Is There Re-staging Surgery Necessity for Borderline Ovarian Tumors

Objective:This study assessed the necessity of surgical re-staging in women with borderline ovarian tumors(BOTs)and evaluated the impact of complete surgical staging,lymphadenectomy,and omentectomy on disease recurrence and survival.Methods:We retrospectively reviewed the medical records of patients with BOTs.A total of 901 patients were eligible for inclusion in the study,and we evaluated some of the variables and clinical/surgical characteristics of the cases.The effects of the type of surgical procedure,surgical staging,and complete or incomplete staging on recurrence were calculated.The rates of disease-free survival,overall survival,and recurrence were compared according to complete surgical staging.A Cox regression analysis was performed to identify potential prognostic factors,and survival curves were constructed using the Kaplan-Meier method.Results:The overall recurrence rate was 13.9%,and recurrence was comparable between the complete surgical staging group and the incomplete groups(P>0.05).The performance of complete surgical staging did not show an effect on long-term survival,and complete surgical staging,omentectomy,and lymphadenectomy had no effect on recurrence.In multivariate analyses,only radical surgery and adjuvant chemotherapy were risk factors for the recurrence of BOTs.Furthermore,we found that omentectomy led to a relatively low recurrence rate in patients with International Federation of Gynecology and Obstetrics(FIGO)stage>Ⅰ(P=0.022).Conclusion:Our results suggest that complete surgical staging should be considered a standard treatment for patients with advanced stage BOTs but not for those at FIGO stageⅠ.It might be safe to reduce the scope of surgical procedures in patients with early-stage BOTs.However,it is not necessary to perform re-staging operations for BOTs with a macroscopically normal extra-ovarian appearance.

Value of ultrasound and magnetic resonance imaging combined with tumor markers in the diagnosis of ovarian tumors

BACKGROUND Compare the diagnostic performance of ultrasound(US),magnetic resonance imaging(MRI),and serum tumor markers alone or in combination for detecting ovarian tumors.AIM To investigate the diagnostic value of US,MRI combined with tumor markers in ovarian tumors.METHODS The data of 110 patients with ovarian tumors,confirmed by surgery and pathology,were collected in our hospital from February 2018 to May 2023.The dataset included 60 cases of benign tumors and 50 cases of malignant tumors.Prior to surgery,all patients underwent preoperative US and MRI examinations,as well as serum tumor marker tests[carbohydrate antigen 125(CA125),human epididymis protein 4(HE4)].The aim of the study was to compare the diagnostic performance of these three methods individually and in combination for ovarian tumors.RESULTS This study found statistically significant differences in the ultrasonic imaging characteristics between benign and malignant tumors.These differences include echo characteristics,presence or absence of a capsule,blood flow resistance index,clear tumor shape,and blood flow signal display rate(P<0.05).The apparent diffusion coefficient values of the solid and cystic parts in benign tumors were found to be higher compared to malignant tumors(P<0.05).Additionally,the time-intensity curve image features of benign and malignant tumors showed significant statistical differences(P<0.05).The levels of serum CA125 and HE4 in benign tumors were lower than those in malignant tumors(P<0.05).The combined use of US,MRI,and tumor markers in the diagnosis of ovarian tumors demonstrates higher accuracy,sensitivity,and specificity compared to using each method individually(P<0.05).CONCLUSION US,MRI,and tumor markers each have their own advantages and disadvantages when it comes to diagnosing ovarian tumors.However,by combining these three methods,we can significantly enhance the accuracy of ovarian tumor diagnosis,enabling early detection and identification of the tumor’s nature,and providing valuable guidance for clinical treatment.

