Mucinous cystadenocarcinoma pathophysiology: Difference between revisions

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==Associated Conditions==
==Associated Conditions==
* [[Mucinous cystadenocarcinoma]] is associated with mature [[cystic]] [[teratoma]].
* Mucinous cystadenocarcinoma is associated with mature [[cystic]] [[teratoma]].
==Gross Pathology==
==Gross Pathology==


'''<big>Mucinous Cystadenocarcinoma of Ovary</big>'''
'''<big>Mucinous Cystadenocarcinoma of Ovary</big>'''
* 8 to 20 cm in size.<ref name="pmid9850171">{{cite journal |vauthors=Hoerl HD, Hart WR |title=Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=22 |issue=12 |pages=1449–62 |date=December 1998 |pmid=9850171 |doi= |url=}}</ref>
* 8 - 20 cm in size.<ref name="pmid9850171">{{cite journal |vauthors=Hoerl HD, Hart WR |title=Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=22 |issue=12 |pages=1449–62 |date=December 1998 |pmid=9850171 |doi= |url=}}</ref>
* [[Cystic]] or solid.
* [[Cystic]] or [[solid]].
* Unilateral and confined to the [[ovary]].
* Unilateral and confined to the [[ovary]].
* Smooth external surface.
* Smooth external surface.
* Intact surface of the ovary without external implants.<ref name="pmid4735836">{{cite journal |vauthors=Hart WR, Norris HJ |title=Borderline and malignant mucinous tumors of the ovary. Histologic criteria and clinical behavior |journal=Cancer |volume=31 |issue=5 |pages=1031–45 |date=May 1973 |pmid=4735836 |doi= |url=}}</ref>
* Intact surface of the [[ovary]] without external implants.<ref name="pmid4735836">{{cite journal |vauthors=Hart WR, Norris HJ |title=Borderline and malignant mucinous tumors of the ovary. Histologic criteria and clinical behavior |journal=Cancer |volume=31 |issue=5 |pages=1031–45 |date=May 1973 |pmid=4735836 |doi= |url=}}</ref>
*Involvement of surface of [[ovary]] in case of [[Metastasized|metastasized tumor]].<ref name="pmid8179074">{{cite journal |vauthors=Prayson RA, Hart WR, Petras RE |title=Pseudomyxoma peritonei. A clinicopathologic study of 19 cases with emphasis on site of origin and nature of associated ovarian tumors |journal=Am. J. Surg. Pathol. |volume=18 |issue=6 |pages=591–603 |date=June 1994 |pmid=8179074 |doi= |url=}}</ref><ref name="pmid2035736">{{cite journal |vauthors=Young RH, Gilks CB, Scully RE |title=Mucinous tumors of the appendix associated with mucinous tumors of the ovary and pseudomyxoma peritonei. A clinicopathological analysis of 22 cases supporting an origin in the appendix |journal=Am. J. Surg. Pathol. |volume=15 |issue=5 |pages=415–29 |date=May 1991 |pmid=2035736 |doi= |url=}}</ref>
*Involvement of surface of [[ovary]] in case of [[Metastasis|metastasized]] [[tumor]].<ref name="pmid8179074">{{cite journal |vauthors=Prayson RA, Hart WR, Petras RE |title=Pseudomyxoma peritonei. A clinicopathologic study of 19 cases with emphasis on site of origin and nature of associated ovarian tumors |journal=Am. J. Surg. Pathol. |volume=18 |issue=6 |pages=591–603 |date=June 1994 |pmid=8179074 |doi= |url=}}</ref><ref name="pmid2035736">{{cite journal |vauthors=Young RH, Gilks CB, Scully RE |title=Mucinous tumors of the appendix associated with mucinous tumors of the ovary and pseudomyxoma peritonei. A clinicopathological analysis of 22 cases supporting an origin in the appendix |journal=Am. J. Surg. Pathol. |volume=15 |issue=5 |pages=415–29 |date=May 1991 |pmid=2035736 |doi= |url=}}</ref>
