IF: 0.644
REUTERS THOMSON

The Clinical and Pathological Analysis of Ovarian Borderline Serous Papillary Epithelioma: A Report of Six Cases

AUTHORS

Manzhen Zuo 1 , * , Hongying Du 2 , Aihua Chen 1 , Yan Wang 1 , Dandan Quan 1 , Yaling Tao 1 , Huamei Song 1

AUTHORS INFORMATION

1 Department of Gynecology and Obstetrics, People’s Hospital of Three Gorges University / The First People’s Hospital of Yichang, Yichang, Hubei, China

2 Department of Gynecology and Obstetrics, People’s Hospital of Dangyang, Dangyang, Hubei, China

How to Cite: Zuo M, Du H, Chen A, Wang Y, Quan D, et al. The Clinical and Pathological Analysis of Ovarian Borderline Serous Papillary Epithelioma: A Report of Six Cases, Iran Red Crescent Med J. 2017 ; 19(5):e40180. doi: 10.5812/ircmj.40180.

ARTICLE INFORMATION

Iranian Red Crescent Medical Journal: 19 (5); e40180
Published Online: October 19, 2016
Article Type: Case Report
Received: June 19, 2016
Revised: August 20, 2016
Accepted: September 9, 2016
Crossmark

Crossmark

CHEKING

READ FULL TEXT
Abstract

Introduction: Ovarian borderline serous papillary epithelioma is a rare epithelial ovarian tumor between adenoma and carcinoma. This study was carried out to compare six cases of ovarian borderline serous papillary epithelioma.

Case Presentation: This retrospective study was conducted on 6 patients with ovarian borderline serous papillary epithelioma regarding clinical symptoms, auxiliary examination, treatment process, and prognosis. These six patients were diagnosed with the disease from January 2010 to June 2013 in the People’s hospital of three Gorges university, Yichang, Hubei, China. Two patients were diagnosed with ovarian surface serous papillary epithelioma. One patient was diagnosed with ovarian surface serous papillary epithelioma transferred to bilateral fallopian tubes. One patient was diagnosed with ovarian borderline serous papillary epithelioma while parts of tissues had become cancerous. One patient was diagnosed with ovarian borderline serous papillary epithelioma with pelvic lymph node metastasis, which had transferred to bilateral fallopian tubes, omentum majus, and epityphlon. One patient was diagnosed with ovarian surface serous papillary epithelioma with epithelial hyperplasia. All the six patients received surgical resection.

Conclusions: We recommend ovarian borderline serous papillary epithelioma evaluation for patients as preoperative observations, intraoperative careful exploration, and pathological diagnosis in order to find and timely treat ovarian borderline serous papillary epithelioma patients.

Keywords

Borderline Ovarian Tumor Serous Pathologic Processes Surgery Prognosis

Copyright © 2016, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Introduction

Ovarian serous borderline tumor is a kind of low-grade serous tumor that is very difficult to find (1). In terms of morphology, this tumor places between benign and malignant (2, 3). Early diagnosis can block its further development. It is asymptomatic in clinic and occasionally detected with abdominal enlargement, or with abdominal pain due to cystic tumor rupture or reversion (4). The young patients present infertility (5). The lack of destructive interstitial infiltrates is the major difference between ovarian serous borderline tumor and ovarian serous adenocarcinoma (6, 7). Ovarian serous borderline tumor is a rare tumor and hence, it is necessary to report cases of ovarian borderline serous papillary epithelioma to be able to evaluate better and treat patients well soon. Currently, ovarian serous borderline tumor is mainly a conservative surgery suitable for young patients with fertility requirements. The aim of this study is to discuss the clinical characterization of ovarian borderline serous papillary epithelioma and its treatment process.

2. Case Presentation

2.1. Patients Information

Six ovarian borderline serous tumor patients were diagnosed from January 2010 to June 2013 in the People’s hospital of three Gorges university, Yichang, Hubei, China. The patients’ age varied from 24 to 34 years, the mean age of the patients was 34 years. The patients were married and never gave birth to a child. The age of menarche varied from 12 to 16 years, with the average age of 14 years.

