The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors.

Abstract

OBJECTIVE:

Ovarian mucinous metastases commonly present as the first sign of the disease and are capable of simulating primary tumors. Our aim was to investigate the role of intratumoral lymphatic vascular density together with other surgical-pathological features in distinguishing primary from secondary mucinous ovarian tumors.

METHODS:

A total of 124 cases of mucinous tumors in the ovary (63 primary and 61 metastatic) were compared according to their clinicopathological features and immunohistochemical profiles. The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.

RESULTS:

Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC. The lymphatic vascular density was increased among primary tumors. However, after multivariate analysis, the best predictors of a secondary tumor were a size of 10.0 cm or less, bilaterality and cytokeratin 7 negativity. Lack of MUC2 expression was an important factor excluding metastasis.

CONCLUSIONS:

The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment. However, considering the differential diagnosis, the best discriminator of a secondary tumor is the combination of tumor size, laterality and the pattern of expression of cytokeratin 7 and MUC2.

• Authors: Bernardo Gomes de Lacerda Almeida, Carlos E Bacchi, Jesus P Carvalho, Cristiane R Ferreira, Filomena M Carvalho
• Journal: Clinics (Sao Paulo, Brazil) (Clinics (Sao Paulo)) Vol. 69 Issue 10 Pg. 660-5 (Dec 2014) ISSN: 1980-5322 [Electronic] United States
• PMID: 25518016 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers, Tumor
• CA-125 Antigen
• MUC16 protein, human
• Membrane Glycoproteins
• Membrane Proteins
• Mucins
• PDPN protein, human
• Keratins

Topics

• Adenocarcinoma, Mucinous (chemistry, pathology, secondary)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Biomarkers, Tumor (analysis)
• CA-125 Antigen (analysis)
• Diagnosis, Differential
• Female
• Humans
• Immunohistochemistry
• Keratins (analysis)
• Lymphatic Metastasis
• Lymphatic Vessels (chemistry, pathology)
• Membrane Glycoproteins (analysis)
• Membrane Proteins (analysis)
• Middle Aged
• Mucins (analysis)
• Ovarian Neoplasms (chemistry, pathology)
• Reference Values
• Tissue Array Analysis
• Tumor Burden
• Young Adult