Mucinous Borderline Tumors Research Articles

A Case of Huge Mucinous Cystadenoma

Introduction: Ovarian mucinous cystadenoma is a benign tumour that arises from the surface epithelium of ovary. Aim/Objectives: To report the occurrence of a huge benign ovarian tumour. Case Report: A 24-year-old female presented to the OPD with complaints of pain lower abdomen, loss of appetite, and abdominal distension since 4 months. Her USG and CT scan reports showed it to be case of mucinous cystadenoma. She underwent laparotomy with left-sided cystectomy. Her Histopathological report showed borderline mucinous tumour. Peritoneal washing showed negative for atypical cells. Discussion: Giant tumours are now a rare presentation due to their early diagnosis due to routine check-ups on ultrasound

Postmenopausal woman with 24 kgs ovarian mucinous cystadenoma: a rare case report

A case of a 53-year-old postmenopausal woman presenting a giant ovarian cystic mucinous tumor weighing 24 kg is reported here. When she was seen first at our outpatient clinic, she had gross abdominal distension since 2 years, and she complained of unbearable aggressive pain. Her computed tomography (CT) scan was done which came suggestive of ovarian serous cystadenoma of large massive size 35 x 40 x 32 cm with moderate ascites. On exploratory laparotomy, a giant, totally cystic, vascularized and smooth mass attached to the right ovary was encountered. On the postoperative tenth day, she was discharged without any problem. Histopathology report of the right ovarian cystic mass came suggestive of multiloculated cyst with capsule intact with Borderline Mucinous tumor of right ovary weighing 24 kg. This is both one of the largest known examples in the literature and the largest ovarian cyst ever seen at our institution.

Immunohistochemical phenotype of fallopian tubes in patients with different grades of serous ovarian carcinoma

During recent years, there is an accumulating evidence that high grade ovarian carcinoma is developed from the fallopian tube epithelial lesions. However, is not yet completely understood and still represents the subject of investigation. We investigated the immunohistochemical phenotype of matched fallopian tubes from the patients with different types and malignancy grades of ovarian carcinoma. Matched fallopian tubes from ovarian cancer patients were available in 260 cases, including mucinous borderline tumor (n=25), mucinous carcinoma (n=15), serous borderline tumor (n=90), low grade serous carcinoma (n=72) and high grade serous carcinoma (n=48). Immunohistochemical investigation included markers of proliferation (Ki67), apoptosis (Bcl2, p53), hormone receptors (ER, PR), epithelial differentiation (CK7), mesenchymal differentiation (vimentin, calretinin) and stem cells (CD44). The results indicate that the presence of fallopian tube carcinoma in situ is significantly correlated with the presence of high grade ovarian serous carcinoma (r=0.44, p<0.001), whilst there was no significant association with low grade and borderline serous tumors or mucinous tumors.

Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents

Describe the current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian masses DESIGN: Prospective cohort study from 2018 to 2021 SETTING: Eleven children's hospitals PARTICIPANTS: Females age 6-21 years undergoing surgical management of an ovarian mass INTERVENTIONS: Obtaining intraoperative FS pathology MAIN OUTCOME MEASURE: Diagnostic accuracy of FS pathology RESULTS: Of 691 patients who underwent surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology. Among FS patients, 12 of 27 (44.4%) underwent ovary-sparing surgery, and 15 of 27 (55.5%) underwent oophorectomy with or without other procedures. FS results were disparate from final pathology in 7 of 27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for identifying malignancy, with a c-statistic of 0.69. Malignant diagnoses missed on FS included serous borderline tumor (n=1), mucinous borderline tumor (n=2), mucinous carcinoma (n=1), and immature teratoma (n=1). FS did not guide intervention in 10 of 27 (37.0%) patients: 9 with benign FS underwent oophorectomy, and 1 with malignant FS did not undergo oophorectomy. Of the 9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%) had malignant final pathology. FSs are infrequently utilized for pediatric and adolescent ovarian masses and could be inaccurate for predicting malignancy and guiding operative decision-making. We recommend continued assessment and refinement of guidance before any standardization of use of FS to assist with intraoperative decision-making for surgical resection and staging in children and adolescents with ovarian masses.

Gene-Expression Profiling of Mucinous Ovarian Tumors and Comparison with Upper and Lower Gastrointestinal Tumors Identifies Markers Associated with Adverse Outcomes.

