Case Study of Ovarian Mature Teratoma Examines Rare Tumor-to-Tumor Metastasis
Posted: Friday, September 13, 2019
A case study published in Diagnostic Pathology reported a tumor-to-tumor metastasis from an appendiceal adenocarcinoma to an ovarian mature teratoma. This metastasis imitated the process of ovarian mature teratoma malignancy.
“To the best of our knowledge, the present case is the first case of tumor-to-tumor metastasis due to the metastasis of appendiceal adenocarcinoma to an ovarian mature teratoma. Awareness of this phenomenon is important to avoid an incorrect diagnosis and to select the appropriate therapy when unusual malignancies in ovarian mature teratomas are encountered,” concluded Masanori Yasuda, MD, PhD, of Saitama Medical University in Japan, and colleagues.
The tumor-to-tumor metastasis occurred in a Japanese woman (aged 67 years) who had originally been diagnosed with a mucinous carcinoma in an ovarian mature teratoma. One year after undergoing a total hysterectomy and bilateral salpingo-oophorectomy, the patient developed an appendiceal mass. Many malignant components present in the initial ovarian tumor were mirrored in the emergent mass.
Due to suspicion that the appendiceal tumor was a malignant transformation of the ovarian tumor or a metastatic adenocarcinoma related to the digestive system, a cecum biopsy was performed. Both the appendiceal tumor and the ovarian teratoma tested positive for CK7, CK20, CDX-2, and SATB2, whereas neither showed signs of pax-8, estrogen or progesterone receptor, synaptophysin, or chromogranin. Signet ring features observed in mucinous cells of the adenocarcinoma were also similar to those found in the ovarian tumor.
Based on these findings, the adenocarcinoma was determined to be the primary tumor, an appendiceal goblet cell carcinoid that had metastasized to the right ovarian mature teratoma and invaded nearby lymph nodes. Although tumor resection was not possible, systemic chemotherapy has resulted in tumor-bearing survival, at a follow-up of 35 months after the initial surgery.
Disclosure: The study authors reported no conflicts of interest.