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Mohammed YM, Hammood ZD, Salih AM, Yasseen HA, Tahir SH, Omar SS, Ali RH, Ali RM, Radha BMM, Mustafa AM, Kakamad FH. Ovarian metastasis from lobular breast carcinoma: A case report with review of literature. Radiol Case Rep 2025; 20:3099-3105. [PMID: 40242375 PMCID: PMC12002769 DOI: 10.1016/j.radcr.2025.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 03/06/2025] [Accepted: 03/11/2025] [Indexed: 04/18/2025] Open
Abstract
Although breast cancer can metastasize to various sites, involvement of the ovaries is infrequent. The current study aims to report a case of ovarian cancer originating from the breast along with an in-depth analysis of the literature. A 58-year-old woman with a history of invasive lobular carcinoma underwent surgery followed by adjuvant chemo-radiotherapy. During regular follow-up, a suspicious ovarian mass was detected, later confirmed to be metastasis from the breast cancer. A review of 25 studies on Google Scholar and PubMed identified 7185 ovarian metastasis patients, with 1253 cases originating from breast cancer, accounting for approximately 17.4% of all metastatic ovarian cancers. Bilateral ovarian involvement was noted in 75% of cases, with right-side involvement in 5.7% and left-side in 19.3%. Only 13 studies documented menopausal status, showing 53.6% were premenopausal. Controversies persist in distinguishing primary ovarian cancer from metastasis using clinical signs, serum markers, and imaging. Metastasis of breast cancer to the ovaries is an uncommon event, even after utilizing various therapeutic approaches. Surgery is the treatment of choice for these cases. This case highlights the importance of long-term surveillance in breast cancer patients and emphasizes the role of surgery in managing ovarian metastases.
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Affiliation(s)
- Yasameen M. Mohammed
- Department of Surgery, Tikrit Teaching Hospital, College of Medicine Street, Saladin, Iraq
| | - Zuhair D. Hammood
- Department of Surgery, Tikrit Teaching Hospital, College of Medicine Street, Saladin, Iraq
| | - Abdulwahid M. Salih
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Hadeel A. Yasseen
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Soran H. Tahir
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Sami S. Omar
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
- Department of Oncology, Rizgary Oncology Center, Peshawa Qazi Street, Erbil, Kurdistan, Iraq
| | - Rebaz Haji Ali
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Department of Oncology, Hiwa Cancer Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Rawa M. Ali
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Belan Mikaeil M. Radha
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Ayman M. Mustafa
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Fahmi H. Kakamad
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization for Scientific Research, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
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Henz Concatto N, Ayadi S, Giovanaz A, Braga Visconti C, Uzan C, Akakpo JP, Canlorbe G, Badachi Y, Lucidarme O. Pictorial review of bilateral adnexal lesions. Abdom Radiol (NY) 2025:10.1007/s00261-025-04978-w. [PMID: 40366413 DOI: 10.1007/s00261-025-04978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Revised: 04/27/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025]
Abstract
Bilateral adnexal lesions involve structures such as the ovaries, fallopian tubes, and surrounding tissues, arising from diverse etiologies, including inflammatory, infectious, neoplastic, and functional causes. Their variable presentation poses a diagnostic challenge in clinical practice, necessitating a multidisciplinary approach for accurate assessment and management. The American College of Radiology (ACR) introduced the Ovarian-Adnexal Reporting and Data System (O-RADS) as a standardized lexicon and risk stratification tool for evaluating adnexal lesions via ultrasound (US) and magnetic resonance imaging (MRI). While MRI is the most accurate modality for assessing indeterminate adnexal masses, bilateral lesions frequently present diagnostic dilemmas, particularly when they exhibit divergent O-RADS classifications or arise from different etiologies. The O-RADS system does not provide specific guidelines for bilateral lesions, requiring independent classification of each lesion, with management dictated by the highest assigned category. Certain pathologies demonstrate a propensity for bilateral involvement, underscoring the importance of recognizing their imaging characteristics and differential diagnoses. Integrating this knowledge into diagnostic reports enhances clinical decision-making and optimizes patient outcomes.
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Affiliation(s)
- Natália Henz Concatto
- Radiology Department, Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil.
| | - Salma Ayadi
- Specialised and Emergency Imaging Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Ariane Giovanaz
- Radiology Department, Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Camila Braga Visconti
- Radiology Department, Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Catherine Uzan
- Breast and Gynecologic Surgery and Oncology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Paul Akakpo
- Specialised and Emergency Imaging Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Geoffroy Canlorbe
- Breast and Gynecologic Surgery and Oncology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Yasmina Badachi
- Specialised and Emergency Imaging Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Lucidarme
- Specialised and Emergency Imaging Department, Pitié-Salpêtrière Hospital, Paris, France
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Zuhdy M, Alghandour R, Awny S, Hamdy O, Tarek S, Metwally IH. Krukenberg Tumors: Does Surgical Resection Improve Survival? Indian J Surg Oncol 2025; 16:8-18. [PMID: 40114869 PMCID: PMC11920549 DOI: 10.1007/s13193-024-02006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/22/2024] [Indexed: 01/05/2025] Open
Abstract
Krukenberg tumors are ovarian malignant tumors characterized by mucin-secreting signet ring cells. They represent 30% of malignant ovarian neoplasms where the stomach, colorectal, and breast are the most common primary sites. The optimal treatment modality is still controversial whether systemic therapy or surgical resection. This is a retrospective cohort study where all patients diagnosed with Krukenberg tumors who presented to a tertiary cancer center from July 2015 to August 2021 were included. Demographic, preoperative, operative, postoperative, pathologic, and oncologic follow-up data were analyzed aiming to assess the overall and disease-free survival of this cohort of patients and the possible role of surgery. Eighty-four patients were enrolled. The mean age was 43.5 years. Colorectal cancer was the commonest primary site in 52.4% followed by gastric and breast cancer. In 69% of patients, the Krukenberg presented primarily, and in 64.3% both ovaries were affected. The median overall survival was 20 (14.1-25.9) months. In multivariate analysis, primary cancer in the breast, resection of both primary and Krukenberg, and R0 resection have better overall survival with hazard ratio (0.31, 2.5, and 0.09 respectively). The median disease-free survival (for those post R0 resection) was 32 (4.4-59.6) months, while peritoneal/omental concomitant metastasis was the only significant predictor of shorter DFS. In conclusion, cytoreductive surgery offers longer overall survival, especially if R0 resection can be achieved. In addition, the patients without peritoneo-omental spread will have a longer disease-free survival after successful R0 resection.
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Affiliation(s)
- Mohammad Zuhdy
- Surgical Oncology Department, Oncology Center Mansoura University, Geehan Street, Mansoura, 35516 Egypt
| | - Reham Alghandour
- Medical Oncology Unit, Oncology Center Mansoura University, Mansoura, Egypt
| | - Shadi Awny
- Surgical Oncology Department, Oncology Center Mansoura University, Geehan Street, Mansoura, 35516 Egypt
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Center Mansoura University, Geehan Street, Mansoura, 35516 Egypt
| | - Selim Tarek
- Mansoura University Hospitals, Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Department, Oncology Center Mansoura University, Geehan Street, Mansoura, 35516 Egypt
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Güler Çekiç S, Atay ÖF, Ülker V, Akbayir Ö. Extraskeletal myxoid chondrosarcoma mimicking mucinous ovarian cancer: A case report. J Obstet Gynaecol Res 2025; 51:e16235. [PMID: 39924782 DOI: 10.1111/jog.16235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 01/27/2025] [Indexed: 02/11/2025]
Abstract
Pelvic masses can represent various etiologies, including gynecologic and non-gynecologic conditions. As discussed in this paper, among all pathologies, intraabdominal dissemination of an extraskeletal myxoid chondrosarcoma (ESMC) presenting as a pelvic mass is a rare condition. The case is a 58-year-old woman with a history of soft tissue sarcoma who presented to the gynecologic oncology department with a pelvic mass and was operated on with the suspicion of mucinous ovarian cancer. She underwent complete cytoreductive surgery, and her final pathology was reported as ESMC. Due to several numbers of metastases shown in positron emission tomography-computed tomography, she had chemotherapy and then operated on for tumorectomy from the right leg. ESMC is a rare, aggressive soft tissue neoplasm that rarely has metastasis to the abdomen. This unique case presents a late recurrence of the disease to the pelvis, which can mimic mucinous ovarian cancer.
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Affiliation(s)
- Sebile Güler Çekiç
- Department of Obstetrics and Gynecology, Koç University Hospital, Istanbul, Turkey
| | - Ömer Faruk Atay
- Pathology Department, Kanuni Sultan Süleyman Research Hospital, Istanbul, Turkey
| | - Volkan Ülker
- Gynecologic Oncology Department, Medipol University Medical Faculty, Istanbul, Turkey
| | - Özgür Akbayir
- Private Clinique on Gynecologic Oncology, Private Clinique at Fulya Vital, Istanbul, Turkey
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Shi SY, Li YA, Qiang JW. Multiparametric MRI-based radiomics nomogram for differentiation of primary mucinous ovarian cancer from metastatic ovarian cancer. Abdom Radiol (NY) 2025; 50:1018-1028. [PMID: 39215773 DOI: 10.1007/s00261-024-04542-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To develop a multiparametric magnetic resonance imaging (mpMRI)-based radiomics nomogram and evaluate its performance in differentiating primary mucinous ovarian cancer (PMOC) from metastatic ovarian cancer (MOC). METHODS A total of 194 patients with PMOC (n = 72) and MOC (n = 122) confirmed by histology were randomly divided into the primary cohort (n = 137) and validation cohort (n = 57). Radiomics features were extracted from axial fat-saturated T2-weighted imaging (FS-T2WI), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging (CE-T1WI) sequences of each lesion. The effective features were selected by minimum redundancy maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) regression to develop a radiomics model. Combined with clinical features, multivariate logistic regression analysis was employed to develop a radiomics nomogram. The efficiency of nomogram was evaluated using the receiver operating characteristic (ROC) curve analysis and compared using DeLong test. Finally, the goodness of fit and clinical benefit of nomogram were assessed by calibration curves and decision curve analysis, respectively. RESULTS The radiomics nomogram, by combining the mpMRI radiomics features with clinical features, yielded area under the curve (AUC) values of 0.931 and 0.934 in the primary and validation cohorts, respectively. The predictive performance of the radiomics nomogram was significantly superior to the radiomics model (0.931 vs. 0.870, P = 0.004; 0.934 vs. 0.844, P = 0.032), the clinical model (0.931 vs. 0.858, P = 0.005; 0.934 vs. 0.847, P = 0.030), and radiologists (all P < 0.05) in the primary and validation cohorts, respectively. The decision curve analysis revealed that the nomogram could provide higher net benefit to patients. CONCLUSION The mpMRI-based radiomics nomogram exhibited notable predictive performance in differentiating PMOC from MOC, emerging as a non-invasive preoperative imaging approach.
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Affiliation(s)
- Shu Yi Shi
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong Ai Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- Department of Radiology, Changzhi People's Hospital, Changzhi, Shanxi, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China.
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6
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Monist MJ, Paśnik I, Semczuk M, Semczuk A. Malignant transformation of the mature ovarian teratoma into early-stage ovarian adenocarcinoma: A case report with literature review. Pathol Res Pract 2025; 266:155793. [PMID: 39755048 DOI: 10.1016/j.prp.2024.155793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 12/23/2024] [Accepted: 12/23/2024] [Indexed: 01/06/2025]
Abstract
Although mature ovarian teratoma (MOT) is one of the most commonly detected benign tumours worldwide, its malignant transformation is rare. This article presents a case of a 47-year-old woman, operated on for emergency reasons due to a giant painful ovarian tumour, showing preoperatively no signs of malignancy. Surprisingly, a pathological report showed MOT coexisting with an early-stage ovarian adenocarcinoma developing as an endophytic papilloma. Interestingly, a previously unclassified mutation variant in exon 18 of BRCA2 (NM_000059.3):c. 8167 G>A (p.Asp2723Asn) was detected in ovarian adenocarcinoma. A brief literature review has been presented discussing the clinicopathological features of MOT being associated with malignant transformation into an early-stage ovarian adenocarcinoma.
