Department of Pathology , The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Int J Gynecol Pathol. 2010 Mar;29(2):108-12. doi: 10.1097/PGP.0b013e3181bc2706.
At a National Cancer Institute-sponsored workshop it was proposed that the borderline category of ovarian intestinal-type mucinous tumors (OInMTs) could be eliminated if the apparent benign behavior of these tumors could be confirmed. We reviewed 33 cases of borderline OInMT, with either optimal or adequate sampling and with at least 5 years of follow-up, to investigate their behavior. Optimal sampling and adequate sampling were defined as at least 1 section per centimeter of maximum tumor dimension and at least 1 section per 2 cm of maximum tumor dimension, respectively. The patients' age ranged from 16 to 89 years (mean 49 yr). Tumor size ranged from 8 to 39 cm (mean 20 cm). The sampling of the ovarian tumor was optimal in 28 cases and adequate in 5 cases. The patients were treated surgically as follows: cystectomy (1), unilateral oophorectomy or unilateral salpingo-oophorectomy with or without total abdominal hysterectomy (13), and bilateral salpingo-oophorectomy with or without total abdominal hysterectomy (19). Complete or partial staging was obtained in 26 patients. All of them had Federation of Gynecology and Obstetrics stage I disease. Thirty-one patients with a follow-up ranging from 5 to 18 years (mean 10 yr) had no recurrences. Two patients had recurrences 12 and 14 months after their initial surgery. The first patient underwent a left salpingo-oophorectomy and limited staging for a borderline OInMT adherent to the ileum and sigmoid. The tumor was incompletely removed and recurred in the pelvis 1 year later. It was again incompletely excised. Ten months later, the tumor re-recurred in the pelvis and could only be drained because of the patient's advanced age and her poor medical status. She died of other causes 5 years later. The second patient with recurrent tumor had undergone a cystectomy and full staging for a borderline OInMT. Fourteen months later, she developed a recurrence in the residual ovary. She underwent a right salpingo-oophorectomy and total abdominal hysterectomy and has been without evidence of disease for 11 years. In this study of 33 Federation of Gynecology and Obstetrics stage I borderline OInMTs that were optimally or adequately sampled to exclude intraepithelial carcinoma, microinvasion, or invasive carcinoma, there were only 2 cases with recurrence, secondary to incomplete excision or cystectomy, and no deaths from disease. However, borderline OInMTs are usually large and heterogeneous, and the standard sampling protocol for them is not evidence based. As indicated by one of our consultation cases, there remains the potential for a sampling artifact in which a focus of carcinoma is missed. Caution dictates retaining the current nomenclature to ensure the follow-up of patients affected by this disease until uncertainty regarding the extent of sampling needed to exclude the presence of carcinoma is resolved.
在国家癌症研究所主办的一次研讨会上，有人提议，如果能够证实这些肿瘤明显的良性行为，那么可以消除卵巢肠型黏液性肿瘤（OInMT）的交界性类别。我们回顾了 33 例交界性 OInMT 病例，这些病例均进行了最佳或充分的取样，并进行了至少 5 年的随访，以研究其行为。最佳取样和充分取样的定义分别为每厘米最大肿瘤尺寸取 1 个切片和每 2 厘米最大肿瘤尺寸取 1 个切片。患者年龄 16 至 89 岁（平均 49 岁）。肿瘤大小 8 至 39 厘米（平均 20 厘米）。28 例卵巢肿瘤的取样为最佳，5 例为充分。患者接受了以下手术治疗：囊切除术（1 例）、单侧卵巢切除术或单侧输卵管卵巢切除术联合或不联合全子宫切除术（13 例）、双侧输卵管卵巢切除术联合或不联合全子宫切除术（19 例）。26 例患者获得了完整或部分分期。他们均为妇科肿瘤学联合会（FIGO）I 期疾病。31 例患者随访 5 至 18 年（平均 10 年），无复发。2 例患者在初次手术后 12 个月和 14 个月复发。第一例患者因与回肠和乙状结肠粘连的交界性 OInMT 而行左侧输卵管卵巢切除术和有限分期。肿瘤未完全切除，1 年后在骨盆内复发。再次不完全切除。10 个月后，肿瘤在骨盆内再次复发，由于患者年龄较大且身体状况不佳，只能引流。她 5 年后死于其他原因。第二例复发性肿瘤患者接受了囊切除术和完整分期治疗交界性 OInMT。14 个月后，她在残余卵巢中复发。她接受了右侧输卵管卵巢切除术和全子宫切除术，至今无疾病证据 11 年。在这项对 33 例 FIGO I 期交界性 OInMT 的研究中，对这些肿瘤进行了最佳或充分的取样，以排除上皮内癌、微浸润或浸润性癌，只有 2 例复发，原因是不完全切除或囊切除术，无疾病死亡。然而，交界性 OInMT 通常较大且异质性，其标准取样方案尚无证据支持。我们的一个咨询病例表明，仍有可能存在取样假象，即遗漏了癌灶。谨慎起见，应保留当前的命名法，以确保对受这种疾病影响的患者进行随访，直到解决需要进行多大范围的取样以排除癌存在的不确定性。
