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PubMed2005

Borderline endometrioid tumor arising in a paratubal cyst: a case report.

BACKGROUND: Paratubal cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. The following represents the first reported case of an endometrioid tumor of low malignant potential arising in a paratubal cyst. CASE REPORT: A 45-year-old nulliparous female was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic bilateral ovarian cystectomy and partial right salpingectomy (for a 3-cm torsed paratubal cyst). All frozen-section diagnoses were benign; however, final pathology revealed a borderline tumor of low malignant potential of endometrioid type in the right paratubal cyst. The patient underwent extensive counseling regarding management options and decided to have a laparoscopic right salpingo-oophorectomy. Final pathologic analysis revealed no evidence of persistent borderline tumor. CONCLUSION: Paratubal cysts are very difficult to diagnose with sonography; therefore, their management should be approached as any other adnexal mass. Laparoscopic surgery is an option in the management of adnexal masses; however, rupture or puncture of masses should be avoided when possible to prevent potential tumor dissemination in the event of a malignancy.

Broad Ligament↗
PubMed2005

Management of borderline ovarian tumors: results of an Italian multicenter study.

OBJECTIVE: A rising number of patients affected by ovarian masses suspected of borderline ovarian tumor are operated on primary laparoscopic procedure. METHODS: From January 1992 to June 2004, 113 patients affected by low malignant ovarian tumor were followed at the Gynecologic Departments of five Italian Institutions. Fifty-two (46.0%) patients were operated on laparoscopic surgery, whereas traditional laparotomic approach was preferred in 61 cases (54%). In 53 patients (46.9%), a fertility-sparing surgical treatment was chosen. RESULTS: The diameter of the ovarian cysts ranged between 20 and 300 mm; in 20 out 113 patients (17.7%), the borderline tumor was bilateral. In 22/113 (19.5%) cases, we observed tumor rupture or spilling during surgery, and this incidence was greater in the group of patients treated by laparoscopy compared to laparotomy, and this difference is statistically significative. In 13/113 (11.5%) patients, we observed a relapse; the incidence of relapse, however, is not dependent on the type of surgical approach. The progression-free survival is higher for stages IA-IC if compared to stages more than Ist and the difference is statistically significant. Type of surgical approach, laparoscopic versus laparotomic, does not seem to influence the PFS; when cystectomy is performed, the PFS is significantly lower if compared with demolitive surgery or monolateral annessectomy. Eight pregnancies were obtained: in one case, miscarriage was observed, whereas 7 healthy babies were born all but two by vaginal delivery. CONCLUSIONS: Conservative laparoscopic surgery may be the treatment of choice; an attractive option is that this surgery should be performed by an oncologist surgeon to obtain correct surgical staging and better results in terms of both relapse-free survival and pregnancies.

Adult↗
PubMed1997

The role of computed tomography in the management of ovarian tumours of borderline malignancy.

Ovarian tumours of borderline malignancy are a distinct histological and clinical entity diagnosed in up to 15% of patients presenting with an ovarian neoplasm. Compared with frankly malignant tumours, they have a much better prognosis, present at an earlier age, and the majority are stage 1 at diagnosis. This study reviewed 35 patients with ovarian tumours of borderline malignancy referred to the CRC Medical Oncology Unit at The Christie Hospital over a 9-year period and evaluated the role of diagnostic imaging, in particular, the value of postoperative computed tomography (CT). We conclude that in cases of FIGO stage 1 disease where there is complete macroscopic removal of tumour, there is no need for further routine imaging. If chemotherapy is to be given for patients with more advanced disease, a baseline postoperative abdomino-pelvic CT scan and a post-treatment scan are appropriate investigations.

Adult↗
PubMed2003

Safety of conservative management and fertility outcome in women with borderline tumors of the ovary.

OBJECTIVE: To assess the safety of fertility-sparing treatment and the remaining chance of childbearing after surgery. DESIGN: Retrospective clinical study. DESIGN: Gynecology department of a university teaching hospital. PATIENT(S): Seventy-five women underwent surgical management in our institution between 1986 and 2001 for borderline tumors of the ovary. INTERVENTION(S): Fifty-nine patients were treated by radical, fertility-compromising surgery. The remaining 16 patients underwent conservative surgery, preserving the uterus and at least some functional ovarian tissue. Seven unilateral adnexectomies, one simple cystectomy, and two adnexectomies associated with contralateral cystectomy were performed. MAIN OUTCOME MEASURE(S): Recurrence, survival, and pregnancy rates. RESULT(S): The observed recurrence rates after radical and conservative surgery were 0.0% and 18.7%, respectively. No disease-related deaths occurred in any group; there is no significant difference in survival rates. We can report 12 pregnancies in 7 of 11 women who underwent fertility-sparing management and who wished to become pregnant. CONCLUSION(S): In certain circumstances, conservative management offers a safe solution for borderline tumors of the ovary. Recurrence is noted significantly more often after this type of treatment, but all cases of recurrent disease can be detected with close follow-up and can be treated accordingly. No significant change in survival rates was found. Moreover, the pregnancy rate in women desiring pregnancy, those treated conservatively, was as high as 63.6%.

