Ovarian junctional tumors are low grade potentially malignant tumors with active epithelial cell proliferation and nuclear atypia, increased nuclear schizophrenic phase, manifested by increased levels of epithelial cells but without mesenchymal infiltration. semi-malignant tumors of the ovary were described by Taylor in 1929 as a subtype of tumor with histologic features and biological behavior intermediate between benign and malignant epithelial ovarian tumors, without mesenchymal infiltration on histologic examination It is a subtype of tumor with histological features and biological behavior between benign and malignant epithelial ovarian tumors. In 1999, WHO suggested that ovarian junctional tumors are more likely to occur in the reproductive age, with an age of onset of 35-53 years, 10 years earlier than infiltrating carcinoma, and often found incidentally for unknown reasons. Infertility (non-pregnancy), failure to give birth, ovarian hyperstimulation syndrome may be high risk factors for the development, pregnancy and oral contraceptives have a protective effect. The incidence accounts for about 10-20% of epithelial tumors. Histological manifestations and biological behaviors BOTs account for 10%-20% of ovarian epithelial tumors, including plasmacytotic junctional tumors, mucinous junctional tumors, endometrioid junctional tumors, clear cell tumors, Brenner junctional tumors and mixed tumors. Plasmacytotic junctional tumors accounted for 65% of all BOTs and mucinous junctional tumors accounted for 32%. Plasmacytotic junctional tumors are bilaterally grown in 25%-40% and are typically homogeneous, whereas mucinous junctional tumors are only bilaterally grown in 8%. Compared with plasmacytotic junctional tumors, a higher proportion of patients with mucinous junctional tumors are stage I. The basic diagnostic criteria of WHO (1973) for ovarian junctional tumors are: (1) epithelial cell replication; (2) nuclear atypia between benign and malignant; (3) proliferating cell clusters out of their normal position; (4) no clear infiltration into the adjacent mesenchyme. The histologic diagnosis of plasmacytic junctional tumor: generally adopt the criteria proposed by Katzenstein et al. (1978): (1) epithelial cell complex and/or budding clusters; (2) cell heterogeneity; (3) nuclear division; (4) no interstitial infiltration. Russel believes that in the absence of true interstitial infiltration, two or more of the above four points must be present for diagnosis. Histologic diagnosis of mucinous junctional tumor: Piura et al. (1992) diagnostic criteria for mucinous junctional tumor are: epithelial hyperplasia, no interstitial infiltration, and two of the following three items: (1) villous-like glandular hyperplasia; (2) mitotic signs or cellular atypia; (3) no more than four layers of cells. (3) If the implantation site is extensively fibrotic and only a few individual cells are located in the interstitium, it is called “implantation with early infiltration”. Scully (1999) suggested that lymph node metastases exist in ovarian junctional tumors, with an incidence of 1%-16%, independent of clinical stage. Most of the lymph nodes involved are pelvic and para-aortic lymph nodes. Whether the tumor is associated with implantation or not, the involved lymph nodes have similar lesions and the prognosis has been reported differently. Lymph node involvement in non-invasive implantation generally does not affect the prognosis, while infiltrative implantation has a high recurrence rate and occasionally affects the prognosis of those who transform into obvious cancer. Diagnosis For any abnormal ovarian tumor found intraoperatively, examination of ascites cytology or abdominal washout fluid is required, and frozen pathology is sent to clarify the nature of the tumor. In one report, the histological diagnosis of frozen sections and paraffin-embedded tissues was 72.7%, 9.0% of plasmacytic junctional tumors and 36.6% of mucinous junctional tumors were misdiagnosed, and the sensitivity of frozen sections for the diagnosis of BOTs was 86.5% and the specificity was 57.1%. Preoperative tumor markers and imaging can only be used as a reference. Serum CA125 is non-specific for the diagnosis of BOTs and is more closely associated with plasmacytotic ovarian junctional tumors, whereas CA199 is associated with mucinous ovarian junctional tumors. Among imaging examinations, it has been reported that ultrasound has the highest sensitivity and is superior to CT and MRI and PET, and in postoperative follow-up, ultrasound is better than CA125 in detecting patients with recurrent BOTs. preoperative vaginal color Doppler ultrasound has been used to evaluate the nature of ovarian tumors, and the detection rates of junctional and malignant tumors