Benign Cystadenoma Research Articles

Mucin Stain of Endoscopic Ultrasound-Guided Pancreatic Cyst Fluid Is Independently Predictive of Mucinous Cystic Neoplasms

Aim: The optimal management of pancreatic cystic neoplasms is not well established. Endoscopic ultrasound (EUS) has now enabled us to safely aspirate cystic lesions for cyst fluid analysis. Thick fluid consistency can limit the volume of aspirate and thereby affect the type of test performed. Mucin staining of the fluid is simple and does not require a significant volume to perform. The aim of our study was to correlate positive mucin stain with surgical pathology. Method: This is a retrospective chart review of all patients who underwent EUS for pancreatic cysts between Feb 2004 and Aug 2006 at the University of Alberta Hospital, Edmonton, Alberta. Cyst fluid was analyzed for malignant cytology, mucin stain and amylase. Patients underwent surgery or were followed conservatively as determined by the result of mucin staining and operability as determined by the surgeon. Result: EUS was performed on 48 patients with pancreatic cystic lesions. There were 29 females. The mean age was 61 yrs (range 28-84 yrs). A total of 43 patients underwent EUS-guided FNA. Results of mucin staining were available for 37 patients. Of these, 26 patients had a positive mucin stain (70%). 15/26 patients with positive mucin stain underwent surgery. Of these, 14 patients were found to have a neoplastic lesion (mucinous cystadenoma in 5, mucinous cystadenocarcinoma in 3, IPMT in 5 and oncocytic neoplasm in 1). Only 1/15 patients had a benign serous cystadenoma. The correlation between positive cyst fluid mucin staining and mucinous cystic neoplasms on histology is 93%. Of the 11 patients with negative mucin staining, 1 patient underwent surgery for persistent abdominal pain and was found to have a serous cystadenoma. Seven patients were followed conservatively for at least 6 months. Three patients were lost to follow-up. Conclusion: Mucin staining of pancreatic cyst fluid appears to be highly predictive of mucinous cystic neoplasms. Further diagnostic testing may not be indicated as most patients are offered surgery. Mucin negative pancreatic cysts, however, represent a management dilemma. As a subset of these patients may have a mucinous neoplasm, further testing with CEA may help clarify those that should undergo surgery. Further prospective studies are needed to confirm this.

Overexpression of mammaglobin B in epithelial ovarian carcinomas

Objective Mammaglobin B is a uteroglobin gene family member recently found highly differentially expressed in serous papillary ovarian cancer by gene expression profiling. In order to evaluate its potential as a novel ovarian cancer biomarker, in this study we quantified and compared Mammaglobin B expression in various histologic types of epithelial ovarian carcinomas (EOC). Methods Mammaglobin B expression was evaluated by real-time PCR and/or immunohistochemistry in fresh-frozen biopsies and paraffin-embedded tissues derived from a total of 137 patients including 69 primary EOC with different histologies, 28 serous papillary omental metastasis, 8 borderline tumors, 26 benign cystadenomas and 14 normal ovaries. Results High levels of Mammaglobin B gene expression were detected in 100% (68 out of 68) of the ovarian cancer biopsies tested by real-time PCR. In contrast, normal human ovarian surface epithelium (HOSE) expressed negligible levels of Mammaglobin B mRNA (EOC versus HOSE, p < 0.01). Although Mammaglobin B gene expression levels were higher in endometrioid, mucinous and undifferentiated tumors when compared to serous papillary tumors, clear cell tumors and those with mixed histology, these differences were not statistically significant. In agreement with real-time PCR results, EOC were found to express significantly higher levels of Mammaglobin B protein when compared to normal ovaries and benign cystadenomas ( p < 0.01). However, only 29 out of 68 (42%) of the EOC samples found positive for Mammaglobin B by real-time PCR showed immunoreactivity by IHC. Conclusions Mammaglobin B gene is highly expressed in EOC and may represent a novel molecular marker for multiple histological types of ovarian cancer. Additional studies to evaluate the clinical utility of Mammaglobin B as a diagnostic and/or therapeutic target in ovarian cancer are warranted.

