Mucinous ovarian cystadenoma is a common epithelial benign tumor in young women. However, recurrence and malignant transformation of mucinous ovarian cystadenoma are rarely reported. We report a 32-years old nulliparous woman who was diagnosed with mucinous ovarian cystadenoma, initially presenting with distended stomach and pelvic pain. After initial left partial oophorocystectomy, the patient had recurrence of abdominal mass, of which left salpingo-oophorocystectomy was performed. Several months after previous surgery, the abdominal mass recurred, which from imaging and pathological examination was diagnosed as borderline mucinous ovarian cystadenoma FIGO class IIIB. A systematic review of 19 articles showed risk of total recurrence and malignant transformation on mucinous ovarian cystadenoma were 13.9% and 1.8%, respectively. Furthermore, choosing fertility sparing surgery could increase the risk of recurrence of borderline ovarian cystadenoma. [ABSTRACT FROM AUTHOR]