Metastases to the female genital tract. Analysis of 325 cases

Breast carcinoma metastatic to endometrial polyp

An elderly woman presented with an enlarged uterus without uterine bleeding. The hysterectomy specimen contained a large, solitary intrauterine mass. Microscopic examination revealed metastatic poorly differentiated adenocarcinoma infiltrating an endometrial polyp. This metastatic tumor appeared histologically identical to the patient's ductal carcinoma of the breast removed by modified radical mastectomy 6 years earlier. An extrapelvic primary carcinoma metastatic to tan endometrial polyp is a very rare event but should be included in the differential diagnosis of endometrial carcinomas.

Use of MoAb D612 in combination with a panel of MoAb for the immunocytochemical identification of metastases from colon-rectum carcinoma

During the course of colon-rectum tumours a number of clinical events may occur in which conventional cytopathology can provide only a partial contribution to the definition of a differential diagnosis, i.e. effusions, distant recurrences and second neoplasias. In the present study we have evaluated whether monoclonal antibody (MoAb) D612, recognising a colon-rectum associated antigen, can be used in this context. To this end, MoAb D612 was employed in combination with a panel of MoAb of well defined tumour specificity in immunocytochemical tests. The immunocytochemical findings obtained were compared with the histological and clinical diagnosis. Of 62 effusions and 40 fine needle aspirates studied, MoAb D612 reactivity correlated with the correct diagnosis in 92.8% of the instances. These results indicate that this reagent may help to improve the current cytopathological diagnosis of colon-rectum tumours by identifying the colonic origin of metastases in patients with unknown primary tumour, differentiating ovarian carcinoma from colon metastases to the ovaries and establishing the presence of a second neoplasia in patients with a previous history other than colon carcinoma.

The consequences of unsuspected secondary ovarian neoplasia: a clinical presentation of four case histories

Secondary ovarian neoplasia is a common clinical entity which represents 3 to 8% of all ovarian tumors. However, despite its apparent prevalence, it remains a diagnostic and management dilemma. The ability to differentiate primary ovarian carcinoma from metastatic disease to the ovary has significant therapeutic and prognostic implications. Four case histories are presented which will demonstrate the necessity of formulating a complete differential diagnosis as well as the need for a thorough preoperative bowel examination.

Abnormal cervical cytology leading to the diagnosis of gastric cancer

There have been nine cases reported in the English literature in which the finding of malignant cells on cervical/vaginal cytology led to the diagnosis of primary gastric cancer. We report on a patient with gastric carcinoma, metastatic to the cervix, in which the diagnosis was suspected by the finding of signet ring cells on a Papanicolaou smear of the cervix. Prior to treatment of this patient, concordance of signet ring carcinoma on cervical and ascitic fluid cytology and on cervical and gastric biopsies was documented; this has not been reported previously. Thirty-four additional cases of gastric carcinoma metastatic to the cervix are reviewed. This paper is presented to remind the clinician that, however rare, metastases from the gastrointestinal tract to the uterine cervix do occur.

Alveolar rhabdomyosarcoma metastatic to the ovary. A report of two cases and a discussion of the differential diagnosis of small cell malignant tumors of the ovary

Two young women with alveolar rhabdomyosarcoma metastatic to the ovary are reported. In each case, the ovarian involvement was detected within a few weeks of the discovery of a soft tissue mass by the patient. Symptoms attributable to the ovarian tumor dominated the initial clinical picture in one case. In the other case, the soft tissue mass was not appreciated by the treating physicians until after the diagnosis of rhabdomyosarcoma had been established by examination of the ovarian tumor. The ovarian tumor was unilateral in one case and bilateral in the other. One primary site was the right foot and the other primary site was the left forearm. These cases illustrate that metastatic alveolar rhabdomyosarcoma rarely enters into the differential diagnosis of a small cell malignant tumor of the ovary. Both patients experienced progression of their disease and died, despite aggressive chemotherapy, within 1 year of presentation.