Endoscopic Ultrasound–Guided Fine-Needle Aspiration of Ascites

The aim of this study is to report a large single-center experience with endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of ascites. Consecutive patients at our institution in whom EUS-guided paracentesis was performed between January 1997 and July 2005 were identified retrospectively. All procedures were performed by or under the supervision of 1 of 5 experienced endosonographers with available on-site cytopathology. Sixty consecutive patients (33 men; mean age, 67 y) were identified. Previously attempted percutaneous paracentesis was unsuccessful in 3 of 6 patients. Ascites confirmed by EUS FNA was visible in 28 of 54 (52%) computerized tomography, 3 of 11 (27%) transabdominal ultrasound, and 4 of 8 (50%) magnetic resonance imaging examinations before EUS. Transgastric (n = 55) or transduodenal (n = 5) EUS-guided paracentesis (mean, 8.9; range, 1-40 mL) revealed malignancy in 16 (27%) from primary pancreatic (n = 9), gastric (n = 2), urothelial (n = 1), esophageal (n = 1), gallbladder (n = 1), bile duct (n = 1) cancer, and lymphoma (n = 1). The cytology from 2 patients was atypical (1 suspicious for malignancy and 1 considered reactive) and the remaining 42 were benign. Potential complications occurred in 2 of 60 (3%) patients with self-limited fever. Of the 8 of 60 (13%) patients who underwent subsequent surgery, 3 had metastatic pancreatic adenocarcinoma (n = 2) and metastatic small intestinal carcinoid (n = 1) to the peritoneum after negative EUS-FNA cytology. EUS frequently identifies ascites missed by other imaging studies. EUS-guided paracentesis may identify malignancy in a subset of patients. Negative ascitic fluid cytology from EUS FNA does not exclude possible peritoneal carcinomatosis.

Germ line and somatic mutations of BRAF V599E in ovarian carcinoma

It has been shown that ovarian low-grade serous carcinoma evolves out of a stepwise progression from benign serous cystadenoma to serous borderline tumor (SBT) to micropapillary serous carcinoma (MPSC), and that BRAF activation is a very early somatic event in the tumorigenesis. We postulated that BRAF could be a SBT susceptibility gene, and investigated both germ line and somatic mutations of BRAF V599E in 104 ovarian cancer patients. BRAF V599E mutation in histologic samples was found in 5 (24%) of 21 SBTs, 1 (33%) of 3 MPSCs, 1 (17%) of 6 endometrioid carcinomas, but not detected in 42 conventional serous carcinomas, 12 mucinous borderline tumors, 10 mucinous, and 10 clear-cell carcinomas. No V599E mutation could be detected in blood samples from these 104 patients. We also found no BRAF V599E mutation in 101 normal healthy women and 10 well-established ovarian cancer cell lines. Our results suggest that BRAF gene plays a "gatekeeper" role but does not act as a predisposition gene in the development of low-grade serous carcinomas.

Mitochondrial DNA sequence variants in epithelial ovarian tumor subtypes and stages

