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BACKGROUND: Ovarian cancer is the most common gynecological cancer associated with increased mortality. Early diagnosis is the important factor in improving the survival rate. OBJECTIVE: To evaluate and compare the performance of RMI, ROMAand R-OPS. METHODS: A validation study was conducted where 60 patients with adnexal mass who were planned to undergo surgery were included. Preoperatively, RMI and ROMAand R-OPS were calculated. The diagnostic performance of each was assessed and compared. RESULTS: 60% had benign mass, 10% had borderline neoplasia and 30% had malignant lesion. In the premenopausal group, RMI had a superior performance with a sensitivity of 75%. In postmenopausal group, R-OPS had a better performance followed by ROMA. CONCLUSION: As a diagnostic tool, an algorithm combining ultrasound imaging and both the serum markers CA125 and HE4 would be more accurate in prediction of malignancy in ovarian mass.

Introduction. Adnexal masses represent a diagnostic dilemma judging from the imaging and serum markers point of view. Making a correct diagnosis is of utmost importance as ovarian cancer represents a real health issue in the entire world nowadays with diagnosis in more advanced stages with low survival rates. Case presentation. Herein we present the case of a 44-year-old patient who arrived at the emergency ward for asthenia, loss of appetite, weight loss and severe dyspnea. When making the clinical examination a nontender distended abdomen was discovered with a large rather irregular mass in the left iliac fossa. An emergency computed tomography and ultrasound was solicited rendering a high suspicion of malignancy. Further analyses rendered an elevated carcinogenic antigen125 marker with high adnex model risk of malignancy and high risk of malignancy assessment score. A scheduled laparotomy was undertaken in a mixed team of gynecology and oncology surgeons discovering an intense pelvic inflammatory disease with good recovery. Conclusions. Ovarian masses represent a diagnostic dilemma as neither the imagistic evaluation nor serum markers represent absolute accuracy. A high degree of suspicion is thus imperative and whenever necessary when scheduling laparotomy a specialized oncology surgeon has to complete the surgical team.

Aim: Based on evidence that African–American (AA) women have lower CA125 values than Caucasian (C) women, we investigated this to see if this disparity would have an impact on ovarian cancer detection using CA125 and multivariate index assay (MIA). Materials & methods: Serum from two prospective trials of 1029 (274 malignancies [250 C/24AA]) were analyzed for CA125 and MIA results. Clinical performance was calculated. Results: Sensitivity of MIA in Caucasian women was 93.2%, 74.4% for CA125 at the ACOG approved cut-off level of 200 U/ml cutoff, and 80.4% using the 2007, Dearking 67 U/ml cutoff. In AA American women, MIA sensitivity was 79.2%, 33.3% for CA125 at the ACOG approved cut-off levels and 62.5% at the 2007, Dearking 67 U/ml cutoff. Conclusion: Our results support that CA125 in AA women with adnexal masses has lower sensitivity than MIA no matter what the cutoff value is. Implementation of MIA in evaluation of adnexal masses should increase sensitivity of detection of malignancy compared with CA125, particularly in AA women.

Female genital tuberculosis is one the known causes of infertility in the tropics. The symptom complex are diverse and it is one of the known causes of pyrexia of unknown origin. Instances of mimicry of ovarian cancer with raised CA125, have been reported. We present a case report in a 42-year-old woman with abdominal pain and progressive abdominal pain of 3 weeks durations, who had confounding symptom of raised CA125, forcing a presumptive diagnosis of ovarian cancer. She had exploratory total abdominal hysterectomy (TAH). The surgical findings and histopathological diagnosis were suggestive of tuberculosis, for which she is undergoing treatment and showing remarkable improvement.

