eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Oncology

Borderline Ovarian Cancer: Workup

Author: Andrew E Green, MD, BA, BS, Consulting Staff, Southeastern Gynecologic Oncology, LLC, Northeast Georgia Medical Center
Contributor Information and Disclosures

Updated: Jan 15, 2008

Workup

Laboratory Studies

  • Cancer antigen 125 (CA-125) levels are not shown to aid in the diagnosis or follow-up care of patients with borderline tumors.

Imaging Studies

  • Preoperative transvaginal color Doppler ultrasound has been used to assess the possibility of malignancy of ovarian masses. The rate of detection of intratumoral blood flow in borderline tumors is similar to that of malignant neoplasms: 90% and 92%, respectively. The resistance and pulsatility indexes are also significantly reduced in carcinoma and borderline ovarian tumors compared to benign tumors. While useful in some situations, this medium is not currently part of the standard workup. It is neither sensitive enough nor specific enough to be used as a screening tool in the normal populations.
  • Some authors use CT scans in their presurgical workup; however, laparotomy is still required.

Histologic Findings

According to Dietel and Hauptmann, the histology of borderline tumors is characterized by the following features:1

  • Epithelial multilayering of more than 4 cell layers
  • Not more than 4 mitoses per 10 high-power field
  • Mild nuclear atypia
  • Increase in nuclear/cytoplasmic ratio
  • Slight-to-complex branching of epithelial papillae and pseudopapillae
  • Epithelial budding and cell detachment into the lumen
  • No destructive stromal invasion - A major component in differentiating malignant from borderline tumors

Mucinous tumors look grossly similar to their benign counterparts, having large multilocular cysts with smooth surfaces. The epithelial layer is characterized by stratification of 2-3 layers. Nuclear atypia, enlarged nuclei, and mitotic figures are observed.

Approximately 25% of borderline tumors have cell proliferations on the outer surface of the lesion with no evidence of growth from the inner surface. Of these, approximately 90% develop peritoneal implants. Only 4% of cases with peritoneal implants do not have surface proliferation.

Peritoneal implants are described as invasive or noninvasive. Noninvasive implants are glandular or papillary proliferations with cell detachments.

Psammoma bodies, cellular atypia, and desmoplastic fibrosis are observed in some instances. The appearance of invasive implants is similar, but they have epithelial cells infiltrating the stroma.

Staging

As with other ovarian masses, staging is performed surgically. Many sources recommend complete staging if a borderline tumor is found. Current guidelines include biopsy specimens of the pelvic peritoneum (cul-de-sac, pelvic wall, and bladder peritoneum), abdominal peritoneum (paracolic gutters and diaphragmatic surfaces), omentum, intestinal serosa and mesentery, and retroperitoneal lymph nodes (pelvic and para-aortic).

More on Borderline Ovarian Cancer

Overview: Borderline Ovarian Cancer
Workup: Borderline Ovarian Cancer
Treatment: Borderline Ovarian Cancer
Follow-up: Borderline Ovarian Cancer
References
Further Reading
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References

  1. Dietel M, Hauptmann S. Serous tumors of low malignant potential of the ovary. 1. Diagnostic pathology. Virchows Arch. May 2000;436(5):403-12. [Medline].

  2. Gershenson DM, Silva EG, Levy L, et al. Ovarian serous borderline tumors with invasive peritoneal implants. Cancer. Mar 15 1998;82(6):1096-103. [Medline].

  3. Lin PS, Gershenson DM, Bevers MW, et al. The current status of surgical staging of ovarian serous borderline tumors. Cancer. Feb 15 1999;85(4):905-11. [Medline].

  4. Chan JK, Lin YG, Loizzi V, et al. Borderline ovarian tumors in reproductive-age women. Fertility-sparing surgery and outcome. J Reprod Med. Oct 2003;48(10):756-60. [Medline].

  5. Eltabbakh GH, Natarajan N, Piver MS, Mettlin CJ. Epidemiologic differences between women with borderline ovarian tumors and women with epithelial ovarian cancer. Gynecol Oncol. Jul 1999;74(1):103-7. [Medline].

  6. Emoto M, Udo T, Obama H, et al. The blood flow characteristics in borderline ovarian tumors based on both color Doppler ultrasound and histopathological analyses. Gynecol Oncol. Sep 1998;70(3):351-7. [Medline].

  7. Harris R, Whittemore AS, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. III. Epithelial tumors of low malignant potential in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. Nov 15 1992;136(10):1204-11. [Medline].

  8. Houck K, Nikrui N, Duska L, et al. Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol. Jun 2000;95(6 Pt 1):839-43. [Medline].

  9. Menzin AW, Gal D, Lovecchio JL. Contemporary surgical management of borderline ovarian tumors: a survey of the Society of Gynecologic Oncologists. Gynecol Oncol. Jul 2000;78(1):7-9. [Medline].

  10. Menzin AW, Rubin SC, Noumoff JS, LiVolsi VA. The accuracy of a frozen section diagnosis of borderline ovarian malignancy. Gynecol Oncol. Nov 1995;59(2):183-5. [Medline].

  11. Morris RT, Gershenson DM, Silva EG, et al. Outcome and reproductive function after conservative surgery for borderline ovarian tumors. Obstet Gynecol. Apr 2000;95(4):541-7. [Medline].

  12. Nielsen JS, Jakobsen E, Holund B, et al. Prognostic significance of p53, Her-2, and EGFR overexpression in borderline and epithelial ovarian cancer. Int J Gynecol Cancer. Nov-Dec 2004;14(6):1086-96. [Medline].

  13. Sherman ME, Mink PJ, Curtis R, et al. Survival among women with borderline ovarian tumors and ovarian carcinoma: a population-based analysis. Cancer. Mar 1 2004;100(5):1045-52. [Medline].

  14. Tamakoshi K, Kikkawa F, Nakashima N, et al. Clinical behavior of borderline ovarian tumors: a study of 150 cases. J Surg Oncol. Feb 1997;64(2):147-52. [Medline].

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Further Reading

See Borderline Ovarian Cancer on Medscape.

See Treatment for Borderline Ovarian Cancer on Medscape.

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Keywords

borderline ovarian tumors, ovarian tumors of low malignant potential, epithelial ovarian tumors of low malignant potential, ovarian masses, cancer antigen 125, CA125, CA-125, mucinous tumors, serous tumors, fertility-sparing surgery, oophorectomy, salpingo-oophorectomy, cystectomy, epithelial ovarian tumors, epithelial ovarian carcinoma

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Contributor Information and Disclosures

Author

Andrew E Green, MD, BA, BS, Consulting Staff, Southeastern Gynecologic Oncology, LLC, Northeast Georgia Medical Center
Andrew E Green, MD, BA, BS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society of Clinical Oncology, and Society of Gynecologist Oncologists
Disclosure: Nothing to disclose.

Medical Editor

Bryan D Cowan, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Veterans Affairs Medical Center; Medical Director, Wiser Hospital for Women, University of Mississippi Medical Center
Bryan D Cowan, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Endocrine Society, Sigma Xi, Society for Assisted Reproductive Technologies, Society for Gynecologic Investigation, Society for the Study of Reproduction, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michel E Rivlin, MD, Associate Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Bryan D Cowan, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Veterans Affairs Medical Center; Medical Director, Wiser Hospital for Women, University of Mississippi Medical Center
Bryan D Cowan, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Endocrine Society, Sigma Xi, Society for Assisted Reproductive Technologies, Society for Gynecologic Investigation, Society for the Study of Reproduction, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

 
 
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