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Cancer of unknown primary (CUP) is a heterogeneous group of metastatic tumors with a usually unfavorable prognosis. A 33‐year‐old female was diagnosed with pelvic squamous cell carcinoma of unknown primary. The tumor was p16‐positive, suggesting that it was human papillomavirus (HPV)‐related. The tumor progressed for 4 months after concurrent chemoradiotherapy (initial treatment) and was refractory to paclitaxel plus carboplatin (second‐line therapy). Liquid‐based cancer genomic profiling identified five pathogenic variants, including Neurofibromin1 (NF1) (p.T1690Mfs*5); however, due to the lack of domestic clinical trials, the patient could not receive genome‐based molecular‐target therapies. Simultaneously, nivolumab was administered to the patient post its approval in Japan for CUP. The tumor responded to nivolumab, accompanied by decreased levels of tumor markers. NF1 mutations and HPV‐related carcinogenesis may be associated with a favorable response to nivolumab treatment. It may therefore serve as a potential treatment against cancers of unknown primaries. [ABSTRACT FROM AUTHOR]

Myoepithelioma‐like tumors of the vulvar region (MELTVR) is a kind of solid tumor newly recognized in recent years, which is characterized by mesenchymal tumors of adult female vulva. The histopathology is similar to myoepithelioma, but the immunohistochemical phenotype and genetic changes are different from myoepithelioma. It usually has clear boundary and partial capsule, mixed with two forms of cells (epithelioid and spindle), the cells are mild, the nucleoli are clear, mitoses are rare, some cases have myxoid differentiation. In this article, a case of MELTVR diagnosed in our hospital is discussed. The patient was a 43‐year‐old female who finds a neoplasm in the pubic tubercle 4 months ago. Local resection was performed. Pathological examination showed that the boundary of the tumor was clear with partial capsule. The cells were arranged in cords or nests, and partially infiltrated the surrounding adipocytes. The tumor cells had two morphologies, epithelioid or spindle shaped. The spindle type cells were dominant, with bright cytoplasm, obvious nucleoli, rare nuclear mitosis (about 1/10HPF), and no necrosis was observed. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, estrogen receptor, progestogen receptor, calponin and were partially positive for cathepsin k. INI1/SMARCB1 expression was deficient. There was no recurrence or metastasis during the 8‐month‐long follow‐up. The unique feature of this case was that the site of the disease was not the vulva, but in front of the pubic tubercle, there was no large amount of mucus production, and the cytoplasm of most tumor cells was transparent. Due to our limited knowledge of MELTVR, its pathogenesis and tissue origin are not clear. Clinicians should be aware of such potential patients. [ABSTRACT FROM AUTHOR]

Ovarian serous cystadenofibroma is a relatively rare subtype of serous cystadenoma classified as ovarian benign epithelial tumor. We report a rare case of ovarian serous cystadenofibroma with scattered lesions in pelvic cavity, like malignant disseminations. The patient was 22 years old, gravida 0, para 0. In the laparoscopic surgery, numerous hard yellowish‐white solid masses of various sizes were present in the bilateral ovaries. Grossly similar masses were scattered in the fimbria of the fallopian tubes, peritoneum, and great omentum. Because the intraoperative rapid histological diagnosis was benign tumor, surgery was completed for only tumor excision. Postoperative histopathological diagnosis is serous cystadenofibroma. Similar pathological findings were noted in the scattered lesions in the peritoneum and great omentum. No malignant or borderline malignant finding was observed. Because of a benign disease, careful treatment taking fertility preservation into consideration is necessary, especially for young patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the postoperative histological features affecting the prognosis of patients with early‐stage cervical cancer who underwent open radical hysterectomy. Methods: This retrospective study enrolled 374 patients with pT1a, 1b1 and 2a1 early‐stage cervical cancer who underwent open radical hysterectomy between 2001 and 2018. Survival outcomes were analyzed by Kaplan–Meier method and compared with log‐rank test. Using the Cox proportional hazards regression test, we conducted a multivariate analysis for disease‐free survival and overall survival. Results: Others histology, including other epithelial tumors and neuroendocrine tumors, had a significantly worse prognosis in both disease‐free survival and overall survival than those of squamous cell carcinoma and adenocarcinoma (hazard ratio, 4.37 and 11.76; P = 0.006 and P = 0.002, respectively), along with lymph node metastasis (hazard ratio, 2.99 and 7.03; P = 0.009 and P = 0.001, respectively). Conclusion: Others histology including adenosquamous carcinoma had a poor prognosis in early‐stage cervical cancer as with high‐risk factors. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify the differences between complex atypical hyperplasia/endometrial intraepithelial neoplasia (CAH/EIN) and endometrioid‐type grade 1 endometrial cancer in terms of preoperative systemic inflammatory markers and to evaluate the effectiveness of such markers in predicting cancer. Methods: Between January 2005 and September 2018, a total of 372 patients with final histopathologic diagnoses of CAH/EIN (n = 143) and endometrioid‐type grade 1 endometrial cancer (n = 229) were included in the study. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and platelet distribution width (PDW) were used as preoperative inflammatory markers. Receiver operating characteristics (ROC) analysis was used to assess the diagnostic prediction of NLR, PLR and PDW values to distinguish the two groups. Univariate and multivariate logistic regression analysis was performed by regrouping the patients according to the cut‐off values found in the ROC analysis. Results: The univariate analysis revealed that advanced age, decreases in PDW and also PLR could be predictors of cancer. The cut‐off values were as ≤48.9% for PDW and ≤133.3 for PLR. The values defined using ROC analysis were found to be statistically significant for PDW and PLR in identifying endometrioid grade 1 endometrial cancer. For PDW, sensitivity, specificity, positive predictive value and negative predictive value were 52.8%, 62.2%, 68.9% and 45.5%, respectively (P = 0.001); for PLR, those were 55.9%, 59.4%, 68.8% and 45.7%, respectively (P = 0.005). In multivariate analysis, advanced age (>53 years), low PDW (≤48.9%) and low PLR (≤133.3) were related to statistically significant odds ratio for diagnostic prediction to differentiate endometrioid grade 1 cases from CAH/EIN of 8.01 (P < 0.001), 1.79 (P = 0.019) and 1.73 (P = 0.025), respectively. Conclusions: The PLR and PDW values in the preoperative blood parameters could be used to differentiate endometrial cancer from precancerous lesions. [ABSTRACT FROM AUTHOR]

