paywalled: Management and Prognosis of Clear Cell Borderline Ovarian Tumor.

Management and Prognosis of Clear Cell Borderline Ovarian Tumor.:

Abstract
BACKGROUND: The clear cell borderline ovarian tumor (CCBOT) of the ovary is a rare tumor accounting for less than 1% of BOT. Fewer than 25 cases have been reported in the literature (including details on clinical management and outcomes). The aim of this study was to determine the prognosis of a series of CCBOTs collected in 2 reference centers.
PATIENTS AND METHODS: This was a retrospective review of patients with CCBOT treated or referred to our institutions. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion.
RESULTS: Twelve patients were identified between 2000 and 2010. The median age of patients was 68 years (range, 36-83 years). Two had been treated conservatively and 9 radically (data unknown in 1). The tumor was unilateral in 11 cases. All patients had stage I disease. All cases were CCBOT with an adenofibromatous pattern. Stromal microinvasion or intraepithelial carcinoma was histologically associated in 2 and 3 cases, respectively. Four of the 12 patients had synchronous endometrial disorders (but no endometrioid carcinoma). No cases were histologically associated with endometriosis. Four patients were lost to follow-up. Among 8 other patients, after a median period of 28 months (range, 2-129 months), no recurrence had occurred (1 patient had died of another disease).
CONCLUSION: Clear cell borderline ovarian tumor carries a good prognosis. All tumors are (blogger's note - 'were' in this study of 12 pts) stage I; therefore, surgical staging is not necessary in most of the cases. Conservative treatment could be proposed to young patients, but uterine curettage would then be required in cases of uterine preservation.

Correspondence: re - Intra-operative frozen section analysis for suspected early-stage ovarian cancer - Twigg - 2012 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

Intra-operative frozen section analysis for suspected early-stage ovarian cancer - Twigg - 2012 - BJOG: An International Journal of Obstetrics & Gynaecology

Correspondence

Volume 119, Issue 7, page 896, June 2012

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Sir,

We read with interest the article by Cross et al.¹ on the use of intra-operative frozen section for suspected early ovarian cancer. We would like to commend the authors for their work in providing these data and we recognise the need for mechanisms that can be used to address the National Institute for Health and Clinical Excellence (NICE) Guidelines CG122, which recommend assessment of the para-aortic lymph nodes in women with early ovarian cancer.²

However, there are a number of areas of practice that we feel need to be examined further before frozen section procedures can be used to alter the management of women with suspected early-stage ovarian cancer.

First, we are perplexed that the authors deemed it necessary to undertake para-aortic lymphadenectomy for women with borderline ovarian tumours. These are by nature an unpredictable class of tumour with mostly good outcomes and little in the way of nonsurgical treatment options when there is disseminated disease. Further, they are usually early-stage tumours and so the utility of a para-aortic lymph node dissection is questionable. If the authors had described the rate of disease in lymph nodes and the difference in outcome this provided for the woman with positive nodes their data would lend stronger support for more widespread implementation.

Accepting this and examining the authors data for ‘all comers’ (Table 1) we calculate that 28.8% (415) of women had an appropriate para-aortic lymph node dissection on the basis of the frozen section prediction, which represents the real-world scenario for the gynaecological oncology surgeon waiting in theatre for a frozen section analysis to be phoned back.

If the authors changed their protocol to only using dissection in women with malignancy on frozen section, 63.8% (918) of women would appropriately not undergo a para-aortic dissection. The total number of women correctly triaged by frozen section analysis would be 92.6%. Of the remainder, 7% would not undergo a para-aortic dissection that should and 0.35% would have a dissection they do not need. Such a protocol change compares with the authors’ figures who, when including a policy of para-aortic dissection for borderline tumours on frozen section, overtreated 8% of the women and undertreated 1.3%.

The answer to deciding which strategy one would wish to take up must come down to the differences in outcome for these women, defined by morbidity and mortality comparisons from overtreatment or undertreatment by surgery or chemotherapy, respectively, and any subsequent influence this has on overall survival. Unfortunately the authors do not provide this information, and only allude to data in preparation that indicate their ability to increase the stage of a woman’s disease. However, this figure can be calculated from their data in Table 1 to equate to 82 women (5.7%) who had a frozen section showing borderline disease but whose final paraffin section report showed a malignancy. Until other centres can validate their techniques and such practice can be shown to translate into a survival benefit for women, it is unlikely that their data will change surgical practice in women with early ovarian cancer.

