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Ovarian cancer is a common gynecologic malignancy. In clinical practice, recurrent ovarian cancer is mainly classified into two categories on the basis of platinum-free interval, platinum-resistant and platinum-sensitive, corresponding to different treatment modalities and prognoses. The treatment of platinum-resistant ovarian cancer is challenging. Some scholars have pointed out limitations in the binary classification of platinum-free interval. In this article, the classification of recurrent ovarian cancer, the treatment challenges of platinum-resistant ovarian cancer, the limitations of the platinum-free interval binary classification, and new classification perspectives were reviewed to help physicians enhance their understanding on the research progress in ovarian cancer classification and develop more effective treatment strategies.

Ovarian cancer is one of the most malignant gynecological tumors. Platinum-based chemotherapy is an important part of ovarian cancer treatment, with platinum resistance as a difficult problem in ovarian cancer treatment. Platinum resis-tance is a complex process involving a variety of mechanisms. This article reviews the molecular mechanisms of platinum resistance in ovarian cancer cells and the advances in treatment, in order to provide a reference for the clinical treatment of this disease.

OBJECTIVE: To find out the association of primary ovarian carcinomas (POC) and metastatic gastrointestinal carcinoma (MGC) by utilizing a panel of antibodies including Cytokeratin (CK) 7, CK20, Caudal-type Homeobox Transcription Factor-2 (CDX2), and SATB2 with their clinicopathological parameters. METHODS: This prospective cross-sectional study was conducted from Mar, 2023 to Dec 2023 at Dow University of Health Sciences, Karachi, Pakistan. Biopsy tissue specimens from female patients over the 40 years, diagnosed with primary and metastatic ovarian carcinomas (MOC), were included. Immunohistochemistry, employing a three-tier scoring system, assessed CK7, CK20, CDX2, and SATB2 expressions. Statistical analysis was performed, utilized SPSS version 26.0 by employing Chi-Square test. RESULTS: Over a 9-month period, 100 biopsied tissue samples were collected from patients aged 42-71 years (mean age 53.24 ± 8.03 years). Among these, 79 were POC (51% serous carcinoma, 9% mucinous carcinoma, 18% endometrioid carcinoma, and 1% clear cell carcinoma), and 21 were MGC. CK7 showed diffuse staining predominantly in POC and was absent in MGC (p < 0.001). CK20 exhibited significant focal and diffuse staining in MGC and was largely absent in POC (p = 0.005). CDX2 was significantly absent in POC and showed diffuse and focal staining in MGC (p < 0.001). SATB2 was absent in POC and displayed focal or diffuse staining in MGC (p < 0.001). CONCLUSION: The inclusion of SATB2 in immunohistochemical panels, alongside CK7, CK20, and CDX2, improves the accuracy of diagnosing primary and metastatic ovarian carcinomas. This approach provides support in the distinction between ovarian and gastrointestinal tumors.

Ovarian fibromatosis is a rare non-neoplastic condition that causes ovarian enlargement in women, typically around the age of 25. This enlargement is due to the proliferation of the collagen-producing ovarian stroma. On T2-weighted MRI, a key diagnostic feature of ovarian fibromatosis is the ‘black garland sign,’ characterized by multilobulated very low signal intensity along the ovarian surface. This condition also features the preservation of normal ovarian stroma or follicles internally. We present a case involving a 65-year-old postmenopausal female who was pathologically misdiagnosed with ovarian fibroma. However, the diagnosis was later revised to ovarian fibromatosis based on characteristic MRI findings. The case report discusses the differential diagnosis and pathologic findings associated with ovarian fibromatosis.

Ovarian cancer stands as the third most prevalent gynecological malignancy. The advent of PARP inhibitors, particularly rucaparib, has revolutionized the landscape of advanced ovarian cancer treatment, demonstrating notable efficacy with minimal toxicity, especially in patients not previously exposed to PARP inhibitors. Rucaparib's precision-driven approach, targeting specific genetic mutations, disrupts DNA repair mechanisms, resulting in cytotoxic effects on neoplastic cells. This comprehensive review delves into the clinical efficacy and safety profile of rucaparib in recurrent ovarian cancer, showcasing its promising therapeutic approach. A systematic search of studies reporting rucaparib efficacy and safety, up to September 2023, was conducted across various reputable databases and sources. The meta-analysis of seven articles revealed a pooled objective response rate (ORR) of 0.331 (95% CI, 0.221–0.449; I2 = 92.4%), underscoring rucaparib's efficacy, particularly evident in the BRCA-mutated cohort. Rucaparib consistently outperformed controls in progression-free survival (PFS) and overall survival (OS). Safety evaluations indicated that 98.7% of patients experienced treatment-emergent adverse events (TEAEs), with 61% being grade ≥3. Notable TEAEs included nausea (69.0%), fatigue (66.8%), vomiting (37.3%), and constipation (32.1%). Hematological concerns comprised anemia (47.9%), thrombocytopenia, elevated AST/ALT (37.3%), and serum creatinine levels (19.7%). Despite favourable outcomes, the rucaparib group recorded higher event rates across various metrics than controls. The findings underscore the need for meticulous monitoring and dose adjustments to optimize therapeutic outcomes and mitigate the increased risks associated with adverse events. International Prospective Register of Systematic Review Identifier: CRD42023459646.

Ferroptosis, a recently identified type of non-apoptotic cell death, triggers the elimination of cells in the presence of lipid peroxidation and in an iron-dependent manner. Indeed, ferroptosis-stimulating factors have the ability of suppressing antioxidant capacity, leading to the accumulation of reactive oxygen species (ROS) and the subsequent oxidative death of the cells. Ferroptosis is involved in the pathophysiological basis of different maladies, such as multiple cancers, among which female-oriented malignancies have attracted much attention in recent years. In this context, it has also been unveiled that non-coding RNA transcripts, including microRNAs, long non-coding RNAs, and circular RNAs have regulatory interconnections with the ferroptotic flux, which controls the pathogenic development of diseases. Furthermore, the potential of employing these RNA transcripts as therapeutic targets during the onset of female-specific neoplasms to modulate ferroptosis has become a research hotspot; however, the molecular mechanisms and functional alterations of ferroptosis still require further investigation. The current review comprehensively highlights ferroptosis and its association with non-coding RNAs with a focus on how this crosstalk affects the pathogenesis of female-oriented malignancies, from breast cancer to ovarian, cervical, and endometrial neoplasms, suggesting novel therapeutic targets to decelerate and even block the expansion and development of these tumors.

Ovarian neoplasms in children and adolescents are rare pathologies (2.6–3.0 per 100,000 patients a year), however, they are sufficiently relevant in pediatric gynecology nowadays. The age of the patients highly correlates with different histological types of ovarian neoplasms. And this is a reason for discussing this disease in different age groups apart. Unfortunately, there are a number of unresolved issues connected with the etiology, pathogenesis and diagnosis. This paper discusses recent information related with the subject “ovarian neoplasms in pediatric gynecology” and particularly questions which require further study.The aim of the work is to conduct a review of recent literature which corresponds to this subject and to discover questions which require further study.The analysis revealed that the etiology and pathogenesis of a number of rare neoplasms has not been discovered fully yet and that can be the cause of the delayed disease diagnostics. Apart from this there are no tools for the preoperative stratification of the risk of malignancy and that can lead to more frequent radical operations for benign tumors.

Abstract Background Neoadjuvant chemotherapy followed by interval debulking surgery is currently a common treatment option for advanced epithelial ovarian cancer (EOC). The Standardized CA-125 ELIMination rate constant K (Std KELIM) and the Platinum Resistant Recurrence (PtRR) Score have been proposed as markers of tumor chemosensitivity. The aim of our study was to validate these tools for predicting platinum sensitivity in a real-world population of patients with advanced EOC treated with neoadjuvant chemotherapy. Experimental design All patients with advanced EOC treated with neoadjuvant chemotherapy at the Institut Curie between 2000 and 2015 were included. The Std KELIM was calculated with the CA-125 concentrations during the first 100 days of chemotherapy. The predictive value of Std KELIM and PtRR scores for the risk of subsequent PtRR was assessed using receiver operating characteristic (ROC) curve analysis, logistic regression and calibration curve. Kaplan–Meier survival analysis was performed for the treatment-free interval from platinum (TFIp) therapy and overall survival (OS). Results Std KELIM data were available for 149 patients. The AUC was 0.67 for PtRR. A low Std KELIM was significantly associated with PtRR (OR = 0.19 (95% CI [0.06, 0.53], p = 0.002)) according to the univariate analysis. The calibration curve of the PtRR showed a slight but significant underestimation (p = 0.02) of the probability of platinum resistance. Favorable Std KELIM (≥ 1) alone and combined with the completeness of surgery were associated with significantly better survival in terms of TFIp and OS. Conclusions Std KELIM is an early prognostic marker of chemosensitivity in a real-life setting complementary to surgical status. It could help the clinician in the early management of patients by identifying those with a worse prognosis.

