Ovarian mucinous cystic tumor of borderline malignancy with a mural nodule of anaplastic spindle cell carcinoma: a case report

Hitoshi Yamazaki,Noriyuki Kyushima,Akiyo Matsuzawa,Hiroyoshi Iguchi,Takashi Shoda

doi:10.1186/1757-2215-6-86

Abstract

Ovarian cystic tumors with a mural nodule are a rare entity. We report a case of a mural nodule of anaplastic spindle cell carcinoma in an ovarian mucinous cystic tumor of borderline malignancy. The patient was a 45-years-old Japanese woman who presented with an ovarian cyst. She suffered from mature cystic teratoma of both ovaries 9 years before the present history. Image analysis and laboratory data showing a high serum CA19-9 level suggested ovarian malignancy. She underwent bilateral salpingo-oophorectomy with hysterectomy and omentectomy. There was a mural nodule in the ovarian mucinous cystic lesion. Microscopically, the nodule was composed of spindle-shaped cells with severe nuclear atypia. Immunohistochemical analysis allowed the cells to be categorized as anaplastic spindle cell carcinoma. Fifteen months after the operation the patient is alive without any clinical findings of tumor recurrence. To the best of our knowledge in the English literature, this is the first report of a mural nodule of an anaplastic spindle cell carcinoma within an ovarian mucinous cystic borderline tumor harboring previously confirmed cystic teratoma.

Highlights

A mural nodule in an ovarian neoplasm is a rare entity with an incidence between 2 to 5 per million
Case presentation We present a rare case of ovarian mucinous cystic tumor of borderline malignancy with mural nodules of an anaplastic spindle cell carcinoma
Because recent immunohistochemical analysis could elucidate that the tumor cells of the mural nodule possess epithelial and/or non-epithelial characteristics, the name sarcoma-like mural nodule (SLMN) alone may be insufficient after detailed histological evaluation

Summary

Background

A mural nodule in an ovarian neoplasm is a rare entity with an incidence between 2 to 5 per million. Mural nodules of benign neoplasms in serous cystic tumors are extremely rare [5,6]. Case presentation We present a rare case of ovarian mucinous cystic tumor of borderline malignancy with mural nodules of an anaplastic spindle cell carcinoma. The inner surface of the cyst was mostly smooth with areas of irregular thickening of the cyst wall, which protruded into the cystic cavity (Figure 2). No aggressively deep invasion of the cells was observed in the cyst wall These features were categorized as a mucinous cystic tumor of borderline malignancy. The mucin-secreting lining cells of the inner surface showed positive stainability for CA19-9 and some epithelial markers such as keratin AE1&3 and keratin CAM5.2 (Figure 4). Mucinous cystic tumor of borderline malignancy with a mural nodule of anaplastic spindle cell carcinoma. Fifteen months after the operation, the patient is alive without any clinical findings of tumor recurrence

Discussion

Conclusions