Mucinous Carcinoma Research Articles

Spectrum of Surgico-Pathological Factors and Lymph Node Metastasis among Epithelial Ovarian Cancers: Experience of a Single Tertiary Care Institution from India

Introduction Epithelial ovarian cancer (EOC) is one of the leading causes of mortality among women worldwide. The present study aimed to estimate the frequency of various histopathological types, clinical and surgico-pathological factors, and spectrum of lymph node (LN) metastasis in early and advanced EOC. Material and Methods Women with EOCs who underwent cytoreductive surgery (CRS) between January 2019 and May 2022 were included. The distribution of Clinico-demographic parameters, histological type, stage, and LN metastasis were analyzed. Results A total of 101 women with EOCs underwent CRS, out of which 5 (4.95%) with coexistent endometrial cancer were excluded (N = 96). Fifty women (52%) underwent primary CRS and 46 (48%) women underwent interval CRS. The mean age of the women was 48.42 ± 11.6 years. Initial serum cancer antigen 125 (CA 125) level was elevated (>35 U/mL) in 88 (91.67%) women and normal in 8 (8.33%) women. Complete cytoreduction was achieved in 75 (78.12%) cases. High-grade serous carcinoma was the most common histology (66/96, 68.75%), followed by mucinous carcinoma (15/96, 15.63%), endometrioid carcinoma (6/96, 6.25%), low-grade serous carcinoma (4/96, 4.17%), and carcinosarcoma (2/96, 2.08%). The majority of women, 69 (71.88%), were in stages III and IV at presentation. Most serous carcinomas were diagnosed at stage III (71.22%) or IV (13.64%). In contrast, the majority of endometrioid, mucinous, and clear cell carcinomas were diagnosed at stages I and II. Seventy-five women (78.13%) with EOC underwent pelvic and/or para-aortic lymphadenectomy, out of which 23 (30.67%) were histologically positive. Three out of 23 patients (13%) with early-stage disease showed positive LNs. Conclusion Serous carcinoma ovary is the most common histological subtype, presenting mostly in the advanced stage. A significant number of affected women were younger at presentation and diagnosis was made a decade earlier than the western population. A systematic pelvic and para-aortic lymphadenectomy in apparently early-stage (pelvic confined) ovarian cancer could detect additional LNs in 13% of women, especially in high-grade tumors and serous histology, suggesting the role of systematic lymphadenectomy for accurate staging in apparently early-stage ovarian cancer.

MRI Evaluation and Characterization of Ovarian Lesions Based on Ovarian-Adnexal Reporting and Data System MRI.

Background Managing ovarian lesions requires differentiating between benign and malignant cases. The development of a multiparametric MRI approach combining anatomical and functional criteria has led to the creation of the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI scoring system, which enhances diagnostic accuracy. Objectives To study ovarian lesions and their characteristics, along with their risk stratification based on MRI O-RADS. Methods A prospective study used the O-RADS MRI criteria to categorize ovarian lesions. Clinical findings and MRI results were compared with histopathological outcomes to assess diagnostic accuracy. Results We identifiedabdominal pain as the most prevalent clinical finding among our cases (64, 91.43%), followed by a lump in the abdomen (33, 47.5%), dysmenorrhea (33, 47.5%), bleeding per vaginal (15, 21.43%), and weight loss (11, 15.71%). A total of 80 ovarian lesions were examined and characterized on the basis of the O-RADSMRI risk stratification system.Among the 80 ovarian lesions, 54 were histopathologically confirmed ovarian lesions (39 (72.22%) were benign, and 15 (27.77%) were malignant). The most common benign lesions were ovarian serous cystadenoma (28.20%) and ovarian mucinous cystadenoma (20.51%), while the most common malignant lesions were serous carcinoma (33.33%) and mucinous carcinoma (20%). Using the O-RADS MRI scoring system, we categorized six lesions (7.5%) as O-RADS 1 (all benign), 34 lesions (42.50%) as O-RADS 2 (32 benign and 2 malignant), 24 lesions (30%) as O-RADS 3 (23 benign and 1 malignant), seven lesions (8.75%) as O-RADS 4 (four benign and three malignant), and nine lesions (11.25%) as O-RADS 5 (all malignant). Our findings revealed significant differences in the size of lesions, the presence of thick septa, high T2-weighted signal intensity within solid tissue, and patterns of solid component enhancement and wall irregularity between malignant and benign lesions. The MRI cut-off score of ≥4 for malignancy demonstrated a sensitivity of 94.59%, a specificity of 97.5%, an accuracy of 97.62%, a positive predictive value of 94.5%, and a negative predictive value of 97.5%. The positive likelihood ratio was 32.7, while the negative likelihood ratio was 0.025. These results affirm the high diagnostic accuracy of the O-RADS MRI scoring system in distinguishing benign from malignant ovarian lesions. Conclusion The O-RADS MRI score is a highly accurate tool for differentiating between benign and malignant ovarian lesions. Its application can significantly enhance the management and treatment outcomes for patients with adnexal masses. The study confirms the scoring system's high sensitivity, specificity, and overall diagnostic accuracy.

