Metastatic tumors of the ovary constitute about 5 percent of all ovarian tumors. The common primary sites from where metastases to the ovaries occur are gastrointestinal tract (pylorus, colon and rarely small intestine), gallbladder, pancreas, breast and endometrial carcinoma.
The mode of spread from the primary growth is through retrograde lymphatics or by implantation from metastases within the peritoneal cavity. The malignant cells from the stomach reach the superior gastric group of lymph glands which also receive the lymphatics of the ovaries. Hematogenous spread is also there.
These are usually bilateral, solid with irregular surfaces. Peritoneal metastases are present, so also ascites. The omentum is involved and becomes solid.
Typical: Histologic picture same as that of primary one.
Atypical: The atypical one is Krukenberg tumor in which the histological picture differs from that of the primary one.
Metastatic tumors from the GI tract can be associated with sex hormone (estrogen and androgen) production.
Patient may present with postmenopausal bleeding.
naked eye appearance: The tumor is usually bilateral, solid with smooth surfaces and usually maintaining the shape of the ovary. They typically form rounded or reniform, firm white masses. Sometimes they are bosselated and may attain a big size. There is no tendency of adhesion (i.e. capsule remains intact).
The cut surfaces usually look yellow or white in color with cystic space at places due to degeneration.
Cut surface has waxy consistency.
Histologically, the stroma is highly cellular. The mucin within epithelial cells compresses the nuclei to one pole, producing ‘signet ring’ appearance. The scattered ‘signet ring’ looking cells are characteristic of Krukenberg tumor.
In most patients with Krukenberg’s tumors, the prognosis is poor. Median survival being less than a year. Rarely, no primary site can be identified and the Krukenberg’s tumor may be a primary tumor.
There are many Homoeopathic remedies which can be used such as:-