Ovarian Tumors Of Borderline Malignancy Research Articles

Fertility potential and safety assessment of residual ovarian cortex in young women diagnosed with epithelial borderline and early-stage malignant ovarian tumors

ObjectiveTo establish the safety and quality of ovarian cortex surrounding epithelial ovarian tumors in women eligible for fertility-sparing surgery by identifying occult malignant lesions and characterizing the ovarian follicle pool. MethodsMulticentric retrospective study of 48 subjects (15–45 years), diagnosed with borderline ovarian tumors (BOTs) or early-stage epithelial ovarian cancers (EOCs) and eligible for fertility-sparing surgery. Histological samples of ovarian cortex surrounding tumors were analyzed to characterize the follicle pool, find any occult malignant lesion using tumor-specific markers (cytokeratin 7 and mucin 1), and quantify tumor-infiltrating lymphocytes (TILs) by CD3 and tumor associated macrophages (TAMs) by CD68. ResultsOccult ovarian lesions were observed in 6 out of 45 cases investigated (14.6%), including one mucinous stage-I BOT (1/14), one serous stage-I BOT (1/13), 3 advanced-stage serous BOTs (3/11) and one early-stage serous EOC (1/7). Notably, follicle density was significantly lower in subjects diagnosed with ovarian tumors compared to controls (p < 0.001) and at a younger age. Significantly higher follicle atresia was encountered in the ovarian tumor group then in controls (20.1 ± 8.8% vs 9.2 ± 9.4%, p < 0.001) at all ages. Both TILs and TAMs were found in ovarian tumors irrespective of histotype, but no link was established with the status of the ovarian reserve. ConclusionsPersonalized counseling for fertility preservation is required in the event of BOTs and early-stage EOCs. Fertility-sparing surgery and adjuvant gamete preservation should be considered, balancing the oncological risks according to tumor stage and histotype and fertility potential, especially at a younger age.

CT-Based Radiomics and Machine Learning for Differentiating Benign, Borderline, and Early-Stage Malignant Ovarian Tumors.

To explore the value of CT-based radiomics model in the differential diagnosis of benign ovarian tumors (BeOTs), borderline ovarian tumors (BOTs), and early malignant ovarian tumors (eMOTs). The retrospective research was conducted with pathologically confirmed 258 ovarian tumor patients from January 2014 to February 2021. The patients were randomly allocated to a training cohort (n = 198) and a test cohort (n = 60). By providing a three-dimensional (3D) characterization of the volume of interest (VOI) at the maximum level of images, 4238 radiomic features were extracted from the VOI per patient. The Wilcoxon-Mann-Whitney (WMW) test, least absolute shrinkage and selection operator (LASSO), and support vector machine (SVM) were employed to select the radiomic features. Five machine learning (ML) algorithms were applied to construct three-class diagnostic models. Leave-one-out cross-validation (LOOCV) was implemented to evaluate the performance of the radiomics models. The test cohort was used to verify the generalization ability of the radiomics models. The receiver-operating characteristic (ROC) was used to evaluate diagnostic performance of radiomics model. Global and discrimination performance of five models was evaluated by average area under the ROC curve (AUC). The average ROC indicated that random forest (RF) diagnostic model in training cohort demonstrated the best diagnostic performance (micro/macro average AUC, 0.98/0.99), which was then confirmed with by LOOCV (micro/macro average AUC, 0.89/0.88) and external validation (test cohort) (micro/macro average AUC, 0.81/0.79). Our proposed CT-based radiomics diagnostic models may effectively assist in preoperatively differentiating BeOTs, BOTs, and eMOTs.

