Ovarian Tumors Of Low Malignant Potential Research Articles

OC259: Low malignant potential ovarian tumors: role of sonographic diagnostic criteria

OC259: Low malignant potential ovarian tumors: role of sonographic diagnostic criteria

Evaluation of restaging in clinical stage 1A low malignant potential ovarian tumours.

This study was undertaken to evaluate whether restaging clinical stage 1A low malignant potential (LMP) tumours previously incompletely staged in a non-gynaecology oncology centre yields useful information for management and prognosis. A retrospective chart review was undertaken of all patients with LMP tumours treated at the Queensland Centre for Gynaecological Cancer (QCGC) from 1982-2000. Fifty-six (69%) of the 81 patients referred with a provisional stage 1A diagnosis underwent a second operation for staging purposes. Four (7%) out of the 56 patients who underwent restaging had their tumours upstaged. A single patient out of the 25 patients who did not undergo restaging had disease recurrence and died as a result. The mean follow-up for all patients in the study was 60 months. It is hard to justify routine surgical restaging for patients with a LMP ovarian tumour apparently confined to a single ovary At the very least, hundreds of patients with clinical stage 1A tumours will need to be restaged before a single patient will have data that will change management. Consequently the morbidity of routine restaging is difficult to justify for such a small clinical gain.

Long-term survival and patterns of care in women with ovarian tumors of low malignant potential.

The objectives of this study were to ascertain long-term survival and patterns of care among women diagnosed with ovarian tumors of low malignant potential (LMP) in a population-based data set. Using the NCI's Surveillance, Epidemiology, and End Results (SEER) database, we identified 2818 women diagnosed with ovarian tumors of low malignant potential between 1988 and 1997. By FIGO stage, 10-year relative survival was as follows: stage I, 99%; stage II, 98%; stage III, 96%; and stage IV 77%. One-quarter of women with stage I disease underwent partial or unilateral oophorectomy only, while women with more advanced disease commonly underwent omentectomy, unilateral or bilateral oophorectomy, and hysterectomy. Adjuvant chemotherapy was given to about 30% of women with stage III and IV disease. Radiation therapy was rarely used. We observed no significant changes in primary surgery or adjuvant treatment over time. The diagnosis of an ovarian tumor of LMP conveys a relatively benign prognosis. Conservative surgery should be considered in younger women with early-stage disease. There are insufficient data to support a role for adjuvant chemotherapy for women with advanced disease.

Proteomic analysis and identification of new biomarkers and therapeutic targets for invasive ovarian cancer

Epithelial ovarian cancer kills almost 16 000 women each year in part due to late stage of presentation and lack of reliable biomarkers for disease detection. CA-125, the currently accepted serum marker, alone lacks the sensitivity for early stage diagnosis, as only 50% of early stage cases are detected with this marker. Although more early stage cases may be detected by lysophosphatidic acid, this marker is also elevated in other cancers. One major objective of the NCI-FDA Tissue Proteomics Initiative has been to combine the technique of laser capture microdissection (LCM) of epithelial tumor cells in human tissue specimens with two-dimensional gel electrophoresis (2-D PAGE) to identify proteins that may serve as invasive ovarian cancer-specific biomarkers for early detection and/or new therapeutic targets. We performed 2-D PAGE on lysates from five microdissected ovarian tumors (three invasive ovarian cancers and two noninvasive, low malignant potential (LMP) ovarian tumors). We then compared silver stained 2-D gels created from microdissected lysates with SYPRO-Ruby stained 2-D PAGE profiles of the patient-matched undissected bulk tumor lysates from all five patients. Twenty-three proteins were consistently differentially expressed between both the LMP and three invasive ovarian tumors in the limited study set. Thirteen were uniquely present in all three of the invasive ovarian cancer cases and absent or underexpressed in the two LMP cases. Ten were uniquely present in the LMP cases but absent or underexpressed in all invasive ovarian cancer cases. Credentialing and preliminary target validation of the mass spectrometry identified proteins cut from the Ruby-red stained gels was performed by LCM coupled Western blot and reverse-phase array technology in a study set of six cases (the aforementioned five cases used in the 2-D PAGE profiling component of the study plus one additional LMP case). The analysis revealed that the 52 kDa FK506 binding protein, Rho G-protein dissociation inhibitor (RhoGDI), and glyoxalase I are found to be uniquely overexpressed in invasive human ovarian cancer when compared to the LMP form of this cancer. The direct comparison of LCM generated proteomic profiles of invasive vs. LMP ovarian cancer may more directly generate important markers for early detection and/or therapeutic targets unique to the invasive phenotype.

