Serous Borderline Ovarian Tumors Research Articles

I saw the “sea anemone” sign: Puffy face of borderline ovarian tumors

The sea anemone sign is a radiologic sign seen on magnetic resonance imaging (MRI) studies that indicates the morphological development of serous borderline ovarian tumors (SBOTs), as papillary projections originating from the wall of the cystic lesion. The presence of T2 hypointense fibrous stroma in the center of the papilla is a helpful tip in the diagnosis of SBOTs. Those projections might also be assumed to have a frond-like appearance which can be seen as branching papillary projections, especially on T2-weighted imaging.The term “sea anemone” sign is described by Tanaka et al. who deemed it as a “hallmark” feature of surface SBOTs.

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.

Abstract A107: Characterizing the genomic and immunologic landscape of serous borderline tumors and low-grade serous ovarian cancer

Abstract A107: Characterizing the genomic and immunologic landscape of serous borderline tumors and low-grade serous ovarian cancer

Expression of selected epithelial–mesenchymal transition (EMT) transcription factors in serous borderline ovarian tumors and type I ovarian cancers

Expression of selected epithelial–mesenchymal transition (EMT) transcription factors in serous borderline ovarian tumors and type I ovarian cancers

Radiomics nomogram for preoperative differentiation of early-stage serous borderline ovarian tumors and serous malignant ovarian tumors.

This study aimed to construct a radiomics nomogram and validate its performance in the preoperative differentiation between early-stage (I and II) serous borderline ovarian tumors (SBOTs) and serous malignant ovarian tumors (SMOTs). Data were collected from 80 patients with early-stage SBOTs and 102 with early-stage SMOTs (training set: n = 127; validation set: n = 55). Univariate and multivariate analyses were performed to identify the independent clinicoradiological factors. A radiomics signature model was constructed using radiomics features extracted from multidetector computed tomography images of the venous phase, in which the least absolute shrinkage and selection operator regression was employed to lessen the dimensionality of the data and choose the radiomics features. A nomogram model was established by combining independent clinicoradiological factors with the radiomics signature. The performance of nomogram calibration, discrimination, and clinical usefulness was evaluated using training and validation sets. In terms of clinicoradiological characteristics, age (p = 0.001), the diameter of the solid component (p = 0.009), and human epididymis protein 4 level (p < 0.001) were identified as the independent risk factors of SMOT, for which the area under the curves (AUCs) were calculated to be 0.850 and 0.836 in the training and validation sets, respectively. Nine features were finally selected to construct the radiomics signature model, which exhibited AUCs of 0.879 and 0.826 for the training and validation sets, respectively. The nomogram model demonstrated considerable calibration and discrimination with AUCs of 0.940 and 0.909 for the training and validation sets, respectively. The nomogram model displayed more prominent clinical usefulness than the clinicoradiological and radiomics signature models according to the decision curve analysis. The nomogram model can be employed as an individualized preoperative non-invasive tool for differentiating early-stage SBOTs from SMOTs.

Role of magnetic resonance imaging to differentiate between borderline and malignant serous epithelial ovarian tumors.

We aimed to differentiate serous borderline ovarian tumors (SBOT) from serous epithelial ovarian carcinomas (SEOC) using morphological and functional MRI findings, to improve the patient management. We retrospectively investigated 24 ovarian lesions diagnosed with SBOT and 64 ovarian lesions diagnosed with SEOC. Additional to the demographic and morphological findings T2W signal intensity ratio, mean apparent diffusion coefficient (ADCmean) and total apparent diffusion coefficient (ADCtotal) values were analyzed and compared between two groups. Bilaterality, pelvic free fluid presence, serum CA-125 level (U/mL), presence of pelvic peritoneal implant were in favor of SEOC. Lower maximum size of solid component and solid size to maximum size ratio, dominantly cystic and solid-cystic appearance, exophytic growth pattern, presence of papiller projection and papillary architecture and internal branching pattern, higher T2W signal intensity ratio, ADCmean and ADCtotal values were in favor of SBOT. Our study revealed that morphological and functional imaging findings were valuable in differentiating BSOT from SEOC.

Management of Borderline Ovarian Tumours: Tertiary Centre Experience from Turkey.

