卵巢上皮性肿瘤的临床病理特征及其细胞周期素D1和p53蛋白表达的研究

目的研究卵巢上皮性癌（卵巢癌）和交界性上皮性肿瘤的临床病理特征及其细胞周期素D1（cyclin D1）和p53蛋白表达的情况,探讨卵巢癌和交界性上皮性肿瘤在发病机制上的联系。方法分析45例卵巢癌（卵巢癌组）和54例卵巢交界性上皮性肿瘤（交界性肿瘤组）的临床病理资料,采用免疫组化法检测两组组织中cyclin D1、p53蛋白的表达情况,并分析其与临床病理特征的相关性。结果（1）临床病理特征：①年龄：交界性肿瘤组平均年龄为42．5岁（14～82岁）,中位数年龄41岁;卵巢癌组平均年龄为53．5岁（26～80岁）,中位数年龄51岁。②分期：按国际妇产科联盟（FIGO）分期标准,交界性肿瘤组Ⅰ期48例、Ⅱ期3例、Ⅲ期3例;卵巢癌组Ⅰ期6例、Ⅱ期8例、Ⅲ期26例、Ⅳ期5例。③病理类型：交界性肿瘤组以黏液型为主[占56％（30／54）],其次为浆液型[其中普通型11例,微乳头型5例;占30％（16／54）];卵巢癌组以浆液型（其中低度恶性19例,高度恶性3例）为主[占49％（22／45）]。④病理分化程度：卵巢癌组高分化5例,中分化17例,低分化或未分化23例。⑤预后：交界性肿瘤组5年生存率为98％,卵巢癌组为51％,两组比较,差异有统计学意义（P=0．000）。（2）cyclin D1和p53蛋白的表达及其与卵巢癌和交界性肿瘤临床病理特征的相关性：卵巢癌组cyclin D1和p53蛋白的阳性表达率分别为31％（14／45）和56％（25／45）,p53蛋白表达强度与病理分化程度呈正相关（r=0．320,P=0．032）;交界性肿瘤组cyclin D1和p53蛋白的阳性表达率分别为69％（37／54）和6％（3／54）。其中,普通型浆液性交界性肿瘤与高度恶性浆液性癌比较（两者cyclin D1蛋白阳性表达率分别为91％和26％,p53蛋白分别为0和58％）,差异有统计学意义（P〈O．01）;而微乳头型浆液性交界性肿瘤与低度恶性浆液癌比较（两者cyclin D1蛋白阳性表达率分别为3／5和2／3,p53蛋白分别为1／5和1／3）,差异则无统计学意义（P〉0．05）。结论cyclin D1蛋白的过度表达常见于卵巢浆液性交界性肿瘤及低度恶性浆液性癌组织中,而p53蛋白的过度表达更多见于高度恶性浆液性癌组织中。卵巢浆液性交界性肿瘤与高度恶性浆液性癌具有不同的发病机制,而微乳头型浆液性交界性肿瘤与低度恶性浆液性癌的关系可能更为密切。     

卵巢交界性肿瘤的临床特征及治疗

目的明确卵巢交界性肿瘤（交界性瘤）的临床特征及治疗方法。方法对３５年来收治的７０例卵巢交界性瘤患者进行回顾性分析。结果患者年龄１６～７６岁,平均４５．６岁。组织类型粘液性４６例（６５．７％）,浆液性２１例（３０％）;临床分期Ⅰ期４６例（６５．７％）,Ⅱ期１例（１．４％）,Ⅲ期１１例（１５．７％）,无Ⅳ期患者。治疗后复发１２例（１７．１％）。ＣＡ１２５升高１１例（１１／２１）,癌胚抗原（ＣＥＡ）升高６例（６／１０）。治疗以手术为主,４５例术后接受辅助治疗。７０例中无瘤存活４５例,带瘤存活４例,死于交界性瘤１１例,死于其他原因１０例。１１例行单侧附件切除的Ⅰ期患者均无瘤存活。１６例术后有肿瘤残留并接受辅助治疗者中完全缓解２例。全组５年、１０年、２０年、３０年存活率分别为９０．０％、８７．１％、８７．１％和８５．６％。多因素分析显示,组织学类型、期别和术后肿瘤残留,是影响预后的主要因素。结论粘液性瘤所占比例明显高于浆液性瘤;手术治疗是交界性瘤有效的治疗手段,应力求将肿瘤完全切除;术后辅助治疗不能改善交界性瘤患者的预后;ＣＡ１２５和ＣＥＡ对于交界性瘤监测有一定意义     

