Borderline ovarian tumors

Ovulation induction drug and ovarian cancer: an updated systematic review and meta-analysis

OBJECTIVE

To explore the association between ovulation induction drugs and ovarian cancer.

DESIGN

Systematic review and meta-analysis.

SETTING

Not applicable.

PATIENT(S)

Women without ovarian cancer who ever or never underwent ovarian induction.

INTERVENTION(S)

An extensive electronic search of the following databases was performed: PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library and CNKI, from inception until January 2022. A total of 34 studies fulfilled our inclusion criteria and were included in the final meta-analysis. The odds ratio (OR) and random-effects model were used to estimate the pooled effects. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Funnel plots and Egger tests were used to assess publication bias.

MAIN OUTCOMES

New diagnosed borderline ovarian tumor (BOT) and invasive ovarian cancer (IOC) between ovulation induction (OI) group and control (CT) group considering fertility outcome, OI cycles and specific OI drugs.

RESULTS

Primarily, there was no significant difference in the incidence of IOC and BOT between the OI and CT groups. Secondly, OI treatment did not increase the risk of IOC and BOT in the multiparous women, nor did it increase the risk of IOC in the nulliparous women. However, the risk of BOT appeared to be higher in nulliparous women treated with OI treatment. Thirdly, among women exposed to OI, the risk of IOC and BOT was higher in nulliparous women than in multiparous women. Fourthly, the risk of IOC did not increase with increasing OI cycles. Lastly, exposure to specific OI drugs also did not contribute to the risk of IOC and BOT.

CONCLUSION

Overall, OI treatment did not increase the risk of IOC and BOT in most women, regardless of OI drug type and OI cycle. However, nulliparous women treated with OI showed a higher risk of ovarian cancer, necessitating their rigorous monitoring and ongoing follow-up.

Characteristics Patients with Borderline Ovarian Tumor at Sanglah General Hospital: From Pre- to Post-operative Approach

BACKGROUND: Specific epidemiology data of borderline ovarian tumor (BOT) might be beneficial for the early diagnosis of BOT. The scarcity of BOT epidemiological data in Indonesia urged the writer to study further. AIM: The objectives of the study were to obtain the characteristics of BOT patients in Sanglah General Hospital between 2018 and 2019 according to sociodemographic, hormonal, clinical, and patient outcome factors. METHODOLOGY: This is a descriptive retrospective study. Data were obtained from patient’s medical records at medical records installation Sanglah General Hospital between March 2020 and July 2020. Descriptive data collected from medical records were analyzed using Microsoft Excel 2010 and presented in tables and narrative form. RESULTS: From sociodemographic factors, we found that majority of BOT patients were >40 years old, multiparous women, married, low educated, housewives, and had normal BMI. From hormonal factors, we found that experienced menarche between 11 and 15 years old, most of the patients were already menopause, did not use any contraception. From clinical factors, we found that many were referral cases, with abdominal pain as the main complaint, varied CA 125 and risk of malignancy index levels, unilateral mass, suspected with malignant ovarian cyst when being diagnosed earlier. From patient outcome factors, we found that the majority underwent definitive surgery with no post-operative CA 125 level, no malignant cells on cytology examination, borderline mucinous type in both frozen section and paraffin block examination, and followed up after surgery. CONCLUSIONS: Clinicians could use these characteristics as a reference in diagnosing a patient who fits the profile.

The Diagnosis, Treatment, Prognosis and Molecular Pathology of Borderline Ovarian Tumors: Current Status and Perspectives

Borderline ovarian tumors (BOTs) are a type of low malignant potential tumor that is typically associated with better outcomes than ovarian cancer. Indeed, its 10-year survival rate is as high as 95%. However, there is a small subset of patients who experience relapse and eventually die. It has been shown that the prognosis of BOTs was based on pathological diagnosis, the age at diagnosis, pre-operative carbohydrate antigen 125 level, invasive implants, and micropapillary patterns. Now the molecular-targeted therapy and molecular-genetic diagnosis have developed into a form of precision medicine. Recent studies on extensive molecular characterizations and molecular pathological mechanisms of BOTs have helped us understand the genomic landscapes of BOTs, and therefore BOTs could be reclassified into biologically and clinically more accurate and effective subtypes. The purpose of this review is to summarize current status for the diagnosis and treatment of BOTs and to describe the research progress on molecular pathologies, with a goal of providing a theoretical perspective for the diagnosis and treatment of BOTs.

Treatment strategy for pediatric giant mucinous cystadenoma: A case report

Because of their rarity, the treatment strategy for pediatric ovarian epithelial tumors is controversial, especially for a giant cystadenoma. We report the largest mucinous cystadenoma (MCA) case in the pediatric literature thus far. A 12-year-old girl had abdominal distention and visited our hospital. She had a multilocular cyst with some protuberance on the inside and high values of CA 19-9 and CA-125. We diagnosed her with a left MCA and performed a left oophorectomy. The tumor was the stage IA borderline malignant MCA and weighed 11.8 kg. Five years have passed, the patient has not experienced recurrence or metastasis. The resection of giant tumors can affect respiration and circulation. However, pre- or intra-operative drainage may lead to dissemination and adhesion. When we treat pediatric giant ovarian epithelial tumors, we must understand the findings that suggest the possibility of malignancy to decide appropriately as to whether drainage should be performed.

Borderline Ovarian Tumors: Fifteen Years' Experience at a Scottish Tertiary Cancer Center

OBJECTIVES

Since the recognition of borderline ovarian tumors (BOTs) in the 1970s, the management of this subset of epithelial ovarian tumors has presented a challenge to clinicians. The majority present at an early stage, but their diagnosis is often only made following surgery, hence the heterogeneity of surgical management. Borderline ovarian tumors are morphologically diverse, and their behavior is subsequently also heterogeneous. We aimed to assess recurrence rates and the rate of malignant transformation in patients diagnosed with BOT. Secondary objectives included a review of current management and assessment of tumor markers, stage, cyst dimensions, and the presence of micropapillary features as prognostic indicators of recurrence.

METHODS

This retrospective cohort study included all patients treated with BOT between 2000 and 2015 in the southeast region of Scotland. Clinical, surgicopathological, and follow-up data were collated. Data were analyzed with reference to recurrence and malignant transformation.

RESULTS

Two hundred seventy-five patients underwent treatment for BOT in the study period. Surgical management was highly variable. A diagnosis of recurrent/persistent BOT or ovarian malignancy following initial treatment of BOT was rare, with only 12 (4%) of 275 cases. There were 7 cases (3%) of ovarian malignancy. Advanced International Federation of Gynecology and Obstetrics stage was the most prominent prognostic factor. Elevated preoperative serum CA-125 and the presence of micropapillary features correlated with advanced stage at presentation. With a lack of clear guidance, follow-up was highly variable with a median of 43 months (0-136 months).

