Sarcoma-like mural nodules combined with a microfocus of anaplastic carcinoma in mucinous ovarian tumor

A case of mucinous ovarian tumor with sarcoma-like mural nodules, one of which coexisted with a microfocus of anaplastic carcinoma, was studied by light, electron microscopic, and histochemical examinations. The case suggested that the formation of sarcoma-like mural nodules may be the result of the proliferation of undifferentiated mesenchymal cells which exist beneath the mucinous epithelium by some stimulation like hemorrhage in the cyst wall. Histologically, the mononucleated cells composing the sarcoma-like mural nodules had epithelioid characteristics, particularly at the areas where the covering mucinous epithelium had already detached. The case also suggested that the findings of epithelioid characteristics in the sarcoma-like mural nodules themselves do not imply these nodules to be anaplastic carcinoma, but merely an epithelioid differentiation from undifferentiated mesenchymal cells, namely one of reactive products. However, the existence of a microfocus of anaplastic carcinoma combined with the sarcoma-like mural nodule necessitates a careful histologic analysis of mural nodules for the treatment of patients and the determination of the prognosis.     

Ovarian mucinous tumor with mural nodules of anaplastic carcinoma

A case of mucinous cystic ovarian tumor with mural nodules of anaplastic carcinoma in a 30-year-old woman is described. The carcinomatous components within the nodules showed strong immunopositivity for cytokeratin and carcinoembryonic antigen, and ultrastructurally they displayed epithelial and glandular differentiation. Omental metastasis had already developed in the patient, and she received postoperative adjuvant chemotherapy consisting of cyclophosphamide and cis-platinum. No sign of recurrence was evident 4 months after the operation. The literature is reviewed and the importance of adjuvant chemotherapy in the postoperative management of such patients highlighted. The salient pathologic features differentiating mural nodules of anaplastic carcinoma and true sarcoma from prognostically favorable sarcoma-like nodules are presented.     

An ovarian mucinous borderline tumour with mixed mural nodules

The occurrence of mural nodules in serous or mucinous ovarian tumours is not frequent. Mural nodule can be developed in benign, borderline or malignant tumours. They can be benign, malignant or mixed type. Thus the prognosis of the ovarian tumour can be dramatically modified by the presence if these nodules. Eighty-two cases of mural nodules were reported in the literature, among which we account four cases of mixed nodules type. We report an additional case of mixed type mural nodules of anaplastic carcinoma and sarcoma-like developed in an ovarian mucinous borderline tumour at a 60-year-old woman.We give details about the classification, the differential diagnosis and prognosis of theses nodules.     

Anaplastic nodules in an ovarian mucinous tumor. Case report and literature review

The case of a 38-year-old woman with an ovarian mucinous cyst that contained solid nodules of anaplastic carcinoma is described. Hitherto, only 17 cases of this aggressive type of ovarian tumor have been reported. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and a para-aortic and pelvic lymphadenectomy. The tumor was classified as FIGO Stage Ic. On flow cytometry the tumor was DNA diploid. Also, on image analysis the regions with well- differentiated carcinoma and the regions with anaplastic nodules were DNA diploid. No adjuvant treatment was given. There is no evidence of disease 30 months after diagnosis.     

Immunohistology of a sarcomatous mural nodule in an ovarian mucinous cystadenocarcinoma

Mucinous tumors of the ovary are incidentally associated with ovarian sarcoma. Several cases of sarcoma-like mural nodules in ovarian mucinous tumors have been described previously, but only two well-documented cases of true sarcoma were reported. The purpose of this article is to report a case of sarcoma occurring in ovarian mucinous neoplasm, which differs histologically from the two cases described earlier. This case is the first of its kind with immunohistochemical characterization.     

Malign mural nodules associated with serous ovarian tumor of borderline malignancy: a case report and literature review

Background  

Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare.     