Ovarian metastases of breast carcinoma. A clinicopathologic study of 59 cases

Of 165 ovarian metastases recorded in the files of L'Hôtel-Dieu de Québec, Canada, between 1951 and 1987, 64 (38%) were from breast adenocarcinomas. Histopathologic material was available in 59 instances, of which 22 were autopsy cases and 28 were incidental findings at therapeutic oophorectomy. The patients' ages ranged from 25 to 80 years (average, 48.6 years). Sixty-four percent of the metastases were bilateral and 36% were unilateral. An ovarian metastasis was detected before the breast cancer in only one instance. The median interval between the diagnosis of breast carcinoma and the ovarian metastasis was 11.5 months and was related to the initial stage of the breast disease. The median survival after the diagnosis of ovarian metastasis was 16 months. The ovaries were grossly normal in 27 (46%) cases and 18 (31%) metastases were less than 1 mm in diameter. The size of the metastases was not related to the interval after the diagnosis of the breast carcinoma and did not influence the outcome of the patients. Forty-four metastases (75%) showed an indian file or ductal patterns easily identifiable as metastases of breast origin. The remaining cases presented various histologic features mimicking primary ovarian tumors or tumor-like conditions such as stromal luteoma, hyperthecosis, dysgerminoma, granulosa cell tumor, and carcinoid tumor. No metastasis had features of Krukenberg tumor. The authors conclude that metastases from breast cancer are generally small and are the reflection of an advanced disease. A metastasis of breast origin can be suspected histologically in most cases.

Ovarian involvement in extragenital cancer

Ovarian involvement from extragenital cancer often presents clinically as probable primary ovarian neoplasm. A retrospective review of the 29 such cases at Parkland Memorial Hospital from 1962 to 1985 was analyzed looking at clinical, surgical, and pathological parameters. The most frequent primary sites were colon (52%), breast (17%), stomach (10%), and pancreas (10%). Most common presenting symptoms were abdominal pain in 48% and increased abdominal girth in 45%. Preoperatively a palpable pelvic mass was detected in 93% and clinical ascites in 41% of patients. At surgery only 20% of patients had isolated ovarian metastases. Abdominal exploration identified the original tumor in 84% of the cases in which the primary originated in the abdomen. Bilateral ovarian involvement was found in 60%, and in 33% of these the contralateral involvement was occult. Eighty-three percent of patients have died with a median survival of 6 months. We conclude that mode of presentation, physical findings, and intraoperative assessment of patients with secondary ovarian neoplasms are no different from primary ovarian malignancy, and that when evaluating a pelvic mass, consideration should always be given to the possibility of secondary ovarian neoplasms.

Analysis of tumor heterogeneity in a patient with synchronously occurring female genital tract malignancies by DNA flow cytometry, DNA fingerprinting, and immunohistochemistry

A case of a patient with bilateral ovarian cancer and a uterine malignant mesodermal mixed tumor with ascites and metastatic disease is presented. Flow cytometry, DNA fingerprinting, and immunohistochemistry were performed to assess the origin of these malignancies. Ploidy analysis showed that both ovarian tumors had different aneuploid stemlines (DNA index [DI] = 1.64, 1.85, right ovary and DI = 1.73, left ovary) indicating independent origins. One of the stemlines in the right ovary (DI = 1.64) was also present in the ascites cells, whereas omentum metastases showed the same stemline (DI = 1.73) as the left ovarian tumor. The uterine malignancy contained three aneuploid stemlines. The highest stemline was associated with epithelial differentiation, but a metastatic origin from the left ovarian tumor seems unlikely. DNA fingerprinting analysis revealed a common change in restriction fragment length pattern in the DNA from all tumor localizations as compared with the patient's constitutional DNA. These results indicate that DNA flow cytometry can be helpful in discriminating intragenital metastatic disease from multiple primary tumors.

CT findings in metastatic ovarian tumors from gastrointestinal tract neoplasms (Krukenberg tumors)

The computed tomographic (CT) findings are reviewed in 7 patients with metastatic ovarian tumors from gastrointestinal tract neoplasms (Krukenberg tumors). All patients presented mixed ovarian masses. In 6 cases the masses were mainly cystic, with internal septa and focal or uniform enlargement of the cyst wall. In the seventh patient the ovarian mass appeared on the CT as mainly solid. The size of the neoplasm varied between 5 and 46 cm. Ascites was only seen in 1 case and in another the existence of a primary tumor in the sigmoid colon was demonstrated. In our cases the CT signs of ovarian metastasis were indistinguishable from primary tumors of the ovary.

