Borderline ovarian tumours

 

How any members believe that  some mucinous borderline tumors of the ovary may actually represent metastasis from the appendix.? Any such belief / experience. If that be so should we remove appendix which is borderline unhealthy in  all Gynae Laparoscopy to minimize mucinous Ca later in life ?? Any study??

Based on molecular studies, it is now belief of many cytopathologist that it is like that(origin) is from Appendix  . They also added that although none of the following have been shown to be statistically significant, factors reportedly linked with borderline tumors include the following:

·        Oral contraceptive use

·        Menarche

·        Age at first pregnancy

·        Age at first delivery

·        Menstrual history

·        Smoking history

·        Family history of ovarian cancer

Incidence of borderline ovarian tumors

One woman in 55 (1.8%) develops some form of ovarian cancer in her lifetime. Approximately 90% of these cancers are tumors of epithelial origin. If benign lesions are included, epithelial tumors account for 60% of all ovarian tumors.

How many members  affords much time and go ahead for biopsy from so many sites and more importantly how many Asst are meticulous in labeling the sample accurately while performing laparotomy for Borderline or frank Ca Ovary??

Ans: It goes without saying that all visible implants should be biopsied. But  ,another common component of staging is the description of the type of implants, as these have significant prognostic value.

Preoperatively, borderline tumors are often presumed to be either benign or malignant ovarian masses; however, 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). This biopsies and staging are best done if the initial operation is done by  gynecologic oncologists

Inaccurate staging

One study found that only 12% of patients were adequately staged at initial operation. Of these patients, 78% were operated on by general obstetrician/gynecologists, 10% by gynecologic oncologists, and 6% by general surgeons. This biopsies and staging are best done if the initial operation is done by  gynecologic oncologists were asked about surgical staging for borderline tumors, 97% recommended some type of staging procedure, although opinions varied significantly about which samples should be taken. 

Your experience please ?  How accurate is pathologic diagnosis of ovarian tumour reported by histologist  by frozen section? Are you happy with HP diag furnished by pathologist at Frozen Section , say in ovarian Ca??

 

Ans: Many are of opinion that   Borderline tumors are correctly diagnosed 58-86% of the time by frozen section, depending on the experience of the pathologist and the site of the operation (eg, tertiary care vs community hospital).Membes may pl note that in one  study at a tertiary referral center, benign disease was excluded in 94% of cases subsequently diagnosed as borderline tumor. They therefore concluded that the proper operation and staging procedures could have been performed during the initial operation in most cases, even though the diagnosis by frozen section was not completely accurate.

·        Feedback

How to assess prognosis of “Borderline Ov tumours”?? Ans: Prognosis in Borderline Ovarian tumours are overall have an excellent prognosis. Approximately 95% of borderline ovarian tumors have diploid deoxyribonucleic acid (DNA). This finding is almost always associated with an excellent prognosis. If the tumor is aneuploid, the recurrence rate is high. These women have a 60% chance of having stage I disease when diagnosed. Postoperative treatment for any stage is controversial; therefore, recommending reoperation for surgical staging alone is difficult. This being said, adequate staging is essential for determining the prognosis. One study showed that the only recurrences were noted in unstaged stage 1 borderline ovarian cancer. Some authors suggest treating these as low-grade invasive carcinoma (also called micropapillary carcinoma).

Conflicting data exist with respect to overexpression of various oncogenes and tumor suppressor genes. Although TP 53 positivity and HER2 overexpression in invasive cancer have been associated with a worse prognosis, the same gene profile has conferred a survival advantage in borderline tumors