Proteomic analysis and identification of new biomarkers and therapeutic targets for invasive ovarian cancer

Epithelial ovarian cancer kills almost 16 000 women each year in part due to late stage of presentation and lack of reliable biomarkers for disease detection. CA-125, the currently accepted serum marker, alone lacks the sensitivity for early stage diagnosis, as only 50% of early stage cases are detected with this marker. Although more early stage cases may be detected by lysophosphatidic acid, this marker is also elevated in other cancers. One major objective of the NCI-FDA Tissue Proteomics Initiative has been to combine the technique of laser capture microdissection (LCM) of epithelial tumor cells in human tissue specimens with two-dimensional gel electrophoresis (2-D PAGE) to identify proteins that may serve as invasive ovarian cancer-specific biomarkers for early detection and/or new therapeutic targets. We performed 2-D PAGE on lysates from five microdissected ovarian tumors (three invasive ovarian cancers and two noninvasive, low malignant potential (LMP) ovarian tumors). We then compared silver stained 2-D gels created from microdissected lysates with SYPRO-Ruby stained 2-D PAGE profiles of the patient-matched undissected bulk tumor lysates from all five patients. Twenty-three proteins were consistently differentially expressed between both the LMP and three invasive ovarian tumors in the limited study set. Thirteen were uniquely present in all three of the invasive ovarian cancer cases and absent or underexpressed in the two LMP cases. Ten were uniquely present in the LMP cases but absent or underexpressed in all invasive ovarian cancer cases. Credentialing and preliminary target validation of the mass spectrometry identified proteins cut from the Ruby-red stained gels was performed by LCM coupled Western blot and reverse-phase array technology in a study set of six cases (the aforementioned five cases used in the 2-D PAGE profiling component of the study plus one additional LMP case). The analysis revealed that the 52 kDa FK506 binding protein, Rho G-protein dissociation inhibitor (RhoGDI), and glyoxalase I are found to be uniquely overexpressed in invasive human ovarian cancer when compared to the LMP form of this cancer. The direct comparison of LCM generated proteomic profiles of invasive vs. LMP ovarian cancer may more directly generate important markers for early detection and/or therapeutic targets unique to the invasive phenotype.

Ovarian tumors of low malignant potential.

Ovarian tumors of low malignant potential (LMP) differ from epithelial ovarian carcinoma in etiology, molecular biology, and prognosis. LMP tumors are not precursor lesions to ovarian carcinoma. Treatment is primarily surgical. Women found to have an ovarian tumor of LMP should undergo removal of the involved adnexa; surgical staging; and cytoreductive surgery. Women in the reproductive years should be given the option of conservative surgery, preserving the contralateral adnexa and uterus. There is no proven benefit to adjuvant chemotherapy or radiotherapy after primary surgery. In most cases, the diagnosis of an ovarian tumor of LMP conveys good prognosis, with excellent long-term survival.

Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors

Objective: To assess clinical outcome and fertility in patients treated conservatively for a low malignant potential (LMP) ovarian tumor. Design: Retrospective study. Setting: Gynecologic oncology department of a cancer care center in France. Patient(s): Forty-four patients treated with conservative management for a stage I (n = 32) or stage II or III (n = 12) LMP tumor. Intervention(s): Thirty-three patients had unilateral adnexectomy and 11 had cystectomy. Cystectomy was bilateral in 1 patient and was done in conjunction with contralateral adnexectomy in 5 patients. Main Outcome Measure(s): Tumor recurrence and pregnancy rates. Result(s): Tumor recurrence rates after radical surgery (hysterectomy with bilateral salpingo-oophorectomy), adnexectomy, and cystectomy were 5.7%, 15.1%, and 36.3%, respectively ( P<.01). Among patients who initially received conservative treatment, tumors did not recur in the form of invasive carcinoma. Five patients who had recurrence underwent repeated conservative management; these patients are alive and free of disease. Seventeen pregnancies (of which 15 were spontaneous) occurred in 14 patients; 13 pregnancies occurred in patients with stage I disease and 4 occurred in patients with stage III disease. Conclusion(s): Conservative management of LMP tumor significantly increases the risk of recurrence but does not affect overall survival. Such management offers even patients with advanced disease the chance to have spontaneous pregnancy. Conservative management might be proposed in young patients who wish to preserve their fertility, but careful follow-up will be required to detect tumor recurrence.

Primary peritoneal carcinoma: a review of the literature.

Target Audience Obstetricians & Gynecologists, Family Physicians Learning Objectives After completion of this article, the reader will be able to understand the similarities and differences between primary peritoneal carcinoma and epithelial ovarian cancer, the criteria used to define peritoneal carcinomas, and the differences in presentation between a low malignant potential tumor of the peritoneum and an ovarian low malignant potential tumor.

Cyclin D1 overexpression and p53 mutation status in epithelial ovarian cancer.

To examine the cyclin D1 mRNA expression level in ovarian tumor samples as compared with normal ovaries and to determine the relationship between cyclin D1 overexpression and p53 mutation status in ovarian tumors. mRNA was isolated and cDNA was prepared from 27 epithelial ovarian tumors (3 tumors of low malignant potential (LMP) and 24 cancers) and 6 normal ovaries. The cyclin D1 sequences were amplified by using a thermal cycler in parallel with the beta-tubulin gene as an internal control. The cyclin D1 mRNA expression level relative to beta-tubulin was determined by 32P phosphoimager analysis. To confirm the overexpression of the cyclin D1 protein in ovarian tumor cells, immunostaining was performed. The p53 gene mutation status was examined by direct cDNA sequencing. mRNA levels of cyclin D1 were significantly higher in 21 (78%) of the 27 ovarian tumors than in normal ovaries. Cyclin D1 overexpression was detected in ovarian LMP tumors as well as in ovarian cancer cases. Positive immunostaining of cyclin D1 protein was observed in 10 of 18 (56%) ovarian tumors examined. p53 mutations were found in 11 (61%) of 18 ovarian tumors. Of 11 ovarian tumor cases with p53 mutations, 5 showed overexpression of cyclin D1. All 7 ovarian tumor cases without p53 mutations showed significant cyclin D1 mRNA overexpression. Cyclin D1 overexpression seems to be an early genetic event in ovarian tumor development. Although p53 may be one of the proteins whose function regulates the expression of G1 cyclins, ovarian tumors with no p53 mutation consistently showed cyclin D1 overexpression. Cyclin D1 overexpression may play an important role in the tumorigenesis of epithelial ovarian tumors.

