Pathologic findings in eight cases of ovarian serous borderline tumors, three with foci of serous carcinoma, that preceded death or morbidity from invasive carcinoma

We sought to assess the frequency of previously reported adverse histopatho logic findings in ovarian serous borderline tumors (SBTs) in cases that pre ceded a patient's death or caused serious morbidity due to invasive carcino ma. SBTs with foci of invasive carcinoma that occupied a minority of the tu mor and were associated with similar outcomes were also studied for potenti al additional insights. Eight cases were found over a 22-year period. Ten t umors in 5 patients were purely SBT; at initial staging, 1 patient had inva sive peritoneal implants; 3 had noninvasive peritoneal implants; 1 was stag e 1. At last follow-up 3 of the 5 patients had died of carcinoma, 1 was ali ve with carcinoma, and 1 had no clinical evidence of disease 4 years after a sigmoid colectomy for invasive serous carcinoma of the bowel wall. Four t umors in 3 patients had foci of invasion that were more than microinvasive; at initial staging, all 3 patients had invasive peritoneal implants, and a ll died of carcinoma. All 14 of the ovarian tumors in the 8 cases had surfa ce involvement by tumor cells, and in 8 tumors in 5 cases they were confine d primarily to the ovarian surface. Foci of "micropapillary serous carcinom a" accompanied more obvious areas of infiltrative carcinoma in 2 of the 4 o varian tumors, the peritoneal implants in 1 of the cases with purely SBTs, and a recurrence in this case and 1 other case. No morphologic finding in t he 10 purely SBTs was predictive of subsequent malignant behavior. We concl ude that extraovarian invasive serous carcinomas, either following or concu rrent with an ovarian SBT, develop from borderline foci that may originate in the ovary, but frequently are likely to have arisen independently in the peritoneum. The carcinomas may be preceded or accompanied by noninvasive-a ppearing micropapillary foci in the peritoneum in some cases, but micropapi llary foci in the ovarian tumors are infrequent and not a necessary anteced ent.