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Synchronous Ovarian and Appendiceal Mucinous Neoplasms in the Absence of Pseudomyxoma Peritonei
  1. Xianyong Gui, MD, PhD,
  2. Jorge Escobar, MD,
  3. Cheng-Han Lee, MD, PhD,
  4. Máire A. Duggan, MD and
  5. Martin Köbel, MD
  1. * Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary; and
  2. Calgary Laboratory Services, Calgary; and
  3. Department of Pathology, University of Alberta, Edmonton, Alberta, Canada.
  1. Address correspondence and reprint requests to Xianyong Gui, MD, PhD, Department of Anatomic Pathology, McCaig Tower, 11th Floor, Foothills Medical Centre, 1403 29th St NW, Calgary, Alberta, Canada T2N 2T9. E-mail: xsean.gui{at}


Background Synchronous ovarian/appendiceal mucinous neoplasms sometimes occur in the absence of clinical pseudomyxoma peritonei (PMP), which raises a question about whether the 2 tumors could be independent.

Methods We identified 11 cases of synchronous ovarian/appendiceal mucinous neoplasms without PMP and subclassified them into groups 1 and 2 based on the presence or absence of microscopic peritoneal/ovarian surface mucin deposits. A 7-marker panel (CK7, CK20, CDX2, PAX8, MUC1, MUC2, and MUC5AC) immunohistochemistry was performed on both tumors.

Results Between the 2 groups, there were no significant differences in age, laterality, size, and histology of ovarian/appendiceal tumors. In group 1, 2 of 4 cases developed PMP later, and both had ovarian surface and contralateral ovarian involvement and appendiceal perforation with microscopic mucin deposits on the peritoneum. No patients in group 2 developed PMP. All group 1 cases showed a high degree of concordance of immunoprofile between the synchronous tumors, with an identical expression of appendiceal pattern in greater than 90% of the markers. In group 2, only 1 of 7 cases showed concordance in all markers.

Conclusions If peritoneal mucin deposits present, even microscopic and acellular, the synchronous tumors are most likely of a single appendiceal origin. Otherwise, they are more heterogeneous, and some may be truly dual primaries.

  • Mucinous neoplasm
  • Appendiceal tumor
  • Ovarian tumor
  • Synchronous tumors
  • Pseudomyxoma peritonei

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  • The authors declare no conflicts of interest.