Mucinous Neoplasms of the Ovary: Radiologic-Pathologic Correlation

Abstract

Mucinous neoplasms of the ovary account for 10%-15% of ovarian neoplasms. They may be benign, borderline, or malignant. The large majority are benign or borderline, accounting for 80% and 16%-17%, respectively. Mucinous neoplasms of the ovary most commonly affect women in their 20s to 40s. The clinical manifestation is nonspecific, but most mucinous ovarian neoplasms manifest as large unilateral pelvic masses. At gross pathologic analysis, mucinous ovarian neoplasms appear as large multiloculated cystic masses. The contents of the cyst loculi vary on the basis of differences in internal mucin content. At histologic analysis, mucinous ovarian neoplasms are composed of multiple cysts lined by mucinous epithelium, often resembling gastrointestinal-type epithelium. Imaging evaluation most commonly includes US and/or MRI. The imaging findings parallel the gross pathologic features and include a large, unilateral, multiloculated cystic mass. The cyst loculi vary in echogenicity, attenuation, and signal intensity depending on the mucin content. Mucinous neoplasms of the ovary are staged surgically using the FIGO (International Federation of Gynecology and Obstetrics) staging system. Primary treatment is surgical, with adjuvant chemotherapy considered in the uncommon case of mucinous carcinoma with extraovarian disease. Since most mucinous ovarian neoplasms are benign or borderline, the overall prognosis is excellent.

Figure 1a.

Bilateral mucinous cystadenoma in a 27-year-old woman with 1 year of weight gain and acute onset of abdominal pain. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a large cystic lesion (white *) with one thin septum arising from the left ovary. There is a smaller unilocular lesion in the right ovary (black * in b). (c) Gross photograph of the left ovarian lesion shows a smooth-walled cyst. (d) Photograph shows that the cyst was filled with over 7 L of serosanguineous fluid. (e) Photomicrograph of the left ovarian lesion shows simple mucinous cystic epithelium (arrow), characteristic of mucinous cystadenoma. (Hematoxylin-eosin [H-E] stain; original magnification, ×200.)

Figure 1b.

Bilateral mucinous cystadenoma in a 27-year-old woman with 1 year of weight gain and acute onset of abdominal pain. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a large cystic lesion (white *) with one thin septum arising from the left ovary. There is a smaller unilocular lesion in the right ovary (black * in b). (c) Gross photograph of the left ovarian lesion shows a smooth-walled cyst. (d) Photograph shows that the cyst was filled with over 7 L of serosanguineous fluid. (e) Photomicrograph of the left ovarian lesion shows simple mucinous cystic epithelium (arrow), characteristic of mucinous cystadenoma. (Hematoxylin-eosin [H-E] stain; original magnification, ×200.)

Figure 1c.

Bilateral mucinous cystadenoma in a 27-year-old woman with 1 year of weight gain and acute onset of abdominal pain. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a large cystic lesion (white *) with one thin septum arising from the left ovary. There is a smaller unilocular lesion in the right ovary (black * in b). (c) Gross photograph of the left ovarian lesion shows a smooth-walled cyst. (d) Photograph shows that the cyst was filled with over 7 L of serosanguineous fluid. (e) Photomicrograph of the left ovarian lesion shows simple mucinous cystic epithelium (arrow), characteristic of mucinous cystadenoma. (Hematoxylin-eosin [H-E] stain; original magnification, ×200.)

Figure 1d.

Bilateral mucinous cystadenoma in a 27-year-old woman with 1 year of weight gain and acute onset of abdominal pain. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a large cystic lesion (white *) with one thin septum arising from the left ovary. There is a smaller unilocular lesion in the right ovary (black * in b). (c) Gross photograph of the left ovarian lesion shows a smooth-walled cyst. (d) Photograph shows that the cyst was filled with over 7 L of serosanguineous fluid. (e) Photomicrograph of the left ovarian lesion shows simple mucinous cystic epithelium (arrow), characteristic of mucinous cystadenoma. (Hematoxylin-eosin [H-E] stain; original magnification, ×200.)

Figure 1e.

Bilateral mucinous cystadenoma in a 27-year-old woman with 1 year of weight gain and acute onset of abdominal pain. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a large cystic lesion (white *) with one thin septum arising from the left ovary. There is a smaller unilocular lesion in the right ovary (black * in b). (c) Gross photograph of the left ovarian lesion shows a smooth-walled cyst. (d) Photograph shows that the cyst was filled with over 7 L of serosanguineous fluid. (e) Photomicrograph of the left ovarian lesion shows simple mucinous cystic epithelium (arrow), characteristic of mucinous cystadenoma. (Hematoxylin-eosin [H-E] stain; original magnification, ×200.)

