Tumor de ovario borderline: concordancia entre biopsia contemporánea y biopsia definitiva / Borderline tumor of the ovary: accuracy of intraoperative frozen section and definitive biopsy

OBJETIVO: Los tumores de ovario borderline (BOT) son un grupo de lesiones neoplásicas de origen epitelial del ovario que presentan características de tumores malignos, pero sin invasión del estroma, y se caracterizan por tener un buen pronóstico. El objetivo del estudio es determinar la concordancia diagnóstica entre biopsia contemporánea y definitiva de los BOT en nuestro centro hospitalario. MÉTODO: Se realizó un estudio analítico retrospectivo de corte transversal de las biopsias contemporáneas y definitivas de BOT en la base de datos de anatomía patológica del Hospital Padre Hurtado, entre los años 2010 y 2019. El análisis estadístico de concordancia se realizó mediante test de kappa. RESULTADOS: Se revisaron 4546 informes de biopsias entre los años 2010 y 2019. Se pesquisaron 163 tumores malignos de ovario, de los cuales 69 (42,33%) correspondieron a BOT. De estos, 39 fueron serosos (56,2%), 28 mucinosos (40,57%) y 2 (2,8%) de tipo endometrioide. El resultado de concordancia diagnóstica de BOT seroso es moderada, del 75,71% con un índice de kappa de 0,5143 (p = 0,000), y el de BOT mucinoso es débil, del 65,71% con un índice de kappa de 0,2398 (p = 0,0222). CONCLUSIONES: Los BOT corresponden a un gran porcentaje dentro de los tumores malignos del ovario, siendo el subtipo seroso el más común. La concordancia entre biopsia contemporánea y definitiva es de débil a moderada.

OBJECTIVE: Borderline ovarian tumors (BOT) are a group of neoplastic lesions of epithelial origin of the ovary that present characteristics of malignant tumors but without stromal invasion and are characterized by having a good prognosis. The objective of the study is to determine the concordance between frozen section and definitive biopsy of BOT in our hospital center. METHOD: A retrospective, cross-sectional analytical study of the frozen section and definitive BOT biopsies was performed in the pathological anatomy database of the Padre Hurtado Hospital during the years 2010 and 2019. The statistical and concordance analysis was performed using kappa tests. RESULTS: 4546 biopsy reports were reviewed during 2010 and 2018. A total of 163 malignant ovarian tumors were investigated, of which 69 (42%) corresponded to BOT. Of these, the most common subtypes were 39 (56.2%) serous, 28 (40.57%) mucinous and 2 (2.8%) endometroid. The concordance results of serous BOT is moderate, 75.71% with a kappa index of 0.5143 (p = 0.000), and mucinous BOT have fair concordance, 65.71% with a kappa index of 0.2398 (p = 0.0222). CONCLUSIONS: BOT correspond to a large percentage of malignant tumors of the ovary, with the serous subtype being the most common. The concordance between contemporary and definitive biopsy is between fair and moderate.

Estudio transoperatorio de tumores limítrofes de ovario. Características que pueden repercutir en el diagnóstico / The intraoperative study in borderline ovarian tumors. Characteristics that can impact the diagnosis

Resumen OBJETIVO: Determinar el porcentaje de concordancia del estudio transoperatorio con el diagnóstico definitivo de tumores limítrofes de ovario. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y descriptivo efectuado en el Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, Ciudad de México, en pacientes operadas entre el 1 de enero de 2018 y el 31 diciembre de 2020 de un tumor abdominopélvico, con examen transoperatorio de tumor limítrofe de ovario. El estudio transoperatorio se evaluó como prueba diagnóstica y el diagnóstico definitivo como patrón de referencia para establecer la concordancia del primero con el diagnóstico definitivo de tumores limítrofes de ovario. RESULTADOS: Se analizaron 68 tumores limítrofes de ovario, entre los diagnosticados en el estudio transoperatorio y el definitivo. Se encontraron 59 casos con diagnóstico definitivo de tumor limítrofe de ovario. La concordancia con el estudio transoperatorio fue de 63.2%. Se sobrediagnosticaron 2 de 68 pacientes (2.9%) y se subdiagnosticaron 23 de 68 (33.8%). CONCLUSIONES: La concordancia obtenida es semejante a lo reportado en la bibliografía internacional. Los tumores mucinosos mayores de 10 cm son subdiagnosticados con mayor frecuencia debido a su extensión.

