Epithelial Ovarian Tumors Research Articles

ClinicoPathological Overview of Ovarian Tumors and Diagnostic Utility of Imprint Cytology

Introduction: For intra-operative diagnosis of ovarian tumors, imprint cytology is the method which gives result within 20 min. It does not affect the quality and utility of the specimen for histopathology. Despite advances in genetics and imaging, histopathological analysis remains the mainstay of ovarian tumor diagnosis. Aim: To describe incidence, age distribution, histological characteristics and whenever feasible, correlate the histopathological diagnosis of ovarian tumors with the imprint cytology technique. Materials and Methods: A total of 200 patients with ovarian tumors were included in this ambispective study from January 2017 to April 2022 at the Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri. Results: One hundred and forty-eight (74%) of the 200 cases were benign, while 52 (26%) were malignant. The peak age incidence of benign tumors was in the second to fourth decades and malignant ovarian tumors was in fourth to sixth decades. Ovarian tumors involved the left ovary (n = 104, 52%) more than the right ovary (n = 90, 45%). Out of 200 cases, 130 cases (65%) were surface epithelial ovarian tumors, followed by 50 cases (25%) were germ cell tumors, followed by 14 cases (7%) were sex cord stromal tumors followed by 3 cases (3%) were secondary/metastatic tumors of ovary. Imprint cytology technique done on 148 cases (74%) showed 100% correlation with the histopathological diagnosis. Conclusion: Imprint cytology diagnosis correlated with the histopathological diagnosis of ovarian tumors.

Frequency of thoracic recurrence based on pathological features in patients with ovarian epithelial tumors in stage I versus higher stages

PurposeThe aim of this study was to clarify the frequency of thoracic recurrence and identify associated pathological features in postoperative patients with borderline or malignant ovarian epithelial tumors (BMOT) in stage I versus higher stages.Materials and methodsA total of 368 consecutive patients with a single primary BMOT were treated at our hospital. This study included the 217 patients with no residual disease on the first CT after standard treatment. The timing and pattern of recurrence on follow-up CT images with a scan range from chest to pelvis were evaluated retrospectively. Patient characteristics, tumor histology, and stage were recorded from electronic medical records.ResultsAfter a median follow-up period of 48 months, recurrence was detected by CT in 9 patients in stage I (n = 159) and 15 in stage II/III (n = 58) (p = 0.0001). Thoracic recurrence was detected in four patients in stage I and four in stage II/III (p = 0.15). Abdominal recurrence was identified as a factor associated with thoracic recurrence (P < 0.001). Clear cell carcinomas accounted for three out of four thoracic recurrences in stage I and two out of four in stage II/III, and had the highest rates of thoracic recurrence (7.7% in stage I and 22.2% in stage II/III) among all histological types associated with thoracic recurrence. Among patients with recurrence, thoracic recurrence-free probability (p = 0.38), median abdominal recurrence-free interval (18 vs 16 months; p = 0.55) and thoracic recurrence-free interval (16.5 vs 23 months; p = 0.89) did not differ significantly between stage I and stage II/III.ConclusionThe frequency and timing of thoracic recurrence did not differ significantly in postoperative patients with BMOT in stage I versus stage II/III. Abdominal recurrence and a histological type of clear cell carcinoma were most often associated with thoracic recurrence in stage I.

Features of distribution of intratumoral lymphocytes in ovarian epithelial tumours of different histological types and degree of malignancy

