Synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN‑FGT): A case report and literature review

Abstract

The present study reported a case of Synchronous Mucinous Metaplasia and Neoplasia of the Female Genital Tract (SMMN-FGT), which occurred in a 47-year-old woman. The patient complained of pelvic mass during a physical examination a month ago. Ultrasound examination found an anechoic spot in the left ovary and several anechoic spots were detected in the cervix. The patient underwent left adnexectomy and the left ovarian frozen section revealed a mucinous borderline tumor. Total abdominal hysterectomy and right salpingo-oophorectomy were subsequently performed. Microscopically, multifocal mucinous lesions were involved in the female genital tract, including bilateral ovarian mucinous borderline tumor, cervical and endometrial mucinous adenocarcinoma and the bilateral fallopian tube epithelium showed mucinous metaplasia. Immunohistochemistry revealed that the tumor cells of the ovary, cervix and endometrium expressed MUC6, exhibiting features of gastric-type differentiation. The Ki-67 proliferative index was ~10-70%. Cumulative evidence established SMMN-FGT as the final histopathological diagnosis with International Federation of Gynecology and Obstetrics stage I. Following surgery, the patient received a course of pelvic radiotherapy and survived for 16 months.

Gastric‐type glandular lesions of the female genital tract excluding the cervix: emerging pathological entities

“…Mucinous metaplasia of the fallopian tube has also been reported, either as an isolated finding or in association with mucinous lesions at other sites in the female genital tract. 39,[81][82][83][84] Some reported cases of mucinous metaplasia of the fallopian tube have occurred in patients with Peutz-Jeghers syndrome. Given the propensity for gastric-type mucinous lesions to occur in more than one female genital tract site and in patients with Peutz-Jeghers syndrome (see section on 'Synchronous/multifocal gastric-type lesions of the female genital tract'), it is probable that some cases of tubal mucinous metaplasia exhibit gastric differentiation; however, such cases have not been subject to immunohistochemical studies.…”

“…The phenomenon of gastric-type mucinous lesions involving multiple gynaecological sites is well documented in the literature and is commonly designated 'synchronous mucinous metaplasia and neoplasia of the female genital tract'. 39,53,55,81,[87][88][89] Some patients have had a history of Peutz-Jeghers syndrome, 87,90 but most reported cases occurred in patients with no predisposing conditions. The mucinous lesions may involve the cervix, endometrium, fallopian tubes and ovaries, with variable combinations of metaplastic and neoplastic lesions at different sites.…”

“…Mucinous metaplasia of the fallopian tube has also been reported, either as an isolated finding or in association with mucinous lesions at other sites in the female genital tract 39,81–84 . Some reported cases of mucinous metaplasia of the fallopian tube have occurred in patients with Peutz–Jeghers syndrome.…”

“…The phenomenon of gastric‐type mucinous lesions involving multiple gynaecological sites is well documented in the literature and is commonly designated ‘synchronous mucinous metaplasia and neoplasia of the female genital tract’ 39,53,55,81,87–89 . Some patients have had a history of Peutz–Jeghers syndrome, 87,90 but most reported cases occurred in patients with no predisposing conditions.…”

“…The mucinous lesions may involve the cervix, endometrium, fallopian tubes and ovaries, with variable combinations of metaplastic and neoplastic lesions at different sites. The lesions previously reported include: (1) gastric‐type adenocarcinoma (previously termed ‘adenoma malignum’), ‘mucinous AIS’ and LEGH of the cervix; (2) mucinous metaplasia (with or without LEGH pattern) and mucinous adenocarcinoma of the endometrium (including lesions reported as ‘adenocarcinoma in situ ’); (3) mucinous metaplasia (with or without ‘borderline features’) of the fallopian tube; and (4) mucinous cystadenoma, mucinous borderline tumour and mucinous carcinoma of the ovary 39,81 . When reporting such cases, the possibility of underlying Peutz–Jeghers syndrome should be mentioned in the pathology report.…”