The pathogenesis, diagnosis, and management of metastatic tumors to the ovary: a comprehensive review

Abstract

Secondary tumors of the ovary account for 10–25% of all ovarian malignancies. The most common tumors that give rise to ovarian metastases include breast, colorectal, endometrial, stomach, and appendix cancer. The correct diagnosis of secondary ovarian tumors may be challenging as they are not infrequently misdiagnosed as primary ovarian cancer, particularly in the case of mucinous adenocarcinomas. The distinction from the latter is essential, as it requires different treatment. Immunohistochemistry plays an important role in distinguishing primary ovarian tumors from extra-ovarian metastases and, furthermore, may suggest the primary tumor site. Despite extensive study, some cases remain equivocal even after assessing a broad spectrum of antigens. Therefore, gene expression profiling represents an approach able to further discriminate equivocal findings, and one that has been proven effective in determining the origin of cancer of unknown primary site. The available data concerning secondary ovarian tumors is rather limited owing to the relative heterogeneity of this group and the practical absence of any prospective trials. However, several intriguing questions are encountered in daily practice, including rational diagnostic workup, the role of cytoreductive surgery, and consequent adjuvant chemotherapy. This review seeks to address these issues comprehensively and summarize current knowledge on the epidemiology, pathogenesis, and management of secondary ovarian tumors, including further discussion on the different pathways of metastatisation, metastatic organotropism, and their possible molecular mechanisms.

An interesting case of likely BRCA2 related bilateral breast cancer with metastasis in the fimbrial part of fallopian tube

“…Ovarian metastases are seen in different settings. A predilection site for metastasis is described in the past few years as metastatic organotropism [7,8]. While in breast cancer there are several molecular and genetic patterns already associated with metastasizing to the brain, lungs, and bones [8,9], yet to the best of our knowledge, there have been no markers that predict metastasis to the uterine adnexa identified so far.…”

“…Hungarian group reported breast cancer to be the primary site in 20% [12]. A review of literature by Kubeček et al [7] shows that breast is the primary site in 1.8% up to 33% of cases of ovarian metastases. Since the survival of patients with metastases into ovaries is worse than the survival of those with primary ovarian cancer, the distinction between the two is critically important to understand [6].…”

Molecular Design of Sugar-Free Migracin Analog Migracinal That Inhibits Ovarian Cancer Cell Migration and Invasion

“…In one hand, ovarian cancer is the most common cause of gynecologic disease-related death. Ovarian carcinomas often metastasize to neighboring organs such as lung, liver and the peritoneal cavity through direct extension, migration, invasion, and lymphatic vessel transport [2,3]. Moreover, clear cell ovarian tumors are part of the epithelial tumor group of ovarian cancers, and these tumors may have a worse prognosis than other epithelial type-ovarian tumors [4].…”

A case of Krukenberg tumor, eight years after treatment of gastric cancer

“…Krukenberg tumor is a rare metastatic tumor involving the ovaries. Gastric cancer is usually the primary site [1]. Friedrich Ernst Krukenberg, who first described the tumor in 1896, originally named it 'ovarian mucocellular fibrosarcoma' [2].…”