Advanced-stage serous borderline tumors of the ovary: a clinicopathological study of 49 cases.

There is controversy about patient outcomes and pathological parameters of prognostic significance in patients with stage II or stage III ovarian serous borderline tumors. Forty-nine cases of stage II and III ovarian serous borderline tumors were identified on review of the medical records at Vancouver Hospital and British Columbia Cancer Agency for the period from 1979 to 1996. Pathological features assessed included presence of micropapillary architecture, tumor cell DNA content (ploidy), and characteristics of the extraovarian implants, including invasiveness and mitotic activity. Clinical follow-up information (3-17 years of follow-up) was obtained for 48 patients. Fifteen patients had stage II tumors and 34 had stage III tumors. Fourteen patients experienced tumor recurrence 1 to 8 (mean 3.5) years after presentation and of these, six patients died of disease (2, 3, 4, 7, 10, and 11 years after presentation). Patients with gross residual disease, as assessed by the surgeon, more frequently experienced a recurrence compared with patients without gross residual disease, but this difference did not reach statistical significance (0.05相似文献   

Ovarian stimulation and borderline ovarian tumors: a case-control study

Objective: To assess the risk of borderline ovarian cancer among infertile women treated with fertility drugs.

Design: Case-control study.

Setting: Nationwide data obtained from public registers and postal questionnaires.

Patient(s): All Danish women <60 years old with borderline ovarian cancer during the period 1989–1994 and randomly selected population controls. The analysis included 231 cases and 1,721 controls.

Intervention(s): None.

Main Outcome Measure(s): Influence of parity, infertility, and fertility drugs on the risk of borderline ovarian cancer after multivariate confounder control.

Result(s): The odds ratio (OR) for borderline ovarian cancer among infertile untreated nulliparous women compared with fertile nulliparous women was 1.9. The OR for borderline ovarian cancer among treated nulliparous women compared with untreated infertile nulliparous women was 1.5, and the OR among treated parous women compared with untreated infertile parous women was 1.5.

Conclusion(s): Among fertile women, the difference in the risk of borderline ovarian cancer between nulliparous women and parous women was not statistically significant. Nulliparous women who were infertile and who did not receive medical treatment had a twofold higher risk of borderline ovarian cancer than fertile nulliparous women. There was no statistically significant increase in the risk of borderline ovarian cancer among nulliparous women who were treated with fertility drugs compared with nulliparous untreated infertile women or among parous women who were treated with fertility drugs compared with parous untreated infertile women.     

Recurrence of borderline papillary serous tumors: a modern dilemma

Background When defining tumors originating from the epithelial surface of the ovary, a distinction between benign and malignant is made based on clinical and pathologic features. This distinction allows clinicians to make difficult decisions as to which treatment will allow the best possible prognosis for patients with aggressive lesions, while avoiding unnecessary operations for those who are not likely to benefit from surgery. Case We would like to present a patient who was found in the operating room setting to have an extensive recurrence of papillary serous tumor of the ovary. Her original operative diagnosis was that of stage IC papillary serous ovarian carcinoma. The tumor re-occurred as a ventral hernia and during abdominal exploration she was found to have extensive disease. Conclusions Although the survivability of borderline ovarian tumors has been well documented, their recurrence and sites of involvement are not easily defined. Additional studies are needed to further categorize serous borderline tumors and to treat them appropriately.     

