Cases Of Ovarian Tumors Research Articles

Characteristic analysis of autoimmune encephalitis with antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor

The clinical data of 7 patients with anti-α-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid receptor (AMPAR) encephalitis admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2024 were retrospectively collected, and 87 cases with complete literature data were included for summary analysis. Seven casess exhibited limbic encephalitis, including 3 with lung cancer and 1 with thymoma. All cases were treated with glucocorticoids and/or human immunoglobulin. Four cases with concurrent tumors were followed up for 1 to 25 months and all died. Among the 94 patients (7 admitted cases and 87 documented cases), there were 76 cases with tumor (80.9%), including 33 cases of thymoma (43.4%), 23 cases of lung cancer (30.3%), 9 cases of breast cancer (11.8%), and 6 cases of ovarian tumor (7.9%). The tumor was diagnosed in 13 cases (18.8%) before encephalitis, 40 cases (58.0%) within 1 month after encephalitis, 13 cases (18.8%) within 1-6 months, 2 case (2.9%) within 6-12 months, and 1 case (1.4%) after 1 year. Compared to the 18 patients without tumors who were followed up for>1 year, the 76 patients with tumors showed an increase in age and incidence of mental disorders (both P<0.05), while follow-up time and proportion of good prognosis were decreased (both P<0.05). Closely follow-up should be conducted within 1 year after anti-AMPAR encephalitis, especially in the lungs, thymus, breast, and ovaries. The prognosis of patients with tumors is poor, and older age and mental disorders may indicate the occurrence of tumors.

The role of stathmin expression in the differential diagnosis, prognosis, and potential treatment of ovarian sex cord-stromal tumors

BackgroundStathmin, a cytosolic microtubule-destabilizing phosphoprotein involved in the regulation of mitosis, is widely expressed in various malignancies and acts as an adverse prognostic factor. Our research analyzed its immunohistochemical expression on a large cohort of ovarian sex cord-stromal tumors, evaluating its potential utility in differential diagnosis, prognosis, and therapeutic application.MethodsWe examined 390 cases of ovarian sex cord-stromal tumors including 281 adult granulosa cell tumors (AGCT), 5 juvenile granulosa cell tumors (JGCT), 33 Sertoli-Leydig cell tumors (SLCT), 50 fibromas/thecomas (F/T), 11 Leydig cell tumors/steroid cell tumors (LCT/SterCT), 5 sex-cord stromal tumors NOS (SCST-NOS), 3 Sertoli cell tumors (SCT), and 2 sclerosing stromal tumors (ScST). Immunohistochemical analysis was performed using TMAs.ResultsStrong expression (> 50%) was observed in all cases of AGCT, JGCT, SLCT, SCST-NOS, SCT and 1 ScST. The other case of ScST exhibited mild expression (5–10%). The negative cases included exclusively F/T and LCT/SterCT, with F/T showing 24% of negative cases and LCT/SterCT comprising 64% of negative cases.ConclusionThe results of our study indicate that stathmin is neither a prognostic marker nor suitable for the differential diagnosis of challenging cases of ovarian sex cord-stromal tumors. However, its predictive value may be theoretically significant, as a decrease in stathmin expression potentialy influences response to chemotherapy treatment.

A report of twenty cases of ovarian Brenner tumor and literature review: a case series study

