Background Accurately predicting the prognosis of primary mucinous ovarian carcinoma (PMOC) remains a significant challenge in gynecologic oncology. This study aimed to develop and validate a deep learning model using histopathological images for precise prognostic prediction and risk stratification in PMOC. Methods Histopathological slides of PMOC patients were retrospectively collected and digitized into whole-slide images (WSIs). A graph-based deep learning survival model was established by integrating histological feature extraction, spatial graph construction, and survival prediction through graph neural networks (GNN) combined with Cox proportional hazards modeling. Patients were subsequently stratified into high- and low-risk groups based on model-generated risk scores. The model’s prognostic performance was assessed using Kaplan-Meier analysis and Cox regression. Interpretability was evaluated through GNNExplainer-generated heatmaps. Results A total of 80 patients (148 WSIs) were included from three medical centers. The best-performing deep learning model achieved a mean C-index of 0.8254 and stratified patients into high-risk and low-risk groups. Patients in the high-risk group demonstrated significantly shorter overall survival (OS) than those in the low-risk group (log-rank p = 7.4 × 10 -8 ). Multivariate Cox analysis confirmed AI-based risk stratification as an independent prognostic factor ( p = 0.000298), exhibiting a higher hazard ratio (HR = 7.974) than both FIGO stage (HR = 5.877) and tumor grade (HR = 4.248). GNNExplainer further visualized key regions associated with the model’s predictions, including infiltrative growth patterns and pronounced nuclear atypia. Conclusions This deep learning model offers accurate prognostic predictions from histopathology, presenting a promising tool to improve risk stratification and guide personalized treatment in PMOC.

Ovarian cancer is a highly lethal gynecological malignancy with poor prognosis. Early diagnosis of ovarian cancer is crucial for improving patient survival rates. Ultrasound is currently the most used imaging modality for the detection of ovarian cancer. However, its diagnostic accuracy is limited, particularly in the early stages of the disease. Circulating tumor DNA (ctDNA) has emerged as a promising noninvasive biomarker for cancer diagnosis. In this study, we aimed to investigate the clinical value of ultrasound combined with ctDNA (mutations in: TP53, KRAS, and PIK3CA) in the early diagnosis of ovarian cancer. A total of 686 participants were enrolled, comprising 186 advanced symptomatic ovarian cancer patients, 16 histologically confirmed asymptomatic ovarian cancer patients, and 484 patients with benign ovarian lesions. Of the 202 ovarian cancer cases, 57.4% were high-grade serous carcinomas, followed by endometrioid (15.8%), clear cell (9.9%), mucinous (7.9%), and low-grade serous carcinomas (6.9%). All participants underwent standardized ultrasound examination and ctDNA analysis. Ultrasound characteristics were evaluated for morphological features including mass composition, border definition, and presence of ascites. Circulating tumor DNA was analyzed for mutations in TP53, KRAS, and PIK3CA genes. Diagnostic performance was assessed through sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculations for individual and combined detection methods. In asymptomatic ovarian cancer patients, ultrasonography revealed complex solid-cystic masses in 50.0% of cases and ascites in 43.75%, with 87.50% sensitivity and 94.33% specificity. Molecular analysis detected ctDNA mutations in 81.25% of asymptomatic cases, predominantly in TP53 (31.25%), KRAS (25.00%), and PIK3CA (25.00%). This analysis, which focused exclusively on these three genes, demonstrated 81.25% sensitivity and 97.46% specificity. The combined diagnostic approach significantly improved detection parameters (p < 0.001), with sensitivity increasing to 93.75%, specificity to 99.25%, PPV to 75.00%, and NPV to 99.85%. False-positive results decreased from 38 (ultrasound alone) and 17 (ctDNA alone) to 5 cases with the combined approach. Distinct mutation profiles were observed between cancer and benign groups, with only 15.91% of benign cases showing detectable ctDNA mutations. Our results suggest that ctDNA is a promising biomarker for the early detection of ovarian cancer, with higher sensitivity and specificity than ultrasound. The combination of ultrasound and ctDNA may provide a more accurate diagnostic strategy for the early detection of ovarian cancer. These findings may contribute to the development of novel noninvasive biomarkers for the early diagnosis of ovarian cancer.

