Cases Of Mucinous Cystadenocarcinoma Research Articles

Comparative Study of Ultrasound and Magnetic Resonance Imaging of Adnexal Masses

Background: Current study aimed to assess the role of ultrasound and MRI in the evaluation of adnexal mass lesions and comparison with clinical outcomes. Subjects & Methods: A total of 30 suspected adnexal mass detected on ultrasonography was performed MRI, and accuracy of both USG and MRI were compared with histopathology. Results: Abdominal pain was predominantly confined to the lower abdomen in13 of 30 cases (43.3%). On USG total number of benign lesions was 19, and the total number of malignancies was 11. However, on MRI, 21 cases were mild, and 9 cases were malignant. six cases were diagnosed as malignant in ultrasound. In these six cases, two cases were serous cystadenocarcinoma, two were mucinous cystadenocarcinoma, one was serious papillary cystadenocarcinoma of the fallopian tube, and one was a malignant tubo-ovarian mass. MRI accurately diagnosed 4 indeterminate cases that correlated with the histopathology report. 9 malignant lesions were diagnosed as malignant by MRI were 3 cases of serous cystadenocarcinoma, 2 cases of mucinous cystadenocarcinoma, 1 case of malignant tubo-ovarian mass, 1 case of endometrioid carcinoma, 1 case of serous papillary cystadenocarcinoma of the fallopian tube and 2 cases of malignant sex cord-stromal neoplasms. Both the cases of serous cystadenomas were correctly diagnosed as benign lesions on both ultrasound and MRI. There were 2 cases of mucinous cystadenocarcinoma, which were accurately diagnosed as malignant on both USG and MRI due to the presence of solid components, mural thickening. The sensitivity, specificity, and accuracy of USG were 36.6%, 94% and 55% respectively. The sensitivity, specificity, and accuracy of MRI were 81.80%, 94.7%, and 65.7%, respectively. Conclusion: The best agreement was observed between MR findings and diagnosis in origin, tissue content, and tissue characteristics. Sonography had a weak correlation in context to the definitive diagnosis for the origin and tissue content of a mass.

Imaging modalities in the differentiation of various adnexal lesions

Aim The purpose of this study was to discuss the role of different imaging modalities in the diagnosis and evaluation of adnexal masses. Patients and methods A total of 50 female patients with 60 adnexal lesions were included in his study. After clinical evaluation, ultrasound examination was carried out for all cases. After observing all gray scale features, color Doppler was superimposed on the gray images to assess the site of blood flow and measure the Doppler indexes. Computed tomography was performed in seven suspicious cases, and MRI was performed in eight suspicious cases. The results were correlated with operative and histopathological findings. Results Nine malignant cases had Alcazar score greater than 6, whereas the benign cases (41 cases) had a score less than 6. There were two cases (4%) of hydrosalpinx, five cases (10%) of ectopic pregnancy, three cases (6%) of tuboovarian abscess, four cases (8%) of polycystic ovaries, and four cases of solid masses (8%) (one case of ovarian fibroma, one case of subserous uterine fibroid, one case of broad ligament fibroid, and one case of Krukenberg tumor). There were 24 cases of cystic masses (48%) either unilocular or multilocular within thin septae (seven cases of follicular ovarian cysts, eight cases of hemorrhagic cysts, one case of corpus luteal cyst, two cases of endometrioma, three cases of dermoid cysts, two cases of serous cystadenoma, and one case of paraovarian cyst). There were eight complex masses (16%) (one case of granulosa cell tumor, one case of dysgerminoma, one case of papillary carcinoma, one case of metastasis, two cases of serous cystadenocarcinoma, and two cases of mucinous cystadenocarcinoma). Conclusion Using ultrasound and color Doppler studies with scoring system was found to be useful in differentiating a benign from a malignant adnexal mass. Computed tomography scan has shown to be beneficial in assessing the disease extent and planning for treatment. MRI was beneficial in characterizing adnexal masses in problematic cases.

Expression and Mutational Analysis of c-kit in Ovarian Surface Epithelial Tumors

Coexpression of Kit ligand and c-kit has been reported in some gynecologic tumors. To determine whether imatinib mesylate is useful in ovarian epithelial tumors, we performed immunohistochemical and mutational analysis. The cases consisted of 33 cases, which included 13 serous cystadenocarcinomas, 1 borderline serous tumor, 8 mucinous cystadenocarcinomas, 6 borderline mucinous tumors and 5 clear cell carcinomas. Five cases of serous cystadenoma and 5 cases of mucinous cystadenoma were also included. In the immunohistochemical study, 3 cases (3/6, 50%) of borderline mucinous cystic tumor and two cases (2/8, 25%) of mucinous cystadenocarcinoma show positive staining for KIT protein. Only one case (1/13, 7.7%) of serous cystadenocarcinoma had positive staining. On mutational analysis, no mutation was identified at exon 11. However, two cases of borderline mucinous tumors and one case of mucinous cystadenocarcinoma had mutations at exon 17. In these cases, the immunohistochemistry also shows focal positive staining at epithelial component. Although, KIT protein expression showed higher incidence in mucinous tumors than serous tumors, they lack KIT-activating mutations in exon 11. Thus, ovarian surface epithelial tumors are unlikely to respond to imatinib mesylate.