Advanced-stage mucinous ovarian carcinoma (MOC) has poor chemotherapy response and prognosis and lacks biomarkers to aid stage I adjuvant treatment. Differentiating primary MOC from gastrointestinal (GI) metastases to the ovary is also challenging due to phenotypic similarities. Clinicopathologic and gene-expression data were analyzed to identify prognostic and diagnostic features. Discovery analyses selected 19 genes with prognostic/diagnostic potential. Validation was performed through the Ovarian Tumor Tissue Analysis consortium and GI cancer biobanks comprising 604 patients with MOC (n = 333), mucinous borderline ovarian tumors (MBOT, n = 151), and upper GI (n = 65) and lower GI tumors (n = 55). Infiltrative pattern of invasion was associated with decreased overall survival (OS) within 2 years from diagnosis, compared with expansile pattern in stage I MOC [hazard ratio (HR), 2.77; 95% confidence interval (CI), 1.04-7.41, P = 0.042]. Increased expression of THBS2 and TAGLN was associated with shorter OS in MOC patients (HR, 1.25; 95% CI, 1.04-1.51, P = 0.016) and (HR, 1.21; 95% CI, 1.01-1.45, P = 0.043), respectively. ERBB2 (HER2) amplification or high mRNA expression was evident in 64 of 243 (26%) of MOCs, but only 8 of 243 (3%) were also infiltrative (4/39, 10%) or stage III/IV (4/31, 13%). An infiltrative growth pattern infers poor prognosis within 2 years from diagnosis and may help select stage I patients for adjuvant therapy. High expression of THBS2 and TAGLN in MOC confers an adverse prognosis and is upregulated in the infiltrative subtype, which warrants further investigation. Anti-HER2 therapy should be investigated in a subset of patients. MOC samples clustered with upper GI, yet markers to differentiate these entities remain elusive, suggesting similar underlying biology and shared treatment strategies.

MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges.

Borderline epithelial ovarian tumors are a distinct pathologic entity characterized by increased epithelial proliferation and nuclear atypia, but without frank stromal invasion. Borderline tumor (BT) is now considered to represent an intermediate phase in the stepwise progression from benign to malignant ovarian epithelial tumor. Since BTs commonly manifest at early stages in women of reproductive age and are associated with a good prognosis, making the correct diagnosis is important in determining whether a patient is a candidate for fertility-sparing surgery. There are six histologic BT subtypes (serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner), and each has different MRI features, reflecting their unique histologic architectures. Radiologists should be aware of the MRI features that can suggest BTs. These features include a hyperintense papillary architecture with hypointense internal branching, which can be observed with serous and seromucinous BTs on T2-weighted images; aggregates of microcysts that have hypointensity on T2-weighted images and reticular enhancement on contrast-enhanced T2-weighted images, which can be seen with mucinous BTs; and moderately high signal intensity on diffusion-weighted images along with relatively high apparent diffusion coefficient values, which can be observed regardless of the histologic subtype. Nevertheless, because the imaging features of BTs overlap with those of many benign lesions (eg, cystadenoma and cystadenofibroma, decidualized endometriosis, and polypoid endometriosis) and malignant tumors (ovarian cancers and metastases), histologic confirmation is required for the final diagnosis. Special emphasis is placed on the MRI features of BTs, pathologic correlation, and the challenges related to diagnosis. ©RSNA, 2022.

Double Trouble

A 55-year-old, Gravida 2 Para 2 (2002), presented with postmenopausal vaginal bleeding. Workups pointed toward ovarian malignancy with distant metastasis (pleural effusion). Exploratory laparotomy, bilateral salpingo-oophorectomy, surgical staging, and appendectomy were performed. On histopathological examination, synchronous high-grade serous carcinoma of the right fallopian tube and borderline mucinous tumor of the left ovary were diagnosed. Primary fallopian tube carcinomas are very uncommon, while synchronous tumors of the female genital tract are extremely rare. Furthermore, there is a paucity of literature discussing the occurrence of synchronous primary malignancies arising from the fallopian tube and the ovary. It is crucial to differentiate primary malignancies from metastatic cancers to determine accurate staging and prognosis, as well as to assign appropriate treatment strategies. Immunohistochemistry and molecular testing play vital roles as adjunctive diagnostic tools to histologic examination in determining the origins of these tumors and distinguishing primary tumors from metastasis.