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Affiliation(s)
- Marta Joanna Monist
- IIND Department of Gynecological Oncology and Gynecological Surgery, Lublin Medical University, Lublin, Poland
| | - Iwona Paśnik
- Department of Anatomopatology, Lublin Medical University, Lublin, Poland
| | - Marek Semczuk
- University of Technology and Humanities, Radom, Poland
| | - Andrzej Semczuk
- IIND Department of Gynecological Oncology and Gynecological Surgery, Lublin Medical University, Lublin, Poland.
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Frølich ND, Andersen JD, Zacho HD. The frequency and characterization of ovarian metastasis from nonovarian cancers using 18F-fluorodeoxyglucose PET/CT. BJR Open 2025; 7:tzaf004. [PMID: 40161429 PMCID: PMC11954554 DOI: 10.1093/bjro/tzaf004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 12/04/2024] [Accepted: 03/08/2025] [Indexed: 04/02/2025] Open
Abstract
Objective Assessing the frequency of ovarian metastasis from nonovarian cancer (N-OC) and evaluate whether any PET-derived parameters can distinguish metastasis from primary ovarian cancer. Methods Patients undergoing FDG PET/CT due to suspected ovarian malignancy from 2006 to 2021 with subsequent histologically proven ovarian metastasis from N-OC were included. Exclusion criteria included ovarian metastasis diagnosed prior to PET/CT or >3 months after. Baseline characteristics were collected from electronic medical records, and PET/CT data were analysed using Siemens syngo.via software. Results Patients (N =1502) were scanned for suspected ovarian malignancies. Sixty-five patients (4%) were included. The most common origin of metastases was lower gastrointestinal cancer (n = 29, 45%), followed by gynaecological cancer (n = 10, 15%) and breast cancer (n = 9, 14%). Among patients with previous cancer history (n = 26), 18 experienced ovarian metastases from a known cancer. Time from primary diagnosis to ovarian metastasis ranged from 47 days to 11.4 years. There were no differences in maximized standardized uptake value, peak standardized uptake value, or clinical parameters between ovarian metastases and primary ovarian tumours. Conclusion The frequency of ovarian metastases from N-OCs was 4%, the most common origin of metastases was lower gastrointestinal tract. Previous cancer history is an important factor in assessing an unknown tumour of the ovary, as metastases can occur several years later. No PET or clinical parameters were useful for separating primary ovarian cancer from ovarian metastases. Advances in knowledge The study finds a low frequency of ovarian metastasis from N-OC and indicates that no PET or clinical parameters can distinguish ovarian metastasis from primary ovarian cancer.
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Affiliation(s)
- Nikoline D Frølich
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Jeannette D Andersen
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Helle D Zacho
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Pariza G, Mavrodin C, Potorac A, Munteanu O, Cirstoiu MM. Status of and Challenges in Therapy of Mucinous Ovarian Cancer Associated with Pseudomyxoma Peritonei Syndrome: Review of Current Options and Future Treatment Trends. Life (Basel) 2024; 14:1390. [PMID: 39598188 PMCID: PMC11595252 DOI: 10.3390/life14111390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/17/2024] [Accepted: 10/24/2024] [Indexed: 11/29/2024] Open
Abstract
OBJECTIVE Pseudomyxoma peritonei (PP) is a rare condition, and differentiating between primary and secondary ovarian causes is crucial for determining the appropriate oncological therapy. Given the resistance of ovarian mucinous carcinoma to standard platinum-based chemotherapy, the objective of this review is to present the current therapeutic approaches and summarize the emerging trends in the treatment of this disease. METHODS The authors conducted an exhaustive evaluation of studies published over a 14-year period (June 2010-May 2024) concerning pseudomyxoma peritonei, mucinous ovarian carcinoma, ovarian causes of PP, and ovarian cancer using the following databases: PubMed, Scopus, and Science Direct. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The results were organized into seven subchapters and analyzed. RESULTS The analyzed studies present surgery followed by HIPEC as the current therapy with the best long-term survival results. However, the oncological treatment is unsatisfactory, and the choice of therapy depending on the primary origin of the tumor becomes particularly important. For the differential diagnosis between pseudomyxoma due to a gastrointestinal cause and that of ovarian origin, genetic analyses are recommended; these include the characteristics of the mucin present in the lesion, as the therapeutic response can have contradictory results depending on the primary origin of the tumor. CONCLUSIONS Surgery followed by HIPEC remains the standard for resectable cases. However, oncological treatment has controversial results in the case of mucinous ovarian carcinoma compared to other types of ovarian cancer and to metastatic ovarian tumors associated with pseudomyxoma of the peritoneum. Based on the articles included in this review, it was found that the current trend is the study of mucin as a resistance factor against chemotherapy based on platinum products and the targeting of oncological therapy according to the tumor's genetic characteristics.
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Affiliation(s)
- George Pariza
- 5th Department of General Surgery, Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.M.); (M.M.C.)
| | - Carmen Mavrodin
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.M.); (M.M.C.)
- 3th Department of General Surgery, Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Alina Potorac
- Department of Obstetrics and Gynecology, Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Octavian Munteanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.M.); (M.M.C.)
- Department of Obstetrics and Gynecology, Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Monica Mihaela Cirstoiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.M.); (M.M.C.)
- Department of Obstetrics and Gynecology, Emergency Hospital Bucharest, 050098 Bucharest, Romania;
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So M, Shimoji A, Iemura Y, Suizu A, Iwami S, Hoki M, Shibuya S. Synchronous gastric and ovarian cancer successfully treated with FOLFOX therapy: a case report and review of the literature. Int Cancer Conf J 2024; 13:427-432. [PMID: 39398934 PMCID: PMC11465018 DOI: 10.1007/s13691-024-00704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/08/2024] [Indexed: 10/15/2024] Open
Abstract
Synchronous gastric and ovarian cancer is extremely rare, and there have been no case reports. Here, we present the first case of synchronous gastric and ovarian cancer successfully treated with chemotherapy and surgery. A 72-year-old Japanese woman presented at our hospital with upper abdominal pain and vomiting. She was diagnosed with gastric cancer after undergoing upper gastrointestinal endoscopy. Simultaneously, ovarian cancer was also suspected based on imaging studies which showed a 9 cm cystic lesion with a solid part on the right ovary. Since her gastric cancer was considered inoperable due to the extent of the lesion, she was treated with four courses of oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX therapy). Since both gastric and ovarian cancer lesions were found to be reduced in size, laparoscopic total gastrectomy (D1 dissection, with Roux-en-Y reconstruction), bilateral adnexectomy, and partial omentectomy were performed. Based on pathological and immunohistochemical findings, the diagnosis of synchronous cancer of poorly differentiated carcinoma of the stomach and endometrioid carcinoma of the ovary was made, and it became clear that FOLFOX therapy was effective especially against ovarian cancer. The patient is currently undergoing postoperative chemotherapy with FOLFOX + nivolumab. She remains alive 8 months after surgery, with no active lesions. This is the first report of a patient with synchronous gastric and ovarian cancer, suggesting that FOLFOX therapy may be effective as a first-line treatment of endometrioid carcinoma of the ovary.
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Affiliation(s)
- Makiko So
- Department of Obstetrics and Gynecology, Kyoto-Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256 Japan
| | - Aya Shimoji
- Department of Obstetrics and Gynecology, Kyoto-Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256 Japan
| | - Yoko Iemura
- Department of Obstetrics and Gynecology, Kyoto-Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256 Japan
| | - Ai Suizu
- Department of Obstetrics and Gynecology, Kyoto-Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256 Japan
| | - Shuichiro Iwami
- Department of Obstetrics and Gynecology, Kyoto-Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256 Japan
| | - Masahito Hoki
- Department of Diagnostic Pathology, Kyoto-Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256 Japan
| | - Shinsuke Shibuya
- Department of Diagnostic Pathology, Kyoto-Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256 Japan
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10
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Yan HP, Lu HR, Zhang YX, Yang L, Chen ZL. Surgical resection and neoadjuvant therapy in patients with gastric cancer and ovarian metastasis: A real-world study. World J Gastrointest Surg 2024; 16:2426-2435. [PMID: 39220050 PMCID: PMC11362938 DOI: 10.4240/wjgs.v16.i8.2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Regarding when to treat gastric cancer and ovarian metastasis (GCOM) and whether to have metastatic resection surgery, there is presently debate on a global scale. The purpose of this research is to examine, in real-world patients with GCOM, the survival rates and efficacy of metastatic vs non-metastasized resection. AIM To investigate the survival time and efficacy of metastatic surgery and neoadjuvant therapy in patients with GCOM. METHODS This study retrospectively analyzed the data of 41 GCOM patients admitted to Zhejiang Provincial People's Hospital from June 2009 to July 2023. The diagnosis of all patients was confirmed by pathology. The primary study endpoints included overall survival (OS), ovarian survival, OS after surgery (OSAS), disease-free survival (DFS), differences in efficacy. RESULTS This study had 41 patients in total. The surgical group (n = 27) exhibited significantly longer median OS (mOS) and median overall months (mOM) compared to the nonoperative group (n = 14) (mOS: 23.0 vs 6.9 months, P = 0.015; mOM: 18.3 vs 3.8 months, P = 0.001). However, there were no significant differences observed in mOS, mOM, median OSAS (mOSAS), and median DFS (mDFS) between patients in the surgical resection plus neoadjuvant therapy group (n = 11) and those who surgical resection without neoadjuvant therapy group (n = 16) (mOS: 26.1 months vs 21.8 months, P = 0.189; mOM: 19.8 vs 15.2 months, P = 0.424; mOSAS: 13.9 vs 8.7 months, P = 0.661, mDFS: 5.1 vs 8.2 months, P = 0.589). CONCLUSION Compared to the non-surgical group, the surgical group's survival duration and efficacy are noticeably longer. The efficacy and survival time of the direct surgery group and the neoadjuvant therapy group did not differ significantly.
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Affiliation(s)
- Hui-Ping Yan
- School of Public Health, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou 310000, Zhejiang Province, China
| | - Hong-Rui Lu
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou 310000, Zhejiang Province, China
| | - Yu-Xia Zhang
- Affiliated Bijie Hospital, Zhejiang Provincial People’s Hospital, Bijie 551700, Guizhou Province, China
| | - Liu Yang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou 310000, Zhejiang Province, China
| | - Zhe-Ling Chen
- School of Public Health, Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou 310000, Zhejiang Province, China
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Hassan B, Abdullah L, Hussein F, Issa A, Al-Assi T, Alshehabi Z. Secondary amenorrhea as the first presentation of Krukenberg tumor arising from the gastroesophageal junction in a 34-year-old woman: A case report. Int J Surg Case Rep 2024; 117:109472. [PMID: 38460292 PMCID: PMC10943424 DOI: 10.1016/j.ijscr.2024.109472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION Krukenberg tumors account for 9 % of metastatic ovarian tumors, they usually originate from the stomach and colon and are microscopically characterized by the presence of mucus-filled signet-ring cells. Krukenberg tumor originating from the gastroesophageal junction is extremely rare, which limits establishing proper diagnosis and management. PRESENTATION OF CASE A 34-year-old women presented with a complaint of amenorrhea, ultrasonography showed bilateral ovarian masses, pathological studies revealed Krukenberg tumor, immunohistochemistry of the tumor was positive for (CK1, and CK20). Upper GI endoscopy revealed the primary lesion located at the inferior esophagus and extending to the cardia. Despite marked improvement after introducing a chemotherapy regimen of oxaliplatin, calcium folinate and fluorouracil, the patient refused to complete her therapeutic course and died 5 months after discontinuation. DISCUSSION Krukenberg tumor may be asymptomatic but may also manifest as pelvic pain, bloating, and menstrual cycle abnormalities. Immunohistochemistry of Krukenberg tumor is mandatory to determine the primary tumor. Positivity of CK1, CK20 and negativity of CK7 indicates the gastrointestinal origin of the tumor. Different choices are available for the management of Krukenberg tumor but it still has a poor prognosis with an average survival rate of 14 months. CONCLUSION Krukenberg tumor from the esophagus is rare and still enigmatic in terms of management. In this article, we aim to draw attention into possible presentations of the tumor by providing the first case in Syria of Krukenberg tumor originating from the esophagus and presenting as secondary amenorrhea and bilateral adnexal masses.
