Farname Inc. in collaboration with Iranian Society of Gynecology Oncology

Authors

1 Department of Gynecology Oncology, Imam Khomeini Hospital Complex, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Gynecology Oncology, Imam Khomeini Hospital Complex, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

3 Oncosurgeon, Surgery Department, Imam Khomeini Hospital Complex, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

Abstract

Borderline ovarian tumors (BOT) consist of epithelial ovarian lesions that express cytological features of malignancy, but unlike malignant ovarian tumors, do not show obvious stromal invasion. The tumor incidence is between 1.8 and 4.8 per 100,000 females per year. The two major groups of BOT include serous BOT (S-BOT) and mucinous BOT (M-BOT). S-BOTs are divided into two categories: tumors limited to ovary and tumors spreading outside the ovary. M-BOTs are divided into two categories. The more common type is intestinal that constitutes 85% of cases and the second type is endocervical or Mullerian. Mullerian M-BOTs is bilateral in 40% of cases, while it is accompanied by pelvic endometriosis in 20-30% of patients. Microscopic examination by intraoperative frozen section is necessary because macroscopic view of ovarian tumors alone is not reliable. It is better to perform conservative surgery until the final report is ready in patients who wish to preserve their fertility. It is hard to differentiate them based on clinical characteristics. Values of tumor markers including CA125, CA19-9 and CEA in diagnosis of BOT are confirmed. Standard treatment of BOT is surgery as is the case with invasive epithelial ovarian cancer. In the majority of patients referred for BOT, since there is no suspicion of malignancy, staging is not performed. In these cases, making decision to repeat surgery and staging depend on factors such as the type of histology, abdominal exploration results in the previous surgery and probability of the presence of residual tumor.

