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Background: Mortality in case of ovarian malignancy is high due to late diagnosis. Early and accurate diagnosis can improve the case specific management. HE4 (human epididymis protein 4) which is proved to be overexpressed in the ovarian cancer cells, is considered a new biomarker for ovarian cancer diagnosis. Aims and objectives: The study was undertaken to evaluate the immunohistochemical expression of HE4 in various epithelial ovarian neoplasm. Material and Methods: It was a cross sectional, prospective, single institution based study, conducted in the department of Pathology in collaboration with the department of Gynecology and Obstetrics, from December 2016 to January 2019 in our institution. A total 71 cases were selected for this study. Results: Serous tumour was the most common epithelial tumour followed by mucinous tumour. Highest percentage of expression of HE4 was seen in high grade serous cancer and malignant endometrioid tumour. Benign serous and mucinous tumour shows negative expression mostly. We found statistically significant correlation between HE4 expression and different types of epithelial ovarian tumours (p=0.000). Conclusions: HE4 was highly expressed in malignant ovarian tumour especially serous and endometrioid carcinoma and can be used as an important biomarker for malignant ovarian neoplasm. Expression in high grade ovarian serous cancer supports its prognostic value also.

Background: Radioactive contamination and chemical pollution of the environment can affect the processes of carcinogenesis, including the formation of malignant neoplasms of the ovaries in women. We used the data of official state statistics for 2000–2020 to test the hypothesis about the effect of radioactive contamination (following the Chernobyl disaster) and chemical pollutants on the incidence of ovarian malignancies in the female population of the Bryansk region. Methods: A variety of statistical approaches were used to estimate the incidence of ovarian malignancies, including the Shapiro–Wilk test, Mann–Whitney U test, Spearman’s rank correlation test and linear regression. Results: We did not establish statistically significant differences in the frequency of primary morbidity of women with malignant neoplasms of the ovaries, regardless of the environmental conditions of living. Furthermore, no significant correlations were found between the frequency of primary morbidity of ovarian malignancies, both with the level of contamination by Cesium-137 and Strontium-90, and air pollution with volatile organic compounds, carbon monoxide, sulfur dioxide and nitrogen oxides. A statistically significant increase in the long-term trend in the frequency of ovarian malignant neoplasms was revealed in the areas of chemical pollution (p = 0.02), however, in other territories, no statistically significant regularities were established. The forecast of the frequency of newly diagnosed malignant neoplasms of the ovaries on average in the Bryansk region shows an increase of 12.4% in 2020 in comparison with the real data for 2020, while the largest increase in predicted values is recorded in the territories of radioactive contamination (by 79.6%), and the least in the combined territories (by 6.9%). Conclusions: The results obtained indicate the need for further work to understand the trends in the presence/absence of independent and combined effects of pollutants and the growth of oncogynecological pathology from the perspective of assessing the distant and regional metastasis, histological and immunohistochemical profile of a specific malignant ovarian neoplasm with levels of environmental contamination.

Objective To investigate the impact of cystectomy for borderline ovarian tumor (BOT) on tumor recurrence compared with salpingo-oophorectomy using inverse probability of treatment weighting (IPTW). Methods A central pathologic review and a search of the medical records from 14 collaborating institutions from 1986 to 2017 identified 4708 women with a malignant ovarian neoplasm. Data for young women with Stage I BOT were extracted. To compare recurrence-free survival between the surgery groups, Cox regression analyses and the IPTW-adjusted Kaplan-Meier method were employed. Results During a median follow-up of 62.0 (1.2-270.4) months, 10 of the 285 patients identified (3.5%) developed recurrence. In multivariate analysis, the practice of cystectomy was not a significant prognostic indicator of recurrence-free survival (hazard ratio [95% confidence interval] 1.276 [0.150-10.864]; P = 0.823). In the IPTW-adjusted cohort, the 5-year recurrence-free survival rates were 95.8% and 96.0% in patients receiving cystectomy and salpingo-oophorectomy, respectively (P = 0.378). Conclusion If patients are selected appropriately, cystectomy in itself may not increase tumor recurrence in young women with early-stage BOT. A large-scale prospective clinical study is necessary to validate this finding.