Introduction: Ovarian cancer has an unknown pathogenesis, and cytokines may play an important role in the aetiology and prognosis. Tumour Necrosis Factor-alpha (TNF-α) and its receptors (TNFR1 and TNFR2) are involved in the biology of ovarian cancer, tumour pathogenesis, and their relationship with prognostic factors. They are involved in biological processes such as immunoregulation, growth modulation, and cell differentiation. Aim: To evaluate stromal immunostaining of TNF-α and its receptors (TNFR1 and TNFR2) in malignant ovarian neoplasms, comparing it with benign ovarian neoplasms and non neoplastic ovarian lesions. Materials and Methods: A cross-sectional study was carried out at the Department of Gynaecology and Obstetrics, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil, from January 1997 to December 2020. Patients with ovarian lesions who underwent surgical treatment according to pre-established criteria (n=95) were included in the study. Patients with benign (n=37) and malignant (n=43) ovarian epithelial neoplasms, and non neoplastic ovarian lesions (n=15) were included. Data evaluated included age, parity, hormonal status (menarche or menopause), histological grade, and staging. Immunohistochemical study was performed to evaluate stromal TNF-α, TNFR1, and TNFR2. Data were analysed by GraphPad Prism 6 and IBM Statistical Package for the Social Sciences (SPSS) Statistics 20.0 software. The comparison between non neoplastic tumours, benign and malignant neoplasms was performed by the Fisher’s exact test with a significance level below 0.05. Results: Considering staining intensity 0 and 1 as “weak immunostaining” and 2 and 3 as “strong immunostaining,” TNF-α stromal immunostaining was stronger (2/3) in benign ovarian neoplasms compared to non neoplastic tumours (p-value=0.0016) and in malignant neoplasms compared to non neoplastic tumours (p-value

OBJECTIVE: To investigate the expression of epidermal growth factor receptor (EGFR) in surface epithelial ovarian cancers (EOCs) among the local population, considering its potential role as a therapeutic target in ovarian cancer treatment. METHODS: This cross-sectional study was conducted at Ayub Medical College, Abbottabad, and Khyber Medical University Peshawar, Pakistan, from July 1st to December 31st, 2022. Data from 73 patients diagnosed with EOC were collected using consecutive sampling. Inclusion criteria required histopathological confirmation of EOC and sufficient biopsy specimens for immune-histochemical (IHC) analysis. Patients who declined participation or lacked adequate biopsy samples for IHC were excluded. Biopsy samples were histologically confirmed for EOC, and IHC staining was performed to detect EGFR-1 protein, validated with positive and negative controls. RESULTS: The mean age of the participants was 53.42±9.99 years, with serous type lesions being the most prevalent (n=40, 54.8%). EGFR expression varied, with 46.6% showing moderate positivity, 27.4% and 19.2% cases demonstrating weak and strong positivity respectively. Significant differences in EGFR positivity were noted between lesion types (p=0.002) and among patients with positive vs. negative family histories (p=0.001). No significant associations were found with parity or socioeconomic status. ANOVA analysis revealed no significant differences in age, age at menarche, or age at menopause based on EGFR positivity levels (p > 0.05). CONCLUSIONS: A moderate to high intensity level of EGFR expression in cases of serous cyst adenocarcinomas and patients with family history of reproductive system malignancy suggest its potential as a therapeutic target for ovarian cancer treatment in such patients.

Objective To investigate the effect of miR-181c-5p on vasculogenic mimicry (VM) in ovarian cancer stem-like cells (OCS-LCs) and its mechanism. Methods OVCAR3 cells were induced into OCS-LCs by serum-free suspension culture. OVCAR3 cells were divided into groups A, B, and C and were transfected with NC-miR-181c-5p, siRNA-miR-181c-5p, and pRNA-miR-181c-5p, respectively. The sphere-forming experiment was used to assess the sphere formation ability of groups A, B, and C. RT-qPCR was used to measure the relative expression level of miR-181c-5p in cells of groups A, B, and C, and Western blot was used to measure the relative protein expression levels of Oct-4, Nanog, HIF-1α, and VEGF in cells of groups A, B, and C. CCK-8 assay was used to measure the viability of cells in groups A, B, and C, and the three-dimensional culture experiment was used to measure the angiogenesis rate of groups A, B, and C. Results OVCAR3 cells were successfully induced into OCS-LCs. RT-qPCR showed that group B had a significantly lower relative expression level of miR-181c-5p than group A, and group C had a significantly higher relative expression level than group A (t=2.25,8.68,P

Background Malignant struma ovarii (MSO) is a very rare disease in which thyroid cancer originates from the ovary. Because it is rare for endocrinologists to encounter patients with MSO, endocrinologists may have a limited understanding of the disease. Therefore, we analyzed and introduced its incidence and clinical course in a tertiary hospital in Korea. Methods We retrospectively investigated the clinical data of 170 patients who underwent surgery for struma ovarii at the Department of Obstetrics and Gynecology of Samsung Medical Center from 1994 to May 2023. Results Among 170 patients with struma ovarii, 15 (8.8%) were diagnosed with MSO. The median age of patients with MSO was 48 years (range, 30 to 74), and the median tumor size was 3.3 cm (range, 0.5 to 11.0). Papillary thyroid carcinoma (46.7%) was the most common subtypes followed by follicular thyroid carcinoma (26.7%). All patients were diagnosed after surgery, with no predictions from preoperative imaging. The surgical extent of gynecological surgery was variable. Four patients (26.7%) underwent thyroidectomy for thyroid cancer, while one underwent total thyroidectomy and radioactive iodine therapy for MSO with peritoneal metastasis. Except for one patient who underwent hemithyroidectomy, thyroid stimulating hormone suppression therapy was performed in four patients. Only 53% of MSO patients were consulted by an endocrinologist. With a median follow-up period of 33 months (range, 4 to 156), 11 patients remained disease-free, one experienced progression with peritoneal seeding, and the remaining one was in treatment. There have been no recurrences or deaths due to MSO. Conclusion An endocrinologist should be involved in establishing a therapeutic plan for MSO, for which the overall prognosis is generally favorable.

Abstract Metastasis from one neoplasm to another is referred to as tumor‐to‐tumor metastasis (TTM). TTM is rarely observed. Here, we present a patient with TTM from a thymic carcinoma to an ovarian mature teratoma. A 25‐year‐old woman, diagnosed with unresectable thymic carcinoma, presented with a cyst with a solid tumor component in her right ovary. Laparoscopic cystectomy of the right ovary revealed that the solid tumor was a distant metastasis of the thymic carcinoma in an ovarian mature teratoma. The possibility of malignant transformation of the ovarian mature teratoma was ruled out, enabling accurate staging of the thymic carcinoma. This case emphasizes the need for clinicians to consider TTM and the importance of pathological confirmation of TTM when investigating potential distant metastases.