CONCLUSIONS

To our knowledge, this study is the largest BOT cohort in the United Kingdom. Recurrent disease is rare in optimally staged, completely resected, early-stage BOT, without high-risk features. Caution is needed in women electing not to undergo completion staging after diagnosis and in those opting for a fertility-preserving approach. Thorough informed consent and clear plans for surveillance and follow-up are needed with consideration of delayed completion surgery as appropriate.

An Unusual Ovarian Mucinous Borderline Tumor with a Large Solid Component

Herein, we report magnetic resonance imaging (MRI) findings of a mucinous borderline tumor of the ovary, which we observed as a mainly solid tumor with large solid components in the lower pelvic cavity. The appearance of ovarian epithelial tumors on imaging is often complex. Cystic to solid appearing masses may be observed, and they often resemble epithelial carcinoma. Due to mucinous or hemorrhage components of packed small or microcystic components, MRI depicts slightly high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Mucinous borderline tumor of the ovary with a large solid component is very rare, but it is clinically important to recognize the possibility of mucinous borderline tumor to avoid unnecessary surgical intervention.

Metabonomic analysis of ovarian tumour cyst fluid by proton nuclear magnetic resonance spectroscopy

The majority of ovarian tumours are of the epithelial type, which can be sub classified as benign, borderline or malignant. Epithelial tumours usually have cystic spaces filled with cyst fluid, the metabolic profile of which reflects the metabolic activity of the tumour cells, due to their close proximity. The approach of metabonomics using 1H-NMR spectroscopy was employed to characterize the metabolic profiles of ovarian cyst fluid samples (n = 23) from benign, borderline and malignant ovarian tumours in order to shed more light into ovarian tumour and cancer development. The analysis revealed that citrate was elevated in benign versus malignant tumours, while the amino acid lysine was elevated in malignant versus non-malignant tumours, both at a 5% significance level. Choline and lactate also had progressively increasing levels from benign to borderline to malignant samples. Finally, hypoxanthine was detected exclusively in a sub-cohort of the malignant tumours. This metabonomic study demonstrates that ovarian cyst fluid samples have potential to be used to distinguish between the different types of ovarian epithelial tumours. Furthermore, the respective metabolic profiles contain mechanistic information which could help identify biomarkers and therapeutic targets for ovarian tumours.

Mucinous tumors of the ovary: current thoughts on diagnosis and management

Mucinous tumors of the ovary represent a spectrum of neoplastic disorders, including benign mucinous cystadenoma, pseudomyxoma peritonei, mucinous tumors of low malignant potential (borderline), and invasive mucinous ovarian carcinoma. These tumors are related closely to each other and are distinct from other histologic subtypes of epithelial ovarian neoplasms from a clinical, histologic, and molecular standpoint. A continuum appears to be present from benign to borderline to malignant, which is different from other types of epithelial ovarian cancer. Mutational profiles are also distinct, as KRAS mutations are common, but p53 and BRCA mutations are infrequent. These characteristics lead to specific biologic behavior and guide both clinical management and research efforts in patients with mucinous ovarian tumors.

BRCA1 promoter hypermethylation and protein expression in ovarian carcinoma--an Indian study

Mounting evidences suggest that aberrant methylation of CpG islands is a major pathway leading to the inactivation of tumour suppressor genes and the development of cancer. The aim of the current study was to examine the prevalence of the promoter hypermethylation and protein expression of the BRCA1 gene in epithelial ovarian carcinoma (EOC) to understand the role of epigenetic silencing in ovarian carcinogenesis. We studied the promoter methylation of the BRCA1 gene by methylation-specific PCR in a cohort of 88 patients with EOC, 14 low malignant potential (LMP) tumours and 20 patients with benign tumours of the ovary. The expression of the BRCA1 protein by immunohistochemical analysis was carried out in a subset of 64 EOCs, 10 LMP tumours, 10 benign tumours and 5 normal ovarian tissues. The frequencies of methylation in EOCs and LMP tumours were 51.2 and 57%, respectively, significantly higher (p = 0.000 and p = 0.001) in comparison to benign tumours and normal ovarian tissue where no methylation was seen. Expression of BRCA1 was significantly lower in EOCs (p = 0.003). Lack of protein expression correlated with tumour grade and type. The methylation status correlated well with downregulation of BRCA1 expression. Our results clearly demonstrate that hypermethylation of BRCA1 promoter is a frequent event in ovarian cancer. These data support the hypothesis that BRCA1 promoter methylation plays an important role in the functional inactivation of BRCA1. Follow-up clinical data will reveal the impact of BRCA1 methylation on survival.

Ovarian borderline tumors in pre-menarche girls

By reason of a new case of an ovarian mucinous borderline tumor (BOT) in a pre-menarche girl, a research of current literature was implemented. Low-grade malignant epithelial tumors are extremely rare in young children and, as far as we know, only a few case reports exist. The patients presented with vomiting, pain, and a swollen lower abdomen. Pre-operative diagnosis primarily consists of imaging techniques. At Stage Ia, the tumor is confined to the ovary without penetration of the capsule, no malignant ascites or peritoneal implants. Treatment consists of removal of the tumor combined with concurrent salpingo oophorectomy, appendectomy, omentectomy, and peritoneal lavage. Although the treatment recommendations are not uniform, basically, preservation of fertility is the main objective. The prognosis is very good, but recurrence is possible even after 10 years.

Imaging strategy for early ovarian cancer: characterization of adnexal masses with conventional and advanced imaging techniques

Early detection of ovarian cancer remains crucial for improving patient survival rates. However, early-stage disease is often asymptomatic, and population screening is currently unproven. Adnexal masses may be incidentally detected, but most are identified at ultrasonography (US) in patients who are symptomatic, and most may be characterized as benign or malignant. Indices are available to estimate the risk of malignancy on the basis of clinical and US findings. However, adnexal masses remain indeterminate in some cases, with some benign lesions demonstrating features of malignancy at US. In these cases, use of magnetic resonance (MR) imaging improves the ability to characterize adnexal masses and reduces the number of indeterminate lesions. Establishing the likelihood of malignancy on the basis of imaging features is important to the preoperative detection of early ovarian cancer and profoundly influences referral and management pathways. Conventional and contrast material-enhanced MR imaging are used to evaluate morphologic features, including lesion complexity, signal intensity, and enhancement of solid areas. At dynamic contrast-enhanced MR imaging with semiquantitative analysis, early enhancement characteristics may help differentiate some complex benign and malignant lesions. Diffusion-weighted imaging has a limited but useful role in evaluating adnexal masses: Those with a hypointense solid area on both diffusion-weighted (b = 1000 sec/mm²) and T2-weighted images are likely benign, whereas those that are hyperintense on diffusion-weighted images (b = 1000 sec/mm²) with intermediate signal intensity on T2-weighted images are likely malignant.

