Malignant Epithelial Ovarian Tumors Research Articles

Mucinous cystadenocarcinoma of ovary in 16 years old postmenarchal patient-A rare case report

Malignant epithelial ovarian tumor is a rare entity in children. Especially, mucinous ovarian cystadenocarcinoma is exceedingly rare in pediatric age group, only a limited number of cases are reported in this age group till date with less than 5 cases reported in adolescence age in the literature. We describe a case of mucinous cystadenocarcinoma in a sixteen-year old postmenarchal girl presenting with complaints of abdominal distension and irregular periods from last three months. Management of such cases is tricky as conservative approach involving sparing fertility of the patient is adopted. This case is presented for its rarity and unique presentation.

Diagnostic efficacy of combining diffusion-weighted magnetic resonance imaging with serum Mucin 1, Mucin 13, and Mucin 16 in distinguishing borderline from malignant epithelial ovarian tumors.

To enhance ovarian tumor diagnosis beyond conventional methods, this study explored combining diffusion-weighted magnetic resonance imaging (DWI-MRI) and serum biomarkers (Mucin 1 [MUC1], MUC13, and MUC16) for distinguishing borderline from malignant epithelial ovarian tumors. A total of 126 patients, including 71 diagnosed with borderline (BEOTs) and 55 with malignant epithelial ovarian tumors (MEOTs), underwent preoperative DWI-MRI. Region of interest (ROI) was manually drawn along the solid component's boundary of the largest tumor, focusing on areas with potentially the lowest apparent diffusion coefficient (ADC). For entirely cystic tumors, a free-form ROI enclosed the maximum number of septa while targeting the lowest ADC. Serum biomarkers were determined using enzyme-linked immunosorbent assay. Basic morphological traits proved inadequate for malignancy diagnosis, warranting this investigation. BEOTs had an ADC mean of (1.670±0.250) × 103 mm2 /s, while MEOTs had a lower ADC mean of (1.332±0.481) × 103 mm2 /s, with a sensitivity of 63.6% and specificity of 90.1%. Median MUC1 (167.0 U/mL vs. 87.3 U/mL), MUC13 (12.44ng/mL vs. 7.77ng/mL), and MUC16 (180.6 U/mL vs. 36.1 U/mL) levels were higher in MEOTs patients. The biomarker performance was: MUC1, sensitivity 50.9%, specificity 100%; MUC13, sensitivity 56.4%, specificity 78.9%; MUC16, sensitivity 83.64%, specificity 100%. Combining serum biomarkers and ADC mean resulted in a sensitivity of 96.4% and specificity of 100%. The integration of DWI-MRI with serum biomarkers (MUC1, MUC13, and MUC16) achieves exceptional diagnostic accuracy, offering a powerful tool for the precise differentiation between borderline and malignant epithelial ovarian tumors.

Clinicohistopathological Features and Immunohistochemical Expression Patterns of p53 in Epithelial Ovarian Tumours: A Cross-sectional Study

Introduction: Ovarian tumours represent 3% of female malignancies, with epithelial tumours constituting more than 90% of all ovarian cancers. Tumour suppressor gene 53 (TP53) mutations play an important role in the prognosis and treatment of ovarian cancer. The tumour suppressor gene Tumour Protein 53 (p53), located on the short arm of chromosome 17, acts by suppressing abnormal cell growth at the beginning of the Synthesis phase (S-phase) of the cell cycle. Previous studies have shown a correlation between p53 mutation or overexpression and patient prognosis in various types of tumours, including breast cancer, rectal cancer, intestinal cancer, lung cancer, and ovarian cancer. Aim: To investigate the clinicohistopathological features and immunohistochemical expression of p53 in Epithelial Ovarian Tumours (EOT). Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India. The duration of the study was one year and two months, from September 2021 to November 2022. A total of 80 cases of EOT were included and histopathological diagnosis was performed, and immunohistochemical expression of p53 was evaluated in all cases. The Chi-square test was used to compare categorical data (the number of benign, borderline, and malignant EOT) and determine whether the difference in p53 expression (positive or negative) was statistically significant, using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The total of 80 cases of EOT in the present study comprised 56 (70%) benign, 5 (6.25%) borderline, and 19 (23.75%) malignant tumours. The p53 expression was statistically significant. Immunohistochemistry (IHC) for p53 showed diffuse strong positive nuclear staining (>60%) of the tumour cells in 14 cases, all of which were malignant epithelial tumours. Focally weak and patchy positive nuclear staining patterns (5%-60%) were observed in 64 cases, including 56 benign cases, four borderline cases, and four cases of malignant epithelial tumours, respectively. p53 positivity (<5% staining of tumour cells) was seen in two cases, one each of borderline and malignant epithelial tumour, respectively. Conclusion: The IHC marker p53 serves as a surrogate marker for p53 gene mutation, and its positivity is observed in serous EOT. Understanding p53 staining patterns can be used in conjunction with a panel of other antibodies to correctly classify morphologically confusing EOT. This can aid in assessing prognosis and understanding the biological behaviour of the tumour, which can be helpful in modifying the treatment plan.