Aim: We report clinical outcomes of transarterial embolization in 19 cases of vaginal cancer. Methods: From August 2011 to October 2019, 19 patients with histologically diagnosed vaginal cancer were identified in our department. Transarterial chemotherapy and embolization was performed for all patients. Patient characteristics, treatment plans and the clinical outcomes, were recorded. Results: Among 19 identified cases, nine of them are squamous cell carcinoma, five of adenocarcinoma, one of adenosquamous carcinoma, two of vaginal malignant melanoma, one leiomyosarcoma and one of stromal sarcoma. Transarterial chemotherapy and embolization was successfully performed in all patients. No related complication was found after intervention treatment. Besides, eight patients received adjuvant chemotherapy, four received both adjuvant chemotherapy and radiotherapy and seven received no therapies. Four patients were cured and seven were stable during follow‐up. Conclusion: Transarterial embolization appears safe and effective for vaginal cancer, with a currently acceptable prognosis. [ABSTRACT FROM AUTHOR]

Aim: Expression of CD44 variant isoforms (CD44v) promotes the synthesis of reduced glutathione and contributes to reactive oxygen species defense through up‐regulation of the intracellular antioxidant. The aim of the study was to investigate the expression of CD44v9 and oxidative DNA damage marker, 8‐OHdG, in benign ovarian endometrioma (OE) and OE harboring clear cell carcinomas (CCC). Methods: A retrospective study was performed at the Department of Gynecology, Nara Medical University hospital from January 2006 to December 2012. Patients with histologically confirmed benign OE (n = 27) and OE harboring areas of CCC (n = 8) were selected. Tissue samples were immunohistochemically analyzed for the presence of CD44v9 and 8‐OHdG using avidin‐biotin complex method. Results: CD44v9 was located on the cell membrane of endometriotic epithelial cells and expressed in 88.9% (24/27) of benign OE tissues. Only 25.0% (2/8) of benign endometriotic lesions adjacent to CCC was found to stain weakly for CD44v9. Percentage of CD44v9 positive cells was 68.5 ± 20.2% (mean ± standard deviation) of benign OE, 16.7 ± 16.5% of CCC endometriotic tissue (P < 0.001). Compared to benign OE, CCC endometriotic tissue showed a significant increase in the proportion of 8‐OHdG expression (77.3 ± 22.5% vs 94.9 ± 3.0%, P = 0.049). A significant negative correlation was observed between CD44v9 status and 8‐OHdG nuclear expression (r = −0.458, P  =  0.006). Conclusion: Alterations in CD44v9 and 8‐OHdG may be associated with malignant transformation of benign OE. [ABSTRACT FROM AUTHOR]