Abstract OBJECTIVE: To determine the percentage of concordance of the transoperative study with the definitive diagnosis of borderline ovarian tumors. MATERIALS AND METHODS: Observational, cross-sectional, retrospective and des-criptive study performed at the Hospital de Gineco Obstetricia 4 Luis Castelazo Ayala, Mexico City, in patients operated between January 1, 2018 and December 31, 2020 for an abdominopelvic tumor, with transoperative examination of borderline ovarian tumor. The transoperative study was evaluated as a diagnostic test and the definitive diagnosis as a reference standard to establish the concordance of the former with the definitive diagnosis of borderline ovarian tumors. RESULTS: Sixty-eight borderline ovarian tumors were analyzed, between those diagnosed in the transoperative study and the definitive one. We found 59 cases with definitive diagnosis of borderline ovarian tumor. The concordance with the transoperative study was 63.2%. Two of 68 patients (2.9%) were overdiagnosed and 23 of 68 (33.8%) were underdiagnosed. CONCLUSIONS: The concordance obtained is like that reported in the international literature. Mucinous tumors larger than 10 cm are most frequently underdiagnosed due to their extension.

Ex vivo retrieval of mature oocytes for fertility preservation in a patient with bilateral borderline ovarian tumor / Recuperação ex vivo de oócitos maduros para preservação da fertilidade em paciente com tumor ovariano borderline bilateral

Abstract We report a case of ultrasound-guided ex vivo oocyte retrieval for fertility preservation in a woman with bilateral borderline ovarian tumor, for whom conventional transvaginal oocyte retrieval was deemed unsafe because of the increased risk of malignant cell spillage. Ovarian stimulation with gonadotropins was performed. Surgery was scheduled according to the ovarian response to exogenous gonadotropic stimulation; oophorectomized specimens were obtained by laparoscopy, and oocyte retrieval was performed ~ 37 hours after the ovulatory trigger. The sum of 20 ovarian follicles were aspirated, and 16 oocytes were obtained.We performed vitrification of 12 metaphase II oocytes and 3 oocytes matured in vitro. Our result emphasizes the viability of ex vivo mature oocyte retrieval after controlled ovarian stimulation for those with high risk of malignant dissemination by conventional approach.

Resumo Relatamos um caso de obtenção ex vivo de óvulos, guiada por ultrassonografia, para preservação da fertilidade em uma mulher com tumor ovariano borderline bilateral, para quem a recuperação transvaginal convencional foi considerada insegura, devido ao aumento do risco de disseminação de célulasmalignas. Foi realizada estimulação ovariana com gonadotrofinas. A cirurgia foi agendada de acordo com a resposta ovariana à estimulação gonadotrófica exógena; após ooforectomia por laparoscopia, ~ 37 horas após a maturação folicular, procedeu-se à recuperação extracorpórea de oócitos. Umtotal de 20 folículos ovarianos foi aspirado e 16 complexos cumulus foramobtidos, resultando na vitrificação de 12 oócitos maduros e de 3 oócitos imaturos amadurecidos in vitro. Nosso resultado enfatiza a viabilidade da recuperação ex vivo de oócitos maduros após estimulação ovariana controlada para mulheres com alto risco de disseminação maligna pela captação oocitária realizada convencionalmente pela via transvaginal.

Borderline ovarian tumour of mixed seromucinous histology and bilateral presentation: a case report and review of literature

This article reports the case of a 40 year old woman who presented to the gynaecologic outpatient clinic with pain lower abdomen and an abdominopelvic lump. Clinical assessment, biochemical and radiological investigations revealed bilateral complex ovarian masses. Surgical exploration and histology of ovarian masses confirmed a rare bilateral borderline seromucinous cystadenoma. The purpose of this paper is to highlight the importance of thorough examination of women with symptoms of ovarian tumour which can be vague and to emphasize the necessity of a good collaboration between various medical specialties (primary physician/gynaecologist, oncosurgeon, radiologist and histopathologist) for correct diagnosis, optimum care and best outcome. This article also provides overview of the pathology and biology of borderline ovarian tumours, diagnosis, principles of surgical management and to appreciate the value of follow up.

