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Objective: To provide an embryological explanation for the presence of ovarian stroma in cystadenomas of the liver and pancreas., Design: Investigation of patients and embryos., Method: From 1997 to 2001 in the Academic Medical Centre, Amsterdam, the Netherlands, nine women were treated for a cystadenoma with ovarian stroma, six of which were situated in the liver and three in the tail of pancreas. In one patient with a cystadenoma in the liver, malignant changes had taken place. In embryos at 5-8 weeks development, the regional differences in the morphology of the epithelium of the peritoneal cavity and the position of the gonads in relation to the embryonic liver, pancreas and spleen were examined., Results: In the foetal period before the gonads begin to descend, they are situated directly dorsal to the liver, tail of pancreas and spleen, but are separated from these by the peritoneal cavity. The cells that cover the urogenital folds distinguish themselves from those elsewhere in the peritoneal cavity as they are bulging in shape as opposed to flattened. This activated morphology suggests that on physical contact with a neighbouring organ the cells covering the gonads may become detached and lodge in that organ., Conclusion: It is likely that cystadenomas of the liver and pancreas have their origin in the cells that cover the embryonic gonads. The anomalous morphology of these covering cells in fact suggests that they are relatively easily mobilized. They are probably comparable with inoculation metastasis in the coelomic cavity. Taking the chance of malignant transformation of a cystadenoma into account, the treatment of choice is radical resection of the abnormality.

The first case of intratesticular papillary mucinous cystadenocarcinoma is described. The tumor was histopathologically different from other types of papillary carcinoma related to the testicle and is believed to have originated from an intratesticular müllerian duct remnant.

On the basis of light microscopic and scanning and transmission ultrastructural observations, we have classified benign mucinous ovarian neoplasms into two types: a pure endocervical type and a mixed intestinal endocervical type. We have also reviewed the literature pertinent to the histogenetic origin of the ovarian mucinous cystoma and found convincing support for a mesodermal, coelomic epithelial, rather than a teratomatous, derivation.