This study aimed to analyse the management protocols, surgical approaches, and outcomes of the women with Borderline ovarian tumours (BOT) at Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey. One hundred and seventy-seven patients diagnosed with serous and mucinous BOT were enrolled in the study. Demographic, clinical, and pathological data were reviewed retrospectively from the medical records. The patients were divided into two groups according to surgical interventions: Laparoscopy group (n=50) and Laparotomy group (n=127). Treatment was conservative in 107 (60.5%) patients. Mean age at diagnosis (48.69 ± 12.52 vs. 41.1±11.66 years, p<0.001), tumour size (84.13 ± 51.85 mm vs. 67.1 ± 34.78 mm, p = 0.013), and number of postmenopausal patients (n = 55 vs. 9, p = 0.002) were significantly higher in the Laparotomy group. There were no significant differences in the rates of intraoperative cyst rupture (22% vs. 18%, p = 0.120) and recurrence (2.25% vs. 5.05%, p = 0.760). There was no difference between radical vs. conservative surgery and laparotomy vs. laparoscopy in terms of recurrences. In appropriate cases, the conservative treatment and laparoscopy may be preferred. Key Words: Borderline ovarian tumour, Laparoscopy, Laparotomy.

Oncological and Reproductive Outcomes after Fertility-Sparing Surgery in Patients with Advanced-Stage Serous Borderline Ovarian Tumor: A Single-Center Retrospective Study.

Our study aimed to analyze the prognosis and reproductive outcomes of patients with advanced-stage serous borderline ovarian tumors (SBOTs) who underwent fertility-sparing surgery (FSS). This study included patients aged ≤ 45 years diagnosed with advanced-stage (International Federation of Gynecology and Obstetrics II and III) SBOTs who were treated with FSS. Conservative surgeries were performed in 65 patients with advanced-stage SBOT with a median age of 28 years (range, 16-44 years). Nine patients had invasive implants. The median follow-up was 81.7 months. Forty-six patients (70.8%) had a relapse (median time to first recurrence, 22.8 months). Thirteen patients subsequently developed recurrence as an invasive disease, and two died due to disease progression. After multivariate analysis, age < 30 years and incomplete cytoreduction were independent risk factors for recurrence. Invasive implants and postoperative residual tumors were significantly associated with shorter disease-free survival. Of 35 patients attempting to conceive, 12 underwent assisted reproductive technology. Additionally, 19 pregnancies, including 15 full-term births, were documented. FSS provides a good chance of reproductive success in women with advanced-stage SBOT who desire fertility preservation, but it has a high recurrence rate and risk of malignancy transformation. Patients with invasive implants should be strictly selected for FSS.

Serous surface papillary borderline ovarian tumors: correlation of sonographic features with clinic pathological findings.

Serous surface papillary borderline ovarian tumor (SSPBOT) is a distinct subtype of serous borderline ovarian tumor characterized by solid tissue deposition confined to the ovarian surface. Because SSPBOT is rare, there are few published reports on the ultrasonographic features of this condition. In this retrospective study, we investigated 12 cases of SSPBOT. Ultrasound imaging of SSPBOT showed grossly normal ovaries that were encased partially or wholly by tumor deposits that were confined to the surface, with clear demarcation between normal ovarian tissue and surrounding tumors. Color Doppler imaging demonstrated the 'fireworks sign' in all cases of SSPBOT, corresponding to an intratumoral vascular bundle originating from the ovarian vessels and supplying hierarchical branching blood flow to the surrounding tumor. No patient with ovarian high-grade serous carcinoma showed these morphological and Doppler features. In our series, the fireworks sign appeared to be a characteristic feature of SSPBOT that could facilitate correct identification of this tumor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Ovarian serous borderline tumors with recurrent or extraovarian lesions: a Japanese, retrospective, multi-institutional, population-based study.

