Pancreatic ductal adenocarcinoma (intestinal-type differentiation) presenting as ovarian metastases: A case report

Abstract

Introduction: Metastasis of pancreatic adenocarcinoma to the ovaries is uncommon and can clinically present similarly to primary ovarian disease, presenting challenges for diagnosis. Immunohistochemical staining is typically useful in distinguishing ovarian primaries from ovarian metastasis. A newer and rarer variant of pancreatic adenocarcinoma, that with intestinal-type differentiation, has not previously been reported as metastasizing to the ovary. Its diagnosis is particularly difficult due to the overlap in staining patterns with primary ovarian neoplasms. Case Report: This case report presents the case of a 60-year-old female who presented with non-specific abdominal symptoms and was found to have a large adnexal mass. Imaging showed additional lesions in the peritoneum, pancreas, and liver. She underwent biopsy with morphology and immunohistochemical staining consistent with pancreatic ductal adenocarcinoma with intestinal-type differentiation. She was started on FOLFIRINOX therapy but ultimately opted to pursue comfort care due to disease progression. Conclusion: Although rare, with this being the first report of this disease course to our knowledge, clinicians should be aware of this possibility, as it impacts choice of treatment.