BackgroundA majority of primary ovarian neoplasms arise from cell surface epithelium of the ovaries. Although old age and a positive family history are associated risk factors, the etiology of the epithelial ovarian tumors is not completely understood. Additionally, knowledge of factors involved in the histogenesis of the various subtypes of this tumor as well as those factors that promote progression to advanced stages of ovarian malignancy are largely unknown. Current evidence suggests that mitochondrial alterations involved in cellular signaling pathways may be associated with tumorigenesis.MethodsIn this study, we determined the presence of polymorphisms and other sequence variants of mitochondrial DNA (mtDNA) in 102 epithelial ovarian tumors including 10 matched normal tissues that paired with some of the tumors. High-resolution restriction endonucleases and PCR-based sequencing were used to assess the mtDNA variants spanning 3.3 kb fragment that comprised the D-Loop and 12S rRNA-tRNAphe, tRNAval, tRNAser, tRNAasp, tRNAlys, ATPase 6, ATPase 8, cytochrome oxidase I and II genes.ResultsThree hundred and fifty-two (352) mtDNA sequence variants were identified, of which 238 of 352 (68%) have not been previously reported. There were relatively high frequencies of three mutations in the 12S rRNA gene at np 772, 773, and 780 in stage IIIC endometrioid tumors, two of which are novel (773delT and 780delC), and occurred with a frequency of 100% (7/7). Furthermore, two mutations were observed in serous tumors only at np 1657 in stage IV (10/10), and at np 8221delA in benign cystadenomas (3/3) and borderline tumors (4/4). A high frequency, 81% (13/16) of TC insertion at np 310 was found only in early stages of serous subtype (benign cystadenomas, 3/3; borderline tumors, 4/4; stage I tumors, 2/5 and matched normal tissues 4/4).ConclusionOur findings indicate that certain mtDNA mutations can reliably distinguish the different histologic subtypes of epithelial ovarian tumors. In addition, these data raise the possibility that certain mtDNA mutations may be useful biomarkers for predicting tumor aggressiveness and may play a potential role in tumorigenesis.

Prostate-derived Ets Factor Is Overexpressed in Serous Epithelial Ovarian Tumors

The frequent overexpression of prostate-derived Ets factor (PDEF) mRNA in ovarian cancer has been previously reported. The aim of this study was to evaluate PDEF protein expression in ovarian cancer and how this expression might vary at different stages of epithelial ovarian tumors in comparison to normal ovary. A new rabbit polyclonal antibody to PDEF was prepared, and immunohistochemistry was performed on tissue sections from 12 normal ovaries, 10 cases of benign serous cystadenoma, 17 cases of low malignant potential tumor, 19 cases of stage 1, and 15 cases of advanced stage primary epithelial (serous) ovarian carcinomas and their peritoneal metastases. Expression levels were assessed based on the percentage of positively staining cells and the intensity of staining. All 12 normal ovary and 10 benign serous cystadenoma cases were negative for PDEF expression. In contrast, 6 of 17 (35%) low malignant potential tumors, 5 of 19 (27%) stage 1, and 5 of 15 (33%) advanced stage ovarian tumors stained positive for PDEF expression. Together, these results show frequent overexpression of PDEF protein in epithelial ovarian tumors and its lack of expression in normal ovary and cystadenomas, and this supports a role for PDEF in ovarian tumorigenesis. Furthermore, these results suggest that PDEF is a potential marker and target in ovarian cancer.

PTEN expression and single nucleotide polymorphisms in epithelial tumors of the ovary

Objective : Phosphate and tensin homolog deleted on chromosome 10 (PTEN) is a potent tumor suppressor gene, localized to chromosome 10q23, and shows extensive homology with auxilin and tension. PTEN has variety roles involved in cell proliferation, invasion, and migration in tumorigenesis of solid tumors. In this study, the expression of the PTEN in the ovarian epithelial tumors, including benign, borderline malignancy, and adenocarcinomas was investigated. Methods : Immunohistochemical expression of PTEN were analyzed in formalin fixed tumor tissues of 20 benign cystadenomas, 22 borderline tumors, and 49 malignant ovarian cancer. In the same tissue extracts, single nucleotide polymorphism were studied. Results : Most of benign and borderline ovarian tumors revealed strong positive reaction, but a few cases showed negative reaction or weak positive reaction. In adenocarcinomas, 33% of cases was negative, and 43% was focal weakly staining, grade 1. The remainder of adenocarcinomas showed strong nuclear staining. In SNP assay, A/A allele of rs1234213 shows low frequency, but A/G allele reveals high frequency. C/C allele of rs701848 shows high frequency, and rs9651492 is not detected polymorphism. Conclusion : These results suggest that loss of PTEN expression is associated with tumorrigenesis of ovarian epithelial tumors, and is related with single nucleotide polymorphism.