Peritoneal Washing Cytology of Ovarian Tumors of Low Malignant Potential

To correlate the cytologic diagnoses of peritoneal washings (PWs) with histologic findings of ovarian tumors of low malignant potential (LMP). PW cytology from 90 patients with histologically confirmed ovarian tumors of LMP were reviewed and correlated with histologic findings. In 90 LMP tumor patients who underwent PW, cytologic diagnoses were reported as positive in 30 (33%) cases, atypical in 5 (6%) cases and negative in 55 (61%) cases. On review of the five atypical cases, three were reclassified as negative and two as positive. Peritoneal washings were positive in 20 (33%) of 60 patients with serous LMP tumors, 12 (44%) of 27 patients with mucinous LMP tumors and none of 3 patients with mixed LMP tumors. The presence of positive cytology was highly indicative of surface ovarian involvement or peritoneal implants in completely staged or selectively biopsied patients (P < .0001). Of 60 (67%) patients who had a staging laparotomy, positive PWs were seen in 3 (75%) of 4 cases with surface involvement only, 13 (94%) of 14 cases with peritoneal implants only, 3 (100%) of 3 cases with both peritoneal implants and ovarian surface involvement, and 9 (23%) of 39 cases without evidence of surface involvement or peritoneal implants. PWs were positive in 4 (13%) of 30 cases without staging laparotomy. PW cytology is a sensitive indicator of peritoneal dissemination of ovarian tumors of LMP. In addition, PWs will detect a high percentage of patients with subclinical intraperitoneal extension of such tumors and should be used routinely in the staging of ovarian tumors of LMP.

Establishment of Long-Term in VitroCultures of Human Ovarian Cystadenomas and LMP Tumors and Examination of Their Spectrum of Expression of Matrix-Degrading Proteinases

Objectives.To obtain long-term cultures of ovarian cystadenomas and ovarian tumors of low malignant potential (LMP) displaying gene expression patterns similar to those found in vivoand test the hypothesis that such cultures would express different levels of matrix-degrading proteinases than cultured ovarian carcinomas. Methods.Transfection with an adenoviral expression vector for simian virus 40 (SV40) large T antigen was used to establish long-term cultures of the above tumors. Levels of expression of various genes were evaluated using molecular biological and immunohistochemical approaches. Zymography and reverse zymography were used to examine the activity of various metalloproteinases and plasminogen activators (PA). Two-sided Pvalues for differences in plasminogen activator expression between different cell types were evaluated by Fisher's exact test. Results.Long-term cultures derived from cystadenomas and LMP tumors were obtained which formed colonies on semisolid supports, but were not tumorigenic in nude mice. The cultured cells expressed keratin, estrogen receptor, gonadotropin receptors, BRCA1, and originated from monoclonal populations. There was no apparent association between the malignant phenotype and the expression of either matrix metalloproteinases or tissue inhibitors of metalloproteinases. However, a correlation was seen between this phenotype and expression of urokinase (uPA) and tissue type (tPA) plasminogen activators ( P= 0.08 and 0.02 respectively). Conclusions.The above cell strains provide a useful model for investigating various aspects of the biology of benign ovarian tumors, including their response to steroid and gonadotropin hormones, and the role of specific proteinases in the acquisition of invasive and metastatic abilities.

Numerical Chromosomal Aberrations in Borderline, Benign, and Malignant Epithelial Tumors of the Ovary: Correlation With p53 Protein Overexpression and Ki-67

Ovarian tumors of low malignant potential (borderline tumors) have a 5-year survival rate of 69-98%, illustrating that while the prognosis is better than in the typical epithelial carcinoma, a significant number of women still succumb to this disease. The aim of our study was to elucidate the role of numerical chromosomal aberrations in borderline tumors of the ovary in comparison with benign and malignant epithelial tumors in an effort to develop parameters to differentiate prospectively borderline lesions from benign and invasive tumors. Cytologic imprints of surgical specimens of 46 ovarian tumors of low-malignant potential, 17 invasive epithelial carcinomas of the ovary, and 18 benign epithelial tumors of the ovary were examined for numerical chromosomal aberrations (trisomy 7, trisomy 12, and trisomy 17) by fluorescence in situ hybridization (FISH). In benign tumors no evidence of trisomy 7 and 17 was present. Trisomy 12 was detected in six cases (33.3%). We did not find p53 protein overexpression in any case. Ki-67 stained positive in three cases (16.7%). In borderline tumors trisomy 12 was detected in 33 patients (71.7%). Numerical aberrations of chromosome 17 were absent in all cases. Fourteen patients (30.4%) showed trisomy 7. No immunohistochemical staining reaction for p53 protein was found. Staining of the proliferation marker Ki-67 was observed in two cases (4.3%). In malignant epithelial tumors of the ovary, trisomy 7, trisomy 12, and trisomy 17 were detected in 14 (82.3%), 11 (64.7%), and 5 (29.4%) cases, respectively. Four tumors (23.5%) showed immunohistochemically detected p53 protein overexpression. Thirteen tumors (76.5%) stained for Ki-67. Our results indicate that trisomy 7 argues against benign disease. Trisomy 17 was specific for invasive disease, while trisomy 12 is common in borderline tumors of the ovary.

