This document provides information on ovarian tumors, including normal ovarian anatomy and function, differential diagnosis of adnexal masses, classification of ovarian neoplasms, clinical presentation, evaluation, and management of ovarian cysts and masses. Key points include:
- Ovarian cysts are a common finding and are usually benign functional cysts.
- Evaluation involves ultrasound, tumor markers like CA-125 and HE4, and risk of malignancy algorithms.
- Management depends on factors like size, symptoms, and patient age/menopausal status.
- Ovarian neoplasms include functional, inflammatory, and neoplastic tumors and are classified based on histology.
- Borderline ovarian tumors have
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Presentation about the the second most common type of ovarian tumors which have a very unique property of being similar to the testicular germ cell tumors.
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. NORMAL OVARIES
• Normal size 5 x 3 x 3cm
• Variation in dimensions can result from
– Endogenous hormonal production(varies with age
and menstrual cycle)
– Exogenous substances, including OCs, GnRH
agonists, or ovulation-inducing medication, may
affect size
3.
4. DIFFERENTIAL DIAGNOSIS OF ADNEXAL MASS
ORGAN CYSTIC SOLID
OVARY Functional cyst, Neoplastic cyst,
Benign, Malignant, Endometriosis
Neoplasm
Benign
Malignant
FALLOPIAN TUBES Tubo-ovarian abscess
Hydrosalpinx
Paraovarian cyst
Tubo-ovarian abscess
Ectopic pregnancy
Neoplasm
UTERUS Intrauterine pregnancy in a bicornuate
uterus
Pedunculated or
inteligamentous myoma
BOWEL Sigmoid or caecum distended with gas
or feces
Diverticulitis, Ileitis,
Appendicitis, Colonic cancer
MISCELLANEOUS Distended bladder, Pelvic kidney,
Urachal cyst
Abdominal wall hematoma or
abscess, retroperitoneal
5. Lifetime Risk of ovarian neoplasm
• A woman has 5–10% lifetime risk of
undergoing surgery for a suspected ovarian
neoplasm and
• 13–21% of these will be found to be have an
ovarian malignancy
8. Functional ovarian cysts
• Follicular cysts
• Corpus luteum cysts
• Theca lutein cysts
• Luteomas of pregnancy
By far the most common clinically detectable
enlargements of the ovary in the reproductive years.
All are benign and usually asymptomatic.
12. II. Sex cord tumors:
• Granulosa-stromal cell tumors, theca cell
tumors
• Androblastomas
• Gynandroblastomas
• Unclassified
13. III. Lipid cell tumors
IV. Germ cell tumors:
• Dysgerminoma
• Endodermal sinus tumor
• Embryonal ca.
• Polyembryoma
• Choriocarcinoma
• Teratoma
• Mixed
14. V. Gonadoblastomas:
• Pure
• Mixed
VI. Soft tissue tumors (not specific to ovary)
VII. Unclassified tumors
VIII. Secondary tumors
IX. Tumor-like conditions
17. CLINICAL PRESENTATION
• Asymptomatic – accidentally discovered on USG
• Chronic pattern of pain, increasing abdominal girth over months or weeks.
• Associated with secondary symptoms of anorexia, nausea, vomiting,
urinary frequency.
• Could be associated with primary or secondary amenorrhea, menstrual
irregularities, virilization, precocious puberty
• Become acutely symptomatic if undergoes torsion, rupture or
haemorrhage.
Benign ovarian neoplasms are indistinguishable clinically from malignant
counterparts
19. PHYSICAL EXAMINATION
• Abdominal and vaginal examination and the
presence or absence of local lymphadenopathy
• Assess
– Laterality
– Cystic Vs solid
– Mobile Vs fixed
– Smooth Vs irregular
– Ascites
– Cul-de-sac nodules
– Rapid growth rate
20. TVS
• Pattern recognition is superior to all other scores.
• Subjective evaluation of ovarian masses based on pattern
recognition can achieve sensitivity of 88% to 100% and specificity of
62% to 96%.
• Adding doppler does not seem to yield much improvement in the
diagnostic precision, but increases the confidence with which a
correct diagnosis of benignity or malignancy is made.
21. DOPPLER EVALUATION
• Hypoxic tissue in tumors recruit low-resistance, high-flow blood
vessels
• Role in evaluating ovarian mass is controversial – as the ranges of
values of RI,PI,MSV between benign and malignant masses overlap.
PI<1, RI<0.4
• To overcome this, vascular sampling of suspicious areas (papillary
projections, solid areas, thick septations) using both 3D USG and
power doppler both has been evaluated and found effective.
