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Background: The timely identification and management of ovarian cancer are critical determinants of patient prognosis. In this study, we developed and validated a deep learning radiomics nomogram (DLR_Nomogram) based on ultrasound (US) imaging to accurately predict the malignant risk of ovarian tumours and compared the diagnostic performance of the DLR_Nomogram to that of the ovarian-adnexal reporting and data system (O-RADS). Methods: This study encompasses two research tasks. Patients were randomly divided into training and testing sets in an 8:2 ratio for both tasks. In task 1, we assessed the malignancy risk of 849 patients with ovarian tumours. In task 2, we evaluated the malignancy risk of 391 patients with O-RADS 4 and O-RADS 5 ovarian neoplasms. Three models were developed and validated to predict the risk of malignancy in ovarian tumours. The predicted outcomes of the models for each sample were merged to form a new feature set that was utilised as an input for the logistic regression (LR) model for constructing a combined model, visualised as the DLR_Nomogram. Then, the diagnostic performance of these models was evaluated by the receiver operating characteristic curve (ROC). Results: The DLR_Nomogram demonstrated superior predictive performance in predicting the malignant risk of ovarian tumours, as evidenced by area under the ROC curve (AUC) values of 0.985 and 0.928 for the training and testing sets of task 1, respectively. The AUC value of its testing set was lower than that of the O-RADS; however, the difference was not statistically significant. The DLR_Nomogram exhibited the highest AUC values of 0.955 and 0.869 in the training and testing sets of task 2, respectively. The DLR_Nomogram showed satisfactory fitting performance for both tasks in Hosmer–Lemeshow testing. Decision curve analysis demonstrated that the DLR_Nomogram yielded greater net clinical benefits for predicting malignant ovarian tumours within a specific range of threshold values. Conclusions: The US-based DLR_Nomogram has shown the capability to accurately predict the malignant risk of ovarian tumours, exhibiting a predictive efficacy comparable to that of O-RADS. [ABSTRACT FROM AUTHOR]

Angiogenic inhibitors have been demonstrated to inhibit tumour cells in ovarian carcinoma, but the initial data are not accurate enough to indicate the influence of these drugs on the post‐therapy wound healing. In order to assess the effect of angiogenic inhibitors on the treatment of wound healing in ovarian carcinoma, we performed a meta‐analysis of related literature. For this meta‐analysis, we looked up the data from 4 databases: PubMed, EMBASE, Web of Science and the Cochrane Library. All literature searches were performed up to October 2023. The ROBINS‐I tool was applied to evaluate the risk of bias in the inclusion trials, and statistical analysis was performed with RevMan 5.3. In this research, 971 related research were chosen, and 9 of them were selected. These studies were published between 2013 and 2023. In all 9 trials, a total of 3902 patients were enrolled. There was a significant reduction in the risk of wound infection in the control group than in those who received angiogenesis inhibitors (OR, 0.66; 95% CI, 0.49–0.89 p = 0.007). The risk of developing an abscess was not significantly different from that of those who received angiogenesis inhibitors (OR, 0.80; 95% CI, 0.20–3.12 p = 0.74). The risk of perforation in the control group was smaller than that in those receiving angiogenic inhibitors (OR, 0.25; 95% CI, 0.11–0.56 p = 0.0006). There was a significant increase in the risk of injury and GI perforation in women who received angiogenic inhibitors than in the control group. But the incidence of abscess did not differ significantly among the two groups. [ABSTRACT FROM AUTHOR]

A forty-six-year-old woman presented with complaints of pain and swelling in the left inguinal region. On examination, it was found to be an incarcerated irreducible left inguinal hernia. A cystic mass was also felt in the left iliac fossa. The patient had a congenital absence of the uterus and right kidney. She had primary amenorrhea, primary infertility and dyspareunia but her secondary sexual characters were developed normally. Ultrasonography (US) of the abdomen and pelvis revealed a loculated anechoic fluid collection and an ovary in the left inguinal canal (Fig. 1) with an empty bilateral renal fossa and an ectopic left pelvic kidney (Fig. 2). Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) of the abdomen and pelvis revealed a cystic lesion in the left inguinal canal with eccentrically placed ovary within the cyst, suggestive of the patent canal of Nuck with herniated ovary (Fig. 3). There was complete agenesis of the uterus, cervix and vaginal canal (Mullerian agenesis) with ectopic pelvic kidney in the left adnexa (Fig. 4). The diagnosis of an ovarian mass herniating through the left inguinal region as a part of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome type II was made and the patient was managed successfully through surgery. [ABSTRACT FROM AUTHOR]

