Mural nodules of ovarian mucinous borderline tumors are rare. In this study, we report a case of mural nodules of clear cell carcinoma in an intestinal type mucinous borderline tumor of the ovary. The patient was a 54-years-old woman presented with back and pelvic pain for 3 months. A right-sided multiloculated ovarian mass approximately 20？cm was identified on the CT scan. CA-125 was moderately elevated. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic and para-aortic lymphadenectomy. Grossly, the right ovarian mass showed a multiloculated cystic mass with mucinous fluid. There were papillations in the internal surface and two mural nodules were seen. Microscopic examination revealed that the cystic mass was an intestinal type borderline mucinous tumor. The mural nodules showed a classic histology of clear cell carcinoma with tubulocystic and papillary growth patterns. This is an extremely rare case of mural nodules of clear cell carcinoma arising in a mucinous borderline tumor. 1. Introduction Mucinous ovarian tumors were first described in 1809 by Ephraim McDowell [1]. Nowadays, mucinous ovarian tumors represent up to 15% of all ovarian tumors. In the current WHO classifications of ovarian neoplasms, mucinous tumors are classified as surface epithelial-stromal tumors. Primary mucinous ovarian tumors are further classified into benign, borderline, or malignant categories depending on their histologic features [2]. Borderline tumors account for 10% of all the mucinous tumors [3]. Mucinous borderline tumors have been further subclassified as intestinal and endocervical types [3]. Intestinal-type mucinous borderline tumors tend to be more heterogeneous in composition and may contain areas of cystadenoma and noninvasive carcinoma [4]. Endocervical-type mucinous borderline tumors are more closely related to borderline serous tumors [4]. On rare occasions, one or more discrete well-circumscribed mural nodules protrude into the lumen of a cystic ovarian epithelial neoplasm; most commonly occur in mucinous tumors of intestinal type [4]. The nodules may be reactive or neoplastic, and some have mixtures of both types. Mural nodules with foci of anaplastic carcinoma, sarcoma, sarcoma-like, and carcinosarcoma-like nodules have been reported in the literature [5–7]. We hereby report a case of mural nodules of clear cell carcinoma in an intestinal-type borderline mucinous ovarian tumor. Although clear cell carcinomas have been found in association with mucinous cystadenomas and endometriosis in the past [8–10], to
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