Giant ovarian mucinous cystadenoma in a young patient: clinical and therapeutic implications

Objective: Recurrence of ovarian mucinous cystadenomas is very rare. This report describes a case of ovarian mucous cystadenoma in a women that recurred 2 years after surgery.
 Case presentation: A 22-year-old patient, with a sizable ovarian tumor underwent laparoscopic-assisted cystectomy. On histopathology, the tumor was diagnosed to be an ovarian mucinous cystadenoma. The mucinous cystadenoma recurred 2 years after surgery and subsequently laparoscopic right adnexectomy was performed.
 Discussion: It has been reported that intraoperative cyst rupture and cystectomy instead of adnexectomy are risk factors for mucinous cystadenoma recurrence. Close follow-up is required for post-cystectomy patients because of the possibility of recurrence.
 Conclusion: The risk of recurrence and the preservation of fertility should be carefully considered when deciding on treatment in young patients with a mucinous cystadenoma. The follow-up is required for post-cystectomy patients because of the possibility of recurrence.

A case of ovarian mucinous cystadenoma in a child that recurred 1 year after surgery

DIFFERENCES IN CLINICAL CHARACTERISTICS, HISTOLOGIC PROFILES, AND OUTCOMES BETWEEN YOUNGER AND STANDARD PATIENTS WITH NON-SMALL CELL LUNG CANCER

Frailty Screening in Critical Care at Scale

Objective To explore the value of MRI in differentiation diagnosis of benign ovarian mucinous cystadenoma (MC) and borderline mucous cystadenoma (BMC). Methods MRI data of 23 cases of benign MC and 14 cases of BMC, confirmed by surgery and pathology, were retrospectively analyzed, including tumor location, shape, size, loculation, signal intensity of cyst fluid, cyst wall, cyst septum and nodules, and they were compared with pathological results. Results Single loculus benign cystadenoma nodules showed isointensity T2WI signal, low T1WI signal, and low DWI signal. Single loculus borderline cystadenoma nodules showed high T2WI signal, low T1WI signal, and high DWI signal. Signs such as honeycomb loculi of multilocular cystadenoma, cyst fluid of high T1WI signal, cyst fluid of low T2W1 signal, cyst wall and irregularly thickened cyst septum (>3 mm) were more seen in BMC (7/11, 6/11 and 7/11) than in MC (5/18, 4/18 and 5/18); 5 cases were with cyst sediments (MC=4, BMC=1), showing moderate T2WI signals, and high T1WI signals. Broken fishing net gathering was only restricted to MC (5/18) with characteristics. Benign multilocular cystadenoma nodules showed low DWI signal, and borderline multilocular cystadenoma nodules showed high DWI signal. Conclusion MRI can well display pathological characteristics of ovarian MC, which has practical value for the differentiation and diagnosis of MC and BMC and can provide the reference for clinical surgery. Key words: Ovary; Mucinous cystadenoma; Magnetic resonance imaging

In a group of 59 patients over the age of 55 years with ovarian serous and mucinous cystadenomas, a total of 29 (49%) showed moderate or strong oestrogenic activity as determined by maturation index in vaginal cytologic smears, in contrast to nine (13%) of 70 control patients with other gynecological disorders than ovarian tumours. The bacterial flora was dominated by Doderlein type bacilli in 24 of the 27 test patients with an elevated maturation index, also reflecting the abnormal oestogenic activity in these patients. When the serous and mucinous cystadenoma groups were compared, a striking difference was found: of the 30 patients with mucinous cystadenomas, 23 (77%) displayed moderate of strong oestrogenic activity, while this was the case with only six (21%) of the 29 patients with serous cystadenomas. These findings stress the importance of an abnormal oestrogenic activity, revealed by an elevated cytologic maturation index, as memento for the possibility of post-menopausal ovarian cystadenoma.

A case report of mucinous cystadenoma with contralateral serous cystadenofibroma in identical twin

Myelodysplastic syndromes (MDS) are a group of clinically and genetically diverse diseases that impose patients with an increased risk of leukemic transformation. While MDS is a disease of the elderly, the interplay between aging and molecular profiles is not fully understood, especially in the Asian population. Thus, we compared the genetic landscape between younger and older patients in a cohort of 698 patients with primary MDS to advance our understanding of the distinct pathogenesis and different survival impacts of gene mutations in MDS according to age. We found that the average mutation number was higher in the older patients than younger ones. The younger patients had more WT1 and CBL mutations, but less mutated ASXL1, DNMT3A, TET2, SF3B1, SRSF2, STAG2, and TP53 than the older patients. In multivariable survival analysis, RUNX1 mutations with higher variant allele frequency (VAF) and U2AF1 and TP53 mutations were independent poor prognostic indicators in the younger patients, whereas DNMT3A and IDH2 mutations with higher VAF and TP53 mutations conferred inferior outcomes in the older patients. In conclusion, we demonstrated the distinct genetic landscape between younger and older patients with MDS and suggested that mutations impact survival in an age-depended manner.

