Non-jinekolojik Kaynaklı Over Metastazları: 29 Olguluk Klinikopatolojik ve İmmünofenotipik Bir İnceleme

Öz

Metastatik tümörler over malignitelerinin önemli bir kısmını oluşturmakta olup primer over neoplazmlarını taklit ederek tanısal güçlükler yaratabilmektedir. Bu çalışmada, jinekolojik olmayan primer odaklardan kaynaklanan over metastazlarının klinikopatolojik, morfolojik ve immünohistokimyasal özellikleri değerlendirilerek primer tümörün belirlenmesini kolaylaştıran özelliklerin ortaya konulması amaçlanmıştır. Tek merkezli bir üçüncü basamak merkezde tanı almış 29 metastatik over tümörü retrospektif olarak incelenmiştir. Klinik veriler, tümör lateralitesi, metastaz zamanı, morfolojik paternler ve immünohistokimyasal profiller değerlendirildi. En sık primer tümör kolorektal karsinom (%41,4) olup bunu gastrik (%20,7), pankreatikobilier (%20,7) ve meme karsinomları (%17,2) izlenmiştir. Bilateral over tutulumu ve desmoplastik stroma eşliğinde diffüz infiltratif büyüme paterni sık gözlenen bulgulardır. Kolorektal metastazlarda sıklıkla tubuloglandüler mimari ve nekroz izlenirken, gastrik tümörler taşlı yüzük hücre morfolojisi ile karakterizedir. İmmünohistokimyasal inceleme köken ile ilişkili ekspresyon paternlerini ortaya koymuştur; CK7−/CK20+ paterni kolorektal kökeni desteklerken, CK7+/CK20− paterni meme karsinomunu düşündürmektedir. SATB2, ER/PR ve GATA3 gibi köken-spesifik belirteçlerin kullanımı tanısal özgüllüğü artırmıştır. Morfolojik değerlendirme ile CK7/CK20 immünboyanma paternleri ve köken-spesifik belirteçlerin entegre değerlendirilmesi, metastatik over lezyonlarında primer tümörün belirlenmesi için pratik bir tanısal çerçeve sunmaktadır.

Anahtar Kelimeler

• Metastatik over tümörleri
• Over metastazı
• İmmünohistokimya
• CK7/CK20 immünofenotipi.

Non-gynecologic Ovarian Metastases: A Clinicopathologic and Immunophenotypic Study of 29 Cases

Öz

Metastatic tumors represent a substantial proportion of ovarian malignancies and may mimic primary ovarian neoplasms, posing significant diagnostic challenges. This study aimed to evaluate the clinicopathologic, morphologic, and immunohistochemical features of ovarian metastases from non-gynecologic primary tumors to facilitate identification of the primary tumor site. A retrospective analysis of 29 metastatic ovarian tumors diagnosed at a tertiary center was performed. Clinical data, tumor laterality, timing of metastasis, morphologic patterns, and immunohistochemical profiles were reviewed. Colorectal carcinoma was the most frequent primary tumor (41.4%), followed by gastric (20.7%), pancreaticobiliary (20.7%), and breast carcinomas (17.2%). Bilateral ovarian involvement and diffuse infiltrative growth with desmoplastic stroma were common findings. Colorectal metastases commonly exhibited tubuloglandular architecture with necrosis, whereas gastric tumors were characterized by signet-ring cell morphology. Immunohistochemical analysis revealed lineage-associated profiles: the CK7−/CK20+ pattern supported colorectal origin, whereas CK7+/CK20− favored breast carcinoma. The use of lineage-specific markers, including SATB2, ER/PR, and GATA3, improved diagnostic specificity. Integration of morphologic evaluation with CK7/CK20 immunophenotypic patterns and lineage-specific markers provides a practical framework for identifying the primary tumor in metastatic ovarian lesions.

Anahtar Kelimeler

• Metastatic ovarian tumors
• Ovarian metastasis
• Immunohistochemistry
• CK7/CK20 immunophenotype.

