Ovario

Histopathology 2005, 47, 231–247. DOI: 10.1111/j.1365-2559.2005.02194.x

REVIEW

Metastatic neoplasms involving the ovary: a review with an emphasis on morphological and immunohistochemical features
W G McCluggage & N Wilkinson1
Department of Pathology, Royal Group of Hospitals Trust, Belfast, and 1Department of Pathology, St James’s University Hospital, Leeds, UK

McCluggage W G &Wilkinson N (2005) Histopathology 47, 231–247

Metastatic neoplasms involving the ovary: a review with an emphasis on morphological and immunohistochemical features
The ovary is a common site of metastatic tumour. In many cases of ovarian metastasis there is a known history of malignancy but in other cases the ovarian tumour is the first manifestation of disease. In this review metastatic colorectal,appendiceal, gastric, breast, pancreatic and biliary tract, hepatocellular, renal, transitional and cervical carcinomas and metastatic malignant melanoma involving the ovary are discussed, as is the issue of synchronous ovarian and endometrial carcinomas. Peritoneal tumours, including primary peritoneal carcinoma, mesothelioma and intra-abdominal desmoplastic small round cell tumour, involving theovary are also discussed, together with a variety of other rare, metastatic ovarian neoplasms. Many metastatic adenocarcinomas involving the ovary, especially those exhibiting mucinous differentiation, closely mimic primary ovarian adenocarcinomas with morphologically bland areas simulating benign and borderline cystadenoma. This is referred to as a maturation phenomenon. In recent yearsimmunohistochemistry, especially but not exclusively differential cytokeratin (CK7 and CK20) staining, has been widely used as an aid to distinguish between a primary and secondary ovarian adenocarcinoma. While immunohistochemistry undoubtedly has a valuable role to play and is paramount in diagnosis in some cases, the results must be interepreted with caution, especially in mucinous tumours, and withinthe relevant clinical context. We feel the significance of differential cytokeratin staining is not always understood by histopathologists and this can result in erroneous interpretation. We critically discuss the value of immunohistochemistry and associated pitfalls with each tumour type described.

Keywords: adenocarcinoma, immunohistochemistry, metastatic tumour, ovary Abbreviations: CCC, clearcell carcinoma; CEA, carcinoembryonic antigen; CIN, cervical intraepithelial neoplasia; CK, cytokeratin; DPAM, disseminated peritoneal adenomucinosis; EIC, endometrial intraepithelial carcinoma; EMA, epithelial membrane antigen; ER, oestrogen receptor; HCC, hepatocellular carcinoma; HPV, human papillomavirus; IADSRCT, intra-abdominal desmoplastic small round cell tumour; OSC, ovarian serouscarcinoma; OSCCHT, ovarian small cell carcinoma of hypercalcaemic type; PMCA, peritoneal mucinous carcinomatosis; PMP, pseudomyxoma peritonei; PPSC, primary peritoneal serous carcinoma; PR, progesterone receptor; USC, uterine serous carcinoma

Address for correspondence: Dr W Glenn McCluggage, Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BL, Northern Ireland.e-mail: glenn.mccluggage@bll.n-i.nhs.uk
Ó 2005 Blackwell Publishing Limited.

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W G McCluggage & N Wilkinson

Introduction
The ovary is a common site of metastasis.1 Tumours may spread to the ovary via a blood-borne or lymphatic route, transperitoneally or by direct extension. In many cases there is a known history of a primary neoplasm but on occasions presentation is with symptomsrelated to an ovarian mass in a patient with no known history of malignancy. In such cases, the primary neoplasm may not manifest itself until some time later. Many metastatic adenocarcinomas involving the ovary can morphologically closely mimic a primary ovarian neoplasm and a metastatic lesion should always be considered, at least briefly. A multidisciplinary approach integrating clinical,...