Background Opportunistic salpingectomy (OS) can be used as a primary prevention of ovarian cancer (OC) , but OS may cause impairment of ovarian function due to the homologous blood supply system shared by ovaries and fallopian tubes, thereby increasing the risk of ovarian aging and early menopause. Objective To evaluate the short-term effects of OS on ovarian reserve based on GRADE evidence grading system. Methods In September 2022, CNKI, Wanfang, VIP, PubMed, Web of Science, and Scopus were searched for literature assessing the short-term effects of OS on ovarian reserve from inception to 10 September 2022. Two investigators independently screened the literature and extracted the data. The Jadad scale was used to evaluate the quality of literature, Stata 17.0 software was used for data processing and meta-analysis, and GRADEpro 3.2 software was used to assess the evidence quality for the results of meta-analysis. Results A total of 9 randomized controlled trials (RCT) were included, involving 482 patients, including 238 cases in the OS group and 244 in the non-OS group. The results of the Jadad risk assessment scale showed that the included RCTs were all of high quality literature. The results of meta-analysis showed that the differences in changes of anti-mullerian hormone (AMH) (WMD=-0.07, 95%CI=-0.28-0.13, P=0.13) , follicle-stimulating hormone (FSH) (WMD=-0.03, 95%CI=-1.65-1.59, P=0.24) , luteinizing hormone (LH) (WMD=-0.39, 95%CI=-1.62-0.83, P=0.08) and estradiol (E2) (WMD=3.08, 95%CI=-4.26-10.43, P=0.35) before and after surgery between the OS and non-OS groups were not significant (P>0.05) . The results of the meta-analysis by GRADEpro software showed high quality evidence for AMH, moderate quality evidence for FSH, and low quality evidence for E2 and LH. Conclusion There is no significant difference in ovarian reserve indicators between the non-menopausal women who receive OS for benign disease in the short term and those who did not receive OS. It is reasonable for premenopausal women who have completed childbearing to prevent OC by OS, but this conclusion remains to be validated by a longer follow-up and more rigorous RCTs with a larger sample size.

Abstract Background Ovarian cancer is the most lethal and endometrial cancer the most common gynaecological cancer in the UK, yet neither have a screening program in place to facilitate early disease detection. The aim is to evaluate whether online search data can be used to differentiate between individuals with malignant and benign gynaecological diagnoses. Methods This is a prospective cohort study evaluating online search data in symptomatic individuals (Google user) referred from primary care (GP) with a suspected cancer to a London Hospital (UK) between December 2020 and June 2022. Informed written consent was obtained and online search data was extracted via Google takeout and anonymised. A health filter was applied to extract health-related terms for 24 months prior to GP referral. A predictive model (outcome: malignancy) was developed using (1) search queries (terms model) and (2) categorised search queries (categories model). Area under the ROC curve (AUC) was used to evaluate model performance. 844 women were approached, 652 were eligible to participate and 392 were recruited. Of those recruited, 108 did not complete enrollment, 12 withdrew and 37 were excluded as they did not track Google searches or had an empty search history, leaving a cohort of 235. Results The cohort had a median age of 53 years old (range 20–81) and a malignancy rate of 26.0%. There was a difference in online search data between those with a benign and malignant diagnosis, noted as early as 360 days in advance of GP referral, when search queries were used directly, but only 60 days in advance, when queries were divided into health categories. A model using online search data from patients (n = 153) who performed health-related search and corrected for sample size, achieved its highest sample-corrected AUC of 0.82, 60 days prior to GP referral. Conclusions Online search data appears to be different between individuals with malignant and benign gynaecological conditions, with a signal observed in advance of GP referral date. Online search data needs to be evaluated in a larger dataset to determine its value as an early disease detection tool and whether its use leads to improved clinical outcomes.

Abstract Mesonephric-like adenocarcinoma is a new class of rare subtypes of the female reproductive system. Its clinical symptoms are similar to other types of ovarian tumors. The diagnosis is based on pathological and immunohistochemical methods. The main treatment option is surgery combined with chemotherapy. Few cases have been reported at home and abroad. We reported a case of a 45-year-old woman with a cystic solid mass in the left adnexa. The postoperative pathological diagnosis was mesonephric-like adenocarcinoma of the left ovary and mature cystic teratoma (partial infiltration of the small intestine). This case had no specific clinical symptoms. Immunohistochemical findings showed positive results of GATA3, TTF1, CD10, ER, and PR. Paclitaxel and carboplatin chemotherapy were given after the operation. Currently, no specific criteria are available for diagnosis and treatment of the disease. This article aims to improve the understanding of clinicians in this disease and create a basis for clinical diagnosis and treatment.

Abstract Objective Management of suspect adnexal masses involves surgery to define the best treatment. Diagnostic choices include a two-stage procedure for histopathology examination (HPE) or intraoperative histological analysis – intraoperative frozen section (IFS) and formalin-fixed and paraffin-soaked tissues (FFPE). Preoperative assessment with ultrasound may also be useful to predict malignancy. We aimed at determining the accuracy of IFS to evaluate adnexal masses stratified by size and morphology having HPE as the diagnostic gold standard. Methods A retrospective chart review of 302 patients undergoing IFS of adnexal masses at Hospital de Clínicas de Porto Alegre, between January2005 and September2011 was performed. Data were collected regarding sonographic size (≤10cm or >10cm), characteristics of the lesion, and diagnosis established in IFS and HPE. Eight groups were studied: unilocular lesions; septated/cystic lesions; heterogeneous (solid/cystic) lesions; and solid lesions, divided in two main groups according to the size of lesion, ≤10cm or >10cm. Kappa agreement between IFS and HPE was calculated for each group. Results Overall agreement between IFS and HPE was 96.1% for benign tumors, 96.1% for malignant tumors, and 73.3% for borderline tumors. Considering the combination of tumor size and morphology, 100% agreement between IFS and HPE was recorded for unilocular and septated tumors ≤10cm and for solid tumors. Conclusion Stratification of adnexal masses according to size and morphology is a good method for preoperative assessment. We should wait for final HPE for staging decision, regardless of IFS results, in heterogeneous adnexal tumors of any size, solid tumors ≤10cm, and all non-solid tumors >10cm.

Objective To explore the diagnostic value of the ovarian-adnexal reporting and data system (O-RADS) in differentiating between benign and malignant ovarian tumors, and to analyze risk factors for malignant ovarian tumors. Methods The clinical data of 417 patients with ovarian tumors diagnosed by pathology were retrospectively analyzed. With pathological results as the gold standard, the patients were divided into malignant group and benign group. The clinical data of the two groups were compared. At the same time, the patients were classified according to ultrasound characteristics and O-RADS. A receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of O-RADS. Results The univariable and mul-tivariable analyses showed that the risk factors for ovarian malignancy included cyst wall thickness ≥3 cm, solid components, blood flow score of 3-4 points, ascites, and peritoneal nodules (P

Introduction. Ovarian carcinoma, being one of the most common gynecologic cancers, has the highest mortality rate. The gold standard for the treatment of patients with advanced ovarian carcinoma, along with angiogenesis inhibitors applied in certain advanced stages, is cytoreductive surgery, followed by chemotherapy (CHT). The use of chemotherapeutic agents in hemodialysis (HD) patients has some specificities and limitations, and no CHT guidelines exist for treating those patients. Case report. We present a 45-year-old female patient with end-stage renal disease undergoing HD treatment. Abdominal and pelvic magnetic resonance imaging showed a multicystic mass with a total diameter of 93 × 115 × 168 mm in the right ovary and two subcapsular lesions in the VI segment of the liver with a diameter of 22 × 14 mm and 9 mm (stage IVb ovarian cancer). The serum level of the tumor marker cancer antigen 125 (CA-125) was 93 U/mL. A total hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy was performed. Histopathological analysis of the surgical specimen confirmed high-grade serous ovarian adenocarcinoma, FIGO stage IVb. After surgery, she was treated with carboplatin and paclitaxel combination CHT, determining the dose of carboplatin according to the Calvert formula and initiating HD within 20 hrs of infusion. Two years after the diagnosis was made, the presented patient is in good condition. Conclusion. HD patients can be treated with a combination CHT regimen of carboplatin and paclitaxel, determining the dose of carboplatin according to the Calvert formula and initiating HD within 20 hrs from the end of the chemotherapeutic infusion.

There are limited treatment options and no consensus on the management of advanced rare ovarian malignancies. Rare ovarian malignancies can present with peritoneal metastases (PM), featuring a similar presentation to more common ovarian subtypes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for PM of non-gynecologic origin and, recently, epithelial ovarian cancer. We evaluated the feasibility of CRS/HIPEC in the management of PM from rare ovarian malignancies and report postoperative outcomes on these patients.