Keywords

  1. Sutton GP. Ovarian Tumor of low malignant potential. In: Rubin SC, Sutton GP, editors. Ovarian cancer. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2001. pp. 399-417.
  2. Cadron I, Leunen K, Van Gorp T, Amant F, Neven P, Vergote I. Management of borderline ovarian neoplasms. J Clin Oncol. 2007;25(20):2928-37. doi: 10.1200/JCO.2007.10.8076. [DOI:10.1200/JCO.2007.10.8076]
  3. Beller U, Benedet JL, Creasman WT, Ngan HY, Quinn MA, Maisonneuve P, et al. Carcinoma of the vagina. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S29-42. [DOI:10.1016/S0020-7292(06)60029-5]
  4. Lenhard MS, Mitterer S, Kumper C, Stieber P, Mayr D, Ditsch N, et al. Long-term follow-up after ovarian borderline tumor: relapse and survival in a large patient cohort. Eur J Obstet Gynecol Reprod Biol. 2009;145(2):189-94. [DOI:10.1016/j.ejogrb.2009.04.031]
  5. Sherman ME, Mink PJ, Curtis R, Cote TR, Brooks S, Hartge P, et al. Survival among women with borderline ovarian tumors and ovarian carcinoma: a population-based analysis. Cancer. 2004;100(5):1045-52. [DOI:10.1002/cncr.20080]
  6. May T, Virtanen C, Sharma M, Milea A, Begley H, Rosen B, et al. Low malignant potential tumors with micropapillary features are molecularly similar to low-grade serous carcinoma of the ovary. Gynecol Oncol. 2010;117(1):9-17. [DOI:10.1016/j.ygyno.2010.01.006]
  7. Prat J. Serous tumors of the ovary (borderline tumors and carcinomas) with and without micropapillary features. Int J Gynecol Pathol. 2003;22(1):25-8. [DOI:10.1097/00004347-200301000-00007]
  8. Bell KA, Smith Sehdev AE, Kurman RJ. Refined diagnostic criteria for implants associated with ovarian atypical proliferative serous tumors (borderline) and micropapillary serous carcinomas. Am J Surg Pathol. 2001;25(4):419-32. [DOI:10.1097/00000478-200104000-00001]
  9. Longacre TA, McKenney JK, Tazelaar HD, Kempson RL, Hendrickson MR. Ovarian serous tumors of low malignant potential (borderlinetumors): outcome-based study of 276 patients with long-term (> or =5-year) follow-up. Am J Surg Pathol. 2005;29(6):707-23. [DOI:10.1097/01.pas.0000164030.82810.db]
  10. Bristow RE, Gossett DR, Shook DR, Zahurak ML, Tomacruz RS, Armstrong DK, et al. Recurrent micropapillary serous ovarian carcinoma. Cancer. 2002;95(4):791-800. [DOI:10.1002/cncr.10789]
  11. Slomovitz BM, Caputo TA, Gretz HF, Economos K, Tortoriello DV, Schlosshauer PW, et al. A comparative analysis of 57 serous borderline tumors with and without a noninvasive micropapillary component. Am J Surg Pathol. 2002;26(5):592-600. [DOI:10.1097/00000478-200205000-00005]
  12. Hart WR. Mucinous tumors of the ovary: a review. Int J Gynecol Pathol. 2005;24(1):4-25.
  13. Fauvet R, Boccara J, Dufournet C, Poncelet C, Darai E. Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Ann Oncol. 2005;16(3):403-10. [DOI:10.1093/annonc/mdi083]
  14. Royal College of Obstetricians and Gynaecologists (RCOG) . RCOG wold congress. 2013; Liverpool, UK.
  15. Camatte S, Morice P, Thoury A, Fourchotte V, Pautier P, Lhomme C, et al. Impact of surgical staging in patients with macroscopic "stage I" ovarian borderline tumours: analysis of a continuous series of 101 cases. Eur J Cancer. 2004;40(12):1842-9. [DOI:10.1016/j.ejca.2004.04.017]
  16. Trope CG, Kaern J, Davidson B. Borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol. 2012;26(3):325-36. [DOI:10.1016/j.bpobgyn.2011.12.006]
  17. Ortiz BH, Ailawadi M, Colitti C, Muto MG, Deavers M, Silva EG, et al. Second primary or recurrence? Comparative patterns of p53 and Kras mutations suggest that serous borderline ovarian tumors and subsequent serous carcinomas are unrelated tumors. Cancer Res. 2001;61(19):7264-7.
  18. Hogg R, Scurry J, Kim SN, Friedlander M, Hacker N. Microinvasion links ovarian serous borderline tumor and grade 1 invasive carcinoma. Gynecol Oncol. 2007;106(1):44-51. [DOI:10.1016/j.ygyno.2007.01.054]
