Primary Malignant Ovarian Tumors Research Articles

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

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

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

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

Clinicopathological Study Of Primary Malignant Ovarian Tumors

Background: Ovarian cancer is third gynecologic cancer after uterine and cervical cancer . It is heterogeneous disease with different in clinical features and outcome. It is a group of many subtypes with variation in biological features that lead to differences in response to treatments, survival and recurrence rates. Aim: This study aims to detect the frequency of histological types of primary malignant ovarian tumors and to find it's clinicopathological correlation. Subject and Methods: The retrospective cross sectional study done from 1st of July 2020 to 1st August 2020 on data of forty cases of primary malignant ovarian tumors who were diagnosed during the last three years (from 2017 to 2020) in Mosul hospitals labs and private labs. Results:Two thirds of cases 72.5% were surface epithelial tumors , followed by germ cell tumors 15% and sex cord‑stromal tumors 12.5% .The serous cystadenocarcinoma was the most common histological type in this study .About one third of the cases 30 %were seen in 51–60 years of age group, most of tumors unilateral with solid cystic in nature .The largest diameter shows in mucinous adenocarcinoma . Pelvic mass was the most presenting sign of ovarian cancer . Conclusion: Malignant surface epithelial tumors comprises the most common type of ovarian cancer and of which serous carcinoma considered the main subtype followed by mucinous cystadenocarcinoma . Advancing age increased the possibility of malignant transformation and most of cases occur over 50 years old especially the cases of surface epithelial type , most of tumors unilateral with solid cystic in nature , pelvic mass was the most presenting sign of ovarian cancer .

Abstract C020: Racial differences in the risks of second primary gynecologic cancers following chemotherapy for malignant ovarian tumors: Asian subgroups in the United States, 2000-2016

Abstract Objective: The incidence of ovarian cancer in the United States varies by race with the highest rates among white women but lower survival observed among black women and other racial and ethnic groups. These disparities in outcomes among women with ovarian cancer are not well understood, including the differential occurrence of second primary cancers according to race. Our objective was to measure racial differences in incidence of second primary gynecologic cancers (SPGC) among women with malignant ovarian tumors following treatment with chemotherapy. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgroups in the United States. Methods: We conducted a retrospective cohort study of women ages 20 years and older diagnosed with first primary malignant ovarian tumors treated with definitive surgery and chemotherapy between 2000 and 2016 from 18 population-based registries in the Surveillance, Epidemiology and End Results (SEER) Program. We collected demographic and clinical information on ovarian histologic subtypes, laterality, tumor grade, type of surgery and treatment with radiotherapy. Census tract-level sociodemographic characteristics of women were also described. The incidence of SPGC in our cohort was compared to expected incidence rates in the general population using age-and region-standardized incidence ratios (SIRs) and 95% confidence intervals (CI) for individual racial/ethnic groups. Results: Among 34,081 women with ovarian cancer, 74% were white, 6% were black, 8% were Asian/Pacific Islander (API) and 11% were Hispanic. Median age at diagnosis was lower among API and Hispanic women (54 years) compared to white (60 years) and black women (58 years). Most ovarian tumors were serous or endometrioid, although API women had a higher proportion of clear cell ovarian tumors (15%) compared to white (6%), black (5%) and Hispanic women (6%). Subgroups of API women also differed in distribution of ovarian tumor histology, grade, and age at diagnosis. Whereas incidence of SPGC was observed to be lower than expected among white women (SIR 0.72 CI 0.59-0.87), estimates were suggestive of higher than expected incidence among black (SIR 1.61, CI 0.88-2.71) and API women (SIR 1.64, CI 0.96-2.63), although confidence intervals included 1.0. Increased risk of vaginal cancers was observed among all women, although risk estimates were highest among API women (SIR 23.90, CI 4.93-69.84) and were also significant for risk of uterine cancers (SIR 2.28 CI 1.21-3.90). Among API women, only Filipinas had significantly increased incidence of SPGC overall including both uterine and vaginal cancers. Conclusions: Risk of SPGC following treatment of ovarian cancer differs by race. The increased incidence of secondary gynecological cancers observed in Asian women is driven largely by increased rates of uterine and vaginal cancers among Filipina women. Further research is warranted to understand the possible mechanism(s) underlying this observed disparity. Citation Format: Nita H Mukand, Ashwini N Zolekar, Naomi Y Ko, Gregory S Calip. Racial differences in the risks of second primary gynecologic cancers following chemotherapy for malignant ovarian tumors: Asian subgroups in the United States, 2000-2016 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C020.