Clinical features and management of women with borderline ovarian tumors in a single center in Brazil / Características clínicas e manejo de mulheres com tumores borderline de ovário em um hospital no Brasil

Abstract Objective The aim of the present study was to describe and analyze data of 57 women with borderline ovarian tumors (BOTs) regarding histological characteristics, clinical features and treatment management at the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas (Unicamp, in the Portuguese acronym). Methods The present retrospective study analyzed data obtained from clinical and histopathological reports of women with BOTs treated in a single cancer center between 2010 and 2018. Results A total of 57 women were included, with a mean age of 48.42 years old (15.43- 80.77), of which 30 (52.63%) were postmenopausal, and 18 (31.58%) were < 40 years old. All of the women underwent surgery. A total of 37 women (64.91%) were submitted to complete surgical staging for BOT, and none (0/57) were submitted to pelvic or paraortic lymphadenectomy. Chemotherapy was administered for two patients who recurred. The final histological diagnoses were: serous in 20 (35.09%) cases, mucinous in 26 (45.61%), seromucinous in 10 (17.54%), and endometrioid in 1 (1.75%) case. Intraoperative analyses of frozen sections were obtained in 42 (73.68%) women, of which 28 (66.67%) matched with the final diagnosis. The mean follow-up was of 42.79 months (range: 2.03-104.87 months). Regard ingthe current status of the women, 45(78.95%) are alive without disease, 2(3.51%) arealive with disease, 9 (15.79%) had their last follow-up visit > 1 year beforethe performanceof the present study but arealive, and 1 patient(1.75%) died of another cause. Conclusion Women in the present study were treated according to the current guidelines and only two patients recurred.

Resumo Objetivo O objetivo do presente estudo foi descrever uma série de 57 mulheres com tumores borderline de ovário (TBO) em relação às características histológicas, clínicas, e ao manejo do tratamento realizado no Departamento de Obstetrícia e Ginecologia da Universidade Estadual de Campinas (Unicamp). Métodos O presente estudo retrospectivo analisou dados obtidos dos registros clínicos e histopatológicos de mulheres com TBO tratadas em um único centro oncológico de 2010 a 2018. Resultados Um total de 57 mulheres foram incluídas, com uma média de idade de 48,42 anos (15,43-80,77), das quais 30 (52,63%) eram menopausadas, e 18 (31,58%) tinham < 40 anos. Todas as mulheres foram operadas. Um total de 37 mulheres (64,91%) foram submetidas a cirurgia de estadiamento completo para TBO, e nenhuma foi submetida a linfadenectomia pélvica ou paraórtica. O tratamento com quimioterapia foi administrado em duas pacientes que recidivaram. Os diagnósticos histológicos finais foram: seroso em 20 mulheres (35,09%), mucinoso em 26 (45,61%), seromucinoso em 10 (17,54%) e endometrióide em 1 (1,75%). A avaliação histológica intraoperatória foi realizada em 42 (73,68%) das mulheres, das quais 28 (66,67%) foram compatíveis com os diagnósticos finais. O tempo médio de seguimento foi de 42,79 meses (variando de 2,03 a 104,87 meses). Em relação ao status atual das mulheres, 45 (78.95%) estão vivas sem doença, 2 (3,51%) estão vivas com doença, 9 (15.79%) tiveram a última consulta de seguimento há > 1 ano antes da realização do presente estudo, mas estão vivas, e 1 paciente faleceu por outra causa. Conclusão As mulheres do presente estudo foram tratadas de acordo com as recomendações atuais e apenas duas mulheres apresentaram recorrência.

Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging / 영남의대학술지

BACKGROUND: We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas.METHODS: Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), K(trans) (vessel permeability), and V(e) (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences.RESULTS: There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, K(trans), and V(e) values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively.CONCLUSION: Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.

