Download PDF
Geburtshilfe Frauenheilkd 1999; 59(10): 488-494
DOI: 10.1055/s-1999-5980
ÜBERSICHT
Georg Thieme Verlag Stuttgart · New York

Borderlinetumoren des Ovars - Darstellung eines sich entwickelnden Konzeptes

Borderline Tumors of the Ovary - An Evolving ConceptO. Reich, M. Lahousen, H. Pickel, R. Winter
  • Geburtshilflich-gynäkologische Universitätsklinik Graz
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: Borderlinetumoren (BOT) sind proliferierende, metastasierungsfähige Intermediärformen der epithelialen Geschwülste des Ovars, die biologisch und histologisch zwischen den Adenomen und Karzinomen stehen. Trotz ihrer Häufigkeit im Auftreten sind diagnostische Abgrenzung und klinisches Management häufiger Gegenstand kontroverser Diskussionen. Fragestellung: Ziel der vorliegenden Übersichtsarbeit war es, unter Einbeziehung eigener Daten wesentliche Aspekte des Konzeptes der ovariellen BOT darzustellen. Methoden: Hierzu wurden 169 Patientinnen, die zwischen 1972 und 1995 an unserer Klinik behandelt und nachbeobachtet wurden, retrospektiv erfaßt. Die klinischen Daten werden anhand der aktuellen Literatur diskutiert. Ergebnisse: Die Diagnostik von BOT beruht ausschließlich auf histologischen und zytologischen Kriterien. BOT mit Mikroinvasion stellen Grenzfälle zu Karzinomen dar. Die Zuordnung peritonealer Implantationen seröser BOT zum nicht-invasiven oder invasiven Typ ist prognostisch und therapeutisch relevant. Das mikropapilläre Karzinom wird als Sonderform seröser BOT diskutiert. Ziel der Primärbehandlung ist die Bestimmung der Tumorausbreitung und die operative Erlangung von Tumorfreiheit. Adjuvante Therapieformen sind High risk-Fällen vorbehalten. Schlußfolgerungen: Für die Zukunft ist zu erwarten, daß es der Einsatz neuer Technologien zur Analyse von Mustern der Genexpression erlauben wird, zu einer verbesserten Charakterisierung von BOT und zu einer individuelleren Therapie zu kommen.

Abstract

Background: Ovarian tumors of low malignant potential are proliferating intermediate epithelial ovarian tumors capable of metastasis. Histologically they lie between adenomas and carcinomas. Despite their relatively high incidence optimal management is often unclear. Methods: We reviewed 169 patients with ovarian tumors of LMP treated between 1972 and 1995. Results: LMP is a histologic diagnosis. Some tumors of LMP show microinvasion. Peritoneal implants can be invasive or noninvasive and this is of prognostic relevance. So-called micropapillary carcinoma may be a specific subtype of serous ovarian tumors of LMP. The goal of primary treatment is to accurately stage the disease and remove it completely. Adjuvant treatment is generally reserved for patients considered at high risk for recurrence. Conclusion: New genetic techniques may permit a more accurate classification of ovarian tumors of LMP and more individualized treatment.

