Introduction:
Tumors of low malignant potential (TLMP) are borderline tumors. 20 % of ovarian tumors are tumors of low malignant potential. TLMP differs from malignant tumors because there is no stromal invasion. Diagnosis of TLMP is a great challenge for pathologists. Abnormal cells form in the tissue covering the ovary. The disease usually remains in the ovaries. Most cases affect people between the ages of 15 and 29, with the average age of women with TLMP ovarian tumors being 49 years. These tumors may affect them at a young age and thus reduce their ability to have children. Low malignant potential ovarian tumors can develop in infertile women who have taken fertility medications, and women who never got pregnant may also be at higher risk. These tumors are recognized because the prognosis and treatment differ from the malignant tumors.
How to Define Tumors of Low Malignant Potential?
Tumors of low malignant potential are a heterogeneous group of neoplasms that straddle the line between benign and malignant tumors. Unlike benign tumors, which cannot invade surrounding tissues or metastasize, and malignant tumors, which aggressively invade tissues and spread to distant sites, LMP tumors exhibit characteristics that fall somewhere in between. These tumors exhibit some features of malignancy, such as cellular atypia and potential for invasion, but lack the full-blown aggressive behavior of malignant tumors.
What Is the Staging of Tumors of Low Malignant Potential?
To define ovarian low malignant potential tumors, FIGO (International Federation of Gynecology and Obstetrics) and the American Joint Committee on Cancer have assigned stages; the FIGO method is most frequently employed.
Definitions of FIGO Stage Ia:
I: Ovarian or fallopian tube tumor.
IA: No tumor on the surface of the ovary or fallopian tube; tumor confined to one ovary (capsule intact); no presence of cancerous cells in the ascites or peritoneal washings.
IB: No tumor on the surface of the ovaries or fallopian tubes; tumor restricted to both ovaries (capsules intact); no cancerous cells in the ascites or peritoneal washings.
IC: Ovaries or fallopian tubes only, with any of the following characteristics:
IC1: Surgery leak.
IC2: Before surgery, the capsule broke or a tumor on an ovary or fallopian tube surface.
Definitions of FIGO Stage IIa:
II: Pelvic extension or primary peritoneal cancer is present along with a tumor involving one or both ovaries or fallopian tubes.
IIA: Uterine extension on the uterus, fallopian tube, and ovaries.
IIB: Extension to other intraperitoneal tissues in the pelvis.
Definitions of FIGO Stage IIIa:
III: Tumor involves one or both ovaries, fallopian tubes, or primary peritoneal cancer with metastases to the retroperitoneal lymph nodes and it is cytologically or histologically confirmed that it has spread to the peritoneum outside the pelvis.
IIIA1: Only retroperitoneal lymph nodes that are positive.
IIIA1: Metastasis with a maximum diameter of 10 millimeters or less.
IIIA1: Metastasis with a maximum size of 10 millimeters.
IIIA2: Positive retroperitoneal lymph nodes with or without microscopic extrapelvic peritoneal involvement.
IIIB: Macroscopic peritoneal metastasis with or without spread to the retroperitoneal lymph nodes, with a maximum diameter of two centimeters beyond the pelvis.
IIIC: Macroscopical retroperitoneal metastasis, with or without metastases to the retroperitoneal lymph nodes, greater than two centimeters in maximum diameter.
Definitions of FIGO Stage IVa:
IV: Distant metastasis excluding peritoneal metastases.
IVA: Pleural effusion with positive cytology.
IVB: Parenchymal metastases and proliferation to the extra-abdominal organs.
What Are the Symptoms of Tumors of Low Malignant Potential?
The symptoms of TLMP include:
- Abdominal pain and swelling.
- Bowel problems like bloating, gas, and constipation.
- Menstrual irregularities.
- These signs and symptoms are caused by other conditions. Proper diagnosis is important for tumors of low malignant potential.
How to Diagnose Tumors of Low Malignant Potential?
15 % of all epithelial ovarian malignancies are borderline tumors, which are tumors with minimal malignant potential. At the time of diagnosis, around 75 % of these tumors are in stage I. These tumors need to be identified since they have a very different prognosis and course of therapy than the blatantly malignant invasive carcinomas. A thorough medical examination is required to diagnose tumors of low malignant potential. Ultrasound is done to evaluate the ovaries. Ultrasound helps in detecting the size of the tumor and to evaluate if it has spread to nearby tissues. Computed tomography scan (CT) and magnetic resonance imaging (MRI) is also performed to detect TLMP. If the above findings are positive, then a biopsy is carried out.
What Is the Treatment of Tumors of Low Malignant Potential?
Doctors will recommend a treatment plan depending on the tumor's size, age, health, whether a patient wants to get pregnant, or if it has spread beyond the ovaries. Surgery is the option to treat tumors of low malignant potential and remove the affected ovary. If a patient has planned for no more pregnancies, then the ovaries, fallopian tubes, uterus, and cervix hysterectomy are removed. Depending on the patient's age and desire to preserve fertility, many specialists would also advise removing the second ovary in addition to a hysterectomy (removal of the uterus), despite the low risk of recurrence. If the tumor has spread beyond the ovaries to the nearby tissues, the doctor will remove it accordingly. After surgery, the patient is kept on follow-up for six months to check the signs and symptoms of the tumor and if it has come back. Palliative treatment is essential; it takes care of the pain and emotions a person is dealing with.
What Is the Prognosis of Tumors of Low Malignant Potential?
The prognosis for these tumors is often excellent with surgery alone, mainly if the tumor is contained in the ovary. In comparison to ovarian cancer, the prognosis is substantially better. Chemotherapy is employed only when specific microscopic characteristics indicate a higher risk of recurrence. This makes it a good idea to have a pathologist with expertise in gynecologic tumors assess the pathology.
Conclusion:
In contrast to invasive ovarian cancer, these lesions affect women far early in life, behave differently, and have a significantly better prognosis. Adjuvant therapy has a limited role in the early stages of the disease, and its use in the later stages is unclear. Surgery is the mainstay of the management of women with LMP tumors. Current research seeks to identify prognostic markers that could help clinicians implement postoperative therapy properly. Regular follow-up is mandatory for the early detection of malignant transformation.
