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As life expectancy increases, older people require strict individualization of management and treatment, taking into account all age and pathophysiological characteristics of a particular patient, a more attentive approach to the features of clinical manifestations of diseases, the presence of comorbid pathology. Timely diagnosis and comprehensive treatment of postmenopausal patients with benign ovarian tumors is a debatable issue, since none of the existing diagnostic methods of research in practice provides sensitivity and specificity equal to or at least approaching 100% of the indicator. The progressive aging of the population raises the question of whether it is necessary to operate on menopausal patients with benign ovarian tumors of small size (up to 5 cm), given the low percentage of malignancy of these formations and the high risk of deterioration in the patients quality of life after surgical interventions.

Background: Leiomyomas comprise 0.5%–1% of all benign ovarian tumors and occur between adolescence and postmenopause; ∼ 80% have been reported in premenopausal women. These tumors are very rare, an...

One of the common types of cancer for women is ovarian cancer. Still, at present, there are no drug therapies that can properly cure this deadly disease. However, early-stage detection could boost the life expectancy of the patients. The main aim of this work is to apply machine learning models along with statistical methods to the clinical data obtained from 349 patient individuals to conduct predictive analytics for early diagnosis. In statistical analysis, Student’s t-test as well as log fold changes of two groups are used to find the significant blood biomarkers. Furthermore, a set of machine learning models including Random Forest (RF), Support Vector Machine (SVM), Decision Tree (DT), Extreme Gradient Boosting Machine (XGBoost), Logistic Regression (LR), Gradient Boosting Machine (GBM) and Light Gradient Boosting Machine (LGBM) are used to build classification models to stratify benign-vs.-malignant ovarian cancer patients. Both of the analysis techniques recognized that the serumsamples carbohydrate antigen 125, carbohydrate antigen 19-9, carcinoembryonic antigen and human epididymis protein 4 are the top-most significant biomarkers as well as neutrophil ratio, thrombocytocrit, hematocrit blood samples, alanine aminotransferase, calcium, indirect bilirubin, uric acid, natriumas as general chemistry tests. Moreover, the results from predictive analysis suggest that the machine learning models can classify malignant patients from benign patients with accuracy as good as 91%. Since generally, early-stage detection is not available, machine learning detection could play a significant role in cancer diagnosis.

Aim of the Study: We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions. Materials and Methods: This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both sides. Results: Eighty-nine patients were included (54 English and 35 Egyptians). Median age at diagnosis in England was 13 years (2-16y), while in Egypt it was 7 years (9m-16y) with P =0.001. Mature teratomas or dermoid cysts were the most common findings in England and Egypt; 75.9% and 82.8% of cases, respectively. The presentation with an acute abdomen represented 27.8% of English and 28.6% of Egyptian patients. Incidentally diagnosed lesions constituted 15% of English patients, whereas none of the Egyptian cases were discovered incidentally. There were variations in diagnostic imaging; England: Ultrasound (USS) (54), magnetic resonance imaging (MRI) (37), and computed tomography (CT) (only one)–Egypt: USS (35), CT (17), and MRI (only one). Minimally invasive surgery (MIS) was performed in 15% of English and 23% of Egyptian patients (P = 0.334). Ovarian-sparing surgery (OSS) was performed in: England 35%, Egypt 37%; P = 0.851. OSS was performed using MIS in 87.5% (7/8) of English patients and 100% (8/8) of Egyptians. Patients presented as emergencies generally had open oophorectomies: England; 86.7% open and 80% oophorectomy–Egypt; 100% open and 90% oophorectomy. Recurrences or metachronous disease occurred in 5.6% of English and 5.7% of Egyptian patients. Conclusions: There were no significant differences regarding surgical management, tumor pathology, and recurrence or metachronous disease. However, age, incidental diagnosis, and imaging modalities showed notable differences. MIS was correlated with ovarian preservation, whereas emergency surgery generally resulted in open oophorectomy.

