Approximately 3000 American women are diagnosed with borderline ovarian tumours annually. Borderline tumours are similar to other types of adnexal masses. Prognostic factors include the International Federation of Gynecology and Obstetrics (FIGO) stage, presence of peritoneal implants, micropapillary pattern (for serous histology), microinvasion and intra-epithelial carcinoma (for mucinous histology). Approximately 65–70% of serous tumours and 90% of mucinous tumours are stage I, and 30% and 10%, respectively, are associated with extra-ovarian spread. Fertility-preservation counselling is recommended for young patients. Fertility-sparing surgery is feasible in a high proportion of women in the reproductive age group. Surgical staging generally includes resection of the primary borderline tumour, by either unilateral salpingo-oophorectomy or ovarian cystectomy, cytologic washings, omentectomy and peritoneal biopsies, and routine lymphadenectomy is not recommended. However, because the accuracy of frozen-section examination is lower than optimal, caution is recommended. Postoperative therapy is recommended only for those women with serous borderline tumours and invasive implants. Fortunately, relapse is uncommon.
Highlights
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Surgical approach – open or minimally invasive – should be individualized.
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Fertility-sparing surgery is feasible in a high proportion of young patients.
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Surgical staging is recommended for borderline ovarian tumours.
Introduction
In 1929, Taylor first described a group of patients with ‘semimalignant’ or hyperplastic ovarian tumours without histological evidence of stromal invasion but with peritoneal implants . He noted that these patients had a better prognosis than those with frankly malignant tumours. However, not until the International Federation of Gynecology and Obstetrics (FIGO) recognized the distinct clinical entity of ‘carcinoma of low malignant potential’ and the World Health Organization (WHO) adopted the term ‘borderline malignancies’ did this group of tumours receive general acceptance. Only within the past two decades or so have we begun to understand their biological behaviour and optimal therapy.
Approximately 3000 American women are diagnosed with borderline ovarian tumours annually. Borderline ovarian tumours account for 10–15% of epithelial tumours. Histological types include serous ( Fig. 1 ) – the most common – mucinous ( Fig. 2 ), endometrioid, clear-cell and transitional-cell (or Brenner) tumours. The latter three histological types are very uncommon. Histological criteria for the diagnosis of borderline ovarian tumours include nuclear atypia, stratification of the epithelium, formation of microscopic papillary projections and the absence of stromal invasion.
