Ovarian Metastases of Intestinal-Type Gastric Carcinoma

James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, MA 02114, USA.
American Journal of Surgical Pathology (Impact Factor: 5.15). 12/2006; 30(11):1382-8. DOI: 10.1097/01.pas.0000213256.75316.4a
Source: PubMed


Ovarian metastases of intestinal-type gastric adenocarcinomas are rare, and information on them is very limited compared with that on signet-ring cell carcinomas that result in the Krukenberg tumor. Four cases are reported herein. The patients averaged 55 years of age. In 3 patients, the ovarian metastases were identified several to 21 months after the diagnosis of the gastric primary, and the tumors were synchronous in the fourth. Two tumors were bilateral, 1 unilateral, and for 1, the laterality was unknown. The ovarian tumors were characteristically solid and cystic, with multinodular growth in 2. In 2 cases, the ovarian tumors had a pseudoendometrioid morphology with tubulo-glandular, cribriform, and papillary patterns; they also had focal trabecular and insular patterns. Prominent necrosis was present, including segmental and intraluminal "dirty" necrosis. In the other 2 cases, the ovarian tumors had a mucinous appearance, 1 being dominantly cystic with occasional goblet cells and the other with prominent foveolar-type cells. Nuclei ranged from deceptively bland to highly atypical. Surface implants were identified in 2 cases. Two ovarian tumors examined expressed cytokeratin 7 and 20 but not estrogen receptor. Three patients with follow-up information all died within 1 year of the ovarian metastases. Although information is limited, our results suggest that metastatic spread to the ovary by intestinal-type gastric adenocarcinoma is usually seen in patients older than those with Krukenberg tumors, with a known history of gastric carcinoma, and with concomitant widespread disease. Involvement of the ovary by intestinal-type gastric carcinoma produces a microscopic picture distinctly different from that of a Krukenberg tumor. These metastatic intestinal-type tumors may be confused with metastases from other gastrointestinal sites that are more frequently the cause of pseudoendometrioid or mucinous metastases, and like such tumors may be confused with primary ovarian endometrioid and mucinous neoplasms.

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    • "Furthermore, positive staining for the gastric mucin gene MUC5AC is important in the diagnosis of metastatic gastric cancer over primary ovarian adenocarcinoma [16]. Nevertheless, it is important to clinically distinguish these tumors because of the significant differences in their treatment protocols, chemotherapy response, and prognosis [17]. There are some cases in the literature in which an initially diagnosed metastatic carcinoma of the ovary was subsequently, upon further investigation, understood to have been early gastric cancer. "
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    ABSTRACT: Gastric cancer, one of the most common cancers in the world, rarely metastasizes to the ovaries. Ovarian metastases of gastric signet ring cell cancer (SRCC) are referred to as Krukenberg tumors and account for 1-2% of all ovarian cancers. Here, we analyze the characteristics, treatment, and prognosis of patients with Krukenberg tumors. We retrospectively analyzed the demographic characteristics, treatment modalities, progression-free survival (PFS), and overall survival (OS) of patients who were diagnosed with Krukenberg tumors of gastric cancer origin and who underwent treatment and follow-up between January 2005 and January 2012 in the Ankara Oncology Education and Research Hospital. Among 1755 patients diagnosed with gastric cancer between January 2005 and January 2012, eight patients (0.45%) with histopathologically identified Krukenberg tumors were enrolled. The median age of the eight patients was 42.2 years (range, 32-69 years). Two (25%) of the patients were stage 3A, two (25%) were stage 3C, and four (50%) were stage 4 at the time of diagnosis. The median PFS was 13.2 months (1-25 months), the median OS after the original diagnosis was 16.7 months (1-41 months), and the median OS after ovarian metastasis was 3.6 months (1-10 months). Krukenberg tumors were seen particularly in young patients and more frequently during the premenopausal period. The prognosis was poor. When only the ovaries were affected, metastasectomy prolonged the survival time.
    Full-text · Article · Dec 2013 · Contemporary Oncology / Wspólczesna Onkologia
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    • "Almost all Krukenberg tumors are the diffused type according to the Luaren's classification of primary gastric cancer. Nevertheless, it has been reported that although it is a very rare tumor, this tumor is almost always associated with disseminated disease like the intestinal type adenocarcinoma of gastric cancer, which has metastasizes to the ovary.(10) Involvement of ovary by intestinal type gastric carcinoma compared with that on signet-ring cell carcinoma that result in the Krukenberg tumor may be confused with primary ovarian mucinous neoplasm, but such cases were not detected at our series. "
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    ABSTRACT: We performed this study to evaluate the clinical presentation as well as the proper surgical intervention for ovarian metastasis from gastric cancers and these tumors were identified during postoperative follow-up. This will help establish the optimal strategy for improving the survival of patients with this entity. 22 patients (3.2%) with ovarian metastasis were noted when performing a retrospective chart review of (693) females patients who had undergone a resection for gastric cancer between 1981 and 2008. The covariates used for the survival analysis were the patient age at the time of ovarian relapse, the size of the tumor, the initial TNM stage of the gastric cancer, the interval to metastasis and the presence of gross residual disease after treatment for Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and they were compared by means of the Log-Rank test. The average age of the patients was 48.6 years (range: 24 to 78 years) and the average survival time of the 22 patients was 18.8 months (the estimated 3-year survival rate was 15.8%) with a range of 2 to 59 months after the diagnosis of Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of the patients with gross residual disease (P=0.0003). In contrast, patient age, the size of ovarian tumor, the initial stage of gastric adenocarcinoma, the interval to metastasis and adjuvant chemotherapy were not prognostic indicators for survival after the development of ovarian metastasis. Early diagnosis and complete resection are the only possible hope to improve survival. As the 3-year survival rate after resection of Krukenberg tumor is 15.8%, it seems worthwhile to consider performing tumorectomy as the second cytoreduction.
    Full-text · Article · Mar 2011 · Journal of Gastric Cancer
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    • "2/3 of the primary tumors originate in the stomach, with other primary sites, by order of frequency, being: appendix, colon, breast, small intestine, rectum, gallbladder and urinary bladder (Kiyokawa et al, 2006). Signet ring cell carcinomas metastasize to the ovary more than twice as often as intestinal-type carcinomas (Lerwill and Young, 2006). It is important to note that some of these patients may have signs or symptoms related to ovarian stromal luteinization particularly during pregnancy, with androgenic manifestations. "
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    ABSTRACT: The occasional finding of simultaneous or metachronous multiple primary cancers in the upper genital tract may represent metastasis from one location to another or independent primary tumors. The overall survival of patients with simultaneous primary cancers of the ovary and uterus suggests multifocal rather than metastatic disease. Diagnosis relies upon conventional clinicopathological criteria. The distinction is important because the prognosis and treatment are different. Metastases to the female genital tract occur frequently in the ovary, sometimes the ovarian tumor being primarly manifested although the extragenital tumor remains occult. In perspective, global genetic profiling should determine the potential prognostic relevance of specific molecular alterations, by correlation of profiling data with patient outcome.
    Full-text · Article · Jan 2008
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