Survival and predictors of mortality among colorectal cancer patients on follow-up in Hawassa University Comprehensive Specialized Hospital, Sidama region, Southern Ethiopia, 2022. A 5-year retrospective cohort study.

The incidence and mortality of colorectal cancer were still rising rapidly in many low-income and middle-income countries, which was linked to ongoing societal and economic status. Colorectal cancer is the leading cancer in Ethiopia with relatively lower survival. However, colorectal cancer patients' survival time and predictors have not been well studied in Southern Ethiopia. This study aimed to assess five-year survival and predictors of mortality among colorectal cancer patients at Hawassa Comprehensive Specialized Hospital, Ethiopia. Facility-based retrospective cohort study was conducted among 323 patients who visited Hawassa Comprehensive Specialized Hospital from May 1st, 2017 to April 30th, 2022. The Kaplan-Meier survival curve with the Log-rank test was used to estimate the survival time. Bivariable and multivariable Cox proportional hazards regression models were used to determine the net effect of each independent variable on time to death after diagnosis. Over the 5-year observation period, the overall mortality rate was 38.5%, with an incidence density of 31 fatalities per 100 person-years observation. Survival at 1, 2, 3, 4, and 5 years was 78%, 53, 32.4%, 23.3%, and 18.7% respectively. The multivariable analysis showed that metastatic disease (AHR = 4.2, CI: 1.5-11.5), baseline carcinoembryonic antigen level ≥5ng/ml (AHR: 2.4, CI: 1.2-5.8), living in rural areas (AHR = 2.2, CI:1.03-4.8) and mucinous carcinoma (AHR = 0.33, CI: 0.13-0.87) were independent predictors of colorectal cancer mortality. Overall survival of colorectal cancer patients in the study was low compared to similar studies in developing and developed worlds. A significantly low survival rate was observed for patients with advanced stage, elevated carcinoembryonic antigen levels, and rural residents indicating the key role of early detection and timely initiation of treatment to improve survival and quality of life of patients with colorectal cancer.

Mucinous Carcinoma of Ovary in a 15-Year-Old Girl, A Rare Case Report and Literature Review.

Ovarian epithelial tumors are common in adults, and the median patient age at presentation is 55 years. In children, epithelial tumors are rare and mostly benign. Mucinous cystadenocarcinoma is reported in only 11 cases less than 15 years old. This report describes the case of a 15-year-old postmenarchal Omani girl with ovarian mucinous carcinoma. She was admitted with severe epigastric pain and abdomen distension. CT scan showed a huge cystic lesion arising from the left adnexa filling the entire abdominal and pelvic cavity. The patient underwent laparotomy with left ovarian cystectomy and omental biopsy which revealed a 35 x 30 cm left ovarian cyst filled with turbid straw color fluid. Histopathology was reported as mucinous carcinoma. The patient later underwent cytoreductive surgery with left salpingo-oophorectomy, omentectomy, appendicectomy, and lymph node dissection that were negative for malignancy or metastatic disease. During follow-up, she developed a lymphocele in the pelvic cavity that was drained. There were no other significant issues during follow-up, as well as no evidence of recurrence or metastasis. Epithelial tumors of the ovary are rare in young girls, with malignant tumors being exceedingly rare. Fertility-sparing surgery is adopted over radical surgery in these patients, even though the recurrence rates with this treatment protocol are high. All cases should be under follow-up to look for recurrence and timely management.

Comparing Clinicopathological and Immunohistochemical Features of Colorectal Carcinoma between Young and Old Age Groups.