Background: Ovarian malignancy is considered to score the highest fatality among women due to lack of significant symptoms. Early diagnosis and treatment lead to good prognosis. Magnetic resonance imaging (MRI) plays a major role in the diagnosis by detecting the lesions and assessing their appearance and consistency. Objective: To determine the accuracy of MRI in the diagnosis of ovarian malignancy and comparing this to histopathology as a gold standard test. Patients and methods: A follow up study was conducted in the MRI unit of the Radiology Department in Baghdad Teaching Hospital / Baghdad Medical City Complex during the period from 1st of February to 31st of December, 2017 on a group of thirty women with clinically suspected adnexal mass(es). All patients were examined with MRI including the diffusion-weighted imaging. Surgical specimens were taken for histopathology assessment. Results: A total of 30 women with adnexal mass were included in this study, with a mean age of 46.8±14.9 years. The MRI T1W image of the cystic part was dark in (60%), while the T2W image of the cystic part was bright (80%), T2W of the solid part was bright in (53.3%), T2W fat saturation of the solid part was bright in the majority (73.3%). T1W fat suppression contrast-enhanced of the solid part was avid in 66.7% of women with an adnexal mass; DWI of the solid part was bright in (76.7%). The mean apparent diffusion coefficient (ADC) value by MRI for women with adnexal mass was 0.9±0.3x103 mm2/sec. Histopathology mainly revealed mucinous cystadenocarcinoma in (10%) and low-grade serous adenocarcinoma in (10%).Validity of the results of MRI regarding malignant adnexal mass were sensitivity (90.9%), specificity (75%), +ve predictive value (90.9%), -ve predictive value (75%) and accuracy (86.6%). The appropriate cutoff value for apparent diffusion coefficient in differentiation between malignant and benign adnexal mass was 0.97 with 100% sensitivity and 90.9% specificity. Conclusions: MRI and diffusion-weighted imaging is a valid and reliable technique in the diagnosis and characterization of ovarian malignancy.

Background The risk of ovarian malignancy algorithm (ROMA) is used for assessing ovarian cancer risk in women with a pelvic mass. Its diagnostic accuracy is variable. We investigated whether the clinically acceptable minimal sensitivity of >80.0% could be obtained with the suggested cutoff of 7.4%/25.3% for pre/postmenopausal women and with adjusted cutoffs set to a specificity of ≥75.0% or a sensitivity of 95.0%, in a hospital with a lower ovarian cancer (OC) prevalence than previously reported. Methods ROMA scores were calculated from measurements of human epididymis protein 4 and cancer antigen 125 in blood specimens from 443 patients with a pelvic mass. The ROMA-based risk group was compared against biopsy (N=309) or clinical follow-up with imaging (N=134) results. The ROMA sensitivity and specificity for predicting epithelial OC (EOC) and borderline ovarian tumor (BOT) were calculated for the suggested and adjusted cutoff values. Results When targeting BOT and EOC, the prevalence was 7.4% and sensitivity and specificity at the suggested cutoff were 63.6% and 90.7%, respectively. Sensitivity was 81.8% at the 4.65%/13.71% cutoff set to a specificity of 75.0%. When targeting only EOC, the prevalence was 4.1% and sensitivity and specificity at the suggested cutoff were 77.8% and 89.4%, respectively. Sensitivity was 88.9% at the 4.78%/14.35% cutoff set to a specificity of 75.0%. Conclusions The sensitivity of ROMA was lower than expected when using the suggested cutoff. When using the adjusted cutoff, its sensitivity reached 80.0%.

Objectives The role of retrospective analysis has evolved greatly in cancer research. We undertook this network meta-analysis to evaluate retrospectively the diagnostic value of ROMA in ovarian cancer. Materials and methods We systematically retrieved 56 relevant articles published about ROMA index from 2009-2018 and about ovarian cancer from China National Knowledge Infrastructure (CNKI), PubMed and EMBASE. Data were comprehensively analyzed by Rev-Man 5.3 and MetaDisc 12.4 software. Results Data of 5,954 cases were retrieved from 23 literatures. Among them, 2,117 cases were in the ovarian cancer group and 3,837 cases in the control group. The pooled estimates for the ROMA index were sensitivity: 0.90 (95% CI: 0.88-0.93), specificity: 0.91 (95% CI: 0.89-0.94), positive predictive: 0.90 (95% CI: 0.88-0.95), negative predictive: 0.93 (95% CI: 0.91-0.95), and area under ROC curve: 0.96, compared to 0.71 (95% CI: 0.56-0.82), 0.87 (95% CI: 0.80-0.92), 0.82 (95% CI: 0.78-0.86), 0.92 (95% CI: 0.90-0.94), and 0.88 of HE4, respectively. Conclusions This meta-analysis confirms that the risk of ovarian malignancy algorithm can facilitate the diagnosis of ovarian cancer to some extent.

Medical diagnosis is essentially a classification problem and usually it is done with multiple ordered classes. For example, cancer diagnosis might be "non-malignant," "early stage," or "late stage." Therefore, appropriate measures are needed to assess the accuracy of diagnostic markers under multiple ordered classes. However, all existing measures fail to differentiate among some distinctly different biomarkers. This paper presents a multi-step procedure for evaluating biomarker accuracy under multiple ordered classes. This procedure leads to two new flexible overall measures as well as three new cut-point selection methods with great computational ease. The performance of proposed measures and cut-point selection methods are numerically explored via a simulation study. In the end, an ovarian cancer dataset from the Prostate, Lung, Colorectal, and Ovarian cancer study is analyzed. The proposed accuracy measures were estimated for markers CA125 and HE4, and cut-points were estimated for the risk of ovarian malignancy algorithm score.