Genetic diagnosis of pseudomyxoma peritonei originating from mucinous borderline tumor inside an ovarian teratoma

BackgroundPseudomyxoma peritonei is a rare disease condition mainly caused by primary mucinous tumors from the appendix and rarely from the ovary, such as when mucinous ovarian tumors arise from within a teratoma. Molecular analyses of pseudomyxoma from the appendix showed that KRAS and GNAS pathogenic variants are common genetic features of pseudomyxoma peritonei. However, the origin of the tumors is difficult to be identified via genetic variants alone. This study presents a case of pseudomyxoma peritonei of ovarian origin, which was diagnosed by comprehensive genomic profiling with ploidy analysis in a series of primary, recurrent, and autopsy tumor specimens.Case presentationA 40-year-old woman was diagnosed with Stage IC2 mucinous ovarian tumor of borderline malignancy with mature cystic teratoma, upon clinical pathology. Immunohistochemical analysis suggested that the mucinous tumor was derived from the intestinal component of an ovarian teratoma. Three years later, intraperitoneal recurrence was detected, which subsequently progressed to pseudomyxoma peritonei. Genomic analysis detected KRAS (G12D), GNAS (R201C), and FBXW7 (R367*) variants in the primary tumor. In addition, the tumor showed aneuploidy with loss of heterozygosity (LOH) in all its chromosomes, which suggested that the primary ovarian tumor was derived from germ cells. Existence of one Barr body suggested the existence of uniparental disomy of the tumors throughout the genome, instead of a haploid genotype. All three pathogenic variants remained positive in the initial recurrent tumor, as well as in the paired DNA from the whole blood in pseudomyxoma peritonei. The pathogenic variant of KRAS (G12D) was also identified in the autopsy specimen of the appendix by droplet digital polymerase chain reaction.ConclusionsThis study pathologically and genetically confirmed that the primary ovarian borderline tumor was derived from the intestinal component of an ovarian teratoma, and that the subsequent pseudomyxoma peritonei progressed from the primary ovarian tumor. Integrative genomic analysis was useful to identify cellular origin of tumors, as well as to precisely interpret the process of disease progression.

Placental Leucine Aminopeptidase as a Potential Specific Urine Biomarker for Invasive Ovarian Cancer.

Background: A non-invasive and sensitive biomarker for the detection of ovarian cancer (OvCa) is lacking. We aim to investigate if urinary placental leucine aminopeptidase (P-LAP) can serve as a reliable biomarker for OvCa. Methods: P-LAP activity was measured using a LAP assay kit (Serotech Co., Ltd., Sapporo, Japan) in the urine of 22 patients with benign or borderline malignant ovarian tumors and 18 patients with OvCa. In this assay, L-methionine was added at 20 mM because P-LAP is functional, but other aminopeptidases are inhibited at this dose of L-methionine. Results: The mean urinary P-LAP activity was significantly higher in the OvCa group than in the benign or borderline malignant tumor group. When the cut-off value of P-LAP was determined as 11.00 U/L, its sensitivity and specificity for differentiating invasive cancer were 77.8% and 95.5%, respectively. Conclusion: Although the usefulness of this test should be confirmed in a larger cohort of cases and controls, our study is the first to highlight the importance of urinary P-LAP as a biomarker for OvCa.

Untargeted Metabolomic Characterization of Ovarian Tumors.

Simple SummaryThis study utilized untargeted metabolomic techniques to detect urine and plasma metabolites. Using support vector machine algorithm, three models for ovarian tumors diagnosis, benign-malignant distinguishing, early diagnosis and borderline-malignant distinguishing were developed. These models have good classification performance and provided a novel insight for non-invasive diagnosis of ovarian cancer.Diagnosis of ovarian cancer is difficult due to the lack of clinical symptoms and effective screening algorithms. In this study, we aim to develop models for ovarian cancer diagnosis by detecting metabolites in urine and plasma samples. Ultra-high-performance liquid chromatography and quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS) in positive ion mode was used for metabolome quantification in 235 urine samples and 331 plasma samples. Then, Urine and plasma metabolomic profiles were analyzed by univariate and multivariate statistics. Four groups of samples: normal control, benign, borderline and malignant ovarian tumors were enrolled in this study. A total of 1330 features and 1302 features were detected from urine and plasma samples respectively. Based on two urine putative metabolites, five plasma putative metabolites and five urine putative metabolites, three models for distinguishing normal-ovarian tumors, benign-malignant (borderline + malignant) and borderline-malignant ovarian tumors were developed respectively. The AUC (Area Under Curve) values were 0.987, 0876 and 0.943 in discovery set and 0.984, 0.896 and 0.836 in validation set for three models. Specially, the diagnostic model based on 5 plasma putative metabolites had better early-stage diagnosis performance than CA125 alone. The AUC values of the model were 0.847 and 0.988 in discovery and validation set respectively. Our results showed that normal and ovarian tumors have unique metabolic signature in urine and plasma samples, which shed light on the ovarian cancer diagnosis and classification.