The article presents a review of scientific works on problems of perinatal care for pregnant women with first-time benign ovarian tumors during this pregnancy. Our interest in these issues is due to the increasing frequency of detection of benign ovarian neoplasms during pregnancy in Ukraine. Diagnosis of ovarian neoplasms during pregnancy is aimed at establishing the nature of this formation (benign or malignant) in order to develop individual tactics for managing this pregnancy. The review of the scientific literature describes the frequency with which ovarian cysts occur during pregnancy and their possible varieties. The histological classification of neoplasms and ovarian cysts is one of the most important because it reflects the understanding of pathogenesis, molecular genetic and biological features of each pathology. Diagnosis and verification of ovarian cysts on the background of pregnancy is a difficult task, since there are limitations in the application of the necessary diagnostic methods, the pathology is characterized by asymptomatic course or clinical manifestations. Possible variants of the diagnostic examination are presented and described in detail, which includes ultrasound examination and magnetic resonance imaging with intravenous amplification. Ovarian cysts are usually diagnosed accidentally in the first trimester of pregnancy. Sonographic examination in early pregnancy increased the incidence of cystic ovarian lesions. The timing of surgery and its possible options: laparoscopic or laparotomy are detailed. The advantages and disadvantages of both options are given. All of the above dictates the need for adherence to the principle of multidisciplinarity and continuity between gynecologists, oncologists, and family physicians in managing this contingent of patients, with a view to timely detection and adequate surgical treatment of neoplasms.

Cystadenofibromas (CAFs) are relatively rare benign ovarian tumors. This study was to describe the ultrasound (US) findings of CAFs. Preoperative US information of 86 CAFs was retrospectively collected. To better illustrate their characteristic, 173 cystadenomas (CADs), 103 borderline ovarian tumors (BOTs), and 129 cystadenocarcinomas (CACs) were recruited as match groups. Besides morphology evaluation, tumors were categorized by the Ovarian-Adnexal Reporting and Data System US system. Higher-risk stratification in CAFs was more often being seen than CADs (63% of CAFs classified as Ovarian-Adnexal Reporting and Data System 4 or 5 vs 35% in CADs). Cystadenofibromas more commonly appeared as unilocular or multilocular solid than CADs. Solid components presented in 59% of CAFs and papillary projections presented in 45%. More CAFs contained solid components and papillary projections than CADs (P < 0.0001). When compared with BOTs and CACs, less CAFs contained solid components (P < 0.017 and P < 0.0001). However, no significant difference was found in CAFs versus BOTs or CACs about the presence of papillary projections. Shadowing was identified in 58% of CAFs; however, in CADs, BOTs, and CACs, the proportion was 2%, 11%, and 11%, respectively. Presence of shadowing in CAFs was noticeably more than CADs, BOTs, and CACs (P < 0.017 or P < 0.0001). Similar to CADs, most CAFs were avascular (76%) and without ascites (99%), which were significantly different from BOTs and CACs. We concluded that the sonographic markers for CAFs that differ from malignant were presence of shadowing, avascular, and absence of ascites.

Introduction/Background* This study aimed to evaluate the diagnostic added-value of serum CA-125 & HE4 to the International Ovarian Tumor Analysis (IOTA) Simple Rules for differentiating malignant and benign ovarian tumors preoperatively. Methodology A Cross sectional study was conducted in the Department of Obstetrics and Gynecology on 100 patients with ovarian masses. Demographic and clinical data were prospectively collected. Histopathologic diagnosis was used as the gold standard test. Evaluation of the utility of HE4, CA125 and IOTs simple rules for preoperative identification of malignacy was based on the increment of the area under the receiver operating characteristic curve (AuROC). Result(s)* Out of the 50 suspected benign masses as per IOTA simple rules, post surgery (considering histopathology as gold standard) 32 (64%) were diagnosed as benign ovarian masses, 4 (8%) borderline and 14 (28%) other malignant ovarian tumors on final histopathology. Out of 50 suspected malignant masses as per IOTA simple rules, 26 (52%) were finally diagnosed as benign, 4(8%) borderline and 20 (40%) were malignant. Sensitivity of combined testing of both tumour markers (HE4 and Ca-125) and IOTA together was calculated to be a 85.3% (69-95) whereas its specificity increased to be 94.8% (86-99). Positive predictive value was determined to 90.6% (75-98) and negative predictive value was calculated 91.7% (82-97) making its diagnostic accuracy as 91.3% (84-96). Conclusion* Combining IOTA Simple rules with knpown tumour markers (CA125 and HE4) increases diagnostic accuracy in predicting malignat ovarian masses preoperatively

