Mucinous Neoplasm Research Articles

Role of Lymph Node Dissection in Primary Staging Surgery of Early-Stage Mucinous Ovarian Cancer (mOC)- A New Insight

This study is done to evaluate whether it is necessary to do systematic retroperitoneal lymphadenectomy in all early-stage mucinous ovarian cancer (mOC) or do we need to change our routine practice according to new scientific clinical-based evidence. This is a single centre observational study where retrospective data of 81 patients of early stage mOC were prospectively analyzed into two groups depending on the systematic dissection of retroperitoneal lymph node i.e. 1. Lymph node dissection (LND+) group versus 2. Lymph node none-dissection (LND-) group. Log Rank (Mantle- Cox) test was used among these two groups to look for a comparison of outcome in terms of progression free survival (PFS) and overall survival (OS). During 2008-2016 out of 268 patients 123 had primary mOC and among them, 81 were early stage. Out of 81 patients, 48 were in LND+ and 33 patients in LND- group. The incidence of grade I mOC was 79.16% and 84.85% in LND+ and LNDgroup respectively. None of the LND+ cases came positive in the final report which shows very rare involvement of lymph nodes (LN)in early stage mOC. PFS was not statistically significant (p-value 0.061) in between the LND+(91.7%) and LND- (75.8%) groups. The same was true for a 5-year OS. There was no significant improvement of OS in between the LND+ (95.8%) and LND- (87.9%) groups. There was no lymph node recurrence even in LND- groups. This study has given us the insight that in early stage mOC routine systematic lymph node dissection (LND) can be omitted as it does not improve PFS and OS

Evaluation of prediction power of fukuoka guideline for malignancy in intraductal papillary mucinous tumor (IPMN) of pancreas: a retrospective study in a single institution

Evaluation of prediction power of fukuoka guideline for malignancy in intraductal papillary mucinous tumor (IPMN) of pancreas: a retrospective study in a single institution

Primary retroperitoneal mucinous tumors

The authors present a review of the literature on the diagnosis, treatment and morphological features of rare tumors – primary retroperitoneal mucinous tumors.

Synchronous primary multiple cancer: distal cholangiocarcinoma of the intrapancreatic common bile duct and intraductal papillary mucinous tumor associated with ductal adenocarcinoma of the pancreatic tail

We present a combination of distal cholangiocarcinoma of the intrapancreatic common bile duct and intraductal papillary mucinous tumor associated with ductal adenocarcinoma of the pancreatic tail. This clinical case is unique. When analyzing the literature, we found no any case of similar primary multiple malignant tumor. Importantly, final diagnosis of simultaneous malignant pancreatobiliary neoplasia is possible only via intraoperative biopsy after adequate morphological dissection and research of resected organ complex including molecular genetic analysis due to identical histological and immunohistochemical picture of ductal neoplasia.

Urachal mucinous cystic tumor of low malignant potential: a report of a rare case with literature review

Neoplasms originating from the urachus are exceptionally uncommon, comprising only 0.17% of all bladder neoplasms. Among these, the mucinous cystic tumor of low malignant potential (MCTLMP) is particularly rare, with only 25 documented cases in medical literature. Despite their rarity, it is essential to identify MCTLMPs given the possibility of severe complications. Fortunately, surgical removal offers promising cure rates. In this report, A 40-year-old female patient presented to the hospital with abdominal pain. Subsequently, a CT scan showed a 9-cm cystic mass pressing the bladder. The lesion was surgically excised and histopathological examination was performed. Grossly, the specimen consisted of a cyst with a smooth external surface and mucinous content. Microscopically, the cyst was lined by columnar mucinous epithelial cells that included basally-located hyperchromatic nuclei and scattered Goblet cells consistent with an intestinal phenotype. The epithelial cells show mild atypia with focal papillary formations and flattening due to compression. Immunohistochemically, the epithelial tumor cells expressed cytokeratin 20, CDX2, beta-catenin (membranous); and were negative for cytokeratin 7. The location, histopathological, and immunohistochemical findings were consistent with a diagnosis of MCTLMP. In this report, we present an instance of urachal MCTLMP, which represents less than 30 cases documented in the medical literature. This case study marks the importance of early identification of MCTLMP due to their potential for severe complications, despite the tumor’s low malignant potential and to exclude more aggressive tumors with areas of intraepithelial or invasive carcinoma.