Recurrent mucinous cystadenoma in a 20‐year‐old woman: Was hysterectomy inevitable?

A recurrence of ovarian mucinous cysts is very rare. Over a period of 21 months, a 20-year-old patient had three laparotomies resulting initially in the removal of one ovary with a mucinous cystadenoma and two cystectomies for the same pathology, but ultimately leading to hysterectomy and salphingo-oopherectomy. Because mucinous tumors are usually benign and most of the time multilocular, management of young patients is challenging, especially in the case of recurrence. Follow-up of these patients is very important and transvaginal ultrasound seems to be currently the most effective diagnostic tool for the follow-up of young patients treated with cystectomy for benign mucinous cystadenomas.

Tracheobronchial Gland Tumors

Tracheal tumors are uncommon, making up only 0.2% of all respiratory malignancies in the United States. One consequence of this low incidence is that few centers accumulate meaningful experience. Another is the lack of awareness of effective therapy. Bronchial gland tumors demonstrate oncologic diversity and include benign, low-grade, and high-grade malignant tumors. We reviewed the present knowledge of bronchial gland tumors of the trachea, carina, and bronchi, including the epidemiology, presentation, evaluation, tumor types, and treatment options. The malignant bronchial gland tumors, adenoid cystic carcinoma and mucoepidermoid carcinoma, are far more common than benign mucinous cystadenoma or pleomorphic adenoma. Complete resection of localized tumors has excellent long-term results in symptomatic benign tumors. The disease-free survival after resection of malignant tumors is limited by distant metastasis and regional disease, while local recurrence is uncommon. Postoperative mediastinal radiation is now accepted adjuvant therapy. Experience at our institute demonstrates a significant survival advantage for patients with complete resection compared to unresectable patients. Expanding knowledge of diagnostic evaluation and surgical therapy can improve the long-term survival of patients with tracheobronchial gland tumors.

DNA fragmentation factor (DFF45): Expression and prognostic value in serous ovarian cancer

This study investigated the expression of DNA fragmentation factor (DFF45), MIB-1, and p53 in formalin-fixed, paraffin-embedded archival tissues of 50 ovarian serous carcinomas. In addition, 10 benign serous cystadenomas and 10 serous neoplasms of low malignant potential (LMP) were included in this DFF45 immunostudy. With regard to quantity and intensity of positively stained cells, immunostaining for DFF45 was scored as low or strong. MIB-1 labeling indexes (LIs) were quantitated as the percentage of positively stained nuclei in 1000 nuclei. For p53, at least 10% of tumor cells had to display nuclear staining to consider a case positive. DFF45 staining was noted predominantly in the nucleus. Low DFF45 expression was identified in all serous cystadenomas and in LMPs, as well as in 18 (36%) ovarian serous carcinomas. The latter displayed strong expression in 32 cases (64%). DFF45 immunoreactivity increased with FIGO stage and with grade ( P = 0.0213 and 0.0084, respectively), as well as with p53 positivity ( P = 0.04 ), but not with MIB-1 LIs ( P = 0.076 ). A trend towards poor outcome was observed in patients whose tumors displayed high levels of DFF45 immunoexpression ( P = 0.0187 ). Apoptotic bodies were consistently DFF45-negative. This study indicates that DFF45 expression is frequently upregulated in ovarian serous carcinomas and may serve as a marker of aggressive behavior with prognostic value.