The aim of the study was to identify risk factors for obstetric and perinatal complications in benign ovarian neoplasms. Materials and research methods. 67 pregnant women with benign ovarian tumors (main group) and 50 pregnant women without ovarian neoplasms and other severe pathology (control group) were examined. The main group was divided into 2 subgroups: 1st - 18 women with obstetric and perinatal complications, 2nd - 49 women without significant complications of pregnancy. Research results and discussion. The frequency of dangerous obstetric and perinatal complications (severe preeclampsia, fetal distress, IGR, perinatal mortality, premature birth before 34 weeks of gestation, severe neonatal asphyxia) with benign neoplasms in the ovaries is 26.9%, which is more than 4 times higher than in the control group (OR = 5.76, 95% CI [1.59; 20.83]). Among patients with obstetric and perinatal complications, 44.4% were operated on during pregnancy (OR = 4.8, 95% CI [1.41; 16.37]). A significantly larger proportion of women in older age groups has been established. Significantly higher percentage of female students and office workers, women with unregistered marriages, which is possibly due to the high level of neuropsychological stress. A high level of comorbidity with various extragenital diseases (pathology of the gastrointestinal tract, urinary system, hepatobiliary pathology, metabolic syndrome) to a certain extent also causes gestational complications. The role of infectious pathology, especially of the urinary system, is also significant. Potential risk factors include menstrual dysfunction, a burdened gynecological and obstetric history. In this pregnancy, early preeclampsia, acute respiratory viral infections and exacerbation of urogenital infection can be predictors of significant obstetric and perinatal complications. Conclusion. Taking into account the established risk factors will become the basis for the development of a pathogenetically grounded complex for the management of pregnant women with benign ovarian pathology., Целью исследования было выявление факторов риска акушерских и перинатальных осложнений при доброкачественных новообразованиях яичников. Материалы и методы исследования. Обследовано 67 беременных с доброкачественными опухолями яичников (основная группа) и 50 беременных без новообразований яичников и другой тяжелой патологии (контрольная группа). Основная группа была разделена на 2 подгруппы: 1-я - 18 женщин с акушерскими и перинатальными осложнениями, 2-я - 49 женщин без существенных осложнений беременности. Результаты исследования и их обсуждение. Частота опасных акушерских и перинатальных осложнений (тяжелая преэклампсия, дистресс плода, ЗРП, перинатальная смертность, преждевременные роды до 34 недель беременности, тяжелая асфиксия новорожденных) при доброкачественных новообразованиях в яичниках составляет 26,9%, что более чем в 4 раза превышает показатель группы контроля (ОШ = 5,76, 95-процентный ДИ [1,59; 20,83]). Среди пациенток с акушерскими и перинатальными осложнениями прооперированы во время беременности 44,4%, (ОШ = 4,8, 95-процентный ДИ [1,41; 16,37]). Установлена существенно большая доля женщин старших возрастных групп. Достоверно больший процент студенток и служащих, женщин с незарегистрированным браком. что возможно связано с высоким уровнем нервно-психологической нагрузки. Высокий уровень коморбидности с различными экстрагенитальными заболеваниями (патология желудочно-кишечного тракта, мочевыделительной системы, гепатобилиарная патология, метаболический синдром) в определенной степени обусловливает и гестационные осложнения. Существенна также роль инфекционной патологии, особенно мочевыделительной системы. К потенциальным факторам риска можно отнести и нарушения менструальной функции, отягощенный гинекологический и акушерский анамнез. При данной беременности ранний гестоз, ОРВИ и обострения урогенитальной инфекции могут быть предикторами значимых акушерских и перинатальных осложнений. Вывод. Учет установленных факторов риска станет основанием для разработки патогенетически обоснованного комплекса ведения беременных с доброкачественной патологией яичников., Мета дослідження – виявлення факторів ризику акушерських і перинатальних ускладнень при доброякісних новоутвореннях яєчників. Матеріали та методи дослідження. Обстежено 67 вагітних з доброякісними пухлинами яєчників (основна група) та 50 вагітних без новоутворень яєчників та іншої тяжкої патології (контрольна група). Основна група поділена на 2 підгрупи: 1-ша – 18 жінок з акушерськими і перинатальними ускладненнями, 2-га – 49 жінок без суттєвих ускладнень вагітності. Результати дослідження та їх обговорення. Частота небезпечних акушерських і перинатальних ускладнень (тяжка прееклампсія, дистрес плода, ЗРП, перинатальна смертність, передчасні пологи до 34 тижнів вагітності, тяжка асфіксія новонароджених) при доброякісних новоутвореннях в яєчниках складає 26,9 %, що більш ніж у 4 рази перевищує показник групи контролю (ВШ=5,76, 95-відсотковий ДІ [1,59; 20,83]). Серед пацієнток з акушерськими і перинатальними ускладненнями прооперовано під час вагітності 44,4 %, (ВШ=4,8, 95-відсотковий ДІ [1,41; 16,37]). Встановлено суттєво більша частка жінок старших вікових груп Достовірно більший відсоток студенток та службовців, жінок з незареєстрованим шлюбом. що можливо пов’язано з вищим рівнем нервово-психологічного навантаження. Високий рівень коморбідності з різними екстрагенітальними захворюваннями (патологія шлунково-кишкового тракту, сечовидільної системи, гепатобіліарна патологія, метаболічний синдром) певною мірою обумовлює і гестаційні ускладнення. Суттєва також роль інфекційної патології, особливо сечовидільної системи. До потенційних факторів ризику можна віднести і порушення менструальної функції, обтяжений гінекологічний та акушерський анамнез. При даній вагітності ранній гестоз, ГРВІ та загострення урогенітальної інфекції можуть бути предикторами значимих акушерських і перинатальних ускладнень. Висновок. Врахування встановлених факторів ризику стане підставою для розробки патогенетично обгрунтованого комплексу ведення вагітних з доброякісною патологією яєчників.

