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1.
One hundred nine cases of ovarian tumors of low malignant potential (borderline tumors) diagnosed at Stanford University Medical Center from 1958 to 1982 were reviewed. The patients ranged in age from 10 to 79 years (mean, 40.5 years). The histologic types and corresponding stages of these neoplasms were 73 serous (Stage IA: 35 patients; Stage IB+C: 16 patients; stage II: 8 patients; Stage III: 14 patients), 30 mucinous (Stage IA: 27 patients; Stage IB+C: 3 patients), and 6 mixed seromucinous (all Stage IA). Borderline endometrioid, clear cell, and Brenner tumors were excluded. Follow-up information from 3 to 27 years from the time of initial diagnosis (mean, 7.6 years; median, 7.1 years) revealed that 89 patients are alive without further evidence of neoplasm, and three patients died of unrelated disease without recurrent tumor. Seventeen patients have developed persistent or recurrent neoplasms in the contralateral ovary (six patients) and/or elsewhere within the peritoneal cavity (15 patients) at 5 to 226 months (mean, 61 months) after the initial excision. All of the second neoplasms were borderline serous or seromucinous tumors histologically identical to the original tumor; none of the borderline mucinous tumors recurred. Patients who initially had Stage III borderline serous tumors developed persistent or recurrent neoplasms more commonly (64%) than did patients with lower stage tumors (12%). No correlation was found between the development of a subsequent serous neoplasm and patient age, the primary tumor size, or any single histologic feature. Following treatment of the subsequent neoplasms, 13 patients are free of neoplasm, one patient is alive with tumor, one patient has died of intercurrent disease with tumor, and two patients have died with widespread abdominal tumor 53 and 232 months after their initial diagnosis. These findings confirm the excellent prognosis for patients with borderline serous tumors, despite involvement of the peritoneal cavity and the development of recrudescent tumor, although long-term follow-up is indicated. Mucinous borderline tumors, as defined by published criteria, almost invariably present as localized (low-stage) tumors and, in our experience, do not recur when confined to the ovary.  相似文献   

2.
3.
D A Bell  M A Weinstock  R E Scully 《Cancer》1988,62(10):2212-2222
The clinicopathologic features of 56 cases of ovarian serous borderline tumors (SBT) associated with peritoneal implants were reviewed. Data from 368 person-years of follow-up (median follow-up, 6.0 years) were analyzed to investigate the possibility that the histologic features of implants of this type of tumor may correlate with the prognosis. Eighty-five percent of the 56 patients were clinically free of tumor at the time of death or at last contact. Thirteen percent of the patients died of tumor, and one patient (2%) was alive with widespread progressive tumor. The product-limit estimate of the probability of death from tumor (+/- standard error) was 4% (+/- 3%) at 5 years and 23% (+/- 9%) at 10 years. The following three histologic features of the implants correlated with an adverse prognosis: (1) invasion (P = 0.0004), (2) severe cytologic atypia in both invasive and noninvasive implants (P = 0.0008) and in noninvasive implants alone (P = 0.02), and (3) the presence of mitotic activity in both types of implants (P = 0.02) and in noninvasive implants alone (P = 0.02). The only other feature that correlated with the prognosis was the presence of residual tumor postoperatively as assessed by the surgeon (P = 0.01). The product-limit estimate of death of tumor in patients with at least one of these four adverse prognostic factors was 56% (+/- 20%) at 10 years. Whether or not the patients received radiation therapy, chemotherapy, or both had no statistically significant effect on the outcome. These data and the results of a stratified analysis suggest that patients may benefit from additional therapy if adverse prognostic factors are present, especially invasiveness or severe cytologic atypia. It is unlikely that additional therapy is necessary in patients without adverse prognostic features, because no deaths occurred in this group.  相似文献   