Role of magnetic resonance imaging to differentiate between borderline and malignant serous epithelial ovarian tumors.

We aimed to differentiate serous borderline ovarian tumors (SBOT) from serous epithelial ovarian carcinomas (SEOC) using morphological and functional MRI findings, to improve the patient management. We retrospectively investigated 24 ovarian lesions diagnosed with SBOT and 64 ovarian lesions diagnosed with SEOC. Additional to the demographic and morphological findings T2W signal intensity ratio, mean apparent diffusion coefficient (ADCmean) and total apparent diffusion coefficient (ADCtotal) values were analyzed and compared between two groups. Bilaterality, pelvic free fluid presence, serum CA-125 level (U/mL), presence of pelvic peritoneal implant were in favor of SEOC. Lower maximum size of solid component and solid size to maximum size ratio, dominantly cystic and solid-cystic appearance, exophytic growth pattern, presence of papiller projection and papillary architecture and internal branching pattern, higher T2W signal intensity ratio, ADCmean and ADCtotal values were in favor of SBOT. Our study revealed that morphological and functional imaging findings were valuable in differentiating BSOT from SEOC.

Analysis of olaparib efficacy in patients with serous ovarian cancer

Modern treatment of ovarian cancer is impossible without understanding the carcinogenesis and the structure of malignant epithelial ovarian tumors and carrying out molecular genetic testing for homologous recombination deficiency. The choice of maintenance therapy depends on the presence of a mutation in the BRCA1/2 genes and the HRD status of the tumor. Targeted drugs, such as bevacizumab and olaparib, are used in the treatment of ovarian cancer. The aim of the work is to determine the effectiveness of olaparib in first-line maintenance therapy and in the treatment of platinum-sensitive recurrence of ovarian cancer. A retrospective study included 67 patients with high-grade serous ovarian cancer stages I–IV who were prescribed olaparib in first-line maintenance therapy or in maintenance therapy for the treatment of disease progression, provided a complete or partial response to platinum-containing chemotherapy in the period from 2016 to 2022. The median life expectancy of the patients receiving first-line maintenance treatment coincides with the median time to progression; only one patient died due to the progression of the disease, and the rest are alive. The median time to progression in the group of patients with maintenance therapy of relapses was 23.0 ± 1.5 months, and the median life expectancy was 24.7 ± 2.3 months. When comparing the patients of the first group, depending on the term of surgical treatment performed, the median life expectancy was statistically higher with primary cytoreduction and constituted 46.0 months, while in the interval cytoreduction group, it was 25.0 months (p = 0.018). When comparing the patients of the second group, depending on the mutation in the BRCA1 and BRCA2 genes, the median life expectancy was statistically higher in the patients with a mutation in the BRCA2 gene — by 38.6 months (p = 0.020). The addition of olaparib to the treatment of BRCA-associated ovarian cancer in first-line maintenance therapy and in the treatment of platinum-sensitive relapses of the disease makes it possible to increase the median time to progression and median life expectancy.

