Hintergrund: Borderlinetumoren (BOT) sind proliferierende, metastasierungsfähige Intermediärformen der epithelialen Geschwülste des Ovars, die biologisch und histologisch zwischen den Adenomen und Karzinomen stehen. Trotz ihrer Häufigkeit im Auftreten sind diagnostische Abgrenzung und klinisches Management häufiger Gegenstand kontroverser Diskussionen. Fragestellung: Ziel der vorliegenden Übersichtsarbeit war es, unter Einbeziehung eigener Daten wesentliche Aspekte des Konzeptes der ovariellen BOT darzustellen. Methoden: Hierzu wurden 169 Patientinnen, die zwischen 1972 und 1995 an unserer Klinik behandelt und nachbeobachtet wurden, retrospektiv erfaßt. Die klinischen Daten werden anhand der aktuellen Literatur diskutiert. Ergebnisse: Die Diagnostik von BOT beruht ausschließlich auf histologischen und zytologischen Kriterien. BOT mit Mikroinvasion stellen Grenzfälle zu Karzinomen dar. Die Zuordnung peritonealer Implantationen seröser BOT zum nicht-invasiven oder invasiven Typ ist prognostisch und therapeutisch relevant. Das mikropapilläre Karzinom wird als Sonderform seröser BOT diskutiert. Ziel der Primärbehandlung ist die Bestimmung der Tumorausbreitung und die operative Erlangung von Tumorfreiheit. Adjuvante Therapieformen sind High risk-Fällen vorbehalten. Schlußfolgerungen: Für die Zukunft ist zu erwarten, daß es der Einsatz neuer Technologien zur Analyse von Mustern der Genexpression erlauben wird, zu einer verbesserten Charakterisierung von BOT und zu einer individuelleren Therapie zu kommen.
Abstract
Background: Ovarian tumors of low malignant potential are proliferating intermediate epithelial ovarian tumors capable of metastasis. Histologically they lie between adenomas and carcinomas. Despite their relatively high incidence optimal management is often unclear. Methods: We reviewed 169 patients with ovarian tumors of LMP treated between 1972 and 1995. Results: LMP is a histologic diagnosis. Some tumors of LMP show microinvasion. Peritoneal implants can be invasive or noninvasive and this is of prognostic relevance. So-called micropapillary carcinoma may be a specific subtype of serous ovarian tumors of LMP. The goal of primary treatment is to accurately stage the disease and remove it completely. Adjuvant treatment is generally reserved for patients considered at high risk for recurrence. Conclusion: New genetic techniques may permit a more accurate classification of ovarian tumors of LMP and more individualized treatment.
Literatur
1
Aure J, Hoeg K, Kolstad P.
Clinical and histologic studies of ovarian carcinoma: long-term follow-up of 990 cases.
Obstet Gynecol.
1971;
37
1-9
2
Barnhill D, Kurman R J, Brandy M F, Omura G A, Yordon E, Given FT, Kucera P R, Roman L D.
Preliminary analysis of the behavior of stage I ovarian serous tumors of low malignant potential: a Gynecologic Oncology Group study.
J Clin Oncol.
1995;
13
2752-2756
6
Burks R T, Sherman M E, Kurman R J.
Micropapillary serous carcinoma of the ovary: a distinctive low-grade carcinoma related to serous borderline tumors.
Am J Surg Pathol.
1996;
20
1319-1330
8
Chuaqui R, Zhuang Z, Emmert-Buck M R, Bryant B R, Nogales F, Tavassoli F A, Merino M J.
Genetic analysis of synchroneous tumors of the ovary and appendix.
Hum Pathol.
1996;
27
165-171
14
Ehrmann R L, Federschneider J M, Knapp R C.
Distinguishing lymph node metastases from benign glandular inclusions in low-grade ovarian carcinoma.
Am J Obstet Gynecol.
1980;
136
737-746
15
Emmert-Buck M R, Chuaqui R, Zhung Z.
Molecular analysis of concomitant uterine and ovarian endometrioid tumors.
Int J Gynecol Pathol.
1997;
16
143-148
16
Friedländer M L, Russell P, Taylor I W, Hedley D W, Tattersal H N.
Flow cytometric analysis of cellular DNA content as an adjunct to the diagnosis of ovarian tumours of borderline malignancy.
Pathology.
