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Li S, Zhu J, Jiang N, Guo Y, Hou M, Liu X, Yang J, Yang X. Recurrent mucinous carcinoma with sarcomatoid and sarcomatous mural nodules: a case report and literature review. Front Oncol 2024; 14:1387700. [PMID: 38903727 PMCID: PMC11187075 DOI: 10.3389/fonc.2024.1387700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Ovarian mucinous tumors with sarcomatous mural nodules are rare. Sarcomatous nodules have a bad prognosis. Its diagnosis and treatment are controversial.It is still controversial whether malignant mural nodules represent a dedifferentiated form of mucinous tumors or collisional tumors. This is a case report of a 32-year-old female diagnosed with ovarian mucinous tumor recurred as a mucinous carcinoma combined with sarcomatoid and undifferentiated sarcoma mural nodules after surgery and chemotherapy. The primary lesion did not have a sarcomatous component after comprehensive sampling and repeated review, while the recurrent lesion had a predominantly sarcomatous component. The patient received a second operation and postoperative chemotherapy plus Anlotinib with no progression at 16 months of follow-up. Primary mucinous carcinoma and sarcomatous mural nodules revealed the same K-RAS mutation(c.35G>T, pG12V), TP53 mutation (c.817C>T, p.R273C), MLL2 mutation(c.13450C>T, p.R4484) and NF1 mutation(c.7876A>G, p.S2626G). We present a comprehensive analysis on morphologic characteristics, molecular detection results, clinical management, and prognosis of ovarian mucinous tumors with mural nodules of sarcomatoid and undifferentiated sarcoma. Mutation sharing between primary mucinous carcinoma and recurrent sarcomatous nodules supports monoclonal origin of primary and recurrent tumors, suggesting a tendency for sarcomatous differentiation during the progression of epithelial tumors. Malignant mural nodules represent dedifferentiation in mucinous ovarian tumors rather than collision of two different tumor types. Therefore, it is imperative to conduct comprehensive sampling, rigorous clinical examination, and postoperative follow-up in order to thoroughly evaluate all mural nodules of ovarian mucinous tumors due to their potential for malignancy and sarcomatous differentiation.
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Affiliation(s)
- Simin Li
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jingyu Zhu
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Na Jiang
- Department of Pathology, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yanping Guo
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Meng Hou
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xi Liu
- Department of Pathology, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jin Yang
- Department of Oncology, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaofeng Yang
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Hernandez Acevedo PI, Carter GJ, Courtney-Brooks M, Clark BZ. Ovarian serous borderline tumor with mural nodules of anaplastic carcinoma and omental involvement: A case report. Rare Tumors 2023; 15:20363613231172260. [PMID: 37113477 PMCID: PMC10126381 DOI: 10.1177/20363613231172260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Mural nodules are rarely identified in cystic ovarian neoplasms, and have been categorized into sarcoma-like, sarcomatous, and anaplastic carcinomatous types. Most reports of these mural nodules have been described in mucinous ovarian tumors. In this case report, we describe an ovarian serous borderline tumor with mural nodules composed of high-grade carcinoma with anaplastic features and necrosis, including the morphologic features, immunoprofile, and results of tumor DNA sequencing. Omental involvement was also identified. Recognition of this phenomenon in serous tumors is important, so that thickened areas of cyst wall in ovarian serous tumors will be thoroughly examined.
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Affiliation(s)
| | - Gloria J Carter
- Division of Breast and Gynecologic Pathology, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Madeleine Courtney-Brooks
- Division of Gynecologic Oncology, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Beth Z Clark
- Division of Breast and Gynecologic Pathology, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA, USA
- Beth Z Clark, Division of Breast and Gynecologic Pathology, Department of Pathology, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA, USA
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Invasive Mucinous Adenocarcinoma of the Lung with a Mural Nodule-like Lesion. Am J Surg Pathol 2022; 46:1524-1532. [PMID: 35939825 DOI: 10.1097/pas.0000000000001938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Invasive mucinous adenocarcinoma (IMA) of the lung shares some clinicopathological features with mucinous carcinoma of other organs, such as the ovary. Sarcoma-like lesions, called mural nodules, have been reported in the cystic walls of ovarian mucinous tumors. In this study, we analyzed 213 surgically resected cases of IMA of the lung to determine whether similar mural nodule-like lesions were present. We considered abrupt discrete lesions composed of dedifferentiated tumor cells as mural nodule-like lesions. Of 213 IMAs, we identified 11 tumors with mural nodule-like lesions that were histologically categorized into three subtypes similar to those in the ovary. The sarcomatoid and anaplastic carcinoma-like nodules were composed of spindle cell proliferations and polygonal undifferentiated carcinoma, respectively. Sarcoma-like lesions mimicked sarcomatoid nodules, but the spindle cell proliferations were considered a fibroblastic reaction to the scattered, isolated clusters of tumor cells. Molecular analysis of the components of differentiated IMAs and mural nodule-like lesions revealed a clonal relationship, suggesting a spectrum of tumors with different histology. Clinicopathologically, an older age, the male sex, and smokers were significantly associated with IMAs with mural nodule-like lesions. Notably, patient outcomes were unaffected by the presence or absence of these lesions. Our findings demonstrated that IMA of the lung rarely develops mural nodule-like lesions (11 of 213, 5%). Despite a histological impression of clinical aggressiveness, there was no clear trend in patient outcomes, suggesting that pathologists should avoid overstating this mural nodule-like lesion.