Ovarian serous borderline tumors (SBT) are typically unilateral and are primarily treated using hysterectomy and bilateral salpingooophorectomy (SO). However, most young patients prefer fertility-sparing surgeries (FSS) with tumorectomy or unilateral SO. Micropapillary morphology and invasive implants have been designated as histopathological risk indicators for recurrence or metastasis, but their clinical impact remains controversial because of limitations like diagnostic inconsistency and incomplete surgical staging. A nationwide multi-institutional population-based retrospective surveillance was conducted with a thorough central pathology review to reveal the clinical features of SBT. Of 313 SBT patients enrolled in the Japanese Society of Clinical Oncology's Surveillance of Gynecologic Rare Tumors, 289 patient records were reviewed for clinical outcomes. The glass slides of patients at stage II-IV or with recurrence or death were re-evaluated by three gynecological pathologists. The 10-year overall and progression-free survival (PFS) rates were 98.6% and 92.3%. The median recurrence period was 40months and 77.0% was observed in the contralateral ovary within 60months. Patients aged ≤ 35years underwent FSS more frequently and relapsed more (p < .001). A clinic-pathological analysis revealed diagnosis during pregnancy, FSS, and treatment at non-university institutes as well as advanced stage and large diameter were independent risk factors of recurrence. Among patients having pathologically confirmed SBTs, PFS was not influenced by the presence of micropapillary pattern or invasive implants. The recurrence rate was lower in this cohort than previous reports, but the clinical impacts of incomplete resection and misclassification of the tumor were still significant on the treatment of SBT.

Evaluation of Borderline Ovarian Tumor Recurrence Rate after Surgery with or without Fertility-Sparing Approach: Results of a Retrospective Analysis.

Borderline ovarian tumors (BOTs) comprise 15-20% of primary ovarian neoplasms and represent an independent disease entity among epithelial ovarian cancers. The present study (Clinical Trial ID: NCT05791838) aimed to report a retrospective analysis of the management and outcomes of 86 consecutive BOTs patients, 54 of which were at a reproductive age. All patients with BOTs undergoing surgical treatment from January 2010 to December 2017 were included. Data were retrospectively reviewed. High levels of Ca-125 were observed in 25.6% of the FIGO stage I patients and 58.3% of the advanced disease patients. Fertility-sparing surgery and comprehensive surgical staging were performed in 36.7% and 49.3% of the patients, respectively. Laparotomy was the most frequent surgical approach (65.1%). The most common diagnosis at frozen sections was serous BOT (50.6%). Serous BOTs have significantly smaller tumor diameters than mucinous BOTs (p < 0.0001). The mean postoperative follow-up was 29.8 months (range 6-87 months). Three patients experienced a recurrence, with an overall recurrence rate of 3.5% (10% considering only the patients who underwent fertility-sparing treatment). BOTs have low recurrence rates, with excellent prognosis. Surgery with proper staging is the main treatment. Conservative surgery is a valid option for women with reproductive potential.

Over tümörlerinin ayırıcı tanısında sistemik inflamatuar belirteçlerin rolü

Aim: The aim of this study is evaluating the predictive value of preoperative inflammatory blood parameters for differential of serous cystadenoma, serous borderline ovarian tumor (BOT) and high-grade serous ovarian (HGSOC) carcinoma.&#x0D; Materials and Method: In this single-center study, we retrospectively enrolled 370 patients with ovarian tumors were divided into three groups. The groups were classified as serous cystadenoma, serous BOT and HGSOC. The potential association of preoperative hemoglobin (Hb), red cell distribution width (RDW), Hb/RDW ratio, ratio of neutrophils to lymphocytes (N/L) and ratio of platelets to lymphocytes (P/L) were analyzed.&#x0D; Results: P/L and N/L were significantly lower in benign serous cystadenoma or serous BOT than HGSOC (p

O-012 Risk of epithelial ovarian tumors among women with polycystic ovary syndrome (PCOS): A nationwide population-based cohort study