Literatur

  • 1 Aure J, Hoeg K, Kolstad P. Clinical and histologic studies of ovarian carcinoma: long-term follow-up of 990 cases.  Obstet Gynecol. 1971;  37 1-9
    PubMedGoogle Scholar
  • 2 Barnhill D, Kurman R J, Brandy M F, Omura G A, Yordon E, Given FT, Kucera P R, Roman L D. Preliminary analysis of the behavior of stage I ovarian serous tumors of low malignant potential: a Gynecologic Oncology Group study.  J Clin Oncol. 1995;  13 2752-2756
    PubMedGoogle Scholar
  • 3 Bell D A, Weinstock M A, Scully R E. Peritoneal implants of serous borderline tumors: Histologic features and prognosis.  Cancer. 1988;  62 2212-2222
    CrossrefPubMedGoogle Scholar
  • 4 Bell D A, Scully R E. Benign and borderline clear cell adenofibromas of the ovary.  Cancer. 1985;  56 2911-2931
    PubMedGoogle Scholar
  • 5 Bell D A, Scully R E. Ovarian serous borderline tumors with stromal microinvasion: A report of 21 cases.  Hum Pathol. 1990;  21 397-403
    CrossrefPubMedGoogle Scholar
  • 6 Burks R T, Sherman M E, Kurman R J. Micropapillary serous carcinoma of the ovary: a distinctive low-grade carcinoma related to serous borderline tumors.  Am J Surg Pathol. 1996;  20 1319-1330
    CrossrefPubMedGoogle Scholar
  • 7 Chambers J T, Merino M J, Kohorn E I, Schwarz P I. Borderline ovarian tumors.  Am J Obstet Gynecol. 1988;  159 1088-1094
    PubMedGoogle Scholar
  • 8 Chuaqui R, Zhuang Z, Emmert-Buck M R, Bryant B R, Nogales F, Tavassoli F A, Merino M J. Genetic analysis of synchroneous tumors of the ovary and appendix.  Hum Pathol. 1996;  27 165-171
    CrossrefPubMedGoogle Scholar
  • 9 Colgan T J, Norris H J. Ovarian epithelial tumors of low malignant potential: A review.  Int J Gynecol Pathol. 1983;  1 367-382
    PubMedGoogle Scholar
  • 10 Creasmann W T, Park R, Norris H, Disaia P J, Morrow C P, Hreshchysyn M M. Stage I borderline ovarian tumors.  Obstet Gynecol. 1982;  59 93-96
    PubMedGoogle Scholar
  • 11 Dallenbach-Hellweg D, Dietel M. Weibliches Genitale. In: Remmele W (Hrsg) Pathologie. Berlin; Springer 1997
    Google Scholar
  • 12 Diebold J, Deisenhofer I, Baretton G B, Blasenbreu S, Suchy B, Schneiderbanger K, Meier W, Haas C J, Löhrs U. Interphase cytogenetic analysis of serous ovarian tumors of low malignant potential: comparisition with serous cystadenomas and invasive serous carcinomas.  Lab Invest. 1996;  75 473-485
    PubMedGoogle Scholar
  • 13 Diebold J. Molekulargenetik der epithelialen Ovarialneoplasien: Korrelation zum Phänotyp und biologischen Verhalten.  Pathologe. 1998;  19 95-103
    CrossrefPubMedGoogle Scholar
  • 14 Ehrmann R L, Federschneider J M, Knapp R C. Distinguishing lymph node metastases from benign glandular inclusions in low-grade ovarian carcinoma.  Am J Obstet Gynecol. 1980;  136 737-746
    PubMedGoogle Scholar
  • 15 Emmert-Buck M R, Chuaqui R, Zhung Z. Molecular analysis of concomitant uterine and ovarian endometrioid tumors.  Int J Gynecol Pathol. 1997;  16 143-148
    PubMedGoogle Scholar
  • 16 Friedländer M L, Russell P, Taylor I W, Hedley D W, Tattersal H N. Flow cytometric analysis of cellular DNA content as an adjunct to the diagnosis of ovarian tumours of borderline malignancy.  Pathology. 1984;  16 301-316
    PubMedGoogle Scholar
  • 17 Gershenson D M, Silva E G, Lewy L, Burke T W, Wolf J K, Tornos C. Ovarian serous borderline tumors with invasive peritoneal implants.  Cancer. 1998;  15 1096-1103
    PubMedGoogle Scholar
  • 18 Gershenson M D, Silva E G. Serous ovarian tumors of low malignant potential with peritoneal implants.  Cancer. 1990;  65 578-585
    PubMedGoogle Scholar
