Regarding borderline ovarian tumours (BOT), which statement is MOST accurate?

• A They are defined by stromal invasion and atypical epithelial proliferation
• B They must be managed by radical surgery with chemotherapy in all stages
• C CA-125 is always elevated and reliably distinguishes them from benign mucinous cystadenomas
• D Serous BOTs with non-invasive peritoneal implants have an excellent prognosis, while invasive implants confer a worse prognosis similar to low-grade serous carcinoma ✓

Explanation

Borderline ovarian tumours (atypical proliferative tumours) are characterised by epithelial proliferation WITHOUT destructive stromal invasion. For serous BOTs, peritoneal implants are classified as non-invasive (excellent prognosis) or invasive (poorer prognosis, similar to low-grade invasive serous carcinoma). Chemotherapy is not routinely indicated; fertility-sparing surgery is acceptable in younger women. CA-125 may be normal in early disease.

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

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