Adult↗
PubMed1984

Endoscopic Nd: YAG laser therapy for gastric borderline lesions.

Endoscopic Nd:YAG laser treatment was used to eradicate 14 broad-based protruded borderline lesions of the stomach in which snare excision might be difficult and hazardous. Multiple pulse irradiations of Nd:YAG laser with a power of 40 to 50 W ablated all the lesions. During and after laser treatments, no complications were recognized. The laser-induced ulcers healed within 4 to 7 weeks after the last procedure, and the biopsy material taken from the sites of the scars showed regenerative epithelium without evidence of atypical cells. These encouraging results suggest that endoscopic laser treatment is the method of choice for therapy of the gastric borderline lesions where snare excision is not feasible.

Adult↗
PubMed2001

Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing.

Unreamed nailing favors biology at the expense of the achievable mechanical stability. It is therefore of interest to define the limits of the clinical indications for this method. The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, to identify the mechanical reasons for the unfavorable clinical results, and to identify borderline indications due to biomechanical factors. In a three-dimensional finite element model of a human tibia, horizontal defects were stabilized by means of unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The loading of the bone, the loading of the implant and the inter-fragmentary strains were computed. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. The results suggest that mechanical conditions are advantageous to unreamed nailing of proximal and mid-diaphyseal defects. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures by means of unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

Biomechanical Phenomena↗
PubMed2003

Alcohol consumption and the risk of borderline and invasive ovarian cancer.

OBJECTIVE: To examine the hypothesis that alcohol consumption is associated with the risk of ovarian cancer by conducting a population-based, case-control study in Hawaii and Los Angeles, California. METHODS: In-person interviews were obtained from 558 women with ovarian cancer and 607 population controls regarding lifetime alcohol consumption and other factors that may be related to the development of ovarian cancer. RESULTS: We found no overall association of alcohol drinking with the odds ratios (OR) for ovarian cancer. However, current alcohol drinkers, but not former drinkers, had a significantly lower OR for ovarian cancer compared with never drinkers (OR 0.69, 95% confidence interval [CI] 0.50, 0.96). Odds ratios for ovarian cancer associated with the current consumption of beer, wine, and spirits were also reduced, but were only significant for wine drinkers. Among current wine drinkers, women who drank red wine had a significantly reduced OR for ovarian cancer compared with never drinkers (OR 0.61, 95% CI 0.39, 0.94). The inverse association of current alcohol drinking with the OR for ovarian cancer was restricted to invasive tumors, especially the endometrioid cell type. The number of glasses of alcohol consumed on a weekly basis was inversely related to the OR for invasive ovarian cancer (P =.009): Current drinkers consuming 14 or more drinks per week had an OR of 0.36 (95% CI 0.19, 0.70) compared with never drinkers. A significantly increased risk of borderline serous tumors was associated with the use of spirits (OR 2.66, 95% CI 1.46, 4.85). The risk for borderline mucinous tumors was also significantly elevated for former wine drinkers. CONCLUSIONS: These findings suggest that the association of alcohol consumption with the OR for ovarian cancer may vary by alcohol type, tumor invasiveness, and histology.

Aged↗
PubMed1997

Early environmental influences can attenuate the blood pressure response to acute stress in borderline hypertensive rats.

The objective of this experiment was to test the hypothesis that early environmental influences could affect cardiovascular reactivity to acute stress in borderline hypertensive rats. This study utilized a cross-fostering paradigm in which borderline hypertensive rat (BHR) pups were reared by their natural spontaneously hypertensive rat (SHR) mothers, by an adoptive SHR dam, or by an adoptive Wistar-Kyoto female. Several maternal behavior measures were taken throughout weaning. Cardiovascular responses to acute stress were measured in adult BHR offspring. SHR dams spent significantly more time engaged in arched, as contrasted with passive, nursing behaviors throughout the preweaning period. Although strain of dam had no effect on resting blood pressure or heart rate, BHR reared by WKY dams had a greatly reduced blood pressure response to acute stress compared with BHR raised by either natural or adoptive SHR dams. These results suggest that the expression of cardiovascular characteristics in the BHR can be modified by early environmental influences and support the hypothesis that the expression of the hypertensive phenotype in the BHR is dependent upon information that is conveyed both genetically and environmentally.

Animals↗
PubMed1977

Ovarian epithelial tumors of borderline malignancy (carcinomas of low malignant potential).

