Abstract
Metastatic neoplasms to the ovary often cause diagnostic problems, in particular those large ovarian masses mimicking primary tumors. Most of these tumors arise from digestive system or breast, while 37-year-old woman diagnosed as right adnexal complex mass, with a subpleural nodule in the apical part of the left lower lobe, at preoperative chest computed tomography scan. The patient underwent total abdominal hysterectomy with right salpingo-oophorectomy (ovarian mass 220 × 200 mm), total omentectomy, left ovarian biopsy, peritoneal random biopsies, and peritoneal washings for cytology. Pathologic and immunohistochemical examination of ovarian specimen suggested morphology and expression of metastatic lung adenocarcinoma with an intense positivity for Thyroid Transcriptional Factor-1 (TTF-1) and Cytokeratin 7 (CK7) staining. Fine needle biopsy of the lung nodule found epithelioid like malignant cells, confirming the diagnosis of an ovarian metastasis from a primary lung cancer.This report focused on the clinical and pathologic diagnostic challenge of distinguishing secondary from primary ovarian neoplasms. Issues on useful immunohistochemical stains are also discussed.
Highlights
Ovarian complex masses are generally primary carcinoma and less frequently metastasis from extra-gynecological tumors, such as the stomach, colon, breast, pancreas, kidney adenocarcinomas
We report a rare case of lung adenocarcinoma with metastasis to the ovary, as the only extra-thoracic localization, and we discuss the clinic-pathologic diagnostic issues in the differential diagnosis, with particular regard to immunoistochemical staining
In a study realized on a series of 500 consecutive malignant ovarian neoplasms from Northern America, 17% were metastatic [3], while, in a study from Turkey [4], 22% of 186 ovarian cancers were metastatic
Summary
Ovarian complex masses are generally primary carcinoma and less frequently metastasis from extra-gynecological tumors, such as the stomach, colon, breast, pancreas, kidney adenocarcinomas. In the presence of synchronous tumors, imaging techniques (ultrasound, computed tomography, magnetic resonance), and even conventional morphology are often inadequate for reliable diagnosis In these circumstances the use of appropriate immunohistochemical markers is able to provide additional evidence to differentiate primary from metastatic neoplasms. Case presentation A 37-year-old woman was admitted to Department of Gynaecologic Oncology in March 2009 for a fast-growing pelvic mass and increased serum levels of tumor markers Her personal oncological history has been characterized by a 1,4 mm melanoma in the left scapular region skin evidenced during the last year, with negative sentinel lymph node and no indications to any postoperative treatment. For the light microscopic examination, ovarian tissue sections were cut at a thickness of 4 μm and conventionally stained with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), and mucicarmin / Alcian blue stains These histologic permanent sections showed a moderately differentiated papillary adenocarcinoma, with diffuse ovarian cortex infiltration and extensive central necrosis (Figures 3, 4).
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