Ovarian Mass with Negative Biomarkers in a Young Patient

Background:

Borderline tumors resemble cancerous ovarian tumors in morphology and composition yet lack the invasive potential. Ovarian tumors are rare in adolescents, and borderline tumors even less. It is estimated that borderline tumors are represented in less than 1% of child/adolescent ovarian tumors and 10-30% of epithelial ovarian neoplasms. Without histology, they are difficult to distinguish from their malignant counterparts and display inconsistent biomarker results.

 

Case:

A 14-year-old African American female presented complaining of right flank pain and nausea. Abdominal exam revealed right lower quadrant pain without distension and was otherwise benign. Urinalysis revealed hematuria and vaginal PCR testing was positive for chlamydia. CT imaging demonstrated a complex right adnexal lesion. Abdominal ultrasound showed a 12cm multi-locular solid mass with a color score of 2, and no signs of torsion were identified. Serum HCG, AFP, LDH, CEA, testosterone, Inhibin B and CA-125 were negative.  Laparoscopic right oophorectomy was performed, and pathology reports diagnosed a serous low malignancy borderline tumor.

 

Conclusion:

Two uncommon features of borderline tumors were illustrated by this case: the age of the patient at diagnosis and the absence of elevated biomarkers. Although CT and transabdominal ultrasound imaging revealed a mass of substantial size with potential neoplastic properties, the tumor remained unidentifiable by tumor markers commonly elevated with ovarian tumors in the adolescent patient. As a result, the tumor was considered likely benign both pre and intra-operatively. This case emphasizes the variant nature and timing of presentation of borderline tumors and is a reminder that it should be included in the differential of ovarian masses in the adolescent patient.