Abstract Study question Is polycystic ovary syndrome (PCOS) associated with epithelial ovarian cancer and borderline ovarian tumors? Summary answer Overall, no association between PCOS and epithelial ovarian tumors was seen, however, we observed an increased risk of ovarian cancer among postmenopausal women with PCOS. What is known already Few studies have investigated the association between PCOS and epithelial ovarian tumors. In general, studies have reported conflicting results, possibly due to methodological differences and varying confounder adjustments. For ovarian cancer, most studies have reported no associations, while two studies reported an increased risk for women with PCOS compared to women without PCOS. For borderline ovarian tumors, most studies found no associations while one study observed an increased risk for serous borderline ovarian tumors among women with PCOS. Only a few studies have investigated the risk associated with PCOS according to menopausal status and histological subtypes of these tumors. Study design, size, duration This is a nationwide cohort study including all women born in Denmark between January 1, 1940 and December 31, 2000. The study cohort consisted of 1,7 million women after exclusion of women who emigrated, died, were diagnosed with cancer, or had bilateral oophorectomy before study start. Participants/materials, setting, methods The study cohorts for ovarian cancer analyses and borderline ovarian tumor analyses were linked to national registers to obtain information on PCOS diagnosis, cancer diagnosis, covariates, migration, and vital status. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) for ovarian cancer and for borderline ovarian tumors, as well as separately for histological subtypes and according to menopausal status (landmark analysis at attained age of 51 years). Main results and the role of chance During a median 26.0 years of follow-up, 6,490 women were diagnosed with epithelial ovarian cancer and 2,990 women were diagnosed with borderline ovarian tumors. Overall, we found no marked associations for ovarian cancer and borderline ovarian tumors among women with PCOS compared to women without PCOS after adjustments for highest obtained level of education and obesity (HR 1.32 95% CI 0.80-2.20 and HR 1.59 95% CI 0.92-2.75, respectively). However, we found an increased risk of ovarian cancer among postmenopausal women (HR 2.18 95% CI 1.04-4.57). Lastly, we observed an increased risk for serous borderline ovarian tumors (HR 2.98 95% CI 1.64-5.42) for women with PCOS. Limitations, reasons for caution The low number of exposed cases, despite the large study population, is a main limitation. Although the register-based exposure data are highly valid, diagnosis of PCOS is challenging, and we are not able to account for changes in diagnostic practices over time. Wider implications of the findings The results from our study and previous studies should be taken into consideration when revising clinical guidelines for the management of long-term health outcomes for women with PCOS. Low statistical precision is an important limitation in our study and in previous studies, and larger studies with pooled analyses are warranted. Trial registration number not applicable

Diagnostic model of low-grade serous ovarian cancer and borderline serous ovarian tumor: Model development and validation based on radiomics.

e17534 Background: Evidence to date indicates that there is a close relationship between low-grade serous ovarian cancer (LGSOC) and serous borderline ovarian tumor, but there is a significant difference in prognosis. Preoperative imaging and clinical information to assess the nature of lesions as accurately as possible is beneficial to the surgical management of patients. Methods: A total of 104 patients who underwent CT examination and surgical treatment for pelvic masses in Qilu Hospital of Shandong University from 2013 to 2021 were included in the study, including 25 patients with low-grade serous ovarian cancer, 34 patients with serous borderline ovarian tumor, and 45 patients with serous cystadenoma. Quantitative image features were extracted from CT and combined with clinical information to construct a diagnostic model. The diagnostic performance was evaluated by ROC and AUC. Results: The diagnostic model was constructed by RFECV (recursive feature elimination and cross validation) together with SVM (support vector machine), random forest and XGBoost (eXtreme Gradient Boosting) algorithms, among which the RFECV combined random forest algorithm model showed the optimal accuracy (0.78) and AUC (0.92). Combined with clinical features, a new diagnostic model was constructed again by RFECV and random forest, and the accuracy (0.91) and AUC (0.96) were further improved. Conclusions: Through the combination of CT image-based radiomics and clinical features, the clinical diagnosis model was successfully constructed, which can accurately evaluate and predict the pathological types of patients, and is expected to be used in clinical practice and guide surgical decision-making.

