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Metabolomics, the global analysis of metabolites in a biological specimen, could potentially provide a fast method of biomarker identification for ovarian cancer. This systematic review aims to examine findings from studies that apply metabolomics to the diagnosis, prognosis, treatment, and recurrence of ovarian cancer. A systematic search of English language publications was conducted on PubMed, Science Direct, and SciFinder. It was augmented by a snowball strategy, whereby further relevant studies are identified from reference lists of included studies. Studies in humans with ovarian cancer which focus on metabolomics of biofluids and tumor tissue were included. No restriction was placed on the time of publication. A separate review of targeted metabolomic studies was conducted for completion. Qualitative data were summarized in a comprehensive table. The studies were assessed for quality and risk of bias using the ROBINS-I tool. 32 global studies were included in the main systematic review. Most studies applied metabolomics to diagnosing ovarian cancer, within which the most frequently reported metabolite changes were a down-regulation of phospholipids and amino acids: histidine, citrulline, alanine, and methionine. Dysregulated phospholipid metabolism was also reported in the separately reviewed 18 targeted studies. Generally, combinations of more than one significant metabolite as a panel, in different studies, achieved a higher sensitivity and specificity for diagnosis than a single metabolite; for example, combinations of different phospholipids. Widespread metabolite differences were observed in studies examining prognosis, treatment, and recurrence, and limited conclusions could be drawn. Cellular processes of proliferation and invasion may be reflected in metabolic changes present in poor prognosis and recurrence. For example, lower levels of lysine, with increased cell invasion as an underlying mechanism, or glutamine dependency of rapidly proliferating cancer cells. In conclusion, this review highlights potential metabolites and biochemical pathways which may aid the clinical care of ovarian cancer if further validated.

Introduction Hysteroscopic management of submucosal fibroids using the intrauterine morcellation technique is increasingly being adopted worldwide but no literature concerning its safety and efficacy is available within our local population. We aimed to determine the safety, satisfaction, and efficiency of hysteroscopic intrauterine morcellation of submucosal fibroids, and to compare this technique with conventional hysteroscopic monopolar loop resection to identify its potential benefits. Methods All cases of hysteroscopic resection of submucosal fibroids performed in a regional hospital in Hong Kong between 1 January 2011 and 31 December 2014, either by hysteroscopic intrauterine morcellation (MyoSure; Hologic, Bedford [MA], US) or conventional hysteroscopic monopolar loop resection, were selected and case notes reviewed. Technical details such as fibroid size, operating time, fluid deficit, operative complications, patient satisfaction, and improvement in haemoglobin level were analysed and compared between the hysteroscopic intrauterine morcellation and the conventional groups. All statistical results were calculated using the Mann-Whitney test. Results During the 3-year period, 29 cases of submucosal fibroids were managed by hysteroscopic surgery. Conventional hysteroscopic monopolar loop resection was performed in 14 patients and another 15 underwent hysteroscopic intrauterine morcellation with the MyoSure device. At 3-month follow-up, there was no significant difference in overall patient satisfaction (84.6% for conventional method vs 93.3% for hysteroscopic intrauterine morcellation method; P=0.841). Both techniques showed improvement in haemoglobin level at 3 months but without significant difference between the two groups: +21.5 g/L (+1 to +44 g/L) for conventional group and +17.0 g/L (-4 to +40 g/L) for hysteroscopic intrauterine morcellation group (P=0.235). Both techniques achieved 100% satisfaction if the submucosal fibroid had over 60% of its contents protruding into the uterine cavity. The operating time was significantly reduced for the hysteroscopic intrauterine morcellation technique (mean, 36.6 mins vs 53.6 mins in conventional hysteroscopic monopolar loop resection; P=0.005), particularly in those whose fibroids were ≤3.0 cm (mean, 27.6 mins vs 53.4 mins; P=0.019). Conclusions This retrospective review suggests that hysteroscopic intrauterine morcellation of submucosal fibroids is a safe and effective method in the management of menorrhagia in Chinese women. Preliminary data suggest this technique to be less time-consuming, especially when managing fibroids of ≤3.0 cm.

A 56 year old postmenopausal lady presented with a rapidly enlarging pelvis mass. Clinical and ultrasonographic features were compatible with a rapidly enlarging fibroid with possible sarcomatous changes, and hence, computated tomography (CT) scan was performed to further delineate the nature and extent of the disease. However, CT scan revealed a huge tumour arising from the retroperitoneal space along the course of the left gonadal vein with typical radiological features of a gonadal vein leiomyosarcoma which were described in previous literatures. With joint collaboration with the surgeons, radical surgery with optimal debulking was subsequently performed for the patient and the diagnosis was confirmed intra-operatively and histologically.