JBRBTR, 2004, 87: 118-119.

MUCINOUS CYSTADENOMA OF THE OVARY

O. Bladt, R. De Man, P. Aerts1
Key-word: Ovary, neoplasms

Background: A 17-year-old woman was referred to the emergency unit by the general
practitioner on suspicion of appendicitis. The patient complained of abdominal pain
which started acutely in the morning and progressively increased during the day. A pregnancy-test, performed by the general practitioner, was negative.
She suffered from pain in the right lower quadrant. Physical examination revealed abdominal
distention. She had no fever and there were no menstruation problems. Routine labora-

tory tests were normal.

C
1
Fig.

2A 2C
3

1.Department of Radiology, H.-Hart Ziekenhuis, Wilgenstraat 2, 8800 Roeselare,

Belgium

2B

MUCINOUS CYSTADENOMA OF THE OVARY BLADT et al.

Work-up
Ultrasonography of the abdomen (Fig. 1A)
shows a huge intra-abdominal cystic mass, with
extension from lower to upper abdomen, presenting with some thin internal septations. The mass
compresses and displaces the organs in the upper
abdomen cranially. There is hydronephrosis of the
right kidney.
Contrast-enhanced CT scan (8-slice spiral CT) of
the abdomen (Fig. 2) demonstrates a huge cystic
mass (A) which originates posteriorly of the uterus
and extends to the upper abdomen, pushing
the uterus anteriorly and caudally and the upper
abdominal organs cranially. The lesion measures
33
20
12 cm (B,C). The cystic mass is well
delineated and shows some thin, regular, internal
septations which enhance after contrast administration. There is hydro-ureteronephrosis of the
right kidney, with delayed nephrogram.
Radiological diagnosis
A large, lobulated, cystic tumor was found at
surgery. After suction of 4 liters of fluid, the mass
was small enough to be resected (Fig. 2A).
Pathological examination showed ovarian mucinous cystadenoma.

119

The two most common types of epithelial neoplasms are serous and mucinous tumors. A tumor
that manifests as a unilocular or multilocular cystic
mass with homogeneous CT attenuation or MRIsignal intensity of the cystic components, a thin
regular wall or septum, and no endocystic or
exocystic vegetation is considered to be a benign
serous cystadenoma. A tumor that manifests as a
multilocular cystic mass that has a thin regular
wall and septa or that contains liquid of different
attenuation or signal intensity but has no endocystic or exocystic vegetation is considered to be
a benign mucinous cystadenoma. Mucinous
cystadenoma tends to be larger than serous cystadenoma at presentation, and is more likely to
remain clinically silent, as in our patient.
Radiological signs of malignant tumors include
a thick irregular wall, thick septations, papillary
projections, and a large soft-tissue component
with necrosis. Identification of papillary projections on an imaging study is important because
they are the single best predictor of the epithelial
character of a neoplasm and may correlate with
the aggressiveness of the tumor. They are usually
absent or very small in benign cystadenomas.
Papillary projections were not present in the
cystadenoma of our patient.
Mucinous adenocarcinomas may rupture and
are associated with pseudomyxoma peritonei.

Discussion
Ovarian tumors are classified on the basis of
tumor origin as epithelial tumors (serous and
mucinous tumors, endometrioid and clear cell
carcinoma, Brenner tumor), germ cell tumors
(mature and immature teratoma, dysgerminoma,
endodermal sinus tumor, embryonal carcinoma),
sex cord-stromal tumors (fibrothecoma, granulosa
cell, sclerosing stromal, and Sertoli-Leydig cell
tumor), and metastatic tumors.
Epithelial ovarian tumors represent 60% of all
ovarian neoplasms and 85% of malignant ovarian
neoplasms. Their prevalence increases with age
and peaks in the sixth and seventh decade of life.
Nevertheless, epithelial tumors with low malignant
potential are often seen in younger patients.
Epithelial ovarian tumors can be classified as
benign (60%), malignant (35%), or borderline
(low-malignant-potential) (5%) depending on their
histologic characteristics and clinical behaviour.

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