Ovarian vein thrombosis (OVT) is observed in the field of obstetrics and gynaecology. It is occasionally diagnosed during the postpartum period or in patients with ovarian malignancy. Few cases of pulmonary thromboembolism (PTE) caused by OVT have been reported previously. We report the case of a 67‐year‐old woman who presented with fatal PTE due to left OVT during hospitalization for cerebral infarction. The left ovary of the postmenopausal elderly patient showed no tumorous appearance. This case of OVT is extremely rare because of its idiopathic nature and fatal result., We report the case of a 67‐year‐old woman who presented with fatal pulmonary thromboembolism due to ovarian vein thrombosis (OVT) during hospitalization for cerebral infarction. The left ovarium of the postmenopausal elderly patient showed no tumorous appearance. This case of OVT is extremely rare because of its idiopathic nature and fatal result.

We conducted a meta-analysis of published data to update and estimate the prevalence of HPV in ovarian cancer. A comprehensive literature search was performed according to the PRISMA guidelines. Eligible articles published from 1989 until 2020 by searching Web of Sciences, Pubmed, Embase, and the Cochrane Library Central databases were gathered. A pooled estimation of HPV prevalence with a 95% confidence interval (CI) was calculated based on a random effect model. Quantitative assessment of heterogeneity was explored using Cochrane test and I2. Additionally, publication bias, sensitivity, meta-regression, and subgroup analyses were also performed. Twenty-nine studies involving 2280 patients with ovarian cancer were included. The statistical heterogeneity was high (I2 = 88%, P

Xanthogranulomatous salpingo-oophoritis is an extremely rare entity. The clinical features are similar to the common benign and malignant adnexal diseases, making it difficult to diagnose. Here we present a case of pelvic mass with high level of tumor markers who was operated with suspicion of adnexal tumor. Histopathology revealed it to be a case of xanthogranulomatous salpingo-oophoritis.

Neoadjuvant chemotherapy allows a minimally invasive approach for interval debulking in patients with ovarian cancer considered unresectable to no residual disease by laparotomy at diagnosis. The aim of the study was to evaluate the type of surgical approach at interval debulking (ID) after three courses of carboplatin and taxol in patients with unresectable ovarian cancer at diagnosis compared with the type of surgical approach at primary debulking (PD). A secondary objective was to compare the perioperative outcomes of MIS vs. laparotomy at ID. A retrospective review of the type of surgical approach at ID following three courses of carboplatin and taxol was compared with the surgical approach at PD, and a review of the perioperative outcomes of MIS vs. open at ID was performed during the period from 21 January 2012, through 21 February 2013, for stage IIIC > 2 cm or IV epithelial ovarian cancer (EOC) unresectable at diagnosis and the surgical approach at PD. During the study period, 127 patients with stage IIIC or IV EOC met the inclusion criteria. Minimally invasive surgery (MIS), laparoscopic or robotic, was used in 21.6% of patients at ID and in 23.3% of patients at PD. At ID, MIS patients had a shorter hospital stay as compared to laparotomy (2 vs. 8 days; p < 0.001). At 5 year follow-up, 31.5% of EOC patients were alive (ID MIS: 47.5% vs. ID open: 30%; PD MIS: 41% vs. PD open: 28%), while 24.4% had no evidence of disease (ID MIS: 39% vs. ID open: 19.5%; PD MIS: 32% vs. PD open: 22%). Among living patients, 22% had evidence of disease. Neoadjuvant chemotherapy is a form of chemo-debulking and allows a minimally invasive approach at interval debulking in about one-fifth of the patients, with initial disease deemed unresectable to no residual tumor at initial diagnosis.

Carcinoma of the ovary keeps on being one of the main causes of death from gynecologic malignancies on the earth. Women determined to have beginning phase (1/2) ovarian disease have considerably better endurance rates contrasted with those analyzed in later stages. The speculation behind screening for ovarian malignant growth is that previous recognition of the illness will bring about more women being analyzed at less propelled stages and that this will convert into lower generally death rates for the ovarian disease. Both transvaginal ultrasound and the Cancer Antigen 125 in blood have been used to screen for early ovarian malignant growth. The aims of our study are to the detection of ovarian malignancy in primary stage and thereby reduce the mortality due to ovarian cancer. In this study, we have used a real-world dataset, namely PLCO to anticipate the discoveries from CA-125 and TVUS joined screening utilizing machine learning models. We obtained a critical presentation from the model as far as accuracy, precision, and recall with the estimations of 80, 86, and 90.25% individually. Our work will support the doctors and the suspected to analyze ovarian threats in the beginning and decreased the complication and mortality due to ovarian malignancy.