The Epithelial-Mesenchymal Transition, E-cadherin and Tumor Progression in Ovarian Serous Tumors.

The epithelial-mesenchymal transition (EMT), which is a change in the cell phenotype from epithelial to mesenchymal morphology, is an important step in the invasion process and metastasis of ovarian carcinomas. It is known that the suppression of cell adhesion molecules such as E-cadherin and the expression of mesenchymal markers such as Vimentin are key processes in EMT. There is controversy in the literature about the EMT status of ovarian carcinomas. To investigate EMT status using immunohistochemical expression of E-cadherin in benign, primary malignant serous ovarian tumors and metastases from them in order to assess their significance in tumor progression. The study included a retrospective investigation of 217 ovarian epithelial tumors. Ninety-two cases of serous ovarian tumors and metastases were examined for expression of E-cadherin. In our study, the predominant histological subtype in benign ovarian tumors and carcinomas was serous (73% and 61%, respectively). 65% of benign tumors demonstrated EMT negative status. The majority of carcinomas demonstrated EMT positive status (82%), whereas negative EMT status was only observed in 18% of cases. 89% of the metastases showed EMT positive status, whereas only 11% of them showed negative EMT status. In 6 selected cases with positive EMT status we found Vimentin expression in tumor cells. Positive EMT status (reduced E-cadherin expression) is a characteristic of ovarian carcinomas and metastases, but not of benign serous ovarian tumors.

Bilateral Ovarian Tumors on MRI: How Should We Differentiate the Lesions?

We investigated the distinguishing pathological features of bilateral ovarian tumors using magnetic resonance (MR) imaging. Eighty-six patients with bilateral ovarian tumors on MR imaging were evaluated. The pathological diagnosis was investigated, and the results were subjected to statistical analysis using Mann-Whitney U test, Fisher's exact test, Chi-squared test and receiver operating characteristic (ROC) curve to determine the features useful for the differentiation of distinct types of lesions. The diagnosis of bilateral ovarian tumors was confirmed in eighty-one patients and the majority of the lesions were further classified into serous carcinoma (n = 36), mature teratoma (n = 20) and metastasis (n = 12). We assessed the existence of factors useful for the MR imaging differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors. Cancer antigen (CA) 125 serum level and maximum tumor diameter were significantly different between metastasis and serous carcinoma and similarly, between metastasis and primary malignant ovarian tumors. MR imaging morphology, ascites and peritoneal implants did not show any significant difference between the different types of lesions. Within our patient cohort, most bilateral ovarian tumor lesions were determined to be serous carcinoma, mature teratoma or metastasis. CA 125 serum level and maximum tumor diameter are useful markers for the differentiation between metastasis and serous carcinoma or primary malignant ovarian tumors.

Treatment Approach and Prognosis of Pediatric and Adolescent Nonepithelial Malignant Ovarian Tumors: A Retrospective Prognosis Analysis.

Nonepithelial malignant ovarian tumors are rare in the pediatric and adolescent population. The aim of this study was to observe the spectrum of pathology, presentation, outcome, and risk factors for survival of pediatric nonepithelial malignant ovarian tumors in a Chinese pediatric population. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a retrospective study of 171 girls (median age at presentation of 14years) diagnosed with primary malignant ovarian tumors between 1990 and 2014 at the Yat-Sen Memorial Hospital and Cancer Center of Sun Yat-sen University. Symptoms, pathological data, treatments, and outcomes were obtained retrospectively from the medical records. Most (85.96%, 147/171) tumors occurred in patients aged 10-18years and most cases were International Federation of Gynecology and Obstetrics stage I (68.42%, 117/171). The predominant pathological type was germ cell tumors (87.13%, 149/171). All patients underwent surgery, and 87 (50.88%, 87/171) underwent conservative incomplete staging surgery (unilateral salpingo-oophorectomy or tumor excision). The 5-year progression-free survival (PFS) was 59.2%. The 5-year overall survival (OS) was 88.7%. Surgical hospital (hazard ratio, 0.388; 95% confidence interval, 0.213-0.706; P=.002) was independently associated with PFS. Recurrence state (hazard ratio, 163.26; 95% confidence interval, 1.321-20,181.875; P=.038) was independently associated with OS. Ovarian cancers in children and adolescents have features of good prognosis. Girls who received their first surgery in a tertiary hospital had better PFS. Patients who did not suffer recurrence had better OS.