Pseudomyxoma Peritonei is characterised by peritoneal metastasis from appendiceal mucinous neoplasms (AMN). The PSOGI classification (2016) categorises PMP into acellular mucin (AM), low-grade mucinous carcinoma peritonei (LGMCP), and high-grade mucinous carcinoma peritonei (HGMCP). This study aimed to determine long-term prognosis based on this classification. Pathology review from PMP patients with AMNs undergoing cytoreductive surgery and heated intraperitoneal chemotherapy (CRS + HIPEC) with curative intent over a 15-year period (2006-2021) was undertaken. Patients underwent standardised surveillance. Cox proportional hazards regression models, log-rank test, and Kaplan-Meier method were used to assess overall (OS) and disease-free survival (DFS) based on histopathological peritoneal metastasis grade. DFS was only calculated for patients who had a complete cytoreduction. 290 PMP patients were identified (AM = 34%, LGMCP = 59%, HGMCP = 7%) with median follow-up of 49months. Median age was 59years (range: 22-79), M: F of 1:2.5, peritoneal cancer index median of 18 (range: 0-39). Univariate OS hazard ratio (HR) is 2.75 for LGMCP vs AM (95% CI: 1.05 -7.21, p < 0.040) and 14.29 for HGMCP vs AM (95% CI: 3.92- 52.11, p < 0.001). DFS HR = 5.15 for LGMCP (95% CI: 2.19-12.10, p < 0.001) and 4.16 for HGMCP (95% CI: 1.03-16.80, p < 0.045) with an overall peritoneal metastasis p value < 0.001. Multivariate OS analysis showed that peritoneal histology for HGMCP remained a significant predictor of poor prognosis for OS (HR: 5.54, 95% CI: 1.32-23.25, p = 0.019), whilst LGMCP did not demonstrate a significant association (HR: 1.59, 95% CI: 0.59-4.26, p = 0.359). Peritoneal metastasis histopathological grade predicts outcome for patients with PMP from AMN following CRS + HIPEC independent of primary histology.

Gallbladder mucinous carcinoma in a child with metachromatic leukodystrophy, case report and literature review.

Mucin-producing breast lesions encompass a diverse range of entities with varied morphologies, distinct molecular genetics and different outcomes. Mucocele-like lesions (MLLs) are being increasingly recognised and sampled due to advancements in imaging techniques. These lesions can present with or without epithelial proliferation and atypia, which hold prognostic significance. Diagnosing MLLs on limited core needle biopsy (CNB) samples can be challenging. Mucinous breast carcinoma (MuBC) generally has an excellent prognosis in its pure form. Recent studies indicate that mucin-producing invasive cancers with micropapillary growth pattern, high nuclear grade or HER2 overexpression/amplification may not fare as well as their pure counterparts, suggesting that they should be distinguished from pure MuBCs. Invasive lobular carcinoma with extracellular mucin (ILCEM) is an emerging subtype of ILC characterised by neoplastic cells in cords, nests and trabeculae, often with signet ring morphology, floating in extracellular mucin. This can lead to misdiagnosis as a ductal phenotype due to varied architectural patterns or a MuBC due to the presence of extracellular mucin. This review highlights the spectrum of mucin-producing breast lesions, focusing on the above-mentioned entities along with recent molecular updates, potential mimics and diagnostic pitfalls on CNB specimens. Awareness of these entities, a practical approach to their diagnosis, combined with judicious use of immunohistochemistry, are crucial for accurate diagnosis by pathologists, which is in turn essential for guiding clinical decision making for optimal patient outcomes.

Breast mass classification via ultrasound is critical for early diagnosis but remains challenging due to overlapping morphological features. This study evaluates the efficacy of optimized transfer learning (TL) based on deep convolutional neural networks (DCNNs) in distinguishing four breast mass categories: invasive ductal carcinoma (IDC), fibroadenoma (FA), mucinous carcinoma (MC), and inflammatory mass (IM). Our approach comprises four key steps: (1) applying extensive data augmentation to a retrospective dataset of 346 ultrasound images from 294 patients (November 2021-March 2023) classified by pathological confirmation; (2) implementing transfer learning with five pretrained DCNN models (ResNet18, ResNet50, DenseNet121, MobileNetV2, GoogLeNet); (3) optimizing model hyperparameters for four-class classification; (4) comparing performance metrics (accuracy, precision, recall, F1-score, AUC-ROC) against two senior radiologists (8- and 10-years’ experience) on a held-out test set. Results: The DenseNet121 and GoogLeNet models demonstrated superior overall accuracy (0.912 and 0.926, respectively), significantly outperforming the radiologists’ consensus (0.691) (p < 0.01). In class-specific analysis, the optimized models achieved notably higher accuracy for IDC, MC, and IM. Statistical testing confirmed the significant performance improvement of the top models over human experts. Optimized TL with DCNNs, particularly DenseNet121 and GoogLeNet, enables highly accurate four-class breast mass classification in ultrasound images, surpassing expert radiologist performance with statistical significance. This approach holds promise for clinical decision support. Code is publicly available at https://github.com/jinlao777/BCC.

