Normal-sized ovary carcinoma syndrome

A clinical situation occasionally presents in which diffuse metastatic disease of the peritoneal cavity is noted, but the ovaries are of normal size, with or without a fine granularity on their external surface. We term this clinical phenomenon the "normal-sized ovary carcinoma syndrome." In an effort to study this dilemma, the clinical records and pathology slides were reviewed for 11 cases identified from 1976-1987. Four diagnostic groups were identified: mesothelioma (four patients), "extragonadal müllerian" tumors (two patients), metastatic tumors of unknown origin (four patients), and ovarian carcinoma (one patient). The survival for each of the first three groups is usually less than 1 year. Improved survival for mesotheliomas may be achieved with a combination of radiotherapy, an adriamycin-based chemotherapy regimen, and debulking surgery. A successful treatment strategy for serous surface papillary carcinoma has not been identified. Patients with metastatic tumors of unknown origin should either be treated with 5-fluorouracil or should not be treated at all. In order to discern the site of origin, satisfactory perioperative radiologic assessment, fastidious surgical exploration, and adequate communication between the surgeon and the pathologist are necessary.