Ovary
Seromucinous tumors
Seromucinous cystadenoma and adenofibroma
Authors: Aysha Mubeen, M.D., Arun Gopinath, M.D.
Editorial Board Member: Gulisa Turashvili, M.D., Ph.D.
Deputy Editor-in-Chief: Jennifer A. Bennett, M.D.
Last author update: 21 November 2022
Last staff update: 24 December 2022
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Seromucinous cystadenoma
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Clinical features | Diagnosis | Radiology description | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1Cite this page: Mubeen A, Gopinath A. Seromucinous cystadenoma and adenofibroma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovaryseromucinouscystadenoma.html. Accessed April 26th, 2024.
Definition / general
- Rare, benign ovarian epithelial tumors exhibiting admixture of 2 or more Müllerian type epithelia (mucinous, serous and endometrioid), each accounting for at least 10% of the epithelium
Essential features
- Benign ovarian neoplasms with admixture of 2 or more Müllerian type epithelia, each accounting for 10% or more
- Mucinous, serous and endometrioid cell types
- Mean age 62 years (Histopathology 2021;78:445)
- Association with endometriosis
Terminology
- Müllerian mucinous cystadenoma (preferred by some authors to reflect association with endometriosis, endometrioid and clear cell tumors rather than serous tumors of the ovary)
ICD coding
- ICD-10: D27 - benign neoplasm of ovary
Epidemiology
- Rare tumors
Clinical features
- Detected incidentally during work up of other gynecological diseases
- May present with an abdominal mass, abdominal pain or swelling
- Unilateral / bilateral (bilateral in 40% of cases) (Int J Gynecol Pathol 2022;41:68)
- Mean size is 9 cm, generally smaller than intestinal type neoplasms (Int J Gynecol Pathol 2022;41:68)
Diagnosis
- Microscopic examination
Radiology description
- Unilocular / multilocular cystic masses (J Comput Assist Tomogr 2019;43:119)
Treatment
- Surgery (cystectomy or oophorectomy)
Gross description
- Cystic masses (unilocular or multilocular)
- Seromucinous cystadenofibroma are solid with a fibrous cut surface
Microscopic (histologic) description
- Single layered epithelial lining with occasional stratification
- Cell types: mucinous (endocervical in appearance), serous (ciliated), endometrioid (nonserous, nonciliated), hybrid morphology (serous and mucinous) (Histopathology 2021;78:445)
- Variable degree of papillae (epithelial papillary tufting or broader papillae with fibrovascular core) (Int J Gynecol Pathol 2022;41:68)
- Neutrophilic infiltrate may be present
- Endometrioid epithelium may have squamous metaplasia
- Some tumors have a prominent fibrous stromal component (classified as seromucinous adenofibroma)
- Associated with endometriosis in 27 - 36% of cases (Histopathology 2021;78:445, Int J Gynecol Pathol 2022;41:68)
Microscopic (histologic) images
Contributed by Gulisa Turashvili, M.D., Ph.D.
Cyst wall lined by simple epithelium
Cyst wall lined by simple epithelium consisting of serous type ciliated cells admixed with endocervical type mucinous cells
Sample pathology report
- Right ovary, cystectomy / oophorectomy:
- Seromucinous cystadenoma
Differential diagnosis
- Serous cystadenoma:
- Lined by nonstratified tubal type epithelium
- Mucinous cystadenoma:
- Lined by nonstratified mucinous epithelium with intestinal differentiation (goblet cells)
- Seromucinous borderline tumor:
- Epithelial proliferation > 10%, complex architecture, papillae with hierarchical branching, edematous papillae with neutrophils
- Metastatic tumors:
- Low grade appendiceal mucinous neoplasms, pancreatic adenocarcinoma, endocervical adenocarcinoma, etc.
- Morphology and immunohistochemical panels are helpful
- Low grade appendiceal mucinous neoplasms, pancreatic adenocarcinoma, endocervical adenocarcinoma, etc.
Additional references
Board review style question #1
Seromucinous cystadenoma of ovary is associated with which of the following conditions?
- Endometriosis
- Hypercalcemia
- Isochromosome 12p
- Peutz-Jeghers syndrome
Board review style answer #1
