Ovarian-adnexal reporting and data system ultrasound evaluation and pathological characteristics of ovarian collision tumor

BACKGROUND Collision tumor are neoplasms,including two histologically distinct tumors that coexist in the same mass without histological admixture.The incidence of collision tumor is low and is rare clinically.AIM To investigate ultrasound images and application of ovarian-adnexal reporting and data system(O-RADS)to evaluate the risk and pathological characteristics of ovarian collision tumor.METHODS This study retrospectively analyzed 17 cases of ovarian collision tumor diagnosed pathologically from January 2020 to December 2023.All clinical features,ultrasound images and histopathological features were collected and analyzed.The O-RADS score was used for classification.The O-RADS score was determined by two senior doctors in the gynecological ultrasound group.Lesions with O-RADS score of 1-3 were classified as benign tumors,and lesions with O-RADS score of 4 or 5 were classified as malignant tumors.RESULTS There were 17 collision tumors detected in 16 of 6274 patients who underwent gynecological surgery.The average age of 17 women with ovarian collision tumor was 36.7 years(range 20-68 years),in whom,one occurred bilaterally and the rest occurred unilaterally.The average tumor diameter was 10 cm,of which three were 2-5 cm,11 were 5-10 cm,and three were>10 cm.Five(29.4%)tumors with O-RADS score 3 were endometriotic cysts with fibroma/serous cystadenoma,and unilocular or multilocular cysts contained a small number of parenchymal components.Eleven(64.7%)tumors had an O-RADS score of 4,including two in category 4A,six in category 4B,and three in category 4C;all of which were multilocular cystic tumors with solid components or multiple papillary components.One(5.9%)tumor had an O-RADS score of 5.This case was a solid mass,and a small amount of pelvic effusion was detected under ultrasound.The pathology was high-grade serous cystic cancer combined with cystic mature teratoma.There were nine(52.9%)tumors with elevated serum carbohydrate antigen(CA)125 and two(11.8%)with elevated serum CA19-9.Histological and pathological results showed that epithelial-cell-derived tumors combined with other tumors were the most common,which was different from previous results.CONCLUSION The ultrasound images of ovarian collision tumor have certain specificity,but diagnosis by preoperative ultrasound is difficult.The combination of epithelial and mesenchymal cell tumors is one of the most common types of ovarian collision tumor.The O-RADS score of ovarian collision tumor is mostly≥4,which can sensitively detect malignant tumors.

Adult-Type Granulosa Cell Tumor with Similar Clinical Findings Seen during Ovarian Cystectomy Performed at the Same Time as Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: An Extremely Rare Case

Polycystic ovary syndrome (PCOS) is a major cause of anovulatory infertility. Laparoscopic ovarian drilling (LOD) is a treatment for PCOS that allows the laparoscopic identification of other intra-abdominal lesions and the provision of diagnostic treatment. This study reports a case of PCOS with an ovarian mass in which LOD was aggressively used and a granulosa cell tumor (GCT) was found. A 34-year-old woman with secondary amenorrhea and irregular menstrual cycles presented to the emergency department with abdominal pain of unknown etiology. Imaging studies revealed a 6-cm left ovarian mass with an internal appearance suggestive of a hemorrhage. The patient’s secondary amenorrhea was subsequently diagnosed as PCOS, and LOD was performed to preserve her fertility. Simultaneously, a cystectomy was performed to evaluate the tumor in the left ovary;the diagnosis was adult-type GCT. Although concomitant GCT and PCOS are extremely rare, the two conditions have similar clinical manifestations. In women of reproductive age, the impact of surgery on future fertility should be considered, and the initial surgical technique should be chosen carefully.

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.

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.

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.

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.