1984;
16
301-316
17
Gershenson D M, Silva E G, Lewy L, Burke T W, Wolf J K, Tornos C.
Ovarian serous borderline tumors with invasive peritoneal implants.
Cancer.
1998;
15
1096-1103
21
International Federation of Gynecology and Obstetrics.
Classification and staging of malignant tumors in the female pelvis.
Acta Obstet Gynecol Scand.
1971;
50
1-7
22
Kaern J, Trope C, Kjorstad K E, Abeler V, Pettersen E O.
Cellular DNA content as a new prognostic tool in patients with borderlinetumors of the ovary.
Gynecol Oncol.
1990;
38
452-457
23
Kaern J, Trope C G, Abeler V M.
A retrospective study of 370 borderline tumors of the ovary treated at the Norwegian Radium Hospital from 1970 to 1982. A review of clinicopathologic features and treatment modalities.
Cancer.
71;
1993
1810-1820
24
Karp L A, Czernobinsky B.
Glandular inclusions in pelvic and abdominal para-aortic lymph nodes. A study of autopsy and surgical material in males and females.
Am J Clin Pathol.
1969;
52
212-218
27
Lim-Tan S K, Cajigas H E, Scully R E.
Ovarian cystectomy for serous borderline tumors: A follow up study of 35 cases.
Obstet Gynecol.
1988;
72
775-781
28
Link C J, Krohn E, Reed E.
The relationship between borderline ovarian tumors and epithelial ovarian carcinoma: epidemiologic, pathologic, and molecular aspects.
Gynecol Oncol.
1996;
60
347-354
30
Padberg B C, Arps H, Franke U, Thiedemann C, Rehpenning W, Stegner H E, Lietz H, Schröder S, Dietel M.
DNA-cytometry and prognosis in ovarian tumors of borderline malignancy - a clinicomorphological study of 80 cases.
Cancer.
1992;
69
2510-2514
31
Powell D E, Puls L, van Nagell J.
Current concepts in epithelial ovarian tumors: does benign to malignant transformation occur?.
Hum Pathol.
1992;
23
846-847
33 Russell P. Surface epithelial-stromal tumors of the ovary. In: Kurman RJ (ed) Blaustein's pathology of the female genital tract. Berlin; Springer 1994
34
Russell P, Bannatyne P M, Solomon H J, Stoddard L D, Tattersall H N.
Multifocal tumorgenesis in the upper female genital tract - implications for staging and management.
Int J Gynecol Pathol.
1985;
4
192-210
36 Russell P. Ovarian epithelial tumours with atypical proliferation. In: Lowe D, Fox H Advances in gynecologic pathology. Edinburgh, New York; Churchill Livingstone 1992
40 Santesson L, Kottmeier H L. General classification of ovarian tumors. In: Gentils F, Junqueira AC (eds) Ovarian cancer. UICC Monogr Ser, vol.11. New York; Springer 1968
41 Scully R E, Young R H, Clement P B. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. Washington; Armed Forces Institute for Pathology 1998
42
Seidmann J D, Kurman R J.
Subclassification of serous borderline tumors of the ovary into benign and malignant types.
Am J Surg Pathol.
1996;
20
1331-1345
43 Serov S F, Scully R E, Sobin L H. International histological classification of tumours. No 9, Histological typing of ovarian tumors. Genf; World Health Organization 1973
44
Shih Y S, Kerr J, Hust T G, Khoo S K, Ward B G, Chenevix-Trench G.
No evidence for microsatellite instability from allelotype analysis of benign and low malignant neoplasms.
Gynecol Oncol.
1998;
69
210-213
48
Sutton G P, Bundy B N, Omura G A, Yordan E L, Beecham J S, Bonfiglio T.
Stage II ovarian tumors of low malignant potential treated with cisplatin combination therapy (a Gynecologic Oncology Group study).
Gynecol Oncol.
1991;
41
230-233
55
Trope C, Kaern J, Vergote I B, Kristensen G, Abeler V.
Are borderline tumors overtreated both surgically and systemically? A review of four prospective randomized trials including 253 patients with borderline tumors.
Gynecol Oncol.
1993;
51
236-243
56
Young R H, Gilks C B, Scully R E.
Mucinous tumors of the appendix associated with mucinous tumors of the ovary and pseudomyxoma peritonei.
Am J Surg Pathol.
1991;
15
415-429