Imaging in gynecological disease (1): ultrasound features of metastases in the ovaries differ depending on the origin of the primary tumor

Objectives: To describe the gray-scale and color Doppler ultrasound findings of metastatic tumors in the ovary according to the origin of the primary tumor. Methods: Information was retrieved retrospectively from 67 patients who had undergone preoperative transvaginal ultrasound examination and who were found subsequently to have metastatic tumors in their ovaries. In all women the ultrasound information had been collected prospectively using a standardized examination technique and predefined definitions of ultrasound characteristics. Information on presenting symptoms and on whether the patient had been treated for a malignancy in the past was retrieved retrospectively from patient records. Results: Most (95%) ovarian metastases were solid, multilocular solid or multilocular. Almost all (38/41, 93%) metastases that derived from the stomach, breast, lymphoma or uterus were solid, while most (31/37, 84%) metastases deriving from the colon, rectum, appendix or biliary tract were multilocular or multilocular solid (P < 0.0001). Metastases that derived from the colon, rectum, appendix or biliary tract were larger than those from the stomach, breast, lymphoma or uterus (median maximum diameter, 122 (range, 16 200) mm vs. 71 (range, 27 170) mm, P = 0.02). In addition, irregular external borders were more common (19/22 (86%) vs. 19/41 (46%), P = 0.002), as were papillary projections (6/22 (27%) vs. 2/41 (5%), P = 0.011). They also appeared to be less vascularized, with 64% (14/22) manifesting moderate-to-abundant vascularization at color Doppler examination in comparison to 88% (36/41) of the ovarian metastases from stomach, breast, lymphoma or uterus (P = 0.024). Conclusions: Ovarian metastases derived from tumors in the stomach, breast, lymphoma or uterus are solid in almost all cases, whereas those derived from the colon, rectum or biliary tract manifest more heterogeneous morphological patterns, most being multicystic with irregular borders.