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Diagnosis: Types of Tumors

Metastatic Neoplasms to the Ovary

Metastatic neoplasms involving the ovaries constitute an important group of neoplasms because the therapy for primary ovarian neoplasms is often different from that used for metastatic tumors derived from other organs. The likelihood that an ovarian neoplasm found on exploration of a pelvic or abdominal mass is metastatic is 6-7%. The most common sites of origin include the gastrointestinal tract (stomach, colon, pancreas, appendix), breast, and hematopoietic system. Tumors of other organs of the female genital tract (endometrium, cervix) also can involve the ovaries secondarily. Several gross and microscopic features strongly suggest the metastatic nature of an ovarian neoplasm. These include bilaterality, presence of multiple nodules of tumor, involvement of the surface and superficial cortex of the ovary, smaller tumor size, and histologic features that are incompatible with an ovarian primary (e.g. signet ring cell carcinoma). Metastases can, however, be unilateral and can have multiple cysts, thus closely mimicking an ovarian primary. One of the most classic forms of metastatic carcinoma involving the ovaries is the Krukenberg tumor. This tumor is a metastatic carcinoma composed of signet ring cells embedded within a hypercellular ovarian stroma that mimics sarcoma and often obscures the signet ring cells. The most common site of origin is the stomach, but other sites (such as the appendix) can give rise to signet ring cell carcinomas that present as ovarian masses.

Primary ovarian neoplasms

Metastatic neoplasms

  • Unilateral
  • Bilateral
  • Typically larger
  • Typically smaller but can be large
  • Multicystic or solid without nodules
  • Multiple nodules +/- cysts
  • Parenchymal involvement with minimal surface involvement
  • Surface and/or superficial cortical involvement

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