Aim: To investigate the prognostic value of serum cancer antigen 125 (CA125) levels during chemotherapy in relapsed epithelial ovarian cancer (EOC) and to identify cut‐off values that distinguish patients who relapse beyond 12 months from those who relapse within 12 months. Methods: About 93 relapsed EOC patients who received cytoreductive surgery and adjuvant chemotherapy at Obstetrics and Gynecology Hospital of Fudan University between January 2003 and March 2015 were selected. Univariate regression analysis was used to determine the significant prognostic factors. The Kaplan–Meier method was used to calculate the overall survival (OS) rate. Results: The CA125 decrease ratio of more than 97.6% after the fourth chemotherapy cycle was significantly associated with relapse time (P = 0.044). The sensitivity was 70.0%, and the specificity was 76.9%. Moreover, in all relapsed patients, the group with the CA125 decrease ratio after the fourth chemotherapy cycle of more than 97.6% had a significantly better OS than any other group (P = 0.0019). Conclusion: The CA125 decrease ratio of less than 97.6% after the fourth chemotherapy cycle can be a predictive factor for relapse within 12 months. Patients without a significant decrease in CA125 after four cycles of chemotherapy should have a more frequent follow‐up and more active re‐examination. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of leuprorelin using a self‐administered quality‐of‐life (QOL) questionnaire in patients with recurrent gynecological cancer. Methods: Records of patients who received 3.75 mg leuprorelin every 4 weeks for the treatment of recurrent gynecological cancer were retrospectively reviewed. The physical domain of the QOL questionnaire, Care Notebook, was used to assess physical symptoms. Symptom deterioration was defined as a ≥10‐point increase in baseline score; otherwise, symptoms were defined as controlled. Radiological and serological responses were evaluated according to the 2011 Gynecological Cancer Intergroup criteria. Results: From 2007 to 2015, 25 patients were administered leuprorelin for the treatment of epithelial ovarian cancer, granulosa cell tumor, endometrial cancer, endometrial stromal sarcoma and clear cell cervical cancer (in 13, 3, 6, 2 and 1 patients, respectively). Twenty patients had received a median of three lines (range 1–12 lines) of chemotherapy. Ten patients had progressive disease during their previous round of chemotherapy. Twenty patients completed the questionnaire every 4 weeks. Following leuprorelin treatment for 8 weeks, the symptom and disease control rates were 65% (13/20) and 44% (11/25), respectively. Two patients, one each with granulosa cell tumor and endometrial cancer, had stable disease at 6 months. Among the 20 patients who completed the QOL questionnaire, symptom control and disease control at 8 weeks showed a significant correlation (P = 0.016). Conclusion: Leuprorelin had minimal anticancer activity. The physical domain of the QOL questionnaire could be used to assess effects of hormonal treatment. [ABSTRACT FROM AUTHOR]

