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The discovery of gene fusions involving Neuregulin-1 (NRG1) within solid tumors has important therapeutic implications, as they are being actively explored as targets for emerging ERBB/ERBB2/ERBB3-directed anti-cancer agents. NRG1 fusions are very uncommon across all tumor types and are infrequently documented in the medical literature. We report a female patient presenting with widespread peritoneal carcinomatosis diagnosed as high grade serous fallopian tube carcinoma, which harbored a previously undescribed MYH10 :: NRG1 fusion. Moreover, we queried the whole transcriptome sequencing results of neoplasms analyzed by a commercial laboratory (Caris Life Sciences) to determine the overall incidence of NRG1 fusions in carcinomas of the ovary, fallopian tube, and peritoneum (0.18%). Twenty-five additional tumors were found to demonstrate NRG1 fusions, including 20 new genes partners that had not been previously identified in gynecologic carcinomas. Overall, NRG1 fusion events are rare in ovarian, fallopian tube, and primary peritoneal carcinomas, but they may carry diagnostic significance in the context of borderline/low grade serous tumors, which demonstrated exclusively CLU::NRG1 fusions, and could have important predictive implications for response to ERBB/ERBB2/ERBB3-directed therapies. [ABSTRACT FROM AUTHOR]

High-grade (HGOC) and low-grade ovarian carcinoma (LGOC) are distinct malignancies with different biological features, treatment paradigms, and life expectancies. However, differences in quality of life (QOL), sleep, and depressive symptoms have not been examined by grade, and neither have inflammatory profiles associated with these symptoms. We aim to characterize QOL and biomarkers by OC grade. Participants included patients with HGOC (N = 578) or LGOC (N = 85). Participants completed baseline assessments of psychosocial factors prior to primary surgery or neoadjuvant chemotherapy and contributed saliva for cortisol and blood for interleukin-6 (IL-6) quantification. Samples were collected intraoperatively to quantify tumor cortisol. General linear models were used to examine differences in biological and psychological variables by grade. At baseline, patients with LGOC reported less depression (p = 0.018) and sleep disturbances (p = 0.014), but no significant difference in depressive mood (p = 0.11) or QOL (p = 0.51) compared to patients with HGOC, adjusting for age and disease stage. There were trends towards lower tumor cortisol levels (p = 0.078) in LGOC compared to HGOC. One-year post-diagnosis, we found a significant improvement in QOL and fatigue, and a decrease in vegetative depression and IL-6 levels irrespective of grade. We present the first characterization of psychosocial experiences of patients with LGOC. Despite having a better disease prognosis, patients with LGOC were just as likely to have mood disturbances as those with HGOC. There was a trend towards differences in tumor cortisol by grade. Our findings highlight the need to address well-being in patients with both low- and high-grade ovarian malignancies. • Low-grade ovarian cancer patients report less vegetative depression than high-grade. • Both low- and high-grade patients report sleep disturbances that do not improve over time. • No difference in overall quality of life by grade at baseline or over time. • Trend towards lower tumor cortisol in low- versus high-grade patients. • No systematic differences in IL-6 or cortisol by grade were observed. [ABSTRACT FROM AUTHOR]

In this case, a 66‐year‐old female patient presented with the chief complaint of abdominal distention. Computed tomography and magnetic resonance imaging revealed no enlarged ovaries or obvious primary lesions; however, massive ascites and peritoneal disseminated nodules were observed. Ascites cytology revealed adenocarcinoma and immunohistochemical findings suggested serous carcinoma. The patient then underwent tumor reduction surgery after preoperative chemotherapy for suspected Stage IIIC primary peritoneal carcinoma. Postoperative histopathology revealed carcinoma consisting mainly of high‐grade serous carcinoma (HGSC) and sarcoma. In addition, serous intraepithelial carcinoma (STIC) of the fallopian tube was observed in the fimbriae of the left fallopian tube. Recently, it has been noted in the literature that most cases of peritoneal carcinoma are metastases or dissemination of carcinoma originating from the fimbriae of the fallopian tube. This is a rare case of peritoneal carcinosarcoma with STIC, and its report leads to a better understanding of the disease's features and possible therapeutic approaches. [ABSTRACT FROM AUTHOR]

Background and Objectives. There is a global trend towards an increase in the number of patients diagnosed with ovarian cancer during their reproductive years. One of the current clinical technologies is the technology of cryopreservation of removed healthy ovaries in order to preserve fertility and their subsequent transplantation after treatment for cancer of other organs. Glycerol is often used as a non-penetrating agent in freezing to improve follicle survival. Materials and Methods. The work examined the ovaries of cats with diagnoses confirmed by histological studies: follicular phase, luteal phase, serous carcinoma, leimyosarcoma. Diffuse reflectance spectroscopy was used to determine the kinetic parameters of dehydration and optical properties of tissues upon interaction with glycerol. Based on the change in mass over a long period of time, the diffusion coefficient of glycerol in the samples was determined. Results. The effective diffusion coefficient of interstitial water in cat ovarian tissue has been measured: D = (2.6 ± 0.4)·10−6 cm2/s (follicular phase), D = (3.3 ± 0.4)·10−6 cm2/s (luteal phase), D = (3.0 ± 0.3)·10−6 cm2/s (leiomyosarcoma), and D = (1.6 ± 0.2)·10−6 cm2/s (serous carcinoma), which is initiated within 1.5–2 hours of interaction. Diffusion of glycerol occurs over a long period of time, about 400 hours, and for the samples under study is: D = (8.3 ± 2.5)·10−8 cm2/s (follicular phase), D = (5.6 ± 1.7)·10−8 cm2/s (luteal phase), D = (2.2 ± 0.2)·10−8 cm2/s (leiomyosarcoma), and D = (1.1 ± 0.4)·10−7 cm2/s (serous carcinoma). Conclusion. The established perfusion-kinetic parameters of glycerol/interstitial water for the studied samples can be used in clinical practice in the preparation of ovarian tissue for transplantation (cryopreservation), in the transmembrane transfer of drugs, the development of new reproductive technologies, etc.

