Papillary ovarian tumors: 1. Benign tumors and serous and mucinous cystadenocarcinomas

Abstract

A clinicopathologic study was made of 923 cases of primary papillary ovarian tumor treated definitively at the Mayo Clinic during a 20 year period ending with 1954. The tumors consisted of: (1) benign papillary ovarian tumor, 270 cases; (2) papillary serous cystadenocarcinoma, 401 cases; (3) papillary mucinous cystadenocarcinoma, 157 cases; (4) endometrial-like (endometrioid) cancer of the ovary, 56 cases; and (5) mesonephroma ovarii, 39 cases. This study covers the findings in the first three categories.A review of the 270 benign papillary ovarian tumors suggests that the cystadenofibromatous type is not a rare tumor. The present study indicates that a spectrum of papillary ovarian tumors exists. Although the complex papillary cystadenofibroma seems to be potentially malignant, it lies slightly on the benign side of a spectrum which has the simple papillary fibroma on one extreme and the highly malignant solid carcinoma on the other. Hysterectomy with bilateral salpingo-oophorectomy seems to be the treatment of choice in older patients; but where ovarian conservation is demanded by the youth of the woman, the remaining ovarian tissue should be searched thoroughly for a similar bilateral tumor.Serous and mucinous cystadenocarcinomas are two of the more common kinds of primary papillary ovarian tumors. They appear to originate from germinal epithelium by metaplasia. The development of these tumors is insidious and produces no characteristic symptoms.The finding of bilateral serous or mucinous lesions at laparotomy is accompanied by a poorer ultimate prognosis, but rupture of the tumor before or during laparotomy has no bad effect on prognosis. The finding of ascites at laparotomy worsened the prognosis only in the serous group. Myxoma peritonei, a rare complication of preoperative rupture of a mucinous malignant cyst, is often a fatal complication, although it is sometimes a long delayed one. Prognosis may be gauged rather accurately from the stage and grade of the ovarian malignancy.All papillary mucinous tumors are malignant, but strict application of histologic criteria is necessary to categorize the papillary serous tumors into benign or malignant groups. The application of these criteria to numerous sections should obviate the “borderline” diagnosis.The treatment for ovarian malignancies is total abdominal hysterectomy and bilateral salpingo-oophorectomy, together with removal of as much tumor tissue as is technically possible and safe for the patient. Postoperative external irradiation is recommended, especially for incompletely removed lesions, since peritoneal metastatic growths do not disappear because of ovarian extirpation alone. The radical treatment can be tempered occasionally in low-grade, early stage serous ovarian tumor, but this is not recommended for any mucinous ovarian lesions.