Ovarian cancer is the leading cause of death from gynaecological cancers worldwide. In Georgia, ovarian cancer ranks fourth in terms of prevalence, and third in terms of mortality rate. According to the latest epidemiological data, there will be 21,421 new cases of ovarian cancer and 13,770 deaths from ovarian cancer in the United States in 2021. Due to the lack of early screening methods and asymptomatic clinical courses, most ovarian cancer is diagnosed at an advanced stage, when the prognosis of the disease is already poor. Despite the advances in modern medical treatment and surgery, ovarian carcinoma remains the most lethal gynaecological cancer. The 5-year survival rate is 46% for all stages combined. The microenvironment of ovarian carcinomas is mainly represented by macrophages, dendritic cells, neutrophils and lymphocytes. Epithelial ovarian carcinoma-infiltrating lymphocytes (TIL) have attracted much interest in the last five years. Ovarian cancer is a heterogeneous disease concerning tumour-infiltrating lymphocytes and TILs. In terms of histological subtypes, most studies include only high-grade serous carcinomas of the ovary, and studies on other histological types are scarce. The results of our study show that the quantitative evaluation of T lymphocytes and their subpopulations does not show a statistically reliable correlation between different histological types of tumours, which may be due to the intratumoral heterogeneity and individual specificity of tumours.

Diffusion-weighted imaging-based radiomics in epithelial ovarian tumors: Assessment of histologic subtype.

Epithelial ovarian tumors (EOTs) are a group of heterogeneous neoplasms. It is importance to preoperatively differentiate the histologic subtypes of EOTs. Our study aims to investigate the potential of radiomics signatures based on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps for categorizing EOTs. This retrospectively enrolled 146 EOTs patients [34 with borderline EOT(BEOT), 30 with type I and 82 with type II epithelial ovarian cancer (EOC)]. A total of 390 radiomics features were extracted from DWI and ADC maps. Subsequently, the LASSO algorithm was used to reduce the feature dimensions. A radiomics signature was established using multivariable logistic regression method with 3-fold cross-validation and repeated 50 times. Patients with bilateral lesions were included in the validation cohort and a heuristic selection method was established to select the tumor with maximum probability for final consideration. A nomogram incorporating the radiomics signature and clinical characteristics was also developed. Receiver operator characteristic, decision curve analysis (DCA), and net reclassification index (NRI) were applied to compare the diagnostic performance and clinical net benefit of predictive model. For distinguishing BEOT from EOC, the radiomics signature and nomogram showed more favorable discrimination than the clinical model (0.915 vs. 0.852 and 0.954 vs. 0.852, respectively) in the training cohort. In classifying early-stage type I and type II EOC, the radiomics signature exhibited superior diagnostic performance over the clinical model (AUC 0.905 vs. 0.735). The diagnostic efficacy of the nomogram was the same as that of the radiomics model with NRI value of -0.1591 (P = 0.7268). DCA also showed that the radiomics model and combined model had higher net benefits than the clinical model. Radiomics analysis based on DWI, and ADC maps serve as an effective quantitative approach to categorize EOTs.

Application of enhanced computed tomography-based radiomics nomogram analysis to differentiate metastatic ovarian tumors from epithelial ovarian tumors.

To investigate the value of nomogram analysis based on conventional features and radiomics features of computed tomography (CT) venous phase to differentiate metastatic ovarian tumors (MOTs) from epithelial ovarian tumors (EOTs). A dataset involving 286 patients pathologically confirmed with EOTs (training cohort: 133 cases, validation cohort: 68 cases) and MOTs (training cohort: 54 cases, validation cohort: 31 cases) is assembled in this study. Radiomics features are extracted from the venous phase of CT images. Logistic regression is employed to build models based on conventional features (model 1), radiomics features (model 2), and the combination of model 1 and model 2 (model 3). Diagnostic performance is assessed and compared. Additionally, a nomogram is plotted for model 3, and decision curve analysis is applied for clinical use. Age, abdominal metastasis, para-aortic lymph node metastasis, location, and septation are chosen to build Model 1. Ten optimal radiomics features are ultimately selected and radiomics score (rad-score) is calculated to build Model 2. Nomogram score is calculated to build model 3 that shows optimal diagnostic performance in both the training (AUC = 0.952) and validation cohorts (AUC = 0.720), followed by model 1 (AUC = 0.872 for training cohort and AUC = 0.709 for validation cohort) and model 2 (AUC = 0.833 for training cohort and AUC = 0.620 for validation cohort). Additionally, Model 3 achieves accuracy, sensitivity, and specificity of 0.893, 0.880, and 0.926 in the training cohort and 0.737, 0.853, and 0.613 in the validation cohort. Model 3 demonstrates the best diagnostic performance for preoperative differentiation of MOTs from EOTs. Thus, nomogram analysis based on Model 3 may be used as a biomarker to differentiate MOTs from EOTs.

