Mural nodules in mucinous ovarian tumors represent a morphologic spectrum of clonal neoplasms: a morphologic, immunohistochemical, and molecular analysis of 13 cases.

TitleMural nodules in mucinous ovarian tumors represent a morphologic spectrum of clonal neoplasms: a morphologic, immunohistochemical, and molecular analysis of 13 cases.
Publication TypeJournal Article
Year of Publication2021
AuthorsChapel DB, Lee EK, Da Silva AFL, Teschan N, Feltmate C, Matulonis UA, Crum CP, Sholl LM, Konstantinopoulos PA, Nucci MR
JournalMod Pathol
Volume34
Issue3
Pagination613-626
Date Published2021 03
ISSN1530-0285
KeywordsAdolescent, Adult, Aged, Biomarkers, Tumor, Biopsy, Female, High-Throughput Nucleotide Sequencing, Humans, Immunohistochemistry, Microtubule-Associated Proteins, Middle Aged, Neoplasms, Cystic, Mucinous, and Serous, Ovarian Neoplasms, Predictive Value of Tests, Prognosis, Tumor Suppressor Protein p53
Abstract

Mucinous ovarian tumors rarely harbor mural nodules, which have historically been classified as sarcoma-like, anaplastic carcinomatous, or sarcomatous on the basis of predominant morphologic features. The molecular relationship between mural nodules and associated mucinous ovarian tumors remains poorly characterized, as does the molecular pathogenesis of these mural nodules. Thus, we analyzed the morphological, immunohistochemical, and genetic features of 13 mucinous ovarian tumors and associated mural nodule(s). Three harbored sarcoma-like mural nodules and ten contained anaplastic carcinomatous nodules, including 1 tumor with spatially discrete anaplastic carcinomatous and sarcomatous nodules. Twelve of 13 cases showed genetic evidence of clonality between the mural nodule(s) and associated mucinous ovarian tumor, including all three tumors with sarcoma-like morphology. Mural nodules were genetically identical in the five cases in which there were multiple discrete mural nodules that were sequenced separately. MTAP and p53 immunohistochemistry confirmed the distribution of neoplastic cells in a subset of sarcoma-like and anaplastic carcinomatous nodules. No single recurrent genetic alteration was associated with mural nodule development. No recurrent genetic differences were identified between mural nodules with sarcoma-like, anaplastic carcinomatous, and sarcomatous morphology. Of 11 patients with clinical follow-up, three died of disease 3, 8, and 9 months after diagnosis, but no recurrent genetic events were associated with poor outcome. These molecular data suggest that sarcoma-like, anaplastic carcinomatous, and sarcomatous nodules represent a morphologic spectrum of clonal neoplasms arising in mucinous ovarian tumors rather than three discrete biological entities.

DOI10.1038/s41379-020-0642-9
Alternate JournalMod Pathol
PubMed ID32759977
Related Faculty: 
Annacarolina Da Silva, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
Surgical Pathology: (212) 746-2700