References

• 1
  Cross P, Naik R, Patel A, Nayar A, Hemming J, Williamson S, et al. Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012;119:194–201.
  

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• 2
  National Institute for Health and Clinical Excellence. The recognition and initial management of ovarian cancer. [http://www.nice.org.uk/CG122]. Accessed 20 January 2012. 
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paywalled: Increased expression of OCIA domain containing 2 during stepwise progression of ovarian mucinous tumor - Pathology Intl

Increased expression of OCIA domain containing 2 during stepwise progression of ovarian mucinous tumor

Ovarian cancer immunoreactive antigen domain containing 2 (OCIAD2) has been reported to show cancer-specific expression in early invasive lung adenocarcinoma. OCIAD2 shows high homology with OCIAD1, which was originally immunoscreened from ascites of a patient with ovarian cancer and found to be a tumor-specific protein. Therefore, like OCIAD1, OCIAD2 is expected to show high immunoreactivity in ovarian tumors.

In this study, we examined the expression pattern of OCIAD2 in 117 ovarian mucinous tumors, and confirmed that it was more highly expressed in borderline tumor and carcinoma (51/74 cases, 69%) than in adenoma (6/43 cases, 14%). The immunoreactivity of OCIAD2 in borderline tumor and carcinoma was more specific than that of OCIAD1 (adenoma, 21/43 cases, 49%), and more sensitive than that of CEA (borderline tumor and carcinoma, 35/74 cases, 47%). Like OCIAD1, OCIAD2 is a cancer-related protein and its expression level increases during the course of malignant progression and is thought to be a very useful marker for evaluating the malignancy of ovarian mucinous tumors.

(Apr 2012) Commentary: Link between endometriosis and ovarian-cancer subtypes : The Lancet Oncology

Link between endometriosis and ovarian-cancer subtypes : The Lancet Oncology

"Previous large epidemiological studies have attempted to identify benign gynaecological disorders that predispose to the development of epithelial ovarian cancer. The only disorder that has been repeatedly1—4 (although not universally5) associated with this cancer is endometriosis. Results of some of these studies have suggested a specific link with endometrioid and clear-cell ovarian cancers, but until now none had the power to allow definitive subgroup analysis based on a contemporary definition of histological subtype.

 

In a study reported in the Lancet Oncology, Celeste Leigh Pearce and colleagues6 assessed self-reported endometriosis data from 13 pooled case—control studies in the Ovarian Cancer Association Consortium (OCAC). They confirm that a history of endometriosis is significantly associated with an increased risk of clear-cell (odds ratio 3·05, 95% CI 2·43—3·84) and endometrioid (2·04, CI 1·67—2·48) ovarian cancers, and for the first time show an association with low-grade serous ovarian cancer (2·11, 1·39—3·20). No association was noted between endometriosis and high-grade serous, mucinous, serous borderline, or mucinous borderline ovarian cancers.

 

With more than 23 000 participants (7911 with a diagnosis of ovarian cancer), the main strengths of this study are its statistical power and its robust methods. Incidences of reported endometriosis differ substantially between the pooled studies. Although clinicopathological and genetic differences between the populations could reasonably be expected, importantly there was no significant heterogeneity of the association with histological subtype in the different studies.

The main truly novel finding is an association between a history of endometriosis and low-grade serous ovarian cancer. Perhaps surprisingly, serous borderline tumours (from which invasive low-grade serous ovarian cancers are believed to arise7) are not also associated with a history of endometriosis.

Pathol. 2012 - abstract (Japan) "Piling up" clear cells in müllerian-type mucinous and mixed cell-type borderline tumor do not represent concomitant clear cell neoplasms (mucinous/mixed/clear cell/borderline/ER....)

Hum Pathol. 2012 Mar 19. [Epub ahead of print]

"Piling up" clear cells in müllerian-type mucinous and mixed cell-type borderline tumor do not represent concomitant clear cell neoplasms.

