James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Int J Gynecol Pathol. 2022 Jan 1;41(1):68-75. doi: 10.1097/PGP.0000000000000765.
A subset of ovarian mucinous tumors demonstrates müllerian-type epithelium, with such lesions variably designated "endocervical-like" and seromucinous since their popularization based on a report of borderline examples in 1989. While müllerian mucinous borderline tumors and carcinomas have been highlighted in the literature, there has been minimal attention given to benign müllerian mucinous tumors, particularly müllerian mucinous cystadenomas. Given the paucity of literature describing the features of müllerian mucinous cystadenomas/cystadenofibromas, diagnostic difficulties may arise when papillary features are present and in cases that show a subtle transition from endometriosis. We thus reviewed 25 cases of müllerian mucinous cystadenoma/cystadenofibroma to highlight the notable characteristics of this entity, including gross, cytologic, and architectural features that aid in the distinction from müllerian mucinous borderline tumors as well as, rarely, metastatic tumors. The patients ranged in age from 26 to 85 yr old. Bilateral ovarian involvement was frequent (40%). The ovaries ranged from 2.3 to 26 cm in greatest dimension. Most were multicystic (18 cases) and contained tenacious mucoid material (14 cases). All cases demonstrated predominantly columnar mucinous epithelium with abundant pale-pink cytoplasm. A minor component of ciliated and endometrioid epithelium was seen in 15 and 2 cases, respectively. Broad papillary formations were frequently encountered (9 cases) as was epithelial papillary tufting comprising <10% of the tumor (6 cases). Endometriosis was present in 9 cases, with a transition from endometriosis to mucinous epithelium noted in 8 cases. This series highlights the morphologic features of a relatively uncommon, benign, endometriosis-associated ovarian tumor that may be confused with a müllerian mucinous borderline tumor or bland metastatic mucinous tumors. It also provides an argument for the terminology "müllerian mucinous cystadenoma" or "cystadenofibroma" rather than "seromucinous cystadenoma" due to the frequent association with endometriosis as well as the dominant mucinous epithelium.
一组卵巢黏液性肿瘤表现出 Müllerian 型上皮，这些病变根据 1989 年报告的交界性病例被不同地命名为“宫颈内膜样”和浆液性黏液性，因为它们得到了普及。虽然 Müllerian 黏液性交界性肿瘤和癌已在文献中得到强调，但对良性 Müllerian 黏液性肿瘤，特别是 Müllerian 黏液性囊腺瘤，关注甚少。鉴于描述 Müllerian 黏液性囊腺瘤/囊腺纤维瘤特征的文献很少，当存在乳头状特征和在表现为从子宫内膜异位症微妙过渡的情况下，可能会出现诊断困难。因此，我们回顾了 25 例 Müllerian 黏液性囊腺瘤/囊腺纤维瘤，以突出该实体的显著特征，包括大体、细胞学和结构特征，这些特征有助于与 Müllerian 黏液性交界性肿瘤以及罕见的转移性肿瘤区分开来。患者年龄从 26 岁到 85 岁不等。双侧卵巢受累很常见（40%）。卵巢最大直径为 2.3 至 26 厘米。大多数为多房性（18 例），含有坚韧的黏液性物质（14 例）。所有病例均表现为主要柱状黏液上皮，伴有丰富的淡粉色细胞质。分别在 15 例和 2 例中观察到少量纤毛和子宫内膜样上皮。广泛的乳头状形成（9 例）和上皮乳头状簇状生长（<10%的肿瘤）（6 例）经常遇到。9 例存在子宫内膜异位症，其中 8 例观察到从子宫内膜异位症到黏液上皮的转变。本系列突出了一种相对罕见的良性、与子宫内膜异位症相关的卵巢肿瘤的形态学特征，这种肿瘤可能与 Müllerian 黏液性交界性肿瘤或良性转移性黏液性肿瘤混淆。它还为术语“Müllerian 黏液性囊腺瘤”或“囊腺纤维瘤”而不是“浆液性黏液性囊腺瘤”提供了论据，因为它经常与子宫内膜异位症相关，并且主要是黏液上皮。
