MURAL NODULES IN COMMON EPITHELIAL TUMORS OF THE OVARY

The occurrence of mural nodules in cystic common epithelial tumors of the ovary is well established, but differences in terminology and diff iculties in histopathologic interpretation have hampered adequate unde rstanding of their differential diagnoses and prognoses. Using immunoh istochemistry and ultrastructural analyses supplementally, we studied two cases, one a serous cystadenocarcinoma with nodules of undifferent iated sarcoma, the other a mucinous cystadenocarcinoma with mural nodu les of anaplastic carcinoma. Based on these cases and a review of 48 c ases in the literature, we propose a standardized terminology. Mural n odules may be either reactive or neoplastic. Neoplastic mural nodules may be composed of benign elements, carcinoma, carcinoma with reactive elements, sarcoma, or an admixture of carcinoma and sarcoma; the latt er category has some similarities to malignant mixed mesodermal tumors . The prognosis of patients with malignant mural nodules is poor, with 50% mortality. Strict morphologic criteria supplemented by immunohist ochemistry aids in the sometimes difficult differential diagnosis amon g these types of mural nodules.