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Seromucinous Tumor of the Ovary
Ming-Chieh Lin 林明杰
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Ovarian Mucinous Tumors
Definition Taditional: Ovarian tumors some or all of whose epithelial cells contain intracytoplasmic mucin Endocervix (endocervical-like, Mullerian type) Gastrointestinal 2014 WHO Mucinous tumor Gastrointestinal epithelium Seromucinous tumor Endocervical-type mixed with serous or other Mullerian cell types
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Ovarian Seromucinous Tumors
Classification: ICD-O codes Benign Seromucinous cyatadenoma /0 Seromucinous adenofibroma /0 Borderline Seromucinous borderline tumor /1 Malignant Seromucinous carcinoma /3
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Benign Seromucinous Tumors
Definition: A benign ovarian tumor with endocervical-type mucinous and tubal-type (serous) cells or more Mullerian cell types, all accounting for at least 10% of the epithelium. Synonym Seromucinous cystadenoma (adenofibroma) Mullerian cystadenoma of mixed cell types
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Benign Seromucinous Tumors
Epidemiology 1% of benign epithelial neoplasms Peak age: late reproductive age Clinical features Non-specific Usually diagnosed incidentally
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Benign Seromucinous Tumors
Macroscopy Unilocular cyst Serous or mucoid fluid Microscopy Variable admixtures of serous and mucinous (endocervical-type) Endometrioid, transitional, squamous
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Benign Seromucinous Tumors
Histogenesis Likely from endometriosis Prognosis and predictive factors Benign
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Seromucinous Borderline Tumors
Definition A non-invasive, proliferative epithelial tumor composed of more than one epithelial cell type, most often serous and endocervical-type mucinous; however, endometrioid, and less often, clear cell, transitional or squamous may be seen Synonyms Endocervical-type mucinous borderline tumor Mullerian mucinous borderline tumor Atypical proliferative Mullerian tumor
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Seromucinous Borderline Tumors
Epidemiology 15% of all mucinous borderline tumor In the past, these tumors have been considered a subset of mucinous tumor (endocervical type) Clinical features Average age: y/o Non-specific S/S Most are FIGO stage I Rare advanced stage Implants and/or lymph node involvement
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Seromucinous Borderline Tumors
Macroscopy Mean size: 8-10 cm Typically unilocular, viscid fluid Papillary projections Often associated with endometriosis Bilateral: 40%
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Seromucinous Borderline Tumors
Microscopy Architectural features similar to serous borderline tumors Complex papillary architecture branching in a hierarchical manner into progressively smaller papillae Terminating in small detached epithelial tufts Larger papillae Edematous stroma with neutrophils
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Seromucinous Borderline Tumors
Microscopoy Epithelial lining Stratified Low grade nuclear atypia Most are endocervical-type mucinous or serous cells Endometrioid, squamous, transitional, clear cells Goblet cells (-) Often associated with endometriosis Immunohistochemistry CK7(+)/CK20(-)/CDX-2(-) ER(+)/PR(+)
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Serous borderline tumor-100X
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Resembling a serous borderline
tumor with bulbous papillae The papillae are lined by stratified endocervical-like mucinous cells The papillae are line by stratified eosinophilic cells, with numerous PMN in the papillae and mucin
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Seromucinous Borderline Tumors
Histogenesis Data is limited Associated with endometriosis, at least 1/3 cases Mucinous metaplasia ER (+) Similar to endometrioid tumor ARID1A mutation (loss of expression): 1/3 Similar to endometrioid and clear cell carcinoma
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Seromucinous Borderline Tumors
Prognosis and predictive factors Good outcome even with peritoneal implants
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Endometriosis-associated Tumor
Endometrioid tumor Clear cell tumor Seromucinous tumor
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Seromucinous Carcinoma
Definition A carcinoma composed predominantly of serous and endocervical-type mucinous epithelium. Foci of clear , endometrioid and squamous cells Synonyms Endocervical-type mucinous carcinoma Mixed epithelial carcinoma of Mullerian type
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Seromucinous Carcinoma
Epidemiology Quite uncommon Data not available Clinical features Mean age: 45 y/o
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Seromucinous Carcinoma
Macroscopy Mean tumor size: 12 cm Bilateral: >50% Unilocular or multilocular with papillary projections and solid areas
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Seromucinous Carcinoma
Microscopy Lack of consensus on diagnostic criteria Immunohistochemically Similar to seromucinous borderline tumor
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Seromucinous Carcinoma
Prognosis and predictive factors Data limited In one series of 54 cases (Am J Surg Pathol. 2002, 26(12): ) Stage I: outcome is favorable Advanced stage: 50% die of disease
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聯醫1589521 Right ovarian cyst Laparoscopic oophorectomy
40-year-old female Right ovarian cyst Laparoscopic oophorectomy Unilocular cyst, 7 x 5 x 5 cm Multiple small papillary projections
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FS-100x-Cyst with papillary projections
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PMN FS-200X Endocervical epithelium Epithelial proliferation
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FS-200X-epithelial proliferation
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聯醫1589521-Frozen Section Right ovary, frozen section:
Mucinous borderline tumor, endocervical-like type (Seromucinous borderline tumor)
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40X-Cyst with papillary projections
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40X-Cyst with papillary projections
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200X-endocervical epithelium
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400X-ciliated cells
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200X-epithelial proliferation
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200X-epithelial proliferation
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400X-Inflammatory cells
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200X-Endometriosis CD10
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400X-Atypical endometriosis
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CK7-100X CK7-200X
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CK20-100X
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ER-200X
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聯醫1589521 Ovary, right, laparoscopic oophorectomy
Mucinous borderline tumor, endocervical type (Seromucinous borderline tumor), associated with endometriosis
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