1016 Jerky Night: Propriospinal myoclonus at sleep onset after Metoclopramide use during pregnancy

Abstract Introduction Propriospinal myoclonus (PSM) at sleep onset is characterized by jerks of axial muscles, spreading caudally and rostrally, during the transition from wakefulness to sleep1. We present a rare case of a patient who suffered severe sleep-onset insomnia due to PSM after metoclopramide use during pregnancy. Report of case(s) A 30-year-old woman with a history of well-controlled herpes simplex virus (HSV) and a resected atypical serous borderline ovarian tumor with microinvasion, presented after a 2-year bout of insomnia due to electrical, jerking sensations in her torso, spreading to the legs just before falling asleep. The symptoms began after an 18-week trial of metoclopramide 20mg, for severe reflux with esophagitis during pregnancy, and persisted after discontinuation of metoclopramide, and postpartum, periodically worsening with menses. On first presentation, the neurological exam was unremarkable; polysomnography was conducted, showing brief myoclonic jerks of the upper extremity, with increased EMG tone and muscle artifact, preventing sleep onset, allowing a total sleep time of merely 1 hour 10 minutes. Event - related recordings on simultaneous electromyogram (EMG)/electroencephalogram (EEG), showed mixed movement disorder and suggested mild CNS hyperexcitability with some volitional muscle jerks, and some myoclonic jerks. An earlier trial of clonazepam 1mg nightly partially improved her symptoms, but caused panic, suicidal ideation, and depression. Month-long, nightly Diphenhydramine 50mg and Trazodone 100mg initially helped with insomnia, while Doxepin 10mg/mL, Daridorexant 25mg, Tizanidine, Gabapentin 900mg, Zolpidem, Cyclobenzaprine, Levetiracetam 500mg, Carbidopa-Levodopa, and sleep restriction all proved ineffective. Eventually, she underwent another trial of clonazepam at 0.25mg with slow titration to 0.75mg while adding melatonin 10mg, without adverse effects noted. Conclusion Our case of PSM at sleep onset was in the context of metoclopramide use during pregnancy. Uniquely, adverse effects were associated with a higher and rapid titration of Clonazepam, but later improved with a lower dose and slower titration, coupled with Melatonin. Notably, both dopamine agonists and antagonists, also cannabis, nitric oxide, interferon, ciprofloxacin, bupivacaine, spinal anesthesia, all have reportedly caused medication-induced myoclonus. Further, reports on similar cases may aid in understanding better the pathophysiology of this rare, disabling condition, and lead to more rapid, effective treatment. Support (if any)

KRAS mutation in primary ovarian serous borderline tumors correlates with tumor recurrence.

Oncogenic activation of the mitogen-activated protein kinase (MAPK) pathway due to KRAS or BRAF gain-of-function mutation is frequently found in ovarian serous borderline tumor (SBT) and their extraovarian implants. We investigated mutational status of KRAS and BRAF of the primary ovarian SBTs that had a high stage presentation in correlation with clinical outcome. Among 39 consecutive primary SBTs with either invasive implants (20 cases) or non-invasive implants (19 cases), KRAS and BRAF mutational analysis was informative in 34 cases. Sixteen cases (47%) harbored a KRAS mutation, while 5 cases (15%) had a BRAF V600E mutation. High-stage disease (IIIC) was seen in 31% (5/16) of patients with a KRAS mutation and 39% (7/18) of patients without a KRAS mutation (p = 0.64). KRAS mutations were present in 9/16 (56%) tumors with invasive implants/LGSC versus 7/18 (39%) tumors with non-invasive implants (p = 0.31). BRAF mutation was seen in 5 cases with non-invasive implants. Tumor recurrence was seen in 31% (5/16) of patients with a KRAS mutation, compared to 6% (1/18) of patients without a KRAS mutation (p = 0.04). A KRAS mutation predicted an adverse disease-free survival (31% survival at 160months) compared to those with wild-type KRAS (94% at 160months; log-rank test, p = 0.037; HR 4.47). In conclusion, KRAS mutation in primary ovarian SBTs is significantly associated with a worse disease-free survival, independent of the high tumor stage or histological subtypes of extraovarian implant. KRAS mutation testing of primary ovarian SBT may servce as a useful biomarker for tumor recurrence.

CASE REPORT- ADOLESCENT BORDERLINE OVARIAN TUMOUR WITH TORSION: A SURGICAL MANAGEMENT.

Background: Ovarian cancer is one of the common and the leading cause of death among women with gynecological malignancies. Ovarian tumor may sometimes present with torsion which is a gynecological emergency.Case presentation: We report a case of 16 years old girl who presented with acute pain in right sided lower abdomen with vomiting. Ultrasonography suggestive of bilateral complex ovarian cysts with right ovarian cyst torsion. The patient underwent right sided salpingo-oophorectomy and left sided multiple cystectomy with removal of excrescence. The conrmed diagnosis of serous borderline ovarian tumor with torsion was made retrospectively with pathology report. Ultrasonography, clinical presentation and pat Conclusions: hological examination play important role in diagnosis and hence in treatment of ovarian tumors

The clinicopathological characteristics of borderline ovarian tumors at Dr. Soetomo Hospital, Surabaya: a single center study

