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Margueritte F, Sallee C, Lacorre A, Gauroy E, Larouzee E, Chereau E, De La Motte Rouge T, Koskas M, Gauthier T. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Epidemiology and Risk Factors of Relapse, Follow-up and Interest of a Completion Surgery]. ACTA ACUST UNITED AC 2020; 48:248-259. [PMID: 32004784 DOI: 10.1016/j.gofs.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide clinical practice guidelines from the French college of obstetrics and gynecology (CNGOF) based on the best evidence available, concerning epidemiology of recurrence, the risk or relapse and the follow-up in case of borderline ovarian tumor after primary management, and evaluation of completion surgery after fertility sparing surgery. MATERIAL AND METHODS English and French review of literature from 2000 to 2019 based on publications from PubMed, Medline, Cochrane, with keywords borderline ovarian tumor, low malignant potential, recurrence, relapse, follow-up, completion surgery. From 2000 up to this day, 448 references have been found, from which only 175 were screened for this work. RESULTS AND CONCLUSION Overall risk of recurrence with Borderline Ovarian Tumour (BOT) may vary from 2 to 24% with a 10-years overall survival>94% and risk of invasive recurrence between 0.5 to 3.8%. Age<40 years (level of evidence 3), advanced initial FIGO stage (LE3), fertility sparing surgery (LE2), residual disease after initial surgery for serous BOT (LE2), implants (invasive or not) (LE2) are risk factors of recurrence. In case of conservative treatment, serous BOT had a higher risk of relapse than mucinous BOT (LE2). Lymphatic involvement (LE3) and use of mini invasive surgery (LE2) are not associated with a higher risk of recurrence. Scores or Nomograms could be useful to assess the risk of recurrence and then to inform patients about this risk (gradeC). In case of serous BOT, completion surgery is not recommended, after conservative treatment and fulfillment of parental project (grade B). It isn't possible to suggest a recommendation about completion surgery for mucinous BOT. There is not any data to advise a frequency of follow-up and use of paraclinic tools in general case of BOT. Follow-up of treated BOT must be achieved beyond 5 years (grade B). A systematic clinical examination is recommended during follow-up (grade B), after treatment of BOT. In case of elevation of CA-125 at diagnosis use of CA-125 serum level is recommended during follow-up of treated BOT (grade B). When a conservative treatment (preservation of ovarian pieces and uterus) of BOT is performed, endovaginal and transabdominal ultrasonography is recommended during follow-up (grade B). There isn't any sufficient data to advise a frequency of these examinations (clinical examination, ultrasound and CA-125) in case of treated BOT. CONCLUSION Risk of relapse after surgical treatment of BOT depends on patients' characteristics, type of BOT (histological features) and modalities of initial treatment. Scores and nomogram are useful tools to assess risk of relapse. Follow-up must be performed beyond 5 years and in case of peculiar situations, use of paraclinic evaluations is recommended.
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Affiliation(s)
- F Margueritte
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - C Sallee
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - A Lacorre
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - E Gauroy
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Larouzee
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - E Chereau
- Service de gynécologie-obstétrique, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
| | - T De La Motte Rouge
- Département d'oncologie médicale, centre Eugène Marquis, avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - T Gauthier
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87000 Limoges, France.
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Canlorbe G, Lecointre L, Chauvet P, Azaïs H, Fauvet R, Uzan C. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Therapeutic Management of Early Stages]. ACTA ACUST UNITED AC 2020; 48:287-303. [PMID: 32004786 DOI: 10.1016/j.gofs.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning early stage borderline ovarian tumors (BOT). METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane, Embase, and international databases. RESULTS Considering management of early stage BOT, if surgery is possible without a risk of tumor rupture, the laparoscopic approach is recommended compared to laparotomy (Grade C). In BOT, it is recommended to take all the measures to avoid tumor rupture, including the peroperative decision of laparoconversion (Grade C). In BOT, extraction of the surgical specimen using an endoscopic bag is recommended (Grade C). In case of early stage, uni or bilateral BOT, suspected in preoperative imaging in a postmenopausal patient, bilateral adnexectomy is recommended (Grade B). In cases of bilateral BOT and desire of fertility preservation, a bilateral cystectomy is recommended (Grade B). In case of mucinous BOT and desire of fertility preservation, it is recommended to perform a unilateral adnexectomy (Grade C). In case of endometrioid BOT and desire of fertility preservation, it is not possible to establish a recommendation of treatment choice between cystectomy and unilateral adnexectomy. In case of mucinous BOT at definitive histological analysis in a woman of childbearing age who had an initial cystectomy, surgical revision for unilateral adnexectomy is recommended (Grade C). In the case of serous BOT with definitive histological analysis in a woman of childbearing age who has had an initial cystectomy, it is not recommended to repeat surgery for adnexectomy in the absence of residual suspicious lesion during initial surgery and/or on postoperative imaging (referent ultrasound or pelvic MRI) (Grade C). An omentectomy is recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous analysis or suspected on preoperative radiological elements (Grade B). There is no data in the literature to recommend the type of omentectomy to be performed. If restaging surgery is decided for a presumed early stage BOT, an omentectomy is recommended (Grade B). Multiple peritoneal biopsies are recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous or suspected on preoperative radiological elements (Grade C). In case of restaging surgery for a presumed early stage BOT, exploration of the abdominal cavity should be complete and peritoneal biopsies should be performed on suspicious areas or systematically (Grade C). A primary peritoneal cytology is recommended in order to achieve complete initial surgical staging when BOT is suspected on preoperative radiological elements (Grade C). In case of restaging surgery for presumed early stage BOT, a first peritoneal cytology is recommended (Grade C). For early serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (Grade C). For early stage endometrioid BOT, and in the absence of a desire to maintain fertility, hysterectomy is recommended for initial surgery or if restaging surgery is indicated (Grade C). For endometrioid-type early stage BOT, if there is a desire for fertility preservation, the uterus may be retained subject to good evaluation of the endometrium by imaging and endometrial sampling (Grade C). In case of surgery (initial or restaging if indicated) for early stage BOT, it is recommended to evaluate the macroscopic appearance of the appendix (Grade B). In case of surgery (initial or restaging if indicated) for early stage BOT, appendectomy is recommended only in case of macroscopically pathological appearance of the appendix (Grade C). Pelvic and lumbar aortic lymphadenectomy is not recommended for initial surgery or restaging surgery for early stage BOT regardless of histologic type (Grade C). In case of BOT diagnosed on definitive histology, the indication of restaging surgery should be discussed in Multidisciplinary Collaborative Meeting. For presumed early stage BOT, it is recommended to use the laparoscopic approach to perform restaging surgery (Grade C). Restaging surgery is recommended for serous BOT with micropapillary appearance and unsatisfactory abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended in case of mucinous BOT if only a cystectomy has been performed or the appendix has not been visualized, then a unilateral adnexectomy will be performed (Grade C). If a restaging surgery is decided in the management of a presumed early stage BOT, the actions to be carried out are as follows: a peritoneal cytology (Grade C), an omentectomy (there is no data in the literature recommending the type of omentectomy to be performed) (Grade B), a complete exploration of the abdominal cavity with peritoneal biopsies on suspect areas or systematically (Grade C), visualization of the appendix± the appendectomy in case of pathological macroscopic appearance (Grade C), unilateral adnexectomy in case of mucinous TFO (Grade C).
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Affiliation(s)
- G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France; Biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Sorbonne université, 75012 Paris, France.
| | - L Lecointre
- Centre hospitalier universitaire Hautepierre, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - P Chauvet
- Département de chirurgie gynécologique, CHU Estaing, Clermont-Ferrand, France; EnCoV, IP, UMR 6602 CNRS, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - R Fauvet
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Caen, 14000 Caen, France; Unité de recherche Inserm U1086 « ANTICIPE » - Axe 2 : biologie et thérapies innovantes des cancers localement agressifs (BioTICLA), université de Normandie Unicaen, 14000 Caen, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France; Biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Sorbonne université, 75012 Paris, France
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Raimond E, Bourdel N. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Surgical Management of Advanced Stages of Borderline Ovarian Tumours]. ACTA ACUST UNITED AC 2020; 48:304-313. [PMID: 32004785 DOI: 10.1016/j.gofs.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the surgical management of borderline ovarian tumors (BOT) in the framework of recommendations for clinical practice made by the National College of Obstetricians and Gynecologists (CNGOF) METHODS: This is a comprehensive review of the literature on the advanced stages of BOT. Bibliographic selection was conducted in PubMed from 2007 to 2019 inclusive, selecting publications in English and French. Articles were selected on the basis of the title, then the abstract and finally the full article. The levels of evidence of the studies were defined according to the scale proposed by the High Authority of Health (HAS). RESULTS By analogy with epithelial ovarian cancer, in case of preoperative suspicion or after a postoperative diagnosis of advanced BOT, the patient must be referred to an expert centre in ovarian cancer (gradeC). There is no data from the literature to conclude that a hysterectomy should be performed routinely, however, the goal in the advanced stages of BOT is no tumor residue (gradeC). In advanced stages of BOT, systematic lymphadenectomy is not recommended, but excision of suspected lymph node on preoperative and intraoperative evaluation, for curative purposes, may be discussed to obtain no residual disease (gradeC). It is recommended to describe peritoneal carcinomatosis before any excision as well as tumor residues at the end of surgery (grade B). The use of a peritoneal carcinomatosis score to evaluate tumor burden such as the "Peritoneal Carcinosis Index" (PCI) is recommended (gradeC). For advanced stages of BOT, a conservative treatment with at least the preservation of the uterus and an ovarian fragment in a patient wishing a pregnancy may be proposed after Multidisciplinary Concertation Meeting (GradeC). Contralateral ovary biopsy is not recommended in advanced stage BOT (GradeC) but restaging surgery associated with removal of all tumor lesions is recommended when not performed initially (GradeC). It is not possible to make a recommendation on chemotherapy indication in advanced stages even with invasive implants. CONCLUSION The weakness of the literature and the retrospective nature of BOT advanced stage studies limit the grade of the recommendations.
