1. Seromucinous Tumor of the Ovary
Ming-Chieh Lin 林明杰

2. Ovarian Mucinous Tumors
Definition
Taditional:
Ovarian tumors some or all of whose epithelial cells contain intracytoplasmic mucin
Endocervix (endocervical-like, Mullerian type)
Gastrointestinal
2014 WHO
Mucinous tumor
Gastrointestinal epithelium
Seromucinous tumor
Endocervical-type mixed with serous or other Mullerian cell types

3. Ovarian Seromucinous Tumors
Classification: ICD-O codes
Benign
Seromucinous cyatadenoma /0
Seromucinous adenofibroma /0
Borderline
Seromucinous borderline tumor /1
Malignant
Seromucinous carcinoma /3

4. Benign Seromucinous Tumors
Definition:
A benign ovarian tumor with endocervical-type mucinous and tubal-type (serous) cells or more Mullerian cell types, all accounting for at least 10% of the epithelium.
Synonym
Seromucinous cystadenoma (adenofibroma)
Mullerian cystadenoma of mixed cell types

5. Benign Seromucinous Tumors
Epidemiology
1% of benign epithelial neoplasms
Peak age: late reproductive age
Clinical features
Non-specific
Usually diagnosed incidentally

6. Benign Seromucinous Tumors
Macroscopy
Unilocular cyst
Serous or mucoid fluid
Microscopy
Variable admixtures of serous and mucinous (endocervical-type)
Endometrioid, transitional, squamous

7. Benign Seromucinous Tumors
Histogenesis
Likely from endometriosis
Prognosis and predictive factors
Benign

8. Seromucinous Borderline Tumors
Definition
A non-invasive, proliferative epithelial tumor composed of more than one epithelial cell type, most often serous and endocervical-type mucinous; however, endometrioid, and less often, clear cell, transitional or squamous may be seen
Synonyms
Endocervical-type mucinous borderline tumor
Mullerian mucinous borderline tumor
Atypical proliferative Mullerian tumor

9. Seromucinous Borderline Tumors
Epidemiology
15% of all mucinous borderline tumor
In the past, these tumors have been considered a subset of mucinous tumor (endocervical type)
Clinical features
Average age: y/o
Non-specific S/S
Most are FIGO stage I
Rare advanced stage
Implants and/or lymph node involvement

10. Seromucinous Borderline Tumors
Macroscopy
Mean size: 8-10 cm
Typically unilocular, viscid fluid
Papillary projections
Often associated with endometriosis
Bilateral: 40%

11. Seromucinous Borderline Tumors
Microscopy
Architectural features similar to serous borderline tumors
Complex papillary architecture
branching in a hierarchical manner into progressively smaller papillae
Terminating in small detached epithelial tufts
Larger papillae
Edematous stroma with neutrophils

12. Seromucinous Borderline Tumors
Microscopoy
Epithelial lining
Stratified
Low grade nuclear atypia
Most are endocervical-type mucinous or serous cells
Endometrioid, squamous, transitional, clear cells
Goblet cells (-)
Often associated with endometriosis
Immunohistochemistry
CK7(+)/CK20(-)/CDX-2(-)
ER(+)/PR(+)

13. Serous borderline tumor-100X

14. Resembling a serous borderline
tumor with bulbous papillae
The papillae are lined by stratified
endocervical-like mucinous cells
The papillae are line by stratified
eosinophilic cells, with numerous
PMN in the papillae and mucin

15. Seromucinous Borderline Tumors
Histogenesis
Data is limited
Associated with endometriosis, at least 1/3 cases
Mucinous metaplasia
ER (+)
Similar to endometrioid tumor
ARID1A mutation (loss of expression): 1/3
Similar to endometrioid and clear cell carcinoma

16. Seromucinous Borderline Tumors
Prognosis and predictive factors
Good outcome even with peritoneal implants

17. Endometriosis-associated Tumor
Endometrioid tumor
Clear cell tumor
Seromucinous tumor

18. Seromucinous Carcinoma
Definition
A carcinoma composed predominantly of serous and endocervical-type mucinous epithelium.
Foci of clear , endometrioid and squamous cells
Synonyms
Endocervical-type mucinous carcinoma
Mixed epithelial carcinoma of Mullerian type

19. Seromucinous Carcinoma
Epidemiology
Quite uncommon
Data not available
Clinical features
Mean age: 45 y/o

20. Seromucinous Carcinoma
Macroscopy
Mean tumor size: 12 cm
Bilateral: >50%
Unilocular or multilocular with papillary projections and solid areas

21. Seromucinous Carcinoma
Microscopy
Lack of consensus on diagnostic criteria
Immunohistochemically
Similar to seromucinous borderline tumor

22. Seromucinous Carcinoma
Prognosis and predictive factors
Data limited
In one series of 54 cases (Am J Surg Pathol. 2002, 26(12): )
Stage I: outcome is favorable
Advanced stage: 50% die of disease

23. 聯醫1589521 Right ovarian cyst Laparoscopic oophorectomy
40-year-old female
Right ovarian cyst
Laparoscopic oophorectomy
Unilocular cyst, 7 x 5 x 5 cm
Multiple small papillary projections

24. FS-100x-Cyst with papillary projections

25. PMN
FS-200X
Endocervical epithelium
Epithelial proliferation

26. FS-200X-epithelial proliferation

27. 聯醫1589521-Frozen Section Right ovary, frozen section:
Mucinous borderline tumor, endocervical-like type (Seromucinous borderline tumor)

28. 40X-Cyst with papillary projections

29. 40X-Cyst with papillary projections

30. 200X-endocervical epithelium

31. 400X-ciliated cells

32. 200X-epithelial proliferation

33. 200X-epithelial proliferation

34. 400X-Inflammatory cells

35. 200X-Endometriosis
CD10

36. 400X-Atypical endometriosis

37. CK7-100X
CK7-200X

38. CK20-100X

39. ER-200X

40. 聯醫1589521 Ovary, right, laparoscopic oophorectomy
Mucinous borderline tumor, endocervical type (Seromucinous borderline tumor), associated with endometriosis