Introduction: Variety of primary ovarian neoplasms reflects the complex function of the ovary. The study was conducted to know distribution of ovarian lesions, analyse their mode of presentation and distribution of various morphological pattern of ovarian neoplasms. Methods: A systematic search identified 205 ovarian lesion specimens submitted in the department over a time period of three years (January 2018-December 2020). The tumours were classified according to World Health Organization (WHO) classification 2016.Results: There was a wide age range from 11 years to 72 years. Among neoplastic ovarian lesions peak was seen in the fourth decade, mean 48.1 years. Sonographic appearance showed a prominent solid component (32/32,100%) in all malignant cases. Non-neoplastic cysts were more common (107, 52.2%) than neoplastic tumours (98, 47.8%). Among the neoplastic tumours (62) 63.3% were benign. Four borderline tumours (4.1%) were noted in the study. Surface epithelial tumours were the commonest histomorphological type 67 (68.4%). Granulosa cell tumour (4/32, 12.5%) was the commonest sex cord stromal tumour. Conclusion: Ovarian lesion possess wide gamut of histology. Non neoplastic ovarian lesions occur more frequently when compared to neoplastic lesions. Major proportion of malignant ovarian tumours was contributed by surface epithelial tumours. [ABSTRACT FROM AUTHOR]

Background: This study aims to validate the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) the Assessment of Different NEoplasias in the adneXa (ADNEX) model in the preoperative diagnosis of adnexal masses in the hands of nonexpert ultrasonographers in a gynaecological oncology centre in China. Methods: This was a single oncology centre, retrospective diagnostic accuracy study of 620 patients. All patients underwent surgery, and the histopathological diagnosis was used as a reference standard. The masses were divided into five types according to the ADNEX model: benign ovarian tumours, borderline ovarian tumours (BOTs), stage I ovarian cancer (OC), stage II-IV OC and ovarian metastasis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of the ADNEX model to classify tumours into different histological types with and without cancer antigen 125 (CA 125) results. Results: Of the 620 women, 402 (64.8%) had a benign ovarian tumour and 218 (35.2%) had a malignant ovarian tumour, including 86 (13.9%) with BOT, 75 (12.1%) with stage I OC, 53 (8.5%) with stage II-IV OC and 4 (0.6%) with ovarian metastasis. The AUC of the model to differentiate benign and malignant adnexal masses was 0.97 (95% CI, 0.96–0.98). Performance was excellent for the discrimination between benign and stage II-IV OC and between benign and ovarian metastasis, with AUCs of 0.99 (95% CI, 0.99–1.00) and 0.99 (95% CI, 0.98–1.00), respectively. The model was less effective at distinguishing between BOT and stage I OC and between BOT and ovarian metastasis, with AUCs of 0.54 (95% CI, 0.45–0.64) and 0.66 (95% CI, 0.56–0.77), respectively. When including CA125 in the model, the performance in discriminating between stage II–IV OC and stage I OC and between stage II–IV OC ovarian metastasis was improved (AUC increased from 0.88 to 0.94, P = 0.01, and from 0.86 to 0.97, p = 0.01). Conclusions: The IOTA ADNEX model has excellent performance in differentiating benign and malignant adnexal masses in the hands of nonexpert ultrasonographers with limited experience in China. In classifying different subtypes of ovarian cancers, the model has difficulty differentiating BOTs from stage I OC and BOTs from ovarian metastases. [ABSTRACT FROM AUTHOR]

Epithelial ovarian neoplasms constitute the majority of ovarian tumours and are the most common malignant ovarian neoplasm. They are the eighth leading cause of cancer deaths worldwide. This study evaluated the epidemiology and histological subtypes of epithelial ovarian neoplasms at a single institution. This retrospective, quantitative analysis evaluated 123 epithelial ovarian neoplasms between 2013 and 2017 and classified them according to age, biological behaviour and histological subtype. Of 123 cases, 64 (52.0%), tumours were benign, 30 (24.4%) were borderline and 29 (23.6%) tumours were malignant. Serous cystadenoma was the most common benign tumour (42.2%). Mucinous borderline tumours were the most common borderline neoplasm (50.0%). High-grade serous carcinoma was the most common carcinoma (58.6%). Patients presented at an older age with borderline tumours and malignant tumours, compared with patients with benign tumours. The current study demonstrated that serous tumours were the most common type of benign and malignant tumours whilst mucinous neoplasms were the commonest subtype of borderline tumours. These findings are congruent with multiple similar studies. A higher number of borderline tumours were seen in this cohort in comparison with previous studies. This suggests a need for additional sampling of borderline tumours, over and above the international standard, in our population, to definitively exclude invasive malignancy. This study also demonstrated the histological progression of benign serous and mucinous tumours to borderline tumours and low-grade serous carcinoma and mucinous carcinoma, respectively, which supports the stepwise tumour progression model of these tumours. [ABSTRACT FROM AUTHOR]

