Endocervical Adenocarcinoma In Situ Phenotype with Ovarian Metastasis

[...]several studies have reported a subset of endocervical tumors with minimal to no evidence of stromal invasion manifesting as metastatic ovarian tumors.2,3 Distinguishing this metastatic disease from a primary ovarian tumor is difficult because ovarian lesions are typically large, unilateral, confined to the ovary, and well differentiated with mucinous or endometrioid-like histology, which are features consistent with a primary ovarian tumor.2 The metastatic nature of these lesions can be confirmed by comparing the human papillomavirus (HPV) type to that of the endocervical tumors.4 In this report, we demonstrate a case of endocervical AIS with no evidence of stromal invasion involving the unilateral ovary and simulating a primary ovarian tumor. The majority of cases with ovarian involvement occur in advanced-stage endoJournal Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1794, Fax: +82-2-362-0860, E-mail: hyunsookim@yuhs.ac Received: September 14, 2018 Revised: December 6, 2018 Accepted: December 16, 2018 cervical adenocarcinoma or in a primary lesion with extrauterine extension.6 However, there have been cases of early-stage disease, and even cases of noninvasive carcinoma, that involved the ovary.1,2,5,7 Most ovarian lesions show well-differentiated villoglandular and confluent glandular patterns, resembling those of primary ovarian borderline mucinous or endometrioid tumor.2 In a previous study, all cases examined were initially thought to represent independent primary ovarian epithelial tumors, including borderline tumors or grade 1 carcinomas of mucinous or endometrioid type.8 In cases with no stromal invasion in an endocervical adenocarcinoma, a borderline-appearing ovarian tumor could reasonably be interpreted as an independent primary ovarian tumor by the pathologist.7 In this situation, the presence of the identical HPV type in both the endocervical and ovarian tumors supports that the ovarian lesion is a metastatic endocervical adenocarcinoma rather than an independent primary ovarian tumor. Studies associating HPV and ovarian tumors have yielded almost universally negative results, suggesting that primary ovarian tumors are etiologically unrelated to HPV infection.7 In addition, p16 immunostaining may prove useful for distinguishing metastases from primary ovarian tumors. p16 immunoreactivity is a surrogate marker of high-risk HPV infectio