Ovarian tumors may be found in women of any age and the period of pregnancy is no exception. Besides, this period is related to some specific adnexal tumors. A systematic use of ultrasonography in the first trimester of pregnancy has led to a wider detection of symptomless adnexal tumors. The majority of adnexal tumors diagnosed during pregnancy are accidental findings of routine examinations of pregnancy. According to various estimations, the incidence of adnexal neoplasms during pregnancy makes up from 0.19 to 8.8 %. Most of cases are diagnosed in the first trimester and their incidence gradually decreases as the period of pregnancy grows: Trimester 1 – from 21.4 to 75.7 %; Trimester 2 – from 10.9 to 44.4 %; Trimester 3 – from 4 to 22.2 %; after labor – from 0 to 7.1 %. Most of adnexal tumors during pregnancy are benign and physiological and often regress spontaneously. Depending on their size and location, ovarian tumors may be related to an adverse obstetrical result caused by mechanical influence. They increase the risk of abortion (from 0 to 6 %), preterm labor (from 5.8 to 10.4 %) and mechanical impediment to labor. In view of the above mentioned considerations, one of the objectives of our research is to make a retrospective analysis of perinatal peculiarities in women with benign ovarian neoplasms.

The originality of the profile of psychological defenses (c, LSY) of women suffering from borderline and benign ovarian tumors is considered. The concepts of constructive LSY profile and non‑constructive LSY profile are introduced. It is shown that the most pronounced tendency to constructive ego‑defenses is among patients with benign ovarian tumors, which is directly related to the process of restoration of their reproductive potential. In patients representing groups of borderline ovarian tumors, the complexity of the course of the disease, the insufficient success of reproduction is accompanied by subjectively reduced self‑esteem, frustration, which is reflected in the predominance of the non‑constructive profile of LSY.Conclusion. The psychological portrait of patients with benign ovarian tumors, characterized by various types of protective behavior, it is advisable to consider when planning the management of this patient population.

PURPOSE: The importance of benign ovarian tumors as precursors or risk markers for ovarian cancer is not fully understood. Studies on the association between benign ovarian tumors and ovarian cancer have provided inconclusive results. We examined the overall and histological type-specific risk of ovarian cancer among 158,221 Danish women diagnosed with a benign ovarian tumor during 1978-2016.METHODS: The study cohort was linked to the Danish Cancer Register to identify all cases of epithelial ovarian cancer, and standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated.RESULTS: After excluding the first year of follow-up, women with benign ovarian tumors did not have an increased risk for overall epithelial ovarian cancer (SIR 1.02; 95% CI 0.93-1.11), as compared with women in the general population. However, we found an increased risk for mucinous ovarian cancer (SIR 2.06; 95% CI 1.67-2.52); both solid and cystic benign ovarian tumors were associated with an increased risk. The risk for mucinous ovarian cancer was increased irrespective of the age at benign ovarian tumors diagnosis and persisted for up to 20 years after the benign ovarian tumor diagnosis. No clear associations for other histological types of ovarian cancer were observed, except for an increased risk for serous ovarian cancer among women diagnosed with benign ovarian tumors at an young age.CONCLUSIONS: Benign ovarian tumors may be associated with long-term increased risk for mucinous ovarian cancer.

