Borderline Ovarian Tumors

Handbook of Research on Oncological and Endoscopical Dilemmas in Modern Gynecological Clinical Practice - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-7998-4213-2.ch016 ◽

2021 ◽

pp. 223-239

Author(s):

George Pados ◽

Dimitrios Zouzoulas

Keyword(s):

Ovarian Cancer ◽

Gold Standard ◽

Early Stage ◽

Ovarian Tumors ◽

Microscopic Appearance ◽

Borderline Tumors ◽

Non Invasive ◽

Borderline Ovarian Tumors ◽

Specific Subgroup ◽

Serous Tumors

Borderline ovarian tumors (BOTs) are a specific subgroup of ovarian tumors and are characterized by cell proliferation and nuclear atypia without invasion or stromal invasion. They are usually more present in younger people than the invasive ovarian cancer and are diagnosed at an early stage and thus have a better prognosis. Histologically, borderline tumors are divided into serous (50%), mucosal (46%), and mixed (4%). The serous tumors are bilateral in 30% of the cases and are accompanied by infiltrations outside the ovary in 35% of the cases. These infiltrations may be non-invasive or invasive depending on their microscopic appearance and may affect treatment. Surgery is the approach of choice, and laparoscopic surgery, with the undeniable advantages it offers today, is the “gold standard.” All the surgical steps required to properly treat borderline tumors, at both diagnostic and therapeutic levels, can be safely and successfully be applied laparoscopically. Manipulations during surgery should be limited, and biopsies for rapid biopsy should be done within an endoscopic bag.

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Demographic and genetic characteristics of patients with borderline ovarian tumors as compared to early stage invasive ovarian cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2005.02.022 ◽

2005 ◽

Vol 97 (3) ◽

pp. 780-783 ◽

Cited By ~ 49

Author(s):

Walter H. Gotlieb ◽

Angela Chetrit ◽

Joseph Menczer ◽

Galit Hirsh-Yechezkel ◽

Flora Lubin ◽

...

Keyword(s):

Ovarian Cancer ◽

Early Stage ◽

Ovarian Tumors ◽

Genetic Characteristics ◽

Borderline Ovarian Tumors

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Minimally invasive treatment options to borderline ovarian tumors

10.1055/s-0039-1685392 ◽

2016 ◽

Author(s):

Punita Bhardwaj ◽

T. K. Das ◽

S. Batra ◽

Keyword(s):

Early Stage ◽

Treatment Options ◽

Malignant Potential ◽

Ovarian Tumors ◽

Conservative Approach ◽

Uncertain Malignant Potential ◽

Invasive Treatment ◽

Younger Women ◽

Borderline Ovarian Tumors

Borderline Ovarian tumors are tumors of uncertain malignant potential. They have favour able prognosis. They occur in younger women and present at an early stage. They are difficult to diagnose preoperatively as macroscopic picture is a combination of benign and invasive ovarian tumors. Over the years surgical treatment has changed from radical to conservative approach without overlooking oncologic safety. Follows up is essential. Prolonged follow up (>10 yrs) is required because of later recurrences. Special attention is to be paid to the conserved ovary in follow up.

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Borderline Ovarian Tumors: Fifteen Years’ Experience at a Scottish Tertiary Cancer Center

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001364 ◽

2018 ◽

Vol 28 (9) ◽

pp. 1683-1691 ◽

Cited By ~ 6

Author(s):

James May ◽

Karolina Skorupskaite ◽

Mario Congiu ◽

Nidal Ghaoui ◽

Graeme A. Walker ◽

...

Keyword(s):