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Affiliation(s)
- Bassam Hassan
- Faculty of Medicine, Cancer Research Center, Tishreen University, Latakia, Syria.
| | - Lava Abdullah
- Department of Obstetrics and Gynecology, Police Hospital, Damascus, Syria
| | - Firas Hussein
- Department of Hematology and Oncology, Tishreen University Hospital, Syria
| | - Aghiad Issa
- Faculty of Medicine, Cancer Research Center, Tishreen University, Latakia, Syria
| | - Thanaa Al-Assi
- Department of Gynecology, Alsaydeh Surgical Hospital, Latakia, Syria
| | - Zuheir Alshehabi
- Faculty of Medicine, Cancer Research Center, Tishreen University, Latakia, Syria; Department of Pathology, Tishreen University, Latakia, Syria
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Li N, Chen Q, Li B. The analysis of preoperative or intraoperative factors in predicting the escalation of surgical pathological staging of patients with clinical stage I endometrioid carcinoma: A retrospective clinical study. Medicine (Baltimore) 2024; 103:e37465. [PMID: 38489719 PMCID: PMC10939695 DOI: 10.1097/md.0000000000037465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
To retrospectively analyze the preoperative and intraoperative influencing factors in predicting the escalation of surgical pathological staging in patients with clinical stage I endometrioid carcinoma. Patients with clinical stage I endometrioid carcinoma at Women's Hospital, School of Medicine, Zhejiang University, between January 2002 and December 2015 were enrolled in this study. Due to preoperative or intraoperative surgical exploration, the patients with one or more preoperative or intraoperative high-risk factors underwent total hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy, totaling 535 cases. The preoperative and intraoperative influencing factors that could lead to the escalation of postoperative surgical pathological staging were further analyzed. 1. There were 535 patients diagnosed with clinical stage I endometrioid carcinoma before surgery, 125 patients were upgraded with postoperative pathological staging, for a rate of 23.36%. 2. Kaplan-Meier survival curve analysis showed that the prognosis in postoperative surgical pathological staging upgraded cases was worse than that in nonupgraded cases. The tumor-free survival and overall survival rates in the 2 groups were significantly different (P < .001). 3. Univariate analysis showed that preoperative degree of myometrial infiltration, intraoperative visual myometrial infiltration depth, massive size of tumor (diameter ≥ 4 cm) and preoperative abnormal serum cancer antigen 125 (CA125) level were associated with the escalation of surgical pathological staging (P < .05). Multivariate analysis indicated that massive size of tumor and preoperative serum abnormal CA125 level were independent predictors of whether postoperative pathological staging would be upgraded (P < .05). 4. The receiver operating characteristic curve drawn with the massive size of tumor and/or the preoperative serum CA125 level abnormality could be used to predict the probability of postoperative pathological upstaging. The results showed that the area from the combination of the 2 factors under the receiver operating characteristic curve was 0.723 (95% confidence interval, 0.672-0.773), suggesting that the combination of massive size of tumor and abnormal preoperative serum CA125 level may serve as an influencing factor for predicting the postoperative pathological staging upgrades. The clinical stage I endometrioid carcinoma patients with massive size of tumor and abnormal preoperative serum CA125 level need to be fully evaluated to ensure appropriate management as soon as possible, since they are more likely to experience postoperative pathological staging upgrades.
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Affiliation(s)
- Na Li
- Department of Gynecologic Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Qin Chen
- Department of Pathology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Baohua Li
- Department of Gynecologic Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Center of Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
- Jilin Hospital of Women’s Hospital, Zhejiang University School of Medicine, Changchun, Jilin, People’s Republic of China
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Jie Y, Li J, Man CF, Fan Y. Ovarian cancer with intestinal wall invasion and hyperamylasemia: a case report. Front Oncol 2024; 14:1299226. [PMID: 38406808 PMCID: PMC10884171 DOI: 10.3389/fonc.2024.1299226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Numerous studies have suggested a robust association between amylase and ovarian cancer. however, few amylase-producing ovarian cancers have been reported because amylase is a rare product of ovarian cancer. A case of an elderly female patient with an upper abdominal unfitness, intestinal wall along with uterine adnexal invasion, and high serum and urinary amylase is summarized in this article. The patient was initially suspected of having a gastrointestinal tumor. Initial laboratory findings showed markedly significantly raised serum and urinary amylase levels. Imaging showed invasion of the intestinal wall and uterine adnexa, and histology of the specimen taken through the abdominal wall lump and electron colonoscopy showed ovarian cancer. The patient's blood amylase levels decreased to normal after 4 cycles of neoadjuvant chemotherapy with paclitaxel and carboplatin. Following this, she underwent interval debulking surgery, which included total hysterectomy, bilateral adnexectomy, great omentectomy, appendectomy, resection of pelvic and abdominal lesions, and partial rectal resection. Postoperative pathology and immunohistochemistry staining confirmed a diagnosis of high-grade serous ovarian cancer. This case suggests that in female patients, hyperamylasemia may indicate the presence of ovarian cancer. It is necessary to perform a multisite, multipoint histologic examination to identify the tumor's origin in patients with multiple sites of invasion.
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Affiliation(s)
| | | | | | - Yu Fan
- Cancer Institute, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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Wang W, Lin CC, Liang WY, Chang SC, Jiang JK. Adenocarcinoma of sigmoid colon with metastasis to an ovarian mature teratoma: A case report. World J Clin Cases 2024; 12:853-858. [PMID: 38322677 PMCID: PMC10841131 DOI: 10.12998/wjcc.v12.i4.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/22/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Colorectal cancer ranks third in global cancer-related mortality, often due to metastases to liver and lungs. Ovarian metastases are less common, accounting for 3.6% to 7.4% of cases. In contrast, mature ovarian teratomas are frequently benign. Tumor-to-tumor metastasis is a rare phenomenon, with a limited number of documented cases. Three cases of mature ovarian teratomas metastasizing from different cancers have been reported. This report focuses on a case of tumor-to-tumor metastasis from sigmoid colon adenocarcinoma to a mature ovarian teratoma. CASE SUMMARY A 41-year-old Taiwanese woman with no known systemic diseases presented with lower back pain, which led to imaging revealing malignant lesions in the spine, pelvis, liver, and multiple lung metastases. She was diagnosed with sigmoid colon adenocarcinoma with metastases to the liver, lung, bone, and a left ovarian teratoma. Treatment involved radiotherapy and chemotherapy, resulting in regression of the primary tumor and stable lung and liver lesions. Due to abdominal symptoms, she underwent exploratory surgery, unveiling a mature teratoma in the left ovary with signs of metastatic adenocarcinoma. CONCLUSION Consider resecting mature ovarian teratomas with concurrent colorectal adenocarcinoma to prevent tumor-to-tumor metastasis.
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Affiliation(s)
- Wei Wang
- Division of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chun-Chi Lin
- Division of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Wen-Yi Liang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Pathology, Taipei Veteran General Hospital, Taipei 11217, Taiwan
| | - Shih-Ching Chang
- Division of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Jeng-Kai Jiang
- Division of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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Miyagawa Y, Kitazawa M, Tokumaru S, Nakamura S, Koyama M, Yamamoto Y, Miyazaki S, Hondo N, Soejima Y. Impact of Oophorectomy on Survival and Improving Nutritional Status in Ovarian Metastasis from Colorectal Adenocarcinoma. Oncology 2023; 102:114-121. [PMID: 37699374 DOI: 10.1159/000533599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Ovarian metastasis of colorectal cancer is known to have a poor prognosis. This study aimed to elucidate the characteristics of patients who underwent oophorectomy for ovarian metastasis from colorectal cancer. METHODS This retrospective study included 16 patients who underwent oophorectomy for colorectal cancer metastasis to the ovary from January 2004 to December 2017. Improvement in patient's symptoms and pre- and postoperative changes in various nutritional and inflammatory indicators were assessed. Survival analysis and identification of prognostic factors were conducted with a median follow-up of 40.7 (5-109) months. RESULTS Of 16 patients, 12 had (75%) synchronous and 4 (25%) had metachronous metastasis. Fourteen patients were symptomatic but symptoms resolved postoperatively. Thirteen patients (81.3%) had ascites and 5 (31.3%) had pleural effusion on preoperative computed tomography that disappeared after surgery in all cases. The median value of prognostic nutritional factor was significantly increased postoperatively (36.0 [preoperatively] vs. 47.5, p < 0.0001). The median (interquartile range) values for lymphocyte-C-reactive protein ratio were 715.2 (110-2,607) preoperatively and 6,095.2 (1,612.3-14,431.8) postoperatively (p = 0.0214). The median survival of the entire cohort was 60.4 months. The 3-year survival rates for R0 + R1 and R2 cases were 83% and 24% (p = 0.018), respectively. Univariate analysis showed that R2 resection and low postoperative lymphocyte-C-reactive protein ratio were associated with poor prognosis. CONCLUSIONS Oophorectomy for ovarian metastasis from colorectal cancers was safely performed. It improved the patients' symptoms and nutritional status and may result in improved prognosis.
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Affiliation(s)
- Yusuke Miyagawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masato Kitazawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeo Tokumaru
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Nakamura
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Koyama
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Yamamoto
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoru Miyazaki
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nao Hondo
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Zhang QW, Yang PP, Gao YJY, Li ZH, Yuan Y, Li SJ, Duan SF, Shao CW, Hao Q, Lu Y, Chen Q, Shen F. Assessing synchronous ovarian metastasis in gastric cancer patients using a clinical-radiomics nomogram based on baseline abdominal contrast-enhanced CT: a two-center study. Cancer Imaging 2023; 23:71. [PMID: 37488597 PMCID: PMC10367237 DOI: 10.1186/s40644-023-00584-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/09/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND To build and validate a radiomics nomogram based on preoperative CT scans and clinical data for detecting synchronous ovarian metastasis (SOM) in female gastric cancer (GC) cases. METHODS Pathologically confirmed GC cases in 2 cohorts were retrospectively enrolled. All cases had presurgical abdominal contrast-enhanced CT and pelvis contrast-enhanced MRI and pathological examinations for any suspicious ovarian lesions detected by MRI. Cohort 1 cases (n = 101) were included as the training set. Radiomics features were obtained to develop a radscore. A nomogram combining the radscore and clinical factors was built to detect SOM. The bootstrap method was carried out in cohort 1 as internal validation. External validation was carried out in cohort 2 (n = 46). Receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA) and the confusion matrix were utilized to assess the performances of the radscore, nomogram and subjective evaluation model. RESULTS The nomogram, which combined age and the radscore, displayed a higher AUC than the radscore and subjective evaluation (0.910 vs 0.827 vs 0.773) in the training cohort. In the external validation cohort, the nomogram also had a higher AUC than the radscore and subjective evaluation (0.850 vs 0.790 vs 0.675). DCA and the confusion matrix confirmed the nomogram was superior to the radscore in both cohorts. CONCLUSIONS This pilot study showed that a nomogram model combining the radscore and clinical characteristics is useful in detecting SOM in female GC cases. It may be applied to improve clinical treatment and is superior to subjective evaluation or the radscore alone.
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Affiliation(s)
- Qian-Wen Zhang
- Department of Radiology, Changhai Hospital, The Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Pan-Pan Yang
- Department of Radiology, Changhai Hospital, The Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yong-Jun-Yi Gao
- Department of Emergency, the Eighth Medical Center of Chinese, PLA General Hospital, 17 Heishanhu Rd, Haidian District, Beijing, 100091, China
| | - Zhi-Hui Li
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuan Yuan
- Department of Radiology, Changhai Hospital, The Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Si-Jie Li
- Department of Radiology, Changhai Hospital, The Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Shao-Feng Duan
- GE Healthcare China, Pudong New Town, No.1 Huatuo Road, Shanghai, 210000, China
| | - Cheng-Wei Shao
- Department of Radiology, Changhai Hospital, The Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital, The Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Chen
- Department of Health Statistics, The Navy Medical University, Shanghai, 200433, China.
| | - Fu Shen
- Department of Radiology, Changhai Hospital, The Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.
