Recurrence of borderline ovarian tumors
Aim - to increase the efficiency of diagnosis and treatment of patients with recurrences of borderline ovarian tumors (BOT). 106 patients with BOT of stage I have been treated and clinically observed: the I group (82 patients, mean age - 38,9 +- 5,5 years), who were treated with standard surgical op...
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
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| Цитувати: | Recurrence of borderline ovarian tumors / V.S. Svintsitskiy, L.I. Vorobyova, E.S. Klymenko, T.V. Dermenzhy, J.G. Tkalya // Experimental Oncology. — 2013. — Т. 35, № 2. — С. 118-121. — Бібліогр.: 17 назв. — англ. |
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irk-123456789-1452042019-01-21T01:23:01Z Recurrence of borderline ovarian tumors Svintsitskiy, V.S. Vorobyova, L.I. Klymenko, E.S. Dermenzhy, T.V. Tkalya, J.G. Original contributions Aim - to increase the efficiency of diagnosis and treatment of patients with recurrences of borderline ovarian tumors (BOT). 106 patients with BOT of stage I have been treated and clinically observed: the I group (82 patients, mean age - 38,9 +- 5,5 years), who were treated with standard surgical operation (panhysterectomy); the II group (24 patients, mean age - 30,3 +- 5,5 years), who underwent preserving surgery. The main method of treatment of patients with BOT is surgical. For patients of older age effective extension is panhysterectomy with the greater omentum resection. Further chemotherapy can be applied as the second stage of complex treatment in case of confounding factor of prognosis. Preserving treatment does not aggravate the indices of the survival rate among patients with BOT, which is confirmed by results of 5- and 10-years survival rate among patients after the preserving (I group) and standard surgery (II group): 87,4 and 79,2 % in the I group respectively, and 80,1 and 72,3 % in the II group respectively. The frequency of recurrence is higher in cases of bilateral affection of ovaries (IB stage), collapse of a capsule prior to the surgery. Sonography is a highly informative method of diagnostics of BOT relapse with its sensitivity 83,5 %, specifity - 64 %, favorable prognostic possibility - 56 %, unfavorable prognostic possibility - 66,4 %. 2013 Article Recurrence of borderline ovarian tumors / V.S. Svintsitskiy, L.I. Vorobyova, E.S. Klymenko, T.V. Dermenzhy, J.G. Tkalya // Experimental Oncology. — 2013. — Т. 35, № 2. — С. 118-121. — Бібліогр.: 17 назв. — англ. 1812-9269 http://dspace.nbuv.gov.ua/handle/123456789/145204 en Experimental Oncology Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Original contributions Original contributions |
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Original contributions Original contributions Svintsitskiy, V.S. Vorobyova, L.I. Klymenko, E.S. Dermenzhy, T.V. Tkalya, J.G. Recurrence of borderline ovarian tumors Experimental Oncology |
| description |
Aim - to increase the efficiency of diagnosis and treatment of patients with recurrences of borderline ovarian tumors (BOT). 106 patients with BOT of stage I have been treated and clinically observed: the I group (82 patients, mean age - 38,9 +- 5,5 years), who were treated with standard surgical operation (panhysterectomy); the II group (24 patients, mean age - 30,3 +- 5,5 years), who underwent preserving surgery. The main method of treatment of patients with BOT is surgical. For patients of older age effective extension is panhysterectomy with the greater omentum resection. Further chemotherapy can be applied as the second stage of complex treatment in case of confounding factor of prognosis. Preserving treatment does not aggravate the indices of the survival rate among patients with BOT, which is confirmed by results of 5- and 10-years survival rate among patients after the preserving (I group) and standard surgery (II group): 87,4 and 79,2 % in the I group respectively, and 80,1 and 72,3 % in the II group respectively. The frequency of recurrence is higher in cases of bilateral affection of ovaries (IB stage), collapse of a capsule prior to the surgery. Sonography is a highly informative method of diagnostics of BOT relapse with its sensitivity 83,5 %, specifity - 64 %, favorable prognostic possibility - 56 %, unfavorable prognostic possibility - 66,4 %. |
