Departments of Pathology, The Johns Hopkins University School of Medicine and Hospital, Baltimore, MD 21231, USA.
Am J Surg Pathol. 2011 Feb;35(2):276-88. doi: 10.1097/PAS.0b013e31820508d0.
Metastatic mucinous carcinomas in the ovary are readily recognized when they show characteristic features, including bilateral involvement, only moderate tumor size, surface and superficial cortical involvement, nodular growth, and an infiltrative pattern. However, it is well established that some metastatic mucinous carcinomas can simulate primary ovarian mucinous tumors grossly and microscopically. 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 and can be erroneously used to support interpretation of the carcinomatous components as arising from these purported precursors within the ovary. Thirty-five cases of metastatic pancreaticobiliary tract adenocarcinomas were analyzed. The mean patient age was 58 years (median, 59 y; range, 33 to 78 y). In 15 cases (43%), the pancreaticobiliary tract and ovarian tumors presented synchronously and in 2 cases (6%) the ovarian tumors presented earlier as the first manifestation of the disease. Ovarian tumors were bilateral in 31 cases (89%). Mean and median tumor sizes were 10.6 and 9.5 cm, respectively (range, 2.5 to 21.0 cm). Nodularity was present in 22 cases (63%) and surface involvement was identified in 14 cases (40%). An infiltrative growth pattern was present at least focally in 28 cases (80%), accompanied by borderline-like and/or cystadenomatous areas in 17 (49%) cases and 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 cases (20%). Dpc4 expression was lost in 20 of 33 tumors analyzed (61%). Of 25 patients with follow-up, 23 patients had died of disease (mean/median time, 9/6 mo; range, 1 to 39) and 2 patients were alive with disease (at 1 and 25 mo). Frequent bilateral ovarian involvement, moderate tumor size, nodularity, and infiltrative patterns are useful features for identifying these ovarian tumors as metastatic. However, many tumors exhibit borderline-like and cystadenomatous patterns that, when dominant and combined with synchronous presentation, make recognition as metastases an ongoing challenge. Loss of Dpc4 expression provides the most useful immunohistochemical evidence for establishing the pancreaticobiliary tract as the most likely source of these metastatic mucinous carcinomas in the ovary.
卵巢转移性黏液性癌在表现出特征性表现时很容易识别，包括双侧受累、肿瘤大小适中、表面和皮质浅层受累、结节状生长和浸润性模式。然而，已经确定，一些转移性黏液性癌在大体和显微镜下可能模拟原发性卵巢黏液性肿瘤。转移性胰胆管腺癌由于其具有交界性和囊腺瘤样生长模式的能力而带来了特殊的诊断挑战，这些模式可能被误解为潜在的原发性卵巢前体肿瘤，并可能被错误地用于支持癌性成分源自卵巢内这些所谓前体肿瘤的解释。分析了 35 例转移性胰胆管腺癌病例。患者平均年龄为 58 岁（中位数为 59 岁；范围为 33 至 78 岁）。在 15 例（43%）中，胰胆管和卵巢肿瘤同时出现，在 2 例（6%）中，卵巢肿瘤较早出现，是疾病的首发表现。31 例（89%）卵巢肿瘤为双侧。平均和中位肿瘤大小分别为 10.6 和 9.5 cm（范围为 2.5 至 21.0 cm）。22 例（63%）存在结节，14 例（40%）存在表面受累。28 例（80%）至少局灶性存在浸润性生长模式，17 例（49%）存在交界性和/或囊腺瘤样区域，11 例（31%）仅存在该模式。相反，24 例（69%）存在交界性和囊腺瘤样模式，7 例（20%）仅存在该模式（纯或混合）。在分析的 33 例肿瘤中，有 20 例（61%）Dpc4 表达缺失。在 25 例有随访的患者中，23 例患者死于疾病（平均/中位时间为 9/6 个月；范围为 1 至 39 个月），2 例患者仍患有疾病（分别为 1 个月和 25 个月）。频繁的双侧卵巢受累、肿瘤大小适中、结节和浸润性模式是识别这些卵巢肿瘤为转移瘤的有用特征。然而，许多肿瘤表现出交界性和囊腺瘤样模式，当这些模式为主且与同时出现时，使识别为转移瘤成为一个持续的挑战。Dpc4 表达缺失为确定这些卵巢转移性黏液性癌最可能来源于胰胆管腺癌提供了最有用的免疫组织化学证据。