Oncologic and obstetric outcomes of conservative surgery for borderline ovarian tumors in women of reproductive age

OBJECTIVE: To compare the oncologic and obstetric outcomes in reproductive-age females with borderline ovarian tumors (BOTs) treated with cyst enucleation (CE) or unilateral salpingo-oophorectomy (USO). METHODS: The medical records of patients with BOTs treated between 1998 and 2014 were retrospectively reviewed. The recurrence rates in the USO and CE groups were compared, and the postoperative obstetric outcomes were assessed via telephone survey. RESULTS: Eighty-nine patients with BOTs underwent USO, and 19 underwent CE. Of these, six patients had recurrent BOTs. The recurrence rate was significantly lower in the USO group (3/89, 3.4%) than in the CE group (3/19, 15.8%) (P=0.032). All patients with recurrent disease were successfully treated with further surgery. Of the 76 patients interviewed by telephone, 71 (93.4%) resumed regular menstruation after surgery. Twenty-six of the 32 patients (81.3%) who attempted to conceive had successful pregnancies. USO (19/24, 79.2%), like CE (7/8, 87.5%), resulted in favorable pregnancy rates for patients with BOTs. CONCLUSION: USO is a suitable fertility-preserving surgery for women with BOTs. CE is also an acceptable option for select patients.

Progress of borderline ovarian tumors / 肿瘤研究与临床

Borderline ovarian tumor (BOT) is a kind of ovarian epithelial tumors with low malignant potency and favorable prognosis, accounting for 10%-20%of ovarian epithelial tumors. BOT occurs mainly in young female during child-bearing period, which may have bad effects on the recurrence and reproductive function in the following treatment. BOT bears some similarities to the clinical features of infiltrating ovarian tumor, however, there is a significant difference in the treatment and prognosis between them. This paper summarizes the progress of BOT, including diagnosis, treatment strategy and prognosis.

Progress of borderline ovarian tumors / 肿瘤研究与临床

Borderline ovarian tumor (BOT) is a kind of ovarian epithelial tumors with low malignant potency and favorable prognosis, accounting for 10%-20%of ovarian epithelial tumors. BOT occurs mainly in young female during child-bearing period, which may have bad effects on the recurrence and reproductive function in the following treatment. BOT bears some similarities to the clinical features of infiltrating ovarian tumor, however, there is a significant difference in the treatment and prognosis between them. This paper summarizes the progress of BOT, including diagnosis, treatment strategy and prognosis.

Epithelial borderline ovarian tumor: Diagnosis and treatment strategy

Epithelial borderline ovarian tumors (BOT) are distinctive from benign tumors and carcinoma. They occur in younger women more often than carcinoma, and there is some difficulty making correct diagnosis of BOT. Two subtypes of BOT, serous and mucinous borderline tumor have different characteristics and very different clinical behavior. Serous borderline tumor (SBT) with micropapillary pattern shows more incidence of extra ovarian disease and often coexists with invasive implant. SBT with micropapillary pattern in advanced stage has showed a worse prognosis than typical SBT. Huge mucinous borderline tumors have histologic heterogeneity, and the accuracy of frozen section diagnosis is relatively low. Extensive sampling is required to reach a correct pathological diagnosis. Mucinous adenoma (intestinal type) also runs the risk of recurrence after cystectomy, or intraoperative rupture of cyst. Laparoscopic procedure for BOT has not increased the risk of recurrence. Fertility preserving procedures are generally accepted, except in advanced stage SBT with invasive implants. Only cystectomy shows a significant risk of recurrence. Re-staging surgery and full staging surgery is not necessary for all BOT. We should not attempt to treat them uniformly, by the single diagnosis of "borderline tumor". It depends on histologic type. Close communication with the pathologist is necessary to gain more detail and ask more pathological samples in order to make the optimal treatment strategy for each individual patients.