Background: Existing data from several reports on the association between lipid profile and ovarian tumour (OT) suggests divergent conclusions. Our aim was to examine whether circulating lipid profile: total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) differed between cases and non-cases of OT.Methods: Electronic repositories; PUBMED, EMBASE and Cochrane library were explored through December 2019 to retrieve published articles for inclusion in the meta-analysis after quality assessment. Heterogeneity was assessed using I2 statistics, the effect of individual studies on the overall effect size was tested using sensitivity analysis and funnel plot was used to evaluate publication bias.Results: Twelve studies, involving 1767 OT cases and 229,167 non-cases of OT were included in this meta-analysis and I2 statistics ranged between 97 and 99%. Mean circulating TC (- 16.60 [- 32.43, - 0.77]mg/dL; P = 0.04) and HDL (- 0.25[- 0.43, - 0.08]mmol/L; P = 0.005) were significantly lower among OT cases compared to non-OT cases.Conclusion: Decreased TC and HDL profiles were observed among subjects with OT in this collection of reports. The implications of TC and HDL in tumour manifestations and growth need to be validated in a large multi-ethnic longitudinal cohort adjusting for relevant confounders. [ABSTRACT FROM AUTHOR]

Aim of the study: To retrospectively evaluate how the International Ovarian Tumor Analysis (IOTA) simple rules used in ultrasound examinations estimate the probability of malignant and benign tumour occurrence in the studied population. Material and methods: The study was performed on a group of 425 patients with ovarian tumours operated in the Clinic of Surgical and Oncological Gynecology at the Medical University of Lodz in the years 2014-2015. Adnexal tumours were rated according to IOTA simple rules, classifying them as probably malignant, probably benign, or unclassified. The results of the study were compared with final histopathological results. The statistical analysis was performed using STATISTICA 13 PL with Medical Pack. Results: We analysed data on n = 43 (11%) patients with malignant, n = 346 (86%) patients with benign, and n = 12 (3%) patients with borderline tumours, respectively. Malignant tumour patients were significantly older (mean age 61.0 ±11.6 vs. 43.6 ±16.2 years, p < 0.001), had higher BMI (mean 27.3 ±7.0 vs. 25.2 ±5.2, p < 0.05), more pregnancies (median 2 vs. 1, p = 0.001), and higher cancer antigen 125 (CA 125) concentrations (median 251.5 vs. 18.5, p < 0.001) than patients with a benign tumour. Also, they more often suffered from diabetes mellitus (19% vs. 8%, p = 0.02) and arterial hypertension (60% vs. 42%, p < 0.01) than benign tumour patients. Conclusions: In our study, IOTA performance in predicting or ruling out a malignant tumour was highly satisfactory and similar to that of CA 125. Both the methods may be complementary and used to assess the risk of malignant vs. benign ovarian neoplasm, although the context of other clinical variables may also be important. [ABSTRACT FROM AUTHOR]

Purpose: This review presents the information about epidemiology, clinical manifestation, diagnosis and treatment of primary ovarian Burkitt's lymphoma (BL), including a literature search of available BL cases. The purpose of this review is to draw clinicians' attention to the possibility of ovarian BL occurrence, which may be important in the differential diagnosis of ovarian tumours.Methods: PubMed and Web of Science databases were searched using the keywords ''Burkitt's'', ''Lymphoma'', ''Ovarian'', ''Primary'', ''Burkitt's lymphoma''. Only cases with histopathologically confirmed diagnosis of primary ovarian BL were included in this review.Results: Fifty articles, reporting cases with an ovarian manifestation of primary non-Hodgkin's lymphoma, were found. Twenty-one cases with a histopathologically confirmed BL were evaluated to compare various manifestations, treatment and prognosis in ovarian BL.Conclusions: Primary ovarian BL is a rare condition, included in the entity of non-Hodgkin lymphoma. The tumour can occur uni- or bilaterally in the ovaries with major symptoms such as abdominal pain or a large abdominal mass. Differential diagnosis, based on imaging features and pathological examination of the specimens, is essential for further treatment due to various aetiology of ovarian tumours. Although most of the patients suffering from ovarian BL underwent surgery after the ovarian tumour had been detected, surgical treatment is not the treatment of choice in patients with ovarian lymphoma. The mainstay of therapy is chemotherapy without further surgery. The prognosis is better if the chemotherapy protocol is more aggressive and followed by prophylactic central nervous system chemotherapy. Nowadays, multiagent protocols are administered, which improves the survival rate. [ABSTRACT FROM AUTHOR]

We present a rare case of large bilateral ovarian tumours, secondarily revealing an ileal neuroendocrine tumour in a 71-year-old woman. Magnetic resonance examination showed bilateral ovarian, entirely solid lesions with a fibrous content and marked enhancement. Computed tomography was able to show a mesenteric retractile mass and a satellite suspicious ileal wall thickening. Gallium-68 DOTATOC confirmed the suspicion of digestive neuroendocrine tumour metastatic to the ovaries and the final diagnosis was made following radical surgery. To the best of our knowledge, the mainly fibrous aspect at imaging, resembling that of the primary tumour, is the first to be described in English literature. Therefore, we think that in the presence of atypical bilateral, solid and mainly fibrous ovarian masses, careful search for a primary lesion along the digestive tract should be conducted. [ABSTRACT FROM AUTHOR]