* Rarely, [[mucinous cystadenocarcinoma]] can lead to [[pseudomyxoma peritonei]].<ref name="pmid11075847">{{cite journal |vauthors=Lee KR, Scully RE |title=Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with 'pseudomyxoma peritonei' |journal=Am. J. Surg. Pathol. |volume=24 |issue=11 |pages=1447–64 |date=November 2000 |pmid=11075847 |doi= |url=}}</ref><ref name="pmid18344868">{{cite journal |vauthors=McKenney JK, Soslow RA, Longacre TA |title=Ovarian mature teratomas with mucinous epithelial neoplasms: morphologic heterogeneity and association with pseudomyxoma peritonei |journal=Am. J. Surg. Pathol. |volume=32 |issue=5 |pages=645–55 |date=May 2008 |pmid=18344868 |doi=10.1097/PAS.0b013e31815b486d |url=}}</ref><ref name="pmid12717249">{{cite journal |vauthors=Ronnett BM, Seidman JD |title=Mucinous tumors arising in ovarian mature cystic teratomas: relationship to the clinical syndrome of pseudomyxoma peritonei |journal=Am. J. Surg. Pathol. |volume=27 |issue=5 |pages=650–7 |date=May 2003 |pmid=12717249 |doi= |url=}}</ref>
* Rarely, mucinous cystadenocarcinoma can lead to [[pseudomyxoma peritonei]] which can have the following features:<ref name="pmid11075847">{{cite journal |vauthors=Lee KR, Scully RE |title=Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with 'pseudomyxoma peritonei' |journal=Am. J. Surg. Pathol. |volume=24 |issue=11 |pages=1447–64 |date=November 2000 |pmid=11075847 |doi= |url=}}</ref><ref name="pmid18344868">{{cite journal |vauthors=McKenney JK, Soslow RA, Longacre TA |title=Ovarian mature teratomas with mucinous epithelial neoplasms: morphologic heterogeneity and association with pseudomyxoma peritonei |journal=Am. J. Surg. Pathol. |volume=32 |issue=5 |pages=645–55 |date=May 2008 |pmid=18344868 |doi=10.1097/PAS.0b013e31815b486d |url=}}</ref><ref name="pmid12717249">{{cite journal |vauthors=Ronnett BM, Seidman JD |title=Mucinous tumors arising in ovarian mature cystic teratomas: relationship to the clinical syndrome of pseudomyxoma peritonei |journal=Am. J. Surg. Pathol. |volume=27 |issue=5 |pages=650–7 |date=May 2003 |pmid=12717249 |doi= |url=}}</ref>
* [[Pseudomyxoma peritonei]] has following features:
:* Multiloculated
:* Multiloculated
:* Sticky, gelatinous fluid (glycoprotein)
:* Sticky, gelatinous [[fluid]] ([[glycoprotein]])
:* [[Necrosis]]
:* [[Necrosis]]
:* Typically unilateral
:* Typically unilateral
:* Smooth gray surface  
:* Smooth gray surface  
:* Internal surface comprised of multilocular mass with thin walls   
:* Internal surface comprised of multilocular [[mass]] with thin walls   
:* [[Mucinous]] material and solid nodules on the wall
:* [[Mucinous]] material and [[solid]] [[Nodule (medicine)|nodules]] on the wall