Aim: The goal of this study was to analyze the specificity of p16/Ki67 dual staining in the detection of high‐grade cervical lesions. Methods: A total of 223 patients with an average age of 39 years old were enrolled in this study. All samples were analyzed by p16/Ki67 immunocytochemical dual staining, liquid‐based cytology and high‐risk human papillomavirus (HR‐HPV) test. Diagnosis of each patient was verified by histopathological test. Results: The specificity of p16/Ki67 dual staining was 68.33%, which was significantly higher than that of cytology (38.33%) and HR‐HPV test (21.67%) (P < 0.05) for CIN2+ detection. p16/Ki67 dual staining had similar sensitivity with HR‐HPV test for CIN2+ detection (90.18% vs 93.87%, P = 0.286). In atypical squamous cells of undetermined significance (ASC‐US) and low‐grade squamous intraepithelial lesion (LSIL) cases, the specificity of p16/Ki67 dual staining was significantly higher than that of HPV test (66.67% vs 3.70%, P < 0.05) and its sensitivity was similar to that of HPV test for CIN2+ detection. The sensitivity and specificity of dual staining for CIN2+ detection in HR‐HPV positive women were 90.85% and 70.21%, respectively, which were higher than those of cytology (83.01% and 42.55%) and HPV16/18 test (70.59% and 44.68%). Conclusions: p16/Ki67 dual staining could improve the specificity of high‐grade cervical lesions detection and have similar sensitivity to HPV test for CIN2+ detection. When triaging women with ASC‐US or LSIL liquid‐based cytology, compared with positive HR‐HPV, the specificity of CIN2+ lesion detection was increased by p16/Ki67 dual staining. p16/Ki67 dual staining could reduce colposcopy referrals and avoid excessive diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This study aimed to evaluate early clinicopathologic factors predicting gross residual disease after neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer. Methods: We analyzed clinicopathologic data of 68 patients with ovarian cancer who were treated with neoadjuvant chemotherapy followed by interval debulking surgery (NAC‐IDS) between March 2006 and December 2016. All the patients received three cycles of NAC followed IDS. We evaluated all possible clinicopathologic characteristics, including reduction rates of serum CA‐125 after each NAC and seven initial abdominopelvic computed tomography (CT) findings related to disease severity. Results: After IDS, no gross residual disease was found in 46 (67.6%) patients and 22 (33.4%) patients had gross residual disease. Multivariate analysis identified that reduction rate of CA‐125 after 2nd NAC, body mass index (BMI) and small bowel lesion in the initial CT findings were significantly associated with gross residual disease after IDS (P = 0.005, 0.030, 0.001, respectively). The optimal cutoff value predicting gross residual disease were less than 50% of CA‐125 reduction rate after 2nd NAC and low BMI (<23 kg/m2). The combined receiver operating characteristic curve analysis of these factors showed good performance for predicting gross residual disease after IDS (area under the curve = 0.845). Conclusion: A model using small bowel mesentery involvement on CT, BMI (<23 kg/m2) and less than 50% reduction of the initial CA‐125 level after the 2nd NAC is highly predictive of gross residual disease after IDS in advanced ovarian cancer patients. These results may be helpful in further treatment planning and patients counseling. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify factors predictive of poor prognosis in women with stage III nonserous epithelial ovarian cancer (EOC) who had undergone maximal or optimal primary cytoreductive surgery (CRS) followed by six cycles of intravenous carboplatin/paclitaxel chemotherapy. Methods: A multicenter, retrospective department database review was performed to identify patients with stage III nonserous EOC who had undergone maximal or optimal primary CRS followed by six cycles of carboplatin/paclitaxel chemotherapy at seven gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Results: A total of 218 women met the inclusion criteria. Of these, 64 (29.4%) patients had endometrioid, 61 (28%) had mucinous, 54 (24.8%) had clear‐cell and 39 (17.9%) had mixed epithelial tumors. Fifty‐five (25.2%) patients underwent maximal CRS, whereas 163 (74.8%) had optimal debulking. With a median follow‐up of 31.5 months, the 5‐year progression‐free survival (PFS) and overall survival (OS) rates were 34.8% and 44.2%, respectively. Bilaterality (hazard ratio [HR] 1.44, 95% CI 1.01–2.056; P = 0.04), age (HR 2.25, 95% CI 1.176–4.323; P = 0.014) and maximal cytoreduction (HR 0.34, 95% CI 0.202–0.58; P < 0.001) were found to be independent prognostic factors for PFS. However, age (HR 2.6, 95% CI 1.215–5.591; P = 0.014) and maximal cytoreduction (HR 0.31, 95% CI 0.166–0.615; P < 0.001) were defined as independent prognostic factors for OS. Conclusion: The extent of CRS seems to be the only modifiable prognostic factor associated with stage III nonserous EOC. Complete cytoreduction to no gross residual disease should be the main goal of management in these women. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To investigate the association of matrix metalloproteinase (MMP)‐7 and MMP‐9 with pelvic lymph node and para‐aortic lymph node metastasis in early cervical cancer. Methods: A total of 137 patients with early cervical cancer (Stage Ia2‐IIa2) were recruited from the Department of Gynecology and Obstetrics, Tumor Hospital of Liaoning Province from January 2009 to May 2014. We evaluated the expression of MMP‐7 and MMP‐9 by immunohistochemistry and their association with the clinicopathological parameters such as pelvic, common iliac and para‐aortic lymph node metastasis. Spearman correlation was performed to analyze the correlation between MMP‐7 and MMP‐9 in cervical cancer. Finally, the areas under the receiver operating characteristic curve (ROC) of MMP‐7 and MMP‐9 in pelvic lymph node metastasis were assessed. Results: MMP‐7 expression was significantly higher in patients with adenocarcinomas and adenosquamous carcinomas (P = 0.014), vascular cancer embolus (P = 0.041), pelvic lymph node metastasis (P = 0.000) and a higher level of Ki‐67 (P = 0.000). MMP‐9 expression was significantly associated with vascular cancer embolus (P = 0.003), depth of stromal invasion (P = 0.001), pelvic lymph node metastasis (P = 0.003), common iliac lymph node metastasis (P = 0.001) and para‐aortic lymph nodes metastasis (P = 0.004). Coexpression of MMP‐7 and MMP‐9 was significantly associated with vascular cancer embolus (P < 0.001), higher expression of Ki‐67 (P < 0.001) and pelvic lymph node metastasis (P < 0.001). Spearman correlation analysis indicated a positive correlation between MMP‐7 and MMP‐9 (r = 0.263, P = 0.002). Areas under the ROC of MMP‐7 and MMP‐9 were 0.707 and 0.646, respectively. Conclusion: MMP‐7 and MMP‐9 expressions were associated with lymph node metastasis in patients with early cervical cancers, suggesting a positive correlation of MMP‐7 and MMP‐9 with invasive potential in early cervical cancers. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This study assesses a clinical potential of immediate early responsive gene X‐1 (IEX‐1), also named IER3, in the diagnosis of epithelial ovarian carcinoma using blood and salivary specimens. Methods: Immediate early responsive gene X‐1 was quantified in blood and saliva by real‐time quantitative reverse transcription polymerase chain reaction in 26 cases of epithelial ovarian carcinoma, 37 cases of benign ovarian tumor and 55 cases of healthy women. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of IEX‐1. Results: Immediate early responsive gene X‐1 was expressed in blood and saliva of the benign ovarian tumor group and the healthy women group, both at a level significantly higher than that of the ovarian carcinoma group (P < 0.017). There were no significant differences in IEX‐1 expression in blood and saliva (P = 0.376 or 0.621, respectively) between the benign ovarian tumor and the healthy women group. Comparison of IEX‐1 expression in blood between the ovarian carcinoma group and the benign ovarian tumor group or the healthy women group demonstrated the ROC‐area under curves (AUC) of 0.947 or 0.929, respectively. In discriminating the ovarian carcinoma group from the benign ovarian tumor group, IEX‐1 expression in blood demonstrated a sensitivity and specificity of 84.6% and 94.6%, respectively. Similarly, blood IEX‐1 expression conferred a sensitivity of 84.6% and specificity of 90.9% in distinguishing the ovarian carcinoma group from the healthy women group. Moreover, salivary IEX‐1 expression had ROC‐AUC of 0.851 when compared between the ovarian carcinoma group and the benign ovarian tumor group or 0.896 when compared between the ovarian cancer group and the healthy women group. IEX‐1 expression was able to discriminate the ovarian carcinoma group from the benign ovarian tumor group with a sensitivity and specificity of 65.4% and 94.6%, respectively, or the ovarian carcinoma from the healthy women with 92.3% sensitivity and 72.5% specificity. Conclusion: These results suggest the clinical potential of IEX‐1 expression in blood and saliva as a sensitive and specific diagnosis for epithelial ovarian carcinoma. [ABSTRACT FROM AUTHOR]