EP42.10: Synchronous low‐grade appendiceal mucinous neoplasm and mucinous borderline tumour of the ovary mimicking mucocele: a case report

EP42.10: Synchronous low‐grade appendiceal mucinous neoplasm and mucinous borderline tumour of the ovary mimicking mucocele: a case report

Death from Malignant Transformation of Untreated Mucinous Borderline Tumor: Case Report

Mucinous borderline tumors (MBT) of the ovary with mild to moderately atypical epithelial cells that produce mucin rarely recur and very rarely become malignant after surgery. Due to their low malignant potential and large tumor size, most cases are diagnosed in stage I and have a good prognosis. The authors reported a case of MBT, which had been left untreated after diagnosis, progressed to stage IV, and caused massive pleural effusion (>3,000 mL) resulting in death. Grossly, severe abdominal swelling, a huge multiloculated cystic mass in the left ovary, and a metastatic mucinous mass in the pleura and peritoneum were observed. Histological findings include gastrointestinal type epithelial cells with mucin secretion, degenerative and autolytic nuclei, and occasional infiltration of inflammatory cells. Because sufficient sections cannot be made according to the clinical pathology criteria in forensic autopsy, efficient decisions are required during autopsy for diagnosis.

Ovarian Mucinous Borderline Tumor With Intraepithelial Carcinoma.

Ovarian Mucinous Borderline Tumor With Intraepithelial Carcinoma.

Ovarian mucinous borderline tumor with anaplastic carcinomatous nodules in adolescents

Bilateral ovarian epithelial neoplasms in adolescents are rare. Moreover, borderline mucinous neoplasms with local intraepithelial carcinoma with anaplastic carcinoma are even more infrequent. Herein, we presented a single case (a 17-year-old female) with regular menstrual cycles and stomach pain when eating who was diagnosed with a left ovarian tumor accompanied by mural nodules. The right ovarian cyst, the left ovary, and the fallopian tube were removed by surgery. Intraoperative diagnosis suggested a bilateral ovarian tumor with mural nodules, which include three different pathological types: sarcomatoid transformation, anaplastic carcinoma, and sarcoma. Paclitaxel combined with carboplatin was given for 6 cycles after an operation, and gonadotropin-releasing hormone agonist (GnRHa) was given at the beginning of chemotherapy for 3 cycles for ovarian function protection. Regular follow-up (the last follow-up was performed 48 months after the operation) of gynecological ultrasound and tumor indicators did not indicate recurrence. In clinical practice, it is necessary to pay attention to the symptoms such as abdominal pain in adolescent females. Routine non-invasive pelvic ultrasound is recommended to fully evaluate the nature of the tumor before surgery, and decide the operation mode. Also, intraoperative frozen pathology of the tissue should be performed as soon as possible.

Appendiceal tumors in patients undergoing primary surgery for mucinous ovarian tumors in a tertiary hospital, in Southern Thailand

ObjectiveTo evaluate the prevalence of appendiceal tumors in patients diagnosed with mucinous ovarian tumors and to determine factors associated with coexisting appendiceal tumors. Materials and methodsRetrospective review of all patients who were diagnosed with mucinous ovarian tumors and underwent an appendectomy during surgery between January 2002 and June 2017 was performed. Univariate and multivariate logistic regression analyses were used to identify risk factors for coexisting appendiceal tumors. ResultsA total of 303 patients with mucinous ovarian tumors who underwent appendectomy were identified, including 77 (25.4%) mucinous cystadenoma and 226 (74.6%) mucinous borderline tumor or carcinoma. Twenty-one (6.9%) had coexisting appendiceal tumors including 8 that were primary appendiceal mucinous adenocarcinomas, 6 low-grade appendiceal mucinous neoplasms, 6 secondary appendiceal metastasis from the ovary, and one hyperplastic polyp. None of mucinous cystadenoma had coexisting appendiceal tumors. Multivariate analysis revealed advanced age ≥50 years, previous rupture of ovarian tumors, abdominal extension of tumors, and grossly abnormal appendix were independent factors for coexisting appendiceal tumors. ConclusionPrevalence of coexisting appendiceal tumors in mucinous ovarian tumors was not uncommon. The risk factors were grossly abnormal appendix, abdominal extension of tumor, previous rupture of ovarian tumors, and advanced age.

