Key Points

Most borderline tumors are stage I/II, with survival rate approaching 100%. Borderline tumors can recur locally even after an extended disease-free interval. Microinvasion, advanced stage, and micropapillary histology are associated with increased ovarian cancer recurrence rates.

Even with advanced disease, adjuvant therapy has not been shown to improve survival in borderline tumors.

Sex cord-stromal tumors are hormonally active tumors and may manifest as symptoms of either estrogen or androgen excess.

Primary treatment for sex cord-stromal tumors is surgical and may include postoperative adjuvant chemotherapy (either combination bleomycin/etoposide/cisplatin [BEP] or taxane/platinum) for high-risk or advanced stages of disease.

Granulosa cell tumors account for 70% to 80% of sex cord-stromal tumors. Most sex cord-stromal tumors are diagnosed at an early stage and have a favorable prognosis. Dysgerminomas are the most common type of germ cell tumor, followed by immature teratomas and endodermal sinus tumors.

Peak incidence of ovarian germ cell tumors is from 15 to 19 years of age, and dysgerminomas are frequently diagnosed during pregnancy. Diagnosis requires a comprehensive workup, including tumor markers: a-fetoprotein, P-human chorionic gonadotropin, and lactate dehydrogenase. Initial management of germ cell tumors is surgical, with fertility-sparing surgery being preferred except in the case of dysgenetic gonads.

Adjuvant chemotherapy for germ cell tumors is BEP. Rates of cure approach 95%, and long-term outcomes with regard to ovarian function are favorable.

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