Benign Ovarian Lesions Research Articles

Imaging of Benign Adnexal Masses

Adnexal masses are common in the general population. Although ovarian cancer is a significant cause of mortality, large screening studies demonstrate that the majority of adnexal masses are benign. These benign masses include physiologic cysts, paraovarian masses, and benign ovarian lesions. It is important that gynecologists and radiologists appreciate the appearance of these lesions on multiple imaging modalities, including ultrasound, computed tomography, and magnetic resonance imaging to avoid unnecessary intervention.

Anti-NMDA-Receptor Encephalitis: An Adolescent with an Ovarian Teratoma

Background Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been reported to be associated with ovarian teratomas. In many patients, surgical excision has resulted in improvement. Case A previously healthy 14-year-old girl presented with confusion which later evolved into a comatose state. Imaging revealed an adnexal mass which was surgically removed and confirmed to be a mature teratoma. Her cerebral spinal fluid was positive for antibodies to NR1/NR2 heteromers of NMDA receptors. Comments Cystic teratomas are one of the most common benign ovarian lesions in children and young women. While an association of ovarian teratomas and paraneoplastic encephalitis is published in the neurologic literature, this association needs to be clarified for the practicing gynecologist who may be asked to consult on these patients.

LyGDI is a Promising Biomarker for Ovarian Cancer

LyGDI is an inhibitor of Rho protein activation by blocking its transformation between guanosine 5'-diphosphate- and guanosine 5'-triphosphate-bound states. The aim of this study was to investigate the usefulness of LyGDI as a biomarker for the detection of ovarian cancer, and its specificity and sensitivity were compared with those of cancer antigen 125 (CA125). The serum levels of LyGDI were determined by enzyme-linked immunosorbent assay in 42 patients with ovarian disease, including 30 ovarian cancers and 12 benign ovarian lesions, and 76 healthy controls. The expression of LyGDI was also evaluated by immunohistochemical staining in resected ovarian tissues of these patients. The serum LyGDI level of cancers was significantly greater than those of the benign and healthy groups (P = 0.002 and P < 0.0001, respectively), whereas no difference was observed between the benign and control groups (P = 0.889). Based upon receiver operating characteristic curve analysis, LyGDI levels were able to distinguish ovarian cancer from benign ovarian disease (P = 0.0001) and healthy control (P < 0.0001; areas under the receiver operating characteristic curves, 0.876 and 0.833, respectively). For ovarian cancers, 83.3% (25/30) or 80.0% (24/30) was identified by serum LyGDI (> or = 1.5 ng/mL) alone or by CA125 (>35 U/mL) alone. It is of particular importance to note that all cancer patients were identified by use of both markers, and the specificity was 83.3% for the benign group. Moreover, in early-stage cancers, 88.9% (8/9) had elevated serum LyGDI levels as compared with 44.4% (4/9) elevation of CA125 levels (P = 0.125). Immunohistochemical staining confirmed the expression of LyGDI on cancerous epithelial cells other than benign ovarian epithelium. These results suggest that LyGDI has significant potential as a marker for detection of ovarian cancer in the patients with ovarian enlargement, including detection of early-stage cancers.

The universal overexpression of a cancer testis antigen hiwi is associated with cancer angiogenesis

The aim of this study was to determine whether the universal overexpression of hiwi is associated with cancer angiogenesis. The difference of mRNA expression in blood vessels derived from DLBCL and RLNH tissues was detected, and hiwi was overexpressed in tumor vessels of lymphoma. The hiwi expression in cell lines and tissues was measured by using RT-PCR and immuno-staining, as well as the Ang-2 and Tie-2 expressions in tissues. Hiwi was significantly expressed in cancer cell lines Hela, MCF-7, MDA-MB-231, MDA-MB-435s, A2780, 111 and 113. Compared with that of chronic cervicitis (CC), hyperplasia of mammary glands (HMG), ovarian benign lesions (OBL) and endometrium benign lesions (EBL), the expression of hiwi, Ang-2 and Tie-2 was increased significantly in uterine cervical cancer (UCC), breast carcinoma (BC), ovarian cancer (OC) and endometrial cancer (EC) (P<0.01). Additionally, the hiwi expression was positively correlated with Ang-2 in UCC, BC and OC, and Tie-2 in OC. These results suggest that hiwi plays an important role in the oncogenesis and is a potential target for cancer angiogenesis.

