Histologically, there is an exuberant growth of epithelial cells distributed on many layers, with clusters of cells detached from the

papillae. Nuclear atypia is

and mitotic activity is occasionally present without exceeding 4 mitoses per 10 hpf. There is no invasion of
mild to moderate the adjacent stroma (Fig. 6.5). Tangential cuts that show epithelial cells surrounded by stroma have to be distinguished from true invasion.

According to other studies, the presence of a micropapillary pattern is less significant for the prognosis than the rather uncommonly encountered invasive peritoneal implants.[16] They are more often associated with peritoneal implants, representing stage II or III borderline ovarian tumors. Peritoneal implants are noninvasive or invasive, the latter being characterized by a more aggressive behavior. Noninvasive implants, epithelial or desmoplastic, resemble the papillary structures of the ovarian borderline tumor forming circumscribed lesions on the surface or in the septa of the omental adipose tissue, often surrounded by an inflammatory reaction (Fig. 6.7). Invasive implants have irregular borders with destruction of the adipose tissue, exhibiting higher degree of nuclear atypia and small rounded nests of epithelial cells. Noninvasive and invasive implants can occur in the same patient.