Asia-Oceania J. Obstet. Gynaecot. Vol. 17,No. 2: 707-112 1991

~linicostatisti~a~ Study of Low Potential Malignancy Ovarian Cystadenoma (Borderline Cases)

Kenji Shiromizu,') Takashi Kawana,Z) Motoyasu Sugase,a) Rikuichi Izumi,4) and Masahiko Mizuno2) 1 ) Division of Gynecology, Saitama Cancer Center, Saitama, Japan 2) Department of Obstetrics and Gynecology, Faculty of Medicirre, University of Tokyo, Tokyo, Japan 3) Division of Obstetrics and Gynecology, Nagano Red Cross Hospital, Nagano, Japan 4 ) Department of Obstetrics and Gynecology, Toyama Medical and Pharmaceutical University, Toyama, Japan

Abstract The number of ovarian cystadenoma of low potential malignancy (abbreviation: LPM) was 31 (5.7%) among common epithelial tumors [benign cystadenoma=400 (74.0%), carcinoma= 110 (20.3%)]. Their mean ages, bilaterality, frequency of ascites and nulligravidity were situated intermediately between those of benign cystadenoma and carcinoma. Abdominal tumor, distention, pain and metromenorrhagia were the main symptoms, although gastrointestinal complaints were rare in LPM cystadenoma. With LPM cystadenoma, 19 (61.3%) patients were at stage I, 7 (22.6%) at stage 11 and 5 (16.1%) at stage 111, but with carcinoma, 44 (40.0%) were at stage 111-IV [33 (30.0%) at stage I, and 31 (28.2%) at stage 111. The 5-year actuarial survival rate was 90% for LPM cystadenoma, but 43% for carcinoma. These results suggest that the clinical and biological features as well as the histological definition of LPM cystadenoma are situated i n t e ~ e d i a t e l ybetween those of benign cystadenoma and carcinoma.

Key words: common epithelia1ovarian tumor, ovarian benign cystadenoma, ovarian cystadenoma of low potential malignancy, ovarian carcinoma, clinicostatistics

Introduction Early detection is of utmost importance in the treatment of cancer patients. As the uterine cervix is easily accessible and the cervical neoplasm has been thought to develop through intraepi~elialdysplasia and carcinoma ir.i sits to

frankly invasive carcinoma, therapeutic procedure in the early stage is possible and so its prognosis has been improved.l) However, although the incidence of ovarian carcinoma is increasing both in Japan,2) and in North America and Europe?) its prognosis has not improved over the last 20 years.'! This

Received: Jul. 10, 1990 Reprint request to: Dr. Kenji Shiromizu, Division of Gynecology, Saitama Cancer Center, 818 Komuro, Ina-machi, Kitaadachi-gun, Saitama 362, Japan

107

K. SHIRONIZU ET AL.

could be attributed to the following causes. Firstly, detection of ovarian carcinoma in the earlier stages is difficult because of its intraperitoneal spread. Secondly, although ovarian dysplasia has been reported to be related to carcinogenesis,4) the biological characteristics of LPM cystadenoma remain to be clarified. Therefore, it is very useful in the treatment of the patients with ovarian tumors to eiucidate the clinicostatistical features of LPM cystadenoma, compared to benign cystadenoma and carcinoma. We clinicopathologi~lly analyzed 541 patients with common epithelial ovarian tumors treated at the Tokyo University Hospital from 1960 to 1979, and reviewed previously reported literature.

Patients and Methods Five hundred and forty-one patients with common epithelial ovarian tumors treated at the Tokyo University Hospital from January 1, 1960 to December 31, 1979 were analyzed clinicostatistically. Histological study was performed according to WHO histological classification~,~) serous, mucinous, endometrioid, clear cell (mesonephroid), mixed and undifferentiated. The FIG0 clinical staging systern6) was adopted for LPM cystadenoma and carcinoma. The ages of patients were those at initial diagnoses. Patients were treated by surgery, chemotherapy and/or radiation. Since this study took place before cis-platinum was avaifable, the obtainable chemotherapeutic agents were cyclophosphamide, 5-fluoro-uracil and mitomycin-C, etc. Follow-up LPM cystadenoma and carcinoma patients was per-

formed till 1984 or death. Patient survival was calculated by the Kaplan-Meier’s method, and x2 test was used for statistical analysis.