Malignant ovarian neoplasm is one of the most lethal malignancies among cancers of the female reproductive system. Occasionally, these tumors originate from non-ovarian organs as metastatic lesions since the ovary is a frequent metastatic target of many cancers. However, there limited clinical information on metastatic ovarian carcinoma (MOC) and its hallmarks are unknown. During the period of 1986–2015, 4,284 patients with malignant ovarian neoplasm were identified using the Tokai Ovarian Tumor Study Group (TOTSG) database. Of these, excluding borderline malignant tumor, 3,478 patients with malignant ovarian cancer were extracted. The pathological slides were evaluated under central pathological review. Among them, a total of 143 (4.1%) patients with MOC were identified. The median age of patients with MOC was 54 (29–82) years. The most and second most frequent original tumors were colorectal (43%, N=62) and gastric (29%, N=42) carcinoma, respectively. The rates of carcinoma of the appendix, breast, and pancreas were 8, 6, and 4%, respectively. This is the one of the largest studies clarifying the rates of MOC among malignant ovarian neoplasms. Although the rate is low, we should keep in mind that MOC, particularly from colorectal and gastric cancer should be considered when encountering clinical practice of ovarian cancer.

Background: Ovarian cancer is the third malignant tumor with the high mortality rate beside breast cancer and cervical cancer. CA 125 is one of the earliest tumor markers and often used by clinicians to diagnosed ovarian cancer. One of the criteria for malignant ovarian neoplasms diagnostic is the elevation of CA 125 levels, but CA 125 level milieu is not specifics indicated ovarian cancer. Contrast – enhanced CT scan of the abdomen and pelvis are the initial imaging modality that used to determined further diagnostic for developed treatment. In addition, preoperative discrimination between benign, borderline and malignant mass in the pelvis was needed. Objective: The objective of this study was to evaluate CT scan feature of ovarian neoplasm at various CA 125 levels. Methods: Retrospective descriptive study in Dr. Soetomo General Academic Hospital January 2017 until June 2020, 91 patients of ovarian neoplasm with pathological confirmed enrolled in the study. Patient did abdominal CT scan and CA 125 serum examination before surgery. CT scan feature was evaluated in raw data. Result: From this study, age range was 22-75 years old, 38.46 % sample was at 51– 60 years, CA 125 level range 7.1 – 8749.5 U/ml. Benign ovarian neoplasm samples were 24. 2 % with CA 125 range 13.1-32.5 U/ml, CT scan feature were cystic (100 %), septated (90.1%), with solid component (72.7%). Borderline ovarian neoplasm sample were 3.3 % with CA 125 range 33.8-454.6 U/ml, CT scan feature were cystic (100 %), septated (100%), with solid component (100%). Malignant ovarian neoplasm samples were 72.5 % with CA 125 range 7.1 – 8749.5 U/ml, CT Scan feature were cystic (100 %), septated (98,4%), with solid component (96.9%), contrast enhancement (96.9 %), irregular walls (84,8 %). Of all, 49 samples were found ascites (85,7% were malignant), 39 samples were found peritoneal carcinomatosis (92 % was malignant ovarian neoplasm). Conclusion: There were no difference finding of the CT scan characteristics in benign and borderline ovarian neoplasm group with normal CA 125 levels and elevated CA 125 levels. The difference between malignant ovarian group, in elevation of CA 125 level showed ascites and peritoneal cacinomatosis more.

Patient: Female, 31-year-old Final Diagnosis: Small cell ovarian cancer • hypercalcemic type Symptoms: Abdominal pain • bloating Medication: — Clinical Procedure: Surgery • adjuvant chemotherapy • adjuvant radiotherapy Specialty: Oncology Objective: Rare disease Background: Small cell ovarian carcinoma, hypercalcemic type is an uncommon malignant ovarian tumor entity with an unfavorable prognosis and a short overall survival rate. It mainly affects women of childbearing age. Case Report: We report a case in which a 31-year-old woman with small cell ovarian carcinoma, hypercalcemic type presented with unspecific symptoms. We emphasize the importance of treatment planning and address fertility-sparing surgical procedures, which remain a therapeutic dilemma. Conclusions: The occurrence of unspecific abdominal symptoms, unilateral tumor masses, and hypercalcemia may indicate the presence of malignant ovarian neoplasm in young adults. Histopathological examination of the mass should be performed by an experienced gynecological pathologist. A misdiagnosis can lead to inadequate surgical and adjuvant treatment. Adjuvant multi-agent chemotherapy and high-dose chemotherapy with autologous stem cell rescue may prolong the progression-free interval and overall survival.