Role of Tissue Factor Pathway Inhibitor-2 in Ovarian Tumor Migration and Invasion

Objective: To elucidate the relation between human tissue factor pathwayinhibitor-2 (TFPI-2) expression and ovarian tumor migration and invasion. Methods: Human TFPI-2expression vector pBos-Cite-neo/TFPI-2 was transfected into ovarian tumor cells line A2780- Afterthe transfected cells were selected by G418, transfected and nontransfected cells were screened forTFPI-2 mRNA and protein by reverse transcription-polymerase chain reaction and Western blotanalysis, respectively. The number of transfected or nontransfected cells passing through membraneof Boyden chamber was counted as the basis assessing tumor cells migratory and invasive behaviors.Results: Expression of mRNA and protein of TFPI-2 was detectable in transfected cells. In invasionassay, the number of TFPI-2-expressing cells to traverse a Matrigel-coated membrane was obviouslydecreased compared with that of nonexpressing cells (59.3±6.5 vs 109.7±5.5, P 【 0.01); While inmigration assay, no significant difference through a noncoated membrane was observed amongtransfected and nontransfected cells (114.7±8.6 vs 127.3±7.1, P 】 0.05). Conclusion: Expression ofTFPI-2 may strongly inhibit the invasive ability of ovarian tumor cells in vitro, but has no effecton the migratory ability which provides an experimental basis for genotherapy of human ovariantumor.

Expression of Wnt-1,beta-catenin and c-myc in Ovarian Epithelial Tumor and Its Implication

Objective： To investigate the expression of Wnt-1, beta-catenin and c-myc in normal ovarian epithelial cell and malignant ovarian epithelial tumor. Methods： Immunohistochemical staining with SP method was conducted to identify the expression of Wnt-1, beta-catenin and c-myc in 18 samples of normal epithelial tissue and 34 cases of malignant epithelial tumor of ovary. Results： The expression rate of Wnt-1 and c-myc in malignant epithelial tumors was higher than those in normal epithelial cell （P〈0.05）. The abnormal expression rate of beta-catenin in malignant ovarian epithelial tumors was higher than that in normal epithelial cell （P〈0.05）. A significant positive correlation was found between Wnt-1, beta-catenin and c-myc in malignant ovarian epithelial tumor （P〈0.05）. A significant difference of expressions of Beta-catenin and C-myc was found between serous and mucinous tumors （P〈0.05）. Conclusion： The abnormal expression of Wnt-1, beta-catenin and c-myc might indicate the malignant transformation in ovarian epithelial tumors.

Malignant peritoneal effusion acting as a tumor environment in ovarian cancer progression: Impact and significance

Until recently, ovarian cancer research has mainly focused on the tumor cells themselves ignoring for the most part the surrounding tumor environment which includes malignant peritoneal effusions. However, one of the major conceptual advances in oncology over the last few years has been the appreciation that cancer progression cannot be explained by aberrations in cancer cells themselves and is strongly influenced by the surrounding tumor environment. The mechanisms of ovarian cancer progression differ from that of other solid tumors because ovarian cancer cells primarily disseminate within the peritoneal cavity.Malignant peritoneal effusion accumulates in the peritoneal cavity during ovarian cancer progression. These exudative fluids act as a unique tumor environment providing a framework that orchestrates cellular and molecular changes contributing to aggressiveness and disease progression. The composition of ascites, which includes cellular and acellular components, constantly adapts during the course of the disease in response to various cellular cues originating from both tumor and stromal cells. The tumor environment that represents peritoneal effusions closely constitute an ecosystem, with specific cell types and signaling molecules increasing and decreasing during the course of the disease progression creating a single complex network. Although recent advances aiming to understand the ovarian tumor environment have focused one at a time on components, the net impact of the whole environment cannot be understood simply from its parts or outside is environmental context.