• “Chaotic” vascular pattern in malignancy
22. OTHER IMAGING MODALITIES
• CT, MRI, PET not recommended in the initial evaluation
• CT scan: evaluating
– LN involvement,
– Omental mets, peritoneal deposits, hepatic mets,
– obstructive uropathy
– or a probable alternate primary site when cancer is suspected based
upon TVS
• MRI : differentiating non adnexal pelvic masses (like leiomyomata),
expensive and inconvenient.
• ACOG GUIDELINES 2007
25. SENSITIVITY SPECIFICITY PPV NPV
61-90% 71-93% 35-91% 67-90%
CA-
125
Most useful when non-mucinous epithelial cancers are present
Elevated in 80% of patients with epithelial ovarian Ca but only in 50% of patients
with stage I disease
Increased sensitivity in post menopausal women esp. when associated with
relevant clinical and USG findings
Cut-off of 30 u/ml, sensitivity of 81% and specificity of 75%
26. HE4
• HE4 is a precursor to the epididymal secretory protein E4 and in normal
ovarian tissue, there is minimal gene expression and production of HE4.
• As a single tumor marker, HE4 had the highest sensitivity for detecting
ovarian cancer, especially Stage I disease.
• Combined CA125 and HE4 is a more accurate predictor of malignancy
than either alone or to any other dual combination of markers
• HE4 levels(>70 pM) were found to be elevated in over half of the patients
with ovarian cancer with normal serum CA125 levels (>35 U/ml)
• HE4 when studied in the premenopausal group of patients was able to
discriminate benign tumors from malignancies
Moore et al. / Gynecologic Oncology, 2008
27. NEW SCORES
• ROMA: Risk of Ovarian Malignancy Algorithm
The dual marker algorithm utilizing HE4 and CA125 to calculate a ROMA value
In patients with stage I and II disease, ROMA achieved a sensitivity of 85.3% compared
with 64.7% for RMI
MOORE ET AL, AJOG 2010
• OVA 1:
FDA approved. Combination of 5 immunoassays
CA 125, transthyrettin, apo lipoprotein A1, transferrin, B2 microglobulin
Sensitivity : 93%, specificity: 43% PPV 42% NPV 93%
COMMUN ONCOL, 2010
28. Asymptomatic simple cysts
<5cms Likely physiological
(do not require follow up)
5-7 cms Yearly USG
>7cm Require further
imaging/surgical intervention.
RCOG 2011
29. Ovarian mass in reproductive age group
<5 cms. >/= 5 cms
USG USG
cystic
observation
Complex,
solid,
suspicious
Persistence or progression
surgery
30. Ovarian mass in childhood:
History and physical examination
Appr. Imaging studies
Simple cyst
- Observe and reassess
Solid or solid cystic
MRI and tumor markers
High suspicion
of malignancy
Low suspicion
of malignancy
Laparotomy laparoscopy
Frozen section
Malignant –
oophorectomy
and staging
Benign - cystectomy
31. Ovarian cysts in postmenopausal women:
• Post menopausal gonad atrophies to a size of
1.5 X 1 X 0.5cm on average
• Shouldn’t be palpable on pelvic examination.
• Presence of palpable ovary must alert the
possibility of an underlying malignancy.
32. • Incidence in asymptomatic post menopausal
women –
1.5% by pelvic examination
3.3% to 14.5% by USG.
obstet gynecol survey, 2002
• Causes -10% functional
90% neoplastic (either benign or malignant)
33. ASSESSMENT
• It is recommended that ovarian cysts in postmenopausal women
should be assessed using CA125 and transvaginal grey scale
sonography.
• There is no routine role yet for Doppler, MRI, CT or PET.
RCOG 2010
SENSITIVITY SPECIFICITY
TVS 89% 73%
CA 125 81% 75%
34.
35.
36. RCOG
• Simple, unilateral, unilocular ovarian cysts, less than 5 cm in diameter, have a
low risk of malignancy. It is recommended that, in the presence of a normal
serum CA125 levels, they be managed conservatively.
• Aspiration is not recommended for the management of ovarian cysts in
postmenopausal women.
• It is recommended that a ‘risk of malignancy index’ should be used to select
women for laparoscopic surgery, to be undertaken by a suitably qualified
surgeon.
• It is recommended that laparoscopic management of ovarian cysts in
postmenopausal women should involve oophorectomy (usually bilateral)
rather than cystectomy.
38. They were not separately classified by the FIGO and the
WHO until the early 1970s.
• Borderline tumors make up approximately 15% of all
epithelial ovarian tumors.
• The mean age of occurrence is approximately 10 years
younger than that of women with frankly malignant
ovarian cancer.
