卵巢交界性上皮性肿瘤的临床病理分析

目的　探讨影响卵巢交界性上皮性肿瘤预后的临床及病理因素。方法　回顾性分析我院 1973年 1月～ 2 0 0 0年 12月收治的 3 4例卵巢交界性上皮性肿瘤及 3 0例Ⅰ期卵巢上皮性癌 (卵巢癌 )患者的临床病理资料 ,并按 1999年WHO的组织学标准核对诊断。结果　 64例患者中 ,符合卵巢交界性上皮性肿瘤诊断者 3 7例 ,其中 6例微浸润的卵巢交界性上皮性肿瘤曾被误诊为Ⅰ期卵巢癌 ,1例卵巢交界性上皮性肿瘤为非浸润性腹膜种植。卵巢癌组织学类型以黏液性和浆液性为主 ,95 %为国际妇产科联盟 (FIGO)临床分期的Ⅰ期。患者均行手术治疗 ,其中 11例行保守手术者复发率为9% ;2 6例肿瘤细胞减灭术后给予环磷酰胺 +阿霉素 +顺铂 (CAP)方案为主的化学药物治疗 (化疗 )。已随访 5年、10年患者的生存率均达 10 0 %。经多因素相关分析显示 ,组织学类型和是否化疗是影响预后的因素 (P <0 0 1)。结论　卵巢交界性上皮性肿瘤患者以手术治疗为主 ,应适当辅以化疗     

Accuracy of frozen section diagnosis of borderline ovarian tumors

Objective

To determine the correlation between the diagnosis of borderline ovarian tumors (BOTs) by frozen section and permanent histology analyses.

Methods

Three hundred fifty-four pathology reports with diagnoses of BOTs by frozen section or permanent histology analysis at a single institution between 1995 and 2010 were evaluated with a review of the literature. Frozen section and permanent histology analyses were compared. Multivariate regression analysis was used to assess the influence of clinicopathological parameters on the likelihood of underdiagnosis.

Results

The overall accuracy, i.e., agreement between frozen section and permanent histology diagnoses, was observed in 228 of 354 (64.4%) cases, yielding a sensitivity of 72.6%, a positive predictive value of 85.1%, underdiagnosis in 108 cases (30.5%), and overdiagnosis in 18 cases (5.1%). Based on multivariate analysis, mucinous histology (OR, 1.48; P = 0.022) was the only significant predictor for underdiagnosis by frozen section. A comprehensive search of the literature identified 46 studies investigating the accuracy of frozen section analysis of BOTs. The data of 7 of 46 studies that met the criteria for inclusion and the data of the current study were pooled. The overall accuracy was 67.1% (741/1104), yielding a sensitivity of 82.1%, a positive predictive value of 78.7%, underdiagnosis in 222 cases (20.1%), and overdiagnosis in 141 cases (12.8%).

Conclusions

Frozen section analysis of BOTs has low accuracy, sensitivity, and positive predictive value, and underdiagnosis and overdiagnosis are frequent. Therefore, surgical decision-making for BOTs based on frozen section diagnosis should be done carefully, especially in tumors with mucinous histology.     

Serous borderline ovarian tumors

Proliferating papillary serous cystadenomas that seldom occur are classified into the group of ovarian tumours of low malignant potential (borderline tumours). The present study includes 33 cases observed in our clinic since 1955. Even though the five-year survival rate being 88% was substantially higher than that for ovarian carcinomas, the prognosis of individual cases cannot be reliably predicted because of the uncertainty as to the biological behaviour in both clinical and histological terms. Consequently, the trend to predominantly radical surgery appears to be a justified approach. Whenever it is desirable to maintain fertility in younger women, conservative surgery would require a unilateral tumour without a ruptured capsule and normal histological findings to be obtained from wedge excision in the opposite ovary.     