Objectives: To present three cases of young women with suspected ovarian malignancy with the aim to evaluate the role of intraoperative frozen section in suspected malignant ovarian neoplasms in women with young age.Case Report: Mrs. M, 25 years old, is a nullipara with a history of fertility treatment. She presented with bilateral ovarian cysts suspected to be malignant and an elevated CA-125 level. Intraoperative frozen section showed borderline ovarian tumor, allowing for conservative management. Mrs. A, 32-years old, with right cystic ovarian neoplasm suspected to be malignant and elevated CA-125. Frozen section showed results of cystadenocarcinoma, patient’s family was informed of the result during the surgery and the operator continued to manage the patient conservatively. Ms. N, 27 years old, was referred with suspected ovarian malignancy and the differential diagnosis of peritoneal tuberculosis. Frozen section confirmed the presence of tuberculosis infection, and the patient was managed accordingly.Conclusion: Despite conservative management being top priority treatment in young-aged women with ovarian neoplasm, additional information of frozen section allows for more accurate management.

Simple Summary Nowadays, the number of malignancies diagnosed during pregnancy is increasing. Despite the fact that diagnosis is occurring on a global scale, their number is still too limited to prepare proper standards of treatment. These problems appear specifically in the least developed countries. The aim of our review is to bring ovarian cancer (OC) as a complication of pregnancy to the attention of doctors and other medical professionals who have to cope with these rare cases. We noted that a variety of malignancies can be included under the heading “ovarian cancer”, and we describe obstetric and patient outcomes, which depend on the histopathology of the tumor. We focus on the current recommendations for diagnostics and treatment, and present future possibilities for the management of OC. Abstract The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15–5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords “ovarian cancer”, “ovarian malignancy”, “adnexal masses”, “ovarian tumor” and “pregnancy” was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother’s decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes.

Background and objectives: To compare the diagnostic accuracy and clinical utility of the Early-stage Ovarian Malignancy (EOM) score with the Risk of Malignancy Index (RMI) in the presurgical assessment of women presenting with adnexal masses. Materials and Methods: A secondary analysis was carried out in a retrospective cohort of women who presented with an adnexal mass and were scheduled for surgery at Phrapokklao Hospital between September 2013 and December 2017. The clinical characteristics, ultrasonographic features of the masses, and preoperative CA-125 levels were recorded. The EOM and the RMI score were calculated and compared in terms of accuracy and clinical utility. Decision curve analysis (DCA), which examined the net benefit (NB) of applying the EOM and the RMI in practice at a range of threshold probabilities, was presented. Results: In this study, data from 270 patients were analyzed. Fifty-four (20.0%) women in the sample had early-stage ovarian cancer. All four RMI versions demonstrated a lower sensitivity for the detection of patients with early-stage ovarian cancer compared to an EOM score &ge, 15. An EOM &ge, 15 resulted in a higher proportion of net true positive or NB than all versions of the RMIs from a threshold probability of 5% to 30%. Conclusions: It also showed a higher capability to reduce the number of inappropriate referrals than the RMIs at a threshold probability between 5% and 30%. The EOM score showed higher diagnostic sensitivity and has the potential to be clinically more useful than the RMIs to triage women who present with adnexal masses for referral to oncologic gynecologists. Further external validation is required to support our findings.

One of the most distressing manifestations of advanced ovarian malignancy is the development of a symptomatic pleural effusion. Left untreated, malignant pleural effusions can cause significant morbidity, affecting prognosis and quality of life. Effective drainage of this fluid and prevention of its

This study aimed to compare the impact of 3 versus 6 cycles of neoadjuvant chemotherapy (NACT) on the optimal cytoreduction in patients of advanced ovarian malignancy during interval debulking surgery (IDS). Thirty patients with advanced-stage IIIc/IV epithelial ovarian cancer, fallopian tube cancer, and primary peritoneal cancer were randomly allocated to receive 6 cycles in the late IDS group versus 3 cycles in early IDS before undergoing interval debulking surgery. A higher percentage of patients achieved optimal cytoreduction in the late IDS group compared to the early IDS group (60 versus 23%) which was statistically significant (

OBJECTIVE. The purpose of this case-based article is to discuss the pathophysiologic findings, common pathways of spread, and imaging features associated with Krukenberg tumors. CONCLUSION. Not all ovarian metastases are Krukenberg tumors. Krukenberg tumors are the most common subtype of ovarian metastases, and they are histologically characterized by signet ring cell mucinous features. Common primary tumor sites include the stomach or colon. Although often difficult, distinguishing between Krukenberg tumors and primary ovarian malignancy on imaging is important because of management and prognostic implications.