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Braun A, Reddy S, Cheng L, Gattuso P, Yan L. Clinicopathologic Review of Metastatic Breast Cancer to the Gynecologic Tract. Int J Gynecol Pathol 2023; 42:414-420. [PMID: 36563298 DOI: 10.1097/pgp.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Metastatic spread is the single most significant predictor of poor survival in breast cancer. Some of the most common metastatic sites are the bones, lungs, liver, brain, and peritoneal cavity. Clinically metastatic breast cancer to the gynecologic tract is usually asymptomatic and diagnosed as an incidental finding during a histologic examination of gynecologic specimens resected for other reasons. Cases of metastatic breast cancer to gynecologic organs diagnosed from August 1995 to January 2021 were retrieved from our institution's pathology databases, and their clinicopathologic features were reviewed. The most common site of metastasis was the ovary which was involved in about 79% (22 of 28 cases) of metastases to the gynecologic tract. Clinically, only 8 cases (36%) presented with ovarian mass detected in imaging studies and the rest of the cases were all incidental findings. Among ovarian metastasis, 59% of cases were invasive lobular carcinoma and 41% were invasive ductal carcinoma. In 5 cases, metastatic breast cancer was found in the endometrium, including 2 cases with endometrial metastasis only and 3 cases with multiple gynecologic organs involved. Metastatic breast cancer rarely involved the lower gynecologic tract, with only 7% vaginal metastasis and 4% found in the vulva. The absolute majority of metastatic breast cancer outside of the ovaries were lobular carcinoma (88%). Most of the metastatic breast carcinomas were positive for estrogen receptor on immunohistochemistry (27 of 28 cases, 96%). Her-2/neu immunostaining was positive in 4 cases only (14%). Metastatic breast cancer needs to be distinguished from gynecologic primary neoplasms and metastatic tumors from adjacent urinary and GI tracts. A careful review of the patient's history and adequate immunohistochemistry panel are helpful to render the diagnosis.
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Grizzi G, Ghidini M, Ratti M, D’Ercole M, Tanzi G, Abbiati A, Celotti A, Spada D, Baiocchi GL, Bonomi M. Krukenberg Tumor Related to Gallbladder Cancer in a Young Woman: A Case Report and Review of the Literature. J Pers Med 2023; 13:957. [PMID: 37373946 PMCID: PMC10304896 DOI: 10.3390/jpm13060957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
A gallbladder tumor is a rare condition, which usually spreads to the liver, lymph nodes, and other organs. A Krukenberg tumor, derived from the biliary tract and gallbladder cancers (GBCs), is an uncommon finding in routine clinical practice. Here, a case of a young woman with a Krukenberg tumor related to a previous diagnosis of GBC is reported. Differential diagnosis of an ovarian malignant lesion is challenging for both clinicians and pathologists. In order to provide a proper diagnosis, integrated multidisciplinary management is essential. The occurrence of Krukenberg tumors should be evaluated in the management of GBC, even if this is rare in clinical practice.
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Affiliation(s)
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | | | - Giulia Tanzi
- Department of Pathology, ASST Cremona, 26100 Cremona, Italy
| | | | - Andrea Celotti
- General Surgery Unit, ASST Cremona, 26100 Cremona, Italy
| | | | | | - Maria Bonomi
- Oncology Unit, ASST Cremona, 26100 Cremona, Italy
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Sato Y, Yano M, Eto S, Takano K, Nasu K. Metastasis from follicular lymphoma to an ovarian mature teratoma: a case report of tumor-to-tumor metastasis. J Ovarian Res 2023; 16:106. [PMID: 37254134 DOI: 10.1186/s13048-023-01188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Tumor-to-tumor metastasis (TTM) is a rare but well-established phenomenon where histologically distinct tumors metastasize within each other. Here we report the first "known" case of follicular lymphoma that metastasized and extended to a mature ovarian teratoma. CASE PRESENTATION A 59-year-old Japanese postmenopausal woman visited our hospital for a detailed examination of an ovarian tumor. Clinical imaging suggested it to be either teratoma-associated ovarian cancer with multiple lymph node metastases, or tumor-to-tumor metastasis from malignant lymphoma to ovarian teratoma. A bilateral adnexectomy and retroperitoneal lymph node biopsy were performed. Lined with squamous epithelium, the cyst constituted a mature ovarian teratoma, and the solid part showed diffuse proliferation of abnormal lymphoid cells. Immunohistochemically, the abnormal lymphoid cells were negative for CD5, MUM1, and CyclinD1, and positive for CD10, CD20, CD21, BCL2, and BCL6. Genetic analysis using G-banding and fluorescence in situ hybridization identified a translocation of t(14;18) (q32;q21), and we diagnosed tumor-to-tumor metastasis from nodal follicular lymphoma to mature ovarian teratoma. Twelve months after surgery, the patient showed no progression without adjuvant therapy. CONCLUSIONS The present case suggests that molecular approaches are useful in the diagnosis of TTM in mature ovarian teratomas when morphologic and immunohistochemical findings alone are insufficient for diagnoses.
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Affiliation(s)
- Yusuke Sato
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Mitsutake Yano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.
| | - Satoshi Eto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kuniko Takano
- Department of Medical Oncology and Hematology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
- Division of Obstetrics and Gynecology, Support System for Community Medicine, Faculty of Medicine, Oita University, Oita, Japan
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Pollard JH, DiCamillo PA, Dundar A, Averill SL, Aswani Y. Gastrointestinal Malignancies. RADIOLOGY‐NUCLEAR MEDICINE DIAGNOSTIC IMAGING 2023:407-455. [DOI: 10.1002/9781119603627.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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21
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Ahmad A, Kumar M, Bhoi NR, Akhtar J, Khan MI, Ajmal M, Ahmad M. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol 2023; 34:291-310. [PMID: 36989026 DOI: 10.1515/jbcpp-2022-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/25/2023] [Indexed: 03/30/2023]
Abstract
Uterine fibroids (UFs), leiomyomas or myomas, are a type of malignancy that affects the smooth muscle of the uterus, and it is most commonly detected in women of reproductive age. Uterine fibroids are benign monoclonal growths that emerge from uterine smooth muscle cells (myometrium) as well as fibroblasts. Uterine fibroid symptoms include abnormal menstrual bleeding leading to anaemia, tiredness, chronic vaginal discharge, and pain during periods. Other symptoms include protrusion of the abdomen, pain during intercourse, dysfunctions of bladder/bowel leading to urinary incontinence/retention, pain, and constipation. It is also associated with reproductive issues like impaired fertility, conceiving complications, and adverse obstetric outcomes. It is the leading cause of gynaecological hospitalisation in the American subcontinent and a common reason for the hysterectomy. Twenty-five percent of the reproductive women experience the symptoms of uterine fibroids, and among them, around 25% require hospitalization due to the severity of the disease. The frequency of the disease remains underestimated as many women stay asymptomatic and symptoms appear gradually; therefore, the condition remains undiagnosed. The exact frequency of uterine fibroids varies depending on the diagnosis, and the population investigated; nonetheless, the incidence of uterine fibroids in reproductive women ranges from 5.4 percent to 77 percent. The uterine fibroid treatment included painkillers, supplementation with iron, vitamin D3, birth control, hormone therapy, gonadotropin-releasing hormone (GnRH) agonists, drugs modulating the estrogen receptors, and surgical removal of the fibroids. However, more research needed at the level of gene to get a keen insight and treat the disease efficiently.
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Affiliation(s)
- Azaz Ahmad
- Department of Pharmacy, Integral University, Lucknow, India
- Department of Reproductive Medicine, Indira IVF Hospital Pvt Ltd, Udaipur, India
| | - Manoj Kumar
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Nihar Ranjan Bhoi
- Department of Reproductive Medicine, Indira IVF Hospital Pvt Ltd, Udaipur, India
| | - Juber Akhtar
- Department of Pharmacy, Integral University, Lucknow, India
| | | | - Mohd Ajmal
- Department of Pharmacy, Integral University, Lucknow, India
| | - Mohammad Ahmad
- Department of Pharmacy, Integral University, Lucknow, India
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22
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Imaging of Metastatic Disease to the Ovary/Adnexa. Magn Reson Imaging Clin N Am 2022; 31:93-107. [DOI: 10.1016/j.mric.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Surgical Management for Transposed Ovarian Recurrence of Cervical Cancer: A Systematic Review with Our Experience. Curr Oncol 2022; 29:7158-7170. [PMID: 36290840 PMCID: PMC9600108 DOI: 10.3390/curroncol29100563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 01/13/2023] Open
Abstract
In early-stage cervical cancer, ovarian metastasis is relatively rare, and ovarian transposition is often performed during surgery. Although rare, the diagnosis and surgical approach for recurrence at transposed ovaries are challenging. This study focused on the diagnosis and surgical management of transposed ovarian recurrence in cervical cancer patients. A 45-year-old premenopausal woman underwent radical hysterectomy, bilateral salpingectomy, and pelvic lymphadenectomy following postoperative concurrent chemoradiotherapy for stage IB1 cervical cancer. During the initial surgery, the ovary was transposed to the paracolic gutter, and no postoperative complications were observed. Ovarian recurrence was diagnosed using positron emission tomography-computed tomography, and a laparoscopic bilateral oophorectomy was performed. A systematic review identified nine women with transposed ovarian recurrence with no other metastases of cervical cancer, and no studies have discussed the optimal surveillance of transposed ovaries. Of those (n = 9), four women had died of the disease within 2 years of the second surgery, and the prognosis of transposed ovarian cervical cancer seemed poor. Nevertheless, three women underwent laparoscopic oophorectomies, none of whom experienced recurrence after the second surgery. Few studies have examined the surgical management of transposed ovarian recurrence. The optimal surgical approach for transposed ovarian recurrence of cervical cancer requires further investigation.
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Ahmadi Tafti SM, Behboudi B, Nili F, Hadizadeh A. Surgical management of a solitary metastatic ovarian adenocarcinoma with colonic origin presenting as gigantic bilateral ovarian masses. Clin Case Rep 2022; 10:e6336. [PMID: 36110333 PMCID: PMC9465689 DOI: 10.1002/ccr3.6336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/04/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
Metastatic ovarian tumors with a gastrointestinal origin have always been a challenge in surgery; in many cases, the primary tumor is diagnosed after the metastasis. This case was presented with bilateral abdominal masses, which were adenocarcinomas originating from gastrointestinal tract. Following colonoscopy and finding a mass, total colectomy was performed.
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Affiliation(s)
- Seyed Mohsen Ahmadi Tafti
- Division of Colorectal Surgery, Department of SurgeryTehran University of Medical SciencesTehranIran
- Colorectal Surgery Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Behnam Behboudi
- Division of Colorectal Surgery, Department of SurgeryTehran University of Medical SciencesTehranIran
- Colorectal Surgery Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Fatemeh Nili
- Department of Pathology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Alireza Hadizadeh
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Center InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
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25
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Tao Y, Tang L, Zuo L, Ma Y, Zhang F, Xu Y. Metastatic ovarian tumor from pancreatic cancer treated with combined immunotherapy: A case report. Oncol Lett 2022; 24:344. [PMID: 36072000 PMCID: PMC9434723 DOI: 10.3892/ol.2022.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Pancreatic cancer (PC) is a fatal disease with a high mortality rate due to difficulties in early diagnosis and metastasis. Common sites of metastasis from PC include the liver, lung, stomach and kidney. Patients diagnosed at already the metastatic stages on presentation constitute 50–55% of the cases, with a 5-year survival rate of 3%. By contrast, secondary ovarian metastases account for 10–25% of all ovarian malignancies, though an accurate diagnosis remain challenging. The present study reports the rare case of a 42-year-old woman with primary hepatic metastasis and secondary ovarian metastasis from PC treated with two lines of immunotherapy, who is also experiencing severe treatment-associated toxicity. The patient first received combined immunotherapy consisting of camrelizumab (200 mg; day 1; every 3 weeks) and chemotherapy with nab-paclitaxel (125 mg/m2; days 1 and 8; every 3 weeks) and gemcitabine (1,000 mg/m2; days 1 and 8; every 3 weeks). She then exhibited a partial response following 4 months of treatment. However, 9 months after the initial treatment, the disease progressed with ovarian involvement, which was confirmed by surgery. Second-line treatment included immunotherapy, targeted therapy and oral chemotherapy (200 mg sintilimab on day 1; 50 mg tegafur from days 1–14, twice daily; and 8 mg anlotinib from days 1–14, every 3 weeks). The progression-free survival time from this second-line treatment was 6 months. Immunotherapy was permanently aborted due to severe intestinal inflammation, where four lines of combined treatments were recommended. The patient remains on treatment with a good quality of life in July 2022, and a current overall survival time of >24 months. In conclusion, the diagnosis of metastatic PC leads to a poor prognosis, but ovarian metastasis from PC is rare. Furthermore, the combination of immunotherapy with chemotherapy or antiangiogenic inhibitors shows promise as a treatment strategy for advanced stages of PC.