4.
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.  相似文献   

5.
M Dietel  H Arps 《Onkologie》1985,8(5):278-80, 285
Antigens A, B, Lea, Leb, CA 12-5, CA 19-9 and CEA were prepared immunohistologically, a DNA-cytophotometry was carried out and the value of a new in vitro proliferation assay to test cytostatic drugs investigated. Material was as follows: 20 normal ovaries and 105 ovarian tumors. Blood group antigens were expressed at a high percentage from well-differentiated epithelial cells, CEA in 50% and CA 12-5 in 70% of the ovarian carcinoma. Predictions about the dignity of borderline tumors can be made with DNA-cytophotometry. The efficacy of 6 different cytostatic agents was investigated in a new in vitro proliferation assay.  相似文献   

6.
Ovarian tumors of low malignant potential, often termed "borderline tumors," have been defined as those that have some but not all of the morphologic features of malignancy (i.e., they are not invasive). With the use of data obtained by the western Washington population-based Cancer Surveillance System for 1975-83, the incidence of serous and mucinous borderline epithelial ovarian tumors was analyzed, as well as the survival of women who developed them. The incidence of borderline tumors increased with increasing age, although at a pace somewhat slower than that of malignant ovarian tumors. There was an upward trend in the incidence of borderline tumors starting in the late 1970's, a trend not present for malignant tumors. Only 12% of borderline tumors were not confined to the ovary, as opposed to 40% of malignant Grade I and 73% of other malignant ovarian neoplasms. At 5 years following diagnosis, the survival of women with borderline tumors was 93% that of the general female population. This percentage varied little by stage or histologic type. Given the reduced survival of women with these ovarian tumors and the lack of a sharp histologic distinction between borderline and Grade I malignant lesions, it is recommended that borderline ovarian tumors be routinely ascertained by population-based cancer registries.  相似文献   

7.
Population-based evidence regarding risk of ovarian cancer after a borderline ovarian tumor (BOT) is sparse. We aimed to examine the incidence of specific types of ovarian cancer in women with serous or mucinous BOTs in a nationwide cohort study with up to 36 years of follow-up. Using the nationwide Danish Pathology Data Bank, we identified 4,281 women with a BOT (2,058 serous BOTs and 2,223 mucinous BOTs) in Denmark during 1978–2012. We computed standardized incidence ratios (SIRs) to compare the incidence of ovarian cancer among women with BOTs compared to general population rates. We found that a serous BOT was especially and strongly associated with subsequent serous ovarian cancer (SIR = 9.2; 95% CI: 6.8–12.2), and that a mucinous BOT was strongly related to mucinous ovarian cancer (SIR = 18.6; 95% CI: 10.8–29.8). The SIRs remained elevated ≥10 years after a serous BOT and up to 5–9 years after a mucinous BOT. The increased incidence of serous ovarian cancer in women with a serous BOT was mostly pronounced in women <50 years at the serous BOT diagnosis. In conclusion, women with a serous BOT experience long-term increased incidence of serous ovarian cancer, and women with a mucinous BOT have long-term elevated incidence of mucinous ovarian cancer compared to the general population. This is the first population-based study to show compelling evidence of the histo-specific increased risk of ovarian cancer following specific types of BOTs. Thus, these results are supportive of the hypothesis that BOTs may be precursor lesions to carcinomas of the corresponding histologic type.  相似文献   

8.
In conclusion, the prognosis for women with stage I borderline tumors is excellent. Surgery alone is the recommended treatment. For young patients, fertility-sparing surgery is optimal, with a small percentage eventually developing tumor in the contralateral ovary. For patients with advanced stage borderline tumors, 10-30% will relapse and approximately 10% will die of tumor. This risk is clearly higher for those with invasive peritoneal implants. Several controversies exist, including the classification of advanced stage serous borderline tumors and the issue of postoperative treatment. Future studies involving larger series and molecular biomarkers will hopefully elucidate the biologic behavior and optimal therapy for this interesting group of tumors.  相似文献   