Recurrent ovarian tumor with low malignant potential and cardiac metastasis

Up to 20% of ovarian epithelial tumors are classified as being of low malignant potential. Most of these low malignant potential tumors are detected at an early stage and have an excellent prognosis. This is a report of a woman with cardiac metastasis from an ovarian low malignant potential tumor. This case describes a 53-year-old woman who presented with congestive heart failure and was found to have a recurrent stage III ovarian tumor of low malignant potential. A transesophageal echocardiogram revealed compression of the inferior vena cava and a mass encompassing the right atrium. Findings at autopsy confirmed a low malignant potential ovarian tumor thrombus involving the inferior vena cava and right atrium. Ovarian low malignant potential tumors can metastasize in an aggressive manner. A transesophageal echocardiogram may be useful when the diagnosis of cardiac tumor thrombus is considered.

Ovarian tumors of low malignant potential: a retrospective study of 234 patients

Two-hundred and thirty-four consecutive patients with a histologic diagnosis of low malignant potential (LMP) ovarian tumors between 1972 and 1994 form the basis of this study. Six patients had a synchronous intra-abdominal or pelvic malignancy and six were considered to have areas of early stromal invasion, these patients being considered separately. The patients ages ranged from 16–93 years. The histologic type was mucinous in 53%, serous in 37%, mixed in 7%, and other in 3%. Ovarian tumors were bilateral in 15% with mucinous and 39% with serous disease. Fourteen patients had pseudomyxoma peritonei. Extra ovarian disease was found in 28 (34%) patients with serous and 15 (13%) with mucinous tumors. Five (6%) patients with serous tumors had invasive implants and four had lymph node implants. Clinically 175 patients had stage I disease, 19 had stage II and 28 stage III disease but only 88 patients were formally staged. Follow-up details were available for 173 (74%) patients, ranging from 2 months to 20 years, mean 54 months. Thirteen patients (6%) died of disease, of whom six had pseudomyxoma peritonei. Twelve patients (6%) had developed invasive malignancy of whom seven died. None of the patients with formally staged Ia or Ib disease had a recurrence. With the exception of patients with synchronous malignancy or pseudomyxoma peritonei the prognosis is good. Surgical staging offers limited prognostic information but sacrifice of fertility is not justified. Adjuvant therapy is not indicated in early stage disease and its role for patients with extra ovarian disease remains controversial.

Unusual Features of Serous Neoplasms of Low Malignant Potential during Pregnancy

Ten serous neoplasms of low malignant potential (LMP) resected during pregnancy were found in the files of the University of Texas M.D. Anderson Cancer Center (UTMDACC). Microscopically, all tumors had marked epithelial proliferation with abundant eosinophilic cells, and eight had intraluminal mucin. Multiple areas of microinvasion were found in eight cases. Additional unusual features were found in three cases. One patient presented with a serous LMP tumor in a supraclavicular lymph node. After resection of an ovarian serous LMP tumor, she was treated with chemotherapy and is without evidence of disease after 21 years. One patient had tumor resected at 24 weeks of gestation and at 2 months postpartum. Marked regression of the epithelial proliferation, the number of eosinophilic cells, and the amount of mucin was seen in the second specimen. Another patient had multiple peritoneal nodules at cesarean section, one of which was biopsied and diagnosed as a primary serous LMP of the peritoneum with multiple areas of microinvasion. Two months later a diagnostic laparoscopy was performed and no residual disease was found. All patients are alive with no evidence of disease. In summary, serous LMP tumors during pregnancy have microscopic and clinical features suggesting aggressive behavior; however, these features appear to regress at the termination of the pregnancy.

