Article Data

  • Views 538
  • Dowloads 117

Original Research

Open Access

Clinical and ultrasound features of benign, borderline, and malignant invasive mucinous ovarian tumors

  • A. Pascual1
  • S. Guerriero2
  • N. Rams3
  • L. Juez4
  • S. Ajossa2
  • B. Graupera1
  • L. Hereter1
  • A. Cappai2
  • M. Pero3
  • M. Perniciano2
  • T. Errasti4
  • J. Parra3
  • M. Solis4
  • J.L. Alcázar4,*,

1Department of Obstetrics, Gynecology and Reproduction, Hospital Quirón Dexeus, University Autonoma of Barcelona, Barcelona, Spain

2Department of Obstetrics and Gynecology, Policlinico Universitario Duilio Casula, University of Cagliari, Monserrato, Cagliari, Italy

3Department of Obstetrics and Gynaecology, Santa Creu i Sant Pau Hospital, University Autonoma of Barcelona, Barcelona, Spain

4Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain

DOI: 10.12892/ejgo3560.2017 Vol.38,Issue 3,June 2017 pp.382-386

Published: 10 June 2017

*Corresponding Author(s): J.L. Alcázar E-mail:


Objective: To compare clinical and sonographic features of benign, borderline, and malignant invasive mucinous ovarian tumors (MOTs). Materials and Methods: Retrospective observational multicenter study comprising 365 women (mean age: 46.1 years) with a histologically confirmed benign, borderline or malignant invasive MOT. Clinical data (patient's age, patient's complaints), tumor markers (CA-125 and CA-19.9), and sonographic data (tumor size, bilaterality, morphology –unilocular, multilocular, unilocular-solid, multilocular-solid and solid-, and IOTA color score) were reviewed and compared among these three groups. Women with ultrasound evidence on intra-abdominal disease spread were excluded. Results: Three hundred seventy-eight MOTs (14 women had bilateral lesions) were analyzed. Histologically, 287 tumors were benign, 51 were borderline, and 40 were malignant. No difference in patient's mean age was observed. Women with borderline or invasive tumors were less frequently asymptomatic. Tumors were larger in case of invasive lesions. Borderline and invasive tumors showed solid components and exhibited IOTA color score 3 or 4, more frequently than benign lesions (p < 0.001). However, the authors discovered that 16 out of 51 (31.4%) of borderline tumors and six out of 40 (15.0%) of invasive cancers had no solid components and a color score 1 or 2, and were considered as a benign lesion by the sonologist. On the other hand, 96 out of 287 (33.4%) benign mucinous cystadenoma exhibited solid components and/or a color score of 3 or 4. Conclusions: In spite of statistical differences, the authors observed significant overlapping in ultrasound features among benign, borderline, and invasive ovarian mucinous tumors that renders a difficult accurate preoperative discrimination among these lesions.


Ovary; Mucinous tumor; Ultrasound; Diagnosis.

Cite and Share

A. Pascual,S. Guerriero,N. Rams,L. Juez,S. Ajossa,B. Graupera,L. Hereter,A. Cappai,M. Pero,M. Perniciano,T. Errasti,J. Parra,M. Solis,J.L. Alcázar. Clinical and ultrasound features of benign, borderline, and malignant invasive mucinous ovarian tumors. European Journal of Gynaecological Oncology. 2017. 38(3);382-386.


[1] Brown J., Frumovitz M.: “Mucinous tumors of the ovary: current thoughts on diagnosis and management”. Curr. Oncol. Rep., 2014, 16, 389

[2] Ledermann J.A., Luvero D., Shafer A., O’Connor D., Mangili G., Friedlander M., et al.: “Gynecologic Cancer InterGroup (GCIG) consensus review for mucinous ovarian carcinoma”. Int. J. Gynecol. Cancer, 2014, 24, S14.

[3] Kurman R.J., Shih IeM.: “Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer—shifting the paradigm”. Hum. Pathol., 2011, 42, 918.

[4] Jordan S.J., Green A.C., Whiteman D.C., Webb P.M., Australian Ovarian Cancer Study Group: “Risk factors for benign, borderline and invasive mucinous ovarian tumors: epidemiological evidence of a neoplastic continuum?” Gynecol. Oncol., 2007, 107, 223.