  19. Trillsch F, Mahner S, Ruetzel J, Harter P, Ewald-Riegler N, Jaenicke F, et al. Clinical management of borderline ovarian tumors. Expert Rev Anticancer Ther. 2010;10(7):1115-24. [DOI:10.1586/era.10.90]
  20. Zapardiel I, Rosenberg P, Peiretti M, Zanagnolo V, Sanguineti F, Aletti G, et al. The role of restaging borderline ovarian tumors: single institution experience and review of the literature. Gynecol Oncol. 2010;119(2):274-7. [DOI:10.1016/j.ygyno.2010.07.034]
  21. Zanetta G, Rota S, Chiari S, Bonazzi C, Bratina G, Mangioni C. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol. 2001;19(10):2658-64. [DOI:10.1200/JCO.2001.19.10.2658]
  22. Ronnett BM, Kurman RJ, Zahn CM, Shmookler BM, Jablonski KA, KassME, et al. Pseudomyxoma peritonei in women: a clinicopathologic analysis of 30 cases with emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors of low malignant potential. Hum Pathol. 1995;26(5):509-24. [DOI:10.1016/0046-8177(95)90247-3]
  23. Seidman JD, Elsayed AM, Sobin LH, Tavassoli FA. Association of mucinous tumors of the ovary and appendix. A clinicopathologic study of 25 cases. Am J Surg Pathol. 1993;17(1):22-34. [DOI:10.1097/00000478-199301000-00003]
  24. Ramirez PT, Slomovitz BM, Soliman PT, Coleman RL, Levenback C. Total laparoscopic radical hysterectomy and lymphadenectomy: the M. D. Anderson Cancer Center experience. Gynecol Oncol. 2006;102(2):252-5. [DOI:10.1016/j.ygyno.2005.12.013]
  25. Tinelli R, Tinelli A, Tinelli FG, Cicinelli E, Malvasi A. Conservative surgery for borderline ovarian tumors: a review. Gynecol Oncol. 2006;100(1):185-91. [DOI:10.1016/j.ygyno.2005.09.021]
  26. Trope C, Davidson B, Paulsen T, Abeler VM, Kaern J. Diagnosis and treatment of borderline ovarian neoplasms "the state of the art". Eur J Gynaecol Oncol. 2009;30(5):471-82.
  27. Burger CW, Prinssen HM, Baak JP, Wagenaar N, Kenemans P. The management of borderline epithelial tumors of the ovary. Int J Gynecol Cancer. 2000;10(3):181-97. [DOI:10.1046/j.1525-1438.2000.010003181.x]
  28. Poncelet C, Fauvet R, Boccara J, Darai E. Recurrence after cystectomy for borderline ovarian tumors: results of a French multicenter study. Ann Surg Oncol. 2006;13(4):565-71. [DOI:10.1245/ASO.2006.12.024]
  29. Franchi D, Boveri S, Fruscio R, Fischerova D, Guerriero S, Moruzzi M, et al. Imaging in gynecological disease: Ultrasound characteristics of ovarian borderline tumor recurrence. Ultrasound Obstet Gynecol. 2012. [DOI:10.1002/uog.12276]
  30. Koskas M, Uzan C, Gouy S, Pautier P, Lhomme C, Haie-Meder C, et al. Prognostic factors of a large retrospective series of mucinous borderline tumors of the ovary (excluding peritoneal pseudomyxoma). Ann Surg Oncol. 2011;18(1):40-8. doi: 10.1245/s10434-010-1293-8. [DOI:10.1245/s10434-010-1293-8]
  31. Practice Committee of American Society for Reproductive M. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2013;100(5):1214-23. [DOI:10.1016/j.fertnstert.2013.08.012]
  32. Beiner ME, Gotlieb WH, Davidson B, Kopolovic J, Ben-Baruch G. Infertility treatment after conservative management of borderline ovarian tumors. Cancer. 2001;92(2):320-5. https://doi.org/10.1002/1097-0142(20010715)92:2<320::AID-CNCR1325>3.0.CO;2-G [DOI:10.1002/1097-0142(20010715)92:23.0.CO;2-G]
  33. Gotlieb WH, Flikker S, Davidson B, Korach Y, Kopolovic J, Ben-Baruch G. Borderline tumors of the ovary: fertility treatment, conservative management, and pregnancy outcome. Cancer. 1998;82(1):141-6. https://doi.org/10.1002/(SICI)1097-0142(19980101)82:1<141::AID-CNCR17>3.0.CO;2-2 [DOI:10.1002/(SICI)1097-0142(19980101)82:13.0.CO;2-2]
  34. Fauvet R, Poncelet C, Darai E. [Feasibility and limits of laparoscopic treatment of borderline ovarian tumours]. Gynecol Obstet Fertil. 2006;34(6):470-8. doi: 10.1016/j.gyobfe.2006.03.022. [DOI:10.1016/j.gyobfe.2006.03.022]
  35. Morice P, Camatte S, El Hassan J, Pautier P, Duvillard P, Castaigne D. Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril. 2001;75(1):92-6. [DOI:10.1016/S0015-0282(00)01633-2]