青春期卵巢上皮性交界瘤7例临床分析

的探讨青春期卵巢上皮性交界瘤的临床特点。方法回顾性分析本院2000年1月～2006年12月收治的7例20岁以下卵巢上皮性交界瘤患者的临床和病理特征。结果患者年龄16～19岁（平均17．8岁）。主要症状为腹胀5例（71．4％，其中3例伴腹痛）、腹痛4例（57．1％），盆腹腔包块，直径7～30cm（中位数20cm）；B超检查盆腹腔囊实性包块6例，实性包块1例，直径7～32cm（中位数19．9cm）。根据术中冰冻病理检查情况，均采用保留生育功能手术（6例患侧附件切除术，1例卵巢肿瘤剔除术）。手术病理分期Ia期卵巢粘液性交界瘤4例（57．1％），Ia期浆液性交界瘤2例（28．6％），Ⅲc期浆液性交界瘤1例（14．3％）。随访18～94月（平均53．9月），6例（85．7％）无复发，1例Ia期浆液性交界瘤患侧附件切除术后18月复发。结论青春期卵巢上皮性交界瘤Ia期多见，病理类型为浆液性和粘液性肿瘤，各期患者保守手术治疗效果均较好。     

Epithelial ovarian tumors of borderline malignancy: a study of 50 cases

Of 50 patients with borderline epithelial ovarian tumors, 32 (64%) had serous, 17 (34%) had mucinous and one (2%) had endometrioid tumor. All patients with mucinous tumor had stage I disease, whereas 4 patients with serous tumor had stage II–III disease. Five patients (10%) were pregnant at the time of diagnosis. Seventeen patients (34%) had initial surgery with ovarian conservation and 7 of them were not subjected to further surgery. Five patients (10%) received adjuvant chemotherapy. Five-year survival and 5-year disease-free survival rates were 100% and 96.4%, respectively. It is concluded that for patients with stage IA disease unilateral salpingo-oophorectomy seems to be adequate treatment and for those with more than stage IA disease, surgery should include total abdominal hysterectomy and bilateral salpingo-oophorectomy. Although the effectiveness of chemotherapy in these tumors is uncertain, adjuvant chemotherapy is advocated for patients in whom spread of the tumor beyond the ovaries has occurred.     

An in vitro study of ovarian atypical proliferating (borderline) serous tumors

Seven human serous ovarian atypically proliferating tumors (tumors of borderline malignancy) were grown in primary culture and compared morphologically with established cell lines derived from serous carcinomas (stage III–IV). Several parameters were investigated in order to establish the place of these tumors in a neoplastic spectrum between benign and frankly malignant serous neoplasms. The atypically proliferating tumors showed serous features, including prominent microvilli and multiple cilia, similar to those found in the malignant serous cells. DNA flow cytometric studies of the atypically proliferating tumors showed them to be diploid. Keratins were strongly expressed immunohistochemically by all the atypically proliferating tumors. Vimentin was also detected in six of the original tumors but only in one primary culture. The capacity to culture and study cells which represent possible intermediate stages in the evolution of ovarian malignancy may prove useful as an in vitro model for this disease.     

Ovarian serous borderline epithelial tumors with multiple retroperitoneal nodal involvement: metastasis or malignant transformation of epithelial glandular inclusions?

One of four patients who underwent lymph node excision at exploration for ovarian serous borderline epithelial tumor (OSBT) at Baystate Medical Center was found to have FIGO Stage III C lesion associated with extensive ovarian external (surface) papillary growth, peritoneal implants in the omentum and cul-de-sac, and involvement of multiple pelvic and periaortic lymph nodes by the tumor. Histologically, the lymph nodes showed an admixture of endosalpingeal glandular inclusions with neoplastic tissue identical to the ovarian tumor. The exact histogenesis and the prognostic significance of the nodal involvement by OSBT are still not fully understood. Although there is a small number of reported cases of lymph node involvement associated with OSBT, they are described as examples of nodal metastases or independent primary foci of malignant transformation. This paper presents an interesting association of OSBT with extensive pelvic and periaortic nodal involvement and reviews the relevant literature.     

Adjuvant platinum-based chemotherapy for borderline serous ovarian tumors with invasive implants

Background

Most borderline ovarian tumors (BOTs) are cured with surgery. However BOTs with invasive implants have a poor prognosis with a mortality of 20–40%. The benefit of adjuvant chemotherapy (CT) in this setting remains poorly defined.