Sertoli–Leydig Cell Tumours (SLCT) accounts for less than 0.5% of all ovarian neoplasms. Presence of mesenchymal heterologous elements in a poorly differentiated SLCT is extremely uncommon. It not only causes diagnostic difficulty but also renders an aggressive behaviour to the tumour. We report a rare case of poorly differentiated SLCT with cartilage and rhabdomyoblastic differentiation along with review of literature. [ABSTRACT FROM AUTHOR]

Purpose: Adnexal masses in pregnancy are often incidentally detected during sonography and most resolve spontaneously by early second trimester. This study aimed to look at the prevalence and management of adnexal masses in pregnancy at a tertiary care referral perinatal hospital. Methods: This is a retrospective study of all women with adnexal masses (excluding ectopic gestations and non-gynaecological lesions) identified pre-pregnancy or during pregnancy (antepartum/intrapartum) from January 2006 to August 2013 at the study institute. Results: The study identified 252 women (0.6, 95 %, CI: 0.5, 0.7) with adnexal masses and mean (SD range) age of 27.1 (4.21, 18-39) years. Majority (80 %) of the masses were diagnosed incidentally. 170 (67.5 %) women were offered conservative management and cysts resolved in half of them. 87 (34.5 %) women had adnexal surgery and 15.1 % were operated during the antepartum period because of persistent abdominal pain or suspicious sonographic findings. Three (1.2 %) malignancies and five (2.0 %) borderline ovarian tumours were diagnosed on histopathological examination. 16 (6.3 %) women were lost to follow-up antenatally. Pregnancy carried to term in 175 (69.4 %) women. Perinatal mortality rate was 31.1/1,000 total births (caused by prematurity). Complications encountered were torsion (7.1 %), malignancy (1.2 %), rupture (0.4 %) and infection (0.4 %). Conclusion: Although conservative management was appropriate in the majority of cases, the study identifies the need to standardize diagnosis, investigations and management for a better evaluation of outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Brenner tumours (BTs), like other epithelial ovarian tumours, are thought to develop from the ovarian surface epithelium. Aim and Methods: We hypothesised that BTs arise from transitional metaplasia near the tuboperitoneal junction which, when embedded in the ovary as Walthard cell nests, may progress to BTs. The aim of this study was to validate this hypothesis by a morphologic and immunohistochemical (IHC) analysis. Results: The IHC analysis revealed that fallopian tube secretory cells, transitional metaplasia, Walthard cell nests and the epithelial component of BTs shared a similar IHC profile, consistently expressing AKR1C3 (an enzyme involved in androgen biosynthesis) and androgen receptor, but not calretinin. The tumour stromal cells that immediately surrounded the epithelial nests showed strong expression of calretinin, inhibin and steroidogenic factor 1 (markers of steroidogenic cells) in the majority of BTs. Using a highly sensitive immunofluorescent staining method, we detected small groups of cilia in transitional metaplasia and Walthard cell nests, multifocal stretches of cilia and/or ciliated vacuoles in benign BTs and well-developed cilia in atypical proliferative BTs. Conclusions: Our findings suggest a tubal origin of BTs through transitional metaplasia and Walthard cell nests, based on their anatomic proximity, similar IHC profile and the presence of cilia. In addition, we hypothesise a role of androgenic stimulation in the pathogenesis of BT, based on the IHC staining pattern of calretinin, inhibin and steroidogenic factor 1 expressed in the luteinised stromal cells surrounding the epithelial nests of the tumours, and AKR1C3 and androgen receptor expressed in both the epithelial and stromal components. [Copyright &y& Elsevier]

Abstract: Objectives: Primary objective: To analyse the impact of restaging, on recurrences and survival, in BLOT. Secondary objective: To cluster patients who could be exempted from restaging. Study design: This retrospective study, included patients operated for a BLOT, between January 1990, and December 2007, in gynaecological surgery units of the University Hospital of Clermont-Ferrand. Two groups were evaluated: patients with and without optimal restaging. Results: One hundred and forty-two patients were included. Optimal initial staging rate was 38.7% (n =55). Among the eighty-seven women not initially staged, two groups were compared: restaged (n =45) and non-restaged patients (n =42). Mean follow-up was 80.5 months. Overall survival was 93.7%. Relapse rate was 7.7% (n =11). Disease free survival (DFS) was 88% after a mean follow-up of 80.5 months. One death was noted. Optimal restaging rate was 31.7% (n =45, 43 by laparoscopy). Mean follow-up was of 87.1 months among restaged patients, 84.5 months among non-restaged patients (p =0.93). Relapse incidence was significantly higher in non restaged, than in restaged patients (p =0.008). DFS was significantly longer among restaged than non-restaged patients, (p =0.072). Younger age (p =0.04), conservative treatment (p <10−4) or non-diploidy (p =0.04) increased the incidence of relapse. Conclusions: When initial staging is missing, restaging improves the patients outcome in comparison to non-restaged groups. Laparoscopy is a valuable surgical option. This study suggests that a selected group of patients, older than 30 years old, submitted to a radical treatment, presenting a diploid, non micropapillar, mucinous BLOT, without visible implants during careful peritoneal inspection, could be exempted from restaging. They represented 11.6% of our population. [Copyright &y& Elsevier]

