Department of Pathology, Tata Memorial Hospital, Mumbai, India.
Diagn Pathol. 2008 Sep 18;3:39. doi: 10.1186/1746-1596-3-39.
The distinction between metastasis from a colorectal adenocarcinoma into the ovary and an ovarian adenocarcinoma is vital, but challenging at times, due to overlapping morphological features. Similarly, a distinction between an ovarian metastasis into the colorectum and a colorectal adenocarcinoma, although rare; is important and can be daunting. We report an analysis of 20 cases of ovarian involvement by metastatic colorectal adenocarcinomas and colorectal involvement by metastatic ovarian adenocarcinomas, including the value of differential expression of cytokeratins 7 & 20 by immunohistochemistry (IHC), in these cases. Nine cases (45%) were identified as colorectal adenocarcinomas metastatic to the ovary. On biopsy, all these cases showed a 'garland-like' tumor necrosis, with desmoplasia and predominantly exhibited a tubuloalveolar pattern (67% cases). On IHC, all 8 of 9 such cases, where staining for cytokeratin 20 was performed, displayed strong positivity and 7 cases, where staining for carcinoembryogenic antigen (CEA) was performed, revealed positivity for this marker (100%). Other 11 cases (55%) were ovarian adenocarcinomas, metastatic to the colorectum. These showed metachronous presentations, with the ovarian tumor preceding the colorectal tumor deposits. Morphologically, psammomatous calcification was noted in 73% of these cases, whereas 'garland-like' necrosis was absent in all. The chief morphological subtype was serous papillary cystadenocarcinoma (55% cases). On IHC, CK7 and CA 125 were positive in all 6 of 11 such cases, whereas CK 20 was negative in all these cases.In cases of complex presentations like an ovarian involvement by a metastatic colorectal adenocarcinoma and vice-versa, certain clinicopathological features are useful. Differential expression of CK 7 and CK20 is vital in resolving these dilemmas. CK20 positivity and CK7 negativity is associated with a colorectal adenocarcinoma. Markers like CEA and CA-125 have an added value.
结直肠腺癌转移至卵巢与卵巢腺癌之间的鉴别至关重要，但由于存在重叠的形态学特征，有时具有挑战性。同样，卵巢转移至结直肠与结直肠腺癌之间的鉴别虽然罕见，但很重要，并且可能令人望而却步。我们报告了 20 例卵巢转移性结直肠腺癌和转移性卵巢腺癌累及结直肠的病例分析，包括免疫组织化学（IHC）中细胞角蛋白 7 和 20 的差异表达的价值。9 例（45%）被确定为转移性结直肠腺癌至卵巢。在活检中，所有这些病例均显示出“花环样”肿瘤坏死，伴有纤维变性，主要表现为管状肺泡模式（67%的病例）。在 IHC 中，所有 9 例进行细胞角蛋白 20 染色的病例均显示强阳性，而 7 例进行癌胚抗原（CEA）染色的病例均显示该标志物阳性（100%）。另外 11 例（55%）为转移性卵巢腺癌至结直肠。这些表现为异时性表现，卵巢肿瘤先于结直肠肿瘤沉积。形态上，73%的病例中存在砂粒体样钙化，而所有病例均不存在“花环样”坏死。主要形态亚型为浆液性乳头状囊腺癌（55%的病例）。在 IHC 中，11 例中的 6 例均为 CK7 和 CA 125 阳性，而所有这些病例的 CK 20 均为阴性。在卵巢转移性结直肠腺癌和反之亦然的复杂表现病例中，某些临床病理特征是有用的。CK7 和 CK20 的差异表达对于解决这些难题至关重要。CK20 阳性和 CK7 阴性与结直肠腺癌相关。CEA 和 CA-125 等标志物具有附加价值。
