Features Aiding Differential Diagnosis of Ovarian Tumors

Appendix 1: Ovarian Tumors With Mucinous Epithelium

■
Surface epithelial tumors
- Mucinous cystic tumors of intestinal and endocervical-like type
- Surface epithelial tumors of mixed cell type with a mucinous component
- Mixed müllerian tumors (adenofibroma, adenosarcoma, MMMT ^a
  
  a Malignant müllerian mixed tumor.
  
  )
- Brenner tumors
■
Germ cell tumors
- Teratomas (mature and immature)
- Mucinous and strumal carcinoid tumors
■
Other
- Sertoli–Leydig cell tumor with heterologous elements
- Adult granulosa cell tumor ^b
  
  b Mucinous epithelium in adult granulosa cell tumors is a rare finding.
- Small cell carcinoma of hypercalcemic type

■
Mucinous carcinoma arising elsewhere in the female genital tract, especially the cervix
■
Mucinous carcinoma from the colon, appendix, small bowel, stomach, pancreas, biliary tract
■
Urinary bladder and urachus
■
Low-grade mucinous tumors from the appendix

■
Endometrioid carcinoma arising elsewhere in female genital tract or endometriosis
■
Intestinal adenocarcinoma of typical and clear cell type
■
Other gastrointestinal, pancreatic, and biliary adenocarcinomas
■
Mucin-poor mucinous adenocarcinomas from other sites, e.g. lung
■
Breast carcinoma
■
Malignant mesothelioma

1.
Histologic similarity of the tumors
2.
Large endometrial tumor and small ovarian tumor(s)
3.
Atypical endometrial hyperplasia also present
4.
Deep myometrial invasion
- a.
  Direct extension into adnexa
- b.
  Vascular space invasion in myometrium
5.
Spread elsewhere in typical pattern of endometrial carcinoma
6.
Ovarian tumors, bilateral and/or multinodular
7.
Hilar location, vascular space invasion, surface implants, ^a

a Rare primary ovarian endometrioid carcinomas may arise from endometriosis on the ovarian surface.

or combination in ovary
8.
Ovarian endometriosis absent
9.
Aneuploidy with similar DNA indices or diploidy of both tumors ^b

b The possibility of tumor heterogeneity must be taken into account in the evaluation of the ploidy findings.
10.
Similar molecular genetic or karyotypic abnormalities in both tumors

1.
Histologic similarity of the tumors
2.
Large ovarian tumor and small endometrial tumor
3.
Ovarian endometriosis present
4.
Location in ovarian parenchyma
5.
Direct extension from ovary predominantly into outer wall of uterus
6.
Spread elsewhere in typical pattern of ovarian carcinoma
7.
Ovarian tumor unilateral (80–90% of cases) and forming single mass
8.
No atypical hyperplasia in endometrium
9.
Aneuploidy with similar DNA indices or diploidy of both tumors ^a

a The possibility of tumor heterogeneity must be taken into account in the evaluation of the ploidy findings.
10.
Similar molecular genetic or karyotypic abnormalities in both tumors

1.
Histologic dissimilarity of the tumors
2.
No or only superficial myometrial invasion of endometrial tumor
3.
No vascular space invasion of endometrial tumor
4.
Atypical endometrial hyperplasia also present
5.
Absence of other evidence of spread of endometrial tumor
6.
Ovarian tumor unilateral (80–90% of cases)
7.
Ovarian tumor located in parenchyma
8.
No vascular space invasion, surface implants, ^a

a Rare primary ovarian endometrioid carcinomas may arise from endometriosis on the ovarian surface.

or predominant hilar location in ovary
9.
Absence of other evidence of spread of ovarian tumor
10.
Ovarian endometriosis present
11.
Different ploidy or DNA indices, if aneuploid, of the tumors ^b

b The possibility of tumor heterogeneity must be taken into account in the evaluation of the ploidy findings.
12.
Dissimilar molecular genetic or karyotypic abnormalities in the tumor

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