This article discusses the detection of primary peritoneal low-grade serous carcinoma in cervical smears. The study reports three cases of asymptomatic women who had abnormal glandular cells in routine Pap smears. Further investigations revealed raised serum CA125 levels and mild ascitic fluid collection in the pelvis. The patients underwent exploratory laparotomy, which confirmed the presence of low-grade serous carcinoma. The article emphasizes the diagnostic value of cellblock immunocytochemistry in confirming the diagnosis. The document also discusses the presence of low-grade serous papillary cell clusters with psammoma bodies in the tubal lumen, which are characteristic of primary peritoneal serous tumors. The document highlights the importance of considering various factors to distinguish primary peritoneal serous carcinomas from other types of serous tumors. The shedding of peritoneal tumor cells into the uterine cavity is proposed as a possible explanation for abnormal Pap tests. [Extracted from the article]

Purpose: Neoadjuvant chemotherapy is often administered for high-grade serous ovarian carcinoma (HGSC) prior to cytoreductive surgery. We evaluated treatment response by CT (simplified peritoneal carcinomatosis index [S-PCI]), pathology (chemotherapy response score [CRS]), laboratory markers (serum CA-125), and surgical outcomes, to identify predictors of disease-free survival. Methods: For this retrospective, HIPAA-compliant, IRB-approved study, we identified 396 women with HGSC receiving neoadjuvant chemotherapy between 2010 and 2019. Two hundred and ninety-nine patients were excluded (surgery not performed; imaging/pathology unavailable). Pre- and post-treatment abdominopelvic CTs were assigned CT S-PCI scores 0–24 (higher score indicating more tumor). Specimens were assigned CRS of 1–3 (minimal to complete response). Clinical data were obtained via chart review. Univariate, multivariate, and survival analyses were performed. Results: Ninety-seven women were studied, with mean age of 65 years ± 10. Interreader agreement was good to excellent for CT S-PCI scores (ICC 0.64–0.77). Despite a significant decrease in CT S-PCI scores after treatment (p < 0.001), mean decrease in CT S-PCI did not differ significantly among CRS categories (p = 0.20) or between patients who were optimally versus suboptimally debulked (p = 0.29). In a survival analysis, lower CRS (more viable tumor) was associated with shorter time to progression (p < 0.001). A joint Cox proportional-hazard models showed that only residual pathologic disease (CRS 1/2) (HR 4.19; p < 0.001) and change in CA-125 (HR 1.79; p = 0.01) predicted progression. Conclusion: HGSC response to neoadjuvant therapy by CT S-PCI did not predict pathologic CRS score, optimal debulking, or progression, revealing discordance between imaging, pathologic, biochemical, and surgical assessments of tumor response. [ABSTRACT FROM AUTHOR]

BACKGROUND: Serous carcinoma is the most prevalent form of ovarian cancer (OC) and has been extensively studied and reviewed. Despite significant research, this aggressive gynecologic neoplasm continues to have a high fatality rate. While dissemination to the brain is rare, metastasis to the cerebellum are the most common. To the best of our knowledge, intraventricular metastasis remains unreported. CASE PRESENTATION: We present a compelling case study involving a 48-year-old female patient with a previous medical history of ovarian cancer, who was treated with bilateral salpingo-oophorectomy and adjuvant chemotherapy. Remarkably, 48 months following her initial treatment, she developed an intraventricular metastasis. Imaging revealed the presence of a multi lobulated mass within the left occipital horn. Despite undergoing a radical surgical resection, her clinical course remained highly aggressive, highlighting the challenging nature of this particular case. CONCLUSION: Radical surgical resection stands out as the primary treatment option for patients with unique metastasis to the ventricular system. This case contributes to the existing body of literature regarding the unfavourable prognosis associated with serous ovarian carcinoma, further emphasizing the importance of early detection and diagnosis awareness. [ABSTRACT FROM AUTHOR]

The discovery of gene fusions involving Neuregulin-1 (NRG1) within solid tumors has important therapeutic implications, as they are being actively explored as targets for emerging ERBB/ERBB2/ERBB3-directed anti-cancer agents. NRG1 fusions are very uncommon across all tumor types and are infrequently documented in the medical literature. We report a female patient presenting with widespread peritoneal carcinomatosis diagnosed as high grade serous fallopian tube carcinoma, which harbored a previously undescribed MYH10::NRG1 fusion. Moreover, we queried the whole transcriptome sequencing results of neoplasms analyzed by a commercial laboratory (Caris Life Sciences) to determine the overall incidence of NRG1 fusions in carcinomas of the ovary, fallopian tube, and peritoneum (0.18%). Twenty-five additional tumors were found to demonstrate NRG1 fusions, including 20 new genes partners that had not been previously identified in gynecologic carcinomas. Overall, NRG1 fusion events are rare in ovarian, fallopian tube, and primary peritoneal carcinomas, but they may carry diagnostic significance in the context of borderline/low grade serous tumors, which demonstrated exclusively CLU::NRG1 fusions, and could have important predictive implications for response to ERBB/ERBB2/ERBB3-directed therapies.

