Three cases of seromucinous carcinoma of the ovary arising in endometriotic cysts

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This report details three ovarian seromucinous carcinoma cases, suggesting development from endometriosis and seromucinous borderline tumors, with MRI findings proving inconclusive for characteristic diagnosis.

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This case report describes three patients with ovarian seromucinous carcinoma, detailing the clinical workup including staging laparotomy and, in two cases, systemic chemotherapy. Across the cases, histology showed concurrent endometriosis and seromucinous borderline tumors, and the authors suggest that seromucinous carcinoma may arise in multiple stages via these precursors. Major caveats are that the paper is limited to three cases, and MRI findings were reported as highly variable with no characteristic imaging features that reliably distinguished the diagnosis. This paper is centrally about endometriosis — specifically, it reports seromucinous carcinoma arising in endometriotic cysts with concurrent detection of endometriosis in all cases.

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Abstract

Ovarian seromucinous carcinoma (SMC) is an uncommon neoplasia and is composed predominantly of serous and endocervical-type mucinous epithelium. Due to its low frequency and difficult diagnosis, the natural history, characteristic imaging findings, and pathological features of SMC have not been adequately described in the literature thus far. We herein report three cases of ovarian SMC along with magnetic resonance imaging (MRI) findings. The diagnosis of SMC was made after staging laparotomy in all cases, and systemic chemotherapy was performed in two cases. No recurrence was observed in any of the cases. The MRI findings in SMC were so varied that characteristic imaging features useful for diagnosis were not found. In two cases, MRI suggested endometriotic cysts, and endometriosis and seromucinous borderline tumors (SMBTs) were detected concurrently in all cases by histological examination. Thus, it was suggested that SMC develops in multiple stages via endometriosis and SMBT. The cooccurrence of endometriosis and SMBT could also make the diagnosis of SMC more convincing.
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Abstract

Ovarian seromucinous carcinoma (SMC) is an uncommon neoplasia and is composed predominantly of serous and endocervical-type mucinous epithelium. Due to its low frequency and difficult diagnosis, the natural history, characteristic imaging findings, and pathological features of SMC have not been adequately described in the literature thus far. We herein report three cases of ovarian SMC along with magnetic resonance imaging (MRI) findings. The diagnosis of SMC was made after staging laparotomy in all cases, and systemic chemotherapy was performed in two cases. No recurrence was observed in any of the cases. The MRI findings in SMC were so varied that characteristic imaging features useful for diagnosis were not found. In two cases, MRI suggested endometriotic cysts, and endometriosis and seromucinous borderline tumors (SMBTs) were detected concurrently in all cases by histological examination. Thus, it was suggested that SMC develops in multiple stages via endometriosis and SMBT. The cooccurrence of endometriosis and SMBT could also make the diagnosis of SMC more convincing. Similar content being viewed by others

References

Kurman RJ, International Agency for Research on Cancer., World Health Organization (2014) WHO classification of tumours of female reproductive organs, 4th edn. International Agency for Research on Cancer, Lyon Han JW, Kim KA, Chang HY et al (2019) Newly categorized seromucinous tumor of the ovary: magnetic resonance imaging findings. J Comput Assist Tomogr 43:119–127. https://doi.org/10.1097/RCT.0000000000000776 Kurata Y, Kido A, Moribata Y et al (2017) Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumour from endometriosis-related malignant ovarian tumour. Eur Radiol 27:1695–1703. https://doi.org/10.1007/s00330-016-4533-x Taylor J, McCluggage WG (2015) Ovarian seromucinous carcinoma: report of a series of a newly categorized and uncommon neoplasm. Am J Surg Pathol 39:983–992. https://doi.org/10.1097/PAS.0000000000000405 Nagamine M, Mikami Y (2020) Ovarian seromucinous tumors: pathogenesis, morphologic spectrum, and clinical issues. Diagnostics (Basel). https://doi.org/10.3390/diagnostics10020077 Rambau PF, McIntyre JB, Taylor J et al (2017) Morphologic reproducibility, genotyping, and immunohistochemical profiling do not support a category of seromucinous carcinoma of the ovary. Am J Surg Pathol 41:685–695. https://doi.org/10.1097/PAS.0000000000000812 Wu CH, Mao TL, Vang R et al (2012) Endocervical-type mucinous borderline tumors are related to endometrioid tumors based on mutation and loss of expression of ARID1A. Int J Gynecol Pathol 31:297–303. https://doi.org/10.1097/PGP.0b013e31823f8482 Wiegand KC, Shah SP, Al-Agha OM et al (2010) ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med 363:1532–1543. https://doi.org/10.1056/NEJMoa1008433 Matias-Guiu X, Stewart CJR (2018) Endometriosis-associated ovarian neoplasia. Pathology 50:190–204. https://doi.org/10.1016/j.pathol.2017.10.006 Catasus L, Bussaglia E, Rodrguez I et al (2004) Molecular genetic alterations in endometrioid carcinomas of the ovary: similar frequency of beta-catenin abnormalities but lower rate of microsatellite instability and PTEN alterations than in uterine endometrioid carcinomas. Hum Pathol 35:1360–1368. https://doi.org/10.1016/j.humpath.2004.07.019 Kurman RJ, Shih Ie M (2016) The dualistic model of ovarian carcinogenesis: revisited, revised, and expanded. Am J Pathol 186:733–747. https://doi.org/10.1016/j.ajpath.2015.11.011 Funding None. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflicts of interest. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent Written informed consent was obtained from the patient for the publication of this case report and its accompanying images. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. About this article Cite this article Taga, Y., Chigusa, Y., Minamiguchi, S. et al. Three cases of seromucinous carcinoma of the ovary arising in endometriotic cysts. Int Canc Conf J 10, 46–53 (2021). https://doi.org/10.1007/s13691-020-00447-x Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13691-020-00447-x

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