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Fertility-sparing treatment has been accepted as a standard treatment for epithelial ovarian cancer in stage IA non-clear cell histology grade 1/grade 2. In order to expand an indication of fertility-sparing treatment, we have started a non-randomized confirmatory trial for stage IA clear cell histology and stage IC unilateral non-clear cell histology grade 1/grade 2. The protocol-defined fertility-sparing surgery is optimal staging laparotomy including unilateral salpingo-oophorectomy, omentectomy, peritoneal cytology and pelvic and para-aortic lymph node dissection or biopsy. After fertility-sparing surgery, four to six cycles of adjuvant chemotherapy with paclitaxel and carboplatin are administered. We plan to enroll 250 patients with an indication of fertility-sparing surgery, and then the primary analysis is to be conducted for 63 operated patients with pathologically confirmed stage IA clear cell histology and stage IC unilateral non-clear cell histology grade 1/grade 2. The primary endpoint is 5-year overall survival. Secondary endpoints are other survival endpoints and factors related to reproduction. This trial has been registered at the UMIN Clinical Trials Registry as UMIN000013380., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: The aim of this study was to investigate the impact of the histological findings on the treatment of malignant ovarian tumors in pregnant women., Methods: This is a retrospective study of 41 patients diagnosed and treated for ovarian malignancy during pregnancy between 1985 and 2010., Results: The median age of the study group was 30 years old, ranging from 20 to 41. Thirty-eight (92 %) patients were diagnosed with stage I, and one (2 %) with each of stages II, III, and IV. Twenty-five (61 %) patients had borderline malignancy, 8 (20 %) were diagnosed with epithelial ovarian cancer, 7 (17 %) with germ cell tumor, and one with sex cord stromal tumor. All patients received primary surgery; 7 (17 %) patients had cystectomy, 32 (78 %) had unilateral salpingo-oophorectomy, and 3 (7 %) underwent hysterectomy with bilateral salpingo-oophorectomy. Thirty-one (76 %) patients delivered live newborns; 21 had borderline tumor (84 %), 2 had ovarian cancers (25 %), and 8 had non-epithelial tumor (100 %). Six cases were terminated in order to perform the standard treatment for ovarian malignancy and 2 cases aborted spontaneously., Conclusion: In pregnant women, ovarian cancer is exceptionally less frequent compared with non-pregnant women, i.e. age-matched, statistically-corrected controls based on the Japanese annual report [8/33 (24 %) vs. control (60 %); ovarian cancer/(ovarian cancer + borderline tumor), P = 0.001]. The pregnant women with ovarian cancer chose to prioritize treatment of ovarian cancer at the sacrifice of their babies while those with borderline tumor or non-epithelial tumor were able to successfully deliver live newborns.

We report a rare case of paraneoplastic limbic encephalitis with autoantibodies to glutamate receptor (GluR) in the cerebrospinal fluid (CSF). The 35-year-old woman with consciousness disturbance was diagnosed initially as non-herpetic encephalitis. Her signs and symptoms improved with acyclovir and steroid pulse therapy. However, after the treatment, an ovarian tumor was discovered, and we detected autoantibodies to GluR in the CSF. A possible association between the ovarian teratoma and GluR is suggested.

Background: The aim of this study was to determine the treatment strategy for ovarian metastases from gastric cancer, by a retrospective study of the treatment results., Methods: We reviewed the records of patients with ovarian metastases from primary gastric cancer. Ovarian metastases were found in 24 of 897 female patients with gastric cancer. Of these, 21 patients with histologically proven disease were studied., Results: Ovarian metastasis was detected before the primary gastric cancer in 1 patient, simultaneously in 6, and after in 14. Ovarian tumors were detected by computed tomography (CT) in a majority of patients (95%), while uterine tumors were detected in only 29%. Metastasis to the uterus was histologically examined in 14 tumors and confirmed in 11 tumors. All patients with positive endometrial cytology had uterine metastases. Total abdominal hysterectomy was performed with bilateral salpingo-oophorectomy in 12 patients and with unilateral resection in 2. In these 14 patients, 5 were curatively operated. In the clinical course, all patients developed multiple metastases, and patients suffered peritoneal dissemination. None survived for longer than 3 years. The median survival time after ovarian metastases (MST) was 10.3 months for all patients; 3.6 months in patients in their sixties, and 12.5 months in those in their fifties. Survival was significantly longer in patients who underwent curative resection (MST, 30.4 months) compared with those who had noncurative resection (MST, 10.3 months)., Conclusion: The prognosis for ovarian metastasis of gastric cancer was poor without curative resection. Because of frequent microscopic metastases to the uterus, total hysterectomy with bilateral oophorectomy is recommended if curative resection is possible.