Objective: To know the risk of endometrial cancer (EC) in a population of women with BRCA 1/2 pathogenic or likely pathogenic variants after risk-reducing salpingo-oophorectomy (RRSO). Methods: The study cohort included data from 857 women with BRCA mutations who underwent RRSO visited four hospitals in Catalonia, Spain, from January 1, 1999 to April 30, 2019. Standardized incidence ratio (SIR) of EC was calculated in these patients using data from a regional population-based cancer registry. Results: After RRSO, eight cases of EC were identified. Four in BRCA 1 carriers and four in BRCA2 carriers. The expected number of cases of EC was 3.67 cases, with a SIR of 2.18 and a 95% CI (0.93–3.95). Conclusions: In our cohort, the risk of EC in BRCA1/2 carriers after RRSO is not greater than expected. Hysterectomy is not routinely recommended for these patients. [ABSTRACT FROM AUTHOR]

Psammocarcinoma (PsC) represents a rare form of low-grade serous tumor of the ovary or peritoneum. Although ovarian cancer generally has a poor prognosis in its late stages, PsC seems to have a more indolent course. We present a patient with a history of unspecific abdominal pain for more than a year, with sudden acute onset of severe inguinal pain. On admission to the hospital, a computed tomography (CT) revealed a pelvic mass of suspected ovarian origin. Radical surgery was attempted but not achieved due to widespread tumor growth. Histopathological evaluation revealed estrogen receptor-positive stage III PsC. Tamoxifen treatment was thus initiated, still maintaining stable disease 10 years later. The patient has undergone extensive radiological work-up, including CT, chest X-ray, 18F-fluoro-deoxy-glucose positron emission tomography (PET)/CT, 99mTc- hydroxymethylene diphosphonate (HDP) bone scintigraphy, 18F-fluoro-thymidine (FLT) PET/CT, Tc-99m depreotide scintigraphy and magnetic resonance imaging. In conclusion, we demonstrate that PsC has characteristic radiological features and different imaging modalities can be suitable in different clinical situations. In contrast to most other ovarian cancers, PsC does not always warrant adjuvant chemotherapy, even in advanced stages. This emphasizes the need for a deeper knowledge of the biological behavior of this rare tumor, to select the optimal treatment strategy. [ABSTRACT FROM AUTHOR]

Psammocarcinoma (PsC) represents a rare form of low-grade serous tumor of the ovary or peritoneum. Although ovarian cancer generally has a poor prognosis in its late stages, PsC seems to have a more indolent course. We present a patient with a history of unspecific abdominal pain for more than a year, with sudden acute onset of severe inguinal pain. On admission to the hospital, a computed tomography (CT) revealed a pelvic mass of suspected ovarian origin. Radical surgery was attempted but not achieved due to widespread tumor growth. Histopathological evaluation revealed estrogen receptor-positive stage III PsC. Tamoxifen treatment was thus initiated, still maintaining stable disease 10 years later. The patient has undergone extensive radiological work-up, including CT, chest X-ray, 18F-fluoro-deoxy-glucose positron emission tomography (PET)/CT, 99mTc- hydroxymethylene diphosphonate (HDP) bone scintigraphy, 18F-fluoro-thymidine (FLT) PET/CT, Tc-99m depreotide scintigraphy and magnetic resonance imaging. In conclusion, we demonstrate that PsC has characteristic radiological features and different imaging modalities can be suitable in different clinical situations. In contrast to most other ovarian cancers, PsC does not always warrant adjuvant chemotherapy, even in advanced stages. This emphasizes the need for a deeper knowledge of the biological behavior of this rare tumor, to select the optimal treatment strategy.

Background: The distinction of endometrial adenocarcinoma (EMA) from endocervical adenocarcinoma (ECA) has great significance preoperatively, since the therapeutic plan depends on the primary site of tumor. Immunohistochemistry (IHC) is an ancillary method in distinguishing primary EMA and ECA, especially in cases of histomorphological overlap. Aims and Objectives: Primary objective of this study was to describe the expression of IHC markers–estrogen receptor (ER), vimentin, monoclonal carcinoembryonic antigen (CEA), P16 in EMA and ECA. Secondary objective of this study was to describe the histomorphological features of EMA and ECA. Materials and Methods: This is a descriptive study done at the Department of Pathology, Government Medical College, Kottayam between November 2019 and May 2021. The sample size was 54 which included primary adenocarcinoma diagnosed on curettage biopsies. IHC was performed using ER, Vimentin, P16, and mCEA. A semiquantitative scoring was done using the German IHC scoring system. Results: Histomorphological features and IHC expression in EMA and ECA were studied. Percentage of cases with expression of IHC markers is as follows. In endometrioid EMA-ER in 100% of cases, Vimentin 83.3%, P16 0%, and CEA in 7.3% cases. About 80% of serous carcinomas showed P16 and vimentin positivity with negative staining for ER and CEA. In ECA-ER in 0% cases, vimentin 16.7%, P16 80%, and CEA in 66.7% of cases. Based on histomorphologic appearance, the common histologic subtype of EMA was endometrioid EMA followed by serous carcinoma. In ECA, the usual type was more common than gastric type. Conclusion: IHC markers-ER, vimentin, P16, and CEA are useful in distinguishing endometrioid EMA and ECA.

Background: Axillary lymph node metastasis is a rare stage IV ovarian carcinoma manifestation. This manuscript aims to systematically review the literature regarding axillary lymph node metastasis from ovarian carcinoma. Methods: We searched three medical internet databases (PubMed, Scopus, and Web of Science) for relevant articles published until 22 July 2023. Cases describing supraclavicular or intramammary lymph node metastases and concurrent metastasis to the breast were excluded. Results: After applying eligibility/inclusion and exclusion criteria, twenty-one manuscripts describing twenty-five cases were included from the English literature. Data were collected and analyzed regarding demographic, clinical, laboratory, radiological, histopathological, and oncological characteristics. Conclusions: We analyzed the clinical and oncological characteristics of patients with axillary lymph node metastasis from ovarian carcinoma, presented either as an initial diagnosis of the disease or as a recurrent disease. The analysis we performed showed a significant difference only in the serum CA-125 level (p = 0.004) between the two groups. There was no observed difference in womens' survival. [ABSTRACT FROM AUTHOR]