Aberrant promoter methylation of the RASSF1A and APC genes in epithelial ovarian carcinoma development

PURPOSE

Tumor suppressor gene (TSG) silencing through promoter hypermethylation plays an important role in cancer development. The aim of this study was to assess the extent of methylation of the RASSF1A and APC TSG promoters in ovarian epithelial adenomas, low malignant potential tumours and carcinomas in order to reveal a role for epigenetic TSG silencing in the development of these ovarian malignancies.

METHOD

The promoter methylation status of the RASSF1A and APC genes was assessed in 19 benign cystadenomas, 14 low malignant potential (LMP) tumours, and 86 carcinomas using methylation specific PCR (MSP).

RESULTS

The methylation frequencies of the RASSF1A and APC gene promoters in benign cystadenomas were found to be 37 % and 16 %, respectively. The LMP tumours exhibited RASSF1A and APC gene promoter methylation frequencies of 50 % and 28 %, respectively, whereas the carcinomas exhibited methylation frequencies of 58 % and 29 %, respectively. Methylation of either the RASSF1A or the APC gene promoter was encountered in 58 % of the invasive carcinomas.

CONCLUSION

The observed aberrant methylation frequencies of the RASSF1A and APC gene promoters indicate that an accumulation of epigenetic events at these specific TSG promoters may be associated with the malignant transformation of benign cystadenomas and LMP tumours to carcinomas.

Laparoscopic resection of massive ovarian mucinous cystadenoma

Benign mucinous cystadenoma of the ovary is extremely rare in children and adolescents. Because of the benign, slow-growing nature, they can be extremely large at the point of presentation. These large abdominal tumors present a challenging opportunity for the application of minimally invasive techniques. The authors present a case of an extraordinarily large childhood mucinous cystadenoma removed laparoscopically.

Ovarian mucinous cystadenoma of borderline malignancy in a premenarchal girl

Ovarian mucinous cystadenomas are benign epithelial neoplasms that occur most often in the third to sixth decade of life. Ovarian mucinous cystadenoma can be classified into 3 categories (benign, borderline malignancy, malignancy) based on histopathologic evaluation. Premenarchal cases of ovarian mucinous cystadenoma of borderline malignancy are exceedingly rare. To the best of our knowledge, there have been only 4 reported cases of borderline ovarian mucinous cystadenoma prior to 2009. Here we report a 13-year-old premenarchal girl with a giant mass occupying almost the whole of the abdomino-pelvic cavity.

Association of Reproductive Factors, Oral Contraceptive Use and Selected Lifestyle Factors with the Risk of Ovarian Borderline Tumors: A Danish Case-control Study

OBJECTIVE

The aim was to examine risk factors for ovarian borderline tumors overall, and according to histological subtype (serous vs. mucinous), in a large Danish population-based case-control study.

METHODS

Ovarian borderline cases and controls were recruited from 1995 to 1999, and personal interviews were conducted. In all, 202 cases and 1,564 randomly selected controls were included. The analysis was performed using multiple logistic regression models.

RESULTS

The risk of ovarian borderline disease decreased with increasing parity (OR=0.79 per birth, 95% CI: 0.63-0.98) and older age at first birth (OR=0.67 per 5 years, 95% CI: 0.53-0.84). Both a history of breastfeeding and use of oral contraceptives reduced the risk of borderline tumor, the effect being most pronounced for serous tumors. Increasing body mass index (BMI) was associated with elevated risk of serous borderline tumor (OR=1.05 per BMI unit; 95% CI: 1.00-1.10), whereas current smoking was a strong risk factor only for mucinous tumors (OR=2.10; 95% CI: 1.22-3.60). Finally, increasing consumption of milk (all types) was found to increase the risk of borderline disease (OR=1.04 per glass milk per week; 95% CI: 1.02-1.06), and increasing intake of total lactose also increased the risk significantly (OR=1.16 per 50 gram lactose per week; 95% CI: 1.06-1.26).

CONCLUSION

The risk profile of ovarian borderline tumors is similar to that of ovarian carcinomas, and we observed significant etiological differences between serous and mucinous borderline tumors.

Genetic alterations of serous borderline tumors of the ovary compared to stage I serous ovarian carcinomas

Borderline tumors of the ovary comprise 10-20% of all epithelial ovarian tumors, and are placed between clearly benign and obviously malignant ovarian tumors. The issue of whether borderline tumors are precursors of invasive carcinoma or distinct clinical entities, however, is still the subject of discussion. To increase our understanding in relation to this issue, the aim of our study was to analyze both serous borderline and invasive ovarian tumors, and to investigate early carcinogenesis in serous ovarian tumors. Using comparative genomic hybridization, we compared cytogenetic changes in borderline ovarian tumors and stage I invasive tumors. The average number of genetic alterations differed significantly between the borderline and the invasive tumors (1.9 and 9.2, respectively). The most common genetic alterations among the borderline tumors were loss of chromosome 17, 20q, and 18p, and gain of 12p13 approximately q23. These changes were also found among the invasive tumors in a similar percentage. In conclusion, we found four distinct cytogenetic alterations that might be early events in serous ovarian tumors, and that might also characterize a subgroup of borderline ovarian tumors that may have the potential to progress and develop malignancy.

Biochemistry and clinical role of trypsinogens and pancreatic secretory trypsin inhibitor

Trypsinogens and PSTI/TATI/SPINK1 are expressed, usually together, at high levels by the pancreas but also by many other normal and malignant tissues. The present review describes studies on the expression and putative functions of trypsinogens and PSTI/TATI/SPINK1 in the human body. The clinical aspects are discussed, including the correlations between expression of trypsinogens and PSTI/TATI/SPINK1 in tissues, serum, and urine of patients with pancreatitis or cancer and clinicopathological characteristics, i.e., the roles of trypsinogens and PSTI/TATI/SPINK1 in spontaneous and hereditary pancreatitis, tumor progression, and prognosis.