Therapeutic strategies for targeting the ovarian tumor stroma

Epithelial ovarian cancer is the most lethal type of gynecologic malignancy. Sixty percent of women who are diagnosed with ovarian cancer present with advancedstage disease that involves the peritoneal cavity and these patients have a 5-year survival rate of less than 30%. For more than two decades, tumor-debulking surgery followed by platinum-taxane combination chemotherapy has remained the conventional first-line treatment of ovarian cancer. Although the initial response rate is 70%-80%, most patients with advancedstage ovarian cancer eventually relapse and succumb to recurrent chemoresistant disease. A number of molecular aberrations that drive tumor progression have been identified in ovarian cancer cells and intensive efforts have focused on developing therapeutic agents that target these aberrations. However, increasing evidence indicates that reciprocal interactions between tumor cells and various types of stromal cells also play important roles in driving ovarian tumor progression and that these stromal cells represent attractive therapeutic targets. Unlike tumor cells, stromal cells within the tumor microenvironment are in general geneticallystable and are therefore less likely to become resistant to therapy. This concise review discusses the biological significance of the cross-talk between ovarian cancer cells and three major types of stromal cells(endothelial cells, fibroblasts, macrophages) and the development of new-generation therapies that target the ovarian tumor microenvironment.

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 sonographicaUy 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 im- aging were evaluated Results The most predictive MR imaging findings for malignancy were presence of vegetations in a cystic lesinn 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 lesinn 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.

Expressions of beta-catenin, APC Protein, C-myc and Cyclin D1 in Ovarian Epithelial Tumor and Their Implication

Objective： To investigate the expressions of beta-catenin, protein APC （adenomatous polyposis coil protein）, c-myc and cyclin D1 and their implication in ovarian epithelial tumor. Methods： Immunohistochemical staining with SP method was conducted to identify the expressions of beta-catenin, APC protein, c-myc and cyclin D1 in ovarian epithelial tumor in 48 cases. Results： The abnormal expression rate of beta-catenin in malignant and borderline ovarian epithelial tumors was higher than that in benign epithelial tumors （P〈0.01）. The expression rates of c-myc and cyclin-D1 in ovarian malignant and borderline epithelial tumors were higher than those in benign epithelial tumors too（P〈0.05）. The prevalence of APC protein positive expression in benign epithelial tumors were significantly greater than that in malignant epithelial tumors （P〈0.05）. A significant negative correlation was found between beta-catenin and APC protein in ovarian epithelial tumors; while a significant positive correlation was found between beta-catenin, c-myc and cyclin-D1 in ovarian epithelial tumor （P〈0.05）. Conclusion： The abnormal expressions of Beta-catenin, APC protein, c-myc and cyclin-D1 might be used to indicate the malignance transform of ovarian epithelial tumors.

Study on Tumor Angiogenesis in Epithelial Ovarian Carcinoma

To investigate tumor angiogenesis in benign, borderline and malignant epithelial ovarian tumors and its relation with the pathogenesis of ovarian carcinoma, polycolonal antibody directed against human von Willebrand factor (factor Ⅷ ) was used to measure the microvessel density (MVD) in 66 cases (11 benign, 10 borderline, and 45 malignant) of epithelial ovarian tumors by using immunohistochemistry. The results showed that the mean MVD in epithelial ovarian cancer (31. 7 ± 11. 2, 400 × ) was higher than in benign and borderline tumors (16. 7± 6. 3, 20. 7± 8. 8 respectively, P<0. 05). There was no difference in MVDs among those in different tumor grades (P>0. 05). But there was significant difference in MVDs among those in different tumor stages (P< 0. 05). MVD in stage Ⅲ - Ⅳ cancer was higher than that in stage Ⅰ - Ⅱ (P<0. 05). It is concluded that the tumor angiogenesis is an early event in ovarian tumorgenesis. The increased tumor micovessel might be responsible for tumor development.

Detection of Laminin in Serum and Ascites from Patients with Epithelial Ovarian Tumor