Infertility and borderline malignant ovarian tumors: a case of successful pregnancy after fertility-preserving management of the disease

Infertility and borderline malignant ovarian tumors: a case of successful pregnancy after fertility-preserving management of the disease

Preservation of fertility in surgery of benign and borderline malignant ovarian tumors

Benign ovarian tumors occur in 7% of women during their procreative years and involve both organic and functional tumors. The average age of onset for borderline ovarian tumors is ten years younger than that for ovarian cancers. Women with benign and borderline malignant ovarian tumors are therefore more likely to be affected by fertility issues. The causal link between infertility and benign ovarian tumor stems more from the therapeutic strategies adopted than from the histological nature of the benign ovarian tumor. The question of fertility preservation must therefore be addressed in the management of these patients through respect for "correct" surgical indications, through gestures centered around ovarian preservation, and finally, if necessary, by recourse to fertility preservation techniques.

Multicystic peritoneal mesothelioma after fertility-sparing surgery for an ovarian tumor of borderline malignancy: A case report

We report a case of a 19-year-old woman with multicystic peritoneal mesothelioma (MCPM) who had previously undergone left adnexectomy due to an ovarian tumor of borderline malignancy at the age of 17 years. Follow-up imaging studies after adnexectomy revealed multiple cystic lesions of increasing size and number, suggesting recurrence of the tumor. Diagnostic laparoscopic surgery was performed, and the cystic lesion was pathologically determined to be MCPM. To our knowledge, this is the first report of MCPM diagnosed and successfully treated by laparoscopic surgery during the course of follow-up for an ovarian tumor. It is important to recognize that MCPM can occur in patients who have previously undergone abdominal surgery, and laparoscopic surgery is recommended for patients of reproductive age, because of the potential risk of infertility associated with extensive pelvic surgery.

Outcome of the treatment for ovarian tumor of borderline malignancy

Outcome of the treatment for ovarian tumor of borderline malignancy

Study on the effect of ultrasound operators' confidence on making diagnosis of ovarian tumor

This study was carried out to determine the accuracy of diagnosis of ovarian tumors by different levels of confidence and experience of ultrasound operators, and the association of histological diagnosis with confidence of ultrasound operators. Ultrasound images of representative cases of benign, borderline and invasive malignant ovarian tumors were independently evaluated by 4 experts and 4 trainers. The operators categorized the ovarian tumor into benign, borderline or invasive malignant, and they also gave a score which indicated the degree of confidence when they made diagnosis. The diagnostic accuracy in differentiating benign, borderline and invasive malignant ovarian tumors were calculated depending based on the level of confidence when diagnosis. 500 images of subjects histological diagnosed with ovarian tumor were examined. The confidence score of experts was significantly higher than that of trainees (p<0.05). The diagnostic accuracy was significantly increased with the raising level of confidence (test for trend, p<0.05). The borderline tumor was seemed difficult to diagnose, and had the lowest accuracy, sensitivity and specificity compared to benign and primary invasive tumors. The experts showed the higher accuracy (88.5) than that of trainees (72.5). The confidence score of experts was positive related to diagnostic accuracy, with the contingency coefficient for benign, borderline and primary invasive of 0.62, 0.33 and 0.56. Our study indicated the accuracy of expert ultrasound depends on the degree of confidence, and the borderline type of ovarian tumor showed the difficult to diagnose. Key words: Ultrasound diagnosis, diagnostic confidence, ovarian tumors, ultrasound experience.

