Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2010  |  Volume : 53  |  Issue : 2  |  Page : 387-

Mucinous carcinoma of the ovary as a source of peritoneal mucinous carcinomatosis


Rangarajan Srinivasan1, Ritesh G Menezes2, S Mamata3,  
1 Department of Pathology, Kasturba Medical College, Manipal, India
2 Department of Forensic Medicine and Toxicology, Manipal College of Medical Sciences, Pokhara, Nepal
3 Department of Anatomy, Kasturba Medical College, Manipal, India

Correspondence Address:
Rangarajan Srinivasan
Department of Pathology, Kasturba Medical College, Manipal - 576 104
India




How to cite this article:
Srinivasan R, Menezes RG, Mamata S. Mucinous carcinoma of the ovary as a source of peritoneal mucinous carcinomatosis.Indian J Pathol Microbiol 2010;53:387-387


How to cite this URL:
Srinivasan R, Menezes RG, Mamata S. Mucinous carcinoma of the ovary as a source of peritoneal mucinous carcinomatosis. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Dec 7 ];53:387-387
Available from: https://www.ijpmonline.org/text.asp?2010/53/2/387/64319


Full Text

Sir,

The coexistence of mucinous ovarian tumors with mature cystic teratoma is indeed rare, as described by Ray et al.,[1] in their recent case report. The authors have described that the mucinous cystadenocarcinoma with mature teratoma was in the right ovary and showed rupture of the capsule. The peritoneal cavity was filled with jelly-like mucinous material. The peritoneal/omental content was not sent for histopathology and hence the nature of the peritoneal lesion was not ascertained.

Going by the details of the reported case, this could well be a case of peritoneal mucinous carcinomatosis (PMCA), which further throws up the question of the possible origin of PMCA. There is compelling evidence in the literature to suggest that the source of PMCA is almost always appendiceal and rarely ovarian mucinous carcinoma. [2] When the ovary is suspected to be the origin of PMCA, it is mandatory to completely sample the appendix and prove that the appendix is histologically normal. [2],[3],[4]

In the case described by Ray et al.,[1] the appendix has not been examined grossly or histologically. This omission by the surgeon could possibly be due to lack of awareness of sampling appendix in all cases of mucinous ascites irrespective of the presence of ovarian mucinous tumor. Hence in this case a coexistent appendiceal mucinous carcinoma has not been ruled out.

The literature on the ovarian origin of pseudomyxoma peritonei (PMP) points at an interesting fact, that in all the documented cases the ovarian mucinous tumor which was the cause for PMP arose in an ovarian mature cystic teratoma. [2],[3],[4] In the three cases documented by Ronett et al,[2] the mucinous tumors displayed a lower gastrointestinal tract type, rather than ovaraian type mucinous tumor immunophenotype (cytokeratin 20-positive/ cytokeratin 7-negative), supporting the interpretation that the mucinous tumors were derived from the a gastrointestinal-type mucinous epithelial component of the teratoma. [2] In the case described by Ray et al., [1] mucinous tumor immunophenotyping with cytokeratins 7 and 20 would have thrown more light on the possible teratomatous origin of the mucinous carcinoma.

The nature of the peritoneal lesion in cases of mucinous ascites has far-reaching therapeutic and prognostic implications. [2],[4] Hence the surgeons need to follow the policy that in all cases of mucinous ascites, the entire peritoneal contents should be sent for histopathological examination; and appendicectomy should be performed (even if it appears normal peroperatively). The pathologist needs to extensively sample the peritoneal mucinous material to determine the nature of the peritoneal lesion (benign vs. malignant); and completely sample the appendix to rule out the possible appendicular pathology causing mucinous ascites. In the absence of any appendicular pathology, the source for PMP could be the ovaries or the lower gastrointestinal tract, and search should be carried on to ascertain the same.

References

1Ray S, De A, Baruli G, Karmakar R, Sinha A, Bhattacharya A. Coexistance of a mature Teratoma and mucinous cystadenocarcinoma in the same ovary: A case report. Indian J Pathol Microbiol 2006;49:420-2.
2Ronett BM, Seidan JD. Mucinous tumors arising in ovarian mature cystic teratomas: Relationship to the clinical syndrome of Pseudomyxoma Peritonei. Am J Surg Pathol 2003;27:650-7.
3Lee KR, Scully RE. Mucinous tumors of the ovary: A clinicopathologic study of 196boderline tumors (of intestinal type) and carcinomas, Including an evaluation of 11 cases with 'Psedomyxoma Perionei'. Am J Surg Pathol 2000:24:1447-64.
4Pranesh N, Menasce LP, Wilson MS, O' Dwyer ST. Pseudomyxoma Peritonei: Unusual origin from an ovarian mature cystic Teratoma. J Clin Pathol 2005;58:1115-7.