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Borderline epithelial ovarian tumors: what the radiologist should know

  • Special Section: Ovarian Cancer
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Abstract

Ovarian borderline tumors are neoplasms of epithelial origin that are typically present in young patients and tend to have a less aggressive clinical course than malignant tumors. Accurate diagnosis and staging of borderline tumors has important prognostic and management implications (like fertility-sparing procedures) for women of child-bearing age. This article will review the sonographic, CT, and MRI features of borderline epithelial ovarian tumors with histopathologic correlation. Borderline tumors have less soft tissue and thinner walls/septations than malignant tumors. Serous borderline tumors more commonly have papillary projections, which can simulate the appearance of a sea anemone. Mucinous borderline tumors often are larger, multi-cystic, and more commonly unilateral. The borderline mucinous tumors may also present with pseudomyxoma peritonei, which can make it difficult to distinguish from malignant mucinous carcinoma. Ultrasound is usually the first-line modality for imaging these tumors with MRI reserved for further characterizing indeterminate cases. CT is best used to stage tumors for both locoregional and distant metastatic disease. Overall, however, the imaging features overlap with both benign and malignant ovarian tumors. Despite this, it is important for the radiologist to be familiar with the imaging appearances of borderline tumors because they can present in younger patients and may benefit from different clinical/surgical management.

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References

  1. Centers for Disease Control and Prevention. Ovarian Cancer Statistics. Cdc.gov//cancer/ovarian/statistics/index.

  2. Torre et al. Ovarian Cancer Statistics 2018. CA Cancer J Clin. 2018 Jul; 68(4): 284–296.

  3. Fischcerova et al. Diagnosis, Treatment, and Follow-Up of Borderline Ovarian Tumors. The Oncologist December 2012vol. 17 no. 12 1515-1533.

  4. Bjorge et al. Trends in the incidence of ovarian cancer and borderline tumours in Norway, 1954-1993. Int J Cancer 71: 780-786, 1997.

  5. Vasconcelos et al. Serous and mucinous borderline ovarian tumours: differences in clinical presentation, high-risk histopathologic features and lethal recurrence rates. BJOG: An International Journal of Obstetrics and Gynecology 2015; 123 (4).

  6. Fang et al. The impact of clinicopathologic and surgical factors on relapse and pregnancy in young patients (<40 years old) with borderline ovarian tumors. BMC Cancer Nov 2018.

  7. Skirinisdotti I. Borderline Ovarian tumors in Sweden 1960-2005: trends in incidence and age at diagnosis compared to ovarian cancer. Int J Cancer 2008; 123(8): 1897.

  8. Mayr D et al. KRAS and BRAF mutations in ovarian tumors: A comprehensive study of invasive carcinomas, borderline tumors and extraovarian implants. Gynecology Oncology Dec 2006; 103(3): 883-887.

  9. Green AE et al. Borderline Ovarian Cancer. Updated 3/18/2019https://emedicine.medscape.com/article/1950573-overview#showall.Hauptmann S et al. Ovarian Borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria. Virchows Arch. 2017; 470(2): 125-142.

  10. Lalwani et al. Current Update on Borderline Ovarian Neoplasms. AJR Feb 2010;194(2): 330-336.

  11. Kawamoto S. et al. CT of Epithelial Ovarian Tumors. RadioGraphics 1999 19:suppl_1, S85-S102

  12. Valentin L et al. Ultrasound Characteristics of Different types of Adnexal Malignancies. Gynecologic Oncology 102 (2006) 41–48

  13. Gotlieb et al. CA 125 measurement and ultrasonography in borderline tumors of the ovary. American Journal of Obstetrics and Gynecology. Vol 183, Issue 3, Sept 2000, Page 541-546.

  14. Otify M et al. A systematic review and meta-analysis of the use of ultrasound to diagnose borderline ovarian tumours. European Journal of Obstetrics and gynecology and Reproductive Biology Jan 2020; 244: 120-127.

  15. American College of Radiology Online. Ovarian-Adnexal Reporting and Data System (O-RADS). https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/O-Rads

  16. Suh-Burgmann E et al. Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study. Gynecolo Oncol. 2006 12;103(3): 841-7.

  17. Grabowska-Derlatka et al. 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: 1597-1602.

  18. Bent CL et al. MRI appearances of borderline ovarian tumors. Clinical Radiology 2009; 64(4): 430-438.

  19. Li H et al. Quantitative dynamic contrast-enhanced MR imaging for differentiating benign, borderline, and malignant ovarian tumors. Abdom Radiol (2018) 43:3132–3141.

  20. Park SY et al. Differentiation between borderline and benign ovarian tumors: combined analysis of MRI with tumor markers for large cystic masses (5 cm). Acta Radiologica 2016, Vol. 57(5) 633–639

  21. Bent CL et al. MRI appearance of borderline ovarian tumours. Clinical Radiology 2009; 64(4):-430-438.

  22. Kim SH et al. Borderline serous surface papillary tumor of the ovary: MRI characteristics. AJR 2005; 184(6):1898-1900.

  23. Tanaka et al. Ovarian serous surface papillary borderline tumors form sea anemone-like masses. AMRI 2011; 33(3): 633-640

  24. deSouza et al. Borderline Tumors of the Ovary: CT and MRI Features and Tumor Markers in Differentiation from Stage 1 Disease. AJR 2005; 184(3): 999-1003.

