Types Of Ovarian Tumors Research Articles

Morphological Types of Epithelial Origin Ovarian Tumours

Aim: To assess the various morphological types of epithelial origin ovarian tumors. Methods: The study involved cases that were presented to the Pathology department between January 2015 to December 2020. Epithelial ovarian tumors that were diagnosed as either benign, borderline, or malignant were analyzed. The inclusion criteria involved pathological specimens of ovarian tumors consisting of cells that are epithelial in origin. Clinical records, ultrasounds, and histopathological investigations of the patients were accessed from the hospital database for analysis. Results: A total of 309 cases were reviewed. Out of these, ovarian epithelial tumors made up at least four-fifths of the total tumors i.e. 258(83.5%). Non-epithelial origin of ovarian tumors only consisted of 51(16.5%) cases. Out of these 153(49.84%) cases were diagnosed as serous, 88(28.48%) as mucinous. A total of 175(61.4%) tumors were benign, 15(5.81%) were borderline, and 68 (26.3%) were malignant. The patients with malignant serous tumors (43.24±13.99 years) were considerably older than individuals with benign (34.54 ± 13.16 years) and borderline (32.71±13.79 years) serous tumors. Conclusion: The present study concludes that epithelial ovarian cancer is the most commonly encountered lesion in our population. Benign and borderline tumors involve slightly younger age groups, mostly below forty years of age. Keywords: Carcinoma, Epithelial-origin tumors, malignancy, ovarian tumors

Ensuring safety and feasibility for resection of pediatric benign ovarian tumors by single-port robot-assisted laparoscopic surgery using the da Vinci Xi system.

BackgroundSingle-port robot-assisted laparoscopic surgery (S-RALS) is rarely applied in pediatric surgery. There is still no study on the application of S-RALS for resection of pediatric benign ovarian tumors. The current study aimed to investigate the safety and feasibility of S-RALS for resection of pediatric benign ovarian tumors using the da Vinci Xi system.MethodsThe clinical data of three patients who underwent S-RALS for resection of benign ovarian tumors in the Department of Pediatric Surgery, Zhongnan Hospital of Wuhan University from May 2020 to September 2021 were retrospectively analyzed. The mean age of these children was 7.9 years (5.8–9.3 years). One was a case of bilateral ovarian tumors, and the other two were cases of right ovarian tumors.ResultsAll three patients successfully underwent the resection of ovarian tumors through S-RALS without conversion to laparotomy. The average operation time was 180 min (118–231 min). The average amount of blood loss was 20 ml (10–35 ml). No drainage tube was placed. All postoperative pathological types of ovarian tumors were mature cystic teratomas in the three cases. All patients started a liquid diet 2 h after surgery. The average length of postoperative hospital stay was 4.7 days (3–7 days). No tumor recurred, no surgical site hernia occurred, and the wound healed very well with a cosmetic scar in the lower umbilical crease during the postoperative follow-up for 6–18 months.ConclusionS-RALS has the advantages of less surgical trauma, quick postoperative recovery, and a cosmetic scar in the lower umbilical crease. It is safe, effective, and feasible for pediatric benign ovarian tumors.

Apparent diffusion coefficient histogram analysis for differentiating solid ovarian tumors.

ObjectiveTo evaluate the utility of apparent diffusion coefficient (ADC) histogram analysis to differentiate between three types of solid ovarian tumors: granulosa cell tumors (GCTs) of the ovary, ovarian fibromas, and high-grade serous ovarian carcinomas (HGSOCs).MethodsThe medical records of 11 patients with GCTs of the ovary (regions of interest [ROI-cs], 137), 61 patients with ovarian fibromas (ROI-cs, 161), and 14 patients with HGSOCs (ROI-cs, 113) confirmed at surgery and histology who underwent diffusion-weighted imaging were retrospectively reviewed. Histogram parameters of ADC maps (ADCmean, ADCmax, ADCmin) were estimated and compared using the Kruskal-WallisH test and Mann-Whitney U test. The area under the curve of receiver operating characteristic curves was used to assess the diagnostic performance of ADC parameters for solid ovarian tumors.ResultsThere were significant differences in ADCmean, ADCmax and ADCmin values between GCTs of the ovary, ovarian fibromas, and HGSOCs. The cutoff ADCmean value for differentiating a GCT of the ovary from an ovarian fibroma was 0.95×10-3 mm2/s, for differentiating a GCT of the ovary from an HGSOC was 0.69×10-3 mm2/s, and for differentiating an ovarian fibroma from an HGSOC was 1.24×10-3 mm2/s.ConclusionADCmean derived from ADC histogram analysis provided quantitative information that allowed accurate differentiation of GCTs of the ovary, ovarian fibromas, and HGSOCs before surgery.