Profile of ovarian tumor in anatomical pathology laboratory of Dr. Soetomo General Academic Hospital Surabaya period 1 January 2016 - 31 December 2020

Ovarian malignant tumors are the fifth leading cause of death from malignant tumors and have the highest mortality rate among uterine malignant tumors in the United States. Factors associated with an increased risk of ovarian cancer include age, nulliparity, and a family history of cancer. The aim of this study was to determine the profile ovarian tumor in anatomical pathological Dr. Soetomo General Academic Hospital during 1 January 2016 – 31 December 2020. This study used a descriptive observational study with a retrospective approach. The data were presented in tables of the distribution of the number of cases, age and histopathological diagnosis. The data was obtained from the electronic medic record (EMR) of Dr. Soetomo General Academic Hospital. There were 1107 cases, the most age was 41-50 years, namely 285 cases (25.75%), mucinous carcinoma was the most histopathological of malignant tumor, namely 145 cases (24.75%), mucinous borderline tumour was the most histopathological of borderline tumor, namely 34 cases (85%) and endometriosis was the most histopathological of benign tumor.

A Novel Case of Recurrent Mucinous Borderline Ovarian Tumor: Early Relapse and Fatal Outcome

Unlike ovarian carcinomas, borderline ovarian tumors (BOTs) are associated with a favorable prognosis: their recurrence rate is around 5–7%, and the survival rate is more than 97% when diagnosed early. There are only a few reports of recurrence and fatal outcomes. Herein, we report a novel case of recurrent mucinous BOT, with a literature review. A 63-year-old woman presented to a local doctor with abdominal fullness. She was diagnosed as having a polycystic tumor. The lesion was suspected to be a mucinous BOT (M-BOT) on magnetic resonance imaging. Upper and lower gastrointestinal endoscopy revealed no digestive cancerous lesions, and surgery was performed. Intra-operative diagnosis confirmed the diagnosis, and total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy were performed. The final pathological diagnosis was non-invasive M-BOT (stage I c1 (T1c1N0M0)). The result of immunohistochemical staining supported the diagnosis of primary ovarian mucinous tumor.Four months after surgery, relapse occurred. Blood tests revealed an elevated carbohydrate antigen 19-9 level, and computed tomography revealed multiple liver metastases, peritoneal dissemination, left ureter infiltration, and carcinomatous peritonitis. Although the patient underwent chemotherapy, she died. This case of a very short progression-free and overall survival in stage I M-BOT indicates that some M-BOTs could result in fatal clinical outcomes despite diagnosis at an early stage. Frequent follow-up appointments after surgery could help detect relapse and increase survival in such cases.

Mucinous borderline ovarian tumors: pathological and prognostic study at Salah Azaiez Institute.

Introductionovarian Mucinous Borderline Tumors (MBT) are characterized by an epithelial proliferation similar to those of well differentiated adenocarcinomas but are distinguished by the absence of stromal invasion. They are often difficult to diagnose histologically. The aim of the work was to specify the pathological and clinical features and to highlight the prognostic of these tumors.Methodsstudy was retrospective including 49 cases of primary ovarian MBT, diagnosed at the Patholgy Department of Salah Azaiez Institute from 1992 to 2019.Resultsmedian age was 48 years old. Histologically, the cases were divided into 34 cases of pure MBT, 13 cases with intraepithelial carcinoma and 2 cases associating an intraepithelial carcinoma with microinvasion. The majority of our cases were classified FIGO I and only one case FIGO III. Sixteen patients received conservative treatment and 30 received radical treatment. The treatment wasn’t specified in three patients. The prognosis was good in the majority of cases. Only one patient had a contralateral recurrence after a follow-up period of three years. There were no significant differences regarding the risk of recurrence and risk factors such as age, gestation, hormonal status, FIGO stage and conservative treatment. We raised this part.Conclusionthe prognosis of the ovarian MBT is good. However, it is necessary to multiply the samples to avoid missing a carcinomatous focus with an anarchic invasion of the stroma which constitutes a poor prognosis factor. It was changed by these sentences below: the diagnosis of MBT is not easy. Indeed, the distinction of MBT from carcinomas remains the greatest challenge for pathologists. Once this diagnosis is made with certainty, the tumor can be considered to have a good prognosis, especially stage I tumors which are the most common.

