Ovarian involvement in extragenital cancer

Ovarian involvement from extragenital cancer often presents clinically as probable primary ovarian neoplasm. A retrospective review of the 29 such cases at Parkland Memorial Hospital from 1962 to 1985 was analyzed looking at clinical, surgical, and pathological parameters. The most frequent primary sites were colon (52%), breast (17%), stomach (10%), and pancreas (10%). Most common presenting symptoms were abdominal pain in 48% and increased abdominal girth in 45%. Preoperatively a palpable pelvic mass was detected in 93% and clinical ascites in 41% of patients. At surgery only 20% of patients had isolated ovarian metastases. Abdominal exploration identified the original tumor in 84% of the cases in which the primary originated in the abdomen. Bilateral ovarian involvement was found in 60%, and in 33% of these the contralateral involvement was occult. Eighty-three percent of patients have died with a median survival of 6 months. We conclude that mode of presentation, physical findings, and intraoperative assessment of patients with secondary ovarian neoplasms are no different from primary ovarian malignancy, and that when evaluating a pelvic mass, consideration should always be given to the possibility of secondary ovarian neoplasms.