Borderline ovarian tumors in both gonads: a clinical case and challenges of an organ-preserving approach

Abstract

Background. Borderline ovarian tumors (BOTs) occupy an intermediate position between benign and malignant neoplasms, frequently affecting women of reproductive age. Bilateral gonadal involvement, observed in 15-25% of cases, significantly complicates the choice of treatment strategy, especially when fertility is being preserved. Making an organ-preserving decision requires a multidisciplinary approach and oncologic vigilance, particularly in the absence of stromal invasion. Study Objective: To present a clinical case of bilateral borderline ovarian tumors in a young patient, with a focus on fertility preservation and oncologic safety. Materials and Methods: An 18-year-old female patient presented with complaints of nagging lower abdominal pain. Ultrasound and MRI revealed a mass with intracapsular inclusions measuring approximately 17 x 15 cm in the right ovary; the left ovary was normal. A laparotomy with right cystectomy and left ovarian resection was performed. Urgent histological findings were obtained intraoperatively: bilateral serous borderline tumors (BSTs) of both ovaries. Healthy ovarian tissue was preserved. A greater omentum biopsy revealed no abnormalities. After confirming the diagnosis of BBTs (serous type), a complete histological examination, immunohistochemical verification, and an oncologic consultation were performed. The patient was included in a follow-up program. Results and discussion. The diagnosis of bilateral serous borderline tumors was confirmed by pathology. Immunohistochemical profile: WT1+, p53 wild-type, Ki-67 <10%. After organ-preserving surgery, the patient recovered without complications. After 12 months, MRI and tumor markers showed no signs of recurrence. Reproductive function is preserved. The patient is recommended to undergo IVF if planning a pregnancy. Conclusion. Organ-preserving treatment of bilateral BLO is possible with strict adherence to oncological principles, an experienced multidisciplinary team, and subsequent dynamic monitoring. This case highlights the need for an individualized approach and the importance of early diagnosis in gynecological oncology in young women.

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