Endocrine cell micronests in an ovarian mucinous borderline tumor: a potential diagnostic pitfall for microinvasion

The occurrence of endocrine cell micronests in ovarian tumors is rarely reported. To our knowledge, there are only three prior cases reported to date: one occurring in an ovarian mucinous cystadenoma, one in an ovarian mucinous cystadenofibroma, and another in an ovarian mucinous carcinoma with a predominant borderline component. This is a 27-year-old woman that presented with a one-month history of abdominal pain and fullness. Imaging studies revealed a large multiloculated cystic and solid mass measuring 23 cm occupying the majority of the pelvis and abdomen concerning for a primary ovarian malignancy. The patient underwent a right salpingo-oophorectomy with appendectomy. Histologic sections from the ovary showed a multiloculated, cystic and focally solid mass lined by gastrointestinal-type mucinous epithelium with variable degrees of proliferation accounting for greater than 10% of the tumor. In addition to the mucinous epithelial component, there were several foci of bland, monotonous epithelioid cells arranged in solid nests with focal tubular/acinar formation within the fibrous septa and mucinous epithelium. Immunohistochemical studies showed that these cells were positive for cytokeratin, EMA, and synaptophysin, while negative for inhibin. The Ki-67 proliferation index was low (<1%). The presence of endocrine cell nests associated with an ovarian mucinous neoplasm is a rare phenomenon. Whether this represents preservation of endocrine cells in the context of epithelial degeneration or an independent neoplastic component is unclear. Progression related to this endocrine cell proliferation is unlikely and the recognition of this phenomenon holds more diagnostic value than prognostic significance, as it could be confused with microinvasion or sex cord stromal elements.

A combination of immunohistochemical markers, MUC1, MUC5AC, PAX8 and growth pattern for characterization of mucinous neoplasm of the ovary

ObjectiveBecause mucinous carcinomas are rare tumors that affect several organ sites and are known to originate from different tissues, leading to frequent misdiagnoses, the objective was to characterize the differences...

A rare case of pseudomyxoma peritonei caused by borderline mucinous tumor arising from primary mature cystic ovarian teratoma

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by diffuse intraperitoneal mucinous spread originating from mucinous neoplasms. The most common cause of PMP is a mucinous epithelial tumor of the appendix, but may also develop from other abdominal organs such as the ovaries, colon, and pancreas. Here, we describe the case of a patient with a prior history of appendectomy, in whom the appendix was easily excluded as the primary site of PMP. Previous studies have reported that only 3–8% of ovarian mucinous tumors may arise from mature cystic teratoma. In addition, borderline ovarian malignancies from mature cystic teratoma are not common, and the occurrence of PMPs from these borderline ovarian mucinous tumors is very rare. We report a rare case of PMP with clinicopathological features between PMP and borderline mucinous tumors arising in a mature cystic teratoma of the ovary.

A cross-sectional study of immunohistochemical evaluation of surface epithelial ovarian tumors

Background: Ovarian cancer is one of the most common malignancies in female patients. In recent years, immunohistochemistry (IHC) has emerged as an important tool in the diagnosis of ovarian tumors. The study aimed to assess estrogen receptors (ERs), progesterone receptors (PRs), Her-2-neu, and Ki-67 by IHC in surface epithelial ovarian tumors and to correlate the findings with different variables. Materials and Methods: It was a cross-sectional study. Oophorectomy/salpingo-oophorectomy/cystectomy specimens were included in this study. IHC was done on 10% neutral buffer formalin-fixed paraffin-embedded tissue sections by using Dako FLEX Ready to use mouse monoclonal antibodies and DakoEnvisionTM FLEX/HRP detection reagent. Results: The study includes 81 cases of surface epithelial ovarian tumors (a benign serous tumor [20], a benign mucinous tumor [18], a borderline mucinous tumor [5], low-grade serous carcinoma [8], high-grade serous carcinoma [19], mucinous carcinoma [7], endometrioid carcinoma [2], borderline Brenner tumor [1], and malignant Brenner tumor [1]. ER had higher expression in malignant cases (51.33%) than in benign cases (15.8%). PR had higher expression in malignant tumors (54.05%) incomparable to benign (18.42%) and borderline tumors (16.66%). PR had higher expression in high grade. Expression of Her-2-neu positivity was found to be 29.7% out of the total 81 cases. Her-2-neu was found in 11 high-grade tumors among 31 malignant cases. CA-125 levels were significantly higher in malignant ovarian tumors (P = 0.0143). Proliferation activity was considered low if proliferation index (PI) &lt;10% and high if PI &gt;10%. The study showed high PI in malignant tumors. Conclusion: Expression of these marks in adjunct to H&amp;E diagnosis may prove beneficial in differentiating benign, borderline, and malignant cases, in which a diagnosis of borderline cases based on sole H &amp; E is doubtful.

Mucinous borderline ovarian tumors recurred with lung metastasisy 1 year after initial surgery : A case report

Mucinous borderline ovarian tumors recurred with lung metastasisy 1 year after initial surgery : A case report