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Introduction: Our objective was to determine whether the educational game SonoQz can improve diagnostic performance in ultrasound assessment of ovarian tumors. Material and Methods: The SonoQz mobile application was developed as an educational tool for medical doctors to practice ultrasound assessment, based on still images of ovarian tumors. The game comprises images from 324 ovarian tumors, examined by an ultrasound expert prior to surgery. A training phase, where the participants assessed at least 200 cases in the SonoQz app, was preceded by a pretraining test, and followed by a posttraining test. Two equal tests (A and B), each consisting of 20 cases, were used as pre‐ and posttraining tests. Half the users took test A first, B second, and the remaining took the tests in the opposite order. Users were asked to classify the tumors (1) according to International Ovarian Tumor Analysis (IOTA) Simple Rules, (2) as benign or malignant, and (3) suggest a specific histological diagnosis. Logistic mixed models with fixed effects for pre‐ and posttraining tests, and crossed random effects for participants and cases, were used to determine any improvement in test scores, sensitivity, and specificity. Results: Fifty‐eight doctors from 19 medical centers participated. Comparing the pre‐ and posttraining test, the median of correctly classified cases, in Simple Rules assessment increased from 72% to 83%, p < 0.001; in classifying the lesion as benign or malignant tumors from 86% to 95%, p < 0.001; and in making a specific diagnosis from 43% to 63%, p < 0.001. When classifying tumors as benign or malignant, at an unchanged level of sensitivity (98% vs. 97%, p = 0.157), the specificity increased from 70% to 89%, p < 0.001. Conclusions: Our results indicate that the educational game SonoQz is an effective tool that may improve diagnostic performance in assessing ovarian tumors, specifically by reducing the number of false positives while maintaining high sensitivity. [ABSTRACT FROM AUTHOR]

Endosalpingiosis is a nonneoplastic lesion defined by the presence of tubal epithelium at ectopic sites such as the peritoneum, bladder, appendix, and even uterus. They may be asymptomatic and detected incidentally on ultrasonography. However, cystic endosalpingiosis is also known to be a mimicker of ovarian neoplasms. It is crucial for both the clinician and the pathologist to be aware of this benign lesion so that overdiagnosis and overtreatment can be avoided. We report a case of endosalpingiosis of the uterine serosa in a 45-year-old woman which was misdiagnosed as an adnexal cyst on radiological investigations.

Abstract Background Mature cystic teratomas (MCT) of the ovary are benign ovarian germ cell neoplasms. Malignant transformation is possible but rare and ovarian carcinoid tumors in MCT are among the most extremely rare subtypes. Case presentation We report a case of a 60-year-old Iranian woman suffering from postmenopausal bleeding and hypogastric pain for the last 40 days. An adnexal mass was detected during the physical examination. Ultrasound imaging showed a (55 × 58) mm mass in the left ovary. Total abdominal hysterectomy, bilateral salpingooophorectomy and comprehensive staging surgery were performed for the patient. Intraoperative frozen section of the left ovarian mass was indicative of a malignant tumor. She was diagnosed with a carcinoid tumor with benign mucinous cystadenoma arising on MCT of the ovary, confirmed in the histopathology and immunohistochemistry examination. The tumor was classified as low grade and no chemotherapy cycles were considered. The patient was followed up long-term and no recurrence was observed during 14 months of examinations. Conclusion Ovarian carcinoids arising from MCT are rare neuroendocrine neoplasms, and proper diagnosis of these tumors requires careful histopathology evaluation and appropriate examination. Therefore, it is necessary to consider these tumors as a possible differential diagnosis and evaluate them in individuals (especially postmenopausal women) who have abdominal pain or abnormal bleeding and a palpable mass.

Background: Mature cystic teratomas (MCT) of the ovary are benign ovarian germ cell neoplasms. Malignant transformation is possible but rare and ovarian carcinoid tumors in MCT are among the most extremely rare subtypes. Case presentation: We report a case of a 60-year-old Iranian woman suffering from postmenopausal bleeding and hypogastric pain for the last 40 days. An adnexal mass was detected during the physical examination. Ultrasound imaging showed a (55 × 58) mm mass in the left ovary. Total abdominal hysterectomy, bilateral salpingooophorectomy and comprehensive staging surgery were performed for the patient. Intraoperative frozen section of the left ovarian mass was indicative of a malignant tumor. She was diagnosed with a carcinoid tumor with benign mucinous cystadenoma arising on MCT of the ovary, confirmed in the histopathology and immunohistochemistry examination. The tumor was classified as low grade and no chemotherapy cycles were considered. The patient was followed up long-term and no recurrence was observed during 14 months of examinations. Conclusion: Ovarian carcinoids arising from MCT are rare neuroendocrine neoplasms, and proper diagnosis of these tumors requires careful histopathology evaluation and appropriate examination. Therefore, it is necessary to consider these tumors as a possible differential diagnosis and evaluate them in individuals (especially postmenopausal women) who have abdominal pain or abnormal bleeding and a palpable mass. [ABSTRACT FROM AUTHOR]

The definition of the association between ovarian cancer and endometriosis was first reported by Sampson in 1925. He identified the following criteria: (a) clear evidence of endometriosis in proximity to the tumour, (b) exclusion of a metastatic tumour to the ovary, (c) presence of tissue resembling endometrial stroma surrounding epithelial glands. The naming of these cancers is "endometriosis-associated ovarian cancer" (EAOC). Scott proposed an additional stringent criterion: evidence of histological transition from endometriosis to cancer is to define "ovarian cancer arising in endometriosis" (OCAE). The aim of this systematic review is to analyse the distribution of different ovarian cancer histotypes in EAOC and OCAE to understand their similarities and differences. A total of 31 studies were included. Four studies added data for both EAOC and OCAE. Twenty-three studies were selected for EAOC, with a total of 800 patients, and 12 studies were selected for OCAE, with a total of 375 patients. The results show no significant differences in the distribution of histotypes in the two populations analysed. Clear cell carcinoma (CCC) and endometrioid carcinoma (EC) were the most common subtypes and were less frequent in EAOC compared to OCAE; the odd ratios were 0.58 (0.26–1.29) and 0.65 (0.33–1.26) respectively, although the difference was not statistically significant. The other histotypes were present in small proportions. This analysis shows that the histological profiles of EAOC and OCAE are similar, suggesting a similar aetiopathological mechanism, which requires further research to investigate whether EAOC and OCAE may be in the same way but at different points of the process to malignancy or have different pathways of progression to malignancy. [ABSTRACT FROM AUTHOR]

Abstract Background Mature cystic teratoma of the ovary is classified among the benign ovarian germ cell neoplasms, and its malignant transformation occurs very rarely (in about 2%). As a result of nonspecific signs and symptoms, preoperative diagnosis of theses malignancies is a challenge to clinicians, resulting in delayed diagnosis (in advanced stages) and poor outcomes. Case presentation We report the case of a 43-year-old Iranian woman with progressive distension of the abdomen and hypogastric pain, who was diagnosed with squamous cell carcinoma transformation in a mature cystic teratoma of the ovary confirmed by histopathology examination. Total abdominal hysterectomy, bilateral salpingooophorectomy, and comprehensive staging surgery were performed for the patient, and she was scheduled for chemotherapy after the surgery. She responded well to the treatment and is currently continuing her chemotherapy process. Conclusion There are a great number of reports in the literature regarding mature cystic teratoma of the ovary transformation into malignancy, so these neoplasms must be considered as a possible differential diagnosis and should be evaluated in older individuals with abdominal pain and palpable mass, or those with considerable tumor diameter and raised serum tumor markers.

