Borderline ovarian serous cystadenoma
Borderline ovarian serous cystadenomas lie in the intermediate range in the spectrum of ovarian serous tumours and represent approximately 15% of all serous tumours.
They present at the younger age group 1-2 than the more malignant serous cystadenocarcinomas with a peak age of presentation of ~ 45 years of age 1.
The tumours are often clinically silent until they achieve an advanced size or stage. The most frequent initial manifestations were abdominal pain, increasing abdominal girth or distension or as an abdominal mass 2.
Borderline tumours fall under ovarian epithelial tumours. They tend to develop in an exophytic growth pattern, on the surface of the ovary, without invading the underlying stroma. Papillary projections are characteristic and may be more of a feature with borderline than malignant serous cystadenocarcinoma of the ovary.
A unique feature of a borderline tumours is the non-invasive behavior of extra-ovarian tumour implants in the advanced stages of the disease 2-3. Implants can occur to the contralateral ovary, omentum, and peritoneal surface in the advanced stages, although they behave in a benign fashion and remain located on the surface of the underlying tissues.
Serum CA-125 level is typically mildly elevated.
Typically seen as bilateral adnexal masses with profuse papillary projections. Bilaterality occurs more frequently than with benign ovarian serous cystadenomas 1.
Serous borderline tumours may display aggressive behaviour, and occasionally present with peritoneal or nodal metastases.
The rate of detection of intra tumoral blood flow on Doppler ultrasound can be very similar to more malignant neoplasms 2.
Borderline tumours are staged using the same ovarian cancer staging as malignant ovarian neoplasms.
Post surgical prognosis is better than for ovarian cystadenocarcinoma, even in the presence of transovarian spread5.
History and etymology
They were first described in 1929 and were designated for separate classification in the early 1970s by the World Health Organisation 2.
- 1. Nucci MR, Oliva E. Gynecologic Pathology. Churchill Livingstone. (2009) ISBN:0443069204. Read it at Google Books - Find it at Amazon
- 2. Burkholz KJ, Wood BP, Zuppan C. Best cases from the AFIP: Borderline papillary serous tumor of the right ovary. Radiographics. 25 (6): 1689-92. doi:10.1148/rg.256055015 - Pubmed citation
- 3. Seidman JD, Kurman RJ. Ovarian serous borderline tumors: a critical review of the literature with emphasis on prognostic indicators. Hum. Pathol. 2000;31 (5): 539-57. - Pubmed citation
- 4. Prat J, De nictolis M. Serous borderline tumors of the ovary: a long-term follow-up study of 137 cases, including 18 with a micropapillary pattern and 20 with microinvasion. Am. J. Surg. Pathol. 2002;26 (9): 1111-28. Am. J. Surg. Pathol. (link) - Pubmed citation
- 5. Wasnik AP, Menias CO, Platt JF et-al. Multimodality imaging of ovarian cystic lesions: Review with an imaging based algorithmic approach. World J Radiol. 2013;5 (3): 113-25. doi:10.4329/wjr.v5.i3.113 - Free text at pubmed - Pubmed citation