WITHDRAWN: Thoracic spinal metastasis as recurrence of borderline Brenner tumor without local recurrence: A case report

Brenner tumor is a rare epithelial ovarian neoplasm that accounts for 2-3% of all ovarian neoplasms. Herein, we report the first case of thoracic spinal metastasis of recurrent Brenner tumor without local recurrence.Case Description.A 70-year-old female presented with a feeling of abdominal distension. Computed tomography revealed cystic lesions in her bilateral ovaries. Blood examination revealed high CA-125 [74.9 U/ml]. We excised bilateral ovaries, uterus, and omentum. Borderline Brenner tumor was diagnosed [Ki-67 labeling index: 10%]. Follow-up abdominal echo and CA-125 examination revealed no local recurrence. 26months later she developed paraplegia. Magnetic resonance imaging revealed tumor in the 5th-9th thoracic vertebra and compression of spinal cord at the 6th thoracic vertebra level. Her paraplegia was progressive. We performed semi-urgent partial resection of tumor and release of spinal cord compression. Spinal metastasis from Brenner tumor was diagnosed [Ki-67 labeling index: 50-60%]. She received adjuvant radiation of 30Gy in 10 fractions to the 4th-10th thoracic vertebra. After radiation and rehabilitation, she was discharged home on foot. She received adjuvant radiation and chemotherapy but died 11months after spinal surgery. An autopsy has not been performed on her, and the cause of death is unknown. We report the first case of thoracic metastasis of recurrent Brenner tumor without local recurrence.

Comparison of Clinico-Pathological Features Between Epithelial Ovarian Cancer Patients With and Without Endometriosis: A Cross-Sectional Study

Objectives: Women with endometriosis have a high risk of developing ovarian carcinoma that may occur due to endometriosis lesions. There is few research have so far focused on the clinical factors in patients with endometriosis-associated ovarian cancer (EAOC). Accordingly, this study aimed at comparing the demographic and obstetric characteristics between ovarian cancer with and without endometriosis Materials and Methods: This cross-sectional study was conducted on 20 EAOC patients and 140 non-EAOC individuals who had gone under surgery from 2011-17 at Al-Zahra hospital. Clinico-pathological characteristics of the two groups including first group only had malignant epithelial ovarian tumor (non-EAOC) and second group had both malignant epithelial ovarian tumor and endometriosis (EAOC). P value less than 0.05 was considered statistically significant. Results: EAOC cases were significantly younger (P=0.002) and had lower number of pregnancy (P=0.002), parity (P=0.004), and term pregnancy (P=0.005) than non-EAOC patients. A large proportion of EAOC cases had clear cell and endometrioid histopathology in comparison to non-EAOC individuals (P&lt;0.001) and most of the tumors in these cases were unilateral (P=0.01). Conclusions: We found that age, parity, gravidity, and term pregnancy as well as laterality and histopathologic type of epithelial ovarian cancers vary in EAOC and non-EAOC individuals. Further research is required to identify these differences.

