Clinical Characteristics

Women with borderline ovarian tumors typically present with pelvic pain and/or a mass that is found incidentally on examination or while imaging for another cause. One study found that pelvic pain was the most common presenting symptom in 39% of patients followed by abdominal distention in 25%; ovarian torsion or hemorrhage may also occur.21 The typical size of a borderline tumor ranges from 7 to 9 cm13,22-24 (Fig. 11-1A). Imaging with ultrasound most often identifies an ovarian cyst, which may include other abnormalities including septations or solid components. Gotleib and associates23 combined their institution's experience with borderline tumors with 11 other studies and found that ultrasound revealed simple cysts in about 9% of patients (17 of 174 patients reported) and septa, solid components, or papillations in 88% (153 of 174). There is no diagnostic imaging modality that is definitive for borderline tumors.

Serum CA-125 measurements are often elevated in borderline tumors and are more commonly increased in serous than in mucinous tumors. Many studies have evaluated the percentage of patients with borderline tumors with elevated CA-125 and found ranges between 24% and 75%.17,22-26 Other tumor markers such as CEA and CA-19-9 have also been evaluated with conflicting results, but these markers

Figure 11-1. A, Gross picture of borderline ovarian tumor. B, Micrograph of serous borderline tumor (hematoxylin & eosin, x400). (B, Courtesy of Dr. Kristen Atkins, Department of Pathology, University of Virginia Health System.)

Figure 11-1. A, Gross picture of borderline ovarian tumor. B, Micrograph of serous borderline tumor (hematoxylin & eosin, x400). (B, Courtesy of Dr. Kristen Atkins, Department of Pathology, University of Virginia Health System.)

may be more useful for mucinous borderline tumors.17,25 26 If elevated, these markers can be used for surveillance.

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