  • 19 Gotlieb W H, Flikker S, Davidson B, Korach Y, Kapolovic J, Ben-Baruch G. Borderline tumors of the ovary - fertility treatment, conservative management, and pregnancy outcome.  Cancer. 1998;  1 141-146
    PubMedGoogle Scholar
  • 20 Hart W R, Norris H J. Borderline and malignant tumors of the ovary.  Cancer. 1973;  31 1031-1045
    PubMedGoogle Scholar
  • 21 International Federation of Gynecology and Obstetrics. Classification and staging of malignant tumors in the female pelvis.  Acta Obstet Gynecol Scand. 1971;  50 1-7
    PubMedGoogle Scholar
  • 22 Kaern J, Trope C, Kjorstad K E, Abeler V, Pettersen E O. Cellular DNA content as a new prognostic tool in patients with borderlinetumors of the ovary.  Gynecol Oncol. 1990;  38 452-457
    CrossrefPubMedGoogle Scholar
  • 23 Kaern J, Trope C G, Abeler V M. A retrospective study of 370 borderline tumors of the ovary treated at the Norwegian Radium Hospital from 1970 to 1982. A review of clinicopathologic features and treatment modalities.  Cancer. 71;  1993 1810-1820
    PubMedGoogle Scholar
  • 24 Karp L A, Czernobinsky B. Glandular inclusions in pelvic and abdominal para-aortic lymph nodes. A study of autopsy and surgical material in males and females.  Am J Clin Pathol. 1969;  52 212-218
    PubMedGoogle Scholar
  • 25 Kurman R J, Trimble C L. The behavior of serous tumors of low malignant potential: are they ever malignant?.  Int J Gynecol Pathol. 1993;  12 120-127
    PubMedGoogle Scholar
  • 26 Lauchlan S C. Conceptual unity of the müllerian tumor group.  Cancer. 1968;  22 601-610
    PubMedGoogle Scholar
  • 27 Lim-Tan S K, Cajigas H E, Scully R E. Ovarian cystectomy for serous borderline tumors: A follow up study of 35 cases.  Obstet Gynecol. 1988;  72 775-781
    PubMedGoogle Scholar
  • 28 Link C J, Krohn E, Reed E. The relationship between borderline ovarian tumors and epithelial ovarian carcinoma: epidemiologic, pathologic, and molecular aspects.  Gynecol Oncol. 1996;  60 347-354
    CrossrefPubMedGoogle Scholar
  • 29 Miles P A, Norris H J. Proliferative and malignant Brenner tumors of the ovary.  Cancer. 1972;  30 174-180
    PubMedGoogle Scholar
  • 30 Padberg B C, Arps H, Franke U, Thiedemann C, Rehpenning W, Stegner H E, Lietz H, Schröder S, Dietel M. DNA-cytometry and prognosis in ovarian tumors of borderline malignancy - a clinicomorphological study of 80 cases.  Cancer. 1992;  69 2510-2514
    PubMedGoogle Scholar
  • 31 Powell D E, Puls L, van Nagell J. Current concepts in epithelial ovarian tumors: does benign to malignant transformation occur?.  Hum Pathol. 1992;  23 846-847
    CrossrefPubMedGoogle Scholar
  • 32 Rosenfeld E D. Peritoneal pseudomyxoma. Four unusual cases.  Arch Pathol. 1949;  48 255-273
    PubMedGoogle Scholar
  • 33 Russell P. Surface epithelial-stromal tumors of the ovary. In: Kurman RJ (ed) Blaustein's pathology of the female genital tract. Berlin; Springer 1994
    Google Scholar
  • 34 Russell P, Bannatyne P M, Solomon H J, Stoddard L D, Tattersall H N. Multifocal tumorgenesis in the upper female genital tract - implications for staging and management.  Int J Gynecol Pathol. 1985;  4 192-210
    PubMedGoogle Scholar
  • 35 Russell P. Borderline epithelial tumors of the ovary: a conceptual dilemma.  Clin Obtet Gynecol. 1984;  11 259-277
    PubMedGoogle Scholar
  • 36 Russell P. Ovarian epithelial tumours with atypical proliferation. In: Lowe D, Fox H Advances in gynecologic pathology. Edinburgh, New York; Churchill Livingstone 1992
    Google Scholar
  • 37 Russell P. The pathological assessment of ovarian neoplasm. II. The proliferating „epithelial” tumors.  Pathology. 1979;  11 251-282
