Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia

The potential for adenocarcinoma metastatic to the ovary to mimic primary mucinous neoplasms is a well-known issue to surgical pathologists, most of the recent literature emphasizing pancreatic and various other origins for the ovarian metastases. Although an origin in the gallbladder or extrahepati...

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Main Authors: Surapan Khunamornpong, Sumalee Siriaunkgul, Prapaporn Suprasert, Suwalee Pojchamarnwiputh, Wittanee Na Chiangmai, Robert H. Young
Format: Journal
Published: 2018
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spelling th-cmuir.6653943832-612322018-09-10T04:07:06Z Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia Surapan Khunamornpong Sumalee Siriaunkgul Prapaporn Suprasert Suwalee Pojchamarnwiputh Wittanee Na Chiangmai Robert H. Young Medicine The potential for adenocarcinoma metastatic to the ovary to mimic primary mucinous neoplasms is a well-known issue to surgical pathologists, most of the recent literature emphasizing pancreatic and various other origins for the ovarian metastases. Although an origin in the gallbladder or extrahepatic bile ducts is acknowledged for some cases little information exists on tumors originating within the intrahepatic bile ducts. Sixteen cases of this type were retrieved from the surgical pathology files of the Chiang Mai University Hospital between January 1992 and December 2006. The patients ranged from 38 to 74 years (mean 52). Thirteen presented with nonspecific pelvic symptoms similar to primary ovarian neoplasms. The hepatic tumors were radiologically detected before the ovarian lesion in 2 cases. Hepatic and ovarian masses were simultaneously detected by preoperative radiologic studies or at exploratory laparotomy in 10 cases. In the remaining 4 cases, the hepatic lesions were detected postoperatively. There were a total of 26 metastatic ovarian lesions which included 22 clinically recognized ovarian masses (range 3 to 20 cm, mean 11.8 cm). Bilateral involvement was present in 10 cases (62%) and unilateral involvement in 6 (38%). The cut surfaces of the 22 grossly enlarged ovaries were predominantly solid in 5, solid-cystic in 10, and multicystic in 7. Microscopically, surface implants were observed in 80% of tumors, multinodular growth in 48%, and infiltrative stromal invasion (including microinvasionlike foci as it would be applied if the tumors were primary) in 86%. The neoplastic epithelium typically formed glands that ranged from small to large and cystically dilated, but small clusters of cells and individual cells were also seen. The epithelium ranged from tall, columnar, and mucinous in appearance to cuboidal or flattened and nonspecific. The tumors most closely mimicked primary mucinous neoplasms although a resemblance to other mullerian neoplasms was also seen. Foci often mimicked mucinous borderline tumors of typical type or with intraepithelial carcinoma and benign-appearing mucinous epithelium was seen in 62% of tumors. Immunohistochemical studies in 15 cases showed a positive reaction for cytokeratin 7 in all and for cytokeratin 20 in 5 cases. Intrahepatic cholangiocarcinoma should be included in the list of origins of possible ovarian metastatic tumors that mimic primary ovarian mucinous neoplasia, particularly in parts of the world where cholangiocarcinoma of the liver is relatively common. © 2007 Lippincott Williams & Wilkins, Inc. 2018-09-10T04:07:06Z 2018-09-10T04:07:06Z 2007-12-01 Journal 01475185 2-s2.0-36448970930 10.1097/PAS.0b013e3180674ded https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=36448970930&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/61232
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Surapan Khunamornpong
Sumalee Siriaunkgul
Prapaporn Suprasert
Suwalee Pojchamarnwiputh
Wittanee Na Chiangmai
Robert H. Young
Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia
description The potential for adenocarcinoma metastatic to the ovary to mimic primary mucinous neoplasms is a well-known issue to surgical pathologists, most of the recent literature emphasizing pancreatic and various other origins for the ovarian metastases. Although an origin in the gallbladder or extrahepatic bile ducts is acknowledged for some cases little information exists on tumors originating within the intrahepatic bile ducts. Sixteen cases of this type were retrieved from the surgical pathology files of the Chiang Mai University Hospital between January 1992 and December 2006. The patients ranged from 38 to 74 years (mean 52). Thirteen presented with nonspecific pelvic symptoms similar to primary ovarian neoplasms. The hepatic tumors were radiologically detected before the ovarian lesion in 2 cases. Hepatic and ovarian masses were simultaneously detected by preoperative radiologic studies or at exploratory laparotomy in 10 cases. In the remaining 4 cases, the hepatic lesions were detected postoperatively. There were a total of 26 metastatic ovarian lesions which included 22 clinically recognized ovarian masses (range 3 to 20 cm, mean 11.8 cm). Bilateral involvement was present in 10 cases (62%) and unilateral involvement in 6 (38%). The cut surfaces of the 22 grossly enlarged ovaries were predominantly solid in 5, solid-cystic in 10, and multicystic in 7. Microscopically, surface implants were observed in 80% of tumors, multinodular growth in 48%, and infiltrative stromal invasion (including microinvasionlike foci as it would be applied if the tumors were primary) in 86%. The neoplastic epithelium typically formed glands that ranged from small to large and cystically dilated, but small clusters of cells and individual cells were also seen. The epithelium ranged from tall, columnar, and mucinous in appearance to cuboidal or flattened and nonspecific. The tumors most closely mimicked primary mucinous neoplasms although a resemblance to other mullerian neoplasms was also seen. Foci often mimicked mucinous borderline tumors of typical type or with intraepithelial carcinoma and benign-appearing mucinous epithelium was seen in 62% of tumors. Immunohistochemical studies in 15 cases showed a positive reaction for cytokeratin 7 in all and for cytokeratin 20 in 5 cases. Intrahepatic cholangiocarcinoma should be included in the list of origins of possible ovarian metastatic tumors that mimic primary ovarian mucinous neoplasia, particularly in parts of the world where cholangiocarcinoma of the liver is relatively common. © 2007 Lippincott Williams & Wilkins, Inc.
format Journal
author Surapan Khunamornpong
Sumalee Siriaunkgul
Prapaporn Suprasert
Suwalee Pojchamarnwiputh
Wittanee Na Chiangmai
Robert H. Young
author_facet Surapan Khunamornpong
Sumalee Siriaunkgul
Prapaporn Suprasert
Suwalee Pojchamarnwiputh
Wittanee Na Chiangmai
Robert H. Young
author_sort Surapan Khunamornpong
title Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia
title_short Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia
title_full Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia
title_fullStr Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia
title_full_unstemmed Intrahepatic cholangiocarcinoma metastatic to the ovary: A report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia
title_sort intrahepatic cholangiocarcinoma metastatic to the ovary: a report of 16 cases of an underemphasized form of secondary tumor in the ovary that may mimic primary neoplasia
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=36448970930&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/61232
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