Resectional Therapy for Cystic Neoplasms of the Pancreas

Currently there is uncertainty in diagnosis between the serous (benign) and mucinous (premalignant) forms of cystic neoplasms of the pancreas without operation. Our objective is to evaluate resectional therapy as a treatment for these lesions. A retrospective review of cases from 1985 to 1999 were performed. There were 14 cases of serous cystadenoma (SCA), 11 cases of mucinous cystadenoma (MCA), and five cases of mucinous cystadenocarcinoma (MCAC). A female predominance was seen in all lesions (100% in SCA, 64% in MCA, and 80% in MCAC) with a mean age at presentation of 59 years. Most patients presented with pain (SCA = 64%, MCA = 55%, and MCAC = 80%). Weight loss was seen in 35 per cent of all patients and was present in all cases of MCAC. Importantly 36 per cent of MCA patients were asymptomatic. Lesions were identified as multicystic on CT reports of 62 per cent of SCA patients, 50 per cent of MCA patients and 75 per cent of MCAC patients. Size was similar between groups. All patients were treated with surgical resection; operative morbidity was 27 per cent and mortality was zero. Actuarial 5-year survival for SCA, MCA, and MCAC was 100, 100, and 33 per cent, respectively. Differentiating serous from mucinous is not possible based on presenting symptoms and radiologic findings. Surgical resection is justified on the basis of low morbidity and negligible mortality rates.

Keratins 7 and 20 as diagnostic markers of carcinomas metastatic to the ovary

The most common carcinomas metastatic to the ovary that mimic ovarian primaries are colonic adenocarcinomas and endometrial carcinomas. Conventional histochemical staining procedures, even in combination with additional immunohistochemical assays, are of limited value in distinguishing between these metastases and primary ovarian carcinomas. In this study we investigated whether the application of monoclonal antibodies against keratins 7, 8, and 20 could help in differentiating between these categories. The reactivity patterns of 40 carcinomas metastatic to the ovary were compared with those of their primary carcinomas on the one hand and with various primary ovarian carcinomas and mesotheliomas on the other. Colon cancer metastatic to the ovary was keratin 7 negative and keratin 20 positive in 94% of the cases; in contrast, all primary ovarian carcinomas were keratin 7 positive and keratin 20 negative, with the exception of two cases of mucinous cystadenocarcinoma. Ovarian metastases of gastric cancer usually contained keratins 7 and 20. Metastases of endometrial cancer to the ovary and primary ovarian carcinomas usually showed similar keratin expression. We propose that keratin 7 and 20 antibodies may be of help to distinguish between primary ovarian carcinomas and carcinoma metastases in the ovary.

Monoclonal antibody, Mab 12C3, is a sensitive immunohistochemical marker of early malignant change in epithelial ovarian tumors.

A murine monoclonal antibody (MAb 12C3) that is specific to human ovarian carcinomas was generated by immunizing mice with a human ovarian germinoma cell line (JOHYC-2). The antigen distribution that was defined by MAb 12C3 in normal and malignant human tissues was analyzed by immunohistochemistry on paraffin-embedded and frozen sections. The antibody reacted with 67.7% (21 of 31 cases) of epithelial ovarian carcinomas (6 of 12 cases of serous cystadenocarcinoma, 5 of 7 cases of mucinous cystadenocarcinoma, 7 of 9 cases of clear cell carcinoma, 3 of 3 cases of endometrioid adenocarcinoma), but did not react with any of the benign epithelial ovarian adenomas tested. Partial regions of borderline ovarian malignancies that exhibited marked papillary projection of the lining cells with cellular atypia reacted positively with MAb 12C3 in 14 of 25 cases (56.0%). The histologic features of regional early malignant change corresponded to the expression of the MAb 12C3 epitope in the borderline malignant tumor cells. There was a low frequency of reaction (4.3%) between the antibody and other gynecologic and nongynecologic malignancies (46 cases of 12 tissues). In normal tissues, the antibody reacted positively with only three tissues, including corpora lutein cells, excretory ducts in the submandibular gland, and basal cells of the sebaceous glands. The antigen epitope defined by MAb 12C3 was present on a glycoprotein with a molecular mass of 200 kDa and did not exhibit any cross-reactivity with other well-known tumor markers. These data suggest that MAb 12C3 may be a useful tool for the immunohistologic detection of early malignant changes in epithelial ovarian tumors. In addition, MAb 12C3 also may facilitate a differential diagnosis between benign and borderline malignancies.

