Ovarian metastases of pancreatic adenocarcinoma: clinical presentation, role of surgery, and potential value of the mutational profile for the differential diagnosis with primary mucinous ovarian carcinoma.

BACKGROUND

Ovarian metastases (OM) of pancreatic adenocarcinoma (PA) (OM-PA) can mimic primary ovarian mucinous carcinoma (POMC) on imaging and histology. These metastases are often symptomatic and not highly chemosensitive, so that oophorectomy may be considered.

AIMS

The aims of this study were to compare the characteristics of OM-PA and POMC, and discuss the role of surgery.

PATIENTS AND METHODS

Clinical, imaging, and histological data of patients with OM-PA and POMC (2000-2017) in three tertiary centers were reviewed. Twenty-six genes were analyzed by next generation sequencing (NGS) on both primary PA and OM-PA.

RESULTS

Twenty-two women with OM-PA ( = 13, 11 with surgical resection) or POMC ( = 9) were selected. OM-PA were smaller than POMC ( = 0.02); imaging, histological, and immunohistochemistry data did not clearly differentiate OM-PA from POMC in 12 of 22 cases (54%). Seven PA/OM-PA pairs were analyzed, and a concordant KRAS mutation was identified in all cases. In four OM-PA, concordant mutations were also found in ( = 3), ( = 1), ( = 1), and ( = 1) genes. The aim of oophorectomy in 11 OM-PA was for antalgic ( = 6) or curative ( = 5) intent. Pain improved in 4/6 of the former patients, but 2/6 had significant morbidity, and 2/6 died of rapid tumor progression. After oophorectomy, median progression-free and overall survivals were 6 (0-11) and 8 months (1-131), respectively.

CONCLUSION

Analysis of mutation profiles in both primary PA and ovarian tumors, especially , can help to determine the pancreatic origin of OM-PA. Surgical resection of OM-AP in highly selected patients may improve pelvic symptoms but may also cause significant morbidity. The benefit to survival requires further studies.