Objective High grade serous ovarian carcinoma (HGSOC) is the most common type of malignant ovarian neoplasm and the main cause of ovarian cancer related deaths worldwide. Although novel biomarkers such as homologous recombination deficiency testing have been implemented into the clinical decision-making algorithm since diagnosis, morphological classification and immunohistochemistry analysis are essential for diagnostic purpose. This study aims at identifying histologic and clinical features that can be predictive of patients' prognosis. Methods Morphological and architectural characterization including SET (Solid-Endometroid-Transitional)/Classic features was carried out in a cohort of 234 patients analyzing 695 slides. From each slide tumor infiltrating lymphocyte (TILs), the presence of necrosis, the number of mitoses, the presence of psammoma bodies, giant cells and atypical mitoses were recorded. Morphological heterogeneity was quantified by the Shannon's diversity index (SDI) considering the percentage of each architectural pattern per patient's slide. Results The frequency of architectural patterns and morphological variables varied with respect of the surgical strategy (primary debulking surgery vs interval surgery after neoadjuvant chemotherapy). HGSOCs exhibiting SET features had a longer overall as well as progression free survival. Among SET features, pseudo-endometrioid and transitional like patterns had the best outcome, while it was heterogenous for solid pattern, that had better outcome for BRCA 1 negative and less heterogeneous tumors. In patients submitted to neoadjuvant chemotherapy a higher intratumor heterogeneity as defined by SDI was a negative independent prognostic factor. Conclusions A comprehensive histological examination considering architectural patterns and their heterogeneity can help in prognostication of HGSOCs.

Ovarian cancer is the most common cause of death among gynecologic malignancies around the world, and there are numerous criteria in preoperative differentiation between benign and malignant ovarian mass. The interaction between cancer and platelets is not yet properly known. Here in, we decided to perform a study about platelets indices in benign and malignant ovarian neoplasm to be the basis for the next conclusion. This study is a descriptive and analytic cross-sectional study and the community consists of patient with epithelial ovarian mass who referred to our Gynecology Oncology center of Imam Hospital of Iran. The information about platelet indices in pre-operational period, extracted from the patients files. Then data were analyzed and descriptive statistics using SPSS software were performed on them. To compare variables between two groups, patients with benign and patients with malignant epithelial ovarian tumors, we used t test. Considering the significance of P value below 0.05, there was a significant difference between two groups in WBC count, MCV and Hb, but in platelet count and platelet indices, there were no significant differences. According to our knowledge, our study is the first one about platelet indices difference, between malignant and non-malignant neoplasm of the ovary. In our research, the mean of platelets count and platelets indexes did not differ between the two groups. In most studies, the mean of Hb, MCV, and WBC count were lower in malignant tumors that our results were the same. Further research is needed to confirm our results so that criteria to differentiate benign and malignant tumors and prognostic factors can be completed.

Rationale: Dysgerminoma is a rare malignant tumor of the ovary, more frequently occurring in young women. The main signs of pseudo-Meigs syndrome (PMS) are ascites and hydrothorax accompanying benign or malignant ovarian tumors (no fibroma or fibroma-like tumor). Patient concerns: A 19-year-old woman with fever and chest tightness for 2 days. Diagnoses: Pectoral-abdominal computed tomography (CT) scan and contrast-enhanced magnetic resonance imaging revealed a large amount of right pleural effusion, a small amount of ascites, and a huge abdominopelvic mass measuring about 29.2cm × 11.8cm × 8.4 cm in the left ovary. The result of hydrothorax examination was consistent with the diagnosis of exudative pleural effusion. In addition, Rivalta-test showed a positive result and lactate dehydrogenase was elevated. The histopathological diagnosis was a giant germ cell tumor, which was consistent with dysgerminoma in terms of both morphology and immunophenotype. Based on these findings, a diagnosis of malignant ovarian neoplasm with PMS was made. Interventions: Surgical resection of the tumor was performed. Outcomes: The patient recovered well after operation, and the pleural effusion and abdominal ascites vanished. No recurrence was observed during the 1-year follow-up period. Lessons: Ovarian dysgerminoma with PMS is a rare malignant tumor of the ovary, which often occurs in young women. It should be considered in differential diagnosis of patients with a pelvic mass, ascites and pleural effusion. Early diagnosis and surgical treatment are beneficial to prolonged survival.