Carcinosarcoma-like mural nodule in intestinal-type mucinous ovarian of borderline malignancy: a case report

Epithelial ovarian tumors of borderline malignancy are tumors with histologic features and biologic behavior between benign and frankly malignant epithelial ovarian neoplasms. To date, we cannot accurately predict the patients who are prone to an aggressive course of disease. Here, we present a 35-year-old patient with carcinosarcoma-like mural nodule in intestinal-type mucinous ovarian tumor of borderline malignancy. Foci of intraepithelial carcinoma (about 10%) without stromal invasion are also noted. Total hysterectomy, bilateral salpingo-oophorectomy, appendectomy, and omentectomy were performed, and the frozen pathology during operation showed mucinous tumor of borderline malignancy of left ovary on April 18, 2002. The patient was followed at our outpatient department for 19 months after operation and was free of the disease without any adjuvant chemotherapy. It is difficult to determine whether intestinal-type borderline mucinous tumors with intraepithelial carcinoma are associated with a worse prognosis compared with those with epithelial atypia alone due to disparate results in the published literature. In contrast, most patients with mural nodules of anaplastic carcinoma have had a malignant, often rapid, course. However, too few cases of carcinosarcoma-like mural nodule in mucinous tumor have been published to warrant a conclusion regarding their prognosis.     

Anaplastic Carcinoma Arising From Ovarian Mucinous Adenocarcinoma With Massive Cardiopulmonary Metastasis: An Autopsy Case Report

Background

The presence of anaplastic and sarcomatoid components in ovarian mucinous carcinoma is extremely rare.

Ovarian serous tumor with mural nodules of carcinomatous derivation (sarcomatoid carcinoma): report of a case

An ovarian serous cystic tumor of low malignant potential with solid mural sarcoma-like nodules is reported. This tumor metastasized to the ileal wall. The nodules in the ovary and in the ileal wall were made up of highly malignant cells with admixed osteoclast-like multinucleate giant cells. Immunohistochemical reactions demonstrated the epithelial differentiation of the tumor. We propose that the term "sarcomatoid carcinoma" of the ovary should be adopted for these lesions.     

Anaplastic carcinoma arising in an ovarian mucinous cystadenocarcinoma in a 17-year-old female

BACKGROUND: Anaplastic carcinoma arising within a mucinous ovarian neoplasm is rare, with only about 30 reported cases. Reported cases have given a broad age range, ranging from 17 to 72 years of age, but occurrence in adolescents is exceptional, with only a few cases reported. CASE: We report a case of anaplastic carcinoma arising in a mucinous cystadenocarcinoma in a 17-year-old female who presented with severe abdominal pain, an unusual symptom for an ovarian malignancy in the postmenopausal patient, but not in the adolescent. The patient had widespread metastases at the time of presentation, consistent with the aggressive behavior of this neoplasm. CONCLUSIONS: This case illustrates that, although rare, epithelial ovarian malignancy is in the differential diagnosis of abdominal pain in an adolescent.     

Ovarian mucinous cystic tumor of borderline malignancy with a mural nodule of anaplastic spindle cell carcinoma: a case report

Ovarian cystic tumors with a mural nodule are a rare entity. We report a case of a mural nodule of anaplastic spindle cell carcinoma in an ovarian mucinous cystic tumor of borderline malignancy. The patient was a 45-years-old Japanese woman who presented with an ovarian cyst. She suffered from mature cystic teratoma of both ovaries 9 years before the present history. Image analysis and laboratory data showing a high serum CA19-9 level suggested ovarian malignancy. She underwent bilateral salpingo-oophorectomy with hysterectomy and omentectomy. There was a mural nodule in the ovarian mucinous cystic lesion. Microscopically, the nodule was composed of spindle-shaped cells with severe nuclear atypia. Immunohistochemical analysis allowed the cells to be categorized as anaplastic spindle cell carcinoma. Fifteen months after the operation the patient is alive without any clinical findings of tumor recurrence. To the best of our knowledge in the English literature, this is the first report of a mural nodule of an anaplastic spindle cell carcinoma within an ovarian mucinous cystic borderline tumor harboring previously confirmed cystic teratoma.     

Aggressive behavior of stage I ovarian mucinous tumors lacking extensive infiltrative invasion: a report of four cases and review of the literature.

