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Văduva CC, Constantinescu C, Ţenovici M, Boldeanu L, Istrate-Ofiţeru5 AM. Conservative treatment of borderline ovarian tumors: a retrospective study. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:143-150. [PMID: 37518870 PMCID: PMC10520401 DOI: 10.47162/rjme.64.2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
Borderline ovarian tumors (BOTs) are a group of tumors with histological aspects and intermediate biological evolution between benign and malignant tumors, characterized by epithelial proliferation, lack of stromal invasion and nuclear atypia. BOTs account for approximately 10-15% of epithelial ovarian carcinomas. The interest in fertility preservation is very important as most BOTs are diagnosed in patients less than 40 years of age. Since borderline tumors occur in young, fertile women, the therapeutic approach depends on both staging and the need to preserve ovarian function and fertility. Treatment of BOT is primarily surgical, but recently fertility-preserving surgery has become more important. If infertility persists, ovarian induction or in vitro fertilization (IVF) may be suggested in selected cases.
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Affiliation(s)
| | - Carmen Constantinescu
- Department of Obstetrics and Gynecology, Railroads Clinical Hospital, Craiova, Romania
| | - Mihaela Ţenovici
- Department of Pathology, Railroads Clinical Hospital, Craiova, Romania
| | - Lidia Boldeanu
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, Romania
| | - Anca-Maria Istrate-Ofiţeru5
- Research Center for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
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Ye D, Shen H, Huang W, Yao L. A retrospective analysis of relapse-related factors for ovarian borderline tumors. Am J Transl Res 2022; 14:5712-5718. [PMID: 36105008 PMCID: PMC9452353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Since patients with borderline ovarian tumors (BOTs) are relatively young with good survival rates, conservative surgery is prioritized as a therapeutic intervention. However, the high recurrence rate of this tumor remains an issue that demands further attention. In addition, it is unclear whether the increment of recurrent risk is attributed to conservative surgery or staging surgery. This study was designed to analyze the relapse-related factors of BOTs. METHODS This retrospective cohort study was comprised of 74 patients with BOTs who underwent surgery at the Obstetrics and Gynecology Hospital of Fudan University from September 2014 to September 2017. The recurrence-free survival (RFS) rate was calculated using the Kaplan-Meier method, while the risk factors of RFS were evaluated using Cox-regression analysis. RESULTS The 3-year RFS was 2.7% with a median follow-up duration of 45 months (range: 28-62). Kaplan-Meier analysis indicated that low tumor node metastasis (TNM) stage (P = 0.005), lymphadenectomy (P = 0.052) and fertility-preservation surgery (P = 0.059) were the factors that may lower recurrence. Meanwhile, Cox-regression showed that only low TNM stage was significantly associated with a better RFS (P = 0.005). CONCLUSIONS With the removal of visible lesions by standard surgery, patients at TNM stage I had a better RFS. Fertility-preservation surgery did not increase the recurrence risk. For bilateral ovarian cyst however, it was unclear whether bilateral cystectomy can increase the recurrence risk. Therefore, further study is required.
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Affiliation(s)
- Dan Ye
- Gynecology Department, Obstetrics and Gynecology Hospital of Fudan University No. 419 Fangxie Road, Shanghai 200090, P. R. China
| | - Haoran Shen
- Gynecology Department, Obstetrics and Gynecology Hospital of Fudan University No. 419 Fangxie Road, Shanghai 200090, P. R. China
| | - Wu Huang
- Gynecology Department, Obstetrics and Gynecology Hospital of Fudan University No. 419 Fangxie Road, Shanghai 200090, P. R. China
| | - Liangqing Yao
- Gynecology Department, Obstetrics and Gynecology Hospital of Fudan University No. 419 Fangxie Road, Shanghai 200090, P. R. China
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Borderline epithelial ovarian tumors: what the radiologist should know. Abdom Radiol (NY) 2021; 46:2350-2366. [PMID: 32860524 DOI: 10.1007/s00261-020-02688-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022]
Abstract
Ovarian borderline tumors are neoplasms of epithelial origin that are typically present in young patients and tend to have a less aggressive clinical course than malignant tumors. Accurate diagnosis and staging of borderline tumors has important prognostic and management implications (like fertility-sparing procedures) for women of child-bearing age. This article will review the sonographic, CT, and MRI features of borderline epithelial ovarian tumors with histopathologic correlation. Borderline tumors have less soft tissue and thinner walls/septations than malignant tumors. Serous borderline tumors more commonly have papillary projections, which can simulate the appearance of a sea anemone. Mucinous borderline tumors often are larger, multi-cystic, and more commonly unilateral. The borderline mucinous tumors may also present with pseudomyxoma peritonei, which can make it difficult to distinguish from malignant mucinous carcinoma. Ultrasound is usually the first-line modality for imaging these tumors with MRI reserved for further characterizing indeterminate cases. CT is best used to stage tumors for both locoregional and distant metastatic disease. Overall, however, the imaging features overlap with both benign and malignant ovarian tumors. Despite this, it is important for the radiologist to be familiar with the imaging appearances of borderline tumors because they can present in younger patients and may benefit from different clinical/surgical management.