Introduction Ovarian cancer has a high mortality and delayed diagnosis. Inflammation is a risk factor for ovarian cancer, and the inflammatory response is involved in almost all stages of tumor development. Immunohistochemical staining in stroma and epithelium of a panel of cytokines in benign and malignant ovarian neoplasm was evaluated. In addition, immunostaining was related to prognostic factors in malignant tumors. Method The study group comprised 28 ovarian benign neoplasias and 28 ovarian malignant neoplasms. A panel of cytokines was evaluated by immunohistochemistry (Th1: IL-2 and IL-8; Th2: IL-5, IL-6, and IL-10; and TNFR1). Chi-square test with Yates’ correction was used, which was considered significant if less than 0.05. Results TNFR1, IL-5, and IL-10 had more frequent immunostaining 2/3 in benign neoplasms compared with malignant tumors. Malignant tumors had more frequent immunostaining 2/3 for IL-2 in relation to benign tumors. The immunostaining 0/1 of IL 8 was more frequent in the stroma of benign neoplasms compared with malignant neoplasms. Evaluation of the ovarian cancer stroma showed that histological grade 3 was significantly correlated with staining 2/3 for IL-2 ( P = 0.004). Women whose disease-free survival was less than 2.5 years had TNFR1 stromal staining 2/3 ( P = 0.03) more frequently. Conclusion IL-2 and TNFR1 stromal immunostaining are related prognostic factors in ovarian cancer and can be the target of new therapeutic strategies.

Meigs’ syndrome represents a triad of pleural effusion, ascites, and an ovarian tumor, which is usually benign, occurring together. We describe here 2 patients with Meigs’ syndrome and 2 patients with pseudo-Meigs’ syndrome. Hydrothorax and ascites symptoms in 4 patients are of outstanding performance characteristics of Meigs’ syndrome and pseudo-Meigs’ syndrome. Ovarian tumors were found by clinical examination and surgically removed. Postoperatively, these signs of hydrothorax and ascites were dissolved completely. Conclusions: These cases highlight the difficulties that may be encountered in the management of patients with Meigs’ syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach, and the adverse impact that Meigs’ syndrome can have on the patient’s condition. Clinical doctors should be alert to this kind of disease under pathological diagnosis in the absence of a clear effect of chemotherapy or radiotherapy and to prevent unnecessary harm to the patient.

OBJECTIVE: The aim of the study was to know the morphological pattern of benign and malignant ovarian neoplasms and their distribution in different age groups in rural population of India. MATERIAL AND METHODS: A retrospective study of all cases of ovarian neoplasms diagnosed at department of pathology, Maharaja Medical College, Agroha during period of five year (Aug, 07— Oct.12) was done. The tumors were classified according to WHO classification after thorough examination of slides and their distribution in different age groups was also noted. RESULTS: There were total fifty three cases of ovarian tumors noted during this period. Benign tumors comprised 81.13% and malignant tumors were18.86%. Surface epithelial tumor emerged as the commonest variety accounting for 60.37%, followed by germ cell tumor (32.07%) and sex cord stromal tumors were least common comprising 7.54 % of all ovarian neoplasm. No metastatic tumor or tumors with borderline malignancy were seen. Serous cystadenoma was the commonest tumor (43.39%) followed by mature cystic teratoma (30.23%).Among the malignant tumor, malignant germ cell tumor were the commonest type (40%), followed by 30 %of each surface epithelial tumor and sex cord stromal tumor. CONCLUSION: Benign ovarian tumors are seen more common than malignant tumor. Malignant epithelial tumors are seen after the age of 30 years and malignant germ cell tumor are seen below the age of 30 years. Bilaterality is more commonly seen in malignant ovarian neoplasm.