Spectrum of fluorodeoxyglucose-positron emission tomography/computed tomography and magnetic resonance imaging findings of ovarian tumors

The purpose of this article is to review fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) findings in a variety of benign, malignant, and borderline malignant ovarian tumors. It is advantageous to become familiar with the wide variety of FDG-PET/CT findings of this entity. Benign ovarian tumors generally have faint uptake, whereas endometriomas, fibromas, and teratomas show mild to moderate uptake. Malignant ovarian tumors generally have intense uptake, whereas tumors with a small solid component often show minimal uptake.

Letters to the Editor

11 November 2009 Dear Editor, BENIGN OVARIAN TUMOUR PRESENTING AS HUGE ABDOMINAL MASS The annual incidence of ovarian neoplasms in the paediatric and adolescent population is estimated to be 2.6 cases per 100 000, with germ cell tumours being the most common ones.1 We presented a girl with a huge abdominal mass without any discomfort or pain. In this paper, we emphasised the diagnosis of serous cystadenoma in children who present with asymptomatic abdominal mass. A 12-year-old pre-menarchal girl presented with a history of increasing abdominal distension, without discomfort, pain or any other urinary and gastrointestinal symptoms (Fig. 1a). The patient's weight was 60 kg, and height was 163 cm. No pain or abdominal masses were noted upon examination. The other physical and systemic examinations were unremarkable. The first ultrasonographic examination of the abdomen was performed by a paediatrician in an effort to reveal the cause of frequent micturition, and a cyst of the left ovary was an incidental finding. Pelvic ultrasonographic examination revealed a large cystic mass (56 cm) arising from the left ovary, reaching to the level of the xiphoid. Magnetic resonance imaging showed a huge mass arising from the left ovary with no signs of organ invasion (Fig. 1b,c). Laboratory results including endocrinological tests (follicle-stimulating hormone (FSH)-immunochemiluminometric assays (ICMA) 25.08 mIU/mL, LH-ICMA 5.06 mIU/mL, oestradiol 58 pg/mL), as well as thyroid-stimulating hormone [TSH] and T4, were normal for the age and pubertal stage of the patient. The ovarian tumour marker values (alfa feto protein [AFP], beta human chorionic gonadotropin [βHCG], carcinoembryonic antigen [CEA], cancer antigen-125 [CA125] and lactate dehydrogenase [LDH]) were also normal. The cyst was surgically removed with preservation of normal ovarian tissue, and histopathology revealed a serous cystadenoma. The huge cyst was unilocular, with a thin wall and clear content. Both of the ovaries were visible by pelvic magnetic resonance imaging, and their volumes were found within normal limits (Fig. 1d). The patient was followed up regularly, and there was no evidence of recurrence 30 months after surgery. (a) The patient with minimal abdominal distension at admission. (b,c) Magnetic resonance imaging demonstrated an enormous mass occupying almost the entire abdomen. (d) Cyst was surgically removed, with preservation of normal ovarian tissue. Although there are numerous classes of epithelial ovarian cancer in adults, the histological subtypes of epithelial ovarian tumours in children include only serous and mucinous tumours.2 Benign serous cystadenomas are rare benign neoplasms in the paediatric age group.3 Although this tumour is rare, this diagnosis should be considered in 11–15-year-old girls presenting with a huge abdominal mass. Malignant transformation is possible in 5–10% of cases, in particular, the adenomatose shapes that can induce transformation into adenocarcinoma.4 However, serous cyst tumour of the ovary in our patient occurred prior to menarche, and these tumours tend to present with abdominal distension. The FSH levels were measured by new ICMA. The normal ranges were calculated by age and Tanner stage (premenopausal: 5–30 IU/L). The patient was a pre-menarchal pubertal girl at Tanner stage 4. She exhibited an elevated basal FSH level; however, the menses had not started, and the mid-follicular oestradiol levels were normal. FSH serum levels were high during spontaneous puberty and slowly normalised thereafter in our patient. The differential diagnosis of ovarian masses in pre-menarchal girls includes cysts, torsion with subsequent oedema, benign or malignant ovarian neoplasm, and, rarely, involvement of the ovary by lymphoma, leukaemia, or metastatic disease.5 Ovarian causes of cysts in adolescents include follicular and corpus luteum cysts, haemorrhagic functional cysts, endometriomas, or benign and malignant neoplasms. Disorders of the fallopian tube such as hydrosalpinx, pyosalpinx, paratubal cyst or ectopic pregnancy can mimic an ovarian cyst. Peritoneal cysts or peri-appendiceal abscesses are occasionally mistaken as adnexal pathology.6 Patients with a serous cyst might present late, and this may lead to renal insufficiency secondary to urinary outflow obstruction. A mass may also be totally asymptomatic and revealed by ultrasonography incidentally. Benign cystadenomas are the most common cysts and are effectively treated by unilateral cystectomy.7 Conservative surgery is adequate for benign lesions and early-stage ovarian tumours of borderline malignancy. Early detection of adnexal masses and surgical techniques makes it possible to remove the tumour and preserve the underlying ovary and subsequent fertility. Surgical treatment of our case was successful, and the patient adjusted well to her post-operative body image.