Figure 2a.

Mucinous cystadenoma in a 42-year-old woman with abdominal bloating. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images show a large cystic mass (*) with minimal complexity. (c) Intraoperative photograph shows a large cyst with a smooth outer surface (*). (d) High-power photomicrograph shows cysts (arrow) and glands (*) lined by simple nonstratified mucinous epithelium, typical of mucinous cystadenoma. (H-E stain.)

Figure 2b.

Mucinous cystadenoma in a 42-year-old woman with abdominal bloating. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images show a large cystic mass (*) with minimal complexity. (c) Intraoperative photograph shows a large cyst with a smooth outer surface (*). (d) High-power photomicrograph shows cysts (arrow) and glands (*) lined by simple nonstratified mucinous epithelium, typical of mucinous cystadenoma. (H-E stain.)

Figure 2c.

Mucinous cystadenoma in a 42-year-old woman with abdominal bloating. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images show a large cystic mass (*) with minimal complexity. (c) Intraoperative photograph shows a large cyst with a smooth outer surface (*). (d) High-power photomicrograph shows cysts (arrow) and glands (*) lined by simple nonstratified mucinous epithelium, typical of mucinous cystadenoma. (H-E stain.)

Figure 2d.

Mucinous cystadenoma in a 42-year-old woman with abdominal bloating. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images show a large cystic mass (*) with minimal complexity. (c) Intraoperative photograph shows a large cyst with a smooth outer surface (*). (d) High-power photomicrograph shows cysts (arrow) and glands (*) lined by simple nonstratified mucinous epithelium, typical of mucinous cystadenoma. (H-E stain.)

Figure 3a.

Mucinous cystadenoma in a 38-year-old woman with dysmenorrhea. (a) Sagittal transabdominal US image shows a cystic mass with multiple septa (*). (b) Axial contrast-enhanced CT image shows a cystic mass (white *) anterior to the uterus (black *). (c–e) Axial T2-weighted (c), sagittal T2-weighted (d), and sagittal contrast-enhanced fat-saturated T1-weighted (e) images show a cystic mass anterior to the uterus with multiple septa (black * in c and d). Enhancement of the septa is seen (arrow in e). Note the incidental left ovarian endometrioma (arrow in c) and adenomyosis (white * in c and d). (f) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (g) High-power photomicrograph shows intestinal differentiation of the lining with goblet cells (arrow), typical of mucinous cystadenoma. (H-E stain.)

Figure 3b.

Mucinous cystadenoma in a 38-year-old woman with dysmenorrhea. (a) Sagittal transabdominal US image shows a cystic mass with multiple septa (*). (b) Axial contrast-enhanced CT image shows a cystic mass (white *) anterior to the uterus (black *). (c–e) Axial T2-weighted (c), sagittal T2-weighted (d), and sagittal contrast-enhanced fat-saturated T1-weighted (e) images show a cystic mass anterior to the uterus with multiple septa (black * in c and d). Enhancement of the septa is seen (arrow in e). Note the incidental left ovarian endometrioma (arrow in c) and adenomyosis (white * in c and d). (f) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (g) High-power photomicrograph shows intestinal differentiation of the lining with goblet cells (arrow), typical of mucinous cystadenoma. (H-E stain.)

Figure 3c.

Mucinous cystadenoma in a 38-year-old woman with dysmenorrhea. (a) Sagittal transabdominal US image shows a cystic mass with multiple septa (*). (b) Axial contrast-enhanced CT image shows a cystic mass (white *) anterior to the uterus (black *). (c–e) Axial T2-weighted (c), sagittal T2-weighted (d), and sagittal contrast-enhanced fat-saturated T1-weighted (e) images show a cystic mass anterior to the uterus with multiple septa (black * in c and d). Enhancement of the septa is seen (arrow in e). Note the incidental left ovarian endometrioma (arrow in c) and adenomyosis (white * in c and d). (f) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (g) High-power photomicrograph shows intestinal differentiation of the lining with goblet cells (arrow), typical of mucinous cystadenoma. (H-E stain.)

Figure 3d.

