Daya D, Nazerali L, Frank G L
Department of Pathology, Hamilton Civic Hospitals, Ontario, Canada.
Am J Clin Pathol. 1992 Jun;97(6):751-8. doi: 10.1093/ajcp/97.6.751.
The distinction of metastatic ovarian carcinoma from a primary malignant ovarian neoplasm is crucial to its subsequent management. The most common metastatic carcinoma that mimics primary ovarian carcinoma is that of large bowel origin. The clinical and pathologic features of 25 cases of intestinal adenocarcinoma metastatic to the ovaries were analyzed. The patients ranged in age from 47 to 80 years (average age, 60 years). Most patients had abdominal pain and a pelvic mass. In 56%, the ovarian tumors and the large bowel carcinomas were discovered synchronously; 44% were metachronous. Seventy-five percent of the tumors were unilateral. Gross examination revealed that all the ovarian tumors were solid and cystic with smooth outer surfaces. Most of the tumors showed hemorrhage and necrosis. Histologic examination showed that 13 cases had a predominantly endometrioid-like pattern, four cases were predominantly mucinous, and the rest demonstrated a mixed pattern. The presence of a garland pattern with cribriform areas and "dirty" necrosis were the most distinctive features that were helpful in correctly differentiating these tumors from primary endometrioid ovarian carcinoma, with which they are often confused. Immunohistochemical stains for carcinoembryonic antigen showed strong intracytoplasmic positive staining in all the cases of intestinal adenocarcinoma metastatic to the ovaries, in contrast to primary ovarian endometrioid carcinoma, which stain negatively for carcinoembryonic antigen or show only intraluminal or apical positivity. As expected, intestinal adenocarcinoma metastatic to the ovaries had a very poor prognosis. Seventy percent of the patients died within a period of 1 to 19 months (average, 8.2 months). Its distinction from primary ovarian carcinoma is crucial because the management and prognosis of metastatic ovarian carcinoma of large intestine origin is different.
区分转移性卵巢癌与原发性恶性卵巢肿瘤对其后续治疗至关重要。最常模仿原发性卵巢癌的转移性癌是大肠来源的。分析了25例转移至卵巢的肠腺癌的临床和病理特征。患者年龄在47至80岁之间（平均年龄60岁）。大多数患者有腹痛和盆腔肿块。56%的患者卵巢肿瘤和大肠癌是同时发现的；44%是异时发现的。75%的肿瘤为单侧。大体检查显示所有卵巢肿瘤均为实性和囊性，外表面光滑。大多数肿瘤有出血和坏死。组织学检查显示，13例主要为子宫内膜样模式，4例主要为黏液性，其余为混合模式。具有筛状区域的花环模式和“脏”坏死的存在是最具特征性的表现，有助于将这些肿瘤与原发性子宫内膜样卵巢癌正确区分，它们常与原发性子宫内膜样卵巢癌混淆。对癌胚抗原的免疫组化染色显示，所有转移至卵巢的肠腺癌病例均有强细胞质内阳性染色，而原发性卵巢子宫内膜样癌对癌胚抗原染色阴性或仅显示腔内或顶端阳性。正如预期的那样，转移至卵巢的肠腺癌预后很差。70%的患者在1至19个月内死亡（平均8.2个月）。将其与原发性卵巢癌区分开来至关重要，因为大肠来源的转移性卵巢癌的治疗和预后不同。