Frequency and Type of Ovarian Tumors in Gynecological Women presenting to DHQ Teaching Hospital Gujranwala

Background: Ovarian cancer (OC) average lifetime risk is 1 in 70(1.4%).Ovarian cancer is diagnosed in 7300 women every year in UK and 239,000 women world wide.There are variations in incidence with ethnicity, white women have the highest incidence approximately14/100,000 where as Asian women have a lower incidence at 10/100,000. Aim: To find the frequency and different types of ovarian carcinomas in women presenting with pain lower abdomen. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, DHQ Hospital Gujranwala from1st May 2020 to 31st October 2020.A total of 282 women presenting with pain lower abdomen were included.All women underwent ultrasonography and ovarian tumors were noted as per operational definition. Patients with ovarian tumor underwent laparotomy, the specimen of tumors were collected with excision biopsies and sent for histopathological analysis. Results: The mean age of cases was 33.808±7.70 years, and the mean duration of complaint was 4.322±1.46 weeks and mean weight was 69.560±13.00 kg. Majority of the patients (82.3%) belonged to 20-40 years age groups. Ovarian Tumor was seen in 65(23%) patients. Among 65 patients with ovarian tumor, 72.3% were benign, 3.1% borderline and 24.6% were malignant. Conclusion: It was concluded that ovarian tumors were common between the 20 and 40 years of age. The frequency of Malignant neoplastic lesions was higher than the benign neoplastic lesions. Keywords: Women, Pain lower abdomen, Ovarian tumors

113 A dermoid cyst as a recurrence of immature teratoma, which had been treated with cystectomy, in a patient with family history of mature teratoma

Objectives: Teratomas are among the most common types of ovarian germ cell tumors, and are mature (benign) in 95% of the cases. [1,2] Immature teratomas account for less than 1% of all teratomas and their incidence is 0.12 per 100,000 woman-years. [3] This case presentation refers to a 17-year-old girl with an ovarian tumor, which was found in the follow-up of her treated immature teratoma. Study design: A 14-year-old patient, in 2016, was admitted urgently into a pediatric clinic with an intermittent lower pelvic pain, fever and vomiting.

GIANT OVARIAN DERMOID CYST - CASE REPORT

The most prevalent type of ovarian germ cell tumour is dermoid cysts, also known as mature cystic teratoma. Dermoid cysts are benign germ cell tumours that account for 10–25% of all ovarian tumours and are bilateral in 10%–15% of cases. They are most common in reproductive-age women, although they can also be detected in postmenopausal women, and they are usually asymptomatic. Torsion, rupture, chemical peritonitis, and malignant transformation can all aggravate it, but infection is unlikely.

Ovarian Tumours: Discordance between Clinical and Radiological Findings: A Case Series.

The five major types of ovarian tumors in females of different age groups are discussed here with respect to discordance between ultrasonography, clinical features and histopathology findings. The importance of clinical examination cannot be denied in such cases as total dependence on investigation modalities may lead to wrong diagnosis and treatment. Five such cases admitted in the year 2017-2018 at Era's Lucknow medical college and hospital were selected for this series. All the cases had varied presentation, and diagnosis in each case was difficult as the nature of the masses differed markedly from the radiological findings. Even in expert hands, a radiological conclusion must go hand in hand with a proper clinical correlation.

