Metastases to the ovary
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 tumours that form only 30-40% of all ovarian metastases.
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.
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 direct spread. There are usually surface deposits of tumors with invasion of the stroma.
Metastases to the ovary commonly arise from the gastrointestinal tract, breast, lungs and contralateral ovaries. Other rare primaries include endometrium, melanoma, pancreas and carcinoid.
These are mixed echogenicity tumours with vascularity of solid component on Doppler.
Soft tissue density with areas of cystic necrosis. On contrast, solid components demonstrate inhomogeneous enhancement.
- T1: iso to hypointense with variable enhancement on contrast
- T2: heterogenous signal of solid component with hyperintensity of cystic component
Treatment and prognosis
Treatment involves radical tumor-reductive surgery. The prognosis for metastases is very poor with a 1-year survival rate less than 10%.
Imaging differential considerations include:
- 1. Lee SJ, Bae JH, Lee AW et-al. Clinical characteristics of metastatic tumors to the ovaries. J. Korean Med. Sci. 01;24 (1): 114-9. doi:10.3346/jkms.2009.24.1.114 - Free text at pubmed - Pubmed citation
- 2. Yada-Hashimoto N, Yamamoto T, Kamiura S et-al. Metastatic ovarian tumors: a review of 64 cases. Gynecol. Oncol. 2003;89 (2): 314-7. Pubmed citation
- 3. Hricak H. Diagnostic Imaging. AMIRSYS. (2007) ISBN:1416033386. Read it at Google Books - Find it at Amazon
- 4. Khunamornpong S, Suprasert P, Chiangmai WN et-al. Metastatic tumors to the ovaries: a study of 170 cases in northern Thailand. Int. J. Gynecol. Cancer. 2006;16 Suppl 1 (S1): 132-8. Int. J. Gynecol. Cancer (full text) - doi:10.1111/j.1525-1438.2006.00302.x - Pubmed citation
- 5. De Waal YR, Thomas CM, Oei AL et-al. Secondary ovarian malignancies: frequency, origin, and characteristics. Int. J. Gynecol. Cancer. 2009;19 (7): 1160-5. doi:10.1111/IGC.0b013e3181b33cce - Pubmed citation