Zusammenfassung
Metastasen sind mit 7–10% aller malignen Ovarialtumoren ein praxisrelevantes Problem. Ihre Erkennung ist schwierig, da die morphologische Bandbreite primärer ovarieller Tumoren sehr groß ist, aber auch, weil Metastasen einen organtypischen Tumor perfekt imitieren können. Die richtige Diagnose ist aber therapeutisch entscheidend. Deswegen sollte bei jedem morphologisch ungewöhnlichen Ovarialtumor an eine Metastase gedacht werden. Aber auch auf den ersten Blick als Primärtumor erscheinende muzinöse und endometrioide Tumoren können metastatischer Herkunft sein. Durch Kenntnis der Krankengeschichte und immunhistochemische Untersuchungen ist in der Regel eine korrekte Diagnose möglich.
Abstract
Ovarian metastases comprise 7–10% of all malignant ovarian tumors. The detection of ovarian metastases is difficult because primary ovarian tumors are a morphologically very heterogeneous group, and metastases can simulate an primary ovarian tumor perfectly. A correct diagnosis, however, is most important in order to avoid an unnecessary and ineffective chemotherapy. Therefore, every morphologically unusual ovarian tumor should raise doubts. In addition, mucinous and endometrioid tumors may also be metastatic in nature. Immunohistochemistry, as well as knowledge on the patient’s history, will clarify most of the suspicious cases.
Literatur
Baker PM, Oliva E (2005) Immunohistochemistry as a tool in the differential diagnosis of ovarian tumors: an update. Int J Gynecol Pathol 24: 39–55
Berezowski K, Stastny JF, Kornstein MJ (1996) Cytokeratins 7 and 20 and carcinoembryonic antigen in ovarian and colonic carcinoma. Mod Pathol 9: 426–429
Bullon A Jr, Arseneau J, Prat J et al. (1981) Tubular Krukenberg tumor. A problem in histopathologic diagnosis. Am J Surg Pathol 5: 225–232
Cao D, Ji H, Ronnett BM (2005) Expression of mesothelin, fascin, and prostate stem cell antigen in primary ovarian mucinous tumors and their utility in differentiating primary ovarian mucinous tumors from metastatic pancreatic mucinous carcinomas in the ovary. Int J Gynecol Pathol 24: 67–72
Cronje HS, Niemand I, Bam RH, Woodruff JD (1999) Review of the granulosa-theca cell tumors from the emil Novak ovarian tumor registry. Am J Obstet Gynecol 180: 323–327
DeCostanzo DC, Elias JM, Chumas JC (1997) Necrosis in 84 ovarian carcinomas: a morphologic study of primary versus metastatic colonic carcinoma with a selective immunohistochemical analysis of cytokeratin subtypes and carcinoembryonic antigen. Int J Gynecol Pathol 16: 245–249
Eifel P, Hendrickson M, Ross J et al. (1982) Simultaneous presentation of carcinoma involving the ovary and the uterine corpus. Cancer 50: 163–170
Elishaev E, Gilks CB, Miller D et al. (2005) Synchronous and metachronous endocervical and ovarian neoplasms: evidence supporting interpretation of the ovarian neoplasms as metastatic endocervical adenocarcinomas simulating primary ovarian surface epithelial neoplasms. Am J Surg Pathol 29: 281–294
Fujii H, Matsumoto T, Yoshida M et al. (2002) Genetics of synchronous uterine and ovarian endometrioid carcinoma: combined analyses of loss of heterozygosity, PTEN mutation, and microsatellite instability. Hum Pathol 33: 421–428
Hanski C, Hofmeier M, Schmitt-Graff A et al. (1997) Overexpression or ectopic expression of MUC2 is the common property of mucinous carcinomas of the colon, pancreas, breast, and ovary. J Pathol 182: 385–391
Ji H, Isacson C, Seidman JD et al. (2002) Cytokeratins 7 and 20, Dpc4, and MUC5AC in the distinction of metastatic mucinous carcinomas in the ovary from primary ovarian mucinous tumors: Dpc4 assists in identifying metastatic pancreatic carcinomas. Int J Gynecol Pathol 21: 391–400
