A Rare Presentation of Multiple Primary Cancers with Extensive Abdominopelvic Cross-Metastasis and Tumor-to-Tumor Metastasis: High-Grade Serous Carcinoma of the Ovary and Well-Differentiated Mucinous Adenocarcinoma of the Appendix.
Xin Zhang, Xin Ma, Jinyu Zheng et al.
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Case in brief
A 73-year-old woman presented with abdominal distension and complex abdominopelvic masses. Ascitic fluid contained two morphologically distinct malignant cell populations. After cytoreductive surgery, histology and immunohistochemistry supported synchronous high-grade serous ovarian carcinoma and well-differentiated appendiceal mucinous adenocarcinoma; targeted sequencing showed distinct mutation profiles in the two tumors. Examination also identified extensive cross-metastasis and tumor-to-tumor metastasis involving the primary sites and metastatic deposits.
What made this case unusual
The two primary cancers showed extensive cross-metastasis, including tumor-to-tumor metastasis, complicating attribution of the abdominopelvic disease to either tumor alone.
Diagnostic / clinical pearl
When cytology or imaging suggests more than one tumor origin, integrate morphology, immunohistochemistry, and molecular profiling to distinguish synchronous primaries and their metastases.