Australian Society of CytologyCase of the Month
November 2002 - Answer and Discussion
Gastric Adenocarcinoma
The features are of an adenocarcinoma which was
- PAS/D positive
- CEA and CK7 positive
- CK20 negative
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) |
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| CEA positive | CK7 positive | CK20 negative |
The staining profiles for gastric vs serous ovarian adenocarcinoma
| Gastric Adenocarcinoma |
Serous Ovarian Adenocarcinoma |
|
| CK7+/CK20+ | 38% | 12% |
| CK7+/CK20- | 17% | 80% |
| CK7-/CK20+ | 35% | 0% |
| CK7-/CK20- | 10% | 8% |
| CEA+ | 80% | 10% |
There is some overlap without absolute distinction although 80% of gastric adenocarcinomas are CEA positive and only 10% of serous ovarian adenocarcinomas are CEA positive.
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| A subsequent gastric biopsy showed poorly differentiated adenocarcinoma. |
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| A later Pap smear also contained tumour cells. |
DISCUSSION
Metastases in Pap Smears- Rarely primary presentation
- Usually known history of malignancy
- Most have history of ascites
- Most are adenocarcinomas
- ~80% lack tumour diathesis - may be present if there is local invasion
- Looks "foreign"
Sites of origin: Ovary,GI tract, pancreas, breast, urinary tract, lung. Others include mesothelioma and melanoma.
