Case History
48-year-old female with 8.0 cm ovarian mass. Gross sections show multiple cysts with papillary projections.
What is the diagnosis:
- Serous adenocarcinoma
- Serous borderline tumor
- Well-differentiated papillary mesothelioma
- Retiform Sertoli-Leydig tumor
Answer is “B”: Serous borderline tumor/Atypical proliferative serous tumor
Age: 4th or 5th decade
Presentation: Often asymptomatic, with indolent course. It may present with abdominal enlargement, rupture. Elevated serum CA125
Histology: Epithelial tumor consisting of hierarchically branching papillae with cellular stratification lined by tubal-type epithelium with low grade cytologic atypia
IHC: CK7, EMA, WT1 positive
Frozen section: If bilateral ovaries are involved by borderline tumor, the surgeon needs to explore and look for extraoavarian disease (up to 56%)
Prognosis: Prognosis depends on the presence of non-invasive implants (recurrence rate 14%) or invasive implants/low grade serous carcinoma (recurrence rate 65%).
Reference: Ovarian borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria, Virchows Arch., 2017: 470(2): 125-142
Case contributed by: Lea Novak, M.D., Associate Professor, Anatomic Pathology