Objective: To evaluate the ability of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate malignant from benign adnexal tumours. Methods: Fifty-six women with 38 malignant and 18 benign tumours underwent MR imaging before surgery for complex adnexal masses. Microvascular parameters were extracted from high temporal resolution DCE-MRI series, using a pharmacokinetic model in the solid tissue of adnexal tumours. These parameters were tissue blood flow (F), blood volume fraction (Vb), permeability-surface area product (PS), interstitial volume fraction (Ve), lag time (Dt) and area under the enhancing curve (rAUC). Area under the receiver operating curve (AUROC) was calculated as a descriptive tool to assess the overall discrimination of parameters. Results: Malignant tumours displayed higher F, Vb, rAUC and lower Ve than benign tumours ( P < 0.0001, P = 0.0006, P = 0.04 and P = 0.0002, respectively). F was the most relevant factor for discriminating malignant from benign tumours (AUROC = 0.86). Primary ovarian invasive tumours displayed higher F and shorter Dt than borderline tumours. Malignant adnexal tumours with associated peritoneal carcinomatosis at surgery displayed a shorter Dt than those without peritoneal carcinomatosis at surgery ( P = 0.01). Conclusion: Quantitative DCE-MRI is a feasible and accurate technique to differentiate malignant from benign adnexal tumours and could potentially help oncologists with management decisions. Key Points: • Quantitative DCE MR imaging allows accurate differentiation between malignant and benign tumours • Quantitative DCE MRI may help predict peritoneal carcinomatosis associated with ovarian tumors • Quantitative DCE MRI helps distinguish between invasive and borderline primary ovarian tumours [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Diagnosis of dysgerminoma in the paediatric age group is uncommon, and most cases arise from dysgenetic gonads of 46, XY pure gonadal dysgenesis (PGD) patients. Bilateral gonadectomy is mandatory in these patients. So, the preoperative diagnosis of PGD is important in order to avoid multiple surgical procedures and delayed patient information in the case of a suspected ‘ovarian’ tumour. Our aim was to discuss preoperative clues that can lead to suspicion of dysgerminoma in the context of PGD. Materials and methods: We reviewed the charts of six patients treated for dysgerminoma associated with 46, XY PGD. We focused on particularities of clinical and biological evaluations. Results: Median age at diagnosis was 11 years. Pubertal development was absent or incomplete even at late ages. Dysgerminoma was associated with gonadoblastoma foci in all cases. Tumoral marker profile was a normal alfafetoprotein level, a high lactate dehydrogenase level and normal or moderate human chorionic gonadotropin (βHCG) secretion, except for one patient who had a mixed tumour with notably a choriocarcinoma share (high βHCG). Follicle-stimulating hormone (FSH) level was very high in all patients tested and, interestingly, also in one prepubertal patient. Conclusions: In the case of a suspected ovarian tumour, delayed pubertal development, moderate βHCG level and elevated FSH level are clinical and biological clues to a diagnosis of dysgerminoma in the context of PGD and should prompt karyotype analysis before surgery. Because FSH is an efficient indirect marker of this condition, we suggest including this analysis in the management of gonadal tumours. [Copyright &y& Elsevier]

Ovarian Sertoli-Leydig cell tumours (SLCT), also termed arrhenoblastomas, are the most frequent virilising tumours in women of reproductive age. Very rare secretory Brenner tumours (BT) have been described, generally after the menopause. A 31-year-old woman sought medical advice for secondary amenorrhoea, progressive hirsutism and a 5-year history of virilisation syndrome with clitoromegaly. Testosterone was markedly high (285 ng/dl, N<85) with moderate elevation of delta 4-androstenedione (D4AD) (311 ng/dl, N <270), dehydroepiandrosterone sulfate (DHEAS) (366 μμg/dl, N <340) and 17-hydroxyprogesterone (17OHP) (275 ng/dl). LH was 9 IU/l, FSH 4.3 IU/l, estradiol 60 pg/ml and progesterone 314 ng/100 ml. Cortisol was decreased (1.3 μμg/dl) after the dexamethasone suppression test. Pelvic MRI showed a 5-cm right ovarian tumour with a 2.5 cm nodular component and cystic areas, and two nodules measuring 11 mm and 15 mm above the right and left ovaries. After right ovariectomy by laparoscopy, pathological examination concluded on a 3-cm SLCT and a 2-cm BT; the nodules above the ovaries were dysembryoplastic cysts. Postoperatively, testosterone level was normal after 24 h (26 ng/dl), estradiol and progesterone rapidly decreased, cyclic secretion then resumed and the patient menstruated at day 27. To our knowledge, this is the first report of an ovarian tumour associating a Sertoli-Leydig cell tumour and a Brenner tumour in a patient with virilisation syndrome which resolved after ovariectomy. [ABSTRACT FROM AUTHOR]

