Ultraconservative, Fertility Sparing Treatment of Bilateral Borderline Ovarian Tumors: A Case Report of a 26-Year-Old, 0-Gravida with an Endometrioid Borderline Ovarian Tumor of the Right Ovary and a Sero-Mucinous Borderline Ovarian Tumor of the Left Ovary and a Review of the Literature

Abstract

Endometrioid borderline ovarian tumors are rare, entailing a lack of data on their natural history as well as the safety of conservative and ultraconservative surgical management, especially in cases with bilateral borderline ovarian tumors including one of endometrioid differentiation. Therefore, we present such a case and provide a review of the literature on endometrioid borderline ovarian tumors. We report the case of a 26-year-old, 0-gravida with an endometrioid borderline ovarian tumor of the right and a sero-mucinous borderline ovarian tumor of the left ovary treated by fertility sparing, ultraconservative surgery with bilateral cystectomy, completed by staging procedures including omentectomy and peritoneal sampling, as well as endometrial sampling by means of curettage. Reviewing the literature and taking into account the course of our case, we propose the feasibility of an ultraconservative management, including endometrial sampling, in young patients with bilateral borderline ovarian tumors including one of endometrioid differentiation who desire to preserve fertility, followed by a closely monitored follow-up.

Keywords: bilateral borderline ovarian tumor; bilateral cystectomy; endometrioid borderline ovarian tumor; fertility sparing surgery; ultraconservative treatment.

Figure 1

Sonographic findings of 03/2018: possible, small endometriotic lesions in the (A) right (yellow arrow) and (B) left (green arrows) ovaries.

Figure 2

Sonographic findings of 11/2018: (A and B) large, septated cystic lesion with mostly ground glass echogenic content and signs of fresh hemorrhages in the right ovary; (C and D) left ovary with endometrioma-like cystic lesions with ground glass echogenic content with a possible papillary structure in one of them (yellow arrow).

Figure 3

Intraoperative findings 11/2018: (A) chocolate like fluid spilling from the endometriotic cyst of the right ovary; (B) papillary structures found lining the bottom of the endometriotic cyst.

Figure 4

Histological findings of the endometrioid borderline ovarian tumor (eBOT): (A) overview including the ovarian capsule; (B) transition from the endometriotic cyst wall (green arrow) to the proliferated part with borderline malignancy (yellow arrow); (C) section with proliferated part; (D) detailed view with mitotic figures (red arrows).

Figure 5

Ultrasound study of the left ovary 4 weeks postoperatively showing progressive enlargement of the ovary itself as well as the cystic structures. (A) the left ovary now measures 64 mm in the maximum diameter (in the previous exam it measured 51 mm, see Figure 2) with cystic lesions with ground glass echogenic content, suggestive of endometriomas; (B) no blood flow is detected within the cystic lesions; (C) in the center of the left ovary a solid part can be distinguished; (D) the solid center shows no increased vascularization (yellow arrow).

Figure 6

Intraoperative findings 01/2019: (A and B) show the intraoperative appearance of the left ovary, with the impression of cystic enlargement and induration on palpation; (C) shows the right ovary after cystectomy 2 months earlier; (D) shows the greater omentum.

Figure 7

Selection process for the literature used for review and discussion.