Borderline ovarian tumour of mixed seromucinous histology and bilateral presentation: a case report and review of literature

This article reports the case of a 40 year old woman who presented to the gynaecologic outpatient clinic with pain lower abdomen and an abdominopelvic lump. Clinical assessment, biochemical and radiological investigations revealed bilateral complex ovarian masses. Surgical exploration and histology of ovarian masses confirmed a rare bilateral borderline seromucinous cystadenoma. The purpose of this paper is to highlight the importance of thorough examination of women with symptoms of ovarian tumour which can be vague and to emphasize the necessity of a good collaboration between various medical specialties (primary physician/gynaecologist, oncosurgeon, radiologist and histopathologist) for correct diagnosis, optimum care and best outcome. This article also provides overview of the pathology and biology of borderline ovarian tumours, diagnosis, principles of surgical management and to appreciate the value of follow up.

Clinicopathological features of ovarian borderline seromucinous tumor / 中国医师进修杂志

Objective To investigate the clinicopathological features of ovarian borderline seromucinous tumor. Methods The clinical data of 22 ovarian borderline seromucinous tumor from April 2015 to March 2018 were retrospectively analyzed. The clinicopathological features were summarized by immunohistochemical staining with EnVision method. Results The age of patients was 23 to 66 years, with an average age of 39.2 years and a median age of 36 years. In the 22 patients, 14 patients were found by physical examination, 7 patients had abdominal discomfort or irregular vaginal bleeding, 4 patients had a history of dysmenorrheal, and 5 patients had cancer antigen 125 and/ or carcinoembryonic antigen elevation. Ultrasonography revealed mass in the adnexal region. The average diameter of these tumors was 7.2 cm. The tumors were cystic or cystic solid property and contained viscid or hemorrhagic fluid, with endogenous or exogenous papilla. Microscopically, these tumors showed complex papillary architecture and the larger papillae tended to have edematous stroma containing neutrophils. The epithelium lining the papillae was typically stratified and mostly composed of endocervical-type mucinous or serous epithelium, but endometrioid epithelium was not unusual. Eleven patients had endometriosis, and 2 cases occurred peritoneal or omental tumor implantation respectively. Immunohistochemistry showed that the estrogen receptor (ER), progesterone receptor (PR), paired box gene (PAX) 8 and cytokeratin (CK) 7 were positive in different degrees, and the CK20 and tail-type homeobox gene (CDX) 2 were negative in all patients. Twenty patients were International Federation of Gynecology and Obstetrics (FIGO)Ⅰstage without recurrence or metastasis in 3 to 36 months (average 13.6 months)′ follow-up. Conclusions Most patients with the ovarian borderline seromucinous tumor are young without specific clinical symptoms. Tumor is associated with endometriosis and maybe has characteristic histological changes. Attention should be paid to the differentiation from borderline serous and mucinous tumor before the final diagnosis. Most patients with ovarian borderline seromucinous tumor are FIGO Ⅰ stage and have the good prognosis. The clinical treatment is referred to the treatment of borderline endometrioid tumors.

Seromucinous component in endometrioid endometrial carcinoma as a histological predictor of prognosis / 부인종양

OBJECTIVE: In 2014 World Health Organization criteria, seromucinous carcinoma was defined as a new histological subtype in ovarian carcinomas, but “seromucinous carcinoma” was not defined in endometrial carcinomas. The aim of this study was to identify seromucinous carcinoma resembling ovarian seromucinous carcinoma in endometrial carcinomas, and to evaluate the clinical significance for prognoses of the patients. METHODS: Central pathological review was conducted for patients with endometrioid carcinoma of the endometrium treated by primary surgery at our hospital between 1990 and 2013. RESULTS: Among 340 cases included in the study, no case had all tumor cells resembling ovarian seromucinous carcinoma in all specimens, and 31 cases (9.1%) had seromucinous component in combination with endometrioid carcinomas. Immunohistochemical analysis revealed seromucinous component had positive reactivity for cytokeratin (CK) 7, and negative reactivity for CK20 and caudal type homeobox 2 (CDX2) in all cases. Seromucinous component showed lower immunoreactivity of estrogen receptor and progesterone receptor, compared with endometrioid carcinoma component. Progression-free survival of the cases with seromucinous component was better than those without seromucinous component (p=0.049). CONCLUSION: Seromucinous component was identified in approximately 10% of endometrioid carcinoma, and could be a histological predictor for prognosis.

Clinicopathological characteristics of ovarian seromucinous borderline tumor / 肿瘤研究与临床

Objective To explore the clinicopathological characteristics,immunohistochemical phenotype and differential diagnosis of ovarian seromucinous borderline tumor.Methods Fifteen cases of ovarian seromucinous borderline tumor in Shanxi Provincial People's Hospital from January 2013 to May 2017 were collected.The surgical specimens were observed after HE and immunohistochemical staining,the patients were followed-up,and the relevant literature was reviewed.Results The age of 15 cases of ovarian seromucinous borderline tumor ranged from 26 to 56 years(mean 37 years).Eight cases occurred in the right,5 cases occurred in the left,only 2 cases were bilateral tumors.The complaint of most patients was abdominal distention,3 cases was ascites.The maximum diameter of these tumors ranged from 4 to 13 cm(mean 9.3 cm).Grossly,15 cases mainly showed cystic performance,varying amounts of papillae inside wall of the cysts.Small region of 2 cases were solid.Microscopically,9 tumors were composed of endocervical-like mucinous epithelium,4 tumors were endocervical-like mucinous epithelium and serous epithelium.2 cases were accompanied with endometriosis.Tumor cells mainly expressed estrogen receptor(ER),progesterone receptor(PR),paired box gene protein 8(PAX-8),cytokeratin 7(CK7),these markers were immunophenotypes of Mullerian tumors.Followed up for 3 to 24 months(mean 16.7 months),2 cases showed bilateral tumors,1 case was peritoneal implantation.No tumor recurrence was found in the remaining 12 cases.Conclusions Different from mucinous borderline tumor,ovarian seromucinous borderline tumor possesses relative special clinicopathological features,morphological and immunohistochemical phenotypes,with better prognosis.Combination of immunohistochemical markers ER,PR,PAX-8,CK7,CK20,Vimentin,CDX-2 and WT-1 can make an accurate diagnosis of this tumor.