Young Robert H
James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Adv Anat Pathol. 2006 Sep;13(5):205-27. doi: 10.1097/01.pap.0000213038.85704.e4.
This review considers historical aspects of metastatic tumors to the ovary, general principles that aid in their evaluation, and metastatic mucinous tumors, including the Krukenberg tumor. The historical timeline on the Krukenberg tumor dates back to the legendary Sir James Paget and the story is followed through the well-known, albeit flawed, contribution of Friedrich Krukenberg and others who have contributed important papers over the years, including the overlooked contribution of the French investigator Gauthier-Villars. Knowledge of metastatic colorectal carcinoma is traced back to the famed British surgeon Sir John Bland-Sutton and followed through to more recent contributions, including the important one of Lash and Hart. Contributions on mucinous tumors conclude the historical perspective, note being made of the recent evidence suggesting that the long held contention of Dr Robert E. Scully that ovarian mucinous tumors in patients with pseudomyxoma peritonei usually originate from the appendix is correct. The section on general principles highlights the many clinical, gross, microscopic, and special techniques such as immunohistochemistry that may aid in determining that an ovarian tumor is metastatic with emphasis on the first 3 mentioned aspects. Problematic features such as a tendency for metastatic tumors to be cystic, even when the primary tumors are not, and for many metastatic tumors to mature in the ovary (so-called maturation phenomenon), are emphasized. Of the many helpful findings that resolve the problem, the characteristic features of surface implants are highlighted. The contribution on the Krukenberg tumor reviews the varied microscopy of this tumor pointing out that the well-known pattern of signet-ring cells in a cellular stroma, albeit characteristic, is often not striking and frequently overshadowed by other microscopic features. The latter include, in many cases, a rather unique microcystic pattern. The final portion of the essay reviews mucinous tumors of non-Krukenberg type, beginning with those that originate from the appendix. The appendiceal neoplasms have distinctive features in most cases being particularly well differentiated, and this is also seen in their ovarian metastases. Other mucinous tumors that commonly simulate closely metastatic neoplasms, include those from the pancreas in particular, but also diverse other sites, are then reviewed.
本综述探讨了卵巢转移性肿瘤的历史背景、有助于评估它们的一般原则以及转移性黏液性肿瘤，包括库肯勃瘤。库肯勃瘤的历史可追溯到传奇人物詹姆斯·佩吉特爵士，随后讲述了弗里德里希·库肯勃及其他多年来发表重要论文者的贡献，尽管存在缺陷，其中还包括法国研究者高蒂埃 - 维拉尔被忽视的贡献。转移性结直肠癌的相关知识可追溯到著名的英国外科医生约翰·布兰德 - 萨顿爵士，并一直延续到近期的贡献，包括拉什和哈特的重要贡献。关于黏液性肿瘤的贡献总结了历史观点，注意到最近的证据表明，罗伯特·E·斯库利博士长期以来的观点是正确的，即患有腹膜假黏液瘤患者的卵巢黏液性肿瘤通常起源于阑尾。一般原则部分强调了许多临床、大体、显微镜及特殊技术，如免疫组化，这些技术有助于确定卵巢肿瘤是转移性的，重点是前面提到的三个方面。强调了一些有问题的特征，如转移性肿瘤即使原发肿瘤不是囊性也倾向于呈囊性，以及许多转移性肿瘤在卵巢中成熟（所谓的成熟现象）。在众多有助于解决问题的发现中，突出了表面种植的特征。关于库肯勃瘤的部分回顾了该肿瘤多样的显微镜表现，指出细胞间质中印戒细胞的著名模式虽具有特征性，但往往不显著，且常被其他显微镜特征所掩盖。在许多情况下，后者包括一种相当独特的微囊性模式。文章的最后部分回顾了非库肯勃型黏液性肿瘤，首先是起源于阑尾的肿瘤。阑尾肿瘤在大多数情况下具有独特特征，分化特别良好，其卵巢转移瘤也有此表现。然后回顾了其他通常与转移性肿瘤极为相似的黏液性肿瘤，特别是来自胰腺的肿瘤，但也包括其他各种部位的肿瘤。