妊娠合并卵巢交界性肿瘤的处理

自从卵巢交界性肿瘤(ovarian borderline tumor,OBT)或低度潜在恶性肿瘤(low malignant tumor,LMP)命名以来,有关其诊断、治疗方面的争议从未停止过。由于卵巢交界性肿瘤临床预后良好,并在生育期妇女中多见,涉及手术能否保留生育能力问题,应将卵巢交界性肿瘤与卵巢癌区分开,对治疗及预后评价有很大指导意义。在研讨妊娠合并卵巢交界性肿瘤问题时,以下几点应引起重视:(1)目前国内外有关妊娠合并卵巢交界性肿瘤的专题报道不多,常见为卵巢交界性肿瘤的统计分析中提及少数卵巢交界性肿瘤合并妊娠问题。(2)妊娠肿瘤的专著中对妊娠合并良性和恶…     

Epithelial ovarian tumors of borderline malignancy

Between January 1975 and January 1987, 80 patients underwent primary surgery at Brigham and Women's Hospital for epithelial ovarian tumors of borderline malignancy. Surgical staging revealed 52 (65%) patients with stage IA, 2 (2.5%) with stage IB, 10 (12.5%) with stage IC, 4 (5%) with stage II, 11 (13.8%) with stage III, and 1 (1.2%) with stage IV. All 37 patients with mucinous tumors had stage I disease, whereas 13 (33%) of 39 patients with serous tumors had stage II-IV disease. The mean sizes of mucinous and serous ovarian tumors were 18.7 and 10 cm, respectively. At initial surgery, 48 (60%) patients had a total abdominal hysterectomy with bilateral salpingo-oophorectomy and 16 (20%) had an oophorectomy. Sixteen (20%) patients underwent cystectomy, 6 (37.5%) of whom subsequently had an oophorectomy. All 10 patients treated by cystectomy alone have remained disease free. CA-125 levels were normal in 5 patients with stage I disease, but were elevated in 6 of 8 patients with more advanced tumors. Current disease status was determined in 72 patients (90%); 69 (95.8%) are alive and disease free, 1 (1.4%) patient is alive with tumor, and 2 (2.8%) patients died, free of disease.     

Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors

OBJECTIVE: To assess clinical outcome and fertility in patients treated conservatively for a low malignant potential (LMP) ovarian tumor. DESIGN: Retrospective study. SETTING: Gynecologic oncology department of a cancer care center in France. PATIENT(S): Forty-four patients treated with conservative management for a stage I (n = 32) or stage II or III (n = 12) LMP tumor. INTERVENTION(S): Thirty-three patients had unilateral adnexectomy and 11 had cystectomy. Cystectomy was bilateral in 1 patient and was done in conjunction with contralateral adnexectomy in 5 patients. MAIN OUTCOME MEASURE(S): Tumor recurrence and pregnancy rates. RESULT(S): Tumor recurrence rates after radical surgery (hysterectomy with bilateral salpingo-oophorectomy), adnexectomy, and cystectomy were 5.7%, 15.1%, and 36.3%, respectively (P<.01). Among patients who initially received conservative treatment, tumors did not recur in the form of invasive carcinoma. Five patients who had recurrence underwent repeated conservative management; these patients are alive and free of disease. Seventeen pregnancies (of which 15 were spontaneous) occurred in 14 patients; 13 pregnancies occurred in patients with stage I disease and 4 occurred in patients with stage III disease. CONCLUSION(S): Conservative management of LMP tumor significantly increases the risk of recurrence but does not affect overall survival. Such management offers even patients with advanced disease the chance to have spontaneous pregnancy. Conservative management might be proposed in young patients who wish to preserve their fertility, but careful follow-up will be required to detect tumor recurrence.     