Endocrine-Disrupting Chemicals: Possible Genesis of Ovarian Tumors

Background: Prolonged exposure to environmental toxicants like endocrine-disrupting chemicals has been linked to several ovarian pathologies. Exposure to endocrine-disrupting chemicals may start at any time of life from the fetal stage to adulthood resulting in various health complications The purpose of our study is to compare the concentration levels and association of benzopyrene, bisphenol A and genistein in patients with ovarian tumors and normal control group. We also sort to evaluate the predictive performance of benzopyrene, bisphenol A and genistein in patients with ovarian tumors. Methods: A case-control study was conducted for randomly selected participants involving 30 patients and 30 controls. 30 patients with radiologically diagnosed and histopathological confirmed ovarian tumors were included in the study between January 2022 and December 2022. Urine samples from each group were analyzed using liquid chromatography-mass spectrometry. Descriptive analysis for normally distributed continuous variables was done accordingly. Concentration levels of endocrine-disrupting chemicals were assessed using the Mann-Whitney test. The association of endocrine-disrupting chemicals with pathological ovarian tumors was analyzed using binary logistic regression. Evaluation of the diagnostic performance of endocrine-disrupting chemicals was analyzed using the ROC curve. Results: Overall, patients were significantly (P = 0.000) older than the healthy controls. Mean years (SD) were 36.7 (7.90) and 28.8 years (4.89) for patients and normal women respectively. Endometriomas had the highest incidence of 50%. The level of benzopyrene and bisphenol A in patients was significantly higher than those in the control group, while the level of genistein was significantly higher in normal controls. Benzopyrene and bisphenol A were significantly associated with ovarian cysts, and the incidence of pathological ovarian cysts was positively correlated to these EDCs, with OR value 64.79 (P = 0.005) for benzopyrene and 9.609 (P = 0.001) for bisphenol A. Genistein was significantly negatively correlated with the incidence of pathological ovarian tumors, with OR value of 0.153 (P = 0.007). Diagnostic performance on the AUC for benzopyrene, bisphenol A and genistein&l.

Identification of serous ovarian tumors based on polarization imaging and correlation analysis with clinicopathological features

Ovarian cancer is one of the most aggressive and heterogeneous female tumors in the world,and serous ovarian cancer(SOC)is of particular concern for being the leading cause of ovarian cancer death.Due to its clinical and biological complexities,ovarian cancer is still considered one of the most di±cult tumors to diagnose and manage.In this study,three datasets were assembled,including 30 cases of serous cystadenoma(SCA),30 cases of serous borderline tumor(SBT),and 45 cases of serous adenocarcinoma(SAC).Mueller matrix microscopy is used to obtain the polarimetry basis parameters(PBPs)of each case,combined with a machine learning(ML)model to derive the polarimetry feature parameters(PFPs)for distinguishing serous ovarian tumor(SOT).The correlation between the mean values of PBPs and the clinicopathological features of serous ovarian cancer was analyzed.The accuracies of PFPs obtained from three types of SOT for identifying dichotomous groups(SCA versus SAC,SCA versus SBT,and SBT versus SAC)were 0.91,0.92,and 0.8,respectively.The accuracy of PFP for identifying triadic groups(SCA versus SBT versus SAC)was 0.75.Correlation analysis between PBPs and the clinicopathological features of SOC was performed.There were correlations between some PBPs(δ,β,q_(L),E_(2),rqcross,P_(2),P_(3),P_(4),and P_(5))and clinicopathological features,including the International Federation of Gynecology and Obstetrics(FIGO)stage,pathological grading,preoperative ascites,malignant ascites,and peritoneal implantation.The research showed that PFPs extracted from polarization images have potential applications in quantitatively differentiating the SOTs.These polarimetry basis parameters related to the clinicopathological features of SOC can be used as prognostic factors.