卵巢交界性上皮性肿瘤50例诊断及治疗探讨

目的：探讨卵巢交界性上皮性肿瘤合理的治理方式和冰冻切片病理检查对卵巢交界性肿瘤的诊断价值。方法：对1980年至1999年我院收治的50例卵巢交界性上皮性肿瘤进行回顾性总结分析,行单侧附件切除术13例,子宫和双附件切除术加（或）不加大网膜,阑尾切除术37例,无一例行腹膜后淋巴结清扫,所有病例术后均无肉眼可见的残余瘤病灶,术后未进行化疗18例,其他32例术后进行了化疗,病例随访1－19年。结果：组织学类型浆液性28例,粘液性18例,分别占56％和36％,临床分期Ⅰ期49例（98％）,Ⅲ期1例（2％）。一侧为交界性肿瘤而对侧卵巢正常44例（88％）,40例（80％）在手术中做了冰冻切片病理检查,2例冰冻切片病理检查结果为良性,无一例将交界性肿瘤诊断为浸润性癌,其诊断符合率为95％（38／40）,随访期间所有病例均存活,结论：对Ⅰ期有生育要求的患者应尽量保留生育功能,对年轻患者应至少保留一侧卵巢,不必常规行淋巴结清扫,不必化疗,冰冻切片病理检查对术中诊断有较大的参考价值。     

卵巢粘液性上皮内癌12例报告

目的:探讨卵巢粘液性上皮内癌的诊断意义和临床特点。方法:回顾分析2001年以来北京协和医院收治的12例卵巢粘液性上皮内癌(组织学检查确诊)的病理及临床特点和预后,并复习文献进行讨论。结果:患者中位年龄40.0岁。肿瘤均为单侧,肿瘤最大直径的中位数19.0cm(8.0~55.0cm)。ⅠA期8例,ⅠC期4例。1例行肿物剔除术,5例行附件切除术,3例行全子宫加双附件切除术,3例行肿瘤细胞减灭术。平均随诊38.8个月,无1例复发或死亡。结论:卵巢粘液性上皮内癌属卵巢粘液性交界瘤范畴,可能是浸润癌的癌前病变。年轻患者可行保留生育功能手术,预后较好,与同期别的粘液性交界瘤相当。     

卵巢浆液性和粘液性肿瘤共享结肠癌抗原决定簇

以抗结肠癌单克隆抗体ＳＣ１３Ａ为探针，应用免疫组织化学染色法，分别对６７例卵巢浆液性和４４例卵巢粘液性肿瘤组织，以及２０例正常卵巢组织中相应的抗原表达进行检测。结果：在浆液性囊腺瘤、交界性囊腺瘤和乳头状囊腺癌中ＳＣ１３Ａ抗原的表达率分别为８．０％，７１．４％和９０．０％；在粘液性囊腺瘤、交界性囊腺瘤和乳头状囊腺癌中ＳＣ１３Ａ抗原的表达率分别为２５．８％、８０．０％和８７．５％；正常卵巢组织中无３Ｃ１３Ａ抗原表达。浆液性、粘液性的交界性囊腺瘤和乳头状囊腺癌的抗原表达率，均显著高于浆液性、粘液性囊腺瘤及正常卵巢组织（Ｐ＜０．００５）。提示：浆液性和粘液性肿瘤抗原之间有内在的联系，这两类肿瘤的抗原中均共同享有与结肠癌抗原相同的抗原决定簇，这种抗原位点在恶性肿瘤中的表达明显高于良性肿瘤。     