Methods

Retrospective study of serous BOT + invasive implants treated with adjuvant CT.

Results

36 patients were referred with serous BOTs + invasive implants and treated with surgery and platinum-based CT between 06/1982 and 02/2011. 83% were stage III/IV. Tumors demonstrated microinvasion, micropapillary pattern or desmoplastic implants in 53%, 47% and 67% of cases, respectively. 8% had fertility-sparing surgery. Taking into account initial and completion surgeries, R0 was achieved in 84% (27/32) (NA, N = 4). The majority (72%) received a combination of platinum + taxane. 11% of patients experienced a G3/G4 toxicity. 13 of 36 (36%) patients relapsed at a median of 27.3 months after diagnosis of invasive implants. Among 12 patients with histologically confirmed relapse, 8 patients progressed with invasive disease in the form of carcinoma or invasive implants. 5 year PFS/OS were 67%/96%. Neither microinvasion, micropapillary pattern, nor desmoplastic implants predicted relapse. In cases with evaluable disease, an objective response to chemotherapy was observed in 4 of 6 patients.

Conclusion

This is the largest study of BOT with invasive implants treated with surgery and adjuvant platinum-based CT. Treatment was well tolerated and the invasive relapse rate was 22% (8/36). Although numbers are small, the objective responses suggest a possible role for adjuvant CT in BOTs with invasive implants.     

Ovarian epithelial tumors of borderline malignancy in Japan

Seventy-one cases of ovarian epithelial tumor of borderline malignancy have been surveyed from a clinicopathologic viewpoint. The majority of the borderline tumors (73.2%) were of the mucinous type, versus only 16.9% of the serous type. The other types--endometrioid (2.8%), Brenner (1.4%), and mixed type (5.6%)--were much rarer. Patients with mucinous tumors were significantly younger (mean age 42.6) than those with serous tumors (mean age 57.5) (P less than 0.01). Of patients with mucinous tumors, 64.2% were of reproductive age (15-45 years), compared with 17% of patients with serous tumors. Some 78.8% of mucinous and 83.3% of serous borderline tumors were FIGO stage I. Serous tumors were more frequently bilateral (66.7%) than mucinous tumors (9.8%). In mucinous borderline tumors, the extent of tumor spread at the first laparotomy had an intimate relationship to the prognosis, but in serous borderline tumors, it was insignificant. The survival rate of patients with mucinous borderline tumors was 69.3% at 5 years and 62.4% at 10 years (Kaplan-Meier method). Most patients with pseudomyxoma peritonei classified as borderline at the time of discovery died within 5 years of the operation. The prognosis of the serous type was extremely favorable. Criteria for borderline tumors of various cell types and differences in the clinicopathologic data of ovarian borderline tumors between Japan and other countries were discussed.     

Nuclear deoxyribonucleic acid heterogeneity of ovarian borderline malignant serous tumors

Sixteen borderline malignant serous ovarian tumors and seven well-differentiated invasive serous ovarian carcinomas were examined with the technique of Feulgen microspectrophotometry for the determination of nuclear deoxyribonucleic acid (DNA) ploidy patterns (diploid versus aneuploid) and ploidy levels of the stem cell lines. Of the nine stage I-II borderline malignant tumors, only one (11%) was aneuploid. In contrast, four of seven (57%) stage III borderline malignant neoplasms and all stage III carcinomas were aneuploid. The stem cell modal values in all borderline serous tumors were less than triploid (3N) while in five of seven carcinomas stem cell modal values were greater than triploidy. This contrast in ploidy patterns and ploidy levels may explain the differences in biologic behavior between borderline malignant serous tumors and invasive serous carcinomas of the ovary.     

