Borderline Papillary Serous Tumor

[Alchemy_42]

Hi Dr,

Last time I posted, you helped me make a decision on time of surgery - thanks again

History: 42 year old - finished childbearing, not a pill user, one twin pregnancy

Over 1 1/2 years left ovarian cyst appeared simple at first, then complex with a small solid component.  Over the course of a year went from 4.5x3.4x3.2cm to 4.5x4.0x6.0 cm with a small solid component, tumour markers normal, no free fluid as well as all other indicators (gyn thought benign).  I had symptoms of fullness, distended stomach, decreased appetite, abnormal bleeding & I still feel bloated post laproscopy.

Oct 07 laproscopic results:

Left salipingo-oophorectomy (collapsed & removed via bag).

Fallopean tube had no pathological diagnosis/unremarkable.  

Left ovary path from frozen and final section was a borderline papillary serous tumor.  Described 5.0x3.5x1.5 cm, upon further section, an irregular firm, granular, yellow area is present attached to inner surface and measures 1.8 cm.

Endometrial curretttings = inactive endometrium and specimen consists of 1.5 cc of brown granular material.

Visually gyn (busy teaching hospital) said took a good visual look around and nothing else apppeared abnormal.

Present:

I am in process of being booked for Total hysterectomy and staging (Jan/Feb).

Questions:
Does any of the details above (size, description, symptoms, results) indicate an increased/decreased chance of having invasive implants?
Is micropapillary same as papillary when I am doing research?
Staging for LMP confuses me - some say the classification is 0, some say 1 (like frank ovca) - do you have a good reference link for this?

Thank you for your help!

[Annekathryn Goodman, M.D.]

Hi There,
It sounds like you are in good hands. You have also done some good research. most borderline tumors are stage I. there is nothing about your report that suggests anything more. but ultimately one does not know until surgery is done. please let us know how things go.
best wishes

[Alchemy_42]

Upon further research today,  a better description of my upcoming surgery would be classified as a "radical hysterectomy" and staging rather than the previously stated "total hysterectomy".

[Casey06]

Hi..I too had LMP this year, removed in August by gyn onc who did full staging (removed uterus, ovaries, tubes, appendix, sampled lynph nodes and omentum).

He said it was Stage 1A (confined to one ovary) Grade 0 (this is the LMP part)

Is a gyn onc doing you next surgery...you should have.

Good luck and keep in touch...sorry about LMP.

[Alchemy_42]

Hi,

Thanks for your reply Casey - sounds like your results were optimal!  That must have been a relief - I'm hoping mine are as good.

If you got your appendix removed you likely had the mucinous type?  They are also removing my cervix - don't know if that is standard or not?......another question - they seem to be neverending!   : )

And yes, a gyn onc is doing the next surgery.  First one was a gyn only - I didn't have a choice in having a gyn onc since all indicators were that it was benign, which unfortunately was not the case.  Did you also have to get two surgeries?  

Thanks for your support!

[Alchemy_42]

Thanks Dr for your reply,

If you hapen to look at follow up post - 2 questions that I still have:

Is removing cervix standard/necessary?
Is micropapillary same as papillary?
(my dx is borderline "papillary" serous tumour)

Thanks again - and yes, I will let you and forum know the results when I get them.

[Alchemy_42]

Me again  - does anyone know whether it is a bad sign for invasive implants that I still feel bloated and have a distended stomach even after my first surgery when they took out the one ovary and tube?

[chelan3]

Micropapillary and papillary are two different types. MPSC (micropapillary) is a more invasive and aggressive type of borderline ovarian cancer.  Papillary is the least aggressive of the borderline ovca it's also called LMP (low malignant potential).  I had LMP stage 1 diag in 2002, I had a TAH followed by 5 years of follow-ups (appt every 6 mos and a yearly CT scan) and have a clean bill of health now.  I had a second opinion done on my pathology as borderline ovca is a tricky pathology.  You might want to get that done to be on the safe side.  
Take care.  
Debbie

[Alchemy_42]

Thank you for your explanation about the micropillary - that helps and sounds familiar from my readings....

Good to hear that you have a clean bill of health after your follow up - that must be a relief.

I assume that you mean to get a second opinion after my hysterectomy?   I believe my hospital treats each path case with a panel of experts and does the analysis from there.

A couple of questions for you:

I've never had a CT for my ovarian problems and nothing has been mentioned in the future about that.  At what stages in your diagnosis did you get it done?

How was the surgical menopause for you?  Any hints/things to be prepared for?

Your diagnosis was Stage 1 - so no implants were found and only affected one ovary?   I hope that I am so lucky!

Thanks again.

[chelan3]

I was diag with a large complex cyst which drs believed was benign.  The radiologist who did u/s was more suspicious and I KNEW something was seriously wrong.  Because my complex cyst was large 6 to 7 cm it had to come out.  They planned to do a laproscope and change to laprotomy if necessary.  I insisted on a frozen section pathology.  They had to switch to a laprotomy because the cyst had grown into fallipian tube, they still thought everything was benign they even closed me up before frozen section came back.  It came back borderline ovca.  The final pathology came back the same - the dr suggested a second opinion from a gynologist pathologist.  Thankfully it also came back Stage 1 Borderline OVCA.  They didn't do a hysterectomy at first surgery (I was 33) and recommended one within a few years.  I opted to have it 2 yrs later.  At every 2nd gyn appt he arranged for a CT "just to be safe".  I didn't have a CT before that.  Cyst was found by ultrasound.  I was concerned about estrogren as some ovca can be estrogen positive so I refused to take estrogren therapy.  My drs were NOT pleased, but I was adamant that I wouldn't take it.  I've overweight which means estrogen stores in fat cells.  I must have had a enough in my fat cells as I have had no real problems with surgical menapause.  Although I do seem to be in the minority with that.  Each person is different.  I did see a women's health specialist at the insistance of my sis-in-law, dr wanted me on a high dose of estrogen!  My gyn just wanted me on the lowest dose possible.  My family dr said if you're not affected by it you don't need it then.  I agreed.   Good Luck with your surgery.  Let us know how you make out.

[chelan3]

Also wanted to mention a good website for women having hysterectomies.  It's hystersisters.com - check it out.