GYNECOLOGICAL MALIGNANCIES

A large study of tumors of low malignant potential confirmed the favorable survival in this group of patients compared to invasive epithelial ovarian tumors. Only 8% of patients died with recurrent disease after surgery. Patients with stage IA borderline tumors with mucinous histology tended to recur later and carried a poorer prognosis than patients with serous histology and similar stage. The group at highest risk for relapse were age greater than 70, stage II or III tumors, and histology other than serous. Long-term survival in this group was less than 75%. This high-risk group of patients should be targeted for innovative adjuvant treatment strategies. This year several well-designed studies with large sample sizes showed DNA ploidy to be an important new independent prognostic factor in stage I ovarian carcinoma. In patients with well-differentiated early stage ovarian cancer, DNA flow cytometric analysis may indicate subgroups with less favorable prognostic characteristics. This method of analysis may be beneficial in determining the need for additional treatments after surgery for early stage ovarian carcinoma. Recommendations for the definitive management of early stage ovarian cancer awaits completion of current GOG and European randomized prospective studies. Paclitaxel given in combination with platinum-containing agents is an intense area of research for treatment of advanced stage disease. Early data from a prospective randomized trial of patients with advanced ovarian cancer showed a higher response rate and longer disease-free survival in patients treated with paclitaxel and cisplatin compared to a standard regimen of cyclophosphamide and cisplatin. The impact of this treatment on long-term survival awaits maturation of data. Preliminary results evaluating G-CSF in combination with paclitaxel and cisplatin for dose escalation was reported. Paclitaxel, 250 mg/m2, and cisplatin, 75 mg/m2, were the maximally tolerated doses, with peripheral neuropathy or myalgias the dose limiting toxicities. Further studies are now underway to test the effect of dose-response with escalation therapies and to determine the optimal dose and schedule for the management of patients with advanced ovarian cancer. IL-3 significantly ameliorated neutropenia but did not prevent cumulative platelet toxicity in a regimen utilizing high-dose carboplatin. This mild improvement in myelosuppression was obtained at the cost of significant toxicity. Nausea, vomiting, malaise, bone pain, headache, fever, chills and facial flushing were frequent. Intraperitoneal chemotherapy was tested as a means of consolidation treatment for patients after having a negative second-look laparotomy. These treatments were shown to be feasible; however, prospective randomized trials will be necessary to determine a benefit over operative therapy alone. Several studies addressed to problem of residual disease after primary surgery and adjuvant chemotherapy. A large phase II study conducted by the GOG confirmed the activity of salvage cisplatin-based intraperitoneal chemotherapy in patients with small-volume residual ovarian cancer with favorable pretreatment characteristics. Whether intraperitoneal platinum-based therapy represents an advantage over systemic platinum therapy is being addressed in a prospective SWOG study. The use of six additional cycles of CAP for treatment of residual disease after primary treatment of surgery and adjuvant chemotherapy did not significantly improve complete pathological response and survival. Prolonged duration of chemotherapy above six cycles is not likely to impact treatment for residual disease. A regimen of high dose carboplatin was compared to whole abdominal radiotherapy for treatment of residual disease after initial chemotherapy. There was no difference in survival or disease-free survival between treatments.(ABSTRACT TRUNCATED)

Endogenous Propionibacterium acnes Promotes Ovarian Cancer Progression via Regulating Hedgehog Signalling Pathway.

The oncogenesis and progression of epithelial ovarian cancer (EOC) is a complicated process involving several key molecules and factors, yet whether microbiota are present in EOC, and their role in the development of EOC, remains greatly unknown. In this study, 30 patients were enrolled to compare the similarities and differences of intratumour microbiota among patients with epithelial benign ovarian tumours (EBOTs) and patients with EOC based on the high-throughput sequencing method. Subsequently, we further isolated the specific EOC-related bacteria and defined Propionibacterium acnes as a key strain in facilitating EOC progression. More importantly, we constructed a mouse EOC model to evaluate the effect of the P. acnes strain on EOC using immunohistochemistry, Western blotting, and RT-qPCR. The high-throughput sequencing showed that the intratumour microbiota in EOC tissues had a higher microbial diversity and richness compared to EBOT tissues. The abundance of previously considered pathogens, Actinomycetales, Acinetobacter, Streptococcus, Ochrobacterium, and Pseudomonadaceae Pseudomonas, was increased in the EOC tissues. Meanwhile, we discovered the facilitating role of the P. acnes strain in the progression of EOC, which may be partially associated with the increased inflammatory response to activate the hedgehog (Hh) signalling pathway. This microbial-induced EOC progression mechanism is further confirmed using the inhibitor GANT61. This study profiled the intratumour microbiota of EBOT and EOC tissues and demonstrated that the diversity and composition of the intratumour microbiota were significantly different. Furthermore, through in vivo and in vitro experiments, we confirmed the molecular mechanism of intratumour microbiota promotion of EOC progression in mice, which induces inflammation to activate the Hh signalling pathway. This could provide us clues for improving EOC treatment.