Abstract

The nature of "piling up" proliferation of clear cells in müllerian mucinous/mixed borderline tumor has not been well characterized. The purpose of this study was to clarify whether or not such clear cells represent concomitant clear cell neoplasms.

First, we carefully reviewed hematoxylin and eosin slides taken from 139 ovarian tumors diagnosed as clear cell carcinoma (112 cases) and müllerian mucinous/mixed borderline tumor (27 cases) to clarify (1) the frequency of piling-up clear cells in müllerian mucinous/mixed borderline tumor and (2) the frequency of the coexistence of typical clear cell carcinoma and müllerian mucinous/mixed borderline tumor.

Second, we investigated the immunohistochemical expression of estrogen receptor, hepatocyte nuclear factor-1β, and glypican-3 in proliferating clear cells in both tumors.

We identified piling-up clear cells in 56% of müllerian mucinous/mixed borderline tumors. Such clear cells lacked the severe nuclear atypia, complex branching, and dense hyalinized cores of typical clear cell carcinoma. We did not find coexistence of typical clear cell carcinoma and müllerian mucinous/mixed borderline tumor in any tumors.

Piling-up clear cells and endocervical-like mucinous cells were positive for estrogen receptor but negative for hepatocyte nuclear factor-1β and glypican-3. Most clear cell carcinomas showed a hepatocyte nuclear factor-1β-positive/estrogen receptor-negative immunophenotype, and about half of them were glypican-3 positive.

In conclusion, piling-up clear cells in müllerian mucinous/mixed borderline tumor do not represent concomitant clear cell neoplasms because clear cell carcinoma and müllerian mucinous/mixed borderline tumor hardly ever coexist and because such clear cells in both tumors are immunophenotypically distinct.

Search Results - 'lmp ovarian' 'borderline ovarian' 2011 ASCO abstract

Find EXACT phrase: lmp ovarian

Found 1 document.

A multivariate longitudinal algorithm for early detection of ovarian cancer using multiple biomarker

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Find EXACT phrase: borderline ovarian
Found 2 documents, showing 1 - 2

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1. Regulation of the tumor suppressor gene PAEP in the transition from serous borderline ovarian tumors to low-grade serous ovarian carcinomas. | 2011 ASCO Annual Meeting Abstracts
   ... from serous borderline ovarian tumors to low-grade serous ovarian carcinomas. | 2011 ASCO ...
   ... Background: Serous borderline ovarian tumors (SBOT) and low grade serous ovarian carcinomas (LG) ...
   
2. Elevation of HE4 and CA 125 in symptomatic patients with invasive epithelial ovarian cancer. | 2011 ASCO Annual Meeting Abstracts
   ... were malignant. Borderline ovarian tumors were excluded from the analyses. A total of 115 cases ...

abstract: Clinical characteristics of borderline ovarian tumors and stage I epithelial ovarian cancer: an analysis of 143 cases

abstract: Trends in incidence of borderline ovarian tumors in Denmark 1978-2006

Note: other research is of the same opinions (see prior blog posts) that incident rates of ovarian cancer are in fact not reducing (eg. population...)


Conclusions. The incidence rate of borderline ovarian tumors increased significantly in Denmark in 1978-2006. In line with results from ovarian cancer, Denmark had a higher incidence rate of borderline ovarian tumors compared with the other Nordic countries in 1978-2006.

abstract: Ovarian serous surface papillary borderline tumors form sea anemone-like masses

PURPOSE: To clarify the imaging characteristics of ovarian serous surface papillary borderline tumor (SSPBT), whose prognosis is far better than that of serous surface papillary adenocarcinoma (SSPC).