Abstract: Labial agglutination has rarely been reported in postmenopausal women and its treatment has been based on experience with prepubertal girls. We describe an 83‐year‐old woman who presented with labial agglutination and severe urinary incontinence. She had been treated intermittently with a topical estrogen cream for 3 years, but her symptoms persisted. Surgery was performed and her urinary incontinence was instantly resolved. Incidental vaginal low‐grade squamous intraepithelial neoplasia was noted. Later, the lesion progressed and was confirmed to be condyloma acuminata. No recurrence of labial agglutination was noted 3 months after the surgery. We emphasize that surgical intervention should be the first consideration for labial agglutination with urinary symptoms in postmenopausal women. This case also highlights that surgery can not only resolve patients’ symptoms early, but can also enable access to the region for essential gynecologic procedures. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We aimed to identify the radiologic features of uterine cervical adenocarcinoma associated with lobular endocervical glandular hyperplasia (LEGH). Methods: We retrospectively analyzed magnetic resonance (MR) images and pathologic findings of eight patients who underwent preoperative MR imaging followed by surgical resection and who were pathologically diagnosed with adenocarcinoma (except for adenocarcinoma in situ) associated with LEGH. We assessed the following MR findings: multicystic component (MC), solid component (SC), signal intensity of SC on diffusion‐weighted imaging (DWI) and the apparent diffusion coefficient (ADC) map, and radiological stage (r‐stage) based on the FIGO classification. A pathologist reevaluated the pathological stage (p‐stage) according to the FIGO classification. We correlated the MR findings with the pathologic features. Results: Eight patients were classified into the following three types based on the MR findings: type A, MC and SC; type B, only SC; and type C, only MC. In the five patients with type A, diffusion restriction (DR) was seen on DWI and the ADC map. In 80% of type A cases, the r‐stage matched the p‐stage. In the one patient with type B, DR was not seen on DWI or the ADC map, and the r‐stage matched the p‐stage. In the remaining type C cases, DR was not seen on DWI or the ADC map, and the r‐stage was underestimated compared with the p‐stage. Conclusion: On MR imaging, the most common type of adenocarcinoma with LEGH is type A; type C is difficult to diagnose as carcinoma. [ABSTRACT FROM AUTHOR]