Ovarian dysgerminomas are rare entity and account for only about 2% of all malignant ovarian neoplasm. The aim of this study was to evaluate the clinicopathologic characteristics, treatment, long-term survival, and fertility outcome of women diagnosed with ovarian dysgerminoma at our institution. Sixty-five women with histologically proven pure ovarian dysgerminoma were identified in this retrospective study. They were treated at King Faisal Specialist Hospital, Riyadh; Saudi Arabia between 1976 and 2010. The median age was 20 years. The most frequent symptoms at presentation were abdominal pain and abdominal/pelvic mass. Thirty-three patients (50.7%) presented with stage I, 2 (3.1%) had stage II, 22 (33.8%) had stage III, and 4 (6.2%) had stage IV (4 unknown stage). Unilateral oophorectomy was performed in 50 patients (76.9%) while bilateral oophorectomy ± hysterectomy was done in 12 patients (18.4%). Three patients had biopsy only. Forty patients (61.5%) received only chemotherapy, and 4 patients (6.2%) received radiotherapy alone. Recurrence was observed in 6 patients (9.2%). With median follow-up of 54 months, the 5-year disease-free survival (DFS) and overall survival (OS) were 88 and 95%, respectively. On univariate analysis, adjuvant chemotherapy was independent better prognostic factor for DFS (HR, 0.09; 95% CI, 0.01–0.84; P = 0.034). Of the 50 patients treated with fertility-sparing surgery, 16 patients (32%) achieved pregnancy with 14 live births. Patients with pure ovarian dysgerminoma have excellent long-term outcome. There is no difference at outcome between fertility-sparing and nonconservative surgeries. Adjuvant chemotherapy was associated with significant improvement in DFS. It is possible to maintain good reproductive function after conservative surgery followed by chemotherapy in our series.

Ovarian fibroma is a sexcord stromal tumor, which accounts for 4% of all ovarian tumors. It is uncommon benign tumor of ovary. Clinically, it is asymptomatic and may typically be detected during routine gynecological examinations. It may be associated with ascitis and hydrothorax known as Meig's Syndrome. Usually these ovarian tumors are unilateral, solid, hard masses with small areas of cystic degeneration. Due to their solid structure, these benign tumors are sometimes confused with malignant ovarian neoplasm during clinical evaluation. A 59 year old postmenopausal woman presented with flank pain and new onset urinary incontinence. Ultrasound evaluation revealed a pelvic mass. Labs showed elevated tumor marker level. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Pathological examination however revealed an ovarian fibroma. During the postmenopausal years, the ovaries become atrophic. The incidence ovarian neoplasm increases with age. A suspicious or persistent complex mass and increased tumor marker like CA125 and OVA1 in post-menopausal woman requires surgical evaluation. The traditional diagnostic tools for ovarian tumors are bimanual examination, pelvic ultrasound and measuring serum biomarker like CA125 level, but these methods have low specificity and sensitivity. Now-a-days the role of some tumor marker such as OVA1in the management of ovarian tumor has been approved by FDA.

Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.

Serous psammocarcinoma is a rare variant of serous carcinoma arising from either ovary or peritoneum, characterized by massive psammoma body formation, low grade cytologic features, and invasiveness. Its clinical behavior is similar to serous borderline tumors with relatively favorable prognosis. We report herein a case of a 60-year-old postmenopausal woman who presented with abdominal distension. Contrast enhanced computed tomography (CECT) revealed calcified pelvic masses with ascites. Elevated serum CA-125 (970 U/mL) suggested malignant ovarian neoplasm. Patient underwent exploratory laparotomy with primary debulking surgery. Histopathology showed bilateral serous psammocarcinoma of ovary with invasive implants on omentum. Adjuvant chemotherapy was advised in view of advanced stage disease, although its benefits are poorly defined due to rarity of the tumor. However, patient opted out of it and is now on follow-up.