Background: Mature cystic teratoma of the ovary is classified among the benign ovarian germ cell neoplasms, and its malignant transformation occurs very rarely (in about 2%). As a result of nonspecific signs and symptoms, preoperative diagnosis of theses malignancies is a challenge to clinicians, resulting in delayed diagnosis (in advanced stages) and poor outcomes. Case presentation: We report the case of a 43-year-old Iranian woman with progressive distension of the abdomen and hypogastric pain, who was diagnosed with squamous cell carcinoma transformation in a mature cystic teratoma of the ovary confirmed by histopathology examination. Total abdominal hysterectomy, bilateral salpingooophorectomy, and comprehensive staging surgery were performed for the patient, and she was scheduled for chemotherapy after the surgery. She responded well to the treatment and is currently continuing her chemotherapy process. Conclusion: There are a great number of reports in the literature regarding mature cystic teratoma of the ovary transformation into malignancy, so these neoplasms must be considered as a possible differential diagnosis and should be evaluated in older individuals with abdominal pain and palpable mass, or those with considerable tumor diameter and raised serum tumor markers. [ABSTRACT FROM AUTHOR]

Objective: To study clinical characters and outcomes in patients of malignant ovarian germ cell tumor (MOGCT) undergoing surgery following neoadjuvant chemotherapy (NACT). Methods: Retrospective study of patients undergoing surgery following NACT for MOGCT at our institute. Platinum based chemotherapy was given in all patients in NACT. Results: Between March 2013 and February 2023, 30 patients had surgery after NACT. Patient's median age was 22 years (range, 12 to 35 years) and median follow up 42months (range, 6 to 132 months). Majority had endodermal sinus tumor (n=12), dysgerminoma (n=9) and mixed GCT (n=7). All had either International Federation of Gynecology and Obstetrics (FIGO) stage 3 (n=19) or FIGO stage 4 disease (n=11). Complete response to NACT seen in 5 patients and 23 patients had partial response. Fertility sparing surgery in 18 patients and complete surgery in 12 patients. Suboptimal surgery was seen in 4 patients. Currently, 20 of 30 patients are alive and disease free, 3 lost for follow up and 7 patients had progression after adjuvant therapy. Five patients had mortality--4 with progression and 1 with bleomycin toxicity. Fifteen of 17 eligible patients have resumed menstruation and one had successful pregnancy. Prognostic factors noted in study are stage, optimal surgery and viable tumor in histopathology. Dysgerminoma had better outcome than other histology. Conclusion: NACT may be a reasonable option in patients with extensive unresectable disease or in whom fertility sparing is not possible or in the poor general condition. Fertility sparing surgery can be attempted post neoadjuvant chemotherapy without adversely affecting prognosis. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical and ultrasound characteristics of recurrent granulosa cell and Sertoli–Leydig cell tumors. Methods: This was a retrospective observational study performed at Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Rome (Gemelli center), Italy. Patients with a histological diagnosis of recurrent granulosa cell tumor or Sertoli–Leydig cell tumor were identified from the database of the Department of Gynecological Oncology. Those who had undergone a preoperative ultrasound examination at the Gemelli center between 2012 and 2020 were included, and the data retrieved from the original ultrasound reports. In all of these reports, the recurrent tumors were described using International Ovarian Tumor Analysis (IOTA) terminology. If a patient had more than one episode of relapse, information from all episodes was collected. If there was more than one recurrent tumor at the same ultrasound examination, all tumors were included. One expert sonographer also reviewed all available ultrasound images to identify typical ultrasound patterns using pattern recognition. Results: We identified 30 patients with a histological diagnosis of recurrent granulosa cell tumor (25 patients, 55 tumors) or Sertoli–Leydig cell tumor (five patients, seven tumors). All 30 had undergone at least one preoperative ultrasound examination at the Gemelli center and were included. These women had a total of 66 episodes of relapse, of which a preoperative ultrasound examination had been performed at the Gemelli center in 34, revealing 62 recurrent lesions: one in 22/34 (64.7%) episodes of relapse, two in 4/34 (11.8%) episodes and three or more in 8/34 (23.5%) episodes. Most recurrent granulosa cell tumors (38/55, 69.1%) and recurrent Sertoli–Leydig tumors (6/7, 85.7%) were classified as solid or multilocular‐solid tumors, while 8/55 (14.5%) recurrent granulosa cell tumors and 1/7 (14.3%) recurrent Sertoli–Leydig cell tumors were unilocular cysts and 9/55 (16.4%) recurrent granulosa cell tumors were multilocular cysts. The nine unilocular cysts had contents that were anechoic (n = 2) or had low‐level echogenicity (n = 7), had either smooth (n = 4) or irregular (n = 5) internal cyst walls, and ranged in largest diameter from 8 to 38 mm, with three being < 20 mm and five being 20–30 mm. On retrospective review of the images, two typical ultrasound patterns were described: small solid tumor measuring < 2 cm (15/62, 24.2%) and tumor with vascularized echogenic ground‐glass‐like content (12/62, 19.4%). Conclusions: Some granulosa cell and Sertoli–Leydig cell recurrences manifest one of two typical ultrasound patterns, while some appear as unilocular cysts. These are usually classified as benign, but in patients being followed up for a granulosa cell tumor or Sertoli–Leydig cell tumor, a unilocular cyst should be considered suspicious of recurrence. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: Pathogenic variants in BRCA genes play a crucial role in the pathogenesis of ovarian cancer. Intronic variants of uncertain significance (VUS) may contribute to pathogenicity by affecting splicing. Currently, the significance of many intronic variants in BRCA has not been clarified, impacting patient treatment strategies and the management of familial cases. Method: A retrospective study was conducted to analyze BRCA intronic VUS in a cohort of 707 unrelated ovarian cancer patients at a single institution from 2018 to 2023. Three splicing predictors were employed to analyze detected intronic VUS. Variants predicted to have splicing alterations were selected for further validation through minigene assays. Patient and familial investigations were conducted to comprehend cancer incidence within pedigrees and the application of poly (ADP-ribose) polymerase inhibitors (PARPi) by the patients. In accordance with the guidelines of the American College of Medical Genetics and Genomics (ACMG), the intronic VUS were reclassified based on minigene assay results and clinical evidence. Result: Approximately 9.8% (69/707) of patients were identified as carriers of 67 different VUS in BRCA1/2, with four intronic variants accounting for 6% (4/67) of all VUS. Splicing predictors indicated potential splicing alterations in splicing for BRCA1 c.4358-2A>G and BRCA2 c.475+5G>C variants. Minigene assays utilizing the pSPL3 exon trapping vector revealed that these variants induced changes in splicing sites and frameshift, resulting in premature termination of translation (p. Ala1453Glyfs and p. Pro143Glyfs). According to ACMG guidelines, BRCA1 c.4358-2A>G and BRCA2 c.475+5G>C were reclassified as pathogenic variants. Pedigree investigations were conducted on patients with BRCA1 c.4358-2A>G variant, and the detailed utilization of PARPi provided valuable insights into research on PARPi resistance. Conclusion: Two intronic VUS were reclassified as pathogenic variants. A precise classification of variants is crucial for the effective treatment and management of both patients and healthy carriers. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study is to examine the clinical, surgical, and pathological factors of stage 1C adult granulosa cell tumor (AGCT) patients and to investigate the effects of adjuvant therapy on recurrence and survival rates in this patient group. Methods: Out of a total of 415 AGCT patients treated by 10 tertiary oncology centers participating in the study, 63 (15.2%) patients with 2014 FIGO stage IC constituted the study group. The FIGO 2014 system was used for staging. Patient group who received adjuvant chemotherapy was compared with patient group who did not receive adjuvant chemotherapy in terms of disease‐free survival (DFS), and disease‐specific survival. Results: The 5‐year DFS of the study cohort was 89%, and the 10‐year DFS was 85%. Those who received adjuvant chemotherapy and those who did not were similar in terms of clinical, surgical and pathological factors, except for peritoneal cytology. In the univariate analysis, none of the clinical, surgical or pathological factors were significant for DFS. Adjuvant chemotherapy and type of treatment protocol had no impact on DFS. Conclusion: Adjuvant chemotherapy was not associated with improved DFS and overall survival in stage IC AGCT. Multicentric and randomized controlled studies are needed for early stage AGCT in order to confirm these results and reach accurate conclusions. [ABSTRACT FROM AUTHOR]

