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Immunohistochemistry in the distinction between primary and metastatic ovarian mucinous neoplasms
  1. W Glenn McCluggage
  1. Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
  1. Correspondence to Professor W Glenn McCluggage, Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BA, Northern Ireland; glenn.mccluggage{at}belfasttrust.hscni.net

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Introduction

Although traditionally regarded as the second most common type of primary ovarian carcinoma following serous carcinoma, recent studies have illustrated that primary ovarian mucinous carcinomas are rather uncommon neoplasms representing approximately 3% of primary malignant ovarian epithelial tumours.1 2 Although some of the differences in prevalence between older and recent studies may be explained by different criteria used to distinguish between a mucinous borderline tumour at the upper end of the spectrum and a well-differentiated mucinous carcinoma with expansile invasion,3–5 the main reason for the decrease in incidence is that previously many metastatic mucinous carcinomas in the ovary were probably misinterpreted as primary ovarian neoplasms; clinical, gross and microscopic pathological features suggestive of a metastatic mucinous carcinoma in the ovary are discussed elsewhere in this issue. One point I wish to make is that although metastatic mucinous carcinomas in the ovary are still sometimes misdiagnosed as a primary ovarian mucinous carcinoma or even a mucinous borderline tumour due to the pronounced maturation effect seen with some secondary mucinous carcinomas in the ovary, we have to some extent come full circle in that, in my opinion, there is now a tendency to overplay the possibility of a secondary mucinous carcinoma even when the pathological features are obviously those of a primary ovarian neoplasm. I consider that in a large majority of cases, the distinction between a primary and a secondary mucinous carcinoma in the ovary can be achieved by careful pathological examination encompassing both the gross and microscopic findings and taking into account the distribution of the disease. It has been stated that when a mucinous carcinoma is diagnosed in the ovary, further investigations, such as colonoscopy and detailed imaging of the upper abdomen, should be undertaken to exclude a primary neoplasm elsewhere. I feel this is unnecessary in …

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