Premature Puberty Revealing an Ovarian Tumor in a Five-Year-Old Girl

Background: Ovarian tumors in the girl child are sometimes revealed by the development of secondary sexual characteristics. The authors report the case of a five-year-old girl in whom the disease was revealed by early puberty. Case presentation: A five-year-old girl with an enlarged abdomen for about four months. The onset of pain and the sensation of a mass prompted the consultation. The development of secondary sexual characteristics (SSC) noted by the family had not been mentioned. The patient was classified as pubertal stage 2 according to the Tanner classification. An abdominal ultrasound and a CT scan showed a large left ovarian mass, an enlarged uterus for the patient’s age and a normal right ovary. The hormonal workup was not contributive. The treatment consisted only of a left salpingo-ovarectomy, without complementary chemotherapy. Anatomic pathological examination of the surgical specimen concluded to a juvenile tumor of the granulosa. The evolution was good with a beginning of regression of the HSC one month after the ovarectomy. Discussion: Granulosa tumors are sometimes secretory cancers, generally with a low potential for malignancy and therefore a very good prognosis. Surgery based on total adnexectomy is the first-line treatment. The large size of the tumor, the presence of ascites and capsular rupture are factors of poor prognosis, hence the importance of early diagnosis. Conclusion: Routine comprehensive physical examination should be de rigueur for abdominal masses in girls, especially in the context of various beliefs that may impede early referral to care.

Robotic-assisted resection of ovarian tumors in children: A case report and review of literature

BACKGROUND Ovarian tumors are common gynecological diseases in children,and the most commonly seen ovarian tumors are germ cell tumors.Robotic surgery is the new access for children ovarian tumors.CASE SUMMARY From June to October 2017,4 children with ovarian tumors were admitted and treated in the Department of Pediatric Surgery of People’s Liberation Army General Hospital.The mean age,height,and weight of these patients were 7.5 (1- 13) years old,123.75 (71-164) cm,and 36.8 (8.5-69.5) kg,respectively.Roboticassisted resection of ovarian tumors was performed for all 4 patients.The 3-port approach was used for robotic manipulation.The surgical procedures were as follows.After creation of the pneumoperitoneum,the robotic scope was placed to explore and find the left ovarian tumor.The trocars for robotic arms 1 and 2 were placed at the sites to the lower right and left of the port of the scope.The tumor capsule in the fallopian tube was incised,and the tumor was completely stripped by an electric hook along the junction of the tumor and the capsule.The resected tumor was completely removed using an endobag.The average docking time of the robotic system was 18.5 min,the average operative time was 120 min,and the average blood loss was 20 mL.No drainage tube was placed except in one patient with a mucinous tumor of the ovary.No fever,pelvic fluid,or intestinal obstruction was reported after surgery.No antibiotics were used during the perioperative period,and the average length of hospital stay after surgery was 3 CONCLUSION Robotic-assisted resection of ovarian tumors is a simple,safe,and effective surgical procedure for selected patients.

Expressions of Beta-catenin,E-cadherin and MMP-7 in Ovarian Epithelial Tumors

Objective： To investigate the expressions of Beta-catenin, E-cadherin and MMP-7 and their implications in ovarian epithelial tumor. Methods： Immunohistochemical staining with SP method was conducted to identify the expressions of Beta-catenin, E-cadherin and MMP-7 in ovarian epithelial tumor in 66 cases. Results： The abnormal expression rate of Beta-catenin in malignant ovarian epithelial tumor was higher than those in borderline and benign epithelial tumors （P〈0.05）. The positive rates of E-cadherin in benign and borderline ovarian epithelial tumors were significantly greater than that in malignant epithelial tumor. The expression rates of MMP-7 in malignant and borderline ovarian epithelial tumors were higher than that in benign epithelial tumor （P〈0.05）. Conclusion： The abnormal expressions of Beta-catenin, E-cadherin and MMP-7 might be used to indicate the malignance transform of ovarian epithelial tumors, but they have no significant correlation with peritoneal dropsy invasion, caul invasion and appendant invasion in ovarian epithelial tumor.

