Lung carcinoma metastatic to the ovary

Five to ten percent of all ovarian tumours are metastases, commonly from the female genital tract, gastrointestinal tract and breast: primary lung carcinoma accounts for only 0.4% of secondary ovarian tumours. All major types of lung carcinoma may metastasis to the ovaries. Ovarian metastases most often occur with small cell carcinomas or adenocarcinomas, less often with large cell carcinoma, rarely with squamous cell carcinoma or atypical carcinoid tumour. Cases of metastatic small cell carcinoma tend to have an occult lung primary. For other types, there is usually a known history of lung cancer.

Metastases may occur to various pre-existing ovarian tumours. The ovarian tumour is commonly multinodular and shows necrosis. There is commonly Lymphovascular invasion. One third of cases show involvement of the ovarian surface. Small cell carcinomas commonly show cystic spaces: the Azzopardi effect is rarely seen.

Immunohistochemistry

Differential diagnosis

• Primary ovarian epithelial tumour

  • clear cell carcinomas: an admixture of solid, tubulocystic, papillary and hobnail foci and coexistent endometriosis favour an ovarian primary.

• Small cell carcinoma: peritoneal spread and an associated epithelial ovarian tumour favour an ovarian primary

  • granulosa cell tumour, with trabeculae and cords of cells

  • endometrial stromal sarcoma

  • lymphoma

  • primitive peripheral neuroectodermal tumour

  • intra-abdominal desmoplastic small round cell tumour

  • alveolar rhabdomyosarcoma

  • neuroblastoma

  • Merkel cell carcinoma

References

1 Irving JA,Young RH Lung carcinoma metastatic to the ovary: a clinicopathologic study of 32 cases emphasizing their morphologic spectrum and problems in differential diagnosis. Am J Surg Pathol 2005; 29:997-1006

2 Castadot P, Magne N, Berghmans T, et al. [Ovarian metastasis and lung adenocarcinoma: a case report]. Cancer Radiother 2005; 9:183-6

This page last revised 27.11.2008.

©SMUHT/PW Bishop