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Affiliation(s)
- E Raimond
- Département de gynécologie-obstétrique, CHU de Reims, université de Reims Champagne-Ardennes, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims, France.
| | - N Bourdel
- Département de chirurgie gynécologique, CHU d'Estaing, 1, rue Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
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Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, Guerra A, Fournier LS, Stojanovic S, Millet I, Bharwani N, Juhan V, Cunha TM, Masselli G, Balleyguier C, Malhaire C, Perrot NF, Sadowski EA, Bazot M, Taourel P, Porcher R, Darai E, Reinhold C, Rockall AG. Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) Score for Risk Stratification of Sonographically Indeterminate Adnexal Masses. JAMA Netw Open 2020; 3:e1919896. [PMID: 31977064 PMCID: PMC6991280 DOI: 10.1001/jamanetworkopen.2019.19896] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Approximately one-quarter of adnexal masses detected at ultrasonography are indeterminate for benignity or malignancy, posing a substantial clinical dilemma. OBJECTIVE To validate the accuracy of a 5-point Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study was conducted between March 1, 2013, and March 31, 2016. Among patients undergoing expectant management, 2-year follow-up data were completed by March 31, 2018. A routine pelvic MRI was performed among consecutive patients referred to characterize a sonographically indeterminate adnexal mass according to routine diagnostic practice at 15 referral centers. The MRI score was prospectively applied by 2 onsite readers and by 1 reader masked to clinical and ultrasonographic data. Data analysis was conducted between April and November 2018. MAIN OUTCOMES AND MEASURES The primary end point was the joint analysis of true-negative and false-negative rates according to the MRI score compared with the reference standard (ie, histology or 2-year follow-up). RESULTS A total of 1340 women (mean [range] age, 49 [18-96] years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 [67.9%]; 2-year follow-up, 362 [32.1%]). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (κ = 0.784; 95% CI, 0.743-0824). Of 580 of 1130 women (51.3%) with a mass on MRI and no specific gynecological symptoms, 362 (62.4%) underwent surgery. Of them, 244 (67.4%) had benign lesions and a score of 3 or less. The MRI score correctly reclassified the mass origin as nonadnexal with a sensitivity of 0.99 (95% CI, 0.98-0.99; 1360 of 1372 patients) and a specificity of 0.78 (95% CI, 0.71-0.85; 102 of 130 patients). CONCLUSIONS AND RELEVANCE In this study, the O-RADS MRI score was accurate when stratifying the risk of malignancy in adnexal masses.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
| | - Edouard Poncelet
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | - Laure S. Fournier
- Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Sanja Stojanovic
- Centre for Radiology, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia and Montenegro
| | - Ingrid Millet
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Nishat Bharwani
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Teresa M. Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Gabriele Masselli
- Department of Radiology, Umberto I Hospital, Sapienza University Roma, Rome, Italy
| | | | | | | | - Elizabeth A. Sadowski
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- University of Wisconsin, Madison, Wisconsin
| | - Marc Bazot
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
| | - Patrice Taourel
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Raphaël Porcher
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Institute national de la santé et de la recherche médicale, Joint Research Unit 1153, Paris, France
| | - Emile Darai
- Service de Gynecologie et Obstetrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Hôpitaux Univesitaires Est Parisien, Paris, France
- Faculté de Médecine Pierre et Marie Curie, Sorbonne Université, Paris, France
| | - Caroline Reinhold
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Medical Imaging, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea G. Rockall
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
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Sullivan MW, Modesitt SC. When to Worry about Cancer: Concurrent Carcinoma and Recurrence in Borderline Ovarian Tumors. South Med J 2019; 112:634-638. [PMID: 31796975 DOI: 10.14423/smj.0000000000001048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objectives of this study were to identify and assess the factors associated with concurrent carcinoma and recurrence in women with epithelial borderline ovarian tumors. METHODS The cancer and pathology databases at a tertiary care academic cancer center were queried for all borderline ovarian tumors from 2005 to 2015. Cases with/without concurrent ovarian carcinoma and with/without recurrence were compared. RESULTS A total of 123 women with borderline tumors were identified (mean age 51.3 years). Concurrent carcinoma was present in 31 (25.2%). Women with concurrent carcinoma were significantly more likely to be peri- or postmenopausal, have an elevated CA-125, and have a nonserous histology. Seven (5.7%) women's cancer recurred at a mean of 23.5 months (mean follow-up 30.0 months). Women with recurrence were more likely to be nonwhite, have concurrent invasive carcinoma, and have had residual disease at the time of surgery. CONCLUSIONS Epithelial borderline ovarian tumors often co-exist with carcinoma and occur more frequently in postmenopausal women, in women with elevated CA-125, and in tumors with nonserous histology. The presence of any of these factors should alert clinicians to the potential need for comprehensive staging at the time of surgery. The recurrence of borderline tumors is associated with nonwhite race, concurrent carcinoma, and residual disease at initial surgery.
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Affiliation(s)
- Mackenzie W Sullivan
- From the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville
| | - Susan C Modesitt
- From the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville
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Association between chemotherapy and disease-specific survival in women with borderline ovarian tumors: A SEER-based study. Eur J Obstet Gynecol Reprod Biol 2019; 242:92-98. [DOI: 10.1016/j.ejogrb.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 12/13/2022]
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Sofoudis C, Vasileiadou D, Fagkrezos D, Lenos M, Papamargaritis E, Gerolymatos A. Necrotized torsion of enormous bilateral borderline tumors in young patient. J Surg Case Rep 2019; 2019:rjz168. [PMID: 31214310 PMCID: PMC6565828 DOI: 10.1093/jscr/rjz168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/13/2019] [Indexed: 11/25/2022] Open
Abstract
Borderline ovarian tumors, or tumors of low malignant potential, are neoplasms of good prognosis that affect mostly patients of reproductive age. They account for 15% of all epithelial ovarian neoplasms and they are managed with surgical cytoreduction. Conservative surgery may be considered in patients who desire fertility preservation. Here we report on a patient who presented with vague abdominal symptoms and was diagnosed with large bilateral borderline tumors, of 18 and 15 cm in size. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy and epiplectomy and received adjuvant chemotherapy. Borderline ovarian tumors are a pathologic entity the gynaecologist should be well acquainted with.
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Affiliation(s)
- Chrisostomos Sofoudis
- Department of Obstetrics & Gynecology, Konstantopouleio, General Hospital, Athens, Greece
- Correspondence address. Department of Obstetrics & Gynecology, Konstantopouleio, General Hospital, Ippoktarous str. 209, 11472, Athens, Greece. E-mail:
| | - Dimitra Vasileiadou
- Department of Obstetrics & Gynecology, Konstantopouleio, General Hospital, Athens, Greece
| | - Dimitrios Fagkrezos
- Department of Computed Tomography, Konstantopouleio, General Hospital, Athens, Greece
| | - Michael Lenos
- Department of Pathology, Konstantopouleio, General Hospital, Athens, Greece
| | | | - Andreas Gerolymatos
- Department of Obstetrics & Gynecology, Konstantopouleio, General Hospital, Athens, Greece
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Colombo N, Sessa C, Bois AD, Ledermann J, McCluggage WG, McNeish I, Morice P, Pignata S, Ray-Coquard I, Vergote I, Baert T, Belaroussi I, Dashora A, Olbrecht S, Planchamp F, Querleu D. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Int J Gynecol Cancer 2019; 29:ijgc-2019-000308. [PMID: 31048403 DOI: 10.1136/ijgc-2019-000308] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
The development of guidelines is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on April 12-14, 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology IRCCS, University of Milan-Bicocca, Milan, Italy
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - I McNeish
- Department of Surgery and Cancer, Imperial College, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - I Vergote
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - I Belaroussi
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Dashora
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - S Olbrecht
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Planchamp
- Clinical Research Unit, Institut Bergonié, Bordeaux, France
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France
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Colombo N, Sessa C, du Bois A, Ledermann J, McCluggage WG, McNeish I, Morice P, Pignata S, Ray-Coquard I, Vergote I, Baert T, Belaroussi I, Dashora A, Olbrecht S, Planchamp F, Querleu D. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease†. Ann Oncol 2019; 30:672-705. [PMID: 31046081 DOI: 10.1093/annonc/mdz062] [Citation(s) in RCA: 591] [Impact Index Per Article: 118.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
The development of guidelines recommendations is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on 12-14 April 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology IRCCS, University of Milan-Bicocca, Milan, Italy.
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast
| | - I McNeish
- Department of Surgery and Cancer, Imperial College, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - I Vergote
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - I Belaroussi
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Dashora
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - S Olbrecht
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France.
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Factors affecting compliance of intraoperative frozen and final histopathology in borderline ovarian tumors: Retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.553698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Arfi A, Bendifallah S, Mathieu D'argent E, Poupon C, Ballester M, Cohen J, Darai E. Nomogram predicting the likelihood of live-birth rate after surgery for deep infiltrating endometriosis without bowel involvement in women who wish to conceive: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2019; 235:81-87. [PMID: 30831447 DOI: 10.1016/j.ejogrb.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/12/2018] [Accepted: 02/05/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To study the fertility and live birth (LB) rate in women after surgery for deep infiltrating endometriosis (DIE) without bowel involvement and to evaluate the predictive factors of LB after DIE surgery without bowel involvement. STUDY DESIGN Retrospective cohort study. A total of 118 women who wished to conceive and who underwent surgery for DIE without bowel involvement were analyzed between January 2006 and December 2014. A multivariate logistic regression analysis of selected factors and a nomogram to predict the subsequent LB rate was constructed. RESULTS Thirty-six woman had a LB (30.5%). In multivariate analysis, factors associated with a LB were: age ≤30 years (p = 0.0024), BMI ≤ 25 kg/m2 (p = 0.029) and Enzian grade 1 (p < 0.001). These factors were associated to develop a nomogram. Before and after the bootstrap sampling procedure, the predictive model had an AUC of 0.84 (95% CI, 0.82-0.86) and 0.81 (95% CI, 0.79-83), respectively, and showed a good calibration. CONCLUSIONS This work presents the originality of describing the fertility and the LB rate after surgery for DIE without bowel involvement with a predictive model. Such tools can help clinicians to support the patient in making an informed decision about fertility treatment options, contributing to the decision-making process by defining simple risk factors of poor LB probability that can help identify good candidates for MAR.
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Affiliation(s)
- Alexandra Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France.
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; INSERM UMR_S_707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris 6, France
| | - Emmanuelle Mathieu D'argent
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Clothilde Poupon
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Groupe de Recherche Clinique 6 (GRC6-UPMC), Centre Expert En Endométriose (C3E), France; UMR_S938 Université Pierre et Marie Curie Paris 6, France
| | - Jonathan Cohen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Groupe de Recherche Clinique 6 (GRC6-UPMC), Centre Expert En Endométriose (C3E), France; UMR_S938 Université Pierre et Marie Curie Paris 6, France
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Yilmaz E, Sahin N, Koleli I, Melekoglu R, Tanrikut E, Faydali S, Karaer A, Coskun EI. RETROSPECTIVE ANALYSIS OF BORDERLINE OVARIAN TUMORS: OUTCOMES AT A SINGLE CENTER. Acta Clin Croat 2019; 58:29-36. [PMID: 31363322 PMCID: PMC6629208 DOI: 10.20471/acc.2019.58.01.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We wanted to discuss our experiences in the approach to borderline ovarian tumors, which constitute a group different from epithelial ovarian tumors with respect to their biological structure in line with retrospective information gathered from our cases. A total of 25 patients operated on for the indication of adnexal masses diagnosed as borderline ovarian tumors based on frozen section results were included in our study. Patient age, tumor diameter, tumor markers and surgeries performed were discussed in the light of the literature. Statistical analyses were performed using the SPSS software. The patient mean age was 43.84±11.34 years. The mass was localized in the right (n=13), left (n=11) or both (n=1) adnexal regions. The mean tumor diameter was 12.9±5.84 cm. Histopathologic examination established the diagnosis of serous borderline (n=14 patients) and mucinous borderline (n=11) ovarian tumors. Although the results of our study are consistent with current literature data, a greater number of current studies should be performed on borderline ovarian tumors, which are defined as a class of tumors different from epithelial ovarian tumors.
