Surgical resection and neoadjuvant therapy in patients with gastric cancer and ovarian metastasis: A real-world study

BACKGROUND Regarding when to treat gastric cancer and ovarian metastasis(GCOM)and whether to have metastatic resection surgery,there is presently debate on a global scale.The purpose of this research is to examine,in real-world patients with GCOM,the survival rates and efficacy of metastatic vs non-metastasized resection.AIM To investigate the survival time and efficacy of metastatic surgery and neoadjuvant therapy in patients with GCOM.METHODS This study retrospectively analyzed the data of 41 GCOM patients admitted to Zhejiang Provincial People’s Hospital from June 2009 to July 2023.The diagnosis of all patients was confirmed by pathology.The primary study endpoints included overall survival(OS),ovarian survival,OS after surgery(OSAS),disease-free survival(DFS),differences in efficacy.RESULTS This study had 41 patients in total.The surgical group(n=27)exhibited significantly longer median OS(mOS)and median overall months(mOM)compared to the nonoperative group(n=14)(mOS:23.0 vs 6.9 months,P=0.015;mOM:18.3 vs 3.8 months,P=0.001).However,there were no significant differences observed in mOS,mOM,median OSAS(mOSAS),and median DFS(mDFS)between patients in the surgical resection plus neoadjuvant therapy group(n=11)and those who surgical resection without neoadjuvant therapy group(n=16)(mOS:26.1 months vs 21.8 months,P=0.189;mOM:19.8 vs 15.2 months,P=0.424;mOSAS:13.9 vs 8.7 months,P=0.661,mDFS:5.1 vs 8.2 months,P=0.589).CONCLUSION Compared to the non-surgical group,the surgical group’s survival duration and efficacy are noticeably longer.The efficacy and survival time of the direct surgery group and the neoadjuvant therapy group did not differ significantly.

Large solitary ovarian metastasis from colorectal cancer diagnosed by endoscopic ultrasound

A case is presented of rectal carcinoma in which during staging by endoscopic ultrasound （EUS） a second large extra recta l mass was seen not otherwise visualized on computer tomograghy （CT） that was a solitary ovarian metastasis. The surgeon was alerted to the EUS finding prior to the planned laparoscopic colectomy. On retrospective review of the CT pelvis after surgery, the radiologist could still not diagnose the ovarian lesion separated from the primary rectal tumor due to their close proximity. However, on EUS we were able to clearly see on real-time imaging that there was a distinct peri-rectal mass apart from the primary rectal tumor.

Establishment and validation of a nomogram to predict the risk of ovarian metastasis in gastric cancer: Based on a large cohort

BACKGROUND Ovarian metastasis is a special type of distant metastasis unique to female patients with gastric cancer.The pathogenesis of ovarian metastasis is incompletely understood,and the treatment options are controversial.Few studies have predicted the risk of ovarian metastasis.It is not clear which type of gastric cancer is more likely to metastasize to the ovary.A prediction model based on risk factors is needed to improve the rate of detection and diagnosis.AIM To analyze risk factors of ovarian metastasis in female patients with gastric cancer and establish a nomogram to predict the probability of occurrence based on different clinicopathological features.METHODS A retrospective cohort of 1696 female patients with gastric cancer between January 2006 and December 2017 were included in a single center,and patients with distant metastasis other than ovary and peritoneum metastasis were excluded.Potential risk factors for ovarian metastasis were analyzed using univariate and multivariable logistic regression.Independent risk factors were chosen to construct a nomogram which received internal validation.RESULTS Ovarian metastasis occurred in 83 of 1696 female patients.Univariate analysis showed that age,Lauren type,whether the primary lesion contained signet-ring cells,vascular tumor emboli,T stage,N stage,the expression of estrogen receptor,the expression of progesterone receptor,serum carbohydrate antigen 125 and the neutrophil-to-lymphocyte ratio were risk factors for ovarian metastasis of gastric cancer(all P<0.05).Multivariate analysis showed that age<50 years,Lauren typing of non-intestinal,gastric cancer lesions containing signet-ring cell components,N stage>N2,positive expression of estrogen receptor,serum carbohydrate antigen 125>35 U/mL,and a neutrophil-to-lymphocyte ratio>2.16 were independent risk factors(all P<0.05).The independent risk factors were constructed into a nomogram model using R language software.The consistency index after continuous correction was 0.840[95%confidence interval:(0.7740.906)].After the internal self-sampling(Bootstrap)test,the calibration curve of the model was obtained with an average absolute error of 0.007.The receiver operating characteristic curve of the obtained model was drawn.The area under the curve was 0.867,the maximal Youden index was 0.613,the corresponding sensitivity was 0.794,and the specificity was 0.819.CONCLUSION The nomogram model performed well in the prediction of ovarian metastasis.Attention should be paid to the possibility of ovarian metastasis in high-risk populations during re-examination,to ensure early detection and treatment.

