Case Report
Volume 3 Issue 3 - 2016
Borderline Ovarian Tumour with Atypical Clinical Presentation: A Case Report
Milena Mitrovic*, Snezana Vukajlovic, Katarina Jeremic, Rajka Argirovic and Dejan Uljarevic
Department of Postoperative care, Clinical center Serbia, Serbia
*Corresponding Author: Milena Mitrovic, Department of Postoperative Care, Clinic of gynaecology and obstetrics, Clinical center Serbia, Milesevska 65, 11000 Belgrade, Serbia.
Received: July 01, 2016; Published: July 19, 2016
Citation: Milena Mitrovic., et al. “Borderline Ovarian Tumour with Atypical Clinical Presentation: A Case Report”. EC Gynaecology 3.3 (2016): 290-293.
Abstract
Borderline ovarian tumours are epithelial ovarian tumour group that takes position between clearly evident benign and malignant tumours. These tumours are usually properly diagnosed in earlier stages of the disease, rarely give relapses and have a long period of survival. The primary treatment is surgery and it requires careful exploration.
73-year-old patient was admitted to the Clinic for Gynaecology and obstetrics due to the existence of large tumour mass in the pelvis. She denied any subjective complaints, there was no data of gynaecological cancer in her family history and in her personal history, she had a cerebrovascular insult and gallbladder calculosis. Values of tumour markers CA 125, CEA иHE4 were in normal range, while CA 19-9 was elevated.
The patient underwent surgery with increased operational risk. Intraoperative findings confirmed the existence of a large cystic tumour mass with origin from right ovary, over 500ml serous fluid in the abdominal cavity and cystic change in the lower half of the liver. After consultation with pathologist, classical hysterectomy with bilateral adnexectomy, partial omentectomy and right pelvic lymphadenectomy was performed.
Postoperative course was complicated with progressive increase in transaminase values and the hepathologist was consulted who suspected that primary biliar cirrhosis of the liver may be the cause. Immunological analyses were taken. Histopathological finding was mucinous multicystic tumour of the right ovary, with no stromal invasion, punching capsules or presence of tumour tissue in opposite adnexa, uterus, perimetrium, lymph nodes and omentum. Tumour board decided that specific oncological treatment is finished.
Diagnosis and treatment of Borderline ovarian tumours are the challenge both for the surgeon and pathologist, but by early and detailed histological analyses and adequate surgical treatment, the disease can be completely cured.
Keywords: Borderline tumour; Surgery; Diagnostic; Treatment
Introduction
Borderline ovarian tumours are epithelial ovarian tumour group which, according to histological and biological characteristics takes position between clearly evident benign and malignant tumours. These tumours are usually properly diagnosed in earlier stages of the disease, rarely give relapses and have a long period of survival. According to FIGO classification from1971. They are classified as cystadenomas of low malignant potential-borderline tumours or proliferative cystadenomas. Borderline tumours of the ovary account for 15% of all epithelial carcinoma and include different histological types: serous (around 60%), mucinous (around 30%) and extremely rare endometrioid and tumours with mixed histological origin [1,2].
The primary treatment is surgery; if the tumour is diagnosed at earlier stage, depending on the menopausal status, ovariectomy, adnexectomy or hysterectomy with bilateral adnexectomy is required. In addition, it requires careful exploration, abdominal resection of peritoneal implants, peritoneal cytology, total omentectomy and in certain cases of serous tumours, pelvic and para aortal lymphadenectomy [3,4].
Case Report
73-year-old patient was admitted to the Clinic for Gynaecology and obstetricsdue to the existence of large tumour mass in the pelvis. She was examined gynaecologically last time seven years ago, denied any subjective complaints, except for the occasional “swelling abdomen”. There was no data of gynaecological cancer in her family history, she was in menopause for 18 years, with two vaginal delivery and few miscarriages. In her personal history, she had a cerebrovascular insult three years ago and gallbladder calculosis.By ultrasound examination of pelvis and abdomen a cystic tumefact with 150x200mm diameter was diagnosed, with multilocular excrescence, probably originated from right ovary. Also, gallbladder calculosis and focal blur, not clearly margined in dimensions 25x20mm in liver on the border of VI and VII segment were mentioned. Values of tumour markers CA 125, CEA иHE4 were in normal range, while CA 19-9 was elevated (360). During preoperative preparations Colour duplex scan of carotid and vertebral arteries, NMR, as well as puncture of ascites were performed. It was not possible to exclude malignant ovarian tumourwith certainty.
The patient underwent surgery with increased operational risk. Intraoperative findings confirmed the existence of a large tumour mass with origin from right ovary, dimensions 230x180x160 mm, light, wrinkled surfacewith numerous cystic prominences on the inner board surface. There was over 500ml serous fluid in the abdominal cavity. Left adnexa, uterus, pelvic peritoneum and other pelvic organs were without pathological changes. Liver with smooth surface and cystic change in the lower half. After consultation with pathologist, classical hysterectomy with bilateral adnexectomy, partial omentectomy and right pelvic lymphadenectomy was performed. Ascites was aspirated and sent to cytological examination.