Aim This study is a comparison of human epididymis protein 4 (HE4) with cancer antigen 125 (CA125), using the Risk of Ovarian Malignancy Algorithm (ROMA), Copenhagen Index (CPH-I), Risk of Malignancy Index (RMI) and Morphology Index (MI) to differentiate ovarian endometriosis from epithelial ovarian cancer (EOC) in premenopausal women. Methods The study was performed at the University Clinic of Obstetrics and Gynecology in Skopje. One hundred and sixty-four premenopausal patients were divided into three study groups, including ovarian endometriosis (37), other benign pelvic masses (57) and EOCs (11), and a control group (59). After ultrasonography, all subjects underwent blood sampling. Surgery and histological verification was performed. Pelvic masses were classified based on histological findings. Mann-Whitney, receiver operating characteristic-area under the curve (AUC), sensitivity, specificity and Kruskal-Wallis tests were used for statistical analysis. The level of significance α was set at 5%. Results For each of the tested markers, sensitivity, specificity and accuracy to distinguish ovarian endometriosis from EOC were as follows: HE4 (81.82%, 100%, 95.83%); CA125 (81.82%, 48.65%, 56.25%); ROMA (90.91%, 83.78%, 85.42%); CPH-I (81.82%, 97.30%, 93.75%); RMI (90.91%, 35.14%, 47.92%); and MI (100%, 75.68%, 81.25%), respectively. The AUC for ovarian endometriosis compared to EOC for tested markers was as follows: HE4 (AUC = 0.934), CA125 (AUC = 0.821), ROMA (AUC = 0.929), CPH-I (AUC = 0.924) and RMI (AUC = 0.880), respectively. Conclusion HE4 and CPH-I perform best to discriminate ovarian endometriosis from EOC in premenopausal women. MI has maximal sensitivity to detect EOC. [ABSTRACT FROM AUTHOR]

Herein, we report a rare case of an epithelioid trophoblastic tumor of the uterus with radiologic-pathologic correlation in a 56-year-old postmenopausal woman. On T2-weighted magnetic resonance (MR) imaging, the tumor appeared as a hypointense irregular mass compared with the surrounding myometrium of the uterine corpus and encircled the cavity of the lower uterine segment. On dynamic contrast-enhanced MR images, the tumor appeared as a hypovascular mass and an inhomogeneously hyperintense mass in the delayed phase. In addition, non-contrast computed tomography images showed some spotty areas of very high density within the tumor. These radiologic findings were well correlated with the histological features, such as abundant hyalinization and calcification within the tumor. Accurate interpretation of MR and computed tomography findings was helpful to differentiate epithelioid trophoblastic tumor from other gestational trophoblastic diseases and uterine carcinomas. [ABSTRACT FROM AUTHOR]

Aim Human epididymis protein 4 (HE4) is a novel biomarker for epithelial ovarian cancer. This study was designed to evaluate the role of HE4 in chemo-response against anti-cancer drugs and prognosis of epithelial ovarian cancer. Methods HE4-depleted cells and HE4-overexpressing cells were generated. The effect of HE4 gene silencing and overexpression was examined using a cell viability assay after exposure to chemotherapeutic agents and the signaling pathway. We studied the expression of HE4 in ovarian cancer tissue and the prognostic significance. Cytoplasmic staining was graded for intensity and percentage of positive cells. The grades were multiplied to determine an H-score. Results Knockdown of HE4 in OVCAR-3 cells resulted in reduction in cell growth and increased sensitivity to paclitaxel and cisplatin compared to control cells. This effect originated from the decreased activation of cell-growth-related signaling, such as AKT and Erk mediated by epidermal growth factor (EGF), while overexpression of HE4 resulted in enhanced cell growth and suppressed the anti-tumorigenic activity of paclitaxel. Activation of AKT and Erk pathways was enhanced in HE4-overexpressing cells compared to control cells. Based on the results of multivariate analysis, the risk of death was significantly higher in patients with an H-score > 4. Conclusion HE4 induces chemoresistance against anti-cancer drugs and activates the AKT and Erk pathways to enhance tumor survival. HE4 expression in ovarian cancer tissue is associated with a worse prognosis for epithelial ovarian cancer patients. [ABSTRACT FROM AUTHOR]

Aim To investigate the expression of Wilms' tumor 1 ( WT1) protein in endometrial adenocarcinoma (EC) and endometrial intra-epithelial neoplasia (EIN). Methods WT1 protein expression was determined on immunohistochemistry in 30 EC patients and in 20 EIN patients. WT1 protein expression in proliferative ( n = 7), secretory ( n = 9) and atrophic endometrium ( n = 9) and benign endometrial polyps ( n = 28) was used as the control group. Cellular and vascular WT1 staining was scored semiquantitatively. Results Cellular WT1 staining was 67% and vascular positivity was 73% in the EC group. In the EIN group the cellular staining was 100% and vascular staining was 85%. Although all EIN samples were positive for cellular WT1 staining, median cellular staining score was similar to that of EC (median, 2; range, 1-3; IQR, 1.75 vs 2, 0-3, 0.75, respectively). Increasing EC grade and stage were not associated with cellular or vascular WT1 staining score. Conclusion WT1 is expressed in EIN. [ABSTRACT FROM AUTHOR]

