Ovarian Tumors Research Articles

Genetic Mutations Associated With TNFAIP3 (A20) Haploinsufficiency and Their Impact on Inflammatory Diseases.

TNF-α-induced protein 3 (TNFAIP3), commonly referred to as A20, is an integral part of the ubiquitin-editing complex that significantly influences immune regulation, apoptosis, and the initiation of diverse immune responses. The A20 protein is characterized by an N-terminal ovarian tumor (OTU) domain and a series of seven zinc finger (ZNF) domains. Mutations in the TNFAIP3 gene are implicated in various immune-related diseases, such as Behçet's disease, polyarticular juvenile idiopathic arthritis, autoimmune thyroiditis, autoimmune hepatitis, and rheumatoid arthritis. These mutations can lead to a spectrum of symptoms, including, but not limited to, recurrent fever, ulcers, rashes, musculoskeletal and gastrointestinal dysfunctions, cardiovascular issues, and respiratory infections. The majority of these mutations are either nonsense (STOP codon) or frameshift mutations, which are typically associated with immune dysfunctions. Nonetheless, missense mutations have also been identified as contributors to these conditions. These genetic alterations may interfere with several biological pathways, notably abnormal NF-κB signaling and dysregulated ubiquitination. Currently, there is no definitive treatment for A20 haploinsufficiency; however, therapeutic strategies can alleviate the symptoms in patients. This review delves into the mutations reported in the TNFAIP3 gene, the clinical progression in affected individuals, potential disease mechanisms, and a brief overview of the available pharmacological interventions for A20 haploinsufficiency. Mandatory genetic testing of the TNFAIP3 gene should be performed in patients diagnosed with autoinflammatory disorders to better understand the genetic underpinnings and guide treatment decisions.

Single-cell RNA sequencing reveals that MYBL2 in malignant epithelial cells is involved in the development and progression of ovarian cancer.

Ovarian carcinoma (OC) is a prevalent gynecological malignancy associated with high recurrence rates and mortality, often diagnosed at advanced stages. Despite advances in immunotherapy, immune exhaustion remains a significant challenge in achieving optimal tumor control. However, the exploration of intratumoral heterogeneity of malignant epithelial cells and the ovarian cancer tumor microenvironment is still limited, hindering our comprehensive understanding of the disease. Utilizing single-cell RNA sequencing (scRNA-seq), we comprehensively investigated the cellular composition across six ovarian cancer patients with omental metastasis. Our focus centered on analysis of the malignant epithelial cells. Employing CytoTRACE and slingshot pseudotime analyses, we identified critical subpopulations and explored associated transcription factors (TFs) influencing ovarian cancer progression. Furthermore, by integrating clinical factors from a large cohort of bulk RNA sequencing data, we have established a novel prognostic model to investigate the impact of the tumor immune microenvironment on ovarian cancer patients. Furthermore, we have investigated the condition of immunological exhaustion. Our study identified a distinct and highly proliferative subgroup of malignant epithelial cells, known as C2 TOP2A+ TCs. This subgroup primarily consisted of patients who hadn't received neoadjuvant chemotherapy. Ovarian cancer patients with elevated TOP2A expression exhibited heightened sensitivity to neoadjuvant chemotherapy (NACT). Moreover, the transcription factor MYBL2 in this subgroup played a critical role in ovarian cancer development. Additionally, we developed an independent prognostic indicator, the TOP2A TCs Risk Score (TTRS), which revealed a correlation between the High TTRS Group and unfavorable outcomes. Furthermore, immune infiltration and drug sensitivity analyses demonstrated increased responsiveness to Paclitaxel, Cisplatin, and Gemcitabine in the Low TTRS Group. This research deepens our understanding of malignant epithelial cells in ovarian cancer and enhances our knowledge of the ovarian cancer immune microenvironment and immune exhaustion. We have revealed the heightened susceptibility of the C2 TOP2A+ TCs subgroup to neoadjuvant chemotherapy and emphasized the role of MYBL2 within the C2 subgroup in promoting the occurrence and progression of ovarian cancer. These insights provide valuable guidance for the management of ovarian cancer treatment.