Ovarian tumors constitute 3.4 % of the structure of oncological diseases in women worldwide. However, the ovaries are also a common target for metastasis of carcinoma from other organs. Conducting differential diagnosis between primary carcinoma and metastasis is often challenging. The aim of this study is to highlight the issues of morphological and immunohistochemical differential diagnosis of primary ovarian carcinomas and metastases from carcinomas of various organs to the ovaries. Materials and methods. Data analysis of clinical and pathohistological studies of 381 patients. Paraffin sections for pathohistological studies were stained with hematoxylin and eosin using standard methodology. Immunohistochemical studies were conducted in 161 cases using a panel of antibodies: cytokeratins, estrogen receptors, progesterone receptors, CA125, TTF1, Vimentin, CDX2, Villin, Chromogranin A, Synaptophysin, CD56, GATA, p53, Inhibin A, FOXL-2, PAX-8, Ki-67. The specimens were examined and analyzed using the Axioskop 40 microscope (Zeiss) with the AxioCam MRc camera (Zeiss). Results. The article discusses key issues of differential diagnosis of primary and metastatic ovarian carcinomas based on a large clinical and operational material. The application of an adequate panel of immunohistochemical antibodies for verification is considered. The results of the frequency of occurrence of different histological variants of ovarian carcinomas and metastases to the ovaries from carcinomas of other organs are provided based on our own research from 2019 to 2023. The main morphological and immunohistochemical indicators for practical use in the work of a pathologist in the verification of ovarian tumors are presented. An example of forming an antibody panel, taking into account clinical and morphological indicators in a specific clinical case from our own practice, is given. Conclusions. Metastases of carcinomas from other organs to the ovaries constitute half of all cases requiring immunohistochemical investigation based on morphological structure. The most common are metastases from breast and colorectal cancers. However, the diagnosis of metastatic intestinal carcinoma is particularly challenging, as there is usually no clear clinical picture. In the differential diagnosis of primary and metastatic ovarian tumors, a comprehensive approach to analyzing the clinical presentation, microscopic structure of the tumor, and the surrounding tissue plays a significant role. Additionally, the formation of an antibody panel, taking into account these data, is crucial. The article provides a list of antibodies that have demonstrated greater effectiveness in our work.

Although the efficacy of surgery followed by taxane- and platinum-based systemic chemotherapy has been clearly demonstrated in the standard first-line treatment of epithelial ovarian cancer, the role of radiation therapy for distant lymph node metastasis in patients with epithelial ovarian cancer is not well-established due to a lack of reported studies. We identified four patients who underwent selective adjuvant radiation therapy for neck and para-aortic lymph node lesions after primary debulking surgery between 2020 and 2022, followed by platinum-based chemotherapy for stage 4B high-grade serous ovarian cancer. Through a retrospective review of medical records, we analyzed patient clinicopathologic features, treatment course, and imaging findings. The median age was 49.25 years (range, 46–54 years). All patients had the International Federation of Gynecology and Obstetrics stage 4B disease. Following primary debulking surgery, all patients received weekly paclitaxel-carboplatin chemotherapy and maintenance treatment with poly(ADP-ribose) polymerase (PARP) inhibitors. All patients received selective adjuvant radiation therapy for neck and para-aortic lymph node metastasis before PARP inhibitor maintenance. The median follow-up time was 36.75 months (range, 19–45 months). All patients achieved a complete response. None of the patients experienced disease recurrence or died during the follow-up period. The management of distant lymph node metastasis in patients with epithelial ovarian cancer remains a matter of debate. Selective adjuvant radiation therapy in first-line treatment for ovarian cancer appears to be a feasible approach with maintenance therapy for stage 4B epithelial ovarian cancer.

Introduction: Peritoneal tuberculosis is a re-emer-ging disease, with an insidious evolution and difficult diagnosis. Peritoneal involvement has a low incidence, affecting both sexes equally between the ages of 35 to 45 years. The high index of sus-picion should be an important factor in early diagnosis, so that once established, treatment can be started and morbidity and mortality rates can be reduced. Case description: 26-year-old patient, with non-specific symptoms; abdominal pain, ascites and fever. She was admitted to the internal medicine service for an etiological ap-proach to ascites, later she was approached as suspected ovarian cancer, she presented to surgery service who decided to perform a laparotomy and whose intraoperative biopsy reported the diagno-sis of peritoneal tuberculosis. Conclusion: Peritoneal tuberculosis is a rare disease; clinical manifestations may suggest the presence of a tumor disease; clinical suspicion is low and in many cases the diagnosis is incidental.

Abstract Purpose To determine if pelvic/ovarian and omental lesions of ovarian cancer can be reliably segmented on computed tomography (CT) using fully automated deep learning-based methods. Methods A deep learning model for the two most common disease sites of high-grade serous ovarian cancer lesions (pelvis/ovaries and omentum) was developed and compared against the well-established “no-new-Net” framework and unrevised trainee radiologist segmentations. A total of 451 CT scans collected from four different institutions were used for training (n = 276), evaluation (n = 104) and testing (n = 71) of the methods. The performance was evaluated using the Dice similarity coefficient (DSC) and compared using a Wilcoxon test. Results Our model outperformed no-new-Net for the pelvic/ovarian lesions in cross-validation, on the evaluation and test set by a significant margin (p values being 4 × 10–7, 3 × 10–4, 4 × 10–2, respectively), and for the omental lesions on the evaluation set (p = 1 × 10–3). Our model did not perform significantly differently in segmenting pelvic/ovarian lesions (p = 0.371) compared to a trainee radiologist. On an independent test set, the model achieved a DSC performance of 71 ± 20 (mean ± standard deviation) for pelvic/ovarian and 61 ± 24 for omental lesions. Conclusion Automated ovarian cancer segmentation on CT scans using deep neural networks is feasible and achieves performance close to a trainee-level radiologist for pelvic/ovarian lesions. Relevance statement Automated segmentation of ovarian cancer may be used by clinicians for CT-based volumetric assessments and researchers for building complex analysis pipelines. Key points • The first automated approach for pelvic/ovarian and omental ovarian cancer lesion segmentation on CT images has been presented. • Automated segmentation of ovarian cancer lesions can be comparable with manual segmentation of trainee radiologists. • Careful hyperparameter tuning can provide models significantly outperforming strong state-of-the-art baselines. Graphical Abstract

Approximately 50% of patients diagnosed with ovarian cancer harbor tumors with mutations in BRCA1, BRCA2, or other genes involved in homologous recombination repair (HR). The presence of homologous recombination deficiency (HRD) is an approved biomarker for poly-ADP-ribose polymerase inhibitors (PARPis) as a maintenance treatment following a positive response to initial platinum-based chemotherapy. Despite this treatment option, the development of resistance to PARPis is common among recurrent disease patients, leading to a poor prognosis. In this study, we conducted a comprehensive analysis using publicly available datasets to elucidate the molecular mechanisms driving PARPi resistance in BRCA1-deficient ovarian cancer. Our findings reveal a central role for the interferon (IFN) pathway in mediating resistance in the context of BRCA1 deficiency. Through integrative bioinformatics approaches, we identified LY6E, an interferon-stimulated gene, as a key mediator of PARPi resistance, with its expression linked to an immunosuppressive tumor microenvironment (TME) encouraging tumor progression and invasion. LY6E amplification correlates with poor prognosis and increased expression of immune-related gene signatures, which is predictive of immunotherapy response. Interestingly, LY6E expression upon PARPi treatment resistance was found to be dependent on BRCA1 status. Gene expression analysis in the Orien/cBioPortal database revealed an association between LY6E and genes involved in DNA repair, such as Rad21 and PUF60, emphasizing the interplay between DNA repair pathways and immune modulation. Moreover, PUF60, Rad21, and LY6E are located on chromosome 8q24, a locus often amplified and associated with the progression of ovarian cancer. Overall, our study provides novel insights into the molecular determinants of PARPi resistance and highlights LY6E as a promising prognostic biomarker in the management of HRD ovarian cancer. Future studies are needed to fully elucidate the molecular mechanisms underlying the role of LY6E in PARPi resistance.