[5] Guerriero S., Ajossa S., Gerada M., Virgiliioo B., Pilloni M., Galvan R., et al.: “Transvaginal ultrasonography in the diagnosis of extrauterine pelvic diseases”. Expert Rev. Obstet. Gynecol., 2008, 3, 731.

[6] Sayasneh A., Ekechi C., Ferrara L., Kaijser J., Stalder C., Sur S., et al.: “The characteristic ultrasound features of specific types of ovarian pathology”. Int. J. Oncol., 2015, 46, 445.

[7] Sokalska A., Timmerman D., Testa A.C., Van Holsbeke C., Lissoni A.A., Leone F.P., et al.: “Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses”. Ultrasound Obstet. Gynecol., 2009, 34, 462.

[8] Alcázar J.L., Guerriero S., Laparte C., Ajossa S., Ruiz-Zambrana A., Melis G.B.: “Diagnostic performance of transvaginal gray-scale ultrasound for specific diagnosis of benign ovarian cysts in relation to menopausal status”. Maturitas, 2011, 68, 182.

[9] Timmerman D., Valentin L., Bourne T.H., Collins W.P., Verrelst H., Vergote I.: “International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group”. Ultrasound Obstet. Gynecol., 2000, 16, 500.

[10] Lerwill M.F., Young R.H.: “Mucinous tumours of the ovary”. Diag. Histopathol., 2008, 14, 366.

[11] Prat J., FIGO Committee on Gynecologic Oncology: “Staging classification for cancer of the ovary, fallopian tube, and peritoneum”. Int. J. Gynaecol. Obstet., 2014, 124, 1.

[12] Alcazar J.L., Ruiz-Perez M.L., Errasti T.: “Transvaginal color Doppler sonography in adnexal masses: which parameter performs best?” Ultrasound Obstet. Gynecol., 1996, 8, 114.

[13] Di Legge A., Testa A.C., Ameye L., Van Calster B., Lissoni A.A., Leone F.P., et al.: “Lesion size affects diagnostic performance of IOTA logistic regression models, IOTA simple rules and risk of malignancy index in discriminating between benign and malignant adnexal masses”. Ultrasound Obstet. Gynecol., 2012, 40, 345.

[14] Canis M., Rabischong B., Houlle C., Botchorishvili R., Jardon K., Safi A., et al.: “Laparoscopic management of adnexal masses: a gold standard?” Curr. Opin. Obstet. Gynecol., 2002, 14, 423.

[15] Ghezzi F., Cromi A., Bergamini V., Uccella S., Siesto G., Franchi M., et al.: “Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses”. BJOG, 2008, 115, 1020.

[16] Göçmen A., Atak T., Uçar M., Sanlikal F.: “Laparoscopy-assisted cystectomy for large adnexal cysts”. Arch. Gynecol. Obstet., 2009, 279, 17.

[17] Scribner D.R. Jr., Lara-Torre E., Weiss P.M.: “Single-site laparoscopic management of a large adnexal mass”. JSLS, 2013, 17, 350.

[18] Havrilesky L.J., Peterson B.L., Dryden D.K., Soper J.T., Clarke- Pearson D.L., Berchuck A.: “Predictors of clinical outcomes in the laparoscopic management of adnexal masses”. Obstet. Gynecol., 2003, 102, 243.

[19] Sagiv R., Golan A., Glezerman M.: “Laparoscopic management of extremely large ovarian cysts”. Obstet. Gynecol., 2005, 105, 1319.

[20] Kim H.S., Ahn J.H., Chung H.H., Kim J.W., Park N.H., Song Y.S., et al.: “Impact of intraoperative rupture of the ovarian capsule on prognosis in patients with early-stage epithelial ovarian cancer: a meta-analysis”. Eur. J. Surg. Oncol., 2013, 39, 279.

[21] Ben-Ami I., Smorgick N., Tovbin J., Fuchs N., Halperin R., Pansky M.: “Does intraoperative spillage of benign ovarian mucinous cystadenoma increase its recurrence rate?” Am. J. Obstet. Gynecol., 2010, 202, 142.e1.

[22] Mizrachi Y., Weiner E., Keidar R., Kerner R., Golan A., Sagiv R.: “Intraoperative rupture of benign mucinous cystadenoma does not increase its recurrence rate”. Arch. Gynecol. Obstet., 2015, 291, 1135.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time