Desfechos reprodutivos e de sobrevida em adolescente tratada com cirurgia preservadora de fertilidade por tumor borderline de ovário em estádio avançado: relato de caso e revisão da literatura / Reproductive and survival outcomes in an adolescent treated with fertility- sparing surgery for advanced stage borderline ovarian tumor: case report and review of the literature

Existem poucos dados na literatura sobre os resultados obstétricos e oncológicos de adolescentes com tumores borderline de ovário em estádio avançado trata- das com cirurgia preservadora da fertilidade. Uma adolescente de 15 anos com diagnóstico de tumor borderline de ovário estádio IIIc foi inicialmente tratada com tumorectomia ovariana bilateral e quimioterapia adjuvante com esquema de platina/taxano (seis ciclos). Durante o seguimento, foi submetida a outras três tumorectomias devido a tumor borderline de ovário (duas vezes) e cistadenoma ovariano (uma vez). Outra recidiva de tumor borderline de ovário ocorreu seis anos após o diagnóstico inicial, quando ela estava grávida; foi tratada com tumorecto- mia realizada durante a cesariana. Em sua última consulta ambulatorial, a mulher de 27 anos não apresentava evidência da doença e tinha um filho saudável. Mesmo em estádio avançado, a cirurgia de preservação da fertilidade foi segura e factível nessa paciente com tumor borderline de ovário.

There are few data in the literature regarding obstetric and oncological outcomes of adolescents with advanced-stage borderline ovarian tumors treated with fertility spa- ring surgery. A 15 years old adolescent who was diagnosed with a stage IIIc borderline ovarian tumor, was treated with bilateral ovarian tumorectomies and adjuvant chemotherapy with platinum/taxane regimen (six cycles). During follow up she was submitted to other three tumorectomies due to borderline ovarian tumor(twice) and ovarian cysta- denoma (once). Another borderline ovarian tumorrecurren- ce occurred six years after initial diagnosis, when she was pregnant; treated with tumorectomy performed during ce- sarean section. At her last outpatient visit, the 27-year-old woman had no evidence of disease and a had healthy child. Even at an advanced stage, fertility sparing surgery was safe and feasible in this patient with borderline ovarian tumor.

Clinical analysis of 210 cases of borderline ovarian tumors / 肿瘤研究与临床

Objective To investigate the clinicopathological characteristics and risk factors for recurrence of epithelial borderline ovarian tumors (BOT). Methods The data of 210 BOT patients from January 2001 to December 2015 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. Results The mean age of 210 BOT patients was(41±16)years old including 68.1 %(143/210)patients of stage IA,and 31.9 %(67/210)patients>stage IA.Twenty-three patients had recurrence and the recurrence rate was 11.3 % (23/204); Univariate analysis showed that there were statistically significant differences in relapse rate among BOT patients with regard to age (P =0.007), stage (P =0.009), microemulsion pattern (P =0.024) and operative mode(P= 0.025). Multivariate logistic regression analysis showed that micropapillary pattern (OR=0.153, 95 % CI 0.044-0.535), the age (≤40 years old) (OR= 0.245, 95 % CI 0.088-0.686) and high stage (OR=3.502, 95 % CI 1.360-9.020) were risk factors for recurrence in BOT patients. Conclusions BOT mainly occurs in young women of child-bearing age,who are at an early stage and have a good prognosis. The patients who belong to 40 years old or below, the staging >ⅠAand micropapillary pattern would be easy to recur.

Controversies in borderline ovarian tumors / 부인종양

Borderline ovarian tumors (BOTs) represent about 15% to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. Historically, standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at earlier stage, in younger age women and have better prognosis, higher survival rate than IOCs, fertility-sparing surgery is one of the option to preserve childbearing capacity. The study of such conservative surgery is being released, and still controversial. After surgery, pregnancy and ovarian induction followed by in vitro fertilization are also significant issues. In surgery, laparoscopic technique can be used by a gynecologic oncology surgeon. So far postoperative chemotherapy, radiotherapy and hormone therapy are not recommended. We will discuss controversial issues of BOTs on this review and present the outline of the management of BOTs.