Mucinous Tumors of the Ovary: Current Diagnosis in Histopathological Perspective

Epithelial malignant tumors account for around 90% of all ovarian malignancies and are the most deadly gynecological malignancies and mucinous borderline ovarian tumors are the most common cases in Asia. According to World Health Organization (WHO) 2020, mucinous ovarian tumors are divided into mucinous cystadenoma, borderline mucinous tumor and mucinous carcinoma. Histopathological features of benign, borderline and invasive mucinous carcinoma can be found together in one tumor. The coexixtence of these varied morphological features makes it difficult to establish a diagnosis due to the limited section evaluated and the large size of tumor. It can contribute to inaccurate diagnosis due to heterogeneity of the morphological features. Metastatic mucinous tumors which often resemble primary mucinous tumors in the ovaries.

The surgical and clinicopathological characteristics of primary mucinous ovarian cancer: a single institution 30-year retrospective analysis.

To evaluate the clinicopathological characteristics of primary mucinous ovarian carcinoma (MOC) and define oncologic outcomes. This retrospective study reviewed patients diagnosed with primary MOC at a single institution and underwent primary treatment between 1990 and 2019. The clinicopathological factors affecting oncological outcomes and treatment response were evaluated. The Kaplan-Meier method was used to evaluate survival outcomes. Survival curves were compared using the log-rank test. The cohort's (n=92) median (range) age was 48 (15-82) years. Seventy-five (81.5%) patients were in the International Federation of Gynecology and Obstetrics stage I-II. Forty patients received platinum-based adjuvant chemotherapy. The 5-year progression-free survival was 98% in stage I-II and 17% for stage III-IV (p<0.001). In multivariate analysis, the only independent risk factor for disease failure was stage (hazard ratio: 6.838, 95% confidence interval: 1,358-34,415; p=0.020). Advanced stage was an independent poor prognostic factor for recurrence in patient with MOC.

Appendiceal Mucinous Incidental Neoplasm a Rare Case Report and Literature Review

Mucinous appendiceal tumors consist of mucinous adenocarcinoma, low-grade appendiceal mucinous neoplasm, and high-grade appendiceal mucinous neoplasm. The incidence of non-mucinous adenocarcinomas is reduced. The most recent edition of the World Health Organization classification and recent consensus guidelines will enable the consistent application of agreed nomenclature. Not only is precise diagnosis essential for effective patient management, but it also facilitates the comparison of results across centers and tumor registries. The most prevalent benign adenoma in the appendix is serrated. It is imperative to differentiate these conditions from low-grade appendiceal mucinous neoplasms, as the latter can also resemble harmless ailments. Adenocarcinomas of the goblet cells are a rare subtype of appendiceal neoplasm. While appendiceal neoplasms are uncommon, they are not entirely so, and even the most seasoned pathologists may find them difficult to diagnose. In addition, appendiceal neoplasia classification and terminology have been subjects of contention for decades. Nonmucinous appendiceal neoplasms are less prevalent than mucinous tumors, and their association with other appendiceal neoplasm subtypes remains uncertain. A literature review of appendiceal mucinous neoplasms identified during laparoscopic appendicectomies is presented here.

Relationship Between Immunophenotypes, Genetic Profiles, and Clinicopathologic Characteristics in Small Bowel Adenocarcinoma.