Epithelial borderline ovarian tumor: Diagnosis and treatment strategy

Epithelial borderline ovarian tumors (BOT) are distinctive from benign tumors and carcinoma. They occur in younger women more often than carcinoma, and there is some difficulty making correct diagnosis of BOT. Two subtypes of BOT, serous and mucinous borderline tumor have different characteristics and very different clinical behavior. Serous borderline tumor (SBT) with micropapillary pattern shows more incidence of extra ovarian disease and often coexists with invasive implant. SBT with micropapillary pattern in advanced stage has showed a worse prognosis than typical SBT. Huge mucinous borderline tumors have histologic heterogeneity, and the accuracy of frozen section diagnosis is relatively low. Extensive sampling is required to reach a correct pathological diagnosis. Mucinous adenoma (intestinal type) also runs the risk of recurrence after cystectomy, or intraoperative rupture of cyst. Laparoscopic procedure for BOT has not increased the risk of recurrence. Fertility preserving procedures are generally accepted, except in advanced stage SBT with invasive implants. Only cystectomy shows a significant risk of recurrence. Re-staging surgery and full staging surgery is not necessary for all BOT. We should not attempt to treat them uniformly, by the single diagnosis of "borderline tumor". It depends on histologic type. Close communication with the pathologist is necessary to gain more detail and ask more pathological samples in order to make the optimal treatment strategy for each individual patients.

Histologic distribution of borderline ovarian tumors worldwide: a systematic review / 부인종양

OBJECTIVE: The histologic types of borderline ovarian tumors (BOTs) exhibit striking differences in clinical behavior and prognosis. Yet, there is no information available on the histologic distribution of BOTs according to geographic region. The purpose of this study was to systematically review this issue worldwide. METHODS: A comprehensive search of the literature was conducted using electronic databases. Studies were eligible if BOTs were investigated and the histologic distribution of the data was shown. The studies were grouped by geographic region and totaled by country. RESULTS: Of 487 potentially relevant studies, 51 met our inclusion criteria, as follows: 8 studies from North America (2 countries); 26 studies from Europe (14 countries); 7 studies from the Middle East (3 countries); and 10 studies from East Asia (5 countries). The histologic distribution of BOTs was considerably different in different parts of the world, but follows specific patterns. In general, serous-type BOTs were the predominantly identified histology in North America, the Middle East, and Europe, while mucinous-type BOTs predominated in East Asia. CONCLUSION: Significant geographic variation is evident among BOT histology in different parts of the world. More research is needed to understand this phenomenon.

Survival of women with ovarian carcinomas and borderline tumors is not affected by estrogen and progesterone receptor status / 부인종양

OBJECTIVE: To examine the patterns of estrogen receptor (ER) and progesterone receptor (PR) expression in borderline ovarian tumors (BOTs) and ovarian carcinomas. We also assessed the disease-free survival (DFS) and overall survival (OS) in women with ovarian carcinoma, in relation to ER and/or PR expression. METHODS: We examined ER/PR expression in 38 BOTs and 172 ovarian carcinomas removed from patients treated at the State University of Campinas-UNICAMP (Brazil), from 1993 to 2008 and followed for up to 60 months using tissue microarray-based immunohistochemistry. RESULTS: Twenty-eight (73.7%) mucinous and 10 (26.3%) serous BOTs were included. Ovarian carcinomas consisted mainly of 79 (46.0%) serous, 44 (25.5%) mucinous, 17 (9.8%) endometrioid, 10 (5.8%) clear-cell types. There was no significant difference of the ER/PR expression between BOT and ovarian carcinoma (p=0.55 for ER alone, 0.90 for PR alone, and 0.12 for combined expression). The level of ER/PR expression in BOTs was significantly higher in serous than in mucinous tumors (p<0.01). In carcinomas, ER/PR was higher in serous tumors than in mucinous (p<0.01) and clear cell tumors (p=0.02), and higher in endometrioid tumors than in mucinous tumors (p<0.01). DFS was affected neither by the clinical characteristics nor by combined steroid receptor status. OS was found to be significantly worse (p<0.01) only in women with stages II-IV tumors and those with residual disease after surgery (p<0.01). CONCLUSION: Overall, serous and endometrioid tumors were predominantly ER/PR positive, whereas mucinous and clear-cell tumors were preponderantly ER/PR negative. DFS and OS were not affected by ER/PR expression.

Human telomerase reverse transcriptase expression in ovarian tumors.

