A clinicopathological study of borderline ovarian tumors: insights from a tertiary care center in Saudi Arabia

Borderline ovarian tumors (BOTs) are a distinct category of epithelial ovarian neoplasms characterized by atypical proliferation without stromal invasion. They account for 10–20% of epithelial ovarian malignancies and are typically diagnosed at early stages in younger women. Despite their generally favorable prognosis, regional data remain limited, particularly from Saudi Arabia. We conducted a retrospective review of all BOT cases managed at King Faisal Specialist Hospital and Research Center, Jeddah, from January 2015 to February 2025. Clinical, surgical, pathological, and follow-up data were collected and analyzed. Comparative analysis was performed between serous and mucinous subtypes. A total of 59 patients were included (mean age: 41.8 ± 15.8 years). Most were premenopausal (71.2%) and presented with stage I disease (79.7%). Serous BOT was the predominant subtype (55.9%). Fertility-sparing surgery was performed in 22% of cases. Implants were observed in 25.4%, and microinvasion in 32.2%. Recurrence occurred in 17% of patients, primarily in the contralateral ovary and peritoneum. Serous BOTs were significantly associated with bilateral tumors, higher FIGO stage (p = 0.011), presence of implants (p = 0.038), and recurrence (p = 0.032), while mucinous BOTs showed higher rates of appendectomy and positive peritoneal cytology. Adjuvant therapy was rarely administered and limited to recurrent cases (n = 2/10). Notably, 2 patients (3.4%) died during follow-up, despite the overall favorable prognosis. This study underscores key clinicopathological differences between BOT subtypes and supports surgery as the cornerstone of treatment. Serous BOTs carry a higher risk of recurrence and advanced disease. Tailored surgical strategies and vigilant follow-up are essential, especially in fertility-preserving cases. Further multicenter studies are warranted to guide regional management.