“…In a retrospective study over 147 patients, Li W et al [14] reported a rate of ovarian metastases of 48.9% by colorectal cancer, 40.8% by gastric cancer, 8.2 by breast cancer and only 1.4% by biliary origin. Unfortunately, there are very few reports that describe cases of metastatic lesions that present clinically as a primary tumor [7,8,[15], [16], [17]]. The high rate of bilaterality, surface involvement by tumor cells, multinodular growth, extensive extra-ovarian tumor, size >10 cm, infiltrative and nodular pattern of invasion, and presence of signet ring cells are the most helpful features for indicating a metastatic nature of an ovarian mass [7,[18], [19], [20], [21]].…”