Ovarian epithelial neoplasms that have morphologic features intermediate between those of clearly benign and unquestionably malignant lesions are currently classified as tumors of borderline malignancy (carcinomas of low malignant potential). Patients with stage I lesions of this type have an excellent prognosis following conservative surgery. Survival rates are remarkably good even when extraovarian spread has developed. The clinicopathologic features and histologic criteria for the diagnosis of borderline tumors of serous and mucinous cell types are detailed in this presentation.

Cystadenoma↗
PubMed1988

Observer variation in histologic classification of malignant and borderline ovarian tumors.

Eight hundred sixty-nine primary malignant or borderline ovarian tumors reported to the Norwegian Cancer Registry were reviewed. The histologic slides were randomly distributed to six observers and classified according to the World Health Organization classification of ovarian tumors. By rotation of slides, each tumor was successively reviewed by three observers. Each observer was given approximately 40 duplicates of slides he or she had typed before, mixed in with the slides for the third review. A contracted version of the classification with 27 entries was used in the analysis. Mean intraobserver reproducibility was 62% (kappa, 0.53), varying from 50% to 75% (kappa, 0.34 to 0.70) for the individual observers. The mean rate of agreement between two observers was 56% (kappa, 0.46), varying from 46% to 65% for the individual pairs of observers. The rate of full agreement among three observers was 41%. The most common disagreements were between different specific types of carcinoma, between undifferentiated and differentiated carcinoma, between borderline and malignant tumors, between unclassified and classified carcinoma, and between mixed and pure types of carcinoma. Very low reproducibility was obtained for mixed and unclassified carcinoma.

Carcinoma↗
PubMed1988

The prognostic significance of grading in borderline mucinous tumors of the ovary.

Fifty-three stage I borderline mucinous tumors of the ovary were placed into four histologic grades according to a simple system of grading based on degree of cell layering, nuclear characteristics, and mitotic count. Three patients died of recurrence and spread of their tumors. All three patients had grade 4 tumors, suggesting that there may be some prognostic value in grading borderline mucinous ovarian tumors.

Adenocarcinoma, Mucinous↗
PubMed1999

Dimensionalities: borderline and intermediate melanocytic neoplasia.

The concept of minimal deviation melanoma is presented in diagrammatic form. In this approach, the precursors of melanoma are presented as having two dimensions and melanomas as having three dimensions. In turn, the relativity between dimensionalities and recommendations for treatment (as indirect correlates of prognostications) provides guidelines for the structuring of two major boundaries along the axis of the diagram. Finally, the domains defined by the two boundaries include borderline lesions, intermediate lesions, and "real melanomas." The lesions in the borderline and intermediate categories qualify as melanocytic neoplasias of indeterminant malignant potential; in these two categories, the predictability of metastases hardly justifies the use of the designation, malignant melanoma.

Diagnosis, Differential↗
PubMed1983

Thromboxane B2 in borderline and essential hypertensive patients.

Thromboxane B2 (TxB2) was measured in the venous and arterial plasma and in the urine of 15 borderline and 15 sustained essential hypertensive patients, and in the plasma and urine of 12 control normotensive age-matched subjects. Plasma and urine thromboxane B2 were significantly higher in both the borderline and sustained hypertensives than in the control normotensives. There was a significant positive correlation between urinary (i.e. renal)TxB2 excretion and the glomerular filtration rate, and between urinary TxB2 excretion and sodium excretion in the hypertensive but not in the normotensive subjects. Thromboxane A2 participates in pressure natriuresis.

Adolescent↗
PubMed2001

Case report of serous ovarian tumor of borderline malignancy (Stage Ic) in a pregnant woman.

We encountered a case of Stage Ic ovarian serous borderline malignancy in the first trimester of pregnancy. At laparotomy, spontaneous rupture of the capsule and a small amount of serous ascites was observed. Because of the laparotomy during pregnancy, correct staging of the tumor might not be performed. This case presented a major problem in deciding the treatment strategy, which are reported here together with some discussion of the literature on the preservation of fertility in borderline ovarian malignancy.

Adult↗
PubMed1997

A pregnant woman with clear cell adenocarcinoma of the ovary arising from endometriosis and with benign and borderline adenofibroma of the clear cell and endometrioid types.

We encountered a case of ovarian cancer in a 33-year-old, 8-week pregnant woman. Histological examination revealed both a transitive form of ovarian endometriosis with marked decidual changes due to pregnancy and clear cell carcinoma. Benign and borderline clear cell adenofibroma and benign and borderline endometrioid adenofibroma were also found. Parts of these adenofibromas showed transformation to clear cell carcinoma. This case suggests that clear cell carcinoma can arise from clear cell adenofibromas and/or ovarian endometriosis, even in young patients.