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Affiliation(s)
- Yiying Tao
- Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Lei Tang
- Department of Oncology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, Jiangsu 215000, P.R. China
| | - Li Zuo
- Department of Oncology, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 201100, P.R. China
| | - Yue Ma
- Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Fengchun Zhang
- Department of Oncology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, Jiangsu 215000, P.R. China
| | - Yingchun Xu
- Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
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26
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Lin CW, Peng SL, Wang SH, Wu PY. A case report of appendiceal adenocarcinoma without gastrointestinal evidence mimicking primary ovarian cancer. J Int Med Res 2022; 50:3000605221088559. [PMID: 35387517 PMCID: PMC9003661 DOI: 10.1177/03000605221088559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Metastatic tumours to the ovary comprise 10–25% of ovarian malignancies and may originate from various primary sites. Here, the case of a 49-year-old female patient who presented with periumbilical nodules and abdominal bloating is reported. She was found to have bilateral ovarian tumours with peritoneal carcinomatosis and ascites. Primary ovarian cancer was suspected while no contributory gastrointestinal lesion was detected by imaging studies and endoscopic examinations. Three cycles of neoadjuvant chemotherapy were administered, followed by interval debulking surgery. Appendiceal cancer was highly suspected based on analysis of a frozen section obtained during surgical debulking. Following the pathology investigation, the patient was finally diagnosed with primary appendiceal adenocarcinoma. She underwent chemotherapy comprising irinotecan and fluorouracil. Due to disease progression despite several chemotherapy regimens, the patient declined further treatment and was lost to follow-up 1 year after the debulking surgery. Metastatic tumours to the ovary may mimic primary ovarian cancers and often present with nonspecific manifestations. Therefore, meticulous exploration of the primary site is warranted if the diagnosis is clinically suspicious.
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Affiliation(s)
- Chih-Wei Lin
- Department of Obstetrics and Gynaecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Shu-Ling Peng
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Shu-Hsien Wang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Pei-Ying Wu
- Department of Obstetrics and Gynaecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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27
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Chuang AY, Watkins JC, Young RH, Lerwill MF. Lobular Carcinoma of the Breast Metastatic to the Ovary: A Clinicopathologic Study of 38 Cases. Am J Surg Pathol 2022; 46:179-189. [PMID: 34931622 DOI: 10.1097/pas.0000000000001812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We evaluated the clinicopathologic features of 38 cases of metastatic lobular (n=33) or predominantly lobular (n=5) carcinoma involving the ovary. The patients were from 39 to 91 years of age (mean: 53 y). In 2 cases, the breast primary and ovarian metastasis were diagnosed synchronously, and in 5, the breast primary was only discovered after the metastatic carcinoma in the ovary was found. In the majority of cases (79%), both ovaries were involved; the mean ovarian tumor size was 5.9 cm. The ovarian tumors demonstrated a range of architectural patterns including macronodular (71%), diffuse/solid growth (87%), single-cell infiltration (87%), cords (74%), and small nests/clusters (50%). Nine cases demonstrated focal signet ring cell morphology. The associated stromal reaction ranged from none to marked, with almost half of cases demonstrating a marked stromal response, largely prominent sclerosis. A variety of neoplasms, most typically sex cord-stromal tumors, lymphoma/leukemia, and desmoplastic small round cell tumor, may enter the differential. In addition to the obvious help afforded in most cases by the clinical history, a combination of judicious sampling, particularly to unearth the delicate cords or single-cell growth of lobular carcinoma, appropriate consideration of the cytologic features of the neoplastic cells, and immunohistochemistry can resolve the diverse issues in differential diagnosis that may arise.
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Affiliation(s)
- Ai-Ying Chuang
- Department of Pathology, Koo Foundation Sun Yat-Sen Cancer Center
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert H Young
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Melinda F Lerwill
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Diagnostic Accuracy of Whole-Body Computed Tomography for Incidental Ovarian Tumors in Patients with Prior Breast Cancer. Diagnostics (Basel) 2022; 12:diagnostics12020347. [PMID: 35204438 PMCID: PMC8870859 DOI: 10.3390/diagnostics12020347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Whole-body computed tomography (WBCT) serves as the first-line imaging modality for breast cancer follow-up. To investigate the imaging characteristics and diagnostic accuracy of WBCT for incidental ovarian tumors in patients with prior breast cancer, we retrospectively reviewed a consecutive cohort of 13,845 patients with breast cancer, of whom 149 had pathologically-proven ovarian lesions. We excluded patients with ovarian diagnosis before breast cancer, CT scan not including ovary, CT-pathology interval >30 days, and severe CT artifact. Among our 60 breast cancer patients (median age, 46 years) with pathologically proven ovarian lesions, 49 patients had benign diseases, seven had primary ovarian cancer and four had ovarian metastasis from breast cancer. The histologic types of breast cancer with ovarian metastases included invasive ductal carcinoma, lobular carcinoma and angiosarcoma. Cystic ovarian lesions identified on WBCT during the breast cancer follow-up are more likely to be benign, while solid-cystic lesions are likely to be primary ovarian cancers, and solid lesions may indicate ovarian metastasis. The diagnostic accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve of WBCT were 98.3%, 100.0%, 98.0%, and 0.99 (malignant vs. benign); 90.0%, 100.0%, 85.7%, and 0.93 (metastasis vs. primary ovarian cancer), respectively. The only false positive solid lesion was a Sertoli–Leydig tumor. In conclusion, WBCT may help diagnose incidental ovarian tumors in patients with prior breast cancers and guide disease management.
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29
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Subhan A, Attia SA, P Torchilin V. Targeted siRNA nanotherapeutics against breast and ovarian metastatic cancer: a comprehensive review of the literature. Nanomedicine (Lond) 2021; 17:41-64. [PMID: 34930021 DOI: 10.2217/nnm-2021-0207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Metastasis is considered the major cause of unsuccessful cancer therapy. The metastatic development requires tumor cells to leave their initial site, circulate in the blood stream, acclimate to new cellular environments at a remote secondary site and endure there. There are several steps in metastasis, including invasion, intravasation, circulation, extravasation, premetastatic niche formation, micrometastasis and metastatic colonization. siRNA therapeutics are appreciated for their usefulness in treatment of cancer metastasis. However, siRNA therapy as a single therapy may not be a sufficient option for control of metastasis. By combining siRNA with targeting, functional agents or small-molecule drugs have shown potential effects that enhance therapeutic effectiveness. This review addresses multidrug resistance and metastasis in breast and ovarian cancers and highlights drug-delivery strategies using siRNA therapeutics.
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Affiliation(s)
- Abdus Subhan
- Department of Chemistry, ShahJalal University of Science & Technology, Sylhet 3114, Bangladesh
| | - Sara Aly Attia
- Center for Pharmaceutical Biotechnology and Nanomedicine, Department of Pharmaceutical Sciences, Northeastern University, Boston, MA, USA
| | - Vladimir P Torchilin
- Center for Pharmaceutical Biotechnology and Nanomedicine, Department of Pharmaceutical Sciences, Northeastern University, Boston, MA, USA.,Department of Oncology, Radiotherapy & Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russia
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30
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Briceño-Morales C, Guerrero-Macías S, González F, Paola Puerto Á, Burgos-Sánchez R, Millán-Matta C, Briceño-Morales X, García-Mora M. Tumores anexiales incidentales en cirugía abdominal. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
La posibilidad de encontrar una neoplasia benigna o maligna del ovario, de forma inesperada durante una intervención quirúrgica abdominal, es una realidad para todos los especialistas en cirugía. Si bien en muchos casos se tratará de una lesión benigna, el riesgo de cáncer no debe subestimarse, ya que, por ejemplo, la ruptura intraoperatoria de una lesión quística maligna puede reestadificar a una paciente con cáncer de ovario del estadio IA al IC, con todas las consecuencias que esto implica, como la necesidad de requerir quimioterapia adyuvante y tener un peor pronóstico. Por otro lado, en mujeres premenopáusicas debe discutirse con la familia o la paciente (idealmente) el riesgo e implicaciones de la ooforectomía uni o bilateral, incluso si esto amerita dejar el quirófano para obtener el consentimiento, o posponer el procedimiento definitivo para un segundo tiempo. La consulta intraoperatoria a un ginecólogo, siempre que sea posible, se debe llevar a cabo con el fin de respaldar la conducta adoptada. Conocer el manejo adecuado de las masas anexiales encontradas de forma incidental durante una cirugía abdominal, es una prioridad para todos los cirujanos generales
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31
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Kim C, Hu YH, Lee K, Lee HA, Lee DH, Ouh YT. Metastatic gallbladder cancer to the ovary presenting as primary ovarian cancer: a case report. J Med Case Rep 2021; 15:413. [PMID: 34348771 PMCID: PMC8340448 DOI: 10.1186/s13256-021-03001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Krukenberg tumors are uncommon and are indicative of an ovarian metastatic carcinoma that originates from another site of primary malignancy. The majority of metastases to ovaries are derived from the stomach and colon. We present a rare case of a metastatic ovarian malignant tumor that originated from gallbladder adenocarcinoma. Case presentation A 45-year-old premenopausal Korean woman presented with abdominal distension. Bilateral multiseptated ovarian tumors and a wall-thickened gallbladder were found on abdominal computed tomography. The patient was diagnosed with metastatic ovarian carcinoma arising from gallbladder adenocarcinoma and was treated with adjuvant chemotherapy. Conclusions Metastases to the ovaries from other sites, including the gallbladder, are rare and usually resemble primary ovarian tumors. Therefore, potential metastatic ovarian tumors of newly diagnosed pelvic masses should be considered in differential diagnoses.
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Affiliation(s)
- Chorong Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, 156, Baengnyeong-ro, Chuncheon-si, Kangwon , Republic of Korea
| | - Yoon Hyeon Hu
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, 156, Baengnyeong-ro, Chuncheon-si, Kangwon , Republic of Korea
| | - Kyoungyul Lee
- Department of Pathology, Graduate School of Medicine, Kangwon National University, Chuncheon-si, Kangwon, Republic of Korea
| | - Hyang Ah Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, 156, Baengnyeong-ro, Chuncheon-si, Kangwon , Republic of Korea
| | - Dong Hun Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, 156, Baengnyeong-ro, Chuncheon-si, Kangwon , Republic of Korea
| | - Yung-Taek Ouh
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, 156, Baengnyeong-ro, Chuncheon-si, Kangwon , Republic of Korea.
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32
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Kubeček O, Laco J, Špaček J, Kubečková A, Petera J, Krulichová IS, Bezrouk A, Filip S, Kopecký J. Clinicopathological Characteristics and Prognostic Factors in Ovarian Metastases from Right- and Left-Sided Colorectal Cancer. ACTA ACUST UNITED AC 2021; 28:2914-2927. [PMID: 34436021 PMCID: PMC8395391 DOI: 10.3390/curroncol28040255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/18/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secondary tumors of the ovary (STOs) account for 10-25% of all ovarian malignancies, including metastases from primary gynecological tumors. Colorectal cancer (CRC) has been recognized as one of the most common causes of STOs in Western countries. Despite it being well-known that CRC originating from the right versus left side of the colon/rectum differ substantially, there is a paucity of information regarding the effect of the primary tumor sidedness on the clinicopathological characteristics of STOs. METHODS This retrospective, observational chart review study included patients with histologically confirmed STOs of CRC origin diagnosed between January 2000 and December 2019. The clinicopathological characteristics of STOs originating from left-sided and right-sided CRC were compared. Univariable and multivariable analyses employing elastic net Cox proportional hazard models were used to evaluate potential prognostic factors. Further, the role of imaging methods in STOs diagnostics was evaluated. RESULTS Fifty-one patients with STOs of colorectal origin were identified. The primary tumor originated in the right and left colon/rectum in 39% and 61% of the cases, respectively. STOs originating from right-sided primary tumors were more frequently bilateral, associated with peritoneal carcinomatosis, had the ovarian surface affected by the tumor, and contained a mucinous component. The independent prognostic factors for overall survival in the whole cohort included: the presence of macroscopic residual disease after cytoreductive surgery, menopausal status, the application of systemic therapy, and the application of targeted therapy. In 54% of cases, the imaging methods failed to determine the laterality of the STOs correctly as compared to pathological reports and/or intraoperative findings. CONCLUSION STOs originating from left-sided and right-sided CRC show distinct clinicopathological characteristics. Moreover, different metastatic pathways might be employed according to the primary tumor sidedness. Considering the discrepancies between radiological assessment and histopathological findings regarding the laterality of STOs, bilateral adnexectomy should be advised whenever feasible.