The Toll-like Receptor 4 Polymorphism Asp299Gly Is Associated with an Increased Risk of Ovarian Cancer.

Ovarian cancer (OC) is one of the most common cancers threatening women’s lives around the world. Epithelial ovarian tumors represent the most common ovarian neoplasms. Most OC patients are diagnosed at the advanced stage, and there is an urgent need to identify novel biomarkers of the disease. Single-nucleotide polymorphisms (SNPs) in TLR genes may serve as crucial markers of cancer susceptibility. We investigated the frequency of TLR polymorphisms in a group of 200 women, including 70 with OC. Four SNPs, two each in TLR4 (rs4986790 and rs4986791) and TLR9 (rs187084 and rs5743836), were analyzed using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). The digested fragments were separated and identified by multicapillary electrophoresis. The load quantification of human papillomavirus (HPV) types 16/18 was determined using a digital droplet PCR method. We found an increased frequency of heterozygous genotype and minor allele of the TLR4 rs4986790 SNP in women with OC compared with healthy controls, and this result remained highly significant after Bonferroni’s correction for multiple testing (p < 0.0001). No evidence of linkage disequilibrium was found with any of the examined TLR SNPs. The findings suggest that the TLR4 Asp299Gly polymorphism could be a genetic risk factor for the development of OC.

Ovarian mucinous cystadenocarcinoma in an 11-year-old girl

Epithelial ovarian tumors are extremely rare in the pediatric age group. Mucinous cystadenocarcinoma in children, a rare form of epithelial tumor, is a malignant cystic ovarian neoplasm. To our knowledge, there are only five cases of mucinous cystadenocarcinoma reported in the English-language in the pediatric age. Here we present a case of an 11-year- old girl with a giant ovarian mucinous cystadenocarcinoma.

Prognostic relevance of autophagy-related markers p62, LC3, and Beclin1 in ovarian cancer

To analyze the expression of autophagy markers p62, LC3, and Beclin1 in ovarian cancer tissue and evaluate the prognostic potential of these markers. The study enrolled 328 patients: 122 with epithelial ovarian carcinoma, 42 with atypical proliferative tumor, and 164 with benign epithelial ovarian tumor. The expression of p62, LC3, and Beclin1 was analyzed in central and invasive tumor segments with immunohistochemistry combined with tissue microarray. The expression levels of the analyzed markers were correlated with relevant histopathology parameters. The expression of all analyzed markers was most remarkable in epithelial ovarian carcinoma. There was a strong positive correlation between the expressions of p62 and LC3, while these two markers negatively correlated with Beclin1. High-grade serous carcinoma had higher p62 and LC3 levels, and lower Beclin1 levels than other tumor types. This expression profile was also observed in more advanced tumor stages. Prominent p62 and LC3 expression in combination with weak Beclin1 expression in high-grade serous carcinoma indicates potential for the application of autophagy inhibitors in patients with this tumor subtype.

