Ovary tumor
Mucinous tumors
Mucinous cystadenocarcinoma / carcinoma

Authors: Shahrzad Ehdaivand, M.D. (see Authors page)

Revised: 20 May 2016, last major update July 2012

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PubMed Search: Ovarian mucinous carcinoma
Cite this page: Mucinous cystadenocarcinoma / carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarytumormucinouscarcinoma.html. Accessed October 28th, 2016.
Definition / General
  • 77% of ovarian mucinous carcinomas are metastases, 23% are ovarian primaries (Am J Surg Pathol 2003;27:985)
  • Of the ovarian primaries, most arise in a benign or borderline tumor; only 5-10% are pure
  • Features favoring primary ovarian carcinoma vs. metastasis are: unilateral, "expansile" pattern of invasion, complex papillary pattern, size > 10 cm, smooth external surface, microscopic cystic glands, necrotic luminal debris, mural nodules and accompanying teratoma, adenofibroma, endometriosis or Brenner tumor (Am J Surg Pathol 2003;27:281)
  • Stromal invasion > 10 mm2 distinguishes these tumors from borderline tumors
  • Two types of invasion - expansile or infiltrative:
    • Expansile tumors are usually stage I and behave "benign"
    • Infiltrative tumors may demonstrate malignant behavior and cause death even if stage I (Am J Surg Pathol 2002;26:139)
Clinical Features
  • Distant metastases are rare
  • Survival: 95% for stage I vs. 32% for stages II or greater
Prognostic Factors
  • Poor prognostic factors for stage I tumors: infiltrative invasion (destructive stromal invasion, Mod Pathol 2005;18:903), high nuclear grade, tumor rupture
  • Anaplastic components in intact tumors do not affect prognosis (Am J Surg Pathol 2002;26:139)
Gross Description
  • Primary tumors are usually unilateral, > 10 cm, smooth capsule, cystic and solid areas of tumor evenly distributed throughout ovary without discrete nodularity
Gross Images

Images hosted on PathOut server:

Mucinous cystadenocarcinoma

Gelatinous with extensive hemorrhage and necrosis

Mucinous cystic tumor with benign, borderline and carcinomatous components

Micro Description
  • Stromal invasion; also more solid growth, atypia, stratification, papillae, loss of glandular architecture, necrosis (resembles colon carcinoma), greater complexity of glands than borderline tumors
  • Stromal invasion may be infiltrative with disorderly penetration of stroma by neoplastic glands, single cells or cell clusters, may have desmoplastic response or expansile (confluent) with complex arrangement of glands, cysts or papillae lined by malignant epithelium with minimal or no intervening stroma with a broad, sharply defined border
  • Glands are almost always intestinal type
  • Endocervical type usually has other epithelial components (serous, endometrioid, squamous)
  • Carcinoma often merges with borderline or benign mucinous tumors
  • Rarely has signet ring cells, but differs from Krukenberg tumor (Am J Surg Pathol 2008;32:1373)

  • Grading:
    • Not standardized, and does not predict prognosis independent of stage (Am J Surg Pathol 2000;24:1447)
    • Grade 1-no solid areas
    • Grade 2-up to 50% solid foci
    • Grade 3-more than 50% solid foci
    • Severe nuclear atypia can increase raise grade I or II carcinomas by one grade
Micro Images

Images hosted on PathOut server:

Cribriform pattern

Resembling endometrioid adenocarcinoma

Mostly apical mucin, but several goblet cells with red mucin

With microinvasion of stroma

Disorderly arrangement of cysts and glands of irregular shapes

Invasive small glands and small collections of signet-ring cells

Cyst lined by cells with abundant mucin and highly stratified; nuclei highly atypical and presence of necrotic debris in lumen

Resembling mucinous (colloid) carcinoma of intestine

Images hosted on other servers:

Destructive invasion

Expansile invasion

Indeterminate for invasion

Mucinous cystadenocarcinoma

Positive Stains
  • CEA, CK7, CK20, CA125 (weak)
Molecular / Cytogenetics Description
  • K-ras mutations are common
Differential Diagnosis
Additional References