CHEK2 variants predispose to benign, borderline and low-grade invasive ovarian tumors

Objective. Three founder alleles of the CHEK2 gene have been associated with predisposition to a range of cancer types in Poland. Two founder alleles (1100delC and IVS2 + 1G > A) result in a truncated CHEK2 protein and the other is a missense substitution, leading to the replacement of a threonine with an isoleucine (I157T). Methods. To establish if these variants play a role in the etiology of ovarian tumors, we genotyped 1108 Polish women with various types of ovarian tumors and 4000 controls for the three CHEK2 variants. We included 539 Polish women with benign ovarian cystadenomas, 122 women with borderline ovarian malignancies and 447 women with invasive ovarian cancer. Results. Positive associations were seen with the CHEK2 I157T missense variant and ovarian cystadenomas (OR = 1.7; P = 0.005), with borderline ovarian cancers (OR = 2.6; P = 0.002) and with low-grade invasive cancers (OR = 2.1; P = 0.04). There was no association with ovarian cancer of high grade (OR = 1.0). The association between the I157T missense variant was then confirmed in a second sample of Russian patients with borderline ovarian cancers (OR = 2.7; P = 0.06). Conclusion. These data indicate that CHEK2 variants may predispose to a range of ovarian tumor types of low malignant potential, but not to aggressive cancers.

Images (and challenges) in the delivery suite: large mucinous cystadenoma coexisting with an intrauterine pregnancy in a healthy parturient

pregnancy present many therapeutic challenges as a result of ever present conflict between optimal maternal therapy (surgical resection) and the well being of the fetus (preterm labor) [1]. At the University of California, San Diego, we recently encountered a 31-year-old, previously healthy female at 22 weeks gestation, who presented with rapidly increasing abdominal size and 2 week history of abdominal pain. An obstetric ultrasound demonstrated a single intrauterine pregnancy (size compatible with dates) coexisting with a large mass in the abdomen (originating from the right ovary), which measured 27.0·27.0·11.0 cm (Figs. 1, 2). Surgical resection (cystectomy and right ovariectomy) under general anesthesia (rapid sequence induction with cricoid pressure) was necessary due to a rapid tumor growth. Pathologic evaluation was reported as benign mucinous cystadenoma. Neither intranor postoperative maternal and fetal complications were reported. However, it should be remembered (and emphasized) that perioperative challenges in these parturients may include supine positioning-related aortocaval compression syndrome (commonly under-appreciated outside of the Labor and Delivery suite) leading to severe hypotension at induction of general anesthesia [2].

High expression of tissue inhibitor of metalloproteinase-2 in serous ovarian carcinomas and the role of this expression in ovarian tumorigenesis

Tissue inhibitors of metalloproteinases (TIMPs) play key roles in maintaining homeostasis of the extracellular matrix by controlling matrix metalloproteinases (MMPs). In addition to their role in regulating MMPs, TIMPs have also been shown to have pluripotential effects on cell growth, apoptosis, and differentiation. The aim of this study was to evaluate TIMP-2 level in serous ovarian tumor tissues and to understand further the role of TIMP-2 protein in ovarian tumorigenesis. The expression of TIMP-2 was assessed by immunohistochemistry in a total of 57 ovarian specimens, including 5 normal ovaries, 12 benign serous cystadenomas, 20 serous borderline tumors, and 20 serous carcinomas. In addition, we transfected a TIMP-2 plasmid into the gynecologic cancer cell lines SKOV-3, 2774, and HeLa and then assayed cell growth, apoptosis, and MMP-2 activation. We found that TIMP-2 immunostaining was significantly more frequent in serous carcinomas, mainly in tumor epithelium, compared with cells of the other tissues studied. Tissue inhibitor of metalloproteinase-2 overexpression in ovarian cancer cells did not mediate proapoptosis, inhibited cisplatin-induced apoptosis, and induced MMP-2 expression. These findings suggest that TIMP-2 may function to favor tumor growth in serous ovarian tumorigenesis. Additional research is now needed to elucidate further the role of TIMP-2 in the biologic behavior of ovarian serous tumors.

