Primary ovarian mucinous cystadenocarcinomas - A clinicopathologic study of 49 cases with long-term follow-up

Prognostic data for ovarian mucinous carcinoma are limited and difficult to interpret because of differing diagnostic criteria and inclusion of second ary tumors. To better characterize these neoplasms, 49 primary ovarian muci nous tumors diagnosed as carcinoma by the Hart and Norris criteria and stag ed by the FIGO system were studied. Forty-four tumors (90%) were stage I, f our were stage III and one was unstaged. Sixteen tumors (33%) were classifi ed as intraglandular ("noninvasive") carcinoma; all were stage I and all pa tients were alive without tumor after 4-216 months (mean, 74 months); two p atients had received adjuvant chemotherapy. Stromal invasion was present in the remaining 33 cases (67%), including 19 tumors with extensive invasion and 14 with one or more discrete foci of microinvasion teach focus less tha n or equal to 1 mm). The microinvasive tumors were reclassified into intrag landular carcinoma with microinvasion (nine cases) and borderline (low mali gnant potential) tumor with microinvasion (five cases). All microinvasive t umors were stage I and none recurred after postoperative intervals of 9-176 months (mean, 71 months) for the microinvasive carcinomas and 33-117 month s (mean, 60 months) for the microinvasive borderline tumors; only 1 of the 14 patients received adjuvant chemotherapy. All 19 extensively invasive car cinomas also had intraglandular carcinoma. Fourteen were stage I, four were stage LII, and one was unstaged. Eleven (79%) of the stage I patients were alive without tumor after 10-220 months (mean, 110 months), including six who received chemotherapy; one was dead without tumor and two developed pro gressive disease tone had received adjuvant chemotherapy). The four extensi vely invasive stage III carcinomas were fatal after 1-59 months. The unstag ed patient received adjuvant chemotherapy and was alive without recurrence at 98 months. Conclusions of this study are as follows: (1) primary mucinou s carcinomas are very uncommon tumors, after rigorous exclusion of metastat ic carcinomas and tumors associated with pseudomyxoma peritonei; (2) bilate rality is not a feature of primary mucinous carcinomas; (3) FIGO stage is t he single most important prognostic factor, with stage I carcinomas having a very favorable prognosis; (4) stage I carcinomas that metastasize have ex tensive stromal invasion; (5) extensive stromal invasion is found only in t umors with a component of intraglandular carcinoma; (6) high-stage carcinom as invariably contain extensively invasive carcinoma and have a very poor p rognosis; and (7) stromal microinvasion with individual foci not exceeding 1 mm does not appear to be an adverse factor in either carcinomas or border line tumors of stage I.