Clinicopathologic Features and Surgical Management of Mucinous Tumors Involving the Ovary: A Retrospective Study of Benign, Borderline, Primary Ovarian, and Metastatic Tumors

Abstract

Objective: To compare the clinicopathologic features and surgical management of benign, borderline, and malignant

mucinous tumors involving the ovary and to characterize primary ovarian and extraovarian origins among malignant

cases.

 

Methods: We retrospectively reviewed 67 patients who underwent surgery between May 2015 and February 2021

and classified their tumors as benign, borderline, or malignant. Clinicopathologic, surgical, treatment, and follow-up

data were recorded. Continuous variables are presented as medians (minimum-maximum) and categorical variables

as numbers and percentages. Groups were compared using the Kruskal-Wallis, chi-square, or Fisher’s exact test, as

appropriate.

 

Results: Of the 67 patients, 33 had benign tumors, 19 had borderline tumors, and 15 had malignant tumors; the malig-

nant group included 10 primary mucinous ovarian carcinomas and five metastases from extraovarian primary tumors.

The median age was 43 years (range, 16-86), and the median tumor diameter was 13 cm (range, 5-50); six tumors

(9.0%) were bilateral. Median age was higher in the malignant group than in the benign and borderline groups [56

(31-71), 38 (21-86), and 42 (16-69) years, respectively; p=0.004]. Tumor diameter also differed among the groups [10

(5-25), 16 (5-50), and 13 (5-40) cm, respectively; p=0.043]. All benign and borderline tumors were unilateral, whereas

40.0% of malignant tumors were bilateral (p<0.001). Appendectomy rates were 53.3% in the malignant group, 47.4%

in the borderline group, and 6.1% in the benign group (p<0.001). Among 19 appendectomy specimens, two showed

metastatic involvement by primary mucinous ovarian carcinoma, one represented a primary appendiceal carcinoma

with ovarian metastasis, and one contained a serrated adenoma. Five malignant tumors (33.3%) arose from extrao-

varian primary sites: three colorectal, one gastric, and one appendiceal; all colorectal metastases were bilateral. Six of

10 primary ovarian carcinomas were stage I.

 

Conclusion: Older age and bilateral involvement were associated with malignant mucinous tumors, whereas tumor

diameter did not increase linearly across the benign-borderline-malignant spectrum. Because one-third of malignant

tumors originated from extraovarian sites, integrated clinicopathologic assessment is essential. Surgical extent and

appendectomy should be individualized according to macroscopic findings, fertility goals, and the distinction between

primary and metastatic disease.

Keywords

• mucinous ovarian tumor
• borderline ovarian tumor
• mucinous ovarian carcinoma
• ovarian metastasis

Overi Tutan Müsinöz Tümörlerin Klinikopatolojik Özellikleri ve Cerrahi Yönetimi: Benign, Borderline, Primer Over Karsinomu ve Metastatik Tümörlerin Retrospektif Analizi

Abstract

Amaç: Overi tutan benign, borderline ve malign müsinöz tümörlerin klinikopatolojik özellikleri ile cerrahi yönetimini karşılaştırmak ve malign olgular arasında primer over ve ekstraovaryan kökenleri tanımlamak. 

Yöntem: Mayıs 2015 ile Şubat 2021 arasında ameliyat edilen 67 hasta retrospektif olarak incelendi ve tümörleri benign (n=33), borderline (n=19) veya malign (n=15) olarak sınıflandırıldı. Malign grup, primer müsinöz over karsinomu (n=10) ve ekstraovaryan primer tümör metastazlarından (n=5) oluşuyordu. Klinikopatolojik, cerrahi, tedavi ve izlem verileri kaydedildi. Sürekli değişkenler medyan (minimum-maksimum), kategorik değişkenler ise sayı ve yüzde olarak sunuldu. Gruplar uygun şekilde Kruskal-Wallis, ki-kare veya Fisher'ın kesin testi kullanılarak karşılaştırıldı. 

Bulgular: Medyan yaş 43 yıl (aralık, 16-86), medyan tümör çapı 13 cm (aralık, 5-50) idi; altı tümör (%9.0) bilateraldi. Medyan yaş malign grupta benign ve borderline gruplara göre daha yüksekti [sırasıyla 56 (31-71), 38 (21-86) ve 42 (16-69) yıl; p=0.004]. Tümör çapı da gruplar arasında farklıydı [sırasıyla 10 (5-25), 16 (5-50) ve 13 (5-40) cm; p=0.043]. Benign ve borderline tümörlerin tümü unilateral iken, malign tümörlerin %40.0'ı bilateraldi (p<0.001). Apendektomi oranları malign grupta %53.3, borderline grupta %47.4 ve benign grupta %6.1 idi (p<0.001). On dokuz apendektomi spesimeninin ikisinde primer müsinöz over karsinomuna ait metastatik tutulum, birinde over metastazı olan primer apendiks karsinomu ve birinde serrated adenom saptandı. Beş malign tümör (%33.3) ekstraovaryan primer bölgelerden köken alıyordu: üçü kolorektal, biri gastrik ve biri apendiks kökenliydi; kolorektal metastazların tümü bilateraldi. On primer over karsinomunun altısı evre I idi. 

Sonuç: İleri yaş ve bilateral tutulum malign müsinöz tümörlerle ilişkiliyken, tümör çapı benign-borderline-malign spektrum boyunca doğrusal olarak artmadı. Malign tümörlerin üçte biri ekstraovaryan bölgelerden köken aldığı için bütüncül klinikopatolojik değerlendirme gereklidir. Cerrahinin kapsamı ve apendektomi; makroskopik bulgular, fertilite hedefleri ve primer-metastatik hastalık ayrımına göre bireyselleştirilmelidir.

Keywords

• müsinöz over tümörü
• borderline over tümörü
• müsinöz over karsinom
• over metastazı

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