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Affiliation(s)
- Ondřej Kubeček
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic; (O.K.); (J.P.); (S.F.)
| | - Jan Laco
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic;
| | - Jiří Špaček
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic;
| | - Alena Kubečková
- Department of Gynecology, First Private Surgical Center, Ltd., Sanus Hradec Králové, Labská kotlina I/1220, 50002 Hradec Králové, Czech Republic;
| | - Jiří Petera
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic; (O.K.); (J.P.); (S.F.)
| | - Iva Selke Krulichová
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, Šimkova 870, 50003 Hradec Králové, Czech Republic; (I.S.K.); (A.B.)
| | - Aleš Bezrouk
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, Šimkova 870, 50003 Hradec Králové, Czech Republic; (I.S.K.); (A.B.)
| | - Stanislav Filip
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic; (O.K.); (J.P.); (S.F.)
| | - Jindřich Kopecký
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic; (O.K.); (J.P.); (S.F.)
- Correspondence: ; Tel.: +420-495-832-176
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Ovarian Metastasis from Pancreatic Ductal Adenocarcinoma. World J Surg 2021; 45:3157-3164. [PMID: 34236477 DOI: 10.1007/s00268-021-06209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) has a high propensity for systemic dissemination. Ovarian metastases are rare and poorly described. METHODS We identified PDAC cases with ovarian metastasis from a prospectively maintained registry. We reported on the association between outcomes and clinicopathologic factors. Recurrence-free (RFS) and overall survival (OS) were calculated using Kaplan-Meier analysis. RESULTS Twelve patients with PDAC and synchronous or metachronous ovarian metastases were identified. Nine patients (75%) underwent pancreatectomy for localized PDAC and developed metachronous ovarian recurrence. The median OS for all patients was 25.4 (IQR:15.4-82.9) months. For the nine patients with metachronous ovarian metastasis, the median RFS and OS were 14.2 (IQR:7.2-58.3) and 44.6 (IQR:18.6-82.9) months, respectively. Nodal disease, poor grade, vascular invasion in the pancreatic primary, and bilateral ovarian disease tended to confer worse outcomes. CONCLUSION Patients with resected PDAC and ovarian recurrence tend to have a comparable disease course to more common patterns of recurrence. Primaries with nodal disease, poorer grade, vascular invasion, and bilateral ovarian disease were indicative of more aggressive disease biology. The ideal management remains largely unknown, and future collaborative efforts should optimize therapeutic strategies.
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34
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Nguyen TYT, Cacciottola L, Camboni A, Ravau J, De Vos M, Demeestere I, Donnez J, Dolmans MM. Ovarian tissue cryopreservation and transplantation in patients with central nervous system tumours. Hum Reprod 2021; 36:1296-1309. [PMID: 33394011 DOI: 10.1093/humrep/deaa353] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is there a possibility of reseeding cancer cells potentially present in frozen ovarian tissue from patients with central nervous system (CNS) tumours? SUMMARY ANSWER Malignancy reseeding in cryopreserved ovarian tissue from 20 patients with CNS tumours was not detected by histology, immunohistochemistry (IHC), molecular biology or xenotransplantation. WHAT IS KNOWN ALREADY Ovarian metastasis potential has been documented in patients with leukaemia, borderline ovarian tumours, advanced breast cancer and Ewing sarcoma. However, data on the safety of transplanting frozen-thawed ovarian tissue from cancer patients with CNS tumours are still lacking. STUDY DESIGN, SIZE, DURATION This prospective experimental study was conducted in an academic gynaecology research laboratory using cryopreserved ovarian cortex from 20 patients suffering from CNS tumours. Long-term (5 months) xenografting was performed in immunodeficient mice. PARTICIPANTS/MATERIALS, SETTING, METHODS Subjects enrolled in the study were suffering from one of six types of CNS tumours including medulloblastoma, ependymoma, primitive neuroectodermal tumours, astrocytoma, glioblastoma and germinoma. The presence of malignant cells was investigated with disease-specific markers for each patient in cryopreserved and xenografted ovarian tissue by histology, IHC via expression of neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP), and reverse transcription droplet digital polymerase chain reaction (RT-ddPCR) for quantification of GFAP and ENO2 gene amplification. MAIN RESULTS AND THE ROLE OF CHANCE Serial sections of cryopreserved and xenografted ovarian tissue from 20 patients showed no malignant cells by histology. All samples were negative for NSE and GFAP, although these neural markers were expressed extensively in the patients' primary tumours. Analysis by RT-ddPCR revealed no cancer cells detected in cryopreserved and xenografted ovarian fragments from subjects with astrocytoma, ependymoma, glioblastoma or medulloblastoma. Taken together, the study found no evidence of malignancy seeding in frozen-thawed and xenotransplanted ovarian tissue from patients affected by CNS cancers. LIMITATIONS, REASONS FOR CAUTION This analysis cannot guarantee complete elimination of disseminated disease from all cryopreserved ovarian cortex, since we are unable to examine the fragments used for transplantation. WIDER IMPLICATIONS OF THE FINDINGS This is the first study to be conducted in patients with CNS cancers undergoing ovarian tissue cryopreservation and transplantation, and clearly demonstrates no tumour seeding in their frozen-thawed and xenografted tissue. This information is vital for doctors to provide patients with meaningful and accurate advice on the possibilities and risks of ovarian tissue reimplantation. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Fonds National de la Recherche Scientifique de Belgique-the Excellence of Science (FNRS-EOS), number 30443682 awarded to M.-M.D. and T.Y.T.N., FNRS grant number 5/4/150/5 and FNRS-PDR Convention grant number T.0077.14 awarded to M.-M.D., grant 2018-042 from the Foundation Against Cancer awarded to A.C., and private donations (Ferrero, de Spoelberch). The authors declare no competing financial interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Thu Yen Thi Nguyen
- Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Luciana Cacciottola
- Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Alessandra Camboni
- Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.,Service d'Anatomie Pathologique, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joachim Ravau
- Laboratory of Pediatric Hepatology and Cell Therapy, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Michel De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Follicle Biology Laboratory (FOBI), UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Isabelle Demeestere
- Research Laboratory in Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Donnez
- Société de Recherche pour l'Infertilité (SRI), Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.,Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Cerkauskaite D, Zilinskas K, Varnelis P, Oreibi ME, Asejev V, Dulskas A. Ovarian metastases from breast cancer: A report of 24 cases. J Gynecol Obstet Hum Reprod 2021; 50:102075. [PMID: 33515851 DOI: 10.1016/j.jogoh.2021.102075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the epidemiological, demographical characteristics and survival outcomes of the patients with ovarian metastases from breast cancer. STUDY DESIGN Medical records of 24 patients with pathologically confirmed metastases in ovaries treated at two tertiary hospitals between 2000 and 2019 were reviewed retrospectively. Patients' as well as tumor characteristics, and treatment data were collected. Ovarian metastases of breast cancer were documented using a system of analogous to the FIGO classification for ovarian cancer. Survival after primary breast cancer diagnosis and after diagnosis of metastases in ovaries were calculated. Outcomes were compared between the three different procedures bilateral salpingo-oophorectomy, total hysterectomy with bilateral salpingo-oophorectomy, and total hysterectomy with bilateral salpingo-oophorectomy with omentectomy. RESULTS The majority of patients had estrogen receptor positive (87 %) and progesterone receptor positive (91 %), 80 % patients were HER2/neu negative. The majority of patients had primary tumor stage by TNM classification T1 (33 %) and T2 (50 %); node- negative (25 %) and node-positive (75 %); 71 % of patients had no distal metastases in primary breast cancer diagnosis (M0) while 29 % of patients had distant metastases. The median age of primary breast cancer diagnosis was 46.5 ± 10.4 years (range 25-69). The mean time to occurrence of secondary ovarian malignancies after primary breast cancer diagnosis was 62.9 ± 62.8 months (range 0-219). The majority of women underwent adnexectomy (37.5 %) or total hysterectomy with adnexectomy (37.5 %). The mean survival after breast cancer treatment was 72 months, and the mean survival after discovery of ovarian metastases was 25 months. CONCLUSIONS Our results showed that more radical surgical treatment of metastases to ovaries has no increase of survival among patients. However, it should be noted that this may be affected by different stage of primary disease. Thus, larger and more standardized studies need to be done in order to confirm prognostic features and the choice of surgical volume.
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Affiliation(s)
- Dovile Cerkauskaite
- Lithuanian University of Health Sciences, Faculty of Medicine, 9 A. Mickeviciaus Str., Kaunas LT -44307, Lithuania
| | - Kastytis Zilinskas
- Department of Oncogynaecology, National Cancer Institute, 1 Santariskiu Str., Vilnius LT - 08406, Lithuania
| | - Povilas Varnelis
- Vilnius University Hospital Santaros Clinics, 2 Santariskių Str., Vilnius LT - 08410, Lithuania; Vilnius University, Faculty of Medicine, 21 M. K. Ciurlionio Str., Vilnius LT - 03101, Lithuania
| | - Mohamad El Oreibi
- Vilnius University Hospital Santaros Clinics, 2 Santariskių Str., Vilnius LT - 08410, Lithuania
| | - Viktor Asejev
- Vilnius University Hospital Santaros Clinics Center of Obstetrics and Gynecology, Vilnius, LT - 08406, Lithuania
| | - Audrius Dulskas
- Vilnius University, Faculty of Medicine, 21 M. K. Ciurlionio Str., Vilnius LT - 03101, Lithuania; Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu Str., Vilnius LT - 08406, Lithuania.
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Preoperative predictive factor analysis of ovarian malignant involvement in premenopausal patients with clinical stage I endometrioid endometrial carcinoma. Sci Rep 2021; 11:1219. [PMID: 33441576 PMCID: PMC7806745 DOI: 10.1038/s41598-020-78953-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022] Open
Abstract
Earlier literature suggests that ovarian preservation in young premenopausal clinical stage I endometrioid endometrial carcinoma patients does not negatively impact prognosis. The main purpose of this study was to clarify the incidence of ovarian malignant involvement in this group and further identify potential preoperative predictive factors of ovarian malignant involvement. A total of 511 premenopausal (age ≤ 50 years) patients were enrolled for the study at Women’s Hospital, Zhejiang University School of Medicine, between January 2002 and December 2016. Ovarian malignant involvements were detected in 23 of the patients (4.5%). Univariate and multivariate logistic analysis validated preoperative imaging of myometrial invasion depth and preoperative serum carbohydrate antigen 125 (CA125) level as independent risk predictors of postoperative ovarian malignant involvement. Receiver operating characteristic (ROC) curves was generated for a combination of the two factors. The area under curve (AUC) was 0.772 (95% confidence interval [CI] 0.661–0.884) for the combined two factors. The incidence of postoperative ovarian malignant involvement was relatively minimal. Preoperative imaging of myometrial invasion depth and serum CA125 level were independent risk predictors of ovarian malignant involvement. These findings may facilitate preoperative counseling of patients and informed clinical decision-making on ovarian preservation in these patients.
