Differential diagnosis of primary and metastatic ovarian carcinomas

Authors

DOI:

https://doi.org/10.14739/2310-1237.2023.3.291530

Keywords:

ovarian neoplasms, carcinoma, neoplasm metastasis, differential diagnosis

Abstract

Ovarian tumors constitute 3.4 % of the structure of oncological diseases in women worldwide. However, the ovaries are also a common target for metastasis of carcinoma from other organs. Conducting differential diagnosis between primary carcinoma and metastasis is often challenging.

The aim of this study is to highlight the issues of morphological and immunohistochemical differential diagnosis of primary ovarian carcinomas and metastases from carcinomas of various organs to the ovaries.

Materials and methods. Data analysis of clinical and pathohistological studies of 381 patients. Paraffin sections for pathohistological studies were stained with hematoxylin and eosin using standard methodology. Immunohistochemical studies were conducted in 161 cases using a panel of antibodies: cytokeratins, estrogen receptors, progesterone receptors, CA125, TTF1, Vimentin, CDX2, Villin, Chromogranin A, Synaptophysin, CD56, GATA, p53, Inhibin A, FOXL-2, PAX-8, Ki-67. The specimens were examined and analyzed using the Axioskop 40 microscope (Zeiss) with the AxioCam MRc camera (Zeiss).

Results. The article discusses key issues of differential diagnosis of primary and metastatic ovarian carcinomas based on a large clinical and operational material. The application of an adequate panel of immunohistochemical antibodies for verification is considered. The results of the frequency of occurrence of different histological variants of ovarian carcinomas and metastases to the ovaries from carcinomas of other organs are provided based on our own research from 2019 to 2023. The main morphological and immunohistochemical indicators for practical use in the work of a pathologist in the verification of ovarian tumors are presented. An example of forming an antibody panel, taking into account clinical and morphological indicators in a specific clinical case from our own practice, is given.

Conclusions. Metastases of carcinomas from other organs to the ovaries constitute half of all cases requiring immunohistochemical investigation based on morphological structure. The most common are metastases from breast and colorectal cancers. However, the diagnosis of metastatic intestinal carcinoma is particularly challenging, as there is usually no clear clinical picture. In the differential diagnosis of primary and metastatic ovarian tumors, a comprehensive approach to analyzing the clinical presentation, microscopic structure of the tumor, and the surrounding tissue plays a significant role. Additionally, the formation of an antibody panel, taking into account these data, is crucial. The article provides a list of antibodies that have demonstrated greater effectiveness in our work.

Author Biographies

L. M. Zakhartseva, Bogomolets National Medical University, Kyiv, Ukraine

MD, PhD, DSc, Professor of the Department of Pathological Anatomy; Head of the Department of Pathological Anatomy with Pathohistological laboratory, Kyiv City Clinical Oncology Center, Ukraine

O. P. Manzhura, Shupyk National Healthcare University of Ukraine, Kyiv

MD, PhD, Associate Professor of the Department of Oncology; Head of the Department of Gynecology, Kyiv City Clinical Oncology Center, Ukraine

I. Yu. Vashchenko, Kyiv City Clinical Oncology Center, Ukraine

MD, Pathologist of the Department of Pathological Anatomy with Pathohistological laboratory

Ye. V. Maistrenko, Kyiv City Clinical Oncology Center, Ukraine

Gynecologist-Oncologist of the Department of Gynecology

O. M. Kravchuk, Kyiv City Clinical Oncology Center, Ukraine

MD, Gynecologist-Oncologist of the Department of Gynecology

K. M. Shatrova, Shupyk National Healthcare University of Ukraine, Kyiv

MD, PhD, Associate Professor of the Department of Pathological Anatomy; Pathologist of the Department of Pathological Anatomy with Pathohistological laboratory, Kyiv City Clinical Oncology Center, Ukraine

O. H. Rudnytska, Bogomolets National Medical University, Kyiv, Ukraine

MD, PhD, Associate Professor of the Department of Pathological Anatomy; Pathologist of the Department of Pathological Anatomy with Pathohistological laboratory, Kyiv City Clinical Oncology Center, Ukraine