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Article |
| author |
Svintsitskiy, V.S. Vorobyova, L.I. Klymenko, E.S. Dermenzhy, T.V. Tkalya, J.G. |
| author_facet |
Svintsitskiy, V.S. Vorobyova, L.I. Klymenko, E.S. Dermenzhy, T.V. Tkalya, J.G. |
| author_sort |
Svintsitskiy, V.S. |
| title |
Recurrence of borderline ovarian tumors |
| title_short |
Recurrence of borderline ovarian tumors |
| title_full |
Recurrence of borderline ovarian tumors |
| title_fullStr |
Recurrence of borderline ovarian tumors |
| title_full_unstemmed |
Recurrence of borderline ovarian tumors |
| title_sort |
recurrence of borderline ovarian tumors |
| publisher |
Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
| publishDate |
2013 |
| topic_facet |
Original contributions |
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http://dspace.nbuv.gov.ua/handle/123456789/145204 |
| citation_txt |
Recurrence of borderline ovarian tumors / V.S. Svintsitskiy, L.I. Vorobyova, E.S. Klymenko, T.V. Dermenzhy, J.G. Tkalya // Experimental Oncology. — 2013. — Т. 35, № 2. — С. 118-121. — Бібліогр.: 17 назв. — англ. |
| series |
Experimental Oncology |
| work_keys_str_mv |
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2025-07-10T21:05:27Z |
| last_indexed |
2025-07-10T21:05:27Z |
| _version_ |
1837295510552051712 |
| fulltext |
118 Experimental Oncology 35, 118–121, 2013 (June)
RECURRENCE OF BORDERLINE OVARIAN TUMORS
V.S. Svintsitskiy1,*, L.I. Vorobyova1, E.S. Klymenko2, T.V. Dermenzhy1, J.G. Tkalya1
1National Cancer Institute, Kyiv, Ukraine
2Clinical Cancer Center, Lugansk, Ukraine
Aim: To increase the efficiency of diagnosis and treatment of patients with recurrences of borderline ovarian tumors (BOT). Materials and Methods:
106 patients with BOT of stage I have been treated and clinically observed: the I group (82 patients, mean age — 38.9 ± 5.5 years), who were
treated with standard surgical operation (panhysterectomy); the II group (24 patients, mean age — 30.3 ± 5.5 years), who underwent preserving
surgery. Results: The main method of treatment of patients with BOT is surgical. For patients of older age effective extension is panhysterectomy
with the greater omentum resection. Further chemotherapy can be applied as the second stage of complex treatment in case of confounding fac-
tor of prognosis. Preserving treatment does not aggravate the indices of the survival rate among patients with BOT, which is confirmed by results
of 5- and 10-years survival rate among patients after the preserving (I group) and standard surgery (II group): 87.4 and 79.2% in the I group
respectively, and 80.1 and 72.3% in the II group respectively. The frequency of recurrence is higher in cases of bilateral affection of ovaries (IB stage),
collapse of a capsule prior to the surgery. Sonography is a highly informative method of diagnostics of BOT relapse with its sensitivity 83.5%,
specifity — 64%, favorable prognostic possibility — 56%, unfavorable prognostic possibility — 66.4%. Conclusion: Additional criterion to evalu-
ate correctness of sonographic investigation is the CA-125 level in the blood serum. In majority of cases (85%) it coincided with the sonographic
results after some time. Sonography in combination with determination of CA-125 level in the blood serum is a reliable method of diagnostics
of BOT. Radical cytoreductive surgery with adjuvant polychemotherapy is important for the treatment of BOT recurrence.
Key Words: borderline ovarian tumors, sonography, recurrence.
