Hauptmann Steffen, Friedrich Katrin, Redline Raymond, Avril Stefanie
Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
Institute of Pathology, University Hospital Dresden, Dresden, Germany.
Virchows Arch. 2017 Feb;470(2):125-142. doi: 10.1007/s00428-016-2040-8. Epub 2016 Dec 27.
Borderline ovarian tumors (BOT) are uncommon but not rare epithelial ovarian neoplasms, intermediate between benign and malignant categories. Since BOT were first identified >40 years ago, they have inspired controversies disproportionate to their incidence. This review discusses diagnostic criteria for the histologic subtypes of BOT, highlighting areas of diagnostic challenges, ongoing controversies, and changes in terminology implemented by the recent 2014 WHO Classification of Tumours of the Female Genital Organs. Emerging knowledge supports the notion that subtypes of borderline ovarian tumors comprise distinct biologic, pathogenetic, and molecular entities, precluding a single unifying concept for BOT. Serous borderline tumors (SBT) share molecular and genetic alterations with low-grade serous carcinomas and can present at higher stages with peritoneal implants and/or lymph node involvement, which validates their borderline malignant potential. All other (non-serous) subtypes of BOT commonly present at stage I confined to the ovary(ies) and are associated with overall survival approaching that of the general population. An important change in the WHO 2014 classification is the new terminology of non-invasive implants associated with SBT, as any invasive foci (previously called "invasive implants") are now in line with their biological behavior considered peritoneal low-grade serous carcinoma (LGSC). The controversy regarding the terminology of non-serous borderline tumors, called by some pathologists "atypical proliferative tumor" in view of their largely benign behavior, has not been resolved. The concepts of intraepithelial carcinoma and microinvasion may evolve in further studies, as their presence appears to have no prognostic impact and is subject to considerable inter-observer variability.
交界性卵巢肿瘤（BOT）是一种不常见但并非罕见的上皮性卵巢肿瘤，介于良性和恶性之间。自40多年前首次发现BOT以来，它们引发的争议与其发病率不相称。本综述讨论了BOT组织学亚型的诊断标准，重点介绍了诊断挑战、持续存在的争议以及2014年世界卫生组织女性生殖器官肿瘤分类所采用的术语变化。新出现的知识支持这样一种观点，即交界性卵巢肿瘤的亚型包括不同的生物学、发病机制和分子实体，排除了对BOT单一统一概念的可能性。浆液性交界性肿瘤（SBT）与低级别浆液性癌共享分子和基因改变，并且可以在更高分期出现腹膜种植和/或淋巴结受累，这证实了它们的交界性恶性潜能。BOT的所有其他（非浆液性）亚型通常在I期局限于卵巢，并且总体生存率与普通人群相近。世界卫生组织2014年分类中的一个重要变化是与SBT相关的非侵袭性种植的新术语，因为任何侵袭性病灶（以前称为“侵袭性种植”）现在根据其生物学行为被视为腹膜低级别浆液性癌（LGSC）。关于非浆液性交界性肿瘤术语的争议尚未解决，一些病理学家鉴于其大多为良性行为将其称为“非典型增生性肿瘤”。上皮内癌和微浸润的概念可能会在进一步研究中演变，因为它们的存在似乎对预后没有影响，并且在观察者之间存在相当大的差异。
