Mucinous cystadenocarcinoma differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Mucinous cystadenocarcinoma must be differentiated from mucinous cystadenoma, serous cystadenoma, and pseudocyst.

Differentiating Mucinous cystadenocarcinoma from other Diseases

Mucinous cystadenocarcinoma of ovary

• Mucinous borderline tumor of the ovary
• Metastatic mucinous carcinoma

Mucinous cystadenocarcinoma of pancreas

• Mucinous cystadenoma of pancreas
• Pancreatic pseudocyst
• Serous cystadenoma of pancreas

Mucinous cystadenocarcinoma of appendix

• Appendicitis
• Mesenteric cyst

Mucinous cystadenocarcinoma of ovary	Clinical manifestations		Para-clinical findings					Gold standard
	Sign and symptoms	Physical examination
			Lab Findings	Imaging			Histopathology
				US	CT	MRI
Mucinous borderline tumor of the ovary	Asymptomatic initially Vaginal bleeding Abdominal mass	Increased abdominal girth Abdominal mass	Decreased Hb Raised CEA	Localizes tumor	Demarcates the cancer	To visulaize the extent of the tumor	Large multiloculated cystic masses mucus-containing cysts	Image guided biopsy and histopathological analysis
Metastatic mucinous carcinoma	Ascities Abdominal mass Abdominal fullness Early satiety Fatigue Bowel obstruction Pleural effusion Pelvic or abdominal pain Venous thromboembolism Bloating Urinary frequency	Increased abdominal girth Abdominal mass Ascities Pallor Lymphadenopathy	Incresed CA-125 Decreased-Hb Raised CEA	For the assessment for ascites and to the extent of cancer	Shows intra-abdominal spread	Shows distant metastasis and extent of the tumor	Mucinous differentiation Tall columnar cells with apical mucin Endocervical or intestinal-like appearance Back-to-back cribriform glands with confluent growth pattern Invasive morphology	Image-guided biopsy of patients with peritoneal metastasis and histopathological analysis
Mucinous cystadenocarcinoma of pancreas	Symptoms	Physical examination	Lab Findings	US	CT	MRI	Histopathology	Gold standard
Mucinous cystadenoma of pancreas	Asymptomatic Epigastric fullness Abdominal mass Nausea and vomiting Back pain	Epigastric mass Abdominal fullness Ascities Pallor Lymphadenopathy	CEA CA 19-9 Hb	EUS for evaluation of the cyst wall, may show nodules within the cyst To obtain aspiration of the cyst material To perform biopsy	CT is important for differentiating MCN from other tumors Shape is smooth Main pancreatic duct is not dilated	MRI cross-sectional images may show unilocular or multilocular cyst with a solid component peripheral calcification wall thickening Papillary structures Hypervascular pattern	Solitary, multilocular or unilocular cysts with a fibrotic wall and containing mucin Columnar epithelium lined mucin-producing cysts with different level of dysplasia	Biopsy and histopathology
Pancreatic pseudocyst	Abdominal pain Abdominal mass Bloating	Abdominal mass	Amylase levels raised (plasma or serum) Lipase levels raised (plasma)	US may not be a good modality of diagnoses as pancreas lies behind the stomach (and so a gas-filled stomach will obscure the pancreas	CT scan is the gold standard for initial assessment and follow-up	To establish the relationship of the pseudocyst to the pancreatic ducts	collection of fluid containing pancreatic enzymes, hemolysed blood and necrotic debris around the pancreas	FNA and cytology
Serous cystadenocarcinoma of pancreas	Abdominal/flank pain Weight loss Per-rectal bleeding	Palpable mass	Amylase levels raised (plasma or serum) Lipase levels raised (plasma)	US localizes the mass and shows its extent	CT shows well-circumscribed, multilocular masses Macrocysts appear well-circumscribed with lobulations Microcysts are not very visible on CT and MRI is used to locate them	Too see features of the primary tumor Local invasion Metastatic lesions Microcyts appear hyperintense	Multiple cysts Cuboidal epithelium Glycogen-rich cells Serous fluid	Biopsy and histopathology
Mucinous cystadenocarcinoma of appendix	Symptoms	Physical examination	Lab Findings	US	CT	MRI	Histopathology	Gold standard
Appendicitis	Abdominal pain Fever Nausea or vomiting Atypical symptoms include: Constant pain in the right iliac fossa Prolonged diarrhea	Fever Tachycardia Hypotension Tachypnea Rebound tenderness Abdominal guarding Rovsing's sign Psoas sign Obturator sign	Leukocytosis shift to the left in the segmented neutrophils	Ultrasound may be helpful in the diagnosis of appendicitis Findings include: Noncompressible, dilated appendix Appendicolith Echogenic prominent Pericaecal fat and periappeniceal fluid collection	CT scans are preferred over ultrasounds for diagnosing appendicitis Increase in appendiceal lumen with the outer-wall-to-outer-wall transverse diameter greater than 6 mm Appendiceal wall thickening (wall ≥ 3mm) Appendiceal wall hyperenhancement Mural stratification of the appendiceal wall	Magnetic resonance imaging has become the common technique for diagnosing appendicitis in children and pregnant patients periappendiceal stranding appears as an increased fluid signal on the T2 weighted sequence (while it is reflected by fat stranding on a CT scan)	Inflammation of the appendiceal wall can result in perforation and development of a contained abscess or generalized peritonitis. The wall of the appendix can become ischemic as vascular and lymphatic occlusion progress.	Histopathological analysis
Mesenteric cyst	Asymptomatic Acute or chronic abdominal pain	Smooth, round and mobile abdominal mass	-	Shows echogenic mass in appendix	CT scan are the best diagnostic tool	Provides significant information of the size and localization Cystic masses associated with areas of fat necrosis and hemorrhage	Lymphangioma: endothelial lining Enteric duplication cyst: Enteric lining and double-muscle lining with neural elements; Enteric cyst: Enteric lining (mucosa with no muscle layer Mesothelial cyst: mesothelial lining Nonpancreatic pseudocyst has no lining, with a fibrous wall.	Enucleation and Histopathological analysis