Clear cell carcinoma of ovary is one of the rare types of ovarian malignancy accounting for less than 5% of all. It has been reported to have an early age of presentation compared to the serous carcinoma variety. The youngest reported case in the literature is of 19 years. But in our case, this clear cell carcinoma is from a 15-year-old girl, making it to be the youngest in the world reported in the literature.

Bowel procedures are commonly performed as part of ovarian cancer cytoreduction. The aim of this study was to assess the postoperative complication rates among women with an ovarian malignancy undergoing bowel resection/repair at the time of cytoreductive surgery compared with a control group (cytoreductive surgery without bowel resection or repair).Analysis of 4965 cytoreductive surgeries for suspected ovarian malignancies recorded in the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) datasets (2006-2017) was performed. One-way ANOVA, Kruskal-Wallis H and Chi-squared tests were used to evaluate and compare baseline characteristics between the groups and controls. Postoperative surgical site infection rates and other 30-day post-operative outcomes were assessed with multivariable logistic and linear regressions.8.3% (413/4965) of cytoreductive procedures had an associated repair of enterotomy (small or large bowel), 10.9% (541/4947) had an associated colectomy with primary anastomosis, and 2.1% (104/4965) had an associated colectomy with colostomy. Surgical site infections (SSI, either superficial incisional, deep incisional, organ space or wound dehiscence) were significantly more prevalent in the bowel resection/repair group (16.9% vs 5.7%, p 0.0001). The odds of surgical infections were 2.67 times higher in patients who underwent a bowel resection or repair after controlling for age, BMI, ASA status, pre-operative weight loss, hypoalbuminemia, NSQIP morbidity score, length and complexity of surgical procedure.Patients undergoing bowel resection/repair at the time of cytoreductive surgery are at increased risk of surgical site infections, without increased risk of 30-day mortality. Interventions to mitigate the risk of infectious complications in these patients should be evaluated in a prospective fashion.

Introduction: Adnexal masses have a wide spectrum with respect to the age of presentation, signs and symptoms, imaging findings, and histopathology report. Materials and Methods: This is a cross-sectional diagnostic study, conducted at All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. The data were collected from department of gynecology over a period of 1½ years from June 2017 to December 2018. All women who were diagnosed to have an adnexal mass irrespective to age, parity, and menopausal status were included in the study. Ultrasonography of the abdomen with the pelvis was ordered in all patients followed by contrast-enhanced computed tomography or magnetic resonance imaging in selective patients. Tumor markers such as Ca-125 was measured, and risk of malignancy index (RMI) was calculated for each tumor. The clinical and imaging findings were correlated with intra-operative findings and finally with the histopathology examination report. Results: A total of 171 women were included in the study who were diagnosed to have adnexal mass. A total of 137 women (80.1%) had benign tumor (Group B), whereas 34 women (19.9%) were found to have malignant tumor (Group M). Mean age in Group B was 35.85 ± 12.46 and in Group M was 46.12 ± 13.46 (P = 0.001). Ca-125 was significantly higher in Group M (1350 U/ml) than Group B (175 U/ml) (P = 0.008). The RMI score was also found to significantly increased in Group M than Group B (P = 0.007). Conclusion: With respect to adnexal masses, both Ca-125, as well as RMI scoring, are important diagnostic tools. RMI scoring has a better overall diagnostic performance than Ca-125 in predicting malignancy.

The understanding of ovarian malignancy pathogenesis has greatly increased with identification of varied genomic mutation profiles, which directs the clinical behavior of the tumors. The present case describes the rare subtype of pure transitional cell carcinoma which is no more included in the newer World Health Organization (WHO) classification as the WHO labels it as a type of high-grade serous ovarian cancer with transitional cell differentiation, although in our case no serous component was identified. Hence, with revised classification of ovarian malignancies, it is important to report all rare subtypes in order to understand their biology and behavior.

The small bowel is an uncommon site for cancer metastasis. Despite this, cases have reported the duodenum as a metastatic site from local organs. However, duodenal involvement from more distant organs, such as the ovaries, has rarely been reported. Herein, we present a case of a 68-year-old female who developed duodenal metastatic disease from a primary ovarian serous adenocarcinoma. The goal of this report is to encourage clinicians to keep a broad differential in patients complaining of abdominal pain, especially in those with a history of primary ovarian malignancy.