Borderline ovarian tumours (BOT), i.e., tumors with
a potentially low level of malignancy, belong to a single
category of epithelial new formations in the International
Hystological Classification of WHO and make up to 8–16%
in the structure of all ovarian neoplasias [1–3]. BOT during
favourable course have a malignant potential — can re-
lapse and metastasize, and the threat of tumorous process
remains during 10 and more years [4, 5].
First described by Taylor in 1929, BOT are character-
ized by cellular stratification, architectural atypia, papillary
excrescenses, have not histological evidence of stromal
invasion, but can be associated with peritoneal implants
[6]. They account for 10–15% of ovarian epithelial tu-
mors and frequently occur in younger women who want
to preserve their reproductive function. The most com-
mon histologic type is serous, the others are mucinous,
endometrial, clear cell and transitional cell tumors. The last
three types are very uncommon. Approximately 65–70%
of all serous and 90% of all mucinous borderline tumors are
stage I by TNM classificaiton, with extra ovarian spreading,
in the form of peritoneal implants, occurring in the rest [7].
Serous borderline tumors are bilateral in about 50%
of cases and in about 20% of cases with mucinous bor-
derline tumors. Endometrioid, clear-cell and transitional
cell tumors are almost always stage I, and almost exclu-
sively unilateral. The peritoneal implants are classified
as non-invasive or invasive depending on their histological
structures, and in any individual patient may be purely non-
invasive, invasive or a combination of both [8, 9]. Mucinous
BOT are further classified into intestinal or endocervical
types, according to the nature of the cell types. Microinva-
sion of BOT, although described, however is a controversial
subject, and it is said to be occured in about 10% of cases,
and especially in pregnant women. It is defined as a focus
less than 3 mm in diameter with infiltration into the stroma
by single cells, nests cells or papillae [10–13]. Although
the data are derived from only small studies, it appears
that microinvasion does not change the patient overall
prognosis, although if it is combined with extra ovarian
spreading, it may be an adverse prognostic factor [14–16].
There are no pathognomonic ultrasonographic fea-
tures associated with borderline tumors. Nevertheless,
ultrasonography is a priority in the diagnostic work-up,
not uncommonly confirming the presence of a complex
ovarian mass in one of the adnexum. CA125 is elevated
by 40–50% of stage I, and >90% in patients with ad-
vanced stage serous tumour and in about 50% of pa-
tients with stage I mucinous tumors [17–18].
MATERIALS AND METHODS
106 adult patients with BOT were included in this
study. Patients were staged in the accordance with TNM
classification (the 6th edition) as T1N0M0. 106 patients
with BOT of stage I have received treatment and been
clinically observed: 1st group (82 patients, mean age
38.9 ± 5.5), who received standard surgical treatment
(panhysterectomy), and the 2nd group (24 patients, mean
age 30.3 ± 5.5), who underwent preserving surgery.
The study protocol was approved by Ethical Committee
permission of National Cancer Institute (Kyiv, Ukraine).
The selection of patients with BOT for the pre-
serving surgery was conducted by the following way:
affection of one ovary (IA stage); tumor capsule was
not damaged with breakage; tumor spreading on the
ovarian surface was absent; tumorous cells were ab-
sent in the ascite liquid or in swabs of the abdominal
cavity, pelvis, diaphragm, liver, retroperitoneal lymph
nodes during urgent cytological investigation; the size
of a tumor did not exceed 10 cm.
Received: April 15, 2013.
Correspondence: E-mail: svs1@voliacable.com
Abbreviations used: BOT — borderline ovarian tumors; NMI — nucle-
ar magnenic imaging; PET — positron emission tomography.
Exp Oncol 2013
35, 2, 118–121
Experimental Oncology 35, 118–121, 2013 (June)35, 118–121, 2013 (June) (June) 119
The method of preserving surgery is represented by the
following way: after the peritoneal cavity was cut with mid-
line laparatomy the organs and tissues were carefully stud-
ied, after which the surgical staging was performed, which
is described above. In case the spread of the process did
not find its place in parietal and visceral peritoneum as well
as tumorous cells in swabs of the peritoneum were absent
(diagnosed by urgent cytological investigation), we consid-
ered the stage of the disease to equal T1aN0M0. In case
of only one ovary being affected, we performed unilateral
removal of the uterine annexes on the affected side and
biopsy of the contralateral ovary, omentum resection with
urgent intrasurgical morphological investigation.