Mucinous cystadenoma in a 38-year-old woman with dysmenorrhea. (a) Sagittal transabdominal US image shows a cystic mass with multiple septa (*). (b) Axial contrast-enhanced CT image shows a cystic mass (white *) anterior to the uterus (black *). (c–e) Axial T2-weighted (c), sagittal T2-weighted (d), and sagittal contrast-enhanced fat-saturated T1-weighted (e) images show a cystic mass anterior to the uterus with multiple septa (black * in c and d). Enhancement of the septa is seen (arrow in e). Note the incidental left ovarian endometrioma (arrow in c) and adenomyosis (white * in c and d). (f) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (g) High-power photomicrograph shows intestinal differentiation of the lining with goblet cells (arrow), typical of mucinous cystadenoma. (H-E stain.)

Figure 3e.

Mucinous cystadenoma in a 38-year-old woman with dysmenorrhea. (a) Sagittal transabdominal US image shows a cystic mass with multiple septa (*). (b) Axial contrast-enhanced CT image shows a cystic mass (white *) anterior to the uterus (black *). (c–e) Axial T2-weighted (c), sagittal T2-weighted (d), and sagittal contrast-enhanced fat-saturated T1-weighted (e) images show a cystic mass anterior to the uterus with multiple septa (black * in c and d). Enhancement of the septa is seen (arrow in e). Note the incidental left ovarian endometrioma (arrow in c) and adenomyosis (white * in c and d). (f) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (g) High-power photomicrograph shows intestinal differentiation of the lining with goblet cells (arrow), typical of mucinous cystadenoma. (H-E stain.)

Figure 3f.

Mucinous cystadenoma in a 38-year-old woman with dysmenorrhea. (a) Sagittal transabdominal US image shows a cystic mass with multiple septa (*). (b) Axial contrast-enhanced CT image shows a cystic mass (white *) anterior to the uterus (black *). (c–e) Axial T2-weighted (c), sagittal T2-weighted (d), and sagittal contrast-enhanced fat-saturated T1-weighted (e) images show a cystic mass anterior to the uterus with multiple septa (black * in c and d). Enhancement of the septa is seen (arrow in e). Note the incidental left ovarian endometrioma (arrow in c) and adenomyosis (white * in c and d). (f) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (g) High-power photomicrograph shows intestinal differentiation of the lining with goblet cells (arrow), typical of mucinous cystadenoma. (H-E stain.)

Figure 3g.

Mucinous cystadenoma in a 38-year-old woman with dysmenorrhea. (a) Sagittal transabdominal US image shows a cystic mass with multiple septa (*). (b) Axial contrast-enhanced CT image shows a cystic mass (white *) anterior to the uterus (black *). (c–e) Axial T2-weighted (c), sagittal T2-weighted (d), and sagittal contrast-enhanced fat-saturated T1-weighted (e) images show a cystic mass anterior to the uterus with multiple septa (black * in c and d). Enhancement of the septa is seen (arrow in e). Note the incidental left ovarian endometrioma (arrow in c) and adenomyosis (white * in c and d). (f) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (g) High-power photomicrograph shows intestinal differentiation of the lining with goblet cells (arrow), typical of mucinous cystadenoma. (H-E stain.)

Figure 4a.

Mucinous cystadenoma and Brenner tumor in a 54-year-old woman with a palpable adnexal lesion at physical examination. (a–c) Coronal T2-weighted fat-saturated (a), axial T2-weighted (b), and axial contrast-enhanced fat-saturated T1-weighted (c) images show a multiloculated cystic mass (*). Enhancing soft tissue along the periphery of the lesion (arrow in c) is not typical in an isolated mucinous cystadenoma. (d) Low-power photomicrograph shows goblet cells lining the cyst wall (arrow) of the mucinous cystadenoma and adjacent Brenner tumor (*). (H-E stain.)

Figure 4b.

Mucinous cystadenoma and Brenner tumor in a 54-year-old woman with a palpable adnexal lesion at physical examination. (a–c) Coronal T2-weighted fat-saturated (a), axial T2-weighted (b), and axial contrast-enhanced fat-saturated T1-weighted (c) images show a multiloculated cystic mass (*). Enhancing soft tissue along the periphery of the lesion (arrow in c) is not typical in an isolated mucinous cystadenoma. (d) Low-power photomicrograph shows goblet cells lining the cyst wall (arrow) of the mucinous cystadenoma and adjacent Brenner tumor (*). (H-E stain.)

Figure 4c.

Mucinous cystadenoma and Brenner tumor in a 54-year-old woman with a palpable adnexal lesion at physical examination. (a–c) Coronal T2-weighted fat-saturated (a), axial T2-weighted (b), and axial contrast-enhanced fat-saturated T1-weighted (c) images show a multiloculated cystic mass (*). Enhancing soft tissue along the periphery of the lesion (arrow in c) is not typical in an isolated mucinous cystadenoma. (d) Low-power photomicrograph shows goblet cells lining the cyst wall (arrow) of the mucinous cystadenoma and adjacent Brenner tumor (*). (H-E stain.)