Purpose: To perform a systematic review and meta-analysis of studies comparing the diagnostic accuracy of Risk of Ovarian Malignancy Algorithm (ROMA) and risk of malignancy index (RMI) for detecting ovarian cancer. Methods: A systematic review and meta-analysis was performed according to PRISMA statement. A search for studies evaluating the diagnostic performance of ROMA and RMI-I indices for detecting ovarian malignancy from January 2010 to October 2018 was performed in the PubMed/MEDLINE and Web of Science databases. The quality of the studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2. Results: Sixty-six citations were identified. After exclusions, 8 papers comprising 2,662 women (1,319 premenopausal and 1,343 postmenopausal) were ultimately included. The mean prevalence of ovarian malignancy was 29.0% in premenopausal women and 51.0% in postmenopausal women. High risk of bias for patient selection was observed for most studies. ROMA and RMI-I had a similar diagnostic performance in postmenopausal women (pooled sensitivity [87 vs. 77%] and specificity [75 vs. 85%], respectively. p = 0.29). In premenopausal women, RMI-I showed better specificity than ROMA (89 vs. 78%, p = 0.022) with similar sensitivity (73 vs. 80%, p= 0.27). Significant heterogeneity was found for sensitivity and specificity in comparisons of both groups. Conclusions: ROMA and RMI-I have similar diagnostic performance for detecting ovarian cancer in women presenting with an adnexal mass. However, RMI-I showed a higher specificity than ROMA in premenopausal women. Notwithstanding, as the risk of bias is high in most studies, our results should be interpreted with caution.

Bioabsorbable hemostatic agents like oxidized regenerated cellulose (ORC) are widely used in surgical practice. Rarely, adverse events due to retained ORC may occur and can pose a diagnostic dilemma. The unique tissue response to ORC may be misdiagnosed as signet ring type of adenocarcinoma. This article aims to highlight this rare phenomenon. We report two such cases involving the ovaries. Both the patients presented with ovarian cysts and tubo-ovarian adhesions 1-2 years following surgery for benign ovarian pathology. The present biopsies were featured by sheets of large cells with abundant vacuolated cytoplasm and often small peripherally displaced nuclei having "signet ring" appearance. These cells were negative for pan-cytokeratin and strongly positive for CD68, indicating the histiocytic nature of the cells. It was confirmed that in both the patients, at the time of the initial surgeries, hemostasis was ensured by packing with ORC.

Object: Analysis of serum tumor markers CA-125, CEA, AFP, & ß-HCG in patientswith ovarian malignant tumors and correlation of their serum levels with histological types. StudyDesign: Institution based descriptive and prospective study. Place & Duration: Department ofPathology, Liaquat University of Medical & Health Sciences, Jamshoro from January 2009 toJune 2011. Material & Methods: One hundred cases, diagnosed as ovarian malignant tumor onH&E staining were selected for study & measurement of serum CA-125, CEA, AFP, & ß-HCGpreoperatively and postoperatively in each case. Results: Out of 100 ovarian cancers diagnosedon H&E stain 33 were serous cystadenocarcinoma, 29 mucinous adenocarcinoma, 19 germ celltumors and 15 sex-cord stromal tumors, 1 endometroid carcinoma, 1 brenner tumor, 1 clear cellcarcinoma and 1 case of NHL. Increased level of CA-125 was seen preoperatively in 33/33 casesof serous cystadenocarcinoma and 24/29 cases of mucinous adenocarcinoma. Surprisinglyincreased levels were also seen in 10/19 germ cell tumor and 8/15 in sex-cord stromal tumors.CEA is raised in mucinous tumors. AFP & ß-HCG were raised in germ cell tumors & sex cordstromaltumors. Serum tumor marker levels were declined following appropriate therapy of thetumors. Conclusions: Serum tumor markers are useful and important for the detection of ovariantumors. They may also help in assessment of response to specific treatment, prognosis & followup of patient.

The estrogen-related receptor α (ERRα), is an orphan transcription factor. Recently, many studies have reported its regulatory mechanisms and transcriptional targets after identification. Therefore, it may be eligible to join the rank of other nuclear receptors that control almost all aspects of cell metabolism. Cellular metabolism reprogramming plays a key role in fueling malignant change. The purpose of this review was to demonstrate that the ERRα plays an important role in the association between gynecological endocrine-related tumors and energy metabolism. Furthermore, regulation of ERRα may represent a promising strategy to induce cellular metabolic vulnerability of cancer from different origins. Thus, a comprehensive understanding of current treatment strategies may be achieved.