Hyperreactio luteinalis with preeclampsia

Hyperreactio luteinalis (HL) is a condition associated with bilateral and, in rare cases, unilateral ovarian enlargement due to theca lutein cysts. HL is a benign condition, usually found incidentally at cesarean section, which can appear anaplastic and lead to unnecessary ovarian resection. A 24-year-old woman with 35 weeks of gestation attended with bilaterally enlarged ovaries. She had preeclampsia and preterm contractions. Due to breech presentation of baby and nulliparity and possible severe preeclampsia, she delivered by cesarean section. The ovaries had an anaplastic appearance and a biopsy was taken during cesarean section. Pathology revealed multiple benign theca lutein cysts. There are 51 reported cases of HL associated with a normal pregnancy in the literature. It is estimated that approximately 60% of the cases of HL is not associated with trophoblastic disease and occurs with normal singleton pregnancy. Only three of them were found to be associated with preeclampsia and this is the fourth case. HL may help explain the underlying cause of preeclampsia in these cases. There are multiple benign ovarian lesions in HL, which can mimic ovarian neoplasms. Accordingly, it is important to exclude these from the differential diagnosis via a wedge biopsy and frozen section to avoid unnecessary surgical excision.

Diagnostic markers for ovarian cancer

the majority of patients with ovarian cancer are generally diagnosed with advanced-stage disease. Despite the advances in chemotherapy, most patients have a poor prognosis due to difficulties in diagnosing the disease. tumor cells often overexpress specific proteins; as a result, tumor-reactive antibodies can be observed in the circulation of patients soon after initial tumor development and before circulating antigens are detected. taylor and colleagues assessed autoantibody responses in patients with benign and malignant ovarian lesions—”assessment of this autoantibody response against specific proteins can provide a cancer screening tool superior to those currently available” state the researchers. tumor-reactive igG has been detected in various tumors, including ovarian cancer. moreover, tumor-reactive igG can be identified early in tumor development and has been associated with tumor progression. the researchers used a Screening

Clinical utility of circulating matrix metalloproteinase-7 (MMP-7), CC chemokine ligand 18 (CCL18) and CC chemokine ligand 11 (CCL11) as markers for diagnosis of epithelial ovarian cancer

Ovarian cancer remains a highly lethal disease. The aim of the present study was to evaluate the usefulness of measuring serum matrix metalloproteinase-7 (MMP-7), CC chemokine ligand 18 (CCL18) and CC chemokine ligand 11 (CCL11) in comparison with serum cancer antigen 125 (CA 125) for diagnosis of epithelial ovarian cancer (EOC). This study included 51 patients with EOC, 27 patients with benign ovarian lesions and 29 healthy volunteers. Serum CA 125 was determined by microparticle enzyme immunoassay, while serum MMP-7, CCL18 and CCL11 were measured using enzyme-linked immunosorbent assay. The sensitivity and specificity were 86.3% and 92.9% for CA 125, 80.4% and 87.5% for MMP-7, 84.3% and 91.1% for CCL18 and, 68.6% and 62.5% for CCL11. Combination of CA 125, MMP-7, CCL18 and CCL11 gave a promising sensitivity of 100%, but specificity was decreased to 60.7%. The combined use of serum CA 125, MMP-7, CCL18 and CCL11 effectively detected early stages EOC with high sensitivity of 94.4%. Our data indicate that serum MMP-7, CCL18 and CCL11, in combination with CA 125 could be useful in diagnosis of EOC.