References

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660

Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 68(6), 394-424. https://doi.org/10.3322/caac.21492

Fedorenko, Z. P., Sumkina, O. V., Zuba, V. O., Horokh, Ye. L., Hulak, L. O., & Ryzhov, A. Yu. (2023). Rak v Ukraini, 2021-2022. Zakhvoriuvanist, smertnist, pokaznyky diialnosti onkolohichnoi sluzhby [Cancer in Ukraine, 2021-2022. Morbidity, mortality, performance indicators of the oncology service]. Bulletin of the National Chancery Register of Ukraine, 24. [in Ukrainian]. http://ncru.inf.ua/publications/BULL_24/index.htm

Gaona-Luviano, P., Adriana, L., Medina-Gaona, & Magaña-Pérez, K. (2020). Epidemiology of ovarian cancer. Chinese clinical oncology, 9(4). https://doi.org/10.21037/cco-20-34

Cabasag, C. J., Arnold, M., Butler, J., Inoue, M., Trabert, B., Webb, P. M., Bray, F., & Soerjomataram, I. (2020). The influence of birth cohort and calendar period on global trends in ovarian cancer incidence. International journal of cancer, 146(3), 749-758. https://doi.org/10.1002/ijc.32322

Kubeček, O., Laco, J., Špaček, J., Petera, J., Kopecký, J., Kubečková, A., & Filip, S. (2017). The pathogenesis, diagnosis, and management of metastatic tumors to the ovary: a comprehensive review. Clinical & experimental metastasis, 34(5), 295-307. https://doi.org/10.1007/s10585-017-9856-8

Kaur, A., Dwivedi, B., Singh, A., Dwivedi, T., Sharma, R., & White, S. (2023). Ileal Adenocarcinoma Presenting with Krukenberg Metastasis to Ovaries- Description of a Rare Case with Review of Literature. American journal of medical case reports, 11(8), 142-145. https://doi.org/10.12691/ajmcr-11-8-3

Romeo, M., Quer, A., Tarrats, A., Molina, C., Radua, J., & Manzano, J. L. (2015). Appendiceal mixed adenoneuroendocrine carcinomas, a rare entity that can present as a Krukenberg tumor: case report and review of the literature. World journal of surgical oncology, 13, 325. https://doi.org/10.1186/s12957-015-0740-1

Pesce, A., Li Destri, G., Amore, F. F., Magro, G., La Greca, G., & Puleo, S. (2019). A rare case of Krukenberg tumor by gallbladder cancer. Annals of medicine and surgery (2012), 47, 50-52. https://doi.org/10.1016/j.amsu.2019.09.014

Bruls, J., Simons, M., Overbeek, L. I., Bulten, J., Massuger, L. F., & Nagtegaal, I. D. (2015). A national population-based study provides insight in the origin of malignancies metastatic to the ovary. Virchows Archiv, 467(1), 79-86. https://doi.org/10.1007/s00428-015-1771-2

Dundr, P., Singh, N., Nožičková, B., Němejcová, K., Bártů, M., & Stružinská, I. (2021). Primary mucinous ovarian tumors vs. ovarian metastases from gastrointestinal tract, pancreas and biliary tree: a review of current problematics. Diagnostic pathology, 16(1), 20. https://doi.org/10.1186/s13000-021-01079-2

Seow-En, I., Hwarng, G., Tan, G. H. C., Ho, L. M. L., & Teo, M. C. C. (2018). Palliative surgery for Krukenberg tumors - 12-year experience and review of the literature. World journal of clinical oncology, 9(1), 13-19. https://doi.org/10.5306/wjco.v9.i1.13

Chow, J. S., Chen, C. C., Ahsan, H., & Neugut, A. I. (1996). A population-based study of the incidence of malignant small bowel tumours: SEER, 1973-1990. International journal of epidemiology, 25(4), 722-728. https://doi.org/10.1093/ije/25.4.722