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Affiliation(s)
| | - Nurhan Sahin
- 1Inonu University Turgut Ozal Medical Centre, Obstetrics and Gynecology Department, Malatya, Turkey; 2Inonu University Turgut Ozal Medical Centre, Pathology Department, Malatya, Turkey; 3Gozde Academy, Malatya, Turkey
| | - Isil Koleli
- 1Inonu University Turgut Ozal Medical Centre, Obstetrics and Gynecology Department, Malatya, Turkey; 2Inonu University Turgut Ozal Medical Centre, Pathology Department, Malatya, Turkey; 3Gozde Academy, Malatya, Turkey
| | - Rauf Melekoglu
- 1Inonu University Turgut Ozal Medical Centre, Obstetrics and Gynecology Department, Malatya, Turkey; 2Inonu University Turgut Ozal Medical Centre, Pathology Department, Malatya, Turkey; 3Gozde Academy, Malatya, Turkey
| | - Emrullah Tanrikut
- 1Inonu University Turgut Ozal Medical Centre, Obstetrics and Gynecology Department, Malatya, Turkey; 2Inonu University Turgut Ozal Medical Centre, Pathology Department, Malatya, Turkey; 3Gozde Academy, Malatya, Turkey
| | - Simge Faydali
- 1Inonu University Turgut Ozal Medical Centre, Obstetrics and Gynecology Department, Malatya, Turkey; 2Inonu University Turgut Ozal Medical Centre, Pathology Department, Malatya, Turkey; 3Gozde Academy, Malatya, Turkey
| | - Abdullah Karaer
- 1Inonu University Turgut Ozal Medical Centre, Obstetrics and Gynecology Department, Malatya, Turkey; 2Inonu University Turgut Ozal Medical Centre, Pathology Department, Malatya, Turkey; 3Gozde Academy, Malatya, Turkey
| | - Ebru Inci Coskun
- 1Inonu University Turgut Ozal Medical Centre, Obstetrics and Gynecology Department, Malatya, Turkey; 2Inonu University Turgut Ozal Medical Centre, Pathology Department, Malatya, Turkey; 3Gozde Academy, Malatya, Turkey
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Tumors of low malignant potential a single institution experience. Int J Surg Case Rep 2019; 55:41-46. [PMID: 30684818 PMCID: PMC6351433 DOI: 10.1016/j.ijscr.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/19/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022] Open
Abstract
The tumors of low malignant potential are an independent group of ovarian epithelial tumors. The overall survival at 5 and 10 years was respectively of 96,9% and 92,8%. After a mean follow up of 10 years, we report 7 cases of locoregional relapse. After conservative surgery two patients achieved full term pregnancies. More studies are required for a higher grade of recommendation.
Background The tumors of low malignant potential are an independent group of the ovarian epithelial tumors. They represents 10–20% of all ovarian epithelial tumors. Our aim through this study to determine how to treat this disease in the most suitable way. Methods A retrospective study involving 73 patients diagnosed with TLMP and treated at our Institute between September 1975 and June 2010. Results The median age was 49 years. In 33% of the cases, the patients were younger than 40 years. Our study included 38 mucinous tumors, 30 serous and 5 mixed. The tumors were stage I in 69% of the cases, stage II in 11% and stage III in 20%. All patients had surgery as a primary treatment. The surgery was radical in 77% of the cases. Five patients had an adjuvant chemotherapy. After a mean follow up of 10 years, we reported 7 cases of local relapses. The prognostic factors for a disease free survival were: the stage of the tumor and the presence of invasive implants. The overall survival at 5 and 10 years was respectively of 96.9% and 92.8%. The prognostic factors for overall survival were: the age, the stage, the existence of a residual tumor, the presence of pseudomyxoma or peritoneal implants. After having a conservative surgery two patients achieved full term pregnancies. Conclusion Randomized studies are required to back-up our findings and give a higher grade of recommendation to the actual standard of care.
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De Decker K, ter Brugge HG, Bart J, Kruitwagen RF, Nijman HW, Kruse AJ. Borderline tumours of the ovary: Common practice in the Netherlands. Gynecol Oncol Rep 2018; 27:25-30. [PMID: 30581952 PMCID: PMC6297066 DOI: 10.1016/j.gore.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives Discordance between frozen section diagnosis and the definite histopathological diagnosis and the fact that the frozen section result is not always unambiguous, may contribute to differences in clinical practice regarding perioperative treatment and follow-up of borderline ovarian tumours (BOTs) patients amongst gynaecologic oncologists, which may lead to over- and undertreatment. The aim of the study was to map the Dutch gynaecologists' preferred treatment and follow-up strategy in case of BOTs. Methods A questionnaire was sent to all Dutch gynaecologists involved in ovarian surgery with perioperative frozen section analysis, and the outcomes were assessed using descriptive statistics. Results Nearly half of the respondents (41.0%) would not perform a staging procedure in case of a BOT. In case of an ambiguous frozen section diagnosis, tending towards invasive carcinoma, a considerable number (sBOT 56.4%; mBOT 30.8%) would perform a lymph node sampling as part of the staging procedure. A relaparotomy/relaparoscopy, to perform a lymph node sampling in case of a serous or mucinous carcinoma after a BOT frozen section diagnosis, would be performed by 97.4% and 48.7% of the respondents, respectively. Conclusions A considerable number of gynaecologists would perform a staging procedure that is recommended for ovarian cancer in case of an ambiguous BOT frozen section diagnosis, especially for serous tumours. In addition, nearly all gynaecologists would perform a second procedure including a lymph node sampling in case of a serous invasive carcinoma after a BOT frozen section diagnosis, which applies to half of the gynaecologists in case of a mucinous carcinoma. In case of an unambiguous frozen section BOT diagnosis, a staging procedure is omitted by nearly half of the gynaecologists. When the frozen section BOT diagnosis is ambiguous, a full ovarian cancer staging procedure is frequently performed. Most gynaecologists perform a second procedure to complete staging when definitive diagnosis shows invasive ovarian cancer. Full staging is performed more frequently in case of serous histopathology, when compared to mucinous tumours.
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Affiliation(s)
- Koen De Decker
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
- Corresponding author at: Isala Clinics, Department of Obstetrics and Gynaecology, PO Box 10400, 8000 GK Zwolle, the Netherlands.
| | - Henk G. ter Brugge
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
| | - Joost Bart
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
| | - Roy F.P.M. Kruitwagen
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hans W. Nijman
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
| | - Arnold-Jan Kruse
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
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Jia SZ, Zhang JJ, Liang ZY, Yang JJ, Xiang Y, Jia CW, Leng JH. Safety and fertility outcomes after the conservative treatment of endometrioid borderline ovarian tumours. BMC Cancer 2018; 18:1160. [PMID: 30470202 PMCID: PMC6251198 DOI: 10.1186/s12885-018-5091-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 11/14/2018] [Indexed: 01/11/2023] Open
Abstract
Background Because of the rarity of endometrioid borderline ovarian tumours (EBOTs), there is a paucity of data concerning the natural history and prognosis of this condition. Thus, the objective of our study was to establish the feasibility of fertility preservation in young women with EBOTs, as well as their oncological and reproductive outcomes. Methods Consecutive patients with EBOTs, treated at a tertiary referral centre during a span of 22 years, were retrospectively analysed. Recurrence-free interval, as well as its association with the type of surgery and with other clinical and pathological features, was assessed using the Kaplan-Meier and Cox proportional hazards methods. Results Of the 59 patients studied, the median follow-up time was 30 months (range, 6–177 months). Nine (15.3%) patients developed 13 recurrences 6–137 months after the initial surgeries, including three patients (5.1%; n = 3/59) who developed six invasive recurrences 8, 18 and 68 months after their initial surgeries. Conservative surgery showed a tendency towards a high recurrence rate (17.2% versus 13.3%); however, this difference was not significant (p = 0.45). The 5-year recurrence-free survival rate was significantly higher in the oophorectomy group than in the cystectomy group (p = 0.001). Cox regression analysis showed that none of the variables assessed were associated with an increased hazard ratio for recurrence, except for a younger age at diagnosis (p = 0.021). Of 20 patients who attempted to conceive, three pregnancies among two patients (10.0%) resulted in two live births. Conclusions Conservative surgery with unilateral adnexectomy can be proposed for young women with EBOTs with fertility desire; however, the reproductive result is not satisfactory. In addition, careful evaluations of the endometria should be offered during the initial surgery and follow-up period. Trial registration Retrospectively registered.
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Affiliation(s)
- Shuang-Zheng Jia
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Jun-Ji Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Jun-Jun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Cong-Wei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Jin-Hua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China.
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Fang C, Zhao L, Chen X, Yu A, Xia L, Zhang P. The impact of clinicopathologic and surgical factors on relapse and pregnancy in young patients (≤40 years old) with borderline ovarian tumors. BMC Cancer 2018; 18:1147. [PMID: 30463533 PMCID: PMC6249857 DOI: 10.1186/s12885-018-4932-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 10/10/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Fertility sparing surgery has been extensively performed among patients with borderline ovarian tumors due to their age and favorable prognosis. Nevertheless, the prognosis and obstetric outcomes in these patients remain uncertain. Thus, the current study was carried out to evaluate the oncological safety and fertility benefits of different fertility sparing surgery subtypes and various clinicopathological parameters. METHODS Young borderline ovarian tumor patients with an age of ≤40 years, who were admitted and treated in Zhejiang Cancer Hospital from January 1996 to December 2016, were enrolled in this study and reviewed retrospectively. The prognostic and obstetric effects of clinicopathological and surgical variables were evaluated using univariate/multivariate analyses and survival curves. RESULTS A total of 92 eligible patients were enrolled in the analysis. Among these patients, 22 (24%) patients showed recurrence after a median follow-up of 46.5 months. Within the fertility sparing surgery group, patients at advanced stage (≥stage II), of serous type, with micropapillary and bilateral tumors were associated with a higher recurrence rate and a shorter recurrence interval. In terms of different modalities of fertility sparing surgery, adnexectomy was remarkably favored over cystectomy-including (P = 0.012); unilateral salpingo-oophorectomy had better prognosis than cystectomy and bilateral cystectomy was favored over unilateral salpingo-oophorectomy+contralateral cystectomy. Univariate Cox regression analysis indicated that the International Federation of Gynecology and Obstetrics stage (≥Stage II), the presence of bilateral and micropapillary lesions, and the application of cystectomy-including surgery were correlated with poorer disease-free survival, while the mucinous type of borderline ovarian tumors was related to improved disease-free survival. In this study, a total of 22 patients attempted to conceive and 15 (68%) of these patients achieved successful pregnancy. CONCLUSIONS Unilateral salpingo-oophorectomy and bilateral cystectomy should be recommended as the preferred choice of treatment for young patients with unilateral and bilateral borderline ovarian tumor who desire to preserve fertility. In addition, borderline ovarian tumor patients at advanced stage (≥stage II), of serous type, with micropapillary and bilateral tumors should pay more attention to the risk of recurrence. Therefore, these patients should choose fertility sparing surgery carefully and attempt to achieve pregnancy as soon as possible.
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Affiliation(s)
- Chenyan Fang
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China
| | - Lingqin Zhao
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China
| | - Xi Chen
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China
| | - Aijun Yu
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China
| | - Liang Xia
- Department of Neurosurgery, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China.
| | - Ping Zhang
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China.