Background: Mature granulosa cell tumour (GCT) is a rare neoplasm. it accounts for about 1-2% of all ovarian tumours. Even more infrequent is the coexistence of GCT with mature cystic teratoma in the same ovary. Case presentation: A 53-year-old woman with constipation, abdominal swelling, and pain presented to our gynaecology clinic. Physical examination revealed a distended abdomen, ascites, cystocele, stress incontinence, and external haemorrhoids. A cystic teratoma co-existing with a granulosa cell tumour was diagnosed histologically. Adjuvant chemotherapy containing Cisplatin [75mg/m2] and Docetaxel [75mg/m2]) was completed, followed by radiotherapy. She has been clinically stable for two years and is currently on long-term follow-up to forestall recurrence. Conclusion: The coexistence of mature granulosa cell tumour (GCT) with mature cystic teratoma especially in the same ovary is an extremely rare pathology. Although total abdominal hysterectomy and bilateral salpingo-oophorectomy are the treatments of choice in postmenopausal and perimenopausal women, these may not always be feasible owing to the nature of the presentation. Adjuvant chemotherapy and radiotherapy may be beneficial as high cases of recurrence have been reported. Follow-ups are strongly advocated due to the recurrence that can occur even as late as 20 years following the removal of the primary neoplasm.

This article reports a case of an ovarian collision tumour consisting of an ovarian fibroma and a serous cystadenoma. A 60-year-old woman exhibited symptoms of post-menopausal bleeding and abdominal pain persisting for three months. Computerized tomography identified a solid mass with a cystic component in the right adnexa, and the patient underwent staging laparotomy. Gross examination of the right ovary revealed a cystic tumour with adjacent solid mass. The histopathological analysis identified a cystic mass that matched the characteristics of a serous cystadenoma, with an adjacent solid mass that matched the characteristics of a sex-cord stromal tumour, both located in the right ovary. Additionally, a small cyst that matched the characteristics of a serous cystadenoma was found in the left ovary. There have been only seven previously reported examples of this specific mix of ovarian tumours. Mostly affecting patients above 60 years of age, although tumour markers levels are normal, such cases may present with a complex clinical scenario, as in this case, and demand a comprehensive diagnostic and therapeutic approach.

BackgroundRisk of ovarian cancer in women with frequent perineal talcum powder product is not well understood. Prior systematic reviews focused on ever use. The purpose of this study is to estimate the association between frequent (at least 2 times per week) perineal talcum powder use and ovarian cancer.MethodsA systematic review and meta-analysis was conducted according to meta-analysis of observational studies in epidemiology guidelines. Study protocol was prospectively registered at PROSPERO (registration number CRD42020172720). Searches were performed in PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials databases from their inception to August 2, 2021. Case-control and cohort studies were included if they reported frequent perineal talcum powder use and an adjusted odds ratio or hazard ratio for ovarian cancer. Review for inclusion, data extraction, and quality assessment (using the Newcastle-Ottawa Scale [NOS]) were performed independently by two reviewers. Pooled adjusted odds ratios with 95% confidence intervals were generated from the random effects model. Heterogeneity was quantified with I2 statistic. Funnel plot and Eger's test were performed to assess publication bias. Subgroup and sensitivity analyses were performed for testing the robustness of the overall findings.ResultsInitial database searches returned 761 unique citations and after review, eleven studies describing 66,876 patients, and 6542 cancers were included (Cohen's κ = 0.88). Publication quality was high (median NOS = 8, range: 4 to 9). Frequent talcum powder use was associated with an elevated risk of ovarian cancer (adjusted pooled summary odds ratio 1.47 (95% CI 1.31, 1.65, P

Abstract Introduction The global low survival rate among ovarian cancer patients has resulted in significant social and economic burdens. Nevertheless, previous studies have produced mixed results when exploring the link between anesthetic techniques and the prognosis of ovarian cancer. The study aims to compare the effect of epidural anesthesia with general anesthesia on survival time after cytoreductive surgery in patients with ovarian cancer. Methods The PubMed (National Library of Medicine), Cochrane library, Web of science, Embase, CNKI (China National Knowledge Internet), Wanfang Med Online (China database), were systematically searched from inception to May, 2023, using the Medical Subject Headings [MeSH] of “Ovarian Neoplasm” and “Anesthesia, Epidural” and free words to identify systematic reviews or meta-analyses. The research methodology involved analyzing randomized controlled trials (RCTs), as well as prospective or retrospective cohort studies, which compared the long-term prognosis of patients with ovarian cancer under general anesthesia combined with epidural anesthesia (GEA) versus general anesthesia alone (GA). The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Data extraction and assessment of study quality were conducted by two independent reviewers. A meta-analysis was then performed to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Overall survival (OS) was defined as the primary outcome, time to tumor recurrence (TTR) was the secondary outcome. Epidural anesthesia could be used intraoperatively and immediately postoperatively (EIP), or postoperatively only (EP). GEA includes EIP and EP. Results In total, 8 retrospective cohort studies with 2036 participants met the inclusion criteria. The pooled results demonstrated that GEA could extend OS (HR 0.75, 95% CI 0.67–0.84, I2 = 0%, P 0.05. 1-10 mm tumor residuals shorten TTR compared with 0 residuals, HR 1.75, 95% CI1.50–2.04, I2 = 0%, fixed-effect model, P

Introduction and aim: Ovarian cancer is a prevalent neoplastic condition among females. Early diagnosis is essential in improving patient outcomes. This study aimed to determine the diagnostic value of magnetic resonance imaging (MRI) compared to histopathological diagnosis to distinguish between benign and malignant ovarian masses. Methods: The present cross-sectional study, which was conducted between 2021 and 2022, included a cohort of women with ovarian mass. Gyneco-oncologists referred all patients to the MRI center. The imaging protocol encompassed T1 and T2 weighted images, T1 fat-suppressed sequence, post-contrast and diffusion-weighted images (DWI). After surgery, the histopathological results were compared to the MRI diagnosis. Statistical analysis was done by using SPSS v.25 software. Results: A total of 67 women aged 15-82 years old were included in this study. Compared to histopathological diagnosis, MRI had a sensitivity of 96%, a specificity of 69%, a positive predictive value of 64.9% and a negative predictive value of 96.7%. Among patients under 40 years old, MRI showed a sensitivity of 100%, a specificity of 76.2%, a positive predictive value of 72.2% and a negative predictive value of 100%. Solid component and contrast enhancement within the solid component was significantly more frequent in patients with malignant diagnoses than those with benign masses (p<0.05). Conclusion: According to the results of the study, MRI is valuable for discriminating between benign and malignant ovarian masses, especially in patients under 40. [ABSTRACT FROM AUTHOR]

