Regular article
Metastatic ovarian tumors: a review of 64 cases

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Abstract

Objective

The goal was to review cases of metastatic ovarian tumor with respect to their clinical features.

Methods

Sixty-four patients with pathologically confirmed metastatic ovarian carcinoma, who were treated between 1978 and 2002 at Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC), were reviewed and the clinical features examined.

Results

We found that metastatic tumors accounted for 21.1% (64/304) of malignant ovarian tumors. Of 64 metastatic ovarian tumors, 26 originated from gynecologic organs, and 38, from nongynecologic organs. Gynecologic primary sites were the uterine body (23%), uterine cervix (14%), and fallopian tube (3%). Eight of nine cervical cancers with ovarian metastases were adenocarcinomas. Adenocarcinoma of the uterine cervix metastasized to the ovaries more frequently than squamous cell carcinoma (5.6% vs 0.1%, respectively; P < 0.01). Among 38 cases of metastatic ovarian tumors from nongynecologic organs, Krukenberg tumors, pathologically characterized by the presence of typical signet-ring cells, were found in 11 patients (29%). Most (8/11) had originated in the stomach. Half (19/38) were preoperatively diagnosed as metastases. The 5-year survival rate after resection of metastatic ovarian tumors from gynecologic organs was significantly higher than the rate after resection of such tumors from nongynecologic organs (47% vs 19%, respectively; P = 0.026).

Conclusions

Metastatic ovarian tumors are likely to be relatively common in Japan because of the high incidence of gastric cancer. In cases of pelvic tumor, metastatic ovarian tumor should always be included in the differential diagnoses. As the 5-year survival after resection of metastatic ovarian tumor is 19%, even for tumors from nongynecologic organs, it seems worthwhile to consider tumorectomy as the second cytoreduction.

Introduction

The ovaries are frequent targets of metastasis for malignant tumors, as are the lung and liver. Although metastatic ovarian tumors are thought to account for 10–30% of malignant ovarian tumors, it is difficult to know the precise incidence of ovarian metastasis [1], [2]. There have been several reports about metastatic ovarian tumors that were diagnosed at autopsy and/or surgery. In cases of breast cancer, microscopic ovarian metastases are occasionally diagnosed at prophylactic oophorectomy. Although intraoperative frozen-section evaluation is useful for the diagnosis of metastatic carcinoma to the adnexa [3], in some cases it is difficult to distinguish primary ovarian tumors from metastatic ones even by histological examination. It is especially difficult to diagnose metastatic ovarian tumors derived from colon cancer. It was reported that 45% of metastatic ovarian tumors from colon cancer were misdiagnosed as primary ovarian cancers [4], [5]. In reports of ovarian metastases, 60% of cases diagnosed at autopsy and 63.3% (57/90) of cases diagnosed at prophylactic oophorectomy had macroscopically normal ovaries [6], [7]. Taken together, these facts indicate that the precise incidence of ovarian metastasis still remains unclear.

Most metastatic ovarian tumors originate from the gastrointestinal tract, breasts, and gynecologic organs. The pathway of cancer cell metastasis from nongynecologic cancer to the ovary remains unclear except for the case of direct dissemination. Although advances in image analysis have made it easier to find lesions, metastatic ovarian tumors from nongynecologic organs are rarely diagnosed before primary treatment; therefore, their prognosis is generally poor in general. There have been a few reviews of metastatic ovarian tumors in Japan. Here we review 64 cases of metastatic ovarian tumors that were surgically treated at our institution, and examine their clinical features.

Section snippets

Patients and methods

Sixty-four patients with pathologically confirmed metastatic ovarian carcinoma, who were treated between 1978 and 2002 at Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC), were reviewed. During that period we had 304 cases of malignant ovarian tumors, which were resected and histogically diagnosed. We retrospectively examined the primary site, histologic type, clinical course, and prognosis from the clinical chart. Overall survival curves were estimated by the Kaplan–Meier

Results

During the past 24 years we have had 64 cases of histologically confirmed metastatic ovarian tumors (including one case of malignant lymphoma) at OMCC, which accounted for 21.1% (64/304) of malignant ovarian tumors. The mean age of the 64 cases was 50.3 ± 11.8. Twenty-six cases (mean age: 53.7 ± 10.1) originated from gynecologic organs, and 38 cases (mean age: 48.1 ± 12.4) originated from nongynecologic organs (Table 1). The primary sites of gynecologic tumors were the uterine body (15/64,

Discussion

We have diagnosed 304 cases of malignant ovarian tumor postoperatively at OMCC during the past 24 years, of which 64 cases (21.1%) were histologically diagnosed as metastatic ovarian tumors. Fox and Langley reported that 4.4% of woman (12/272) who died of malignant tumors were discovered to have ovarian metastases at autopsy [8]. Lumb and Mackenzie reported that 29.4% of breast cancer patients (56/190) who received prophylactic oophorectomy had ovarian metastases [7]. Webb et al. reported that

Conclusions

Metastatic ovarian tumors are likely to be more common in Japan due to the high incidence of gastric cancer. In cases of pelvic tumors, metastatic ovarian tumor should always be included in the differential diagnoses. As the 5-year survival rate after resection of metastatic ovarian tumors is 19% even in cases of nongynecologic tumors, it seems worthwhile to consider tumorectomy as the second cytoreduction.

References (20)

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