Faisabilité et limites du traitement cœlioscopique des tumeurs frontières de l'ovaire

Borderline ovarian tumours (BOT) are mainly diagnosed in young women with early stage disease. Due to the absence of specific pre operative criteria for BOT, a laparoscopy is usually performed. A review of the literature found no pejorative data on laparoscopic approach for BOT. Strict surgical procedures must be performed to avoid incomplete surgical staging, cells dissemination and port-site metastases. The limits of the laparoscopic management are the stage of disease and the tumour size. Laparoscopic treatment of BOT for women with early stage disease is feasible. This treatment should be evaluated in specialized centres for women with advanced stage diseases and/or peritoneal implants.

Promoter hypermethylation profile of ovarian epithelial neoplasms

PURPOSE

Ovarian carcinomas are believed to arise de novo from surface epithelium, but the actual molecular pathogenesis is unknown. The aim of this study was to compare the promoter hypermethylation profiles of ovarian epithelial neoplasms to better understand the role of epigenetic silencing in carcinogenesis.

EXPERIMENTAL DESIGN

We analyzed the DNA promoter methylation status of eight tumor suppressor and cancer-related genes (p16, RARbeta, E-cadherin,H-cadherin, APC, GSTP1, MGMT, RASSF1A) in 23 benign cystadenomas, 23 low malignant potential (LMP) tumors, and 23 invasive carcinomas by methylation-specific PCR.

RESULTS

Benign cystadenomas exhibited promoter hypermethylation in only two genes, p16 (13%) and E-cadherin (13%). LMP tumors also showed p16 (22%) and E-cadherin (17%) methylation, in addition to RARbeta (9%) and H-cadherin (4%). All eight genes were hypermethylated in invasive cancers at a frequency of 9% to 30%. The mean methylation index was highest in invasive tumors [0.20 versus 0.065 (LMP) and 0.033 (cystadenomas); P = 0.001]. Promoter methylation of at least one gene was most commonly observed among invasive cancers [78% versus 44% (LMP; P = 0.03) and 26% (cystadenomas; P = 0.0009)]. Three genes exhibited higher methylation frequencies in invasive tumors: RASSF1A (30% versus 0%; P = 0.0002), H-cadherin (22% versus 2%; P = 0.013), and APC (22% versus 0%; P = 0.003).

CONCLUSIONS

Promoter hypermethylation is a frequent epigenetic event that occurs most commonly in invasive epithelial ovarian carcinomas. The profile of aberrant methylation suggests that an accumulation of events at specific genes may trigger malignant transformation of some benign cystadenomas and LMP tumors.

Voluminous mucinous cystadenoma of the ovary in a 13-year-old girl

BACKGROUND

Mucinous cystadenoma of the ovary constitutes about 15% of ovarian tumors. It is more common in women between 20 and 40, but is rare in teenagers and exceptional in pre-menstrual girls. Malignant transformation is possible in 5-10% of cases. Spontaneous or iatrogenic breaks are more common. It makes the different diagnosis of pseudomixoma peritonei more difficult.

CASE REPORT

A 13-year-old girl came to the National Cancer Institute "Regina Elena" of Rome, with increasing abdominal distension over 2 months. The abdominal mass was removed and a left salpingo-oophorectomy was performed. Histological examination of the mass revealed a 40-cm diameter mucinous cystadenoma of the ovary.

CONCLUSION

The rapid enlargement of the ovarian mass, the young age and the difficulty of certain pre-operative diagnosis, make this case interesting. Management of this pathology and fertility-conserving treatment need careful follow-up because of the possibility of recurrence in the remaining ovary.

Management of borderline ovarian tumors: results of an Italian multicenter study

OBJECTIVE

A rising number of patients affected by ovarian masses suspected of borderline ovarian tumor are operated on primary laparoscopic procedure.

METHODS

From January 1992 to June 2004, 113 patients affected by low malignant ovarian tumor were followed at the Gynecologic Departments of five Italian Institutions. Fifty-two (46.0%) patients were operated on laparoscopic surgery, whereas traditional laparotomic approach was preferred in 61 cases (54%). In 53 patients (46.9%), a fertility-sparing surgical treatment was chosen.

RESULTS

The diameter of the ovarian cysts ranged between 20 and 300 mm; in 20 out 113 patients (17.7%), the borderline tumor was bilateral. In 22/113 (19.5%) cases, we observed tumor rupture or spilling during surgery, and this incidence was greater in the group of patients treated by laparoscopy compared to laparotomy, and this difference is statistically significative. In 13/113 (11.5%) patients, we observed a relapse; the incidence of relapse, however, is not dependent on the type of surgical approach. The progression-free survival is higher for stages IA-IC if compared to stages more than Ist and the difference is statistically significant. Type of surgical approach, laparoscopic versus laparotomic, does not seem to influence the PFS; when cystectomy is performed, the PFS is significantly lower if compared with demolitive surgery or monolateral annessectomy. Eight pregnancies were obtained: in one case, miscarriage was observed, whereas 7 healthy babies were born all but two by vaginal delivery.

CONCLUSIONS

Conservative laparoscopic surgery may be the treatment of choice; an attractive option is that this surgery should be performed by an oncologist surgeon to obtain correct surgical staging and better results in terms of both relapse-free survival and pregnancies.

Recurrence and prognostic factors in borderline ovarian tumors

OBJECTIVE

The purpose of this study was to evaluate the survival estimates and clinico-pathological variables in patients treated for borderline ovarian tumors.

METHODS

The patients treated for borderline ovarian tumors were evaluated retrospectively. Data were obtained from hospital records and special gynecologic oncology forms.

RESULTS

Overall, 100 patients were evaluated. The mean age at the time of diagnosis was 41.7 (range, 19-84). Seventy one (71%) patients underwent surgical staging including 49 (49%) of them with comprehensive surgical staging, 22 (22%) with fertility-sparing surgery. Only 30 (30%) patients were unstaged. The histopathological diagnosis was serous, mucinous, and the other types of borderline ovarian tumor in 54 (54%), 39 (39%), and 7 (7%) of the patients, respectively. Seventy patients had stage IA (70%), 10 had stage IB (10%), 9 had stage IC (9%), 3 had stage IIIA (3%), and 8 had stage IIIC (8%) disease. The stage of only four patients in which disease confined to ovary was upgraded as stage IIIC following surgical staging procedure. The recurrence rate was found 3% (3). The overall disease-free survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.92%, 95.00%, and 96.30%, respectively. But, the overall tumor-free survival was significantly found to be decreased in cases of young age (<30 years old), performing fertility-sparing surgery and presence of micropapillary architecture or peritoneal implants. Overall survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.9%, and 100% and 100%, respectively.