Malignant Transformation ◽

Surgical Management ◽

Early Stage ◽

Ovarian Tumors ◽

Ca 125 ◽

Ovarian Malignancy ◽

Borderline Ovarian Tumors ◽

Gynecology And Obstetrics ◽

Preoperative Serum

ObjectivesSince the recognition of borderline ovarian tumors (BOTs) in the 1970s, the management of this subset of epithelial ovarian tumors has presented a challenge to clinicians. The majority present at an early stage, but their diagnosis is often only made following surgery, hence the heterogeneity of surgical management. Borderline ovarian tumors are morphologically diverse, and their behavior is subsequently also heterogeneous. We aimed to assess recurrence rates and the rate of malignant transformation in patients diagnosed with BOT. Secondary objectives included a review of current management and assessment of tumor markers, stage, cyst dimensions, and the presence of micropapillary features as prognostic indicators of recurrence.MethodsThis retrospective cohort study included all patients treated with BOT between 2000 and 2015 in the southeast region of Scotland. Clinical, surgicopathological, and follow-up data were collated. Data were analyzed with reference to recurrence and malignant transformation.ResultsTwo hundred seventy-five patients underwent treatment for BOT in the study period. Surgical management was highly variable. A diagnosis of recurrent/persistent BOT or ovarian malignancy following initial treatment of BOT was rare, with only 12 (4%) of 275 cases. There were 7 cases (3%) of ovarian malignancy. Advanced International Federation of Gynecology and Obstetrics stage was the most prominent prognostic factor. Elevated preoperative serum CA-125 and the presence of micropapillary features correlated with advanced stage at presentation. With a lack of clear guidance, follow-up was highly variable with a median of 43 months (0–136 months).ConclusionsTo our knowledge, this study is the largest BOT cohort in the United Kingdom. Recurrent disease is rare in optimally staged, completely resected, early-stage BOT, without high-risk features. Caution is needed in women electing not to undergo completion staging after diagnosis and in those opting for a fertility-preserving approach. Thorough informed consent and clear plans for surveillance and follow-up are needed with consideration of delayed completion surgery as appropriate.

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Assessing the landscape of ovarian serous borderline tumors

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000086 ◽

2019 ◽

Vol 29 (3) ◽

pp. 572-578 ◽

Cited By ~ 2

Author(s):

Irini Messini ◽

Triada Doulgeraki ◽

Dimitris Chrysanthakis ◽

Petros Yiannou ◽

Theofani Gavresea ◽

...

Keyword(s):

Univariate Analysis ◽

Lymph Node Involvement ◽

Serous Carcinoma ◽

Low Grade ◽

Borderline Tumors ◽

Non Invasive ◽

Node Involvement ◽

Serous Tumor ◽

Serous Tumors ◽

Micropapillary Pattern

AimTo compare distinct clinicopathological features between atypical proliferative serous tumors and non-invasive low-grade ovarian serous carcinomas.MethodsOur study group comprised 203 cases of serous borderline tumors sub-classified as atypical proliferative serous tumors or as non-invasive low-grade serous carcinomas. All pathological features related to borderline tumors were re-evaluated by two gynecological pathologists. Data concerning recurrences and survival were retrieved from the medical records of the patients.ResultsWhen comparing atypical proliferative serous tumors to non-invasive low-grade serous carcinomas, the latter were statistically related to advanced stage at diagnosis, bilateral disease, exophytic pattern of growth, microinvasive carcinoma, and the presence of invasive implants. In univariate analysis, recurrences were statistically related to the exophytic pattern of growth, to microinvasion, and to the presence of implants (both invasive and non-invasive). Nevertheless, in multivariate analysis, only microinvasion and the presence of invasive implants were related to recurrence. Women who eventually succumbed to the disease were only those with invasive implants. Their ovarian tumor was either a non-invasive low-grade serous carcinoma or an atypical proliferative serous tumor with ‘minimal’ micropapillary pattern. Neither lymph node involvement nor endosalpingiosis seemed to influence the course of the disease.ConclusionsThe results of our study underline the increased possibility of non-invasive low-grade serous carcinomas to be related with features indicative of aggressive behavior as opposed to atypical proliferative serous tumors. Nevertheless, irrespective of tumor histology, the presence of invasive implants and microinvasion were the only independent prognostications of recurrence.

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Ultrasonographic markers and preoperative CA-125 to distinguish between borderline ovarian tumors and stage I ovarian cancer

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/aogs.12046 ◽

2012 ◽

Vol 92 (3) ◽

pp. 285-292 ◽

Cited By ~ 8

Author(s):

Dimitrios Zacharakis ◽

Nikolaos Thomakos ◽

Ioannis Biliatis ◽

Alexandros Rodolakis ◽

Maria Simou ◽

...

Keyword(s):

Ovarian Cancer ◽

Ovarian Tumors ◽

Stage I ◽

Ca 125 ◽

Borderline Ovarian Tumors

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Impact of infertility treatment in patients with previous history of borderline ovarian tumors: Results of a multicenter study

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.5055 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 5055-5055

Author(s):

A. Fortin ◽

P. Morice ◽

A. Thoury ◽

C. Yazbeck ◽

S. Camatte ◽

...

