title: The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors.
abstract: OBJECTIVE
  Ovarian mucinous metastases commonly present as the first sign of the disease and are capable of simulating primary tumors. Our aim was to investigate the role of intratumoral lymphatic vascular density together with other surgical-pathological features in distinguishing primary from secondary mucinous ovarian tumors.
  
  
  METHODS
  A total of 124 cases of mucinous tumors in the ovary (63 primary and 61 metastatic) were compared according to their clinicopathological features and immunohistochemical profiles. The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.
  
  
  RESULTS
  Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC. The lymphatic vascular density was increased among primary tumors. However, after multivariate analysis, the best predictors of a secondary tumor were a size of 10.0 cm or less, bilaterality and cytokeratin 7 negativity. Lack of MUC2 expression was an important factor excluding metastasis.
  
  
  CONCLUSIONS
  The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment. However, considering the differential diagnosis, the best discriminator of a secondary tumor is the combination of tumor size, laterality and the pattern of expression of cytokeratin 7 and MUC2.
authors.affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Bernardo Gomes de Lacerda
authors.initials: BG
authors.lastname: Almeida
authors.affiliation: Botucatu - Consultoria em Patologia, Laboratório Bacchi, Botucatu, SP, Brazil.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Bacchi
authors.affiliation: Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Jesus P
authors.initials: JP
authors.lastname: Carvalho
authors.affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Cristiane R
authors.initials: CR
authors.lastname: Ferreira
authors.affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Filomena M
authors.initials: FM
authors.lastname: Carvalho
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000737:chemistry / Q000473:pathology* / Q000556:secondary*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D018394:CA-125 Antigen / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000737:chemistry / Q000473:pathology*; D008562:Membrane Glycoproteins / Q000032:analysis; D008565:Membrane Proteins / Q000032:analysis; D008875:Middle Aged; D009077:Mucins / Q000032:analysis; D010051:Ovarian Neoplasms / Q000737:chemistry / Q000473:pathology*; D012016:Reference Values; D046888:Tissue Array Analysis; D047368:Tumor Burden; D055815:Young Adult; D000098853:Podoplanin
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D007633:Keratins; D008562:Membrane Glycoproteins; D008565:Membrane Proteins; D009077:Mucins; C451759:MUC16 protein, human; C117468:PDPN protein, human; D000098853:Podoplanin