Description of a case report of an intestinal-type ... - Cancer Therapy

Longo et al: Description of a case report of an intestinal-type mucinous borderline ovarian tumor
of total proteins with hypoalbuminemia. The serum level of CA-
125 was 120 U/ml (normal range < 35 U/ml).
The patient underwent surgical resection of the tumor with
hysterectomy, bilateral salpingo-oophorectomy, appendectomy
and infracolic omentectomy (Figure 2A). A careful inspection of
the peritoneum, associated to multiple random biopsies,
documented the absence of peritoneal tumor implants. Peritoneal
cytology was negative and no enlarged retroperitoneal lymph
nodes were also detected. Histology documented an intestinaltype
MBT of the left ovary (diameter of 33x29x27cm; weight of
17 Kg) (Figure 2B) containing focal areas of “in situ”
adenocarciroma (Figure 2C, small arrows) and aspects of early
stromal desmoplastic reaction (Figure 2C, big arrows).
The postoperative course was uneventful and the patient
was discharged 10 days post-operatively. After a follow up of 19
months, the patient is alive, in good clinical conditions, and
disease-free as documented by a whole body CT scan and serum
level of CA-125 that returned to within normal ranges.
III. Discussion
BOTs represent approximately 10% to 20% of all
ovarian malignancies and can be quite large in size,
particularly mucinous histotype. In 1988, two MBOT
subtypes have been described: the intestinal-type (85%)
and the endocervical-like (Mullerian) type (15%) (Acs,
2005; Hart, 2005a,b; Wong et al, 2007). MBOTs,
particularly the intestinal-type, can be associated with
pseudomyxoma peritonei (10%) and necessitates a
thorough investigation of the gastrointestinal tract with
special attention to the appendix (Acs, 2005; Hart, 2005a;
Vang et al, 2006).
The endocervical-like type is clinically and pathologically
related to serous borderline tumors with which it is often
mixed and it is usually associated with endometriosis
(Acs, 2005; Hart, 2005a; Vang et al, 2006). The intestinaltype
is much more common and occurs over a very wide
age range (9-70 years), with a mean age of 35 years (Acs,
2005; Hart, 2005a,b; Wong et al, 2007). Typically, it is
characterized by large multicystic masses (mean diameter,
17 cm) with smooth outer surfaces like benign mucinous
cystadenomas (Acs, 2005; Hart, 2005a,b; Wong et al,
2007). Over 90% of these tumors are unilateral and may
have an heterogeneous composition, with coexisting areas
of cystadenoma, noninvasive carcinoma, and sometimes
occult areas of invasive carcinoma. For this reason, an
adequate sampling is particularly important (Acs, 2005;
Hart, 2005a,b; Vang et al, 2006; Wong et al, 2007).
Figure 1. Whole body CT scan showed a massive and multicystic ovarian lesion (arrows) occupaying the whole abdominal (A-C) and
pelvic (D) cavity and compressing the other intrabdominal organs, such as liver, spleen, and kidneys.
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