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Uterus (excludes Cervix)

Epithelial tumors

Mucinous Carcinoma

Reviewer: Mohamed Mokhtar Desouki, MD, PhD (see Reviewers page)
Revised: 22 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● Adenocarcinoma with abundant intracellular mucin
● May have enteric features
● May have a microglandular pattern with eosinophilic, mucinous intraluminal secretion and acute inflammation, simulating microglandular hyperplasia
● Mucin should be a predominant component of the tumor since scattered mucin is present in ordinary endometrial adenocarcinoma
● Mucinous carcinomas may be primed by exogenous estrogen therapy

Epidemiology
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● Rare tumor (<1% of endometrial carcinomas, up to 9% of stage I endometrial carcinomas) that affects patients 47-89 years

Etiology
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● Unknown

Clinical features
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● Most patients are menopausal and present with vaginal bleeding, usually not abdominal pain
● Both nulliparous and multiparous women

Prognostic factors
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● Usually FIGO grade 1 and nuclear grade 1 with favorable prognosis (Int J Gynecol Pathol 1987;6:347)

Treatment
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● Total abdominal hysterectomy with pre- and postoperative radiation

Gross description
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● Similar to other low-grade adenocarcinomas at gross examination; may not be grossly apparent
● Visible tumors vary from sessile polyps to nodules or irregular, thickened plaques that may be localized or diffuse

Micro description
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● Intracellular (not intraluminal) mucin is required for diagnosis; best demonstrated with mucicarmine or other mucin stain; however, mucin is easily visible with H&E staining
● Malignant features include architectural complexity of proliferation, epithelial stratification, loss of epithelial polarity, nuclear atypicality (Am J Surg Pathol 1983;7:715)
● Microglandular pattern and intestinal differentiation with goblet cells are different variants
● Low grade tumors also occur (Am J Surg Pathol 2011;35:537)

Micro images
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This invasive adenocarcinoma contains abundant mucin both within lumina and in the cytoplasm of the glandular cells


Irregular, confluent malignant glands are lined by well-differentiated cells containing intracytoplasmic mucin

Cytology description
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● Tumor cells arranged in papillary configuration and tumor cell clusters with bubbles in cytoplasm

Positive stains
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● Mucicarmine (mucin), vimentin, ER; also keratin; may be focally CEA+

Differential Diagnosis
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● Primary, mucinous carcinoma of endocervix: CEA+, negative for vimentin and ER
● Endocervical adenocarcinoma: may need differential biopsy and fractional curettage, not associated with endometrial hyperplasia or metaplasia, no foam cells
● Mucinous metaplasia: no atypia
● Microglandular hyperplasia: benign, no atypia

End of Uterus > Epithelial tumors > Mucinous carcinoma

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