Fertility potential and safety assessment of residual ovarian cortex in young women diagnosed with epithelial borderline and early-stage malignant ovarian tumors

Objective. To establish the safety and quality of ovarian cortex surrounding epithelial ovarian tumors in women eligible for fertility -sparing surgery by identifying occult malignant lesions and characterizing the ovarian follicle pool. Methods. Multicentric retrospective study of 48 subjects (15 -45 years), diagnosed with borderline ovarian tumors (BOTs) or early -stage epithelial ovarian cancers (EOCs) and eligible for fertility -sparing surgery. Histological samples of ovarian cortex surrounding tumors were analyzed to characterize the follicle pool, find any occult malignant lesion using tumor -speci fic markers (cytokeratin 7 and mucin 1), and quantify tumor -in filtrating lymphocytes (TILs) by CD3 and tumor associated macrophages (TAMs) by CD68. Results. Occult ovarian lesions were observed in 6 out of 45 cases investigated (14.6%), including one mucinous stage -I BOT (1/14), one serous stage -I BOT (1/13), 3 advanced -stage serous BOTs (3/11) and one early -stage serous EOC (1/7). Notably, follicle density was signi ficantly lower in subjects diagnosed with ovarian tumors compared to controls ( p < 0.001) and at a younger age. Signi ficantly higher follicle atresia was encountered in the ovarian tumor group then in controls (20.1 +/- 8.8% vs 9.2 +/- 9.4%, p < 0.001) at all ages. Both TILs and TAMs were found in ovarian tumors irrespective of histotype, but no link was established with the status of the ovarian reserve. Conclusions. Personalized counseling for fertility preservation is required in the event of BOTs and early -stage EOCs. Fertility -sparing surgery and adjuvant gamete preservation should be considered, balancing the oncological risks according to tumor stage and histotype and fertility potential, especially at a younger age. (c) 2024 Published by Elsevier Inc.