Objective. The purpose of this study was to explore epidemiological features of malignant ovarian neoplasm in Japan. Methods. The number of deaths from malignant ovarian neoplasm was obtained from the national vital statistics. Estimated incidence rates, based on several cancer registries, were also used for analyses. We divided the subjects into two age groups (0–29 and 30+ years) and examined secular trends in mortality (1950–1997) and incidence (1975–1993) by age, time, and birth cohort. Results. The age-adjusted mortality rate has increased approximately 4-fold (from 0.9 to 3.6 per 100,000 women) from 1950 to 1997. Age-specific mortality rates showed a rising pattern in the elderly, whereas mortality in the younger people tended to increase in the 1950s and 1960s, but then decreased in the 1970s and afterward. In analyses using a mathematical model, the time effect in the population aged 0–29 years increased with advancing period up to 1970, and then decreased. The cohort effects had positive values, which indicate higher than additive influence from age/time effect, for birth cohorts from 1900 to 1935. The age-adjusted incidence rate increased approximately 1.5-fold (from 3.6 to 5.7) from 1975 to 1993. The rate increased in the early 1980s, but has remained stable since the late 1980s. Age-specific incidence rates in older age groups increased steadily up to 1985, and have remained stable since, while the rates in younger women have remained almost unchanged. Conclusion. The major effects on malignant ovarian neoplasm in Japan are supposed to be due to declining parity and therapeutic improvements.

The distinction of metastatic ovarian carcinoma from a primary malignant ovarian neoplasm is crucial to its subsequent management. The most common metastatic carcinoma that mimics primary ovarian carcinoma is that of large bowel origin. The clinical and pathologic features of 25 cases of intestinal adenocarcinoma metastatic to the ovaries were analyzed. The patients ranged in age from 47 to 80 years (average age, 60 years). Most patients had abdominal pain and a pelvic mass. In 56%, the ovarian tumors and the large bowel carcinomas were discovered synchronously; 44% were metachronous. Seventy-five percent of the tumors were unilateral. Gross examination revealed that all the ovarian tumors were solid and cystic with smooth outer surfaces. Most of the tumors showed hemorrhage and necrosis. Histologic examination showed that 13 cases had a predominantly endometrioid-like pattern, four cases were predominantly mucinous, and the rest demonstrated a mixed pattern. The presence of a garland pattern with cribriform areas and "dirty" necrosis were the most distinctive features that were helpful in correctly differentiating these tumors from primary endometrioid ovarian carcinoma, with which they are often confused. Immunohistochemical stains for carcinoembryonic antigen showed strong intracytoplasmic positive staining in all the cases of intestinal adenocarcinoma metastatic to the ovaries, in contrast to primary ovarian endometrioid carcinoma, which stain negatively for carcinoembryonic antigen or show only intraluminal or apical positivity. As expected, intestinal adenocarcinoma metastatic to the ovaries had a very poor prognosis. Seventy percent of the patients died within a period of 1 to 19 months (average, 8.2 months). Its distinction from primary ovarian carcinoma is crucial because the management and prognosis of metastatic ovarian carcinoma of large intestine origin is different.

Ovarian neoplasms in pregnancy are usually asymptomatic rarely leading onto complications. A 30-year-old G2 P1+0+0+1 was referred at 30 weeks of pregnancy with an ultrasound diagnosis of a large multicystic ovarian cyst with no solid areas, ascites or evidence of metastasis. Antenatal corticosteroid was administered and she was advised to follow-up with reports of tumor markers. She presented a week later with acute pain abdomen and breathlessness. Clinical examination revealed a relaxed uterus and ultrasound was suggestive of rupture of the ovarian cyst. Exploratory laparotomy revealed a ruptured left mucinous ovarian cyst with no evidence of solid areas or metastasis. Left ovariotomy with infracolic omentectomy and concurrent cesarean section was done. A healthy male baby of weight 1.880 kg was delivered. Histopathology revealed stage-1c mucinous cyst adenocarcinoma of left ovary. This was followed-up, with a complete surgery done after a month. She is now receiving postoperative chemotherapy. This is the first reported case of a ruptured malignant ovarian tumor in pregnancy. Torsion or rupture of ovarian masses is an important differential diagnosis of abdominal or pelvic pain during pregnancy.