Borderline ovarian tumors: modern diagnostic criteria at the preoperative stage

AIM: The aim of this study was to define and standardize the clinical and diagnostic criteria for borderline ovarian tumors at the preoperative stage.
 MATERIALS AND METHODS: A retrospective analysis of 35 clinical case histories of patients with morphologically established borderline ovarian tumors has been conducted. Clinical and morphological data were analyzed: age, anamnesis, examination data, disease stage, histological study results. Laboratory parameters were assessed: CA-125 tumor marker level and ultrasound characteristics using criteria defined by IOTA, ADNEX and O-RADS groups.
 RESULTS: A single cyst with a solid component was a typical ultrasound type of borderline ovarian tumors (45.71%). The application of the simple IOTA rules in regards to evaluating the formations proved possible in 100% of the cases and the formation was regarded as undefined in 62.86% of the cases. In 51.43% of the cases, the formation belonged to O-RADS 4 (10% to 50% risk of malignancy). The study of CA-125 tumor marker levels showed insufficient sensitivity, only 57.14% of patients having the parameter above the norm.
 CONCLUSIONS: The application of the IOTA and O-RADS criteria allows for differentiating not only benign and malignant, but also borderline ovarian tumors, thus determining the choice of an organ-preserving treatment for patients of reproductive age.

Significance of Endocan Expression in Various Types of Epithelial Ovarian Tumors.

Background & Objective:Ovarian cancer is associated with the highest mortality rate among gynecologic malignancies. Despite new therapeutic strategies, ovarian cancer still has a high risk of metastasis and mortality. Endocan is a newly identified endothelial cell activation marker, which is responsible for angiogenesis, tumor invasion, and aggressive behavior of tumors. The aim of this study was to assess Endocan expression in different types of ovarian tumors and to identify its relationship with clinicopathologic characteristics of ovarian tumors. Methods:This cross-sectional study was conducted on 183 tissue samples, including benign, borderline, and malignant ovarian tumors collected from the University Kebangsaan Malaysia Medical Center archive of Pathology during 2005-2015. Mouse monoclonal anti-human Endocan/ESM-1 Clone MEP08 was used at a dilution of 1:400 for immunohistochemical (IHC) staining. All the information was collected by a checklist, and the association between clinicopathological features and high or low levels of Endocan -MVD was evaluated using Pearson chi-square, Fischer's exact, or Monte Carlo tests.Results:The prevalence of Endocan positivity was significantly higher in malignant compared to borderline and benign ovarian tumors (P<0.001). There was also a significant association between type of tumor and Endocan status in malignant ovarian tumors (P=0.02), indicating that Endocan positivity was more likely in serous malignant ovarian tumors compared to other ovarian tumor types. However, the tumor stage was not significantly associated with Endocan status (P=0.31). Conclusion:This study showed that Endocan positivity may show the highest prevalence among malignant tumors suggesting that high Endocan expression would be negatively associated with ovarian tumor behavior.

18F-FDG PET/CT in Bilateral Breasts Metastasis From Ovarian Carcinoma.

Ovarian carcinomas generally metastasize within the peritoneal cavity due to exfoliation of malignant cells from primary tumor. Metastasis to the breasts is an unusual event and may mimic primary neoplastic disease. Usually, breast metastasis presents as a single isolated, well-circumscribed soft tissue lesion, and serous papillary carcinoma is the most common type of ovarian tumor that can metastasize to the breast. Concurrent bilateral breast metastasis is rare event. We present a follow-up case of metastatic carcinoma ovary, demonstrating FDG-avid soft tissue density masses in the bilateral breast parenchyma along with bilateral axillary lymphadenopathy, biopsy of which revealed metastatic deposits from carcinoma ovary.

Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report

BACKGROUNDPostmenopausal bleeding (PMB) is a common gynecologic complaint among elderly women, and endometrial hyperplasia is a common cause of this bleeding. Ovarian fibromas are the most common type of ovarian sex cord-stromal tumor (SCST). They arise from non-functioning stroma, rarely show estrogenic activity, and stimulate endometrial hyperplasia, causing abnormal vaginal bleeding.CASE SUMMARYWe report herein the case of a 64-year-old Chinese woman who presented with recurrent PMB. A sex hormone test revealed that her estrogen level was significantly higher than normal, and other causes of hyperestrogenism had been excluded. The patient had undergone four curettage and hysteroscopy procedures in the past 7 years due to recurrent PMB and endometrial hyperplasia. The culprit behind the increase in estrogen level—an ovarian cellular fibroma with estrogenic activity—was eventually found during the fifth operation.CONCLUSIONOvarian cellular fibromas occur insidiously, and some may have endocrine functions. Postmenopausal patients with recurrent PMB and endometrial thickening observed on ultrasonography are recommended to undergo sex hormone testing while waiting for results regarding the pathology of the endometrium. If the estrogen level remains elevated, the clinician should consider the possibility of an ovarian SCST and follow-up the patient closely, even if the imaging results do not indicate ovarian tumors. Once the tumor is found, it should be removed as soon as possible no matter the size to avoid endometrial lesions due to long-term estrogen stimulation. More studies are needed to confirm whether preventive total hysterectomy with bilateral salpingo-oophorectomy should be recommended for women with recurrent PMB exhibiting elevated estrogen levels, despite the auxiliary examination results not indicating ovarian mass. The physical and psychological burden caused by repeated curettage could be prevented using this technique.

Management of malignant dysgerminoma of the ovary

The evolution of treatment for malignant ovarian germ cell tumors has been one of the most successful in the history of gynecologic oncology, with dysgerminoma as the most common type of malignant ovarian germ cell tumors. Since the introduction of platinum-based chemotherapy in the 1980s, 5-year survival rates for early-stage dysgerminomas have been close to 100%, and as high as 98% for advanced stages. Despite this remarkable achievement, many questions remain in routine treatment. By performing a literature review, we aim to highlight both the current treatment of malignant dysgerminoma and unanswered questions in the modern management of this disease. These issues relate firstly to surgical therapy, such as the role of routine omentectomy and lymphadenectomy, the value of complete surgical resection, and the possibility of fertility-sparing surgery. Second, chemotherapy and the question of the possibility of de-escalation in early stages and the potential of neoadjuvant chemotherapy in advanced stages will be addressed. Finally, a brief overview of the current developments of new drug treatment regimens will be given.

A rare mixed ovarian tumor associating borderline endometrioid component and borderline serous component.

A 37-year-old woman was admitted to the department of Gynecology and Obstetrics for management of ovarian cyst, for which a left oophorectomy was performed. The specimen was evaluated then in the department of pathology. On gross examination, the ovarian cyst had a smooth surface and measured 5.5x4.5x 2.5cm. Cut section revealed that the cyst was multilocular, filled with clear fluid and containing several buds. Microscopically, the cyst consisted in a biphasic tumor associating borderline endometrioid component, composed of confluent glands of endometrioid-type epithelium with mild atypical nuclei and borderline serous component. This serous component was made by numerous bulbous, irregularly contoured papillae with fibrous cores and lined by pseudostratified columnar cells with moderate atypia. Immunohistochemical study using WT1 showed positive labeling in the borderline serous component (blue asterisk) and absence of labeling in the borderline endometrioid component (red asterisk). The diagnosis of a mixed ovarian tumor associating a borderline endometrioid component and a borderline serous component was given. A mixed tumor associating two types of ovarian borderline tumors is exceptionally described in the literature. In our case, the presence of a borderline endometrioid component associated with a borderline serous component raises the role of endometriosis in the genesis of ovarian tumors. The pathogenetic transformation from endometriosis to ovarian tumors is not fully understood, but it seems mainly related to many factors: inflammation, oxidative stress, hyperestrogenism, and specific genomic alterations.

CD133 Act as an Essential Marker in Ovarian Carcinogenesis.