CONCLUSION

Low malignant potential ovarian tumors have excellent survival, and the patients can be treated safely by conservative surgery.

Conservative surgery for borderline ovarian tumors: a review

OBJECTIVE

Borderline tumor of the ovary is an epithelial tumor with a low rate of growth and a low potential to invade or metastasize. This review will outline the most recent information regarding the molecular pathogenesis, pathology, fertility and tumor recurrence rate after conservative management of young women with early-stage borderline ovarian tumors.

METHODS

We performed a MEDLINE literature search of relevant clinical trials for the scope of this review that evaluated conservative treatment of borderline ovarian tumors for young women with low-stage disease who wish to preserve their fertility.

RESULTS

Recently, investigators have begun to identify subsets of patients with a worse prognosis, such as patients with aneuploid tumors. A number of oncogenes are under investigation to determine their role in the pathogenesis of borderline ovarian tumors. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Laparoscopic treatment of adnexal masses has proved to be a safe and effective diagnostic and therapeutic tool in the hands of experienced laparoscopists. For women who are treated conservatively, follow-up is important. Surgery remains the most effective therapy for later stage lesions. Adjuvant therapy for advanced stage of borderline ovarian tumors remains controversial.

CONCLUSION

Conservative management of borderline ovarian tumors is an appropriate therapeutic option for young women with early-stage lesions who wish to preserve their childbearing potential. Available data indicate that in these patients fertility, pregnancy outcome and survival remain excellent.

Serous and mucinous borderline (low malignant potential) tumors of the ovary

The prognosis for stage I serous borderline ovarian tumors (SBOTs) is thought to be excellent, despite rare, late recurrences. The behavior of advanced-stage SBOTs primarily depends on the invasiveness vs noninvasiveness of associated extraovarian implants. Pelvic and abdominal lymph node involvement and foci of microinvasion do not seem to adversely affect prognosis. Serous tumors with a micropapillary and/or cribriform growth pattern seem to be more frequently bilateral and exophytic and manifest at an advanced stage with a higher incidence of invasive implants than typical SBOTs. Molecular data suggest that such tumors may represent an intermediate stage in the typical SBOT-invasive low-grade serous carcinoma progression. Limited experience with endocervical (müllerian)-type mucinous borderline tumors shows a possible relation to SBOTs in clinicopathologic features and biologic behavior Intestinal-type mucinous borderline ovarian tumors (I-MBOTs) and well-differentiated mucinous carcinomas manifest at stage I in most cases; the prognosis is excellent. Mucinous tumors associated with pseudomyxoma peritonei are almost always secondary to similar tumors of the appendix or other gastrointestinal sites and should not be diagnosed as high-stage I-MBOTs. Rare primary ovarian mucinous tumors associated with pseudomyxoma peritonei are those arising in mature cystic teratomas. Advanced-stage ovarian mucinous carcinomas typically show frank, infiltrative-type invasion; the prognosis is poor.

Discrimination between serous low malignant potential and invasive epithelial ovarian tumors using molecular profiling

Tumors of low malignant potential (LMP) represent 20% of epithelial ovarian cancers (EOCs) and are associated with a better prognosis than the invasive tumors (TOV). Defining the relationship between LMPs and TOVs remains an important goal towards understanding the molecular pathways that contribute to prognosis, as well as providing molecular markers, for these EOCs. To this end, DNA microarray analyses were performed either in a primary culture or a tumor tissue model system and selected candidate genes showing a distinctive expression profile between LMPs and TOVs were identified using a class prediction approach based on three statistical methods of analysis. Both model systems appear relevant as candidate genes identified by either model allowed the proper reclassification of samples as either LMPs or TOVs. Selected candidate genes (CAS, CCNE1, LGALS8, ITGbeta3, ATP1B1, FLIP, KRT7 and KRT19) were validated by real-time quantitative PCR analysis and show differential expression between LMPs and TOVs. Immunohistochemistry analyses showed that the two tumor classes were distinguishable by their expression of CAS, TNFR1A, FLIP, CKS1 and CCNE1. These results define signature patterns for gene expression of LMPs and TOVs and identify gene candidates that warrant further study to deepen our understanding of the biology of EOC.

Borderline endometrioid tumor arising in a paratubal cyst: a case report

BACKGROUND

Paratubal cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. The following represents the first reported case of an endometrioid tumor of low malignant potential arising in a paratubal cyst.

CASE REPORT

A 45-year-old nulliparous female was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic bilateral ovarian cystectomy and partial right salpingectomy (for a 3-cm torsed paratubal cyst). All frozen-section diagnoses were benign; however, final pathology revealed a borderline tumor of low malignant potential of endometrioid type in the right paratubal cyst. The patient underwent extensive counseling regarding management options and decided to have a laparoscopic right salpingo-oophorectomy. Final pathologic analysis revealed no evidence of persistent borderline tumor.

CONCLUSION

Paratubal cysts are very difficult to diagnose with sonography; therefore, their management should be approached as any other adnexal mass. Laparoscopic surgery is an option in the management of adnexal masses; however, rupture or puncture of masses should be avoided when possible to prevent potential tumor dissemination in the event of a malignancy.

HER-2 and cancer antigen 125 evaluation in ovarian borderline tumors by immunohistochemistry and fluorescence in situ hybridization

The study determined the expression of cancer antigen (CA) 125 and HER-2 in 45 borderline ovarian tumors (BOTs) and investigated the correlation of these biologic markers with histologic type, clinical stage, and outcome. The level of CA 125 protein was assessed using DAKO's M-11 clone antibody in immunohistochemistry (IHC) assays (Carpinteria, CA). The HER-2 protein expression was assessed in IHC assays using the HercepTest (DAKO), and the HER-2 gene copy number per cell was investigated through fluorescence in situ hybridization (FISH) assays using VYSIS' PathVysion DNA Probe (Downers Grove, IL). Expression of the CA 125 protein was detected in 49% of the samples (22 out of 45 tumors) and significantly associated with the serous histologic type. However, CA 125 expression did not associate with clinical stage or outcome. Protein overexpression or gene amplification of HER-2 was not found. However, abnormal FISH results were detected in 16% (seven out of 45 patients) of specimens comprising extranumerary copies of HER-2 and/or chromosome 17 per cell. Abnormal FISH results were found to be independent of CA 125 expression and histologic type whereas they positively associate with advanced clinical stage. Our data show that HER-2 is not altered in BOTs, and the presence of aneusomy for chromosome 17 and HER-2 may predict tumor progression.

