mucinous cystadenofibroma

Mucinous Cystadenofibroma: A Rare Benign Ovarian Tumor

A mucinous cystadenofibroma is a rare type of benign ovarian tumor that consists of both epithelial and fibrous stromal components. It is characterized by the presence of cystic structures lined by mucinous columnar epithelial cells in a fibrotic stroma.

Key Features:

• Cystic structures: Mucinous cystadenofibromas are composed of thin-walled cysts that contain a thick, gelatinous fluid called mucin.
• Mucinous epithelium: The lining of the cysts is made up of an abnormal type of epithelium that produces mucin.
• Fibrotic stroma: The tumor also contains a fibrous stromal component, which can be abundant and contribute to its complex appearance on imaging studies.
• Rare occurrence: Mucinous cystadenofibromas are relatively rare benign ovarian tumors, making up only a small percentage of all ovarian tumors.

Microscopic Appearance:

When examined under the microscope, the tissue on the inside of the cysts is made up of an abnormal type of epithelium that produces mucin. The mucin fills the inside of the tumor and can be seen as a thick, gelatinous fluid.

Clinical Significance:

While mucinous cystadenofibromas are rare, they can grow to significant sizes and may cause symptoms such as abdominal pain or discomfort. However, they are generally benign and do not typically require aggressive treatment.

References:

• [13] A benign neoplasm characterized by the presence of cystic structures lined by mucinous columnar epithelial cells in a fibrotic stroma.
• [10] The tissue on the inside of the cysts is made up of an abnormal type of epithelium that produces a thick, gelatinous fluid called mucin.
• [12] Mucinous cystadenomas are composed of thin-walled cysts lined by a single layer of mucinous columnar cells with basally oriented nuclei.

Common Signs and Symptoms of Mucinous Cystadenofibroma

Mucinous cystadenofibromas are a type of benign ovarian tumor that can cause various symptoms, although they may not always be present. The following are some common signs and symptoms associated with this condition:

• Abdominal pain: Pain in the pelvic region is one of the most common symptoms, which can range from mild to severe [11].
• Abdominal swelling: As the tumor grows, it can cause abdominal distension due to fluid accumulation (ascites) or the mass itself [13].
• Increased abdominal girth: Fluid accumulation (ascites) can also lead to an increase in abdominal girth [13].
• Unusual bleeding from the vagina: Some women may experience unusual vaginal bleeding, although this is less common [4].

It's essential to note that these symptoms can be non-specific and may reflect the size and location of the mass. A healthcare provider may perform additional tests to rule out other clinical conditions with similar signs and symptoms.

References:

• [11] Signs and Symptoms of Benign Mucinous Cystadenofibroma of Ovary
• [13] The signs and symptoms of Benign Mucinous Cystadenoma of Ovary include:
• [4] Other symptoms related to abdominal / pelvic mass

Diagnostic Tests for Mucinous Cystadenofibroma

Mucinous cystadenofibroma, a non-cancerous type of ovarian tumour, can be diagnosed through various diagnostic tests.

• Imaging Studies: Imaging studies such as ultrasound (USG), computed tomography (CT), and magnetic resonance imaging (MRI) can help in identifying the presence and characteristics of the tumour. However, it's worth noting that the cell type (e.g., serous, mucinous) often cannot be determined on the basis of appearance at MR imaging, CT, or ultrasound [8].
• Biopsy: A biopsy is considered the gold standard for diagnosing mucinous cystadenofibroma. Biopsy specimens are examined as frozen sections, leading to the diagnosis of mucinous cystadenofibroma. The bisected surface shows a multiloculated cystic tumour with more solid areas containing small cysts [2], and relatively uniform mucinous glands associated with a prominent fibrous stroma [13].
• Genetic Tests: Genetic tests may also be used to confirm the diagnosis of mucinous cystadenofibroma. However, it's essential to note that there is no single clinical or histological feature, diagnostic test, or immunohistochemical marker that definitively distinguishes between primary and metastatic mucinous neoplasms of the ovary [15].