Feulgen cytometry in simultaneous endometrial and ovarian carcinoma

The modal DNA value was measured in six patients with simultaneous endometrial and ovarian carcinoma by Feulgen static cytometry. One patient with low-grade endometrial and ovarian carcinoma manifested diploid indices at both sites. Another patient demonstrated aneuploid ovarian carcinoma and diploid endometrial carcinoma, indicating that these were separate neoplasms. The remaining four patients with Stage III disease had aneuploid endometrial and ovarian carcinomas with identical DNA indices. These data support a single neoplastic process with metastasis in the latter four patients. There was good correlation with the clinicopathologic impression on the likelihood of synchronous primaries versus metastatic neoplasms. It was concluded that DNA analysis is a useful adjunct in assessing the probability that spatially separate neoplasms represent metastasis.

The value of tumour marker CA 125 in surgical pathology

CA 125 is a tumour marker located primarily on non-mucinous epithelial ovarian tumours and which is recognized by the monoclonal antibody OC 125. In this study the value of CA 125 in surgical pathology was assessed. In fresh frozen material, the expression of CA 125 was demonstrated in 82% of 83 epithelial ovarian neoplasms using the indirect immunoperoxidase technique. In addition, all adenocarcinomas of cervix (n = 5) and endometrium (n = 15) tested expressed CA 125, and 25 of 111 (22%) non-gynaecological malignant tumours were positive. The positive cases included 20 breast carcinomas, one carcinoma of the stomach and one of the colon. Using a commercial kit on routinely fixed, paraffin embedded material, CA 125 positivity was demonstrated in 29 of 36 (80%) serous cystadenocarcinomas after pronase pre-treatment of the sections, in contrast to 100% (n = 25) positivity on frozen tissue sections. CA 125 can, therefore, be demonstrated in routinely fixed paraffin embedded material, although the number of positive results is less than in fresh frozen sections.

Glandular lesions of the uterine cervix: the present state of our knowledge

The assessment of squamous lesions of the uterine cervix is a major preoccupation of diagnostic histopathologists and this can overshadow the recognition of significant abnormalities affecting the adjacent endocervical glands. This review gives an account of recent advances in our knowledge of the histology and histochemistry of endocervical glands. The review of benign lesions concentrates on those that continue to cause diagnostic difficulty. Adenocarcinoma in situ, lesser degrees of possibly pre-malignant cervical glandular atypia and histological subtypes of adenocarcinoma are outlined. The increasing awareness that glandular and squamous lesions often co-exist is emphasized. Finally, adenocarcinoma metastatic to the cervix is discussed.

Ovarian metastases from cancer of the lung: problems in interpretation--a report of seven cases

Seven women, 26 to 66 (average 42) years of age, from whom ovarian tumors were removed before (three cases), synchronously with (three cases), or less than 1 year after (one case) the discovery of a pulmonary neoplasm are the subjects of this report. The ovarian tumor was unilateral in six cases and bilateral in one case and was unassociated with intraabdominal spread. The lung tumors, which were similar to the ovarian tumors on microscopic examination, were central in six cases and peripheral in one; three of them were small cell undifferentiated carcinomas, two large cell undifferentiated carcinomas, one a poorly differentiated adenocarcinoma, and one an atypical spindle cell carcinoid tumor. In each case the question of the primary site of the tumor had been raised clinically. The histological similarity of the ovarian and pulmonary tumors in all the cases to well-recognized forms of pulmonary neoplasia as well as additional clinical and pathological features of the cases led to an interpretation of a pulmonary origin of the tumors in all the cases.

Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 34 cases

Twenty-one of 34 simultaneous cancers involving the endometrium and ovary were classified as endometrial primary tumors with ovarian metastases. The criteria for this classification were either a multinodular ovarian pattern (major criterion) or two or more of the following minor criteria: small (less than 5 cm) ovary(ies), bilateral ovarian involvement, deep myometrial invasion, vascular invasion, and tubal lumen involvement. Twelve cancers were classified as independent neoplasms, primarily by the absence of the above criteria. Although they were classified as independent, the histologic features of the endometrial and ovarian tumors were the same in 11 of these 12 cases. Only one case represented an ovarian primary tumor with an endometrial metastasis. Both the group believed to have endometrial primaries with ovarian metastases and that with independent primaries showed high incidences of associated endometrial hyperplasia, supporting the belief that the endometrium is a primary site in both groups. The cancers classified as metastatic, with no known spread outside the endometrium-myometrium and ovary, were found to involve other sites significantly (P less than 0.01) more frequently than those classified as independent. Grade 3 endometrioid carcinoma, adenosquamous carcinoma, and malignant mixed müllerian tumors occurred only in the metastatic group, whereas the independent group had a variety of endometrioid and nonendometrioid tumors.