304PD Treatment approach and prognosis of pediatric and adolescent non-epithelial malignant ovarian tumors: A retrospective prognosis analysis

Background Non-epithelial malignant ovarian tumors are rare in the pediatric and adolescent population. Because of the rarity of the disease, few studies with a large sample size are available, and survival and prognostic factors in this specific group of patients are poorly known. Methods This was a retrospective study of 170 girls (median age at presentation of 14 years) diagnosed with primary non-epithelial malignant ovarian tumors between 1990 and 2014 at the Sun Yat-sen Memorial Hospital and Cancer Center of Sun Yat-sen University. Symptoms, pathological data, treatments, and outcomes were obtained retrospectively from the medical records. Results Most (85.29%) tumors occurred in patients aged 10-18 years and most cases were FIGO stage I (70.0%). The predominant pathological type was germ cell tumors (87.06%). All patients underwent surgery, and 80 (47.06%) underwent conservative incomplete staging surgery (unilateral salpingo-oophorectomy or tumor excision). The 5-year progression-free survival (PFS) was 59.2%.The 5-year overall survival (OS) was 88.7%. Surgical hospital (HR = 0.388,95%CI=0.213-0.706, P = 0.002) was independently associated with PFS. Recurrence state (HR = 163.26,95%CI=1.321- 20181.875, P = 0.038) was independentlyassociatedwith OS. Conclusions Ovarian cancers in children and adolescents have features of good prognosis. Girls who received first operation in tertiary hospitals had better PFS. Patients who did not suffer recurrence had better OS. Legal entity responsible for the study Sun Yat-sen Memorial Hospital Funding N/A Disclosure All authors have declared no conflicts of interest.

Fascin and EMMPRIN expression in primary mucinous tumors of ovary: A tissue microarray study

ObjectivesThe aim of this study was to compare the expressions of fascin and EMMPRIN in primary malignant, borderline and benign mucinous ovarian tumors, and to investigate the relationship of these markers with tumor progression and their applicability to differential diagnosis. Materials and methodsAn immunohistochemical study was performed for fascin and EMMPRIN using the tissue microarray technique. Eighty-one cases were included in the study; there were 37 benign, 25 borderline and 19 malignant primary mucinous ovarian tumors. For each case, a total staining score was determined, consisting of scores for extent of staining and intensity of staining. The cases were allocated to negative, weakly positive and strongly positive staining categories, according to the total staining score. ResultsBoth of the markers were significantly negative in benign tumors as compared with borderline and malignant tumors. There was no significant difference between borderline and malignant groups for both markers. Sixty-eight percent of malignant tumors were stained positive by fascin, while this rate was 40% for borderline mucinous tumors. All malignant tumors were strongly stained positive for EMMPRIN, while this rate was 92% for borderline mucinous tumors. The rest of the cases stained weakly positive. No significant difference in staining score was found between fascin and EMMPRIN expression. ConclusionsIn ovarian primary mucinous tumors, fascin and EMMPRIN may play an important role in tumor progression from benign tumor to carcinoma. In that context, EMMPRIN and fascin expression may have potential application in the differential diagnosis of some diagnostically problematic mucinous ovarian tumors. However, the differential diagnostic applicability of EMMPRIN appears to be more limited than that of fascin due to its wide spectrum of staining in mucinous ovarian tumors.