Telomerase activity in benign and malignant epithelial ovarian tumors.

Ovarian epithelial tumors include benign lesions lacking invasive and metastatic abilities (cystadenomas) in addition to malignant lesions (carcinomas). An intermediate category, called tumors of low malignant potential (LMP), is also recognized. The merit of this classification is being challenged because the clinical behavior of LMP tumors appears closer to that of cystadenomas than to that of carcinomas. To verify our hypothesis that the expression of the enzyme telomerase distinguishes these two categories of ovarian epithelial tumors, we examined and compared such expression in ovarian cystadenomas and carcinomas. By examining the expression of telomerase in LMP tumors, we then sought to determine if these tumors were more closely related to cystadenomas or to carcinomas with regard to telomerase expression. We examined a total of 64 consecutive ovarian tumors subdivided into 20 carcinomas, 17 LMP tumors, and 27 cystadenomas. We subsequently discarded three of the 27 cystadenomas because of the presence of admixed normal ovarian stroma in those specimens. Tumor subtyping was done without knowledge of the telomerase results, and telomerase assays were likewise interpreted without knowledge of tumor types. Telomerase activity was determined by use of the TRAP (i.e., telomeric repeat amplification protocol) assay. Differences between the proportions of tumors expressing this enzyme in each subgroup were evaluated by use of Fisher's exact test (two-sided). Telomerase activity was detected in all 20 carcinomas and in all 17 LMP tumors examined. In contrast, it was not detected in 19 of the 24 cystadenomas. These differences between rates of telomerase expression in either carcinomas or LMP tumors and those in cystadenomas were statistically significant (P<.0001). All five of the telomerase-positive cystadenomas belonged to a variant called papillary cystadenomas, whereas none of the telomerase-negative cystadenomas belonged to this variant (P<.0001). The presence of telomerase expression in ovarian LMP tumors supports the merit of continuing to separate these tumors from cystadenomas, in spite of their apparent benign clinical course. The finding of telomerase expression in papillary cystadenomas suggests that such tumors may be mechanistically related to LMP tumors and should perhaps be reclassified as variants of LMP tumors. Lack of telomerase expression in ovarian cystadenomas raises questions about the alleged immortality of these tumors because expression of this enzyme is thought to be essential for continuous growth in adult tumors.

Sonographic and Doppler flow characteristics of ovarian tumors of low-malignant potential.

To outline the sonographic and color Doppler flow imaging characteristics of ovarian tumors of low-malignant potential (OCLMP). Fourteen women with ovarian tumors of low-malignant potential were compared with 26 women with ovarian cystadenomas and 23 with ovarian carcinomas. Sonographically, more complex structures and echogenic lesions were found in the OCLMP and malignant tumors than in the cystadenomas, and the difference was statistically significant. Color blood flow imaging revealed a similar resistant index (RI) in the OCLMP (0.487 +/- 0.07) and cystadenomas (0.489 +/- 0.09) when compared with statistically significant lower RI in the ovarian carcinomas (0.391 +/- 0.05) (P < 0.001). Among young women, the combination of a complex ovarian mass with turbid fluid and echogenic lesions whose color Doppler flow imaging registers in the low range (RI < 0.5) should raise the suspicion of an ovarian tumor of low-malignant potential.

Low malignant potential ovarian tumours: a review of 175 consecutive cases.