The incidence of colorectal carcinoma (CRC) is increasing among individuals younger than 50, and some studies suggest the presence of differences in CRC among old and young individuals regarding clinical and histopathological features. The aim of this study was to compare clinicopathological features, mismatch repair protein status, and expression of certain immunohistochemical stains between young and old groups. The study included 180 cases and found significant histological and immunohistochemical differences between the two groups. CRC in the young tends to be more right-sided and has a higher percentage of dMMR proteins, but less expression of p53 mutations. These features are commoner in Lynch syndrome, and more investigations to study the relationship between young-onset CRC and hereditary syndromes are needed. Young-onset CRC also tends to show higher expression of tumor cell PD-L1, which is an expected finding, as dMMR cases are more likely to be immunogenic. Two other significant differences are the higher percentage of mucinous carcinoma and the higher tumor grade in young-onset CRC. These two features suggest a more advanced disease with possibly worse outcomes; however, there is no difference in disease stage between the two age groups.

Intraoperative severe gastric venous congestion during total pancreatectomy with replaced common hepatic artery: a case report

BackgroundGastric venous congestion (GVC) is one of the complications of total pancreatectomy (TP). Here, we report a case of intraoperative severe GVC during TP with a replaced common hepatic artery (RCHA).Case presentationA 65-year-old female patient was diagnosed with intraductal papillary mucinous carcinoma. Her CHA branched from the superior mesenteric artery as RCHA. She underwent subtotal stomach preserving TP. The tumor was resected with splenic artery (SpA) and total gastric vein transections. Severe GVC and bleeding from the stomach tube occurred intraoperatively. A strong pulsation was observed in the left gastric artery (LGA), and we suspected an increased blood flow from the celiac artery (CeA) to the LGA after SpA resection. Total gastrectomy (TG) was then performed to control the severe GVC-related bleeding. The patient was discharged without complications 19 days postoperatively.ConclusionTP with RCHA may increase the risk of severe GVC due to increased blood flow from CeA to LGA.

Role of diffusion-weighted magnetic resonance imaging in detection of lymph node metastasis in rectal cancer

BackgroundRectal cancer is the most prevalent gastrointestinal tumor. Early diagnosis, accurate staging as well as early treatment are the keys for improving the five-year survival rate. The objective of this research is to assess the effectiveness of diffusion-weighted MRI (DWI) in identifying lymph nodes and distinguishing between benign and metastatic nodes throughout the first stage of primary rectal cancer.ResultsThe study showed that mean ADC value was significantly higher in mucinous carcinoma (1.72 ± 0.36 × 10–3 mm2/sec) than that in non-mucinous carcinoma (0.981 ± 0.276 × 10–3 mm2/sec) with a cutoff value of (1.3 × 10–3) mm2/s which was the precise value to produce high sensitivity, specificity and accuracy of 93%, 94%, and 94%, respectively. ADC analysis showed either intermediate or low signal in 49 (70%) and high signal in 21 (30%) L.Ns. Mean ADC value showed a significant reduction in malignant L.Ns (1.01 ± 0.54 × 10–3 mm2/sec) compared to benign L.Ns (1.51 ± 0.51 × 10–3 mm2/sec), AUC of 0.674 (P = 0.008) and a cutoff value of 0.987 × 10–3 mm2/s with sensitivity, specificity and accuracy of 44.4%, 91.2% and 67.5%, respectively. The mean L.N /tumor ratio was 1.65 ± 0.73 in benign L.Ns and 1.06 ± 0.37 in malignant L.Ns.ConclusionsIn rectal cancer, there was a significant difference between benign and malignant L.Ns regarding diffusion result, L.Ns size, shape, and margin. The study demonstrated the effectiveness of DWI in diagnosing lymph node metastasis in colorectal cancer; true diffusion restriction was significantly noted in malignant L.Ns compared to benign L.Ns. Mean ADC value showed a significant reduction in malignant L.Ns compared to benign L.Ns. L.N/tumor ratio showed a significant reduction in malignant L.Ns compared to benign L.Ns.