Objective：To discuss the inhibitory effect of chelerythrine (CHE) on the migration, invasion, and epithelial-mesenchymal transition (EMT) of the human ovarian cancer SKOV3 cells，and to clarify the associated mechanism. Methods：The SKOV3 cells were cultured in vitro and divided into control group and 2. 5，5. 0，10. 0，20. 0, and 40. 0 μmol·L－1 CHE groups. Methylthiazolydiphenyltetrazolium (MTT) assay was used to detect the inhibitory rates of proliferation of the cells in various groups. The SKOV3 cells were cultured in vitro and divided into control group, transforming growth factor-β1 (TGF-β1) group, TGF-β1+5 μmol·L－1 CHE group, and TGF-β1+10 μmol·L－1 CHE group. Cell scratch assay was used to detect the migration rates of the cells in various groups； Transwell chamber assay was used to detect the numbers of migration and invasion cells in various groups； Western blotting method was used to detect the expression levels of E-cadherin, N-cadherin, and Vimentin proteins in the cells in various groups； immunofluorescence staining method was used to detect the fluorescence intensities of E-cadherin and N-cadherin in the cells in various groups. Results：The MTT assay results showed that compared with control group, the inhibitory rates of proliferation of the cells in 5. 0，10. 0，20. 0, and 40. 0 μmol·L－1 CHE groups were significantly increased (P<0. 05 or P<0. 01) . The cell scratch assay results showed that compared with control group, the migration rate of the cells in TGF- β1 group was increased (P<0. 01) ； compared with TGF-β1 group, the migration rates of the cells in TGF-β1+5 μmol·L－1 CHE group and TGF- β1+10 μmol·L－1 CHE group were significantly decreased (P<0. 01) . The Transwell chamber assay results showed that compared with control group, the numbers of migration and invasion cells in TGF-β1 group were significantly increased (P<0. 05) ； compared with TGF-β1 group, the numbers of migration and invasion cells in TGF-β1+5 μmol·L－1 CHE group and TGF-β1+10 μmol·L－1 CHE group were significantly decreased (P<0. 01) . The Western blotting results showed that compared with control group, the expression level of E-cadherin protein in the cells in TGF- β1 group was significantly decreased (P<0. 01), while the expression levels of N-cadherin and Vimentin proteins were increased (P< 0. 05 or P<0. 01) ； compared with TGF-β1 group, the expression levels of E-cadherin protein in the cells in TGF- β1+5 μmol·L－1 CHE group and TGF- β1+10 μmol·L－1 CHE group were significantly increased (P<0. 01), and the expression levels of N-cadherin and Vimentin proteins were significantly decreased (P<0. 01) . The immunofluorescence staining results showed that compared with control group, the fluorescence intensity of E-cadherin in the cells in TGF- β1 group was decreased, and the fluorescence intensity of N-cadherin was increased； compared with TGF- β1 group, the fluorescence intensities of E-cadherin in the cells in TGF-β 1+5 μmol·L－1 CHE group and TGF-β1+10 μmol·L－1 CHE group were significantly increased, and the fluorescence intensities of N-cadherin were decreased. Conclusion：CHE can inhibit the proliferation, migration, invasion, and EMT of the human ovarian cancer SKOV3 cells. [ABSTRACT FROM AUTHOR]

Mature cystic teratomas (MCTs) are benign ovarian tumors known to undergo malignant transformation in 1%-2% of cases. Most of these cases lead to squamous cell carcinomas (SCC), and the prognosis is often poor, particularly in advanced-stage disease. A 50-yearold postmenopausal woman presented with a large pelvic mass. The patient initially underwent suboptimal primary surgery and was later diagnosed with stage IIIA SCC arising from MCT. Following the first cycle of chemotherapy with carboplatin and paclitaxel, a computed tomography scan showed a rapidly growing large mass in the pelvic cavity after 4 weeks of primary surgery, leading to a second debulking surgery. However, the patient underwent only one cycle of chemotherapy after secondary debulking surgery because of her poor performance status. Subsequently, after 4 months of secondary debulking surgery, the patient developed rapidly progressive disease, leading to her death approximately after 8 months of diagnosis. While an appropriate multimodal treatment strategy has yet to be established, optimal cytoreductive surgery and adjuvant chemotherapy should be considered for treatment of advanced-stage diseases to improve survival outcomes. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Yolk sac tumors are rare and malignant germ cell tumors of the ovary occurring in children and young women. Fertility‐sparing surgical intervention with adjuvant chemotherapy has shown to improve prognosis. We present a case of a 14‐year‐old girl who presented with the complaints of lower abdominal pain and distention. Her tumor markers were increased, and radiological investigation suggested the diagnosis of malignant left ovarian mass. Histopathology confirmed the diagnosis of Yolk sac tumor. She was subsequently managed with fertility‐sparing surgery and adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Introduction: The global low survival rate among ovarian cancer patients has resulted in significant social and economic burdens. Nevertheless, previous studies have produced mixed results when exploring the link between anesthetic techniques and the prognosis of ovarian cancer. The study aims to compare the effect of epidural anesthesia with general anesthesia on survival time after cytoreductive surgery in patients with ovarian cancer. Methods: The PubMed (National Library of Medicine), Cochrane library, Web of science, Embase, CNKI (China National Knowledge Internet), Wanfang Med Online (China database), were systematically searched from inception to May, 2023, using the Medical Subject Headings [MeSH] of "Ovarian Neoplasm" and "Anesthesia, Epidural" and free words to identify systematic reviews or meta-analyses. The research methodology involved analyzing randomized controlled trials (RCTs), as well as prospective or retrospective cohort studies, which compared the long-term prognosis of patients with ovarian cancer under general anesthesia combined with epidural anesthesia (GEA) versus general anesthesia alone (GA). The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Data extraction and assessment of study quality were conducted by two independent reviewers. A meta-analysis was then performed to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Overall survival (OS) was defined as the primary outcome, time to tumor recurrence (TTR) was the secondary outcome. Epidural anesthesia could be used intraoperatively and immediately postoperatively (EIP), or postoperatively only (EP). GEA includes EIP and EP. Results: In total, 8 retrospective cohort studies with 2036 participants met the inclusion criteria. The pooled results demonstrated that GEA could extend OS (HR 0.75, 95% CI 0.67–0.84, I2 = 0%, P < 0.05, fixed-effect model) when compared with GA in ovarian cancer patients undergoing cytoreductive surgery, but not TTR (sensitivity analysis revealed substantial heterogeneity among the included studies). The result of analyzing a total of 1490 patients in 4 studies was that EIP had a better prognosis on OS than GA (HR 0.68, 95%CI 0.55–0.85, I2 = 61%, P < 0.05, random-effect model). However, EP had no advantage in TTR (sensitivity analysis revealed it was unstable outcome). Ovarian cancer FIGO(International Federation of Gynecology and Obstetrics) stage III, stage IV compared to stage I on OS was statistically significant, HRs respectively are 3.67 (95%CI 2.25–5.98), I2 = 0%, fixed-effect model, P < 0.05, and 7.43 (95%CI 3.67–15.03), I2 = 31%, fixed-effect model, P < 0.05, but there was no statistically significant difference between stage II and stage I, HR 2.00, 95%CI0.98–4.09, I2 = 0%, fixed-effect model, P > 0.05. 1-10 mm tumor residuals shorten TTR compared with 0 residuals, HR 1.75, 95% CI1.50–2.04, I2 = 0%, fixed-effect model, P < 0.05. Conclusions: It is hard to conclude that postoperative epidural analgesia offers greater benefits than GA. However, general anesthesia combined with epidural anesthesia (EIP) can improve overall survival in ovarian cancer patients, allowing the anesthesiologist to use anesthesia techniques to provide a favorable prognosis for the ovarian cancer patient. Tumor staging and the extent of cell reduction are also critical factors that significantly influence the long-prognosis of ovarian cancer patients. [ABSTRACT FROM AUTHOR]

Ovarian steroid cell tumors are rare, representing less than 0.1% of all ovarian neoplasms. Among the myriad causes of hirsutism, ovarian tumors account for 1% of the reported cases. We present the case of a 49-year-old parous postmenopausal woman who sought medical attention for hirsutism for 2 years. This case illustrates the unusual and interesting connection between rare ovarian pathology and the clinical manifestation of hirsutism in a postmenopausal patient. Her ultrasonography and MRI showed a right adnexal mass of solid-cystic consistency with thin septations. Her laboratory workup revealed high levels of total testosterone of 256 ng/ml (8.4-48.1ng/ml) and free testosterone of 7.36 pg/ml (0.2-4.1 pg/ml), while DHEAS - 234 µg/dl (35.4-256 µg/dl) and CA125 - 15.8U/L (0.0-35 U/L) were in the normal range. She underwent exploratory laparotomy with a total abdominal hysterectomy and oophorectomy. Histopathological examination and immunohistochemistry conclusively established the presence of a steroid cell tumor, specifically classified as "Not Otherwise Specified"(NOS), in the right ovary.

