3D microvascular imaging features of an ovarian borderline tumor with coexisting clear cell carcinoma

Ovarian clear cell carcinoma (OCCC) is an endometriosis-associated epithelial malignancy that can evolve from a precursor borderline tumor (BOT). Preoperative diagnosis is difficulty in distinguish benign lesions from malignancy using conventional imaging. Three-dimensional (3D) microvascular imaging (MVI) enables high-resolution visualization of small-vessel architecture, providing critical insights for preoperative diagnosis and surgical decision-making. A 35-year-old woman with a long-standing history of a stable ovarian cyst presented with a recent change in lesion morphology. Multimodal imaging (US, MRI, and CT) suggested malignancy. Notably, ultrasound precisely delineated the coexistence of BOT features and malignant vascular patterns. These findings guided a multidisciplinary surgical decision to perform fertility-sparing ovarian cancer staging. Histopathology confirmed Stage IC OCCC. Detailed preoperative assessment using 3D-MVI offered valuable clues for detecting potential malignancy in stable ovarian cysts, and helped timely surgical decision-making, including consideration of fertility-sparing strategies.