Figure 4d.

Mucinous cystadenoma and Brenner tumor in a 54-year-old woman with a palpable adnexal lesion at physical examination. (a–c) Coronal T2-weighted fat-saturated (a), axial T2-weighted (b), and axial contrast-enhanced fat-saturated T1-weighted (c) images show a multiloculated cystic mass (*). Enhancing soft tissue along the periphery of the lesion (arrow in c) is not typical in an isolated mucinous cystadenoma. (d) Low-power photomicrograph shows goblet cells lining the cyst wall (arrow) of the mucinous cystadenoma and adjacent Brenner tumor (*). (H-E stain.)

Figure 5a.

Mucinous borderline tumor in a 63-year-old woman with minimal abdominal pain and urinary frequency. (a) Sagittal US image shows a cystic mass (*) superior and anterior to the bladder (BL). (b–d) Sagittal T2-weighted (b), coronal T2-weighted (c), and coronal contrast-enhanced fat-saturated T1-weighted (d) images show a cystic mass (*) with minimal complexity (arrow in c and d). (e) Photograph of the gross pathologic specimen shows a mass with minimal complexity (black arrow) filled with thick fluid (white arrow). (f) High-power photomicrograph shows epithelial proliferation, stratification, and atypia (*), consistent with mucinous borderline tumor. (H-E stain.)

Figure 5b.

Mucinous borderline tumor in a 63-year-old woman with minimal abdominal pain and urinary frequency. (a) Sagittal US image shows a cystic mass (*) superior and anterior to the bladder (BL). (b–d) Sagittal T2-weighted (b), coronal T2-weighted (c), and coronal contrast-enhanced fat-saturated T1-weighted (d) images show a cystic mass (*) with minimal complexity (arrow in c and d). (e) Photograph of the gross pathologic specimen shows a mass with minimal complexity (black arrow) filled with thick fluid (white arrow). (f) High-power photomicrograph shows epithelial proliferation, stratification, and atypia (*), consistent with mucinous borderline tumor. (H-E stain.)

Figure 5c.

Mucinous borderline tumor in a 63-year-old woman with minimal abdominal pain and urinary frequency. (a) Sagittal US image shows a cystic mass (*) superior and anterior to the bladder (BL). (b–d) Sagittal T2-weighted (b), coronal T2-weighted (c), and coronal contrast-enhanced fat-saturated T1-weighted (d) images show a cystic mass (*) with minimal complexity (arrow in c and d). (e) Photograph of the gross pathologic specimen shows a mass with minimal complexity (black arrow) filled with thick fluid (white arrow). (f) High-power photomicrograph shows epithelial proliferation, stratification, and atypia (*), consistent with mucinous borderline tumor. (H-E stain.)

Figure 5d.

Mucinous borderline tumor in a 63-year-old woman with minimal abdominal pain and urinary frequency. (a) Sagittal US image shows a cystic mass (*) superior and anterior to the bladder (BL). (b–d) Sagittal T2-weighted (b), coronal T2-weighted (c), and coronal contrast-enhanced fat-saturated T1-weighted (d) images show a cystic mass (*) with minimal complexity (arrow in c and d). (e) Photograph of the gross pathologic specimen shows a mass with minimal complexity (black arrow) filled with thick fluid (white arrow). (f) High-power photomicrograph shows epithelial proliferation, stratification, and atypia (*), consistent with mucinous borderline tumor. (H-E stain.)

Figure 5e.

Mucinous borderline tumor in a 63-year-old woman with minimal abdominal pain and urinary frequency. (a) Sagittal US image shows a cystic mass (*) superior and anterior to the bladder (BL). (b–d) Sagittal T2-weighted (b), coronal T2-weighted (c), and coronal contrast-enhanced fat-saturated T1-weighted (d) images show a cystic mass (*) with minimal complexity (arrow in c and d). (e) Photograph of the gross pathologic specimen shows a mass with minimal complexity (black arrow) filled with thick fluid (white arrow). (f) High-power photomicrograph shows epithelial proliferation, stratification, and atypia (*), consistent with mucinous borderline tumor. (H-E stain.)

Figure 5f.

