Sarcoma-Like Mural Nodules in Mucinous Cystic Tumors of the Ovary Revisited

Abstract

Ten mucinous cystic ovarian tumors that contained sarcoma-like mural nodules are described. The nodules were studied by conventional and immunohistochemical methods. The sarcoma-like mural nodules occurred predominantly in middle-aged women, were multiple and sharply demarcated from the adjacent mucinous tumor, had small size, and exhibited a heterogeneous cell population. Distinction of these lesions from true sarcomatous nodules and foci of anaplastic carcinoma is important because of the worse prognosis of the two latter tumors compared with the favorable behavior of the sarcoma-like mural nodules. Six of the eight patients with follow-up information were alive and clinically free of recurrence at a mean follow-up interval of 12 years. Two patients died of other causes (thyroid and breast carcinomas). The nature of the nodules is not clear. Sarcoma-like mural nodules probably represent a reactive and self-limited phenomenon within a neoplasia. Their coexpression of vimentin and cytokeratins is consistent with an origin from submesothelial mesenchymal cells, which undergo partial transformation into epithelial cells.

Asymptomatic Ovarian Mucinous Cystadenoma with a Solid Mural Leiomyoma Case report and brief review

“…Case report and brief review *Mariam Mathew, 1 Hazel Gonsalves, 1 Sinan Al-Azawi, 2 Saparamadu P.A.M 3 case report C ystic tumours of the ovary, whether benign or malignant, may be associated with mural nodules of various types. These mural nodules are composed of an epithelial or stromal component, or a mixture of both.…”

Ovarian carcinomas, including secondary tumors: diagnostically challenging areas

“…The nodules have been classified into three major subtypes: (a) sarcoma-like mural nodules; (b) nodules of anaplastic carcinoma; and (c) sarcoma. [17][18][19][20] However, mixed nodules have also been described. 21 Sarcoma-like mural nodules occur predominantly in middle-aged women (mean age, 39 years) as redbrown nodules (0.6-6 cm in diameter), which appear sharply demarcated from the adjacent mucinous epithelium ( Figure 7).…”

“…The mitotic index in the most cellular areas range from 5 to 10 per 10 high power fields (HPF). Immunohistochemical staining shows positivity for histiocyte markers and vimentin, with weak and focal staining for cytokeratins (CKs), suggesting a possible origin from submesothelial mesenchymal cells 20 possibly stimulated to proliferate as a result of spillage of mucin or hemorrhage into aggregates of these cells within the ovary. All of the lesions that have been accurately diagnosed have had a benign clinical course.…”

“…All of the lesions that have been accurately diagnosed have had a benign clinical course. 20 The nodules of anaplastic carcinoma are characterized by either a diffuse collection of large rhabdoid cells with abundant eosinophilic cytoplasm, eccentric nuclei, and one or more prominent nucleoli ( Figure 9); sarcomatoid spindle cells with atypical and vesicular nuclei often exhibiting a herringbone pattern; or pleomorphic cells. 22 CK immunostaining is usually strongly positive.…”

“…Also, in tumors containing multiple nodules, some of them may be of one type and others of another type. 20 …”