Surgical Staging of Ovarian Low Malignant Potential Tumors

OBJECTIVE

Women diagnosed with ovarian tumors of low malignant potential have an excellent prognosis. Because few will receive adjuvant therapy, the benefit of surgical staging has recently been challenged. The purpose of this study was to compare the outcome of surgically staged patients with low malignant potential tumors with those who were not staged.

METHODS

Between 1984 and 2003, all women with ovarian low malignant potential tumors were identified at 3 institutions. Data were extracted from clinical records.

RESULTS

One hundred eighty-three (74%) of 248 women were surgically staged. Forty of 183 staged patients had clinically obvious extraovarian disease. Forty (28%) of the remaining 143 women with disease apparently confined to the ovary were upstaged. Cytologic washings were positive in 28 cases, 10 had microscopic implants detected by peritoneal or omental biopsy, and 2 were upstaged to stage IIIC solely on the basis of nodal metastases. One hundred eighteen women underwent pelvic node dissection (median: 5 nodes), and 86 underwent para-aortic node dissection (median: 2 nodes). Overall, 9 (1%) metastases were detected in 832 submitted pelvic nodes. All 314 para-aortic nodes were negative. Intraoperative blood loss (P <.001) and length of hospital stay (P <.001) were increased in women without gross disease who were surgically staged. Eight (3%) of 248 patients received adjuvant platinum-based chemotherapy, but neither of the women upstaged to IIIC based on the results of their nodal dissection were treated. Fifteen (6%) recurrences developed and 1 (0.4%) death occurred after a median follow-up of 28 (range, 1-208) months.

CONCLUSION

Routine pelvic and para-aortic lymph node dissection is not necessary in the majority of women with ovarian low malignant potential tumors.

Allelic loss at 19q12 and Xq11-12 predict an adverse clinical outcome in patients with mucinous ovarian tumours of low malignant potential

Ovarian tumours of low malignant potential (LMP) are intermediate between adenomas and ovarian carcinomas. These tumours are often associated with a significantly better prognosis than ovarian carcinomas. However, a subset of these tumours can progress and become lethal. In order to seek sensitive diagnostic tools for monitoring patients after surgical operation, we performed a genome-wide scan for loss of heterozygosity (LOH) in 41 mucinous LMPs using 91 polymorphic microsatellite markers at an average interval of 50 cM across all of the human chromosomes and 25 LOH markers reportedly associated with ovarian carcinoma. In addition, we assessed whether clinicopathological parameters, microvessel density, Ki-67 labeling index, apoptotic index or p53 overexpression would be useful for predicting the postoperative outcome of LMP patients. Of the 116 markers examined, 19q12 and Xq11-12 showed significant correlation between postoperative progression-free survival time and LOH status (P<0.05). Patients with a high Ki-67 labeling index had a significantly poorer progression-free survival time than those with lower levels (P=0.042). Other clinicopathological factors and immunohistochemical analysis had no correlation with progression-free survival time in this series of patients. When the combination of LOH at 19q12 and/or Xq11-12 was assessed using Cox's regression analysis, patients with tumours that showed LOH at these positions were at greatest risk of progression (P=0.0073). These findings suggest that the identification of LOH at 19q12 and/or Xq11-12 in former mucinous LMP sites should alert the clinician to the presence of a potentially aggressive lesion in the coelomic epithelium, even if a distinction between second primary tumours or recurrence could not be determined.

Safety of conservative management and fertility outcome in women with borderline tumors of the ovary

OBJECTIVE

To assess the safety of fertility-sparing treatment and the remaining chance of childbearing after surgery.

DESIGN

Retrospective clinical study.

DESIGN

Gynecology department of a university teaching hospital.

PATIENT(S)

Seventy-five women underwent surgical management in our institution between 1986 and 2001 for borderline tumors of the ovary.

INTERVENTION(S)

Fifty-nine patients were treated by radical, fertility-compromising surgery. The remaining 16 patients underwent conservative surgery, preserving the uterus and at least some functional ovarian tissue. Seven unilateral adnexectomies, one simple cystectomy, and two adnexectomies associated with contralateral cystectomy were performed.

MAIN OUTCOME MEASURE(S)

Recurrence, survival, and pregnancy rates.

RESULT(S)

The observed recurrence rates after radical and conservative surgery were 0.0% and 18.7%, respectively. No disease-related deaths occurred in any group; there is no significant difference in survival rates. We can report 12 pregnancies in 7 of 11 women who underwent fertility-sparing management and who wished to become pregnant.

CONCLUSION(S)

In certain circumstances, conservative management offers a safe solution for borderline tumors of the ovary. Recurrence is noted significantly more often after this type of treatment, but all cases of recurrent disease can be detected with close follow-up and can be treated accordingly. No significant change in survival rates was found. Moreover, the pregnancy rate in women desiring pregnancy, those treated conservatively, was as high as 63.6%.

Low-malignant-potential tumor of the ovary: sonographic features with clinicopathologic correlation in 41 patients

The biologic, behavioral, and pathologic features of low-malignant-potential (LMP) tumor of the ovary are distinct from their invasive counterpart. LMP tumors affect patients at a younger age and have a much better 5- and 20-year survival rate compared with invasive ovarian malignancy. The authors retrospectively reviewed the records and sonograms of 41 patients (51 masses) with LMP tumor of the ovary. They demonstrated a wide variety of morphologies on the presentation sonograms with six masses favored to be benign, four indeterminate, 18 likely malignant, and 23 clearly malignant. Eighteen of 51 masses (35.3%) had a unique appearance-a cyst within the ovary of small to medium size with vascular mural nodularity and preserved surrounding ovarian parenchyma. Low-level echoes within the cystic components of the mass, reminiscent of typical endometrioma, were present in 19 of 51 masses (37.2%). Peritoneal dissemination was present in six patients at presentation, all! whom were alive at follow-up between 45 and 120 months. The authors think that many LMP tumors may be recognized and treated while they are still small. Ovary-sparing surgery may preserve patient fertility. LMP tumors may present initially with a benign morphology, although temporal evolution tends to show more suspicious features. Because these tumors may also appear frankly malignant or show peritoneal dissemination, the possibility of LMP tumor must be considered in light of their much better prognosis compared with invasive ovarian malignancy.

