Ovarian seromucinous tumors: clinicopathological features of 10 cases with a detailed review of the literature

Abstract

Background The 2014 WHO Classification of ovarian neoplasms introduced a new entity of seromucinous tumors associated with endometriosis. These tumors encompassed a spectrum from benign to malignant and included seromucinous cystadenoma/ cystadenofibroma, seromucinous borderline tumor/atypical proliferative seromucinous tumor and seromucinous carcinoma. However, the 2020 WHO Classification of Female Genital Tumours removed seromucinous carcinomas as a distinct entity and recategorized them as Endometrioid carcinomas with mucinous differentiation. Here we describe clinico-morphologic features of seromucinous tumors recategorizing cases originally diagnosed as seromucinous carcinoma in light of 2020 WHO classification and present detailed review of literature. Methods Slides of seromucinous tumors were reviewed. Special emphasis was given to evaluation of stromal invasion. Follow-up was obtained. Results Ten cases were diagnosed. Mean age was 40 years. Four cases were bilateral. Mean size was 19 cm. Grossly; luminal papillary projections were seen in 6 cases. Tumors demonstrated a papillary architecture with papillae lined by stratified seromucinous epithelium showing nuclear atypia. Stromal invasion was seen in 4 cases. Six cases were reported as borderline seromucinous tumors and 4 cases originally diagnosed as seromucinous carcinoma were recategorized as endometrioid carcinoma with mucinous differentiation on review. Endometriosis was seen in 4 cases. CK7, PAX8 and ER were positive in 7/7 cases. Two cases showed extra-ovarian involvement. Follow up was available in 7 cases. Six patients were alive and well at follow up ranging from 8 to 46 months. Six patients received chemotherapy postoperatively. One patient with carcinoma died of disease 18 months postoperatively. Conclusion In our series, 4 cases were originally diagnosed as seromucinous carcinomas. However, these were recategorized in light of the 2020 WHO Classification of Female Genital tumors as endometrioid carcinomas with mucinous differentiation. Six cases were diagnosed as seromucinous borderline tumors. Thus, majority of cases were borderline in agreement with published literature.

New insights of liquid biopsy in ovarian cancer

“…The development of tumors is imposed by the tumor microenvironment. Extracellular matrix molecules regulate cancer invasion and metastasis and, at the same time, downregulation of miRNAs controls tumor spreading by degrading extracellular matrix [65,66].…”

“…The classi ication of ovarian cancer is generally made according to the stage at the time of tumor discovery, early or advanced stage and according to the histology of the tumor, classi ied as epithelial or non-epithelial, of which the most frequent is the high-grade serous ovarian carcinoma (HGSOC) [2][3][4]. This type of cancer is characterized by an unusual dissemination mechanism: rapid growth, disruption of ovarian tumor capsules and malignant cells spread into the peritoneal cavity which usually involves the accumulation of ascites.…”

“…Therefore, the development of new methods for investigating circulating cells is widely reported as a rational avenue for improving clinical ef iciency and preventing the progression of disease in patients with ovarian cancer. Given the challenges of screening, diagnosis and monitoring, and the impact that the early diagnosis has on the patient's prognosis, new emerging tools are needed to increase the precision of the diagnosis and to monitor and better understand and predict the response to the treatment [4,5].…”

The clinical significance of initial symptoms in endometriosis-associated ovarian cancer

“…Ovarian clear cell carcinoma (OCCC) and ovarian endometrioid carcinoma (OEC) are representative histological subtypes of EAOC [8,9]. Seromucinous borderline tumor (SMBT), which is not strictly a cancer but a borderline malignancy, is also known to arise from endometriosis occasionally [10].…”

Seromucinous carcinoma of ovary - A rare entity

“…These tumors histomorphologically are a mixture of serous and endocervical type with ocassionally having foci of clear cell, squamous, transitional and endometroid epithelium. 2 Ovarian seromucinous carcinoma was removed as separate entity and renamed as ovarian endometrioid carcinoma with mucinous differentiation according to 2020 World Health Organisation classification of Female Genital Tumors. 3 Seromucinous carcinoma does not exhibit a distinct genotype or immunophenotype and its morphological diagnosis is also not very reliable.…”