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Zhou Y, Layton O, Hong L. Identification of Genes and Pathways Involved in Ovarian Epithelial Cancer by Bioinformatics Analysis. J Cancer 2018; 9:3016-3022. [PMID: 30210623 PMCID: PMC6134813 DOI: 10.7150/jca.26133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/09/2018] [Indexed: 01/05/2023] Open
Abstract
Ovarian epithelial cancer (OEC) is an often fatal disease with poor prognosis in women with high-stage disease. In contrast, ovarian low malignant potential (LMP) tumors with favorable prognosis behaves as a disease between benign and malignant tumors. The involved genes and pathways between benign-like LMP and aggressive OEC are largely unknown. This study integrated two cohorts profile datasets to investigate the potential key candidate genes and pathways associated with OEC. Gene expression in two datasets (GSE9891 and GSE12172), including 327 OECs and 48 LMP tumors, were analyzed. 559 differentially expressed genes were found to overlap, 251 up-regulated and 308 down-regulated. Subsequently, analysis of gene ontology, signaling pathway enrichment and protein-protein interaction (PPI) network was performed. Gene ontology analysis clustered the up-regulated and down-regulated genes based on significant enrichment. 282 nodes/ differentially expressed genes (DEGs) were identified from DEGs PPI network complex, and two most significant k-clique modules were identified from PPI. In a summary, using integrated bioinformatics analysis, we are able to identify biomarkers potentially significant in the pathogenesis of OEC, which can improve our understanding of the cause and molecular events. These candidate genes and pathways could be used for further confirmation, and lead to better disease diagnose and therapy.
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Affiliation(s)
- Yun Zhou
- Department of Gynaecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P.R. China
| | - Olivia Layton
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Li Hong
- Department of Gynaecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P.R. China
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Jia SZ, Zhang JJ, Yang JJ, Xiang Y, Liang Z, Leng JH. Risk of synchronous endometrial disorders in women with endometrioid borderline tumors of the ovary. J Ovarian Res 2018; 11:30. [PMID: 29673382 PMCID: PMC5909205 DOI: 10.1186/s13048-018-0405-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Synchronous endometrial disorders have been poorly studied in women with endometrioid borderline ovarian tumors (EBOT). The aims of this study were to investigate the risk of endometrial disorders among women with EBOT and associated factors, as well as their oncological and fertility outcomes. Results This retrospective study included 33 women with EBOT. Their mean age was 41.9 years, and endometria were evaluated in 25 of these patients. The prevalence of synchronous endometrial disorders was 52.0% (n = 13/25) and this incidence was 41.4% (n = 46/111) after systematic analysis. Univariable analysis showed that EBOT patients who were younger, nulliparous, and had experienced abnormal vaginal bleeding were more likely to have synchronous endometrial disorders. The median follow-up was 54 months (range: 14-250 months), and three patients (10.3%) developed recurrences. No deaths due to EBOT were recorded. Among the nine nulliparous women treated conservatively who were attempting to conceive, only one (11.1%) pregnancy resulted in a live birth. Conclusions Synchronous endometrial disorders are common in women with EBOT, especially in those who are younger, nulliparous, and have experienced abnormal vaginal bleeding. Thus, endometrial sampling should be performed in women with EBOT undergoing conservative surgery, and a hysterectomy should be performed in cases requiring radical treatment.
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Affiliation(s)
- Shuang-Zheng Jia
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Jun-Ji Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Jun-Jun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Jin-Hua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, People's Republic of China.
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Prognostic Factors for Recurrence After Fertility-Preserving Surgery in Patients With Borderline Ovarian Tumors: A Systematic Review and Meta-analysis of Observational Studies. Int J Gynecol Cancer 2018; 27:1833-1841. [PMID: 28816706 DOI: 10.1097/igc.0000000000001092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to find the unfavorable prognostic factors for recurrence after fertility-preserving surgery (FPS) in patients with borderline ovarian tumors (BOTs). METHODS To perform a meta-analysis to compare the recurrence rates of BOT patients after FPS according to different prognostic factors, we searched PubMed, EMBASE, and Cochrane for observational studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a fixed-effects model. RESULTS We analyzed 32 studies that included 2691 BOT patients who underwent FPS, 383 patients of whom had a relapse in the follow-up. In meta-analysis, risks associated with recurrence in patients with unilateral cystectomy (OR, 2.49; 95% CI, 1.86-3.33) or serous borderline ovarian tumors (OR, 3.15; 95% CI, 1.97-5.02) were significantly increased, and there was no significantly increased OR for patients with laparoscopy compared with those with laparotomy (OR, 0.96; 95% CI, 0.57-1.60). CONCLUSIONS Unilateral cystectomy (19.4%) and serous BOTs (19.2%) are significantly associated with higher recurrence rates, and no negative impact of laparoscopy on recurrence can be demonstrated when compared with laparotomy in the meta-analysis.
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CT Features of Ovarian Tumors: Defining Key Differences Between Serous Borderline Tumors and Low-Grade Serous Carcinomas. AJR Am J Roentgenol 2018; 210:918-926. [PMID: 29489407 DOI: 10.2214/ajr.17.18254] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of our study was to investigate whether the CT features of serous borderline tumors (SBTs) differ from those of low-grade serous carcinomas (LGSCs) and to evaluate if mutation status is associated with distinct CT phenotypes. MATERIALS AND METHODS This retrospective study included 59 women, 37 with SBT and 22 with LGSC, who underwent CT before primary surgical resection. Thirty of 59 patients were genetically profiled. Two radiologists (readers 1 and 2) independently and retrospectively reviewed CT examinations for qualitative features and quantified total tumor volumes (TTVs), solid tumor volumes (STVs), and solid proportion of ovarian masses. Univariate and multivariate associations of the CT features with histopathologic diagnoses and mutations were evaluated, and interreader agreement was determined. RESULTS At multivariate analysis, the presence of bilateral ovarian masses (p = 0.03), the presence of peritoneal disease (PD) (p = 0.002), and higher STV of ovarian masses (p = 0.002) were associated with LGSC. The presence of nodular PD pattern (p < 0.001 each reader) and the presence of PD calcifications (reader 1, p = 0.02; reader 2, p = 0.003) were associated with invasive peritoneal lesions (i.e., LGSC). The presence of bilateral ovarian masses (p = 0.04 each reader), PD (reader 1, p = 0.01; reader 2, p = 0.004), and higher STV (p = 0.03 for each reader) were associated with the absence of BRAF mutation (i.e., wild type [wt]-BRAF). CONCLUSION The CT features of LGSCs were distinct from those of SBTs. The CT manifestations of LGSC and the wt-BRAF phenotype were similar.
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Just the tip of the iceberg: difficulties in assessing and managing extreme obesity in routine clinical care. Eur J Clin Nutr 2018; 72:452-454. [PMID: 29379145 DOI: 10.1038/s41430-017-0056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/09/2017] [Indexed: 11/08/2022]
Abstract
As obesity prevalence increases worldwide, healthcare professionals are often faced with challenging cases associated with massive obesity. A 33-year-old woman (weight 342 kg, body mass index = 100 kg/m²) presented with respiratory failure, limb edema and ascites. Abdominal CT scan became feasible after initial weight loss and showed a large pelvic mass in contact with the left ovary. The surgical removal performed despite a high-risk profile led to the diagnosis of a giant mucinous borderline tumor whose growth was due to delayed care and responsible for multiple severe complications: sepsis, anemia, esophagitis, constipation, anorexia due to mechanical compression, undernutrition, sarcopenia and lower limb edema contributing to a severe disability. After 7 months under specialized care, her weight decreased to 180 kg, complications were treated and disability improved. This case, showing that, despite barriers, a multidisciplinary approach makes quality of care possible even in massively obese patients, is an educational example to reduce stigma.
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Lou T, Yuan F, Feng Y, Wang S, Bai H, Zhang Z. The safety of fertility and ipsilateral ovary procedures for borderline ovarian tumors. Oncotarget 2017; 8:115718-115729. [PMID: 29383195 PMCID: PMC5777807 DOI: 10.18632/oncotarget.23021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/17/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the optimal treatment options for women with borderline ovarian tumors (BOTs). Materials and Methods The medical records of consecutive patients with BOTs in two academic institutions were retrospectively collected. The pertinent data, including clinicopathological characteristics and, treatment and prognostic information were evaluated. Results A total of 281 cases of BOTs were included in this analysis. For the entire series, the 5- year disease-free survival (DFS) and overall survival (OS) rates were 91.8% and 98.5%, respectively. In the multivariate analysis, reservation of the ipsilateral ovary (HR: 0.104 [95% CI, 0.036–0.304], p = 0.000) and FIGO stage II–III (HR: 6.811 [95% CI, 2.700–17.181], p = 0.000) were the independent risk factors for recurrence. Ovarian surface involvement (HR: 64.996 [95% CI, 4.054–1041.941], p = 0.003) was the only independent prognostic factor for OS. Lymphadenectomy and adjunct chemotherapy had no significant impact on patients’ recurrence and survival (recurrence: p = 0.332 and 0.290, respectively, survival: p = 0.896 and 0.216, respectively). Conclusions Fertility-sparing surgery with healthy ovarian preservation seems safe and feasible for young women who prefer fertility-sparing treatment. Ovarian cystectomy to conserve the affected ovary/ovaries without ovarian surface involvement may be cautiously performed under fully informed consent for young women with bilateral BOTs who strongly prefer fertility-sparing treatment and have no evidence of infertility. However, long-term follow-up is necessary due to the relapse susceptibility of the ovary.
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Affiliation(s)
- Tong Lou
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fang Yuan
- Department of Obstetrics and Gynecology, the affiliated hospital of Qingdao University, Qingdao, China
| | - Ying Feng
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuzhen Wang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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The Evaluation of Risk Factors Associated With Relapse and Recurrence of Borderline Ovarian Tumors With Long-Term Follow-up. Int J Gynecol Cancer 2017; 26:1053-61. [PMID: 27177283 DOI: 10.1097/igc.0000000000000722] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The goal was to analyze the risk factors of relapse and to compare the type of recurrence in patients with borderline tumors treated and followed up in Oncologic Center in Warsaw. MATERIALS AND METHODS This is a retrospective-prospective cohort study of 307 patients with confirmed borderline ovarian tumors treated in the Maria Sklodowska-Curie Memorial Cancer Center in Warsaw between 1994 and 2010. Univariate and multivariate analysis as well as Kaplan-Meier estimates were used to explore the impact of different covariates on progression-free survival. The analysis included the following potential prognostic factors: age, CA 125 value, stage according to classification of the International Federation of Gynecology and Obstetrics (FIGO), methods and radicality of operation, staging, tumor capsule rupture, histopathology, implants, ascites, and microinvasion. The analysis of relapses was also performed. RESULTS Univariate analysis showed the negative impact of 2 factors on progression-free survival: FIGO II/III (implants) (P = 0.011) and ascites (P = 0.027). The multivariate analyses showed the detrimental effect of FIGO Ic (HR, 2.63; 95% confidence interval [CI], 1.12-6.17, P = 0.027), FIGO II or III (implants) (HR, 3.67; 95% CI, 1.56-8.61, P = 0.003), and incomplete staging (HR, 3.63; 95% CI, 1.09-12.07, P = 0.035), but not ascites (P > 0.1). Relapse occurred in 32 (10%) patients: in 22 patients as borderline and in 10 patients as invasive tumor. Seven (70%) patients with invasive relapse died of disease. All patients with borderline relapses were successfully managed by second surgery, which in 80% was again conservative. CONCLUSIONS Relapses in borderline ovarian tumor are uncommon, in 10% of patients. Invasive relapses are rare, only in 3% of patients, but often with fatal course irrespective of the treatment applied. The most important clinical risk factors of relapse are implants (FIGO II/III), FIGO Ic, and incomplete staging and this patients as well as patients with ascites should be closely followed. Relapses of borderline histology are easily detected and successfully managed by surgery.