Lee KR, Young RH (2003) The distinction between primary and metastatic mucinous carcinomas of the ovary: gross and histologic findings in 50 cases. Am J Surg Pathol 27: 281–292
Logani S, Oliva E, Arnell PM et al. (2005) Use of novel immunohistochemical markers expressed in colonic adenocarcinoma to distinguish primary ovarian tumors from metastatic colorectal carcinoma. Mod Pathol 18: 19–25
McCluggage WG (2004) WT1 is of value in ascertaining the site of origin of serous carcinomas within the female genital tract. Int J Gynecol Pathol 23: 97–99
Moreno-Bueno G, Gamallo C, Perez-Gallego L et al. (2001) Beta-Catenin expression pattern, beta-catenin gene mutations, and microsatellite instability in endometrioid ovarian carcinomas and synchronous endometrial carcinomas. Diagn Mol Pathol 10: 116–122
Ordi J, Romagosa C, Tavassoli FA et al. (2003) CD10 expression in epithelial tissues and tumors of the gynecologic tract: a useful marker in the diagnosis of mesonephric, trophoblastic, and clear cell tumors. Am J Surg Pathol 27: 178–186
Park SY, Kim HS, Hong EK, Kim WH (2002) Expression of cytokeratins 7 and 20 in primary carcinomas of the stomach and colorectum and their value in the differential diagnosis of metastatic carcinomas to the ovary. Hum Pathol 33: 1078–1085
Parker DC, Folpe AL, Bell J et al. (2003) Potential utility of uroplakin III, thrombomodulin, high molecular weight cytokeratin, and cytokeratin 20 in noninvasive, invasive, and metastatic urothelial (transitional cell) carcinomas. Am J Surg Pathol 27: 1–10
Prat J (2005) Ovarian carcinomas, including secondary tumors: diagnostically challenging areas. Mod Pathol 18 Suppl 2: S99–S111
Prat J, Matias-Guiu X, Barreto J (1991) Simultaneous carcinoma involving the endometrium and the ovary. A clinicopathologic, immunohistochemical, and DNA flow cytometric study of 18 cases. Cancer 68: 2455–2459
Seidman JD, Kurman RJ, Ronnett BM (2003) Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am J Surg Pathol 27: 985–993
Ulbright TM, Roth LM (1985) Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 34 cases. Hum Pathol 16: 28–34
Vang R, Bague S, Tavassoli FA, Prat J (2004) Signet-ring stromal tumor of the ovary: clinicopathologic analysis and comparison with Krukenberg tumor. Int J Gynecol Pathol 23: 45–51
Watson MA, Dintzis S, Darrow CM et al. (1999) Mammaglobin expression in primary, metastatic, and occult breast cancer. Cancer Res 59: 3028–3031
Wauters CC, Smedts F, Gerrits LG et al. (1995) Keratins 7 and 20 as diagnostic markers of carcinomas metastatic to the ovary. Hum Pathol 26: 852–855
Young RH, Gilks CB, Scully RE (1991) Mucinous tumors of the appendix associated with mucinous tumors of the ovary and pseudomyxoma peritonei. A clinicopathological analysis of 22 cases supporting an origin in the appendix. Am J Surg Pathol 15: 415–429
Young RH, Hart WR (1989) Metastases from carcinomas of the pancreas simulating primary mucinous tumors of the ovary. A report of seven cases. Am J Surg Pathol 13: 748–756
Young RH, Hart WR (1998) Metastatic intestinal carcinomas simulating primary ovarian clear cell carcinoma and secretory endometrioid carcinoma: a clinicopathologic and immunohistochemical study of five cases. Am J Surg Pathol 22: 805–815
Young RH, Prat J, Scully RE (1984) Endometrioid stromal sarcomas of the ovary. A clinicopathologic analysis of 23 cases. Cancer 53: 1143–1155
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Hauptmann, S. Differenzialdiagnostik ovarieller Metastasen. Pathologe 28, 215–221 (2007). https://doi.org/10.1007/s00292-007-0906-x
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DOI: https://doi.org/10.1007/s00292-007-0906-x