Deep Learning-Based Ovarian Cancer Subtype Classification Using VGG16 and MobileNetV2 with Squeeze-and-Excitation Blocks

Background: Ovarian carcinoma remains one of the deadliest gynecological malignancies due to its heterogeneity and late-stage detection. Accurate classification of its subtypes—High-Grade Serous Carcinoma (HGSC), Clear-Cell Carcinoma (CC), Endometrioid Carcinoma (EC), Low-Grade Serous Carcinoma (LGSC), and Mucinous Carcinoma (MC)—is essential for tailored treatments, yet traditional histopathological methods often lack precision. This study aimed to develop a deep learning (DL) model to enhance ovarian cancer subtype classification using histopathological images. Methods: Histopathological images were collected from medical repositories, and data augmentation techniques were applied to increase dataset diversity. Two convolutional neural network (CNN) architectures, VGG16 and MobileNetV2, were fine-tuned using transfer learning to classify the subtypes. The models were pre-trained on the ImageNet dataset and evaluated through accuracy, precision, recall, F1-score, and ROC-AUC, with K-fold cross-validation ensuring robustness. Results: Results indicated that VGG16 improved classification over baseline CNN models, while MobileNetV2, with Squeeze-and-Excitation (SE) blocks, achieved the highest performance, offering greater accuracy and computational efficiency. MobileNetV2’s lightweight architecture captured intricate tissue patterns more effectively, making it the superior model. Conclusion: This study highlights the potential of advanced DL models, particularly MobileNetV2 with SE block attention, for improving ovarian cancer subtype classification. These findings offer promising implications for clinical practice and personalized treatment approaches. Future research should focus on larger datasets and integrating multimodal data for further advancements.

HIGH DOSE RATE BRACHYTHERAPY IN THE TREATMENT OF OPERATED ENDOMETRIAL CANCERS: ABOUT 60 CASES

Introduction:Endometrial cancer is the third gyneco-mammary cancer in the radiotherapy-brachytherapy department of the RABAT national oncology institute.Brachytherapy has an important place in the therapeutic strategy. The objective of the study:Is to analyze the coverage of target volumes as well as the dose to organs at risk with three-dimensional dosimetric planning and toxicity assessment. Material and methods:This is a retrospective study of 60 cases of operated endometrial cancers treated by high dose rate brachytherapy without external radiotherapy or chemotherapy collected in the radiotherapy department of the National Institute of Oncology RABAT between January 2018 and December 2020. A dosimetric scan without injection was performed at the first session and was used to delineate the clinical anatomic target volume (CTV). We evaluated the D100 of the clinical target volume and the D2 cm3 of the bladder, rectum and small intestine. We also analyzed acute genitourinary and gastrointestinal toxicity. Results:The average age of the patients was 49 years. Endometrioid carcinoma accounted for 98.5%, with one case of mucinous carcinoma. All patients underwent surgery.The brachytherapy protocol used was 3 × 7 Gy (75%) or 4 × 5.5 Gy (17%) in weekly sessions A single patient received a reduced total dose of 19.8 Gy in 3 fractions of 5.5 Gy due to a high rectal dose.The average target volume coverage (D100) was 96.50%.The average D2 cm3 per session received by the bladder, rectum and small intestine were 4.06 Gy, 4.9 Gy and 2.8 Gy, respectively.Regarding genitourinary toxicity, we noted two grade 1 cystitis, one grade 2, two grade 1 mucositis and one grade 2.For gastrointestinal toxicity, no cases of grade greater than 1 were noted.No grade 3 or 4 toxicities were recorded. Conclusion:High dose rate brachytherapy has an important place in the therapeutic strategy for endometrial cancer.The very low toxicity recalls the good tolerance of this treatment whichapplies to the entire population.

Pancreaticoduodenectomy after postoperative gastric tube reconstruction for esophageal cancer with median arcuate ligament syndrome: a case report

