JBRBTR, 2004, 87: 118-119.

MUCINOUS CYSTADENOMA OF THE OVARY

O. Bladt, R. De Man, P Aerts1 . Key-word: Ovary, neoplasms

Background: A 17-year-old woman was referred to the emergency unit by the general practitioner on suspicion of appendicitis. The patient complained of abdominal pain which started acutely in the morning and progressively increased during the day. A pregnancy-test, performed by the general practitioner, was negative. She suffered from pain in the right lower quadrant. Physical examination revealed abdominal distention. She had no fever and there were no menstruation problems. Routine labora-

tory tests were normal.

C
1 Fig. 2B 2A 2C 3

1.Department of Radiology, H.-Hart Ziekenhuis, Wilgenstraat 2, 8800 Roeselare, Belgium

MUCINOUS CYSTADENOMA OF THE OVARY BLADT et al.

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Work-up Ultrasonography of the abdomen (Fig. 1A) shows a huge intra-abdominal cystic mass, with extension from lower to upper abdomen, presenting with some thin internal septations. The mass compresses and displaces the organs in the upper abdomen cranially. There is hydronephrosis of the right kidney. Contrast-enhanced CT scan (8-slice spiral CT) of the abdomen (Fig. 2) demonstrates a huge cystic mass (A) which originates posteriorly of the uterus and extends to the upper abdomen, pushing the uterus anteriorly and caudally and the upper abdominal organs cranially. The lesion measures 33 20 12 cm (B,C). The cystic mass is well delineated and shows some thin, regular, internal septations which enhance after contrast administration. There is hydro-ureteronephrosis of the right kidney, with delayed nephrogram. Radiological diagnosis A large, lobulated, cystic tumor was found at surgery. After suction of 4 liters of fluid, the mass was small enough to be resected (Fig. 2A). Pathological examination showed ovarian mucinous cystadenoma. Discussion Ovarian tumors are classified on the basis of tumor origin as epithelial tumors (serous and mucinous tumors, endometrioid and clear cell carcinoma, Brenner tumor), germ cell tumors (mature and immature teratoma, dysgerminoma, endodermal sinus tumor, embryonal carcinoma), sex cord-stromal tumors (fibrothecoma, granulosa cell, sclerosing stromal, and Sertoli-Leydig cell tumor), and metastatic tumors. Epithelial ovarian tumors represent 60% of all ovarian neoplasms and 85% of malignant ovarian neoplasms. Their prevalence increases with age and peaks in the sixth and seventh decade of life. Nevertheless, epithelial tumors with low malignant potential are often seen in younger patients. Epithelial ovarian tumors can be classified as benign (60%), malignant (35%), or borderline (low-malignant-potential) (5%) depending on their histologic characteristics and clinical behaviour.

The two most common types of epithelial neoplasms are serous and mucinous tumors. A tumor that manifests as a unilocular or multilocular cystic mass with homogeneous CT attenuation or MRIsignal intensity of the cystic components, a thin regular wall or septum, and no endocystic or exocystic vegetation is considered to be a benign serous cystadenoma. A tumor that manifests as a multilocular cystic mass that has a thin regular wall and septa or that contains liquid of different attenuation or signal intensity but has no endocystic or exocystic vegetation is considered to be a benign mucinous cystadenoma. Mucinous cystadenoma tends to be larger than serous cystadenoma at presentation, and is more likely to remain clinically silent, as in our patient. Radiological signs of malignant tumors include a thick irregular wall, thick septations, papillary projections, and a large soft-tissue component with necrosis. Identification of papillary projections on an imaging study is important because they are the single best predictor of the epithelial character of a neoplasm and may correlate with the aggressiveness of the tumor. They are usually absent or very small in benign cystadenomas. Papillary projections were not present in the cystadenoma of our patient. Mucinous adenocarcinomas may rupture and are associated with pseudomyxoma peritonei. Bibliography 1. Jung S.E., Lee J.M., Rha S.E., et al.: CT and MRimaging of ovarian tumors with emphasis on differential diagnosis. Radiographics, 2002, 22: 1305-1325. 2. Kawamoto S., Urban B.A., Fishman E.K.: CT of epithelial ovarian tumors. Radiographics, 1999, 19: S85-S102. 3. Occhipinti K.A.: Computed tomography and magnetic resonance imaging of the ovary. In: Anderson JC, ed. Gynecologic imaging. London, England: Churchill Livingstone, 1999, 345-359. 4. Buy J.N., Ghossain M.A., Sciot C., et al.: Epithelial tumors of the ovary: CT-findings and correlation with US. Radiology, 1991, 178: 811818.