Performing Routine Appendectomy in Mucinous Borderline Ovarian Tumours: An Experience of 15 Years From a Cancer Centre.

It is very controversial whether appendectomy should be performed as a routine part of the staging procedure for mucinous borderline ovarian tumours (mBOTs) or not, as the involvement of the appendix in women undergoing surgery for mBOTs and the exact magnitude of the benefit of appendectomy are unclear. This study was conducted to determine the frequency of appendiceal involvement in patients of mBOTs and morbidity associated with surgery and to evaluate recurrence-free survival after surgery. This retrospective cohort study was conducted at a cancer centre from January 2008 to December 2022 (15 years). The hospital database was searched for patients whose final diagnosis was mBOTs. All women who have been operated for mBOTs were included in the study. Descriptive analysis was performed for study variables. The survival curve was calculated according to the Kaplan-Meier method. Ninety cases whose final diagnosis was mBOTs were identified from the Cancer Registry. Of those, 39 cases were excluded as they did not fulfil the inclusion criteria. Fifty-one patients were finally selected for the study. Of the 51 patients, appendectomy was not performed in eight patients, and the reason was not mentioned in the hospital record. The appendix was macroscopically abnormal in only two patients. None of the patients was diagnosed with mucinous borderline tumours of the appendix in our study. The appendectomy itself was not associated with any complications. Only one patient with mBOT had recurrence after four months of surgery, which was surgically treated and no patient died during the median follow-up of 36 months. If the appendix is grossly normal looking, then appendectomy can be omitted in surgery of mBOTs. mBOTs have good recurrence free and overall survival outcomes post surgery.

Laparoscopic-Assisted Fertility-Sparing Surgery for Growing Teratoma Syndrome of the Ovary: Experience From a Tertiary Center

Study ObjectiveThe main objective is to evaluate the feasibility of laparoscopic fertility-sparing surgery in women with growing teratoma syndrome. DesignRetrospective cohort study. SettingChinese tertiary university hospital. PatientsPatients with growing teratoma syndrome who underwent fertility-sparing surgery between January 2015 and August 2023. InterventionsBaseline characteristics and surgical outcomes were evaluated, including clinical information, surgical procedures, operative time, intraoperative blood loss, complications, length of hospital stay, and follow-up information. Measurement and Main ResultsTwenty-six patients with ovarian growing teratoma syndrome underwent fertility-sparing surgery: 12 had laparoscopic surgery and 14 underwent laparotomic surgery. In the laparoscopic group, the median age of the patients during initial management of immature teratoma or mixed malignant ovarian germ cell tumor was 14.0 years (interquartile range: 13.0-24.5 years). Eleven patients were nulliparous. The primary ovarian tumor was pure immature teratoma in 10 patients and mixed ovarian germ cell tumor in 2 patients. Complete laparoscopic tumor resection was achieved in 11 patients. Patients in laparoscopic group had shorter median operative time (76.5 vs 180.0 minutes, p = 0.001), lower estimated blood loss (20.0 vs 400.0 ml, p < 0.001), decreased postoperative hospital stay (2.0 vs 7.0 days, p < 0.001), compared with laparotomic surgery. There was no conversion to laparotomy and no perioperative complications. Histological examination confirmed mature teratoma in all cases. During a median follow-up of 21.9 months (interquartile range: 7.6-44.9 months), 11 patients were alive without disease and 1 was alive with disease. One pregnancy was achieved postoperatively. ConclusionLaparoscopic fertility-sparing surgery may represent a feasible option in well-selected patients with ovarian growing teratoma syndrome. Surgery should be performed in gynecologic oncology centers by experienced staff trained in endoscopic procedures. More research and long-time follow-up are needed to determine the oncological outcomes and safety of laparoscopic surgery in this population.