CA125、CA19．9、CEA在卵巢上皮性交界性肿瘤中的临床价值

目的：探讨测定血清CA125、CA19．9、CEA在诊断卵巢上皮性交界性肿瘤中的临床价值。方法：回顾分析卵巢交界性肿瘤50例血清CA125、CA19．9、CEA水平与临床资料。结果：浆液性及粘液性肿瘤中CA125的阳性率分别为53．85％和60％，差异无显著性（P＞0．05），临床分期晚者CA125阳性率有增高趋势；粘液性肿瘤中CA19．9的阳性率为43．75％；CEA阳性率为12％，仅见于粘液性或以粘液性为主的肿瘤中；与术前相比，术后CA125、CA19．9水平及阳性率均显著下降（P＜0．05）。结论：CA125、CA19．9对卵巢上皮性交界性肿瘤的术前诊断及疗效监测有一定价值，CEA则在鉴别组织学类型中有一定价值。     

术前诊断卵巢交界性肿瘤的超声特征

目的探讨卵巢交界性肿瘤的术前超声特点，以便早期诊断。方法总结分析1995年10月-2005年12月，在我院住院手术的卵巢交界性肿瘤患者，术前经阴道超声检查、多普勒血流频谱检测，手术病理证实为交界性卵巢肿瘤的患者共54例，年龄18-82岁。同时与同期手术的卵巢良性上皮性肿瘤60例、I期卵巢癌22例做对比。结果54例卵巢交界性肿瘤中，浆液性19例，黏液性28例，混合型7例。其中浆液性肿瘤与黏液性肿瘤相比，肿瘤体积小（P=0．003）、单房多见（P〈0．001）、其内多有乳头与实性区（P〈0．001）。54例卵巢交界性肿瘤中，29／54（53．70％）例内壁有乳头或实性区，良性肿瘤7／60（11．67％）例内壁有乳头或实性区，I期卵巢癌20／22（90．91％）例内壁有乳头或实性区（P〈0．001）。50例交界性肿瘤行彩色多普勒检查，45／50（90．00％）例可探测到血流信号（与良性肿瘤相比P〈0．001；与I期卵巢癌相比P=0．297），其中29例阻力指数〈0．50。结论经阴道超声检查发现卵巢囊性肿物内出现乳头状突起、实性区或密集房隔、房隔增厚时应警惕有可能为交界性肿瘤，如联合多普勒血流频谱检测肿瘤阻力指数〈0．50更有助于术前诊断。     

卵巢浆液性交界性肿瘤的病理学改变及其手术范围对预后的影响

分析４９例卵巢浆液性交界性肿瘤及其伴有微灶浸润病例的临床病理学资料。结果１３例交界性伴有微灶浸润的病例的复发与死亡率，与单纯交界性病例差别无显著性（Ｐ＞０．０５）；４０例临床分期Ⅰ期的病人中，９７．５％长期生存，Ⅲ期则显著下降（１／３，Ｐ＜０．０１）；全子宫双侧附件切除术或单侧附件切除术不影响预后；进行单侧附件切除和囊肿剥出术的１６例中，５例（３１．３％）在随访过程中正常妊娠和分娩。提示：卵巢浆液性交界性肿瘤的恶性度是较低的，在伴有微小范围癌变时不影响病人预后。对临床Ⅰ期，尤需保留生育能力者，单侧附件切除是安全可靠的手术方式。     