Cytoplasmic CD24 expression in advanced ovarian serous borderline tumors

OBJECTIVES: CD24, originally described as a B-cell marker, has been revealed as one of the candidate molecular markers of epithelial ovarian cancer. We aimed to determine the pattern and extent of CD24 expression in ovarian serous tumors and to clarify its relationship with pathological parameters, especially those associated with the early events of tumor progression in serous tumors of borderline malignancy. METHODS: A total of 114 ovarian serous tumors, including 9 adenomas, 34 borderline, and 71 carcinomas, were analyzed immunohistochemically using a CD24 monoclonal antibody on paraffin blocks. RESULTS: In normal epithelium and serous cystadenomas, the CD24 expression was localized to the apical membranous portion. In some of borderline tumors (26.4%), additional cytoplasmic expression was observed. The cytoplasmic expression of CD24 in borderline tumors was associated with microinvasion (P = 0.001) and omental implants (P = 0.033) with statistical significance. Serous adenocarcinomas showed strong diffuse cytoplasmic expression of CD24, which was significantly associated with shortened survival rate both in univariate (P = 0.011) and multivariate (P = 0.009) analysis. CONCLUSION: The loss of apical localization with the acquisition of the cytoplasmic staining of CD24 protein is a surrogate marker of stromal invasion in ovarian serous tumors of borderline malignancy. Furthermore, the increase in the cytoplasmic expression of CD24 protein is a strong independent molecular marker for shortened survival rate of patients with ovarian serous adenocarcinomas.     

Microdissection-based mutational genotyping of serous borderline tumors of the ovary.

Mutational changes in a number of genetic foci were studied in 12 serous borderline tumors (SBTs) of the ovary including 2 with a micropapillary pattern. The analysis was focused on chromosomal regions that have not been previously studied in these tumors. The findings were correlated with the morphology and the FIGO stage of the tumors. Six of the tumors were stage I, one was stage II, and five were stage III. Loss of heterozygosity analysis in each tumor was performed with a panel of 12 polymorphic markers on chromosomes 1p, 5q, 9p, 9q, 10q, and 17p. The ovarian tumors displayed allelic losses most frequently on 1p (83.3%), 9q (70%), and 17p (41.7%). In the extraovarian implants, allelic losses on 1p, 9q, and 17p were present in 66.7%, 75%, and 66.7% of cases respectively. In five of six cases, allelic losses were 88% concordant between multiple tumor sites. Only one case of stage III tumor displayed a discordant pattern of allelic loss at different tumor sites. Cumulative allelic losses did not show a statistically significant difference in stage I vs. higher stage disease. The pattern and cumulative allelic loss in the two cases with micropapillary architecture was similar to that of the other tumors. We report a high frequency of allelic loss on 1p and 9q that has not been previously reported in SBTs. Morphologically heterogenous areas including benign-appearing, typical borderline, and micropapillary areas had a similar pattern of allelic loss. Although the majority of SBTs seem to be monoclonal, a minor subset may be multiclonal in origin.     

Ovarian tumors of borderline malignancy: a review of 247 patients from 1991 to 2004

Borderline ovarian tumors account for 15% of epithelial ovarian cancers and are different from invasive malignant carcinoma. Majority are early stage, occurring in women in the reproductive age group, where fertility is important. We reviewed retrospectively 247 such cases treated at the Gynaecological-Oncology Unit, KK Women's and Children's Hospital, between January 1991 and December 2004. The mean age was 38 years (16-89 years). Majority of the cases (92%) were FIGO stage I (Ia, 75%; Ib, 1%; and Ic, 16%). Seven (3.5%) patients were diagnosed as having stage II disease, six (2.5%) as stage IIIa, two (1%) as stage IIIb, and four (2%) as stage IIIc. Histological origin was as follows: mucinous (68%), serous (26%), endometrioid (2.6%), and clear cell (1.2%). Primary surgical procedures undertaken were as follows: hysterectomy with bilateral salpingo-oophorectomy (52%), unilateral salpingo-oophorectomy (33%), or ovarian cystectomy (15%). Adjuvant chemotherapy was administered in 13 patients (5.2% of cases), of which 4 patients were given chemotherapy only because of synchronous malignancies. There were six recurrences (2.4% of cases). Overall mean time to recurrence was 59 months. Recurrence rate for patients who underwent a primary pelvic clearance was 1.6% compared to fertility-sparing conservative surgery (3.3%; although P= 0.683). No significant difference was noted in recurrence and mortality between staged versus unstaged procedures. The overall survival rate was 98.0%. There were a total of five deaths (2.8%): three (1.5%) from invasive ovarian/peritoneal carcinoma and two from synchronous uterine malignancies. It appears that surgical resection is the mainstay of treatment, with conservative surgery where fertility is desired or pelvic clearance if the family is complete. Surgical staging is important to identify invasive extraovarian implants that portend an adverse prognosis. The role of adjuvant chemotherapy is not established.     