BackgroundFemale patients with pelvic/adnexal masses often undergo gynecologic operations due to presumed ovarian origin. The diagnosis of an appendiceal tumor is often only made postoperatively after suboptimal cytoreduction has been performed. We hypothesized that an index gynecological procedure increases the morbidity of definitive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in patients with appendiceal mucinous tumors.MethodsA single-center retrospective review was performed to identify female patients undergoing CRS/HIPEC for appendiceal tumors from 2012 to 2020.ResultsDuring the 8-year period, CRS/HIPEC was performed in 36 female patients with appendiceal mucinous tumors. Eighteen patients (50.0%) had received a prior pelvic operation by gynecologists (PPO Group) for presumed ovarian origin before referral for definitive CRS/HIPEC. The median peritoneal cancer index (PCI) was higher in the PPO group (21 vs. 9, p = 0.04). The median number of days from gynecologic procedure to definitive CRS/HIPEC was 169 days. Compared to patients who did not undergo a prior gynecologic operation, those in the PPO group had higher intraoperative blood loss (650 vs 100 mL, p

Key Clinical Message Yolk sac tumors are rare and malignant germ cell tumors of the ovary occurring in children and young women. Fertility‐sparing surgical intervention with adjuvant chemotherapy has shown to improve prognosis. Abstract We present a case of a 14‐year‐old girl who presented with the complaints of lower abdominal pain and distention. Her tumor markers were increased, and radiological investigation suggested the diagnosis of malignant left ovarian mass. Histopathology confirmed the diagnosis of Yolk sac tumor. She was subsequently managed with fertility‐sparing surgery and adjuvant chemotherapy.

Keywords: dermoid cyst; ovarian neoplasm; immunohistochemistry; English literature; John Keats EN dermoid cyst ovarian neoplasm immunohistochemistry English literature John Keats 1319 1322 4 10/10/23 20231001 NES 231001 We are unaware of any report which documents the presence of Mullerian tissue in a mature ovarian teratoma. Why Mullerian tissue, which is the embryologic precursor of female genital tract tissue, has not been documented in mature ovarian teratomas, whereas a wide spectrum of ectodermal, mesodermal, and endodermal tissues have been noted, is not known. We excluded the possibility of a tissue carry-over or floater because almost all of the extra-marrow hematopoietic tissue was within the blood vessels only; besides, the hematopoietic cells in the vessels were adherent to the vascular endothelium. [Extracted from the article]

Objective: To evaluate the performance of subjective assessment and the Assessment of Different NEoplasias in the adneXa (ADNEX) model in discriminating between benign and malignant adnexal tumors and between metastatic and primary adnexal tumors in patients with a personal history of breast cancer. Methods: This was a retrospective single‐center study including patients with a history of breast cancer who underwent surgery for an adnexal mass between 2013 and 2020. All patients had been examined with transvaginal or transrectal ultrasound using a standardized examination technique and all ultrasound reports had been stored and were retrieved for the purposes of this study. The specific diagnosis suggested by the original ultrasound examiner in the retrieved report was analyzed. For each mass, the ADNEX model risks were calculated prospectively and the highest relative risk was used to categorize each into one of five categories (benign, borderline, primary Stage I, primary Stages II–IV or metastatic ovarian cancer) for analysis of the ADNEX model in predicting the specific tumor type. The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal tumors and between primary and metastatic adnexal tumors was evaluated, using final histology as the reference standard. Results: Included in the study were 202 women with a history of breast cancer who underwent surgery for an adnexal mass. At histology, 93/202 (46.0%) masses were benign, 76/202 (37.6%) were primary malignancies (four borderline and 72 invasive tumors) and 33/202 (16.3%) were metastases. The original ultrasound examiner classified correctly 79/93 (84.9%) benign adnexal masses, 72/76 (94.7%) primary adnexal malignancies and 30/33 (90.9%) metastatic tumors. Subjective ultrasound evaluation had a sensitivity of 93.6%, specificity of 84.9% and accuracy of 89.6%, while the ADNEX model had higher sensitivity (98.2%) but lower specificity (78.5%), with similar accuracy (89.1%), in discriminating between benign and malignant ovarian masses. Subjective evaluation had a sensitivity of 51.5%, specificity of 88.8% and accuracy of 82.7% in distinguishing metastatic and primary tumors (including benign, borderline and invasive tumors), and the ADNEX model had a sensitivity of 63.6%, specificity of 84.6% and similar accuracy (81.2%). Conclusions: The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal masses in this series of patients with history of breast cancer was relatively similar. Both subjective assessment and the ADNEX model demonstrated good accuracy and specificity in discriminating between metastatic and primary tumors, but the sensitivity was low. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical and sonographic features of ovarian benign Brenner tumor (BBT) and malignant Brenner tumor (MBT), and to compare performance of four diagnostic models in differentiating them. Methods: Fifteen patients with BBTs and nine patients with MBTs were retrospectively identified in our institution from January 2003 and December 2021. One ultrasound examiner categorized each mass according to ovarian-adnexal reporting and data system (O-RADS), international ovarian tumor analysis (IOTA) Simple Rules Risk (SR-Risk) assessment and assessment of different neoplasias in the adnexa (ADNEX) models with/without CA125. Receiver operating characteristic curves were generated to compare diagnostic performance. Results: Patients with MBT had higher CA125 serum level (62.5% vs. 6.7%, P = 0.009) and larger maximum diameter of lesion (89 mm vs. 43 mm, P = 0.009) than did those with BBT. BBT tended to have higher prevalence of calcifications (100% vs. 55.6%, P = 0.012) and acoustic shadowing (93.3% vs. 33.3%, P = 0.004), and lower color scores manifesting none or minimal flow (100.0% vs. 22.2%, P < 0.001). Areas under curves of O-RADS, IOTA SR-Risk and ADNEX models with/without CA125 were 0.896, 0.913, 0.892 and 0.896, respectively. There were no significant differences between them. Conclusion: BBTs are often small solid tumors with sparse color Doppler signals, which contain calcifications with posterior acoustic shadowing. The most common pattern of MBT is a large multilocular-solid or solid mass with irregular tumor borders, and most were moderately or richly vascularized at color Doppler. These four models have excellent performance in distinguishing them. [ABSTRACT FROM AUTHOR]