Mitsushita, J., Netsu, S., Suzuki, K., Nokubi, M., & Tanaka, A. (2017). Metastatic Ovarian Tumors Originating From a Small Bowel Adenocarcinoma - A Case Report and Brief Literature Review. International journal of gynecological pathology, 36(3), 253-260. https://doi.org/10.1097/PGP.0000000000000314

Simons, M., Bolhuis, T., De Haan, A. F., Bruggink, A. H., Bulten, J., Massuger, L. F., & Nagtegaal, I. D. (2019). A novel algorithm for better distinction of primary mucinous ovarian carcinomas and mucinous carcinomas metastatic to the ovary. Virchows Archiv, 474(3), 289-296. https://doi.org/10.1007/s00428-018-2504-0

Ramesan, C. K., Vinotha, T., Dhanya, S. T., Ajit, S., Anitha, T., Rachel, G. C., & Peedicayil, A. (2021). Metastatic Tumors to the Ovary-a Surgeon's Dilemma. Indian journal of surgical oncology, 12(1), 152-157. https://doi.org/10.1007/s13193-020-01267-4

Talia, K. L., Parra-Herran, C., & McCluggage, W. G. (2022). Ovarian mucinous and seromucinous neoplasms: problematic aspects and modern diagnostic approach. Histopathology, 80(2), 255-278. https://doi.org/10.1111/his.14399

da Silveira Santos, J. P. L., Machado, C. J., Junior, E. P., Rodrigues, J. B. S. R., Vidigal, P. T., & Resende, V. (2018). Immunohistochemical Predictors for Intestinal and Pancreatobiliary Types of Adenocarcinoma of The Ampulla of Vater. Journal of gastrointestinal surgery, 22(7), 1171-1178. https://doi.org/10.1007/s11605-018-3797-7

Zhang, W., Tan, C., Xu, M., & Wu, X. (2020). Primary appendiceal mucinous neoplasm: Gynecological manifestations, management, and prognosis. Gynecologic oncology, 156(2), 357-362. https://doi.org/10.1016/j.ygyno.2019.11.030

Park, C. K., & Kim, H. S. (2018). Clinicopathological Characteristics of Ovarian Metastasis from Colorectal and Pancreatobiliary Carcinomas Mimicking Primary Ovarian Mucinous Tumor. Anticancer research, 38(9), 5465-5473. https://doi.org/10.21873/anticanres.12879

Bellizzi A. M. (2020). An Algorithmic Immunohistochemical Approach to Define Tumor Type and Assign Site of Origin. Advances in anatomic pathology, 27(3), 114-163. https://doi.org/10.1097/PAP.0000000000000256

Neri, G., Arpa, G., Guerini, C., Grillo, F., Lenti, M. V., Giuffrida, P., Furlan, D., Sessa, F., Quaquarini, E., Viglio, A., Ubezio, C., Pasini, A., Ferrero, S., Sampietro, G., Ardizzone, S., Latella, G., Mescoli, C., Rugge, M., Zingone, F., Barresi, V., … Vanoli, A. (2020). Small Bowel Adenocarcinomas Featuring Special AT-Rich Sequence-Binding Protein 2 (SATB2) Expression and a Colorectal Cancer-Like Immunophenotype: A Potential Diagnostic Pitfall. Cancers, 12(11), 3441. https://doi.org/10.3390/cancers12113441

An-Chieh Liu, A., Chen, C. H., Liu, W. M., & Chang, C. W. (2018). A rare Krukenberg tumor arising from a primary adenocarcinoma of the small intestine. Taiwanese journal of obstetrics & gynecology, 57(2), 319-322. https://doi.org/10.1016/j.tjog.2018.02.025

Published

2023-12-22

How to Cite

1.
Zakhartseva LM, Manzhura OP, Vashchenko IY, Maistrenko YV, Kravchuk OM, Shatrova KM, Rudnytska OH. Differential diagnosis of primary and metastatic ovarian carcinomas. Pathologia [Internet]. 2023Dec.22 [cited 2024Mar.2];20(3):281-8. Available from: http://pat.zsmu.edu.ua/article/view/291530

Issue

Section

Case Reports