  36. Liu CS, Nagarsheth NP, Nezhat FR. Laparoscopy and ovarian cancer: a paradigm change in the management of ovarian cancer?. J Minim Invasive Gynecol. 2009;16(3):250-62. [DOI:10.1016/j.jmig.2009.01.007]
  37. Iglesias DA, Ramirez PT. Role of minimally invasive surgery in staging of ovarian cancer. Curr Treat Options Oncol. 2011;12(3):217-29. [DOI:10.1007/s11864-011-0155-3]
  38. Tinelli R, Malzoni M, Cosentino F, Perone C, Tinelli A, Malvasi A, et al. Feasibility, safety, and efficacy of conservative laparoscopic treatment of borderline ovarian tumors. Fertil Steril. 2009;92(2):736-41. [DOI:10.1016/j.fertnstert.2008.07.1716]
  39. Leary A, Petrella MC, Pautier P, Duvillard P, Uzan C, Tazi Y, et al. Adjuvant platinum-based chemotherapy for borderline serous ovarian tumors with invasive implants. Gynecol Oncol. 2014;132(1):23-7. [DOI:10.1016/j.ygyno.2013.11.006]
  40. Morice P, Camatte S, Rouzier R, Pautier P, Atallah D, Pomel C, et al. [Prognostic factors and treatment for advanced-stage borderline ovarian tumors]. J Gynecol Obstet Biol Reprod (Paris). 2002;31(7):623-8.
  41. Faluyi O, Mackean M, Gourley C, Bryant A, Dickinson HO. Interventions for the treatment of borderline ovarian tumours. Cochrane Database Syst Rev. 2010(9):CD007696. [DOI:10.1002/14651858.CD007696.pub2]
  42. Shih KK, Zhou Q, Huh J, Morgan JC, Iasonos A, Aghajanian C, et al. Risk factors for recurrence of ovarian borderline tumors. Gynecol Oncol. 2011;120(3):480-4. [DOI:10.1016/j.ygyno.2010.11.016]
  43. Seidman JD, Kurman RJ. Ovarian serous borderline tumors: a critical review of the literature with emphasis on prognostic indicators. Hum Pathol. 2000;31(5):539-57. [DOI:10.1053/hp.2000.8048]
  44. Morice P, Uzan C, Fauvet R, Gouy S, Duvillard P, Darai E. Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence. Lancet Oncol. 2012;13(3):e103-15. [DOI:10.1016/S1470-2045(11)70288-1]
  45. De Gregorio N, Baumann KH, Keyver-Paik M, Reuss A, Canzler U, Wollschlaeger K, et al, editors. Outcome of patients with borderline ovarian tumors: Results of the multicenter AGO ROBOT study. ASCO annual meeting proceedings. 2012; p. 5005. [DOI:10.1200/jco.2012.30.15_suppl.5005]
  46. DeVita V, Lawrence T, Rosenberg S. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2011.
  47. Halprin E, Wazer D, Perez C, Brady L. Perez and brady's principles and practice of radiation oncology. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2013.
  48. Fischerova D, Zikan M, Dundr P, Cibula D. Diagnosis, treatment, and Obstet Gynecol Cancer Res. 2016; 1(1):e7338.
  49. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-33. [DOI:10.1001/jama.288.3.321]
  50. Trope CG, Kristensen G, Makar A. Surgery for borderline tumor of the ovary. Semin Surg Oncol. 2000;19(1):69-75. https://doi.org/10.1002/1098-2388(200007/08)19:1<69::AID-SSU11>3.0.CO;2-E [DOI:10.1002/1098-2388(200007/08)19:13.0.CO;2-E]
  51. Russo J, Nelson AL. Contraception for women with medical conditions. In: Shoupe D, Mishell Jr DR, editors. The Handbook of Contraception: A Guide for Practical Management. 2nd ed. Switzerland: Springer International Publishing; 2016. pp. 43-60. [DOI:10.1007/978-3-319-20185-6_3]
  52. Allard J, Somers E, Theil R, Moore RG, editors. Use of a novel biomarker HE4 for monitoring patients with epithelial ovarian cancer. ASCO annual meeting proceedings. 2008; p. 5535. [DOI:10.1200/jco.2008.26.15_suppl.5535]
  53. Ibeanu O, Modesitt SC, Ducie J, von Gruenigen V, Agueh M, Fader AN. Hormone replacement therapy in gynecologic cancer survivors: why not?. Gynecol Oncol. 2011;122(2):447-54. [DOI:10.1016/j.ygyno.2011.03.012]
  54. Fulham MJ, Carter J, Baldey A, Hicks RJ, Ramshaw JE, Gibson M. The impact of PET-CT in suspected recurrent ovarian cancer: A prospective multi-centre study as part of the Australian PET Data Collection Project. Gynecol Oncol. 2009;112(3):462-8. [DOI:10.1016/j.ygyno.2008.08.027]