Mucinous borderline tumor in a 63-year-old woman with minimal abdominal pain and urinary frequency. (a) Sagittal US image shows a cystic mass (*) superior and anterior to the bladder (BL). (b–d) Sagittal T2-weighted (b), coronal T2-weighted (c), and coronal contrast-enhanced fat-saturated T1-weighted (d) images show a cystic mass (*) with minimal complexity (arrow in c and d). (e) Photograph of the gross pathologic specimen shows a mass with minimal complexity (black arrow) filled with thick fluid (white arrow). (f) High-power photomicrograph shows epithelial proliferation, stratification, and atypia (*), consistent with mucinous borderline tumor. (H-E stain.)

Figure 6a.

Mucinous borderline tumor in a 58-year-old woman with abdominal distention. (a–c) Sagittal gray-scale (a), color Doppler (b), and spectral (c) US images show a cystic mass (* in a) with vascular flow (arrows in b and c). (d) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (e) Photomicrograph shows nuclear enlargement and hyperchromatic nuclei (arrow), seen in mucinous borderline tumors. (H-E stain; original magnification, ×20.)

Figure 6b.

Mucinous borderline tumor in a 58-year-old woman with abdominal distention. (a–c) Sagittal gray-scale (a), color Doppler (b), and spectral (c) US images show a cystic mass (* in a) with vascular flow (arrows in b and c). (d) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (e) Photomicrograph shows nuclear enlargement and hyperchromatic nuclei (arrow), seen in mucinous borderline tumors. (H-E stain; original magnification, ×20.)

Figure 6c.

Mucinous borderline tumor in a 58-year-old woman with abdominal distention. (a–c) Sagittal gray-scale (a), color Doppler (b), and spectral (c) US images show a cystic mass (* in a) with vascular flow (arrows in b and c). (d) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (e) Photomicrograph shows nuclear enlargement and hyperchromatic nuclei (arrow), seen in mucinous borderline tumors. (H-E stain; original magnification, ×20.)

Figure 6d.

Mucinous borderline tumor in a 58-year-old woman with abdominal distention. (a–c) Sagittal gray-scale (a), color Doppler (b), and spectral (c) US images show a cystic mass (* in a) with vascular flow (arrows in b and c). (d) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (e) Photomicrograph shows nuclear enlargement and hyperchromatic nuclei (arrow), seen in mucinous borderline tumors. (H-E stain; original magnification, ×20.)

Figure 6e.

Mucinous borderline tumor in a 58-year-old woman with abdominal distention. (a–c) Sagittal gray-scale (a), color Doppler (b), and spectral (c) US images show a cystic mass (* in a) with vascular flow (arrows in b and c). (d) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (e) Photomicrograph shows nuclear enlargement and hyperchromatic nuclei (arrow), seen in mucinous borderline tumors. (H-E stain; original magnification, ×20.)

Figure 7a.

Mucinous cystadenocarcinoma in a 31-year-old woman with acute severe abdominal pain. (a) Axial contrast-enhanced CT image shows an enhancing mass in the right adnexa (black *). Note the normal left ovary (arrow) and ascites (white *). (b) Intraoperative photograph shows rupture of the tumor capsule (arrow), as can be seen with mucinous cystadenocarcinoma. (c) Photograph of the gross pathologic specimen shows a solid and cystic mass containing viscous material (arrow). (d) High-power photomicrograph shows back-to-back glands lined by malignant-appearing cells with little or no intervening stroma (*), characteristic of the confluent glandular/expansile invasive pattern seen in mucinous cystadenocarcinoma. (H-E stain.)

Figure 7b.

Mucinous cystadenocarcinoma in a 31-year-old woman with acute severe abdominal pain. (a) Axial contrast-enhanced CT image shows an enhancing mass in the right adnexa (black *). Note the normal left ovary (arrow) and ascites (white *). (b) Intraoperative photograph shows rupture of the tumor capsule (arrow), as can be seen with mucinous cystadenocarcinoma. (c) Photograph of the gross pathologic specimen shows a solid and cystic mass containing viscous material (arrow). (d) High-power photomicrograph shows back-to-back glands lined by malignant-appearing cells with little or no intervening stroma (*), characteristic of the confluent glandular/expansile invasive pattern seen in mucinous cystadenocarcinoma. (H-E stain.)

Figure 7c.

Mucinous cystadenocarcinoma in a 31-year-old woman with acute severe abdominal pain. (a) Axial contrast-enhanced CT image shows an enhancing mass in the right adnexa (black *). Note the normal left ovary (arrow) and ascites (white *). (b) Intraoperative photograph shows rupture of the tumor capsule (arrow), as can be seen with mucinous cystadenocarcinoma. (c) Photograph of the gross pathologic specimen shows a solid and cystic mass containing viscous material (arrow). (d) High-power photomicrograph shows back-to-back glands lined by malignant-appearing cells with little or no intervening stroma (*), characteristic of the confluent glandular/expansile invasive pattern seen in mucinous cystadenocarcinoma. (H-E stain.)

