A 45-year-old woman undergoes salpingo-oophorectomy for a 12 cm ovarian mass. Histology shows a mucinous tumor with nuclear stratification up to 3 layers, mild architectural atypia, but no stromal invasion. Which WHO classification category does this belong to, and what is the appropriate management?

• A Mucinous cystadenoma; no further management required
• B Mucinous carcinoma Grade 1; full staging laparotomy mandatory regardless of age
• C Mucinous borderline tumor with intraepithelial carcinoma; requires adjuvant chemotherapy
• D Mucinous borderline tumor (low malignant potential); unilateral salpingo-oophorectomy is adequate for Stage I disease in women desiring fertility ✓

Explanation

Ovarian borderline tumors (BOTs) by WHO criteria show nuclear stratification, mitotic activity, and nuclear atypia but lack stromal invasion — the defining criterion distinguishing them from carcinoma. Mucinous BOTs are typically Stage I at diagnosis and unilateral salpingo-oophorectomy is curative in fertility-sparing cases (Stage IA). No adjuvant chemotherapy is recommended for true BOTs without stromal invasion. The presence of intraepithelial carcinoma (nuclear grade 3 changes within epithelium) does not mandate chemotherapy if there is no microinvasion or stromal invasion.

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

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Written and medically reviewed by the StethoPrep medical team.