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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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Tomao F, Di Pinto A, Sassu CM, Bardhi E, Di Donato V, Muzii L, Petrella MC, Peccatori FA, Panici PB. Fertility preservation in ovarian tumours. Ecancermedicalscience 2018; 12:885. [PMID: 30679952 PMCID: PMC6345054 DOI: 10.3332/ecancer.2018.885] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 12/14/2022] Open
Abstract
A considerable number of patients with a cancer diagnosis are of childbearing age and have not satisfied their desire for a family. Despite ovarian cancer (OC) usually occurring in older patients, 3%-14% are diagnosed at a fertile age with the overall 5-year survival rate being 91.2% in women ≤44 years of age when it is found at 1A-B stage. In this scenario, testing the safety and the efficacy of fertility sparing strategies in OC patients is very important overall in terms of quality of life. Unfortunately, the lack of randomised trials to validate conservative approaches does not guarantee the safety of fertility preservation strategies. However, evidence-based data from descriptive series suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. This conservative surgery helps to maintain organ function, giving patients of childbearing age the possibility to preserve their fertility. We hereby analysed the main evidence from the international literature on this topic in order to highlight the selected criteria for conservative management of OC patients, including healthy BRCA mutations carriers.
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Affiliation(s)
- Federica Tomao
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Di Pinto
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Carolina Maria Sassu
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Erlisa Bardhi
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Violante Di Donato
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Ludovico Muzii
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | | | | | - Pierluigi Benedetti Panici
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Shen F, Chen S, Gao Y, Dai X, Chen Q. The prevalence of malignant and borderline ovarian cancer in pre- and post-menopausal Chinese women. Oncotarget 2017; 8:80589-80594. [PMID: 29113327 PMCID: PMC5655222 DOI: 10.18632/oncotarget.20384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/25/2017] [Indexed: 12/24/2022] Open
Abstract
The incidence of ovarian cancer depends on the ethnicity and geographical area. Menopausal status is a well-known risk factor for ovarian cancer and most cases occur after menopause in Caucasians. However, it is less clear how the status of menopause or age at diagnosis is associated with ovarian cancer including its subtypes in Chinese women. Data on 1,283 women with primary malignant or borderline ovarian cancer including age at diagnosis, age at menopause and histology from the largest women's hospital in China was analysed. The median age at diagnosis was 53, 44 and 23 years for epithelial ovarian cancer or sex-cord tumors or germ cell tumors respectively. 58% of epithelial ovarian cancers were diagnosed after menopause, while 58% and 95% of sex-cord tumors and germ cell tumors were diagnosed before menopause. Around 60% of serous, endometrioid and clear-cell carcinoma of epithelial ovarian cancer were diagnosed after menopause, while 23% of mucinous carcinoma was diagnosed after menopause. The median age at diagnosis was 35 years for borderline ovarian cancer and 80% of patients were diagnosed before menopause. Our data demonstrates that the median age at diagnosis of ovarian cancer is younger in our study population than Caucasians reported in the literature regardless of malignant or borderline ovarian cancers, and regardless of subtypes of epithelial ovarian cancer. The prevalence of ovarian cancer is proportionately higher in our study population before menopause than Caucasians. Our results suggest clinicians to be more aware of the symptoms of ovarian cancer in premenopausal Chinese women.
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Affiliation(s)
- Fang Shen
- The Hospital of Obstetrics and Gynaecology, Fudan University, China
| | - Shouzhen Chen
- The Hospital of Obstetrics and Gynaecology, Fudan University, China
| | - Yifei Gao
- The Hospital of Obstetrics and Gynaecology, Fudan University, China
| | - Xujing Dai
- The Hospital of Obstetrics and Gynaecology, Fudan University, China
| | - Qi Chen
- The Hospital of Obstetrics and Gynaecology, Fudan University, China.,Department of Obstetrics and Gynaecology, The University of Auckland, New Zealand
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Findeklee S, Lotz L, Heusinger K, Hoffmann I, Dittrich R, Beckmann MW. Twenty-five-year-old Woman with Bilateral Borderline Ovarian Tumour Desiring to Preserve Fertility - Case Report and Literature Review on the Current State of Fertility Preservation in Women with Borderline Ovarian Tumours. Geburtshilfe Frauenheilkd 2016; 76:1189-1193. [PMID: 27904170 PMCID: PMC5123880 DOI: 10.1055/s-0042-109267] [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: 01/09/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 01/05/2023] Open
Abstract
Borderline ovarian tumours are semimalignant tumours occurring unilaterally or bilaterally with a peak incidence among women of reproductive age. Since the affected women often wish to preserve fertility, particular precautions must be taken when counselling the patient and obtaining consent prior to planning an individual treatment. Options for preserving fertility include an organ-sparing surgical procedure and cryopreservation of oocytes and/or ovarian tissue. In this article, we report on a 25-year-old patient with a bilateral seromucinous borderline tumour who desired all fertility-preserving options. In order to perform the procedure without delay, we opted to perform luteal phase stimulation prior to oocyte retrieval. We conclude by discussing the current literature on the state of fertility preservation in the treatment of borderline ovarian tumours.
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Affiliation(s)
- S. Findeklee
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - L. Lotz
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - K. Heusinger
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - I. Hoffmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - R. Dittrich
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M. W. Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
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Seong SJ, Kim DH, Kim MK, Song T. Controversies in borderline ovarian tumors. J Gynecol Oncol 2015; 26:343-9. [PMID: 26404125 PMCID: PMC4620372 DOI: 10.3802/jgo.2015.26.4.343] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/16/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023] Open
Abstract
Borderline ovarian tumors (BOTs) represent about 15% to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. Historically, standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at earlier stage, in younger age women and have better prognosis, higher survival rate than IOCs, fertility-sparing surgery is one of the option to preserve childbearing capacity. The study of such conservative surgery is being released, and still controversial. After surgery, pregnancy and ovarian induction followed by in vitro fertilization are also significant issues. In surgery, laparoscopic technique can be used by a gynecologic oncology surgeon. So far postoperative chemotherapy, radiotherapy and hormone therapy are not recommended. We will discuss controversial issues of BOTs on this review and present the outline of the management of BOTs.
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Affiliation(s)
- Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Da Hee Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
| | - Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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