Case Report: Hyperandrogenism in Menopause.

Postmenopausal androgen excess often occurs due to the imbalance between the rapid decline in ovarian estrogen and a relatively gradual decline in androgen secretion. The rapid onset of hirsutism, alopecia, and acne, on the other hand, is a rare occurrence and requires further investigation in order to rule out an underlying neoplasm. A 54-year-old woman arrived at the endocrinology outpatient clinic for the appearance of hirsutism and defluvium capitis in the past 9 months. She had hypertrichosis of the face, trunk, and mammary areolae and reduced timbre of voice. Circulating androgens were higher than normal levels (testosterone: 7.7 ng/mL, DHEAS: 5437 mcg/L, 17-OH-progesterone: 3.1 nmol/L), gonadotropin and prolactin levels were normal, and Nugent test was negative. Abdominal CT scan was negative for adrenal lesions, while transvaginal ovarian ultrasonography revealed a left adnexal formation (19x18x24 mm) compatible with stromal neoplasm. A bilateral hysteroannessiectomy was performed. Histological examination was diagnostic for multiple ovarian Leydig cell tumors. The most frequent cause of postmenopausal hyperandrogenism is polycystic ovary syndrome. It is necessary to exclude the presence of neoplastic causes (ovarian or adrenal androgen- secreting tumors). In case of marked virilization and severe hyperandrogenism, it is useful to perform transvaginal ultrasonography to search for the presence of ovarian hypertrichosis or androgen-secreting ovarian tumors and a CT/RM scan to study the adrenal glands. The best treatment for hyperandrogenism of neoplastic origin is surgery. Patients who are not candidates for this approach are candidates for therapy with GnRH agonists.

Pan-cancer analysis reveals GGPS1 plays an important role in tumorigenesis in multiple tumor types

The deletion of geranylgeranyl diphosphate synthase 1 (GGPS1) has been reported to inhibit the proliferation of multiple cells. Although emerging evidence has demonstrated a correlation between GGPS1 and cancer, no pan-cancer analysis has been conducted to date. This study explored the potential tumorigenesis of GGPS1 using data from the cancer genome atlas human clinical database. GGPS1 expression was considerably upregulated at both the RNA and protein levels in several cancer types, especially in breast carcinoma (BRCA), (liver) hepatocellular carcinoma (LIHC/HCC) and lung adenocarcinoma (LUAD). Amplification is the most common form of genetic alteration observed in invasive BRCA, ovarian epithelial tumor and HCC. Additionally, elevated GGPS1 expression was markedly related to poor patient prognosis and overall survival in several cancer types including LIHC. GGPS1 expression was also linked to cancer-associated fibroblasts (CAFs) infiltration in several cancer types, such as BRCA and LUAD. Moreover, GGPPS-interacting proteins and GGPS1-correlated genes in cancers were functionally enriched in terpenoid backbone biosynthesis, steroid biosynthesis, and metabolic pathways. These results indicate that GGPS1 may play a role in promoting the tumorigenesis and tumor development, particularly in BRCA and LUAD, and may play a role in steroid biosynthesis and metabolic pathways.

Borderline ovarian tumors in women of childbearing age: diagnosis, treatment

Borderline ovarian tumors in women of childbearing age: diagnosis, treatment

Immunohistochemistry Markers in Ovarian and Fallopian Tube Neoplasms: a Comprehensive Review.