39. Tumour subtypes
• 2 major histological tumor subtypes
– Serous(50%)
• (bilateral in 30%)
• Could be associated with extraovarian lesion : implants(35%)
– Mucinous (46%)
• Mucinous tumors do not have a clearly defined origin.
– Substantial information indicates that many tumors may
actually originate from the appendix; thus, this organ should
be removed at the time of surgery.
40.
41. Histology and Cytology
• According to Dietel and Hauptmann, the histology of borderline
tumors is characterized by the following features:
– Epithelial multi-layering of more than 4 cell layers
– Not more than 4 mitoses per 10 high-power field (HPF)
– Mild nuclear atypia
– Increase in nuclear/cytoplasmic ratio
– Slight to complex branching of epithelial papillae and pseudopapillae
– Epithelial budding and cell detachment into the lumen
– No destructive stromal invasion - A major component in
differentiating malignant from borderline tumors
42. TUMOR STAGING
• Comprehensive staging : of significant
prognostic value and is performed surgically
• Borderline ovarian tumors are staged
according to the FIGO classification of ovarian
cancer.
43. International Federation Of Obstetrics And
Gynecology (FIGO) staging
FIGO stage Definition
I Tumor confined to the ovary
II Peritoneal implants within the pelvis
III Peritoneal implants beyond the pelvis,
Positive lymph nodes, or both
IV Liver parenchyma involvement, or tumor
beyond the peritoneal cavity
Using these rules the reported sensitivity was 95%, specificity 91%, positive
likelihood ratio of 10.37 and negative likelihood ratio of 0.06.
The morphology index (MI) presently used in the University of Kentucky Ovarian Cancer Screening Trial was published initially by Ueland and colleagues and is illustrated in Figure 49.3. Both morphologic complexity and tumor volume, as calculated by the prolate ellipsoid formula, were related directly to the risk of malignancy
Morphologic abnormalities were easy to categorize, and interobserver variation was minimal. Risk of malignancy varied from 0.3% in ovarian tumors with a MI of <5 to 84% in tumors with a MI >=8. Using a MI >=5 as indicative of malignancy, the following statistical parameters were observed: sensitivity 0.981, specificity 0.808, PPV 0.409, and NPV 0.997. Therefore, morphologic indexing is a relatively accurate and cost-effective method to predict risk of malignancy in an ovarian tumor.
Wenever possible conservative or minimally invasive surgery is preferred to preserve endocrine and reproductive function.
BOTs form a separate entity within the group of ovarian tumours
BOTs can be divided according to their epithelial characteristics as serous (50%),mucinous (46%), and mixed, endometrioid, clear cell, or Brenner tumors (3.9%). Serous BOTs are bilateral in 30% of patients and can be associated with extraovarian lesions (so-called implants) in 35%. These implants can be invasive or noninvasive depending on their microscopic appearance, which will in turn influence therapeutic options. Mucinous BOTs are classified as intestinal (85%) or endocervical/Mullerian type (15%) depending on the nature of the epithelial lining. They can be associated with pseudomyxoma peritonei (10%), necessitating a thorough investigation of the GI tract with special attention to the appendix because this
can be the primary tumor origin.
Presenting symptoms of borderline ovarian tumors
Borderline tumors, as with other ovarian tumors, are difficult to detect clinically until they are advanced in size or stage. In one study, the most common presenting symptoms were abdominal pain, increasing girth or abdominal distention, and abdominal mass. Approximately 23% of patients were asymptomatic.
Without comprehensive surgical staging, the prognosis for an individual patient is difficult to predict.
Many clinicians group stages II-IV together for prognostic consideration.
Important component is description of the type of implants, as these have significant prognostic value.
Preoperatively, borderline tumors are often presumed to be either benign or malignant ovarian masses; however, as with other ovarian masses, staging is performed surgically. Many sources recommend complete staging if a borderline tumor is found. Current guidelines include biopsy specimens of the pelvic peritoneum (cul-de-sac, pelvic wall, and bladder peritoneum), abdominal peritoneum (paracolic gutters and diaphragmatic surfaces), omentum, intestinal serosa and mesentery, and retroperitoneal lymph nodes (pelvic and para-aortic).
Surgical removal of BOTs is the cornerstone in the management of BOTs, but a lot of debate exists on the extent of the staging procedure and the surgical approach. Lately, the use of laparoscopy and conservative surgery, which is defined as surgery with complete staging but with
preservation of the uterus and at least part of one ovary (Fig 1), is gaining popularity. However, the question arises about whether this management is appropriate or whether we should be more cautious.