When confronted by a woman with simultaneous tumors in the endometrium and ovary the pathologist can distinguish between different possible primary and metastatic tumor combinations based on the pathologic features.
|
Feature |
Endometrial Primary, Ovarian Secondary |
Ovarian Primary, Endometrial Secondary |
Endometrial and Ovarian Primaries |
|
histologic similarities |
similar |
similar |
dissimilar |
|
size |
endometrium large, ovary small |
ovary large, endometrial small |
variable |
|
atypical endometrial hyperplasia |
present |
none |
present |
|
myometrial invasion |
deep with direct extension into adnexa |
direct extension into outer uterus |
variable |
|
vascular invasion in myometrial vessels |
present |
none |
none or present |
|
spread typical for endometrial cancer |
none or typical |
none |
none or typical |
|
ovarian tumors |
bilateral or multinodular |
usually unilateral |
usually unilateral |
|
ovarian extent |
hilar, vascular space, surface implants |
located in parenchyma |
located in parenchyma, not surface, not vascular, not hilar |
|
ovarian endometriosis |
absent |
present |
present |
|
spread typical for ovarian tumor |
none |
none or typical |
none or typical |
|
DNA analysis |
similar |
similar |
different |
|
molecular and karyotypic features |
similar |
similar |
different |
where:
• DNA analysis involves aneuploidy vs diploidy. The possibility of tumor heterogeneity should be taken into account when evaluating the ploidy findings.
Implementation notes:
• I scored each feature 1 in favor of, 0 neutral and -1 for against the diagnosis. Points for each diagnosis are summated and the one with the highest score should be the favored diagnosis.
• An alternative approach would be that used in genetics, with the probability of each finding given and then the product of the probabilities reported.
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