Immunohistochemistry (IHC) has emerged as a crucial tool in diagnosing and managing ovarian cancer, offering invaluable insights into tumor biology and guiding therapeutic decisions. The intricate histopathological landscape of ovarian cancer presents challenges in accurate diagnosis and classification. IHC offers a complementary approach, aiding in the characterization of tumor subtypes, prognostication, and prediction of treatment response. By targeting specific biomarkers, IHC enables the identification of diverse histological features and molecular alterations associated with ovarian malignancies. The integration of IHC into routine diagnostic workflows enhances diagnostic accuracy, aids in the subclassification of ovarian tumors, and facilitates personalized treatment strategies. Emphasis is placed on the judicious selection of antibody panels tailored to specific clinical scenarios, ensuring optimal utilization of resources and minimizing diagnostic pitfalls. Overall, this review underscores the pivotal role of IHC in refining the diagnosis, prognostication, and management of ovarian cancer, highlighting its significance in the era of precision medicine. By leveraging the molecular insights provided by IHC, clinicians and pathologists can optimize patient care and improve outcomes in ovarian cancer management.

Learning Curve Analysis of Single-Incision Ovarian Cystectomy: Comparative Study of Robotic and Conventional Laparoscopic Techniques.

Ovarian cystectomy, aimed at preserving fertility, has advanced through minimally invasive surgical techniques. This study evaluates the learning curves and surgical outcomes of three such approaches: DaVinci Robotic Single-Site (RSS), DaVinci Robotic Single-Port (RSP), and laparo-endoscopic single-site surgery (LESS). To analyze the learning curves and surgical outcomes for these techniques, providing insights into their effectiveness and proficiency development. Retrospective analysis of 104 patients with ovarian tumors, divided into RSS (n = 52), RSP (n = 22), and LESS (n = 30) groups. Metrics analyzed included age, BMI, tumor size, hemoglobin drop, operative time, docking time, console time, and tumor location. No significant differences in age, BMI, transfusion rate, hemoglobin drop, or length of stay were found among the groups. RSS had larger tumors on average, and LESS had a higher occurrence rate on the right side. LESS demonstrated the shortest operative time, while RSS and RSP had comparable times. Docking and console times did not differ significantly between RSS and RSP. RSP reached proficiency faster than RSS in docking and console times, while LESS exhibited the greatest variability in operative time. RSP offers a faster and more consistent learning curve, making it advantageous for complex procedures, whereas LESS provides shorter operative times but with higher variability. These findings are crucial for surgical training and resource allocation in medical institutions.

Deep vein thrombosis secondary to an ovarian tumor – approach in low resource settings: A case report

We present a case of a 37-year-old woman who exhibited symptomatic acute deep vein thrombosis (DVT) due to extrinsic compression from a giant ovarian cyst, detected during clinical examination. Doppler ultrasound confirmed a thrombus in the left iliac vein. Although surgery was initially planned to insert a vena cava filter, the absence of this resource during her 14-day hospital stay led to the decision to proceed without it. The surgery was carried out without complications, and she was discharged on the second postoperative day. A 3-month follow-up indicated favorable recovery.

Concurrent RB1 Loss and BRCA Deficiency Predicts Enhanced Immunologic Response and Long-term Survival in Tubo-ovarian High-grade Serous Carcinoma.

The purpose of this study was to evaluate RB1 expression and survival across ovarian carcinoma histotypes and how co-occurrence of BRCA1 or BRCA2 (BRCA) alterations and RB1 loss influences survival in tubo-ovarian high-grade serous carcinoma (HGSC). RB1 protein expression was classified by immunohistochemistry in ovarian carcinomas of 7,436 patients from the Ovarian Tumor Tissue Analysis consortium. We examined RB1 expression and germline BRCA status in a subset of 1,134 HGSC, and related genotype to overall survival (OS), tumor-infiltrating CD8+ lymphocytes, and transcriptomic subtypes. Using CRISPR-Cas9, we deleted RB1 in HGSC cells with and without BRCA1 alterations to model co-loss with treatment response. We performed whole-genome and transcriptome data analyses on 126 patients with primary HGSC to characterize tumors with concurrent BRCA deficiency and RB1 loss. RB1 loss was associated with longer OS in HGSC but with poorer prognosis in endometrioid ovarian carcinoma. Patients with HGSC harboring both RB1 loss and pathogenic germline BRCA variants had superior OS compared with patients with either alteration alone, and their median OS was three times longer than those without pathogenic BRCA variants and retained RB1 expression (9.3 vs. 3.1 years). Enhanced sensitivity to cisplatin and paclitaxel was seen in BRCA1-altered cells with RB1 knockout. Combined RB1 loss and BRCA deficiency correlated with transcriptional markers of enhanced IFN response, cell-cycle deregulation, and reduced epithelial-mesenchymal transition. CD8+ lymphocytes were most prevalent in BRCA-deficient HGSC with co-loss of RB1. Co-occurrence of RB1 loss and BRCA deficiency was associated with exceptionally long survival in patients with HGSC, potentially due to better treatment response and immune stimulation.