Objective Particularly interesting cys-his rich protein (PINCH/LIMS-1), a protein implicated in cell adhesion, is assumed to oversee the development and invasion of cancer cells in tumors and tumor-associated stroma. This study aimed to assess PINCH-1 expression in serous borderline tumor (SBT) and serous carcinoma (SC) in the tumor and peritumoral stroma and scrutinize any associations between its expression and various clinical and pathological parameters. Material and Method In this study, the expression of the PINCH-1 antibody was analyzed in 21 cases of SBT and 89 cases of SC using the indirect immunoperoxidase technique with streptavidin/HRP-biotin. The staining pattern of PINCH-1 in the tumor and peritumoral stroma was evaluated using a semiquantitative scoring method. The staining procedure used in the study allowed for the accurate identification of PINCH-1 expression, and the data obtained through the semiquantitative scoring method provided a reliable of assessing the degree and intensity of PINCH-1 staining. Thus, the correlation between PINCH-1 expression and various pathologic factors such as patient age, tumor size, FIGO stage, intra-abdominal washing cytology, capsule invasion, tumor location in the ovary, tumor grade, and cancer antigen 125 (CA125) levels at the time of diagnosis was examined. Results The study found that PINCH-1 was more prevalent in cases of SC than in SBT cases. The tumors in SC cases had stronger staining than those in SBT cases (p<0.001). The study also found a positive correlation between the diffusiveness and intensity of PINCH-1 staining in the tissue surrounding the tumor and whether the tumor was located on one or both sides of the ovaries (p = 0.038 for diffusiveness, p = 0.024 for intensity). However, there was a negative correlation between PINCH-1 staining and tumor size (p=0.019 for diffusiveness, p=0.007 for intensity). Furthermore, the intensity of PINCH-1 tumor staining exhibited statistical significance in Figo stage and tumor grades as these increased (p = 0.032 and p = 0.001, respectively). Conclusion The results of this study indicate that SCs exhibit a higher level of PINCH-1 staining intensity than SBTs. Furthermore, an increase in the FIGO stage and tumor grade is associated with increased intensity of PINCH-1 staining in the tumor tissue. Additionally, the diffusiveness and intensity of PINCH-1 staining in the peritumoral stroma is more remarkable in cases of bilateral tumors but is inversely correlated with tumor size. The observed association between PINCH-1 expression and important clinicopathologic factors suggests that this molecule may be involved in developing serous ovarian cancer. Overall, these findings may contribute to a better understanding of the role of PINCH-1 in ovarian tumorigenesis and may have implications for developing novel therapeutic strategies targeting this pathway. [ABSTRACT FROM AUTHOR]

Abstract Purpose To investigate outcomes of adjuvant treatments for non-endometrioid endometrial carcinomas (NEEC), as previous studies are limited by its rarity and heterogeneity. Patients and methods Patients with endometrial serous carcinoma (SC), clear cell carcinoma (CCC) and carcinosarcoma were identified between 2004 and 2018 from SEER database. Propensity score matching (PSM) along with inverse probability treatment weighting (IPTW) technique were employed to balance confounding factors. Multivariate, exploratory subgroup and sensitivity analyses were conducted to evaluate the impact of adjuvant treatment on overall survival (OS) and cause-specific survival (CSS). Results The cohort comprised 5577 serous, 977 clear cell, and 959 carcinosarcomas. Combined chemotherapy and radiotherapy (CRT), chemotherapy alone, and radiotherapy alone were respectively administered in 42.21%, 47.27% and 10.58% of the whole cohort. Prior to adjusting, chemotherapy plus brachytherapy yielded the most beneficial effect among various strategies. After PSM-IPTW adjustment, CRT still demonstrated beneficial effect on OS and CSS. Subgroup analysis indicated CRT improved survival among various TNM stages, particularly with uterine carcinosarcoma. In the sensitivity analyses for serous histology, brachytherapy with or without chemotherapy appeared to benefit stage I-II patients. In stage III-IV SC patients, chemotherapy plus brachytherapy was still associated with improved survival outcomes. When nodal metastases were identified, additional external beam radiotherapy (EBRT) to CT was more utilized with survival improvement. Conclusion In NEEC patients, combined CRT yielded beneficial effects than any single mode. Both chemotherapy and brachytherapy promoted survival in early stage SC patients. Late stage SC patients may benefit from chemotherapy plus either EBRT or brachytherapy.

Psammocarcinoma is an uncommon subtype of low-grade serous carcinoma. It is characterized by the presence of extensive psammoma bodies and can have either an ovarian or peritoneal origin. To our knowledge fewer than 30 cases of primary peritoneal psammocarcinoma (PPP) have been reported in the English literature. We report a rare case of PPP in a 74-year-old female, discovered fortuitously within a laparotomy for gallbladder lithiasis. At laparotomy, multiple nodular implants involving the omentum, the peritoneum and a magma of intestinal loops in the right iliac fossa were noted. A biopsy from nodules was performed. Gross examination showed multiple nodules of different sizes in the fat tissue. Pathologic examination showed massive psammoma bodies representing more than 75% of the tumor. The final diagnosis was psammocarcinoma. Our patient was referred to the gynecologic department for further investigation and to ascertain whether the tumor arose from the ovaries or peritoneum. Hysterectomy, bilateral adnexectomy and omentectomy were performed. Macroscopic examination showed that both ovaries were intact having a normal size. No invasion of ovarian stroma was shown in microscopic examination. The patient died of SARS-CoV-2 (COVID-19) six days after the surgery. PPP is a rare type of low-grade serous carcinoma. The behavior of this tumor is unclear, and the treatment is not standardized because of its rarity and lack of long-term follow-up. More cases need to be studied for better understanding and improvement of the management protocols.

