ABSTRACT
Tumors of low malignant potential (also called borderline tumors) account for approximately 10% of malignant ovarian neoplasm. Borderline tumors have a much better prognosis and, because they are noninvasive, may be treated less radically than invasive ovarian cancer. The ability to distinguish borderline tumor from early stage malignant disease preoperatively considerably influences surgical treatment, and allows improved counseling of patients. CA 125 is a useful tumor marker in the diagnosis of malignant ovarian tumors. However, in the case of borderline ovarian tumor, the value of CA 125 as a diagnostic tool seems to be invalid. Herein, we report a case of borderline ovarian tumor with extremely elevated serum CA 125 level.
Subject(s)
Humans , Counseling , Ovarian Neoplasms , PrognosisABSTRACT
Tumors of low malignant potential (also called borderline tumors) account for approximately 10% of malignant ovarian neoplasm. Borderline tumors have a much better prognosis and, because they are noninvasive, may be treated less radically than invasive ovarian cancer. The ability to distinguish borderline tumor from early stage malignant disease preoperatively considerably influences surgical treatment, and allows improved counseling of patients. CA 125 is a useful tumor marker in the diagnosis of malignant ovarian tumors. However, in the case of borderline ovarian tumor, the value of CA 125 as a diagnostic tool seems to be invalid. Herein, we report a case of borderline ovarian tumor with extremely elevated serum CA 125 level.
Subject(s)
Humans , Counseling , Ovarian Neoplasms , PrognosisABSTRACT
OBJECTIVE: We have assessed the accuracy of frozen section diagnosis and the outcomes of misdiagnosis in borderline tumors of the ovary (BTO) according to frozen section. METHODS: All pathology reports with BTO in both frozen and permanent section analyses between 1994 and 2008 at Seoul St. Mary's Hospital were reviewed. Frozen section diagnosis and permanent section histology reports were compared. Logistic regression models were conducted to evaluate the correlation of patient and tumor characteristics with diagnostic accuracy. The clinical outcomes of misdiagnosis were evaluated. RESULTS: Agreement between frozen section diagnosis and permanent histology was observed in 63 of 101 patients (62.4%). Among the 76 patients with frozen section proven BTO, under-diagnosis and over-diagnosis occurred in 8 of 76 (10.5%) and 5 of 76 patients (6.6%), respectively. Mean diameter of under-diagnosed tumor was larger than matched BTO (21.0+/-11.4 vs. 13.7+/-7.1; p=0.021). Tumor size 20 cm was determined as the optimal cut-off for under-diagnosis (50% sensitivity, 87.3% specificity). Among 8 under-diagnosed patients, no patient relapsed. Among 5 over-diagnosed patients, 2 patients < 35 years of age had fertility-preserving surgery. CONCLUSION: Although frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian tumors, over-diagnosis and under-diagnosis are relatively frequent in frozen proven BTO. Surgical decision-making for BTO based on frozen section diagnosis should be done carefully, especially in large tumors.
Subject(s)
Female , Humans , Diagnostic Errors , Frozen Sections , Logistic Models , OvaryABSTRACT
Sixty-two patients with borderline tumors of ovary were historical cohort analyzed for survival characteristics. There were 9 patients with FIGO stage IA, 9 with stage IC, 3 with stage IIIA, 2 with stage IIIB, 4 with stage IIIC, 1 with stage IV and 34 with inadequate stage tumors. Twenty one patients had surgical staging with radical surgery, 10 patient had at least a total abdominal hysterectomy and bilateral salpingo-oophorectomy, 6 patient had surgical staging with conservative surgery, 24 patient had at least a unilateral salphingo-oophorectomy or ovarian cystectomy and 1 patient had biopsy. Sixteen patients received cisplatin-based combination chemotherapy, that were 8 with inadequate stage tumors, 7 with stage III tumors and 1 with stage IV tumor. Follow-up range from 0.02 to 10.48 years, with a median of 3.5 years. Fifty nine patient were alive. Three patients died, all of disease. Recurrence were found in 4 patients. The overall 2-years survival rate was 96% and 10-years survival rate was 94%. In log rank test, residual disease and histology type were significant predictor of survival.