Management and prognosis of clear cell borderline ovarian tumor

Clear Cell Borderline Ovarian Tumor: Clinical Characteristics, Prognosis, and Management

BACKGROUND

Clear cell borderline ovarian tumor (CCBOT) is one of the rarest subtypes of borderline ovarian malignancies. The aim of this study was to determine the prognosis of a series of CCBOT.

PATIENTS AND METHODS

A retrospective review of patients with CCBOT treated or referred to our institutions. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion.

RESULTS

Nineteen patients were identified. Median age was 62 (range 36-83) years. Four patients underwent a conservative surgery and 14 a bilateral salpingo-oophorectomy +/- hysterectomy (unknown in 1 case). One patient had bilateral tumor, and all cases were stage-I disease. All CCBOTs showed an adenofibromatous pattern. Stromal microinvasion was observed in seven cases and intraepithelial carcinoma in two cases. Endometriosis was histologically associated in one case. The median follow-up was 76 (range 6-231) months. No recurrence occurred. Two patients died of intercurrent disease.

CONCLUSIONS

Peritoneal staging procedures should always be associated, but restaging surgery could be omitted if there was no suspicious lesion in the peritoneum during initial surgery, since all patients reported had stage-I disease. Fertility-sparing surgery appears to be a safe alternative in young patients. Synchronous endometrial disorders with atypia are infrequent. Prognosis is generally excellent, and long-term risk of recurrence is low. The two recurrences described in literature occurred in stage-IC diseases, highlighting the importance of avoiding perioperative rupture.

Clear cell borderline tumor without fibromatous component: Pathological and literature review and report of two cases

The aim of the present study was to examine the clinical outcome of ovarian clear cell borderline tumor (CCBT) through pathological review for cases with clear cell carcinoma (CCC) and CCBT between 1984 and 2015 who received surgery at the National Defense Medical College Hospital using 2020 World Health Organization (WHO) criteria. In addition to the definition of CCBT in 2020 WHO criteria, clear cell with atypia of the glandular epithelium without fibromatous component was added to the diagnostic criteria of CCBT. Two cases with CCBT were identified through review in the current study. There were no cases that changed from the initial CCBT diagnosis that were included in the current study. Case 1 was a 43-year-old woman who received total hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy. Pathologically, cysts were lined by cuboidal, hobnail and clear cells with eosinophilic cytoplasm and moderate nuclear atypia without the fibromatous component. These cells were adjacent to atypical endometriosis and non-atypical endometriosis, and the patient was diagnosed with CCBT. She exhibited no evidence of the disease for 37 months following surgery. Case 2 was a 42-year-old woman who received left salpingo-oophorectomy, partial omentectomy and pelvic lymphadenectomy. The tumor exhibited a cyst (80 mm) and nodular component. Pathologically, the tumor cells were lined by hobnail cells with mild atypia and eosinophilic cytoplasm without the fibromatous component. This patient was diagnosed with CCBT and exhibited no evidence of disease for 20 months following surgery. CCBT without fibromatous component is a rare and non-aggressive histological subtype. Additionally, regardless of fibromatous component, CCBT was able to be diagnosed.

Borderline Clear Cell Adenofibroma of the Ovary

Borderline clear cell tumors are extremely rare, and few cases have been reported in the literature. Herein, we present a case of borderline clear cell adenofibroma of the ovary in a 58-year-old woman who presented with a pelvic mass and constipation. Physical examination revealed a 10 cm solid midline pelvic mass. Computed tomography showed an 8 cm heterogeneous enhancing mass attached to the left posterolateral wall of the uterus. The patient's serum CA 125 levels were slightly elevated (80.9 U/ml). The patient was given a total abdominal hysterectomy with bilateral salpingooophorectomy. On gross examination, it was found that the left ovarian tumor was an 8.0 × 7.5 × 8.0 cm solid multilobulated mass containing tiny cysts. Histologically, the tumor was composed of small glands in dense fibrous and myxoid stroma. The glands were lined with cuboidal cells with clear cytoplasm and mild to moderate nuclear atypia. No stromal invasion was observed. The pathological diagnosis was borderline clear cell adenofibroma of the left ovary. There was no reoccurrence 36 months post operation.