Psammocarcinoma is an uncommon subtype of low-grade serous carcinoma. It is characterized by the presence of extensive psammoma bodies and can have either an ovarian or peritoneal origin. To our knowledge fewer than 30 cases of primary peritoneal psammocarcinoma (PPP) have been reported in the English literature. We report a rare case of PPP in a 74-year-old female, discovered fortuitously within a laparotomy for gallbladder lithiasis. At laparotomy, multiple nodular implants involving the omentum, the peritoneum and a magma of intestinal loops in the right iliac fossa were noted. A biopsy from nodules was performed. Gross examination showed multiple nodules of different sizes in the fat tissue. Pathologic examination showed massive psammoma bodies representing more than 75% of the tumor. The final diagnosis was psammocarcinoma. Our patient was referred to the gynecologic department for further investigation and to ascertain whether the tumor arose from the ovaries or peritoneum. Hysterectomy, bilateral adnexectomy and omentectomy were performed. Macroscopic examination showed that both ovaries were intact having a normal size. No invasion of ovarian stroma was shown in microscopic examination. The patient died of SARS-CoV-2 (COVID-19) six days after the surgery. PPP is a rare type of low-grade serous carcinoma. The behavior of this tumor is unclear, and the treatment is not standardized because of its rarity and lack of long-term follow-up. More cases need to be studied for better understanding and improvement of the management protocols.

Background: The distinction of endometrial adenocarcinoma (EMA) from endocervical adenocarcinoma (ECA) has great significance preoperatively, since the therapeutic plan depends on the primary site of tumor. Immunohistochemistry (IHC) is an ancillary method in distinguishing primary EMA and ECA, especially in cases of histomorphological overlap. Aims and Objectives: Primary objective of this study was to describe the expression of IHC markers-estrogen receptor (ER), vimentin, monoclonal carcinoembryonic antigen (CEA), P16 in EMA and ECA. Secondary objective of this study was to describe the histomorphological features of EMA and ECA. Materials and Methods: This is a descriptive study done at the Department of Pathology, Government Medical College, Kottayam between November 2019 and May 2021. The sample size was 54 which included primary adenocarcinoma diagnosed on curettage biopsies. IHC was performed using ER, Vimentin, P16, and mCEA. A semiquantitative scoring was done using the German IHC scoring system. Results: Histomorphological features and IHC expression in EMA and ECA were studied. Percentage of cases with expression of IHC markers is as follows. In endometrioid EMA-ER in 100% of cases, Vimentin 88.4%, P16 0%, and CEA in 7.3% cases. About 80% of serous carcinomas showed P16 and vimentin positivity with negative staining for ER and CEA. In ECA-ER in 0% cases, Vimentin 33.3%, P16. 83.3%, and CEA in 66.7% of cases. Based on histomorphologic appearance, the common histologic subtype of EMA was endometrioid EMA followed by serous carcinoma. In ECA, the usual type was more common than gastric type. Conclusion: IHC markers-ER, vimentin, P16, and CEA are useful in distinguishing endometrioid EMA and ECA. [ABSTRACT FROM AUTHOR]

The malignant gastrointestinal endometriosis transformation is represented by endometriosis-associated intestinal tumors. Endometrioid adenocarcinoma and clear cell adenocarcinoma are most common among the endometrial cancers of all organs. Only four cases of mixed serous carcinoma and large cell neuroendocrine carcinoma have been reported, and all these cases originated from the uterus. A 59-year-old woman with a month's history of bloody stools was admitted. She was stable until the hematochezia occurred but is 11 years post-hysterectomy. A circumferential type-3 advanced upper rectum tumor was seen on colonoscopy. Adenocarcinoma was revealed from the forceps biopsies of the type-3 tumor component. Computed tomography showed narrowed lumen with a thickened rectum wall, a continuing mass, and a component on the anorectal side. Swollen lymph nodes were observed around the rectum, but no distant metastatic lymph nodes or organs were found. To treat the lesion, rectal surgical resection with D3 lymph node dissection was performed. Histological examination revealed combined high-grade serous and large cell neuroendocrine carcinomas. Tumor was contiguous to the endometrium in the sub-serosa. Endometriosis was determined to be the origin of both carcinomas. Therefore, endometriosis-associated intestinal tumors should be included in the differential diagnosis when rectal tumors with cystic structures are found post-hysterectomy. [ABSTRACT FROM AUTHOR]

Abstract Background Uterine somatic choriocarcinoma is a rare, clinically aggressive malignant tumor. They frequently concur with other cancer. However, the molecular pathogenesis between somatic choriocarcinoma and the concurrent carcinoma has rarely been addressed to date. Case presentation We report a 68-years old Chinese woman with a uterine choriocarcinoma arising from serous carcinoma. The patient underwent radical surgery including total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and pelvic lymph node resection. She received 10 courses of post-operative chemotherapy. She died of disease 13 months after her surgery. Microscopically, the tumor showed a biphasic pattern of choriocarcinoma and serous carcinoma. The choriocarcinomatous component showed a combination of cytotrophoblast, intermediate trophoblast and syncytiotrophoblast with hemorrhage and necrosis. The component of serous carcinoma was characterized by solid sheets of small cells with marked nuclear atypia and occasional glandular and papillary formation. PD-L1 was exclusively expressed in the choriocarcinomatous component. Next-generation sequencing revealed that the genetic abnormalities were overlapping between the two components.