Recurrence of intraductal papillary mucinous neoplasms (IPMNs) in the remnant pancreas after surgery is a significant clinical challenge. A 68-year-old woman was incidentally found to have a 50-mm mixed-type intraductal papillary mucinous carcinoma (IPMC) in the pancreatic head during a health check. She underwent subtotal stomach-preserving pancreaticoduodenectomy with pancreatogastrostomy. Pathology revealed intestinal-type IPMC (pStage IA) with venous invasion and negative margins. Adjuvant oral S-1 chemotherapy was administered for six months. Eighteen months later, she developed rapid increases in HbA1c and tumor markers. Computed tomography showed 8-mm main pancreatic duct dilation in the remnant pancreas. Upper gastrointestinal endoscopy revealed a papillary tumor extending into the gastric mucosa, and biopsy confirmed adenocarcinoma. She was diagnosed with recurrent IPMC in the remnant pancreas and underwent total pancreatectomy with splenectomy. Intraoperative gastric endoscopy determined the extent of gastric wall resection. Postoperative chylous leakage occurred but resolved, and she was discharged on day 26. Pathology revealed non-invasive gastric-type IPMC, distinct from the intestinal-type lesion in the initial surgery. This case represents a rare metachronous recurrence of gastric-type IPMC following resection of intestinal-type IPMC, emphasizing the need for vigilant long-term surveillance and awareness of potential histologic subtype changes.

To investigate the associations of homologous recombination repair (HRR) gene mutations with clinical prognosis in epithelial ovarian cancer (EOC) patients with various histological subtypes. The EOC patients treated at our institute from January 2014 to March 2021 were included. Gene mutations were detected using 24 target HRR genes. The associations between HRR gene mutations and clinical outcomes were analyzed. A total of 318 patients were evaluated, 37 patients had BRCA, and 21 patients had other HRR gene mutations. EOC patients with HRR gene mutations were associated with platinum sensitivity than wild type (82.8% vs. 68.7%, p=0.033), and it remained significant in patients with advanced stage (79.5% vs. 57.6%, p=0.007), serous carcinoma (89.4% vs. 66.2%, p=0.002) or optimal debulking surgery (97.1% vs. 79.1%, p=0.013). In serous carcinoma, advanced stage (hazard ratio [HR]=2.11; p=0.031), HRR mutation (HR=0.62; p=0.021) and 1st line poly(ADP-ribose) polymerase inhibitor (PARPi, HR=0.28; p<0.001) were significant for cancer recurrence. Suboptimal debulking surgery (HR=1.58; p=0.044) and HRR gene mutation (HR=0.33; p=0.001) were important for cancer-related death. In non-serous carcinoma, mucinous carcinoma (HR=3.91; p=0.023), advanced stage (HR=3.10; p<0.001) and suboptimal debulking surgery (HR=2.63; p=0.001) were significant for cancer recurrence. Mucinous carcinoma (HR=9.17; p=0.001), advanced stage (HR=4.26; p<0.001), and suboptimal debulking surgery (HR=3.80; p<0.001) were important for cancer-related death. HRR gene mutations were associated with platinum sensitivity, PARPi response and favorable survival in serous EOC patients. In non-serous EOC, HRR gene mutations did not show the same trend, which warrants further investigation.