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Wang XJ, Wang CY, Xi YF, Bu P, Wang P. Ovarian mucinous tumor with mural nodules of anaplastic carcinoma: Three case reports. World J Clin Cases 2022; 10:7459-7466. [PMID: 36158006 PMCID: PMC9353926 DOI: 10.12998/wjcc.v10.i21.7459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/08/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anaplastic carcinoma mural nodules in ovarian mucinous tumors are very rare. This study aimed to report the morphological characteristics, molecular detection results, clinical treatment and prognosis of three ovarian mucinous tumors with mural nodules of anaplastic carcinoma.
CASE SUMMARY The pathomorphological features, molecular detection results, clinical treatment and prognosis of anaplastic carcinoma mural nodules were described in three cases. In case 1, sarcoma-like mural nodules (SLMNs) coexisted with anaplastic carcinoma mural nodules. No mutation was found in mucinous tumors. KRAS mutation was found in anaplastic carcinoma nodules and heterotypic cells were found in SLMNs. In case 2, KRAS mutation occurred in the mucinous epithelium and BRAF mutation occurred in mural nodules. In case 3, both mural nodules and mucinous tumors had the same KRAS mutation and a morphological transition between them was observed. All three patients died within 2 years, whether receiving chemotherapy or not.
CONCLUSION Anaplastic carcinoma mural nodules may develop from dedifferentiation of mucinous tumors or are unrelated to mucinous tumors.
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Affiliation(s)
- Xiao-Juan Wang
- Department of Pathology, Shanxi Cancer Hospital and Institute, Taiyuan 030013, Shanxi Province, China
| | - Chun-Yan Wang
- Department of Molecular Biology, Department of Blood Transfusion, Shanxi Cancer Hospital and Institute, Taiyuan 030013, Shanxi Province, China
| | - Yan-Feng Xi
- Department of Pathology, Shanxi Cancer Hospital and Institute, Taiyuan 030013, Shanxi Province, China
| | - Peng Bu
- Department of Pathology, Shanxi Cancer Hospital and Institute, Taiyuan 030013, Shanxi Province, China
| | - Pei Wang
- Department of Gynecology, Shanxi Cancer Hospital and Institute, Taiyuan 030013, Shanxi Province, China
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Huang M, Lv Q, Xie J. Ovarian mucinous borderline tumor with anaplastic carcinomatous nodules in adolescents. J Ovarian Res 2022; 15:83. [PMID: 35836292 PMCID: PMC9284891 DOI: 10.1186/s13048-022-01010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
Bilateral ovarian epithelial neoplasms in adolescents are rare. Moreover, borderline mucinous neoplasms with local intraepithelial carcinoma with anaplastic carcinoma are even more infrequent. Herein, we presented a single case (a 17-year-old female) with regular menstrual cycles and stomach pain when eating who was diagnosed with a left ovarian tumor accompanied by mural nodules. The right ovarian cyst, the left ovary, and the fallopian tube were removed by surgery. Intraoperative diagnosis suggested a bilateral ovarian tumor with mural nodules, which include three different pathological types: sarcomatoid transformation, anaplastic carcinoma, and sarcoma. Paclitaxel combined with carboplatin was given for 6 cycles after an operation, and gonadotropin-releasing hormone agonist (GnRHa) was given at the beginning of chemotherapy for 3 cycles for ovarian function protection. Regular follow-up (the last follow-up was performed 48 months after the operation) of gynecological ultrasound and tumor indicators did not indicate recurrence. In clinical practice, it is necessary to pay attention to the symptoms such as abdominal pain in adolescent females. Routine non-invasive pelvic ultrasound is recommended to fully evaluate the nature of the tumor before surgery, and decide the operation mode. Also, intraoperative frozen pathology of the tissue should be performed as soon as possible.
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Affiliation(s)
- Mengqi Huang
- Departments of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China
| | - Qian Lv
- Departments of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China
| | - Jingyan Xie
- Departments of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China.
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Lakshmi Haridas K, Menon A, Deepthi B. Borderline ovarian mucinous tumor with anaplastic carcinomatous mural nodule: A case report. Gynecol Oncol Rep 2021; 37:100809. [PMID: 34189229 PMCID: PMC8217701 DOI: 10.1016/j.gore.2021.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 11/15/2022] Open
Abstract
Malignant mural nodules in borderline ovarian tumors are rare. Among them, anaplastic mural nodules are infrequent and only limited case reports are available. Here we report a patient diagnosed as borderline ovarian mucinous tumor with an anaplastic carcinomatous mural nodule. She underwent comprehensive staging laparotomy and six cycles of adjuvant chemotherapy with paclitaxel - carboplatin and has no evidence of disease progression at eight months of follow up. This tumor has an aggressive behaviour and patients with stage ≥1C have inferior survival.
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Affiliation(s)
- K Lakshmi Haridas
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum 695011, Kerala, India
| | - Abhilash Menon
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum 695011, Kerala, India
| | - B Deepthi
- Department of Pathology, Regional Cancer Centre, Trivandrum 695011, Kerala, India
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