Lash R H, Hart W R
Am J Surg Pathol. 1987 Feb;11(2):114-21. doi: 10.1097/00000478-198702000-00005.
The most common secondary ovarian neoplasm to mimic an ovarian primary tumor is metastatic large intestinal adenocarcinoma. Even after histologic examination, metastases often are mistaken for primary adenocarcinomas, especially endometrioid carcinoma. We analyzed the clinical and pathologic features of 22 cases of documented large intestinal carcinoma metastatic to the ovary. Patients' ages ranged from 42 to 76 years. None of the intestinal primary tumors were Dukes stage A, 32% were Dukes B, and 68% were Dukes C. In nine patients (41%), the intestinal carcinomas had been resected previously from 4 to 60 months before removal of the ovarian metastases. Both ovaries were involved in 43% of the cases. Histologically, 19 cases were classified as pseudoendometrioid type, two as mucinous type, and one as mixed pseudoendometrioid-mucinous type. The most characteristic microscopic features of the ovarian metastases were garland and cribriform growth patterns, intraluminal "dirty" necrosis, segmental destruction of glands, and absence of squamous metaplasia. Special stains for mucosubstances were variable and not helpful in differential diagnosis. Immunohistochemical staining for carcinoembryonic antigen (CEA) was strongly positive. Recognition of these distinctive histologic features is crucial to proper identification of the intestinal origin of these ovarian tumors. Inappropriate treatment as primary ovarian carcinomas thereby is avoided, and more accurate assessment of prognosis is achieved.
最常被误诊为原发性卵巢肿瘤的继发性卵巢肿瘤是转移性大肠腺癌。即使经过组织学检查，转移瘤也常被误诊为原发性腺癌，尤其是子宫内膜样癌。我们分析了22例有记录的大肠腺癌转移至卵巢的临床和病理特征。患者年龄在42岁至76岁之间。所有肠道原发性肿瘤均非Dukes A期，32%为Dukes B期，68%为Dukes C期。9例患者（41%）在切除卵巢转移瘤之前4至60个月曾切除过肠道癌。43%的病例双侧卵巢均受累。组织学上，19例被归类为假子宫内膜样型，2例为黏液型，1例为假子宫内膜样-黏液混合型。卵巢转移瘤最具特征性的微观特征是花环样和筛状生长模式、管腔内“污秽”坏死、腺体节段性破坏以及无鳞状化生。黏液物质的特殊染色结果不一，对鉴别诊断无帮助。癌胚抗原（CEA）免疫组化染色呈强阳性。认识到这些独特的组织学特征对于正确识别这些卵巢肿瘤的肠道起源至关重要。从而避免了将其不恰当地作为原发性卵巢癌进行治疗，并能更准确地评估预后。