Association of Preoperative Neutrophil to Lymphocyte Ratio in Patients with Epithelial Ovarian Tumor

Objective: Ovarian cancer is a leading cause of gynecological cancer death among women worldwide. Silent growth of the tumor and challenges associated with preoperative evaluation of an ovarian mass are responsible for late presentation. The aim of this study was to evaluate the association between preoperative neutrophil to lymphocyte ratio (NLR) and epithelial ovarian tumor. Methods: A total of 60 patients diagnosed with ovarian tumor who fulfilled the selection criteria were recruited as study population. The ovarian tumor was subsequently diagnosed by histopathological analysis as either malignant epithelial ovarian tumor or benign epithelial ovarian tumor. Preoperative demographic and laboratory variables are reviewed in all patients. Association of preoperative NLR was assessed in benign and malignant epithelial ovarian tumor using unpaired t test. Receiver operating characteristics curve was used to calculate optimal cut off value for NLR to predict ovarian cancer preoperatively. A p-value of <0.05 was considered to indicate statistically significant differences. Results: There was statistically significant difference between the groups in terms of age, menopausal status, and NLR (all p=0.001, except for menopausal status p=0.007). NLR value was significantly higher (3.47±1.52) in patients with malignant ovarian tumor (p=0.001) than that of benign ovarian tumor. Higher NLR value predicted ovarian cancer at the cut-off value of 2.78, with 75.6% sensitivity and 78.9% specificity (95% CI, 0.97-1.0). Conclusion: Malignant epithelial ovarian tumor is associated with higher NLR. Preoperative NLR may be helpful for prediction of malignant ovarian tumor.

Differences in the position of endometriosis-associated and non-associated ovarian cancer relative to the uterus

BackgroundPreoperative assessment of the histological type of ovarian cancer is essential to determine the appropriate treatment strategy. Tumor location may be helpful in this regard. The purpose of this study was to compare the position of endometriosis-associated (EAOCs) and non-associated (non-EAOCs) ovarian cancer relative to the uterus using MRI.MethodsThis retrospective study included patients with pathologically confirmed malignant epithelial ovarian tumors who underwent MRI at our hospital between January 2015 and January 2023. T2-weighted images of the sagittal and axial sections of the long axis of the uterine body were used for the analysis. Three blinded experienced radiologists independently interpreted the images and assessed whether the ovarian tumor was attached to the uterus, and the angle between the uterus and the tumor was measured. The presence of attachment and the measured angles were compared for each histology. In addition, the angles between EAOCs, including endometrioid carcinomas (ECs) and clear cell carcinomas (CCCs), were compared with non-EAOCs.ResultsIn total, 184 women (mean age, 56 years; age range, 20–91 years) were evaluated. High-grade serous carcinomas (HGSCs) were significantly smaller than the others and had significantly less uterine attachment than CCCs (p < 0.01 for all readers). According to the mean of the measured angles, CCCs were positioned significantly more posteriorly than HGSCs and mucinous carcinomas (p < 0.02), and EAOCs were positioned significantly more posteriorly to the uterus than non-EAOCs (p < 0.01).ConclusionHGSCs are often not attached to the uterus, and EAOCs are positioned more posteriorly to the uterus than non-EAOCs.Critical relevance statementHigh-grade serous carcinomas were often not attached to the uterus, and endometriosis-associated ovarian cancers were positioned more posteriorly to the uterus than non-endometriosis-associated ovarian cancers.Key points• The position of the ovarian tumor can be determined using MRI.• High-grade serous carcinomas had less attachment to the uterus.• Endometriosis-associated cancers were positioned more posteriorly to the uterus.• The location of ovarian tumors is helpful in estimating histology.Graphical abstract

Comparison of the diagnostic accuracy of HE4 with CA125 and validation of the ROMA index in differentiating malignant and benign epithelial ovarian tumours among patients in Lagos, Nigeria.