2.2. Preoperative Observations

Three patients (labeled with 2#, 3#, 5#) were hospitalized due to the non-specific gastrointestinal symptoms, three patients (labeled with 1#, 4#, 6#)were hospitalized due to an abnormal pelvic masses that were found during gynecologic examination. All the patients were identified with pelvic masses using B ultrasound and magnetic resonance (MR). The pelvic masses located around the uterine adnexa and uterus, and rich blood supply signals were detected inside the pelvic masses. A large amount of ascites were found in 2 cases of patients (2# and 3#) with preoperative imaging. The preoperative CA125 level measured by ELISA increased in 4 cases of patients (3#, 4#, 5#, 6#), varied from 115.9 to 498.6 U/ml (> 35.0 U/mL). Finally, none of patients were diagnosed with abnormal vaginal bleeding and lymph node metastasis.

2.3. Intraoperative Findings

The representative intraoperative findings are shown in Figure 1. During the operation, in patient #1, the abdominal cavity fully filled with massive ascites, uterus front wall adhered to the bladder, the end of the uterine adnexa formed a mass (5 × 4 × 3 cm) by ultrasound diagnosis , and the dow cavity of uterus back wall had a 4 × 3 × 3 cm nodule.

Figure 1. The Representative Intraoperative Pictures of Six Patients
The Representative Intraoperative Pictures of Six Patients

During the operation, we could see the particular information in enterocoelia by laparoscope

In patient #2, a severe pelvic adhesion was seen by laparoscope. There was no normal morphology of fallopian tube and ovary in bilateral adnexa area, and 5 × 4 × 5 cm masses were presented in each adnexa. The rectum adhered to uterus in large areas, when separated the adhesion area, a lot of yellow sticky pus released from the left ovary, and two cauliflower-like masses 1 cm in diameter were emerged on the surface of the right ovary.

In patient #3, a mass of yellow ascites was found in enterocelia, omentum majus adhered to the anterior abdominal wall and bladder, and adnexa adhered to uterus. We were unable to discern the shape of adnexa and uterus. After separating the adnexa and uterus, grape-like masses were seen in adnexa.

In patient #4, the whole pelvic cavity was enclosed, the pelvic wall strongly adhered to omentum majus and urinary bladder, and it was not possible to discern the uterine and bilateral adnexa. After separating pelvic from omentum majus, we found that the position of uterus moved forward, and bilateral adnexa severely adhered to pelvic wall, uterus back wall, and rectum. By further separation of adhesion, we found that the right ovary enlarged about 6 × 7 cm, and papillary neoplasm was seen on the surface of right ovary.

In patient #5, a mass of yellow ascites was found in enterocelia. The left ovary enlarged about 11 × 8 × 8 cm. The size of right ovary was normal, but 2 × 2 cm cauliflower-like mass was seen on the surface. The morphology of bilateral fallopian tube was normal; uterus adhered to a part of intestinal tube and the left side of the adnexa.

In patient #6, omentum majus seriously adhered to intestinal tube and uterus. The uterus enlarged just like a 50-day pregnancy. 2 × 2 cm myoma was seen on anterior uterine wall. Bilateral adnexa severely adhered to intestinal tube and uterus. The size of the right ovary was normal, however, a 6 × 2 cm cauliflower-like mass was seen on the surface. Also, a fist-sized mass was found in the left fallopian.

2.4. Histopathological Analysis

As shown in Figure 2, patient #1 was identified as low-grade malignant ovarian serous adenocarcinoma (Right ovarian) and ovarian surface borderline serous papillary epithelioma (Left ovarian). Patient #2 was identified as right ovarian surface papillary epithelioma in combination with local borderline lesion, which had transferred to the bilateral fallopian tube size film. Patient #3 was identified as bilateral ovarian surface borderline serous papillary epithelioma. Patient #4 was identified as bilateral ovarian serous papillary epithelioma in combination with epithelial hyperplasia. Patient #5 was identified as bilateral ovarian surface borderline serous papillary epithelioma, which had transferred to bilateral fallopian tube, omentum majus, epityphlon, and pelvic lymph node. Patient #6 was identified as right ovarian surface borderline serous papillary epithelioma and leiomyoma of uterus.

Figure 2. The Representative Histopathological Analysis Results of Six Patients Respectively
The Representative Histopathological Analysis Results of Six Patients Respectively

From the results of each patient, we could identify the type of ovarian cancer in each patient.