9.
PURPOSE: We used conventional cytogenetics, molecular cytogenetics, and molecular genetic analyses to study the pattern of allelic loss on chromosome 6q in a cohort of borderline epithelial ovarian tumors. EXPERIMENTAL DESIGN: Fifteen tumor samples were collected from patients undergoing surgery for ovarian tumors. The tumors of borderline malignancy, classified according to the standard criteria, included 4 mucinous and 11 serous tumors. Cytogenetic and molecular cytogenetic (with yeast artificial chromosome clones from 6q26-27) studies were performed on tumor areas contiguous to those used for histological examination ensuring the appropriate sampling. Moreover loss of heterozygosity analysis was performed using PCR amplification of eight microsatellite markers mapping on 6q27 (D6S193, D6S297), 6q26 (D6S305, D6S415, D6S441), 6q21 (D6S287), 6q16 (D6S311), and 6q14 (D6S300). RESULTS: Deletions of this chromosome arm, in particular of 6q24-27, were the most frequent lesions found in this set of tumors. In a tumor with a normal karyotype the only detectable alteration was a deletion of approximately 300 kb within the D6S149-D6S193 interval at band 6q27. This is, to date, the smallest deletion described for borderline tumors. CONCLUSION: Alterations in the above-mentioned interval are a common finding in advanced ovarian carcinomas but also in benign ovarian cysts, implying that some tumors of borderline malignancy may arise from benign tumors and that malignant ones may evolve from tumors of borderline malignancy. Genes located in 6q27 seem to be crucial for this mechanism of early events in ovarian tumorigenesis.  相似文献   

10.
Borderline ovarian tumors (BOTs) are epithelial tumors of the ovaries characterized by cellular proliferation and nuclear atypia but without an infiltrative growth pattern. As they frequently affect younger patients the clinical management is complicated by considerations such as preserving fertility and reducing postoperative morbidity. Over the past several decades surgical therapy has shifted from a radical approach to more conservative treatment. There are various modes of surgery applied to the patients. All these developments have to be considered from an oncologic standpoint as BOTs represent a potentially malignant disease. Oncologic safety, as well as patients’ desires and expectations, have to be balanced to reach the most appropriate treatment for BOTs. For this reason current literature will be discussed in this review to give a thorough overview of this topic and to develop recommendations for the surgical management of these patients. Open questions will be identified to elaborate the need for future surveys and research.  相似文献   

11.
卵巢交界性上皮性肿瘤36例临床分析   总被引:2,自引:0,他引:2  
目的:探讨卵巢交界性上皮肿瘤的临床特征和治疗方法。方法:收集江西省妇幼保健院2003年至2007年36例卵巢交界性上皮性肿瘤患者临床资料,运用SPSS 11.5软件进行临床和病理统计分析。结果:发病年龄平均37.9岁,粘液性17例(47.2%),浆液性16例(44.5%),子宫内膜样2例(5.5%),透明细胞1例(2.8%)。34例患者行手术治疗,其中Ⅰ期28例(82.4%),Ⅲ期5例(14.7%)均为浆液性,治疗后1例(2.9%,Ⅰ期)浆液性复发。治疗方法以手术为主,21例于术后补充TP或PAc方案化疗,Ⅱ期与Ⅲ期患者均辅以化疗。结论:卵巢交界性上皮性肿瘤顶后良好,手术是其有效的治疗手段,对临床Ⅰa期,尤其需保留生育功能者,保守性手术较安全有效。浆液性外生性乳头状交界瘤多伴有腹膜种植,应行分期手术。CA125是监测卵巢非黏液性肿瘤复发及进展的有效指标。  相似文献   