Aim: Recent studies have demonstrated that the neural precursor cell expressed, developmentally downregulated 4-like (Nedd4L) gene plays a role in the progression of various cancers. However, reports describingNedd4L expression in ovarian cancer tissues are limited. Material and Methods: A cohort (n=117) of archival formalin-fixed, paraffin embedded resected normal ovarian epithelial tissues (n = 10), benign ovarian epithelial tumor tissues (n = 10), serous borderline ovarian epithelial tumor tissues (n = 14), mucous borderline ovarian epithelial tumor tissues (n=11), and invasive ovarian epithelial cancer tissues (n = 72) were assessed for Nedd4L protein expression using immunohistochemistry. Results: Nedd4L protein expression was significantly decreased in invasive ovarian epithelial cancer tissues compared to non-cancer tissues (P<0.05). Decreased Nedd4L protein expression correlated with clinical stage, pathological grade, lymph node metastasis and survival (P<0.05). Conclusion: Nedd4L protein expression may be an independent prognostic marker of ovarian cancer development. [ABSTRACT FROM AUTHOR]

Aim The aim of the study was to describe clinicopathologic characteristics, survival outcomes and the factors associated with recurrence in patients diagnosed with synchronous primary endometrial and epithelial ovarian cancers. Material and Methods In this retrospective study, 50 patients who were diagnosed with synchronous primary endometrial and epithelial ovarian cancers and underwent surgery between 1998 and 2010 were reviewed. Results In our study, the median age at the time of diagnosis was 53 years (range 28-79). The most common presenting symptom was abnormal uterine bleeding with a ratio of 36%. Fifty-four percent of the patients had endometrioid type endometrial cancer and endometrioid type ovarian cancer. All patients were surgically staged and the majority of the patients were in stage I for both endometrial cancer (58%) and ovarian cancer (60%). Nearly one-third (32%) of the patients had a recurrence during the follow-up period and by Cox regression analysis the level of cancer antigen 125 ( P = 0.023) at diagnosis, serous or clear-cell histopathologic type ovarian cancer ( P = 0.029) and stage of endometrial cancer above I ( P = 0.048) were found to be independent risk factors associated with development of recurrence. Patients with endometrioid type endometrium histology and endometrioid type ovarian histology had favorable prognosis with 120.00 months mean disease-free survival and 92% disease-free survival rate at 36 months. Conclusion In our cohort, we found that endometrioid/endometrioid type synchronous primary endometrial and ovarian cancer had different clinical histopathologic characteristics and favorable prognosis compared to the other histologic types of these cancers. Histopathologic type of the ovarian cancer component, stage of endometrial cancer and level of cancer antigen 125 at diagnosis were observed to have a great influence on the development of recurrence and survival of synchronous primary carcinomas of the endometrium and ovary. [ABSTRACT FROM AUTHOR]

Aim Adjuvant chemotherapy is generally recommended for early stage epithelial ovarian cancer. However, it remains uncertain which histological subtypes and substages of stage I disease should receive adjuvant chemotherapy. The objective of this study is to determine the impact of chemotherapy among stage I epithelial ovarian cancer. Material and Methods Of the 267 patients with stage I epithelial ovarian cancer analyzed in this study, 152 patients received adjuvant chemotherapy ( AC-positive group) and 115 patients did not ( AC-negative group). Survival analysis was retrospectively performed to determine the effectiveness of adjuvant chemotherapy in stage I epithelial ovarian cancer patients. Results Recurrence was observed in 14 patients in the AC-negative group and 20 patients in the AC-positive group. There were no statistically significant differences in disease-free survival ( DFS) and overall survival between the two groups. In stage IA and IB patients, there was no statistically significant difference in DFS and overall survival based on adjuvant chemotherapy status. However, in patients with intraoperative tumor capsule rupture, the AC-positive group had significantly better DFS than the AC-negative group ( P = 0.01). Patients with clear cell carcinoma who received adjuvant chemotherapy had better DFS than patients who did not ( P = 0.004). Conclusions Adjuvant chemotherapy may not be necessary for patients with stage IA or IB epithelial ovarian cancer, but may be beneficial for clear cell carcinoma patients with intraoperative tumor rupture. [ABSTRACT FROM AUTHOR]

Aim The purpose of the present study was to explore variation and prognostic significance of serum plasminogen activator inhibitor-1 ( PAI-1) before the first cycle of chemotherapy and after the sixth cycle of chemotherapy in epithelial ovarian cancer ( EOC) patients who had undergone cytoreductive surgery. Material and Methods We retrospectively evaluated the serum PAI-1 level of EOC patients and healthy controls and investigated the correlation between both serum PAI-1 levels of EOC patients we detected and clinicopathological characteristics. Survival rates were analyzed by using the Kaplan- Meier technique and Cox regression model. Results Serum PAI-1 levels of EOC patients before the first cycle of chemotherapy and after the sixth cycle of chemotherapy were significantly higher than those of healthy controls (both P < 0.05). The results of Kaplan- Meier analysis indicated that both serum PAI-1 levels of EOC patients were associated with progression-free survival and overall survival. Multivariate Cox regression analysis revealed the PAI-1 level before the first cycle of chemotherapy was an independent prognostic marker of progression-free survival (28.4 vs 49.6 months; P = 0.013) and overall survival (41.8 vs 53.8 months; P = 0.043). Conclusions Both serum PAI-1 levels of EOC patients we detected were associated with International Federation of Gynecology and Obstetrics stage, residual tumor size and lymph node metastasis. The serum PAI-1 level before the first cycle of chemotherapy is an independent predictor for EOC patients. [ABSTRACT FROM AUTHOR]