Small bowel adenocarcinoma (SBA) is rare, and scant data exist regarding its molecular and clinicopathologic characteristics. This study aimed to clarify the correlation between immunophenotypes, DNA mismatch repair status, genomic profiling, and clinicopathologic characteristics in patients with SBA. We examined 68 surgical resections from patients with primary SBA for immunohistochemical analyses of CK7, CK20, CD10, CDX2, MUC1, MUC2, MUC4, MUC5AC, and MUC6 expression as well as mismatch repair status. Genomic profiling was performed on 30 cases using targeted next-generation sequencing. Tumor mucin phenotypes were classified as gastric, intestinal, gastrointestinal, or null based on MUC2, MUC5AC, MUC6, and CD10 immunostaining. The expression of these proteins was categorized into 3 classifications according to their relationship to: (1) tumor location: CK7/CK20, MUC4, and MUC6; (2) histologic type: mucinous adenocarcinoma was positive for MUC2 and negative for MUC6; and (3) TNM stage: CD10 was downregulated, whereas MUC1 was upregulated in advanced TNM stages. CDX2 was a specific marker for SBA generally expressed in the small intestine. MUC1 and MUC4 expression was significantly associated with worse prognosis. MUC2 expression correlated with better prognosis, except for mucinous adenocarcinoma. Although the difference was not statistically significant, gastric-type tumors were more frequently located in the duodenum and were absent in the ileum. APC and CTNNB1 mutations were not found in the gastric-type tumors. The SBA immunophenotype correlated with tumor location, biological behavior, and genomic alterations. Our results suggest that the molecular pathway involved in carcinogenesis of gastric-type SBA differs from that of intestinal-type SBA.

Evaluation of Toll-Like Receptor (TLR) 3, 4, 7, 8 and 9 in Mucinous and Serous Ovarian Cancer

Background: The aim of this study was to investigate the expression of TLR3, TLR4, TLR7, TLR8 and TLR9 in ovary tissue of ovarian cancer patients.&#x0D; Methods:In the case control study, 122 paraffin-embedded tissue blocks of patients with ovarian cancer and control groups were collected. Immunohistochemistry technique was used for detecting the expression of TLR3, TLR4, TLR7, TLR8 and TLR 9 in ovary tissues.&#x0D; Results: The mean Immunoreactivity Score (IS) of TLR3 in the case and the control groups was 0.6±0.99 and 0.16±0.1, respectively. The mean IS of TLR7 in the case and the control groups was 1.03±1.05 and 0.66±1.07, respectively. A significant difference was observed between the case and control groups in terms of IS of TLR3 (p=0.001) and TLR7 (p=0.013). However, no significant difference was observed between the case and control groups regarding IS of TLR 4, 8 and 9 (p&gt;0.05).&#x0D; Conclusion: High IS of TLR3 and TLR7 in these patients may confirm the likelihood of association of viral infection with ovarian cancer. Also, considering that TLR3 is one of the receptors that have viral and bacterial ligands, there is a possibility that a bacterial infection is also involved in the development of ovarian cancer. In addition, the expression of TLR4, TLR8 and TLR9 was not different in ovarian tissue of the case and control groups. It is proposed to conduct this study with RT-PCR technique on the paraffin block sample and compare the results with the above results in future studies.

Rare non-serous fallopian tube cancers: institutional experience and literature review.

We reviewed 63reports from the literature on rare non-serous tumors of the fallopian tubes and carried out acomparative analysis of clinical manifestations and diagnostic methods. We also report our observations from patients with these tumors. Of 157 patients with primary fallopian tube cancer (FTC) treated in our regional oncological hospital between 1970 and 2020, there were nine (6%) cases of rare non-serous cancers, including one case each of choriocarcinoma, carcinosarcoma, and neuroendocrine tumor, and two cases each of non-keratinizing squamous cell carcinoma, mucinous adenocarcinoma, and clear cell adenocarcinoma. For carcinosarcoma and squamous cell, clear cell, and transitional cell carcinomas, clinical history, patient age, and clinical manifestations were similar to the main group of FTCs. Choriocarcinoma differed significantly from other cancers of the fallopian tubes in terms of patient age and clinical course. Mucinous adenocarcinoma, mesothelioma, and borderline tumors, with rare exceptions, were almost always asymptomatic and were found only incidentally during surgery. Choriocarcinoma and carcinosarcoma had an aggressive course, while squamous cell, transitional cell, clear cell, and mucinous carcinomas were less aggressive. Since most rare non-serous tumors have asimilar disease course to typical FTCs and there is alack of appropriate treatment protocols for rare tumors, treatment options developed for ovarian tumors and FTC are justified for these tumors. Rare non-serous malignant fallopian tube tumors are very similar to serous and endometrioid FTC in terms of clinical manifestations and diagnosis.

