Hu Jingjing, Khalifa Raji D, Roma Andres A, Fadare Oluwole
Department of Pathology, University of California San Diego, San Diego, CA, United States of America.
Department of Pathology, University of California San Diego, San Diego, CA, United States of America.
Ann Diagn Pathol. 2018 Dec;37:1-6. doi: 10.1016/j.anndiagpath.2018.07.001. Epub 2018 Aug 8.
The problems associated with the pathologic distinction of primary ovarian mucinous tumors from their metastatic counterparts are well-recognized. Herein, we systematically evaluate a variety of gross parameters to determine the combination of features that most optimally separate primary from secondary mucinous ovarian tumors, and to address the tumor types that are most frequently associated with exceptions. 129 consecutive mucinous tumors involving the ovary formed the study set, including 61 primary mucinous tumors (16 carcinomas, 45 borderline tumors), and 68 metastatic carcinomas (21 colon; 28 appendix; 5 breast; 3 lung; 3 pancreas; 3 cervix; 1 bladder; 4 stomach). Consistent with prior studies, we found that as compared with metastases, primary ovarian mucinous tumors tend to be larger, more frequently unilateral and were more likely to be predominantly cystic and devoid of surface nodules. 41 of the 68 cases in the metastatic group showed intraperitoneal disease, as compared with only 3 of the 61 cases in the primary group (p < 0.0001). In 21% (14/68) of the metastatic group, the ovarian tumor was the first clinical indication of the primary tumor, and 82% of those cases were of gastrointestinal tract primary; this group of cases showed significantly larger tumors than ovarian tumors for patients with an established diagnosis of cancer. Receiver operating curve analyses showed that a tumor size cut off of <13 cm for metastatic disease yielded the maximal area under the curve of 0.877 (sensitivity 80%; specificity 80%); the most frequent exception to the size cut off of <13 cm for metastases was colorectal carcinoma, 30% of which were ≥13 cm. An algorithm whereby a tumor ≥13 cm is considered primary unless it displays surface nodules or bilaterality, and a tumor <13 cm is considered metastatic unless it is unilateral, correctly classified 94% (64/68) of the metastatic tumors and 98% (60/61) of the primary tumors. 3 of the 4 incorrectly classified cases in the metastatic group had intraperitoneal disease. We conclude that gross features are very useful in the distinction of primary from metastatic mucinous tumors in the ovary, and the presence of intraperitoneal disease provides additional diagnostic information. Although algorithms such as the one described herein are imperfect classifiers, they do provide baseline information on which additional findings, including microscopic features, can be added to ultimately provide the most accurate diagnostic classification.
原发性卵巢黏液性肿瘤与其转移性肿瘤在病理上进行区分所涉及的问题已得到充分认识。在此，我们系统地评估了各种大体参数，以确定最能理想区分原发性与继发性卵巢黏液性肿瘤的特征组合，并探讨最常出现例外情况的肿瘤类型。连续129例累及卵巢的黏液性肿瘤构成了研究样本，包括61例原发性黏液性肿瘤（16例癌，45例交界性肿瘤）和68例转移性癌（21例来自结肠；28例来自阑尾；5例来自乳腺；3例来自肺；3例来自胰腺；3例来自宫颈；1例来自膀胱；4例来自胃）。与先前研究一致，我们发现与转移瘤相比，原发性卵巢黏液性肿瘤往往更大，更常为单侧，且更可能主要为囊性且无表面结节。转移组68例中有41例显示有腹膜内病变，而原发性组61例中仅有3例（p<0.0001）。在转移组的21%（14/68）中，卵巢肿瘤是原发性肿瘤的首个临床指征，其中82%的病例原发性肿瘤来自胃肠道；这组病例的肿瘤明显大于已确诊癌症患者的卵巢肿瘤。受试者工作特征曲线分析显示，对于转移性疾病，肿瘤大小截断值<13 cm时曲线下面积最大，为0.877（敏感性80%；特异性80%）；转移瘤大小截断值<13 cm最常见的例外情况是结直肠癌，其中30%的肿瘤≥13 cm。一种算法为：肿瘤≥13 cm除非有表面结节或双侧性则考虑为原发性，肿瘤<13 cm除非为单侧性则考虑为转移性，该算法正确分类了94%（64/68）的转移瘤和98%（60/61）的原发性肿瘤。转移组4例分类错误的病例中有3例有腹膜内病变。我们得出结论，大体特征在区分卵巢原发性与转移性黏液性肿瘤方面非常有用，腹膜内病变的存在提供了额外的诊断信息。尽管本文所述的算法等分类方法并不完美，但它们确实提供了基线信息，在此基础上可以添加包括微观特征在内的其他发现，最终提供最准确的诊断分类。