Aim The aim of this study is to investigate the impact of preoperative platelet counts, parameters and aggregation rates (maximal aggregation rate: MAR) on prognosis in patients with epithelial ovarian cancer ( EOC). Methods Preoperative platelet count, parameters and MAR in 182 EOC patients, 122 patients with benign ovarian tumor and 150 healthy women were retrospectively analyzed. The correlation between thrombocytosis, platelet parameters, MAR and clinicopathological factors were evaluated in EOC. Results Forty-five (24.73%) EOC patients had preoperative thrombocytosis in this study. The mean platelet count in the EOC group was significantly higher than that of benign and healthy groups ( P < 0.001). The MAR in the EOC group was significantly higher than that in the healthy group (71.96% vs 57.03%, P = 0.025). The platelet parameters (mean platelet volume, platelet distribution width, thrombocytocrit and large platelet ratio) were consistently higher in the EOC group than those in the benign and healthy groups, but the differences were insignificant. A significant correlation between thrombocytosis and MAR was observed in EOC patients ( r = 0.694, P < 0.001). EOC patients with thrombocytosis were found to have significantly higher grade ( P = 0.048), more advanced stage ( P = 0.045), higher level carbohydrate antigen-125 ( P = 0.007) and greater likelihood of suboptimal cytoreduction ( P = 0.035). EOC patients with both thrombocytosis and high MAR were found to have shorter progression-free survival ( P = 0.001)and overall survival ( P = 0.004). The combination of thrombocytosis and MAR, as well as stage and optimal cytoreduction, retained significance as an independent prognostic factor for overall survival. Conclusion Thrombocytosis, accompanied by increasing of platelet aggregation rates, is associated with more aggressive tumor biology in EOC. The combination of thrombocytosis and MAR is an independent negative prognostic factor for overall survival in EOC patients. [ABSTRACT FROM AUTHOR]

We report a non-invasive mixed mucin-producing and squamous differentiated tumor of the uterine cervix. This tumor was composed of two cell types: mucin-producing cells and non-mucin-producing cells. These cells were intimately mixed with each other, and showed intraepithelial spreading. The mucin-producing cells showed signet-ring or columnar shapes, and were localized to the lower-to-upper epithelial layer. The non-mucin-producing cells had eosinophilic cytoplasms with a monotonous appearance through the epithelium. Mitosis was sometimes observed in both cell types. Immunohistochemically, both cell types were positive for p16INK4A. The non-mucin-producing cells were positive for p63 and 34βE12, suggesting squamous differentiation. Although most mucin-producing cells were p63-, a few of them were p63+ and many 34βE12 immunoreactive cells were found in the mucin-producing cells. This tumor was adenosquamous carcinoma in situ. [ABSTRACT FROM AUTHOR]

Aim To examine the effect that human papillomavirus (HPV) vaccination has had in Akita Prefecture, by comparing cervical cytology results from women aged 20-24 years with or without HPV vaccination. Methods We examined cervical cytology results from 2425 subjects who underwent cervical cancer screening under the jurisdiction of the Akita Foundation for Healthcare between January 2014 and October 2016. We compared the prevalence of cytologic abnormalities among women aged 20-24 years with or without HPV vaccination. Results The rate of atypical squamous cells of undetermined significance (ASC-US) or worse was 0.242% (1/413) with HPV vaccination, and 2.04% (41/2012) without HPV vaccination. Overall, the prevalence of abnormal cytology results was significantly lower in women aged 20-24 years who had received an HPV vaccination than in those who had not ( P = 0.011). The reduction in the rate of abnormal cervical cytology results by HPV vaccination was 88.1%. Conclusion Within a 4-year-5-year period following vaccination, women aged 20-24 years who received an HPV vaccination had significantly lower rates of abnormal cervical cytology results than those who did not receive the vaccine. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Prognostic significance of thrombocytosis, platelet parameters and aggregation rates in epithelial ovarian cancer," by X. Ma and colleagues in the September 2013 issue.

A response from the authors of the article "Prognostic significance of mean platelet volume in epithelial ovarian cancer" is presented.