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Presented by Saeid Movahedi, M.D. and prepared by Shien Micchelli, M.D.
Case 4: 34 y/o female with a complex adnexal mass.
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1. Question
Week 238: Case 4
34 y/o female with a complex adnexal mass.images/9_12_05case4a.jpg
images/9_12_05case4c.jpg
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images/9_12_05case4e.jpgCorrect
Answer: Atypical proliferative (borderline) seromucinous tumor
Histology: On low power, the cystic neoplasm has a papillary architecture composed of large, bulbous papillae as well as smaller cellular papillae. There are cysts of various sizes, many filled with mucin containing large number of neutrophils. Closer inspection of the cysts and papilla linings reveals the neoplasm to be composed predominantly of cells containing abundant mucin with occasional cells with serous/tubal (ciliated cell) differentiation and eosinophilic cytoplasm lacking mucinous differentiation. No stromal invasion is identified.
Discussion: Atypical proliferative (borderline) seromucinous tumors (APSMT) are uncommon ovarian neoplasms, accounting for approximately 15% of atypical proliferative mucinous tumors. Tumors are more often bilateral than the gastrointestinal type mucinous tumors and are often associated with endometriosis. These tumors are characterized by papillary architecture, similar to that of atypical proliferative serous tumors, and exhibit both serous and endocervical-like mucinous differentiation, at times with a minor endometrioid component..
The differential diagnosis includes atypical proliferative (borderline) serous tumor and atypical proliferative (borderline) mucinous tumor (gastrointestinal type).
Incorrect
Answer: Atypical proliferative (borderline) seromucinous tumor
Histology: On low power, the cystic neoplasm has a papillary architecture composed of large, bulbous papillae as well as smaller cellular papillae. There are cysts of various sizes, many filled with mucin containing large number of neutrophils. Closer inspection of the cysts and papilla linings reveals the neoplasm to be composed predominantly of cells containing abundant mucin with occasional cells with serous/tubal (ciliated cell) differentiation and eosinophilic cytoplasm lacking mucinous differentiation. No stromal invasion is identified.
Discussion: Atypical proliferative (borderline) seromucinous tumors (APSMT) are uncommon ovarian neoplasms, accounting for approximately 15% of atypical proliferative mucinous tumors. Tumors are more often bilateral than the gastrointestinal type mucinous tumors and are often associated with endometriosis. These tumors are characterized by papillary architecture, similar to that of atypical proliferative serous tumors, and exhibit both serous and endocervical-like mucinous differentiation, at times with a minor endometrioid component..
The differential diagnosis includes atypical proliferative (borderline) serous tumor and atypical proliferative (borderline) mucinous tumor (gastrointestinal type).