BackgroundTo explore the clinical characteristics of ovarian Brenner tumors and provide some basis for the treatment regimen of ovarian Brenner tumors.MethodsA retrospective analysis of the pathology database of surgical specimens at the Huzhou Maternal and Child Health Hospital from September 2008 to February 2023 was conducted. Patients who were pathologically diagnosed with ovarian Brenner tumors were included. Clinical data of patients was collected, and their diagnostic and treatment characteristics were summarized and analyzed.ResultsA total of 20 cases were included in this study, all of which were histologically confirmed by surgical pathology. Among them, 8 cases (40%) were combined with serous, mucinous cystadenoma, or simple cyst. One case presented with a benign ovarian Brenner tumor combined with mucinous cystadenoma, underwent right adnexectomy, and relapsed 5 years later as a malignant Brenner tumor (MBT) coexisting with ovarian squamous cell carcinoma. Multiple tumor markers were elevated malignantly, with CA199 being the most significant. Treatments included unilateral adnexectomy in 7 cases, bilateral adnexectomy in 3 cases, total hysterectomy with bilateral adnexectomy in 7 cases, radical hysterectomy in 1 case, and 2 cases underwent ovarian staging surgery. MBT patients received three cycles of postoperative chemotherapy with the carboplatin-paclitaxel (TC) regimen. Follow-up: One case with concomitant cervical cancer was lost to follow-up after surgery in an external hospital; one case with concomitant ovarian cancer received no further treatment after surgery and was lost to follow-up after 2 years; one case with concomitant endometrial cancer received no further treatment after surgery, and had no recurrence after 4 years of follow-up. Regular follow-up for MBT patients continued for 5 years without recurrence. The remaining 16 cases were followed up for a period ranging from 6 months to 7 years, with no reported recurrences.ConclusionClinical manifestations and auxiliary examinations of ovarian Brenner tumors lack obvious specificity. When necessary, a combination of tumor markers and imaging examinations can aid in diagnosis. Surgical strategies should be selected according to the patient's menopausal status.Trial registrationNot applicable.

The clinical importance of IFN-γ and human epididymis protein 4 in Egyptian patients with epithelial ovarian cancer combined with HPV infection

BackgroundHigh-grade Epithelial Ovarian Cancer (HGEOC) is an aggressive disease that usually presents at an advanced stage. Thus, detecting the circulating cytokines (IFNγ and TNF-α) may serve as a biomarker to identify malignancy and manage therapeutic decisions. ObjectivesAssessing the clinical importance of inflammatory mediators and tumor markers in EOC Egyptian patients compared with benign cases. Moreover, identifying the distinct inflammatory mediators in EOC patients combined with HPV infection. MethodsThis study was conducted on 61 Egyptian patients, divided into 25 patients with HGEOC, 22 patients with LGEOC, and 14 benign ovarian tumor cases. Measurements of serum HE4, CA125, CEA, and CA19-9 were determined by Roche Elecsys immunoassays. Serum levels of TNF-α and IFN-γ were measured using quantitative sandwich ELISA. Quantitative genotyping of HPV DNA types 16, 18, and 45 was assessed for the HPV DNA-positive samples. ResultsHPV DNA was detected in 25.53 % of malignant cases, HPV 16 was detected in 50 % of HPV-positive cases, and only 1 case of HPV 18 was detected out of 12 positive cases. The Human Epididymis protein 4 (HE4) was statistically different between patients with EOC and benign cases (p-value = 0.007) and between HPV DNA positive and HPV DNA negative cases (p-value = 0.008). The serum levels of IFN- γ were statistically different between HGEOC and LGEOC (p-value < 0.001), while the serum levels of TNF-α didn’t differ statistically between the two groups. ConclusionIFN-γ could be used as a biomarker to discriminate HGEOC and LGEOC. Initial evidence for the possible association between HE4 and the progression of HPV-associated EOC was speculated.

Ovarian-adnexal reporting and data system ultrasound evaluation and pathological characteristics of ovarian collision tumor.

Collision tumor are neoplasms, including two histologically distinct tumors that coexist in the same mass without histological admixture. The incidence of collision tumor is low and is rare clinically. To investigate ultrasound images and application of ovarian-adnexal reporting and data system (O-RADS) to evaluate the risk and pathological characteristics of ovarian collision tumor. This study retrospectively analyzed 17 cases of ovarian collision tumor diagnosed pathologically from January 2020 to December 2023. All clinical features, ultrasound images and histopathological features were collected and analyzed. The O-RADS score was used for classification. The O-RADS score was determined by two senior doctors in the gynecological ultrasound group. Lesions with O-RADS score of 1-3 were classified as benign tumors, and lesions with O-RADS score of 4 or 5 were classified as malignant tumors. There were 17 collision tumors detected in 16 of 6274 patients who underwent gynecological surgery. The average age of 17 women with ovarian collision tumor was 36.7 years (range 20-68 years), in whom, one occurred bilaterally and the rest occurred unilaterally. The average tumor diameter was 10 cm, of which three were 2-5 cm, 11 were 5-10 cm, and three were > 10 cm. Five (29.4%) tumors with O-RADS score 3 were endometriotic cysts with fibroma/serous cystadenoma, and unilocular or multilocular cysts contained a small number of parenchymal components. Eleven (64.7%) tumors had an O-RADS score of 4, including two in category 4A, six in category 4B, and three in category 4C; all of which were multilocular cystic tumors with solid components or multiple papillary components. One (5.9%) tumor had an O-RADS score of 5. This case was a solid mass, and a small amount of pelvic effusion was detected under ultrasound. The pathology was high-grade serous cystic cancer combined with cystic mature teratoma. There were nine (52.9%) tumors with elevated serum carbohydrate antigen (CA)125 and two (11.8%) with elevated serum CA19-9. Histological and pathological results showed that epithelial-cell-derived tumors combined with other tumors were the most common, which was different from previous results. The ultrasound images of ovarian collision tumor have certain specificity, but diagnosis by preoperative ultrasound is difficult. The combination of epithelial and mesenchymal cell tumors is one of the most common types of ovarian collision tumor. The O-RADS score of ovarian collision tumor is mostly ≥ 4, which can sensitively detect malignant tumors.