Results Patients with LPM cystadenoma accounted for 31 (5.7%) of 541 patients with common epithelial tumors [benign cystadenoma=400 (74.0%), carcinoma= 110 (20.3%)] (Table 1). The incidence of serous and mucinous LPM cystadenoma was 13 (4.5%) and 18 ( 9 . 0 ( ~ ) , respectively. The mean ages of the patients were 48.5 years for serous and 42.0 years for mucinous LPM cystadenoma. These were situated intermediately between those of benign cystadenoma (serous=38.7, mucinous=36.3) and of carcinoma (serous=51.8, mucinous=43.5, others= 52.3) (Table 2). In LPM cystadenoma and carcinoma, the number of patients under 30 years was more for mucinous tumors (9 patients, 29%) than for serous ones (3 patients, 5%). Bilaterality was 46.1% for serous LPM cystadenoma but 0% for rnucinous cases. Bilaterality was 4.6% for benign cystadenoma and 28.4% for carcinoma (Table 3). Bilaterality i n mucinous LPM cystadenoma and carcinoma was less than that in serous ones (6.5% vs. 35 .a%). Intraperitoneal fluid was found in 22.6% of patients with LPM cystadenoma (serous= 15.4%, mucinous~27.8%)with 3.8% for benign cystadenoma and 47.3% for carcinoma (Table 4). Bloody fluid was found in about 1/4 of ascites positive patients with benign and

Table 1. Histopathology of patient population Benign cystadenoma

___

Serous Mucinous Endometrioid Clear cell Mixed Undifferentiated Total ~

( ):

108

LPM cystadenoma

Carcinoma

13(4.5) 18(9.0) 0 0 0 0

47 (16.1) 13( 6.5) 12 18 5 15

291 (100.0) 200 (100.0) 12 18

llO(20.3)

541 (100.0)

231 (79.4) 169 (84.5) 0 0 0 0 400 (74.0)

31(5.7) -

percent of serous, mucinous or total cases

Total

-

...-_____

--

5

15

CYSTADENOMA OF LOW POTENTIAL MALIGNANCY

Table 2. Age distribution Age in years

~

10-19

20-29

30-39 40-49

50-59

60-69 12

Benign cystadenoma

Serous Mucinous

6 10

54 58

66 46

68 23

17 19

LPM cystadenoma

Serous Mucinous

0 1

2 4

1 3

4 3

3 5

~~~~~~

~~

Carcinoma

~

~~

~

Serous Mucinous Others

~~

~~~

5

1 2 0

0 2 0

0 7

~-

11

2 1

~

13 3 15

Mean age

70-79 2

38.7) 37.7 36.3

1

48.5) 44.7 42.0

~~~~~~

19 3 15

6 3 9

3 4

52.3

Table 3. Laterality Unilateral Bilateral Right

Left

Benign cystadenoma

Serous Mucinous

39.8 39.9

54.0 57.7

LPM cystadenoma

Serous Mucinous

38.5 44.4

15.4 55.6

"")0.0

Carcinoma

Serous Mucinous Others

46.8 53.8 36.7

21.3 30.8 34.7

28.6

6*2] 4.6 2.4 19.4

(%) Table 4. Peritoneal fluid

Benign cystadenoma LPM cystadenoma Carcinoma ( ):

Present

Bloody

>500 ml

15( 3.8) 7(22.6) 52 (47.3)

4 2 25

1 1 25

percent

LPM cystadenomas, but in about half of positive patients with carcinoma. Over 500 ml was found in almost 50% of ascites positive patients with carcinoma, but only in 6.7% of benign cystadenoma and 14.3% of LPM cystadenoma, respectively. In serous LPM cystadenoma, about onehalf of the tumors were smaller than fetal head size ($+11 cm), but in mucinous ones all tumors were larger than fist size ($+9 cm) (Table 5). More than 50% of tumors were distributed in size from goose-egg size ($+7 cm) to fetal head size in serous, and from fist size

to man-head size ($+15 cm) in mucinous benign cystadenoma. With carcinoma, 50-70y0 of tumors ranged from goose-egg to fetal head size. With LPM cystadenoma or carcinoma, the incidence of tumors larger than fetal head size were more for mucinous types than serous types (p

Clinicostatistical study of low potential malignancy ovarian cystadenoma (borderline cases).

The number of ovarian cystadenoma of low potential malignancy (abbreviation: LPM) was 31 (5.7%) among common epithelial tumors [benign cystadenoma = 4...
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