Objective:To analyze the role of cancer stem cells (CSC) in ovarian carcinogenesis through the identification of CD133 expression in the normal ovary (NO), serous cystadenoma (SC), borderline serous tumour (BST), low-grade serous carcinoma (LGSC), and high-grade serous carcinoma (HGSC). Materials and methods:A total of 48 tissue samples contain 5 NO, 10 SC, 5 BST, 8 LGSC, and 20 HGSC were stained with anti-CD133 antibody by immunohistochemical protocol. The difference in the H-score of CD133 expression between groups and their relationship to age, histomorphology, and localization was analyzed. Results:CD133 expression varied among tumor groups, with clinicopathologic parameters showing diverse associations (age p = 0.773; histomorphology p = 0.001; and localization p = 0.026). The comparison of CD133 H-scores differed significantly between each group (p = 0.0031), in which precursor and malignant lesions possessed more robust CD133 expression. Conclusion:The presence of CD133 cellular expression and localization in different types of serous ovarian tumours suggests that these markers are involved in ovarian tumorigenesis.

An improved YOLOv3 model for detecting location information of ovarian cancer from CT images

Ovarian cancer is a malignant tumor that poses a serious threat to women’s lives. Computer-aided diagnosis (CAD) systems can classify the type of ovarian tumors, but few of them can provide exactly the location information of ovarian cancer cells. Recently, deep learning technology becomes hot for automatic detection of cancer cells, particularly for detecting their locations. In this work, we propose a novel end-to-end network YOLO-OC (Ovarian cancer) model, which can extract the characteristics of ovarian cancer more efficiently. In our method, deformable convolution is used to enhance the model’s ability to learn geometric deformation in space. Squeeze-and-Excitation (SE) module is proposed to automatically learn the importance of different channel features. Data experiments are conducted on datasets collected from The Affiliated Hospital of Qingdao University Medical College, China. Experimental results show that our YOLO-OC model achieves 91.83%, 85.66% and 73.82% on mean average precision mAP@.5, mAP@.75 and mAP@[.5,.95], respectively, which performs better than Faster R-CNN, SSD and RetinaNet on both accuracy and efficiency.

Peutz-Jeghers syndrome: Skin manifestations and endocrine anomalies (Review).

Peutz-Jeghers syndrome (PJS), a rare autosomal dominant serine/threonine kinase 11 (STK11)/ liver kinase B1 (LKB1) gene-related genodermatosis, is characterized by oral hyperpigmentation (OHP); multiple gastro-intestinal mucosal benign hamartomatous polyps causing local bleeding, occlusion, intussusception, post-resection small bowel syndrome, associated increased risk of small intestinal cancer (incidence during the third decade); and 76% cumulative higher risk than the global population of developing non-gastrointestinal tumors (female predominance) including ovarian/testicular neoplasia, pancreatic and gynecologic (breast, uterus, ovarian) cancers. Suggestive PJS-associated OHP requires STK11 genetic testing. Abdominal pain in an OHP patient may be related to PJS-associated polyps. Other features include focal depigmentation followed by hyperpigmentation, and xeroderma pigmentosum-like lesions. The severity of the dermatological findings is correlated with gastrointestinal polyps. The STK11 gene is linked to reserve of primordial follicles, polycystic ovary syndrome, female fertility, and spermatogenesis. PJS is associated with 2 types of ovarian sex-cord stroma tumors (SCSTs): annular tubules (SCTATs) and pure Sertoli cell tumors. SCSTs accounts for 8% of ovarian cancer and SCTATs represents 2% of SCST, which may be associated with the overproduction of progesterone. PJS-SCTAT vs. non-PJS-SCTAT reveals bilateral/multifocal, small tumors with a benign behavior vs. a unique ovarian, large tumor with increased malignant/metastasis risk. Male precocious puberty is due to large cell calcifying Sertoli cell tumors (LCCSCTs). Notably, 30-40% of LCCSCTs are caused by PJS or Carney complex. PJS-LCCSCT is not aggressive, but it may be bilateral/multifocal, with the ultrasound hallmark being micro-calcifications. Testicular, intra-tubular large cell hyalinizing Sertoli cell tumor is the second testicle neoplasia in PJS. The skin and mucosal lesions are useful markers of PJS, assisting with the early identification of hamartomatouspolyps and initiation of serial surveillance of ovarian, or testicular neoplasia.