Prediction of ovarian cancer using artificial intelligence tools.

Ovarian cancer is a common type of cancer and a leading cause of death in women. Therefore, accurate and fast prediction of ovarian tumors is crucial. One of the appropriate and precise methods for predicting and diagnosing this cancer is to build a model based on artificial intelligence methods. These methods provide a tool for predicting ovarian cancer according to the characteristics and conditions of each person. In this study, a data set included records related to 171 cases of benign ovarian tumors, and 178 records related to cases of ovarian cancer were analyzed. The data set contains the records of blood test results and tumor markers of the patients. After data preprocessing, including removing outliers and replacing missing values, the weight of the effective factors was determined using information gain indices and the Gini index. In the next step, predictive models were created using random forest (RF), support vector machine (SVM), decision trees (DT), and artificial neural network (ANN) models. The performance of these models was evaluated using the 10-fold cross-validation method using the indicators of specificity, sensitivity, accuracy, and the area under the receiver operating characteristic curve. Finally, by comparing the performance of the models, the best predictive model of ovarian cancer was selected. The most important predictive factors were HE4, CA125, and NEU. The RF model was identified as the best predictive model, with an accuracy of more than 86%. The predictive accuracy of DT, SVM, and ANN models was estimated as 82.91%, 85.25%, and 79.35%, respectively. Various artificial intelligence (AI) tools can be used with high accuracy and sensitivity in predicting ovarian cancer. Therefore, the use of these tools can help specialists and patients with early, easier, and less expensive diagnosis of ovarian cancer. Future studies can leverage AI to integrate image data with serum biomarkers, thereby facilitating the creation of novel models and advancing the diagnosis and treatment of ovarian cancer.

Histopathological and Immunohistochemical Evaluation of Malignant Ovarian Tumours

Objective: To determine the frequency and histological types of malignant ovarian tumours using morphological features and immunohistochemistry. Study Design: Cross-sectional study. Place and Duration of Study: Department of Histopathology, Army Medical College, Rawalpindi Pakistan, Jan 2016 to Dec 2018. Methodology: Newly diagnosed cases of malignant ovarian tumour who had not received chemotherapy were included. Cases of benign ovarian tumours and those who were treated with pre-surgical chemotherapy were excluded. Results: In total, 118 cases of malignant ovarian tumours were evaluated. High-grade serous carcinomas were 61(51.7%), which outnumber others, followed by granulosa cell tumours 17(14.4%), germ cell tumours 13(11%), endometrioid carcinoma 9(7.6%), clear cell carcinoma 4(3.4%), mucinous carcinoma 4(3.4%), low-grade serous carcinoma 2(1.7%) and carcinosarcoma in one case (0.8%). Cancer in the ovary was metastatic in 7(5.9%) cases. No Sertoli Leydig cell tumour, malignant Brenner tumour, embryonal carcinoma or immature teratomas were diagnosed. Conclusion: Surface epithelial tumours were the most common malignancy, followed by granulosa cell tumours and dysgerminoma. An increase in the frequency of ovarian tumours in younger age groups was also noted. Immunohistochemistry was a useful adjuvant diagnostic tool in cases of ovarian malignancy. Metastases to the ovary were mostly gastrointestinal in origin.