Clinicopathological study of metallothionein immunohistochemical expression, in benign, borderline and malignant ovarian epithelial tumors.

Metallothioneins (MTs) are a family of cystein-rich metal-binding proteins, which are expressed in normal cells during fetal and postnatal life but also in a variety of human neoplasms. MT expression in human tumors has been linked to resistance to anticancer drugs and differentiation and progression in some types of tumors. This study examined the immunohistochemical expression of MTs in benign, borderline and malignant tumors of ovarian surface epithelium and the possible correlations with clinicopathological parameters and survival. A total of 87 cases with diagnosis of ovarian surface epithelial tumors were included. Specifically, 21 cases of benign cystadenomas (11 serous and 10 mucinous), 14 borderline (low malignant potential tumors, 8 mucinous and 6 serous) and 52 cases of ovarian cancer were analysed. Immunohistochemical expression of MT (cut-off level > 10% of tumor cells) was clearly associated with malignancy. A statistically significant correlation was found between the expression of MT in cancer cases and benign tumors (p < 0.0001) and cancer cases and borderline tumors p = 0.003. In cancer cases a difference was observed between grade I and III (p = 0.002). There was no correlation of MT overexpression with survival in the small number of ovarian carcinoma patients where it was analysed. MT constitutes a marker that characterizes aggressiveness and a high malignant potential in ovarian epithelial tumors. In diagnostic problems MT may help distinguish between benign, borderline and malignant tumors.

Mucinous cystadenoma of the ovary in perimenarchal girls

Ovarian masses in children are an uncommon occurrence. They represent less than 2% of all tumours in girls less than 16 years of age. Mucinous tumours of the ovary occur principally in middle adult life and are extremely rare prior to menarche. To the best of our knowledge, there are only 13 previous cases of benign mucinous cystadenoma (MCA) of the ovary in perimenarchal girls reported in the literature. We present six cases of this rare tumour. We reviewed the charts of six patients who presented with large MCA of the ovary. The patient's ages ranged from 13 to 14 years (mean 13.6 years). Two were premenarchal and four were within 1 year of menarche. All children presented with marked abdominal distension and discomfort. Except for one child who had ultrasound scan alone, all the others had either CT or MRI scan as well. Ultrasound demonstrated a large multiloculated cystic mass arising from the pelvis reaching the level of the xiphoid. CT demonstrated an enormous mass occupying almost the entire abdomen. The mass was partly solid, partly cystic and the cystic elements were multiloculated in all patients. Three patients demonstrated contralateral hydronephrosis on imaging. Laparotomy revealed a tumour arising from the left ovary in five patients and from the right ovary in one. Several litres of fluid were aspirated in order to deliver the tumour from the abdomen. All patients underwent oophorectomy or salpingo-oophorectomy. Histology revealed benign MCA of the ovary in all cases. On follow up, ranging from 2.4 to 5 years, all patients were well with no evidence of recurrence. MCA in perimenarchal girls usually affects the left ovary. Although this tumour is rare, this diagnosis should be considered in 11 to 15-year-old girls presenting with a very large abdominal mass.

P63 expression in epithelial ovarian tumors

Ovarian cancer is a highly lethal disease and its underlying biology is poorly understood. The p63 is a homologue gene of the tumor suppressor p53. p63 appears to be important for the development and differentiation of reproductive epithelium and interacts with p53 in human tumorigenesis. This study presents the immunoexpression of the p63 in benign and malignant epithelial ovarian tumors. We evaluated the p63 immunoexpression in 91 ovarian benign cystadenomas (29 mucinous and 62 serous) and in 29 ovarian malignant tumors (3 mucinous borderline, 3 serous borderline, 17 serous carcinomas, 2 endometrioid, 2 undifferentiated, 1 mucinous, and 1 clear-cell carcinoma) using a monoclonal antibody clone 4A4 (1:200), which recognizes all p63 variants. The tumors were considered p63 positive if 5% or more cells presented nuclear immunostaining. We observed 85.7% of positivity in benign tumors, 50% in borderline tumors, and 8.7% in invasive ovarian cancer (P < .0001). The benign serous cystadenomas were positive in 91.9% of cases and benign mucinous cystadenomas in 72.4% (P= .02). These data suggests an important role of p63 in the control of ovarian epithelium behavior. The p63 may be involved in the development of benign and malignant epithelial ovarian tumors.

