Ovarian Metastases of Pancreaticobiliary Tract Adenocarcinomas: Analysis of 35 Cases, with Emphasis on the Ability of Metastases To Simulate Primary Ovarian Mucinous Tumors.
Zina Meriden, Anna V Yemelyanova, Russell Vang, Brigitte M Ronnett. Johns Hopkins Medical Institutions, Baltimore, MD
Background: Metastatic mucinous carcinomas in the ovary are readily recognized when they display characteristic features (bilateral involvement, moderate tumor size, surface involvement, nodular growth, an infiltrative pattern) but are capable of simulating primary ovarian mucinous tumors. Metastatic pancreaticobiliary tract adenocarcinomas present a particular diagnostic challenge due to their ability to exhibit borderline-like and cystadenomatous growth patterns which can be misinterpreted as underlying primary ovarian precursor tumors.
Design: Clinicopathologic features of 35 metastatic pancreaticobiliary tract adenocarcinomas in the ovary were analyzed. Immunohistochemical analysis of Dpc4 expression was performed on 33 cases and clinical follow-up was obtained.
Results: Mean patient age was 58 years (median, 59; range, 33-78). In 15 cases (43%), the pancreaticobiliary tract and ovarian tumors presented synchronously and in 2 cases (6%) the ovarian tumors presented prior as the first manifestation of disease. Ovarian tumors were bilateral in 31 cases (89%). Mean and median sizes were 10.6 and 9.5 cm, respectively (range, 2.5-21 cm). Nodularity was present in 22 cases (63%) and surface involvement was identified in 14 cases (40%). An infiltrative pattern was present in 28 cases (80%), most often admixed with borderline-like and cystadenomatous areas but as the exclusive pattern in 11 cases (31%). Conversely, borderline-like and cystadenomatous patterns were identified in 24 cases (69%) and as the exclusive patterns (either pure or combined with one another) in 7 (20%). Dpc4 expression was lost in 20 of 33 tumors analyzed (61%). Of 25 patients with follow-up, 23 died of disease (mean/median time, 9/6 months; range, 1-39) and 2 were alive with disease (at 1 and 25 months).
Conclusions: Frequent bilateral ovarian involvement, moderate tumor size, nodularity, and infiltrative patterns are useful features for identifying these ovarian tumors as metastatic; however, many also exhibit borderline-like and cystadenomatous patterns which, when dominant and combined with synchronous presentation, make recognition as metastases challenging. Loss of Dpc4 expression provides the most useful immunohistochemical evidence for establishing the pancreaticobiliary tract as the most likely source of these metastases.
Category: Gynecologic & Obstetrics
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 146, Monday Morning