Endometriosis-associated ovarian cancer (EAOC) is a unique subtype of ovarian malignant tumor originating from endometriosis (EMS) malignant transformation, which has gradually become one of the hot topics in clinical and basic research in recent years. According to clinicopathological and epidemiological findings, precancerous lesions of ovarian clear cell carcinoma (OCCC) and ovarian endometrioid carcinoma (OEC) are considered as EMS. Given the large number of patients with endometriosis and its long time window for malignant transformation, sufficient attention should be paid to EAOC. At present, the pathogenesis of EAOC has not been clarified, no reliable biomarkers have been found in the diagnosis, and there is still a lack of basis and targets for stratified management and precise treatment in the treatment. At the same time, due to the long medical history of patients, the fast growth rate of cancer cells, and the possibility of eliminating the earliest endometriosis-associated ovarian cancer, it is difficult to find the corresponding histological evidence. As a result, few patients are finally diagnosed with EAOC, which increases the difficulty of in-depth study of EAOC. This article reviews the epidemiology, pathogenesis, risk factors, clinical diagnosis, new treatment strategies and prognosis of endometriosis-associated ovarian cancer, and prospects the future direction of basic research and clinical transformation, in order to achieve stratified management and personalized treatment of ovarian cancer patients.

Abstract High heritability and strong correlation have been observed in breast and ovarian cancers. However, their shared genetic architecture remained unclear. Linkage disequilibrium score regression (LDSC) and heritability estimation from summary statistics (ρ-HESS) were applied to estimate heritability and genetic correlations. Bivariate causal mixture model (MiXeR) was used to qualify the polygenic overlap. Then, stratified-LDSC (S-LDSC) was used to identify tissue and cell type specificity. Meanwhile, the adaptive association test called MTaSPUsSet was performed to identify potential pleiotropic genes. The Single Nucleotide Polymorphisms (SNP) heritability was 13% for breast cancer and 5% for ovarian cancer. There was a significant genetic correlation between breast and ovarian cancers (rg=0.21). Breast and ovarian cancers exhibited polygenic overlap, sharing 0.4 K out 2.8 K of causal variants. Tissue and cell type specificity displayed significant enrichment in female breast mammary, uterus, kidney tissues, and adipose cell. Moreover, the 74 potential pleiotropic genes were identified between breast and ovarian cancers, which were related to the regulation of cell cycle and cell death. We quantified the shared genetic architecture between breast and ovarian cancers and shed light on the biological basis of the co-morbidity. Ultimately, these findings facilitated the understanding of disease etiology.

Borderline ovarian tumors typically exhibit indolent behavior and boast a favorable prognosis; however, a subset of patients experiences disease recurrence and progression to low-grade ovarian carcinoma. The complex biology underlying these phenomena has been illuminated through molecular analyses. KRAS and BRAF mutations have emerged as recurrent ?ndings in borderline ovarian tumors. Speci?cally, KRAS mutations have been linked to a higher risk of recurrence and progression to low-grade ovarian carcinoma, while BRAF mutations seem to confer a protective e?ect, inducing a senescent state that mitigates the likelihood of progression. In this comprehensive review, we explore the biology and the molecular pro?le of borderline ovarian tumors, shedding light on recent discoveries that have enriched our comprehension. Additionally, we discuss the current state of borderline ovarian tumors management. Surgery remains the cornerstone of treatment. While cytotoxic therapies role is limited so far, molecular characterization emphasizes the imminent potential for personalized therapeutic approaches.

Sertoli–Leydig cell tumors (SLCTs), also known as androblastoma, are rare, accounting for less than 1% of ovarian neoplasms. The clinical manifestations of SLCT range from asymptomatic to severe virilization. The majority of Sertoli cell tumors are highly differentiated, with homogeneous nuclei and few mitotic signs among the neoplastic cells. This study is a case report of a 3-year-old girl who was admitted to Kashani hospital with abdominal pain and a protruding stomach. On the right side of the abdomen, there was a large, lump palpable. Inhibin, calretinin, actine, and WT1 were all detected as positive by immunohistochemistry (IHC) testing. However, CD30, NSE, synaptophysin, vimentin, chromogranin, S100, and AFP were all detected to be negative. Additional information about ovarian sex cord tumors is provided in this case. Sertoli cell tumor should be considered a differential diagnosis in a young girl who has hirsutism, irregular bleeding, and breast atrophy with a pelvic mass.

Abstract Background Assessing malignancy risk is important to choose appropriate management of ovarian tumors. We compared six algorithms to estimate the probabilities that an ovarian tumor is benign, borderline malignant, stage I primary invasive, stage II-IV primary invasive, or secondary metastatic. Methods This retrospective cohort study used 5909 patients recruited from 1999 to 2012 for model development, and 3199 patients recruited from 2012 to 2015 for model validation. Patients were recruited at oncology referral or general centers and underwent an ultrasound examination and surgery ≤ 120 days later. We developed models using standard multinomial logistic regression (MLR), Ridge MLR, random forest (RF), XGBoost, neural networks (NN), and support vector machines (SVM). We used nine clinical and ultrasound predictors but developed models with or without CA125. Results Most tumors were benign (3980 in development and 1688 in validation data), secondary metastatic tumors were least common (246 and 172). The c-statistic (AUROC) to discriminate benign from any type of malignant tumor ranged from 0.89 to 0.92 for models with CA125, from 0.89 to 0.91 for models without. The multiclass c-statistic ranged from 0.41 (SVM) to 0.55 (XGBoost) for models with CA125, and from 0.42 (SVM) to 0.51 (standard MLR) for models without. Multiclass calibration was best for RF and XGBoost. Estimated probabilities for a benign tumor in the same patient often differed by more than 0.2 (20% points) depending on the model. Net Benefit for diagnosing malignancy was similar for algorithms at the commonly used 10% risk threshold, but was slightly higher for RF at higher thresholds. Comparing models, between 3% (XGBoost vs. NN, with CA125) and 30% (NN vs. SVM, without CA125) of patients fell on opposite sides of the 10% threshold. Conclusion Although several models had similarly good performance, individual probability estimates varied substantially.

Objective To investigate the incidence, trends, and survival rates of all gynecologic cancers using the Korea Central Cancer Registry (KCCR) database from 1999–2019. Methods Gynecologic cancer data were obtained from the KCCR database between 1999 and 2019. Age-standardized incidence rates (ASRs), annual percentage changes, and average annual percentage changes (AAPCs) were calculated. The relative survival rate (RSR) was reported by age group, stage, and 6-year period (I: 1999–2005, II: 2006–2012, III: 2013–2019). Results The gynecologic cancer ASRs were 26.2 and 24.9 per 100,000 individuals in 1999 and 2019, respectively. Trends of incidence in gynecologic cancer revealed a decrease in cervical cancer and gestational trophoblastic neoplasia (GTN) with AAPCs of −3.4 and −4.3, respectively. Conversely, the incidence of uterine, ovarian, and vulvar cancers increased with AAPCs of 4.7, 2.3, and 2.1, respectively. AAPC for vaginal cancer showed no change. The 5-year survival rate was highest for GTN (90.5%) and lowest for vaginal cancer (56.6%). An increase in age was correlated with poorer survival rates across all gynecologic cancers, excluding vaginal cancer. For all gynecologic cancer types, the prognosis deteriorates with advancing cancer stages. The RSR of uterine cancer improved consistently across all periods. The ovarian cancer RSR improved more in period III than in periods I or II. Additionally, the vulvar cancer RSR improved more in periods II and III than in period I. Conclusion In Korea, the incidence of cervical cancer and GTN decreased, whereas the incidence of uterine, ovarian, and vulvar cancer increased from 1999 to 2019. The RSR for uterine, ovarian, and vulvar cancers showed consistent improvements over different periods. Effective screening programs and the adoption of advanced treatments may be necessary to further reduce the burden of gynecologic cancer.