CAP方案治疗卵巢上皮性癌127例远期疗效分析

目的 :评价接受CAP方案 (环磷酰胺、卡铂 /顺铂、阿霉素 )治疗卵巢上皮性癌 12 7例的远期疗效。方法 :回顾分析 12 7例手术及病理证实的卵巢上皮性癌I～IV期患者手术后接受CAP方案化疗的疗效。比较各期、各病理类型患者术后复发率及生存率。结果 :Ia、Ib～c、II、III期患者术后 8年生存率分别为 10 0 %、87.9%、36 .1%、34.8% ;复发率分别为 4 3.5 %、32 .1%、81.9%、89.2 %。IV期患者 4年生存率为 2 7.0 % ,复发率为10 0 %。II～IV期卵巢透明细胞癌术后 1年生存率为 15 .6 % ,与浆液性、粘液性和内膜样卵巢腺癌 89.2 %的 1年生存率相比差异有显著性 (P =0 .0 10 8)。结论 :CAP方案仍可作为卵巢上皮性癌常规治疗的方案 ,但对透明细胞癌、铂类治疗后复发性癌及IV期卵巢上皮性癌效果不佳     

卵巢交界性上皮性肿瘤

卵巢交界性上皮性肿瘤首由Taylor在1929年确定为一独立的临床和病理类型。1961年FIGO将其归为卵巢囊腺瘤的一个亚型,即肿瘤不侵犯间质,但有较大程度的上皮增生,以此区别于良性和恶性型。本文复习1975年1月～1987年1月在Brigham和Women’s医院行初次手术的80例卵巢交界性上皮瘤患者的治疗情况。患者平均年龄39岁(17～77岁)。其中浆液性细胞型39例(48.7%),粘液性37例     

Ovarian cancer in girls]

DESIGN: The aim of our study was a clinical analysys of diagnosis, operative treatment and monitoring of epithelial ovarian cancer in girls. MATERIALS AND METHODS: Authors described 11 epithelial malignant tumors of ovaries in girls aged 12-16. Clinical aspects, pathology stage, grade treatment, monitoring and survival were evaluated. Three of the patients had ovarian cancer. A 19-year old patient with stage Ia of epithelial ovarian cancer was managed conservatively. Four years later she give birth. For 10 years no malignant of has been observed. Seven patients with ovarian borderline epithelial tumors were treated. The tumors in 5 patients were of serous and in 2 of mucinous type. CONCLUSIONS: We suggested that patients of stage I who wish to preserve childbearing function may be treated with unilateral salpingo-ovariectomy and chemotherapy.     

卵巢交界性上皮性肿瘤临床分析

目的分析卵巢交界性上皮性肿瘤的临床特点、治疗及预后情况,并探讨影响卵巢交界性肿瘤复发及预后的相关因素。方法回顾性分析1980年1月至2009年8月间在北京大学人民医院诊断的卵巢交界性上皮性肿瘤130例,所有患者均经手术治疗及术后病理证实。且经正规肿瘤术后随访12～240个月。结果平均发病年龄为42.3岁;Ⅰ、Ⅱ、Ⅲ期分别为106、6、18例;浆液性、黏液性和其他病理类型各48、63、19例;49.0%(51/104)的患者CA125升高;1%有微乳头浸润,0.05%有浸润性种植;所有患者均进行手术治疗,其中42.3%保留生育功能。复发率为6%(8例),其中18例行卵巢肿物剥除术2例复发,34例单侧或双侧附件切除术未见复发。肿瘤分期手术与一侧附件切除及单纯肿物剥除术的5年及10年存活率分别为100%、100%、95%。结论卵巢交界性肿瘤发病年龄较轻,Ⅰ期为主,黏液性肿瘤多见,预后良好,手术是主要的治疗手段,对早期患者行保留生育功能的手术是安全有效的,术后需长期随访。FIGO分期、微乳头型病变,浸润性种植及初次术后是否残留是影响复发及预后的相关因素。     