  25. Mansour et al. Semi-quantitative contrast-enhanced MR analysis of indeterminate ovarian tumour: when to say malignancy? Br J Radiol. 2015; 88(1053): 20150099.

  26. Thomassin-Naggara et al. Dynamic contrast enhanced magnetic resonance imaging: A useful tool for characterizing ovarian epithelial tumors. JMRI 2008; 28(1): 111-120.

  27. Li et al. MRI features and score for differentiating borderline from malignant epithelial ovarian tumors. European Journal of Radiology 98 (2018): 136-142.

  28. Fan et al. Role of diffusion-weighted magnetic resonance imaging in differentiating malignancies from benign ovarian tumors. Int J Clin Exp Med 2015 8(11): 19928-19937.

  29. Nakasone et al. Differentiation between stage 1 ovarian cancer and borderline epithelial ovarian tumor by apparent diffusion coefficient value. Radiology and Medical Diagnostic Imaging 1(2):2-5.

  30. Denewar FA et al. Multiparametric MRI for differentiation of borderline ovarian tumors from stage I malignant epithelial ovarian tumors using multi-variate logistic regression analysis.

  31. Zhao et la. Diffusion-weighted MR imaging for differentiating borderline from malignant epithelia tumours of the ovary: pathological correlation.

  32. Prentice L et al. What is endosal**iosis? Fertility and Sterility Journal 2012; 98(4): 942-947.

  33. Esselen KM et al. Endosal**iosis: More than just an incidental findings at the time of gynecologic surgery? Gynecologic Oncology 2016; 142:255-260.

  34. Esselen et al. Endosal**iosis. Uptodate. Last update 12/7/2018.

  35. Bazot et al. Imaging of endosal**iosis. Clin Radiol. 1999 Jul;54(7):482-5.

  36. Lesieur B et al. Prognostic value of lymph node involvement in ovarian serous borderline tumors. Am J Obstet Gynecol. 20011 May;204(5): 438.

  37. Alvarez et al. Fertility sparing treatment in borderline ovarian tumors. Ecancermedicinescience 2015; 9:507.

  38. Feigenburg et al. Is routine appendectomy at the time of primary surgery for mucinous ovarian neoplasms beneficial? Int J Gynecol Cancer 2013; 23:1205-1209.

  39. Patel et al. Should the appendix always be removed during surgery for mucinous ovarian tumor? IJRCOG 2018; 7(2): 667-684.Lenhard et al. Long term follow up after ovarian borderline tumor: relapse and survival in a large patient cohort. Eur J Obstet Gynecol Reprod Biol. 2009 Aug; 145(2): 189-94

  40. Morice P et al. Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril. 2001 Jan;75(1): 92-6.

  41. Ovarian Low Malignant Potential Tumors Treatment. National Cancer Institute Online. https://www.cancer.gov/types/ovarian/hp/ovarian-low-malignant-treatment-pdq.

  42. Patrono MG, Minig L, Diaz-Padilla I, Romero N, Rodriguez Moreno JF, Garcia-Donas J. Borderline tumours of the ovary, current controversies regarding their diagnosis and treatment. ecancermedicalscience. 2013;7:379. https://doi.org/10.3332/ecancer.2013.379.

  43. Barakat et al. Platinum based chemotherapy for advanced stage serous ovarian tumors of low malignant potential. Gynecol Oncol 1995 Dec; 59(3): 390-3.

  44. Salani et al. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendation. Gynecologic Oncology 2017; 146: 3-10.

  45. NCCN Guidelines Version 3.2019 Ovarian Borderline Epithleial Tumors Monitoring and Follow up. https://www.nccn.org/patients/guidelines/content/PDF/ovarian-patient.pdf

  46. Cadron I et al. Management of Borderline Ovarian Tumors. Journal of Clinical Oncology 2007 25(20):2925-2937.

  47. Oh et al. Usefulness of FDG PET in the differential diagnosis of borderline ovarian tumors from early stage malignant ovarian tumors. J Nucl Med May 2011 vol. 52 no. supplement 1 147.

  48. Jung DC et al. Discordant MRI/FDG-PET Imaging for the diagnosis of Borderline Ovarian Tumors. Int J Gyncologic Cancer. July-Aug 2008;18(4)’ 637-41.

  49. Mokry T, Mlynarska-Bujny A et al. Ultra-High-b-Value Kurtosis Imaging for Noninvasive Tissue Characterization of Ovarian lesions. Radiology. Published online 6/16/2020

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Authors and Affiliations

  1. Department of Radiology Rochester, Mayo Clinic Rochester, Rochester, MN, USA

    K. T. Flicek, W. VanBuren & K. Dudiak

  2. Department of Radiology Phoenix, Mayo Clinic Arizona, Phoenix, AZ, USA

    C. O. Menias

  3. Department of Radiology, Memorial Sloan Kettering, New York, NY, USA

    Y. Lahkman

  4. Department of Pathology Phoenix, Mayo Clinic Arizona, Phoenix, AZ, USA

    L. W. Chen

  5. Department of Obstetrics and Gynecology Phoenix, Mayo Clinic Arizona, Phoenix, AZ, USA

    K. Butler

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  1. K. T. Flicek
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  2. W. VanBuren
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Correspondence to K. T. Flicek.

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Flicek, K.T., VanBuren, W., Dudiak, K. et al. Borderline epithelial ovarian tumors: what the radiologist should know. Abdom Radiol 46, 2350–2366 (2021). https://doi.org/10.1007/s00261-020-02688-z

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