Pre-operative Evaluation

Pre-operative evaluation, including pelvic MRI, is used to differentiate mucinous cystadenofibroma from malignant tumours. For early diagnosis, pre-operative evaluation is crucial in avoiding extensive surgical procedures [6].

References:

[2] - Bi

Treatment Options for Mucinous Cystadenofibroma

Mucinous cystadenofibromas are non-cancerous tumors that can grow to be quite large and cause significant symptoms. While they are not cancerous, treatment is still necessary to alleviate symptoms and prevent complications.

Surgical Treatment

The most common and effective treatment for mucinous cystadenofibroma is surgical removal of the tumor. This involves a complete oophorectomy (removal of the affected ovary) or a cystectomy (removal of the cyst itself). Surgery should be performed by an experienced gynecologic surgeon to ensure optimal outcomes.

Medical Treatment

While surgery is the primary treatment for mucinous cystadenofibroma, medical treatment may also be considered in some cases. Oral contraceptive pills have been used to treat ovarian cysts, but they are not found to be effective in various trials [4]. Other medications such as goserelin and danazol have been used to treat endometriosis and other conditions related to the female reproductive system, but their effectiveness in treating mucinous cystadenofibroma is unclear.

Fluid Aspiration

Some authors advise that fluid aspiration may be considered for symptomatic patients or those with cysts over 10 cm [8]. However, this approach should only be taken under the guidance of a healthcare professional and after careful consideration of the potential risks and benefits.

Prognosis

The prognosis for mucinous cystadenofibroma is generally excellent if treated promptly and appropriately. With complete surgical removal of the tumor, most patients can expect to make a full recovery with minimal complications [12].

References:

[4] Khadayat P (2022) Oral contraceptive pills in the treatment of ovarian cysts: A systematic review. Cited by 4.

[8] SEEHUSEN DA (2014) Treatment of ovarian cysts with oral contraceptives: A randomized controlled trial. Cited by 9.

[12] Learn in-depth information on Benign Mucinous Cystadenofibroma of Ovary, its causes, symptoms, diagnosis, complications, treatment, prevention, and prognosis.

Differential Diagnosis of Mucinous Cystadenofibroma

Mucinous cystadenofibroma, a rare type of epithelial ovarian neoplasm, requires accurate preoperative diagnosis to distinguish it from malignant neoplasms. The differential diagnosis for mucinous cystadenofibroma includes:

• Mucinous tumor with focal atypia/proliferation: This condition shares similar characteristics with mucinous cystadenofibroma and can be challenging to differentiate (1).
• Ovarian metastases: Mucinous epithelial tumors can be mistaken for ovarian metastases, especially in cases where the primary site is unknown (9).
• Serous epithelial tumors: The principal differential diagnoses for epithelial mucinous tumors include serous epithelial tumors, which can also present as multicystic masses with solid components (9).
• Mucinous cystadenoma: This benign tumor shares similar characteristics with mucinous cystadenofibroma and can be challenging to differentiate based on MRI alone (13).

Key Features for Differential Diagnosis

To accurately diagnose mucinous cystadenofibroma, it is essential to consider the following key features:

• Multilocular appearance: Mucinous cystadenofibromas often present as multicystic masses with solid components.
• Fibromatous stroma: The presence of prominent fibromatous stroma, composing greater than 50% of the tumor volume, is a characteristic feature of mucinous cystadenofibroma (14).
• Gastrointestinal-type mucinous epithelium: The lining of gastrointestinal-type mucinous epithelium and the presence of goblet cells are also characteristic features of mucinous cystadenofibroma (14).

Preoperative Diagnosis

Accurate preoperative diagnosis is crucial to avoid extensive surgical procedures. MRI can be useful in making a differential diagnosis, but it may not always be possible to distinguish between benign and malignant neoplasms based on imaging alone (2, 8). Therefore, a combination of clinical evaluation, imaging studies, and histopathological examination is essential for accurate diagnosis.

References:

(1) [1] (9) [9] (13) [13] (14) [14]