Objective To explore the safety of fertility-sparing surgery and the selection of ovulation induction protocols in patients with early-stage borderline ovarian tumors (BOTs). Methods Clinical data were collected from four patients with early-stage BOTs who underwent fertility-sparing surgery and later sought treatment for infertility with assisted reproduction and successfully delivered in Xinhua Hospital Affiliated to School of Medicine in Shanghai Jiao Tong University from January 2015 to December 2021. The postoperative follow-up and assisted reproduction of the patients were reviewed in combination with the literature. The estrogen levels of patients on HCG day were compared between antagonist protocol, agonist protocol, and letrozole mild stimulation protocol. Results Two of the four patients with early-stage BOTs relapsed after fertility-sparing surgery. The pa-thological type of relapse was BOTs without malignant transformation. No recurrence was observed during follow-up after the se-cond operation. All four patients underwent assisted reproduction and achieved delivery. One of the patients who experienced relapse underwent oocyte retrieval before the second surgery and achieved pregnancy through frozen embryo transplantation after the surgery. Three out of four patients used letrozole mild stimulation protocol (two of them achieved pregnancy, while the other patient switched to agonist protocol after failing to retrieve oocytes and subsequently became pregnant). The remaining patient used anta-gonist protocol and achieved pregnancy. Compared with the antagonist and agonist protocols, letrozole mild stimulation protocol had the lowest serum estrogen level on the HCG day. Conclusion Fertility-sparing surgery for patients with early-stage BOTs is safe and feasible. Oocyte retrieval can be considered in case of recurrence before reoperation. Letrozole mild stimulation protocol provides a relatively safe option with minimal adverse effects on the ovaries.

Breast and gynecological cancers are the most common malignancies in females. Early-stage detection and treatment could significantly reduce the mortality rate in patients. However, common treatments such as chemotherapy and radiotherapy fail after a while and lead to recurrence and drug resistance in cancer cells. The recent use of nanotechnology has enabled the development of novel approaches for diagnosing and treating oncological diseases. Chitosan-based polymer nanoparticles (CHPNPs) with unique properties such as non-toxicity, biocompatibility, and anti-carcinogenic effects are promising tools for the clinical development of targeted delivery systems. So far, various methods have been applied to use these nanoparticles in the diagnosis and treatment of various cancers. Identifying the most practical methods is one of the most important challenges in achieving effective treatments. A review of these studies can provide better horizons to realize effective treatment. In this review, we evaluate and discuss the use of CHPNPs from published literature to assess diagnostic and therapeutic strategies in breast and gynecological cancers, including ovarian and uterine neoplasms, as well as their advantages and challenges.

Abstract Objectives The study aim was to conduct a systematic review of the literature reporting the application of radiomics to imaging techniques in patients with ovarian lesions. Methods MEDLINE/PubMed, Web of Science, Scopus, EMBASE, Ovid and ClinicalTrials.gov were searched for relevant articles. Using PRISMA criteria, data were extracted from short-listed studies. Validity and bias were assessed independently by 2 researchers in consensus using the Quality in Prognosis Studies (QUIPS) tool. Radiomic Quality Score (RQS) was utilised to assess radiomic methodology. Results After duplicate removal, 63 articles were identified, of which 33 were eligible. Fifteen assessed lesion classifications, 10 treatment outcomes, 5 outcome predictions, 2 metastatic disease predictions and 1 classification/outcome prediction. The sample size ranged from 28 to 501 patients. Twelve studies investigated CT, 11 MRI, 4 ultrasound and 1 FDG PET-CT. Twenty-three studies (70%) incorporated 3D segmentation. Various modelling methods were used, most commonly LASSO (least absolute shrinkage and selection operator) (10/33). Five studies (15%) compared radiomic models to radiologist interpretation, all demonstrating superior performance. Only 6 studies (18%) included external validation. Five studies (15%) had a low overall risk of bias, 9 (27%) moderate, and 19 (58%) high risk of bias. The highest RQS achieved was 61.1%, and the lowest was − 16.7%. Conclusion Radiomics has the potential as a clinical diagnostic tool in patients with ovarian masses and may allow better lesion stratification, guiding more personalised patient care in the future. Standardisation of the feature extraction methodology, larger and more diverse patient cohorts and real-world evaluation is required before clinical translation. Clinical relevance statement Radiomics shows promising results in improving lesion stratification, treatment selection and outcome prediction. Modelling with larger cohorts and real-world evaluation is required before clinical translation. Key points • Radiomics is emerging as a tool for enhancing clinical decisions in patients with ovarian masses. • Radiomics shows promising results in improving lesion stratification, treatment selection and outcome prediction. • Modelling with larger cohorts and real-world evaluation is required before clinical translation. Graphical Abstract

Abstract High-grade serous ovarian cancer is the most lethal gynaecological malignancy. Detailed molecular studies have revealed marked intra-patient heterogeneity at the tumour microenvironment level, likely contributing to poor prognosis. Despite large quantities of clinical, molecular and imaging data on ovarian cancer being accumulated worldwide and the rise of high-throughput computing, data frequently remain siloed and are thus inaccessible for integrated analyses. Only a minority of studies on ovarian cancer have set out to harness artificial intelligence (AI) for the integration of multiomics data and for developing powerful algorithms that capture the characteristics of ovarian cancer at multiple scales and levels. Clinical data, serum markers, and imaging data were most frequently used, followed by genomics and transcriptomics. The current literature proves that integrative multiomics approaches outperform models based on single data types and indicates that imaging can be used for the longitudinal tracking of tumour heterogeneity in space and potentially over time. This review presents an overview of studies that integrated two or more data types to develop AI-based classifiers or prediction models. Relevance statement Integrative multiomics models for ovarian cancer outperform models using single data types for classification, prognostication, and predictive tasks. Key points • This review presents studies using multiomics and artificial intelligence in ovarian cancer. • Current literature proves that integrative multiomics outperform models using single data types. • Around 60% of studies used a combination of imaging with clinical data. • The combination of genomics and transcriptomics with imaging data was infrequently used. Graphical Abstract

Ovarian cancer (OC) is a leading cause of death among gynaecological malignancies. The haemostatic system, which controls blood flow and prevents clotting disorders, paradoxically drives OC progression while increasing the risk of venous thromboembolism (VTE). MicroRNAs (miRNAs) have emerged as crucial in understanding VTE pathogenesis. Exploring the connection between cancer and thrombosis through these RNAs could lead to novel biomarkers of cancer-associated thrombosis (CAT) and OC, as well as potential therapeutic targets for tumour management. Thus, this study examined the impact of eight plasma miRNAs targeting the tissue factor (TF) coagulation pathway—miR-18a-5p, -19a-3p, -20a-5p, -23a-3p, -27a-3p, -103a-3p, -126-5p and -616-3p—in 55 OC patients. Briefly, VTE occurrence post-OC diagnosis was linked to shorter disease progression time (log-rank test, p = 0.024) and poorer overall survival (OS) (log-rank test, p < 0.001). High pre-chemotherapy levels of miR-20a-5p (targeting coagulation factor 3 (F3) and tissue factor pathway inhibitor 2 (TFPI2)) and miR-616-3p (targeting TFPI2) predicted VTE after OC diagnosis (χ2, p < 0.05). Regarding patients’ prognosis regardless of VTE, miR-20a-5p independently predicted OC progression (adjusted hazard ratio (aHR) = 6.13, p = 0.005), while miR-616-3p significantly impacted patients’ survival (aHR = 3.72, p = 0.020). Further investigation is warranted for their translation into clinical practice.

Background: This study aims to evaluate the effectiveness of the Naples Prognostic Score (NPS), Systemic Inflammation Score (SIS), and Controlling Nutritional Status Score (COUNT) in distinguishing benign from malignant ovarian neoplasms. Additionally, a nomogram is developed utilizing these nutritional and inflammatory indicators to enhance preoperative assessment of ovarian neoplasms. Methods: Patients with ovarian neoplasms who underwent surgery at Shengjing Hospital of China Medical University between June 2017 and June 2022 were retrospectively analyzed. Benign ovarian disease or epithelial ovarian cancer (EOC) was diagnosed postoperatively by pathology. Patients were randomly divided into training and test cohorts. Univariate and multivariate logistic regression analyses were conducted to identify significant clinical and imaging risk factors, along with NPS, SIS, and COUNT. Nomograms were constructed to predict EOC and externally validated. Diagnostic accuracy was assessed using decision curve analysis (DCA) and the area under the receiver operating characteristic (ROC) curve (AUC). Results: A total of 2226 patients (1788 benign and 438 EOC) were included. Factors such as age, multilocular tumors, solid nodules, larger tumor diameter, ascites, and higher tumor marker levels were associated with an increased risk of EOC. The AUC values for models incorporating NPS, SIS, and COUNT were 0.907, 0.897, and 0.883, respectively, indicating superior diagnostic ability compared to models without nutritional/inflammatory indicators. The nomogram with NPS demonstrated the highest diagnostic value and clinical utility based on DCA (p < 0.001). External validation confirmed good agreement between the predicted and observed values. Conclusions: The model including NPS exhibited superior diagnostic value for preoperative diagnosis of EOC compared to models with SIS or COUNT. The nomogram combining NPS with clinical and imaging indicators displayed the highest diagnostic value and efficacy.

