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.

Aetiology

Metastases to the ovary commonly arise from the gastrointestinal tract, breast, lungs and contralateral ovaries. Other rare primaries include endometrium, melanoma, pancreas and carcinoid.

Ultrasound

These are mixed echogenicity tumours 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 solid component with hyperintensity of cystic component

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:

  • primary ovarian cancer: see ovarian tumours
    • predominantly multiloculated cystic masses are primary ovarian cancers whereas predominantly solid to mixed tumours are metastases
  • ovarian lymphoma: ovarian lymphomas are homogeneously solid masses with extensive lymph nodal involvement
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Article information

rID: 20935
System: Gynaecology
Section: Gamuts
Tag: cases
Synonyms or Alternate Spellings:
  • Ovarian matastases
  • Metastases to the ovaries
  • Metastases to ovaries

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Cases and figures

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    Case 1: Krukenberg tumour
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    Case 2: colorectal metastasis
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