Ovarian mucinous cystic tumor associated with sarcomatous mural nodule and benign Brenner tumor: A case report and literature review

Abstract

Rationale: Ovarian mucinous tumor with malignant mural nodule is exceedingly rare. We report a case of ovarian mucinous cystic tumor associated with sarcomatous mural nodule and benign Brenner tumor and accompanied by nodular histiocytic aggregates in the greater omentum.

Patient concerns: A 60-year-old postmenopausal woman was presented with a history of one month of lower abdominal discomfort, abdominal distension, nausea, and vomiting. A physical examination revealed a hard, palpable mass with mild tenderness in her right lower abdomen.

Diagnoses: The mucinous tumor was solid and cystic and contained benign, borderline, and malignant elements. Within the solid areas, two nodules representing pleomorphic undifferentiated sarcoma and benign Brenner tumor were identified. The diagnosis of malignant mural nodule was based on vascular invasion and marked nuclear atypia, including atypical mitoses and mitotic activity.

Interventions: Bilateral salpingo-oophorectomy and partial omentectomy were performed. Malignant cells were not found on cytologic examination of the peritoneal washing fluid. The patient underwent three cycles of chemotherapy with 210 mg paclitaxel liposome via an intravenous drip, 20 mg nedaplatin via an intravenous drip, and 80 mg nedaplatin via intraperitoneal perfusion.

Outcomes: The patient has been followed up for 3 years without evidence of tumor recurrence and metastasis.

Lessons: Careful classification of a mural nodule is important to triage patients in need of aggressive adjuvant treatment.

Figure 1

Microscopic appearance of ovarian tumor and greater omental lesion (hematoxylin-eosin staining). A: A mucinous cystadenoma is the main part of the epithelial elements (×100). B: The sarcomatous mural nodule consists of ovoid mononucleated cells and numerous multinucleated osteoclast-like giant cells (×100). C: Nine mitotic figures are observed in one high-power field in the mural nodule consisting of pleomorphic undifferentiated sarcoma (×400). D: Vascular invasion is observed in the lager mural nodule (×200). E: Benign Brenner tumor is composed of nests of transitional epithelium (×100). F: The greater omental lesion shows nodular histiocytic aggregates.

Figure 2

Immunohistochemical features of mural nodule of pleomorphic undifferentiated sarcoma. Mononucleated and multinucleated cells are positive for vimentin (A, ×200) and CD68 (B, ×200). CD34 staining shows tumor cells infiltrating capillary vessels (C, ×400).

Figure 3

Immunohistochemical features of nodular histiocytic aggregates in the greater omentum (×200). The mononuclear cells on the surface of the greater omentum show diffuse and strong reactivity against vimentin (A), CD68 (B), and scattered positivity for calretinin (C).