Potential probiotic and functional properties of Brettanomyces strains isolated from kombucha tea.

Kombucha, a beverage traditionally obtained through the fermentation of tea, is believed to have beneficial health properties. Therefore, characterizing the microorganisms responsible for this fermentation is essential to demonstrate its potential health benefits and to identify candidates for new probiotics. In this study, four probiotic yeast strains isolated from kombucha tea were identified, by the PCR-RFLP analysis of the ribosomal ITS region and the sequence of the D1/D2 domain of the 26S rDNA, as Brettanomyces bruxellensis (UVI55 and UVI56) and B. anomalus (UVI57 and UVI58). Properties relevant to probiotics were also studied in these strains. All of them showed excellent survival in simulated gastric (99%-100%) and duodenal (95%-100%) juices. The ability to self-aggregate (38%-100%), adhesion to xylene (15%-50%) and, above all, adhesion to Caco-2 cells (4%-21%), revealed its potential capacity to adhere to the intestinal epithelium. In addition, the tested strains showed excellent antioxidant capacity (82%-94%), antimicrobial activity against different pathogens (Escherichia coli, Staphylococcus aureus, Salmonella enterica, Listeria monocytogenes, and Bacillus cereus), as well as remarkable cytotoxic activity against colon, melanoma and ovarian tumor cell lines. Finally, using Caenorhabditis elegans as a model, strain UVI56 exhibited ability to both extend the lifespan of the nematode and protect it against infection by S. enterica. These results support the probiotic and functional properties of the analyzed strains. In conclusion, the study revealed that kombucha tea could be a source of potential probiotics that contribute to its health-promoting properties and that the characterized Brettanomyces strains could be exploited directly as probiotics or for the development of new functional foods.

Distinguishing Benign and Malignant Ovarian Tumors Preoperatively

Ovarian cancer ranks as the fifth leading cause of cancer-related mortality among women globally. In 2020, there were approximately 314,000 reported cases of new ovarian cancer patients, resulting in an estimated 207,000 deaths.1 The highest incidence rates were observed in non-Hispanic white women, with 12.0 cases per 100,000 individuals, followed by Hispanics (10.3 per 100,000), non-Hispanic blacks (9.4 per 100,000), and Asian/Pacific Islander women (9.2 per 100,000). Disparities in access to healthcare services and treatment modalities contribute to varied mortality patterns, with the highest rates recorded among African populations. In Indonesia, ovarian cancer ranks as the third most prevalent cancer, comprising 7.84% of total cancers diagnosed in women.1 The heightened mortality rate observed in ovarian cancer can be ascribed to several factors including asymptomatic tumor growth, delayed manifestation of symptoms, and inadequate screening methods, ultimately resulting in diagnoses at advanced stages. Consequently, ovarian cancer is frequently described as a “silent killer”.2 To address diagnostic delays and reduce mortality rates associated with ovarian cancer, early detection and differentiation between benign and malignant ovarian tumors are crucial. This requires a comprehensive assessment comprising patient history, physical examination, and supporting investigation.

FREE: Enhanced Feature Representation for Isotopic Envelope Evaluation in Top-Down Mass Spectra Deconvolution.

