Metastatic Adenocarcinoma from Pancreas Involving the Ovary; Histopathologic Analysis of 11 Cases
Ho-Seop Park, Chang Okh Sung, Kyu-Rae Kim. University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Background: Metastatic carcinoma involving ovary from pancreas (MOCPA) is rare, but one of the most frequently misdiagnosed neoplasm as a primary benign, borderline and malignant mucinous neoplasm of the ovary. Histopathologic features are among the most important clue for the diagnosis because immunohistochemical profiles between primary and metastatic carcinomas are considerably overlapping, and the ovarian mass is often a first manifestation of the disease. However, there are only a few literature describing detailed histologic features.
Design: In an attempt to find helpful findings for differential diagnosis, we reviewed histopathologic features and immunohistochemical profiles for cytokeratin 7(CK7), cytokeratin 20(CK20), CDX-2, Villin, DPC-4, PAX-2, and PAX-8 of 11 cases of MOCPA that were diagnosed at Asan Medical Center, Seoul, Korea, during 19 year-period and recognized a few hitherto undescribed histologic findings.
Results: At lower magnification, there were four major histologic patterns including 1) cystadenoma-like, 2) microcystic serous cystadenoma-like, 3) primary mucinous borderline tumor-like, and 4) infiltrative and desmoplastic patterns. Two or more histologic patterns were admixed in most cases. At higher magnification, single layered epithelium in the cystadenoma-like pattern was lined by cytologically malignant cells, showing cytologic-architectural dissociation and having significantly increased Ki-67 labeling index (17-38%, mean 29%), whereas in primary mucinous tumors the degrees of architectural complexity and cytologic atypia were usually parallel and Ki-67 lableing index is low (less than 6%) in the cystadenoma. Immunohistochemical expressions were variable; CK7 (100%), CK20 (75%), CDX-2 (71%), villin (100%), loss of DPC-4 (63%), and PAX-2 (0%) and PAX-8 (0%). Cystadenoma-like and microcystic serous cystadenoma-like features have not been described in metastatic carcinoma to the ovary from other organs. Primary mucinous borderline tumor-like pattern showed signficantly increased number of goblet cells compared to primary mucinous borderline tumors. Since all extraovarian tumor foci within the same tumor showed usual infiltrative patterns regardless of intraovarian histologic patterns, the peculiar intraovarian histology appears to be related to the specific ovarian environment.
Conclusions: Awareness of major histopathologic and cytologic-architectural patterns can be useful for the recognition of metastatic carcinoma of pancreatic origin and differentiation from primary mucinous neoplasm, especially during the frozen sections.
Category: Gynecologic & Obstetrics
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 170, Wednesday Morning