腹腔鏡下手術で卵巣転移と診断したgastrointestinal stromal tumor（GIST）の1例

A gastrointestinal stromal tumor (GIST) is the most common type of mesenchymal tumor of the gastrointestinal tract. A GIST often presents with an extra-intestinal growth pattern or peritoneal dissemination. It requires a differential diagnosis that includes malignant gynecologic tumors; however, ovarian metastasis of a GIST is extremely rare. We are reporting a case of a GIST metastatic to the ovary, diagnosed with laparoscopic surgery, which required differentiating from a malignant ovarian tumor. The patient was a 59-year-old woman referred to our department for a detailed evaluation of a left ovarian mass. She had a history of an intestinal GIST at the age of 56, which was completely excised. Three years after the operation, a chest-abdominal computed tomography imaged a left ovarian mass and multiple nodules in the mesentery, greater omentum, and the right lung. Because a GIST seldom metastasizes to the ovary, a diagnostic laparoscopy to differentiate from primary malignant ovarian tumors was performed. A left salpingo-oophorectomy and a biopsy of a peritoneal tumor was performed; the histopathologic diagnosis was a GIST metastatic to the left ovary with peritoneal dissemination. Consequently, the patient underwent molecular targeted therapy. The possibility of a mesenchymal tumor of the gastrointestinal tract such as a GIST should be considered in the differential diagnosis of a pelvic mass. Less invasive laparoscopic surgery facilitates intraperitoneal excision of the tumor and a histological diagnosis. Laparoscopic surgery can be useful for making a definitive diagnosis and treating malignant tumors.

Intraoperative diagnosis by frozen section study would prevent unnecessary surgery in ovarian Burkitt′s lymphoma

Sir, Ovarian Burkitt's lymphoma is a rare form of malignant ovarian tumors accounting for 1% of all ovarian neoplasms.[1,2,3] It has been reported as a cause of ovarian torsion.[4] Herein, we briefly report a case of bilateral ovarian Burkitt's lymphoma in a 29-year-old woman presenting with vague suprapubic pain and abdominal distension. On physical examination, a rather large midline pelvic mass with abdominal extension was palpated. Serum beta hCG was negative and serum CA-125 level was within normal limits. Ultrasonography revealed homogenous and slightly echogenic large lobulated masses in both adnexae, each measuring approximately 10 cm in diameter. Pelvic and abdominal computed tomography confirmed the ultrasound findings and also detected enlarged paraaortic lymph nodes. The clinicoradiologic features of the tumor mimicked a primary malignant ovarian epithelial neoplasm despite the normal serum CA-125 level, and the patient became candidate for surgery. At surgery, peritoneal deposits and partial involvement of small intestine were also detected. The patient underwent surgical removal of the ovarian masses, paraaortic lymph node dissection, and peritoneal sampling. Permanent pathology revealed the ovarian masses to be Burkitt's lymphoma with the involvement of paraaortic lymph nodes and peritoneal seedings. The diagnosis was further confirmed by immunohistochemistry showing positive reactivity with leukocyte common antigen (LCA) and CD20 and CD10 markers. Following surgery, the patient underwent chemotherapy for Burkitt's lymphoma. However, an appropriate intraoperative management and diagnosis using tumor sampling and frozen section study would have avoided extensive and unnecessary surgery in this case. In fact, what made us consider extensive surgery was the presence of bilateral ovarian masses with diffuse peritoneal deposits and paraaortic lymphadenopathy, leading to an erroneous impression of primary malignant ovarian tumor originating from the surface epithelium. The main treatment of ovarian lymphoma is chemotherapy, and the overall prognosis of the tumor is good.[5,6] Spontaneous conception with live birth outcome has been reported following gonadotoxic chemotherapy for bilateral Burkitt's lymphoma.[7] The role of surgery is in question and debatable with the present available chemotherapeutic agents.[1] We do emphasize that, although rare, ovarian lymphoma should be considered in the differential diagnosis of advanced ovarian neoplasms, especially bilateral tumors in young women. Appropriate intraoperative management prevents unnecessary surgery in these cases.