Tumor extracellular hydroxyapatite: a potential biomarker for imaging ovarian cancer

<h3>Objectives:</h3> In ovarian cancer, the criteria to determine whether a patient should undergo primary surgery or be treated with neoadjuvant chemotherapy remain controversial. Furthermore, development of resistance to treatment is common. This is because there are limited biomarkers to predict response to treatment, making the choice of therapy, especially in the recurrent setting, often a matter of trial and error. This may lead to patients being treated with ineffective and toxic therapies. There is clearly a need for more suitable biomarkers that can help predict disease prognosis and which patients may benefit from neoadjuvant chemotherapy versus primary debulking surgery. While tumor calcification has been widely observed in ovarian cancer settings, the origins and significance of these calcifications has never been investigated before. This abstract reports on the discovery of the presence of hydroxyapatite (HAP); Ca10(PO4)6OH2 in the extracellular space of many types of ovarian tumors. We tested 69 annotated tissue microarrays (TMAs) of epithelial ovarian cancer cases patients with ovarian cancer cases originally diagnosed as high-grade serous/papillary ovarian cancer (HGSOC) for HAP. The aim of this investigation was to identify any correlations between tumor extracellular HAP and tumor characteristics, surgical and chemotherapeutic outcome, recurrence and patient survival rate. <h3>Methods:</h3> The TMAs were stained with alizarin red S for calcium, von Kossa for calcium phosphates, and underwent Raman spectroscopy for calcium phosphate hydroxyapatite. <h3>Results:</h3> Preliminary analysis of the TMAs showed that 24 cases tested positive for extracellular HAP (see figure 1 for example). Within these 28 HAP positive cases, 83% were HGSOC, the overall survival was 2.63 ± 1.97 years (mean ± STD) post diagnosis and 38% of cases had recurrence post treatment. On the other hand, of those cases that were negative for extracellular HAP, only 41% were HGSOC, the overall survival was 3.80 ± 3.69 years, and only 20% of those cases had tumor recurrence. <h3>Conclusions:</h3> Those the sample size tested was small and no statistical significance could be established, the results demonstrate the potential importance for testing patients with ovarian tumors for extracellular HAP. Additionally, the lower overall survival and higher recurrence rates of the cases with HAP compared to those without may suggest that not only should patients with ovarian tumors that contain extracellular HAP be monitored more frequently post treatment, but also a different treatment approach altogether may be merited.

Immunotherapy in rare ovarian cancer.

Ovarian cancer (OC) is a heterogeneous disease and a mounting body of evidence shows that a 'one-size-fits-all' approach is obsolete. Differences in epidemiology, tumor biology, genetic profiles and treatment responses of these different types necessitate a tumor and patient-specific approach. Ninety percentage consists of epithelial OC with 70% being high-grade serous OC. The other rarer subtypes are low-grade serous (5%), clear cell (12%), endometrioid (11%) and mucinous carcinoma (3%). The remaining 10% are nonepithelial rare OCs: germ cell (3%) and sex-cord stromal tumors (7%). Over the past few decades, the 5-year survival rates have only improved modestly, therefore novel therapies are urgently needed. Recently, immunotherapy has been introduced into clinical practice in a number of solid tumors. Although preclinical data confirm the presence of an immunogenic microenvironment in a number of ovarian tumor types, no single-agent immune checkpoint inhibitor has been approved hitherto. Identifying suitable treatment combinations, adequate patient selection and thus correct implementation of immunotherapy remain major challenges. In this review, we focus on the rationale of incorporating immune therapy in rare OC, we summarize the recent developments with preclinical data and results of clinical trials, with particular focus on rare ovarian histological subtypes.