Table 1. Some Characteristics and Symptoms of the Patients; Such as Age, CA125, Ascites, and Pathology
VariableCase 1Case 2Case 3Case 4Case 5Case 6
Age, y243433383431
CA125< 35< 35≥ 35≥ 35≥ 35≥ 35
AscitesNoneYesYesNoneNoneNone
PathologyMalignantBorderlineBorderlinBenignBorderlinBorderlin

3. Discussion

Ovarian serous tumor is a common tumor in ovary. It can be divided into serous cystic tumors, surface serous papillary epithelioma, and serous cystic adenoma, which correspond to the cyst formation of epithelial tumor, epidermis hyperplasia, and interstitial hyperplasia, respectively (8, 9). The subtypes of ovarian borderline serous tumor include surface borderline serous tumor, borderline serous adenofibroma, and capsule gland fibroma (10).

Ovarian borderline serous papillary epithelioma is rare in clinic, it is hard to find because there is no clinical symptoms in the early stage (11). It is discovered by chance in gynecological examination or pathologic examination (12, 13). The nipples in middle or advanced-stage ovarian patients are without a tumor capsule, so it is easy to drop into pelvic and abdominal cavity, and transfer to peritoneum, omentum or organs of abdominopelvic cavity, resulting in pelvic and abdominal conglutination and massive ascites (14). Patients with abdominal distension, abdominal pain, abdominal mass, or other nonspecific gastrointestinal symptoms as starting symptoms visit a physician, even though these symptoms exist with intra-abdominal metastases or lymph node metastases, the prognosis of ovarian serous papillary adenoma is excellent, and this is one of the most important clinical characteristics (15-17).

The six cases studied in this report were of particular importance since there are a few reported cases of ovarian borderline serous papillary epithelioma with patients detailed information, preoperative observations, intraoperative findings, and histopathological analysis of tissues. There were no cysts and nipples formation inside of the ovary of patients with ovarian borderline serous papillary epithelioma, while lots of nipples covered the surface of ovarian (16, 18). Some studies reported that this kind of tumor always develops in postmenopausal women’s bilateral ovaries (17, 19). However in our study, we found that ovarian borderline serous papillary epithelioma was found in young women.

Limitations of our study are as follows: since recurrence of disease is possible after many years, the patient’s long-term follow-up is necessary that was ignored in this study (20). Because of the risk of treatment, we did not use another treatment method for patients. The clinical and pathological analysis of ovarian borderline serous papillary epithelioma may help identify disease, and thus improve the determination of treatment.

In conclusion, the diagnosis of ovarian borderline serous papillary epithelioma is very difficult, and it mainly depends on the intraoperative careful exploration and pathological diagnosis. The results of this study will provide visual evidence for the disease diagnosis. It will be convenient for doctors to find and diagnose the disease in the early stage to prevent further deterioration of the ovarian borderline serous papillary epithelioma . Surgical removal is the main treatment, and has a good prognosis.

