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Mucinous ovarian tumors associated with pseudomyxoma peritonei of adenomucinosis type: immunohistochemical evidence that they are secondary tumors
  1. C. R. Ferreira*,
  2. J. P. Carvalho,
  3. F. A. Soares,
  4. S. A.C. Siqueira§ and
  5. F. M. Carvalho*
  1. *Departments of Pathology and
  2. Departments of Obstetrics and Gynecologic, University of Sao Paulo Medical School, Sao Paulo, Brazil;
  3. Departments of Department of Pathology, Hospital do Cancer A.C. Camargo, Sao Paulo, Brazil; and
  4. §Departments of Division of Surgical Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
  1. Address correspondence and reprint requests to: Jesus Paula Carvalho, MD, PhD, Department of Gynecology, University of Sao Paulo Medical School, Rua Barata Ribeiro 414–cj 93, Sao Paulo 01380-000, Brazil. Email: jpcarvalho{at}


Pseudomyxoma peritonei (PMP) is a clinical condition initially thought to be related to ovarian mucinous tumors; however, immunohistochemistry and molecular biology techniques have convincingly made the link to appendiceal mucinous neoplasms, resulting in changes in histologic and clinical approaches. The objective of this study was to compare the immunohistochemical profile of ovarian tumors associated with PMP and intestinal mucinous ovarian neoplasms without PMP. The study was retrospective and included 28 intestinal ovarian mucinous tumors selected from the files of the Division of Surgical Pathology of the University of Sao Paulo Medical School, from 1996 to 2005. Seven cases were associated with PMP of disseminated peritoneal adenomucinosis-type and all presented borderline histology. Immunohistochemical staining for mucin genes products (MUC1, MUC2, MUC5AC, and MUC6), CK7, CK20, CA19.9, and CA125 were performed in tissue microarrays. Of note, we detected differences in the expression of MUC2 and CK20 between cases with and without PMP. Comparisons of borderline histology with that of benign/malignant tumors also revealed differences in MUC2 and CK20. Our results confirm that there is a distinct profile of intestinal ovarian tumors associated with pseudomyxoma, particularly with respect to the expression of the gel-forming mucin MUC2. The profile of borderline tumors, even in cases without PMP, was distinct from that of other primary mucinous tumors of the intestinal type, suggesting that borderline histology may represent a secondary tumor or a less aggressive variant of PMP. An appendiceal origin seems the most probable for this group of neoplasias.

  • appendix
  • epithelial tumors
  • immunohistochemistry
  • intestinal type tumors
  • mucinous tumors
  • ovarian tumors
  • pseudomyxoma peritonei
  • tissue-microarray

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