Laparoscopic management of borderline ovarian tumors; KBSMC experience / 대한산부인과학회지

OBJECTIVE: To evaluate feasibility and efficacy of laparoscopic management for borderline ovarian tumors. METHODS: From May 2005 to October 2007 in our institution, laparoscopic treatments were performed for 16 patients for borderline ovarian tumors. Through clinical records, the patients' age, parity, operating time, tumor diameter, length of hospital stay, change in hemoglobin level, intraoperative and postoperative complications, and recurrence were analyzed. RESULTS: The median age of the patients was 38 years (27-72 years), the median parity was 1 (0-3), and 6 patients were nulliparous., Eight patients were performed conservative surgery, and radical surgery was performed in the remainder. The median operating time was 90 minutes (50-305 minutes), the median hospital stay was 5 days (4-16 days), the median change of the hemoglobin level was 1.5 g/dL (0.2-4.5 g/dL), and the median diameter of the tumors was 8.5 cm. FIGO stage was Ia for 9 patients, Ib for 2, Ic for 4, and IIIc for the last one. Histopathological results showed mucinous tumor for 8 patients, serous tumor for 6, and mixed type and endometrioid tumor for each remaining. Laparoscopic pelvic and paraaortic lymphadenectomy were performed 4 patients. There was no upstaging by intraoperative cystic rupture. Neither laparoconversion nor intraoperative complication was noted. The median duration of follow-up was 20 months (3-53 months) and none showed recurrence. One of 8 patients who were treated conservatively obtained a baby by vaginal delivery in 32th postoperative month. CONCLUSION: This preliminary analysis demonstrated patients with borderline ovarian tumor can feasibly and efficiently undergo laparoscopic management.

Clinical significance of surgical staging and lymphadenectomy in patients with borderline ovarian tumors / 부인종양

OBJECTIVE: To compare the outcome of patients with borderline ovarian tumors who had been surgically staged with those who were not staged. METHODS: Between 1997 and 2004, there were 204 patients who underwent surgery and were diagnosed as borderline ovarian tumors. A retrospective review was performed. Two groups were identified: patients who underwent surgical staging (n=98) versus those who were not staged (n=106). Clinical outcomes were compared between the two groups. RESULTS: Between the two groups, there were no differences of the mean age of the time of diagnosis, parity, BMI, family history, pretreatment CA 125 level, tumor size, and disease recurrence, but were significant differences of FIGO stage (p=0.04), histologic types (p<0.01), operation time (p<0.01), length of hospital stay (p<0.01), and adjuvant chemotherapy (p<0.01). The lymph node positivity rate were 3.5% and 7.1% in patients with pelvic and para-aortic lymphadenectomy respectively. All patients with postive lymph nodes showed the micropapillary serous carcinoma. The 5 year disease-free survival rate was 90%. The overall disease-free survival was significantly found to be decreased in patients with advanced FIGO stage (p<0.01). There was no significant difference of overall disease-free survival regard to pretreatment CA 125 level (p=0.72), histologic types (p=0.78), adjuvant chemotherapy (p=0.45), and surgical staging with lymphadenectomy (p=0.79). CONCLUSION: Disease-free survival was not significantly different between staged and unstaged patients who had surgery with borderline ovarian tumors. It seems that routine pelvic and para-aortic lymphadenectomy is not necessary in the majority of women with borderline ovarian tumors.

Clinical Study of Borderline Ovarian Malignancy / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study is to investigate the clinicopathologic characteristics and the risk factors affecting the recurrence in patients with borderline ovarian malignancy. METHODS: From January 1996 to January 2001, 37 patients with borderline tumors of the ovaries were retrospectively investigated in the Department of Obstetrics and Gynecology, Catholic University, Kangnam and Uijongbu St. Mary's Hospital. Several clinicopathologic factors including DNA ploicly was analyzed for the prognosis and recurrence. Analysis for the kinds of treatment and recurrence were conducted to test the prognostic significance of several clinicopathologic factors including DNA analysis. RESULTS: Histologically, 27 borderline tumors were serous, 9 were mucinous and 1 was mixed epithelial type. The FIGO stage I was 91.8% (34/37) and stageII was 8.2% (3/37). Mean value of CA125 in mucinous borderline malignancy was significantly higher (162.4 IU/mL) than serous types (52.2 IU/mL) (p35 IU/mL) were 56.3% (9/16) in serous type and 75% (6/8) in mucinous tumors. Ten of 13 cases with DNA flow cytometry showed aneuploidy (76.9%). When considering pathologic types between diploid and aneuploid groups, there were no statistically significant differences. However, the patients with old age (>40) were more likely to be aneuploid (p<0.05). Mean duration of follow-up investigation was 26 months after primary operation. In this period, only one patient with serous borderline tumor stage Ia had recurrence on the contra-lateral ovary at 13-month. CONCLUSION: Data from this study showed that the majority of borderline tumors have good prognosis. And young patients who have not completed childbearing can be safely treated with unilateral salpingo- oophorectomy and omentectomy in stage I diploid tumor. In ovarian bordeline tumors, further studies on DNA ploidy would be needed.