Diagnostic value of a CT-based radiomics nomogram for discrimination of benign and early stage malignant ovarian tumors

BackgroundThis study aimed to identify the diagnostic value of models constructed using computed tomography-based radiomics features for discrimination of benign and early stage malignant ovarian tumors.MethodsThe imaging and clinicopathological data of 197 cases of benign and early stage malignant ovarian tumors (FIGO stage I/II), were retrospectively analyzed. The patients were randomly assigned into training data set and validation data set. Radiomics features were extracted from images of plain computed tomography scan and contrast-enhanced computed tomography scan, were then screened in the training data set, and a radiomics model was constructed. Multivariate logistic regression analysis was used to construct a radiomic nomogram, containing the traditional diagnostic model and the radiomics model. Moreover, the decision curve analysis was used to assess the clinical application value of the radiomics nomogram.ResultsSix textural features with the greatest diagnostic efficiency were finally screened. The value of the area under the receiver operating characteristic curve showed that the radiomics nomogram was superior to the traditional diagnostic model and the radiomics model (P < 0.05) in the training data set. In the validation data set, the radiomics nomogram was superior to the traditional diagnostic model (P < 0.05), but there was no statistically significant difference compared to the radiomics model (P > 0.05). The calibration curve and the Hosmer–Lemeshow test revealed that the three models all had a great degree of fit (All P > 0.05). The results of decision curve analysis indicated that utilization of the radiomics nomogram to distinguish benign and early stage malignant ovarian tumors had a greater clinical application value when the risk threshold was 0.4–1.0.ConclusionsThe computed tomography-based radiomics nomogram could be a non-invasive and reliable imaging method to discriminate benign and early stage malignant ovarian tumors.

A Rare Case of Lung Hypoplasia, Cardiac Anomalies and Ovarian Tumour in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome

Hypoplasia of the lung is an uncommon congenital abnormality of the respiratory system in contrast to pulmonary agenesis. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the congenital absence of the upper two-thirds of the vagina and uterus with normal secondary sexual characteristics, ovary and normal karyotype. We report a 31-year-old female patient who presented in 2022 with cough with expectoration, left-side chest pain and breathlessness for 4 years to tertiary hospital, Puducherry, India. She was evaluated for amenorrhoea and diagnosed as MRKH syndrome and the patient underwent right-side oophorectomy for right ovarian torsion with a tumour. Computed tomography pulmonary angiogram and fiberoptic endoscopy were suggestive of left lung hypoplasia and the patient was advised symptomatic treatment for lung hypoplasia and planned for vaginoplasty for which she refused. Keywords: Pulmonary Hypoplasia; Infertility; Mullerian Aplasia; Left-Sided Superior Vena Cava; Case Report; India.

Rare ovarian tumor in post hysterectomized status: case report

Ovarian tumors are known for their silent nature, non-availability of definitive screening methods and varied clinico pathological variations. Conservation of normal looking ovaries macroscopically during hysterectomy is recommended to benefit the future health of the woman. Still the development of new issues related to ovaries need to be counseled to the patient and stringent vigilance by the clinician is mandatory. Steroid cell tumor is rare ovarian tumor and histopathology is the gold standard for diagnosis. Any patient with high testosterone levels should be investigated meticulously to define the origin adrenal/ovarian with an awareness about this rare entity with malignant potential. Lifetime follow up of the ovaries in women are crucial at all ages. Here we report a case of rare ovarian tumor in post hysterectomized patient.

SAT361 A Rare Case of Ovarian Steroid Cell Tumor in a Patient With Known Polycystic Ovarian Syndrome

