Download 65 Krukenberg Tumor Primary Sites

CK
Krukenberg Tumor
Primary Sites
Primary Site
% of Cases
Stomach
76
Appendix / colon / rectum
11
Gallbladder / biliary tract
3
Breast
4
Others
6
Total
978 cases
Kiyokawa T et al, Am J Surg Pathol 2006; 30:277-299.
Differentiating Primary Sites of
Metastatic Signet Ring Cell Carcinomas
Breast
ER+, MUC1+
Stomach
CDX2 (2+, var), HepPar1+,
var MUC2, MUC5AC, MUC6+
Colon
CDX2 (4+, hom), MUC2+
Chu PG et al Am J Clin Pathol 2004;121:884-892)
65
CDX2
Hepar1
MUC5ac
Metastatic Colorectal
Carcinoma
• 2-13% of women develop ovarian
metastases
• Ovarian tumors are most likely metastases,
but:
– 17% of ovarian tumors were primary
carcinomas and 26% were benign tumors
in one study
• Prophylactic oophorectomy does not
improve survival
• Poor prognosis
66
“Garland” pattern
“Dirty” necrosis
“Segmental” necrosis
High nuclear grade for architecture
67
Surface implant
Haphazard infiltrative growth
through desmoplastic stroma
Tumor emboli in hilar lymphatic
spaces
68
Metastatic Colorectal
Carcinoma Can
Resemble:
• Endometrioid Carcinoma
• Mucinous carcinoma
Metastatic Colorectal Carcinoma
vs Endometrioid Carcinoma
CK7
ER
PAX8
CDX-2
CK20
CEA
Mucin
Endometrioid
Metastatic
+
+
+
-
+
+
+
+
Metastatic Colorectal Carcinoma
vs Mucinous Carcinoma
CK7
CK20
CDX-2
Villin
CEA
Mucin
Mucinous
Metastatic
+
+ Patchy
-/+
+
+
+
+
+
+
+
+
69
CK20
CK7
CDX-2
pCEA
Villin
70
Metastatic Carcinomas That Mimic
Ovarian Carcinomas
Endometrioid
Mucinous
Large intestine Large intestine
Clear Cell
Transitional
Cell
Kidney
Urinary tract
Biliary
Pancreas
Large intestine
Stomach
Stomach
Small intestine
Appendix
Biliary
Serous
Breast
Intestine
Small intestine Small intestine
Breast
Appendix
Bladder
Am J Surg Pathol 1998; 22:805-815
71