Myxoma of the Ovary.
A 12-year-old girl was under follow-up for menstrual irregularities for 1 year and pelvic ultrasonography revealed bilateral para-ovarian simple semisolid lesions. Pelvic magnetic resonance imaging was performed, and a cystic lesion (65 x 4 cm) in the right adnexal region that was hyperintense on T2-AG and hypointense on T1-AG was observed (Figure la). Ovarian tumor markers and routine laboratory evaluations were all within normal limits. The right adnexal para-ovarian cystic mass was completely excised. Macroscopically cutting the surface of a cystic tissue sample totally 6 x 4.5 x 3 cm dimensions was bloody, and a solid myxoid area of 3 x 2.5 cm was observed on one side (Figure 1b). Microscopically, there was a tumor consisting of stellate or spindle-shaped tumor cells in a large myxoid matrix (Figure 1c). There was not any increase in cellularity, nuclear polymorphism, mitosis or necrosis determined in the tumor (Figure 1d). Histochemically, positive staining with Alcian blue was observed in myxomatous stroma (Figure 1e). Immunohistochemical evaluation revealed diffuse positive staining with smooth muscle actin and vimentin, and negative staining with desmin, inhibin, cytokeratin and S-100 protein in the tumor (Figure 1f). Based on these findings, the patient was diagnosed with ovarian myxoma.
Written informed consent was obtained from the patient before the aforementioned work was carried out.
Ovarian myxoma is quite a rare condition that is a rare entity (2). Histologically, these tumors are produced from the cells in a random sequence in a myxoid matrix without an infiltrative growth pattern, mitotic activity, cytological atypia or necrosis (3,4).
The differential diagnosis of ovarian myxomas with other ovarian myxoid lesions should be performed. The differential diagnosis includes angio-myxomas, fibromas with widespread myxoid degeneration, and primary ovarian stromal lesions containing high amounts of myxoid matrix, such as massive edema, or non-ovarian stromal lesions that are generally maligned (2,5). In massive edema of the ovaries, the normal residual ovarian stromal and intercellular structures together with the mucin negativity in connective tissue are observed around the edematous tissue. Fibromas with myxoid degeneration comprise normal fibrous tissue in some areas. Aggressive angiomyxoma may commonly mimic ovarian myxoma both with immunohistochemical and ultrastructural findings. In aggressive angio-myxomas, there are infiltrative borders with finger-like invasions through the surrounding fat tissue together with a definitive thick-walled vascular pattern. In angio-myxomas, the intercellular matrix shows weak staining with Alcian blue while a dense positive staining is observed in ovarian myxomas due to the presence of hyaluronic acid (2,4).
Although ovarian myxomas are benign, their behavior is uncertain and recurrences may be seen (3). In the literature, this condition was explained by the difficulty of total excision of viscous material that may cause recurrences. For that reason, total excision of myxomatous ovarian tumors together with the adnexal structures was advised. Increases in mitotic activity, cellularity or nuclear atypia in tumors are the predictors that aid in an estimation of recurrences (2).
In conclusion, ovarian myxomas are rare, and they should be differentiated from other lesions of the ovaries with myxoid alterations. The preoperative diagnosis is difficult, and the exact diagnosis must be performed with the histopathological investigations. We believe thatthis tumor shouldbe differentiated carefully from other benign and malign myxoid lesions of the ovaries by the aid of immunohistochemical evaluation.
Conflict of interest: No conflict of interest was declared by the authors.
(1.) Rix GH, Perez-Clemente MP, Spencer PJ, Al-Rufaie HK. Myxoma of the ovary. J Obstet Gynaecol 1998;18:295-6.
(2.) Kumar R, Dey P, Nijhawan R. Myxoma of ovary: an uncommon entity. Arch Gynecol Obstet 2011;284:1317-9.
(3.) Rywlin AM. Alcian blue in the differential diagnosis between myxoma of the ovary and massive ovarian edema. Hum Pathol 1979; 10:357.
(4.) Eichhorn JH, Scully RE. Ovarian myxoma: clinicopathologic and immunocytologic analysis of five cases and a review of the literature. Int J Gynecol Pathol 1991;10:156-69.
(5.) Costa MJ, Thomas W, Majmudar B, Hewan-Lowe K. Ovarian myxoma: ultrastructural and immunohistochemical findings. Ultrastruct Pathol 1992;16:429-38.
Recep Bedir (1), Rukiye Yilmaz (1), Ahmet Salih Calapoglu (2)
(1) Department of Pathology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
(2) Department of Pediatric Surgery, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
Address for Correspondence: Dr. Recep Bedir, Department of Pathology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
Phone: +90 505 733 16 95
ORCID ID: orcid.org/0000-0001-8247-3781
Received: 20 June 2017
Accepted: 24 August 2017
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|Title Annotation:||Clinical Image|
|Author:||Bedir, Recep; Yilmaz, Rukiye; Calapoglu, Ahmet Salih|
|Publication:||Balkan Medical Journal|
|Article Type:||Clinical report|
|Date:||Jan 1, 2018|
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