The aim of deconvolution of top-down mass spectra is to recognize monoisotopic peaks from the experimental envelopes in raw mass spectra. So accurate assessment of similarity between theoretical and experimental envelopes is a critical step in mass spectra data deconvolution. Existing evaluation methods primarily rely on intensity differences and m/z similarity, potentially lacking a comprehensive assessment. To overcome this constraint and facilitate a comprehensive and refined assessment of the similarity between theoretical and experimental envelopes, there exists an imperative to systematically explore and identify increasingly efficacious features for assessing this correspondence. We present enhanced feature representation for isotopic envelope evaluation (FREE) that derives diverse feature representations, encapsulating fundamental physical attributes of envelopes, including peak intensity and envelope shape. We trained FREE and evaluated its performance on both the ovarian tumor (OT) (human OT cells) data set and zebrafish (ZF) (brain in mature female ZF) data set. Specifically, comparing the state-of-art method, FREE demonstrates higher performance in multiple evaluation metrics across both the OT and ZF data sets, with a particular emphasis on precision, and it demonstrates accurate predictions of a greater number of positive envelopes among the top-ranked envelopes based on their scores. Moreover, within a cross-species data set of ZF, FREE identified a higher number of proteoform-spectrum matches (PrSMs), increasing the count from 50,795 to 52,927 compared to EnvCNN, the amalgamation of FREE with TopFD also exhibits a commendable capacity to discern 117,883 fragment ions, thus surpassing the 97,554 fragment ions identified through the application of EnvCNN in conjunction with TopFD. To further validate the performance of FREE, we have tested 10 a cross-species top-down proteomes containing 36 subdata set from ProteomeXchange. The results reveal that, after deconvolution with TopFD + FREE, TopPIC identifies more PrSMs across these 10 data sets in both the first and second rounds of experiments. These findings underscore the robustness and generalization capabilities of the FREE approach in diverse proteomes.

OTUD1 Deficiency Alleviates LPS-Induced Acute Lung Injury in Mice by Reducing Inflammatory Response.

The ovarian tumor (OTU) family consists of deubiquitinating enzymes thought to play a crucial role in immunity. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) pose substantial clinical challenges due to severe respiratory complications and high mortality resulting from uncontrolled inflammation. Despite this, no study has explored the potential link between the OTU family and ALI/ARDS. Using publicly available high-throughput data, 14 OTUs were screened in a simulating bacteria- or LPS-induced ALI model. Subsequently, gene knockout mice and transcriptome sequencing were employed to explore the roles and mechanisms of the selected OTUs in ALI. Our screen identified OTUD1 in the OTU family as a deubiquitinase highly related to ALI. In the LPS-induced ALI model, deficiency of OTUD1 significantly ameliorated pulmonary edema, reduced permeability damage, and decreased lung immunocyte infiltration. Furthermore, RNA-seq analysis revealed that OTUD1 deficiency inhibited key pathways, including the IFN-γ/STAT1 and TNF-α/NF-κB axes, ultimately mitigating the severity of immune responses in ALI. In summary, our study highlights OTUD1 as a critical immunomodulatory factor in acute inflammation. These findings suggest that targeting OTUD1 could hold promise for the development of novel treatments against ALI/ARDS.

Is It Possible to Prevent Nontherapeutic Laparotomies in Breast Cancer Patients With Isolated Adnexal Masses?