Clinicopathological and Oncological Outcomes of Borderline Mucinous Tumours of Ovary: a Large Case Series.

The objective is to study the clinico-demographic profile, treatment patterns and oncological outcomes in borderline mucinous tumours of the ovary. Retrospective cohort analysis was carried out between January 2017 and December 2019 for patients with a diagnosis of borderline mucinous tumours of the ovary who were treated at our centre. Kaplan-Meier method was used for the estimation of the probability of DFS and OS. Univariate and multivariate analyses based on the Cox proportional hazard model were performed to identify factors associated with DFS and OS. A p-value ≤ 0.05 in a two-tailed test was considered statistically significant. The study population included 75 patients and the median follow-up time for the entire cohort was 24months. The 5-year DFS for the entire cohort was 79.6% and OS was 90.5%, whereas for stage I disease, 5-year OS was 92.6% as opposed to 60% in the advanced stage. On univariate analysis, only the stage of the disease had a significant association with DFS and OS. Fertility-preserving surgeries had no impact on OS or DFS, and hence, it is suggested that fertility-sparing surgeries may be considered a viable option in young patients with mucinous ovarian tumours. Borderline mucinous tumours of the ovary have excellent survival outcomes and fertility-sparing surgeries should be done whenever feasible.

Safety of fertility-sparing surgery in young women with stage I endometrioid epithelial and mucinous ovarian cancer: A population-based analysis

IntroductionThe aim of this study was to assess the safety of fertility-sparing surgery (FSS) in stage I endometrioid epithelial cancer (EEOC) and mucinous ovarian cancer (MOC). MethodsA retrospective case‒controlled study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database, focusing on stage I EEOC and MOC between 2000 and 2016. The effects of FSS on overall survival (OS) were compared using log-rank tests. Univariate and multivariate Cox analyses were performed to control for confounders. ResultsThe study identified 970 patients with FIGO stage I EEOC and 810 with stage I MOC. Of these patients, 116 (12.0%) EEOC and 268 (33.1%) MOC patients underwent fertility-sparing surgery. The results showed that patients with G3 EEOC had a worse 5-year OS than patients with G1 EEOC (96.1% vs. 90.1%, p = 0.020). IC stage MOC patients had a worse prognosis than IA and IB stage patients (94.9% vs. 88.7%, p = 0.001). FSS did not significantly affect the 5-year OS of patients with EEOC (94.8% vs. 95.4%, p = 0.687) or MOC (95.9% vs. 92.3%, p = 0.071). Further subgroup analysis according to tumor stage and histological grade did not show a worse OS with FSS in stage I EEOC or MOC patients, even with high-risk types such as G3 histology and IC phase. In a multivariable analysis, the application of FSS was not associated with inferior OS in EEOC or MOC. ConclusionsFSS for patients with stage I EEOC or MOC does not lead to worse outcomes than radical surgery, making it a viable option for young patients with early-stage disease wishing to preserve fertility.