12.
目的:探讨卵巢交界性上皮肿瘤的临床特征和治疗方法.方法:收集江西省妇幼保健院2003年至2007年36例卵巢交界性上皮性肿瘤患者临床资料,运用SPSS 11.5软件进行临床和病理统计分析.结果:发病年龄平均37.9岁,粘液性17例(47.2% ),浆液性16例(44.5% ),子宫内膜样2例(5.5%),透明细胞1例(2.8%).34例患者行手术治疗,其中Ⅰ期28例(82.4%),Ⅲ期5例(14.7%)均为浆液性,治疗后1例(2.9% ,Ⅰ期)浆液性复发.治疗方法以手术为主,21例于术后补充TP或PAC方案化疗,Ⅱ期与Ⅲ期患者均辅以化疗.结论:卵巢交界性上皮性肿瘤预后良好,手术是其有效的治疗手段,对临床Ⅰa期,尤其需保留生育功能者,保守性手术较安全有效.浆液性外生性乳头状交界瘤多伴有腹膜种植,应行分期手术.CA125是监测卵巢非黏液性肿瘤复发及进展的有效指标.  相似文献   

13.

Purpose  

Little is known about the influence of postmenopausal hormone therapy on the risk of ovarian borderline tumors. We aimed at assessing the influence of different hormone therapies on this risk.  相似文献   

14.
BACKGROUND: Laparoscopy in the management of women with borderline ovarian tumors remains controversial. We therefore evaluated the adequacy of initial laparoscopic staging according to FIGO guidelines, by comparison with laparotomy. PATIENTS AND METHODS: In a French retrospective multicenter study of 358 women with borderline ovarian tumors, we compared epidemiological characteristics, sonographic findings, serum tumor marker levels, and surgical and histological parameters between women undergoing laparoscopy and women undergoing laparotomy. RESULTS: One hundred and forty-nine (41.6%) of the 358 women underwent laparoscopy. Mean age, mean gestity and parity, and mean tumor size were higher in the laparotomy group. Forty-two women (28.2%) underwent laparoconversion, mainly for suspected ovarian cancer or large tumor volume. Conservative treatment and cyst rupture were more frequent in the laparoscopy group than in the laparoconversion and laparotomy groups (P < 0.0001). The rate of complete staging was lower in the laparoscopy group than in the laparoconversion and laparotomy groups (P < 0.0001), with no difference between these latter two groups. No difference in the recurrence rate was noted between the groups, but a higher recurrence rate was observed after conservative treatment (P < 0.001). CONCLUSIONS: Laparoscopic management of borderline ovarian tumors is associated with a higher rate of cyst rupture and incomplete staging. Recurrence was more frequent after conservative treatment. Whatever the surgical route, the rate of complete initial staging was low, emphasizing the need to respect treatment guidelines for borderline ovarian tumors.  相似文献   

15.

Purpose

Borderline ovarian tumors (BOT) became no longer reportable in 2001, and few registries still collect information on these still poorly understood tumors. This study’s objective was to describe epidemiologic features, trends, and survival of BOTs compared with those of low-grade (LG) and high-grade (HG) epithelial ovarian cancer (EOC) in the large and diverse population of California.

Methods

Data from the California Cancer Registry were used to examine demographic and tumor characteristics among women diagnosed with BOT (n = 9,786), LG-EOC (n = 3,656), and HG-EOC (n = 40,611) from 1988 to 2010. Annual percent changes in BOT and LG-EOC incidence rates were estimated using Joinpoint regression; 5-year relative survival was calculated for both BOTs and LG-EOCs by age, race/ethnicity, and histology.

Results

Age-adjusted incidence rates of BOT in 2009 were 3.1, 2.3, 2.2, and 1.4 per 100,000 among whites, Latinas, African Americans, and Asian/Pacific Islanders, respectively. Incidence rates for LG-EOC decreased by 2.2 % per year; rates for BOT increased by 7.3 % per year until 1993, remained unchanged until 2006, and seemed to decline thereafter. Compared with LG-EOCs, BOTs were diagnosed in higher frequency among Latinas, at younger age, and were more likely to affect only one ovary. Overall, 5-year relative survival for BOT was 98.9 %; among women diagnosed with stage IV BOT, survival was 77.1 %.

