Ovarian mucinous neoplasms

Ovarian mucinous neoplasms
Updated: 12/06/2018
© Jun Wang, MD, PhD

General feature
  • Tumor with most cells produce mucin
  • Resemble endocervical, gastric or intestinal type epithelium
  • Second most frequent epithelial tumor after serous
  • More common in teenagers and young adults
  • Need to be differentiated from metastatic adenocarcinoma to ovary
Benign mucinous tumors
  • Includes cystadenoma, cystadenofibroma, adenofibroma
  • Various amounts of cysts, glands, and stroma
  • 5% bilateral
  • Associated: Carcinoid tumors in same ovary, dermoid cyst, Brenner tumor, endocervical adenocarcinoma; rarely with Zollinger-Ellison syndrome
  • Excellent prognosis
Mucinous borderline tumor
  • Most commonly intestinal type (morphology similar to intestinal epithelium)
  • Endocervial type (morphology similar to endocervical epithelium) more likely to be bilateral
  • Need to differentiate from metastasis to ovary if high stage
  • Usually good prognosis
Mucinous carcinoma
  • Small portion are ovarian primary
  • Most arising from benign or borderline tumors
  • Most useful serum tumor marker: Carcinoembryonic antigen (CEA), CA19.9
  • Indicators of poor prognosis: Infiltrative invasion, high nuclear grade, tumor rupture
Key morphological features
  • Benign
Smooth surface, multiple cystic spaces, variable amount of solid areas
Usually translucent viscous fluid
Tall, columnar, nonciliated cells with basally located nuclei
Abundant intracellular mucin
NO atypia
  • Borderline
Soft papillary excrescences
Broad, branching papillae (hierarchical branching)
Focally stratified epithelium
More crowded enlarged nuclei
Cytological atypia
Usually NO invasion
  • Malignant
Solid growth
Necrosis
Gelatinous (mucin production)
Marked architectural and cytological atypia, with irregular nuclei and prominent nucleoli
Markers
  • Positive: CEA, CA19.9
  • Negative: WT1, CA125
Molecular abnormality
  • KRAS mutation
Treatment
  • Benign: surgery
  • Borderline: staging, surgery
  • Malignant: staging, surgery, chemo

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