Abstract Disclosure: O.A. Aluko: None. S. Patel: None. A. Graul: None. M. Deshmukh: None. Introduction.Sex cord stromal cell tumors are rare tumors of the ovary that usually occur inthe first twotothreedecades of life. Specifically, steroid cell tumors of the ovary account for 0.1% of all ovariantumors.Testosterone productionis typical, with hirsutism and virilizationbeing the most commonsymptoms. Amarkedly elevated testosterone level &amp;gt;200ng/dl is animportant diagnostic threshold for discriminatingandrogen- secreting tumors from non-neoplastic lesions.We report acase of ovariansteroid cell tumor inapatient with knownPCOS.Case ReportA 28-year old female with past medical history of PCOS and infertility was referred tothe Endocrinologyoffice for evaluationof worsening hirsutism and elevated testosterone level.She reported increased facial hair especially onher upper lipand chin, abdomenand inner thighs. Shehad ahistory of irregular periods and had beenonoral contraceptives as aresult. She was started onspironolactone 50mg daily by her PCP with noimprovement insymptoms.Bloodwork done prior tovisit showed elevated total testosterone of 312ng/dL (n13-71ng/dL) withelevated free testosterone of 5.8pg/dL (n0.0- 4.2pg/dL). Pelvic ultrasound showed peripherally orientedfollicles inkeeping with knowndiagnosis of PCOS with nosuspicious adnexal mass or loculatedcollections. Repeat bloodwork done three weeks after discontinuing spironolactone showed worsening elevatedserum testosterone of 561ng/dL with elevated free testosterone of 7.7pg/dL. Further workuptorule outother underlying causes returned negative. DHEA-S, Androstenedione, 24hr urinary cortisol, salivarycortisol X3, ACTH, InhibinB, LDH, Ca-125, betaHCG, were all withinnormal limits.CT abdomenand pelvis showed anenhancing nodule inthe right ovary with normal adrenal glands.Repeat pelvic ultrasound showed anew 2.9cm right ovariansolid isoechoic hyperemic nodule O-RADScategory 5(50% risk of malignancy) similar toMRI findings.She underwent aright laparoscopic ovariancystectomy with pathology diagnosis of sex cord steroidal celltumor with noevidence of increased mitotic activity or necrosis. Immuno-histochemistry supported thediagnosis with positive steroidogenic factor-1(SF-1) gene. Repeat total testosterone and freetestosterone levels six weeks after surgery were 44ng/dl and 2.4ng/dl respectively, both withinnormallimits.ConclusionInthe setting of rapid onset hirsutism with significantly elevated testosterone levels, there should be ahigh clinical suspicionfor anandrogensecreting tumor which must be excluded, irrespective of knowndiagnosis of PCOS. Repeat imaging after non-neoplastic processes are ruled out should be consideredas surgical resectionis the primary treatment for ovariansteroid cell tumors and should not be missed. Presentation Date: Saturday, June 17, 2023

Histopathological spectrum of ovarian tumors in tertiary care centre of central India

Abstract Background: Ovarian tumors are common, ranking third in frequency after cervical and uterine cancer. According to the World Ovarian Cancer Coalition Atlas 2018, India has the second-highest incidence of ovarian carcinoma worldwide. In Chhattisgarh, ovarian malignancy accounts for 5.21% of all malignancies in females. Materials and Methods: The present descriptive observational cross-sectional study encompassed 108 cases of ovarian tumors. A histopathological examination was done, and data was compiled and analyzed. Observations and Results: Among the 108 ovarian tumors, 59.25% were noted in women aged 40–59 years. The primary presenting symptom was abdominal pain, reported by 57.40% of the cases. The majority of ovarian tumors were unilateral, the right side being more common. Primary ovarian tumors constituted 91.66%, while 8.33% were classified as secondary or metastatic ovarian tumors. Of 108 cases, 55.5% were malignant, 40.7% were benign, and 3.7% were borderline tumors. Surface epithelial tumors accounted for 73.14% of the cases; germ cell tumors constituted 9.25%, sex cord-stromal tumors were 7.4%, and mesenchymal tumors were 1.85%. Among surface epithelial tumors, serous cystadenocarcinoma was most common. Mature cystic teratoma was the most common germ cell tumor, and granulosa cell tumor was the most common sex cord-stromal tumor. Conclusion: Ovarian tumors were more commonly seen in the peri and postmenopausal age group. Primary malignant epithelial tumors were the most common type of ovarian tumor. The histopathological evaluation of ovarian tumors remains the gold standard for definitive diagnosis.

