E2184. Metastases to the Ovary: A Guide to Understanding the Routes of Disease Spread
  1. Shakib Islam; University of Cincinnati Medical Center
  2. Juliana Tobler; University of Cincinnati Medical Center
  3. Shaun Wahab; University of Cincinnati Medical Center
The prognosis of metastases to the ovaries is significantly worse compared to primary ovarian neoplasms. Metastases can masquerade as primary ovarian neoplastic and nonneoplastic etiologies. Many different primary tumor origins have been described, but the overall rarity of metastases to the ovaries poses a challenge in understanding imaging patterns helpful in the differential diagnosis. The purpose of this exhibit is to offer a framework for readers to categorize routes of spread of metastases to the ovaries and to discuss imaging findings associated with different primary tumors which can aid in differentiating between primary ovarian neoplasms and ovarian metastases.

Educational Goals / Teaching Points
Readers will learn about separate routes of metastatic spread to the ovaries, which vary according to the site of primary malignancy. Routes of hematogenous, lymphatic, peritoneal, and direct metastatic spread will be discussed alongside cases featuring multimodality imaging findings. Certain primary tumors have characteristic imaging findings, which can be useful in differentiating primary ovarian tumors from metastases to the ovaries and in differentiating between various primary tumors to the ovary.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Certain primaries, such as colorectal cancer, have a predilection for hematogenous spread to the ovaries. Gastric cancer commonly spreads via lymphatic routes. Direct route of spread is common for primary tumors near the ovary, including uterus, bladder, and small bowel. Peritoneal spread, despite being the main route of primary ovarian tumor metastases, is reported as one of the least common routes of spread to the ovaries. Some metastases to the ovary will more commonly present bilaterally and have solid components, though these features are not exclusive to metastases.

Both primary ovarian tumors and metastases to the ovaries can appear very similar, creating a diagnostic dilemma for radiologists and increasing the risk for misdiagnosis. Early recognition of metastases to the ovary is important in engaging the appropriate clinical and surgical services, as treatment of metastases differs from the treatment of primary ovarian tumors.