Purpose: To investigate outcomes of adjuvant treatments for non-endometrioid endometrial carcinomas (NEEC), as previous studies are limited by its rarity and heterogeneity. Patients and methods: Patients with endometrial serous carcinoma (SC), clear cell carcinoma (CCC) and carcinosarcoma were identified between 2004 and 2018 from SEER database. Propensity score matching (PSM) along with inverse probability treatment weighting (IPTW) technique were employed to balance confounding factors. Multivariate, exploratory subgroup and sensitivity analyses were conducted to evaluate the impact of adjuvant treatment on overall survival (OS) and cause-specific survival (CSS). Results: The cohort comprised 5577 serous, 977 clear cell, and 959 carcinosarcomas. Combined chemotherapy and radiotherapy (CRT), chemotherapy alone, and radiotherapy alone were respectively administered in 42.21%, 47.27% and 10.58% of the whole cohort. Prior to adjusting, chemotherapy plus brachytherapy yielded the most beneficial effect among various strategies. After PSM-IPTW adjustment, CRT still demonstrated beneficial effect on OS and CSS. Subgroup analysis indicated CRT improved survival among various TNM stages, particularly with uterine carcinosarcoma. In the sensitivity analyses for serous histology, brachytherapy with or without chemotherapy appeared to benefit stage I-II patients. In stage III-IV SC patients, chemotherapy plus brachytherapy was still associated with improved survival outcomes. When nodal metastases were identified, additional external beam radiotherapy (EBRT) to CT was more utilized with survival improvement. Conclusion: In NEEC patients, combined CRT yielded beneficial effects than any single mode. Both chemotherapy and brachytherapy promoted survival in early stage SC patients. Late stage SC patients may benefit from chemotherapy plus either EBRT or brachytherapy. [ABSTRACT FROM AUTHOR]

Summary: Low-grade and high-grade serous carcinomas have unique clinical, morphological, underlying molecular alterations, and vastly different biologic behavior (Prat et al., 2018, Vang et al., 2009). The differentiation into high and low-grade serous carcinoma is important for clinical management and prognosis and is easily recognized by practicing pathologists. High-grade serous carcinoma is characterized by marked nuclear atypia and pleomorphism, frequent, often atypical mitosis with papillary or three-dimensional clusters, p53 mutation, and block-like p16 staining. In contrast, low-grade serous carcinomas have a different morphologic appearance with micropapillary formation, small nests of tumor cells having low to intermediate grade nuclei, and absence of significant mitosis. Low-grade serous carcinoma is often associated with micropapillary variant of ovarian serous borderline tumor. The low-grade serous carcinoma shows wild type p53 expression, patchy p16 staining, and often K-RAS, N-RAS, and/or B-RAF mutation. Here we report a case of mullerian high grade serous with a deceptive morphology resembling low-grade serous carcinoma with micropapillary features and moderate nuclear atypia. However, the tumor is simultaneously p53 and K-RAS mutated. This case illustrates three critical issues; a) potential to be mistaken as a low-grade serous carcinoma because of morphologic appearance and relative uniform cytologic feature. b). raise the question of true progression of low-grade to high-grade serous carcinoma, a rare phenomenon as described in the literature, and c). whether the biologic behavior and/or response to therapy would differ from the classic forms.

Serous endometrial intraepithelial carcinoma (SEIC) is a rare but highly aggressive form of uterine endometrial cancer. We report two cases of post-menopausal, 58-year-old patients with abundant vaginal bleeding and pelvic pain. The first patient had a history of surgical hysteroscopy in 2019 for an endocervical polyp. The second patient had a history of breast resection, axillary lymph node dissection, chemotherapy, radiation therapy, and tamoxifen therapy for breast carcinoma 6 years ago. An abdominal hysterectomy was performed in both patients. The pathological assessment showed serous endometrial intraepithelial carcinoma. Diagnosis of a serous proliferation of the uterus implies the exploration of other genital tract organs as well as distant locations in search of metastatic disease. [ABSTRACT FROM AUTHOR]

Most high-grade serous ovarian carcinomas (HGSOCs) involving the peritoneum are aggressive. Epidermal growth factor receptor 2 (HER2) is aberrantly activated in a variety of solid cancers. The HER2 status of a tumor is based on cytoplasmic membrane staining of an intracellular domain (ICD)-specific HER2 antibody. We compared four anti-HER2 antibodies in an immunohistochemical study of HGSOC with peritoneal dissemination. HER2 expression was assessed in peritoneal disseminated HGSOC specimens from 38 patients by immunohistochemistry using four different anti-HER2 antibodies (an ICD antibody (clone A0485), an extracellular domain (ECD) antibody (clone SP3), and two antibodies recognizing HER2 phosphorylated at tyrosine 877 or 1248 (pHER2Y877 and pHER2Y1248)). HER2 gene amplification was accessed by chromogenic in situ hybridization (CISH). The antibodies showed HER2 positivity as follows: 31.6% of cases (12/38) with A0485, 26.3% (10/38) with SP3, 7.9% (3/38) with pHER2Y877, and 21.1% (8/38) with pHER2Y1248. Fifteen out of thirty-eight (39.5%) cases were positive for at least one of the four HER2 antibodies. HER2 gene amplification was detected in 3/19 cases. All four HER2 antibodies could be used for patient selection for anti-HER2 therapies. These findings raise the possibility of anti-HER2 therapeutic strategies for HGSOC with peritoneal dissemination. [ABSTRACT FROM AUTHOR]

Serous carcinoma arising in adenomyosis is rare, with only 8 cases reported in the literature. Primary small cell carcinoma of the ovary-the pulmonary type (SCCOPT) is a rare and aggressive entity associated with poor outcomes and limited treatment options. The presence of two malignant tumors synchronously happening in one patient has never been reported before. In this study, we summarized and analyzed the clinicopathological features of a serous carcinoma arising in adenomyosis synchronous with SCCOPT and reviewed the corresponding literature. A 60-year-old postmenopausal woman presented to our hospital with abdominal distension, abdominal pain, and constipation. A colonoscopy and lung computed tomography (CT) scan showed no abnormalities. Ultrasonography and CT scans revealed a solid-cystic mass in the pelvic cavity, with a slightly thickened uterine myometrium at the fundus with heterogeneous echo. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy, and the final pathology showed serous carcinoma originating from adenomyosis, while the eutopic endometrium and both fallopian epithelia had no cancer infiltrations. The solid-cystic mass in the right ovary was diagnosed with SCCOPT, which was found to metastasize to the uterine myometrium. The prognosis of previously reported cancers of adenomyosis origin and SCCOPT were poor, while our case was alive without disease during an 18-month follow-up. Findings from this case report could expand our recognition on the coexistence of serous carcinoma arising in adenomyosis with small cell carcinoma of the ovary-pulmonary type. [ABSTRACT FROM AUTHOR]