This prospective cross-sectional study compared the diagnostic accuracy of human epididymal protein 4 (HE4) with cancer antigen 125 (CA 125) and validates the risk of malignancy algorithm (ROMA) in differentiating benign from malignant ovarian tumours. The study population included 112 women with an ultrasound diagnosis of an adnexal mass, out of whom 49 women had a diagnosis of ovarian cancer following optimal debulking surgery, and 63 women had a diagnosis of benign ovarian tumour. All diagnosis was confirmed by histopathological analysis. Serum HE4 and CA 125 were assessed preoperatively according to the manufacturer's instructions. CA 125 and HE4 cut-offs were 35 U/mL and 70 pM/L respectively. Serum CA 125 and HE4 were significantly higher in ovarian cancer patients compared to those with benign ovarian tumours (p < 0.001 and p < 0.000, respectively). HE4 had higher sensitivity (77.5% versus 69.4%), specificity (96.8% versus 82.5%), positive predictive value (PPV) (95% versus 75.6%) and negative predictive value (84.7% versus 77.6%) than CA 125. When the two markers were combined with each other in the ROMA index, Specificity and PPV reached 100% each. In the receiver operative characteristics analysis, the area under the curve for CA 125 was 0.679 (95% CI 0.566-0.791, p = 0.001), HE4 was 0.845 (95% CI 0.760-0.930, p = 0.000) and ROMA was 0.902 (95% CI 0.851-0.998, p = 0.000) and this was statistically significant (p < 0.001). Conclusively, HE4 performed better than CA 125 in differentiating benign from malignant ovarian tumours and the combination of the two biomarkers improved the detection of ovarian cancer. In addition, the cut off values corresponding to the highest accuracy for CA 125 and HE4 were 126 U/mL and 42 pM/L respectively in this study. The value for CA 125 is much higher while that of HE4 is much lower than the reference values obtained predominantly from the white population.

Differentiation of Borderline Epithelial Ovarian Tumors from Benign and Malignant Epithelial Ovarian Tumors by MRI Scoring.

The distinction between benign and borderline epithelial ovarian tumors is important because treatment and follow-up strategies differ. We aimed to evaluate benign, borderline, and malignant epithelial ovarian tumors using MRI features and contributed to the preoperative evaluation. MRIs of 81 patients (20 bilateral), including 31 benign, 27 borderline, and 23 malignant, who had pelvic imaging between 2013-2020, were evaluated retrospectively. The evaluation was made blindly to the pathology result by two radiologists with MRI scoring and features that we determined. MRI evaluation was performed with T1 TSE, T2 TSE, fat-suppressed T2 TSE, and before and after contrast T1 fat-suppressed and non-fat-suppressed TSE images. The numbers and findings obtained in scoring were evaluated by Chi-Square, ordinal logistic regression, and 2 and 3 category ROC analysis. The total score varied between 7 and 24. Among the three groups, a significant difference was found in terms of T1, T2 signal intensity (p <0.01), size (p = 0.055), solid area (p <0.001), septa number (p <0.05), ovarian parenchyma (p = 0.001), ascites (p <0.001), peritoneal involvement (p <0.001), laterality (p <0.001), contrast enhancement pattern (p <0.001). On the other hand, no significant difference was found in terms of wall thickness, lymph node involvement and endometrial thickness (p> 0.05). Cut-off values were found as 11.5 and 18.5 in the 3-category ROC analysis performed for the score (VUS: 0.8109). Patients with a score below 11.5 were classified as benign, those between 11.5-18.5 as borderline, and those over 18.5 as malignant. The differentiation of borderline tumors from benign and malignant tumors by MRI scoring will contribute to the preoperative diagnosis.

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.

Evaluation of the Expression Intensity of Glucose Transporter-1 Marker and its Diagnostic Value in Differentiating Between Borderline and Malignant Ovarian Epithelial Tumors

Background: Ovarian cancer ranks second among gynecological cancers worldwide. This study aimed to compare the glucose transporter-1 (GLUT-1) expression in benign, borderline, and malignant ovarian epithelial tumors and evaluate GLUT-1 expression as a diagnostic tool for distinguishing tumors in the ovary. Materials and Methods: This descriptive-analytical cross-sectional study analyzed 69 pathological samples of patients diagnosed with ovarian epithelial tumors who underwent oophorectomy. Immunohistochemical staining was performed using GLUT-1 antibody. The intensity of cell membrane staining and the proportion of positive neoplastic cells were graded to score immunostaining. Chi-square/Fisher’s exact test was used to analyze the data. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and staining accuracy for GLUT-1 in distinguishing borderline from invasive tumors were calculated by standard methods (P&lt;0.05). Results: In all benign tumors, GLUT-1 staining was negative. In addition, weak staining intensity was observed in 38.5% of borderline tumors, and 96% of invasive tumors had strong staining intensity (P&lt;0.001). Strong GLUT-1 staining was found in 94.7% of Papillary Serous Carcinoma, 9/1% of Borderline Serous tumors, 100% of Brenner tumors, and clear cell carcinoma. The results demonstrated a high diagnostic value of GLUT-1 expression intensity in differentiating between borderline and malignant ovarian epithelial tumors (Accuracy: 97.10, Sensitivity: 96%, Specificity: 97.73). Conclusion: Overall, GLUT-1 expression could help distinguish benign from borderline, especially borderline from malignant ovarian epithelial tumors. Thus, it seems that it provides useful prognostic information, particularly for the borderline category.