Microinvasive breast cancer with supraclavicular lymph node and ovarian metastasis as clinical findings: a rare case report

Breast cancer is a common malignancy among women. Due to the improvement of social awareness and advances in imaging technologies, significant achievements are obtained at its diagnosis and treatment each passing day. A 54-year-old, multiparous and postmenopausal woman, who presented with a palpable lymph node in the right supraclavicular region and a right adnexal mass but had no findings from the breast examination, is reported in this article. Following advanced assessment, metastatic carcinoma was identified in the lymph node biopsy and the adnexal mass. During the exploration for the primary origin, microinvasive breast cancer was diagnosed following mammographic imaging and an excisional biopsy from the right breast. Microinvasive breast cancer, which did present itself with clinical findings with metastases despite the lack of local findings, was discussed with the review of the literature.

Gastric signet-ring adenocarcinoma presenting with breast metastasis

Breast metastases from gastric cancer are extremely rare. A case report of a 37-year-old female with breast inflammatory invasion and ascites is described. Breast biopsy revealed carcinomatous invasion of the lymphatics from adenocarcinoma cells with signet-ring features. Estrogen （ER） and progesterone receptors （PR） and c-erb-B2 were negative. Upper gastrointestinal endoscopy revealed a prepyloric ulcerative mass. Histopathologic examination of the lesion showed infiltration from a highgrade adenocarcinoma, identical with that of the breast. Immunostaining was positive for cytokeratins CK-7 and CK-20 and CEA and negative for ER and PR. Ascitic fluid cytology was positive for adenocarcinoma cells. Mammography was not diagnostic. Abdominal CT scanning revealed large ovarian masses suggestive of metastases （Krukenberg＇s tumor）. A cisplatin-based regimen was given but no objective response was observed. The patient died six months after initial diagnosis. A review of the literature is performed.

Pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from transverse colon cancer

Pseudo-Meigs&#x02019; syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs&#x02019; syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs&#x02019; syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient&#x02019;s postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs&#x02019; syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.

Metastatic Ovarian Tumor of Vulvar Malignant Melanoma in a 43-Year-Old Woman: A Case Report and Literature Review

An ovarian malignant melanoma sometimes occurs from ovarian teratoma. Ovarian metastatic malignant melanoma is extremely rare. We describe a patient in whom vulvar melanoma (previously resected) metastasized to the ovary, making ovarian metastatic malignant melanoma. A 43-year-old Japanese woman was referred to us because of left ovarian tumor. She had undergone resection for malignant melanoma on the right labia minora with inguinal lymph node metastasis (pT1bN1aM0, stage IIIA, FIGO 2008). Eighteen months after this surgery, CT scans revealed left ovarian tumor and swelled pelvic lymph nodes, with a pelvic examination disclosing a left adnexal solid mass, with normal serum CA125 level (21.7 U/mL). Laparotomy revealed a left solid ovarian tumor measuring 4 cm, which was covered with a smooth grayish capsule. The right ovary, uterus, and pelvic cavity appeared normal. Upon sectioning during the surgery, the cross-sectional surface of the left ovary revealed a dark brown solid tumor. Following an intra-operative frozen-section diagnosis as metastatic melanoma, total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph dissection was performed. Histological examination confirmed the diagnosis as malignant melanoma metastasis to the left ovary and the obturator lymph node: the same laterality (left) as the primary site. The tumor was entirely composed of malignant melanoma cells with no evidence of teratoma. Combined chemotherapy with dabrafenib mesylate and trametinib was planned based on the positive BRAF mutations. This case highlights the importance that physicians should have high index of suspicion for the occurrence of ovarian melanoma metastasis after melanoma surgery. We also made extensive literature review on this issue, of which description may contribute to better understanding of this condition.