Risk of malignancy in sonographically confirmed septated cystic ovarian tumors

Objective To determine the risk of malignancy in septated cystic ovarian tumors. Materials 1319 (4.4%) of 29,829 women were identified by transvaginal sonography (TVS) as having a complex cystic ovarian tumor with septations without solid areas or papillary projections and were placed on long-term ultrasound surveillance for ovarian malignancy. Results These 1319 patients had a total of 2870 septated cystic ovarian tumors. 2288 tumors (79.7%) had a septal width < 2 mm and 582 (20.3%) had a septal width ≥ 2 mm. 2286 tumors (79.6%) were < 5 cm in diameter and 584 (20.4%) were ≥ 5 cm in diameter. 1114 septated cystic tumors (38.8%) resolved spontaneously (mean duration to resolution—12 months) and 1756 (61.2%) tumors persisted. 128 patients underwent surgical tumor removal within 3 months of ultrasound. Most common histopathology was: serous cystadenoma (75), mucinous cystadenoma (13), and endometrioma (10). One patient had an ovarian tumor of borderline malignancy (Stage IB). There were no cases of ovarian cancer. Patients were followed from 4 to 252 months (mean—77 months). One patient developed papillary morphology in the contralateral ovary 3.2 years after detection of a septated ovarian cyst and had epithelial ovarian cancer in that ovary and in the omentum (Stage IIIC disease). The remaining patients are all free of ovarian neoplasia after a total of 7642 follow-up years. Conclusions Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery.

Oviductal Glycoprotein (OVGP1, MUC9)

Epithelial ovarian carcinomas are highly lethal because most are detected at late stages. A previous immunohistochemical analysis showed that oviductal glycoprotein 1 (OVGP1), a secretory product of the oviductal epithelium under estrogen dominance, is produced predominantly by borderline and low-grade malignant epithelial ovarian tumors. In the present study, we investigated OVGP1 as a possible serum marker for the detection of ovarian cancer. We generated a highly specific monoclonal antibody, clone 7E10, to human OVGP1. Using 7E10 and a polyclonal antibody, a sandwich enzyme-linked immunosorbent assay was developed to assay OVGP1 levels in 135 normal sera, and sera from 21 benign tumors, 12 borderline tumors, and 87 ovarian cancers (18, grade 1-2 serous; 44, grade 3 serous; 10, mucinous; 10, clear cell; and 5, endometrioid). Using a 95% confidence interval cutoff from the mean of normal postmenopausal sera, median OVGP1 levels were elevated in the sera from 75% of the women with borderline tumors and 80% of the women with mucinous, 60% with clear cell, 59% with grade 1 and 2 serous, 22% with grade 3 serous, and 0% with endometrioid carcinomas. By stage, OVGP1 levels were highest in the sera from the borderline tumors, stage I and II serous carcinomas, and mucinous carcinomas. OVGP1 levels varied independently of cancer antigen 125 (CA125). Increases in OVGP1 serum levels vary with ovarian tumor histotypes and stages. Being differentiation based, OVGP1 seems to detect a different spectrum of ovarian epithelial cancers than other markers and thus should be a useful adjunct for more accurate detection, particularly of early serous ovarian cancers and mucinous carcinomas, which tend to lack increased CA125.