Introduction: The risk of ovarian malignancy is increasing in patients with a history of breast cancer. Thus, well-defined predictors of ovarian malignancy should be identified to determine surgical or conservative management of adnexal masses in women with breast cancer. This study aimed to clarify the predictors of malignant ovarian tumors in patients with breast cancer with an isolated adnexal mass. Methods: Breast cancer patients diagnosed with an adnexal mass who underwent surgery between 2010 and 2021 at a tertiary cancer center were included in the study. Patients with suspected extra ovarian metastases were excluded. Results: A total of 40 breast cancer patients who underwent surgery for ovarian masses were identified. 23 (57.5%) women had benign ovarian tumors and 17 (42.5%) had malignant ovarian tumors. Among the malignant ovarian tumors, there were three (17.6%) metastatic breast cancers in the ovary and 14 (82.4%) primary ovarian cancers. In univariate analyses, the risk of malignant ovarian tumors increased in women with age >52years (P = .012), postmenopausal status (P = .023), CA 125 ≥ 35IU/ml (P = .001), CA 15-3 ≥ 32IU/ml (P = .002), and complex ovarian masses (P < .001). Ovarian malignancies were observed in 82.4% of patients who had complex ovarian masses. Conclusion: Ovarian malignancies were diagnosed in 82.4% of the breast cancers who had complex ovarian mass on USG examination. Therefore, surgery is recommended in women with complex ovarian masses. Postmenopausal status, age >52years, CA 125 ≥ 35IU/ml, and CA 15-3 ≥ 32 were other risk factors for ovarian malignancy.

Reprogramming of normal fibroblasts into ovarian cancer-associated fibroblasts via non-vesicular paracrine signaling induces an activated fibroblast phenotype

Cancer-associated fibroblasts (CAFs) are key contributors to ovarian cancer (OC) progression and therapeutic resistance through dysregulation of the extracellular matrix (ECM). CAFs are a heterogenous population derived from different cell types through activation and reprogramming. Current studies rely on uncharacterized heterogenous primary CAFs or normal fibroblasts that fail to recapitulate CAF-like tumor behavior. Here, we present that conditioned media from ovarian cancer lines leads to an increase in the activated state of fibroblasts demonstrated by functional assays and up-regulation of known CAF-related genes and ECM pathways. Phenotypic and functional characterization demonstrated that the conditioned CAFs expressed a CAF-like phenotype, strengthened proliferation, secretory, contractility, and ECM remodeling properties when compared to resting normal fibroblasts, consistent with an activated fibroblast status. Moreover, conditioned CAFs significantly enhanced drug resistance and tumor progression. Critically, the conditioned CAFs resemble a transcriptional signature with involvement of ECM remodeling. The present study provides mechanistic and functional insights about the activation and reprogramming of CAFs in the ovarian tumor microenvironment mediated by non-vesicular paracrine signaling. Moreover, it provides a translational based approach to reprogram normal fibroblasts from both uterine and ovarian origin into CAFs using tumor-derived conditioned media. Using these resources, further development of therapeutics that possess potentiality and specificity towards CAF/ECM-mediated chemoresistance in OC are further warranted.

Contrast-enhanced photon-counting micro-CT of tumor xenograft models

Objective. Photon-counting micro-computed tomography (micro-CT) is a major advance in small animal preclinical imaging. Small molecule- and nanoparticle-based contrast agents have been widely used to enable the differentiation of liver tumors from surrounding tissues using photon-counting micro-CT. However, there is a notable gap in the application of these market-available agents to the imaging of breast and ovarian tumors using photon-counting micro-CT. Herein, we have used photon-counting micro-CT to determine the effectiveness of these contrast agents in differentiating ovarian and breast tumor xenografts in live, intact mice. Approach. Nude mice carrying different types of breast and ovarian tumor xenografts (AU565, MDA-MB-231 and SKOV-3 human cancer cells) were injected with ISOVUE-370 (a small molecule-based agent) or Exitron Nano 12000 (a nanoparticle-based agent) and subjected to photon-counting micro-CT. To improve tumor visualization using photon-counting micro-CT, we developed a novel color visualization method, which changes color tones to highlight contrast media distribution, offering a robust alternative to traditional material decomposition methods with less computational demand. Main results. Our in vivo experiments confirm the effectiveness of this color visualization approach, showing distinct enhancement characteristics for each contrast agent. Qualitative and quantitative analyses suggest that Exitron Nano 12000 provides superior vasculature enhancement and better quantitative consistency across scans, while ISOVUE-370 delivers a more comprehensive tumor enhancement but with significant variance between scans due to its short blood half-time. Further, a paired t-test on mean and standard deviation values within tumor volumes showed significant differences between the AU565 and SKOV-3 tumor models with the nanoparticle-based contrast agent (p-values < 0.02), attributable to their distinct vascularity, as confirmed by immunohistochemical analysis. Significance. These findings underscore the utility of photon-counting micro-CT in non-invasively assessing the morphology and anatomy of different tumor xenografts, which is crucial for tumor characterization and longitudinal monitoring of tumor progression and response to treatments.