[[File:Mucinous Cystadenocarcinoma of the Ovary.jpg|500px|thumb|none|Multiple cysts in the ovary, typical of mucinous cystadenocarcinoma of the ovary. [https://commons.wikimedia.org/wiki/File:Mucinous_Cystadenocarcinoma_of_the_Ovary.jpg Source: Wikimedia commons]]]
[[File:Mucinous Cystadenocarcinoma of the Ovary.jpg|500px|thumb|none|Multiple cysts in the ovary, typical of mucinous cystadenocarcinoma of the ovary. [https://commons.wikimedia.org/wiki/File:Mucinous_Cystadenocarcinoma_of_the_Ovary.jpg Source: Wikimedia commons]]]

Latest revision as of 20:22, 30 April 2019

Mucinous cystadenocarcinoma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qurrat-ul-ain Abid, M.D.[2], Ammu Susheela, M.D. [3]

Overview

Mucinous cystadenocarcinoma is one of the most aggressive forms of cancer. KRAS mutations are found in mucinous carcinomas. The organs involved in the pathogenesis of mucinous cystadenocarcinoma are ovary, appendix, pancreas, colon, rectum, retroperitoneal organs, testes, salivary gland, lung, bladder, and breast. On gross pathology, multiloculated, smooth gray surface, and multilocular mass with thin walls and mucinous material are characteristic findings of mucinous cystadenocarcinoma. On microscopic histopathological analysis, mucinous differentiation, nuclear atypia, and necrosis are characteristic findings of mucinous cystadenocarcinoma.

Pathogenesis

  • Mucinous cytsadenocarcinoma is one of the most aggressive forms of cancer.

Mucinous Cystadenocarcinoma of Ovary

Mucinous Cystadenocarcinoma of Pancreas

Mucinous Cystadenocarcinoma of Appendix

Associated Conditions

  • Mucinous cystadenocarcinoma is associated with mature cystic teratoma.

Gross Pathology

Mucinous Cystadenocarcinoma of Ovary

Multiple cysts in the ovary, typical of mucinous cystadenocarcinoma of the ovary. Source: Wikimedia commons

Mucinous Cystadenoma of Pancreas

Mucinous Cystadenoma of Appendix

Microscopic Pathology

Microscopic features:

Following features are common to mucinous cystadenocarcinoma of all regions:

  • Mucinous differentiation
  • Tall columnar cells with apical mucin
  • Endocervical or intestinal-like appearance
  • Back-to-back cribriform glands with confluent growth pattern
  • Invasive morphology
  • Desmoplastic stromal response
  • Infiltration of the tumor capsule

Malignant characteristics on microscopy:

Mucinous Cystadenocarcinoma of Ovary

Immunophenotype:

Molecular biology:

Mucinous Cystadenoma of Pancreas

  • Epithelium may form a single layer or papillary folds.
  • May show mitoses
  • Stroma is composed of small spindle-shaped cells

Immunohistochemistry[21]

Stroma is usually positive for:

