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.     

Borderline ovarian tumors

Forty three patients with borderline ovarian tumours were examined from 1987 till 2000. 28 patients (65.1%) were serous tumours and 15 patients (35%) were mucinous. The median age was 42.2 +/- 15.4 years. The follow-up period was 5.4 +/- 3.2 years. Preoperatively Ca125 were 52.5 +/- 50.3 and of Ca19.9-42.4 +/- 46.8 IU. 83% of the patients were in stage I and 17% in stage III. There was no significant difference in the tumour volumes. Ca125 were significantly increased in the serous tumours and Ca19.9 were increased in the mucinous tumours. All the patients were followed up and are in good health or remission with exception of 2 who developed recurrence.     

Masculinizing ovarian tumors.

In a study of 194 masculinizing ovarian tumors from the Ovarian Tumor Registry, the criteria for reclassifying these tumors on a histologic basis are discussed. It is proposed that the terms "gynandroblastoma" and "arrhenoblastoma" be discarded in favor of "gonadal stromal," and that the general classification of "lipoid tumor" can be avoided if careful search is made for specific histologic structures. Finally, it is suggested that the malignancy rate for gonadal stromal tumors, Sertoli-Leydig tumors, hilus cell tumors and adrenal rest tumors is closer to 5% rather than 25-30%.     

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.     

Management of massive ovarian tumors

Two patients with massive ovarian tumors, one with a 51 kilogram Stage IC mucinous cystadenocarcinoma and the other with a 34 kilogram mucinous cystadenoma, are presented. Problems associated with resection of massive ovarian tumors, including respiratory failure, intraoperative fluid shifts, adequate exposure, orthostatic hypotension and adynamic intestine, are identified. Guidelines for avoiding these pitfalls by the use of appropriate monitoring, controlled drainage of the cyst and transverse elliptic incision with abdominoplasty are suggested.