Cyclooxygenase-2 expression in borderline ovarian tumors

OBJECTIVES: The aim of the study was to investigate by immunohistochemistry the expression of cyclooxygenase-2 (COX-2) in a single institutional series of borderline ovarian tumors (BOT). Moreover, to perform a comparative analysis, COX-2 expression was also analyzed in benign and malignant ovarian tumors. METHODS: Paraffin-embedded sections form 51 BOT, 26 benign, and 37 malignant ovarian tumors were incubated with polyclonal antiserum against COX-2. The results were calculated as the product of the percentage of the immunostained tumor cells by the relative staining score. Cases with immunostaining values of >1 were considered COX-2-positive. RESULTS: Thirty-four (66.7%) of fifty-one BOT were considered as COX-2-positive, and this rate was not significantly different with respect to COX-2 positivity in benign (50.0%) and in malignant (51.3%) ovarian tumors (P value = 0.23). A significantly higher percentage of COX-2 positivity was found in serous (24 of 24, 100%) with respect to mucinous (9 of 26, 34.6%) BOT (P value = 0.0001). Moreover, 7 (63.6%) of 11 endocervical-type mucinous borderline ovarian tumors were COX-2-positive with respect to only 2 of 15 (13.3%) intestinal-type mucinous BOT (P value = 0.013). The same trend was observed in benign lesions, with COX-2 positivity in 9 of 11 (81.8%) of serous versus 4 of 15 (26.7%) of mucinous tumors (P value = 0.015). On the other hand, no difference was found in the percentage of COX-2 positivity in serous (14 of 29, 48.3%) versus mucinous (5 of 8, 62.5%) ovarian carcinomas (P value = 0.22). CONCLUSIONS: COX-2 is differently expressed in BOT according to different histotype. Moreover, an increase of COX-2 positivity was observed from mucinous intestinal BOT to frankly malignant ovarian tumors suggesting that COX-2 overexpression might be involved in mucinous ovarian carcinogenesis.     

卵巢上皮性交界性肿瘤的新概念及诊疗现状

卵巢上皮性交界性肿瘤是一组至今还在不断认识中的疾病,形态学表现为“交界性”,生物学行为更接近于良性肿瘤。手术是首选治疗手段,但更趋向于保守性手术,一般无需辅助性化疗。     

卵巢交界性上皮性肿瘤的预后分析

目的:探讨卵巢交界性上皮性肿瘤影响预后的因素。方法:回顾分析71例卵巢交界性上皮性肿瘤患者的临床资料,采用单因素和多因素分析方法分析影响复发和预后的因素。结果:BOT患者的5年总生存率97.0%,5年无瘤生存率为94.0%。单因素分析发现,FIGO分期、微浸润、腹膜种植、手术切除类型(肿瘤剥除与附件切除)、肿瘤包膜破裂、双侧卵巢受累与卵巢交界性肿瘤的预后有关(P0.05)。COX多因素模型分析提示,手术切除类型、肿瘤包膜破裂是影响预后的独立因素(P0.05)。结论:BOT发病年龄轻,预后良好,其复发与肿瘤FIGO分期、微浸润、腹膜种植、手术切除类型、包膜破裂等相关。对有高危因素者术后需长期密切随访。     

The preoperative diagnosis of borderline ovarian tumors: a review of current literature

Purpose  

To evaluate the available information on the preoperative diagnosis of borderline ovarian tumors (BOTs).     

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.     

Second primary cancers following borderline ovarian tumors

Background  

Several studies have reported an increased risk of second primary cancers subsequent to invasive epithelial ovarian cancer. However, there is no adequate data regarding such risk in borderline ovarian tumors (BOTs). The aim of this study was to evaluate the risk of subsequent second primary cancers among women with BOTs.     

Clinical analysis of patients with recurrences of borderline ovarian tumors including surgical treatment

