Abstract
Ovarian borderline serous tumors present with peritoneal involvement in 20% of cases, either as non-invasive or invasive implants, also known as extraovarian low-grade serous carcinoma. The coexistence of high-grade serous carcinoma is rare, suggesting a synchronous neoplasia with a distinct and independent tumor biology and behavior. We aim to describe a case of a synchronous ovary-peritoneum neoplasia: serous borderline tumor and primary peritoneal high-grade serous carcinoma. A discussion and literature review concerning the optimal diagnostic and therapeutic approach is provided.
Highlights
Serous borderline tumors/atypical proliferative serous tumors (SBT/APST) are defined as non-invasive tumors displaying greater epithelial proliferation and cytological atypia than their benign counterparts
There are some similarities in risk-factor associations to high-grade serous carcinoma (HGSC), infertility is more common and there is usually no relation with BRCA1/BRCA2 mutations[2,3]
Peritoneal lesions associated with SBT/APST may occur in 20% of cases and were classically defined as non-invasive or invasive implants based on the capacity to infiltrate the underlying tissue
Summary
Serous borderline tumors/atypical proliferative serous tumors (SBT/APST) are defined as non-invasive tumors displaying greater epithelial proliferation and cytological atypia than their benign counterparts. Case report We present the case of a 52-year-old postmenopausal woman with no relevant medical history, referred to an oncologic center due to a voluminous adnexal mass. The patient was submitted to exploratory laparotomy, revealing a frozen pelvis and peritoneal carcinomatosis: the right ovary was transformed into a voluminous neoplasia; independently, a large tumor mass involving omentum and the transverse portion of colon, apparently not surgically resectable; the left ovary was macroscopically normal. Intraoperative frozen section of the right ovary revealed a borderline tumor, whereby cytoreductive surgery was performed, including hysterectomy, double adnexectomy, omentectomy and resection of the peritoneal implants. The final histology with hematoxylin and eosin staining revealed two synchronous tumors: BST of the right ovary and HGSC of probably primary peritoneal origin, FIGO stage IIIC (Figure 1A–C). The post-operative CT scan performed four weeks later revealed rapid peritoneal disease progression, with high-volume ascites and hydronephrosis, resulting in an important decline on clinical status and death before initiating palliative chemotherapy
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