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A comparative study of RTK gene status between primary tumors, lymph-node metastases, and Krukenberg tumors. Mod Pathol 2021; 34:42-50. [PMID: 32732929 DOI: 10.1038/s41379-020-0636-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/08/2022]
Abstract
Krukenberg tumor (KT) refers to a rare ovarian tumor that has metastasized from a primary site. Patients with KTs have a poorer prognosis and worse survival. Thus far, little is known about the frequency of receptor tyrosine kinase (RTK) gene amplification and the concordance of gene amplification between primary tumors, lymph-node metastases, and KTs. Herein, 50 paired samples, including primary cancers, metastatic lymph nodes, and KTs were collected, and RTK gene amplification was tested by fluorescence in situ hybridization (FISH). There were four cases positive for human epidermal growth factor receptor type 2 (HER2) amplification, all of which showed conversion of HER2 status between different lesions. Of the two cases with c-mesenchymal-epithelial transition (c-MET) amplification, the primary tumors and lymph nodes were negative while the right involved ovaries were positive. Inconsistent fibroblast growth factor receptor 2 (FGFR2) status in different lesions was observed in three of the six FGFR2-amplified cases. Co-amplification of RTK genes was identified in only one patient for primary cancer and two for KTs. Collectively, there were 46, 48, 50, and 44 cases negative for HER2, c-MET, EGFR, and FGFR2 amplification in all lesions, respectively. There was no significant difference in overall survival between KTs of gastric origin and colorectal origin. However, of all synchronous cancers, KTs of colorectal origin had a better prognosis than those of gastric origin. In conclusion, the positive rate of RTK gene amplification in KTs was low. Intratumoral heterogeneity was frequent in KTs with RTK gene amplification. A mutually exclusive pattern of RTK gene amplification was dominant in primary cancers, lymph-node metastases, and KTs. There was no survival difference between KTs of gastric origin and colorectal origin. However, of all synchronous cancers, KTs of colorectal origin had a better prognosis than those of gastric origin.
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Zhang JJ, Cao DY, Yang JX, Shen K. Ovarian metastasis from nongynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience. J Ovarian Res 2020; 13:128. [PMID: 33109236 PMCID: PMC7592359 DOI: 10.1186/s13048-020-00714-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Metastasis to the ovary from nongynecologic organs accounts for 9% of all ovarian malignancies. Although the most common nongynecologic primary site of ovarian metastasis is the gastrointestinal tract, metastasis from other sites to the ovary is not uncommon. Differential diagnosis of primary and metastatic ovarian tumors is important; otherwise, appropriate treatment cannot be determined. Furthermore, an optimal treatment strategy for ovarian metastasis from nongynecologic primary sites still needs to be explored. METHODS One hundred seventy-seven patients with ovarian metastasis from nongynecologic primary sites admitted to Peking Union Medical College Hospital between May 2005 and May 2018 were retrospectively evaluated. RESULTS The mean age was 48 years (range, 18-83). Approximately 60% of patients were premenopausal women. The two most common nongynecologic primary sites of ovarian metastasis were the colorectum (68 cases) and stomach (61 cases). In addition to the most common symptoms of abdominal distension (39.0%), abdominal pain (37.9%), and ascites (27.7%), 18.1% of patients presented with abnormal uterine bleeding. Half of the patients who tested serum CA-125 preoperatively had elevated CA-125 levels within the range of 35 U/ml to 200 U/ml. More than 70% of synchronous ovarian metastases were preoperatively misdiagnosed as primary ovarian cancer. Of all included cases, 56.5% achieved optimal cytoreductive surgery (the diameter of the largest residual lesion < 2 cm). The overall 5-year survival rate and median survival time were 10% and 20 months, respectively. The primary site, optimal cytoreductive surgery, tumor differentiation, and postoperative adjuvant treatment were identified as prognostic indicators. CONCLUSIONS The colorectum and stomach are the most common nongynecologic primary sites of ovarian metastasis. Synchronous ovarian metastasis is easily misdiagnosed as primary ovarian cancer. Optimal cytoreductive surgery and postoperative adjuvant treatment can be performed to confer survival benefit in selected patients.
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Affiliation(s)
- Jing-Jing Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 ShuaiFuYuan, Dongcheng District, Beijing, 100730, China.,Department of Gynecology, Sun Yat-sen First Affiliated Hospital, No. 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Dong-Yan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 ShuaiFuYuan, Dongcheng District, Beijing, 100730, China.
| | - Jia-Xin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 ShuaiFuYuan, Dongcheng District, Beijing, 100730, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 ShuaiFuYuan, Dongcheng District, Beijing, 100730, China.
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Kurokawa R, Nakai Y, Gonoi W, Mori H, Tsuruga T, Makise N, Ushiku T, Abe O. Differentiation between ovarian metastasis from colorectal carcinoma and primary ovarian carcinoma: Evaluation of tumour markers and "mille-feuille sign" on computed tomography/magnetic resonance imaging. Eur J Radiol 2020; 124:108823. [PMID: 31935596 DOI: 10.1016/j.ejrad.2020.108823] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/21/2019] [Accepted: 12/28/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the usefulness of serum tumour markers and morphological characteristics in CT/MRI to differentiate between ovarian metastases from colorectal carcinomas (OMCRC) and primary ovarian carcinomas (POC). METHOD Preoperative radiological images of 41 OMCRCs from 27 patients (mean age ± SD: 52.2 ± 10.7 years) and 46 POCs from 36 patients (52.1 ± 12.7 years) were included. Three blinded gynecological radiologists classified tumour morphology into 'mille-feuille sign', 'solid and cystic', 'multicystic without nodules', and 'multicystic with nodules' groups and analysed using Fisher's exact test. Serum carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), and carbohydrate antigen 19-9 levels were compared by Wilcoxon rank-sum test. RESULTS 'Mille-feuille sign' indicated OMCRC (OMCRC: 8/41, POC: 1/46, specificity = 0.98, p = 0.011) and had excellent interobserver agreement (Fleiss's kappa value = 0.96). 'Solid and cystic' indicated POC (18/41 vs 41/45, p < 0.001) and 'multicystic without nodules' indicated OMCRC (8/41 vs 2/46, p = 0.041). There was no significant difference in 'multicystic with nodules'. CA125 levels were higher in POCs (292.5 U/mL vs. 41.0 U/mL, p = 0.003). CEA levels were higher in OMCRCs (24.5 ng/mL vs 2 ng/mL, p < 0.001). CEA (< 6.3 ng/mL) AND (CA125 (≥87.0 U/mL) OR 'solid and cystic') indicated POC with high accuracy (3/41 vs 44/46, accuracy = 0.94, p < 0.001). CONCLUSIONS Our new method with morphological classification and tumour markers were useful for differentiating the two tumours. In particular, the 'mille-feuille sign' frequently indicated OMCRC with high specificity and excellent interobserver agreement.
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Affiliation(s)
- Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Yudai Nakai
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Harushi Mori
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Naohiro Makise
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Buza N. Frozen Section Diagnosis of Ovarian Epithelial Tumors: Diagnostic Pearls and Pitfalls. Arch Pathol Lab Med 2019; 143:47-64. [PMID: 30785337 DOI: 10.5858/arpa.2018-0289-ra] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Epithelial tumors of the ovary are one of the most frequently encountered gynecologic specimens in the frozen section laboratory. The preoperative diagnostic workup of an ovarian mass is typically limited to imaging studies and serum markers, both of which suffer from low sensitivity and specificity. Therefore, intraoperative frozen section evaluation is crucial for determining the required extent of surgery, that is, cystectomy for benign tumors, oophorectomy or limited surgical staging for borderline tumors in younger patients to preserve fertility, or extensive staging procedure for ovarian carcinomas. Ovarian epithelial tumors may exhibit a wide range of morphologic patterns, which often overlap with each other and can mimic a variety of other ovarian nonepithelial neoplasms as well. A combination of careful gross examination, appropriate sampling and interpretation of morphologic findings, and familiarity with the clinical context is the key to the accurate frozen section diagnosis and successful intraoperative consultation. OBJECTIVE.— To review the salient frozen section diagnostic features of ovarian epithelial tumors, with special emphasis on useful clinicopathologic and morphologic clues and potential diagnostic pitfalls. DATA SOURCES.— Review of the literature and personal experience of the author. CONCLUSIONS.— Frozen section evaluation of ovarian tumors continues to pose a significant diagnostic challenge for practicing pathologists. This review article presents detailed discussions of the most common clinical scenarios and diagnostic problems encountered during intraoperative frozen section evaluation of mucinous, serous, endometrioid, and clear cell ovarian tumors.
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Affiliation(s)
- Natalia Buza
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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41
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Tumor-to-tumor metastasis from appendiceal adenocarcinoma to an ovarian mature teratoma, mimicking malignant transformation of a teratoma: a case report. Diagn Pathol 2019; 14:88. [PMID: 31409389 PMCID: PMC6692929 DOI: 10.1186/s13000-019-0865-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Tumor-to-tumor metastasis (TTM) is a rare but well-documented phenomenon that is defined as metastasis in a histologically distinct tumor. Ovarian mature teratomas (OMTs) can coexist with various cancers by malignant transformation, which may make it difficult to distinguish these from TTM. Herein, we report a case of TTM from appendiceal adenocarcinoma to the OMT, mimicking the malignant transformation of OMT. Case presentation A 67-year-old Japanese woman underwent abdominal total hysterectomy and bilateral salpingo-oophorectomy for an ovarian tumor in another hospital. She was initially diagnosed with mucinous carcinoma/carcinoid arising in the OMT. One year after surgery, she was referred to our hospital after the presentation of increased appendiceal mass. Cecal biopsy targeting an appendiceal tumor revealed scattered mucinous cells with signet ring features, which were morphologically similar to the malignant components in the previously diagnosed right OMT. Both the appendiceal adenocarcinoma and malignant components of the OMT stained positive for CK7, CK20, CDX-2, and SATB2 but negative for estrogen receptor, progesterone receptor, and pax-8. Finally, we confirmed the diagnosis of appendiceal goblet cell carcinoid metastasizing to the right OMT. The patient had tumor-bearing survival due to systemic chemotherapy administered for 35 months after the initial surgery. Conclusions Awareness of the TTM phenomenon is important to avoid an incorrect diagnosis and to select the appropriate therapy when unusual malignancy is encountered in the OMTs.
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Karaosmanoglu AD, Onur MR, Salman MC, Usubutun A, Karcaaltincaba M, Ozmen MN, Akata D. Imaging in secondary tumors of the ovary. Abdom Radiol (NY) 2019; 44:1493-1505. [PMID: 30361868 DOI: 10.1007/s00261-018-1809-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Metastatic involvement of the ovaries is not rare. The most common tumor types metastasizing to the ovaries, from non-gynecological organs, are breast, colorectal, gastric, and appendix tumors. Lymphogenous, hematogenous, and transcoelomic pathways have all been proposed among potential pathways. Early diagnosis and treatment have an important potential to improve the patient outcome. Krukenberg tumors typically appear as complex semisolid masses with varying amounts of solid and cystic components. Ovarian metastases from the colon primaries are predominantly cystic in nature. Secondary lymphomatous involvement of ovary is mostly bilateral and solid with heterogeneous signal intensity on MRI. Metastatic breast cancer to the ovaries is typically bilateral and tends to be of small size. Among all the other imaging characteristics, bilateral involvement of secondary tumors of the ovary appears to be most potentially helpful finding in differentiating from primary ones.
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Affiliation(s)
- Ali Devrim Karaosmanoglu
- Department of Radiology, Faculty of Medicine, School of Medicine, Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, School of Medicine, Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey.
| | - Mehmet Coskun Salman
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Alp Usubutun
- Faculty of Medicine, Department of Pathology, Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Musturay Karcaaltincaba
- Department of Radiology, Faculty of Medicine, School of Medicine, Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Faculty of Medicine, School of Medicine, Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Faculty of Medicine, School of Medicine, Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
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Tian W, Zhou Y, Wu M, Yao Y, Deng Y. Ovarian metastasis from breast cancer: a comprehensive review. Clin Transl Oncol 2018; 21:819-827. [DOI: 10.1007/s12094-018-02007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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Koufopoulos N, Nasi D, Antoniadou F, Kokkali S, Theocharis S. Kidney Carcinoma Ovarian Metastasis: Review of the Literature. Cureus 2018; 10:e3620. [PMID: 30693167 PMCID: PMC6344066 DOI: 10.7759/cureus.3620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Ovarian metastasis is common with secondary tumors representing up to 15% of ovarian neoplasms. The malignancies most commonly involving the ovaries are carcinomas of the stomach, colon, breast, endocervix, endometrium, and lymphoma. Secondary ovarian involvement by kidney carcinoma occurs very rarely and is usually associated with widespread dissemination. We conducted a review of kidney carcinoma with ovarian metastasis in the literature using the keywords clear cell renal cell carcinoma, papillary renal cell carcinoma, chromophobe renal cell carcinoma collecting duct carcinoma, and ovarian metastasis on Google Scholar and PubMed indices in April 2018, including a case diagnosed in our department. To date, 30 articles presenting 41 cases of kidney carcinoma with ovarian metastasis are reported in the literature. All reviewed cases were analyzed for diagnosis, surgical and systemic therapy, and outcome. Diagnosis may sometimes be challenging, requiring appropriate immunohistochemical markers in difficult cases. A combination of surgery and adjuvant therapy offers significant benefit in disease control or palliation of symptoms. Due to inconsistency in the reported data, further studies are needed to make safe conclusions regarding survival.