BackgroundPancreaticoduodenectomy (PD) is considered a challenging surgery for resecting the gastroduodenal artery (GDA), right gastric artery (RGA), and lymph node tumors. In cases of pancreatic head cancer surgery, vascular anastomosis or right gastroepiploic artery (RGEA)/GDA preservation is necessary after postoperative gastric tube reconstruction for esophageal cancer. Therefore, we report for the first time an extremely rare case of PD in a patient with pancreatic head cancer and median arcuate ligament syndrome (MALS) after gastric tube reconstruction following esophageal cancer surgery, in which the entire pancreatic head arcade was preserved.Case presentationThe patient was a 76-year-old man who had undergone esophageal cancer surgery after sternal gastric tube reconstruction 7 years ago. He was referred to our hospital because of the suspicion of intraductal papillary mucinous carcinoma (IPMC) owing to an enlarged cystic lesion and a substantial component in the uncinate process of the pancreas. Preoperative three-dimensional computed (3D-CT) tomography angiography showed celiac axis stenosis and pancreatic head arcade dilation. The diagnosis was IPMC without evidence of invasion; therefore, gastric tube blood flow was maintained by preserving the GDA and RGEA. Due to MALS, the GDA blood flow was supplied through the pancreatic head arcade, necessitating its preservation. The GDA-RGEA, right gastroepiploic vein, and anterior superior pancreaticoduodenal artery were taped over the entire pancreatic head for preservation. The inferior pancreaticoduodenal artery (IPDA) was also taped on the dorsal pancreas and the posterior or anterior IPDA, which further bifurcates were taped to preserve them. Subsequently, PD was performed.ConclusionWe report a case of PD after gastric tube reconstruction for esophageal cancer with MALS, in which the pancreatic head arcade vessels were successfully preserved using 3D-CT to confirm the operation of the vessels.

Urinary microRNA-210-3p as a novel and non-invasive biomarker for the detection of pancreatic cancer, including intraductal papillary mucinous carcinoma

BackgroundThis study aims to explore novel microRNAs in urine for screening and predicting clinical characteristics in pancreatic cancer (PC) patients using a microRNA array-based approach.MethodsWe used the Toray® 3D-Gene microRNA array-based approach to compare urinary levels between PC patients and healthy volunteers.Results(1) Four oncogenic microRNAs (miR-744-5p, miR-572, miR-210-3p, and miR-575) that were highly upregulated in the urine of PC patients compared to healthy individuals were identified by comprehensive microRNA array analysis. (2) Test-scale analysis by quantitative RT-PCR for each group of 20 cases showed that miR-210-3p was significantly upregulated in the urine of PC patients compared to healthy individuals (P = 0.009). (3) Validation analysis (58 PC patients and 35 healthy individuals) confirmed that miR-210-3p was significantly upregulated in the urine of PC patients compared to healthy individuals (P < 0.001, area under the receiver operating characteristic curve = 0.79, sensitivity: 0.828, specificity: 0.743). We differentiated PC patients into invasive ductal carcinoma (IDCa) and intraductal papillary mucinous carcinoma (IPMC) groups. In addition to urinary miR-210-3p levels being upregulated in IDCa over healthy individuals (P = 0.009), urinary miR-210-3p levels were also elevated in IPMC over healthy individuals (P = 0.0018). Urinary miR-210-3p can differentiate IPMC from healthy individuals by a cutoff of 8.02 with an AUC value of 0.762, sensitivity of 94%, and specificity of 63%. (4) To test whether urinary miR210-3p levels reflected plasma miR-210-3p levels, we examined the correlation between urinary and plasma levels. Spearman’s correlation analysis showed a moderate positive correlation (ρ = 0.64, P = 0.005) between miR-210-3p expression in plasma and urine.ConclusionsUrinary miR-210-3p is a promising, non-invasive diagnostic biomarker of PC, including IPMC.Trial registrationNot applicable.

Deep fine-KNN classification of ovarian cancer subtypes using efficientNet-B0 extracted features: a comprehensive analysis

This study presents a robust approach for the classification of ovarian cancer subtypes through the integration of deep learning and k-nearest neighbor (KNN) methods. The proposed model leverages the powerful feature extraction capabilities of EfficientNet-B0, utilizing its deep features for subsequent fine-grained classification using the fine-KNN approach. The UBC-OCEAN dataset, encompassing histopathological images of five distinct ovarian cancer subtypes, namely, high-grade serous carcinoma (HGSC), clear-cell ovarian carcinoma (CC), endometrioid carcinoma (EC), low-grade serous carcinoma (LGSC), and mucinous carcinoma (MC), served as the foundation for our investigation. With a dataset comprising 725 images, divided into 80% for training and 20% for testing, our model exhibits exceptional performance. Both the validation and testing phases achieved 100% accuracy, underscoring the efficacy of the proposed methodology. In addition, the area under the curve (AUC), a key metric for evaluating the model’s discriminative ability, demonstrated high performance across various subtypes, with AUC values of 0.94, 0.78, 0.69, 0.92, and 0.94 for MC. Furthermore, the positive likelihood ratios (LR+) were indicative of the model’s diagnostic utility, with notable values for each subtype: CC (27.294), EC (9.441), HGSC (12.588), LGSC (17.942), and MC (17.942). These findings demonstrate the effectiveness of the model in distinguishing between ovarian cancer subtypes, positioning it as a promising tool for diagnostic applications. The demonstrated accuracy, AUC values, and LR+ values underscore the potential of the model as a valuable diagnostic tool, contributing to the advancement of precision medicine in the field of ovarian cancer research.