Borderline ovarian tumors

Borderline ovarian tumors are classified between benign cystadenoma and malignant cystadenocarcinoma. They are characterized as malignant tumors by histopathological features, which make them different from the benign ones. These tumors are commonly diagnosed at the early disease stage. The treatment of these tumors is surgical. The prognosis depends on the stage of disease and histopahtological types. We present 10 patients operated at the Institute of Oncology Sremska Kamenica because of malignant tumors with low malignant oncogenic potential in the period between 2000 and 2005. All patients had surgical treatment with ex tempore diagnostics, hysterectomy and adnexectomy with total omentectomy, or unilaterals adnexectomy. All patients had negative cytoanalytic findings of the small pelvis. Histopathological findings are necessary to confirm the diagnosis of disease. In young patients who had no children fertility can be preserved.

Biliary cystadenoma with mesenchymal stroma: Report of a case and review of the literature

Biliary cystadenomas are rare, cystic neoplasms of the biliary ductal system that usually occur in middle-aged women. They cannot be safely differentiated from cystadenocarcinomas before operation and should always be considered for resection. Cystadenomas have a strong tendency to recur, particularly following incomplete excision, and a potential of malignant transformation. Therefore, complete resection is the therapy of choice and thorough histopathologic evaluation is imperative. A case of benign biliary cystadenoma with mesenchymal stroma is presented along with a review of the relative literature addressing the clinical presentation, histology, histogenesis, differential diagnosis, imaging features, treatment and prognosis of this interesting and rare entity.

The expression of tissue inhibitors of metalloproteinase-2 (TIMP-2) in epithelial serous ovarian tumors

Objective：Tissue inhibitors of metalloproteinases (TIMPs) play a key role in maintaining homeostasis of the extracellular matrix (ECM) by controlling matrix metalloproteinases (MMPs). In addition to their role in regulating MMPs, TIMPs have also been shown to have pluripotential effects on cell growth, apoptosis and differentiation. The aim of this study was to examine TIMP-2 level in serous ovarian tumor tissues and to understand further the role of TIMP-2 protein in ovarian tumorigenesis. Methods：Expression of TIMP-2 was assessed by immunohistochemistry in a total of 57 ovarian specimens including five normal ovaries, 12 benign serous cystadenomas, 20 serous borderline tumors and 20 serous carcinomas. Results：The present study found that TIMP-2 immunostaining was significantly more frequent in serous carcinomas, mainly in tumor epithelium, compared with cells of the other tissues studied. Conclusion：TIMP-2 in serous ovarian carcinoma may function to favor tumor growth in serous ovarian tumorigenesis. Additional research is now needed to elucidate further the role of TIMP-2 in the biological behavior of ovarian serous tumors.

Computed tomography and fine-needle aspiration cytology for preoperative evaluation of cystic tumours of the pancreas.

Cystic neoplasms of the pancreas are rare. They may present as a mucinous (malignant or potentially malignant) tumour or as benign serous cystadenoma. Accurate preoperative diagnosis is therefore essential, as an asymptomatic serous tumour may safely be followed clinically for years, whereas mucinous tumours require aggressive surgery. Thirteen patients with cystadenoma and cystadenocarcinoma of the pancreas were reviewed and how best to improve the rate of preoperative diagnosis was considered. Fine-needle aspiration cytology and computed tomography enable accurate preoperative distinction between mucinous and serous cystic tumours of the pancreas.