年轻非良性卵巢肿瘤患者保留生育功能57例临床分析

目的分析年轻非良性卵巢肿瘤患者保留生育功能治疗的现状及复发情况。方法选择2000年1月至2010年4月北京大学人民医院收治的年龄≤40岁、未完成生育功能、因交界性或恶性卵巢肿瘤行保留生育功能治疗的患者57例,分析临床资料并随访肿瘤的复发情况。结果在57例患者中,交界性卵巢上皮性肿瘤38例（66.7%）,恶性生殖细胞肿瘤17例（29.8%）,其他类型2例;肿瘤分期Ⅰ期49例（86.0%）,Ⅱ期2例,Ⅲ期6例;单侧附件切除手术者33例（57.9%）,行分期手术者17例（29.8%）;化疗29例（50.9%）。成功随访42例,中位随访时间40.5个月（10～119个月）。恶性肿瘤患者无复发;交界性肿瘤患者中,8例复发,复发率25.0%。交界性肿瘤复发组（8例）和非复发组（24例）患者中位无瘤生存时间分别为21.5个月和40.5个月（P〈0.01）。微乳头结构是交界性浆液性卵巢肿瘤患者复发的危险因素（P〈0.05）。结论≤40岁、未完成生育功能的非良性卵巢肿瘤患者中以交界性肿瘤最常见;目前保留生育功能的治疗存在不同程度的问题;但肿瘤本身的特点是影响复发的主要因素。     

Borderline ovarian tumors

Ninety-four patients with borderline ovarian tumors were retrospectively analyzed for clinical features, treatments, and survival characteristics. There were 46 patients with FIGO stage IA cancer, 7 with stage IB, 20 with stage IC, 4 with stage IIB, 5 with stage IIC, 5 with stage IIIA, 3 with stage IIIB, and 4 with stage IIIC tumors. Seventy patients had at least a total abdominal hysterectomy and bilateral salpingo-oophorectomy, 20 patients had conservative surgery including unilateral salpingo-oophorectomy or ovarian cystectomy, and 4 patients had bilateral salpingo-oophorectomy. Fifteen patients with stage I disease received adjuvant melphalan therapy and 2 received external beam radiation for concomitant gynecologic cancers; 7 with stage II tumors received adjuvant melphalan therapy and 1 received external beam radiation; and 5 with stage III tumors received melphalan therapy and 6 patients received cisplatin-based combination chemotherapy. Follow-up ranged from 1 to 117 months, with a median of 33.5 months. Eighty-seven patients were alive. Seven patients died, two of disease. The overall 5-year survival rate was 83.0%; those treated with adjuvant therapy had a 79.5% survival, whereas the others had 84.6% survival. Second-look surgery was performed in 10 patients; six results were negative after melphalan therapy, one was negative after cisplatin combination therapy, and one was negative after no adjuvant treatment. Two patients had positive second-look surgery, one with stage IIIC disease treated with a cisplatin combination and the other with stage IC disease treated with melphalan. This review did not demonstrate that patients with borderline ovarian tumors benefited from adjuvant therapy.     

Ovarian cystectomy for serous borderline tumors: a follow-up study of 35 cases

We have investigated the frequency of persistence or recurrence of tumor in 35 patients with ovarian serous borderline tumors treated by unilateral cystectomy, bilateral cystectomy, or unilateral cystectomy with contralateral oophorectomy or salpingo-oophorectomy. Nineteen of the patients had stage Ia, ten had stage Ib, four had stage Ic, and two had stage III tumors. Tumor persisted or recurred only in the ovary that had been subjected to cystectomy in two (6%) of the 33 patients with stage I tumors, in both the ipsilateral and contralateral ovary in one patient (3%), and in the contralateral ovary only in one patient (3%). The frequency of ipsilateral persistence or recurrence of tumor per ovary subjected to cystectomy in this group of patients was 8%. Both patients with stage III tumors had persistence or recurrence of their tumors. Involvement of the resection margin of the cystectomy specimen and the removal of more than one cyst from an ovary were almost always associated with persistence or recurrence of tumor. Follow-up of the 35 patients showed that despite the occasional complication of persistence or recurrence of tumor, all were alive without evidence of disease 3-18 years after the initial operation, with an average follow-up of 7.5 and a median follow-up of 6.5 years.     