Extremely elevated CA 125, usually suggestive of ovarian malignancy, can be found in physiological or benign conditions such as endometriosis. We present a case of an extremely elevated serum CA 125 level in a patient with stage four endometriosis and bilateral unruptured ovarian endometriomas, with evidence of leakage unilaterally. To avoid costly and unnecessarily invasive tests and procedures it is important to consider the differential diagnosis of endometriosis and/or leaking endometrioma in patients with a profoundly elevated CA 125 level.

Objective The objective of this study was to assess the effectiveness of human epididymis protein 4 (HE4) and cancer antigen 125 (CA125), and risk of ovarian malignancy algorithm (ROMA) in identifying type I and type II epithelial ovarian cancers (EOCs). Methods A cross-sectional diagnostic study was conducted of 499 Thai women older than 18 years who had clinically diagnosed pelvic masses and underwent elective surgery at our hospital between July 2012 and July 2014. Preoperative serum HE4 and CA125 levels were measured, and postoperative pathologic slides were reviewed. Results Of 499 Thai women enrolled in this study, 357 were noncancerous (NC), 79 had type I EOCs (EOCs-I) and 63 had type II (EOCs-II). Risk of ovarian malignancy algorithm revealed significantly better performance than HE4 and CA125 in discriminating between NC and EOCs-I (receiver operating characteristic curve and area under the curve [ROC-AUC]: ROMA, 0.86; HE4, 0.80; and CA125, 0.77), and NC and EOCs-II (ROC-AUC: ROMA, 0.97; HE4, 0.95; and CA125, 0.93). In differentiation between EOCs-I and EOCs-II (setting EOC-II as reference), ROMA yielded a better performance than HE4 and CA125 (ROC-AUC: ROMA, 0.83; HE4, 0.82; and CA125, 0.77); however, CA125 and HE4 showed higher sensitivity (CA125, 77.8%; HE4, 76.2%), whereas ROMA had the highest specificity (79.8%). Conclusions In women who present with pelvic masses, ROMA performed very well in distinguishing between noncancer lesions and EOCs but the combined HE4 and CA125 test was more effective in predicting EOC types.

The reported frequency of malignant diseases in unilocular cysts varies in different studies, giving conflicting results. To quantify the risk of malignancies among echoic and anechoic unilocular adnexal cysts, in premenopausal and postmenopausal women, we performed a PubMed/MEDLINE search of papers published in English evaluating the histopathological diagnoses of removed ovarian cysts diagnosed as simple unilocular cysts at pre-operative ultrasound examination. From 34 selected publications, we extracted data on ovarian malignancy in the total series, and separately for premenopausal and postmenopausal women, and women with cysts 5 cm and ≥5 cm in diameter. Of the 2177 surgically removed lesions classified as unilocular cysts on pre-operative ultrasound, 24 (1.1%; 95% CI: 0.74-1.66) were malignant (among these 12 had borderline malignancy: 0.6%). The rates were lower for premenopausal women (6/987, 0.6%) than postmenopausal ones (12/372, 3.2%). Of the 2290 surgically removed lesions classified as anechoic unilocular cysts on ultrasound, 20 (0.9%; 95% CI: 0.57-1.35) were malignant (among these 8 had borderline malignancy: 0.3%). The rates were lower for premenopausal women (3/907, 0.3%) than postmenopausal ones (13/681, 1.9%) (Pearson chi-square P = 0.002). When we performed meta-analysis selecting studies including only anechoic unilocular cysts published after 2000 and with 100 or more patients, the estimate was 0.5 (95% CI 0.1-1.2) with no heterogeneity (heterogeneity chi-square P = 0.175). The oncogenic risk of unilocular adnexal cysts is low, suggesting that the final choice about surgical treatment of these cysts should be based on the combination of each patient's overall risk profile as well as personal priorities.

