MANAGEMENT OF EPITHELIAL OVARIAN-TUMORS OF LOW MALIGNANT POTENTIAL

The distinct pathologic and biologic nature of ovarian tumors of low m alignant potential (LMP) has been officially recognized by FIGO and th e World Health Organization. LMP tumors may comprise 10% of ovarian ne oplasms; they occur at a mean age of 40 years. Pregnancy, breast-feedi ng, and the use of oral contraceptives are protective against the deve lopment of tumors of LMP. A history of infertility and use of infertil ity drugs appear to increase the risk of these tumors. No association with hereditary ovarian cancer syndromes has been reported. The surviv al associated with these tumors is 99% at mean follow-up of 7 years fo r patients with stage I disease, and 92% for those with stage II and I I disease. Retrospectively, more patients appear to have died from com plications associated with adjuvant therapy than from progressive dise ase. The recommended treatment is surgical, consisting of total abdomi nal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aor tic lymph node biopsies, peritoneal washings, and tumor debulking. In young patients with early-stage disease, conservative surgery, preserv ing the uterus and contralateral ovary, is acceptable. A role has not yet been established for adjuvant therapy, whether radiotherapy or che motherapy. Laboratory investigations have not demonstrated that these tumors represent an intermediate step between benign ovarian tumors an d carcinoma nor have they identified that small subset of tumors with aggressive clinical behavior. We should perhaps consider tumors of LMP in the same light as ''benign'' proliferative gynecologic conditions, such as endometriosis and leiomyomata. (C) 1994 Academic Press, Inc.