Despite curative surgery and adjuvant chemotherapy, a significant number of early stage I to II ovarian cancers relapse. The CA125 ELIMination rate constant K (KELIM) is a pragmatic indicator of tumor intrinsic chemosensitivity in advanced epithelial ovarian cancer. We assessed the prognostic value of KELIM in patients with early-stage ovarian cancer, with respect to 5-year recurrence-free survival and overall survival, using the Meta-Analysis in Ovarian Cancer, which is the Gynecologic Cancer InterGroup individual patient-data meta-analysis of randomized trials evaluating different adjuvant chemotherapy regimens. Individual patient KELIM values were previously estimated in 5884 patients from the Meta-Analysis in Ovarian Cancer. The prognostic value of KELIM was assessed using univariable & multivariable analyses in patients with resected International Federation of Gynecology and Obstetrics stage I and II disease. Overall, 1143 patients were identified, including clear cell (46.7%); serous (23.7%); endometrioid (12.4%); and mucinous carcinomas (3.9%). In multivariable analyses, a favorable KELIM score (≥1.0) was associated with higher 5-year recurrence-free survival (68.3% vs 55.9%; HR 0.61, 95% CI 0.48 to 0.77) and 5-year overall survival (80.7% vs 72.8%; HR 0.50, 95% CI 0.36 to 0.68), as was the histological sub-type. In exploratory analyses, KELIM score was a prognostic factor regarding 5-year recurrence-free survival and overall survival across all sub-types (especially clear cell carcinoma and serous, with HR ranging from 0.45 to 0.63) with baseline CA125 ≥15 IU/L, except for mucinous histology. The pragmatic KELIM score is an independent prognostic factor in patients with a non-mucinous stage I to II ovarian cancer optimally resected and treated with adjuvant chemotherapy. KELIM may help identify the patients at higher risk of relapse and death requiring closer follow-up or treatment intensification.

Introduction: Triple Negative Breast Cancer (TNBC) is a subtype of breast cancer, characterised by the lack of expression of Oestrogen Receptor (ER) Progesterone Receptor (PR) and Human Epidermal growth factor Receptor (HER2). TNBC is an aggressive type of invasive breast cancer. The clinical, histopathology, and immunohistochemistry study are vital in diagnosing TNBCs. TNBC have rarely been studied in relation to rare prevalence, diagnostic difficulties, and special histological variants. Aim: To study the clinicopathological profile of TNBC pateints. Materials and Methods: The present cross-sectional study, which included all the patients undergoing lumpectomy or modified radical mastectomy received in the the Surgical Pathology Section of tertiary care hospital and department of molecular biology and genetic laboratory, at Krishna Institute of Medical Sciences, Karad, Maharashtra, India from May 2019 to April 2021. During the study period, total of 302 specimens of modified radical mastectomy or lumpectomy that met the inclusion/exclusion criteria were received in the Surgical Pathology department were included in this study. All specimens were analysed using immunohistochemistry for ER, PR, and HER2 Neu expression. Out of these, 100 (33.1%) cases were negative for all three markers, reported as TNBCs. These 100 TNBC cases were evaluated based on the clinicopathological parameters such as patient age, tumour laterality, location, tumour size, histopathological type, histologic Grade, lymphovascular invasion and lymph nodal status of TNBCs and to analyse different histomorphological type. Results: In this total of 302 specimens of modified radical mastectomy, the Invasive Breast Carcinoma No Special Type (IBC NST) (82.70%, 250 out of 302 specimens) was the commonest histopathological diagnosis, followed by medullary carcinoma seven cases (7.0%), metaplastic carcinoma two cases (2.0%), invasive lobular carcinoma two cases (2.0%), one case of apocrine carcinoma (1.0%), one case of neuroendocrine carcinoma (1.0%) and one case of each (1.0%) as malignant phyllode’s tumour, mucinous carcinoma, etc. Conclusion: Prevalence of TNBC in India is considerably higher compared with that seen in Western populations. Present study included extensive analysis of breast cancer showing increasing in incidence of TNBC and is challenging to treat due to its adverse clinicopathological profile. The TNBC is associated with younger age, larger tumour size, higher histopathological Grades, extensive tumour necrosis, more regional lymph node metastasis, advanced stage at diagnosis and aggressive nature of tumour.