Confidence of expert ultrasound operators in making a diagnosis of adnexal tumor: effect on diagnostic accuracy and interobserver agreement

To assess the degree of confidence with which expert ultrasound operators make a diagnosis of benign, borderline and invasive malignant ovarian tumors and its effect on diagnostic accuracy and interobserver agreement. Digitally stored static two-dimensional B-mode images of representative cases of benign, borderline and invasive malignant ovarian tumors were independently assessed by three expert ultrasound operators who had not performed the original real-time ultrasound examination. The experts classified the tumors as benign, borderline or invasive malignant and they also indicated the degree of confidence with which they made the diagnosis (certain, probable and uncertain). The diagnostic accuracy and interobserver agreement, in differentiating benign, borderline and invasive malignant ovarian tumors, were calculated depending on the level of confidence with which the diagnosis was made. One hundred and sixty-six cases were included in the final data analysis. The diagnostic accuracy of all three experts decreased with decreasing level of confidence. Interobserver agreement between any two experts was very high when they were certain of the diagnosis (rates of agreement 98%, 99% and 100%), but it was significantly lower with a moderate level of confidence (rates of agreement 78%, 71% and 76%) (P < 0.01 for any two experts). The agreement in both diagnosis and confidence was lowest in cases of borderline ovarian tumors compared to benign and primary invasive lesions. The accuracy of expert ultrasound operators using pattern recognition depends on the degree of certainty with which the diagnosis is made. Interobserver variability is also influenced by the operators' confidence in making the diagnosis. Our findings suggest that the level of confidence with which the diagnosis is made should be included in the ultrasound report.

Use of ultrasound pattern recognition by expert operators to identify borderline ovarian tumors: a study of diagnostic performance and interobserver agreement

To assess the accuracy and reproducibility of ultrasound 'pattern recognition' for the diagnosis of borderline ovarian tumors by asking experienced ultrasound operators to evaluate representative images of different types of adnexal tumor. Digitally stored static two-dimensional B-mode images of representative cases of benign, borderline and invasive malignant ovarian tumors were independently assessed by three expert sonologists who had not performed the original real-time ultrasound examination. The outcome measures included diagnostic accuracy and interobserver agreement in the diagnosis of benign, borderline or invasive malignant ovarian tumors. One hundred and sixty-six cases were included in the final data analysis. A correct classification was made by all three experts in 83% of the primary invasive cancers, 76% of the benign masses and in 44% of the borderline malignant tumors (P < 0.01). The experts showed a tendency to misclassify borderline tumors as benign rather than primary invasive (ratio of 8 : 1 for Expert A, 4 : 1 for B and 6 : 1 for C). The interobserver agreement between any two experts was very good when they were tested for their ability to discriminate between invasive and non-invasive (benign and borderline) ovarian tumors (Cohen's kappa 0.85-0.88), but poorer for the discrimination between malignant (invasive and borderline) and benign tumors (kappa 0.70-0.78). The accuracy of ultrasound diagnosis of borderline tumors is lower in comparison with benign and invasive malignant lesions. The diagnostic performance and interobserver agreement are better when the outcomes are dichotomized into non-invasive and invasive malignant lesions, as opposed to the traditional diagnosis of benign and malignant tumors.

