Serous borderline ovarian tumors: where are we now?

In the present article we report the revised microscopical features of serous borderline ovarian tumors (S-BOTs) in the context of a long personal experience, drawing parallels with the definitions and issues elaborated at the Borderline Ovarian Tumor Workshop held in August 2003 in Bethesda. In our opinion none of the histopathologic criteria of the primary tumor including micropapillary subtype of the S-BOT can be used yet as a prognostic marker. The most realistic assumption is that in the clinical course of the S-BOT dynamic transformation of different clones occurs and the process develops simultaneously with multicentric blastomogenesis in the peritoneal cavity. Hence the failure of our efforts to forecast the prognosis of the disease using the microscopical structure of the primary tumor as a point of issue. It is indispensable to control the course of the S-BOTs by performing repeated biopsies at each relapse and modify the treatment schedules according to the microscopic patterns revealed at a given stage of the disease. Relapses of the S-BOTS may occur up to 50 years later so the patient should be under surveillance especially by a urologist to detect the earliest symptoms of urinary tract obstruction. Much more attention should be paid to the local intraabdominal administration of drugs and the search for new systemic chemotherapy regimens.