japan-korea-taiwan gyn conferece mini lecture

Yoshiki Mikami, M.D., Ph.D.

Department of Diagnostic PathologyKumamoto University Hospital

Seromucinous Tumor

Japan-Korea-Taiwan GYN ConfereceMini Lecture

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Mucinous tumorsIntestinal Benign

Borderline

Malignant

Endocervical-like Borderline

WHO2003

Mucinous tumorsBenign

Borderline

Malignant

Seromucinoustumors

Benign

Borderline

Malignant

WHO2014

Overview

•General understanding

•Controversies

–Discussion

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Seromucinous borderline tumor

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• Unilocular oroligolocular

• Granular or papillaryexcrescences

• Viscid and/orpurulent material

• Frequently bilateral(40%) and a/wendometriosis (50%)

Seromucinous borderline tumor

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• Microscopicfeatures

Architecturallyresembling SBT

Wide papillaeshowing hierarchicalbranching

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Seromucinous borderline tumor

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• Microscopicfeatures

Cytology• Mucinous cells• Ciliated cells

Seromucinous borderline tumor

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• Microscopicfeatures

Cytology• Mucinous cells• Ciliated cells

Seromucinous borderline tumor

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• Microscopicfeatures

Cytology• Mucinous cells• Ciliated cells• Indifferent cells

Implants11

Implants12

Implants13

14Implants（desmoplastic）

15Implants（desmoplastic）

Seromucinouscystadenoma / adenofibroma

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Seromucinous borderline tumorwith intraepithelial carcinoma

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Seromucinous carcinoma

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Overview

•General understanding

•Controversies

–Discussion

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30Normal endocervical glands

31Normal endocervical glands

32SeromucinousNormal

Endocervical gland

• Ovarian tumors of low malignantpotential exhibiting an epithelialproliferation of mucinous type cellsgreater than seen in their benigncounterparts but without destructivestromal invasion

• The mucinous epithelial cells resembleendocervical epithelium

Endocervical-like mucinousborderline tumor

WHO2003

• Non-invasive proliferative tumorcomposed of more than one typesof epithelial cells

• Predominantly serous andendocervical types

• Occasionally admixed withendometrioid, clear cell, andsquamous epithelium

Seromucinous borderline tumor

WHO2014

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Seromucinous borderline tumor

WHO2014

Synonyms

• Endocervical-like MBT• Müllerian MBT• Borderline müllerian tumor

Seromucinous borderline tumor

WHO2014

Name Morphology Definition

“Seromucinous” Endocervical Mixed müllerian

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Seromucinous borderline tumor

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Seromucinous borderline tumor

Endocervical type

Serous typeEndometrioid typeClear cell typeSquamous type(Transitional type)

! No strict quantitative criteria

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Seromucinous borderline tumor

! No strict quantitative criteria

Seromucinous ????

Serous typeEndometrioid typeClear cell typeSquamous type(Transitional type)

Endocervical type

Seromucinous borderline tumor

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KRAS mutation(Kim KR et al,2010)

Similar toendometrioidtumors

Seromucinous borderline tumor

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ER/PR＋WT1－CK20－、CDX2－ARID1A mutation(Kurman et al. 2016)

Similar toendometrioid orclear cell tumors

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Seromucinous Tumors of the OvaryWhat’s in a Name ?

Kurman RJ and Shih I-M. Int J Gynecol Pathol 2016; 35: 78-81

… Based on their clinicopathologic,immunohistochemical and molecular geneticfeatures we believe a more appropriatedesignation for this group of tumors is "mixedmüllerian tumors" which can be subcategorized as"mixed müllerian cystadenomas", "mixed müllerianatypical proliferative (borderline) tumors" and"mixed müllerian carcinomas".

Seromucinous carcinoma

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Vs Endometrioid carcinoma withmucinous differentiation

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Seromucinous carcinoma Endometrioid carcinomawith mucinousdifferentiation

Background Seromucinous borderline tumor Prototypical endometrioidcarcinoma

53Rambau PF, et al. Am J Surg Pathol. 2017;41: 685-695.

• Seromucinous carcinomamay be reclassified toendometrioid, low-gradeserous, and mucinouscarcinomas by integratingmorphology,immunophenotype, andgenotype.

• the category ofseromucinous carcinomabe discontinued asancillary molecular testscan assign cases to oneof the major histotypes

54Rambau PF, et al. Am J Surg Pathol. 2017;41: 685-695.

• Seromucinous carcinomamay be reclassified toendometrioid, low-gradeserous, and mucinouscarcinomas by integratingmorphology,immunophenotype, andgenotype.

• the category ofseromucinous carcinomabe discontinued asancillary molecular testscan assign cases to oneof the major histotypes

55Rambau PF, et al. Am J Surg Pathol. 2017;41: 685-695.

• Seromucinous carcinomamay be reclassified toendometrioid, low-gradeserous, and mucinouscarcinomas by integratingmorphology,immunophenotype, andgenotype.

• the category ofseromucinous carcinomabe discontinued asancillary molecular testscan assign cases to oneof the major histotypes

LG-ndometrioid

LG Serous

Mucinous

"SEROMUCINOUSCARCINOMA"

8/32 (25%)

23/32 (72%)

1/32 (3%)

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Yoshiki Mikami, M.D.

Kumamoto University Hospitalmika@kuhp.kyoto-u.ac.jp

Thank you for

your attention