Background Mucinous ovarian tumors (MOT) can be divided into three types: benign〔such as mucinous cystadenoma (MCA) 〕, borderline〔such as mucinous borderline tumor (MBT) 〕, and malignant〔such as mucinous cystadenocarcinoma (MC) 〕. It is difficult to differentiate between the types preoperatively, and the final diagnosis depends on surgical pathology. So how to reduce the difficulty in making a preoperative differential diagnosis, and improve the preoperative diagnostic accuracy is particularly important for doctors to make a diagnosis and for patients to choose a treatment option. Objective To explore the high-risk factors associated with malignant transformation of MOT, and to evaluate the predictive value of B-ultrasound combined with tumor markers for malignant transformation of MOT. Methods Retrospective observational study selected surgery-treated 414 women with a histologically confirmed MCA (n=305) , MBT (n=79) and MC (n=30) from the First Affiliated Hospital with Nanjing Medical University during 2010 to 2020. Patients' data, including age, clinical symptoms, sonographic data (tumor size, properties, papilla-shaped protuberance on the cystic wall, blood flow signals, multilocular) and serum tumor markers〔carcinoembryonic antigen (CEA) , carbohydrate antigen 125 (CA125) , carbohydrate antigen 199 (CA199) , carbohydrate antigen 724 (CA724) 〕and D-dimer were collected. Multivariate Logistic regression analysis was used to explore the risk factors of malignant transformation of MOT. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of B-ultrasound with tumor markers for malignant transformation of MOT, and the area under the curve (AUC) with the corresponding 95%CI were calculated. Results There were statistically significant differences in B-ultrasound manifestations and serological indicators among the three groups (P

Abstract Background Ovarian cancer (OC) is associated with a poor prognosis, which calls for earlier diagnosis. This study aimed to analyse the health care use in primary care and at hospitals among women with OC compared to non-cancerous women to identify a window of opportunity for earlier diagnosis. Methods This nationwide register-based observational cohort study included all Danish women aged ≥ 40 years who were diagnosed with a first-time OC or borderline ovarian tumour in 2012–2018 and with no previous cancer diagnosis (n = 4,255). For each case, ten non-cancerous women were identified (n = 42,550). We estimated monthly incidence rate ratios using a negative binomial regression model to assess the use of health care services. We calculated risk ratios of having multiple contacts to general practice before a diagnosis using a binary regression model. Results Cases had statistically significantly higher contact rates to general practice from five months prior to the diagnosis compared to references. From six to eight months prior to diagnosis, an increased use of transvaginal ultrasound and gynaecologist was seen for cases compared to references. Conclusions Increased healthcare use was seen relatively closely to the time of diagnosis for women with OC. This indicates a narrow window of opportunity for a timelier diagnosis. Still, the use of specialised assessment increased at six to eight months before the diagnosis. When women present unspecific symptoms, awareness of potential ovarian malignancies and safety-netting by the general practitioner may be pivotal. Trial registration Not relevant.

Abstract Background In randomized trials in women with breast cancer, exercise has been shown to have beneficial effects on cancer‐related circulating biomarkers that may impact survival. Such studies are lacking for ovarian cancer. Methods This secondary analysis of a published randomized controlled trial examined the impact of a 6‐month exercise intervention versus attention‐control on change in prespecified circulating biomarkers (cancer antigen 125 (CA‐125), C‐reactive protein (CRP), insulin‐like growth factor‐1(IGF‐1), insulin and leptin) in a subset of participants who provided a fasting blood draw (N = 104/144) at enrollment and at 6 months. Change in biomarkers between study arms was compared using a linear mixed effects model analysis. An exploratory analysis of the exercise intervention versus attention‐control on all‐cause mortality included all (N = 144) participants. All statistical tests were two‐sided. Results Participants included in the biomarker analysis were 57.0 ± 8.8 (mean ± SD) years old and 1.6 ± 0.9 years post‐diagnosis. Adherence to the exercise intervention was 176.4 ± 63.5 min/week. Post intervention IGF‐1 (group difference in change: −14.2 (−26.1 to −2.3) ng/mL (least squared means (95% CI))) and leptin (−8.9 (−16.5 to −1.4) ng/mL) were significantly reduced in the exercise group (N = 53) compared to those in attention‐control (N = 51). No group difference in change was seen for CA‐125 (p = 0.54), CRP (p = 0.95), or insulin (p = 0.37). With median follow‐up of 70 months [range 6.6–105.4 months], 50/144 (34.7%) (exercise group; 24/74 (32.4%) versus attention‐control group; 26/70 (37.1%)) participants died with no between group difference in overall survival (p = 0.99). Conclusions Further studies are needed to determine the clinical significance of exercise‐induced changes in cancer‐related circulating biomarkers in women with ovarian cancer.

Abstract Objectives We aimed to present the state of the art of CT- and MRI-based radiomics in the context of ovarian cancer (OC), with a focus on the methodological quality of these studies and the clinical utility of these proposed radiomics models. Methods Original articles investigating radiomics in OC published in PubMed, Embase, Web of Science, and the Cochrane Library between January 1, 2002, and January 6, 2023, were extracted. The methodological quality was evaluated using the radiomics quality score (RQS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pairwise correlation analyses were performed to compare the methodological quality, baseline information, and performance metrics. Additional meta-analyses of studies exploring differential diagnoses and prognostic prediction in patients with OC were performed separately. Results Fifty-seven studies encompassing 11,693 patients were included. The mean RQS was 30.7% (range − 4 to 22); less than 25% of studies had a high risk of bias and applicability concerns in each domain of QUADAS-2. A high RQS was significantly associated with a low QUADAS-2 risk and recent publication year. Significantly higher performance metrics were observed in studies examining differential diagnosis; 16 such studies as well as 13 exploring prognostic prediction were included in a separate meta-analysis, which revealed diagnostic odds ratios of 25.76 (95% confidence interval (CI) 13.50–49.13) and 12.55 (95% CI 8.38–18.77), respectively. Conclusion Current evidence suggests that the methodological quality of OC-related radiomics studies is unsatisfactory. Radiomics analysis based on CT and MRI showed promising results in terms of differential diagnosis and prognostic prediction. Critical relevance statement Radiomics analysis has potential clinical utility; however, shortcomings persist in existing studies in terms of reproducibility. We suggest that future radiomics studies should be more standardized to better bridge the gap between concepts and clinical applications. Graphical abstract

Abstract Background Ovarian cancer screening in BRCA1/2 mutation carriers utilizes assessment of carbohydrate antigen 125 (CA125) and transvaginal ultrasound (TVU), despite low sensitivity and specificity. We evaluated the association between CA125 levels, BRCA1/2 mutation status and menopausal status to provide more information on clinical conditions that may influence CA125 levels. Methods We retrospectively analyzed repeated measurements of CA125 levels and clinical data of 466 women at high risk for ovarian cancer. CA125 levels were compared between women with and without deleterious mutations in BRCA1/2. Pearson's correlation was used to determine the association between age and CA125 serum level. Differences in CA125 levels were assessed with the Mann–Whitney U test. The effect of BRCA1/2 mutation status and menopausal status on the change in CA125 levels was determined by Two-factor analysis of variance (ANOVA). Results The CA125 serum levels of premenopausal women (median, 13.8 kU/mL; range, 9.4 – 19.5 kU/mL) were significantly higher than in postmenopausal women (median, 10.4 kU/mL; range, 7.7 – 14.0 kU/mL; p

Background: Ovarian cancer is the most prevalent gynecologic malignancy in Egypt. Although metastasis from ovarian cancer is common, there are still sites with rarely reported deposits as non-regional nodes, bone, and brain. Method: We retrospectively recruited a group of patients over a 7-year period from the data system of a cancer center. All the recruited patients suffered from a rare distant metastasis from ovarian cancer. We used statistical software (SPSS) for the analysis of the study results. Continuous variables were presented as mean and standard deviation, if normally distributed, or median and range when non-normally distributed. Independent samples t-test was utilized to compare parametric data, whereas nonparametric data were compared through the use of the Mann-Whitney U test. Categorical data were compared with Pearson's Chi-square test or Fischer-Exact test when appropriate. A P-value < 0.05 was considered to be statistically significant. Results: Nearly half of the patients already had metastasis at the time of the initial presentation, while the rest developed it during the disease course. Debulking was feasible in nearly half of the patients with long overall and progression-free survival. Tumors with non-regional nodal metastases seemed to have excellent survival. Conclusion: We could recommend offering these patients optimal debulking and considering those with a non-regional nodal spread as having a curable disease.