Evaluation of estrogen receptor, progesterone receptor, and Ki 67 immunoexpression in epithelial ovarian tumors with histopathological correlation

Abstract Background: Ovarian cancer ranks sixth among women’s cancers globally and seventh among cancer-related deaths. Around 90% of ovarian cancers have an epithelial genesis. Steroid hormones like progesterone and estrogen largely influence the development of ovarian cancers. In ovarian neoplasms, the proliferation marker Ki 67 helps forecast the course of the disease. Objective: To study the immunohistochemical expression pattern of estrogen receptor (ER), progesterone receptor (PR), and Ki 67 in the surface epithelial ovarian tumors (SEOTs) and correlate the findings with the standard histopathological. Materials and Methods: This prospective study was conducted in the Department of Pathology, MKCG Medical College and Hospital, Brahmapur, from November 2020 to October 2022 on 62 surface epithelial ovarian tumor cases. All the patients were evaluated for standard histopathological parameters and immuno-histochemistry (IHC) status using ER, PR, and Ki 67 as primary antibodies. Results: A total of 62 cases of SEOTs constituted the study group, of which 42 (67.74%) were benign, 5 (8.06%) were borderline, and 15 (24.2%) were malignant on histopathological evaluation: serous SEOTs (41, 66.12%), mucinous SEOTs (18, 29.03%), endometrioid SEOTs (2, 3.22%), and clear cell carcinoma (1, 1.61%). ER expression was more in malignant tumors (10/15; 66.66%) than in borderline (3/5; 60%) and benign (11/42; 26.19%), but the expression of PR was more in benign (27/42; 64.28%), followed by borderline (3/5; 60%) and malignant (8/15; 53.33%) SEOTs. Expression of Ki 67 was found to be more malignant (14/15; 93.33%) than borderline (4/5; 80%) and benign (2/42; 4.76%) SEOTs. Conclusion: ER and Ki 67 were expressed more in malignant, followed by borderline and benign, whereas PR expression was more innocent than borderline and malignant.

Immunohistochemical Evaluation of Notch1 in Ovarian Tumours and Its Prognostic Implications.

Ovarian cancer is the fifth most common malignancy among women and the second most common gynaecological malignancy. Surface epithelial ovarian tumours constitute two-thirds of all ovarian tumours. Most high-grade serous carcinoma patients gain an initial complete response but eventually succumb to relapse and death leaving the overall survival grim. Therefore, new regimens targeting the pathways involved in metastasis and chemoresistance are essential for the development of more effective therapies. Notch signalling is one of the pleiotropic signalling pathways that plays a key role in differentiation and tissue morphogenesis. It has been observed that this Notch signalling pathway is seen to be deregulated in various cancers. It is thought to have an oncogenic role in ovarian cancer. Our objective in this study is to evaluate theimmunohistochemical expression pattern of Notch1 in surface epithelial ovarian tumours and its correlation with the clinicopathological profile. This study includes a total of 100 cases of borderline and malignant surface epithelial ovarian tumours. Clinical data of the patients were obtained from the medical records section. HPE slides were examined and one representative paraffin block was selected for each patient. IHC of Notch1 was performed and analyzed. The staining pattern for Notch1 was calculated using the Q score. Immunohistochemistry (IHC) evaluation of Notch1 in surface epithelial ovarian tumours in this study showed an increased intensity of Notch1 staining in high-grade serous malignant tumours.The grading and staging of tumours were compared with Notch1 expression. Statistical analysis was performed using Spearman Rank order correlation analysis. There was a significant correlation (0.01 level, two-tailed)between the grading and staging of ovarian tumours and Notch1 expression. Assessing Notch1 expression in ovarian cancer by IHC is a useful tool in view of its clinical applications, development oftargeted therapies andas a marker of prognosis. The intensity of the Notch1 stain appears to be directly proportional to the grade of tumour. This may offer a potential targeted therapy against the Notch signalling pathway in tumours that strongly express Notch1.

Microsatellite instability in non-endometrioid ovarian epithelial tumors: a study of 400 cases comparing immunohistochemistry, PCR, and NGS based testing with mutation status of MMR genes

