Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study

OBJECTIVES: To examine outcomes in women treated with conservative surgery for borderline ovarian tumor in a large population-based cohort with long-term follow-up. METHODS: Women treated by conservative surgery for borderline tumor of the ovary from 1982-2004 within a large HMO setting were identified using electronic and tumor registry data. Chart review was performed when electronic data were incomplete. The indications for and outcomes from any subsequent gynecologic surgery and the risk of recurrent ovarian borderline and malignant tumor were determined. Risk factors for recurrence were analyzed using multivariate regression. RESULTS: Among one hundred and ninety-three patients identified, the average age was 33 (12-95), with 97% having apparent Stage I disease. Patients were followed with remaining ovarian tissue in situ for a mean of 6.9 years, with 59 women having 10 or more years of such observation. There were 21 recurrences with borderline tumor (11%) with a median time to first recurrence of 4.7 years; women treated by cystectomy recurred three times more often compared to women treated by oophorectomy (23% versus 7%). Two patients (1%) recurred with malignant disease involving remaining ovarian tissue, both within the first 3 years after surgery, with one death due to recurrence. During long-term follow-up, 19% of patients eventually underwent complete removal of ovarian tissue: in 8%, the surgery was prophylactic, in 5%, surgery was done for benign pathology, and in 6% for recurrent disease. CONCLUSIONS: In this population-based HMO setting, 11% of women treated with conservative surgery for borderline tumor recurred; however, half of these recurrences were successfully managed by repeat conservative surgery, with only 6% of women overall needing eventual complete removal of ovaries for recurrent disease. Patients treated by cystectomy were three times more likely to recur than those treated by oophorectomy. Malignant recurrences were rare, and while borderline recurrences often occurred more than 3 years after initial surgery, late malignant recurrences were not observed. These favorable long-term outcomes provide support for conservative surgery for these women.     

中药敷贴疗法治疗高血压随机对照研究

[目的]探讨中药敷贴疗法防治中老年人高血压的临床效果。[方法]选择2009年5月至2011年4月我院收治的37例临界高血压患者,随机分为治疗组和对照组,治疗组18例,对照组19例;治疗组使用中药敷贴涌泉穴进行治疗,将吴茱萸150g,肉桂150g,共捣烂如泥,加生姜汁,调成膏状。将药物涂抹于医用胶布上,并贴敷于涌泉穴处,涌泉穴位于中趾根部与足跟连线1/3处。每日治疗1次,30min/次,每10次为1个疗程,共治疗3个疗程,同时配合低盐低脂饮食。对照组使用饮食控制进行治疗。观察并比较相关指标的改变情况,并进行治疗后的随访评价工作。[结果]两组治疗前后内皮素及尿微量白蛋白改善情况比较,治疗组优于对照组(P<0.01);两组治疗前后血压改善情况比较,治疗组优于对照组(P<0.01);对照组与治疗前比较,治疗组优于对照组(P<0.05)。[结论]中药敷贴涌泉穴能更好的提高临界高血压的临床疗效。     

Is Target Oriented Surgery Sufficient with Borderline Ovarian Tumors? - Role of Accompanying Pathologies

Background: There are limited data in the literature related to concomitant genital or extra-genital organ pathologies in patients with borderline ovarian tumors (BOTs). The aim of this study was to evaluate our experience with 183 patients to draw attention to the accompanying organ pathologies with BOTs. Materialsand Methods: One hundred eighty-three patients with BOTs, diagnosed and/or treated in our center between January of 2000 and March of 2013 were evaluated retrospectively. Data related to age, tumor histology, lesion side, disease stage, accompanying incidental ipsilateral and/or contralateral ovarian pathologies, treatment approaches, and follow-up periods were investigated. Incidental gynecologic and non-gynecologic concomitant organ pathologies were also recorded. Results: The mean age at diagnosis was 40.6 years (range: 17-78). Ninetyfive patients (51%) were ≤40 years. A hundred and forty-seven patients (80%) were at stage IA of the disease. The most common type of BOT was serous in histology. Non-invasive tumor implants were diagnosed in 4% anduterine involvement was found 2% among patients who underwent hysterectomies. There were 12 patients with positive peritoneal washings. Only 17 and 84 patients respectively had concomitant ipsilateral and concomitantcontralateral incidental ovarian pathologies. The most common type of uterine, appendicular and omental pathologies were chronic cervicitis, lymphoid hyperplasia and chronic inflammatory reaction. Conclusions: According to our findings most of accompanying pathologies for BOT are benign in nature. Nevertheless, there were additional malignant diseases necessitating further therapy. We emphasize the importance of the evaluation of all abdominal organs during surgery.     