OBJECTIVE: Rapid growth patterns and recurrence with variable rates have been reported in the literature, making mucinous cystadenomas different from other ovarian benign neoplasms. The study aimed to predict and prevent recurrence based on the obtained results. STUDY DESIGN: In this case-control study among the 2,341 patients who underwent surgery for ovarian cysts, 221 met the inclusion criteria. The 221 patients diagnosed with mucinous cystadenoma were categorized into two groups: 14 patients (6.3%) with recurrence and 207 patients (93.7%) without recurrence. Patients in these groups were compared in terms of demographic characteristics, ovarian cyst size, operative technique, type of surgery (oophorectomy or cystectomy), Ca19-9, CA125, and CEA values of the patients, and duration of postoperative follow-up. RESULTS: The mean age was statistically lower in the group with recurrence (27 ± 5 vs 44 ± 14; p<0.001). The follow-up period of recurrent cases was significantly longer (6.8 ± 3.5 vs 4.9 ± 2.2 years; p=0.045). The recurrence rate was significantly higher in patients who underwent cystectomy (p<0.001; odds ratio: 22.8). When all patients were examined, cystectomy was preferred in younger patients [31 (18-65) vs 48 (18-81); p<0.001]. According to regression analysis, cystectomy alone is an independent risk factor (p=0.041). CONCLUSION: Unlike conventional ovarian cystadenomas, mucinous cystadenomas should be followed up owing to the possibility of recurrence, especially when detected at an early age. Since cystectomy is the only independent risk factor, oophorectomy should be the primary treatment for patients >40 years of age who have no desire for childbearing.

Ovarian mucinous cystadenomas are benign, but they can rarely recur if incompletely excised. We are the very first to report a case of recurrent mucinous neoplasm originating from an ovarian mucinous cystadenoma after adnexectomy as the first procedure. A 58-year-old woman was referred to our hospital with a two-year history of abdominal fullness. Magnetic resonance imaging (MRI) demonstrated a pelvi-abdominal cyst measuring 37 cm, without solid components within the cyst. A laparotomy revealed a huge cystic tumor originating from the right ovary. A right adnexectomy was performed without intraoperative cyst rupture or spillage. Histologically, the cyst was diagnosed as a mucinous cystadenoma. A month after the operation, ultrasonography revealed a cystic lesion measuring 1.8 cm adjacent to the right side of the uterine body. During the follow-up every three months, the cyst enlarged gradually, and an MRI performed 42 months after the operation revealed a cystic mass measuring 5.5 cm, including an internal protrusion. The second laparotomy revealed a cystic mass arising from the right surface of the uterine body, and a total hysterectomy and left adnexectomy were performed. Histologically, this uterine tumor was diagnosed as a mucinous borderline tumor that recurred from the ovarian mucinous cystadenoma. On histological examination of the resected uterus, the silken threads used at the first operation were observed in proximity to the tumor lesion. We speculated that the reason for the recurrence of our case may be the uterine-side remanence of the mucinous tumor cells from the first operation. Because the utero-ovarian ligament became short due to the large ovarian cyst, adnexectomy as a first procedure may be insufficient. A close follow-up of these patients is required for early detection of the recurrence, and attention is necessary for patients having malignant transformation due to an adenoma-borderline-malignant sequence of ovarian mucinous tumors.

Non-small cell lung cancer (NSCLC) is a disease primarily of the elderly, with a small proportion of patients in the younger age group. This subgroup of younger patients accounts for 1-10% among the Asian population and 2% in Caucasians. While variable age cut-offs have been taken for studies among these patients, there is sparse knowledge about the unique predisposing factors and etiology of lung cancer arising in them. Prior studies suggest that genetic factors, including Mendelian inheritance patterns and germline mutations, may contribute to early-onset lung cancer. Additionally, shorter durations of tobacco exposure in younger patients raise questions about alternative etiologies. Thus, there is potential for further research into the role of pathogenic germline mutations such as of the BRCA1, BRCA2 and TP53 genes. The higher prevalence of targetable genomic alterations such as EGFR mutations, ALK and ROS1 fusions in the young, and the lower proportion of BRAF, KRAS and MET alterations has therapeutic implications. Therapeutic outcomes among younger patients with lung cancer in localized and metastatic settings in real-world studies have been shown to be better than their older counterparts. It is notable that very young patients (less than 30 years of age) may have worse biology than those a decade older. Clinical trials assessing targeted treatments with tyrosine kinase inhibitors demonstrated equivalent results across age subgroups but representation of younger patients is disproportionate. Survival outcomes with immunotherapy for advanced lung cancer have shown the most improvement in those aged less than 55 years. Hence, treatment outcomes remain a subject of interest within this specific population, along with the issues of fertility, cancer treatment during pregnancy, financial toxicity and psychosocial counseling. There is paucity of literature on young Indian patients with lung cancer despite them presenting a decade earlier than the global population. Further studies are needed focusing on driving mutations, genetic, environmental and demographic factors influencing the presentation and treatment outcomes among Indian patients. This review focuses on the knowledge that exists and that which needs to be generated on these issues on young patients with lung cancer, with a spotlight on the Indian setting.