Testing of microsatellite instability is not only used as a triage for possible Lynch syndrome, but also to predict immunotherapy treatment response. The aim of this study was to assess the frequency of mismatch repair deficiency (MMR-D) / microsatellite instability (MSI) in 400 cases of non-endometrioid ovarian tumors (high-grade serous, low-grade serous, mucinous and clear cell), to compare different methodological approaches of testing, and to assess the optimal approach for next generation sequencing (NGS) MSI testing. For all tumors, we evaluated immunohistochemical (IHC) expression of MMR proteins and assessed microsatellite markers by PCR-based method. Except for high-grade serous carcinoma, we correlated the findings of IHC and PCR with NGS-based MSI testing. We compared the results with somatic and germline mutation in MMR genes. Among the whole cohort, seven MMR-D cases, all clear cell carcinomas (CCC), were found. On PCR analysis, six cases were MSI-high and one was MSS. In all cases, mutation of an MMR gene was found; in two cases, the mutation was germline (Lynch syndrome). An additional five cases with a mutation in MMR gene(s) with MSS status and without MMR-D were identified. We further utilized sequence capture NGS for MSI testing. Employing 53 microsatellite loci provided high sensitivity and specificity. Our study shows that MSI occurs in 7% of CCC while it is rare or absent in other non-endometrioid ovarian neoplasms. Lynch syndrome was present in 2% of patients with CCC. However, some cases with MSH6 mutation can evade all testing methods, including IHC, PCR, and NGS-MSI.

Granulosa cell tumor of the ovary: Clinical features, treatment, and outcome factors: A study report of 25 cases

Introduction: Ovarian granulosa tumors are malignant tumors belonging to the group of sexual cord and stromal tumors. Two histological forms are distinguished: a form of adult which is the most common, and a much rarer juvenile form. Case Report: Our study is retrospective and concerned 25 cases of ovarian granulosa tumor, collected at the Mohammed VI center for the treatment of gynecological mammary cancers at the Ibn Rochd University Hospital in Casablanca during the period from January 2010 to December 2021. It aims to study the clinical, radiological, anatomopathological, therapeutic, and prognostic features of this tumor. Conclusion: Granulosa cell tumor of the ovary is a rare malignancy with a particularly slow evolution; got is characterized by the frequency of the stages localized, its tendency to late recurrence. The prognosis of the tumor granulosa of the ovary is relatively good and depends mainly on the stage (FIGO).

Clinicopathological Parameters Associated With Peritoneal Involvement in Epithelial Ovarian Tumors.

Introduction Ovarian tumors remain one of the leading malignancies of the female genital tract, with a high mortality rate due to their insidious onset and lack of detection at an earlier stage. These tumors metastasize by direct extension into the neighboring pelvic organs; hence, the detection of peritoneal metastasis is valuable for staging and prognostic purposes. Peritoneal wash cytological analysis is an effective predictor of the involvement of the ovarian surface and peritoneal dissemination even in subclinical involvement of the peritoneum. The study aims to determine the significance of peritoneal wash cytology as a prognostic parameter and correlate it with various clinicohistological features. Methods A retrospective study was conducted at the Department of Histopathology, Liaquat National Hospital, Karachi, Pakistan, between July 2017 and June 2022. During this period, all the cases of ovarian tumors (borderline and malignant) that underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omental and lymph node sampling were included in the study. After opening the abdominal cavity, the free fluid present was aspirated immediately, the peritoneum was lavaged with 50-100 mL of warm saline, and samples were collected and sent for cytological analysis. Four cytospin smear slides and cell block preparation were prepared. The findings of peritoneal cytology were correlated with various clinicohistological features. Results A total of 118 cases of ovarian tumors were included in the study. Serous carcinoma was the most common sub-type (50.8%), followed by endometrioid carcinoma (14.4%), and the mean age at diagnosis was found to be 49.9±14.9 years. The mean tumor size was 11.2 cm. The majority of the cases of ovarian carcinoma were of high grade (78.8%), with capsular invasion present in 61% of cases. Positive peritoneal cytology was noted in 58.5% of cases, with omental involvement in 52.5% of cases. Serous carcinoma showed the highest frequency of positive cytology (69.6%) and omental metastasis (74.2%). Apart from tumor type, positive peritoneal cytology showed a significantly positive correlation with age, tumor grade, and capsular invasion. Conclusion Based on our study findings, we conclude that peritoneal wash cytology is a sensitive indicator of the peritoneal spread of ovarian carcinoma, with a significant prognostic value. Serous carcinomas, especially high-grade with capsular invasion, were found to be predictors of peritoneal involvement of ovarian tumors. Although we found smaller tumors to be associated with peritoneal disease more compared to larger ones, this most likely is attributed to tumor histology, as larger tumors were most commonly mucinous compared to serous carcinomas.