Surgery as sole treatment for serous borderline tumors of the ovary with noninvasive implants

OBJECTIVES: The objectives were to describe the clinical characteristics and prognosis of surgically treated patients with stage II and III serous borderline tumors of the ovary with noninvasive implants. MATERIALS AND METHODS: From 1990 to 2000, 16 patients with stage II and III ovarian serous borderline tumors and noninvasive implants were diagnosed and prospectively followed at our center. All patients underwent surgical treatment including staging and their pathology was reviewed. Fifteen patients had thorough surgical staging by laparotomy, while one patient was staged laparoscopically. No patient was treated with adjuvant therapy (radiation or chemotherapy) after surgical treatment and none were lost to follow-up. RESULTS: The mean age at diagnosis was 42 years (range 26-59). Fourteen patients were treated by abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies, while 2 patients were treated conservatively for fertility preservation. Two patients underwent pelvic and para-aortic lymph node dissection. Fifteen of 16 patients had ovarian surface involvement with tumor. All patients but 2 had clinical evidence of extraovarian disease at the time of surgery. The mean duration of follow-up was 60.7 months (range 2-134 months). Thirteen patients (81%) are alive without evidence of disease. Four patients (25%) required subsequent surgery for recurrent disease and all are still alive. Two patients have been treated with chemotherapy (paclitaxel/carboplatin) for progressive borderline disease, while an additional patient was treated after first relapse with chemotherapy for an invasive recurrence. CONCLUSIONS: Carefully staged patients with advanced serous borderline tumors of the ovary and noninvasive implants have a good prognosis without adjuvant therapy.     

卵巢交界性肿瘤47例临床分析

目的探讨卵巢交界性肿瘤的临床特点、治疗方法及影响复发的临床病理因素。方法回顾性分析北京大学人民医院2004年8月至2009年6月收治的47例卵巢交界性肿瘤患者的临床资料。结果Ⅰ期卵巢交界性肿瘤患者39例(82.98%),Ⅱ期3例(6.38%),Ⅲ期5例(10.64%);术前彩超提示卵巢囊肿内有乳头状或实性区结构;伴血流信号者41例(87.23%),其中低血流阻力者13例(31.71%);CA125增高者25例(55.56%),CA199增高者10例(26.32%)。患者均行手术治疗,术中冰冻与石蜡病理的符合率为78.71%。术后化疗15例(31.91%)。24例行保守手术者复发4例,复发率16.67%,23例行根治性手术者复发2例,复发率8.69%,平均复发时间为20.83个月(7个月～3年),2例死亡。结论有复发高危因素的卵巢交界性肿瘤患者应进行化疗,以改善患者的预后。     

Borderline ovarian tumors in reproductive-age women. Fertility-sparing surgery and outcome

OBJECTIVE: To evaluate the fertility and survival outcomes in young women with borderline ovarian tumors treated with fertility-sparing surgery. STUDY DESIGN: From 1985 to 2002, 25 women with borderline ovarian cancers surgically managed with preservation of the uterus and at least a portion of 1 ovary were identified from tumor registry databases at 2 southern California hospitals. Data for analysis were collected from hospital charts, office records and tumor registry files. RESULTS: Twenty-five patients (median age, 29 years) with borderline ovarian tumors, including 10 with stage IA, 3 with stage IC, 1 with stage IIIA and 11 with unstaged disease, underwent fertility-sparing surgery, consisting of unilateral adnexectomy in 19, unilateral adnexectomy with contralateral cystectomy in 5 and unilateral cystectomy in 1. No disease recurred, providing an overall survival of 100%. Fertility status was available on 15 patients 4-157 months after surgery; 6 of them attempted to become pregnant. Five women had successful pregnancies, with a total of 5 live births. One woman underwent assisted reproductive techniques, became pregnant but aborted. The median follow-up was 80 months (range, 4-157). CONCLUSION: Conservative surgery for borderline ovarian tumors should be considered for women in the reproductive age group who desire preservation of fertility.     