Serum Tumor Markers Combined with 18F-FDG PET/CT Volumetric Metabolic Parameters in the Prognosis of Ovarian Cancer

Ovarian cancer (OC) is the most fatal gynecological malignancy, and identifying reliable prognostic indicators can help guide therapeutic treatment. Various tumor marker-guided treatment regimens can considerably improve patient prognosis with a better understanding of the molecular underpinnings of ovarian cancer recurrence and metastasis. Fluorine-18-fluorodeoxyglucose Positron emission tomography/computed tomography (18F-FDG PET/CT) is a molecular imaging tool that provides anatomical and functional information about the tumor, and its volume-based metabolic parameters allow for quantifiable observation of ovarian cancer recurrence, prognosis, and therapeutic efficacy. The combined utilization of serological and radiologic markers has been found to provide increased clinical benefit. This article reviewed the predictive value of serum tumor markers and 18F-FDG PET/CT volumetric metabolic parameters for the prognosis of patients with ovarian cancer.

DIFFERENTIATION BETWEEN MALIGNANT AND BENIGN OVARIAN TUMORS BY MAGNETIC RESONANCE IMAGING

Objective To determine the magnetic resonance (MR) imaging findings of an ovarian mass which are most predictive of malignancy and assess the value of intravenous gadolinium administration in the characterization of an ovarian mass. Methods Totally 74 consecutive patients with a clinically or sonographically indeterminate adnexal mass underwent MR imaging, of whom 59 had subsequent surgical resection of 70 adnexal masses. These 59 patients formed the study population. MR imaging studies were prospectively and independently reviewed by a senior and a junior radiologist. The senior radiologist also reevaluated the studies in a blind fashion after a minimum 6 months interval. The sensitivity, specificity, positive predictive value, and negative predictive value of contrast-enhanced and unenhanced MR imaging were evaluated. Results The most predictive MR imaging findings for malignancy were presence of vegetations in a cystic lesion and presence of necrosis in a solid lesion. The odds ratio was even higher when the ancillary finding of peritoneal metastasis or ascites was present. Contrast media contributed significantly to lesion characterization. Total 70 ovarian masses were detected by contrast-enhanced MR imaging including 37 malignant ovarian masses and 33 benign ovarian masses with 87% (61/70) accuracy, 86% (32/37) sensitivity, 88% (29/33) specificity, 89% (32/36) positive predictive value, and 85% (29/34) negative predictive value, whereas 70 ovarian masses were detected by unenhanced MR imaging with 74% (52/70) accuracy, 73% (27/37) sensitivity, 76% (25/33) specificity, 77% (27/35) positive predictive value, and 71% (25/35) negative predictive value. There were significant differences in accuracy (P<0.01), sensitivity (P<0.01), specificity (P<0.01) between contrast-enhanced and unenhanced MR imaging. Conclusion Contrast-enhanced MR imaging is highly accurate in detection and characterization of complex adnexal masses.

Clinical characteristics and treatment of ovarian serous borderline tumors

Ovarian serous borderline tumors (SBTs) are characterized by good prognosis and occasional late recurrence. The 5-year and 10-year survival rates are all more than 90%. But traditionally patients with SBTs used to be treated with bilateral oophorectomy, hysterectomy and postoperative chemotherapy. A high proportion of SBTs occurred in young patients. The traditional treatment with complete excision of reproductive organs seemed to be too aggressive for young patients. It is imperative that conservative surgical procedures with fertility sparing should be employed to them. In this paper the literatures in regard to the final outcome of the conservative surgical therapy for SBTs were reviewed and the appropriate extent of conservative surgical procedures was discussed in detail.

MUTATIONAL SCREEN AT THE OEYTS-JEGHERS (LKB1) LOCUS IN SPORDIC COLON AND OVARIAN TUMORS

Objective: To screen LKB1 mutation in sporadic colon and ovarian tumors. Methods: Using PCR-SSCP analysis, 72 colon cancer, 45 ovarian cancer, 14 granulosa cell tumor were screened for LKB1 mutation. Results: no mutation was in sporadic colon and ovarian adenocarcinomas. Two mutations were detected in one of the granulosa cell tumors: a mis-sense mutation affecting the putative start codon (ATG→ACG, MIT); and a silent change in erxon 7 (CTT→CTA, leucine). Conclusion: LKB1 mutations in sporadic colon and ovarian cancers are rare event and LKB1 is not the target gene lost on chromosome 19p13.3 in ovarian cancers.