To be able to detect a relapse after the primary
treatment was completed, patients were under dy-
namic surveillance as out-patients. Complex check-
up apart from clinical examination, included sonogra-
phy of the pelvic organs applying vaginal and abdomi-
nal sensors, colour Doppler mapping, determianiton
of CA-125 tumor marker’s concentration in the blood
serum, and additional methods of investigation (X-Ray
of the thoracic organs, CT) when they were requested.
Statistics. Statistical processing was performed
using the parametric criteria of Student’s t-test. Dif-
ferences were considered statistically significant
at p < 0.05 (95% accuracy).
RESULTS AND DISCUSSION
3 patients out of 82 of the 1st group were excluded
from the observation, and 79 patients have been ob-
served during 1–16 years after the primary treatment.
Out of 79 patients 16 (20.2%) had tumor progress,
10 (12.6%) patients out of whom underwent a full sur-
gery, 6 patients (7.5%) — after the preserving surgery.
Monitoring of CA-125 after the treatment of 82 patients
with BOT was conducted to 73 (89.0%), 13 (17.8%) out
of whom had increased level of CA-125 and diagnosed dis-
ease relapse. Increase of marker’s concentration was reg-
istered within 2–8 months before the clinical signs of the
disease progress among 25.0% of cases (3 patients out
of 13). Average index of CA-125 among patients with BOT
relapse was high and constituted 354.0 ± 22.7 unit/ml.
Relapse occurred among 16 patients at different
times after the surgery: more often late —12–14 years
of observation — 7 (43.8%) patients: 1–6 years —
6 (37.6%) patients. Thus, relapse among patients with
BOT during the observation occurred within the period
of 1–12 years (Table).
Table. Frequency and term of relapse among patients with BOT (I group
after the surgery)
Diagnosis Term of relapse occurrence, years Number of patients
n %
BOT < 1 1 6.3
1–3 3 18.8
3–5 3 18.8
5–12 7 43.8
> 12 2 12.3
Total 16 100.0
In the II group of 24 patients, who were performed
preserving surgery, distant metastases occurred
in 23 (95.7%). Tumor relapse after preserving surgery
became known among 3 (13.0%) patients in the term
of 5–11 years. Metastases into the greater omentum
were diagnosed in 1 (4.3%) patient.
Disease progress among patients of group I and II had
manifestations of severe dissemination in the peritoneum.
It has to be noted the aggressiveness of the disease among
patients with serous BOT, more greater number of relapse
within 5 years after the primary treatment, and more often
among patients with bilateral ovarian affection, rather than
among patients with mucinous BOT. Progression of the
main process by local regional recurrence was deter-
mined in 4 (25%) patients, dissemination on the abdomen
complicated by polyserositis — in 6 (37.5%) of 16 patients
of group I. At mucinous BOT the most frequent sign of tu-
mor progression was the development of pseudomyxoma.
Loco-regional relapse in the greater omentum was
diagnosed in 2 out of 6 patients, who did not undergo
omentectomy during the primary treatment. 1 patient
after the conventional surgery with omentectomy had
metastases in the residual limb of the greater omentum.
Local relapse of BOT after standard surgery (bilat-
eral adnexectomy with the uterus removal and the greater
omentum resection) appear in the region of the pelvis af-
fecting adjacent organs. After the preserving surgery (uni-
lateral adnexectomy, ovary resection) a tumor has grown
primarily in the remaining tissue of the operated ovary with
its further spread to the uterus and adjacent tissues.