30岁以下卵巢上皮性癌患者21例临床分析

目的探讨年轻卵巢上皮性癌患者的临床表现、病理类型、手术病理分期、治疗及预后。方法回顾性分析1986年1月至2002年3月间在我院治疗、年龄<30岁的卵巢上皮性癌21例患者的临床资料。结果21例患者确诊为卵巢上皮性癌时的中位数年龄为24岁(16～29岁),占同期全体卵巢上皮性癌患者的4.99%(21/421)。21例均在月经初潮后发病。12例有各种症状,腹痛8例、腹胀4例、月经改变3例等。21例中,急诊手术5例,16例为择期手术。肿物最大径线平均为17.6cm。16例肿瘤为单侧,4例为双侧,1例不详。手术病理分期,Ⅰ期10例、Ⅲ期5例、分期不详6例。病理类型以黏液性乳头状囊腺癌(9例)和浆液性乳头状囊腺癌(6例)最多见。病理分化程度,除6例不详外,高分化11例,中分化2例,低分化2例。初治时行肿瘤细胞减灭术或分期手术15例,复发后行再次肿瘤细胞减灭术6例;除2例患者外,肿瘤均切除干净或基本切除干净。共8例患者保留了生育功能。18例患者进行了以铂类或紫杉醇为基础药物的联合化疗,其中7例化疗达6个疗程以上。平均随访50个月(2～192个月)。结果6例患者死亡,2例带瘤生存,11例无瘤生存,2例失访。3年生存率为89%,5年生存率为76%。结论30岁以下妇女患卵巢上皮性癌较罕见,患者于月经初潮后发病,肿瘤体积较大,单侧多见;临床手术病理分期早期、病理分化程度高分化,病理类型以黏液性囊腺癌为多见,经手术及化疗,预后相对较好。     

Pathologic findings in eight cases of ovarian serous borderline tumors, three with foci of serous carcinoma, that preceded death or morbidity from invasive carcinoma.

We sought to assess the frequency of previously reported adverse histopathologic findings in ovarian serous borderline tumors (SBTs) in cases that preceded a patient's death or caused serious morbidity due to invasive carcinoma. SBTs with foci of invasive carcinoma that occupied a minority of the tumor and were associated with similar outcomes were also studied for potential additional insights. Eight cases were found over a 22-year period. Ten tumors in 5 patients were purely SBT; at initial staging, 1 patient had invasive peritoneal implants; 3 had noninvasive peritoneal implants; 1 was stage I. At last follow-up 3 of the 5 patients had died of carcinoma, 1 was alive with carcinoma, and 1 had no clinical evidence of disease 4 years after a sigmoid colectomy for invasive serous carcinoma of the bowel wall. Four tumors in 3 patients had foci of invasion that were more than microinvasive; at initial staging, all 3 patients had invasive peritoneal implants, and all died of carcinoma. All 14 of the ovarian tumors in the 8 cases had surface involvement by tumor cells, and in 8 tumors in 5 cases they were confined primarily to the ovarian surface. Foci of "micropapillary serous carcinoma" accompanied more obvious areas of infiltrative carcinoma in 2 of the 4 ovarian tumors, the peritoneal implants in 1 of the cases with purely SBTs, and a recurrence in this case and 1 other case. No morphologic finding in the 10 purely SBTs was predictive of subsequent malignant behavior. We conclude that extraovarian invasive serous carcinomas, either following or concurrent with an ovarian SBT, develop from borderline foci that may originate in the ovary, but frequently are likely to have arisen independently in the peritoneum. The carcinomas may be preceded or accompanied by noninvasive-appearing micropapillary foci in the peritoneum in some cases, but micropapillary foci in the ovarian tumors are infrequent and not a necessary antecedent.