts had a prior history of EAC, and surgery was performed to evaluate a new pelvic mass. In two of these patients, MtEC occurred 7 and 25 years, respectively. In 19 pts, EAC was deeply invasive into the outermost endocervical stroma. In 1 pt, invasive EAC was confined to the inner half of the stroma. In 3 pts, EAC was minimally invasive: 3/15 mm, 1/5 mm and 2/7 mm respectively. In the remaining cases, only biopsies were performed precluding an accurate assesment of invasive carcinoma. Histologic features of MtEC included: surface involvement, 14 cases; increased mitotic activity for level of cytologic atypia, 7 cases; infiltrative invasion, 6 cases; apoptosis, 4 cases, pseudomyxoma ovarii, 4 cases; tumor location in hilum, 3 cases; tumor in lymphatic spaces of ovary only, 2 cases; dirty necrosis, 1 case.
Conclusions: MtEC in the ovary can present a diagnostic challenge. In 5.5% of the series cases, MtEC was the first manifestation of disease and originally interpreted as a mucinous borderline tumor. Additionally, the absence of deep cervical stromal invasion should not preclude a diagnosis of MtEC as this can occur in the presence of superficially invasive EAC as observed in 3 of the study cases. Further study is required to determine whether ovaries should be left in situ in patients with EAC.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 147, Wednesday Morning