Borderline ovarian tumours: a continuing conundrum?

Commentary

 Whereas benign and malignant primary tumours of the ovary are well understood clinically, the concept of borderline ones are less so. Of the epithelial tumours of the ovary, the concept is best described in serous tumours, and less so in the other types, largely because serous tumours can present with extra-ovarian nonmalignant spread at the time of diagnosis. The pathological diagnosis of a borderline tumour is essentially one of dysplasia, with no (or minimal) invasion, on good histological sampling of the ovary. In the area of ovarian serous tumours, this has been further complicated by the identification of the micro-papillary subset, and of serous epithelium involving other tissues (implants—invasive versus noninvasive) and what the diagnostic criteria are and what they mean biologically......

 Why does this matter? The clinical dilemma of what do with women with a borderline ovarian tumour diagnosis is problematic in the extreme. Do these women warrant more aggressive treatment at diagnosis or can a watchful waiting policy be more appropriate? We still cannot predict which cases will/may progress with any certainty. The majority of these women are pre-menopausal, with many years of life ahead of them, and hence over-treatment may be just as harmful as under-treatment. The need for accurate pathology, and the distinction from a true low grade serous carcinoma, is vital but often very difficult. The need to exclude metastatic mucinous tumours from a primary ovarian one, even of borderline type, is well described. The questions are easy to raise, but answering them is and continues to be far harder.