Postoperative course was complicated with progressive increase in transaminase values and the hepathologist was consulted who suspected that primary biliar cirrhosis of the liver may be the cause. Immunological analyses were taken.
The patient was discharged in a good general condition, recovered, with normal laboratory tests. Histopathological finding was mucinous multicystic tumour of the right ovary, mostly coated with one-level mucinous epithelium without atypical findings. In a few focuses were formations of papillary structures with discrete nuclear atypia. There was no stromal invasion, punching capsules or presence of tumour tissue in opposite adnexa, uterus, perimetrium, lymph nodes and omentum. Cytological findings showed many reactive-modified mesothelial cells.
PHDg: Atypicalproliferating-borderlinemucinoustumorovariidextri, FIGO Ia.
This case was presented to Tumour board specialist group who decided that there is no need for further oncological treatment.
Discussion
Classification of mucinous Borderline ovarian tumours includes two main histological types: mainly intestinal and rare endocervical. Exceptionally, mucinous Borderline ovarian tumourscan be intraepithelial or micro invasive carcinomas.
They are typically multilocular, with possible solid structures, areas of necrosis and haemorrhage, but the presence of ascites is very unusual. Mucinous tumours of the intestinal histological type are usually bilateral and show mixed mucinous-epithelial components[5].
In this case unilateral tumour was diagnosed with large amount of ascites, suspected tumour change in liver, followed with minimal subjective complaints, so it was difficult to set preoperative diagnosis. It was decided to make midline laparotomy, and after exclusion of malignancy by pathologist adequate surgical procedure was performed. During postoperative period, hepathologist was consulted and suggested that described changes in liver were most likely primary biliar cirrhosis and not a malignant change. Diagnosis and treatment of Borderline ovarian tumours are the challenge both for the surgeon and pathologist, but by early and detailed histological analyses and adequate surgical treatment, the disease can be completely cured.
Conclusion
Classification of mucinous Borderline ovarian tumours includes two main histological types: mainly intestinal and rare endocervical. Exceptionally, mucinous Borderline ovarian tumours can be intraepithelial or micro invasive carcinomas.
They are typically multilocular, with possible solid structures, areas of necrosis and haemorrhage, but the presence of ascites is very unusual. Mucinous tumours of the intestinal histological type are usually bilateral and show mixed mucinous-epithelial components.
In this case unilateral tumour was diagnosed with large amount of ascites, suspected tumour change in liver, followed with minimal subjective complaints, so it was difficult to set preoperative diagnosis. It was decided to make midline laparotomy, and after exclusion of malignancy by pathologist adequate surgical procedure was performed. During postoperative period, hepathologist was consulted and suggested that described changes in liver were most likely primary biliar cirrhosis and not a malignant change. Diagnosis and treatment of Borderline ovarian tumours are the challenge both for the surgeon and pathologist, but by early and detailed histological analyses and adequate surgical treatment, the disease can be completely cured.
Bibliography
  1. Cadron I., et al. “Management of borderline ovarian neoplasms”. Journal of Clinical Oncology 25.20 (2007): 2928-2937.
  2. C Paul Morrow MD. “Morrows Gynecologic cancer surgery”. second edition (2013).
  3. Hart WR. “Borderline epithelial tumors of the ovary”. Modern Pathology18.Suppl 2 (2005): S33-S50.
  4. Rodriguez IM., et al. “Mucinous tumors of the ovary: a clinicopathological analysis of 75 borderline tumors (of intestinal type) and carcinomas”. American Journal of Surgical Pathology 26.2 (2002): 139-152.
  5. McKenney JK., et al. “Patterns of stromal invasion in ovarian serous tumours of low malignant potential: a revaluation of the concept of stromal micro invasion”. American Journal of Surgical Pathology 30.10 (2006): 1209-1221.
Copyright: © 2016 Milena Mitrovic., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


December Issue Release

We Always feel pleasure to share an update with you all. Here, notifying you that we have successfully released December issue for the respective journals and can be viewed in the current issue pages.

Submission Deadline for January Issue

E-Cronicon delightfully welcome all the authors around the globe for an effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before December 26, 2019.

Certificate of Publication

E-Cronicon honours with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

E-Cronicon certify the Editors for their first review done towards assigned article of the respective journals.

Latest Articles

Latest articles will be updated immediately in the articles in press page of the respective journals.

Immediate Assistance

Prime moto of this team is to clarify all the queries without any delay or hesitation in order to avoid the inconvenience. For an immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk