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Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report

RATIONALE: Sarcomatous or anaplastic carcinoma mural nodules presenting in ovarian mucinous cystic tumors are very rare. Here, we reported the ultrasonic and pathological features of 2 such cases. PATIENT CONCERNS: A 60-year-old woman presented with a complaint of lower abdominal pain. Physical exam...

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Autores principales: Zhang, Yan, Yuan, Zheng, Sun, Kai, Li, Peifeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690793/
https://www.ncbi.nlm.nih.gov/pubmed/29137100
http://dx.doi.org/10.1097/MD.0000000000008636
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author Zhang, Yan
Yuan, Zheng
Sun, Kai
Li, Peifeng
author_facet Zhang, Yan
Yuan, Zheng
Sun, Kai
Li, Peifeng
author_sort Zhang, Yan
collection PubMed
description RATIONALE: Sarcomatous or anaplastic carcinoma mural nodules presenting in ovarian mucinous cystic tumors are very rare. Here, we reported the ultrasonic and pathological features of 2 such cases. PATIENT CONCERNS: A 60-year-old woman presented with a complaint of lower abdominal pain. Physical examination revealed a hard, palpable mass in her right lower abdomen with mild tenderness. In addition, a 48-year-old woman presented with left abdominal pain and abdominal fullness. Physical examination revealed a palpable mass in her left lower abdomen. DIAGNOSES: The diagnosis of ovarian mucinous cystic tumor (including mucinous cystadenoma, mucinous cystadenoma of borderline malignancy, and intraepithelial carcinoma) associated with the sarcomatous mural nodule was made for the first patient. The mass of the second patient was mucinous cystic tumor (including mucinous cystadenoma, borderline malignant mucinous cystadenoma, and mucinous cystadenocarcinoma) associated with sarcoma-like mural nodules and multifocal anaplastic carcinoma. INTERVENTIONS: Both patients underwent bilateral salpingo-oophorectomy and omentectomy. In addition, appendectomy was also performed for the younger patient. OUTCOMES: Ultrasonic imaging showed huge pelvic cavity mixed masses with reticular or petaloid fluid sonolucent areas, uneven thickness separation, and multiple various mural nodules. The internal echo of the masses was complex and varied. The ultrasonic features of mural nodules were characteristic, including irregular shape, rough surface, wide basement, and nonuniform internal echogenicity. Pathological examination revealed multiple nodules with obvious atypia and mucinous cystic tumors with different malignancy. Sarcomatous or anaplastic carcinoma mural nodules showed irregular structure, significant cell atypia, and noticeable mitoses. The discovery of vascular invasion has an important role in the diagnosis of sarcomatous mural nodules. Immunohistochemical features of positive cytokeratin and negative vimentin can identify the anaplastic carcinoma component from the bizarre stromal components of the nodule. LESSONS: Ultrasonography was helpful to evaluate the preoperative diagnosis and determining the surgical approach, and pathology was indispensable to the diagnosis of these diseases.
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spelling pubmed-56907932017-11-28 Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report Zhang, Yan Yuan, Zheng Sun, Kai Li, Peifeng Medicine (Baltimore) 5600 RATIONALE: Sarcomatous or anaplastic carcinoma mural nodules presenting in ovarian mucinous cystic tumors are very rare. Here, we reported the ultrasonic and pathological features of 2 such cases. PATIENT CONCERNS: A 60-year-old woman presented with a complaint of lower abdominal pain. Physical examination revealed a hard, palpable mass in her right lower abdomen with mild tenderness. In addition, a 48-year-old woman presented with left abdominal pain and abdominal fullness. Physical examination revealed a palpable mass in her left lower abdomen. DIAGNOSES: The diagnosis of ovarian mucinous cystic tumor (including mucinous cystadenoma, mucinous cystadenoma of borderline malignancy, and intraepithelial carcinoma) associated with the sarcomatous mural nodule was made for the first patient. The mass of the second patient was mucinous cystic tumor (including mucinous cystadenoma, borderline malignant mucinous cystadenoma, and mucinous cystadenocarcinoma) associated with sarcoma-like mural nodules and multifocal anaplastic carcinoma. INTERVENTIONS: Both patients underwent bilateral salpingo-oophorectomy and omentectomy. In addition, appendectomy was also performed for the younger patient. OUTCOMES: Ultrasonic imaging showed huge pelvic cavity mixed masses with reticular or petaloid fluid sonolucent areas, uneven thickness separation, and multiple various mural nodules. The internal echo of the masses was complex and varied. The ultrasonic features of mural nodules were characteristic, including irregular shape, rough surface, wide basement, and nonuniform internal echogenicity. Pathological examination revealed multiple nodules with obvious atypia and mucinous cystic tumors with different malignancy. Sarcomatous or anaplastic carcinoma mural nodules showed irregular structure, significant cell atypia, and noticeable mitoses. The discovery of vascular invasion has an important role in the diagnosis of sarcomatous mural nodules. Immunohistochemical features of positive cytokeratin and negative vimentin can identify the anaplastic carcinoma component from the bizarre stromal components of the nodule. LESSONS: Ultrasonography was helpful to evaluate the preoperative diagnosis and determining the surgical approach, and pathology was indispensable to the diagnosis of these diseases. Wolters Kluwer Health 2017-11-10 /pmc/articles/PMC5690793/ /pubmed/29137100 http://dx.doi.org/10.1097/MD.0000000000008636 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 5600
Zhang, Yan
Yuan, Zheng
Sun, Kai
Li, Peifeng
Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report
title Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report
title_full Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report
title_fullStr Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report
title_full_unstemmed Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report
title_short Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: Two cases report
title_sort ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules: two cases report
topic 5600
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690793/
https://www.ncbi.nlm.nih.gov/pubmed/29137100
http://dx.doi.org/10.1097/MD.0000000000008636
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