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Helpman L, Yaniv A, Beiner ME, Aviel-Ronen S, Perri T, Ben-Baruch G, Hogen Ben-David L, Jakobson-Setton A, Korach J. Fertility preservation in women with borderline ovarian tumors - how does it impact disease outcome? A cohort study. Acta Obstet Gynecol Scand 2017; 96:1300-1306. [PMID: 28815550 DOI: 10.1111/aogs.13203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/02/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Borderline ovarian tumors are typically indolent neoplasms. Since many are diagnosed in younger women, fertility conservation is an important consideration and has been advocated based on retrospective data. The objective of this study was to identify features impacting on recurrence and survival in a series of borderline ovarian tumors, and to assess the safety of a fertility-sparing approach. MATERIAL AND METHODS A historical cohort study of consecutive borderline ovarian tumors cases treated at a single institution over 30 years (1981-2011). Data on surgical approach (fertility-sparing or otherwise), disease stage, CA125 levels, histological features, adjuvant treatment and follow-up data were collected. Recurrence and survival were assessed using the Kaplan-Meier method and associations with the variables of interest were evaluated using a multivariate Cox proportional hazards model. RESULTS 213 patients were included. Of 132 women age 40 years and below at diagnosis, 112 (85%) had a fertility-sparing procedure and 60 (46%) had conservation of an involved ovary. Fifty patients (24%) developed recurrences; fertility preservation (hazard ratio = 2.57; 95% confidence interval 1.1-6; p = 0.029) and advanced stage (hazard ratio = 4.15; 95% confidence interval 2.3-7.6; p < 0.001) were independently associated with recurrence on multivariate analysis. Eleven (5%) patients died of their disease. Fertility preservation was not associated with compromised survival. CONCLUSIONS Borderline ovarian tumors carry a good prognosis overall. Fertility preservation is associated with a higher risk of disease relapse; however, as most relapses are localized and may be salvaged with surgical treatment, overall survival is not compromised.
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Affiliation(s)
- Limor Helpman
- Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Yaniv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mario E Beiner
- Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Aviel-Ronen
- Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Perri
- Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Ben-Baruch
- Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Jacob Korach
- Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Boyraz G, Salman MC, Gultekin M, Ozkan NT, Uckan HH, Gungorduk K, Gulseren V, Ayik H, Toptas T, Kuru O, Sozen H, Erturk A, Ozgul N, Meydanlı MM, Sanci M, Turan T, Gungor T, Simsek T, Topuz S, Yuce K. What is the impact of stromal microinvasion on oncologic outcomes in borderline ovarian tumors? A multicenter case-control study. Arch Gynecol Obstet 2017; 296:979-987. [PMID: 28866783 DOI: 10.1007/s00404-017-4496-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate clinicopathological characteristics and oncological outcome of women with microinvasive BOTs. METHODS A retrospective multicenter case-control study was conducted on 902 patients with BOT, who underwent surgery from January 2002 to December 2015 at six participating gynecologic oncology centers from Turkey. Among 902 patients, 69 had microinvasive BOT. For every patient with microinvasive BOT, two controls were randomly selected from another database based on decade of age and stage of disease at diagnosis. The clinical-pathological characteristics and oncological outcomes were compared between BOT patients with and without stromal microinvasion. Risk factors for poor oncological outcomes were investigated in a multivariate analysis model. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. RESULTS Patients with microinvasive BOT had a significantly higher rate of recurrence than patients without microinvasive BOT (17.4 vs 7.8%, OR 3.55, %95 CI 1.091-11.59, p = 0.03). Stage at diagnosis (stage I versus II/III) and type of surgery (cystectomy versus others) were found as other significant prognostic factors for recurrence in multivariate analysis (OR 8.63, %95 CI 2.48-29.9, p = 0.001 and OR 19.4, %95 CI 3.59-105.6, p = 0.001, respectively). Stromal microinvasion was found as a prognostic factor for significantly shorter DFS (26.7 vs 11.9 months, p = 0.031, log rank). However, there was no significant difference in OS between two groups (p = 0.99, log rank). CONCLUSION Stromal microinvasion is significantly associated with decreased DFS. In addition, our study confirms that the risk of recurrence is higher in patients with microinvasive BOT.
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Affiliation(s)
- Gokhan Boyraz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Mehmet Coskun Salman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Gultekin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nazlı Topfedaisi Ozkan
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health, Education and Research Hospital, Ankara, Turkey
| | - Hasan H Uckan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kemal Gungorduk
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, 35120, Izmir, Turkey
| | - Varol Gulseren
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, 35120, Izmir, Turkey
| | - Hulya Ayik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Tayfun Toptas
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Oguzhan Kuru
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hamdullah Sozen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, 34390, Istanbul, Turkey
| | - Anıl Erturk
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Mutlu Meydanlı
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health, Education and Research Hospital, Ankara, Turkey
| | - Muzaffer Sanci
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, 35120, Izmir, Turkey
| | - Taner Turan
- Division of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Etlik St, 06010, Kecioren/Ankara, Turkey
| | - Tayfun Gungor
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health, Education and Research Hospital, Ankara, Turkey
| | - Tayup Simsek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Samet Topuz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, 34390, Istanbul, Turkey
| | - Kunter Yuce
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Semczuk A, Gogacz M, Semczuk-Sikora A, Jóźwik M, Rechberger T. The Putative Role of TP53 Alterations and p53 Expression in Borderline Ovarian Tumors - Correlation with Clinicopathological Features and Prognosis: A Mini-Review. J Cancer 2017; 8:2684-2691. [PMID: 28928856 PMCID: PMC5604199 DOI: 10.7150/jca.19691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/07/2017] [Indexed: 01/10/2023] Open
Abstract
Borderline ovarian tumors (BOTs) represent an independent group among ovarian malignancies, being diagnosed at clinical stage earlier than invasive ovarian carcinomas (OCs) and characterized by a rather favorable outcome after careful surgical management. Data published worldwide showed a substantial discordance of p53 expression in BOTs. The purpose of this work was to present the current status of knowledge on the significance of TP53 gene and p53 protein product alterations in BOTs. In general, higher p53 expression patterns were reported for ovarian malignancies compared to BOTs. Serous, mucinous, and endometrioid BOTs differ substantially in relation to p53 immunostaining, but data concerning the relationship between the protein's immunoreactivity and other clinico-pathological variables are scarce. Finally, reports published to date support the view that TP53 alterations may not be commonly associated with the borderline phenotype of ovarian tumors but they probably occur during the development of invasive OCs. In light of these uncertainties, the impact of TP53 alterations and p53 expression on overall survival in women affected by BOTs requires further multi-institutional studies in large cohorts of patients.
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Affiliation(s)
- Andrzej Semczuk
- II ND Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Marek Gogacz
- II ND Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Anna Semczuk-Sikora
- Department of Pathology of Pregnancy, Medical University of Lublin, Lublin, Poland
| | - Maciej Jóźwik
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, Białystok, Poland
| | - Tomasz Rechberger
- II ND Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Pais P, Huchon C, Chevrot A, Cohen J, Fauconnier A, Rouzier R, Mimouni M. [External multicentric validation of two scores predicting the risk of relapse in patients with borderline ovarian tumors: The nomogram of Bendifallah and the score of Ouldamer]. Bull Cancer 2017; 104:721-726. [PMID: 28778341 DOI: 10.1016/j.bulcan.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/20/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Borderline ovarian tumors are rare and can occur in young women. For these patients, a fertility sparing surgery should be discussed. Two predicting borderline ovarian tumor relapse risk models were developed in 2014 (Nomogram of Bendifallah) and 2017 (Score of Ouldamer). This study aimed to valid in an external population, these two scores using a multi-institutional BOT database. METHODS In this bicentric and retrospective study, all consecutive patients comprising the variable nomogram documented treated between January 2006 and December 2012 for BOT in centre hospitalier de Poissy-Saint-Germain and hôpital René-Huguenin were included. A ROC model was established for each predicting scores. RESULTS Sixty-five patients were included in the study. Twelve patients showed a recurrence (19%), three of them experienced an infiltrative cancer (5%). The median time of recurrence was 25 months (range: 8-115). The concordance index for the Nomogram of Bendifallah and the Score of Ouldamer were 0.88 (IC 95% [0.78-0.98]) and 0.87 (IC 95% [0.77-0.96]) respectively. CONCLUSION This study from an independent population valids the Bendifallah nomogram and Ouldamer score for clinical use in predicting borderline ovarian recurrence.
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Affiliation(s)
- Prescilla Pais
- CHI Poissy-Saint-Germain, service de gynécologie et obstétrique, 10, rue du Champ-Gaillard, 78300 Poissy, France.
| | - Cyrille Huchon
- CHI Poissy-Saint-Germain, service de gynécologie et obstétrique, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-Saint-Quentin en Yvelines, EA 7285 risques cliniques et sécurité en santé des femmes, 55, avenue de Paris, 78000 Versailles, France
| | - Audrey Chevrot
- Centre René-Huguenin, service de chirurgie sénologique et gynécologique, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Julien Cohen
- Medistats, 10, rue de la Conception, 13004 Marseille, France
| | - Arnaud Fauconnier
- CHI Poissy-Saint-Germain, service de gynécologie et obstétrique, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-Saint-Quentin en Yvelines, EA 7285 risques cliniques et sécurité en santé des femmes, 55, avenue de Paris, 78000 Versailles, France
| | - Roman Rouzier
- Université Versailles-Saint-Quentin en Yvelines, EA 7285 risques cliniques et sécurité en santé des femmes, 55, avenue de Paris, 78000 Versailles, France; Centre René-Huguenin, service de chirurgie sénologique et gynécologique, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Myriam Mimouni
- CHI Poissy-Saint-Germain, service de gynécologie et obstétrique, 10, rue du Champ-Gaillard, 78300 Poissy, France; Institut national de recherche en agronomie (INRA), unité biologie du développement et reproduction, allée de Vilvert, 78352 Jouy-en-Josas, France
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Bilyk O, Coatham M, Jewer M, Postovit LM. Epithelial-to-Mesenchymal Transition in the Female Reproductive Tract: From Normal Functioning to Disease Pathology. Front Oncol 2017; 7:145. [PMID: 28725636 PMCID: PMC5497565 DOI: 10.3389/fonc.2017.00145] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022] Open
Abstract
Epithelial-to-mesenchymal transition (EMT) is a physiological process that is vital throughout the human lifespan. In addition to contributing to the development of various tissues within the growing embryo, EMT is also responsible for wound healing and tissue regeneration later in adulthood. In this review, we highlight the importance of EMT in the development and normal functioning of the female reproductive organs (the ovaries and the uterus) and describe how dysregulation of EMT can lead to pathological conditions, such as endometriosis, adenomyosis, and carcinogenesis. We also summarize the current literature relating to EMT in the context of ovarian and endometrial carcinomas, with a particular focus on how molecular mechanisms and the tumor microenvironment can govern cancer cell plasticity, therapy resistance, and metastasis.