Background This study aimed to examine the performance of the four risk of malignancy index (RMI) in discriminating borderline ovarian tumors (BOTs) and benign ovarian masses in daily clinical practice. Methods A total of 162 women with BOTs and 379 women with benign ovarian tumors diagnosed at the Second Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were enrolled in this retrospective study. Also, we classified these patients into serous borderline ovarian tumor (SBOT) and mucinous borderline ovarian tumor (MBOT) subgroup. Preoperative ultrasound findings, cancer antigen 125 (CA125) and menopausal status were reviewed. The area under the curve (AUC) of receiver operator characteristic curves (ROC) and performance indices of RMI I, RMI II, RMI III and RMI IV were calculated and compared for discrimination between benign ovarian tumors and BOTs. Results RMI I had the highest AUC (0.825, 95% CI: 0.790–0.856) among the four RMIs in BOTs group. Similar results were found in SBOT (0.839, 95% CI: 0.804–0.871) and MBOT (0.791, 95% CI: 0.749–0.829) subgroups. RMI I had the highest specificity among the BOTs group (87.6, 95% CI: 83.9–90.7%), SBOT (87.6, 95% CI: 83.9–90.7%) and MBOT group (87.6, 95% CI: 83.9–90.7%). RMI II scored the highest overall in terms of sensitivity among the BOTs group (69.75, 95% CI: 62.1–76.7%), SBOT (74.34, 95% CI: 65.3–82.1%) and MBOT (59.18, 95% CI: 44.2–73.0%) group. Conclusion Compared to other RMIs, RMI I was the best-performed method for differentiation of BOTs from benign ovarian tumors. At the same time, RMI I also performed best in the discrimination SBOT from benign ovarian tumors.

Objectives. Defining precisely the normal range of HE4 protein is crucial for the proper interpretation of tumor marker results and for a more efficient diagnosis of ovarian malignancy. The aim of our study was to evaluate a reference limit of HE4 protein in a population to promote and facilitate the common use of HE4 protein assays. We also tried to identify potential association of HE4 levels with other conditions such as smoking, age, BMI, and creatinine levels. Methods. Blood samples were collected from 617 patients divided into three groups: healthy, pregnant, and with benign ovarian tumors. Serum HE4 concentrations were measured following a standard procedure. HE4 reference ranges for each group and association of HE4 levels with BMI, creatinine, and smoking were investigated. Results. HE4 reference limit for healthy patients equals 85 pmol/l, which becomes 73 pmol/l and 93 pmol/l for pre and postmenopausal subgroups, respectively. There is a statistically significant correlation between HE4 serum level and smoking (p=0.000001) and there is no correlation with creatinine. But if we take into account age and smoking, in multivariate analysis, there is a correlation. For pregnant, the upper limit values of normal HE4 levels are 55 pmol/l (median=40 pmol/l), 80 pmol/l (median=43 pmol/l), and 106 pmol/l (median=53 pmol/l) for the first, second, and third trimesters, respectively. Conclusions. HE4 protein value strongly depends on the patient’s age and smoking. The serum concentration of HE4 marker increases with the duration of pregnancy. Understanding the normal range of HE4 protein enables the correct interpretation of marker measurements. This may result in an earlier and more effective diagnosis of ovarian cancer.

Objectives Cystadenofibromas (CAFs) are rare benign ovarian tumors without a widely accepted ultrasound (US) pattern. They are usually described by as thin-walled, unilocular or multilocular, and at times septated cysts with scant blood flow and no solid components. We describe a unique US feature, the "shadow sign," seen in prospectively diagnosed benign CAFs. We also provide the histopathologic basis for this typical US appearance. Methods Ultrasound (US) examinations were performed in our obstetric and gynecologic US unit. Pathologic examinations were performed by a dedicated gynecologic pathology team. The US and pathology department's database was searched for the diagnosis of a CAF between 2010 and 2017. Results We identified 20 patients who underwent transvaginal US examinations with a sole US diagnosis of a CAF, and the tumors were surgically removed. The common US feature across the 20 cases was the presence of hyperechoic avascular shadowing nodules. The correlating histologic features were unilocular or multilocular cysts with a smooth internal wall surface lined by a simple epithelium and occasional robust polypoid fibrous stroma. Conclusions This US marker helps in differentiating CAFs from borderline ovarian tumors, which do not show this US feature. We hope that recognizing the suggested shadow sign as an additional descriptor of CAFs will lead to minimizing their unnecessary removal and eliminating additional and unnecessary imaging by computed tomography and magnetic resonance imaging.