P694 Efficacy of Indole-3-Carbinol and Epigallokatechin-3-gallat in women with associated pathology of reproductive tract and benign ovarian lesions used as pathogenetic pre-IVF treatment

P694 Efficacy of Indole-3-Carbinol and Epigallokatechin-3-gallat in women with associated pathology of reproductive tract and benign ovarian lesions used as pathogenetic pre-IVF treatment

P195 Predictive value of transvaginal ultrasonographic findings in differentiating benign ovarian lesions from malignant tumors: The role of pathologic outcomes and clinical presentations

P195 Predictive value of transvaginal ultrasonographic findings in differentiating benign ovarian lesions from malignant tumors: The role of pathologic outcomes and clinical presentations

Preoperative diagnosis of ovarian tumors using Logistic model

Objective To assess the diagnostic value of Logistic model in differentiating between malignant and benign ovarian lesions. Methods Thirty-five indexes of clinical and ultrasound data were recorded in 601 ovarian lesions confirmed by surgical pathology. The Logistic model was developed on a training set( n - 400) and tested on a test set( n = 201). Results Variable selection resulted in a set of 10 variables for the models: personal history of ovarian cancer, maximal diameter of the lesion, maximal diameter of the solid component, multilocular-solid tumor, solid tumor, ascites, flow within papillation, irregular walls, very strong intratumoral blood flow (i. e. color score 4) and acoustic shadows. Test set area under the receiver-operating characteristics curve was 0.963 with a sensitivity 93.9% and a specificity 93. 1 %. Conclusions Logistic model can accurately separate malignant from benign ovarian masses. Key words: Ultrasonography; Ovarian neoplasms; Diagnosis, differential; Logistic model

Posterior colpotomy revisited: a forgotten route for retrieving larger benign ovarian lesions following laparoscopic excision

Although simple, ovarian cysts can be decompressed (within an impermeable pouch) following laparoscopic excision to allow lesions of up to 10 cm to be delivered safely. It is more difficult to remove solid or semi-solid ovarian tumours (such as fibromas and dermoid cysts) through this route. We present a modification of laparoscopic-assisted transvaginal retrieval of ovarian tumours through a posterior colpotomy incision (in a bag) and suggest that this is a route that allows large specimens to be retrieved safely and with minimal spillage. Women with solid or semi-solid ovarian cysts of greater than 5 cm, undergoing operative laparoscopy, were offered the option of having the specimens delivered through a posterior colpotomy, if retrieval through the abdominal ports proved difficult. The median specimen diameter was 6 cm (range 4-8 cm) and the median blood loss was 200 ml (range 150-250 ml). The median operating time was 50 min (range 40-90 min) with most patients being discharged within 24 h (median 18 h; range 16-21 h). There was no inadvertent spillage of cyst content or any intra or post-operative complications. Laparoscopic-assisted transvaginal removal of these lesions (in a bag!) allows large specimens to be removed securely and with minimal spillage.

IMP3 Expression in Human Ovarian Cancer is Associated With Improved Survival

The insulin-like growth factor-II mRNA-binding protein IMP3 plays an important role in embryogenesis and recent reports suggest an involvement in tumorigenesis. Although IMP3 expression has been well studied in mouse and human fetal and adult gonads, its role in ovarian cancer is unknown. We investigated the expression of IMP3 at protein and mRNA levels in a cohort of primary ovarian carcinomas and in 11 ovarian cancer cell lines. Western blot analysis revealed an expression of IMP3 in all ovarian cancer cell lines and immunohistochemistry demonstrated a positive cytoplasmic staining in 32 of 68 carcinomas (47%). In contrast, epithelium of borderline tumors, as well as, benign ovarian lesions and normal ovaries exhibited only weak or no IMP3 expression. In univariate Kaplan-Meier analysis, IMP3 protein expression was significantly associated with better overall survival (P=0.048). To confirm these findings, we further determined IMP3 mRNA expression in 43 ovarian cancer specimens by real time quantitative reverse transcription-polymerase chain reaction. A significant correlation between protein and mRNA levels (r=0.414, P=0.006), as well as a correlation of IMP3 mRNA expression with patient overall survival (P=0.044), was observed. Our results demonstrate that IMP3 is expressed in a subpopulation of ovarian cancer and a marker of good prognosis.

