Borderline Tid bits

Question 1

What % of a cystadenoma needs to have a borderline change in order to be classified as a BOT?

Answer 1

10%

Question 2

What size does an invasive component need to be in a BOT in order for microinvasion to be diagnosed?

Answer 2

Micro invasive foci are often surrounded by retraction spaces and a stroma rich in fibroblasts and cannot exceed 5 mm in the largest linear dimension. Need to be < 5mm.

Question 3

Define microinvasion in BOT.

Answer 3

Isolated rounded eosinophilic cells or cell clusters within the stroma, with a cytomorphology resembling the epithelial cells lining the surface of the papillae.

Question 4

Difference between microinvasion and LGSC?

Answer 4

Solid nests or cribriform glands cytologically resembling low-grade serous carcinoma are now designated LGSC regardless of their size. These were previously also classified as microinvasion when measuring <5 mm.

Question 5

Define a SBOT

Answer 5

Serous borderline tumour (SBT) is a non-invasive, low-grade, proliferative serous epithelial neoplasm.

Question 6

What % of SBOT are bilateral and bilaterality is more common in which type?

Answer 6

Bilateral in ~ 1/3 of cases
More common in micropapillary / cribiform type.

Question 7

How does the micropapillary variant differ histologically

Answer 7

The micropapillary/cribriform subtype has
- elongated micropapillae without stromal cores (at least 5 times longer than wide) that
- directly emanate from large papillae (the so-called Medusa head appearance) and/or
- small punched-out cribriform spaces.

Question 8

After cystectomy for a SBOT what is the likelihood of recurrence in that ovary?

Answer 8

10 - 40 % in retrospective studies

Question 9

What is the risk of invasive Ca a BOT recurrence?

Answer 9

2 - 3%

Question 10

Does the recommendation for fertility sparing surgery change in the presence of invasive implants?

Answer 10

Yes - “conservative mx should be used with caution in this setting”

Question 11

GCIG CA125 - What is defined as a response to treatment

Answer 11

> 50% reduction from pre-treatment sample. confirmed with 2 samples and maintained for at least 28 days (caveats based on initial level & assay)
Date when CA125 level is reduced by 1/2 is the date of CA 125 response

Question 12

GCIG CA125 - For disease progression if the mesaureable disease is shrinking and the CA 125 is rising should the patient continue on trial meds

Answer 12

Yes - the measurable disease shrinkage takes precedence

Question 13

GCIG CA125 - For disease progression if the mesaureable disease is STABLE and the CA 125 is rising should the patient continue on trial meds

Answer 13

With stable disease and rising CA125 after 3 cycles of therapy protocol treatmen should be changed

Question 14

GCIG CA125 - with a CA125 in normal range post treatment define progression.

Answer 14

CA-125 >/= 2 x ULN on two occasions at least one week apart

Question 15

GCIG CA125 - with a CA125 that never normalises how do you define progression?

Answer 15

CA125 2 x the nadir value on two occasions at least one week apart.

Question 16

What % of all primary neoplasms are borderline tumours?

Answer 16

~15%

Question 17

Which are more common SBOT or MBT?

Answer 17

SBOT ~ 70%, MBT ~ 15% (uptodate)

Question 18

What % of patients with an BOT are <40y?

Answer 18

About 1/3

Question 19

In a meta-analysis of 120 mostly restrospective studies with an average follow up off 3 - 6 years what was the borderline recurrence rate? malignant recurrence rate and death rate? (combined USO and cystectomy)

Answer 19

Borderline recurrence 13%
malignant recurrence 1.6%
Death rate 0.5%