A Case of Ovarian Mucinous Cystic Tumor with Mural Nodules Including a Few Small Foci of Carcinomatous Lesion

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A case of ovarian mucinous cystic tumor with mural nodules, containing reactive fibro-histiocytic lesions and a few small foci of anaplastic carcinomatous lesion, is reported. Macroscopically, the tumor was 19.5×6.3 cm and weighed 1800 g. The cut surface of the tumor was mucinous and multicystic with mural nodules. Microscopically, the inner surface of the cyst wall was lined with endocervical and intestinal type mucinous epithelium. In some areas, stratified atypical epithelium was seen, but as there was no evidence of stromal invasion, we considered it a borderline malignancy. In the mural nodules, a few granulomatous lesions consisting of atypical cells with multinucleated giant cells were seen. These atypical cells were positive for AE1 / AE3, cytokeratin 7, vimentin and periodic acid Schiff, and negative for cytokeratin 20, CD68, carcinoembryonic antigen and alcian-blue. These results suggested a diagnosis of anaplastic carcinoma. A foreign body reaction was seen surrounding the granulomatous lesions, most likely in response to mucin excursion. The prognosis for patients with sarcomatous mural nodules associated with cystic common epithelial tumors of the ovary is not good, however this patient is alive and free of disease two years postoperatively without additional therapy.