OBJECTIVES: Risk of recurrences of borderline ovarian tumors is low (7-10%) but the cases with incidence of recurrence have worse prognosis. The time between primary operation and the first diagnosis of recurrence and treatment is different. DESIGN: The purpose of the current study was to evaluate frequency and the methods of treatment patients with recurrences of borderline ovarian tumors. MATERIALS AND METHODS: The analyzing group consists of 129 patients with borderline tumors of the ovary (BTO) diagnosed and treated in Department of Gynecology between years 1978-2000. RESULTS: In our recurrences developed in 7% of patients. The recurrences in BTO were connected with stage of BTO, types of primary operations and residual disease. Recurrences developed in 5,9% patients with stage I and in 18,1% patients with stage II/III. Similarly recurrences developed in 5,8% patients with no residual disease and in 20% patient with residual disease. A higher relapse rate was observed in patients treated conservatively but recurrences was quickly recognized and efficaciously treated. 5 years survival of patients without recurrences was 91,7% and with recurrences was 72,9%. CONCLUSIONS: 1. Risk of recurrences of BTO is low (7%) and depends on stage and residual disease. 2. Risk of recurrences is higher after primary conservative operation but long follow-up and regular gynecological examinations allows to early diagnosis and treatment of recurrences. 3. Prognosis of patients with recurrences of BTO is good. 5-years survival was 90,6% of group without and 72,9% of group with recurrences of BTO.     

Risk factors for recurrence of ovarian borderline tumors

Objective

The objective of this study was to identify clinicopathologic features that are associated with an increased risk of recurrence for borderline ovarian tumors (BOT).

Methods

We performed a retrospective review of all patients treated for BOT at our institution from 1979 to 2008. Progression-free survival (PFS) was defined as the time of diagnosis to time of recurrence/death or last follow-up. The Kaplan-Meier method was used to calculate the PFS rate and the Wilcoxon-Gehan test was performed to identify prognostic factors.

Results

A total of 266 patients were identified. The median age was 43 years (range, 15-94 years). The majority of patients (68.4%) had FIGO stage I disease and serous histology (73.7%). Only 23 (8.6%) patients developed recurrent disease. The median PFS was 19 years and the median follow-up was 4 years. Abnormal baseline CA-125 (> 35 U/ml), advanced stage, age at diagnosis, and invasive implants were associated with decreased PFS. Of the 196 patients with serous BOT, those with a micropapillary pattern had a 3-year PFS of 75.9% (95%CI, 55.6-87.8) compared with 94.3% (95% CI, 88.4-97.3) for patients without micropapillary pattern (P < 0.001).

Conclusion

Age at diagnosis, an elevated preoperative CA-125, invasive implants, and micropapillary histology were clinical factors associated with increased risk of recurrence in women with BOT. Including these clinicopathologic features will likely identify patients at higher risk for recurrence, for whom development of new treatment strategies would be appropriate.     

Conservative treatment of patients with borderline ovarian tumors

OBJECTIVES: The aim of this study was to characterise group of patients with borderline tumours undergoing surgical treatment. DESIGN: The analysis included 83 patients with ovarian tumours of borderline malignancy at stage Ia, operated in the Gynaecological Department of Medical University of Gdańsk between 1978-1997. The study takes into account comparison of: age of patients, type of surgery, tumour pathology, post surgical treatment. Furthermore, long term follow up was assessed. RESULTS: In the group of 83 patients with stage Ia 37 ware treated with conservative surgery, 46 underwent radical treatment. Postsurgical chemical treatment was not applied. Three patients had to be reoperated because of neoplasm disease recurrence. 8 patients were died from reasons not connected with main disease. CONCLUSIONS: Conservative surgery is proper treatment for young women with borderline ovary tumours in stage Ia. For older, perimenopausal women TAH with BSO without additional chemotherapy is suggested.     

卵巢交界性上皮性肿瘤的治疗方式及预后

分析１９６５～１９９２年卵巢交界性上皮性肿瘤２０例的临床资料及随访结果。其中浆液性９例，粘液性ＩＩ例。临床Ｉ期１５例，ＩＩ期３例，ＩＩＩ期２例。１２例行全子宫及单侧或双侧附件切除，其中２例死于肿瘤复发。８例行单侧附件切除，无死于肿瘤复发者。１４例进行术后化疗，现１２例仍存活，占９２．３％；死亡２例，１例为ＩＩＩ期患者，另１例死于其他疾病。未化疗者６例，其中３例Ｉａ期患者健在；死亡１例，为Ｉｂ期。结果提不：预后与手术方式关系不密切，而与分期有关；对具有高危因素，如外生乳头、肿瘤破裂、腹水等患者，以进行化疗为宜。