A young nulliparous woman with right ovarian serous borderline tumor and left ovarian micropapillary serous carcinoma

Abstract

Serous borderline tumor (SBT) of low malignant potential (LMP) is heterogeneous group, neither wholly benign nor frankly malignant. It usually involves premenopausal age patients, has good prognosis and may recur even after 20 years. Decades later, transformation to low grade serous carcinoma can occur in 7%, mandating prolonged follow-up. Ten and 20 years survival in stage I is 95% and 80% respectively. Micropapillary type and invasive tumor implants warrant treatment like carcinoma and need adjuvant chemotherapy. We present the case of a 25-year-old nullipara, married for four years who had ovarian cystectomy one year back. She reported to our institute with massive ascites and failure of anti-tubercular treatment of three months. Diagnostic tap revealed cells suggestive of metastatic adenocarcinoma. Bilateral complex adnexal masses with ascites were seen on computed tomography (CT) scan. CA125 was 191 U/mL. Thorough staging laparotomy i.e., inspection and palpation of abdomen and pelvic organs, ascitic fluid cytology, bilateral salpingo-oophorectomy, and bilateral pelvic and aortocaval lymph nodes sampling up to inferior mesenteric artery level, along with supracolic and infracolic omentectomy, and multiple peritoneal biopsies was carried out. Uterus was preserved. In our patient while right ovarian tumor was the benign type of SBT, the left ovarian tumor was the aggressive micropapillary type of SBT. This case emphasizes the need of subclassification of serous borderline tumors showing a broad spectrum of clinical and biological behavior from benign to low grade carcinoma. We suggest that in patients of reproductive age with infertility and adnexal masses, despite malignant cells in ascites, serous borderline tumor should be kept as a differential diagnosis and conservative surgery be offered.