Serous papillary cystadenofibroma of ovary: A rare entity diagnosed on frozen section

Ovarian cystadenofibroma are rare slow growing benign epithelial ovarian neoplasms. It usually occurs as solid and cystic component. Most of the tumours are asymptomatic and detected incidentally during abdominal ultrasound for some other purpose. They may mimick malignant neoplasm with their gross appearance and imaging modalities. So a diagnosis of serous papillary cystadenofibroma of ovary on frozen section can save the patient from unwanted extensive surgery. We here in discuss a case of serous papillary cystadenofibroma of ovary in a 45 year old multipara that was diagnosed initially on frozen section and later confirmed on histopathology, thus highlighting the role of frozen section in diagnosis of intraoperative ovarian neoplasms.

Molecular Characterizations of Gynecologic Carcinosarcomas: A Focus on the Immune Microenvironment.

Simple SummaryGynecologic carcinosarcomas are rare and highly aggressive tumors. Despite treatment, response rates are low, and the survival outcomes of patients with carcinosarcoma are far worse than high-grade tumors of the same origin. Due to this, there is a need for new, tailored therapies. The role of immunotherapy has not been extensively studied in gynecologic carcinosarcomas, but emerging studies suggest that there is a potential role that should be explored further. The aim of this review is to outline the current knowledge about gynecologic carcinosarcomas, with a focus on their molecular profiles and the tumor immune microenvironment, and discuss possible directions for future research.Gynecologic carcinosarcomas, specifically of endometrial and ovarian origin, are aggressive and rare tumors. Treatment data are limited and are often extrapolated from other histologies and smaller retrospective studies. While the optimal therapy approach remains contentious, treatment is often multimodal and may include surgery, chemotherapy, radiation, or a combination of multiple strategies. However, despite aggressive treatment, these tumors fare worse than carcinomas of the same anatomic sites irrespective of their stage. Recent studies have described in-depth molecular characterizations of gynecologic carcinosarcomas. Although many molecular features mirror those seen in other uterine and ovarian epithelial tumors, the high prevalence of epithelial-mesenchymal transition is more unique. Recently, molecular descriptions have expanded to begin to characterize the tumor immune microenvironment. While the importance of the immune microenvironment has been well-established for other tumor types, it has been less systematically explored in gynecologic carcinosarcomas. Furthermore, the use of immunotherapy in patients with gynecologic carcinosarcomas has not been extensively evaluated. In this review, we summarize the available data surrounding gynecologic carcinosarcomas, with a focus on the immune microenvironment. We end with a discussion of potential immunotherapy uses and future directions for the field.

Blood-based DNA methylation profiling for the detection of ovarian cancer

ObjectivesOvarian cancer is a fatal gynecological cancer due to the lack of effective screening strategies at early stage. This study explored the utility of DNA methylation profiling of blood samples for the detection of ovarian cancer. MethodsTargeted bisulfite sequencing was performed on tissue (n = 152) and blood samples (n = 373) obtained from healthy women, women with benign ovarian tumors, or malignant epithelial ovarian tumors. Based on the tissue-derived differentially-methylated regions, a supervised machine learning algorithm was implemented and cross-validated using the blood-derived DNA methylation profiles of the training cohort (n = 178) to predict and classify each blood sample as malignant or non-malignant. The model was further evaluated using an independent test cohort (n = 184). ResultsComparison of the DNA methylation profiles of normal/benign and malignant tumor samples identified 1272 differentially-methylated regions, with 49.4% hypermethylated regions and 50.6% hypomethylated regions. Five-fold cross-validation of the model using the training dataset yielded an area under the curve of 0.94. Using the test dataset, the model accurately predicted non-malignancy in 96.2% of healthy women (n = 53) and 93.5% of women with benign tumors (n = 46). For patients with malignant tumors, the model accurately predicted malignancy in 44.4% of stage I-II (n = 9), 86.4% of stage III (n = 59), 100.0% of stage IV tumors (n = 6), and 81.8% of tumors with unknown stage (n = 11). Overall, the model yielded a predictive accuracy of 89.5%. ConclusionsOur study demonstrates the potential clinical application of blood-based DNA methylation profiling for the detection of ovarian cancer.

MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges.