Figure 7d.

Mucinous cystadenocarcinoma in a 31-year-old woman with acute severe abdominal pain. (a) Axial contrast-enhanced CT image shows an enhancing mass in the right adnexa (black *). Note the normal left ovary (arrow) and ascites (white *). (b) Intraoperative photograph shows rupture of the tumor capsule (arrow), as can be seen with mucinous cystadenocarcinoma. (c) Photograph of the gross pathologic specimen shows a solid and cystic mass containing viscous material (arrow). (d) High-power photomicrograph shows back-to-back glands lined by malignant-appearing cells with little or no intervening stroma (*), characteristic of the confluent glandular/expansile invasive pattern seen in mucinous cystadenocarcinoma. (H-E stain.)

Figure 8a.

Appendiceal mucinous adenocarcinoma mimicking an ovarian mucinous neoplasm in a 58-year-old woman with increasing abdominal distention over the course of 1 year. (a, b) Sagittal gray-scale (a) and color Doppler (b) US images show a heterogeneous mass (* in a) in the midabdomen with internal flow (arrow in b). (c, d) Axial (c) and coronal (d) contrast-enhanced CT images show the extent of the cystic mass (white *) and areas suspicious for pseudomyxoma peritonei (black * in d). (e) Photograph of the gross pathologic specimen shows the cystic ovarian mass (*). (f) Photomicrograph shows mucin within glands (*). (H-E stain; original magnification, ×100.) (g) Photomicrograph shows positive CDX2 staining in the lining of the glands (arrow), which is specific for adenocarcinoma arising from the gastrointestinal tract. (Original magnification, ×100.)

Figure 8b.

Appendiceal mucinous adenocarcinoma mimicking an ovarian mucinous neoplasm in a 58-year-old woman with increasing abdominal distention over the course of 1 year. (a, b) Sagittal gray-scale (a) and color Doppler (b) US images show a heterogeneous mass (* in a) in the midabdomen with internal flow (arrow in b). (c, d) Axial (c) and coronal (d) contrast-enhanced CT images show the extent of the cystic mass (white *) and areas suspicious for pseudomyxoma peritonei (black * in d). (e) Photograph of the gross pathologic specimen shows the cystic ovarian mass (*). (f) Photomicrograph shows mucin within glands (*). (H-E stain; original magnification, ×100.) (g) Photomicrograph shows positive CDX2 staining in the lining of the glands (arrow), which is specific for adenocarcinoma arising from the gastrointestinal tract. (Original magnification, ×100.)

Figure 8c.

Appendiceal mucinous adenocarcinoma mimicking an ovarian mucinous neoplasm in a 58-year-old woman with increasing abdominal distention over the course of 1 year. (a, b) Sagittal gray-scale (a) and color Doppler (b) US images show a heterogeneous mass (* in a) in the midabdomen with internal flow (arrow in b). (c, d) Axial (c) and coronal (d) contrast-enhanced CT images show the extent of the cystic mass (white *) and areas suspicious for pseudomyxoma peritonei (black * in d). (e) Photograph of the gross pathologic specimen shows the cystic ovarian mass (*). (f) Photomicrograph shows mucin within glands (*). (H-E stain; original magnification, ×100.) (g) Photomicrograph shows positive CDX2 staining in the lining of the glands (arrow), which is specific for adenocarcinoma arising from the gastrointestinal tract. (Original magnification, ×100.)

Figure 8d.

Appendiceal mucinous adenocarcinoma mimicking an ovarian mucinous neoplasm in a 58-year-old woman with increasing abdominal distention over the course of 1 year. (a, b) Sagittal gray-scale (a) and color Doppler (b) US images show a heterogeneous mass (* in a) in the midabdomen with internal flow (arrow in b). (c, d) Axial (c) and coronal (d) contrast-enhanced CT images show the extent of the cystic mass (white *) and areas suspicious for pseudomyxoma peritonei (black * in d). (e) Photograph of the gross pathologic specimen shows the cystic ovarian mass (*). (f) Photomicrograph shows mucin within glands (*). (H-E stain; original magnification, ×100.) (g) Photomicrograph shows positive CDX2 staining in the lining of the glands (arrow), which is specific for adenocarcinoma arising from the gastrointestinal tract. (Original magnification, ×100.)

Figure 8e.