Abstract: Ovarian tumours in pregnancy are a diagnostic and management challenge that is increasingly being faced by the clinician. While most masses are benign and resolve spontaneously, there are others that persist and indicate the need for surgical management. Ultrasound not only detects asymptomatic masses but also helps to guide their management based on presence or absence of features suspicious of malignancy. The role of tumour markers in pregnancy is limited due to their non-specific nature. Most masses treated in pregnancy are benign (most commonly dermoids), and most malignancies are either of low malignant potential or germ cell tumours, usually early stage disease. Surgical management is indicated for symptomatic masses or those with increasing size or complexity indicating possible malignancy. Both laparoscopy and laparotomy have similar results with regard to obstetric outcome. Conservative management is preferred in the remainder. MRI may help in better characterization of doubtful masses. National tumour registries can help to establish guidelines. [Copyright &y& Elsevier]

Kim T H, Kim Y K, Kwon Y, Heo J H, Kang H, Kim G & An H J (2010) Histopathology, 734-743 The pathological and clinical significance of aberrant miRNA expression in ovarian tumours has yet to be adequately documented. The aim of this study was to assess the differences in miRNA expression of human ovarian tumours according to histological subtype, and to determine whether miRNAs are potential diagnostic and prognostic markers in ovarian cancers. The miRNA expression profiles of 103 human ovarian tumours were evaluated. Via a bead-based miRNA microarray, five aberrant miRNAs were selected which were expressed differentially in malignant serous tumours from borderline and benign ovarian tumours, including miRNA (miR)-519a, miR-18b (up-regulation) and miR-153, miR-511 and miR-485-5p (down-regulation). We conducted quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) in order to confirm that these miRNAs are differentially expressed in different histological subtypes of ovarian tumours, and compared the expression profiles of these miRNAs between different clinical subsets. The expression of these miRNAs was correlated with clinicopathological parameters. miR-519a, miR-153 and miR-485-5p were differentially expressed in four major histotypes of ovarian cancers ( P < 0.05), which suggests that they might be of potential importance as diagnostic biomarkers. Down-regulation of miR-153 and miR-485-5p was correlated significantly with FIGO grade 3 ( P < 0.05). Down-regulation of miR-153 and up-regulation of miR-519a were correlated significantly with advanced clinical stage ( P < 0.05). The results of Kaplan-Meier survival analysis indicated that the higher expression of miR-519a in late stage serous carcinoma was associated significantly with poor progression-free survival ( P = 0.0058). A significant correlation was detected between the deregulation of specific types of miRNAs, such as miR-519a, miR-153 and miR-485-5p, and clinical variables as well as histological subtypes in ovarian cancers. Hence, these miRNAs may perform functions as diagnostic or prognostic biomarkers. [ABSTRACT FROM AUTHOR]

Massive ovarian edema (MOE) is a rare, benign disease of young women. Because preoperatively in most cases the differential diagnosis primarily appears to indicate the presence of a malignant tumour, there is a risk that these patients will be subjected to unnecessary overtreatment. In the case of the 18-year-old patient described here, on the basis of the preoperative data the suspected clinical diagnosis was polycystic ovarian (PCO) syndrome. In the MRI the enlarged ovary was interpreted as a mucous tumour. The laparotomy showed a smooth-walled, opalescent ovarian tumour with adnexal torsion. Histopathological examination of the adnexectomy specimen gave the diagnosis of a massive ovarian edema (MOE). Therapeutically, a wedge-shaped excision, immediate-section histology and derotation and suspension of the ovary would have been sufficient. Unnecessary overtreatment can be avoided in young women with enlarged ovaries, if MOE is included in the differential diagnosis and if the characteristic sonography, MRI and macroscopy findings are known. [ABSTRACT FROM AUTHOR]

Background: Ovarian neoplasms are an important cause of morbidity and mortality in women. The surgical management of ovarian neoplasms depends on their correct categorisation as benign, borderline and malignant. Aim: The aim of this study was to determine the clinical benefits of intraoperative frozen section analysis into the surgical management policy of women referred with an adnexal mass suspicious of ovarian cancer. Methods: A retrospective study of 106 ovarian frozen section results was examined to determine the accuracy of frozen section diagnosis. The accuracy, sensitivity, specificity, and positive and negative predictive value of frozen section were studied. Results: The overall accuracy to determine the status of malignancy was 93.3%. Sensitivity of the test was highest in the benign groups at 97.4% and lowest in the borderline groups at 25%. The accuracy of frozen section was 80% in serous tumours and 60% in mucinous. There were two (2.5%) false positive, three (10.7%) false negative and two overestimated diagnosis in frozen section examination. Eight malignancies (30.7%) were of metastatic origin, all of which (100%), were correctly identified on frozen section. Conclusion: Frozen section appears to be an accurate technique for the histopathological diagnosis of ovarian tumours. Some limitations were observed among borderline and mucinous tumours. This emphasises the great value of frozen section in the diagnosis of ovarian tumours. [ABSTRACT FROM AUTHOR]

