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A comparative analysis of 57 serous borderline tumors with and without a noninvasive micropapillary component
Brian M Slomovitz1, Thomas A Caputo, Herbert F Gretz
1Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA.
Abstract:
The literature concerning serous borderline tumors with a noninvasive micropapillary component suggests an association with invasive implants. We compared the clinicopathologic features of micropapillary serous borderline tumors (MSBTs) with typical SBTs to determine the following: 1) the importance of focal micropapillary architecture in an otherwise typical SBT, 2) the behavior of low-stage MSBTs, 3) whether high-stage MSBTs are inherently more aggressive than high-stage SBTs, and 4) whether invasive implants are prevalent in an MSBT cohort without referral selection bias. The 57 borderline tumors studied were diagnosed at a university hospital between 1981 and 1998; they included 14 MSBTs, 35 SBTs, and 8 SBTs with focal micropapillary features. None of the specimens were referrals for expert pathologic consultation, thus distinguishing our study group from most of those previously reported. Neither MSBTs nor SBTs were associated with invasive implants at diagnosis (0 of 14 and 0 of 43, respectively). They also did not differ with respect to overall stage at diagnosis, but MSBTs were more frequently bilateral than SBTs (71% versus 23%, p = 0.001). There was an increased risk of recurrence in MSBT versus SBT (3 of 14 versus 1 of 43, p = 0.035), but this was stage related; there was no difference between groups when evaluating recurrence in stage I disease (0 of 8 versus 0 of 27). There was no difference in recurrence or stage at diagnosis between SBTs with focal micropapillary features and other SBTs. There was 100% survival in all groups. We conclude that high-stage MSBTs with noninvasive implants should be considered a subtype of SBTs with an increased risk of recurrence. Stage I MSBTs demonstrate clinical features that are similar to low-stage SBTs. Focal micropapillary architecture (<5 mm) has no bearing on outcome. MSBTs in the general population are not strongly associated with invasive implants.
Insights
Micropapillary serous borderline tumors (MSBTs) show increased recurrence risk in high stages but not low stages. Focal micropapillary features do not impact outcomes in typical serous borderline tumors (SBTs).
Area of Science:
- Gynecologic Pathology
- Ovarian Neoplasms
- Oncology
Background:
- Serous borderline tumors (SBTs) with micropapillary components are suspected to correlate with invasive implants.
- Previous studies on micropapillary serous borderline tumors (MSBTs) may have selection bias due to referral for expert consultation.
Purpose of the Study:
- To evaluate the significance of focal micropapillary architecture in typical SBTs.
- To determine the behavior of low-stage MSBTs.
- To assess if high-stage MSBTs are more aggressive than high-stage SBTs.
- To ascertain the prevalence of invasive implants in a non-referred MSBT cohort.
Main Methods:
- Clinicopathologic features of 57 borderline tumors (14 MSBTs, 35 SBTs, 8 SBTs with focal micropapillary features) diagnosed between 1981-1998 were compared.
- Tumors were from a university hospital and not referrals for expert pathologic consultation.
Main Results:
- No association was found between MSBTs or SBTs and invasive implants at diagnosis.
- MSBTs were significantly more often bilateral than SBTs (71% vs 23%).
- A higher recurrence risk was observed for MSBTs compared to SBTs, but this was stage-dependent; no difference was seen in Stage I disease.
- SBTs with focal micropapillary features showed no difference in outcomes compared to typical SBTs.
- All patient groups exhibited 100% survival.
Conclusions:
- High-stage MSBTs with noninvasive implants represent a subtype of SBTs with elevated recurrence risk.
- Stage I MSBTs share clinical characteristics with low-stage SBTs.
- Focal micropapillary architecture (<5 mm) does not influence tumor outcome.
- MSBTs in the general population are not strongly linked to invasive implants.