Kaiser score diagnosis of breast MRI lesions: Factors associated with false-negative and false-positive results

PurposeWe sought factors associated with false-negative and false-positive results in the diagnosis of breast lesions using the Kaiser score (KS) on breast magnetic resonance imaging (MRI). MethodsWe retrospectively analyzed 1058 patients with 1058 breast lesions who underwent preoperative breast MRI with successful histopathologic results. Two radiologists assessed each lesion according to KS criteria, and clinicopathologic features and MRI findings were analyzed. Multivariate regression analysis was conducted to identify factors associated with false-negative and false-positive KS results. ResultsOf the 1058 lesions, 859 were malignant and 199 were benign. Particularly high misdiagnosis rates were observed for intraductal papilloma, inflammatory lesion, and mucinous carcinoma. For breast cancer, KS yielded 821 (95.6 %) true-positive and 38 (4.4 %) false-negative results. Multivariate analysis showed that smaller lesion size (≤1 cm) (OR, 3.698; 95 %CI, 1.430–9.567; p = 0.007), absence of ipsilateral breast hypervascularity (OR, 3.029; 95 %CI, 1.370–6.693; p = 0.006), and presence of hyperintensity on T2WI (OR, 2.405; 95 %CI, 1.121–5.162; p = 0.024) were significantly associated with false-negative breast cancer results. For benign lesions, KS yielded 141 (70.9 %) true-negative and 58 (29.1 %) false-positive results. Multivariate regression analysis revealed that non-mass enhancement lesions (OR, 4.660; 95 %CI, 2.018–10.762; p＜0.001), moderate/high background parenchymal enhancement (OR, 2.402; 95 %CI, 1.180–4.892; p = 0.016), and the presence of hyperintensity on T2WI (OR, 2.986; 95 %CI, 1.386–6.433; p = 0.005) were significantly associated with false-positive KS results. ConclusionSeveral clinicopathologic and MRI features influence the accuracy of KS diagnosis. Understanding these factors may facilitate appropriate use of KS and guide alternative diagnostic approaches, ultimately improving diagnostic accuracy in the evaluation of breast lesions.

Immunohistochemical expression of SATB2 and PAX8 in differentiating primary from metastatic ovarian mucinous neoplasms.

Accurate stratification of an ovarian mucinous neoplasm as primary or secondary is always challenging as they show overlapping histomorphological and immunohistochemical features. Immunohistochemical staining for SATB2 and PAX8 was performed on 80 cases of mucinous ovarian neoplasms subdivided into 53 primary [25 primary ovarian mucinous carcinomas (POMCs) and 28 mucinous borderline tumors (MBTs)] and 27 secondary (12 of colonic origin, 7 of appendiceal origin, and 8 of gastric origin). Expression was correlated with different clinicopathologic parameters. PAX8-positive immunostaining was detected in 38 out of 53 cases (71.69%) of primary ovarian mucinous neoplasms (POMNs) with null positivity in the secondary ovarian mucinous tumors (0/27). SATB2-positive expression was detected in 16 out of 27 cases (59.26%) of the secondary ovarian mucinous tumors. None of the studied POMNs showed any positive immunostaining for SATB2 (0/53). A profile of SATB2-/PAX8+ and SATB2+/PAX8- can be used to differentiate POMNCs from secondary ovarian mucinous tumors of GI origin, respectively, with 100% specificity. PAX8 expression is associated with some clinicopathologic parameters providing the basis for the possible usage of PAX8 as prognostic marker.

Multimodal diagnostic strategies and precision medicine in mucinous ovarian carcinoma: a comprehensive approach.

