To investigate the metastatic pathways from the primary organs to the ovaries, we examined the microscopic findings from 18 original and 18 metastatic ovarian tumors carefully. In addition, we examined the immunohistochemical findings (Victoria blue stain for vascular invasion and D2-40 expression for lymphangio invasion) of metastatic ovarian tumors carefully. There were 4 (57%) ovarian lymphangio invasion cases in the 7 gastric cancers, but there were no cases in the 6 colorectal cancers (P < 0.05). There were 4 (67%) ovarian vascular invasion cases and one (17%) liver metastasis case in the 6 colorectal cancers, while there were no ovarian vascular invasions (P < 0.05) or no liver metastases in the 7 gastric cancers. The patients with metastatic ovarian tumors originating from distant organs who were treated at the same time as the original cancers had a significantly poorer prognosis than the patients with ovarian tumors treated later (P < 0.05). The rate of lymphatic metastasis from the stomach to the ovary was significantly higher than from the colon to the ovary. In addition we hypothesized that the rate of intravascular metastasis from the colorectum to the ovary was relatively higher than from the stomach to the ovary. 1. Introduction Tumors metastasize to the ovaries from many organs, including the stomach, small intestine, colon, rectum, gall bladder, appendix, pancreas, breast, uterus, fallopian tube, and peritoneum. Tumors from the stomach, colon, and breast are the 3 most common neoplasms that metastasize to the ovary. Novak and Gray advanced the following criteria for Krukenberg tumors: (1) cancer in the ovary, (2) the presence of mucin-producing neoplastic signet-ring cells, and (3) ovarian stromal sarcomatoid proliferation？？[1]. Krukenberg tumors are defined as gastrointestinal cancers that metastasize to the ovary. Recently, the term Krukenberg tumor has been used more widely and loosely to describe any metastatic lesion to the ovary. Metastatic tumors, except for Krukenberg tumors, show the various pathologic findings in the ovary？？[2–4]. Recently, specific immunohistochemical methods have been tried in order to identify the primary neoplasm site [5, 6]. Many tumors arising from primary organs spread to the ovaries by various routes. Direct spread is one of the pathways for cancer invasion into adjacent organs. Spread from more distant sites is mainly via other routes, for example, blood vessels, lymphatics, and surface implantation from intra-abdominal cancers. There are many different pathways from distant origins, and sometimes
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