Ovarian mucinous and mixed XXXX of mullerian (endocervical-like) type: a clinicopathologic analysis of four cases of an uncommon variant associated with @entity46 .

@entity43 @entity1 @entity1204 @entity172 @entity71041 @entity1420 @entity5 @entity2225 @entity189 @entity46 @entity1820 @entity2277 @entity5822
The epithelial cells of @entity43 may sometimes appear similar to those of @entity1820 , but most are composed of cells that do not suggest any particular derivation. We report four cases of mucinous @entity43 in which the cells were entirely or almost entirely endocervical-like. The @entity1 ' ages were 34, 43, 44, and 50 years. Two @entity1 had @entity5 confined to the ovaries at initial staging; both also had synchronous @entity1204 of the mucinous type. The two other @entity1 had @entity5 , both with invasive metastases in the pelvis and abdomen at initial staging. In one of the latter cases a @entity5 (MMBT) of the opposite ovary had been removed 5 years earlier, and in this case and two other cases the @entity43 had foci resembling @entity71041 , suggesting that they may be an invasive counterpart to these @entity5 . The six @entity5 ranged from 4 to 19 cm; five were grossly cystic with papillary or solid areas, and one was entirely solid. They were composed of closely packed glands, cysts, and cysts containing complex papillae. There was abundant intraglandular and intracystic mucin. The epithelial cells were well differentiated with infrequent mitoses and most were tall with mucinous cytoplasm resembling normal endocervical glandular cells. In three @entity5 there also were round to polygonal cells with eosinophilic cytoplasm; endometrioid foci were present in three @entity5 and a squamous focus was present in one. One @entity5 had a focally infiltrative growth pattern with a desmoplastic stromal reaction; the remaining five @entity5 had an exclusively confluent (expansile) pattern of invasion. Endometriosis was present in residual ovarian tissue adjacent to four @entity5 in three @entity1 and had marked epithelial proliferation in three. All @entity1 were treated postoperatively with chemotherapy and were without clinical recurrence with follow-up intervals of 8 months, 1.2 years, 2.9 years, and 3.8 years. By immunohistochemical analysis the neoplastic epithelium was positive for @entity172 and @entity1420 receptor proteins, @entity2277 , and @entity5822 , and negative or only focally positive for carcinoembryonic antigen and @entity2225 , a profile that differs from that of the @entity43 and is supportive of a mullerian derivation. As with MMBTs, there was a strong association with @entity46 , and these @entity5 likely arise from @entity46 , possibly through an MMBT precursor in some cases. To better understand their clinicopathologic features and pathogenesis, this uncommon variant should be separated from the usual type in future studies of @entity189 of the ovary.