Background : Ovarian cancer is the 6 th most common cancer among women. In ovarian tumors, the borderline category is not well defined due to the difficulty in assessing stromal invasion. The World Health Organization (WHO) defined it as tumor that lacks obvious invasion of the stroma with mitotic activity and nuclear abnormalities intermediate between clearly benign and unquestionably malignant. Telomerase is expressed in many human cancers and is hence a potential biomarker for cancer. Immunohistochemical study of anti-human telomerase enzyme reverse transcriptase (hTERT) antibody allows direct visualization of its expression. The aim of this study was to determine the expression of hTERT and serum CA-125 level in ovarian epithelial tumors, and their ability to distinguish borderline tumor from malignancy. Materials and Methods : This was a retrospective study on 68 ovarian epithelial tumors, comprising of 41 cystadenocarcinoma, 22 borderline tumor and five cystadenoma. By immunohistochemistry, hTERT expression was graded as negative (0-10%), focal (11-25%), regional (26-75%) and diffuse (>75%) positivity. Results : hTERT protein expression in ovarian cystadenocarcinoma, borderline tumor and cystadenoma were 71.4%, 59.1% and 0%, respectively. hTERT and CA-125 had a linear relationship with tumor grade and stage. hTERT protein is detected as large granules/speckled in the cytoplasm and nuclei of ovarian tumors. Conclusions : hTERT protein was highly expression in ovarian epithelial carcinoma. However, the difference between carcinoma and borderline tumor was not statistically significant (P-value = 0.51). It is not an independent biomarker to differentiate borderline tumor from malignant tumor. We suggest using the combination of hTERT immunohistochemistry and serum CA-125 to evaluate difficult situations where histological evaluation fails to distinguish malignant from borderline ovarian tumor.

Single-port access laparoscopic staging operation for a borderline ovarian tumor / 부인종양

Minimally invasive surgery is widely used in benign gynecologic diseases and may be used in malignancies. We performed a single-port access laparoscopy staging - bilateral salpingo-oophorectomy, laparoscopy-assisted vaginal hysterectomy, bilateral pelvic lymphadenectomy, infracolic omentectomy, and washing cytology - in a borderline ovarian tumor. The number of harvested pelvic lymph nodes were twenty-three and there were no intraoperative or postoperative complications. Single-port access laparoscopic staging may be performed in selected patients. The efficacy, safety, and potential benefits of this technique should be evaluated in further trials.

The Serum CA-125 Concentration Data Assists in Evaluating CT Imaging Information When Used to Differentiate Borderline Ovarian Tumor from Malignant Epithelial Ovarian Tumors

OBJECTIVE: We wanted to evaluate the diagnostic value of serum CA-125 concentration, when used in combination with the preoperative contrast-enhanced CT results, to differentiate borderline ovarian tumors (BOTs) from stage I malignant epithelial ovarian tumors (MEOTs). MATERIALS AND METHODS: Ninety-eight masses (46 BOTs and 52 stage I MEOTs) from 87 consecutive patients (49 with BOTs and 38 with stage I MEOTs) who had undergone preoperative contrast-enhanced computed tomography (CT) and surgical staging were evaluated retrospectively and independently by two radiologists. The preoperative serum CA-125 concentration was measured in all patients. The utility of analyzing serum CA-125 concentration in combination with the CT results was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: An irregular tumor surface and lymphadenopathy were predictive of a MEOT. ROC analysis showed that the combination of CT data and the serum CA-125 level resulted in a higher diagnostic performance than did using the CT alone for differentiating BOTs from MEOTs. The areas under the curves (AUCs) without and with the use of the serum CA-125 level data were 0.67 (95% confidence interval [CI]: 0.57-0.77) and 0.78 (95% CI: 0.68-0.85), respectively, for reader 1 (p = 0.029) and 0.71 (95% CI: 0.61-0.80) and 0.81 (95% CI: 0.72-0.89), respectively, for reader 2 (p = 0.009). CONCLUSION: The serum CA-125 concentration is of additional diagnostic value when used in conjunction with the CT imaging results for differentiating BOTs from MEOTs.