The tissue-specific translation elongation factor eEF1A2 is a potential oncogene that is overexpressed in human ovarian cancer. eEF1A2 is highly similar (98%) to the near-ubiquitously expressed eEF1A1 (formerly known as EF1-alpha) making analysis with commercial antibodies difficult. We wanted to establish the expression pattern of eEF1A2 in ovarian cancer of defined histological subtypes at both the RNA and protein level, and to establish the mechanism for the overexpression of eEF1A2 in tumours. We show that while overexpression of eEF1A2 is seen at both the RNA and protein level in up to 75% of clear cell carcinomas, it occurs at a lower frequency in other histological subtypes. The copy number at the EEF1A2 locus does not correlate with expression level of the gene, no functional mutations were found, and the gene is unmethylated in both normal and tumour DNA, showing that overexpression is not dependent on genetic or epigenetic modifications at the EEF1A2 locus. We suggest that the cause of overexpression of eEF1A2 may be the inappropriate expression of a trans-acting factor. The oncogenicity of eEF1A2 may be related either to its role in protein synthesis or to potential non-canonical functions. [ABSTRACT FROM AUTHOR]

Our purpose was to evaluate the pathologic features and outcome of pregnancies that were complicated with adnexal masses and were managed surgically. A review of patients who had persistent adnexal masses during pregnancy and needed surgical removal of tumours was performed from January 1998 to April 2001. There were 14 cases of persistent adnexal masses identified among 2000 deliveries. There were 13 patients who had surgical interventions: nine (69.2%) had surgery during ongoing pregnancy (at mean gestational age 17+/-3.7 weeks), two (15.3%) with caesarean section, one (7.6%) after evacuation of missed abortion and one (7.5%) after delivery. Out of 13, ten (76.9%) were benign [mature cystic teratoma, six (46.9%); serous cyst adenoma, two (15.3%); mucinous cyst adenoma, one (7.6%); paratubal cyst, one (7.6%)] and three (23%) were malignant (one immature teratoma, one papillary cyst adenocarcinoma and one krukenberg tumour]. Both patients operated on after 24 weeks had pre-term delivery. The worst outcome in the form of PPROM and preterm delivery at 28 weeks occurred in a patient who underwent emergency surgery. The incidence of malignancy was four- to fivefold greater in our series than reported in the literature. Ultrasound was unable to distinguish malignant cases. Pregnancy outcome was poorer if surgical intervention was done after >24 weeks and that, too, was done as emergency surgery. [ABSTRACT FROM AUTHOR]

Abstract The Drosophila ovarian tumour gene is required at multiple times in the germline for oogenesis. A second gene, Sex-lethal , controls sex determination in the soma and also has a separate germline function affecting similar oogenic stages as ovarian tumour . We demonstrate that ovarian tumour is not required for early Sex-lethal gene expression in the female germline, as had been previously reported. Instead, we provide evidence that ovarian tumour has a specific role in the developmentally regulated accumulation of SEX-LETHAL protein within the cytoplasm and nucleus. Furthermore, the examination of nurse cell polytene chromosomes produced by certain ovarian tumour mutations showed that SEX-LETHAL protein can associate with discrete chromosomal sites in the germline and that this pattern appears to change as the egg chamber matures. This is the first indication that SEX-LETHAL is capable of direct physical interactions with chromosomes (albeit in a mutant background) and is consistent with the developmentally regulated nuclear localization of SEX-LETHAL being important for oogenesis. [ABSTRACT FROM AUTHOR]

ObjectiveIn a prospective study we analysed the frequency of intraoperative capsule rupture among 161 ovarian tumours operated on endoscopically, using total removal of the adnexa with protected retrieval. Subjects and methodsBetween June 1993 and September 1997 we carried out endoscopic surgery on 161 consecutive patients, presenting with ovarian tumours up to 10 cm in diameter, and assumed to have an increased risk for malignancy on the basis of menopausal status, sonography findings or endoscopic evaluation. The risk of tumour rupture was related to the different phases of the operation (resection and extraction) and to the presence and location of intra-abdominal adhesions. ResultsMalignancies were found in 6.83% of the patients. Capsule rupture occurred in 13 cases (8%). There was no instance of malignant cell spillage because of intraoperative capsule rupture. The statistical probability of malignant cell dissemination was 0.55% in our series. During resection, rupture of suspicious but not malignant tumours occurred in six cases (3.7%). The probability of spilling cyst contents was closely associated with the presence and the location of intra-abdominal adhesions, the highest spillage rate (16.6%) being found in tumours with adhesions to intestine. During extraction, contamination on account of bag rupture occurred in seven cases (4.3%). ConclusionUsing adequate endoscopic resection and removal techniques, suspicious ovarian tumours under 10 cm in diameter can be operated on endoscopically with a low risk of tumour rupture. [ABSTRACT FROM AUTHOR]

