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Borderline ovarian neoplasms (also called tumors of low malignant potential) are epithelial ovarian tumors that show epithelial proliferation and nuclear atypia without stromal invasion. They are biologically intermediate between benign cystadenomas and invasive carcinomas.

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Etiopathogenesis

• Age: Typically affect younger women (mean age 30–40 years), younger than those with invasive ovarian carcinomas.
• Incidence: 10–20% of epithelial ovarian tumors.
• Histogenesis: Arise from ovarian surface epithelium or cortical inclusion cysts.
• Risk factors: Similar to epithelial ovarian cancer (low parity, infertility, family history), but many cases occur sporadically.

Pathology

• Histological hallmark: Stratification of epithelial lining with nuclear atypia, mitotic activity, and papillary architecture but no destructive stromal invasion.
• Subtypes:
  1. Serous borderline tumor – most common.
  2. Mucinous borderline tumor – often very large, multiloculated.
  3. Endometrioid, clear cell, and Brenner borderline tumors – rare.
• Spread: May seed peritoneal surfaces (non-invasive implants).

Clinical Presentation

• Abdominal/pelvic mass (often large, cystic).
• Abdominal distension, pain, bloating.
• Frequently discovered incidentally.
• Usually confined to the ovary (Stage I) at diagnosis.

Radiology