Renal Cell Carcinoma Metastatic to the Ovary

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Abstract
Summary The clinical and pathological features of three personally observed and six previously reported cases of renal cell carcinoma metastatic to the ovary are reviewed. The patients' ages ranged from 39 to 64 (average, 52) years. In five patients the ovarian tumor was discovered first. In four of these patients renal tumors were detected during the initial clinical studies or in the early postoperative period, but in the fifth the renal primary tumor was not detected until 8 years later. The ovarian tumor in two cases was initially misdiagnosed as a primary ovarian clear cell carcinoma. In the remaining four patients the ovarian metastasis was detected 5 months, 12 months, 19 months, and 11 years after a renal tumor had been removed. In two patients the initial clinical manifestations were due to a metastasis of the renal tumor, to the thyroid gland in one and to the vagina in the other. The renal tumors in these nine patients typically were well-differentiated renal cell adenocarcinomas of clear cell type. The ovarian tumors measured from 7 to 18 (average, 12.5) cm in greatest dimension; two of them were bilateral. Grossly they were usually solid or solid and cystic; one was a unilocular cyst with a predominantly smooth lining and a 2.5-cm solid nodule in one area. The solid component of the tumors was typically either uniformly yellow or had focal yellow areas with hemorrhagic foci. Microscopic examination showed a relatively uniform picture in most cases: solid or alveolar nests of epithelial cells with abundant clear cytoplasm or tubules lined by clear cells and containing intraluminal eosinophilic material and extravasated blood. A prominent sinusoidal vascular pattern was characteristically present. Special stains for mucin were negative. The major features of metastatic renal cell carcinoma that distinguish it from primary ovarian clear cell adenocarcinoma are the presence of a striking sinusoidal vascular pattern, a homogeneous clear cell pattern with an absence of hobnail cells, the absence of hyaline basement membrane-like material, negative intraluminal mucin, and a lack of the mixtures of solid, papillary, and tubulocystic or glandular histologic patterns usually found in primary ovarian clear cell adenocarcinoma.

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