BackgroundRisk of malignancy index (RMI) is scoring system which was introduced to differentiate between benign and malignant ovarian tumor. It incorporates CA-125, ultrasound score and menopausal status for prediction of ovarian malignancies in preoperative period. There is no universal screening method to discriminate between benign and malignant adnexal masses yet. So, this study was conducted to determine the diagnostic accuracy of RMI and determine best cut off value for RMI.MethodsProspective cross-sectional study was carried out among women with ovarian mass admitted to Gynecology ward and operated from September 1, 2019 to June 30, 2020.Data analysis was carried out using SPSS version 26. CA-125 level, menopausal status and ultrasound score were used to calculate RMI. Finally, RMI score was compared to histopathology result used as gold standard.ResultsNinity nine patients were enrolled in this study. Prevalence of benign ovarian tumors were 61.6% (61/99) and that of malignant ovarian tumors were 38.4% (38/99). The mean age for benign tumors was 30±9yrs and the mean age for malignant tumors was 50.6±10.8yrs. Among benign tumors, serous cystadenoma was the most common (36%), followed by dermoid cyst (32.9%), mucinous cyst adenoma (14.8%). The most common malignant ovarian tumor was serous cyst adenocarcinoma (63.2%), followed by mucinous cystadenocarcinoma (23.8%) and dysgerminoma (5.3%). Overall, using RMI score cut off value 220 has good sensitivity (84.2%), specificity (77%), PPV (69.5%), NPV (88.7%) and diagnostic accuracy (79.8%) for discriminating between benign and malignant ovarian tumors.ConclusionFrom this study there were high proportion of women with RMI>=220 in malignant ovarian tumors group. The study shows that there is significant role of RMI in prediction of ovarian malignancy thus helping in deciding which patients need referral to a center where gynecologic oncologists are available. It is good practice to use it in developing countries including our country because of its simplicity, safety and applicability in initial evaluations of patients with adnexal mass.

Circulating microRNAs (miRNAs) have the potential to become reliable and noninvasive biomarkers for ovarian cancer (OC) diagnosis; however, the conventional miRNAs detection techniques exhibit enduring limitations of low sensitivity and specificity. Graphene oxide (GO), a novel nanomaterial, is at the forefront of material design for extensive biomedical applications. Owing to the excellent water affinity and single-stranded DNA (ssDNA) adsorption characteristics of GO, we designed and developed a GO-based qRT-PCR assay for the detection of miRNAs associated with OC. In the GO-based qRT-PCR system, GO could significantly improve the sensitivity and specificity of the qRT-PCR assay by noncovalently interacting with primers and ssDNA and reducing the occurrence of non-specific amplification. Moreover, the detection of miRNAs associated with OC confirmed that GO-based qRT-PCR assay could differentiate benign ovarian tumors from OC (sensitivity, 0.91; specificity, 1.00). Collectively, these findings provide robust evidence that GO-based qRT-PCR assay can be effectively used as a promising method to detect miRNAs for the screening of OC patients.

The use of routine blood tests has recently been shown to be promising in deter- mining disease- free and overall survival in patients with various malignancies, and also in gyneco- logic malignancies. The aim of this study was to evaluate whether salivary and serum CA125 levels correlate and whether salivary and serum CA125, C- reactive protein and routine blood tests might serve as a prognostic factor in malignant ovarian tumors, and whether they might differentiate be- tween benign and malignant ovarian tumors. A total of 98 women were included (48 with benign ovarian tumors and 50 with malignant ovarian tumors), in whom routine blood tests were made and salivary and serum CA125 levels were determined by use of ELISA. Increase in serum CA125 and amylase decreased overall survival, whereas increase in salivary CA125, potassium levels and hemoglo- bin increased overall survival. Significant correlation of serum CA125 and C-reactive protein was found in the group with malignant tumors. In conclusion, significant increase in the levels of serum CA125 and amylase correlated with decreased survival, whereas increased salivary CA125, hemoglo- bin and potassium levels significantly correlated with increased survival.

Fibrothecomas are mostly benign ovarian tumors. We describe a rare case of fibrothecoma in a 59-year-old woman with a history of recurrent massive ascites and postmenopausal bleeding. Over 2 years she has undergone more than 50 paracenteses with 8–11 L withdrawn each time. She presented with a newly diagnosed pelvic mass and bilateral hydrosalpinges demonstrated on ultrasound and were confirmed with computed tomography. The pelvic magnetic resonance imaging showed a large complex cystic mass arising from the left ovary measuring 16.6 × 12.1 × 8.6 cm3 with an area of irregular mural enhancement. The patient underwent left salpingo-oophorectomy with benign frozen section results. The final pathology was consistent with cystic degeneration of fibrothecoma