Borderline epithelial ovarian tumors are a distinct pathologic entity characterized by increased epithelial proliferation and nuclear atypia, but without frank stromal invasion. Borderline tumor (BT) is now considered to represent an intermediate phase in the stepwise progression from benign to malignant ovarian epithelial tumor. Since BTs commonly manifest at early stages in women of reproductive age and are associated with a good prognosis, making the correct diagnosis is important in determining whether a patient is a candidate for fertility-sparing surgery. There are six histologic BT subtypes (serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner), and each has different MRI features, reflecting their unique histologic architectures. Radiologists should be aware of the MRI features that can suggest BTs. These features include a hyperintense papillary architecture with hypointense internal branching, which can be observed with serous and seromucinous BTs on T2-weighted images; aggregates of microcysts that have hypointensity on T2-weighted images and reticular enhancement on contrast-enhanced T2-weighted images, which can be seen with mucinous BTs; and moderately high signal intensity on diffusion-weighted images along with relatively high apparent diffusion coefficient values, which can be observed regardless of the histologic subtype. Nevertheless, because the imaging features of BTs overlap with those of many benign lesions (eg, cystadenoma and cystadenofibroma, decidualized endometriosis, and polypoid endometriosis) and malignant tumors (ovarian cancers and metastases), histologic confirmation is required for the final diagnosis. Special emphasis is placed on the MRI features of BTs, pathologic correlation, and the challenges related to diagnosis. ©RSNA, 2022.

Morphological Types of Epithelial Origin Ovarian Tumours

Aim: To assess the various morphological types of epithelial origin ovarian tumors. Methods: The study involved cases that were presented to the Pathology department between January 2015 to December 2020. Epithelial ovarian tumors that were diagnosed as either benign, borderline, or malignant were analyzed. The inclusion criteria involved pathological specimens of ovarian tumors consisting of cells that are epithelial in origin. Clinical records, ultrasounds, and histopathological investigations of the patients were accessed from the hospital database for analysis. Results: A total of 309 cases were reviewed. Out of these, ovarian epithelial tumors made up at least four-fifths of the total tumors i.e. 258(83.5%). Non-epithelial origin of ovarian tumors only consisted of 51(16.5%) cases. Out of these 153(49.84%) cases were diagnosed as serous, 88(28.48%) as mucinous. A total of 175(61.4%) tumors were benign, 15(5.81%) were borderline, and 68 (26.3%) were malignant. The patients with malignant serous tumors (43.24±13.99 years) were considerably older than individuals with benign (34.54 ± 13.16 years) and borderline (32.71±13.79 years) serous tumors. Conclusion: The present study concludes that epithelial ovarian cancer is the most commonly encountered lesion in our population. Benign and borderline tumors involve slightly younger age groups, mostly below forty years of age. Keywords: Carcinoma, Epithelial-origin tumors, malignancy, ovarian tumors

KRAS Mutation in Endometriosis-Associated Ovarian Borderline and Malignant Epithelial Tumors

Background: Endometriosis is a common disease among women with the capacity to transform into ovarian neoplasms. KRAS mutation is a keystone in tumor-genesis of many malignant neoplasms. Objectives: In the current study, we investigated KRAS mutations in endometriosis-associated ovarian borderline and malignant epithelial tumors. Methods: The specimens of 42 consecutive patients undergoing a surgical procedure whose final diagnosis comprised endometriosis-associated borderline and malignant epithelial ovarian tumors including 12 borderline epithelial tumors and 30 ovarian epithelial carcinomas were histopathologically reviewed. All cases were evaluated regarding the type of tumor, differentiation and simultaneous presence of endometriosis or atypical endometriosis. DNA extraction from the selected paraffin block was done and mutation of codons 12 and 13 was assessed. Results: Due to the quality of genomic DNA for PCR study was not acceptable in 6 out of 42 cases, among remaining 36 cases, KRAS mutation was observed in 6 cases including 2 cases with mutations in 2nd base of 12th codon (G→T), 3 cases with substitution of G→A in the 2nd base of 12th codon, and one with substitution of G→T in the 1st base of 12th codon. Conclusions: We evaluated the KRAS mutation in the spectrum of ovarian epithelial tumors associated with endometriosis for treatment approaches including targeted therapies. Our results suggested a possible link between KRAS mutation and endometriosis-associated ovarian borderline and malignant tumors but there was no convincing evidence to prove a definite linkage.