Ovarian Sex Cord-Stromal Tumors in Postmenopausal Women and Total Laparoscopical Management

BACKGROUND: Ovarian sex-cord stromal tumors (SCST) take up 5% of the ovarian neoplasm and may develop in?to?an ovarian mass or a haemoperitoneum. The surgical management of SCST in early-stage adult patients is not well?defined. CASE REPORT: A 69 year-old postmenopausal woman was admitted for metrorrhagia, a right ovary mass and?increasing pelvic pain. Preoperative clinical and instrumental examination suspected an ovarian tumor, and the?laparoscopic right ophorectomy and the frozen section suggested an ovarian SCST. To fast restore and preserve woman?integrity, total laparoscopic hysterectomy (TLH) plus left salpingo-ophorectomy (SO) were performed, without complications?in the short and long term follow-up. CONCLUSION: In the authors’ opinion, the minimally invasive management?of SCST by TLH plus bilateral SO followed by a prolonged surveillance and without intensive surgical staging,?could be an appropriate clinical and surgical choice in elder patient at early stage, since these tumors are slow at?growth, recurring locally and only a long time after initial treatment. We suggest, after a minimally invasive treatment,?a possible “wait and see” option, as in our case report.

A Retrospective Study of Ovarian Sex Cord Stromal Tumors at the Egyptian National Cancer Institute

Background: Ovarian sex cord-stromal tumors are an uncommon heterogeneous group of tumors with different biological behaviors and clinico-patho- logic aspects. Aim of the Work: This study will review the clinico-pathologic aspects of sex-cord stromal ovarian tumors at the National Cancer Institute (NCI), Cairo University, Egypt, as well as their management and follow-up regarding disease free survival and overall survival. Patients and Methods: This retrospective study was conducted at the National Cancer Institute Cairo University, Egypt on female patients with ovarian sex cord stromal tumors in the period from January 2008 to December 2012 with a follow-up period of 24 to 84 months. The age of the patients, different clinical presentations, radiological findings, associated uterine bleeding (need for endometrial biopsy), pre-operative CA125 levels, surgical management done, different histopathological types, different biological behaviors, presence of ascites (and its correlation with the histopathology), Adjuvant chemotherapy (according to biological behavior and pathological type), and follow-up of non-benign cases for up to 84 months will all be documented and studied. Results: The mean age at presentation was 47.34;abdominal pain and mass were the commonest presentations 54.5% and 53.2% respectively;the main radiologic findings were a pelvic mass +/- ascites which had no correlation to the pathological type (p = 0.075). Endometrial hyperplasia and endometrial carcinoma were associated with 22% and 2.5% of cases respectively. Stages I and II represented 95% of patients with non-benign tumors (48 patients). Panhysterectomy +/- infracolic omentectomy or fertility sparing surgery were done in 70.1% and 29.9% of patients respectively. AGCTs were the commonest pathological type (49.4%). Adjuvant chemotherapy was given to 14 patients (46.7%) with non-benign tumors. 6 recurrences (20%) in 30 patients with non-benign tumors on regular follow-up were documented. The median of disease free survival (DFS) was 50.5 months. The median overall survival was 49.5 months. Conclusion: Ovarian SCSTs are uncommon neoplasms with different biological behaviors where AGCTs are the commonest among Egyptian females. Hormonal manifestations are uncommon where abnormal vaginal bleeding is the commonest one. The presence of ascitic fluid has no correlation with the pathological type of the tumor. Early stages (I and II) represented about 95% of non-benign tumors. Surgical management without lymphadenectomy +/- adjuvant chemotherapy is the main line of treatment at our institute. The OS was shorter than that documented in the literature. A small number of patients, reluctance of follow-up and unavailability of some patients’ data were the main drawbacks in this study.

