Balancing Fertility and Oncologic Outcomes: Can We Have Our Cake and Eat It Too?

Excerpt

During the last decade, gynecologic oncologists and pathologists have begun to reconsider which clinical and pathologic factors effect outcomes in patients with borderline tumors of the ovary. These tumors of low malignant potential lack the deep stromal invasion (>5 mm or >10 mm²) of their invasive carcinoma counterparts. And unlike epithelial carcinomas, which have six different subtypes (serous, endometrioid, mucinous, clear cell, transitional, and undifferentiated), borderline tumors of the ovary are almost exclusively either serous or mucinous. Serous borderline tumors tend to be smaller than their mucinous counterparts and rarely have areas of invasive carcinoma in the same specimen. Furthermore, they seldom recur once removed; however, when they do, they typically return as recurrent borderline histology and rarely undergo malignant transformation into low-grade serous carcinoma. It is exceedingly rare for a serous borderline tumor to recur as a high-grade carcinoma. Mucinous borderline tumors, on the other hand, seem to be a step along the continuum from normal to invasive mucinous carcinoma. Pathologic specimens may have areas of normal ovary, benign mucinous cystadenoma, borderline tumor, and high-grade invasive mucinous carcinoma side by side with one another. Because these neoplasms often can be >10 cm in size at surgical resection, making frozen section exclusion of invasive carcinoma difficult, most gynecologic oncologists perform a modified staging procedure, which includes appendectomy for all mucinous neoplasms (benign or borderline) in the event that final pathology returns an invasive carcinoma. …