BACKGROUND: Endometrioid borderline ovarian tumors (EBOTs) are a rare subtype posing a significant diagnostic challenge on intraoperative frozen section analysis due to their morphological overlap with benign lesions and invasive carcinoma. Misdiagnosis, particularly as adenocarcinoma, can lead to unwarranted extensive surgical staging, resulting in potential overtreatment. This study aims to highlight the diagnostic challenge of a rare bilateral EBOT on intraoperative FS analysis and the consequent risk of surgical overtreatment, through a case report and a review of the literature.

CASE REPORT: A 55-year-old postmenopausal woman presented with a pelvic mass. Intraoperative FS analysis misdiagnosed the tumors as ovarian adenocarcinoma, prompting comprehensive surgical staging, including hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, omentectomy, and appendectomy. The final histopathological and immunohistochemical examination established the diagnosis of bilateral ovarian borderline endometrioid adenofibroma. A literature review (PubMed, 2006-2026) was conducted, which, after screening, included 6 studies reporting a total of 11 cases of bilateral EBOTs. The review revealed a predominant trend toward radical surgical intervention in these reported cases.

CONCLUSIONS: This case and literature review underscores the considerable risk of FS misdiagnosis and subsequent surgical overtreatment for rare bilateral EBOTs. The findings emphasize the critical role of final paraffin pathology in providing a definitive diagnosis for such challenging tumors. They also highlight the need for heightened diagnostic caution, explicit communication of diagnostic uncertainty in FS reports, and management strategies tailored to individual patient profiles rather than relying solely on equivocal intraoperative findings to guide the extent of surgery.

Keywords: Case Reports, Ovarian Neoplasms, Gynecology, Endometrioid Tumor, Frozen Sections, misdiagnosis