Appendiceal mucinous adenocarcinoma mimicking an ovarian mucinous neoplasm in a 58-year-old woman with increasing abdominal distention over the course of 1 year. (a, b) Sagittal gray-scale (a) and color Doppler (b) US images show a heterogeneous mass (* in a) in the midabdomen with internal flow (arrow in b). (c, d) Axial (c) and coronal (d) contrast-enhanced CT images show the extent of the cystic mass (white *) and areas suspicious for pseudomyxoma peritonei (black * in d). (e) Photograph of the gross pathologic specimen shows the cystic ovarian mass (*). (f) Photomicrograph shows mucin within glands (*). (H-E stain; original magnification, ×100.) (g) Photomicrograph shows positive CDX2 staining in the lining of the glands (arrow), which is specific for adenocarcinoma arising from the gastrointestinal tract. (Original magnification, ×100.)

Figure 8f.

Appendiceal mucinous adenocarcinoma mimicking an ovarian mucinous neoplasm in a 58-year-old woman with increasing abdominal distention over the course of 1 year. (a, b) Sagittal gray-scale (a) and color Doppler (b) US images show a heterogeneous mass (* in a) in the midabdomen with internal flow (arrow in b). (c, d) Axial (c) and coronal (d) contrast-enhanced CT images show the extent of the cystic mass (white *) and areas suspicious for pseudomyxoma peritonei (black * in d). (e) Photograph of the gross pathologic specimen shows the cystic ovarian mass (*). (f) Photomicrograph shows mucin within glands (*). (H-E stain; original magnification, ×100.) (g) Photomicrograph shows positive CDX2 staining in the lining of the glands (arrow), which is specific for adenocarcinoma arising from the gastrointestinal tract. (Original magnification, ×100.)

Figure 8g.

Appendiceal mucinous adenocarcinoma mimicking an ovarian mucinous neoplasm in a 58-year-old woman with increasing abdominal distention over the course of 1 year. (a, b) Sagittal gray-scale (a) and color Doppler (b) US images show a heterogeneous mass (* in a) in the midabdomen with internal flow (arrow in b). (c, d) Axial (c) and coronal (d) contrast-enhanced CT images show the extent of the cystic mass (white *) and areas suspicious for pseudomyxoma peritonei (black * in d). (e) Photograph of the gross pathologic specimen shows the cystic ovarian mass (*). (f) Photomicrograph shows mucin within glands (*). (H-E stain; original magnification, ×100.) (g) Photomicrograph shows positive CDX2 staining in the lining of the glands (arrow), which is specific for adenocarcinoma arising from the gastrointestinal tract. (Original magnification, ×100.)

Figure 9a.

Borderline mucinous tumor arising from mucinous cystadenoma in a 41-year-old woman with abdominal distention. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a multiloculated cystic mass (black *). Note the ascites (white * in b). (c) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (d) Photomicrograph shows benign mucinous cystadenoma (arrow) and borderline mucinous cystadenoma (*). (H-E stain; original magnification, ×4.)

Figure 9b.

Borderline mucinous tumor arising from mucinous cystadenoma in a 41-year-old woman with abdominal distention. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a multiloculated cystic mass (black *). Note the ascites (white * in b). (c) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (d) Photomicrograph shows benign mucinous cystadenoma (arrow) and borderline mucinous cystadenoma (*). (H-E stain; original magnification, ×4.)

Figure 9c.

Borderline mucinous tumor arising from mucinous cystadenoma in a 41-year-old woman with abdominal distention. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a multiloculated cystic mass (black *). Note the ascites (white * in b). (c) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (d) Photomicrograph shows benign mucinous cystadenoma (arrow) and borderline mucinous cystadenoma (*). (H-E stain; original magnification, ×4.)

Figure 9d.

Borderline mucinous tumor arising from mucinous cystadenoma in a 41-year-old woman with abdominal distention. (a, b) Axial (a) and sagittal (b) contrast-enhanced CT images show a multiloculated cystic mass (black *). Note the ascites (white * in b). (c) Photograph of the gross pathologic specimen shows a multiloculated cystic mass. (d) Photomicrograph shows benign mucinous cystadenoma (arrow) and borderline mucinous cystadenoma (*). (H-E stain; original magnification, ×4.)

Figure 10a.

Mucinous borderline tumor in a 55-year-old woman with increasing abdominal bloating and early satiety. (a, b) Sagittal US images show a cystic mass (white *) in the right adnexa. Note the size of the mass compared with the uterus (black * in a), (c–f) Sagittal (c) and axial (d) T2-weighted, axial fat-saturated T1-weighted (e), and axial contrast-enhanced fat-saturated T1-weighted (f) images show a multiloculated cystic mass (* in c and d) with high-signal-intensity cysts at T1-weighted imaging (* in e) and enhancement (arrow in f). (g) Photomicrograph shows multiple cysts (*) filled with mucin, corresponding to the cysts seen at imaging. (H-E stain; original magnification, ×2.)