Background: Most Indian population-based cancer registries have reported a gradual rise in the ovarian cancer incidence over the years. These neoplasms exhibit a spectrum of genetic background, much more varied than any other gynecological condition and present a big challenge to a gynecological oncologist. Therefore, proper recognition and classification of such pelvic masses is important for appropriate therapy and better prognosis. Objectives This study aimed to look at the demographics and clinical profile of various ovarian lesions in the local population of the central India. Patients and Methods: A prospective observational study was carried out on the surgically resected ovarian samples that were referred to the Pathology department over two and half year. A total of 100 ovarian cases were included. Relevant clinical information regarding age, bleeding, pain in abdomen, menstrual history, histopathological examination reports were recorded. Results: Out of 100 cases of ovarian lesions, majority were neoplastic lesions. Most of the cases of non-neoplastic ovarian lesions belonged to 31-40 years’ age group, whereas most cases of neoplastic ovarian lesions belonged to 41-50 years’ age group. Most common presenting symptom was abnormal uterine bleeding in non-neoplastic cases. But neoplastic cases presented mainly with abdominal pain. Conclusion: Majority of the ovarian lesions in central India population present after second parity, are benign in nature and present with abnormal uterine bleeding, whereas malignant ovarian lesions mainly present with abdominal pain and after 40 years of age.

Objective: Malignant transformation in dermoid cysts is rare, and Squamous Cell Carcinoma (SCC) is the most common form. This event often occurs in large tumors and middle-aged women. Case report: In this study, two cases are presented. They were menopause, and abdominal pain and adnexal mass was a common manifestation in both. Case 1 with adenocarcinoma arising in mature cystic teratoma had abnormal tumor markers and was diagnosed with a frozen section during surgery, but case 2 with SCC transformation had normal tumor markers, and the frozen section was not helpful in the first surgery. Both underwent complete staging surgery, and due to stage IC1 in case 1, she received chemotherapy, and in case 2, no adjuvant treatment was needed because of stage IA. Conclusion: Considering the rarity of malignant transformation in the dermoid cyst, the best surgical approach and adjuvant therapy indications need further research

Endometriosis is a chronic inflammatory disease caused by the presence of extra-uterine endometrial tissue that affects women of reproductive age. Although the etiology remains not totally elucidated, recent advances in molecular technology, especially the ability for whole genome sequencing, have gradually revealed both genetic and epigenetic backgrounds for the development of the disease. Endometriosis has been recognized as a precursor lesion for certain types of ovarian cancer (endometriosis-associated ovarian cancers - EAOC) and the knowledge of this malignant potential is of paramount importance to seek for predictive factors and to select patients at risk. We report five different EAOC cases in our recent clinical practice, in order to draw attention to this issue through a literature review, and to provide clinicians with tools to communicate accurately and effectively with patients with endometriosis about their risk of ovarian cancer.

Endometriosis is a chronic inflammatory disease caused by the presence of extra-uterine endometrial tissue that affects women of reproductive age. Although the etiology remains not totally elucidated, recent advances in molecular technology, especially the ability for whole genome sequencing, have gradually revealed both genetic and epigenetic backgrounds for the development of the disease. Endometriosis has been recognized as a precursor lesion for certain types of ovarian cancer (endometriosis-associated ovarian cancers - EAOC) and the knowledge of this malignant potential is of paramount importance to seek for predictive factors and to select patients at risk. We report five different EAOC cases in our recent clinical practice, in order to draw attention to this issue through a literature review, and to provide clinicians with tools to communicate accurately and effectively with patients with endometriosis about their risk of ovarian cancer.

Endometriosis is a chronic inflammatory disease caused by the presence of extra-uterine endometrial tissue that affects women of reproductive age. Although the etiology remains not totally elucidated, recent advances in molecular technology, especially the ability for whole genome sequencing, have gradually revealed both genetic and epigenetic backgrounds for the development of the disease. Endometriosis has been recognized as a precursor lesion for certain types of ovarian cancer (endometriosis-associated ovarian cancers - EAOC) and the knowledge of this malignant potential is of paramount importance to seek for predictive factors and to select patients at risk. We report five different EAOC cases in our recent clinical practice, in order to draw attention to this issue through a literature review, and to provide clinicians with tools to communicate accurately and effectively with patients with endometriosis about their risk of ovarian cancer.

Hydatid cyst is a parasitic infestation caused by Echinococcus larvae. Hydatid cyst of the ovary is a highly unusual presentation. Herein, we present a case of a young woman who complained of episodic lower abdominal pain. Ultrasound of the abdomen revealed a multi-cystic left adnexal mass measuring 86 mm x 67 mm. A possibility of ovarian cystic neoplasm was suggested. Unilateral salpingo-oophorectomy was performed. On histopathological examination, a cyst measuring 8.0 x 5.5 x 4.5 cm was found, replacing the entire ovary. The cyst cavity was filled with serous fluid and multiple pearly white membranous structures, giving a multiloculated appearance. Microscopic examination showed a cyst lined by a lamellar membrane containing protoscolices and hooklets. Hydatid disease is a zoonotic ailment caused by tapeworms (Echinococcus granulosus or, less commonly, Echinococcus multilocularis). The definitive hosts are carnivores. Humans are the accidental intermediate hosts. The hydatid cyst commonly affects the liver and the lungs. The primary hydatid cyst of the ovary is quite rare, with few case reports in the literature. In most cases, symptoms are vague, and the lesion is misdiagnosed as benign or malignant ovarian cystic neoplasm on clinical and radiological examination. Ovarian hydatid cyst is treated by surgery with ovarian cystectomy as the gold standard. The possibility of a hydatid cyst should be kept under differential diagnoses while evaluating the cystic diseases of the ovary.

Background: There is age related increase in the incidence of ovarian cancer. Most Indian population-based cancer registries have reported a gradual rise in the ovarian cancer incidence over the years. Since ovary is composed of totipotent gametocytes and multipotent mesenchymal tissues, almost any type of tumor can arise from these tissues. Therefore, their proper recognition and classification is important for appropriate therapy and better prognosis.Aim: to look at the histopathological profile of various ovarian lesions in the local female subjects from central India.Methods: A prospective observational study was carried out on the surgically resected ovarian samples that were referred to the Pathology department over two and half year. A total of 100 ovarian cases were included. Histopathological examination of the specimen was done using standard protocols.Results: On gross examination, majority of non-neoplastic specimen showed unremarkable findings. Microscopic examination of non-neoplastic cases revealed that most of the cases were of follicular cyst followed by corpus luteum cyst. On the contrary, majority of neoplastic specimen showed cystic external surface on gross examination. Surface epithelial tumor was the most common histologic type amongst neoplastic cases. Most common histologic subtype amongst the surface epithelial tumors was found to be benign simple serous cystadenoma. Conclusion: In women from central India, commonest non-neoplastic lesion of ovary is follicular cyst whereas most common neoplastic lesion is surface epithelial tumor (benign simple serous cystadenoma).