by Emily Goebel, MD FRCPC
June 7, 2023
A mucinous borderline tumour is a non-cancerous type of ovarian tumour. While the tumour is considered non-cancerous, it is associated with a small risk of turning into cancer over time. The behaviour of this tumour is thought to fall somewhere in between a mucinous cystadenoma which is a non-cancerous tumour and mucinous carcinoma which is a type of cancer.
For most women, the diagnosis of a mucinous borderline tumour is only made when the entire tumour has been surgically removed and sent to a pathologist for examination. The fallopian tube and uterus may be removed at the same time.
Your surgeon may request an intraoperative or frozen section consultation from your pathologist. The diagnosis made by your pathologist during the intraoperative consultation can change the type of surgery performed or the treatment offered after the surgery is completed.
When the tumour is examined under the microscope, the tumour is usually made up of many small spaces. Pathologists call these spaces cysts. The walls of the cysts can be thin or thick and more solid areas may be found inside some of the cysts. The tissue on the inside of the cysts and the solid areas are made up of an abnormal type of epithelium that forms glands and produces a thick, gelatinous fluid called mucin. The mucin fills the inside of the tumour.
All ovarian tumours are examined to see if there are any holes or tears in the outer (capsular) surface of the ovary. The capsular surface is described as intact if no holes or tears are identified. The capsular surface is described as ruptured if it contains any large holes or tears. If the ovary or tumour is received in multiple pieces, it may not be possible for your pathologist to tell if the capsular surface has ruptured or not.
This information is important because a capsular surface that ruptures inside the body may spill tumour cells into the abdominal cavity. A ruptured capsule is associated with a worse prognosis and is used to determine the tumour (T) stage.
Your pathologist will carefully examine the tissue under the microscope to see if there are any tumour cells on the surface of the ovary. Tumour cells on the surface of the ovary increase the risk that the tumour will spread to other organs in the pelvis or abdomen. It is also used to determine the tumour stage (see Pathologic stage below).
Small samples of tissue are commonly removed in a procedure called a biopsy to see if tumour cells have spread to the pelvis or abdomen. These biopsies which are often called omentum or peritoneum are sent for pathological examination along with the tumour.
Other organs (such as the bladder, small intestine, or large intestine) are not typically removed and sent for pathological examination unless they are directly attached to the tumour. In these cases, your pathologist will examine each organ under the microscope to see if there are any tumour cells attached to those organs. Tumour cells in other organs are used to determine the tumour stage.
If you have been diagnosed with a mucinous borderline tumour or if your doctor suspects you may have a mucin-producing tumour, your appendix might also be removed and sent for pathological examination. In these cases, your pathologist will examine the appendix for any tumour cells. Tumours of the appendix can look very similar to the mucinous borderline of the ovary. Tumours that start in the appendix can spread from the appendix to the ovary.