Ovarian mucinous tumors with sarcoma-like mural nodules: a report of seven cases

Seven cases of mucinous ovarian tumors with sarcoma-like nodules in their walls are reported. The age of the patients ranged from 18--81 years. Each of them had a large abdominal mass which proved on exploration to be a Stage Ia cystic ovarian tumor. All the specimens contained one or more discrete nodules in their walls, most of which were soft, dark brown, and hemorrhagic. On microscopical examination the epithelial component of four of the tumors was of borderline malignancy and of three was well-differentiated carcinoma. Three patterns were encountered in the nodules: pleomorphic and epulis-like in four cases, pleomorphic and spindle-celled in one case, and giant cell-histiocytic in two cases. These patterns simulated those of malignant giant cell tumor of soft parts, spindle cell sarcoma, and well-differentiated rhabdomyosarcoma, respectively. Postoperative follow-up ranging from 1 to 11 1/2 years (average 7 1/2 years) revealed no evidence of recurrence. Reports of seven similar tumors were found in the literature. Although follow-up has been less complete in these cases, none of the tumors is known to have spread beyond the ovary. These data suggest that mural nodules of the types described are not sarcomatous but could represent a reactive process that has no effect on the prognosis of the patient.