Conclusions

In this study, differences between BOTs and LG-EOCs were marked but varied substantially by histologic subtype and were far less dramatic than differences between BOTs and HG-EOCs. Findings underscore the importance of understanding these enigmatic tumors.  相似文献   

16.
目的探讨卵巢交界性肿瘤(BOT)患者的临床病理学特点及复发相关危险因素。方法回顾性分析山西省肿瘤医院2001年1月至2015年12月收治的210例BOT患者的临床资料。结果210例BOT患者平均年龄为(41±16)岁,68.1%(143/210)的患者为ⅠA期,31.9%(67/210)的患者〉ⅠA期;术后23例复发,复发率为11.3%(23/204)。单因素分析结果显示,在不同年龄(P=0.007)、临床分期(P=0.009)、是否微乳头型(P=0.024)及手术方式(P=0.025)分组中,BOT患者的复发率差异有统计学意义。多因素logistic回归分析结果显示,微乳头型(OR=0.153,95% CI 0.044~0.535)、年龄≤40岁(OR=0.245,95% CI 0.088~0.686)、分期晚(OR=3.502,95% CI 1.360~9.020)是BOT患者复发的危险因素。结论BOT主要发生在育龄期女性,临床分期相对较早,预后良好;年龄≤40岁、分期〉ⅠA期及微乳头型患者易复发。  相似文献   

17.
18.
The clinicopathologic features of 44 serous borderline tumors (SBT) of the ovary were evaluated. Nineteen were Stages II and III, and 9 had invasive peritoneal implants. All 19 patients received chemotherapy and 4, who had invasive implants, died of disease after 3, 4.3, 8, and 9 years. The other 25 patients were free of tumor 1-14 years (mean, 5.3 years) after surgery. Coexpression of low molecular weight keratins (AE1, CAM 5.2) and vimentin was found in all tumors and their implants. No significant differences were found between SBT with different volume-corrected mitotic indices (M/Vi) with respect to gross features, presence or absence of implants, stage, and survival. Cytometric DNA analysis also was performed on the primary ovarian tumors and the implants. Twenty-one primary tumors had diploid or tetraploid histograms, and 23 had aneuploid histograms. DNA ploidy of the primary ovarian tumors did not correlate with gross features, the presence or absence of implants, M/Vi, stage, and survival. The data from this study confirm that most SBT are clinically benign, but SBT with invasive implants may behave aggressively. Expression of intermediate filaments, M/Vi, and DNA ploidy evaluation of the primary ovarian tumors seem to be of no value in predicting prognosis. However, four of seven patients with aneuploid DNA implants died of tumor.  相似文献   

19.
For diagnostic purposes 14 histologically benign, 15 dysplastic, and 16 malignant squamous epithelial lesions were subjected to DNA cytophotometry. Results were computed according to an algorithm for DNA diagnosis and grading of malignancy. In cases of unequivocally malignant or benign lesions all DNA diagnoses agreed with the histologic diagnoses. In one case the allegedly faulty DNA diagnosis of cancer was proven to be correct on clinical follow-up. Within the group of histologically mild to moderate dysplasias the algorithm identified four cases as malignant that were proved to be malignant either in the follow-up or at another site of the same lesion. With the aid of the DNA malignancy grade two groups of patients with squamous epithelial carcinomas of the larynx could be discerned with a highly significant difference according to their survival times.  相似文献   

20.
A case of ovarian endometrioid adenofibroma of borderline malignancy with an increased serum estradiol level, which rapidly disappeared after removal of the tumor, is reported. Vaginal cytologic analysis showed estrogenic effects, and endometrial cystic glandular hyperplasia was thought to be the reason for genital bleeding. To determine the origin of estradiol production in the tumor, stromal cells were enzymatically isolated from the tumor and cultured in vitro. Estradiol levels in the cultured media increased in parallel with cell growth. This is the first report showing estrogen secretion from stromal cells in an ovarian endometrioid adenofibroma.  相似文献   

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