Mucinous Cystadenoma of Appendix

Reference

  1. ↑ 1.0 1.1 1.2 1.3 Hart WR, Norris HJ (May 1973). "Borderline and malignant mucinous tumors of the ovary. Histologic criteria and clinical behavior". Cancer. 31 (5): 1031–45. PMID 4735836.
  2. ↑ 2.0 2.1 Riopel MA, Ronnett BM, Kurman RJ (June 1999). "Evaluation of diagnostic criteria and behavior of ovarian intestinal-type mucinous tumors: atypical proliferative (borderline) tumors and intraepithelial, microinvasive, invasive, and metastatic carcinomas". Am. J. Surg. Pathol. 23 (6): 617–35. PMID 10366144.
  3. ↑ 3.0 3.1 3.2 Hoerl HD, Hart WR (December 1998). "Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up". Am. J. Surg. Pathol. 22 (12): 1449–62. PMID 9850171.
  4. ↑ 4.0 4.1 4.2 4.3 Lee KR, Scully RE (November 2000). "Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with 'pseudomyxoma peritonei'". Am. J. Surg. Pathol. 24 (11): 1447–64. PMID 11075847.
  5. ↑ Bladt O, De Man R, Aerts R (2004). "Mucinous cystadenoma of the ovary". JBR-BTR. 87 (3): 118–9. PMID 15293671.
  6. ↑ 6.0 6.1 de Nictolis M, Montironi R, Tommasoni S, Valli M, Pisani E, Fabris G, Prat J (January 1994). "Benign, borderline, and well-differentiated malignant intestinal mucinous tumors of the ovary: a clinicopathologic, histochemical, immunohistochemical, and nuclear quantitative study of 57 cases". Int. J. Gynecol. Pathol. 13 (1): 10–21. PMID 8112952.
  7. ↑ Hart WR (January 2005). "Mucinous tumors of the ovary: a review". Int. J. Gynecol. Pathol. 24 (1): 4–25. PMID 15626914.
  8. ↑ Ovary Epithelial tumors. Atlasgeneticsoncology (2016).http://atlasgeneticsoncology.org/Tumors/OvaryEpithTumID5230.html Accessed on February 29, 2016
  9. ↑ Klöppel G (February 2007). "Chronic pancreatitis, pseudotumors and other tumor-like lesions". Mod. Pathol. 20 Suppl 1: S113–31. doi:10.1038/modpathol.3800690. PMID 17486047.
  10. ↑ Basturk O, Hong SM, Wood LD, Adsay NV, Albores-Saavedra J, Biankin AV, Brosens LA, Fukushima N, Goggins M, Hruban RH, Kato Y, Klimstra DS, Klöppel G, Krasinskas A, Longnecker DS, Matthaei H, Offerhaus GJ, Shimizu M, Takaori K, Terris B, Yachida S, Esposito I, Furukawa T (December 2015). "A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas". Am. J. Surg. Pathol. 39 (12): 1730–41. doi:10.1097/PAS.0000000000000533. PMC 4646710. PMID 26559377.
  11. ↑ Bernard P, Scoazec JY, Joubert M, Kahn X, Le Borgne J, Berger F, Partensky C (November 2002). "Intraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases". Arch Surg. 137 (11): 1274–8. PMID 12413317.
  12. ↑ Crippa S, Salvia R, Warshaw AL, Domínguez I, Bassi C, Falconi M, Thayer SP, Zamboni G, Lauwers GY, Mino-Kenudson M, Capelli P, Pederzoli P, Castillo CF (April 2008). "Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients". Ann. Surg. 247 (4): 571–9. doi:10.1097/SLA.0b013e31811f4449. PMC 3806104. PMID 18362619.
  13. ↑ Baker ML, Seeley ES, Pai R, Suriawinata AA, Mino-Kenudson M, Zamboni G, Klöppel G, Longnecker DS (December 2012). "Invasive mucinous cystic neoplasms of the pancreas". Exp. Mol. Pathol. 93 (3): 345–9. doi:10.1016/j.yexmp.2012.07.005. PMID 22902940.
  14. ↑ Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ (January 2016). "A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process". Am. J. Surg. Pathol. 40 (1): 14–26. doi:10.1097/PAS.0000000000000535. PMID 26492181.
  15. ↑ Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ (January 2016). "A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process". Am. J. Surg. Pathol. 40 (1): 14–26. doi:10.1097/PAS.0000000000000535. PMID 26492181.