Explainable AI for Interpretation of Ovarian Tumor Classification Using Enhanced ResNet50.

Deep learning architectures like ResNet and Inception have produced accurate predictions for classifying benign and malignant tumors in the healthcare domain. This enables healthcare institutions to make data-driven decisions and potentially enable early detection of malignancy by employing computer-vision-based deep learning algorithms. These CNN algorithms, in addition to requiring huge amounts of data, can identify higher- and lower-level features that are significant while classifying tumors into benign or malignant. However, the existing literature is limited in terms of the explainability of the resultant classification, and identifying the exact features that are of importance, which is essential in the decision-making process for healthcare practitioners. Thus, the motivation of this work is to implement a custom classifier on the ovarian tumor dataset, which exhibits high classification performance and subsequently interpret the classification results qualitatively, using various Explainable AI methods, to identify which pixels or regions of interest are given highest importance by the model for classification. The dataset comprises CT scanned images of ovarian tumors taken from to the axial, saggital and coronal planes. State-of-the-art architectures, including a modified ResNet50 derived from the standard pre-trained ResNet50, are implemented in the paper. When compared to the existing state-of-the-art techniques, the proposed modified ResNet50 exhibited a classification accuracy of 97.5 % on the test dataset without increasing the the complexity of the architecture. The results then were carried for interpretation using several explainable AI techniques. The results show that the shape and localized nature of the tumors play important roles for qualitatively determining the ability of the tumor to metastasize and thereafter to be classified as benign or malignant.

High-grade Anaplastic Transformation of Ovarian Serous Borderline Tumor: A Distinctive Morphology With Abundant Dense Eosinophilic Cytoplasm and Dismal Prognosis.

Ovarian serous borderline tumors (SBTs) have a generally favorable prognosis. Although the risk of progression to low-grade serous carcinoma is well documented, progression to high-grade carcinoma is rare. We report the clinicopathologic features of seven SBTs, each associated with the presence of a morphologically unique high-grade component with an extremely dismal prognosis. All of the SBTs exhibited typical hierarchical branching and scattered eosinophilic cells, whereas the high-grade component consisted of a profuse proliferation of epithelioid cells with abundant dense, eosinophilic cytoplasm, variable nuclear pleomorphism, and evident loss of WT1, estrogen receptor, and p16 positivity. In most cases, the SBT demonstrated an abrupt transition to the high-grade component, but one patient initially presented with the usual SBT and developed a recurrent disease that was composed entirely of the high-grade component. Targeted next-generation sequencing revealed identical driver mutations in both the SBT and high-grade components (BRAF in 3, KRAS in 1), confirming clonality. Three cases, in addition, harbored telomerase reverse transcriptase promoter mutations in both components. One case, despite insufficient material for sequencing, was BRAF V600E-positive by immunohistochemistry. Most patients with available follow-up data died within 9 months of diagnosis. This study confirms prior reports of ovarian SBT transformation to high-grade carcinoma and further characterizes a distinct subset with abundant dense eosinophilic cytoplasm and an extremely dismal prognosis. The presence of BRAF mutations in a major subset of these tumors questions the notion that BRAF is associated with senescent eosinophilic cells and improved outcomes in SBT. The role of the additional telomerase reverse transcriptase promoter mutations merits further investigation.