Vorinostat decrease M2 macrophage polarization through ARID1A6488delG/HDAC6/IL-10 signaling pathway in endometriosis-associated ovarian carcinoma

Endometriosis is a common disease in women and may be one of the factors that induces malignant epithelial ovarian tumors. Previous studies suggested that endometriosis is related to ARID1A mutation mediating the expression of HDAC6, but the detailed pathogenic mechanism is still unclear. First, we collected endometriosis-associated ovarian carcinoma (EAOC) clinical samples and examined the expression of HDAC6. Our results found that the high HDAC6 expression group was positively correlated with EAOC histology (P = 0.015), stage (P < 0.000), and tumor size (P < 0.000) and inversely correlated with survival (P < 0.000). We also found that ARID1A6488delG/HDAC6 induced M2 polarization of macrophages through IL-10. In addition, the HDAC inhibitor (HDACi) vorinostat inhibited cell growth and blocked the effect of HDAC6. Tomographic microscopy was used to monitor the live cell morphology of these treated cells, and we found that vorinostat treatment resulted in substantial cell apoptosis by 3 h 42 min. Next, we established a transgenic mouse model of EAOC and found that vorinostat significantly reduced the size of ovarian tumors by inhibiting M2 macrophage polarization in mice. Together, these data demonstrate that the signaling pathway of E4F1/ARID1A6488delG/HDAC6/GATA3 mediates macrophage polarization and provides a novel immune cell-associated therapeutic strategy targeting IL-10 in EAOC.

Expression of Salivary Immediate Early Response Gene X-1 as a Predictor of Malignancy in Epithelial Ovarian Tumor

Objective: This diagnostic study aims to determine the expression of salivary IEX-1 as a predictor of malignancy in epithelial ovarian tumors.  &#x0D; Methods: Samples were obtained from ovarian cancer patients who were scheduled for elective surgery. Patients' saliva was collected before surgery and used as the study's research material. Research subjects who met the inclusion and exclusion criteria were divided into two groups based on the post-operative histopathological results, benign and malignant epithelial ovarian tumors. The salivary IEX-1 expression was examined using the Real Time qPCR method. We compared and analyzed the salivary IEX-1 expression ​​in benign and malignant epithelial ovarian tumors.  &#x0D; Results: The results of this study were obtained from 47 epithelial ovarian tumors subjects, 22 malignant tumors and 27 benign tumors. The mean salivary IEX-1 expression in benign epithelial ovarian tumors was higher (1.976) than the malignant tumors (0.554) (p&lt;0.001). The AUC value of IEX-1 expression was 0.949 (95% CI 0.894-1,000), cut off point of salivary IEX-1 is ≥ 0,9115 with sensitivity 84%, specificity 86,4%, positive predictive value 82.6% and negative predictive value 87.5%. There was a significant correlation between salivary IEX-1 expression and malignant epithelial ovarian tumors with an OR 5.031 (95% CI 2.039-12.4; p&lt;0,001)&#x0D; Conclusion: Salivary IEX-1 expression declines in tandem with the development of malignant epithelial ovarian tumors, providing a very sensitive and specific indicator of the presence of these malignant tumors.&#x0D; Keywords: Expression of IEX-1, Malignant epithelial ovarian tumor, Salivary IEX-1, Tumor Marker.

Immunohistochemical profiling of the tumour microenvironment in borderline and malignant ovarian tumours in young women.

