A case of ovarian serous borderline tumors with normal ovarian findings on preoperative imaging
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250880Keywords:
Serous borderline tumor, Micropapillary pattern, Surface papillary type, Laparoscopic surgeryAbstract
Ovarian serous borderline tumors (SBTs) are typically diagnosed through imaging techniques such as ultrasound and magnetic resonance imaging (MRI); however, diagnosis can be challenging when the tumor exhibits unusual growth patterns or is of small size. We report the case of a 55-year-old woman in whom bilateral SBTs were discovered during surgery, although preoperative imaging showed no ovarian abnormalities. The patient underwent laparoscopic total hysterectomy and bilateral adnexectomy for uterine fibroids. Preoperative MRI and transvaginal ultrasound did not reveal any ovarian abnormalities, but during laparoscopic surgery, small nodules growing outward were observed on both ovaries. Pathological examination led to the diagnosis of a serous borderline tumor with micropapillary pattern (SBT-MP). This case highlights the limitations of preoperative imaging in detecting small serous borderline tumors with surface papillary growth, as no abnormalities were observed preoperatively despite bilateral ovarian involvement. When an ovarian tumor exhibiting surface growth is identified during surgery, even if it is too small to be detected preoperatively, it is crucial to consider the possibility of a borderline tumor. In such cases, it is essential to perform pathological examination, including intraoperative frozen section analysis, and conduct a thorough macroscopic inspection of the abdominal cavity.
Metrics
References
Clement PB, Young RH. Atlas of gynecologic surgical pathology. 2nd Edition. Philadelphia: Elsevier. 2008;308-18.
Hauptmann S, Friedrich K, Redline R, Avril S. Ovarian borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria. Virchows Arch. 2017;470:125-42. DOI: https://doi.org/10.1007/s00428-016-2040-8
Scully RE, Young RH, Clement PB. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. 3rd series ed. Vol. 23. Atlas of Tumor Pathology. Washington DC: Armed Forces Institutes of Pathology. 1996;51-79.
Ludovisi M, Foo X, Mainenti S, Testa AC, Arora R, Jurkovic D. Ultrasound Diagnosis of Serous Surface Papillary Borderline Ovarian Tumor: A Case Series with a Review of the Literature. J Clin Ultrasound. 2014;43(9):573-7. DOI: https://doi.org/10.1002/jcu.22266
Tanaka YO, Okada S, Satoh T, Matsumoto K, Oki A, Nishida M, et al. Ovarian serous surface papillary borderline tumors form sea anemone-like masses. J Magn Reson Imaging. 2011;33(3):633-40. DOI: https://doi.org/10.1002/jmri.22430
Park JY, Kim DY, Kim JH, Kim YM, Kim KR, Kim YT, et al. Micropapillary pattern in serous borderline ovarian tumors: does it matter? Gynecol Oncol. 2011;123(3):511-6. DOI: https://doi.org/10.1016/j.ygyno.2011.08.008
Nakai G, Yamada T, Yamamoto K, Hirose Y, Ohmichi M, Narumi Y. MRI appearance of ovarian serous borderline tumors of the micropapillary type compared to that of typical ovarian serous borderline tumors: radiologic-pathologic correlation. J Ovarian Res. 2018;11(1):7. DOI: https://doi.org/10.1186/s13048-018-0379-y
Li K, Song F, Yu L, Shi H, Wang J, Cheng X. Role of MRI in characterizing serous borderline ovarian tumor and its subtypes: Correlation of MRI features with clinicopathological characteristics. Eur J Radiol. 2022;147:110112. DOI: https://doi.org/10.1016/j.ejrad.2021.110112
Park JS, Choi SB, Kim HJ, Cho NH, Kim SW, Kim YT, et al. Intraoperative Diagnosis Support Tool for Serous Ovarian Tumors Based on Microarray Data Using Multicategory Machine Learning. Int J Gynecol Cancer. 2016;26(1):104-13. DOI: https://doi.org/10.1097/IGC.0000000000000566
Salcedo-Hernández RA, Cantú-de-León DF, Pérez-Montiel D, García-Pérez L, Lino-Silva LS, Zepeda-Najar C, et al. The usefulness of intraoperative consultation for the diagnosis of borderline ovarian tumors. Ann Transl Med. 2021;9(3):261. DOI: https://doi.org/10.21037/atm-20-3932
Capozzi VA, Scarpelli E, Monfardini L, Mandato VD, Merisio C, Uccella S, et al. Do Exophytic and Endophytic Patterns in Borderline Ovarian Tumors Have Different Prognostic Implications? A Large Multicentric Experience. J Clin Med. 2023;12(10):3544. DOI: https://doi.org/10.3390/jcm12103544
Ureyen I, Karalok A, Tasci T, Turkmen O, Boran N, Tulunay G, et al. The Factors Predicting Recurrence in Patients With Serous Borderline Ovarian Tumor. Int J Gynecol Cancer. 2016;26(1):66-72. DOI: https://doi.org/10.1097/IGC.0000000000000568
Gouy S, Maria S, Faron M, Maulard A, Pautier P, Leary A, et al. Results After Conservative Surgery of Stage II/III Serous Borderline Ovarian Tumors. Ann Surg Oncol. 2021;28(7):3597-604. DOI: https://doi.org/10.1245/s10434-020-09250-7
Silva EG, Gershenson DM, Malpica A, Deavers M. The recurrence and the overall survival rates of ovarian serous borderline neoplasms with noninvasive implants is time dependent. Am J Surg Pathol. 2006;30(11):1367-71. DOI: https://doi.org/10.1097/01.pas.0000213294.81154.95
Yokoyama Y, Moriya T, Takano T, Shoji T, Takahashi O, Nakahara K, et al. Clinical outcome and risk factors for recurrence in borderline ovarian tumours. Br J Cancer. 2006;94(11):1586-91. DOI: https://doi.org/10.1038/sj.bjc.6603139
Chang SJ, Ryu HS, Chang KH, Yoo SC, Yoon JH. Prognostic significance of the micropapillary pattern in patients with serous borderline ovarian tumors. Acta Obstet Gynecol Scand. 2008;87(4):476-81. DOI: https://doi.org/10.1080/00016340801995640
Shih KK, Zhou Q, Huh J, Morgan JC, Iasonos A, Aghajanian C, et al. Risk factors for recurrence of ovarian borderline tumors. Gynecol Oncol. 2011;120(3):480-4. DOI: https://doi.org/10.1016/j.ygyno.2010.11.016
Uzan C, Muller E, Kane A, Rey A, Gouy S, Bendiffallah S, et al. Prognostic factors for recurrence after conservative treatment in a series of 119 patients with stage I serous borderline tumors of the ovary. Ann Oncol. 2014;25(1):166-71. DOI: https://doi.org/10.1093/annonc/mdt430