Mucinous ovarian carcinoma (MOC) represents a distinct entity within ovarian malignancies, characterized by diagnostic challenges due to its rarity and the potential overlap with other tumor types. The determination of tumor origin is important for precise postsurgical treatment. This article highlights the accurate diagnosis and management of MOC, including the use of imaging modalities, serological tumor markers, immunohistochemistry, and genomic analyses. Transabdominal and transvaginal ultrasonography, complemented by MRI and CT, plays a pivotal role in differentiating MOC from other mucinous tumors and in surgical planning, particularly for fertility preservation. Serological markers like CA19-9, CA-125, and CEA, though not definitive, provide valuable preoperative insights. Immunohistochemistry aids in distinguishing primary MOC from metastatic mucinous carcinomas, while genomic profiling offers the potential for precision medicine through the identification of specific molecular signatures and treatment susceptibilities. Despite advancements in diagnostic techniques, no single method conclusively differentiates between primary and metastatic tumors intraoperatively. The paper reviews the origins, diagnosis, and differential diagnosis of primary mucinous ovarian carcinoma highlights the need for a multimodal diagnostic approach and advocates for the inclusion of MOC patients in clinical trials for personalized therapies, recognizing the heterogeneity of the disease at the molecular level.

Reduced expression of SOX11 in colorectal adenocarcinoma is associated with mucinous and signet ring cell types, poor survival, and lower ALK expression

BackgroundMucinous and signet ring cell colorectal carcinoma (m/srCRC) are challenging colorectal adenocarcinoma (CRC) types with poor prognosis. This study aimed to investigate SOX11 and ALK immunohistochemical expression in the m/srCRC group, comparing the results to those of nonmucinous CRC (nmCRC) and studying their association with different clinicopathological CRC features to better understand their significance and role. Besides, the study assesses which marker has a better predictive value for clinical practice. MethodsTissue microarrays were prepared from 150 CRC blocks distributed equally between the m/srCRC and nmCRC groups. SOX11 and ALK immunohistochemical expressions were compared between both groups. In addition, their association with CRC clinicopathological data and survival was investigated. The Receiver Operating Characteristic (ROC) Curve analysis examined the predictive ability of SOX11 and ALK IHC expression for CRC mortality. ResultsBoth SOX11 and ALK expression were significantly reduced in m/srCRC compared to nmCRC. SOX11 is significantly associated with other prognostic clinicopathological factors (tumor size, lymph node status, overall TNM stage, grade, lymphovascular and perineural invasion) and overall survival. SOX11 significantly positively correlates with ALK expression. Using the ROC analysis, SOX11 is superior to ALK in survival prediction. ConclusionSOX11 can be used as a prognostic marker and is a suggested therapeutic target in mucinous and signet ring cell colorectal carcinoma through upregulation modulation.

A morphological and immunohistochemical study of ductal carcinoma in situ, invasive breast carcinoma of no special type, and mucinous carcinoma of the breast in comparison with solid papillary carcinoma regarding neuroendocrine marker expression.

The exact relationship between solid papillary carcinoma (SPC) and invasive breast carcinoma of no special type (IBC-NST) with neuroendocrine differentiation and SPC and mucinous carcinoma (MC) of the breast remains unclear. To clarify the relationship, we conducted a comparative study of morphological and neuroendocrine features between ductal carcinoma in situ (DCIS, 72 cases) and SPC in situ (35 cases), and IBC-NST (103 cases) and invasive SPC (92 cases). We also conducted the study between MC associated with and without SPC. Synaptophysin, chromogranin A, and INSM1 were employed for the immunohistochemical study. IBC-NST had occasionally a morphological similarity with invasive SPC. While 123 of 127 cases with SPC demonstrated diffuse staining with one or more of the neuroendocrine markers, the only one case of DCIS and none of IBC-NST showed it. Type B was observed in 16 of 18 cases of MC associated with SPC and in 13 of 33 cases of MC without it. All the cases of MC with SPC and 6 of 33 cases without it showed diffuse staining for at least one of the neuroendocrine markers. In conclusion, a careful distinction between invasive SPC and IBC-NST with neuroendocrine differentiation is required. We assume that SPC in situ is a potential candidate for precursor of IBC-NST with neuroendocrine differentiation. MC of the breast is suggested to have two pathogenetic pathways through SPC in situ or non-SPC in situ. SPC in situ is thought to be less common as a precursor of MC than non-SPC in situ.