Background: Ovarian serous carcinoma is the most common type of ovarian cancer. Abnormal protein expression in this type of cancer cells may identify prognosis of patient. Objective: To determine the breast cancer type 1 (BRCA1) status by using immunostaining in ovarian serous carcinoma patients and compare with clinicopathological characteristics and survival outcome. Materials and Methods: Serous ovarian cancer specimens and clinicopathological data were collected from Songkhlanagarind hospital between 2008 and 2017. There were 166 cases during that time. The BRCA1 protein expression was evaluated by tissue microarray and immunohistochemical staining of BRCA1 (clone MS110). Results: The results showed loss of BRCA1 expression in 44 cases or 25.4%. In seven patients who had history of breast cancer, four cases or 57.0% lost BRCA1 protein expression. The median overall survival was 44.3 months, 32.5 months in loss of the expression group and 50.4 months in the expression group. The BRCA1 expression was not associated with survival outcome (p=0.90). Tumor staging was an independence prognostic factor. Conclusion: The percentage of BRCA1 loss of expression in ovarian serous cancer was slightly high in Southern Thailand, but BRCA1 loss of expression did not statically associated with survival outcome. [ABSTRACT FROM AUTHOR]

Background: Uterine somatic choriocarcinoma is a rare, clinically aggressive malignant tumor. They frequently concur with other cancer. However, the molecular pathogenesis between somatic choriocarcinoma and the concurrent carcinoma has rarely been addressed to date. Case presentation: We report a 68-years old Chinese woman with a uterine choriocarcinoma arising from serous carcinoma. The patient underwent radical surgery including total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and pelvic lymph node resection. She received 10 courses of post-operative chemotherapy. She died of disease 13 months after her surgery. Microscopically, the tumor showed a biphasic pattern of choriocarcinoma and serous carcinoma. The choriocarcinomatous component showed a combination of cytotrophoblast, intermediate trophoblast and syncytiotrophoblast with hemorrhage and necrosis. The component of serous carcinoma was characterized by solid sheets of small cells with marked nuclear atypia and occasional glandular and papillary formation. PD-L1 was exclusively expressed in the choriocarcinomatous component. Next-generation sequencing revealed that the genetic abnormalities were overlapping between the two components. [ABSTRACT FROM AUTHOR]

While screening has improved early detection of primary breast cancers, it may also identify metastasis to the breast in rare instances. High-grade carcinomas identified on breast screening may have non-specific morphology and immunoprofiles, making distinction from metastasis problematic. High-grade carcinomas frequently lose expression of specific tumor markers. New evidence specifically challenges GATA3/PAX8 exclusivity in the differential diagnosis of high-grade triple-negative breast cancer and high-grade serous carcinoma of müllerian origin. This case series provides a careful and detailed review of immunohistochemistry interpretation, with focus on PAX8, and the potential pitfalls in making a definitive pathological diagnosis, which is essential in determining oncological treatment options. [ABSTRACT FROM AUTHOR]

Background: Currently the clinicopathologic significance of psammoma bodies in cytology specimens are not completely understood, including types of cytology specimens and pathologic conditions frequently associated with this unique cytologic feature. In this study, we undertook a retrospective approach to review the specimen types, cytology preparations, patient characteristics, organs or tissues involved and differential diagnoses in cytology specimens with the finding of psammoma bodies., Methods: Cytology cases with the finding of psammoma bodies from January 2004 to December 2022 were retrieved from our institution's pathology databases, and their clinicopathological features were reviewed., Results: A total of 78 cytology specimens with the finding of psammoma bodies were recorded in our CoPath system. The mean age at diagnosis was 59 years. The patient group showed female gender predominancy (90%). FNA specimens comprised about 38.5% of total cases. Other common specimen types were body cavity fluids (38.5%), including pleural effusion and peritoneal fluid, and about 20.5% of the cases were pelvic washing performed during gynecologic surgeries. Most cytology cases with psammoma bodies had a malignant diagnosis (69%). About 18% of the cases were in the indeterminate diagnostic categories, with 12% suspicious for malignancy and 6% of the cases with atypical cells. About 5% of cases were placed in the neoplastic category, while 8% of cases were negative for malignancy. About 79% of peritoneal cytology with psammoma bodies were neoplastic and mostly gynecologic tumors. Pleural fluids with psammoma bodies were very likely to be malignant and involved by serous carcinoma (15 of 16 cases, 94%). Papillary thyroid carcinoma was the second most common malignancy in our series, present in about 53% of thyroid cytologies with the finding of psammoma bodies., Conclusion: Our study showed that psammoma bodies in cytology preparations were more often associated with malignancies in our study of 78 cytology specimens (69%). The most sampled location in our study was peritoneal cavity, followed by pleural cavity, thyroid, lymph nodes, neck masses, and omentum. The clinicopathologic value of psammoma bodies in predicting malignancy varies depending on locations and specimen types., (© 2024 Wiley Periodicals LLC.)

E-cadherin is a cell adhesion molecule crucial for maintaining cellular integrity and survival. E-cadherin is the focus of this study, which aims to evaluate its immunohistochemical staining patterns in endometrial carcinoma (EC). Material and methods In this retrospective study, 25 formalin-fixed, paraffin-embedded tissue blocks of EC were retrieved from the Department of Pathology at Saveetha Medical College. These samples, collected between September 2020 and May 2023, were identified using unique histopathology numbers. Results The analysis revealed that E-cadherin expression decreased as the endometrial tissue progressed from normal to carcinoma. This reduction was more pronounced in cancers with greater depth of invasion and in more advanced stages compared to those with less invasive depth and earlier stages. Additionally, E-cadherin expression was higher in grade 1 tumors but became heterogeneous or negative in grade 3 tumors. Conclusion The downregulation of E-cadherin is likely due to disruptions in the cadherin-catenin complex, which is linked to the potential for local and distant metastasis in cancer. This study underscores the significance of cell adhesion molecule expression in predicting the prognosis of EC., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jayaraman et al.)