The differential diagnosis for precocious puberty in a young female includes peripheral causes. This case report documents a rare cause of isosexual precocious puberty, a juvenile granulosa cell tumor of the ovary-and a brief literature review. A 7-year-old girl presented with rapid onset of pubertal development and elevated estradiol levels. Abdominal ultrasound revealed a mass in the right adnexa. Other causes of precocious puberty were excluded. Elective surgery was planned, but the patient presented to the emergency room with torsion of ovary. She underwent an exploratory laparotomy for tumor resection and right salpingo oophorectomy. Pathology reported a juvenile granulosa cell tumor of the ovary. Postoperatively, she experienced a cessation of vaginal bleeding and estradiol levels normalized. Early stage disease has good prognosis. Adjuvant chemotherapy is not indicated in this setting. [ABSTRACT FROM AUTHOR]

A 14-year-old girl underwent left oopherectomy for a multicystic ovarian mass. Histology revealed this to be an intestinal type mucinous borderline tumour (IMBT). In view of this, a semi-urgent laparoscopic appendicectomy was carried out. The appendix was histologically normal. IMBT of the ovary is a mucinous tumour with atypical proliferation of the goblet cell containing epithelium. It is known to occur simultaneously with tumours of the appendix. Paediatric surgeons need to be aware of this rare tumour and when operating on any ovarian pathology should always inspect the peritoneal cavity for mucinous deposits and examine the appendix. [ABSTRACT FROM AUTHOR]

Introduction: An ovarian Sertoli cell tumour was detected in a 4-year-old girl with gonadotrophin-independent precocious puberty. Such gonadal tumours can be associated with Peutz-Jeghers syndrome, caused by mutations in the STK11 gene. We have therefore sequenced the STK11 gene.Results: Mutation analysis revealed a nonsense mutation in exon 1 (c.130A>T;p.Lys44X) of the SKT11 gene, which resulted in a truncated, inactive protein. The mutation was heterozygous in patient's lymphocytes and almost homozygous in the tumour, indicating loss of heterozygosity.Conclusion: This is the first report of a STK11 germline mutation in a girl with an ovarian Sertoli cell tumour. It remains to be shown whether this particular mutation predisposes the patient to the development of ovarian tumours. [ABSTRACT FROM AUTHOR]

The overall incidence of ovarian tumours in pregnancy is 2.4-5.7% and because of the asymptomatic nature of ovarian mass it is usually diagnosed in late pregnancy when there may be symptoms produced by it. Due to the similarity of symptoms there has always been perplexity when a patient presents with mass per abdomen in pregnancy. During pregnancy, mild hydronephrosis is considered a normal phenomenon and may be present in up to 90% of pregnancies. Dilation is usually more pronounced on the right kidney and after mid-pregnancy. Here, we present a case which presented as a huge abdominal mass in pregnancy which was mistaken to be an ovarian mass in pregnancy and then later diagnosed as pyonephrosis. [ABSTRACT FROM AUTHOR]

Leiomyomas are known to arise from uterus, but rarely from broad ligament. Further, cellular leiomyoma of broad ligament is the least common variant reported in literature. The diagnostic dilemma arises when leiomyomas undergo degenerative changes. This poses both clinical and radiological difficulty in differentiating with an ovarian tumour. We present an unusual case of a huge broad ligament mass measuring 29x19x09cm, mimicking an ovarian tumour both clinically and radiologically. Histopathology revealed cellular leiomyoma of broad ligament with cystic and myxoid degeneration hereby being the second case reported in literature. This case is being presented not only because of the rare incidence but also due to its diagnostic confusion with ovarian malignancy on clinical evaluation and radiological findings. [ABSTRACT FROM AUTHOR]

Discusses a case report on growing teratoma syndrome in a female patient with nonseminomatous germ cell tumor (NSGTC) of the ovary. Antineoplastic agents received by the patient for medication; Effect of chemotherapy on serum alfa-fetoprotein; Importance of surgical resection of the enlarging tumor in a case of NSGCT.

Abstract: Ovarian masses are very frequent and represent one of the most common reasons for gynaecological consultation, even in the paediatric/adolescent population. In recent years, the increased availability of ultrasonography has revealed a great number of ovarian ‘neoplasms’ in different age groups. In more than 90% of cases, these are considered ‘functional’ and resolve spontaneously, and simple ultrasonographic follow-up can demonstrate their disappearance. Rarely, and mainly due to greater size, they can cause complications such as torsion, bleeding and rupture, and require surgical attention. Only a small portion of all ovarian masses are represented by tumours, which can be benign or malignant. The general approach to ovarian tumours must consist of a conservative attitude toward functional and benign neoplasms, and an aggressive and surgically/oncologically correct strategy for malignant tumours. The correct balance between these two positions has to rely on accurate diagnosis and an honest evaluation of the risk represented by a ‘wait and see’ policy. [Copyright &y& Elsevier]