Case Report Ultrasound Diagnosis of Serous Surface Papillary Borderline Ovarian Tumor: A Case Series with a Review of the Literature Manuela Ludovisi, MD, PhD, 1,2 Xulin Foo, MD, 1 Sara Mainenti, MD, 1,2 Antonia Carla Testa, MD, PhD, 2 Rupali Arora, MD, 3 Davor Jurkovic, MD, FRCOG 1 1 Gynaecology Diagnostic and Treatment Unit, University College Hospital, LondonUK 2 Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy 3 Department of Hystopathology, University College Hospital, London, UK Received 13 December 2013; accepted 16 November 2014 ABSTRACT: Serous surface papillary borderline ovar- ian tumors (SSPBOTs) are a rare morphologic variant of serous ovarian tumors that are typically confined to the ovarian surface, while the ovaries themselves tend to appear normal in size and shape. In this report, we describe the findings from five premeno- pausal women diagnosed with SSPBOTs, in whom ultrasound showed grossly normal ovaries that were partially or wholly covered with irregular solid tumors. In all five cases, histologic examination showed evidence of borderline serous tumors. These findings demonstrate that SSPBOTs can be diag- nosed on a preoperative sonographic examination, which could facilitate conservative, fertility-sparing surgery in young women affected by this condition. V C 2015 Wiley Periodicals, Inc. J Clin Ultrasound 00:000– 000, 2015; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu.22266 Keywords: borderline; ultrasonography; tumor; ovary; gynecologic oncology INTRODUCTION B orderline ovarian tumors (BOTs) account for approximately 15% of all epithelial ovarian tumors. 1 One-third of those occur in women younger than 40 years old, who often wish to preserve their reproductive capacity. 2,3 Serous surface papillary BOTs (SSPBOTs) are a dis- tinct subtype of serous ovarian tumors. They are typically confined to the ovarian surface, while the ovaries themselves tend to appear normal in size and shape. 4,5 Serous BOTs have a generally good prognosis, and conservative fertility-sparing surgery needs to be considered in all women of fertile age, pref- erably by using a laparoscopic approach. 6,7 It is sometimes difficult to differentiate between bor- derline and invasive epithelial tumors intraoper- atively, so an accurate preoperative diagnosis is essential for optimizing patient management. Ultrasound (US) is routinely used for the assessment of women with adnexal tumors. Vari- ous studies have described the morphologic char- acteristics of serous borderline tumors on US, which typically appear as cystic ovarian lesions with papillary projections. 8–10 In comparison, only a few reports have described SSPBOTs using different imaging modalities. 11–14 In this report, we describe the cases of five women with SSPBOTs that were all correctly classified as serous BOTs on preoperative US examinations. CASE REPORTS Over a period of 3 years, we identified five women with a diagnosis of SSPBOT. The indica- tions for examination were suspected ovarian tumors on previous US or MRI examinations in three women, oligomenorrhea and clinical suspi- cion of polycystic ovary syndrome in one Correspondence to: M. Ludovisi V C 2015 Wiley Periodicals, Inc. VOL. 00, NO. 00, MONTH 2015 1