Keyword(s):

Retrospective Study ◽

Early Stage ◽

Case Reports ◽

Previous History ◽

Infertility Treatment ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

History Of

5055 Background: The use of infertility drugs (ID) in infertile patients treated conservatively for ovarian malignancies remains theoretically contraindicated. Few recent case reports seem to suggest that ID could be used in patients treated for a borderline ovarian tumors (BOT). The aim of this multicenter retrospective study was to report the outcomes of the largest series of patients with a previous history of a BOT who underwent the use of ID. Methods: A multicenter retrospective study was conducted among centers which participate in the French National Register on In Vitro Fertilization registry to evaluate the outcomes of patients with a previous history of a BOT treated with ID. Four criteria were defined to select cases: 1. Histologic confirmation of BOT, 2. The use of a conservative surgery, 3. The use of ID and 4. A follow-up ≥ 12 months after the end of infertility treatment. Results: Thirty cases fulfilled inclusion criteria. Infertility therapy began in November 1989. Disease stages were: I (n = 20), II /III with noninvasive implants (n = 8) and unknown in 2 cases. The mean number of cycles of ovarian induction per patient was 2.6 (range,1–10). After a median follow-up of 42 months after infertility treatment, 4 recurrences were observed (all of them were borderline tumors on a remaining ovary treated by surgery alone). All patients are currently disease-free. Thirteen patients have since become pregnant. The median interval between treatment of the BOT and the use of ID is shorter in patients who relapsed compared to patients who did not (5 versus 29 months; p=.07). Conclusions: These results suggest that infertility drugs could be safely used in patients who experience infertility after conservative management of an early-stage BOT. A minimal interval should be respected between treatment of the ovarian tumor and the use of infertility drugs in order to decrease the risk of recurrence. No significant financial relationships to disclose.

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Borderline ovarian tumors: Long-term survival and preservation of fertility.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15508 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15508-e15508

Author(s):

Natasha Gercovich ◽

Carlos Garcia Gerardi ◽

Ernesto Gil Deza ◽

Eduardo L. Morgenfeld ◽

Edgardo G. J. Rivarola ◽

...

Keyword(s):

Young Patients ◽

Conservative Surgery ◽

Ovarian Tumors ◽

Population Characteristics ◽

Borderline Tumor ◽

Term Survival ◽

Borderline Tumors ◽

Borderline Ovarian Tumors ◽

The Usa

e15508 Background: Borderline ovarian tumors, also called low-malignancy potential tumors, are infrequent tumors present predominantly in pre-menopause women. Their evolution after surgical treatment is generally very good. The main objective of this paper is to show the evolution of a group of borderline tumors treated at our institution. Methods: Between January 1, 2000 and January 1, 2010, 36 patients diagnosed with ovarian borderline tumors were examined by two independent pathologists, according to the guidelines established by the USA Association of Directors of Anatomic and Surgical Pathology. These patients were followed at IOHM and comprise this paper’s study group. Results: Population Characteristics: Mean Age: 41 years (Range: 20-85). Affected Ovary (Right: 17 pts; Left: 14 pts; Both: 5 pts). Pathology: Mucinous (17 pts), Serous (16 pts), Clear, Brenner and Endometroid Cells (1 pt each). Stages: IA (24 pts), IB (5 pts), IC (2pts), IIIA (4 pts), IIIC (1 pt). Five patients presented non-invasive peritoneal implants and three presented positive peritoneal liquid. All patients were surgically treated: 28 with total anexohisterectomy (TAH) and 8 with unilateral ooforectomy. No patient was given any chemotherapy or radiotherapy treatment. Four patients did not attend follow-up consultations and were lost after 4, 6, 12 and 29 months with no evidence of disease (NED). Thirty-two patients were followed bi-annually during the first five years and annually thereafter. One patient became pregnant after the surgery. All patients are alive and NED with an average follow up of 50 months (range: 29-133). Conclusions: 1) Although half the cases in the study were under 35 years old, there were 12 tumors present in patients over 50 years of age and 1 borderline tumor present in an 85 year old patient. 2) Surgically treated ovarian borderline tumors have a high chance of being curable without the need of chemotherapy or radiotherapy. 3) Conservative surgery in young patients allows a conservation of fertility, provided they are subject to an adequate follow-up.

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