FDG-PET/CT as a molecular biomarker in ovarian cancer

In the clinical setting the vast majority of positron emission tomography (PET) procedures use the glucose analogue F-18 fluorodeoxyglucose (FDG) to visualize the increased glucose consumption of malignant lesions. Co-registered PET/CT has improved the diagnostic accuracy compared to either imaging procedure alone, particularly in ovarian cancer. FDG-PET/CT demonstrates primary malignant ovarian tumors; however, it is often unable to accurately differentiate between benign and malignant pelvic masses and to visualize borderline ovarian tumors. FDG-PET/CT has a suggested role for staging, by improving treatment planning in individual cases, but it is particularly helpful in the setting of disease recurrence when CA125 tumor marker levels are rising and conventional imaging (CT or MR) is inconclusive or negative. The aim of this review is to demonstrate the value of FDG-PET-CT in diagnosis and management of patients with ovarian malignancies, outlining its advantages and limitations.

Fertility sparing surgery for ovarian tumors in children and young adults

To study the outcome of fertility conserving surgery for ovarian tumors in children and young adults (≤ 20 years) over 6 years (2003-2009). This prospective study included 183 patients diagnosed with ovarian cysts or tumors requiring surgical excision. Ovarian cystectomy/ovariectomy was carried out followed by frozen section histopathology. Malignant cases were subjected to staging laparotomy and fertility sparing surgery. The median age at diagnosis was 17 years (range 7-20 years). 160/183 (87.4%) were non-neoplastic ovarian cysts or benign tumors. In 131/160 (81.8%) of non-neoplastic and benign tumors, it was possible to preserve the affected ovary. Twenty cases (11%) were diagnosed as primary malignant ovarian tumors, 2/183 (1.1%) were borderline tumors and 1 case (0.55%) was metastatic colonic carcinoma. The median follow up of cases with primary malignant ovarian tumors was 36 months. During this period, two recurrences (9.1%) were detected, both of the germ cell type (immature teratoma and yolk sac tumor). Recurrent cases were managed by local excision and lymph node sampling followed by chemotherapy. Fertility sparing surgery for malignant ovarian tumors in children and young adults has excellent prognosis and should be attempted whenever possible.

Abstract 4854: Mutations activating proliferation pathways in ovarian cancer

Abstract Ovarian malignancies may arise through different mechanisms of oncogenesis, which influence their treatment and are important for prognosis. Essential to carcinogenesis is the activation of proliferation pathways such as those directed by PI3 kinase or KRAS. New sequencing technologies may improve the detection of somatic mutations in tumor tissue, which is complicated by the low representation of a mutation within a tissue sample inevitably containing normal cells and subpopulations of malignant cells. We analyzed selected exons in PIK3CA, PIK3R, KRAS, BRAF, EGFR and ERBB2 in 34 primary malignant ovarian tumors, including 10 serous, 4 borderline, 11 endometrioid, and 9 mixed or rare subtypes. DNA was extracted from flash-frozen tumor tissues, amplified, and sequenced on a 454-GS-Flx Genome Sequencer. Expression of PTEN, p53, Bcl2, ALDH and Ki67 were assessed by immunohistochemistry on formalin-fixed tissues. Nine mutations were observed in PIK3CA, 5 in BRAF, 4 in KRAS, and 2 in EGFR. SNPs present in the amplicons analyzed allowed allelic imbalance to be estimated, showing possible amplification of EGFR in 9 of 20 informative samples, and of PIK3CA in 6 of 19 informative samples, none of which contained a point mutation. Endometrioid tumors frequently showed anomalies in PIK3CA, Bcl2 expression, and not p53 overexpression. P53 overexpression was typical of serous tumors, and was associated with the absence of mutations in any of the genes sequenced. Borderline and low grade tumors were characterized by BRAF mutation, no imbalance at EGFR, no anomalies at PIK3CA, and less frequent p53 overexpression. The absence of BRAF mutations in high grade tumors suggested that they do not evolve from borderline tumors. PIK3CA mutations were not mutually exclusive with KRAS mutations, confirming the non-redundancy of these intertwined signaling pathways. PTEN extinction was not significantly negatively associated with either point mutations or allelic imbalance at PIK3CA, consistent with different roles for PTEN loss and PI3-kinase activation at different stages of tumorogenesis, in spite of the close association of PTEN with the PI3-kinase pathway. No significant associations were observed between ALDH and Ki67 and any parameters measured. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4854. doi:10.1158/1538-7445.AM2011-4854