Ovarian cancer is a major cause of cancer-related deaths in women. Our previous study highlighted the interaction between cancer cells and the host immune response in solid cancers. The present study aimed to analyse the proportion, density and distribution of T and B lymphocytes within the tumour and surrounding stroma, and their prognostic significance in young women with borderline and malignant ovarian surface epithelial tumours. Full clinicopathological and outcome data were collected for 57 women aged <50 years diagnosed between January 2010 and December 2015. Representative tumour sections were stained for CD3 (T cells) and CD20 (B cells) and tumour-infiltrating lymphocytes (TILs) were scored following the TILs Working Group Recommendations and described as stromal, intra-tumoural, lymphoid aggregates and touching lymphocytes. Data were statistically analysed and the association with clinicopathological variables was assessed. The median age was 41 years and the most common histological type was serous carcinoma (n=21). The risk of malignancy index was a significant predictor of ovarian cancer diagnosis (P<0.05). A total of 15 out of 34 patients with cancer died. There was significantly greater stromal infiltration of CD3 and CD20 TILs (P=0.01 and P=0.03, respectively) and higher intratumoral CD20 expression in ovarian epithelial cancers compared with borderline tumours. The highest CD3 stroma count and density were observed in serous carcinoma, which also exhibited the highest numbers of CD3 and CD20 aggregates. There was no statistically significant difference between touching lymphocytes and tumour histological subtype. There was no significant association between TIL expression and patient survival. The count, distribution and density of T and B lymphocytes in ovarian tumours varied depending on tumour type and invasiveness. Their topographic distribution within the tumour and surrounding stroma did not impact prognosis in young women with ovarian cancer. TIL analysis in an older age group of women with ovarian tumours is ongoing to determine its potential prognostic significance.

Combined use of CA125, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for the diagnosis of borderline and malignant epithelial ovarian tumors

BackgroundThe mortality rate of ovarian cancer ranks first among three common gynecological malignant tumors due to insidious onset and lack of effective early diagnosis methods. Borderline epithelial ovarian tumor (BEOT) is a type of low malignant potential tumor that is typically associated with better outcomes than ovarian cancer. However, BEOTs are easily confused with benign and malignant epithelial ovarian tumors (EOTs) due to similar clinical symptoms and lack of specific tumor biomarkers and imaging examinations. Notably, a small subset of BEOTs will transform into low-grade serous ovarian carcinoma with a poor prognosis. Therefore, searching for potential biomarkers that can be easily obtained and accurately identify malignant epithelial ovarian tumors (MEOTs) as well as BEOTs is essential for the clinician. Cancer antigen 125 (CA125) is a commonly used biomarker for the diagnosis of EOTs in the preoperative scenario but has low sensitivity and specificity. Nowadays, inflammatory biomarkers including inflammatory cell counts and derived ratios such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been proved to be associated with tumor progression and poor prognosis, and were considered to be the most economically potential surrogate biomarkers for various malignancies. The purpose of this study was to find appropriate combinations of inflammatory and tumor biomarkers to improve the diagnostic efficiency of EOTs, especially the BEOTs.ResultsCA125, NLR and PLR increased steadily among benign, borderline and malignant EOTs and tended to be higher in advanced (stage III-IV) and lymph node metastasis MEOT groups than in early stage (stage I-II) and non-lymph node metastasis MEOT groups. CA125, NLR and PLR could be used separately in the differentiation of EOTs but could not take into account both sensitivity and specificity. The combined use of CA125, NLR and PLR was evaluated to be more efficient, especially in the identification of BEOTs, with both high sensitivity and high specificity.ConclusionsThe levels of CA125, NLR and PLR were closely related to the nature of EOTs and malignant progression of MEOTs. The combination of CA125, NLR and PLR was more accurate in identifying the nature of EOTs than either alone or double combination, especially for BEOTs.

Computed Tomography Indicators for Differentiating Stage 1 Borderline Ovarian Tumors from Stage I Malignant Epithelial Ovarian Tumors.

Preoperative diagnosis of borderline ovarian tumors (BOTs) is of increasing concern. This study aimed to determine computed tomography (CT) features in differentiating stage 1 BOTs from stage I malignant epithelial ovarian tumors (MEOTs). A total of 170 ovarian masses (97 BOTs and 73 MEOTs) from 141 consecutive patients who underwent preoperative CT imaging were retrospectively analyzed. Two readers independently and retrospectively reviewed quantitative and qualitative CT features. Multivariate logistic analysis demonstrated that a larger tumor size (p = 0.0284 for reader 1, p = 0.0391 for reader 2) and a smaller solid component (p = 0.0007 for reader 1, p = 0.0003 for reader 2) were significantly associated with BOTs compared with MEOTs. In the subanalysis of cases with a solid component, smaller (p = 0.0092 for reader 1, p = 0.0014 for reader 2) and ill-defined (p = 0.0016 for reader 1, p = 0.0414 for reader 2) solid component was significantly associated with BOTs compared with MEOTs. Tumor size and the size and margin of the solid component were useful for differentiating stage 1 BOTs from stage 1 MEOTs on CT images.