Objective To investigate the genetic, clinical and pathological characteristics of families with hereditary breast-ovarian cancer syndrome (HBOCS) and to explore the implementation of genetic counseling and preventive surgery. Methods Four siblings with HBOCS in Cancer Hospital/Chinese Academy of Medical Sciences were selected as the study subjects. BRCA gene testing and genetic counseling were performed, family history was traced and family map was drawn. Results There were 7 cancer patients (I 2. II 4. II 8, 7, 10, 11, III 12) in three generations in the family. One patient (III 7) had breast cancer and ovarian cancer successively. The first generation (I 2) developed cancer at age 60, the second generation (II 4 and II 8) developed cancer at 55. The third generation (III 7, III 10, III 11, III 12) developed cancer at the age of 42-50 years. Four HBOCS patients were treated in our hospital, and all of them were found to have deleterious BRCA1 mutation. Two had already developed ovarian cancer (III 10, 12), while in one case (II 11), tubal carcinoma was found during preventive total hysterectomy and pelvic lymph node metastasis was found after the supplementary staging surgery. The other patient without cancer underwent preventive bilateral salpingectomy (III 15). Conclusion The HBOCS family reported in this study is relatively rare, the onset time of tumor was younger generation by generation. It is very important to pay attention to the genetic counseling of ovarian cancer patients and to timely detect the HBOCS families for genetic testing and prophylactic surgery. [ABSTRACT FROM AUTHOR]

Introduction: Adnexal mass is a common clinical presentation in gynaecologic practice and can be of gynaecologic or non-gynaecologic origin. The term adnexa is derived from the pleural form of the Latin word meaning "appendage". It includes ovaries, fallopian tubes, broad ligament and structures within broad ligament that are developed from the embryonic nests. The term adnexal mass is most often used for masses involving the ovary because of the high propensity of the ovary for neoplasia. Fewer neoplasms occur in the fallopian tubes which are generally involved in inflammatory process. Aims: To describe the range of clinical features at the time of presentation among the patients suffering from benign adnexal masses, to find out the etiology of benign adnexal masses and to ascertain the outcome of different varieties of benign adnexal masses. Materials and Methods: The present study was a hospital based prospective observational study. This Study was conducted 18 months at Bankura Sammilani Medical College and Hospital. 104 patients were included in this study. Result: It is observed that maximum (95.2%) patients are symptomatic. Only 4.8% patients are asymptomatic. Asymptomatic patients are diagnosed incidentally when they are referred from another department. Mostly tiny simple cysts and fimbrial cysts have no specific symptoms. Conclusion: Ultrasonography (USG) is the primary modality used for detection and characterization of adnexal masses. Sonography including Doppler study is useful to make early and more specific pre- operative diagnosis and evaluation of adnexal mass and to develop individual strategies to avoid unnecessary interventions. Surgical excision is considered in benign adnexal masses >5cm in size and adnexal masses with complications. [ABSTRACT FROM AUTHOR]

Granulosa cell tumors (GCTs) frequently present with elevated levels of estrogen and inhibin. Most diagnoses in the pediatric and adolescent population are juvenile-type GCTs; adult-type GCTs in this population are rare. We describe a 14-year-old female who presented with a large adnexal mass and clinical hyperandrogenism. Laboratory evaluation revealed elevated levels of free and total testosterone, low-normal estradiol, and mildly elevated alpha-fetoprotein (AFP). Other tumor markers, including inhibin, were within normal limits. Intraoperative assessment with unilateral oophorectomy, pathology, and imaging resulted in a diagnosis of a stage IA adult-type GCT. GCTs often result in elevated estrogen and inhibin B levels; however, this case demonstrates that non-classic elevations in testosterone and normal inhibin levels should not eliminate concern for a GCT, particularly in the setting of a large ovarian mass. [ABSTRACT FROM AUTHOR]

Background: Antineoplastic drugs produce serious drug-related problems and their management is challenging. DRPs are critical, for saving on therapeutic costs, particularly in resource poor settings within low-middle-income countries such as India. Indicators are clues that helps to detect DRPs within the healthcare organization and minimize overall harm from medications. Indicators enable healthcare professionals to determine the future therapeutic course. And enable healthcare professionals to take a proactive stand, and stay informed and empowered to both prevent and manage DRPs. This study aims to develop evidence-based indicators for detecting potential drug-related problems in ovarian cancer patients. Patients and Methods: A retrospective study was conducted in the Department of Oncology of a tertiary care teaching hospital in South India. Based on literature search, we developed a list of indicators, which were validated by a Delphi panel of multidisciplinary healthcare professionals (16 members). Based on 2 years of ovarian cancer data, we performed a feasibility test retrospectively and classified the DRPs according to the Pharmaceutical Care Network Europe classification of DRPs version-9.1. Results: The feasibility test identified 130 out of 200 indicators. A total of 803 pDRPs were identified under four main categories: drug selection problem, drug use problem, adverse drug reaction and drug-drug interaction The most frequently observed were ADR 381 (47.45%), DDIs 354 (44.08%), and drug selection problems 62 (7.72%). Conclusion: Indicators developed by us effectively identified pDRPs in ovarian cancer patients, which can potentially help healthcare professionals in the early detection, timely management, and attenuating severity of DRPs. Identifying the pDDIs can potentially improve interdisciplinary involvement and task sharing, including enhanced pharmacists' participation within the healthcare team. [ABSTRACT FROM AUTHOR]

Brenner tumours of the ovary are typically discovered incidentally, and they are a rare occurrence primarily affecting women in their fifth to sixth decade of life. These tumours are classified as transitional cell tumours of the ovary, encompassing benign, borderline, and malignant Brenner tumours, as well as transitional cell carcinoma. Unfortunately, there is no dependable tumour marker for diagnosing Brenner tumours, and they cannot be accurately identified through imaging studies. In this case report, we present an unusual instance of a 50-year-old postmenopausal woman who experienced abdominal pain and detected a lump in her abdomen. As a result, she underwent a Total abdominal hysterectomy with bilateral salpingooopherectomy the postoperative histological analysis confirmed the presence of a tumour in the right ovary. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical characteristics and diagnosis and treatment of the patient with primary ovarian dedifferentiated liposarcoma (DDLPS), and to improve the clinicians’ understandings of the disease and the levels of diagnosis and treatment. Methods: The clinical data of one patient with primary ovarian DDLPS was colected, and the clinicopathological manifestations, diagnosis, differential diagnosis, treatment, and prognosis were retrospectively analyzed, and the related literatures were reviewed. Results: A 63-year-old female patient was admitted to hospital because of a huge mass in the lower abdomen for half a month. The gynecological ultrasound results showed there was a solid hypoechoic mass, with the size of 17. 0 cm × 9. 3 cm, with an irregular shape and a clear boundary in the middle pelvic cavity after hysterectomy, and there were blood flow signals in the periphery; the bilateral ovaries were not found. The whole abdominal CT results showed there was a huge mixed-density mass in the pelvic cavity, with the lobed lobes and poorly defined boundaries; the size was about 132 mm×86 mm, and the CT value was about 33 HU. The enhancement scaning results showed obvious uneven enhancement of the lesion, obvious enhancement of the edge, and no obvious enhancement of the low-density shadow in the pelvic cavity; the multiple lymph node shadows with the diameter smaller than 6 mm were seen in the pelvic cavity, and the CT enhancement scaning results showed that the lymph nodes were slightly enhancement. The tumor markers had no significant abnormalities. The patient was diagnosis as pelvic mass and the probability of ovarian malignancy was high. After completing all the relevant examinations, the transabdominal bilateral salpingectomy and oophorectomy were performed after general anesthesia. The results of the pathological diagnosis after operation were ovarian DDLPS. No recurrence of the patient was found 10 months after operation. Conclusion: The primary ovarian DDLPS is rare, and the clinical manifestations are not specific; imagological methods are helpful for the diagnosis; radical surgery is the main treatment method; targeted therapy can bring good efficacy for the patients; the disease has high malignancy, poor prognosis, and it is easy to relapse; so long-term follow-up should be performed. [ABSTRACT FROM AUTHOR]

