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.
- appearance is similar to an ovarian mucinous cystadenoma, but with mural thickening, solid components, or aggressive features
CT may demonstrate high attenuation in some loculi due to the high protein content of the mucoid material
- 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
- 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.
Treatment and prognosis
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.
- 1. Park JH, Whang SO, Song ES et-al. An ovarian mucinous cystadenocarcinoma arising from mature cystic teratoma with para-aortic lymph node metastasis: a case report. J Gynecol Oncol. 2008;19 (4): 275-8. doi:10.3802/jgo.2008.19.4.275 - Free text at pubmed - Pubmed citation
- 2. Ulker V, Gedikbasi A, Numanoglu C et-al. Mucinous adenocarcinoma arising in ovarian mature cystic teratoma in pregnancy. Arch. Gynecol. Obstet. 2009;280 (2): 287-91. doi:10.1007/s00404-008-0878-y - Pubmed citation
- 3. Kawamoto S, Urban BA, Fishman EK. CT of epithelial ovarian tumors. Radiographics. 1999;19 Spec No : S85-102. - Pubmed citation
- 4. Zaino RJ, Brady MF, Lele SM et-al. Advanced stage mucinous adenocarcinoma of the ovary is both rare and highly lethal: a Gynecologic Oncology Group study. Cancer. 2011;117 (3): 554-62. doi:10.1002/cncr.25460 - Free text at pubmed - Pubmed citation
- 5. Sholi A, Martino MA, Martino MM et-al. Mucinous adenocarcinoma of the ovary. Semin. Oncol. 2010;37 (4): 314-20. doi:10.1053/j.seminoncol.2010.06.013 - Pubmed citation
- 6. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 20 (5): 1445-70. Radiographics (full text) - Pubmed citation
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