  16. ↑ Carr NJ, Bibeau F, Bradley RF, Dartigues P, Feakins RM, Geisinger KR, Gui X, Isaac S, Milione M, Misdraji J, Pai RK, Rodriguez-Justo M, Sobin LH, van Velthuysen MF, Yantiss RK (December 2017). "The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei". Histopathology. 71 (6): 847–858. doi:10.1111/his.13324. PMID 28746986.
  17. ↑ Prayson RA, Hart WR, Petras RE (June 1994). "Pseudomyxoma peritonei. A clinicopathologic study of 19 cases with emphasis on site of origin and nature of associated ovarian tumors". Am. J. Surg. Pathol. 18 (6): 591–603. PMID 8179074.
  18. ↑ Young RH, Gilks CB, Scully RE (May 1991). "Mucinous tumors of the appendix associated with mucinous tumors of the ovary and pseudomyxoma peritonei. A clinicopathological analysis of 22 cases supporting an origin in the appendix". Am. J. Surg. Pathol. 15 (5): 415–29. PMID 2035736.
  19. ↑ McKenney JK, Soslow RA, Longacre TA (May 2008). "Ovarian mature teratomas with mucinous epithelial neoplasms: morphologic heterogeneity and association with pseudomyxoma peritonei". Am. J. Surg. Pathol. 32 (5): 645–55. doi:10.1097/PAS.0b013e31815b486d. PMID 18344868.
  20. ↑ Ronnett BM, Seidman JD (May 2003). "Mucinous tumors arising in ovarian mature cystic teratomas: relationship to the clinical syndrome of pseudomyxoma peritonei". Am. J. Surg. Pathol. 27 (5): 650–7. PMID 12717249.
  21. ↑ 21.0 21.1 21.2 Masia R, Mino-Kenudson M, Warshaw AL, Pitman MB, Misdraji J (February 2011). "Pancreatic mucinous cystic neoplasm of the main pancreatic duct". Arch. Pathol. Lab. Med. 135 (2): 264–7. doi:10.1043/1543-2165-135.2.264. PMID 21284448.
  22. ↑ Raijman I, Leong S, Hassaram S, Marcon NE (March 1994). "Appendiceal mucocele: endoscopic appearance". Endoscopy. 26 (3): 326–8. doi:10.1055/s-2007-1008979. PMID 8076556.
  23. ↑ Mizuma N, Kabemura T, Akahoshi K, Yasuda D, Okabe H, Chijiiwa Y, Nawata H, Matsui N (December 1997). "Endosonographic features of mucocele of the appendix: report of a case". Gastrointest. Endosc. 46 (6): 549–52. PMID 9434225.
  24. ↑ Rodríguez IM, Prat J (February 2002). "Mucinous tumors of the ovary: a clinicopathologic analysis of 75 borderline tumors (of intestinal type) and carcinomas". Am. J. Surg. Pathol. 26 (2): 139–52. PMID 11812936.
  25. ↑ Vang R, Gown AM, Barry TS, Wheeler DT, Yemelyanova A, Seidman JD, Ronnett BM (September 2006). "Cytokeratins 7 and 20 in primary and secondary mucinous tumors of the ovary: analysis of coordinate immunohistochemical expression profiles and staining distribution in 179 cases". Am. J. Surg. Pathol. 30 (9): 1130–9. doi:10.1097/01.pas.0000213281.43036.bb. PMID 16931958.
  26. ↑ Baker PM, Oliva E (January 2005). "Immunohistochemistry as a tool in the differential diagnosis of ovarian tumors: an update". Int. J. Gynecol. Pathol. 24 (1): 39–55. PMID 15626916.
  27. ↑ McCluggage WG (April 2006). "Immunohistochemical and functional biomarkers of value in female genital tract lesions". Int. J. Gynecol. Pathol. 25 (2): 101–20. doi:10.1097/01.pgp.0000192269.14666.68. PMID 16633059.
  28. ↑ Vang R, Gown AM, Barry TS, Wheeler DT, Ronnett BM (January 2006). "Immunohistochemistry for estrogen and progesterone receptors in the distinction of primary and metastatic mucinous tumors in the ovary: an analysis of 124 cases". Mod. Pathol. 19 (1): 97–105. doi:10.1038/modpathol.3800510. PMID 16294196.