Ovarian carcinomas are heterogeneous neoplasms associated with distinct molecular abnormalities. The P53 tumor suppressor gene plays a key role in cell cycle regulation and carcinogenesis, while Ki-67 protein serves as a marker of cellular proliferation. This study aimed to identify the types of ovarian neoplasms received, evaluate P53 and Ki-67 expression in surface epithelial carcinomas and correlate findings with tumor grading. This cross-sectional descriptive type of observational study was carried out in the Department of Pathology, Mymensingh Medical College, Bangladesh, from July 2018 to August 2019. A total of 166 specimens of ovarian tumor from patients admitted in the Department of Gynaecology and Obstetrics were included in this study. Of these, 35 cases were histopathologically diagnosed as epithelial ovarian carcinoma (EOC). All EOC specimens were processed for immunohistochemistry using P53 and Ki-67 antibodies. Demographic data, including age and diagnosis, were retrieved from requisition forms and statistical analysis was performed. The most frequent histological pattern (81.0%) was surface epithelial tumor. Among EOCs, serous carcinoma was predominant (82.0%), followed by mucinous (8.0%) and endometrioid carcinoma (2.0%). The mean age of patients was 50.69 years, with Grade 1 tumors being most common (45.7%). Immunohistochemical analysis revealed significant associations of P53 and Ki-67 expression with EOC (p=0.001). A significant correlation was observed between total histologic score and percentage of positive staining for both markers. P53 expression was strongly associated with higher histological grade (p<0.05), whereas Ki-67 showed no significant correlation with grade but correlated with total histologic score. These findings suggest that P53 expression is linked to tumor aggressiveness, while Ki-67 reflects proliferative activity without direct grade correlation. Assessment of P53 and Ki-67 may provide valuable insight into the biological behavior of epithelial ovarian carcinoma and guide treatment modification.

We report a rare case of intraductal papillary mucinous carcinoma (IPMC) in a young male who initially presented with imaging findings suggestive of autoimmune pancreatitis (AIP) and was later diagnosed with tumor-associated pancreatitis. Despite symptom resolution with conservative treatment, follow-up imaging revealed a pancreatic tumor. Surgical resection confirmed the presence of IPMC with adenocarcinoma components. This case highlights the importance of excluding malignancy even in young patients with AIP-like features. Given the limited sensitivity of FDG-PET for early stage tumors, adjunctive modalities such as endoscopic ultrasound (EUS) and serial pancreatic juice aspiration cytological examination (SPACE) should be actively considered.

Different histologic subtypes of ovarian cancer have distinct risk factors, clinical features, and prognosis. This analysis intends to examine the regional differences in the incidence rates of different histologic subtypes of ovarian cancer in China and the changes in incidence in different age groups. Data on ovarian cancer in China from the Cancer Incidence in Five Continents, Volume XII database between 2013 and 2017 were employed in this descriptive study. The age-standardized incidence rates (ASR) of ovarian cancer for serous carcinoma (SC), mucinous carcinoma (MC), endometrioid carcinoma (EC), clear cell carcinoma (CCC), and other unidentified subtypes were calculated. The crude incidence rates of ovarian cancer in different age groups were calculated. Regional differences were analyzed using the six major administrative regions (Northeast, North China, Northwest, East China, Central South, and Southwest) and 20 provincial administrative regions, respectively. A total of 32,817 ovarian cancer patients were included, among which 7,742 (23.59%) had SC, 1,709 (5.21%) had MC, 1,319 (4.02%) had CCC, 1,233 (3.76%) had EC, and 20,814 (64.42%) had unclassified histologic subtypes. The ASR was 5.31 (95%CI: 5.26-5.37) per 100,000 people for overall ovarian cancer, 1.27 (95%CI: 1.24-1.29) for SC, 0.30 (95%CI: 0.28-0.31) for MC, 0.21 (95%CI: 0.20-0.22) for EC, 0.22 (95%CI: 0.21-0.23) for CCC, and 0.47 (95%CI: 0.47-0.48) for unclassified subtypes. There were differences in the distribution of subtypes in different regions of China: SC and CCC occurred most in the Northeast and North China, MC in the Northeast and Central South, and EC in the North China and Central South. The distribution of subtypes also varied across economic level regions, with higher frequencies of SC, CCC, and EC in the high economic level group. Furthermore, the crude incidence rates of SC subtypes in China increased with age, but showed a decreasing trend at age 60 years. The crude incidence rates of CCC, EC, MC, and other subtypes do not change distinctly with age. This study explored the incidence distribution of histologic subtypes of ovarian cancer in China, which may provide a reference for the screening, prevention, and control of the disease in the Chinese population.

The impact of microsatellite instability and tumor characteristics on survival of patients with right-sided colon cancer.

Identifying and capitalizing on unique molecular alterations of mucinous ovarian carcinoma for the development of novel therapeutic strategies

Neuroendocrine Neoplasms of the Breast: Evolving Concepts and Reappraisal of Classification.

CT and MRI characteristics of ovarian mucinous tumors associated with mature teratomas.

TRPS1 expression in 451 tubo-ovarian tumours: a potential prognostic marker for high-grade serous carcinoma.

Prognostic implications of HER2 in ovarian cancer: Associations with homologous recombination deficiency and folate receptor alpha expression.

Endometrial carcinomas - Challenges and updates on selected topics.