A comprehensive immunohistochemical analysis of 26 markers in 250 cases of serous ovarian tumors

BackgroundWe examined a large cohort of serous tubo-ovarian tumors with 26 immunohistochemical markers, with the aim to assess their value for differential diagnosis and prognosis.MethodsImmunohistochemical analyses with 26 immunomarkers were performed on 250 primary tubo-ovarian tumors including 114 high grade serous carcinomas (HGSC), 97 low grade serous carcinomas (LGSC), and 39 serous borderline tumors (micropapillary variant, mSBT). The associations of overall positivity with clinicopathological characteristics were evaluated using the chi-squared test or Fisher’s Exact test.ResultsWe found significantly different expression of p53, p16, ER, PR, PTEN, PAX2, Mammaglobin, RB1, Cyclin E1, stathmin, LMP2, L1CAM, CD44, and Ki67 in HGSCs compared to LGSCs. No significant differences were found between LGSC and mSBT. None of the other included markers (PAX8, ARID1A, HNF1B, Napsin A, CDX2, SATB2, MUC4, BRG1, AMACR, TTF1, BCOR, NTRK) showed any differences between the investigated serous tumors. Regarding the prognosis, only PR and stathmin showed a statistically significant prognostic meaning in LGSCs, with better overall survival (OS) and recurrence-free survival (RFS) in cases positive for PR, and worse outcome (RFS) for stathmin. None of the study markers showed prognostic significance in HGSCs.ConclusionWe provided an extensive immunohistochemical analysis of serous ovarian/tubo-ovarian tumors. Although we found some differences in the expression of some markers in HGSCs compared to LGSCs, only p53, p16, and Ki67 seem to be useful in real diagnostic practice. We also suggested the best discriminative cut-off for Ki67 (10% of positive tumor cells) for distinguishing HGSC from LGSC. We found prognostic significance of PR and stathmin in LGSCs. Moreover, the high expression of stathmin could also be of predictive value in ovarian carcinomas as target-specific anti-stathmin effectors are potential therapeutic targets.

A comprehensive immunohistochemical analysis of IMP2 and IMP3 in 542 cases of ovarian tumors

BackgroundIMP2 and IMP3 are mRNA binding proteins involved in carcinogenesis. We examined a large cohort of ovarian tumors with the aim to assess the value of IMP2 and IMP3 for differential diagnosis, and to assess their prognostic significance.MethodsImmunohistochemical analyses with antibodies against IMP2 and IMP3 were performed on 554 primary ovarian tumors including 114 high grade serous carcinomas, 100 low grade serous carcinomas, 124 clear cell carcinomas, 54 endometrioid carcinomas, 34 mucinous carcinomas, 75 mucinous borderline tumors, and 41 serous borderline tumors (micropapillary variant). The associations of overall positivity with clinicopathological characteristics were evaluated using the chi-squared test or Fisher’s Exact test.ResultsWe found IMP2 expression (in more than 5% of tumor cells) in nearly all cases of all tumor types, so the prognostic meaning could not be analyzed. The positive IMP3 expression (in more than 5% of tumor cells) was most common in mucinous carcinomas (82%) and mucinous borderline tumors (81%), followed by high grade serous (67%) and clear cell carcinomas (67%). The expression was less frequent in endometrioid carcinomas (39%), low grade serous carcinomas (23%), and micropapillary variant of serous borderline tumors (20%). Prognostic significance of IMP3 could be evaluated only in low grade serous carcinomas in the case of relapse-free survival, where negative cases showed better RFS (p = 0.033).ConclusionConcerning differential diagnosis our results imply that despite the differences in expression in the different ovarian tumor types, the practical value for diagnostic purposes is limited. Contrary to other solid tumors, we did not find prognostic significance of IMP3 in ovarian cancer, with the exception of RFS in low grade serous carcinomas. However, the high expression of IMP2 and IMP3 could be of predictive value in ovarian carcinomas since IMP proteins are potential therapeutical targets.

A Case of Adolescent Ovarian Sertoli-Leydig Cell Tumor and Literature Review

A Case of Adolescent Ovarian Sertoli-Leydig Cell Tumor and Literature Review