Ovarian serous borderline tumor with mural nodules of anaplastic carcinoma and omental involvement: A case report

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.

Keywords: Ovary serous borderline tumor; mural nodules.

Figure 1.

Representative hematoxylin and eosin (h and e) images of the tumor. (a): Focus of epithelial proliferation with stratification, hierarchical branching, and mild nuclear atypia; (b): Nodule composed of spindle cells, abutting serous cyst lining; (c): Focal papillary epithelioid growth pattern within nodule; (d): Nodule with spindle morphology.

Figure 2.

Immunoprofile of serous cyst lining and anaplastic nodule. (a): Cytokeratin eight shows diffuse reactivity in cyst lining and nodule; (b): p53 shows wild-type reactivity in serous component, but diffuse strong nuclear reactivity in anaplastic nodule; (c): PAX-8 shows diffuse reactivity in cyst lining and nodule; (d): WT-1 shows strong nuclear reactivity in cyst lining but only weak expression in anaplastic nodule.