T2-weighted MRI-based radiomics for discriminating between benign and borderline epithelial ovarian tumors: a multicenter study

BackgroundPreoperative differentiation between benign and borderline epithelial ovarian tumors (EOTs) is challenging and can significantly impact clinical decision making. The purpose was to investigate whether radiomics based on T2-weighted MRI can discriminate between benign and borderline EOTs preoperatively.MethodsA total of 417 patients (309, 78, and 30 samples in the training and internal and external validation sets) with pathologically proven benign and borderline EOTs were included in this multicenter study. In total, 1130 radiomics features were extracted from manually delineated tumor volumes of interest on images. The following three different models were constructed and evaluated: radiomics features only (radiomics model); clinical and radiological characteristics only (clinic-radiological model); and a combination of them all (combined model). The diagnostic performances of models were assessed using receiver operating characteristic (ROC) analysis, and area under the ROC curves (AUCs) were compared using the DeLong test.ResultsThe best machine learning algorithm to distinguish borderline from benign EOTs was the logistic regression. The combined model achieved the best performance in discriminating between benign and borderline EOTs, with an AUC of 0.86 ± 0.07. The radiomics model showed a moderate AUC of 0.82 ± 0.07, outperforming the clinic-radiological model (AUC of 0.79 ± 0.06). In the external validation set, the combined model performed significantly better than the clinic-radiological model (AUCs of 0.86 vs. 0.63, p = 0.021 [DeLong test]).ConclusionsRadiomics, based on T2-weighted MRI, can provide critical diagnostic information for discriminating between benign and borderline EOTs, thus having the potential to aid personalized treatment options.

ANALYSIS OF SYMPTOMS IN OVARIAN CANCER AND ITS HISTOPATHOLOGICAL CORRELATION: A CROSS SECTIONAL STUDY

Ovarian cancer is the fth common cancer affecting the population and it is a silent killer, as it is diagnosed in later stages. The symptoms of ovarian cancer are nonspecic and a screening tool for ovarian cancer is not there. Diagnosis of ovarian cancer is often delayed due to their presentation with vague and nonspecic symptoms. This study tried to evaluate the symptoms in patients with ovarian cancer and correlate them with the type and stage of malignancy. Analyze the type, duration and frequency of the symptomsObjective: in patients with ovarian cancer and to correlate these symptoms with the type of malignancy and stage of the disease. All patientsMethods: admitted to the Gynaecology Department of Government Medical College, Thrissur with suspected ovarian cancer during the study period were recruited and surveyed using a baseline health questionnaire and a symptom index assessment form suggested by Goff et al was used (1). Assessment was then done to look for any correlation between the symptom duration, severity and frequency of symptoms and the type of ovarian malignancy. Fatigue followed by indigestion, increase in abdominal size, abdominal bloating, backache,Results and Discussion- feeling full quickly were the most common symptoms. A mean of 7.6 symptoms out of 23 symptoms enquired about in these women were present for a duration of 1 - 4 months. Abdominal bloating sensation was signicantly increased in patients more than 50yrs of age. A rise in CA125 value was also associated signicantly with fatigue and abdominal bloating sensation. Epithelial ovarian tumors were found to be signicantly associated with indigestion and feeling of fullness quickly. Non epithelial varieties were more often associated with menstrual irregularities and constipation. The symptom index can be used as a screening tool for ovarian cancer. Ignoring early warning symptoms will result inConclusion- late diagnosis of ovarian malignancy and thereby worsen the prognosis for such women.