交界性卵巢肿瘤保留生育功能治疗方法进展

保留生育功能的手术治疗是交界性卵巢肿瘤(borderline ovarian tumors,BOTs)年轻患者保留生育能力的最佳治疗手段。保留生育功能的手术不仅对早期BOTs患者较安全,对于晚期有卵巢外种植的患者,若病灶可完全摘除,也可接受此种手术治疗。术后妊娠率可观,且大部分可通过自然方式妊娠。术后妊娠对病程影响较小,妊娠并发症也很少发生。早期BOTs患者术后不孕可给予促排卵药物治疗,但晚期患者则需要谨慎对待。若病变累及双侧卵巢不宜进行保守性手术,可选择胚胎冻存、卵母细胞冻存、卵巢组织冻存、接受卵母细胞赠送等方法。     

29例卵巢交界性肿瘤伴上皮内癌临床病理分析

目的 探讨卵巢交界性肿瘤伴上皮内癌（OIC）的临床病理特征、预后情况及保留生育功能术后患者的生育状况。方法 回顾性分析四川大学华西第二医院妇科2005年1月至2014年3月收治的29例OIC患者的临床资料,随访6~93月,比较复发率及保留生育功能术后的妊娠率。结果 OIC患者在交界性肿瘤中占4.0%（29/719）,其中有生育要求者51.7%（15/29）。所有患者均接受手术治疗,行保守性手术51.7%（15/29）,根治性手术48.3%（14/29）,辅助化疗27.6%（8/29）。病理类型:黏液性69.0%（20/29）,浆液性13.8%（4/29）,宫内膜样性6.9%（2/29）,混合型10.3%（3/29）。FIGO分期:Ⅰa期75.9%（22/29）,Ⅰb期17.2%（5/29）,Ⅰc期6.9%（2/29）。平均随访时间49.6月,复发率10.3%（3/29）,妊娠率66.7%（10/15）。肿瘤期别较高及术中保留患侧卵巢的复发率较高（ P=0.005, P=0.005）;年龄较小者的妊娠率较高（ P=0.017）。结论 OIC患者较年轻,发现时多为早期。病理类型以黏液性为主。对于有生育要求患者,卵巢肿瘤剥除术的复发率较高。     

Psychotraumatisme,fonctionnement limite et addiction à l’adolescence : réévaluation de la notion de « comorbidité » pour l’hypothèse d’un « complexe » symptomatique et une nouvelle explicitation des perspectives thérapeutiques

Background

We live in a world where traumatic situations seem almost permanent, shown continuously by the media. In addtion, the increase of the number of diagnoses of borderline pathologies raises the question of the location of the disorders, in particular during adolescence, according to their developmental axis and associated comorbidity. This clinical frame can lead to drug consumption and then addiction. These data being established, however, the fact is that many patients do not meet the criteria, which are sometimes too strict, of PTSD.

Differences in mental health among young adults with borderline personality symptoms of various severities

Purpose

This study examined the differences in mental health and behavioral problems among young adults with borderline personality symptoms of various severities.

Borderline Ovarian Tumor in the Pediatric and Adolescent Population: A Case Series and Literature Review

Study Objective

To determine the diagnosis, management, and outcome for children and adolescents with borderline ovarian tumor (BOT), and to provide a review of the literature on BOT in children and adolescents.

Staging procedures in patients with mucinous borderline tumors of the ovary do not reveal peritoneal or omental disease

Objectives

Staging in case of a borderline tumor of the ovary (BOT) is a controversial issue. Upstaging is not uncommon, but this occurs especially with presumed stage I serous borderline tumors. There are only a few documented cases of BOTs of non-serous histology that were not confined to the ovary. The aim of this study was to assess the incidence of non-invasive and invasive implants in the omentum and other (extra)pelvic peritoneal surfaces in patients with a mucinous BOT (mBOT).

Borderline ovarian tumors: features and controversial aspects

Objective

To investigate features and controversial aspects of the borderline ovarian tumor (BOT), a neoplasm with favorable prognosis representing 10–15% of epithelial ovarian tumors.

Study design

: We retrospectively studied all patients treated at our institution from 2000 to 2010 taking into account the age, the stage, the type of surgery, the tumor size, the symptoms, the pre- and post-intervention tumor marker levels (CA125, CA19.9, CA15.3 and CEA), the presence of recurrence, the overall survival (OS), the progression-free survival (PFS).

Results

A total of 43 patients were identified. The median age was 49 years (range: 15–82 years). The most frequent FIGO stage was IA (74% of the cases) with a prevalence of serous histotype, and 49% of the patients were asymptomatic. The CA125 level was abnormal in 55% of the patients before surgery, returning to the normal range in all cases after tumor removal. The PFS was 96% and 77% at five and sixty months respectively.

Conclusion

The BOT is closer to a benign than to a malignant tumor in the early stages, when confined to the ovary (IA and IB). In these stages conservative surgery is safe and advisable for women seeking offspring. In the other stages the need for a careful and long-term follow-up arises. CA125, despite its modest sensitivity and specificity, has a role in the follow-up of BOT.