Figure 10b.

Mucinous borderline tumor in a 55-year-old woman with increasing abdominal bloating and early satiety. (a, b) Sagittal US images show a cystic mass (white *) in the right adnexa. Note the size of the mass compared with the uterus (black * in a), (c–f) Sagittal (c) and axial (d) T2-weighted, axial fat-saturated T1-weighted (e), and axial contrast-enhanced fat-saturated T1-weighted (f) images show a multiloculated cystic mass (* in c and d) with high-signal-intensity cysts at T1-weighted imaging (* in e) and enhancement (arrow in f). (g) Photomicrograph shows multiple cysts (*) filled with mucin, corresponding to the cysts seen at imaging. (H-E stain; original magnification, ×2.)

Figure 10c.

Mucinous borderline tumor in a 55-year-old woman with increasing abdominal bloating and early satiety. (a, b) Sagittal US images show a cystic mass (white *) in the right adnexa. Note the size of the mass compared with the uterus (black * in a), (c–f) Sagittal (c) and axial (d) T2-weighted, axial fat-saturated T1-weighted (e), and axial contrast-enhanced fat-saturated T1-weighted (f) images show a multiloculated cystic mass (* in c and d) with high-signal-intensity cysts at T1-weighted imaging (* in e) and enhancement (arrow in f). (g) Photomicrograph shows multiple cysts (*) filled with mucin, corresponding to the cysts seen at imaging. (H-E stain; original magnification, ×2.)

Figure 10d.

Mucinous borderline tumor in a 55-year-old woman with increasing abdominal bloating and early satiety. (a, b) Sagittal US images show a cystic mass (white *) in the right adnexa. Note the size of the mass compared with the uterus (black * in a), (c–f) Sagittal (c) and axial (d) T2-weighted, axial fat-saturated T1-weighted (e), and axial contrast-enhanced fat-saturated T1-weighted (f) images show a multiloculated cystic mass (* in c and d) with high-signal-intensity cysts at T1-weighted imaging (* in e) and enhancement (arrow in f). (g) Photomicrograph shows multiple cysts (*) filled with mucin, corresponding to the cysts seen at imaging. (H-E stain; original magnification, ×2.)

Figure 10e.

Mucinous borderline tumor in a 55-year-old woman with increasing abdominal bloating and early satiety. (a, b) Sagittal US images show a cystic mass (white *) in the right adnexa. Note the size of the mass compared with the uterus (black * in a), (c–f) Sagittal (c) and axial (d) T2-weighted, axial fat-saturated T1-weighted (e), and axial contrast-enhanced fat-saturated T1-weighted (f) images show a multiloculated cystic mass (* in c and d) with high-signal-intensity cysts at T1-weighted imaging (* in e) and enhancement (arrow in f). (g) Photomicrograph shows multiple cysts (*) filled with mucin, corresponding to the cysts seen at imaging. (H-E stain; original magnification, ×2.)

Figure 10f.

Mucinous borderline tumor in a 55-year-old woman with increasing abdominal bloating and early satiety. (a, b) Sagittal US images show a cystic mass (white *) in the right adnexa. Note the size of the mass compared with the uterus (black * in a), (c–f) Sagittal (c) and axial (d) T2-weighted, axial fat-saturated T1-weighted (e), and axial contrast-enhanced fat-saturated T1-weighted (f) images show a multiloculated cystic mass (* in c and d) with high-signal-intensity cysts at T1-weighted imaging (* in e) and enhancement (arrow in f). (g) Photomicrograph shows multiple cysts (*) filled with mucin, corresponding to the cysts seen at imaging. (H-E stain; original magnification, ×2.)

Figure 10g.

Mucinous borderline tumor in a 55-year-old woman with increasing abdominal bloating and early satiety. (a, b) Sagittal US images show a cystic mass (white *) in the right adnexa. Note the size of the mass compared with the uterus (black * in a), (c–f) Sagittal (c) and axial (d) T2-weighted, axial fat-saturated T1-weighted (e), and axial contrast-enhanced fat-saturated T1-weighted (f) images show a multiloculated cystic mass (* in c and d) with high-signal-intensity cysts at T1-weighted imaging (* in e) and enhancement (arrow in f). (g) Photomicrograph shows multiple cysts (*) filled with mucin, corresponding to the cysts seen at imaging. (H-E stain; original magnification, ×2.)