Molecular classification of borderline ovarian tumors using hierarchical cluster analysis of protein expression profiles

Ovarian tumors range from benign to aggressive malignant tumors, including an intermediate class referred to as borderline carcinoma. The prognosis of the disease is strongly dependent on tumor classification, where patients with borderline tumors have much better prognosis than patients with carcinomas. We here describe the use of hierarchical clustering analysis of quantitative protein expression data for classification of this type of tumor. An accurate classification was not achieved using an unselected set of 1,584 protein spots for clustering analysis. Different approaches were used to select spots that were differentially expressed between tumors of different malignant potential and to use these sets of spots for classification. When sets of proteins were selected that differentiated benign and malignant tumors, borderline tumors clustered in the benign group. This is consistent with the biologic properties of these tumors. Our results indicate that hierarchical clustering analysis is a useful approach for analysis of protein profiles and show that this approach can be used for differential diagnosis of ovarian carcinomas and borderline tumors.

Molecular evidence for the independent origin of extra-ovarian papillary serous tumors of low malignant potential

BACKGROUND

Molecular data suggest that peritoneal tumors in women with advanced-stage ovarian papillary serous adenocarcinoma are monoclonal in origin. Whether the same is true for ovarian tumors of low malignant potential is not known. We compared peritoneal and ovarian tumors from women with advanced-stage ovarian papillary serous tumors of low malignant potential to determine whether the peritoneal tumors arose from the same clone as the ovarian tumors.

METHODS

We studied the clonality of 73 peritoneal and ovarian tumors from 18 women with advanced-stage ovarian papillary serous tumors of low malignant potential. Formalin-fixed, paraffin-embedded tumors and representative normal tissues were sectioned and stained with hematoxylin-eosin, representative sections from separate tumors were manually microdissected, genomic DNA was extracted from the microdissected tumors, and the polymerase chain reaction was used to amplify a CAG polymorphic site in the human androgen receptor locus on the X chromosome to determine the inactivation pattern of the X chromosome and the clonality of the tumors.

RESULTS

The pattern of X-chromosome inactivation could be determined from the tumors of 13 of 18 patients. Of the 13 patients, seven (54%) had nonrandom inactivation of the X chromosome, and six of the seven had different inactivation patterns in the peritoneal and ovarian tumors. Three of these patients also had different patterns of nonrandom X-chromosome inactivation in tumors from each ovary. The remaining six patients had random patterns of X-chromosome inactivation in the peritoneal and ovarian tumors.

CONCLUSIONS

Our data suggest that peritoneal and ovarian tumors of low malignant potential arise independently.

k-ras mutation may be an early event in mucinous ovarian tumorigenesis

We explored the possible pathogenetic pathway for mucinous ovarian tumorigenesis by examining the k-ras mutational patterns in ovarian mucinous tumors (OMTs) with benign, borderline, and invasive epithelium in which the different types of mucinous epithelium are in close proximity. Sixteen patients with ovarian mucinous borderline tumors (OMBTs) and 4 patients with grade 1 ovarian mucinous adenocarcinomas (OMCs) were selected for the presence of a single histologic section which contained a clear "transition" zone from benign mucinous epithelium to borderline mucinous epithelium, and in four cases, to invasive epithelium. A PixCell II Laser Capture Microscope was used to microdissect and retrieve benign, borderline, and invasive epithelium separately from the 20 OMTs. Normal ovarian stroma from the same histologic section in each case was also microdissected and retrieved for use as a control. k-ras mutations were detected in these samples by PCR-SSCP analysis followed by direct PCR cycle sequencing. k-ras mutations were found in 8/16 (50%) of the OMBTs and 2/4 (50%) of the grade 1 OMCs. In 6 of these 10 cases (4 in OMBTs, 2 in grade 1 OMCs), the same k-ras mutation was found in both the benign and borderline (and invasive) regions. In 3 cases in which k-ras mutations were identified, the mutation was found in either the benign or borderline tissue samples alone, and in one case, two distinct mutations were found. No k-ras mutations were identified in the normal ovarian stroma. The presence of a k-ras mutation in adjacent benign and borderline regions of a single OMT may suggest a progression in the development of OMTs from benign to borderline and grade 1 OMCs. k-ras mutations, when they occur, are likely early genetic changes but may not alone be sufficient for malignant transformation of ovarian epithelium.

Borderline ovarian tumors

Borderline ovarian tumors (BOTs) represent a small subset of epithelial ovarian cancers that were first described more than 70 years ago. Recognized in a systematic way in only the last three decades, BOTs occur most often in women in their reproductive years but are associated with an excellent long-term prognosis. The management of these tumors is primarily surgical, with the role of medical therapy a topic of ongoing research and debate.

Mucinous cystadenoma of the ovary in a 15-year-old girl

Benign neoplasms of the ovary originating from epithelial tissue are common tumors in adult women. They are, however, rarely seen in children or adolescent girls. Here the authors present a case of an ovarian mucinous cystadenoma in a premenarchal girl. To our knowledge, there are only 5 other cases reported in the literature.

Classification of human ovarian tumors using multivariate data analysis of polypeptide expression patterns

Large amounts of data on quantitative gene expression are generated by procedures such as 2-DE analysis of proteins or cDNA microarrays. Quantitative molecular variation may potentially be used for the development of methods for the classification of tumors. We used here the statistical concepts of principal components analysis (PCA) and partial least square analysis (PLS) in an attempt to type ovarian tumors. Using a set of 170 polypeptides, 22 tumors were used to establish a model ("learning set") for classification into 3 groups (benign/borderline/malignant). Eighteen tumors were then used to test the model. Six of 8 carcinomas and 3 of 4 borderline tumors were correctly classified. Two of 6 benign lesions were correctly classified, 3 were classified as borderline and 1 as carcinoma. We conclude that it may be possible to classify tumors according to their constitutive protein expression profile using multivariate analysis, thus making classification by artificial intelligence a future possibility.

Ovarian serous borderline tumors: a critical review of the literature with emphasis on prognostic indicators

BACKGROUND

The behavior of ovarian serous borderline tumors (SBTs) and significance of various prognostic factors are unclear and difficult to evaluate because of inconsistencies and confusion in the literature. Recent studies have suggested that the morphological features of the primary tumor (presence or absence of micropapillary features) and the peritoneal "implants" (presence or absence of invasive features) can reliably subclassify SBTs into benign and malignant types. The aim of the current review was to test two hypotheses. First, that the alleged malignant behavior of SBTs is poorly documented, and second, that the morphological features of the primary ovarian tumors and the associated peritoneal implants are sufficient to separate SBTs into benign and malignant types, thereby obviating the need for the category.

METHODS

245 studies reporting approximately 18,000 patients with borderline ovarian tumors were reviewed. After excluding series that lacked clinical follow-up or were not analyzable for other reasons, there remained 97 reports that included 4,129 patients. In addition to recurrences and survival, we evaluated the type of peritoneal implants, microinvasion, lymph node involvement, late recurrences, and progression to carcinoma, as these features have served as the underpinning of the concept of "borderline malignancy" or "low malignant potential."