Patient: Female, 72Final Diagnosis: Benign ovarian mucinous cystadenomaSymptoms: Difficulty breathing and ambulation • heartburn • reflux • early satiety • nauseaMedication: —Clinical Procedure: Total abdominal hysterectomy along with bilateral salpingo-oophorectomySpecialty: Obstetrics and GynecologyObjective:Rare diseaseBackground:Mucinous cystadenoma is a benign cystic ovarian tumor arising from the surface epithelium of the ovary; it usually presents with vague, unspecific abdominal symptoms. If not detected early, they have the potential to grow to a substantial size and can present with huge abdominal distention leading to various compression symptoms. Mucinous cystadenomas most commonly occur in the third to sixth decades of life, and rarely occur in extremes of age. The reported incidence of giant ovarian cystadenoma in postmenopausal women is low or relatively unknown due to widespread use of ultrasound and other radiological imaging modalities these days. Here, we report a case of giant mucinous cystadenoma in a 72-year-old postmenopausal woman with multiple comorbidities.Case Report:We present the case of a 72-year-old postmenopausal high-risk patient who presented with a huge abdominal distention which started gradually 1 year before. Abdominopelvic ultrasound showed a left giant multiloculated abdominal cyst. An intact 27-kg ovarian cyst was removed, and a total abdominal hysterectomy (TAH) along with bilateral salpingo-oophorectomy (BSO) was performed. The final histopathological report showed a benign ovarian mucinous cystadenoma.Conclusions:Mucinous cystadenoma is a benign neoplastic disease that can reach a massive size. They are rare in the post-menopausal age group, but when they do occur, they pose a diagnostic and therapeutic challenge. This case report highlights the importance of early detection and management of adnexal masses in postmenopausal high-risk patients to decrease preoperative and postoperative complications and improve quality of life.

Giant ovarian mucinous cystadenoma in a young patient: clinical and therapeutic implications Luteal phase stimulation – an overview of the literature Comparative efficacy of granulocyte colony stimulating factor and platelet-rich plasma on clinical pregnancy rates and endometrial outcomes in women undergoing frozen embryo transfer: a randomized controlled trial with 560 subjects

EDITORIAL COMMENT: This comment was prepared to discuss the question of whether or not a macroscopically normal ovary should be sectioned for evidence of bilaterality when the opposite ovary is found to contain a cystic teratoma. This practice is often mentioned but, in the experience of the editorial committee, seldom performed. Wedge resection of a normal ovary can result in adhesions and impairment of fertility. Readers are referred to a series of clinicopathological evaluation of286 cases of ovarian teratomas in Turkey (A). In this series bilaterality of the tumour was present in 65.9% (29 of 44) of women with bilateral adnexal masses but only in 1.1% (2 of 182) of women who had a unilateral mass and who had histological examination of a wedge resection from the macroscopically uninvolved ovary. The authors concluded that ‘as the risk of bilaterality of the tumour in the normal‐appearing contralateral ovary was so small, we no longer perform the routine ovarian wedge biopsy in patients with mature ovarian teratoma, in order not to decrease the fertility potential of the patient’. Readers can decide whether the case presented here is an exception to this rule! Ayhan A, Aksu T, Develioglu O, Tuncer S, Ayhan A. Complications and Bilaterality of Mature Ovarian Teratomas. Aust NZ J Obstet Gynaecol 1991; 31: 83–85. Summary: Over a period of 6 years a young patient had 3 laparotomies resulting in the removal of 5 benign ovarian dermoid cysts and 1 ovarian mucinous cystadenoma. The occurrence of 3 dermoid cysts at I procedure and the recurrence of bilateral dermoid cysts raises questions regarding the histogenesis of these tumours. The subsequent occurrence of a mucinous cystadenoma confirms the known relationship between these benign ovarian neoplasms.

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