Abstract
BackgroundPrimary ovarian mucinous tumors with mural nodules are very rare. The histogenesis of the mural nodules remains unclear.MethodsWe investigated the clincopathological and molecular features in 3 cases with mural nodules.ResultsPatient 1 was diagnosed as mucinous carcinoma with mural nodules of anaplastic carcinoma that was composed of CK+ and CK7+ spindled cells and polygonal cells with marked pleomorphism. Aberrant p53 staining was found in the mural nodules rather than in the mucinous components. A concordant KRAS mutation (c.35G > A p.G12A) was identified in both mucinous tumors and mural nodules. She died of disease at 44 months. The mural nodule in patient 2 was interpreted as a sarcoma, no other specified. The uniform short spindle cells were separated by abundant myxoid matrix. They were CD10 + , CCND1-, SMA-, and negative for break-apart BCOR, PHF1, and JAZF1 FISH assay. The adenocarcinomatous component harbored LOH at D18S51 and FGA loci while the sarcomatous component had LOH at D19S433. She had lung metastasis at 18 months and was alive without evidence of disease for 40 months. Patient 3 harbored multiple mural nodules that were composed of vimentin+, focal CK+, atypical spindle cells. A diagnosis of sarcoma-like mural nodules was rendered. She was alive with no evidence of disease for 13 months. No hotspot mutant AKT1, KRAS, HRAS, and PI3KCA alleles were found in patients 2 and 3.ConclusionsMural nodules with anaplastic carcinoma or with true sarcomas may represent the dedifferentiation form of mucinous tumors or collision tumors, respectively. The worrisome histology in sarcoma-like mural nodules necessitates meticulous treatment for these patients.
Highlights
Mural nodules can occur in ovarian mucinous tumors, usually in borderline tumors and adenocarcinomas, but they are very uncommon [1]
Mucinous tumors with malignant mural nodules tend to occur in older patients, and to have a poor clinical outcome; they are best regarded as the variants of carcinomas or carcinosarcomas [2]
sarcoma-like mural nodules (SLMN) is the major form in the benign group whereas the most commonly reported nodules are composed of anaplastic carcinoma [3, 4, 13, 14]
Summary
Mural nodules can occur in ovarian mucinous tumors, usually in borderline tumors and adenocarcinomas, but they are very uncommon [1]. Mucinous tumors with malignant mural nodules (anaplastic carcinomas and sarcomas) tend to occur in older patients, and to have a poor clinical outcome; they are best regarded as the variants of carcinomas or carcinosarcomas [2]. Patients with benign (mainly sarcoma-like) nodules tend to be younger and are believed to be benign, but should be treated with caution because of their worrisome morphology and very limited follow-up data to date [1, 3, 4]. The histogenesis of the mural nodules in ovarian mucinous tumors remains unclear. The histogenesis of the mural nodules remains unclear
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