RESULTS

Among 4,129 patients with SBTs reviewed, the recurrence rate after a mean follow-up of 6.7 years was 0.27% per year for stage I tumors, the disease-free survival was 98.2%, and the overall disease-specific survival rate was 99.5%. For patients with advanced-stage tumors, the recurrence rate was 2.4% per year. However, the majority (69%) of reported recurrences were not pathologically documented, and only 26 cases (8.4% of all recurrences) were documented to have recurred from an adequately sampled ovarian tumor. The most reliable prognostic indicator for advanced stage tumors was the type of peritoneal implant. After 7.4 years of follow-up, the survival of patients with noninvasive peritoneal inplants was 95.3%, as compared with 66% for invasive implants (P < .0001). Microinvasion in the primary ovarian tumor was associated with a 100% survival rate at 6.7 years, and lymph node involvement was associated with a 98% survival rate at 6.5 years. The few reported cases of stage IV disease, progression to invasive carcinoma, and very late (>20 years) recurrences were poorly documented. The survival for all stages among approximately 373 patients in 6 prospective randomized trials followed for a mean of 6.7 years was 100%.

CONCLUSION

Surgical pathological stage and subclassification of extraovarian disease into invasive and noninvasive implants are the most important prognostic indicators for SBTs. Survival for stage I tumors is virtually 100%. Survival for advanced stage tumors with noninvasive implants is 95.3%, whereas survival for tumors with invasive implants is 66%. Invasive implants behave as carcinomas and are most likely metastatic. The precise nature of so-called noninvasive implants is not clear, but they behave in a benign fashion. The presence of a micropapillary architecture in the primary ovarian tumor is a strong predictor of invasive implants. These data support the recommendation that ovarian tumors with a micropapillary architecture be designated "micropapillary serous carcinomas," and those lacking these features, "atypical proliferative serous tumors."

Reduction of BRCA1 expression in sporadic ovarian cancer

OBJECTIVE

The purpose of this study was to examine BRCA1 expression and its relationship to cell proliferation in sporadic ovarian epithelial tumors (OETs).

METHODS

We investigated BRCA1 expression and cell proliferative activity in 72 unselected OETs. They comprised 16 benign cystadenomas, 18 borderline (low malignant potential) tumors, and 38 carcinomas (OECs). These patients had no known family history of breast and/or ovarian cancer. BRCA1 and the cell proliferation marker, MIB-1, expressions in fixed tissue were investigated in all 72 cases by immunohistochemistry (IHC). BRCA1 mRNA in fresh frozen tissue samples from 20 of these cases was measured by a semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) method.

RESULTS

The average percentage of BRCA1-positive cells was 5.6% in cystadenomas, 29.7% in borderline tumors, and 6.6% in OECs. The average decreased steadily with increasing grade of OECs: grade 1 (21.4%), grade 2 (1.1%), and grade 3 (0%). The average percentage of MIB-1-positive cells increased steadily from cystadenomas (7.5%) to borderline tumors (22.6%) to carcinomas (41.2%). BRCA1 expression was highly correlated with MIB-1 expression in cystadenomas and borderline tumors. Six of seven OECs negative for BRCA1 by IHC showed low levels of BRCA1 mRNA by RT-PCR.

CONCLUSIONS

BRCA1 expression paralleled cell proliferation in benign and borderline OETs, but not in OECs. Sporadic OECs showed significantly reduced levels, rather than complete loss, of BRCA1 expression. The reduction was closely related to tumor grade. Reduction of BRCA1 expression may be of etiologic significance in the occurrence and progression of sporadic ovarian cancer.

Gonadal cryopreservation in the young patient with gynaecological malignancy

For patients who are planning to have chemotherapy, radiotherapy or to undergo bilateral oophorectomy, the loss of ovarian function will result in premature ovarian menopause and loss of fertility. Embryo preservation is not an option for single women or married women because delaying treatment for at least 2 months of in-vitro fertilization cycles is inappropriate and may be life-threatening. This study reports on the indications for ovarian tissue cryobanking and the state of the art of this method in preserving fertility in women with iatrogenic premature menopause.

Application of a marker of ciliated epithelial cells to gynaecological pathology

BACKGROUND

The assessment of neoplastic disease in gynaecological histopathology can be complicated by the high incidence of metaplasia seen in tissues of the female genital tract. There is a need to identify specific tissue markers which can be applied in routine histopathological practice.

AIM

To examine the clinical potential of a monoclonal antibody, LhS28, which reacts with basal bodies of ciliated epithelial cells.

METHODS

A panel of normal and pathological gynaecological tissues was processed and labelled with LhS28.

RESULTS

LhS28 immunoreactivity was found in the normal Fallopian tube where it was confined to ciliated rather than secretory epithelial cells. In the remaining specimens, LhS28 was associated exclusively with ciliated cells in tubal metaplasias of the cervix and endometrium and in benign serous lined inclusion cysts.

CONCLUSIONS

LhS28 may be a valuable marker for identifying metaplasia of tubal type and may find application in distinguishing tubal metaplasia from low grade cervical glandular intraepithelial neoplasia.

Phenotypic analysis of ovarian carcinoma: polypeptide expression in benign, borderline and malignant tumors

Studies of multiple markers in tumors are required for adequate biological characterization. We have characterized the expression of multiple proteins in human ovarian tumors using the technique of 2-dimensional gel electrophoresis (2-DE/PDQUEST). Tumor cells were prepared from the tissue of 22 ovarian tumors. Large variations were observed between tumors in the expression of various polypeptides, indicating heterogeneity in gene expression. An increase in the spot density of 2 cell-cycle-related proteins, PCNA and OP18/stathmin, was observed in carcinomas. Borderline tumors expressed low levels of these proteins. Significant increases in the levels of nm23, GST-pi, elongation factor 2 and triose phosphate isomerase were recorded in ovarian carcinomas. Furthermore, decreases in the levels of tropomyosin-2 and lamin C were observed in malignant as compared with benign tumors. The pattern of expression of 9 protein markers was examined in individual tumors. All malignant tumors showed simultaneous alterations in the expression of 5 or more of these proteins, whereas no benign tumor showed alterations in the expression of more than 3 polypeptides. Borderline tumors showed alterations in 0 to 6 markers. We conclude that the simultaneous analysis of multiple polypeptides, which can be achieved by 2-DE, is useful for characterization of gene expression and diagnostic studies in ovarian tumors.