Metastasen des Ovars

Torquiertes,
eingeblutetes Ovar mit Gewebe eines Adenokarzinoms des oberen Gastrointestinaltraktes (Krukenbergtumor; Primarius noch nicht identifiziert).
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Renal cell
carcinoma metastasis to the ovary: a case report. Contrast CT scan of the Left Ovarian metastasis; showing a 4 cm heterogeneous mass with fairly intense enhancement.
casesjournal.biomedcentral.com • CC-by-2.0
Ovarian
metastasis from thyroid carcinoma: a case report and literature review. Pelvic magnetic resonance. A) Axial fat suppressed T1-weighted image after intravenous gadolinium enhancement. B) Sagittal T2-weighted image showing left solid ovarian mass.
diagnosticpathology.biomedcentral.com • CC-by-4.0
Giant ovarian
metastasis from sigmoid colon cancer. Large heterogeneous cystic mass occupying two thirds of the abdominal cavity.
www.eurorad.org • CC by-nc-sa-4.0
Giant ovarian
metastasis from sigmoid colon cancer. CECT of the abdomen+pelvis. Axial section. Arterial phase. Large cystic mass, with enhancing capsule and septa and an area of sigmoid wall thickening.
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Metastases to the ovary are relatively common with a documented incidence of 5-30% of all malignant ovarian masses.

These may be incorrectly grouped under Krukenberg tumors, which are signet cell containing tumors that form only 30-40% of all ovarian metastases.

Clinical presentation

There is often a known primary at presentation. Patients may present with abdominal symptoms such as pain or palpable pelvic mass. Hormonal overactivity can also be occasionally seen due to hyperplasia of ovarian stroma.

Pathology

These are large lobulated tumors with areas of hemorrhage and necrosis. The contour of the ovary is usually preserved. Lesions are commonly bilateral.

They usually spread by haematogenous route, lymphatic route or by the direct spread. There are usually surface deposits of tumors with invasion of the stroma.

Etiology

Metastases to the ovary commonly arise from the gastrointestinal tract, breast, lungs and contralateral ovaries. Other rare primaries include endometrium, melanoma, pancreas, carcinoid, leukemia, renal cell carcinoma , hepatocellular carcinoma, gallbladder carcinoma, bladder transitional cell carcinoma , neuroblastoma , and reticuloendothelial tumors .

Radiographic features

Ultrasound

These are mixed echogenicity tumors with vascularity of solid component on Doppler.

CT

Soft tissue density with areas of cystic necrosis. On contrast, solid components demonstrate inhomogeneous enhancement.

MRI
  • T1: iso to hypointense with variable enhancement on contrast
  • T2: heterogenous signal of the solid component with hyperintensity of the cystic component

Treatment and prognosis

Treatment involves radical tumor-reductive surgery. The prognosis for metastases is very poor with a 1-year rate of survival less than 10%.

Differential diagnosis

Imaging differential considerations include:

  • primary ovarian cancer: see ovarian tumors
    • predominantly multiloculated cystic masses are primary ovarian cancers whereas predominantly solid to mixed tumors are metastases
  • ovarian lymphoma: ovarian lymphomas are homogeneously solid masses with extensive lymph nodal involvement
Siehe auch:
Assoziationen und Differentialdiagnosen zu Metastasen des Ovars:
Neoplasien
des Ovars
Wikipedia • CC BY-SA 4.0
Krukenberg-Tumor
 
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