Ultrasonic and pathological characteristics of ovarian mucinous cystic tumors with malignant mural nodules

RATIONALE Sarcomatous or anaplastic carcinoma mural nodules presenting in ovarian mucinous cystic tumors are very rare. Here, we reported the ultrasonic and pathological features of 2 such cases. PATIENT CONCERNS A 60-year-old woman presented with a complaint of lower abdominal pain. Physical examination revealed a hard, palpable mass in her right lower abdomen with mild tenderness. In addition, a 48-year-old woman presented with left abdominal pain and abdominal fullness. Physical examination revealed a palpable mass in her left lower abdomen. DIAGNOSES The diagnosis of ovarian mucinous cystic tumor (including mucinous cystadenoma, mucinous cystadenoma of borderline malignancy, and intraepithelial carcinoma) associated with the sarcomatous mural nodule was made for the first patient. The mass of the second patient was mucinous cystic tumor (including mucinous cystadenoma, borderline malignant mucinous cystadenoma, and mucinous cystadenocarcinoma) associated with sarcoma-like mural nodules and multifocal anaplastic carcinoma. INTERVENTIONS Both patients underwent bilateral salpingo-oophorectomy and omentectomy. In addition, appendectomy was also performed for the younger patient. OUTCOMES Ultrasonic imaging showed huge pelvic cavity mixed masses with reticular or petaloid fluid sonolucent areas, uneven thickness separation, and multiple various mural nodules. The internal echo of the masses was complex and varied. The ultrasonic features of mural nodules were characteristic, including irregular shape, rough surface, wide basement, and nonuniform internal echogenicity. Pathological examination revealed multiple nodules with obvious atypia and mucinous cystic tumors with different malignancy. Sarcomatous or anaplastic carcinoma mural nodules showed irregular structure, significant cell atypia, and noticeable mitoses. The discovery of vascular invasion has an important role in the diagnosis of sarcomatous mural nodules. Immunohistochemical features of positive cytokeratin and negative vimentin can identify the anaplastic carcinoma component from the bizarre stromal components of the nodule. LESSONS Ultrasonography was helpful to evaluate the preoperative diagnosis and determining the surgical approach, and pathology was indispensable to the diagnosis of these diseases.