Abstract Background The debate surrounding systematic lymphadenectomy in the epithelial cancers of the ovary (EOC) was temporarily put to rest by the LION trial. However, there was a glaring disparity between the number of patients registered and the number of patients randomized suggesting inadvertent selection. A subsequent meta-analysis after this trial included all types of studies in the literature (randomized, non-randomized, case series, and, retrospective cohort), thus diluting the results. Methods We conducted a meta-analysis of hazard ratios of randomized controlled trials, to study the role of systematic para-aortic and pelvic lymph node dissection in the EOC. A detailed search of MEDLINE, Cochrane, and Embase databases was done to look for the published randomized controlled trials (RCT) comparing lymphadenectomy versus no lymphadenectomy in EOC. A meta-analysis of hazard ratios (HR) was performed for overall survival (OS) and progression-free survival (PFS) using fixed and random effect models. The quality of the RCTs was evaluated on Jadad’s score, and the risk of bias was estimated by the Cochrane tool. Results A total of 1342 patients with EOC were included for quantitative analysis. On meta-analysis, HR for PFS was 0.9 (95% CI 0.79–1.04) favoring lymphadenectomy. HR for OS was 1 (95% CI 0.84–1.18) signifying no benefit of systematic lymphadenectomy. Conclusion The results show a trend towards increased PFS which did not reach statistical significance nor translate into any meaningful benefit in OS. There is still a need for a greater number of well-conducted, suitably powered trials to convincingly answer this question.

Abstract The detection of peritoneal carcinomatosis in patients with ovarian cancer is crucial to establish the correct therapeutic planning (debulking surgery versus neoadjuvant chemotherapy). Often, however, the nodules of peritoneal carcinomatosis are very small in size or have a reticular appearance that can mimic the fat stranding that is typical of acute inflammation conditions. Our hypothesis is that the use of dual-layer spectral computed tomography with its applications, such as virtual monoenergetic imaging and Z-effective imaging, might improve the detection and the characterisation of peritoneal nodules, increasing sensitivity and diagnostic accuracy, as recently described for other oncological diseases.

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare neoplasm that occurs mostly in women younger than 40 years of age. The unknown histogenesis makes the diagnosis of SCCOHT difficult. SCCOHT was recently shown to be associated with SMARCA4 gene mutation. Serum calcium levels can be used as a marker of treatment response and relapse in SCCOHT. Here we report on a 16-year-old girl who presented with pelvic mass and hypercalcemia. SCCOHT was diagnosed histopathologically. However, loss of neither BRG1 nor INI1 expression was detected. The diagnosis of SCCOHT should be among the differential diagnoses in adolescents presenting with pelvic mass and hypercalcemia. We would like to share our experience with this rare case, discuss recent management, and emphasize the importance of a multidisciplinary approach. Although it is known that almost all cases have a loss of BRG1 expression and a small group exhibit loss of INI1 , our patient indicates that there could be exceptional cases with hitherto undescribed genetic abnormalities. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to estimate the cumulative risks of all cancers in women from 50 to 75 years of age with a BRCA1 or BRCA2 pathogenic variant. Methods: Participants were women with BRCA1 or BRCA2 pathogenic variants from 85 centers in 16 countries. Women were eligible if they had no cancer before the age of 50 years. Participants completed a baseline questionnaire and follow‐up questionnaires every 2 years. Women were followed from age 50 until a diagnosis of cancer, death, age 75, or last follow‐up. The risk of all cancers combined from age 50 to 75 was estimated using the Kaplan–Meier method. Results: There were 2211 women included (1470 BRCA1 and 742 BRCA2). There were 379 cancers diagnosed in the cohort between 50 and 75 years. The actuarial risk of any cancer from age 50 to 75 was 49% for BRCA1 and 43% for BRCA2. Breast (n = 186) and ovarian (n = 45) were the most frequent cancers observed. For women who had both risk‐reducing mastectomy and bilateral salpingo‐oophorectomy before age 50, the risk of developing any cancer between age 50 and 75 was 9%. Conclusion: Women with a BRCA1 or BRCA2 pathogenic variant have a high risk of cancer between the ages of 50 and 75 years and should be counselled appropriately. Women with a BRCA1 or BRCA2 pathogenic variant have a high risk of cancer after age 50 and should be counseled appropriately. [ABSTRACT FROM AUTHOR]

Background: Epithelial ovarian cancer is very common in women and causes hundreds of deaths per year worldwide. Chemotherapy drugs including cisplatin have adverse effects on patients' health. Complementary treatments and the use of herbal medicines can help improve the performance of medicine. 6-Gingerol is the major pharmacologically active component of ginger. In this study, we compared the effects of 6-gingerol, cisplatin, and their combination in apoptotic and angiogenetic activities in silico, in test tubes, and in in vivo assays against two ovarian cancer cell lines: OVCAR-3 and human umbilical vein endothelial cells (HUVECs). Methods: The drug-treated cell lines were evaluated for their cytotoxicity, cell cycle, and apoptotic and angiogenetic gene expression changes. Results: The proportion of apoptosis treated by 6-gingerol coupled with cisplatin was significantly high. In the evaluation of the cell cycle, the combination therapy also showed a significant promotion of a higher extent of the S sequence. The expression of p53 level, Caspase-8, Bax, and Apaf1 genes was amplified again with combination therapy. Conversely, in both cell lines, the cumulative drug concentrations reduced the expression of VEGF, FLT1, KDR, and Bcl-2 genes. Similarly, in the control group, combination treatment significantly decreased the expression of VEGF, FLT1, KDR, and Bcl-2 genes in comparison to cisplatin alone. Conclusions: The findings of the present study demonstrated that the cisplatin and 6-gingerol combination is more effective in inducing apoptosis and suppressing the angiogenesis of ovarian cancer cells than using each drug alone. [ABSTRACT FROM AUTHOR]

Objective: Previous work has suggested that the ultrasound‐based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two‐step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. Methods: This was a retrospective analysis using data from the 2‐year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase‐5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow‐up. Multiple imputation was used when outcome based on follow‐up was uncertain according to predefined criteria. Results: A total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow‐up at recruitment and all patients from 19 centers that did not fulfil our criteria for good‐quality surgical and follow‐up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two‐step strategy based on ADNEX without CA125 had an area under the receiver‐operating‐characteristics curve (AUC) of 0.94 (95% CI, 0.92–0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two‐step strategy without CA125 of 0.93 (95% CI, 0.91–0.95). Conclusion: A large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two‐step strategy is convenient for clinical use. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Jurkovic. Click here to view the Editorial. [ABSTRACT FROM AUTHOR]

Background: Antineoplastic drugs produce serious drug-related problems and their management is challenging. DRPs are critical, for saving on therapeutic costs, particularly in resource poor settings within low-middle-income countries such as India. Indicators are clues that helps to detect DRPs within the healthcare organization and minimize overall harm from medications. Indicators enable healthcare professionals to determine the future therapeutic course. And enable healthcare professionals to take a proactive stand, and stay informed and empowered to both prevent and manage DRPs. This study aims to develop evidence-based indicators for detecting potential drug-related problems in ovarian cancer patients.Patients and Methods: A retrospective study was conducted in the Department of Oncology of a tertiary care teaching hospital in South India. Based on literature search, we developed a list of indicators, which were validated by a Delphi panel of multidisciplinary healthcare professionals (16 members). Based on 2 years of ovarian cancer data, we performed a feasibility test retrospectively and classified the DRPs according to the Pharmaceutical Care Network Europe classification of DRPs version-9.1.Results: The feasibility test identified 130 out of 200 indicators. A total of 803 pDRPs were identified under four main categories: drug selection problem, drug use problem, adverse drug reaction and drug-drug interaction The most frequently observed were ADR 381 (47.45%), DDIs 354 (44.08%), and drug selection problems 62 (7.72%).Conclusion: Indicators developed by us effectively identified pDRPs in ovarian cancer patients, which can potentially help healthcare professionals in the early detection, timely management, and attenuating severity of DRPs. Identifying the pDDIs can potentially improve interdisciplinary involvement and task sharing, including enhanced pharmacists’ participation within the healthcare team.