Retrospective Clinico-pathological and Morphological Analysis of Appendicular Tumors on Appendectomy Specimens for Acute Appendicitis

Background and Study Aims: Appendiceal Tumors are rare. Difficult to diagnose, these tumors are often accidentally discovered following acute appendicitis. The aim of this study is to describe the clinical, pathological and morphologic characteristics of these tumors in order to define an appropriate management. Patients and Methods: From a pathological database, all appendiceal tumors found on appendectomy specimens performed between January 2017 and July 2019 were retrospectively analysed. Results: Among the 1480 appendectomies performed, 15 cases of appendiceal tumors were collected (1.01%). The mean age was estimated at 44.7 ± 21.5 years (17-80). Pain in the right iliac fossa was present in all patients. Abdominal ultrasonography coupled with computed tomography (CT) scan led to the diagnosis of appendiceal tumors in 40% of cases (6/15). All patients underwent emergency surgery. An appendectomy was performed in 13 patients (86%). A mucinous tumor was found in 9 patients (60%). In 40% of the cases (6/15), it was a neuroendocrine tumor. Conclusion: Appendiceal tumors are often discovered incidentally on appendectomy specimens for acute appendicitis. They can be seen at any age and their diagnosis is not easy, even with the support of imaging. Ideally, the diagnosis of these tumors should be made preoperatively; this can change the surgical approach and avoid the need for additional surgery. All appendectomy specimens should be examined in histopathology.

Synergy of the microRNA Ratio as a Promising Diagnosis Biomarker for Mucinous Borderline and Malignant Ovarian Tumors.

Epithelial ovarian cancers (EOCs) are a heterogeneous collection of malignancies, each with their own developmental origin, clinical behavior and molecular profile. With less than 5% of EOC cases, mucinous ovarian carcinoma is a rare form with a poor prognosis and a 5-year survival of 11% for advanced stages (III/IV). At the early stages, these malignant forms are clinically difficult to distinguish from borderline (15%) and benign (80%) forms with a better prognosis due to the large size and heterogeneity of mucinous tumors. Improving their diagnosis is therefore a challenge with regard to the risk of under-treating a malignant form or of unnecessarily undertaking radical surgical excision. The involvement of microRNAs (miRNAs) in tumor progression and their potential as biomarkers of diagnosis are becoming increasingly recognized. In this study, the comparison of miRNA microarray expression profiles between malignant and borderline tumor FFPE samples identified 10 down-regulated and 5 up-regulated malignant miRNAs, which were validated by individual RT-qPCR. To overcome normalization issues and to improve the accuracy of the results, a ratio analysis combining paired up-regulated and down-regulated miRNAs was performed. Although 21/50 miRNA expression ratios were significantly different between malignant and borderline tumor samples, any ratio could perfectly discriminate the two groups. However, a combination of 14 pairs of miRNA ratios (double ratio) showed high discriminatory potential, with 100% of accuracy in distinguishing malignant and borderline ovarian tumors, which suggests that miRNAs may hold significant clinical potential as a diagnostic tool. In summary, these ratio miRNA-based signatures may help to improve the precision of histological diagnosis, likely to provide a preoperative diagnosis in order to adapt surgical procedures.

Intraductal papillary mucinous tumors of the pancreas and Von Hippel Lindau disease: A rare association

Intraductal papillary mucinous tumors of the pancreas and Von Hippel Lindau disease: A rare association

Should the Baseline MRI Staging Criteria Differentiate Between Mucinous and Classical Rectal Adenocarcinoma?

To compare baseline MR imaging features for pre-treatment staging between rectal mucinous adenocarcinoma (RMAC) and rectal classical adenocarcinoma (RCAC), and to investigate whether the subtype of mucinous carcinoma influences MRI evaluation criteria and high-risk tumors identifying. A total of 306 patients who underwent surgical rectal cancer resection were retrospectively reviewed in the study. MR imaging parameters of the primary tumor and lymph nodes (LNs) were compared between two subtypes. Logistic regression and receiver operating characteristic analyses were performed to test significant associations between LN imaging parameters and malignant LN status in RMAC and RCAC, respectively. The length of mucinous tumors was larger than RCAC tumors in pT3 and pT4 stage. For pN0 patients, the long and short diameters of the largest LN on MRI were more likely to be larger in RCAC than RMAC. For pN+patients, the proportion of LNs exhibiting internal heterogeneity in RMAC was obviously greater than that in RCAC. The best cut-off value of the largest short diameter of malignant LNs was 6.05mm for RMAC and 8.05mm for RCAC. And the highest AUC for predicting LNs metastases based on the largest short diameter was 0.794 for RMAC using 6mm size cut-off, and 0.667 for RCAC using 8mm cut-off. The imaging features that were associated with LN metastases were different between RMAC and RCAC, and different size criteria of LNs was suggested to distinguish high-risk tumors. Clinicians should stay vigilant of LN status and take histologic subtypes into consideration before assigning clinical strategies.