Physiologic FDG Uptake in the Ovary Together With an Abdominal Wall Leiomyoma Mimicking Metastasizing Ovarian Cancer on PET/CT Imaging

F-18 fluorodeoxyglucose (FDG)-PET-CT is increasingly used in the management of patients with ovarian cancer. However, there is a considerable overlap in the imaging features of malignant and benign ovarian lesions because physiological FDG-uptake in the ovaries can occur, depending on the menstrual cycle in premenopausal women.We present a case of FDG uptake in the ovary co-occurring with an intensely FDG active tumor of the abdominal wall in a 44-year-old woman. PET-CT findings, together with medical history, raised the suspicion for a metastasizing ovarian cancer. However, histologic examination demonstrated benign findings, namely abdominal wall leiomyoma and an ovarian follicular cyst.

Comparison of diagnostic accuracy of transvaginal ultrasound with laparoscopy in the management of patients with adnexal masses

PurposeThe aims of this study was (a) to compare the diagnostic accuracy of ultrasound examination with laparoscopic findings and both with the gold standard (histology) in the management of benign ovarian lesions, and (b) to assess the feasibility of laparoscopy in their diagnosis and management.MethodsProspective, comparative study (Canadian Task Force Classification II-2). A total of 117 women 15–59 years old were examined at outpatient department and had transvaginal ultrasound assessment. Ninety-eight women (three postmenopausal) with 105 cystic ovarian lesions met inclusion criteria and underwent operative laparoscopy. Histology was performed in all cases.ResultsAlthough laparoscopy showed an overall higher performance compared to transvaginal ultrasound, statistically significant difference was found only in the detection of endometriomas compared to ultrasound (P = 0.004 for sensitivity and P = 0.046 for specificity).ConclusionLaparoscopy exhibits higher diagnostic accuracy, especially in endometriomas, compared to transvaginal scan. Laparoscopic diagnosis appears to be safe and accurate. Conservative laparoscopic management of benign adnexal masses is safe and with low morbidity.

Imaging of Benign Adnexal Masses: Characteristic Presentations on Ultrasound, Computed Tomography, and Magnetic Resonance Imaging

Adnexal masses are common in the general population. Although ovarian cancer is a significant cause of mortality, large screening studies demonstrate that the majority of adnexal masses are benign. These benign masses include physiologic cysts, paraovarian masses, and benign ovarian lesions. It is important that gynecologists and radiologists appreciate the appearance of these lesions on multiple imaging modalities, including ultrasound, computed tomography, and magnetic resonance imaging to avoid unnecessary intervention.

The management of ovarian pathology in pregnancy

The extensive use of ultrasound in early pregnancy populations has led to more ovarian lesions being diagnosed incidentally in asymptomatic gravid women. The majority of these lesions are physiological in nature and tend to resolve spontaneously as the pregnancy progresses. Expectant management or a "watch and wait" approach is the benchmark standard of care for a woman with an ovarian mass diagnosed during pregnancy. This approach assumes the woman is relatively asymptomatic, and the likelihood of malignancy is negligible. The prevalence of malignancy in pregnancy is rare indeed, i.e. 1 in 15,000-32,000. It is the discriminatory ability of ultrasound, in experienced hands, to distinguish between benign and malignant ovarian lesions that allow appropriate triaging during pregnancy. Discriminating benign from malignant masses is crucial not only to optimize the management of malignancies, but also to avoid unnecessary intervention that may adversely affect maternal or foetal outcomes. This review will focus on the management of ovarian masses in pregnancy.

Neoplastic and nonneoplastic ovarian masses: Diagnosis on cytology

Objective:To evaluate the role of fine needle aspiration cytology (FNAC) in the distinction between neoplastic and nonneoplastic ovarian masses.Materials and Methods:One hundred and twenty patients with ovarian masses were studied. After detailed history and clinical examination, ultrasound (USG)-guided FNAC was performed in 92 clinical benign cases while FNAC and/or imprints of surgically resected ovarian masses was performed in 28 clinically suspected malignant cases. The smears were stained with Papanicolaou stain and histopathological sections were stained with hematoxylin and eosin stain with inclusion of special stain whenever required. Serum β-human chorionic gonadotrophin and α-fetoprotein estimations were carried out in cytologically diagnosed germ cell tumors.Results:The overall sensitivity, specificity and diagnostic accuracy of FNAC in diagnosing various ovarian masses were 79.2%, 90.6% and 89.9%, respectively.Conclusions:The clinical examination, pelvic ultrasound and FNAC were complementary and none of the methods was, in itself, diagnostic. However, USG-guided FNAC was found to be a fairly specific and accurate technique and should be employed as a routine, especially in young females with clinically benign ovarian lesions. The reasons for false diagnosis and limitations of USG and FNAC have been analyzed.

THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF GYNAECOLOGIC PELVIC TUMOURS

Objective : To assess the role of magnetic resonance imaging in the diagnosis of gynaecological pelvic tumours.Design: Prospective study.Setting : Tanta University Hospitals .Patients : The study included 49 women diagnosed clinically as having pelvic tumours.Intervention: All the patients were subjected to history laking, physical examination, transabdominal and/ortransvaginal ultrasound, pelvic MRI and pathological examination of the specimens.Outcome measures: Specificity of MRI in diagnosis of gynecologic pelvic tumours.Results: We found that the specificity of MRI in the diagnosis of uterine fibromyomata and adenomyosis was 100%. Incases of malignant uterine tumours, we found that MR was the imaging modality of choice in crarly diagnosis andstaging of cndomctrial carcinoma as it exhibits if there is myometrial invasion or not. Ultrasound was false negative in40% of cndomctrial carcinoma. Both ultrasound and MRI were equivocal in diagnosis of benign ovarian lesions, butMRI was superior to ultrasound in diagnosis of benign cxtraovarian lesions. MRI succeeded in diagnosis of thepathological pattern of benign ovarian lesions and in the discrimination between benign and malignant ovarian tumours.Conclusion: MR imaging is a valuable modality in the evaluation of female pelvic tumours when the sonographicdiagnosis is nonspecific.

Expression analysis and RNA localization of PAI-RBP1 ( SERBP1) in epithelial ovarian cancer: Association with tumor progression

Objective The plasminogen activator system (PA) plays an important role in invasion and metastasis of solid tumors. The PA Inhibitor type 1 (PAI-1) is the main physiologic regulator of plasminogen activation. A recently characterized protein, PAI-RBP1 (PAI-1 mRNA Binding Protein 1), appears to regulate the stability of PAI-1 mRNA. Expression of PAI-RBP1 (the new, approved gene symbol is SERBP1) has not been previously analyzed in human tumors. We present herein for the first time expression analysis of PAI-RBP1 in epithelial ovarian cancer. Methods PAI-RBP1 was identified as gene overexpressed in ovarian cancer by an in silico approach using EST database mining. A thorough expression analysis of PAI-RBP1 and PAI-1 was performed in normal ovary ( n = 4), benign ( n = 6) and malignant ( n = 42) ovarian lesions using non-radioactive RNA in situ hybridization and immunohistochemistry, respectively. Results PAI-RBP1 mRNA and PAI-1 were significantly overexpressed in tumor epithelial cells as compared to benign and normal ovarian tissue. A significant correlation between PAI-RBP1 expression and advanced disease stage (FIGO) was found ( p = 0.042). Conclusion In ovarian cancer, PAI-RBP1 is significantly overexpressed in tumor epithelial cells, suggesting a biological role in tumor invasion and metastasis. Its expression is higher in advanced disease, thus the prognostic significance of PAI-RBP1 in ovarian cancer remains to be evaluated in further studies.

A Practical Approach to the Ultrasound Characterization of Adnexal Masses

Because pelvic ultrasound is commonly used to evaluate adnexal masses, it is important to understand the most useful sonographic features for predicting benign and malignant masses. Determining whether an adnexal mass is of ovarian or extraovarian origin is key in arriving at the most likely diagnosis. Most adnexal masses are benign, and each of the most common benign ovarian lesions has a typical sonographic appearance. Additionally, most malignant ovarian neoplasms have a solid component with detectable flow by Doppler ultrasound, allowing one to strongly suggest the diagnosis. We will review an approach to the ultrasound diagnosis of adnexal masses that progresses through a series of 4 questions to help lead one to the most likely diagnosis.