Objective To determine the diagnostic accuracy of ROMA in postmenopausal women with history of ovarian mass. Study design Observational study. Place and duration of study Dr. Ziauddin University Hospital, Karachi, from May 2014 to June 2015. Methodology Two hundred and sixty postmenopausal women of 40-65 years of age with ovarian masses, planned for surgery, were included in the study. Their samples were obtained preoperatively and analysed on Abbot Architect i1000 SR immunoassay analyser for quantitative estimation of tumor markers, i.e. HE4 and CA125. By combination of these two tumor markers, ROMA scores were calculated and studied after histopathological verification of masses. Results Total number of patients were 260, out of which 122 (46.9%) were diagnosed as having ovarian cancer, while 138 (53.0%) were diagnosed as benign condition. Median ROMA score levels in patients with malignant masses were 95.58 (IQR=44.4) as compared to 20.6 (IQR=14) in benign masses. ROMA had sensitivity 92.6% (CI=86.47-96.04), specificity 78.3% (CI=70.09-83.82), positive predictive value 79% (CI=70.87-84.29), negative predictive value 92.3% (CI=86.02-95.9) and positive likelihood ratio 4.26, while negative likelihood ratio 0.1. Diagnostic accuracy of ROMA was 85%, based on ROC curve analysis. ROMA had the highest sensitivity in detecting ovarian carcinoma. Conclusion ROMA is a very useful diagnostic tool for the preoperative stratification of patients with ovarian masses showing 85% diagnostic accuracy. However, there is need of more studies with homogenous laboratory procedures for HE4 and CA125 assays as well as patients, selection criteria, so we can draw firm conclusion about utility of ROMA in clinical setups.

Tujuan : Membandingkan penanda tumor osteopontin (OPN), cancer antigen 125 (CA125), kombinasi sebagai prediktor keganasan pada penderita tumor ovarium. Metode : Penelitian cross sectional ini dilakukan pada pasien dengan keganasan pada kista ovarium jenis epitel. Analisis data dilakukan secara univariat dan bivariat. Hasil : 47 pasien dengan hasil hitopatologi jinak dan 43 dengan hasil histopatologi ganas masuk dalam penelitian. Hasil nilai median CA125 kelompok ganas dibanding kelompok jinak (142,2 vs 61,030, p < 0,05), cut off point CA125 99,9 U/mL, sensitivitas 76,7% dan spesifisitas 61,7%. Diskusi: Kombinasi CA125 dan OPN memiliki sensitivitas lebih rendah dibandingkan CA125. Kombinasi CA125 dan OPN akan meningkatkan spesifitas, nilai duga positif dan akurasi yang lebih baik. Tumor marker OPN tidak tepat digunakan untuk proses deteksi dini, tetapi lebih tepat untuk penegakan diagnosis lebih baik dibandingkan dengan gold standard CA125. Kesimpulan : Kombinasi OPN dan CA125 memiliki nilai tingkat akurasi paling tinggi apabila dibandingkan pemeriksaan tunggal CA125, OPN. Single Check of Serum Ostepontin and CA 125 Levels as A Predictor of Malignancy in Epitheliaal Ovarium Tumor is Inferior to Combined Examination Abstract Objective : To compare the sensitivity, specificity, expected value positive, expected value negative and accuracy among osteopontin (OPN), cancer antigen 125 (CA125), and combination as predictor of malignancy in ovarian tumor patients. Method : A cross sectional study was done to compare parameters OPN and CA125 in determining malignancy of ovarian cysts. Data analysis was performed by univariate and bivariate analysis. Results: A total of 47 subjects were included with benign histopathological result and 43 subjects with malignant histopathological result. The median value of CA125 in malignant group was compared to that of benign group (142.2 vs. 61.030, p value

Objectives: To determine the frequency of ovarian malignancy in women ofreproductive age presenting with ovarian mass and to determine frequency of factors leadingto ovarian malignancy. Study Design: Cross sectional study. Setting: Department of Obstetrics& Gynaecology, Lady Wallington Hospital, Lahore. Period with Dates: From 05.11.11 to26.06.12. Results: The result of our study reveals majority of the patients between 21-30 yearsi.e. 45.88%(n=39), common age was 24.21+3.76 years, 43.53%(n=37) were nulliparous (inmajority), while frequency of ovarian malignancy in women of reproductive age presenting withovarian mass was recorded in 14.11%(n=12) while frequency of factors leading to ovarianmalignancy was 91.67%(n=11) patients were nulliparous while family history of ovarianmalignancy was in 8.33%(n=1) patients. Conclusions: The frequency of ovarian malignancy ishigher among reproductive age females with increased risk of nulliparity.

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours of alimentary tract comprising 0.2% of gastrointestinal tumors and only 0.04% of small intestinal tumours. Jejunal GISTs are one of the rarest subtypes. GISTs display various morphological forms like spindle and epitheloid cells in a variety of patterns and can be submucosal, intramuscular or subserosal in location. Grossly they are solid and cyst with variable hemorrhage and necrosis. Most of the gastrointestinal stromal tumors have mutations in either KIT (CD117) or PDGFRα gene. DOG 1 is a sensitive and specic marker of GIST independent of CD117 or PGDFRα expression. Here we present a case of malignant jejunal GIST with missed diagnosis on CECT abdomen.