Characteristics, diagnosis and treatment of hepatic metastasis of pure immature ovarian teratoma

Objective To analyze the characteristics of hepatic metastasis of pure immature ovarian teratoma and explore its proper diagnosis and treatment.Methods Eighteen cases of hepatic metastasis of pure immature ovarian teratoma were included in this study. The clinical stage, operation, chemotherapy and histopathology of primary and secondary tumors as well as the data from long term follow-ups were analyzed retrospectively,Results All of the hepatic metastatic tumors were located on the surface of the liver. 61.1％ (11/18) of them were clinical stage Ⅲ and 44.4％ (8/18) were grade 1 at first operation. The hepatic metastatic rate was 16.7％ (3/18) in the standard adjuvant chemotherapy group but increased markedly to 31.2％ (15/48) in the irregular chemotherapy group. Auxiliary diagnostic methods could not indicate the correct results. The surgical resection rate of hepatic metastasis of pure immature ovarian teratoma was 94.4％ (17/18). There were less complications in the group with tumor diameter less than 15 cm. The follow-up time ranged from 3 to 205 months with a mean of 20.9 months. The 3-year-survival rate was 77.8％ (14/ 18), and mortality rate was 22.2％. The 5- and 10-year-survival rate was 55.6％ (10/18) and 38.9％ (7/18), respectively. The rate of loss in follow-up was 22.2％ (4/18) and 38.9％ (7/18), respectively, and one patient has survived for more than 17 years.Conclusions The hepatic metastatic rate of pure immature ovarian teratoma could be decreased using standard adjuvant chemotherapy. Suitable surgical treatment could reduce complications and improve the prognosis for patients.

Role of surgical resection for non-colorectal non-neuroendocrine liver metastases

It is widely accepted that the indications for hepatectomy in colorectal cancer liver metastases and liver metastases of neuro-endocrine tumors result in relatively better prognoses, whereas, the indications and prognoses of hepatectomy for non-colorectal non-neuroendocrine liver metastases(NCNNLM) remain controversial owing to the limited number of cases and the heterogeneity of the primary diseases. There have been many publications on NCNNLM; however, its background heterogeneity makes it difficult to reach a specific conclusion. This heterogeneous disease group should be discussed in the order from its general to specific aspect. The present review paper describes the general prognosis and risk factors associated with NCNNLM while specifically focusing on the liver metastases of each primary disease. A multidisciplinary approach that takes into consideration appropriate timing for hepatectomy combined with chemotherapy may prolong survival and/or contribute to the improvement of the quality of life while giving respite from systemic chemotherapy.

Gene expression profile differences in high and low metastatic human ovarian cancer cell lines by gene chip

Objectives To study the difference between gene expressions of high (H0-8910PM) and low (HO-8910) metastatic human ovarian carcinoma cell lines and screen novel associated genes by cDNA microarray. Methods cDNA retro-transcribed from equal quantities of mRNA derived from high and low metastatic tumor cells or normal ovarian tissues were labeled with Cy5 and Cy3 fluorescein as probes. The mixed probe was hybridized with two pieces of BioDoor 4096 double dot human whole gene chip and scanned with a ScanArray 3000 laser scanner. The acquired image was analyzed by ImaGene 3.0 software. Results A total of 355 genes with expression levels more than 3 times larger were found by comparing the HO-8910 cell with normal ovarian epithelial cells. A total of 323 genes with expression levels more than 3 times larger in HO-8910PM cells compared to normal ovarian epithelium cells were also detected. A total of 165 genes whose expression levels were more than two times those of HO-8910PM cells compared to their mother cell line (HO-8910) were detected. Twenty-one genes with expression levels 】3 times were found from comparison of these two tumor cell lines.Conclusions cDNA microarray techniques are effective in screening differential gene expression between two human ovarian cancer cell lines (H0-8910PM; HO-8910) and normal ovarian epithelial cells. These genes may be related to the genesis and development of ovarian carcinoma. Analysis of the human ovarian cancer gene expression profile with cDNA microarray may help in gene diagnosis, treatment and prevention.