A 28-year-old woman with a unilateral 8 cm ovarian mass undergoes laparotomy. Intraoperative frozen section shows a borderline serous tumor (serous borderline ovarian tumor, SBOT). The pathologist reports micropapillary variant. What is the clinical significance of this variant over classic SBOT?

• A Higher rate of lymph node metastasis requiring systematic lymphadenectomy
• B Greater association with invasive peritoneal implants (non-invasive vs invasive implants) and higher risk of recurrence as invasive carcinoma ✓
• C Markedly elevated serum CA-125 with specific epitopes not seen in classic SBOT
• D Exclusively bilateral occurrence requiring bilateral salpingo-oophorectomy even in young women

Explanation

The micropapillary variant of SBOT (also called non-invasive micropapillary serous carcinoma) is associated with a higher rate of invasive peritoneal implants (rather than non-invasive implants seen in classic SBOT), bilateral involvement, and greater risk of progression to low-grade serous carcinoma. Studies show micropapillary SBOT has invasive implant rates up to 4× higher than classic SBOT, translating to worse survival. Lymphadenectomy (A) is not standard even for micropapillary variant as nodal involvement is rare and does not affect prognosis in BOTs. Serum CA-125 (C) is not specifically discriminatory between SBOT subtypes. Bilateral occurrence is more common but fertility-sparing surgery remains possible (D is overstated).

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.