Pancreaticobiliary metastasis presenting as primary mucinous ovarian neoplasm: A systematic literature review

Abstract

True primary mucinous ovarian carcinomas are rarer than originally thought and their clinical behavior and treatment response are different than more common epithelial ovarian carcinomas. Secondary ovarian neoplasms often mimic the clinical and histological features of mucinous ovarian cancer making their diagnosis, and therefore treatment, more difficult. Misdiagnosis can have a significant impact on both treatment and prognosis. The majority of these secondary ovarian neoplasms arise from the gastrointestinal tract, with mucinous histology often of pancreaticobiliary origin. Our study objective was to review current evidence distinguishing pancreaticobiliary ovarian metastasis from primary mucinous ovarian carcinoma. We utilized a PubMed search using MeSH terms and selected articles were reviewed, synthesized and summarized. Thirty-nine articles were included in the review. The clinical, gross, histological and immunohistochemical features distinguishing primary mucinous ovarian carcinomas from pancreaticobiliary ovarian metastasis were identified. Compared to primary mucinous ovarian carcinoma, metastatic pancreaticobiliary tumors are more often bilateral, <10 cm, have irregular external surface and surface implants, display an infiltrative pattern of invasion and stain for MUC1 and CK17. Primary ovarian mucinous tumors rarely (<3%) have signet ring cells or involvement of the hilum. Metastatic mucinous tumors mimic their primary mucinous ovarian counterparts and their clinical and histopathological features overlap in many ways. However, these metastatic tumors have features that can help differentiate them from primary mucinous carcinoma. With a high index of suspicion and knowledge of the reviewed features, distinguishing these tumors will continue to become easier.

Primary mucinous ovarian tumors vs. ovarian metastases from gastrointestinal tract, pancreas and biliary tree: a review of current problematics

“…The summary of current knowledge shows that most tumors can be reliably classified with respect to the primary source based on the morphological criteria, which include the assessment of macroscopic features, microscopic findings, and immunohistochemical profile of the tumor. However, a minority of tumors, especially from the upper GIT, pancreas and biliary tree, remain problematic in this context [55,66,94]. The problem is especially caused by the fact that the morphologic features and immunophenotype of primary mucinous ovarian tumors are not specific, and there are overlapping features with metastases.…”

“…Metastases from the pancreatobiliary tract represent probably the most problematic category with regard to possible confusion with primary ovarian tumors [8,17,66,94]. Regarding the IHC examination, the antibodies listed in the differential diagnosis between primary ovarian mucinous tumors and metastases of the "lower" GIT are practically useless in the context of pancreatobiliary neoplasms.…”

“…A loss of DPC4 (SMAD4) expression occurs in 53% of pancreatic and only about 5-10% of primary ovarian mucinous tumors [28,36,37,95]. According to the literature, cytokeratin 17 seems to be negative in ovarian mucinous tumors and positive in 27-83% of metastatic pancreatic carcinomas, but the data is very limited [94,96].…”

Gene-Expression Profiling of Mucinous Ovarian Tumors and Comparison with Upper and Lower Gastrointestinal Tumors Identifies Markers Associated with Adverse Outcomes

“…Earlier literature has focused on differentiating MOC from lower GI tumors, due to the relatively high frequency of reclassification from “primary MOC” to primary colorectal or appendiceal neoplasms metastatic to the ovary following expert pathologic review ( 1 ). Gene and protein expression studies have led to improved diagnostic algorithms for lower GI tumors ( 4 ), but robust markers to differentiate primary MOC from metastases of upper GI origin are lacking ( 5 ).…”

Clinicopathologic characteristics of epithelial ovarian tumours in Ile-Ife, Nigeria

“…Once metastatic ovarian tumours are excluded by morphological features and ancillary methods, primary mucinous EOT tend to have a low occurrence of between 2% and 8% of epithelial carcinoma. [21,22 ] These tumours are often larger than the serous tumours, the largest size in this study was a 30cm mucinous cystadenoma which was bigger than the largest serous cystadenoma of 26cm size. The largest mucinous carcinoma was 27cm compared with the largest serous carcinoma which was 26cm, likewise, the mucinous borderline tumour was 27cm in the widest diameter.…”