(1) Background: The aim of this study is to compare the IOTA-ADNEX (international ovarian tumor analysis&ndash, assessment of different neoplasias in the adnexa) model with gynecologic experts in differentiating ovarian diseases. (2) Methods: All participants in this prospective study underwent ultrasonography (US) equipped with the IOTA-ADNEXTM model and subjective assessment by a sonographic expert. Receiver operating characteristic (ROC) curves were also generated to compare overall accuracies. The optimal cut-off value of the ADNEX model for excluding benign diseases was calculated. (3) Results: Fifty-nine participants were eligible: 54 and 5 underwent surgery and follow-up computed tomography (CT), respectively. Benign and malignant diseases were confirmed in 49 (83.1%) and 10 (16.9%) participants, respectively. The specificity of the ADNEX model was 0.816 (95% confidence interval (CI): 0.680&ndash, 0.912) in all participants and 0.795 (95% CI, 0.647&ndash, 0.902) in the surgical group. The area under the ROC curve of the ADNEX model (0.924) was not significantly different from that of subjective assessment (0.953 in all participants, 0.951 in the surgical group, p = 0.391 in all participants, p = 0.407 in the surgical group). The optimal cut-off point using the ADNEX model was 47.3%, with a specificity of 0.977 (95% CI: 0.880&ndash, 0.999). (4) Conclusions: The IOTA-ADNEX model is equal to gynecologic US experts in excluding benign ovarian tumors. Subsequently, being familiar with this US software may help gynecologic beginners to reduce unnecessary surgery.

Background Ovarian tumors are one of the prevalent gynecological tumors. They are the fifth commonest tumor in women. The therapeutic strategy depends on whether the tumor is benign, borderline or malignant. They always cause nonspecific symptoms at early stages and diagnosed at advanced stages. We tried to test and compare the sensitivity and accuracy of diffusion-weighted imaging (DWI) and MR perfusion in the diagnosis of ovarian tumors among fifty patients with ovarian masses who collected after meeting the inclusion criteria depending on grayscale sonographic findings after the approval of the ethical committee of our institution. The sensitivity and accuracy of the techniques were compared. Results The surgical and pathological reports of our patients proved a non-tumorous lesion in three patients. They also proved benign ovarian tumors in 18/47 (38.3%) patients, borderline tumors in 4/47 (8.5%) patients and malignant ovarian tumors in 25/47 (53.2%) patients. According to conventional MRI, ovarian tumors could be diagnosed with sensitivity 92%, specificity 61.11%, PPV 76.7%, NPV 84.6% and accuracy 79.1%. DWI and MR perfusion showed the same results where they showed sensitivity 98%, specificity 83%, PPV 90%, NPV 98% and accuracy 93% with ADC cut-off value 1 × 10−3 mm2/s. Conclusion Diffusion-weighted imaging and MR perfusion are useful in the diagnosis of ovarian tumors with approximately the same sensitivity and positive impact on operative management.

Benign ovarian tumors occur in 7% of women during their procreative years and involve both organic and functional tumors. The average age of onset for borderline ovarian tumors is ten years younger than that for ovarian cancers. Women with benign and borderline malignant ovarian tumors are therefore more likely to be affected by fertility issues. The causal link between infertility and benign ovarian tumor stems more from the therapeutic strategies adopted than from the histological nature of the benign ovarian tumor. The question of fertility preservation must therefore be addressed in the management of these patients through respect for "correct" surgical indications, through gestures centered around ovarian preservation, and finally, if necessary, by recourse to fertility preservation techniques.

Fawen Chen,1,2 Jing Shen,3 Jianwei Wang,1 Pengwei Cai,1 Yi Huang3 1Department of Clinical Laboratory, Fujian Provincial Hospital South Branch, 2Department of Blood Transfusion, 3Department of Clinical Laboratory, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, People’s Republic of China Purpose: To investigate the diagnostic values of human epididymis protein 4 (HE4), carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) for ovarian tumors. Methods: The participants were divided into three groups: 386 healthy women (control group), 262 patients with benign ovarian tumors (the benign group), and 196 patients with malignant pelvic tumors (the malignant group). The serum levels of HE4, CA125, CA19-9, and CEA were analyzed by electrochemiluminescent immunoassay. Results: It showed that serum levels of HE4, CA125, CA19-9, and CEA of patients with ­malignant ovarian tumors were significantly higher than those in the control group and benign group (P0.05). Conclusion: The combination of three or four tumor markers did not improve the diagnostic efficacy when compared with the combination of HE4 and CA125. Keywords: human epididymis protein 4, carbohydrate antigen 125, carbohydrate antigen 19-9, carcinoembryonic antigen, pelvic tumor

