Metastatic tumors make up 5-6% of ovarian cancers. Most often, ovaries metastasize tumors of the genitals, breast, gastrointestinal tract and malignant lymphomas.
Damage to the ovaries occurs by implantation, hematogenous or lymphogenous. It is also possible with a direct transition of the tumor to the ovary from a neighboring organ (germination).
The clinical presentation of primary and metastatic ovarian cancer is similar. Amenorrhea is often noted. This is explained by the presence of luteinized cells in the stroma of the metastatic tumor, similar to those found in the stroma of primary hormone-active tumors, as well as in the foci of tecomatosis.
Metastatic ovarian tumors are mainly bilateral, of a solid structure, ranging in size from 2-3 cm to 15-20 cm. They have an oval, coarse-tuberous shape, can be gigantic; the color is whitish, grayish-white, yellowish with a crimson hue; the consistency is often dense, sometimes soft. These tumors are not associated with the uterus, have a well-defined leg. Diagnostic errors are explained by the fact that they are mistaken for a primary ovarian tumor in the absence of symptoms from the primary focus. It occurs mainly in women under 40-45 years old. Tumors are characterized by rapid growth and may appear earlier than the primary focus.
Metastases of malignant genital tumors
Ovarian damage in malignant genital tumors occurs by contact, hematogenous or lymphogenous route.
With malignant tumors of the fallopian tubes, ovarian involvement is observed in 13%. In most cases, the tumor directly passes from the fallopian tube to the ovary. It is sometimes difficult to figure out where the primary tumor is located – in the ovary or fallopian tube. Cervical cancer metastasizes to the ovaries in less than 1% of cases. This usually occurs in the later stages, as well as with cervical adenocarcinoma. Uterine cancer metastases in the ovaries are observed in 5%. The tumor can then go directly to the ovary. However, primary-multiple cancer of the uterus and ovary is much more common. Endometrial adenocarcinoma and endometrioid ovarian cancer are usually combined.
Other metastatic ovarian tumors
Often metastases to the ovaries of breast cancer. With autopsy of those who died from disseminated breast cancer, ovarian damage is detected in 24%. In 80% of cases it is bilateral. With ovariectomy in terms of complex treatment of breast cancer, ovarian metastases are detected in 20-30% of patients, and in 60%, the lesion is also bilateral. Metastases in the early stages of breast cancer are rare, although their exact frequency is unknown.
Krukenberg metastases account for 30-40% of metastatic ovarian tumors. These tumors are formed by cricoid cells containing a large amount of mucus, and are observed in cancer of the stomach, less often in the colon, mammary gland, or bile ducts. Very rarely, Krukenberg metastases occur in cancer of the cervix or bladder. A distinctive feature of all these tumors is the ability of their tissue to mucus.
Metastases of other malignant tumors of the gastrointestinal tract
Not all metastases in the ovaries of malignant tumors of the gastrointestinal tract are Krukenberg. Metastases without intracellular mucus formation are usually observed in cancer of the colon, less often – small intestine. Ovarian metastases occur in 1-2% of patients with colon cancer. With metastases of colon cancer in the ovaries, a differential diagnosis with mucinous ovarian cancer should be made.
Ovarian damage in hemoblastoses
Ovarian metastases (usually both) are also observed with hemoblastoses. With lymphogranulomatosis, tumors in the ovaries are found in 5% of patients. Sometimes the ovaries are the only affected organ of the pelvis and abdominal cavity.
Treatment. In the case of tumor operability in the primary lesion, if the patient is in satisfactory condition, removal of the primary tumor and metastatically altered ovaries is possible. In the absence of recurrence of the primary tumor and the detection of metastases in the ovaries, their removal is indicated. The scope of the operation for metastases in the ovaries is the extirpation of the uterus with appendages, removal of the greater omentum. After the operation, it is advisable to conduct several courses of combined chemotherapy with drugs in accordance with the sensitivity of the primary tumor and its metastases. When the tumor process is generalized, the removal of metastatically changed ovaries is performed only according to vital indications with a palliative purpose.
Serous Ovarian Cystadenocarcinoma
Serous cystadenocarcinoma accounts for 45-60% of all malignant epithelial tumors of the ovary. The average age of patients is 50-60 years, but it can occur in women of reproductive age and looks at the initial stages as a simple serous cystoma. The appearance of these tumors is diverse. It can be cysts with one or another number of papillae both on the inner and outer surfaces, or solid tumors, often bilateral. In a common process, solid or heterogeneous masses sprout the capsule of the tumor and surrounding tissues and organs, forming a conglomerate that performs the small and large pelvis, with access to the abdominal cavity. In this case, there are multiple small and larger implantation metastases along the parietal and visceral peritoneum, metastases in the greater omentum, liver, and lower surface of the diaphragm. In some cases, the greater omentum is completely infiltrated by the tumor masses; it can grow together with the underlying loops of the intestines and the peritoneum of the lateral flanks of the abdominal cavity. An ascites of a serous or hemorrhagic nature is detected. The microscopically lining epithelium of serous tumors is very diverse and resembles the epithelium of the fallopian tubes or the superficial epithelium of the ovary; usually has a papillary structure, but the tumors are predominantly solid.