Previous studies have indicated that mucinous carcinomas of the ovary associated with extraovarian spread at the time of presentation or follow-up almost always have extensive infiltrative invasion within the primary tumor. We present four cases of stage I ovarian mucinous tumors that lacked extensive infiltrative invasion but were associated with an unexpectedly aggressive behavior. The patients were 18, 20, 41, and 45 years of age at presentation. All four of them presented with an abdominal mass or increased abdominal girth. The tumors were all stage Ia, 17 to 37 centimeters in maximal dimension, and typically multicystic with solid areas. The number of blocks per centimeter of tumor diameter was 0.65, 0.88, 0.92, and 1.0 in the four tumors, respectively, a degree of sampling within that recommended in previous studies. Clinical findings supported that they were primary tumors rather than metastatic from an occult primary tumor. On microscopic examination, the tumors all contained foci of intraepithelial carcinoma and foci of invasion as follows: expansile invasion only (two cases), expansile invasion and microinvasive carcinoma (one case), and microinvasive carcinoma only (one case). The expansile invasion was extensive in each of the three cases in which it was present. On follow-up, each patient experienced recurrent disease 7 months to 4.5 years after diagnosis, including hematogenous spread to lung and/or bone and liver in three patients. Three of four patients developed intraperitoneal spread. Three of four patients died of disease, and one patient is alive with persistent disease. Although ovarian mucinous tumors with only expansile invasion or only microinvasive carcinoma are usually associated with an excellent prognosis, this study indicates that these tumors can rarely behave in an aggressive fashion with hematogenous spread and a fatal outcome. Some of these tumors may have contained unsampled foci of infiltrative invasion. Although the optimum level of sampling in mucinous tumors remains to be determined, we recommend additional sampling of tumors in which the initial sections reveal intraepithelial carcinoma, microinvasive carcinoma, expansile invasion, or combinations thereof.     

Ovarian mucinous and mixed epithelial carcinomas of mullerian (endocervical-like) type: a clinicopathologic analysis of four cases of an uncommon variant associated with endometriosis.

The epithelial cells of ovarian mucinous carcinomas may sometimes appear similar to those of gastrointestinal or endocervical mucinous carcinomas, but most are composed of cells that do not suggest any particular derivation. We report four cases of mucinous ovarian carcinoma in which the cells were entirely or almost entirely endocervical-like. The patients' ages were 34, 43, 44, and 50 years. Two patients had bilateral tumors confined to the ovaries at initial staging; both also had synchronous endometrial carcinomas of the mucinous type. The two other patients had unilateral tumors, both with invasive metastases in the pelvis and abdomen at initial staging. In one of the latter cases a mullerian (endocervical-like) mucinous borderline tumor (MMBT) of the opposite ovary had been removed 5 years earlier, and in this case and two other cases the ovarian carcinomas had foci resembling MMBT, suggesting that they may be an invasive counterpart to these tumors. The six tumors ranged from 4 to 19 cm; five were grossly cystic with papillary or solid areas, and one was entirely solid. They were composed of closely packed glands, cysts, and cysts containing complex papillae. There was abundant intraglandular and intracystic mucin. The epithelial cells were well differentiated with infrequent mitoses and most were tall with mucinous cytoplasm resembling normal endocervical glandular cells. In three tumors there also were round to polygonal cells with eosinophilic cytoplasm; endometrioid foci were present in three tumors and a squamous focus was present in one. One tumor had a focally infiltrative growth pattern with a desmoplastic stromal reaction; the remaining five tumors had an exclusively confluent (expansile) pattern of invasion. Endometriosis was present in residual ovarian tissue adjacent to four tumors in three patients and had marked epithelial proliferation in three. All patients were treated postoperatively with chemotherapy and were without clinical recurrence with follow-up intervals of 8 months, 1.2 years, 2.9 years, and 3.8 years. By immunohistochemical analysis the neoplastic epithelium was positive for estrogen and progesterone receptor proteins, vimentin, and cytokeratin 7, and negative or only focally positive for carcinoembryonic antigen and cytokeratin 20, a profile that differs from that of the usual mucinous ovarian carcinoma and is supportive of a mullerian derivation. As with MMBTs, there was a strong association with endometriosis, and these tumors likely arise from endometriosis, possibly through an MMBT precursor in some cases. To better understand their clinicopathologic features and pathogenesis, this uncommon variant should be separated from the usual type in future studies of mucinous carcinomas of the ovary.     