Develop a nomogram to predict overall survival of patients with borderline ovarian tumors

BACKGROUND The prognosis of borderline ovarian tumors(BOTs)has been the concern of clinicians and patients.It is urgent to develop a model to predict the survival of patients with BOTs.AIM To construct a nomogram to predict the likelihood of overall survival(OS)in patients with BOTs.METHODS A total of 192 patients with histologically verified BOTs and 374 patients with epithelial ovarian cancer(EOC)were retrospectively investigated for clinical characteristics and survival outcomes.A 1:1 propensity score matching(PSM)analysis was performed to eliminate selection bias.Survival was analyzed by using the log-rank test and the restricted mean survival time(RMST).Next,univariate and multivariate Cox regression analyses were used to identify meaningful independent prognostic factors.In addition,a nomogram model was developed to predict the 1-,3-,and 5-year overall survival of patients with BOTs.The predictive performance of the model was assessed by using the concordance index(C-index),calibration curves,and decision curve analysis(DCA).RESULTS For clinical data,there was no significant difference in body mass index,preoperative CA199 concentration,or tumor localization between the BOTs group and EOC group.Women with BOTs were significantly younger than those with EOC.There was a significant difference in menopausal status,parity,preoperative serum CA125 concentration,Federation International of gynecology and obstetrics(FIGO)stage,and whether patients accepted postoperative adjuvant therapy between the BOT and EOC group.After PSM,patients with BOTs had better overall survival than patients with EOC(P value=0.0067);more importantly,the 5-year RMST of BOTs was longer than that of EOC(P value=0.0002,95%CI-1.137 to-0.263).Multivariate Cox regression analysis showed that diagnosed age and surgical type were independent risk factors for BOT patient OS(P value<0.05).A nomogram was developed based on diagnosed age,preoperative serum CA125 and CA199 Levels,surgical type,FIGO stage,and tumor size.Moreover,the c-index(0.959,95%confidence interval 0.8708–1.0472),calibration plot of 1-,3-,and 5-year OS,and decision curve analysis indicated the accurate predictive ability of this model.CONCLUSION Patients with BOTs had a better prognosis than patients with EOC.The nomogram we constructed might be helpful for clinicians in personalized treatment planning and patient counseling.

Ovarian desmoplastic small round cell tumors: Prognosis is poor! Case report

The tumor desmoplastic small round cell in women is rare. Ovarian its location is exceptional. We report a patient of 20 years, the originalNorth Africawho consulted for an increase in abdominal volume with impaired general condition. Pelvic ultrasonography and computed tomography were in favor of multiple peritoneal masses with ascites. After surgical exploration, the histological and immunohistochemical data for diagnosis small round cell desmoplastic tumor of ovarian the patient was a candidate for poly chemotherapy but she was died a month later. Diagnosis relies on histological and immunohistochemical data. The demonstration of a nonrandom translocation t (11;22) (p13;q12) is specific for the disease. The management is multidisciplinary and combining surgery, a poly aggressive chemotherapy and radiotherapy. The prognosis remains poor.

