Filly's 15th Law
I can’t quite figure out what pathologists mean by “borderline ovarian cancer,” but I do know that it is unrelated to gross pathology. Because I am a “gross pathologist” by trade, I don’t over think the possibility that the lesion I am looking at is somewhere in the “borderland.”
I lied a bit. I do know how pathologists define these neoplasms, but the key point is that the pathologic observations are all at the microscopic level. Borderline tumors of the ovary are more frequently termed "low malignant potential ovarian tumors." In the literature you will find these neoplasms referred to by a variety of terms, including: borderline, atypical proliferative, as well as tumors of low malignant potential. Borderline neoplasm is currently the most widely used designation by pathologists, gynecologists, and oncologists, and has been adopted into the World Health Organization classification
You will definitely “deal” with this problem, as borderline tumors are relatively common accounting for 14 to 15 percent of all primary ovarian neoplasms.
I have always tried to concentrate on the diagnoses that I can make and eschew those that I cannot. I know that my ability to diagnosis an ovarian mass as “benign” is much better than my ability to diagnose an ovarian mass as “malignant.”
I can predict with near certainty that a lesion is benign if it is a unilocular, thin-walled, anechoic cyst < 10 cm. in a premenopausal woman or less than 5 cm. in a postmenopausal woman. Any unilocular cyst with hemorrhage in it is benign. If I observe old blood in a unilocular cyst (or even on with one or two thin septations) I am confident that it is benign. Indeed, any relatively thin-walled, anechoic cyst with one or two septations is virtually always benign. And one can add to the list any mass containing high amplitude regional echoes that cast an acoustic shadow. (It would be good to review my lecture on ovarian masses with an emphasis on benign lesions.)
However, outside of the above lesions, it becomes very difficult to be certain that an ovarian lesion is not malignant. That is why any lesion that is not unequivocally benign must be viewed with suspicion. Sonography is only approximately 75% accurate when predicting malignancy and virtually all errors are “overcalls” of benign lesions as malignant.
You reports should usually conclude:
- The lesion is almost certainly benign.
- The lesion has a high probability of benignancy.
- The lesion contains material that could be blood products. Recommend follow-up.
- The lesion shows features that could indicate malignancy.
- The lesion is very likely malignant.