Risk factors for recurrence of ovarian borderline tumors - abstract

abstract: Clinical features of 215 stage I ovarian tumors in Japanese women (borderline vs stage 1 clear cell; stage1C)

PURPOSE: Differences of the clinical features of Stage I borderline ovarian tumors and Stage I ovarian cancer need to be clarified.
METHODS: We retrospectively investigated 215 patients with Stage I ovarian tumors (67 with borderline tumors and 148 with ovarian cancer) treated between 1988 and 2001.
RESULTS: Only one patient with a borderline tumor developed recurrence, while recurrence was found in 20 patients with Stage I ovarian cancer. There was a significant difference in the recurrence rate between patients with Stage Ia or Ib ovarian cancer and those with Stage Ic cancer (p = 0.007). Clear cell adenocarcinoma showed a higher recurrence rate. Among our patients with recurrence, only five in whom the recurrent tumor could be surgically resected are currently alive and disease-free.
CONCLUSIONS: This study confirmed the low aggressiveness of Stage I borderline ovarian tumors and high aggressiveness of Stage Ic ovarian cancer or clear cell adenocarcinoma. In patients with recurrence, surgical resection may improve survival.

PMID: 20882880 [PubMed - in process]

Serous and mucinous borderline ovarian tumors (LMP): are there real differences between these two entities?

Objective
To evaluate the clinical outcome and pathological features of patients with borderline ovarian tumors (BOT) with special emphasis on serous and mucinous histology.


Conclusions
Serous tumors present more unfavorable anatomopathological characteristics but are associated with better prognosis than mucinous tumors. If mucinous BOT diagnosis is retained physicians should be aware that their aggressive potential is not negligible.

Abstract: Cervical manifestation of a borderline type ovarian cancer with pseudomyxoma peritonei - a case report

Note: mucinous cell type is a cell type found in numerous organs including colon/rectum Abstract: Borderline tumours of the ovary (BOTs) are rare tumour entities that do not show any destructive or invasive growth in the majority of cases, even though they can display characteristics of malignant tumours The mucinous subtype can also originate from the appendix, and ovarian metastases can mimic primary ovarian BOTs, often accompanied by peritoneal manifestation in terms of pseudomyxoma peritonei. In cases where a concomitant appendiceal tumour is present, it may prove difficult to determine the primary tumour. This report describes a special case of BOT with a specific example of the complexity of the differential diagnosis of pseudomyxoma peritonei. Especially the case was simultaneously linked to appendiceal and ovarian cancer. Moreover, this case was exceptional for its unusual manifestation of BOT in the cervix.

full free access: Genomic aberrations in borderline ovarian tumors

Note: this paper is long and technical but of importance given, in part, the connection to Lynch Syndrome (MSI testing, microsatellite). Microsatellite testing is a test commonly used for suspected Lynch Syndrome patients. Specific research regarding ovarian cancer (epithelial) /MSI is limited.

Background
"According to the scientific literature, less than 30 borderline ovarian tumors have been karyotyped and less than 100 analyzed for genomic imbalances by CGH."

Ovarian Low Malignant Potential Tumors (borderline ovarian tumors) Treatment, Masonic Cancer Center, University of Minnesota

Note: also commonly referred to as "LMP"

The pathology of and controversial aspects of ovarian borderline tumours

Abstract
PURPOSE OF REVIEW: Ovarian borderline tumours are relatively uncommon, but not rare, neoplasms. Pathologists and oncologists often struggle with various aspects of borderline tumours which are sometimes controversial and poorly understood.

Phase II trial of the histone deacetylase inhibitor belinostat in women with platinum resistant epithelial ovarian cancer and micropapillary (LMP) ovarian tumours

Phase II trial of the histone deacetylase inhibitor belinostat in women with platinum resistant epithelial ovarian cancer and micropapillary (LMP) ovarian tumours.

CONCLUSIONS: Belinostat is well tolerated in both patient groups and shows some activity in patients with micropapillary (LMP) disease.

Evaluation of the risk of malignancy index in daily clinical management of adnexal masses

Conclusions

"In our study population, introduction of the RMI would improve the management of adnexal masses, with a higher percentage of ovarian cancer patients that are operated by a gynecologic oncologist. At the same time, referral of patients with non-invasive (benign and borderline) lesions would be reduced."

abstract: Current Update on Borderline Ovarian Neoplasms

CONCLUSION. Borderline tumors are considered to be precursors of low-grade ovarian cancers. Accurate diagnosis and staging facilitate optimal patient management particularly in patients desiring to preserve fertility.