Background: Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are currently used to evaluate ovarian tumors.Functional imaging by means of diffusion weighted magnetic resonance imaging (DW-MRI) is now part of the standard imaging protocols for evaluation of the female pelvis. DW-MRI is important MR imaging technique which enable the radiologist to move from morphological to functional assessment of diseases of the female pelvis. Aim of the Study: The aim of the current study is to evaluate the diffusion-weighted MR imaging in prediction of the nature of suspicious ovarian masses which are detected previously by conventional ultrasound. Patients and Methods: MRI Unit, radiodiagnosis department, Ain Shams University hospital. The study is prospective, included thirty women who presented with suspicious adnexal masses on previous ultrasound examination and referred for further assessment and characterization by DW-MRI. Patients with contraindications to MRI (e.g. claustrophobia, cardiac prosthesis and metallic plates) are excluded. Results: The study included 30 women ranging in age between 24 and 61 years with mean age 43.22±11.15. Out of 30 cases, 12 had of benign ovarian tumors while 18 had malignant tumors. Conclusion: Thus, combination of DWI and conventional MRI implies using a completely noninvasive technique with no radiation exposure. It is cost effective (no additional cost to MRI examination), and easily added to the MR study protocols with no marked lengthening of examination time. It improves the specificity of MRI and thus increasing radiologist’s confidence in image interpretation which will finally reflect on patient’s outcome and prognosis.

Purpose We sought to develop a matrix assisted laser desorption ionization-time of flight (MALDI-TOF)-based, ovarian cancer (OVC), low-mass-ion discriminant equation (LOME) and to evaluate a possible supportive role for triple-TOF mass analysis in identifying metabolic biomarkers. Materials and methods A total of 114 serum samples from patients with OVC and benign ovarian tumors were subjected to MALDI-TOF analysis and a total of 137 serum samples from healthy female individuals and patients with OVC, colorectal cancer, hepatobiliary cancer, and pancreatic cancer were subjected to triple-TOF analysis. An OVC LOME was constructed by reference to the peak intensity ratios of discriminatory low-mass ion (LMI) pairs. Triple-TOF analysiswas used to select and identify metabolic biomarkers for OVC screening. Results Three OVC LOMEs were finally constructed using discriminatory LMI pairs (137.1690 and 84.4119 m/z; 496.5022 and 709.7642 m/z; and 524.5614 and 709.7642 m/z); all afforded accuracies of g 90%. The LMIs at 496.5022 m/z and 524.5614 m/z were those of lysophosphatidylcholine (LPC) 16:0 and LPC 18:0. Triple-TOF analysis selected seven discriminative LMIs; each LMI had a specificity g 90%. Of the seven LMIs, fourwith a 137.0455 m/z ion atretention times of 2.04-3.14 minuteswere upregulated in sera from OVC patients; the ion was identified as that derived from hypoxanthine. Conclusion MALDI-TOF-based OVC LOMEs combined with triple-TOF-based OVC metabolic biomarkers allow reliable OVC screening; the techniques are mutually complementary both quantitatively and qualitatively.

Обследовано 294 беременные женщины с доброкачественными, пограничными и злокачественными опухолями яичников. До операции проводили ультразвуковое исследование, тонкоигольную биопсию яичников, определяли концентрацию СА-125, sFas, VEGF, интерлейкина-6 в сыворотке крови. Полученные результаты сопоставляли с данными морфологических исследований. Выполняли органосохраняющее и радикальное хирургическое лечение, при необходимости - химиотерапию. В результате исследования был разработан способ дифференциальной диагностики опухолей яичников по ультразвуковым признакам. Отмечено, что достоверное изменение сывороточных маркеров происходит только при злокачественных опухолях яичников. Проведенное исследование позволило определить рациональную врачебную тактику при сочетании беременности с опухолями яичников., The study included 294 pregnant women with benign, borderline, and malignant ovarian tumors. Before surgery, all patients underwent ultrasound examination, fine-needle biopsy of ovaries, and blood test (CA-125, sFas, VEGF, interleukin-6). Obtained results were compared with morphological studies. Organ-preserving and radical surgery and, if necessary, chemotherapy were performed. The study allowed obtaining the method for differential diagnosis of ovarian tumors by ultrasound signs. Significant change in serum markers occured only in patients with malignant ovarian tumors. The study made it possible to determine rational medical tactics for pregnant women with ovarian tumors.