The mistaken diagnosis of carcinoma of the ovary.

The primary site of carcinoma was investigated in 339 women diagnosed as having carcinoma of the ovary. After a review of medical records and microscopic slides, 43 women were discovered not to have a primary carcinoma of the ovary. Of these 43 women, 15 had benign ovarian tumors, 13 had primary carcinoma of the peritoneum and 15 had primary carcinoma of the intestines. Review of the medical records of 15 women found to have benign ovarian tumors disclosed the original pathologic interpretation of cancer was not supported by clinical or operative observations and no second opinion pathologic review was noted in the records. Until our review, 13 women who were diagnosed as having carcinoma of the ovary had primary peritoneal tumors. Nine of these women either had normal ovaries removed previously or had normal results of biopsies of the ovary done intraoperatively. Of those women entering the study with a diagnosis of carcinoma of the ovary, but in whom our review noted carcinoma of the intestines, 14 of 15 had intestinal complaints before operation. More than one-half of the patients did not have the intestine studied preoperatively, most had diffuse disease at operation and almost one-half of the women had normal sized ovaries at operation. By not performing gastrointestinal roentgenographic studies and suspecting the possibility of metastasis and by misleading the pathologist by presenting the specimen as an ovarian tumor, patients were erroneously diagnosed as having primary carcinoma of the ovary.