Adenocarcinoma, Clear Cell↗
PubMed1997

Serous papillary cystadenoma of borderline malignancy of the broad ligament.

Serous papillary cystadenoma of borderline malignancy arising in the broad ligament is extremely rare. We report the case of a 28-year-old female with a cystic mass in the broad ligament, who underwent complete excision of the mass, right salpingo-oophorectomy, omentectomy and multiple peritoneal biopsies. Pathology showed a serous papillary cystadenoma of borderline malignancy of the broad ligament, without peritoneal and omental involvement. A review of the literature about this rare pathologic condition is reported.

Adnexal Diseases↗
PubMed1981

Benign, borderline and malignant serous cystadenomas of the ovary. A transmission and scanning electron microscopical study.

In this study benign, malignant and borderline types of ovarian cystadenomas were studied by different morphological, transmission electron microscopical and scanning electron microscopical methods. The main cell type, the tubal cell, contained numerous microvilli projecting into the lumen, some cells also possessed cilia in addition to microvilli. Infrequently endometrial like cells were found with branched cilia intermixed with microvillous projections similar to that of the endometrium. Endocervical-like cells, very uncommon, evidenced numerous cytoplasmic projections extending into the lumen, arranged in a wavelike pattern. The surface structures were well developed in benign tumors, in borderline tumors focal denuded areas with histologically atypias were seen and in malignant ones the surface cells were devoid of specialised structures. The results also support a metaplastic origin from ovarian surface epithelium for these tumors.

Cilia↗
PubMed1999

Effectiveness of accelerated radiotherapy for patients with inoperable non-small cell lung cancer (NSCLC) and borderline prognostic factors without distant metastasis: a retrospective review.

PURPOSE: The standard treatment for patients with unresectable or medically inoperable non-small cell lung cancer (NSCLC) and good prognostic factors (e.g., weight loss [WL] < or = 5% and Karnofsky performance status [KPS] > or = 70) is induction chemotherapy followed by definitive radiotherapy to the primary site at 1.8-2.0 Gy per fraction with a total dose of 60-63 Gy to the target volume. Patients with poor prognostic factors usually receive radiotherapy alone, but the fractionation schedule and total dose have not been standardized. To attempt to optimize irradiation doses and schedule, we compared the effectiveness of accelerated radiotherapy (ACRT) alone to 45 Gy at 3 Gy per fraction with standard radiation therapy (STRT) of 60-66 Gy at 2 Gy per fraction in regard to tumor response, local control, distant metastasis, toxicity, and survival. METHODS AND MATERIALS: Fifty-five patients treated with radiation for NSCLC at The University of Texas M. D. Anderson Cancer Center between 1990 and 1994 were identified. All 55 patients had node-positive, and no distant metastasis (N+, M0) of NSCLC. Two cohorts were identified. One cohort (26 patients) had borderline poor prognostic factors (KPS less than 70 but higher than 50, and/or WL of more than 5%) and was treated with radiotherapy alone to 45 Gy over 3 weeks at 3 Gy/fraction (ACRT). The second cohort (29 patients) had significantly better prognostic factors (KPS > or = 70 and WL < or = 5%) and was treated to 60-66 Gy over 6 to 6 1/2 weeks at 2 Gy per fraction (STRT) during the same period. RESULTS: In the first cohort treated by ACRT, the distribution of patients by AJCC stage was IIB 8%, IIIA 19%, and IIIB 73%. Sixty-two percent had KPS <70, and 76% had a WL of >5%. The maximum response rate as determined by chest X-ray was 60% among 45 of 55 patients who were evaluable for response: combined complete responses (20%) and partial responses (40%). Overall survival in these patients was 13% at 2 and 5 years, with a locoregional control rate of 42% and a freedom from distant metastasis rate of 54%. The ACRT cohort treated with 3 Gy per fraction had significantly lower KPS scores (p = 0.003) and greater WL (p = 0.063) than the cohort STRT treated with 2 Gy per fraction. However, treatment results and toxicity were not significantly different between the two cohorts in spite of significantly better prognostic factors in the STRT cohort. CONCLUSIONS: Despite having worse prognostic factors, the cohort treated with radiotherapy alone to 45 Gy at 3 Gy per fraction over 3 weeks (ACRT) had response rates, locoregional control, and overall survival comparable to those in the cohort treated by a total dose of 60-66 Gy at 2 Gy per fraction over 6 to 6 1/2 weeks (STRT). Given that accelerated treatment schedules decrease treatment time and cost less, these may, in the current health care environment, be important factors for health care providers to consider in treating patients who have locally advanced NSCLC and borderline poor prognostic factors.

Carcinoma, Non-Small-Cell Lung↗