To identify sonographic criteria of treatment’s ef-
ficiency among patients with BOT there was conducted
a retrospective analysis of sonographic data of the
peritoneal space and pelvis among the women, who
have been treated or consultated for BOT in National
Cancer Institute from 2000 to 2012.
It was detected that the increase of CA-125 level
in the blood serum was correlated with sonographic
results and each of mentioned indices separately
confirmed disease recurrence in 77% of patients with
BOT. In 11.1% of patients CA-125 level primarily increase
from 36 to 100 units/ml without any sonographic signs
of the relapse was observed. Moreover, in 7.6% of pa-
tients CA-125 level was below to be detected and did not
increase within the normal range, but the sonography
detected signs of BOT recurrence 2–4 months before
the CA-125 increase (more than 33 units/ml). At primary
treatment CA-125 level among these patients was higher.
Sonographic signs of BOT recurrence were tumor
nodes from 0.5 to 1.5 cm in diameter with fine-grained
or “spongy” solid structure, round or irregular shape
which were localized in vesicouterine fold or above the
cervical stump or in lateral canals.
Tumors of more than 2 cm had solid or cystic-solid
structure. It must be mentioned that tumor recurrence
had distinct borders in most cases (81.6%) and lumpy,
uneven (8.4%). Tumors of more than 1.5 cm had solid
or cystic-solid structure (Fig. 1 a–c).
Clinic-ultrasound correlation has identified that tumour
size evaluated by laparotomy, in general coincided with
the sonographic reports (83.5%). The difference ranged
within millimeters. During some observations the size
of tumors was mistakenly announced bigger with the so-
nography (1–6 cm). The ground of sonographic and gyn-
120 Experimental Oncology 35, 118–121, 2013 (June)
aecological checkup mistakes were mostly caused by the
frank adhesive process — intestinal loops grown together
with the tumor — which were identified as a single node.
Sonographic evaluation of the state of anatomical
structures and functional changes due to the charac-
teristic reactions to the tumorous process lead to im-
provement of the diagnostics of topographic relations
between the tumour and adjacent tissues and organs.
Deformation of the urinary bladder’s wall and
pyelectasis were considered as a signs of uterine-
bladder ligament tumors infiltration and probable
invasive growth into the urinary bladder, which was
confirmed in 3 patients while the secondary cytoreduc-
tive intervention. Pyelectasia was the first indirect sign
of metastatic affection of ileac lymph nodes.
Having collated the sonographic reports with intra-
surgical and morphological ones the following signs
were proclaimed for the operability of patients with
BOT recurrence: one or more tumorous nodes mostly
of solid structure with distinct borders, regular shape,
signs of partial or complete mobility, located in the pelvis
or in the retroperitoneum; the absence of distant metas-
tasis of BTO in liver, spleen, retroperitoneal lymph nodes.
The signs of visual multiple metastases along the
parietal and visceral space and the diaphragm, spread tu-
morous affection on the pelvic region, deformation of uri-
nary bladder’s walls, frank adhesive process, referred
to impossibility of surgical intervention to be conducted.
Received data proved that sonography is a highly infor-
mative method of diagnostics for BOT relapse with its sen-
sitivity of 83.5%, specificity of 64%, favourable prognostic
accuracy 56%, unfavourable prognostic possibility 66.4%.
Summarizing the results of clinicosonographic
correlation, it is important to emphasize that such
an investigation expands our insight about sonography
for the diagnostics of BOT recurrence. The acquired
parallel data explains to a full extent variability of the
sonographic picture, which hinges on histological
structure of an ovarian tumor, allows analyzing a pos-
sibility of tumor invasion in other organs.
On the grounds of the correlated reports of the ul-
trasound investigation with intrasurgical and morpho-
logical results it is possible to distinguish main signs
of operability of patients with BOT relapse: recidive
tumor of solid or cystic-solid structure, mobile with
vivid lumpy border; no multiple distant metastases.
