Ovarian mucinous cystadenocarcinoma

Last revised by Joachim Feger on 19 Dec 2023

Mucinous cystadenocarcinoma of the ovary is a rare malignant ovarian mucinous tumor. This type can account for 5-10% of all ovarian mucinous tumors. It is a type of ovarian epithelial tumor

Retrospective studies have suggested that many mucinous carcinomas initially diagnosed as primary to the ovary have in fact metastasized from another site 4.

  • a development of mucinous cystadenocarcinoma has been very rarely associated with malignant transformation of a mature cystic teratoma 1

In general, the cell type (e.g. serous, mucinous) often cannot be determined on the basis of appearance at MR imaging, CT, or ultrasound 6. Biopsy or excision is necessary.

Mucinous tumors are typically multilocular, with numerous smooth, thin-walled cysts. Mucoid material is found within the cysts, sometimes accompanied by hemorrhagic or cellular debris. The imaging appearances are variable depending on the proportion of mucinous content. A proportionately greater solid/nodular, non-fatty, non-fibrous tissue is often considered the most powerful predictor of malignancy 6. Thick septa and solid nodules usually exhibit enhancement. Mucinous ovarian carcinoma is less likely to be bilateral than serous carcinoma, with bilateral lesions occurring in 5-10% of the stage I cases. They often present as large masses spanning >6 cm.

CT may demonstrate high attenuation in some loculi due to the high protein content of the mucoid material

  • T1
    • the signal intensity of mucin on T1-weighted images varies depending on the degree of mucin concentration
    • on T1-weighted images, loculi with watery mucin have a lower signal intensity than loculi with thicker mucin
  • T2
    • on T2-weighted images, the corresponding signal intensities are flipped, so that loculi with watery mucin have a high signal intensity and loculi with thicker mucin appear slightly hypointense

The staging is the same as general ovarian cancer staging.

Often presenting as large masses at stage I disease, the most conventional means of treatment are tumor-debulking operations and neoadjuvant chemotherapy. The latter may be performed pre- or post-operatively. The estimated median survival when presenting at an advanced stage is significantly shorter (14 months) compared to ovarian serous cystadenocarcinoma (42 months) 4.

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