MUCINOUS CYSTIC TUMOR OF LOW MALIGNANT POTENTIAL THOUGHT TO BE OF URACHAL ORIGIN: A CASE REPORT

Mucinous cystic tumor of low malignant potential (MCTLMP) is a very rare disease.The patient was a 50-year-old man. Contrast-enhanced computed tomography and magnetic resonance imaging showed a multiocular cystic lesion on the top of the bladder. We performed surgery to remove the tumor for definitive diagnosis. Intraoperative rapid pathological diagnosis of the cyst wall showed no malignant findings, so we performed combined resection of the peritoneum and part of the bladder wall.Based on imaging findings, tumor location, and pathological and immunostaining findings (CK20 and CDX2 positivity; β-catenin negativity), the patient was diagnosed with MCTLMP thought to be of urachal origin. After the operation, recurrence was not observed.

Immunohistochemical features of ovarian cancer

Ovarian cancer is the leading cause of death among women with gynecological oncological diseases. Diagnosis at the early stages of the disease allows for better chances of treatment and prognosis of ovarian cancer. It is reflected in the reduction of morbidity and mortality rates. An immunohistochemical study is used for differential diagnosis and accurate establishment of the histotype of ovarian cancer. Objective: to systematize literature data about the immunohistochemical features of ovarian cancer. In 90% of cases, ovarian cancer is epithelial-stromal, among which the main histological types are distinguished: serous (low- and high-grade), endometrioid, mucinous, and clear cell. In serous and other ovarian tumors, cytokeratins (CK) are widely used. CK 7 is present in all tumors, including mucinous tumors, expressing CK 20. Mucinous tumors also express villin and are negative for CDX-2. Endometrioid tumors react positively to vimentin, which is not observed in serous and mucinous tumors. Clear cell carcinoma expresses CK 8, 18, and EMA (epithelial membrane antigen).Conclusion. Therefore, immunohistochemical features of ovarian cancer ensure accuracy in the differential diagnosis of one or another histological type.

Successful delivery after in vitro fertilization-embryo transfer in a woman with metachronous primary cancer of ovary and endometrium: a case report

BackgroundThe appearance of malignancies at various times in the same individual, excluding metastases of the initial primary cancer, is termed multiple primary cancers. Double primary gynecological cancers cause inevitable damage to female reproductive function, and the preservation of fertility in such patients remains a challenging issue as relatively few cases have been reported. This case report provides management options for dual primary ovarian and endometrial cancers, including the choice of ovulation induction protocols, considerations during pregnancy and parturition, with the aim of providing assistance to clinicians.Case presentationWe report a case of a 39-year-old woman with primary infertility and a medical history of right-sided ovarian mucinous borderline tumor with intraepithelial carcinoma, left-sided ovarian mucinous cystadenoma and endometrial cancer, who successfully conceived with in vitro fertilization-embryo transfer (IVF-ET) after three different ovulation induction protocols. During her pregnancy, she was complicated by central placenta praevia with placental implantation and eventually delivered a healthy female infant by caesarean section at 33 gestational weeks.ConclusionsFor patients with double primary gynecological cancers who have an intense desire for fertility, the most appropriate oncological treatment should be applied according to the patient’s individual situation, and fertility preservation should be performed promptly. Ovulation induction protocol should be individualized and deliberate, with the aim of ensuring that the patient’s hormone levels do not precipitate a recurrence of the primary disease during induction of ovulation and maximizing fertility outcomes. In addition, the risk of postpartum hemorrhage due to placental factors cannot be neglected in such patients.