Primary mucinous carcinoma of eyelid skin, a rare finding

Primary mucinous carcinoma of eyelid skin is a rare type of sweat gland carcinoma, with around 300 cases described to date. The most frequent clinical presentation is an asymptomatic nodule with characteristics very similar to those of other benign nodules, so the definitive diagnosis is always histopathological. Although the primary mucinous carcinoma of the skin (PMCS) risk of metastasis is low, its recurrence is much more frequent, so it is critical to expose the cases that we find of this tumor to help a better diagnosis in daily practice. We present the case of a patient with a nodule on the eyelid, and biopsy revealed findings compatible with PMCS.

The Utility and Feasibility of Laparoscopic Surgery in Patients Diagnosed With Cervical Cystic Lesions.

This observation study aimed to differentiate between lobular endocervical glandular hyperplasia (LEGH) and gastric-type mucinous carcinoma (GAS) while evaluating the feasibility and efficacy of laparoscopic surgery in the preoperative diagnosis of cervical cystic lesions. A retrospectivestudy was conducted to evaluate the diagnostic process and laparoscopic surgical management of cervical cystic lesions suspected to be LEGH or GAS. Preoperatively and postoperatively, MRI, cytology, histology, tumor marker analysis, and surgical outcomes (blood loss during surgery, operative time) were assessed. Six individuals were selected based on magnetic resonance imaging (MRI) results indicating a preoperative suspicion of LEGH or GAS. These patients underwent laparoscopic surgical treatment without indications of malignancy based on preoperative histology or cytology. Initially, all individuals were suspected to have LEGH based on MRI findings. Postoperatively, two patients were diagnosed with LEGH, two with adenocarcinoma in situ (AIS) and minimal deviation adenocarcinoma (MDA), and two showed no notable findings on pathology (one diagnosed endometrioid carcinoma in endometrial tissue). Patients with malignancies exhibited longer surgical times and higher intraoperative blood loss. Preoperatively, no significant variation was observed in maximal lesion diameter between adenocarcinoma and LEGH. However, lesion diameter increased significantly over time in patients with GAS. Laparoscopic surgery demonstrated feasibility and provided crucial diagnostic and therapeutic outcomes, with no postoperative recurrence observed in cases of malignancy, despite the challenges associated with preoperative differentiation. These findings underscore the potential of laparoscopic surgery in enhancing both diagnostic accuracy and therapeutic efficacy for cervical cystic lesions, offering promise for improved patient outcomes and management strategies in clinical practice.

Pseudomyxoma peritonei leading to “jelly belly” abdomen: a case report and review of the literature

BackgroundPseudomyxoma peritonei is an infrequent condition with a global annual incidence of only one to two cases per million people. Mucinous neoplasms, widespread intraperitoneal implants, and mucinous ascites characterize it. Currently, most clinicians misdiagnose this condition, which leads to delayed management.Case presentationA 44-year-old North Indian female presented with a 1.5-month history of an abdominal lump. Physical examination revealed a sizeable abdominopelvic mass at 36 weeks. Contrast-enhanced computed tomography showed a massive multiloculated right ovarian cystic mass measuring 28 × 23 × 13 cm with mild ascites and elevated carcinoembryonic antigen levels (113.75 ng/ml). A provisional diagnosis of ovarian mucinous neoplasm was made, for which the patient underwent laparotomy. Intraoperatively, there were gross mucinous ascites, along with a large, circumscribed, ruptured right ovarian tumor filled with gelatinous material. The appendicular lump was also filled with mucinous material along with the omentum, ascending colon, right lateral aspect of the rectum, splenic surface, and small bowel mesentery. Cytoreductive surgery was performed along with an oncosurgeon, including total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy, right hemicolectomy, lower anterior resection, ileo-transverse stapled anastomosis with proximal ileal loop diversion stoma, excision of multiple peritoneal gelatinous implants, and peritoneal lavage. Histopathology and immunohistochemistry confirmed the presence of intestinal-type mucinous carcinoma. Postoperatively, the patient was given six cycles of chemotherapy. She tolerated it without any specific morbidity and had an uneventful recovery. Postoperative follow-up at 15 months revealed normal tumor marker levels and abdominal computed tomography findings and no signs suggestive of local recurrence or distal metastases.ConclusionsPseudomyxoma peritonei is a rare disease that is frequently misdiagnosed in the preoperative phase. Therefore, radiologists and clinicians should maintain a high index of suspicion for accurate diagnosis and multidisciplinary management.