    PubMedGoogle Scholar
  • 38 Rutgers J L, Scully R E. Ovarian mullerian mucinous papillary cystadenomas of borderline malignancy. A clinicopathologic analysis.  Cancer. 1988;  61 340-348
    PubMedGoogle Scholar
  • 39 Sandenbergh H A, Woodruff J D. Histogenesis of pseudomyxoma peritonei. Review of 9 cases.  Obstet Gynecol. 1977;  49 339-345
    PubMedGoogle Scholar
  • 40 Santesson L, Kottmeier H L. General classification of ovarian tumors. In: Gentils F, Junqueira AC (eds) Ovarian cancer. UICC Monogr Ser, vol.11. New York; Springer 1968
    Google Scholar
  • 41 Scully R E, Young R H, Clement P B. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. Washington; Armed Forces Institute for Pathology 1998
  • 42 Seidmann J D, Kurman R J. Subclassification of serous borderline tumors of the ovary into benign and malignant types.  Am J Surg Pathol. 1996;  20 1331-1345
    CrossrefPubMedGoogle Scholar
  • 43 Serov S F, Scully R E, Sobin L H. International histological classification of tumours. No 9, Histological typing of ovarian tumors. Genf; World Health Organization 1973
  • 44 Shih Y S, Kerr J, Hust T G, Khoo S K, Ward B G, Chenevix-Trench G. No evidence for microsatellite instability from allelotype analysis of benign and low malignant neoplasms.  Gynecol Oncol. 1998;  69 210-213
    CrossrefPubMedGoogle Scholar
  • 45 Silva E G, Kurman R J, Russell P, Scully R E. Symposium: Ovarian tumors of borderline malignancy.  Int J Gynecol Pathol. 1996;  15 281-302
    PubMedGoogle Scholar
  • 46 Stegner H E. Pathologie der weiblichen Genitalorgane II. Pathologie der Ovarien und Eileiter. Berlin; Springer 1994
  • 47 Sumithran E, Susil B J, Looi L M. The prognostic significance of grading in borderline mucinous tumors of the ovary.  Hum Pathol. 1988;  19 15-18
    PubMedGoogle Scholar
  • 48 Sutton G P, Bundy B N, Omura G A, Yordan E L, Beecham J S, Bonfiglio T. Stage II ovarian tumors of low malignant potential treated with cisplatin combination therapy (a Gynecologic Oncology Group study).  Gynecol Oncol. 1991;  41 230-233
    CrossrefPubMedGoogle Scholar
  • 49 Svenes K B, Eide J. Proliferative Brenner tumor or ovarian metastases? A case report.  Cancer. 1984;  53 2692-2697
    PubMedGoogle Scholar
  • 50 Tavassoli F A. Serous tumor of low malignant potential with early stromal invasion (serous LMP with microinvasion).  Modern Pathol. 1988;  1 407-413
    PubMedGoogle Scholar
  • 51 Taylor H C. Malignant and semimalignant tumours of the ovary.  Surg Gynecol Obstet. 1929;  48 204-230
    PubMedGoogle Scholar
  • 52 TNM Klassifikation maligner Tumoren. In: Wittekind C, Wagner G Berlin; Springer 1997
  • 53 Trimble C L, Trimble E L. Management of epithelial ovarian tumors of low malignant potential.  Gynecol Oncol. 1994;  55 52-56
    CrossrefPubMedGoogle Scholar
  • 54 Trope C, Kaern J. Management of borderline tumors of the ovary: state of the art.  Sem Oncol. 1998;  25 372-380
    PubMedGoogle Scholar
  • 55 Trope C, Kaern J, Vergote I B, Kristensen G, Abeler V. Are borderline tumors overtreated both surgically and systemically? A review of four prospective randomized trials including 253 patients with borderline tumors.  Gynecol Oncol. 1993;  51 236-243
    CrossrefPubMedGoogle Scholar
  • 56 Young R H, Gilks C B, Scully R E. Mucinous tumors of the appendix associated with mucinous tumors of the ovary and pseudomyxoma peritonei.  Am J Surg Pathol. 1991;  15 415-429
    PubMedGoogle Scholar

Dr. Olaf Reich

Geburtshilflich-gynäkologische Universitätsklinik Graz

Auenbruggerplatz 14

A-8036 Graz

      >