Malign mural nodules associated with serous ovarian tumor of borderline malignancy: a case report and literature review

Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare. A 54-year-old woman referred with abdominal swelling. Imaging studies revealed a huge mass localized in pelvis and lower abdomen and grade 1-2 left renal hydronephrosis. Preoperative Ca-125 was 798 U/ml. In exploratory laparotomy there was a 16 cm mass adherent to lateral abdominal wall and intestines. Adhesiolysis and de-bulking surgery were performed including bilateral pelvic, para-aortic lymphadenectomy, appendectomy and omentectomy. Left ureter was found to be dilated because of the infiltration of distal part by the tumor, so distal ureteral resection and neoureterocystostomy were performed. Final pathology revealed borderline serous ovarian tumor with mural nodules which were consisted of SLMNs, multiple and sharply demarcated from the adjacent tumor, and sarcomatous nodules showing infiltrative appearance in metastatic regions. Mural nodules showed a positive reaction for vimentin and SMA but were negative for cytokeratin and also necrosis, hemorrhage, and 10-15 mitoses in 10 high power fields were noted. She had postoperative chemotherapy and follow-up is going on without metastases in her first year. The existence of sarcomatous nodules combined with the SLMN necessitates a careful histologic analysis for treatment and the determination of prognosis. However, too few cases of mixed type mural nodules have been published to warrant a conclusion regarding their prognosis.

MR images of postoperatively diagnosed borderline malignant ovarian tumors after laparoscopic surgery

Background; MR images are considered to be highly effective to examine ovarian tumors. However, in some case, it is difficult to differentiate malignant ovarian tumors from benign ones.Methods; Five hundred eighty-nine cases of ovarian tumors were managed by laparoscopic surgery during a period of six years. Of these cases, 15 cases were diagnosed as borderline ovarian tumors after surgery, and MR images of these cases were retrospectively reviewed.Results; The mean age was 35 years old and the mean follow-up period was 36 months. Pathological results revealed ten cases of mucinous borderline tumors (67%), three cases of serous borderline tumors (20%), and the other two cases. In reviewing preoperative MR images, six cases showed solid parts within the tumor walls enhanced by contrast agents or huge tumor size (over 20 cm in diameter). Of ten cases of pathologically proven mucinous borderline tumors, five cases were interpreted as endometrial cysts before surgery.Conclusion; For the gynecologic laparoscopists, it is necessary to thoroughly understand the characteristic features of MR images for ovarian tumors. If MR images show any possibility of malignancy, proper strategies such as frozen section diagnosis should be considered.

112: Adnexal Cyst With Papillae: Role of Three Dimensional Power Doppler Ultrasound for Discrimination Between Benign, Borderline and Invasive Malignant Ovarian Tumors

The presence of papillae within an ovarian cyst is often associated to borderline (BOT) or invasive malignant tumors. However, at two dimensional (2D) ultrasound, neither papillae nor presence of vessels within the papillae constituted highly sensitive sonographic markers to distinguish BOT from ovarian cancer. The aim of this study was to evaluate whether three dimensional (3D) transvaginal sonography (TVS) associated to vascular flow indexes, is able to differentiate between benign, borderline and invasive malignant ovarian tumors.

OC153: Logistic regression models to distinguish between benign, primary invasive, borderline malignant and metastatic ovarian tumors

infiltrating adenomysosis. Pathological reports of surgically removed uteri and/or at magnetic resonance imaging (MRI) reports were considered the gold standard. Demographic and sonographic data were recorded. Results: Median age was 44 (IR, 40–48) years. Seven patients underwent MRI because of concomitant ovarian and deep infiltrating endometriosis. Seventeen patients underwent hysterectomy for final surgical treatment of symptoms. Pathological and MRI reports confirmed deep uterine adenomyosis in all patients. Diffuse, anterior and posterior deep uterine adenomyosis was observed in 13 (54%), six (25%) and five (21%) patients, respectively. Conclusions: The diagnosis of deep uterine adenomyosis at 3D-TVS by VCI analysis was correct in all cases. This was probably due to the enhancement of tissue echogenic pattern by adding up the highresolution information from single ultrathin sonographic planes into 2-mm slices. These preliminary results, if confirmed in a larger study, could define 3D-TVS VCI as a possible standard for the diagnosis of deep uterine adenomyosis.