Acknowledgements

Footnotes

References

  • 1. Auer K, Bachmayr-Heyda A, Aust S, Sukhbaatar N, Reiner AT, Grimm C, et al. Peritoneal tumor spread in serous ovarian cancer-epithelial mesenchymal status and outcome. Oncotarget. 2015; 6(19) : 17261 -75 [DOI][PubMed]
  • 2. Ghaemi N, Bagheri S, Elmi S, Mohammadzade Rezaee S, Elmi S, Erfani Sayyar R. Delayed Diagnosis of Hypothyroidism in Children: Report of 3 Cases. Iran Red Crescent Med J. 2015; 17(11) : 20306 [DOI][PubMed]
  • 3. Imamura H, Ohishi Y, Aman M, Shida K, Shinozaki T, Yasutake N, et al. Ovarian high-grade serous carcinoma with a noninvasive growth pattern simulating a serous borderline tumor. Hum Pathol. 2015; 46(10) : 1455 -63 [DOI][PubMed]
  • 4. Boyd C, McCluggage WG. Low-grade ovarian serous neoplasms (low-grade serous carcinoma and serous borderline tumor) associated with high-grade serous carcinoma or undifferentiated carcinoma: report of a series of cases of an unusual phenomenon. Am J Surg Pathol. 2012; 36(3) : 368 -75 [DOI][PubMed]
  • 5. Hale D, Senem DA, Ovgu A, Hakan E, Sennur I, Zerrin C, et al. Serous Ovarian Carcinoma Recurring as Malignant Mixed Mullerian Tumor. Case Rep Obstet Gynecol. 2015; 2015 : 612824 [DOI][PubMed]
  • 6. Cheng JC, Auersperg N, Leung PC. TGF-beta induces serous borderline ovarian tumor cell invasion by activating EMT but triggers apoptosis in low-grade serous ovarian carcinoma cells. PLoS One. 2012; 7(8) : 42436 [DOI][PubMed]
  • 7. Shih Ie M. Ovarian serous low malignant potential (borderline) tumor--does "micropapillary" matter? Gynecol Oncol. 2010; 117(1) : 1 -3 [DOI][PubMed]
  • 8. Homaei Shandiz F, Kadkhodayan S, Hsanzade Mofrad M, Yousefi Roodsari Z, Sharifi Sistani N, Nabizadeh Marvast M, et al. Prolonged survival of a patient with pelvic recurrence of ovarian malignant mixed mullerian tumor after chemoradiotherapy. Iran Red Crescent Med J. 2014; 16(9) : 14919 [DOI][PubMed]
  • 9. Ludovisi M, Foo X, Mainenti S, Testa AC, Arora R, Jurkovic D. Ultrasound diagnosis of serous surface papillary borderline ovarian tumor: A case series with a review of the literature. J Clin Ultrasound. 2015; 43(9) : 573 -7 [DOI][PubMed]
  • 10. Njim L, Moussa A, Saidani Z, Touil N, Mlik L, Belghith M, et al. Bilateral ovarian serous borderline tumor with a giant non-invasive peritoneal implant in a four-year-old girl. J Pediatr Adolesc Gynecol. 2010; 23(1) : 1 -4 [DOI][PubMed]
  • 11. Tepeoglu M, Ozen O, Ayhan A. Ovarian serous borderline tumor detected by conventional papanicolaou smear: a case report. Acta Cytol. 2013; 57(1) : 96 -9 [DOI][PubMed]
  • 12. Pourganji M, Hosseini M, Soukhtanloo M, Zabihi H, Hadjzadeh MA. Protective role of endogenous ovarian hormones against learning and memory impairments and brain tissues oxidative damage induced by lipopolysaccharide. Iran Red Crescent Med J. 2014; 16(3) : 13954 [DOI][PubMed]
  • 13. Ohman AW, Hasan N, Dinulescu DM. Advances in tumor screening, imaging, and avatar technologies for high-grade serous ovarian cancer. Front Oncol. 2014; 4 : 322 [DOI][PubMed]
  • 14. Rekhi B, Vinarkar S, Shylasree ST. Bilateral ovarian serous cystadenofibromas coexisting with an incidental unilateral Brenner tumor and Walthard cell rests in bilateral Fallopian tubes: an unusual case with diagnostic implications and histogenesis. Indian J Pathol Microbiol. 2014; 57(2) : 347 -8 [DOI][PubMed]
  • 15. Shimamoto A, Isomoto I, Segawa K, Matsumoto A, Abe K, Uetani M. The MRI findings in a case of ovarian mucinous borderline tumor mimicking a serous surface borderline tumor. Jpn J Radiol. 2014; 32(9) : 552 -5 [DOI][PubMed]
  • 16. Zhang C, Wang YE, Zhang P, Liu F, Sung CJ, Steinhoff MM, et al. Progressive loss of selenium-binding protein 1 expression correlates with increasing epithelial proliferation and papillary complexity in ovarian serous borderline tumor and low-grade serous carcinoma. Hum Pathol. 2010; 41(2) : 255 -61 [DOI][PubMed]
  • 17. Ureyen I, Karalok A, Tasci T, Turkmen O, Boran N, Tulunay G, et al. The Factors Predicting Recurrence in Patients With Serous Borderline Ovarian Tumor. Int J Gynecol Cancer. 2016; 26(1) : 66 -72 [DOI][PubMed]
  • 18. Akman L, Akdemir A, Terek MC, Zekioglu O. Ovarian malignant Brenner tumor in patients over 65 years of age. Kaohsiung J Med Sci. 2014; 30(3) : 159 -60 [DOI][PubMed]
  • 19. Cho HJ, Suh DS, Moon SH, Song YJ, Yoon MS, Park DY, et al. Silibinin inhibits tumor growth through downregulation of extracellular signal-regulated kinase and Akt in vitro and in vivo in human ovarian cancer cells. J Agric Food Chem. 2013; 61(17) : 4089 -96 [DOI][PubMed]
  • 20. Grabowska-Derlatka L, Derlatka P, Palczewski P, Danska-Bidzinska A, Pacho R. Differentiation of ovarian cancers from borderline ovarian tumors on the basis of evaluation of tumor vascularity in multi-row detector computed tomography--comparison with histopathology. Int J Gynecol Cancer. 2013; 23(9) : 1597 -602 [DOI][PubMed]
  • COMMENTS

    LEAVE A COMMENT HERE: