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Sarcoma-like mural nodule in a borderline mucinous tumor of the ovary: A rare entity.

Ghosh P, Saha K, Bhowmik S - J Midlife Health (2014)

Bottom Line: Sarcoma-like mural nodule (SLMN) is a very uncommon and misleading benign entity which may be associated with benign, borderline or malignant mucinous neoplasm of the ovary.It should be distinguished from other malignant mural nodules with sarcoma, carcinosarcoma or anaplastic carcinoma for proper management.In spite of having confusing histopathological features the final diagnosis was made depending on the younger age of the patient, well circumscription of the nodule, absence of vascular invasion and immunohistochemical profile.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, DESUN (NEON) Reference Lab, Kolkata, West Bengal, India.

ABSTRACT
Sarcoma-like mural nodule (SLMN) is a very uncommon and misleading benign entity which may be associated with benign, borderline or malignant mucinous neoplasm of the ovary. It should be distinguished from other malignant mural nodules with sarcoma, carcinosarcoma or anaplastic carcinoma for proper management. We report a rare case of SLMN in a borderline mucinous tumor of the ovary in a 30-year-old lady. In spite of having confusing histopathological features the final diagnosis was made depending on the younger age of the patient, well circumscription of the nodule, absence of vascular invasion and immunohistochemical profile.

No MeSH data available.


Related in: MedlinePlus

(a) Photomicrograph showing prominent mitotic figures and smooth muscle differentiation in SLMN (H and E, ×400) (b) Rhabdomyoblastic differentiation in SLMN (H and E, ×400) (c) Photomicrograph showing coagulative necrosis in SLMN (H and E, ×400) (d) Atypical mucinous glands showing strong cytokeratin positivity and spindle cells of the nodule in the background displaying focal and weak cytokeratin positivity (H and E, ×100)
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Figure 2: (a) Photomicrograph showing prominent mitotic figures and smooth muscle differentiation in SLMN (H and E, ×400) (b) Rhabdomyoblastic differentiation in SLMN (H and E, ×400) (c) Photomicrograph showing coagulative necrosis in SLMN (H and E, ×400) (d) Atypical mucinous glands showing strong cytokeratin positivity and spindle cells of the nodule in the background displaying focal and weak cytokeratin positivity (H and E, ×100)

Mentions: A 30-year-old unmarried female patient presented with progressive abdominal enlargement for last 7 months. She also complained of mild lower abdominal pain and discomfort for last 2 and half months. A cystic swelling of about 18-20 weeks size reaching just below the level of umbilicus was felt on physical examination. Her menstrual cycle was normal. Ultrasonography revealed a left ovarian cystic space-occupying lesion(SOL) of 12 cm × 9.6-cm size with internal echogenicity and septations. Uterus was normal in size and right adnexa were unremarkable. Her routine laboratory tests were otherwise normal. Left ovarian cystectomy was performed. Grossly the cystic ovarian mass [Figure 1a] measured 13.8 cm × 12 cm × 8 cm. The outer surface was smooth and grayish whitewith wide areas of congestion. The cut section revealed multilocularcyst containing reddish-brown thick mucoid fluid. An elevated firm, well-definednodular area measuring 4.8 cm × 3.6 cm × 2.5 cm was noticed on the inner surface of the largest locule. Microscopic examination displayed the histopathological features of a borderline mucinous tumor showing complex cribriform architecture with mild to moderate cellular atypia along with an adjacent circumscribed nodular area [Figure 1b and d]. However, no recognizable glandular structures infiltrating into the deeper part of the nodule were identified. The nodular area was predominantly composed of pleomorphic spindle cells with hyperchromatic nuclei and occasional prominent nucleoli arranged in a vaguely fascicular pattern. The pleomorphic cells focally demonstrated smooth muscle and rhabdomyoblastic differentiation [Figure 2a and b]. Frequent mitotic figures including atypical forms admixed with histiocytes and inflammatory cells especially eosinophils were noticed. Conspicuous areas of coagulative necrosis [Figure 2c] and hemorrhage were also observed. Immunohistochemistry for cytokeratin was focally positive and vimentin was diffusely positive in the pleomorphic spindle cells of the nodule. The atypical mucinous glands displayed strong cytokeratin positivity [Figure 2d]. Overall, the histopathogical features of the nodule closely mimicked that of a sarcoma except the presence of circumscription and absence of vascular invasion. True sarcoma, atypical inflammatory myofibroblastic tumor, carcinosarcoma were considered as differential diagnoses. However, considering the circumscription of the nodule in macroscopy as well as in microscopy along with corroborative histopathological and immunohistochemical findings, the diagnosis of a borderline mucinous tumor with SLMN was made.


Sarcoma-like mural nodule in a borderline mucinous tumor of the ovary: A rare entity.

Ghosh P, Saha K, Bhowmik S - J Midlife Health (2014)

(a) Photomicrograph showing prominent mitotic figures and smooth muscle differentiation in SLMN (H and E, ×400) (b) Rhabdomyoblastic differentiation in SLMN (H and E, ×400) (c) Photomicrograph showing coagulative necrosis in SLMN (H and E, ×400) (d) Atypical mucinous glands showing strong cytokeratin positivity and spindle cells of the nodule in the background displaying focal and weak cytokeratin positivity (H and E, ×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4264283&req=5

Figure 2: (a) Photomicrograph showing prominent mitotic figures and smooth muscle differentiation in SLMN (H and E, ×400) (b) Rhabdomyoblastic differentiation in SLMN (H and E, ×400) (c) Photomicrograph showing coagulative necrosis in SLMN (H and E, ×400) (d) Atypical mucinous glands showing strong cytokeratin positivity and spindle cells of the nodule in the background displaying focal and weak cytokeratin positivity (H and E, ×100)
Mentions: A 30-year-old unmarried female patient presented with progressive abdominal enlargement for last 7 months. She also complained of mild lower abdominal pain and discomfort for last 2 and half months. A cystic swelling of about 18-20 weeks size reaching just below the level of umbilicus was felt on physical examination. Her menstrual cycle was normal. Ultrasonography revealed a left ovarian cystic space-occupying lesion(SOL) of 12 cm × 9.6-cm size with internal echogenicity and septations. Uterus was normal in size and right adnexa were unremarkable. Her routine laboratory tests were otherwise normal. Left ovarian cystectomy was performed. Grossly the cystic ovarian mass [Figure 1a] measured 13.8 cm × 12 cm × 8 cm. The outer surface was smooth and grayish whitewith wide areas of congestion. The cut section revealed multilocularcyst containing reddish-brown thick mucoid fluid. An elevated firm, well-definednodular area measuring 4.8 cm × 3.6 cm × 2.5 cm was noticed on the inner surface of the largest locule. Microscopic examination displayed the histopathological features of a borderline mucinous tumor showing complex cribriform architecture with mild to moderate cellular atypia along with an adjacent circumscribed nodular area [Figure 1b and d]. However, no recognizable glandular structures infiltrating into the deeper part of the nodule were identified. The nodular area was predominantly composed of pleomorphic spindle cells with hyperchromatic nuclei and occasional prominent nucleoli arranged in a vaguely fascicular pattern. The pleomorphic cells focally demonstrated smooth muscle and rhabdomyoblastic differentiation [Figure 2a and b]. Frequent mitotic figures including atypical forms admixed with histiocytes and inflammatory cells especially eosinophils were noticed. Conspicuous areas of coagulative necrosis [Figure 2c] and hemorrhage were also observed. Immunohistochemistry for cytokeratin was focally positive and vimentin was diffusely positive in the pleomorphic spindle cells of the nodule. The atypical mucinous glands displayed strong cytokeratin positivity [Figure 2d]. Overall, the histopathogical features of the nodule closely mimicked that of a sarcoma except the presence of circumscription and absence of vascular invasion. True sarcoma, atypical inflammatory myofibroblastic tumor, carcinosarcoma were considered as differential diagnoses. However, considering the circumscription of the nodule in macroscopy as well as in microscopy along with corroborative histopathological and immunohistochemical findings, the diagnosis of a borderline mucinous tumor with SLMN was made.

Bottom Line: Sarcoma-like mural nodule (SLMN) is a very uncommon and misleading benign entity which may be associated with benign, borderline or malignant mucinous neoplasm of the ovary.It should be distinguished from other malignant mural nodules with sarcoma, carcinosarcoma or anaplastic carcinoma for proper management.In spite of having confusing histopathological features the final diagnosis was made depending on the younger age of the patient, well circumscription of the nodule, absence of vascular invasion and immunohistochemical profile.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, DESUN (NEON) Reference Lab, Kolkata, West Bengal, India.

ABSTRACT
Sarcoma-like mural nodule (SLMN) is a very uncommon and misleading benign entity which may be associated with benign, borderline or malignant mucinous neoplasm of the ovary. It should be distinguished from other malignant mural nodules with sarcoma, carcinosarcoma or anaplastic carcinoma for proper management. We report a rare case of SLMN in a borderline mucinous tumor of the ovary in a 30-year-old lady. In spite of having confusing histopathological features the final diagnosis was made depending on the younger age of the patient, well circumscription of the nodule, absence of vascular invasion and immunohistochemical profile.

No MeSH data available.


Related in: MedlinePlus