Background: Borderline ovarian tumors (BOT) are a subset of epithelial neoplasms histologically defined as atypical epithelial proliferation without stromal invasion. BOTs account for 10-20% of ovarian cancer cases. This study aims to know the clinical and pathological characteristics and determine the differences in these characteristics based on age classification. Methods: A 5-year retrospective study was conducted in a single center. Information was obtained from the pathological reports of 53 patients with BOTs between 2016-2021. Statistical analysis was performed using the Student’s t-test with SPSS version 20.0 (SPSS Inc). Continuous data were analyzed using t-tests, and categorical data were tested with Chi-square or Fisher's exact test to assess differences in clinical and pathological features between the &lt;40 years and the &gt;40 years age groups Results: Most of the tumor diameters were &gt;10 cm (92.45%) and &lt;10 cm (7.55%). For histopathological description, respectively are MBOT (69.81%), SBOT (24.53%), EBOT (3.77%), and SMBOT (1.89%). There were 29 (45.28%) cases with elevated CA125 levels, and normal levels were 24 (45.283%). Unilateral tumors were 36 (67.92%), and bilateral tumors were 17 cases (32.08%). Serous borderline Ovarian tumor histology was higher in the &gt;40 years group than in the &lt; 40 years group (p&lt;0.05). There was no relationship between cancer antigen (CA) 125 levels and bilaterality, tumor size, or stage (p &gt; 0.05). The mean CA 125 level was higher in the &gt;40 years group (257.92± 64.35) than in the &lt;40 years group (74.42±63.02) (p &lt; 0.05). Conclusion: The median age of BOT was 40 years old and the majority had a large unilateral tumor with mucinous, the most common histologic type. There was a correlation between age, SBOT histologic type, and elevated CA-125.

Lymph Node Involvement in Recurrent Serous Borderline Ovarian Tumors: Current Evidence, Controversies, and a Review of the Literature.

Borderline ovarian tumors (BOTs) account for 10-20% of epithelial ovarian neoplasms. They are characterized by their lack of destructive stromal invasion. In comparison to invasive ovarian cancers, BOTs occur in younger patients and have better outcome. Serous borderline ovarian tumor (SBOT) represents the most common subtype of BOT. Complete surgical staging is the current standard management but fertility-sparing surgery is an option for SBOT patients who are at reproductive age. While most cases of SBOTs have an indolent course with favorable prognosis, late recurrence and malignant transformation can occur, usually in the form of low-grade serous carcinoma (LGSC). Thus, assessment of the recurrence risk is essential for the management of those patients. SBOTs can be associated with lymph node involvement (LNI) in up to 30% of patients who undergo lymph node dissection at diagnosis, and whether LNI affects prognosis is controversial. The present review suggests that recurrent SBOTs with LNI have poorer oncological outcomes and highlights the biases due to the scarcity of reports in the literature. Preventing SBOTs from recurring and becoming invasive overtime and a more profound understanding of the underlying mechanisms at play are necessary.

Interobserver Reproducibility in Assessing Eosinophilic Cells in Ovarian Serous Borderline Tumors to Predict BRAF Mutational Status.

Ovarian serous borderline tumors (SBTs) harboring the BRAFV600E mutation are associated with decreased risk of progression to low-grade serous carcinoma, and often prominently feature tumor cells with abundant eosinophilic cytoplasm. Since eosinophilic cells (ECs) may be a marker of the underlying genetic driver, we proposed morphologic criteria and evaluated the interobserver reproducibility for assessing this histologic feature. Following the completion of an online training module, representative tumor slides from 40 SBTs ( BRAFV600E -mutated, n=18, BRAF -wildtype, n=22) were independently reviewed by 5 pathologists. For each case, reviewers provided a semiquantitative assessment of the extent of ECs (0: absent, 1: <10%, 2: 10%-50%, or 3: >50%, of tumor area). Interobserver reproducibility for estimating the extent of ECs was moderate (κ=0.41). Applying a cut-off score of ≥2, the median sensitivity and specificity for predicting BRAFV600E mutation were 67% and 95%, respectively. With a cut-off score of ≥1, median sensitivity and specificity were 100% and 82%, respectively. Morphologic mimics of ECs, including tumor cells with tufting or hobnail change and detached cell clusters in micropapillary SBTs, were possible contributing factors for discordant interobserver interpretations. BRAFV600E immunohistochemistry showed diffuse staining in BRAF -mutated tumors, including those with few ECs. In conclusion, the finding of extensive ECs in SBT is highly specific for BRAFV600E mutation. However, in some BRAF -mutated SBTs, ECs may be focal and/or difficult to distinguish from other tumor cells with overlapping cytologic features. The morphologic finding of definitive ECs, even when scarce, should therefore prompt consideration for BRAFV 600E mutation testing.