Management Dilemmas in Borderline Ovarian Tumor

Introduction Borderline ovarian tumors (BOT) constitute 15% of all epithelial ovarian cancers. As the term borderline implies they clinically behave intermediate between benign and malignant tumors. Synonyms of BOT include tumors of borderline malignancy, tumors of low malignant potential, and atypical proliferative tumors (1). Histologically, the borderline tumors are defined by the presence of nuclear atypia, epithelial stratification, mitotic activity, and absence of stromal invasion (2,3). Lack of invasion of the ovarian stroma by neoplastic cells is the cardinal feature that separates BOT from invasive ovarian carcinomas (IOC). According to the World Health Organization classification schemata, 2003 (4), BOT are classified on the basis of histopathology and histogenesis into serous, mucinous, endometrioid, clear cell, and transitional (Brenner) subtypes. Serous and mucinous neoplasms constitute the majority of BOT and occur mostly in women of reproductive age. The mean age of presentation of BOT is approximately 20 years earlier than that of IOC (5). It is most frequently seen between the ages 30 and 50 years. Because BOT behaves in a much less aggressive way, in most women the condition has not spread beyond the ovary when it is diagnosed (stage 1 disease). Despite some of the histologic features suggestive of malignancy, the clinical prognosis of these tumors is excellent compared with that of invasive ovarian carcinoma. Although patients have an excellent prognosis, risk of recurrence remains in some cases (6). We present an interesting case series of BOTs and discuss the management dilemmas associated.