Tumor endometrioide borderline de ovário em adolescente: relato de caso / Borderline ovarian endometrioid tumor in adolescent: case report and review of the literature

Os tumores endometrioides malignos ovarianos são neoplasias epiteliais raras em pacientes jovens. Enquanto os carcinomas endometrioides ovarianos acometem mulheres na quinta e na sexta décadas de vida, os tumores borderline acometem mulheres em uma faixa etária mais ampla (de 22 a 77 anos). Descreveremos a seguir um caso raro de tumor endometrioide borderline ocorrendo em paciente de 16 anos. Desde que tumores do saco vitelino (TSV) e de Sertoli-Leydig (TCSL) podem mimetizar morfologicamente tumor endometrioide, o uso da imuno-histoquímica, além dos aspectos morfológicos, foi fundamental para estabelecer o diagnóstico diferencial entre essas condições.

Malignant endometrioid ovarian tumors are rare epithelial neoplasias among young patients. Whereas endometrioid ovarian carcinomas are more common among women in their fifth and sixth decades of life, borderline endometrioid tumors affect 22 to 77 year-old women. The present study reports a rare case of borderline endometrioid tumor in a 16 year-old patient. Since yolk sac and Sertoli-Leydig cell tumor may morphologically mimic endometrioid tumor, both the use of immunohistochemistry and morphological aspects were essential to establish the differential diagnosis.

Current management of borderline ovarian tumor / 대한산부인과학회지

The mainstream in management of borderline ovarian tumor has been thorough surgical staging and close observation. Recent trends prefer conservative management especially for the young, reproductive aged women due to the good prognosis profile and wide use of laparoscopy, although the safety for oncologic outcome of conservative treatment has not been fully established. The present article updates published literatures respecting management of borderline ovarian tumor. A proper staging procedure is necessary for all the patients to estimate the risk of recurrence. Fertility-sparing surgery is a tolerable option in young patients with stage I disease. Patients with advanced-stage disease or who are finished childbearing are treated with radical surgery. The roles of adjuvant chemotherapy or laparoscopic staging are not definite up to now.

Outcomes of Controlled Ovarian Hyperstimulation/In Vitro Fertilization for Infertile Patients with Borderline Ovarian Tumor after Conservative Treatment

To evaluate the outcomes of controlled ovarian hyperstimulation (COH)-in vitro fertilization (IVF) such as clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) for infertile patients with borderline ovarian tumor (BOT) after conservative treatment, 10 IVF cycles in five patients from January 1999 to July 2005 were analyzed. At the time of diagnosis with BOT, the mean age of patients was 30.0 yr (range, 22-40). For 8 cycles out of 10 attempted IVF cycles, except for 2 cancellation cycles, the mean number of oocytes retrieved was 5.6 (range, 2-16) with a mean fertilization rate of 74.4%. The CPR, IR, and LBR were 50.0% (4/8 cycles), 31.6% (6/19) and 50.0% (4/8 cycles) respectively. The mean follow-up period after COH-IVF initiation was 29.6 (range, 14-61) months. A gynecological oncologist followed all patients every 3 months during the first year and every 6 months thereafter. There was no recurrence during the follow-up period. Our results suggest that COH-IVF may be acceptable for infertile patients with BOT, especially in patients with early-stage BOT after conservative treatment.

A clinical study of borderline malignant tumors of the ovary / 부인종양

OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathological features, and to find relationship between treatment modality and prognosis of borderline ovarian tumors. METHODS: Ninety-three cases of borderline ovarian tumors that had been treated were reviewed retrospectively. RESULTS: Histologic types of this study group composed of 67 cases of mucinous borderline tumor, 23 cases of serous borderline tumor, 2 cases of mixed type, and 1 case of Brenner tumor. The mean age was 41.6 years (range 14 to 83), and 41 (44.1%) patients were nullipara. The most common chief complaint was palpable mass (39.8%) and asymptomatic cases were presented in 23 patients (24.7%). The cases of elevated serum CA125 (< or =35 IU/ml) were 25.8% in mucinous type and 61.9% in serous type. Surgical staging was completed in 57 cases and other 36 cases were incompletely staged. 45 cases were managed by conservative surgery. There were 4 cases with recurrence, and all of them were related to conservative surgery. Chemotherapy was given to 40 cases. Mean follow-up period was 27.3 months. One patient expired during follow-up, and overall 5-year survival rate was 95.2%. CONCLUSION: Borderline ovarian tumors have a good prognosis. But recurrence rate was high in conservative surgery. In conclusion, careful preoperative evaluations, complete surgical exploration and long-term follow-up after treatment are needed.