Kaynakça

1. 1. Bruls J, Simons M, Overbeek LI, Bulten J, Massuger LF, Nagtegaal ID. A national population-based study provides insight in the origin of malignancies metastatic to the ovary. Virchows Arch. 2015;467(1):79-86.
2. 2. McCluggage WG, Wilkinson N. Metastatic neoplasms involving the ovary: a review with an emphasis on morphological and immunohistochemical features. Histopathology. 2005;47(3):231-47.
3. 3. Lobo J, Machado B, Vieira R, Bartosch C. The challenge of diagnosing a malignancy metastatic to the ovary: clinicopathological characteristics vary and morphology can be different from that of the corresponding primary tumor. Virchows Arch. 2017;470(1):69-80.
4. 4. Leen SL, Singh N. Pathology of primary and metastatic mucinous ovarian neoplasms. J Clin Pathol. 2012;65(7):591-5.
5. 5. Challa VR, Goud YG, Rangappa P, Deshmane V, Kumar KV, Madhusudhana BA. "Ovarian Metastases from Colorectal Cancer: Our Experience". Indian J Surg Oncol. 2015;6(2):95-8.
6. 6. Mori Y, Nyuya A, Yasui K, Toshima T, Kawai T, Taniguchi F, et al. Clinical outcomes of women with ovarian metastases of colorectal cancer treated with oophorectomy with respect to their somatic mutation profiles. Oncotarget. 2018;9(23):16477-88.
7. 7. Hussein MRA, Alqahtani AS, Ibrahim AF, Bazeed MF, Alqahtani SA, Alasmari AM, et al. Case Report Ovarian metastasis from adenocarcinoma of the rectosigmoid colon. Int J Clin Exp Med. 2023;16(7):155-65.
8. 8. Cerkauskaite D, Zilinskas K, Varnelis P, Oreibi ME, Asejev V, Dulskas A. Ovarian metastases from breast cancer: A report of 24 cases. J Gynecol Obstet Hum Reprod. 2021;50(6):102075.

9. 9. Chuang AY, Watkins JC, Young RH, Lerwill MF. Lobular Carcinoma of the Breast Metastatic to the Ovary: A Clinicopathologic Study of 38 Cases. Am J Surg Pathol. 2022;46(2):179-89.
10. 10. Dundr P, Singh N, Nožičková B, Němejcová K, Bártů M, Stružinská I. Primary mucinous ovarian tumors vs. ovarian metastases from gastrointestinal tract, pancreas and biliary tree: a review of current problematics. Diagn Pathol. 2021;16(1):20.
11. 11. Köle MÇ, Alcı A, Kahraman A, Gökkaya M, Yalçın N, Kandemir S, et al. Clinicopathological characteristics and prognosis in ovarian metastatic tumors from non-gynecologic primary sites. Türk Jinekolojik Onkoloji Dergisi. 2023;23(3):44-51.
12. 12. Leung OJ, Mora KE, Brunetti A, Schwartz LE. Metastatic Malignancies to the Ovaries: Often Hiding in Plain Sight. Archives of Pathology & Laboratory Medicine. 2025.
13. 13. de Waal YR, Thomas CM, Oei AL, Sweep FC, Massuger LF. Secondary ovarian malignancies: frequency, origin, and characteristics. Int J Gynecol Cancer. 2009;19(7):1160-5.
14. 14. Yemelyanova AV, Vang R, Judson K, Wu LS, Ronnett BM. Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification. Am J Surg Pathol. 2008;32(1):128-38.
15. 15. Kubeček O, Laco J, Špaček J, Kubečková A, Petera J, Krulichová IS, et al. Clinicopathological Characteristics and Prognostic Factors in Ovarian Metastases from Right- and Left-Sided Colorectal Cancer. Curr Oncol. 2021;28(4):2914-27.
16. 16. Kiyokawa T, Young RH, Scully RE. Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol. 2006;30(3):277-99.
17. 17. Young RH. From Krukenberg to today: the ever present problems posed by metastatic tumors in the ovary. Part II. Adv Anat Pathol. 2007;14(3):149-77.