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Affiliation(s)
- Olena Bilyk
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Mackenzie Coatham
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Michael Jewer
- Department of Oncology, University of Alberta, Edmonton, AB, Canada.,Department of Anatomy and Cell Biology, Western University, London, ON, Canada
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Oncologic and obstetric outcomes of conservative surgery for borderline ovarian tumors in women of reproductive age. Obstet Gynecol Sci 2017; 60:289-295. [PMID: 28534015 PMCID: PMC5439278 DOI: 10.5468/ogs.2017.60.3.289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/12/2016] [Accepted: 12/03/2016] [Indexed: 11/08/2022] Open
Abstract
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.
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81
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El-Balat A, Schmeil I, Karn T, Becker S, Sänger N, Holtrich U, Arsenic R. TFF3 Expression as Stratification Marker in Borderline Epithelial Tumors of the Ovary. Pathol Oncol Res 2017; 24:277-282. [PMID: 28470574 DOI: 10.1007/s12253-017-0240-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
Abstract
Borderline tumors (BOT) of the ovary account for 10% to 20% of ovarian neoplasms. Like ovarian cancer, BOT encompass several different histological subtypes (serous, mucinous, endometrioid, clear cell, transitional cell and mixed) with serous (SBOT) and mucinous (MBOT) the most common. Current hypotheses suggest low-grade serous carcinoma may develop in a stepwise fashion from SBOT whereas the majority of high grade serous carcinomas develop rapidly presumably from inclusion cysts or ovarian surface epithelium. The pathogenesis of mucinous ovarian tumors is still puzzling. Molecular markers could help to better define relationships between such entities. Trefoil factor-3 (TFF3) is an estrogen-regulated gene associated with prognosis in different types of cancer. It has also been included in a recent marker panel predicting subtypes of ovarian carcinoma. We analyzed the expression of TFF3 by immunohistochemistry in a cohort of 137 BOT and its association with histopathological features. Overall expression rate of TFF3 was 21.9%. None of the BOT with serous and endometrioid histology displayed strong TFF3 expression. On the other hand, TFF3 was highly expressed in 61.4% of MBOT cases and 33.3% of BOT with mixed histology (P < 0.001) suggesting a potential function of the protein in that subtypes. Associations of TFF3 expression with FIGO stage and micropapillary pattern were significant in the overall cohort but confounded by their correlation with histological subtypes. The highly specific expression of TFF3 in MBOT may help to further clarify potential relationships of tumors with mucinous histology and warrants further studies.
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Affiliation(s)
- Ahmed El-Balat
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Iryna Schmeil
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas Karn
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Sven Becker
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Nicole Sänger
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Uwe Holtrich
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ruza Arsenic
- Institute of Pathology, Charite University Hospital, Chariteplatz 1, 10117, Berlin, Germany
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82
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Gershenson DM. Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol 2017; 41:49-59. [DOI: 10.1016/j.bpobgyn.2016.09.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
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83
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Ouldamer L, Bendifallah S, Nikpayam M, Body G, Fritel X, Uzan C, Morice P, Daraï E, Ballester M. Improving the clinical management of women with borderline tumours: a recurrence risk scoring system from a French multicentre study. BJOG 2017; 124:937-944. [DOI: 10.1111/1471-0528.14577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2017] [Indexed: 12/12/2022]
Affiliation(s)
- L Ouldamer
- Department of Gynaecology; Centre Hospitalier Universitaire de Tours; Tours France
- INSERM U1069; Université François-Rabelais; Tours France
| | - S Bendifallah
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- UMR S 707; Epidemiology; Information Systems; Modelling; Université Pierre et Marie Curie; Paris France
| | - M Nikpayam
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- UMR S 707; Epidemiology; Information Systems; Modelling; Université Pierre et Marie Curie; Paris France
| | - G Body
- Department of Gynaecology; Centre Hospitalier Universitaire de Tours; Tours France
- INSERM U1069; Université François-Rabelais; Tours France
| | - X Fritel
- Department of Obstetrics and Gynaecology; Faculté de Médecine et Pharmacie; CHU de Poitiers; Université de Poitiers; Poitiers France
- INSERM CIC 1402; CHU de Poitiers; Poitiers France
| | - C Uzan
- Department of Gynaecological Surgery; Institut Gustave Roussy; Villejuif France
- INSERM U 10-30; Institut Gustave Roussy; Villejuif France
| | - P Morice
- Department of Gynaecological Surgery; Institut Gustave Roussy; Villejuif France
- INSERM U 10-30; Institut Gustave Roussy; Villejuif France
| | - E Daraï
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- INSERM UMR S 938; Université Pierre et Marie Curie; Paris France
| | - M Ballester
- Department of Obstetrics and Gynaecology; Hôpital Tenon; Paris France
- INSERM UMR S 938; Université Pierre et Marie Curie; Paris France
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84
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Chang C, Chen J, Chen WA, Ho SP, Liou WS, Chiang AJ. Assessing the risk of clinical and pathologic factors for relapse of borderline ovarian tumours. J OBSTET GYNAECOL 2016; 37:233-237. [PMID: 27922289 DOI: 10.1080/01443615.2016.1244810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to identify clinical and pathologic factors that are significant to relapse in borderline ovarian tumours (BOT). All patients with BOTs from 1997 to 2012 in our institute were identified. 115 patients were included in the study. The Cox proportional hazards model was used to identify significant factors. The median age was 42 years (range 14-85 years). The majority of the patients were at FIGO stage I (88.7%), and most of the patients had mucinous histology (66.1%), reflecting the predominant distribution of mucinous BOTs in East Asia. The median follow-up was 3.3 years (range 0-4.1 years). Twelve patients (10.4%) relapsed and two died consequently. Advanced stage, invasive implants and restaging surgery were significant factors of recurrence. Serous tumours had slightly higher risk than mucinous tumours, but the difference was not significant. As the study was performed in an area where mucinous BOTs are predominant, the results may complement current literature on BOT management.
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Affiliation(s)
- Chung Chang
- a Department of Applied Mathematics , National Sun Yat-sen University , Taiwan , ROC
| | - Jiabin Chen
- b Multidisciplinary Science Research Center , National Sun Yat-sen University , Taiwan , ROC
| | - Wei-An Chen
- a Department of Applied Mathematics , National Sun Yat-sen University , Taiwan , ROC
| | - Szu-Pei Ho
- c Department of Pathology and Laboratory Medicine , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan , ROC
| | - Wen Shiung Liou
- d Department of Obstetrics and Gynecology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan , ROC
| | - An Jen Chiang
- d Department of Obstetrics and Gynecology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan , ROC.,e Department of Biological Sciences , National Sun Yat-sen University , Kaohsiung , Taiwan , ROC.,f Department of Pharmacy and Graduate Institute of Pharmaceutical Technology , Ta-Jen University , Pingtung , Taiwan , ROC.,g Institute of Biomedical Sciences , National Sun Yat-Sen University , Kaohsiung , Taiwan , ROC
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85
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De Decker K, Speth S, Ter Brugge HG, Bart J, Massuger LFAG, Kleppe M, Kooreman LFS, Kruitwagen RFPM, Kruse AJ. Staging procedures in patients with mucinous borderline tumors of the ovary do not reveal peritoneal or omental disease. Gynecol Oncol 2016; 144:285-289. [PMID: 27889017 DOI: 10.1016/j.ygyno.2016.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/11/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Staging in case of a borderline tumor of the ovary (BOT) is a controversial issue. Upstaging is not uncommon, but this occurs especially with presumed stage I serous borderline tumors. There are only a few documented cases of BOTs of non-serous histology that were not confined to the ovary. The aim of this study was to assess the incidence of non-invasive and invasive implants in the omentum and other (extra)pelvic peritoneal surfaces in patients with a mucinous BOT (mBOT). METHODS A retrospective cohort study was performed in three hospitals in the Netherlands. All patients with a histopathological diagnosis of mBOT diagnosed from January 1st 1990 to December 1st 2015 were identified and included when the inclusion criteria were met. RESULTS In total, 74 patients were included. Of these 74 patients, 46 (62.2%) underwent a staging procedure. In 12 (26.1%) patients, only omental tissue was obtained, in 32 (69.6%) patients, omental tissue and peritoneal biopsies were obtained and in two (4.3%) patients, only peritoneal biopsies were obtained. No implants were seen upon microscopic examination in any of the patients. Two patients (3%) developed a recurrence. CONCLUSIONS Because no extra-ovarian disease was found, staging procedures in the case of an mBOT may be omitted. However, the actual perioperative decision for staging or not should be taken in the context of a frozen section diagnosis, which is not always accurate and straightforward. Recurrence with malignant disease is rare after mBOT. The value of post-treatment surveillance seems limited after bilateral salpingo-oophorectomy.
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Affiliation(s)
- Koen De Decker
- Isala Hospital, Department of Obstetrics and Gynecology, Zwolle, The Netherlands.
| | - Stephanie Speth
- Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands
| | - Henk G Ter Brugge
- Isala Hospital, Department of Obstetrics and Gynecology, Zwolle, The Netherlands
| | - Joost Bart
- Isala Hospital, Department of Pathology, Zwolle, The Netherlands
| | - Leon F A G Massuger
- Radboud University Nijmegen Medical Centre, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands
| | - Marjolein Kleppe
- Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands
| | - Loes F S Kooreman
- Maastricht University Medical Center, Department of Pathology, Maastricht, The Netherlands
| | - Roy F P M Kruitwagen
- Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arnold-Jan Kruse
- Isala Hospital, Department of Obstetrics and Gynecology, Zwolle, The Netherlands; Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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The Factors Predicting Recurrence in Patients With Serous Borderline Ovarian Tumor. Int J Gynecol Cancer 2016; 26:66-72. [PMID: 26512785 DOI: 10.1097/igc.0000000000000568] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In this study, we aimed to demonstrate the characteristics, recurrence rates, survival, and factors associated with survival of patients with serous borderline ovarian tumor (BOT) who were operated on in a single institution. Our secondary goal was to evaluate the necessity of staging surgery and the importance of a comprehensive lymphadenectomy in these patients. MATERIALS AND METHODS The patients who were diagnosed in our institution between January 1990 and April 2014 with a final diagnosis of serous BOT were evaluated retrospectively. Kaplan-Meier method was used for analysis of progression-free survival (PFS). Univariate Cox proportional hazards model and log rank test were used for analysis of continuous and categorical variables affecting survival, respectively. RESULTS One hundred twenty-one (75%) patients underwent staging surgery. Stage I disease was observed in 63%, stage III was observed in 11% of the patients, and only 0.6% of patients had stage II disease. Among 162 patients, 72 patients (44%) had conservative surgery. Eight (4.9%) patients had recurrence, one of which was invasive. All recurrences were in the patients who had conservative surgery. Median follow-up of the patients was 57 months (range, 37-270 years). Five- and 10-year PFS rates were 94.9% and 92.8%, respectively. In the univariate analysis of patients with serous BOT, PFS was worse in the presence of positive para-aortic lymph nodes, positive abdominal cytology, and conservative surgery (P = 0.008, P < 0.001, P = 0.007, respectively). The patients having noninvasive implant and advanced-stage disease had a tendency to have worse PFS (P = 0.067, P = 0.069, respectively). CONCLUSIONS Staging surgery generally gives us an idea of the probability of recurrence but not an idea of overall survival. Therefore, staging surgery including lymphadenectomy could be suggested to have information about the probability of recurrence and to be able to detect patients with an invasive implant that is the only probable factor affecting overall survival.
