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Ovarian Tumor of Low Malignant Potential

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Posted: May 10, 2016

Dr. NCN operated on this patient on 10/13/2003 for a 25 cm right ovarian tumor through a low transverse incision. Her pre-op CA 125 was elevated at 235. He drained 4500 cc of fluid from the tumor with spillage in order to remove it. The path report indicated an ovarian tumor of low malignant potential (LMP). The patient denied she was informed that this was a low grade cancer. On 12/1/2005 a biopsy diagnosed recurrent ovarian tumor “of at least low malignant potential “. The patient was referred to a gynecologic oncologist, who determined the large pelvic–abdominal tumor was not respectable and chemotherapy was started.

Dr. NCN departed from standard of care by not consulting with a gyn oncologist before, during or after surgery, operating on a large tumor through a transverse incision, causing spill of tumor contents, not getting a frozen section path diagnosis, doing an incomplete cancer staging procedure and not informing the patient that she had a low grade cancer condition. However, the actual consequence of these multiple failures is not significant because chemotherapy is not initially given even for advanced stage LMP tumors with residual disease remaining at the end of surgery. This is because these tumors are very indolent and slow growing, which makes them relatively insensitive to chemotherapy. Treatment is only begun when such tumors show evidence of progression, as in this case.

The disease progression in this patient was unusually rapid for an LMP tumor. I strongly suspect that the pathologist under read the tumor. If it was really a grade 1 cancer instead of an LMP tumor, that would have required immediate post-op treatment with chemo by a gyn oncologist. It would be worth having a pathology expert review the original slides. If the tumor was actually grade 1 or more, then there is a strong case here against the pathologist. If an LMP tumor is confirmed by a path expert, then no case exists.

 
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