Needle aspiration cytology in the diagnosis of mucinous cystadenocarcinoma of pancreas

In this study, our experience with five cases of mucinous cystadenocarcinoma of the pancreas is described, which was seen over a 13-yr period. The diagnosis in four of the cases was made from aspirated material that was obtained under computed tomography (CT) guidance and, in one case, following an intraoperative aspirate. In four cases, the tumor was found to be in the head of pancreas, whereas in one case, the neoplasm was located in the tail. All the cases were elderly male patients. As a result of our study, it is believed that aspiration cytodiagnosis of mucinous cystadenocarcinoma (a rare subtype of pancreatic carcinoma) can be made with confidence when performed intraoperatively or with imaging assistance. Also, aspiration cytology is a sensitive, specific, and relatively simple procedure that provides adequate material on which a confident diagnostic interpretation can be made of this uncommon neoplasm.

PRIMARY CYSTADENOCARCINOMA OF THE APPENDIX PENETRATED TO THE RETROPERITONEUM-REPORT OF A CASE-

A rare case of cystadenocarcinoma of the appendix penetrated to the retroperitoneum and developed an abdominal wall abscess is reported. A 75-year-old woman was admitted to the hospital because of right lower abdominal pain and swelling. Ultrasonography (US) revealed to have an abdominal abscess. Light green gelatinous elements in the discharge from the abscess was evident on the surgical drainage. Barium enema did not visualize the appendix and computed tomography and US showed that a cystic mass lesion existed posteriorly in the cecum. These findings suggested that she probably had a carcinoma of the appendix, and operation was performed. It disclosed that a mucinous cystic lesion penetrated to the abdominal wall, and when the adhered appendix was detached from the retroperitoneum, a large amount of mucinous collection was found in the retroperitoneum cavity. This patient was diagnosed as to have mucinous cystadenocarcinoma of the appendix, histopathologically. This might present with a rare clinical manifestation in the disease. This rarity has prompted us to report the present case. There have been few cases of mucinous cystadenocarcinoma of the appendix which did not present with pseudomucinous cyst but penetrated to the retroperitoneum so far. This paper describes a case presenting with such a rare manifestation.

Immunolocalisation of α-Amylase in Ovarian Mucinous Tumours

The distribution of alpha-amylase was studied immunohistochemically in 42 cases of ovarian mucinous tumour. Intense immunoreactivity for amylase was found in 6 of 8 cases of mucinous cystadenocarcinoma. In contrast, only 6 of 20 benign mucinous cystadenomas showed immunoreactive amylase, which was weak and patchy. Mucinous cystadenomas of borderline malignancy showed an intermediate degree of amylase immunoreactivity. The patterns seen are very similar to those reported in normal endocervix, cervical glandular atypia, and invasive adenocarcinoma and suggest molecular as well as morphologic similarities in neoplasia at these sites.

CLINICOPATHOLOGICAL STUDIES ON PRIMARY RETROPERITONEAL AND MESENTERIC TUMOR

Fifteen cases of primary retroperitoneal tumor and six of primary mesenteric tumor were studied retrospectively. Since retroperitoneal space and mesentery belong to the same organ embryologicaly, the distribution of tumors according to histological type is similar. Histological calssifications of these 21 tumors were as follows: malignant lymphoma, 4; leiomyosarcoma, 3; liposarcoma, 3; mucinous cyst adenocarcinoma, 2; lipoma, 1; teratoma, 3; cyst, 5. Fifty-seven percent were malignant. An abdominal mass was palpable in 90% of the patients. Tumors were evaluated preoperatively by CT examination in 16 cases, ultrasonography in 15 cases, and arteriography in 13 cases; CT examination proved most valuable. Accurate preoperative diagnosis of location could be made in 93% of retroperitoneal tumors and 33% of mesenteric tumors, and specific diagnosis by histology was suspected in cases of teratoma, cyst, lipoma and leiomyosarcoma. Prognosis of twelve malignant cases was as follows: four cases of malignant lymphoma are dead, one case of leiomyosarcoma is alive and two cases are dead, two cases of liposarcoma are alive and one case is dead, and two cases of mucinous cyst adenocarcinoma are alive. The three year survival rate of all malignant cases was 25%.

DNA content of mucinous tumors of the ovary

The DNA content of epithelial cell nuclei of 9 cases of intermediate papillary mucinous cystomas of the ovary was determined by microspectrophotometric measurements of Feulgen-stained sections. Two cases of histologically benign and 3 cases of malignant mucinous cystomas were also measured. A diploid to tetraploid DNA distribution was found in each case of mucinous cystadenoma (MCA). The 3 cases of mucinous cystadenocarcinoma had an aneuploid DNA distribution. Three of 9 intermediate papillary mucinous cystomas had an aneuploid DNA pattern whereas in the remainder of that group the distribution was within the diploid to tetraploid range.