Mucinous tumours of the ovary—primary and metastatic

A persistent problem in gynaecological differential diagnosis is the differentiation of primary ovarian mucinous carcinoma from metastatic disease either in the ovary or disseminated throughout the abdomen and pelvis from extragenital organs. Traditionally, there has been a tendency to vary treatment depending on a perception of origin in the ovary, secondary mullerian system1 or enteric system, although Naik et al 2 in the accompanying review seem to suggest that this may no longer be appropriate. In their review, they indicate that disseminated mucinous carcinoma of whatever origin behaves worse than serous carcinoma and treatment may need to be varied accordingly. This highlights the considerable importance of accurate histological typing of lesions. Further, the distinction between a primary ovarian mucinous carcinoma arising in either the background of borderline change or as a carcinoma within a teratoma, although admittedly both are unusual, and a metastasis, for example, from a bowel carcinoma, which may be confused with the endometrioid type of primary carcinoma,3 is important, since a primary carcinoma confined to the ovary will not usually warrant chemotherapy. Dr Wilmott and Professor Rockall4 outline the radiological strategies used in differentiating primary and …