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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