Surgery as sole treatment for serous borderline tumors of the ovary with noninvasive implants

OBJECTIVES: The objectives were to describe the clinical characteristics and prognosis of surgically treated patients with stage II and III serous borderline tumors of the ovary with noninvasive implants. MATERIALS AND METHODS: From 1990 to 2000, 16 patients with stage II and III ovarian serous borderline tumors and noninvasive implants were diagnosed and prospectively followed at our center. All patients underwent surgical treatment including staging and their pathology was reviewed. Fifteen patients had thorough surgical staging by laparotomy, while one patient was staged laparoscopically. No patient was treated with adjuvant therapy (radiation or chemotherapy) after surgical treatment and none were lost to follow-up. RESULTS: The mean age at diagnosis was 42 years (range 26-59). Fourteen patients were treated by abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies, while 2 patients were treated conservatively for fertility preservation. Two patients underwent pelvic and para-aortic lymph node dissection. Fifteen of 16 patients had ovarian surface involvement with tumor. All patients but 2 had clinical evidence of extraovarian disease at the time of surgery. The mean duration of follow-up was 60.7 months (range 2-134 months). Thirteen patients (81%) are alive without evidence of disease. Four patients (25%) required subsequent surgery for recurrent disease and all are still alive. Two patients have been treated with chemotherapy (paclitaxel/carboplatin) for progressive borderline disease, while an additional patient was treated after first relapse with chemotherapy for an invasive recurrence. CONCLUSIONS: Carefully staged patients with advanced serous borderline tumors of the ovary and noninvasive implants have a good prognosis without adjuvant therapy.     

Serous and mucinous borderline tumors of the ovary: a clinicopathologic and DNA-ploidy study of 102 cases

One-hundred and two patients with epithelial borderline ovarian tumors treated at Tampere University Hospital between January 1965 and September 1991 were evaluated. There were 48 patients with serous tumors and 54 with mucinous tumors. Ninety-three (91%) patients had clinical stage I and nine had stage III disease. Abdominal hysterectomy and bilateral salpingo-oophorectomy were performed in 70% of the patients. Forty percent of those with serous and 20% with mucinous tumors were operated conservatively. After conservative surgery six patients had a total of 10 deliveries and none of these had a recurrence. Seven patients received chemotherapy, none had radiation therapy. An aneuploid DNA pattern was identified in 8.2% of 85 specimens studied and a high S-phase fraction was found in 8.6% of 81 specimens studied. DNA measurement failed to identify the malignantly behaving tumors. Elevated preoperative serum levels of CA125 were found in 10 (63%) out of 16 cases studied. All of them dropped postoperatively to normal. During the follow-up period (mean 11.6 years, range 4.5–29.7 years) 22 patients died but in 17 of them death was unrelated to ovarian tumor. The corrected (borderline malignancies related) 5-year survival rate was 100% in patients with serous tumor and 96% with mucinous tumor, 25-year survival rate was 97% and 91%, respectively. There was no difference between the serous and mucinous groups. Our results show that ovarian borderline tumors have a good prognosis. Quite conservative therapy is often enough, especially in low-stage disease in young women who want to retain their fertility.