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Seromucinous Tumor of the Ovary

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1 Seromucinous Tumor of the Ovary
Ming-Chieh Lin 林明杰

2 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

3 Ovarian Seromucinous Tumors
Classification: ICD-O codes Benign Seromucinous cyatadenoma /0 Seromucinous adenofibroma /0 Borderline Seromucinous borderline tumor /1 Malignant Seromucinous carcinoma /3

4 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

5 Benign Seromucinous Tumors
Epidemiology 1% of benign epithelial neoplasms Peak age: late reproductive age Clinical features Non-specific Usually diagnosed incidentally

6 Benign Seromucinous Tumors
Macroscopy Unilocular cyst Serous or mucoid fluid Microscopy Variable admixtures of serous and mucinous (endocervical-type) Endometrioid, transitional, squamous

7 Benign Seromucinous Tumors
Histogenesis Likely from endometriosis Prognosis and predictive factors Benign

8 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

9 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

10 Seromucinous Borderline Tumors
Macroscopy Mean size: 8-10 cm Typically unilocular, viscid fluid Papillary projections Often associated with endometriosis Bilateral: 40%

11 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

12 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(+)

13 Serous borderline tumor-100X

14 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

15 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

16 Seromucinous Borderline Tumors
Prognosis and predictive factors Good outcome even with peritoneal implants

17 Endometriosis-associated Tumor
Endometrioid tumor Clear cell tumor Seromucinous tumor

18 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

19 Seromucinous Carcinoma
Epidemiology Quite uncommon Data not available Clinical features Mean age: 45 y/o

20 Seromucinous Carcinoma
Macroscopy Mean tumor size: 12 cm Bilateral: >50% Unilocular or multilocular with papillary projections and solid areas

21 Seromucinous Carcinoma
Microscopy Lack of consensus on diagnostic criteria Immunohistochemically Similar to seromucinous borderline tumor

22 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

23 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

24 FS-100x-Cyst with papillary projections

25 PMN FS-200X Endocervical epithelium Epithelial proliferation

26 FS-200X-epithelial proliferation

27 聯醫1589521-Frozen Section Right ovary, frozen section:
Mucinous borderline tumor, endocervical-like type (Seromucinous borderline tumor)

28 40X-Cyst with papillary projections

29 40X-Cyst with papillary projections

30 200X-endocervical epithelium

31 400X-ciliated cells

32 200X-epithelial proliferation

33 200X-epithelial proliferation

34 400X-Inflammatory cells

35 200X-Endometriosis CD10

36 400X-Atypical endometriosis

37 CK7-100X CK7-200X

38 CK20-100X

39 ER-200X

40 聯醫1589521 Ovary, right, laparoscopic oophorectomy
Mucinous borderline tumor, endocervical type (Seromucinous borderline tumor), associated with endometriosis


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