TUMOR RECURRENCE IN STAGE-I OVARIAN SEROUS NEOPLASMS OF LOW MALIGNANTPOTENTIAL

Eleven patients treated at the University of Texas M. D. Anderson Canc er Center for recurrent disease after resection of a stage I ovarian s erous neoplasm of low malignant potential (SNLMP) are reported. At the time of diagnosis, the age of the patients ranged from 26 to 43 years (mean 33). Seven patients had stage IB tumors and 4 had stage IA tumo rs. All patients were treated with a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The size of the ovarian tumors ranged from 4 to 15 cm in maximum dimension. Stromal microinvasion was seen in 2 cases, and foci of endosalpingiosis were seen in the peritoneum i n 8 cases. Nine patients were treated with radiotherapy and 2 with che motherapy, The time to recurrent disease ranged from 7 to 39 years (me an 16). Eight tumors recurred in the pelvis or abdomen, 2 in the neck with subsequent abdominal involvement, and 1 in the pleura without abd ominal or pelvic involvement. In 10 cases, the recurrent tumors were s erous carcinoma, and in 1 case it was a SNLMP. Recurrences were treate d with chemotherapy in 10 cases and with hormones in 1 case. Seven pat ients died of progressive serous carcinoma 2 to 5 years after the recu rrence. One patient died of leukemia with recurrent ovarian tumor 10 y ears after the recurrence was detected. Two patients are alive with pr ogressive disease 1 and 7 years after the recurrence, and 1 patient wh ose disease recurred as a SNLMP is alive with no evidence of disease 9 years after the recurrence. These 11 patients were compared with 16 p atients who had stage I ovarian SNLMPs that did not recur after a mini mum follow-up of 15 years. There was no difference in the age of the p atients, gravidity, size of the tumors, or several microscopic paramet ers, including degree of epithelial proliferation, number of mitoses, and nuclear atypia, Microinvasion was found in one case. The only sign ificant difference between the two groups was the low frequency of end osalpingiosis in the cases that had no disease recurrences (12.5% vers us 72.7%), In summary, we found no clinical or pathologic features tha t can unequivocally predict the recurrence of stage I ovarian SNLMPs. Because of the long interval to recurrence, the fact that the recurren t tumors in 10 of II patients were serous carcinomas, and the result o f the X-chromosome inactivation in one case, the recurrent tumors coul d represent independent primaries or a slow progression of one clone p resent in the SNLMPs.