Analyzing the Opportunities to Target DNA Double-Strand Breaks Repair and Replicative Stress Responses to Improve Therapeutic Index of Colorectal Cancer.

Simple SummaryColorectal cancer (CRC) is among the most common cancers and the third leading cause of cancer deaths worldwide. Despite the identification of alterations in DNA repair genes and the resulting genomic instability in sub-populations of CRC, therapies that exploit defects in DNA repair pathways or high level of replicative stress have been explored only in breast, ovarian, and other tumor types, but not yet systematically in CRC. Here, we discuss how targeting genes involved in the responses to replication stress and the repair of DNA double-strand breaks (DSBs) could provide new therapeutic opportunities to treat CRCs and have the potential to confer increased sensitivity to current chemotherapy regimens, thus, expanding the spectrum of therapy options, and potentially improving clinical outcomes for CRC patients.Despite the ample improvements of CRC molecular landscape, the therapeutic options still rely on conventional chemotherapy-based regimens for early disease, and few targeted agents are recommended for clinical use in the metastatic setting. Moreover, the impact of cytotoxic, targeted agents, and immunotherapy combinations in the metastatic scenario is not fully satisfactory, especially the outcomes for patients who develop resistance to these treatments need to be improved. Here, we examine the opportunity to consider therapeutic agents targeting DNA repair and DNA replication stress response as strategies to exploit genetic or functional defects in the DNA damage response (DDR) pathways through synthetic lethal mechanisms, still not explored in CRC. These include the multiple actors involved in the repair of DNA double-strand breaks (DSBs) through homologous recombination (HR), classical non-homologous end joining (NHEJ), and microhomology-mediated end-joining (MMEJ), inhibitors of the base excision repair (BER) protein poly (ADP-ribose) polymerase (PARP), as well as inhibitors of the DNA damage kinases ataxia-telangiectasia and Rad3 related (ATR), CHK1, WEE1, and ataxia-telangiectasia mutated (ATM). We also review the biomarkers that guide the use of these agents, and current clinical trials with targeted DDR therapies.

Imaging in gynecological disease (22): clinical and ultrasound characteristics of ovarian embryonal carcinomas, non-gestational choriocarcinomas and malignant mixed germ cell tumors.

To describe the clinical and ultrasound characteristics of three types of rare malignant ovarian germ cell tumor: embryonal carcinoma, non-gestational choriocarcinoma and malignant mixed germ cell tumor. This was a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histological diagnosis of ovarian embryonal carcinoma, non-gestational choriocarcinoma or malignant mixed germ cell tumor, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2000 and 2020. Additional patients with the same histology were identified from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. Three examiners reviewed all available ultrasound images and described them using pattern recognition. One patient with embryonal carcinoma, five patients with non-gestational ovarian choriocarcinoma and seven patients with ovarian malignant mixed germ cell tumor (six primary tumors and one recurrence) were identified. Seven patients were included in the IOTA studies and six patients were examined outside of the IOTA studies. The median age at diagnosis was 26 (range, 14-77) years. Beta-human chorionic gonadotropin levels were highest in non-gestational choriocarcinomas and alpha-fetoprotein levels were highest in malignant mixed germ cell tumors. Most tumors were International Federation of Gynecology and Obstetrics (FIGO) Stage I (9/12 (75.0%)). All tumors were unilateral, and the median largest diameter was 129 (range, 38-216) mm. Of the tumors, 11/13 (84.6%) were solid and 2/13 (15.4%) were multilocular-solid; 9/13 (69.2%) manifested abundant vascularization on color Doppler examination. Using pattern recognition, the typical ultrasound appearance was a large solid tumor with inhomogeneous echogenicity of the solid tissue and often dispersed cysts which, in most cases, were small and irregular. Some tumors had smooth contours while others had irregular contours. A unilateral, large solid tumor with inhomogeneous echogenicity of the solid tissue and with dispersed small cystic areas in a young woman should raise the suspicion of a rare malignant germ cell tumor. This suspicion can guide the clinician to test tumor markers specific for malignant germ cell tumors. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.