Objective: The objective of this study was to study the distribution of ovarian tumors histopathologically in different age groups and their various clinical presentations. Methods: 100 patients who presented with 142 ovarian lesions on either or both sides were analyzed during a period of 3 years and a further two year follow-up of patients with malignant tumors were done in a tertiary cancer hospital. Results: There were 142 lesions comprising of 56% of neoplastic lesions, 30% of non-neoplastic lesions and 14% borderline lesions. Serous tumors were the commonest tumors (42%) followed by germ cell tumors. Serous cystadenoma (33.3%) was the commonest non-neoplastic lesion. The distribution of benign tumors in the reproductive age groups was more commonly seen. Malignant tumors were in the perimenopausal and postmenopausal age group (57.1%). Bilaterality of lesions was seen in 42 patients. Lump in abdomen was seen in 62.5% cases with benign lesions and vague discomfort was reported in all cases of malignant ovarian tumors. Out of 56 cases of malignant ovarian tumor, 34 patients presented in stage 1 and 10 patients presented in stage 4. Conclusions: Ovarian neoplasia is one of the most common and lethal malignancy in female reproductive tract in older age group. Since most of the ovarian cancer remain asymptomatic for prolong period so measures should be taken for early diagnosis for better outcome.

Abstract Background Mature cystic teratomas of the ovary (MCTO) are a type of germ cell tumor that may contain well-differentiated tissues developed from three germ cell layers and constitute about 20% of ovarian germ cell tumors. They are rare ovarian tumors with an annual incidence variable from 1.2 to 14.2 cases per 100,000 that occur mainly in women of reproductive age. They are frequently benign with a slow growth rate, even if they can undergo a malignant transformation in about 1–2% of cases. Case presentation Here, we present the case of an elderly woman referred to gynecological first aid for acute abdominal pain and showing a giant and unusual MCTO at rapid growth with malignant transformation in squamous cell carcinoma (FIGO stage Ia). The patient underwent pelvic mass removal trough emergency longitudinal midline laparotomic incision with intraoperative frozen pathologic examination. A complete surgical staging during the first surgery was performed. After about 9 years of follow-up, she died of non-oncological reasons without recurrence. Conclusions Present case highlights that CMTO with malignant transformation should always be suspected in elderly women in presence of pelvic mass at rapid growth, even if in absence of other clinical and ultrasonographic signs of malignancy. An intraoperative frozen pathologic examination may drive the best treatment.

BackgroundEpithelial ovarian cancer is very common in women and causes hundreds of deaths per year worldwide. Chemotherapy drugs including cisplatin have adverse effects on patients’ health. Complementary treatments and the use of herbal medicines can help improve the performance of medicine. 6-Gingerol is the major pharmacologically active component of ginger. In this study, we compared the effects of 6-gingerol, cisplatin, and their combination in apoptotic and angiogenetic activities in silico, in test tubes, and in in vivo assays against two ovarian cancer cell lines: OVCAR-3 and human umbilical vein endothelial cells (HUVECs).MethodsThe drug-treated cell lines were evaluated for their cytotoxicity, cell cycle, and apoptotic and angiogenetic gene expression changes.ResultsThe proportion of apoptosis treated by 6-gingerol coupled with cisplatin was significantly high. In the evaluation of the cell cycle, the combination therapy also showed a significant promotion of a higher extent of the S sequence. The expression of p53 level, Caspase-8, Bax, and Apaf1 genes was amplified again with combination therapy. Conversely, in both cell lines, the cumulative drug concentrations reduced the expression of VEGF, FLT1, KDR, and Bcl-2 genes. Similarly, in the control group, combination treatment significantly decreased the expression of VEGF, FLT1, KDR, and Bcl-2 genes in comparison to cisplatin alone.ConclusionsThe findings of the present study demonstrated that the cisplatin and 6-gingerol combination is more effective in inducing apoptosis and suppressing the angiogenesis of ovarian cancer cells than using each drug alone.

Summary: Background: PARP inhibitors (PARPi) have revolutionized the management of advanced ovarian carcinoma, and were investigated as forefront treatment in recurrent disease. The objective was to explore if mathematical modeling of the early longitudinal CA-125 kinetics could be used as a pragmatic indicator of the subsequent rucaparib efficacy, like it is for platinum-based chemotherapy. Methods: The datasets of ARIEL2 and Study 10 involving recurrent HGOC patients treated with rucaparib were retrospectively investigated. The same strategy as those successfully developed for platinum chemotherapy, based on CA-125 ELIMination rate constant K (KELIM™), was implemented. Individual values of rucaparib-adjusted KELIM (KELIM-PARP) were estimated based on the longitudinal CA-125 kinetics during the first 100 treatment days, and then scored as favorable (KELIM-PARP ≥1.0) or unfavorable (KELIM-PARP

Introduction Ovarian neoplasms comprises 23% of all gynaecological tumors. They are common tumors in female and ovaries are a common site for benign and malignant neoplasm. This retrospective study aimed to study spectrum, frequency and age distribution with clinicopathological correlation of ovarian tumor. Material and method This is a two-year retrospective study carried out in department of pathology National Institute of Medical sciences and Research, Jaipur (Rajasthan) from 1 June 2020 - 31 May 2022. Result Total 52 ovarian neoplasm were included in this study. It was found that right side (59.60%) was more commonly involved by tumors than left side (40.3%). Most benign ovarian tumors were seen in age group of 21-30 years and malignant ovarian tumors in 61-70 years of age group. The age group ranged from 21 - 70 years. In young patients benign serous cystadenoma was most commonly found. And in old patients mucinous adenocarcinoma was most common. Conclusion The ovarian tumors in our institute represented a wide histological spectrum. As the natural history, treatment modalities and prognosis of ovarian neoplasms differ, thus histomorphological study remains the gold standard for categorization and for proper treatment. [ABSTRACT FROM AUTHOR]

Ovarian clear cell carcinomas (OCCs) arise from endometriotic cysts that many women develop. Biomarkers for early OCC detection need to be identified. Extracellular vesicles have attracted attention as biomarker carriers. This study aims to identify cancer-specific miRNAs as novel OCC biomarkers using tissue-exudative extracellular vesicles (Te-EVs). Te-EVs were collected from four patients with OCC on one side and a normal ovary on the other side. Microarray analysis was performed to identify cancer-specific miRNAs in Te-EVs. Serum samples obtained before and after surgery from patients with OCC and atypical endometrial hyperplasia (AEH) (controls) were compared using real-time PCR to examine changes in the detected EV miRNA levels. Thirty-seven miRNAs were >2-fold upregulated on the OCC side compared with the normal ovarian side. We selected 17 miRNAs and created specific primers for 12 of these miRNAs. The levels of six EV miRNAs were significantly decreased in postoperative OCC serum compared to those in preoperative OCC serum. In contrast, no significant change was observed between the pre and postoperative values in the control group. We identified OCC tissue-specific miRNAs in the EVs secreted by OCC tissues. These EV miRNAs have potential for use as biomarkers for the early diagnosis and detection of OCC. [ABSTRACT FROM AUTHOR]

Vaginal bleeding is reported among 4%-11% of postmenopausal women. Hematometra is commonly associated with cervical stenosis due to senile atrophy, radiotherapy, or a uterine neoplastic lesion in women of postmenopausal age. Ovarian steroid cell tumor is a rare hormone-secreting tumor subtype accounting for approximately 0.1% of all ovarian tumors. Here we report a case of hematometra in a postmenopausal woman with high estrogen levels who was later diagnosed with a steroid cell tumor. [ABSTRACT FROM AUTHOR]