Ovarian metastases from carcinoma of the gallbladder and extrahepatic bile ducts simulating primary tumors of the ovary. A report of six cases

Abstract

Six cases in which ovarian metastases from carcinoma of the gallbladder or bile ducts were discovered during the life of the patient are described. The patients ranged from 33 to 72 (average, 57) years of age. In one case, the ovarian tumor was discovered 5 weeks before a gallbladder carcinoma was detected: in three cases, gallbladder tumors and ovarian metastases were discovered simultaneously; and in two cases, ovarian metastases were recognized 1 and 2 years after the biliary tumors. The ovarian tumors were bilateral in five cases. One of them was a 13-cm multiloculated, cystic neoplasm that simulated a primary mucinous tumor of the ovary. The remaining neoplasms were uniformly or predominantly solid and ranged up to 6.5 cm in diameter. They typically had lobulated external surfaces and were often multinodular on sectioning. Three ovarian tumors posed significant problems in differential diagnosis on microscopic examination. One of them closely simulated an endometrioid carcinoma, another simulated a mucinous cystadeno-carcinoma, and a third suggested the possible diagnosis of a Sertoli-Leydig cell tumor. Features helpful in establishing the metastatic nature of the ovarian tumors in these and the other cases included bilaterality, surface implants, multinodularity, and extraovarian spread. The gallbladder and bile ducts are rare sources of metastatic tumors, which may simulate primary ovarian neoplasms.