METASTATIC INTESTINAL CARCINOMAS SIMULATING PRIMARY OVARIAN CLEAR-CELL CARCINOMA AND SECRETORY ENDOMETRIOID CARCINOMA - A CLINICOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF 5 CASES

Five cases of ovarian metastases of intestinal adenocarcinomas that su ggested the diagnosis of clear cell adenocarcinoma or the secretory va riant of endometrioid carcinoma of the ovary are reported. Patient age ranged from 27 to 71 years at the time of diagnosis of the ovarian ne oplasms. In four, the ovarian and intestinal tumors were discovered sy nchronously, and, in the fifth, the ovarian metastasis occurred 1 year after the intestinal primary was diagnosed. The ovarian tumors were u nilateral in three patients and bilateral in two. They were up to 18 c m (mean, 12 cm) in maximum dimension and were characterized on microsc opic evaluation by glands and cysts lined by cells whose most striking feature was abundant clear cytoplasm. In two cases, striking subnucle ar or supranuclear vacuoles were present. An important clue to the dia gnosis of metastatic intestinal adenocarcinoma was the presence in all cases of ''dirty necrosis.'' The metastatic nature of the ovarian tum ors was supported by the immunohistochemical findings. All tumors stai ned were strongly positive for carcinoembryonic antigen and cytokerati n 20 and failed to stain for CA125, whereas staining for HAM56 and cyt okeratin 7 was absent or only focally positive in one case each. Three intestinal primary tumors involved the small bowel. Microscopic evalu ation of the intestinal tumors in three cases and metastases in a four th, in which the intestinal primary was not resected, showed the featu res of the uncommon clear cell variant of intestinal adenocarcinoma; t he fifth was predominantly a conventional intestinal adenocarcinoma wi th only a focal clear cell component. Although intestinal adenocarcino mas metastatic in the ovary typically simulate endometrioid adenocarci noma of the usual type or mucinous adenocarcinoma, they may mimic eith er primary clear cell adenocarcinoma or the secretory variant of endom etrioid adenocarcinoma, particularly when the primary tumor is, even f ocally, the clear cell variant of intestinal adenocarcinoma.