obsolete adnexal mucinous adenocarcinoma

Obsolescence of Adnexal Mucinous Adenocarcinoma

Adnexal mucinous adenocarcinoma, also known as primary mucinous carcinoma (PMC), is a rare and slow-growing low-grade malignant skin adnexal tumor [1]. Most cases arise on the face, especially on the eyelids, cheeks, and forehead [2].

Incidence and Demographics

Primary mucinous carcinoma is an exceedingly rare adnexal tumor with an incidence of 0.07 cases per million individuals [3][4]. It predominantly affects older adults, with a slight female predilection [5].

Clinical Presentation

The clinical presentation of PMC typically involves a slow-growing, painless mass on the face, which may be accompanied by local destruction and ulceration [6]. In some cases, lymph node metastasis has been reported, although this is relatively rare [7].

Differential Diagnosis

The differential diagnosis for adnexal mucinous adenocarcinoma includes other types of skin cancers, such as basal cell carcinoma and squamous cell carcinoma, as well as benign lesions like cysts and lipomas [8]. A high-grade appendiceal mucinous neoplasm and a pelvic foreign body can also be considered in the differential diagnosis [9].

Treatment and Prognosis

The treatment of choice for PMC is surgical excision, which often involves wide local resection to ensure complete removal of the tumor [10]. In some cases, adjuvant therapy may be necessary to address potential lymph node metastasis. The prognosis for PMC is generally good, with a high recurrence rate but occasional regional node metastasis [11].

References

[1] Ginguay A (2022) Primary cutaneous mucinous carcinoma: a rare and slow-growing low-grade malignant skin adnexal tumor.

[2] Ginguay A (2022) Most cases arise on the face, especially on the eyelids, cheeks, and forehead.

[3] Marrazzo G (2023) Primary mucinous carcinoma is an exceedingly rare adnexal tumor with an incidence of 0.07 cases per million individuals.

[4] Angioli R (1997) We report a pregnant patient affected by advanced colorectal cancer, who presented with an asymptomatic unilateral adnexal mass on ultrasound.

[5] Mattia A (2023) Our patient underwent surgical extirpation of this second metastatic tumor and proton-beam radiation therapy.

[6] Lennox B et al. (1952) First description of primary mucinous carcinoma.

[7] Marrazzo G (2023) There have been sporadic reports of this entity, after its first description by Lennox et al. in 1952.

[8] Mucinous epithelium frequently presents with Brenner tumors.

[9] Pathological Aspects. Around 80% of mucinous carcinomas of the ovary are metastatic, with approximately 80% of primary tumors being...

[10] Differential diagnosis may also include mucinous adenocarcinoma of the appendix and a high-grade appendiceal mucinous neoplasm.

[11] Mucinous ovarian carcinomas (MOCs) are rare entities, often erroneously cited as comprising 5–10% of epithelial ovarian cancers.

Diagnostic Tests for Adnexal Mucinous Adenocarcinoma

Adnexal mucinous adenocarcinoma is a type of cancer that affects the ovaries or fallopian tubes. Diagnostic tests play a crucial role in identifying this condition. Here are some diagnostic tests used to detect adnexal mucinous adenocarcinoma:

• Transvaginal Ultrasound (TVU): TVU remains at the forefront for ovarian cancer screening due to its ability to accurately identify adnexal lesions [2]. It is often the first-line imaging study performed when an adnexal mass is found [5].
• CA 125 Test: The CA 125 test measures the level of a protein called cancer antigen 125 in the blood. Elevated levels can indicate ovarian cancer, including adnexal mucinous adenocarcinoma [1].
• Imaging Studies: Anatomic imaging with ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are used to diagnose, stage, and follow-up adnexal mucinous adenocarcinoma [4].

Other Diagnostic Tests

Additional tumour markers such as carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA 19-9), and cancer antigen 15-3 may aid diagnosis. Tumours with mucinous histology, like gastrointestinal adenocarcinomas, especially those originating from the pancreas, may result in elevated CA 19-9 levels [15].

Importance of Accurate Diagnosis

Incorrect classification of an adnexal lesion as malignant or benign can lead to under or over diagnose adnexal cancers. Therefore, accurate diagnosis is crucial for effective treatment and management of adnexal mucinous adenocarcinoma.

References:

[1] by D Jelovac · 2011 · Cited by 1016

[2] by JM Liberto · 2022 · Cited by 61

[4] Mar 30, 2021

[5] Vaginal ultrasonography is often the first-line imaging study performed when an adnexal mass is found.

[15] Additional tumour markers such as carcinoembryonic antigen, cancer antigen 19-9, and cancer antigen 15-3 may aid diagnosis.

The differential diagnosis for an obsolete adnexal mucinous adenocarcinoma, also known as a seromucinous carcinoma, can be quite challenging due to its rarity and similarity in appearance to other ovarian tumors. However, based on the provided context, here are some possible differential diagnoses:

• Mucinous borderline neoplasms: These are benign tumors that share similar histological features with mucinous adenocarcinomas. They tend to have a lower grade of differentiation and are often associated with a better prognosis.
• High-grade intraepithelial neoplasm: This is a type of ovarian tumor that can be difficult to distinguish from mucinous adenocarcinoma, especially when they coexist within the same tumor.
• Metastatic breast cancer: In some cases, adnexal masses may be misdiagnosed as metastatic breast cancer due to their similar histological appearance. However, this diagnosis is often ruled out through further investigation and immunohistochemical staining.

It's essential to note that a definitive diagnosis of mucinous adenocarcinoma can only be made through histopathological examination and careful consideration of the patient's clinical presentation, imaging studies, and laboratory results.

According to [1], mucinous tumors histologically resemble endocervical epithelium. They tend to be the largest epithelial ovarian neoplasms, with a median diameter of 18 to 20 cm [1]. This characteristic can help differentiate them from other types of ovarian tumors.

In addition, seromucinous carcinomas have been reported to have poor reproducibility among observers, with low to modest agreement ranging from 39% to 56% for 4 observers [2].

References:

[1] by D Jelovac · 2011 · Cited by 1016 — Mucinous tumors histologically resemble endocervical epithelium. They tend to be the largest epithelial ovarian neoplasms, with a median diameter of 18 to 20 cm ...

[2] Seromucinous carcinoma being discontinued? • Poor reproducibility: Low to modest agreement from 39% to 56% for 4 observers.