are similar, 90% and 92% respectively. their blood flow is abundant, and the resistance index (RI) and However, the screening is not sensitive and specific in the normal population. There are two types of surgery: conservative and radical. Conservative surgery means surgery to preserve the reproductive function, including tumor removal and adnexal resection on the affected side. Radical surgery is a total hysterectomy with both adnexa, as well as the removal of extra-ovarian lesions. The type of surgery to be performed is based on the staging, the patient’s age and the requirements for fertility. Conservative surgery Conservative surgery is performed on patients with BOTs to preserve at least part of the ovaries and uterus in order to preserve fertility. It is suitable for stage I, young patients who desire to have children. Conservative surgical procedures include tumor resection alone or adnexal resection on the affected side, cytologic examination of peritoneal washings, and multi-point biopsy of the peritoneum. The reasons for this include unclear tumor borders, intraoperative pathological diagnosis difficulties in surgical margins, and the presence of multifocal tumor growth. In conclusion, most scholars believe that in order to reduce recurrence while preserving reproductive function, conservative surgery is preferred to adnexal resection on the affected side, and simple tumor resection is only suitable for patients with bilateral tumors or those who have undergone adnexal resection on one side and have only the affected adnexa remaining. In patients with unilateral BOTs, many authors recommend routine intraoperative biopsy of the contralateral ovary; however, it has been reported that microscopic lesions are not found in many ovarian tissues that are normal to the naked eye, and conversely, in many patients with recurrent BOTs, biopsy of the contralateral ovary was performed during the previous surgery without finding a lesion. In addition, biopsy can cause decreased fertility because it can increase complications such as postoperative adhesions. Therefore, most scholars now believe that routine biopsy of the contralateral ovarian tissue is not recommended unless there is a suspicious lesion in the contralateral ovary observed intraoperatively by the naked eye. The relationship between assisted reproductive technology and ovarian cancer is unclear. 2. radical surgery For patients with all stages of BOTs who do not need to preserve reproductive function. stage I patients are operated by total hysterectomy, bilateral adnexal, greater omentum, and lymph node dissection, which is the standard staging procedure. However, a recent retrospective study by four authors concluded that although staging surgery can reveal some implantation lesions that are considered normal to the naked eye compared to conservative surgery, it does not affect the prognosis mainly in BOTs, where patients’ implantation lesions are usually non-invasive and lymph node metastases are often isolated. In stage II-IV patients undergoing tumor cytoreductive surgery, BOTs rarely metastasize extensively and infiltrate deeply, even in advanced cases, all lesions that can be explored during surgery should be resected, with special attention to lesions on the intestinal canal to avoid future recurrence of intestinal obstruction, whether the tumor can be completely resected varies greatly in patient prognosis. The incidence of pelvic lymphatic metastasis is 2.8%, and the incidence of para-aortic lymphatic metastasis is 3.2%. Therefore, most scholars believe that lymph node metastasis is rare in BOTs and do not recommend lymph node dissection or biopsy as a routine step in BOTs, intraoperatively. Chemotherapy is generally considered to be poorly sensitive and ineffective for BOTs with good differentiation and metabolic activity similar to that of benign tumors. Most scholars believe that postoperative adjuvant chemotherapy is not needed for stage I BOTs, while there is still controversy over whether to treat stage II-IV BOTs with chemotherapy or not LMP has low malignancy and good prognosis. Recurrence is late and can extend up to 20 years, and the recurrence rate increases with time. Tumor DNA ploidy, micropapillary structure, infiltrative implantation, and mitochondrial activity are not significant predictors of tumor recurrence and death. Prognostic factors closely associated with survival were age, recurrence and surgical modality, and negatively associated with surgery were adjuvant therapy and residual foci. The 5-year survival rates of ovarian epithelial carcinoma were reported in China: 90. 0%, 72. 7%, 35. 9% and 15. 0% for clinical stage I, II, III and IV, respectively; and 81. 4%, 50. 5% and 25. 0% for G1, G2 and G3, respectively.