To evaluate the intratumoral reliability of color Doppler parameters and the contribution of Doppler sonography to the gray-scale differential diagnosis of ovarian masses.An observational study was performed including 67 patients, 15 (22.4%) with malignant ovarian neoplasm and 52 (77.6%) with benign ovarian diseases. We performed the Doppler evaluation in two distinct vessels selected after decreasing the Doppler gain to sample only vessels with higher velocity flow. Doppler measurements were obtained from each identified vessel, and resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) were measured. Intraclass coefficient of correlation (ICC), sensitivity, specificity, and potential improvement in gray-scale ultrasound performance were calculated.The general ICC were 0.60 (95% CI 0.42-0.73) for RI, 0.65 (95% CI 0.49-0.77) for PI, 0.07 (95% CI -0.17-0.30) for PSV, and 0.19 (95% CI -0.05-0.41) for EDV. The sensitivity and specificity were respectively 84.6% and 86.7% for RI, 69.2% and 93.3% for PI, 80.0% and 65.4% for gray-scale sonography, and 93.3% and 65.4% for gray-scale plus RI (p = 0.013).Gynecologists must be careful in interpreting results from Doppler evaluation of ovarian masses because PSV and EDV present poor intratumoral reliability. The lower RI value, evaluated in at least two distinct sites of the tumor, was able to improve the performance of gray-scale ultrasound in differential diagnosis of ovarian masses.

To investigate differences according to racial classification in the frequency of ovarian cancer-related surgical procedures and in access to high-volume surgical providers among women undergoing initial surgery for ovarian cancer.The Maryland Health Services Cost Review Commission database was accessed for women age18years undergoing a surgical procedure that included oophorectomy for a malignant ovarian neoplasm between 7/1/01 and 6/30/09. Multivariate logistic regression analyses were used to evaluate for differences in the likelihood of selected surgical procedures and access to high-volume surgical providers (surgeons≥10 cases/year; hospitals≥20 case/year) according racial classification.A total of 2487 patients were identified who underwent a primary surgical procedure that included oophorectomy for a malignant ovarian neoplasm: White=1884 (75.4%), African-American=400 (16.1%), and other/unknown=203 (8.2%). Compared to White patients, African-American patients were significantly younger (mean age 55.4years vs 59.9years, P0.0001) and less likely to have commercial insurance (28.5% vs 39.5%, p0.0001). Compared to White patients, African-American racial classification was associated with a statistically significant and independent lower likelihood of hysterectomy (OR=0.53, 95%CI=0.42-0.66, p0.0001), colon resection (OR=0.65, 95%CI=0.48-0.87, p=0.004), lymphadenectomy (OR=0.67, 95%CI=0.50-0.91, p=0.01), and surgery by a high-volume surgeon (OR=0.55, 95%CI=0.44-0.69, p0.0001).Among women undergoing initial surgery for ovarian cancer, African-American patients are significantly less likely to be operated on by a high-volume surgeon and to undergo important ovarian cancer-specific surgical procedures compared to White patients.

A 46-year-old women was examined for severe constipation. Pelvic examination revealed a large pelvic mass extending to the level of the umbilicus. Computed tomography showed a large multicystic, septated mass in the pelvis and a small amount of fluid in the cul de sac. In addition, multiple ill-defined, mixed-attenuation hepatic lesions were identified. A malignant ovarian neoplasm with liver metastases was considered, so the pelvic mass was resected. Interestingly, histopathologic analysis revealed malignant struma ovarii of the follicular type. Biopsy of the liver lesions confirmed metastatic disease with similar histopathologic findings. All thyroid laboratory values were in the normal range. The patient then had a total thyroidectomy to optimize thyroid ablation therapy with I-131. This revealed a small follicular adenoma but no evidence of cancer. An I-131 whole-body scan was performed and showed uptake in multiple functioning liver metastases.

Objective : Our purpose was to determine whether relatives of patients with ovarian germ cell malignancies not associated with sex chromosome abnormalities are at increased risk for similar tumors. Study Design : We reviewed pedigrees of 78 presumptive 46,XX patients (ages ranging from newborn to 20 years) with malignant ovarian germ cell tumors, excluding cases of dysgerminoma and gonadoblastoma. A three-generation family history of each proband was reviewed specifically to identify cancer in any family member. Results : Seventy-eight mothers, 87 sisters, 135 aunts, and 156 grandmothers were surveyed. None had a malignant ovarian germ cell neoplasm or other malignant ovarian neoplasm. Conclusion : First- and second-degree relatives of probards with ovarian germ cell malignancies do not have an increased risk for similar tumors. These findings were not predicted because of the well-recognized association of hereditary tumors and early age of onset.