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Affiliation(s)
| | - Despoina Nasi
- Department of Oncology, "Saint Savvas" Cancer Hospital, Athens, GRC
| | | | - Stefania Kokkali
- Department of Oncology, "Saint Savvas" Cancer Hospital, Athens, GRC
| | - Stamatios Theocharis
- Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
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Kutasovic JR, McCart Reed AE, Males R, Sim S, Saunus JM, Dalley A, McEvoy CR, Dedina L, Miller G, Peyton S, Reid L, Lal S, Niland C, Ferguson K, Fellowes AP, Al-Ejeh F, Lakhani SR, Cummings MC, Simpson PT. Breast cancer metastasis to gynaecological organs: a clinico-pathological and molecular profiling study. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2018; 5:25-39. [PMID: 30246500 PMCID: PMC6317061 DOI: 10.1002/cjp2.118] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 12/21/2022]
Abstract
Breast cancer metastasis to gynaecological organs is an understudied pattern of tumour spread. We explored clinico-pathological and molecular features of these metastases to better understand whether this pattern of dissemination is organotropic or a consequence of wider metastatic dissemination. Primary and metastatic tumours from 54 breast cancer patients with gynaecological metastases were analysed using immunohistochemistry, DNA copy-number profiling, and targeted sequencing of 386 cancer-related genes. The median age of primary tumour diagnosis amongst patients with gynaecological metastases was significantly younger compared to a general breast cancer population (46.5 versus 60 years; p < 0.0001). Median age at metastatic diagnosis was 54.4, time to progression was 4.8 years (range 0-20 years), and survival following a diagnosis of metastasis was 1.95 years (range 0-18 years). Patients had an average of five involved sites (most frequently ovary, fallopian tube, omentum/peritoneum), with fewer instances of spread to the lungs, liver, or brain. Invasive lobular histology and luminal A-like phenotype were over-represented in this group (42.8 and 87.5%, respectively) and most patients had involved axillary lymph nodes (p < 0.001). Primary tumours frequently co-expressed oestrogen receptor cofactors (GATA3, FOXA1) and harboured amplifications at 8p12, 8q24, and 11q13. In terms of phenotype conversion, oestrogen receptor status was generally maintained in metastases, FOXA1 increased, and expression of progesterone receptor, androgen receptor, and GATA3 decreased. ESR1 and novel AR mutations were identified. Metastasis to gynaecological organs is a complication frequently affecting young women with invasive lobular carcinoma and luminal A-like breast cancer, and hence may be driven by sustained hormonal signalling. Molecular analyses reveal a spectrum of factors that could contribute to de novo or acquired resistance to therapy and disease progression.
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Affiliation(s)
- Jamie R Kutasovic
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Personalised Medicine, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Amy E McCart Reed
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Personalised Medicine, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Renique Males
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sarah Sim
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Pathology Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jodi M Saunus
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Personalised Medicine, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Andrew Dalley
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Liana Dedina
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gregory Miller
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Pathology Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stephen Peyton
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Pathology Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Lynne Reid
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Samir Lal
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Colleen Niland
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kaltin Ferguson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andrew P Fellowes
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Fares Al-Ejeh
- Personalised Medicine, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sunil R Lakhani
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Pathology Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Margaret C Cummings
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Pathology Queensland, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Peter T Simpson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Mori Y, Nyuya A, Yasui K, Toshima T, Kawai T, Taniguchi F, Kimura K, Inada R, Nishizaki M, Haraga J, Nakamura K, Umeda Y, Kishimoto H, Fujiwara T, Katata Y, Yamaguchi Y, Nagasaka T. Clinical outcomes of women with ovarian metastases of colorectal cancer treated with oophorectomy with respect to their somatic mutation profiles. Oncotarget 2018; 9:16477-16488. [PMID: 29662660 PMCID: PMC5893255 DOI: 10.18632/oncotarget.24735] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/21/2018] [Indexed: 12/31/2022] Open
Abstract
We clarified the clinical prevalence of ovarian metastases from colorectal cancers (CRCs) in 296 female patients with CRC and evaluated clinical outcomes with relation to their mutational profiles, such as BRAF/KRAS mutation and microsatellite instability (MSI) status. The female CRCs were categorised into three subsets: CRCs with ovarian metastases [6.4% (n = 19), 5-year overall survival (OS) = 24.7%], CRCs with extra-ovarian metastases only [32.4% (n = 96), 5-year OS = 34.5%] and CRCs without any recurrence or metastasis [61.2% (n = 181), 5-year OS = 91.3%]. All patients with ovarian metastases underwent oophorectomy; of these, 9 who received preoperative chemotherapy had measurable metastases to extra-ovarian sites and the ovaries. Although 5 of 9 (56%) achieved partial response or complete response at extra-ovarian sites, no patient archived objective response at ovarian sites. Regarding the mutation profiles, in CRCs with extra-ovarian metastases only, the median survival time (MST) after initial treatments to progression to stage IV or recurrence was 13 [95% confidence interval (CI): 7–16 months] in BRAF-mutant and 34 months (95% CI: 22–58 months) in BRAF wild-type (P = 0.0033). Although ovarian metastases demonstrated poor response to systemic chemotherapy in CRCs with ovarian metastases, the MST after initial treatments to progression to stage IV or recurrence was 22 (95% CI: 21–25 months) in BRAF-mutant and 38 months (95% CI: 24–42 months) in BRAF wild-type (P = 0.0398). The outcomes of patients with ovarian metastases could be improved by oophorectomy regardless of their mutation profiles.
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Affiliation(s)
- Yoshiko Mori
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Clinical Genomic Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akihiro Nyuya
- Department of Clinical Oncology, Kawasaki Medical School, Kurashiki City, Japan
| | - Kazuya Yasui
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiaki Toshima
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Kawai
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumitaka Taniguchi
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keisuke Kimura
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryo Inada
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masahiko Nishizaki
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Junko Haraga
- Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Nakamura
- Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuzo Umeda
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Kishimoto
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Departments of Gastroenterological Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Katata
- Department of Clinical Oncology, Kawasaki Medical School, Kurashiki City, Japan
| | - Yoshiyuki Yamaguchi
- Department of Clinical Oncology, Kawasaki Medical School, Kurashiki City, Japan
| | - Takeshi Nagasaka
- Department of Clinical Oncology, Kawasaki Medical School, Kurashiki City, Japan
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48
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Olesinski T. Surgical treatment of gastric carcinoma with ovarian metastases. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2018. [DOI: 10.1515/cipms-2017-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Ovarian metastases from extragenital neoplasms are rare. The prevalent sites of the primary tumors were the breast, colorectum and the stomach. The Krukenberg tumor (KT) is defined as a gastrointestinal cancer which metastasized to the ovaries. Metastasis to the ovary may appear at the time of diagnosis of the primary tumor (synchronous) or during observation (metachronous). Common clinical presentations are abdominal distention, pain, palpable mass, bloating, ascites or pain during sexual intercourse. Diagnosis can be made by ultrasound examinations, CT or EMR scans, laparotomy and/or a biopsy of the ovary. The current standard treatment for patients with metastatic gastric cancer is systemic chemotherapy, however, treatment strategy for KTs from gastric cancer has not been clearly established and surgical treatment is considered mainly for metachronous tumors. The prognosis of patients with ovarian metastasis of gastric cancer origin is poorer compared with that of other primary tumors. Although the results of cytoreductive surgery – especially in combination with modern chemotherapy – seems to be promising, the optimal therapeutic strategies for such patients requires further prospective studies.
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Affiliation(s)
- Tomasz Olesinski
- Maria Sklodowska-Curie Institute – Oncology Center , W. K. Roentgena 5, 02-781 Warsaw , Poland
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49
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Schmoeckel E, Kirchner T, Mayr D. SATB2 is a supportive marker for the differentiation of a primary mucinous tumor of the ovary and an ovarian metastasis of a low-grade appendiceal mucinous neoplasm (LAMN): A series of seven cases. Pathol Res Pract 2017; 214:426-430. [PMID: 29487003 DOI: 10.1016/j.prp.2017.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
The differentiation between a primary mucinous ovarian neoplasm and an extra-ovarian metastasis in the ovary is often challenging in the histopathologic practice. Among various ovarian metastases from the gastro-intestinal tract the low-grade appendiceal mucinous neoplasm (LAMN) is an important differential diagnosis to consider particularly in case of pseudomyxoma peritonei. A newly recognized marker in the routine diagnostic of a mucinous neoplasm in the ovary is SATB2 (Special AT-rich sequence-binding protein 2). The expression of SATB2 is, within cells of epithelial lineages, mainly restricted to the lower gastro-intestinal tract, indicating colorectal or appendiceal cancer origin. We report seven cases of LAMN, which clinically became apparent due to ovarian metastases in context of pseudomyxoma peritonei or at least small foci of peritoneal tumor spread. An immunohistochemical marker-panel including SATB2, CDX2, CK20, CK7, PAX8, ER and PR revealed a strong expression of SATB2 in all seven cases. On the contrary SATB2-negativity could be demonstrated in the 40 cases of mucinous borderline tumors and primary mucinous carcinomas of the ovary. The histopathologic tentative diagnosis of an ovarian metastasis of LAMN could be confirmed in the findings of the Appendix in six of seven cases. This report supports SATB2 as an additional diagnostic marker for the diagnosis of an ovarian manifestation of LAMN.
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Affiliation(s)
- Elisa Schmoeckel
- Institute of Pathology, Faculty of Medicine, LMU Munich, Germany.
| | - Thomas Kirchner
- Institute of Pathology, Faculty of Medicine, LMU Munich, Germany
| | - Doris Mayr
- Institute of Pathology, Faculty of Medicine, LMU Munich, Germany
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50
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Agnes A, Biondi A, Ricci R, Gallotta V, D'Ugo D, Persiani R. Krukenberg tumors: Seed, route and soil. Surg Oncol 2017; 26:438-445. [PMID: 29113663 DOI: 10.1016/j.suronc.2017.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/28/2017] [Accepted: 09/09/2017] [Indexed: 01/10/2023]
Abstract
The aim of this narrative review was to summarize the current evidence on Krukenberg tumors (KTs), addressing what is known on their natural history and their impact on the clinical prognosis and which are the most appropriate management strategies to treat this condition. A literature search was conducted on Pubmed up to December 2016, selecting the most relevant studies on the basis of the scope of the review. KTs are ovarian metastases from primary signet-ring cell carcinomas., characterized by the presence of a sarcoma-like stroma. They have three possible routes of diffusion (lymphatic, peritoneal and hematogenous), but the preferential one is still unclear. Prognosis is dismal. When KTs are encountered in the clinical practice, it is reasonable to offer surgical resection to young, fit patients with limited disease. Palliative surgery should be considered for all patients with symptomatic disease. Further studies should clarify the clinicopathologic characteristics of KTs, their main routes of diffusion, and the possible role of prophylactic oophorectomy, lymphadenectomy and intraperitoneal chemotherapy. Molecular and transitional research should parallel the clinical one to help understanding the natural history of signet-ring cell carcinomas.
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Affiliation(s)
- Annamaria Agnes
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, 1 00168 Rome, Italy
| | - Alberto Biondi
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, 1 00168 Rome, Italy.
| | - Riccardo Ricci
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, 1 00168 Rome, Italy
| | - Valerio Gallotta
- Polo Scienze Della Salute Della Donna E Del Bambino, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, 1 00168 Rome, Italy
| | - Domenico D'Ugo
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, 1 00168 Rome, Italy
| | - Roberto Persiani
- Polo Scienze Gastroenterologiche ed Endocrino-Metaboliche, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Largo F. Vito, 1 00168 Rome, Italy
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