A rare case of the coexistence of ovarian clear cell carcinoma, mucinous cystadenoma, and endometriosis in the same ovary

Clear cell carcinomas and endometrioid carcinomas are associated with endometriosis. The association of clear cell carcinomas with mucinous lesions has only been reported infrequently, and with mucinous cystadenoma has been rarely reported. This is the second reported case of the coexistence of ovarian clear cell carcinoma, mucinous cystadenoma, and endometriosis in the same ovary. A 57-year-old woman presented with lower abdominal pain for three weeks. Ultrasonography revealed a 16 x 14 x 10 cm mass in the left ovary with solid and cystic components. Hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathological examination of the left ovary revealed the presence of clear cell carcinoma, mucinous cystadenoma, and endometriosis. Continuity between the areas of mucinous epithelium and clear cell carcinoma were noted; this may suggest that clear cell carcinoma may arise from endometriosis or mucinous cystic tumors.     

Ovarian metastases from carcinoma of the gallbladder and extrahepatic bile ducts simulating primary tumors of the ovary. A report of six cases

Six cases in which ovarian metastases from carcinoma of the gallbladder or bile ducts were discovered during the life of the patient are described. The patients ranged from 33 to 72 (average, 57) years of age. In one case, the ovarian tumor was discovered 5 weeks before a gallbladder carcinoma was detected: in three cases, gallbladder tumors and ovarian metastases were discovered simultaneously; and in two cases, ovarian metastases were recognized 1 and 2 years after the biliary tumors. The ovarian tumors were bilateral in five cases. One of them was a 13-cm multiloculated, cystic neoplasm that simulated a primary mucinous tumor of the ovary. The remaining neoplasms were uniformly or predominantly solid and ranged up to 6.5 cm in diameter. They typically had lobulated external surfaces and were often multinodular on sectioning. Three ovarian tumors posed significant problems in differential diagnosis on microscopic examination. One of them closely simulated an endometrioid carcinoma, another simulated a mucinous cystadeno-carcinoma, and a third suggested the possible diagnosis of a Sertoli-Leydig cell tumor. Features helpful in establishing the metastatic nature of the ovarian tumors in these and the other cases included bilaterality, surface implants, multinodularity, and extraovarian spread. The gallbladder and bile ducts are rare sources of metastatic tumors, which may simulate primary ovarian neoplasms.     

Computed Tomography and Clinical Analysis of Ovarian Mucinous Tumors in Adolescent Patients

Study ObjectiveTo investigate the clinical and computed tomography features of ovarian mucinous tumors in children and adolescents.Design, Setting, and ParticipantsA retrospective analysis of clinical and preoperative computed tomography (CT) data was performed in 59 patients who were 20 years or younger with ovarian mucinous tumors confirmed by histopathology. Patients’ age, medical history, symptoms, tumor marker levels, and CT imaging findings were recorded.InterventionsNone.Main Outcome MeasuresIdentification of the clinical and CT features of ovarian mucinous tumors in pediatric and adolescent patients.ResultsThere were 41 mucinous cystadenomas in 39 cases, 12 borderline mucinous cystadenomas in 11 cases, and 9 mucinous cystadenocarcinomas in 9 patients. A total of 55 tumors were multilocular (55/62, 88.7%), including fewer than 10 loculations in 23 tumors, 10–20 loculations in 17 tumors, and over 20 loculations in 15 tumors. Eleven borderline mucinous cystadenomas were multilocular (11/12, 91.7%), with over 10 loculations in 7 tumors (7/12, 58.3%). Twelve tumors appeared as multilocular cystic-solid (12/62, 19.4%), and a case of mucinous cystadenocarcinoma was predominantly solid (1/62, 1.6%). Seventeen tumors showed honeycomb sign and stained glass appearance. Six mural nodules, with sizes ranging from 1.1 to 3.5 cm (average: 2.8 cm), were found in borderline mucinous cystadenoma and mucinous cystadenocarcinoma.ConclusionsThe CT findings of ovarian mucinous tumors in children are characteristic. The preoperative CT is helpful in making differential diagnoses.     