OC27.06: Ultrasound features of rare primary malignant ovarian tumors

surgical and pathological findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy with respect to the residual disease after laparotomy have been calculated for each US parameters. Results: At laparotomy, 78 patients (53%) were considered to suffer from unresectable disease and in 6 patients (0.4%) cytoreductive surgery was undertaken, resulting in suboptimal residual disease (RT >1 cm). The accuracy of the US parameters with laparotomic findings ranged between 81% for mesenteric retraction and 98% for ascites. The overall accuracy rate of the US parameters with regard the unresectable disease ranged between 52%, for superficial liver metastases, and 65% for peritoneal carcinomatosis, omental involvement and ascites. Conclusions: Preoperative US examination might represent a valid tool to assess the intrabdominal extension of ovarian cancer disease. Further analyses are necessary to explore the role of the US examination in predicting optimal cytoreduction.

Occult gallbladder carcinoma presenting as a primary ovarian tumor in two women: two case reports and a review of the literature

IntroductionThe ovary is a common site of metastasis from various organs. However, little is known about gallbladder carcinoma metastasizing to the ovaries and presenting as a primary ovarian tumor.Case presentationWe report two cases of a metastatic gallbladder carcinoma which mimicked a primary ovarian tumor in a 35-year-old and a 62-year-old North Indian woman. Clinically, both our patients presented with abdominal masses without obvious signs and symptoms related to gallbladder carcinoma. Radiology suggested the possibility of a primary ovarian tumor with chronic cholecystitis and cholelithiasis. The gross features also mimicked a primary malignant ovarian tumor in the first case and a benign mucinous neoplasm in the second case. Exact diagnoses could only be made after thorough sampling from both the ovaries and gallbladder.ConclusionsGallbladder carcinoma with metastasis to the ovaries can mimic both malignant and benign primary ovarian tumors. Extensive cystic change in the ovary due to metastasis from gallbladder carcinoma has rarely been reported. A high index of suspicion and thorough sampling are essential to avoid misdiagnosis in such cases.

Solid non-invasive ovarian masses on MR: Histopathology and a diagnostic approach

Purpose The purpose is to clarify the histopathology of the solid, non-invasive ovarian masses and to investigate the MR characteristics that distinguish benign from malignant. Materials and methods From 1996 to 2008, we identified 38 cases with predominantly solid non-invasive ovarian masses examined by contrast MR. We evaluated the signal intensity on T2WI and degree of contrast enhancement. In 31 of these cases with dynamic contrast study, we classified the enhancing patterns of the masses into gradually increasing and plateau after rapid increase patterns. Result Sixteen cases were benign sex-cord stromal tumors, three were other types of benign tumors, nine cases were diagnosed with primary malignant ovarian tumors, and 10 showed metastatic tumors. Low intensity on T2WI was observed in 15 benign and 2 malignant tumors. The gradually increasing pattern was observed in all 17 benignancies and 5 of the 14 malignancies. In the equilibrium phase, the masses were weakly enhanced in all 19 benignancies and only 4 of 19 malignancies. The diagnostic criteria, that low signal intensity masses with gradual weak enhancement are benign showed 93.3% accuracy and 100% positive predictive value. Conclusion Benign solid ovarian masses tended to show low signal intensity on T2WI and gradual weak enhancement.