Epithelial ovarian tumours of low malignant potential (LMP) are known to have a generally good prognosis, although there is not universal agreement on all aspects of treatment. We report a series of 175 patients with LMP ovarian tumours referred to the Queensland Centre for Gynaecological Cancer between January, 1982 and December, 1993. Stage I disease accounted for 142 cases, with only 1 patient dead from disease at 293 months. Twenty nine patients in this group had conservative surgery with 1 recurrence only (in the contralateral ovary) giving a recurrence rate of 3.5%. Survival and treatment data for other stages are presented, and the current literature reviewed. It is suggested that early stage disease may be treated conservatively depending upon the patient's desire to retain reproductive capacity. While adjuvant therapy is not recommended, long-term follow-up is indicated. More advanced disease should be debulked to the smallest practical volume. The role of lymphadenectomy has been questioned, as survival has not been shown to be affected by treatment decisions made as a result of knowing the lymph node status. Whilst some centres give platinum-based adjuvant therapy, the evidence that it is beneficial is not supported by any prospective randomized trials.

Alterations in DNA methylation are early, but not initial, events in ovarian tumorigenesis.

We compared global levels of DNA methylation as well as methylation of a specific locus (MyoD1) in ovarian cystadenomas, ovarian tumours of low malignant potential (LMP) and ovarian carcinomas to investigate the association between changes in DNA methylation and ovarian tumour development. As we realized that cystadenomas showed different methylation patterns from both LMP tumours and carcinomas, we verified their monoclonal origin as a means of confirming their true neoplastic nature. High-pressure liquid chromatographic (HPLC) analyses showed that global methylation levels in LMP tumours and carcinomas were 21% and 25% lower than in cystadenomas respectively (P = 0.0001 by one-way variance analysis). Changes in the methylation status of the MyoD1 locus were not seen in any of ten cystadenomas analysed but were present in five of ten LMP tumours and in five of ten carcinomas (P = 0.03). These findings suggest that alterations in DNA methylation are absent (or at least not as extensive) in ovarian cystadenomas, but are present in LMP tumours, the phenotypic features of which are intermediate between those of benign and malignant ovarian tumours. The results also emphasize the merit of distinguishing ovarian LMP tumours from cystadenomas, in spite of their similar clinical characteristics.

Ovarian papillary serous tumors of low malignant potential (Serous borderline tumors): A long term follow-up study, including patients with microinvasion, lymph node metastasis, and transformation to invasive serous carcinoma

The clinical outcome of patients with ovarian serous tumors of low malignant potential (LMP) remains controversial, especially for those with extraovarian disease. We retrospectively reviewed our experience to study this question further, to assess the safety of conservative management of patients with limited disease, and to determine whether exophytic ovarian surface tumor was predictive of tumor recurrence. The clinical and pathologic records of 76 patients with ovarian serous LMP tumors accessioned at the Cleveland Clinic Foundation from 1979 to 1990 were reviewed. International Federation of Gynecology and Obstetrics (FIGO) staging was retrospectively assigned, follow-up information obtained, and clinicopathologic correlations made. An exophytic ovarian surface component was present in 39 of 76 patients (51%). Stage II or III disease was present in 28 of 74 staged patients (38%). Follow-up information was available on 66 patients, ranging from 8 to 264 months (mean, 99 months). Twenty-five patients of 66 patients with follow-up information (38%) received adjuvant therapy. Only 1 patient (1.5%) developed progressive disease; she died of widespread invasive serous carcinoma. Two of 18 conservatively managed patients (11%) developed "recurrent" disease, including 1 patient with a second primary serous LMP tumor of the preserved ovary and 1 patient with an incidentally discovered microscopic serosal implant. There were no other recurrences in the study group, which included four patients with stromal microinvasion and one with lymph node involvement. The long term outcome of serous LMP tumors is extremely favorable. Exophytic ovarian surface tumor did not serve as a predictor for subsequent peritoneal implants. Conservative surgical management in young patients with localized disease is supported and the use of adjuvant therapy in the initial management of patients with advanced tumors is further questioned.