Expression of Matrix Metalloproteinase-7 in Serous Ovarian Tumors

Objective:To explore the expression of matrix metalloproteinase-7 in serous ovarian tumors. Methods: Expression of MMP- 1 in 6 normal ovaries, 12 serous cystadenomas of ovary, 6 borderline cystadenomas of ovary, and 22 serous cystadenocarcinomas of ovary were studied by immunohistoc/temical SP staining. Results: No expression of MMP- 1 was detected in normal ovaries. In most serous ovarian tumors, expression of MMP-7 was detected in both the cytoplasm of tumor cells and stroma, although it was reported in other tumors that MMP- 7 was mainly expressed in the cytoplasm of tumor cells. The expression level of MMP-7 in the cytoplasm of tumor cells was statistically insignificant between serous cystadenomas of ovary, borderline cystadenomas of ovary, and serous cystadenocarcinomas of ovary. But in the stroma, the expression level of MMP-7 in borderline cystadenomas of ovary and serous cystadenocarcinomas of ovary was significantly higher than that in serous cystadenomas of ovary (P<0. 05). In borderline cystadenomas and serous cystadenocarcinomas of ovary, expression of MMP-7 could also be detected in the nuclei of some tumor cells. Conclusion: MMP-7 may play an important role in the progression of serous ovarian tumors.

Oncology and reproductive outcomes over 16 years of malignant ovarian germ cell tumors treated by fertility sparing surgery

BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.

Clinical Presentation of Ovarian Tumors

Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed although presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory.

Expresions and Clinical Significance of C-erbB_2、P_(21) and P_(53) in Ovarian Tumors

应用免疫组化方法，检测５４例卵巢良性、交界性及恶性肿瘤组织中的ＣｅｒｂＢ２癌基因、Ｐ２１蛋白（ｒａｓ癌基因产物）、Ｐ５３抑癌基因的表达状况，并分析其过度表达与肿瘤预后等诸因素间的关系。结果表明，ＣｅｒｂＢ２、Ｐ２１、Ｐ５３的表达率从良性、交界性至恶性肿瘤呈梯度升高，三者在卵巢恶性肿瘤组织中的过度表达率与其在良性肿瘤组织中比较，有极显著差异；与交界性肿瘤组织比较，亦有显著差异。三者的表达率在卵巢原发性和转移性恶性肿瘤中均无显著性差异。ＣｅｒｂＢ２的表达与卵巢恶性肿瘤患者的临床分期及淋巴结转移无关，而与病理分级有显著相关性。Ｐ２１和Ｐ５３的表达与卵巢恶性肿瘤患者的临床分期、病理分级及淋巴结转移均无显著相关性，但Ｐ５３的过度表达均见于期别较晚、分化较差、淋巴结有转移的晚期肿瘤。提示ＣｅｒｂＢ２、Ｐ２１和Ｐ５３三种基因可能在卵巢肿瘤恶变过程中起重要作用，可作为早期诊断的检测指标之一。

APOPTOTIC AND PROLIFERATIVE ACTIVITY IN OVARIAN BENIGN,BORDERLINE AND MALIGNANT TUMORS

Objective.To determine the apoptotic and proliferative activities in various ovarian epithelial tumors.Methods.Formalin-fixed,paraffin-embedded tissues of 86ovarian epithelial tu mors,including 52adenocarcino-mas,23borderline tumors and 11cystadenomas,were retrieved.Apoptoti c(AI )and proliferative(PI )index were estimated using the monoclonal antibodies:M30,Ki-67and Ki-S1in t hese tumors.Quantitative assess-ment of AI and PI was estimated by calc ulating the percentage of positive c ells among no less than 1000tumor cells.Results.Statistically significant differe nce in AI was found between benign and borderline tumors or carcino-mas(P=0.028,0.001,respectively).Significant differences in PI,as a ssessed by both Ki-67and topo IIα,were demonstrated between carcinom as and benign or borderline tumors(both P<0.001).Benign tumors had both low PI and AI;borderline tumors had lower PI but higher AI,while aden ocarcinomas had both high prolifera-tive and high apoptotic rates.Among borderline tumors,serous tumors had significantly lower AI and higher PI than mucinous ones.Conclusions.The results suggest that apoptotic a nd proliferative activities play im portant roles in the pathogene-sis and development of ovarian borderline and malignant tumors.The high apoptotic rate in borderline tumor m ay explain its relatively indolent beh avior while the high proliferative r ate in carcinomas tends to explain its aggres-sive behavior.