Fertility-sparing Surgery in Children and Adolescents with Borderline Ovarian Tumors: a Retrospective Study

Overview

Journal J Ovarian Res

Publisher Biomed Central

Specialties Gynecology & Obstetrics
Reproductive Medicine

Date 2024 May 9

PMID 38720349

Authors

Jiayuan Zhao

Dan Wang

Ruojiao Wang

Yonglan He

Congwei Jia

Lingya Pan

Shuiqing Ma

Ming Wu

Weidi Wang

Xinghan Cheng

Junjun Yang

Yang Xiang

Affiliations

Soon will be listed here.

Abstract

Objective: To describe the characteristics of children and adolescents with borderline ovarian tumors (BOTs) and evaluate the efficacy and safety of fertility-sparing surgery (FSS) in these patients.

Methods: Patients with BOTs younger than 20 years who underwent FSS were included in this study.

Results: A total of 34 patients were included, with a median patient age of 17 (range, 3-19) years; 97.1% (33/34) of cases occurred after menarche. Of the patients, 82.4% had mucinous borderline tumors (MBOTs), 14.7% had serous borderline tumors (SBOTs), and 2.9% had seromucinous borderline tumor (SMBOT). The median tumor size was 20.4 (range, 8-40)cm. All patients were at International Federation of Gynecology and Obstetrics stage I and all underwent FSS: cystectomy (unilateral ovarian cystectomy, UC, 14/34, 41.2% and bilateral ovarian cystectomy, BC, 1/34, 2.9%), unilateral salpingo-oophorectomy (USO; 18/34; 52.9%), or USO + contralateral ovarian cystectomy (1/34; 2.9%). The median follow-up time was 65 (range, 10-148) months. Recurrence was experienced by 10 of the 34 patients (29.4%). One patient with SBOT experienced progression to low-grade serous carcinoma after the third relapse. Two patients had a total of four pregnancies, resulting in three live births. The recurrence rate of UC was significantly higher in MBOTs than in USO (p = 0.005). The 5-year disease-free survival rate was 67.1%, and the 5-year overall survival rate was 100%.

Conclusions: Fertility-sparing surgery is feasible and safe for children and adolescents with BOTs. For patients with MBOTs, USO is recommended to lower the risk of recurrence.

References

Flicek K, VanBuren W, Dudiak K, Lahkman Y, Chen L, Butler K . Borderline epithelial ovarian tumors: what the radiologist should know. Abdom Radiol (NY). 2020; 46(6):2350-2366. DOI: 10.1007/s00261-020-02688-z. View

Tsikouras P, Liberis V, Galazios G, Panagiotidou C, Bouchlariotou S, Teichmann A . A retrospective analysis of twenty-eight borderline ovarian tumours in adolescent girls. Eur J Gynaecol Oncol. 2009; 30(1):49-53. View

Yazbek J, Aslam N, Tailor A, Hillaby K, Raju K, Jurkovic D . A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer. Ultrasound Obstet Gynecol. 2006; 28(3):320-4. DOI: 10.1002/uog.2842. View

Morice P, Uzan C, Fauvet R, Gouy S, Duvillard P, Darai E . Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence. Lancet Oncol. 2012; 13(3):e103-15. DOI: 10.1016/S1470-2045(11)70288-1. View

Song T, Choi C, Lee Y, Kim T, Lee J, Bae D . Pediatric borderline ovarian tumors: a retrospective analysis. J Pediatr Surg. 2010; 45(10):1955-60. DOI: 10.1016/j.jpedsurg.2010.06.012. View

Cass D, Hawkins E, Brandt M, Chintagumpala M, Bloss R, Milewicz A . Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period. J Pediatr Surg. 2001; 36(5):693-9. DOI: 10.1053/jpsu.2001.22939. View

Hauptmann S, Friedrich K, Redline R, Avril S . Ovarian borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria. Virchows Arch. 2016; 470(2):125-142. PMC: 5298321. DOI: 10.1007/s00428-016-2040-8. View

Tsai H, Ko C, Yeh C, Chen Y, Twu N, Chao K . Unilateral salpingo-oophorectomy as fertility-sparing surgery for borderline ovarian tumors. J Chin Med Assoc. 2011; 74(6):250-4. DOI: 10.1016/j.jcma.2011.04.003. View

Tsuboyama T, Sato K, Ota T, Fukui H, Onishi H, Nakamoto A . MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges. Radiographics. 2022; 42(7):2095-2111. DOI: 10.1148/rg.220068. View

10.

Wang P, Fang L . Salpingo-oophorectomy versus cystectomy in patients with borderline ovarian tumors: a systemic review and meta-analysis on postoperative recurrence and fertility. World J Surg Oncol. 2021; 19(1):132. PMC: 8061226. DOI: 10.1186/s12957-021-02241-2. View

11.

Gauroy E, Larouzee E, Chereau E, de La Motte Rouge T, Margueritte F, Sallee C . [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Diagnosis and Management of Recurrent Borderline Ovarian Tumours]. Gynecol Obstet Fertil Senol. 2020; 48(3):314-321. DOI: 10.1016/j.gofs.2020.01.019. View

12.

Colombo N, Sessa C, Bois A, Ledermann J, McCluggage W, McNeish I . ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease†. Ann Oncol. 2019; 30(5):672-705. DOI: 10.1093/annonc/mdz062. View

13.

Gershenson D . Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol. 2016; 41:49-59. DOI: 10.1016/j.bpobgyn.2016.09.012. View

14.

Lee K, Young R . The distinction between primary and metastatic mucinous carcinomas of the ovary: gross and histologic findings in 50 cases. Am J Surg Pathol. 2003; 27(3):281-92. DOI: 10.1097/00000478-200303000-00001. View

15.

Falcone F, Breda E, Ferrandina G, Malzoni M, Perrone A, Cormio G . Fertility-sparing treatment in advanced-stage serous borderline ovarian tumors. An analysis from the MITO14 study database. Gynecol Oncol. 2021; 161(3):825-831. DOI: 10.1016/j.ygyno.2021.03.023. View

16.

Morowitz M, Huff D, von Allmen D . Epithelial ovarian tumors in children: a retrospective analysis. J Pediatr Surg. 2003; 38(3):331-5; discussion 331-5. DOI: 10.1053/jpsu.2003.50103. View

17.

Xu M, Wang B, Shi Y . Borderline ovarian tumor in the pediatric and adolescent population: a clinopathologic analysis of fourteen cases. Int J Clin Exp Pathol. 2020; 13(5):1053-1059. PMC: 7270684. View

18.

Massicot R, Rousseau V, Darwish A, Sauvat F, Jaubert F, Nihoul-Fekete C . Serous and seromucinous infantile ovarian cystadenomas--a study of 42 cases. Eur J Obstet Gynecol Reprod Biol. 2008; 142(1):64-7. DOI: 10.1016/j.ejogrb.2008.09.007. View

19.

Yokoyama Y, Moriya T, Takano T, Shoji T, Takahashi O, Nakahara K . Clinical outcome and risk factors for recurrence in borderline ovarian tumours. Br J Cancer. 2006; 94(11):1586-91. PMC: 2361313. DOI: 10.1038/sj.bjc.6603139. View

20.

Donnez J, Munschke A, Berliere M, Pirard C, Jadoul P, Smets M . Safety of conservative management and fertility outcome in women with borderline tumors of the ovary. Fertil Steril. 2003; 79(5):1216-21. DOI: 10.1016/s0015-0282(03)00160-2. View