Serum levels of dehydroepiandrosterone sulfate (DHEAS) were measured in 41 postmenopausal women with ovarian tumor (16 with ovarian cancer, 6 with borderline malignant and 19 with benign ovarian tumor) and in 21 postmenopausal women without ovarian neoplasm. Circulating DHEAS levels were significantly lower in patients with ovarian cancer than in women with benign ovarian tumor and in control subjects. Women with advanced ovarian cancer had lower DHEAS levels than those with local ovarian cancer. An age-related decrease in DHEAS levels was noted in the control group, while circulating DHEAS levels were independent of age in the ovarian cancer group. The results indicate the effect of ovarian cancer on this adrenal androgen and the possible presence of ovarian factor in malignant ovarian neoplasm.

Endodermal sinus tumor of the ovary can be differentiated histologically and immunohistochemically from ovarian embryonal cell carcinoma. A case report of a patient with endodermal sinus tumor is presented in which a long-term remission was achieved by unilateral adnexectomy and combination chemotherapy. Review of the current literature indicates that tumor removal followed by combination chemotherapy with vincristine, actinomycin D, and cyclophosphamide is the most effective method of therapy for this highly malignant ovarian neoplasm. The addition of hysterectomy with contralateral ovariectomy or radiation therapy does not appear to significantly improve the survival of patients with this tumor. Serial plasma determinations of alpha fetoprotein provide biochemical monitoring of response to therapy and may be useful in predicting occult tumor recurrence.

Seventy-four patients with malignant ovarian neoplasm have been treated at two Portland hospitals by the combined use of definitive surgery and intraperitoneal radioactive gold instillation over an 11 year period. Fifty-two of these patients have been followed from 3 to 11 years. The over-all survival rates are 43.9 per cent. A survival rate of 75 per cent was obtained in Class IIB, but in the presence of far-advanced lesions (Class IV) there were no survivors. Prevention or relief of ascites formation was accomplished in 84.3 per cent of patients who died. Complications from the use of gold in our hands have been mild and transient. While other methods of treatment, such as chemotherapy, have recently appeared, none seemed to have any great advantage over the combination of surgery and routine radiogold.

We studied the pretreatment serum levels of 6 tumor markers in gynecological patients with and without malignant disease. The tumor markers were carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), ferritin, Schwangerschaftsprotein 1 (SP1), Schwangerschaftsprotein 3 (SP3) and cancer antigen 125 (CA125). The results were as follows: (1) Serum CA125 and TPA levels were raised in 81% and 57% of patients with ovarian serous cystadenocarcinoma: CEA and SP3, in 52% and 43% respectively of patients with ovarian mucinous cystadenocarcinoma; CA125, TPA and SP3, in 76%, 48% and 48% respectively of patients with other ovarian malignancies; and TPA and SP3, in 56% and 40% respectively of patients with endometrial carcinoma. (2) Serum levels of TPA, ferritin and CA125 were more often raised with advancing stages of malignant disease. (3) Serum TPA levels were elevated in 55% of patients with stage I endometrial carcinoma, and serum SP3 levels were elevated in 35% of patients with a stage I malignant ovarian neoplasm and in 45% of patients with endometrial carcinoma. (4) One of the 6 tumor markers showed a raised level in 84% of patients with gynecologic malignancy as against 56% in those with benign gynecologic diseases.

The authors describe the first case of calcified breast and axillary lymph node metastases from papillary serous cystadenocarcinoma of the ovary. The patient also exhibited psammomatous calcification in the pelvis. They also report the fourth case of curvilinear calcification of pseudomyxoma peritonei from pseudomucinous cystadenocarcinoma of the ovary. Inconsistencies in the literature regarding psammomatous calcification in benign ovarian papillary serous neoplasms are discussed, and the roentgenographic differentiation from other conditions is offered.