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87
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Virant-Klun I, Stimpfel M. Novel population of small tumour-initiating stem cells in the ovaries of women with borderline ovarian cancer. Sci Rep 2016; 6:34730. [PMID: 27703207 PMCID: PMC5050448 DOI: 10.1038/srep34730] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/15/2016] [Indexed: 12/12/2022] Open
Abstract
Small stem cells with diameters of up to 5 μm previously isolated from adult human ovaries indicated pluripotency and germinal lineage, especially primordial germ cells, and developed into primitive oocyte-like cells in vitro. Here, we show that a comparable population of small stem cells can be found in the ovarian tissue of women with borderline ovarian cancer, which, in contrast to small stem cells in "healthy" ovaries, formed spontaneous tumour-like structures and expressed some markers related to pluripotency and germinal lineage. The gene expression profile of these small putative cancer stem cells differed from similar cells sorted from "healthy" ovaries by 132 upregulated and 97 downregulated genes, including some important forkhead box and homeobox genes related to transcription regulation, developmental processes, embryogenesis, and ovarian cancer. These putative cancer stem cells are suggested to be a novel population of ovarian tumour-initiating cells in humans.
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Affiliation(s)
- Irma Virant-Klun
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Martin Stimpfel
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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88
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Abstract
ObjectivesThis study aimed to determine the overall survival (OS) and progression-free interval and the influence of fertility-preserving surgery (FPS) versus radical surgery (RS) in patients with serous borderline ovarian tumor (BOT).MethodsClinical parameters of patients with serous BOT treated between 1993 and 2013 in one institution were retrospectively investigated. All tumors were examined by one pathologist with experience in gynecological pathology.ResultsOne hundred thirty-two patients with serous BOT (inclusive 16 microinvasive) were analyzed (45% were ≤40 years), with a median follow-up of 6 years. Thirty-two percent (42/132) of the patients received FPS; 14% (18/132) relapsed (invasive or borderline). The 5-year progression-free survival was 89%. The risk of recurrence was higher in patients 40 years or younger (P = 0.019), after FPS (P = 0.002), in patients with a higher International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.016), for bilateral BOT (P = 0.0132), and for the micropapillary variant (P = 0.067). The OS at 5 years was 97%. There was no statistically significant difference in OS between FPS and RS [all (6 of 90) patients, except for 1, with RS died]. One patient died of relapsed BOT. Among the recurrences, low-grade invasive carcinoma was diagnosed in 4 patients. Three of these 4 patients were originally operated radically, 2 had a micropapillary variant FIGO stage III, and 1 had a papillary pattern FIGO stage II with microinvasion; all 3 had noninvasive implants and are alive. One patient with a micropapillary variant, FIGO stage IIIC with microinvasion and invasive implants, received FPS and died of disease.ConclusionsThe risk of recurrence is higher after FPS compared with RS; however, no influence on OS was observed. This was because most of the patients relapsed as BOT. Fertility preservation is justified in young patients with serous borderline tumors.
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89
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Fertility preservation in women with borderline ovarian tumours. Cancer Treat Rev 2016; 49:13-24. [DOI: 10.1016/j.ctrv.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/15/2022]
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Hayashi H, Taniguchi S, Kurihara S, Hachisuga K, Fukuda S, Inada C, Shimao Y, Marutsuka K, Shimamoto T. Pelvic recurrence of an ovarian seromucinous borderline tumor detected by vaginal cytology: A case report and review of the literature. Diagn Cytopathol 2016; 44:912-916. [PMID: 27381491 DOI: 10.1002/dc.23525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/15/2016] [Indexed: 11/11/2022]
Abstract
Seromucinous borderline tumors are typically confined to the ovaries and rarely relapse after surgery. We report the case of a woman with a seromucinous borderline tumor with peritoneal implant at the Douglas pouch, who was affected by a recurrent tumor at the vaginal stump 2 years and 6 months after the primary surgery. The recurrent lesion was detected by vaginal cytology. Histology of the recurrent lesion showed perineural infiltration, and progression to low-grade adenocarcinoma was suggested. After the second surgery, vaginal cytology showed that the tumor cells remained positive. At postoperative follow-ups of ovarian borderline tumors, an examination of the specific region where recurrence is likely to occur can contribute to the early detection of tumor relapse. Diagn. Cytopathol. 2016;44:912-916. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hironori Hayashi
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
| | - Shuichi Taniguchi
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
| | - Shuichi Kurihara
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan.
| | - Kazuhisa Hachisuga
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
| | - Saori Fukuda
- Department of Pathology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
| | - Chifumi Inada
- Department of Pathology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
| | - Yoshiya Shimao
- Department of Pathology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
| | - Kousuke Marutsuka
- Department of Pathology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
| | - Tomihiro Shimamoto
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Hospital, Kitatakamatsucho 5-30, Miyazaki, Miyazaki, 880-8510, Japan
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91
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Ouldamer L, Bendifallah S, Naoura I, Body G, Uzan C, Morice P, Ballester M, Daraï E. Nomogram to predict live birth rate after fertility-sparing surgery for borderline ovarian tumours. Hum Reprod 2016; 31:1732-7. [DOI: 10.1093/humrep/dew137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/19/2016] [Indexed: 12/23/2022] Open
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Karlsen NMS, Karlsen MA, Høgdall E, Nedergaard L, Christensen IJ, Høgdall C. Relapse and disease specific survival in 1143 Danish women diagnosed with borderline ovarian tumours (BOT). Gynecol Oncol 2016; 142:50-53. [PMID: 27168006 DOI: 10.1016/j.ygyno.2016.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the rate of relapse as well as disease-free, overall, and disease-specific survival in women with borderline ovarian tumour (BOT). Furthermore, the study aims to identify the clinical parameters correlated to relapse. METHODS National clinical data of women diagnosed with BOT from January 2005 to January 2013 constituted the basis for our study population. The prognostic influence of clinical variables was evaluated using univariate and multivariate analyses. RESULTS A total of 1143 women were eligible for analysis, with 87.9% in FIGO stage I and 12.1% in FIGO stages II-IV. Relapse of BOT was detected in 3.7%, hereof 40.5% with malignant transformation. The five-year disease-free survival was 97.6% in FIGO stage I and 87.3% in FIGO stages II-IV. Younger age, laparoscopic surgical approach, fertility sparing surgery, FIGO stages II-IV, bilateral tumour presence, serous histology, implants and microinvasion of the tumour were significantly associated with relapse in univariate analyses. The overall five-year survival rate was 92.2% in FIGO stage I and 89.0% in FIGO stages II-IV. Out of 77 deaths in total, only seven women died from BOT. CONCLUSIONS A general favourable prognosis in women with BOT was confirmed in our study. Our findings indicate that systematic, long-term follow-up does not seem necessary in women treated for FIGO stage IA BOT with no residual disease or microinvasion.
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Affiliation(s)
| | - Mona Aarenstrup Karlsen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark; Department of Gynecology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Estrid Høgdall
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Lotte Nedergaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ib Jarle Christensen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Claus Høgdall
- Department of Gynecology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Hermans AJ, Kluivers KB, Siebers AG, Wijnen MHWA, Bulten J, Massuger LFAG, Coppus SFPJ. The value of fine needle aspiration cytology diagnosis in ovarian masses in children and adolescents. Hum Reprod 2016; 31:1236-40. [PMID: 27067508 DOI: 10.1093/humrep/dew072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/07/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is ovarian cytology a reliable predictor for a malignant ovarian mass? SUMMARY ANSWER Cytology of an ovarian mass in children and adolescents cannot be used to exclude malignancy. WHAT IS KNOWN ALREADY It is hard to predict malignancy in case of an ovarian mass in a child or adolescent. The most common reason to perform fine needle aspiration cytology (FNAC) is to exclude malignancy. Ovarian cytology has shown varying results in adults, but test performance in a younger population is unknown. STUDY DESIGN, SIZE, DURATION This was a retrospective diagnostic test accuracy study. We used a nationwide registry, the PALGA database, to select girls aged 18 or younger with matching ovarian cytology and histology reports available between 1990 and 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Histology diagnoses were classified according to the WHO classification of ovarian pathology. Cytology diagnoses were classified as benign, borderline malignant or malignant. Cases with inconclusive cytology diagnoses were excluded from the analysis of diagnostic accuracy. Diagnostic accuracy was calculated using a 2 × 2 table. MAIN RESULTS AND THE ROLE OF CHANCE Included were 552 girls under the age of 18 who had a cytology and a histology report of the same ovary available in the PALGA database. In 523 (94.7%) patients the mass was benign; 19 (3.4%) patients had a borderline malignancy and 9 (1.7%) patients had a malignant tumour. The histology diagnosis was unknown in one patient due to torsion of the ovary. Cytological diagnosis was inconclusive in 96 patients (17.4%). Cytology had a sensitivity of 32.0% and a specificity of 99.8%. Post-test probability of malignancy with positive cytology was 88.9%; the post-test probability of a malignancy with negative cytology was 3.8%, compared with a pre-test probability of 5.5%. LIMITATIONS, REASONS FOR CAUTION This study was retrospective, using data gathered over 24 years. Cytology was retrieved during surgery or at the pathology department in 86.6% of the cases and pathologists were not blinded, which can be a cause for bias. WIDER IMPLICATIONS OF THE FINDINGS Since the sensitivity is low, FNAC is not a recommended diagnostic tool in children. The post-test probability of a negative test compared with the incidence in our population resulted in a minimal difference not worth an invasive procedure. STUDY FUNDING/COMPETING INTERESTS No study funding was received and no competing interests are present. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- A J Hermans
- Department of Obstetrics & Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| | - K B Kluivers
- Department of Obstetrics & Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| | - A G Siebers
- Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands
| | - M H W A Wijnen
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - J Bulten
- Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands
| | - L F A G Massuger
- Department of Obstetrics & Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| | - S F P J Coppus
- Department of Obstetrics & Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
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94
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Outcome of patients with advanced-stage borderline ovarian tumors after a first peritoneal noninvasive recurrence: impact on further management. Int J Gynecol Cancer 2016; 25:830-6. [PMID: 25828751 DOI: 10.1097/igc.0000000000000437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aims of this study were to report the outcome of patients with advanced-stage serous borderline ovarian tumors (SBOT) after a first noninvasive recurrence and the impact of conservative treatment in that context and to define the best management for those patients. STUDY DESIGN From 1973 to 2006, 168 patients were treated at or referred to our institution for an SBOT with peritoneal implants. Their slides were reviewed by the same expert pathologist. Selection criteria were as follows: advanced stage (International Federation of Gynecology and Obstetrics ≥ II), with at least 1 recurrence (only noninvasive ones) and more than 5 years of follow-up. RESULTS Twenty patients met the inclusion criteria. The median duration of follow-up was 12 years (range, 6-23 years). Median age was 26 years (14-61 years). Initial surgical management was conservative for 14 patients and radical for 6. In the study population, 4 patients recurred, all with invasive disease. Time to invasive recurrence was at least 3 years for 3 of 4 patients. None of those 4 patients had a second-look surgery initially or after the first recurrence. Two patients had small-sized residual disease after initial management; only 1 of these 4 patients is currently alive and disease-free. There was no significant difference between conservative and radical treatment of the risk of second recurrence. CONCLUSIONS This study emphasizes the need for a long follow-up after recurrence of advanced-stage SBOT and the risk of a new invasive recurrence after a first noninvasive peritoneal recurrence. Conservative treatment does not seem as a risk factor and is still justified after a first noninvasive recurrence for young patients who desire to preserve fertility.
