Photos 1~6 show an invasive mucinous adenocarcinoma. The remaining photos show a mucinous or mixed seromucinous borderline tumor. I do not see definite residual ovarian or fallopian tubal tissue to be sure of the exact anatomic location of these two lesions. If the two tissue fragments are from the same lesion, it is probably a malignant mucinous adenocarcinoma arising from a pre-existing borderline tumor. If the two tissue fragments are separate from each other anatomically, and the malignancy is also present elsewhere on the surfaces of the pelvis and peritoneal cavity, colorectal, pancreatic and appendiceal metastastic origins need to be considered in addition to ovarian primary malignancy. Immunohistochemical stains (CDX-2, CK20, CA19.9) and, MUCH MORE IMPORTANTLY, accurate detailed clinical history and intraoperative findings would help. The pre-op images and the following important questions need answered by the gynecologist or the surgeon before further workup is done:

(1) Where were the two lesions from anatomically?

(2) Were the uterus and ovaries present in the pelvis? If yes, were they abnormal? If not, when were they removed and for what reasons?

(3) How did the omentum, vermiform appendix, pancreas and the entire gastrointestinal tract appear during surgery and on abdominal/pelvic CT scans or MRI?

（abin译）图片1-6为浸润性粘液腺癌。其余图片为粘液性或混合性浆/粘液性交界性肿瘤。未见明确的卵巢或输卵管组织残留，不能明确这两个病变的确切解剖部位。如果这两块破碎组织来自同一病变，它可能是起源于以前存在的交界性肿瘤的粘液性腺癌。如果这两块破碎组织在解剖学上相互分隔，并且盆壁其它位置也有这样的恶性病变，除了考虑卵巢原发性恶性肿瘤外，还需要考虑结直肠、胰腺和阑尾的转移性肿瘤。免疫组化染色(CDX-2, CK20, CA19.9)，更重要的是，准确、详尽的临床病史和术中所见，这些会有助于确诊。在进一步处理之前，手术医生需要复习术前影像检查并回答以下问题：
（1）这两个病变的解剖部位在哪里？
（2）盆腔内还有子宫和卵巢吗？如果有，正常吗？如果没有，何时切除的？为什么切除？
（3）网膜、阑尾、胰腺和整个消化道的术中探查情况和腹盆腔CT或MRI检查情况如何？