  29. ↑ Vang R, Gown AM, Wu LS, Barry TS, Wheeler DT, Yemelyanova A, Seidman JD, Ronnett BM (November 2006). "Immunohistochemical expression of CDX2 in primary ovarian mucinous tumors and metastatic mucinous carcinomas involving the ovary: comparison with CK20 and correlation with coordinate expression of CK7". Mod. Pathol. 19 (11): 1421–8. doi:10.1038/modpathol.3800698. PMID 16980943.
  30. ↑ Vang R, Gown AM, Farinola M, Barry TS, Wheeler DT, Yemelyanova A, Seidman JD, Judson K, Ronnett BM (May 2007). "p16 expression in primary ovarian mucinous and endometrioid tumors and metastatic adenocarcinomas in the ovary: utility for identification of metastatic HPV-related endocervical adenocarcinomas". Am. J. Surg. Pathol. 31 (5): 653–63. doi:10.1097/01.pas.0000213369.71676.25. PMID 17460447.
  31. ↑ Gemignani ML, Schlaerth AC, Bogomolniy F, Barakat RR, Lin O, Soslow R, Venkatraman E, Boyd J (August 2003). "Role of KRAS and BRAF gene mutations in mucinous ovarian carcinoma". Gynecol. Oncol. 90 (2): 378–81. PMID 12893203.
  32. ↑ Mayr D, Hirschmann A, Löhrs U, Diebold J (December 2006). "KRAS and BRAF mutations in ovarian tumors: a comprehensive study of invasive carcinomas, borderline tumors and extraovarian implants". Gynecol. Oncol. 103 (3): 883–7. doi:10.1016/j.ygyno.2006.05.029. PMID 16806438.
  33. ↑ Cuatrecasas M, Villanueva A, Matias-Guiu X, Prat J (April 1997). "K-ras mutations in mucinous ovarian tumors: a clinicopathologic and molecular study of 95 cases". Cancer. 79 (8): 1581–6. PMID 9118042.
  34. ↑ Kuo KT, Guan B, Feng Y, Mao TL, Chen X, Jinawath N, Wang Y, Kurman RJ, Shih I, Wang TL (May 2009). "Analysis of DNA copy number alterations in ovarian serous tumors identifies new molecular genetic changes in low-grade and high-grade carcinomas". Cancer Res. 69 (9): 4036–42. doi:10.1158/0008-5472.CAN-08-3913. PMC 2782554. PMID 19383911. Vancouver style error: initials (help)
  35. ↑ Shi H, Wang MX, Caldwell CW (September 2007). "CpG islands: their potential as biomarkers for cancer". Expert Rev. Mol. Diagn. 7 (5): 519–31. doi:10.1586/14737159.7.5.519. PMID 17892361.
  36. ↑ Kurman RJ, Shih I (April 2008). "Pathogenesis of ovarian cancer: lessons from morphology and molecular biology and their clinical implications". Int. J. Gynecol. Pathol. 27 (2): 151–60. doi:10.1097/PGP.0b013e318161e4f5. PMC 2794425. PMID 18317228. Vancouver style error: initials (help)
  37. ↑ Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ (January 2016). "A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process". Am. J. Surg. Pathol. 40 (1): 14–26. doi:10.1097/PAS.0000000000000535. PMID 26492181.
  38. ↑ Carr NJ, Bibeau F, Bradley RF, Dartigues P, Feakins RM, Geisinger KR, Gui X, Isaac S, Milione M, Misdraji J, Pai RK, Rodriguez-Justo M, Sobin LH, van Velthuysen MF, Yantiss RK (December 2017). "The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei". Histopathology. 71 (6): 847–858. doi:10.1111/his.13324. PMID 28746986.
  39. ↑ Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ (January 2016). "A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process". Am. J. Surg. Pathol. 40 (1): 14–26. doi:10.1097/PAS.0000000000000535. PMID 26492181.
  40. ↑ Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ (January 2016). "A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process". Am. J. Surg. Pathol. 40 (1): 14–26. doi:10.1097/PAS.0000000000000535. PMID 26492181.
  41. ↑ Aho AJ, Heinonen R, Laurén P (1973). "Benign and malignant mucocele of the appendix. Histological types and prognosis". Acta Chir Scand. 139 (4): 392–400. PMID 4718184.

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