Increased risk of concurrent primary malignancies in patients diagnosed with a primary malignant epithelial ovarian tumor

AbstractOvarian cancer and second malignant neoplasms are found to occur rather frequently in the same patient. From a clinical perspective, it is important to have quantitative information on concurrent malignancies in the same year of diagnosis of the epithelial ovarian cancer. In this population-based study, we used data from the Netherlands Nationwide Network for Registry of histo- and cytopathology (PALGA) and the Netherlands Cancer Registry (NCR). Data of the ovarian cancer as well as data on previous or later cancers were obtained. Age-specific cancer rates from the NCR were used to calculate expected numbers of cancer. Between 1987 and 1993, histopathology reports were identified of 4577 patients with primary epithelial malignant or primary borderline malignant ovarian cancers and its longitudinal data. As the database may lack detailed information on histopathology, a recent sample of 789 patients diagnosed with ovarian cancer in 1996–2003 was comprehensively studied as well. In the eventual data analysis of 5366 patients, 244 cases (4.5%) of concurrent primary malignancy were reported in the same year that the malignant epithelial ovarian tumor had been diagnosed against 51 expected. The observed vs expected ratio was 4.8 and the 95% confidence interval (CI) (4.3–5.5). For cancer of the uterus/endometrium the observed vs expected ratio was 62.3 (95% CI 52.5–73.5). For skin, breast, colorectal, urinary bladder, renal and cervical cancer the ratio was also larger than unity. The elevated risk of concurrent cancer may lead to clinical screening protocols. The findings on endometrial cancer may prompt research on common etiologies and biomarkers.

Preservation of ovarian function, reproductive ability and emotional attitudes in patients with malignant ovarian tumors

Objectives Although cancer is predominantly a disease of aging, an increasing number of women survive malignancies before or during their reproductive years, which may interfere with their fertility potential. Although a variety of studies have tried to document the impact of conservative treatment aimed at preserving ovarian function and reproductive ability, little information has been available regarding survivors’ attitudes, emotions, and choices to have children. The aim of this study is to evaluate the reproductive history, experiences, attitudes, and emotions with regard to having children in conservatively treated patients with Stage I epithelial ovarian cancer, any stage LMP tumors, malignant ovarian germ cell tumors (MOGCTs) and Stage I sex cord-stromal tumors (SCSTs). Study design Between 1986 and 2000, a total of 75 patients with primary malignant ovarian tumors underwent conservative treatment. Out of 75 patients in the study, 14 women (19%) presented Stage I epithelial ovarian cancer, 23 (31%) LMP tumors, 33 (43%) MOGCTs, and five (7%) SCSTs. Information was obtained from medical records and from a questionnaire mailed to all patients who were at least 15 years old at the time of the diagnosis (68 subjects). Median time of follow-up was 102 months (35–192 months). There were four (5.2%) clinical recurrences within 35 months. Only 20 patients (49%) had tried to conceive after the completion of their treatment; of these, 15 women (75%) succeeded and delivered 19 healthy children. Seventy percent (32/41) of the respondents claimed that their disease did not have any impact on their desire to have children. Whereas 51% (21/41) fear that their ovarian disease could have damaged their reproductive potential, 76% (31/41) are not concerned about the effects of the treatment they received on offspring. The impact of the disease on the patients’ attitudes toward life was reported as positive. Conclusion The results from our study, in agreement with the data from the literature, confirm that management of Stage I (grade 1, grade 2) epithelial ovarian cancer, any stage LMP tumors, MOGCTs and Stage I SCSTs with fertility-sparing surgery is a safe, practicable treatment option. Though preliminary, this survey provides insight into the attitudes and experiences of young women ovarian cancer survivors regarding fertility.

Computed Tomography Findings of Ovarian Metastases From Colon Cancer

The computed tomography (CT) findings of ovarian metastases from colon cancer were evaluated and were compared with those of primary malignant ovarian tumors. Sixteen patients with 21 masses from colon cancer and 20 patients with 31 primary malignant ovarian tumors were included in this study. The CT findings (laterality, size, margin, shape, mass characteristic, strong enhancement of cyst wall, enhancement of solid portion, amount of ascites, peritoneal seeding, lymph node enlargement, and metastasis) and ages of the patients in both groups were compared. Univariate analysis, the Pearson chi test, and the independent-samples t test were used to distinguish them. A smooth margin of the tumor (odds ratio=24.3, 95% confidence interval: 2.9-204.2) and cystic nature of the mass (Pearson chi=12.96, P=0.005) were strong predictors of ovarian metastasis from colon cancer. Ovarian metastases from colon cancer show a smooth margin and more cystic nature on CT compared with primary malignant ovarian tumors.