Immunohistochemical localization of estradiol in malignant epithelial tumors of the ovary

Granulosa cell tumors derived from sexcord-stromal cells are thought to be generally estrogen producing neoplasms. However recent reports show that these common epithelial tumors, adenocarcinomas and Brenner tumors, are capable of estrogen activity. We have studied the production of estrogen in common epithelial malignant tumors of the ovary. Two cases of serous cystadeno-carcinomas, five cases of mucinous cystadeno-carcinomas and two cases of endometrioid carcinomas were examined for the presence of estradiol using an indirect immunoperoxidase method. The results were as follows: In all tumors, one case of serous cystadeno-carcinoma, four cases of mucinous cystadeno-carcinomas and one case of endometrioid carcinoma had a positive immunoperoxidase reaction. The incidence of positive reaction showed that mucinous cystadeno-carcinomas were more numerous than others. In positive cases, estradiol localization was recognized in the epithelial cell of mucinous tumors to various degrees, but there was no estradiol localization in admixed goblet like cells. In serous tumors and endometrioid carcinomas also estradiol localization was seen in the cytoplasm. Stromal cells tended to be more weakly positive than epithelial cells. No estradiol localization was detected in any of the spindle cells or fibrinous connective tissues. These results suggest that some common epithelial malignant tumors of the ovary have estrogen activity and estradiol is produced not only in stromal cells but also in epithelial cells.     

Adenocarcinoma of the endometrium: Analysis of 256 cases with carcinoma limited to the uterine corpus: Pathology review and analysis of prognostic variables

Histologic specimens of all patients undergoing hysterectomy for clinical Stage I adenocarcinoma of the endometrium at Stanford University Hospital between 1959 and 1975 were reexamined. From this group 256 acceptable cases of adenocarcinoma confined to the uterine corpus (Pathologic Stage I) were identified. In patients treated with initial surgery, relapse rate was highly correlated with depth of myometrial invasion (P = 0.0001) and also with the histologic grade of the uterine adenocarcinoma (P = 0.008). Twenty-six patients (10%) had lesions with papillary architecture and anaplastic cytology similar to papillary serous carcinoma of the ovary. These women with uterine papillary serous carcinoma (UPSC) had a 50% relapse rate and accounted for one-half the treatment failures ( ) in the entire study group. Six of the seven upper abdominal relapses in this study were in patients with UPSC, suggesting that this histologic variant may behave more like ovarian serous carcinoma than the usual endometrial adenocarcinoma. Twenty-one patients (9%) had endometrial carcinomas with extensive mucinous differentiation (mucinous carcinoma), while 38% of all the cases of endometrial carcinoma showed at least some focal mucin production. Twenty percent showed focal squamous differentiation. Neither mucinous nor squamous differentiation, as we have applied these designations, were significantly correlated with relapse rate. Among the patients undergoing hysterectomy for clinical Stage I adenocarcinoma, 99 patients were found on review to have lesions which fell short of our current criteria for diagnosis of carcinoma in the uterine corpus and were reinterpreted as metaplasia and/or hyperplasia. None of these patients subsequently developed clinical relapse. The results of this study suggest a need for modification in the FIGO grading system for endometrial cancer and also support a definition of well-differentiated endometrial carcinoma more restrictive than that commonly employed.     

Retroperitoneal primary mucinous adenocarcinoma with a mural nodule of anaplastic tumor: a case report and literature review.

A 38-year-old female presented with a lower abdominal mass. During the operation the mass was found to be retroperitoneal and was excised. Gross examination revealed a mucin-containing cystic lesion with a mural nodule. On microscopic examination, the cystic areas were lined by an invasive mucinous adenocarcinoma and the nodule was composed of an anaplastic sarcomatoid tumor that was immunoreactive for cytokeratin. This present case is the 21st example of a retroperitoneal primary mucinous cystadenocarcinoma and the fourth with a mural nodule. Three of four cases with a mural nodule, including our case, had a rapidly fatal outcome.     

Adenocarcinoma of the uterine cervix with beta-hCG production: a case report and review of the literature

The production of unexpected cell products, including the placental protein human chorionic gonadotrophin (hCG), has been reported in a variety of tumors at different anatomical sites. Some of the reported tumors have also expressed morphological features suggesting choriocarcinoma. Such is the case in this tumor of the uterine cervix which has a major component of anaplastic tumour with beta-hCG production confirmed both by positive staining using immunoperoxidase techniques and by pre- and postoperative serum assays for beta-hCG. The differing immunohistochemical features seen in the two components of the tumor are reported. The relationship of the anaplastic component to the adjacent mucinous adenocarcinoma in the present case, and to similar cases at other sites from the literature, is discussed.