Psammocarcinoma is an uncommon subtype of low-grade serous carcinoma. It is characterized by the presence of extensive psammoma bodies and can have either an ovarian or peritoneal origin. To our knowledge fewer than 30 cases of primary peritoneal psammocarcinoma (PPP) have been reported in the English literature. We report a rare case of PPP in a 74-year-old female, discovered fortuitously within a laparotomy for gallbladder lithiasis. At laparotomy, multiple nodular implants involving the omentum, the peritoneum and a magma of intestinal loops in the right iliac fossa were noted. A biopsy from nodules was performed. Gross examination showed multiple nodules of different sizes in the fat tissue. Pathologic examination showed massive psammoma bodies representing more than 75% of the tumor. The final diagnosis was psammocarcinoma. Our patient was referred to the gynecologic department for further investigation and to ascertain whether the tumor arose from the ovaries or peritoneum. Hysterectomy, bilateral adnexectomy and omentectomy were performed. Macroscopic examination showed that both ovaries were intact having a normal size. No invasion of ovarian stroma was shown in microscopic examination. The patient died of SARS-CoV-2 (COVID-19) six days after the surgery. PPP is a rare type of low-grade serous carcinoma. The behavior of this tumor is unclear, and the treatment is not standardized because of its rarity and lack of long-term follow-up. More cases need to be studied for better understanding and improvement of the management protocols.

Background & objectives: Endometrial serous carcinoma (ESC) is a high-grade epithelial neoplasm with increased risk for metastasis and recurrence. This study was aimed to assess various histomorphological features of ESC and their clinicopathological association with disease-free survival (DFS) and overall survival (OS). Methods: A total of 205 slides (belonging to 120 patients) diagnosed as ESC from January 2009 to December 2015 were reviewed. Receiver operating characteristics (ROC) curves were established for the diagnostic performance of depth of invasion (DOI), tumour-free distance (TFD) to serosa and percentage myometrial invasion (MI%). OS and DFS were generated by Kaplan-Meier curves and prognostic significance by Cox regression analysis. Results: The mean age at diagnosis was 61.8 yr and the mean tumour size was 4.01 cm. Majority of the females were multiparous (84%; n=94) and postmenopausal (89.2%; n=107). On histopathology, <50 per cent of MI was identified in 37 of the 104 (35%), while 62/104 (59.61%) patients had ≥50 per cent MI. Seven (6.7%) patients had full-thickness invasion with serosal involvement, while five (4.8%) patients had no microscopic MI (minimal uterine serous carcinoma). Information about MI was not available in 16 patients. TFD ≥7.0 mm, DOI ≥6.0 mm and MI% ≥40 were significant variables in univariate analyses for OS; however, on multivariate analysis; none of these turned out to be an independent predictor in terms of OS. For DFS, DOI (≥6.0 mm) and MI% (≥40%) showed a significant association, in univariate as well as multivariate analysis; however, TFD (≤7.0 mm) did not show any significant association with DFS. Follow up data were available in 111 of the 120 (92.5%) patients with a five-year OS and DFS of 22.2 and 17.2 per cent, respectively. Interpretation & conclusions: Conventionally calculated DOI (less than or more than half thickness) did not show significance in the present study. Thus, calculating the actual myometrial DOI, MI% and TFD to serosa have the potential for contributing meaningfully to prognostication of ESC. [ABSTRACT FROM AUTHOR]

This case study examines a patient with severe hydronephrosis caused by ureteral obstruction, secondary to ovarian serous carcinoma. Gynecologic malignancies, especially advanced ovarian carcinoma, are common extrinsic causes of obstructive hydronephrosis. Sonography is a valuable modality to visualize the kidneys, diagnose hydronephrosis, and determine the grade of hydronephrosis. The treatment of hydronephrosis aims to remove the build-up of urine, prevent permanent kidney damage, and treat the underlying cause. Prolonged or severe cases of hydronephrosis can lead to acute kidney injury. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the correlation of intraoperative and definitive diagnosis in high-risk endometrial carcinomas, and percentages of compliance or non-compliance of intraoperative examination in high-risk endometrial carcinoma cases. Material and Methods: In this retrospective study, the pathology archives of our center were evaluated and 90 high risk endometrial carcinoma cases that were examined intraoperatively, between 2005-2017 were analyzed. The following criteria were used to identify high-risk endometrial carcinoma cases: Grade 3 endometrioid carcinomas with lymphovascular invasion and/or myometrial invasion of more than half, tumors of stage 2, 3, 4 and non-endometrioid endometrial carcinoma. Results: Histopathological subtyping was accurate in 52 of the 57 cases of endometrioid carcinoma, 3 of the 20 cases of serous carcinoma and 1 of the 4 cases of clear cell carcinoma. None of the patients diagnosed with mixed carcinoma were accurately diagnosed in frozen section. When results of intraoperative and permenant evaluations were compared; 74.4% of the cases were compatible for histopathological subtype, 76.7% for grade, and 77.7% for myometrial invasion. Conclusion: In patients with high-risk endometrial carcinoma without a preoperative diagnosis, intraoperative evaluation is essential for determining prognostic parameters and performing surgical staging intraoperatively. Despite the careful evaluation of pathologists, the error rate is high in intraoperative evaluation of high-risk endometrial carcinomas. In order to minimize the error rate, both gross and microscopical assessment should be performed with utmost care. [ABSTRACT FROM AUTHOR]