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95
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Shim SH, Kim SN, Jung PS, Dong M, Kim JE, Lee SJ. Impact of surgical staging on prognosis in patients with borderline ovarian tumours: A meta-analysis. Eur J Cancer 2016; 54:84-95. [DOI: 10.1016/j.ejca.2015.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/21/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
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96
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Lee SH, Kim TH, Lee HH, Lee A, Kim YS, Jeon DS, Kwak JJ, Yang YS. Mucinous Borderline Ovarian Tumor in Very Old Aged Postmenopausal Woman. J Menopausal Med 2016; 21:160-4. [PMID: 26793682 PMCID: PMC4719091 DOI: 10.6118/jmm.2015.21.3.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/25/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
Abstract
Mucinous borderline ovarian tumors (BOTs) occur most often in women between the ages of 20 and 30. Early-stage detection of the condition has a more favorable prognosis. In this case report, the authors present an elderly 93-year old woman who visited our hospital due to severe abdominal pain after being diagnosed with a pelvic mass 2 years ago and not undergoing any treatment since the diagnosis was made. She underwent emergency left salpingo-oophorectomy and was diagnosed with mucinous BOT according to biopsy results.
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Affiliation(s)
- Seung-Hee Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hae-Hyeog Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Arum Lee
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University, Asan, Korea
| | - Yeon-Suk Kim
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University, Asan, Korea
| | - Dong-Su Jeon
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jeong Ja Kwak
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yo-Sep Yang
- Department of Medicine, Soonchunhyang University, Asan, Korea
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97
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Vasconcelos I, Darb-Esfahani S, Sehouli J. Serous and mucinous borderline ovarian tumours: differences in clinical presentation, high-risk histopathological features, and lethal recurrence rates. BJOG 2015; 123:498-508. [PMID: 26705090 DOI: 10.1111/1471-0528.13840] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mucinous and serous borderline ovarian tumours (mBOTs and sBOTs) are controversial diseases. OBJECTIVES With this systematic review we aim to evaluate the different high-risk histopathological features and recurrence rates. SEARCH STRATEGY The PubMed database was searched using two terms: {serous AND [(borderline) OR (low malignant potential)] AND ovarian AND tumour} and {mucinous AND [(borderline) OR (low malignant potential)] AND ovarian AND tumour}. SELECTION CRITERIA Cohorts of either sBOT or mBOT, peer-reviewed, retrospective, or prospective. DATA COLLECTION AND ANALYSIS Lethal recurrence data for micropapillary patterns (MPs), microinvasion, non-invasive and invasive implants, and intraepithelial carcinoma (IECA). The primary measure of effect was the odds ratio of lethal recurrence reduction. RESULTS Data from patients in 42 studies including 4414 sBOTs and 12 studies including 894 mBOTs were pooled. Of these, 53.3% presented early-stage typical sBOTs, 24.4% presented with MPs, 22.3% presented with microinvasion, 34.4% presented with non-invasive implants, and 7.3% presented with invasive implants. The pooled lethal recurrence rates were, respectively: 18.3, 16.8, 10.7, 16.2, and 33.8%. Patients with MPs were more likely to suffer lethal recurrence when compared with high-stage sBOTs (odds ratio, OR 0.501; P = 0.003), whereas the trend in microinvasive sBOTs did not reach statistical significance. Regarding mBOTs, 61.6% presented with early-stage typical mBOTs, 19.6% presented with microinvasion, 34.8% presented with IECA, and six patients presented with non-invasive implants; none presented with invasive implants. The lethal recurrence rates were, respectively: 3.6, 0, 3.7, and 0%. CONCLUSION Micropapillary patterns (MPs) showed a higher risk for lethal recurrence when compared with high-stage sBOTs. Regarding mBOTs, IECA and microinvasion do not play a role in the lethal recurrence rate. TWEETABLE ABSTRACT Micropapillary pattern confirmed as high-risk in BOT. IECA and microinvasion don't play a role in mucinous BOT.
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Affiliation(s)
- I Vasconcelos
- Department of Gynaecology, Charité Medical University of Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - S Darb-Esfahani
- Department of Pathology, Charité Medical University of Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - J Sehouli
- Department of Gynaecology, Charité Medical University of Berlin, Campus Virchow Klinikum, Berlin, Germany
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98
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Seckin KD, Karslı MF, Yucel B, Bestel M, Yıldırım D, Canaz E, Akbayır O. The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor. Eur J Obstet Gynecol Reprod Biol 2015; 196:60-3. [PMID: 26683535 DOI: 10.1016/j.ejogrb.2015.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/12/2015] [Accepted: 10/28/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the utility of tumor markers and complete blood count to increase the diagnostic accuracy to detect malignant cases that are intraoperatively reported as mucinous borderline ovarian tumors (BOT). STUDY DESIGN Patients who underwent laparotomy at our gynecologic oncology clinic between 2007 and 2015 for evaluation of an adnexal mass with an intraoperative frozen section report of mucinous BOT were retrospectively analyzed. Patients were grouped according to the final pathological diagnoses (malignant, borderline and benign), and were compared in terms of tumor marker levels and complete blood count parameters. Significant parameters were evaluated together with frozen section results, and were assessed for diagnostic accuracy. RESULTS A total of 63 patients were included in the study. Of these, 41 patients had borderline, 11 patients had benign, and 11 patients had malignant mucinous ovarian tumors. Patient age, menopausal status, hemoglobin, platelet and lymphocyte counts were similar among the groups (p>0.05). On the other hand, white blood cell, neutrophil counts and neutrophil/lymphocyte ratio (NLR) were significantly higher in malignant cases (p<0.05). Similarly, CA125 and CA19-9 were significantly higher in malignant group (p<0.05). When evaluated with the frozen section results, CA19-9 and NLR had the highest sensitivity to detect mucinous cancers (81 and 78 percent, respectively). CONCLUSIONS In patients who have an intraoperative frozen section diagnosis of borderline mucinous ovarian tumors, CA19-9, NLR and CA125 were significant predictors of malignancy. In light of larger future studies, we believe that integrating these parameters into routine clinical practice may decrease the rate of under diagnosis.
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Affiliation(s)
- Kerem Doga Seckin
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Fatih Karslı
- Obstetrics and Gynecology Department, Sami Ulus Women and Children Health Training and Research Hospital, Ankara, Turkey
| | - Burak Yucel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Melih Bestel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Dogukan Yıldırım
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Emel Canaz
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Akbayır
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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99
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Ouldamer L, Lacoste C, Cormier B, Arbion F, Marret H, Jallais L, Fignon A, Body G. Is there a justification for hysterectomy in patients with borderline ovarian tumors? Surg Oncol 2015; 25:1-5. [PMID: 26979634 DOI: 10.1016/j.suronc.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/18/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the frequency of uterine involvement in patients with borderline ovarian tumors (BOT) and to evaluate the recurrence risk and survival after hysterectomy. MATERIALS AND METHODS In two French hospitals: A tertiary referral centre (University hospital centre of Tours, France) and the Alliance community hospital of Tours (France), we reviewed data of consecutive women undergoing surgery for presumed stage I BOT between January 1997 and December 2012. Patients were divided into two groups: patients treated with fertility sparing surgery (group 1) and those treated with radical surgery (group 2). RESULTS A total of 135 patients were evaluated. 35 had fertility sparing surgery, 81 had radical surgery with hysterectomy and 19 had previous hysterectomy for other reasons. There were more recurrent borderline ovarian disease and more ovarian invasive disease developed in group 1 (p = 0.02, p = 0.04, respectively). Hysterectomy affected favorably borderline disease-free survival, OR = 0.09 95%CI (0.005-0.69), p = 0.04, but perceived benefits may be related to bilateral salpingo-oophorectomy and not hysterectomy directly.
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Affiliation(s)
- L Ouldamer
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; INSERM Unit 1069, Tours, France; François-Rabelais University, Tours, France.
| | - C Lacoste
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François-Rabelais University, Tours, France
| | - B Cormier
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - F Arbion
- Department of Pathology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France
| | - H Marret
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François-Rabelais University, Tours, France
| | - L Jallais
- Department of Pathology, Clinique de l'Alliance, 1 boulevard Alfred Nobel, 37540, St-Cyr-sur-Loire, France
| | - A Fignon
- Department of Gynecology, Clinique de l'Alliance, 1 boulevard Alfred Nobel, 37540, St-Cyr-sur-Loire, France
| | - G Body
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours, France; François-Rabelais University, Tours, France
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100
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El-Balat A, Arsenic R, Sänger N, Karn T, Becker S, Holtrich U, Engels K. Fascin-1 expression as stratification marker in borderline epithelial tumours of the ovary. J Clin Pathol 2015; 69:142-8. [PMID: 26362828 DOI: 10.1136/jclinpath-2015-203224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/29/2015] [Indexed: 02/02/2023]
Abstract
AIMS To evaluate the actin-bundling protein fascin-1 (FSCN1) as marker for borderline ovarian tumours (BOTs). METHODS We analysed a retrospective cohort of 140 BOTs with validated diagnosis by an independent pathologist. Immunohistochemical detection of FSCN1 was quantified as combined immunoreactive score (CIS) blinded to clinical patient data. Analyses were first performed for FSCN1 positive versus negative, and then verified using three categories derived from the observed distribution (negative, weak, strong; CIS 0, 1-2, 3-9). RESULTS We detected FSCN1 positivity in 51.4%, and strong expression (CIS 3-9) in 14.3% of the samples. FSCN1 positivity was associated with serous subtype (p<0.001) and micropapillary pattern (p<0.001). Correlation with micropapillary pattern remained significant within the serous BOT (SBOT) subgroup (p=0.022). Strong FSCN1 expression (CIS 3-9) was associated both with the presence of implants (p=0.022), and a higher International Federation of Gynecology and Obstetrics (FIGO) stage (p=0.020). CONCLUSIONS Our analysis links FSCN1 with SBOT with micropapillary pattern. Strong expression is associated with higher FIGO stage and the presence of implants, both related to elevated risk of recurrence. Hence, FSCN1 is an interesting marker worth further analyses of its prognostic value in BOTs.
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Affiliation(s)
- Ahmed El-Balat
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt, Germany
| | - Ruza Arsenic
- Institute of Pathology, Charité University Hospital, Berlin, Germany
| | - Nicole Sänger
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Karn
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt, Germany
| | - Sven Becker
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt, Germany
| | - Uwe Holtrich
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt, Germany
| | - Knut Engels
- Center for Pathology, Cytology and Molecular Pathology, Neuss, Germany
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