Management of Borderline ovarian tumors (BOT): results of a retrospective, single center study in Switzerland

BackgroundBorderline tumors are malignant epithelial ovarian tumors with a very low incidence. Thus experience in diagnostics and treatment is still rare. The aim of this study was to present and analyze data of women with borderline ovarian tumor (BOT) regarding clinical features, histological characteristics, diagnostics and treatment management.MethodsIn this single center retrospective study women with BOT treated at the Departement of Gynecology and Obstetrics at the Kantonsspital Luzern between 2011 and 2018 were analyzed according to their clinical and histological reports.ResultsA total of 42 women were enrolled. The median age was 58.5 with a range from 26 to 85, of which 31 (73.8%) were postmenopausal. Regarding the histological subtypes, 23 women (54.8%) had serous and 15 (35.7%) had mucinous BOT. Seromucinous histology was found in 3 patients (7.1%) and endometrioid in 1 woman (2.4%), respectively. All women underwent surgery. In a total of 39 women (92.9%) a complete surgical staging for BOT was performed. In 29 women (69.0%) staging was performed by laparoscopy, 13 (31.0%) underwent laparotomy. The mean follow up was 52 months (range = 16.3–101.4 months). During this period two patients, initially diagnosed in FIGO stage 1, recurred after 21.7 and 44 months, respectively, the second woman died after 53 months because of the BOT.ConclusionIn the present study women were treated according to the international therapy recommendations and the rate of recurrence was very low. The most common risk factors for relapse are known to be FIGO stage, incomplete staging and peritoneal implants but were not present in our group. Thus further studies are necessary to investigate additional recurrence risks.

Histomorphological Evaluation of Desmoplastic Tumor Stroma in Malignant Ovarian Surface Epithelial Tumors.

Ovarian cancer is the 8th most common cancer in women worldwide. Tumor budding is defined as a type of invasive growth in carcinomas with either a single tumor cell or a cluster of up to four cells at the invasive tumor front and is associated with epithelial-mesenchymal transition. A reactive stroma rich in cancer-associated fibroblasts is associated with higher tumor grade and poorer prognosis in breast, colorectal, and oral cancers. The present study was conducted to highlight the prognostic significance of tumor budding and fibrotic cancer stroma in malignant ovarian surface epithelial tumors with known prognostic parameters. This was a retrospective cross-sectional study conducted over a 2-year period, in which all histologically diagnosed cases of malignant ovarian surface epithelial tumors who underwent surgery were included. The fibrotic stroma was classified into three distinct categories - mature, intermediate, and immature. The number of tumor buds was counted at the invasive front of the tumor and graded based on the number of buds - 0-5, 5-9, and ≥10 buds. Among the 50 cases, 32% (16 cases) had mature stroma, whereas 30% (15 cases) and 38% (19 cases) had intermediate and immature stroma, respectively. Although a significant association could not be established between tumor budding and stroma grade, a fair agreement was established between them. A significant association could be established between histological grade with both tumor budding (P = 0.03) and fibrotic stroma grade (P = 0.02). The study highlighted the role of stromal response in malignant surface epithelial tumors of the ovary since a higher-grade tumor was associated with an immature stroma, whereas a lower-grade tumor was associated with a mature stroma.

Comprehensive ultrasound diagnosis of ovarian cancer, assessment of its local and distant spread. Part I. Ultrasound diagnosis of primary malignant ovarian epithelial tumors. Options. Semiotics

Comprehensive ultrasound diagnosis of ovarian cancer, assessment of its local and distant spread. Part I. Ultrasound diagnosis of primary malignant ovarian epithelial tumors. Options. Semiotics

Comprehensive ultrasound diagnosis of ovarian cancer, assessment of its local and distant spread. Part 2. Ultrasound diagnosis of local and distant spread of the tumor process of primary malignant ovarian epithelial tumors. Options. Semiotics. Errors

Comprehensive ultrasound diagnosis of ovarian cancer, assessment of its local and distant spread. Part 2. Ultrasound diagnosis of local and distant spread of the tumor process of primary malignant ovarian epithelial tumors. Options. Semiotics. Errors