An additional evaluation criterion of correct sono-
graphic conclusion for tumors with positive markers
is CA-125 in the blood serum. In the most observations
(85%) after some time it coincided with sonographic
reports.
Thus, sonography in combination of CA-125 level
in the blood serum is a reliable method of diagnostics
for patients with BOT. Also, it must be emphasized that
sonography is remained the only generally available
method, that allows to control the efficiency of therapy
and to correct the treatment in the group of patients
with tumors and negative markers.
Among all BOT patients with recurrence after
a conventional surgery, 8 patients have been under-
gone to surgical treatment. The terms of the surgery
are from 7 months to 3 years. The following surgical
interventions were conducted: removal of the recidi-
vating tumor located in the pelvis (5), eliminating of ob-
struction which arose due to general tumor growth
(1), mucinous liquid evacuation from the peritoneum
at pseudomyxoma of the peritoneum (2), in addition
1 patient was operated twice (Fig. 2 a–c).
Among all patients who underwent the preser-
ving surgery on the first stage of treatment 3 patients
with the disease relapse had secondary laparotomy
and panhysterectomy with the resection of greater
omentum. In all patients who underwent cytoreduc-
tive operations BOT were confirmed histologically. All
the patients after the detected BOT progression had
3–6 cycles of polychemotherapy after the surgery ac-
cording to the PC system (cysplatin 75 mg/m2 + cyclo-
phosphan 600 mg/m2 intravenously/intracutaneously
within 3 weeks). Therefore organ preserving treatment
doesn’t affect the long-term results in patients with
BTO of stage I. It was confirmed by the results of 5- and
10-years survival rate: in group of patients who under-
went standard operation it equaled to 92.7 and 83.2%
and in case of organ preserving treatment — 98.2 and
91.4%, respectively.
Therefore, the main method of treatments for BOT
patients is surgical one. For patients of older age group
effective expansion is panhysterectomy with the greater
omentum resection. Further chemotherapy will be ap-
plied as the second stage of combined treatment in case
of confounding factor of prognosis. High survival rate
among young patients at early stages of BOT (47.6% pa-
tients of the reproductive period) confirms the necessity
of active implementation of preserving surgery.
According to the results of investigation one of the
most important factor of BOT recurrence is insufficient
a b c
Fig. 1. Sonography of the BOT relapse: a — seedy cystic structure of the round shape; b — multi-chamber cystic structure of ir-
regular shape; c — “sponge” solid structure of irregular shape
Experimental Oncology 35, 118–121, 2013 (June)35, 118–121, 2013 (June) (June) 121
expansion of the surgical treatment. In the treatment
of BOT recurrence main importance is given to sur-
gical intervention for radical cytoreductive surgery,
which further will be complemented with adjuvant
polychemotherapy.
During the dynamic observation of patients with
BOT after the surgery the determination of CA-125 le-
vel in the blood serum demonstrates a great clinical
relevance for the control of disease progression.
It was studied the dynamics of tumor marker CA-
125 and sonography for conservative treatment of pa-
tients with BOT relapse. As for the information content
these methods are not inferior to others and are avail-
able for a great group of patients. Sonography being
in demand is caused by the fact that palpatory data
for the evaluation of conducted treatment’s efficiency
is subjective, but the endoscopic or X-ray investiga-
tion is linked to radioactive burden and certain risk for
complications, which prohibits the application of this
method often. Such high-tech methods as magnetic
resonance tomography and positron emission tomog-
raphy have high informational content but characterized
by high cost.
An additional criterion to assess the correctness
of sonographic conclusion at marker positive tumors
is CA-125 level in the blood serum. In majority of cases
(85%) it coincides with the sonography investigation.
Therefore, sonography in combination with determi-
nation of tumour marker CA-125 in the blood serum
is a reliable method of diagnostics for patients with
recurrence of BOT.
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a b c
Fig. 2. Secondary surgical treatment of a patient with recurrence of BOT: a — before the tumor removal; b — after the tumor re-
moval; c — surgical intervention is completed
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