The change in serum laminin (LN) level and its clinical significance in epithelial ovarian tumor were investigated. The LN levels in serum and ascites samples from 69 patients with epithelial ovarian tumor and 42 cases as control group before and after operation were analyzed by radioimmunoassay. The results showed that the serum LN levels in the patients with malignant tumors (157.85 ±14.37 ng/ml) were significantly higher than that in the control group (125.14 ±7.03 ng/ml) and in the patients with benign tumors (128.36±8.75 ng/ml)(both P <0.01) before operation. The serum LN levels in the malignant group were decreased significantly after operation as compared with those before operation ( P <0.05). The serum LN levels in low differentiated tumors was higher than those in moderate differentiated tumors and high differentiated tumors ( P <0.05). The LN levels in ascites (172.94±15.26 ng/ml) was significantly higher than in serum (161.34±6.59 ng/ml)( P <0.05) in malignant tumors. The serum LN levels in the patients with lymph node metastasis (165.41±19.91 ng/ml) was obviously higher than those without lymph node metastasis (152.35±10.34 ng/ml)( P <0.05). It was concluded that LN levels in serum and acistes were remarkably increased in malignant epithelial ovarian tumors, suggesting that LN might be one of important diameters reflecting tumor biological characteristics.

CLINICAL VALUE OF SERUM TUMOR SUPPLIED GROUP OF FACTOR IN DIAGNOSIS OF EPITHELIAL OVARIAN CANCER

Objective: To evaluate the clinical value of serum tumor supplied group of factor (TSGF) in diagnosis of epithelial ovarian cancer. Methods: The serum TSGF was tested in 69 patients with epithelial ovarian cancer, 28 patients with benign ovarian lesion and 61 healthy women. The serum levels of vascular endothelial growth factor (VEGF) and CA125 were determined in patients with epithelial ovarian cancer and in those with benign ovarian lesion. The correlations of TSGF with VEGF and CA125 were investigated. Results: The serum level of TSGF in patients with epithelial ovarian cancer was obviously higher than in patients with benign ovarian lesion and in healthy women (P<0.01). The serum level of TSGF in patients with epithelial cancer was associated with stage and grade. TSGF was highest in stage III, followed by stage IV, and was lowest in stage I-II. The TSGF level was lower in well-differentiated tumors and was higher in poorly differentiated tumor. There were no significant difference among diagnostic value of TSGF, VEGF, and CA125 in differentiation between epithelial ovarian cancer and benign ovarian lesion (P>0.05). The serum level of TSGF and VEGF and CA125 in patients with epithelial ovarian cancer showed positive correlation (P<0.01, P<0.05, respectively). Conclusion: There is no marked difference in diagnostic value among TSGF, VEGF and CA125. TSGF has a certain value in diagnosis of epithelial ovarian cancer, and is helpful to distinguish epithelial ovarian cancer from benign ovarian lesion.

Uterine tumor resembling an ovarian sex cord tumor:A case report and review of literature

BACKGROUND Endometrial stromal tumors originate from the endometrial stroma and account for<2%of all uterine tumors.Uterine tumor resembling an ovarian sex cord tumor(UTROSCT)is a rare histological class of endometrial stromal and related tumors according to the latest World Health Organization classification of female genital tumors.Here,we report a case of UTROSCT in a 51-year-old woman.CASE SUMMARY A 51-year-old woman had irregular menses for 6 mo.The patient visited a local hospital for vaginal bleeding.Pelvic computed tomography(CT)showed a mass in the pelvic cavity.Five days later,she came to our hospital for further diagnosis.The results of contrast-enhanced CT and pelvic ultrasound at our hospital suggested a malignant pelvic tumor.She then underwent total removal of the uterus with bilateral salpingectomy.Postoperative histological examination showed that the tumor cells had abundant cytoplasm,ovoid and spindle-shaped nuclei,fine chromatin,a high nucleoplasm ratio,and a lamellar distribution.The findings were consistent with UTROSCT,and the results of immunohistochemical analysis supported that diagnosis.The tumor was International Federation of Gynecology and Obstetrics stage IB.No adjuvant therapy was administered after radical surgery.The patient was followed up for 58 mo,and no recurrence was found.CONCLUSION We report a case of UTROSCT with abnormal menstruation as a symptom,which is one of the most common symptoms.In patients with vaginal bleeding,ultrasonography can be used as a screening test because of its convenience,speed,and lack of radiation exposure.For patients with long-term tamoxifen use,routine monitoring of the endometrium is recommended.As UTROSCT may have low malignant potential,surgery remains the primary management strategy.Additionally,fertility preservation in patients of childbearing age is a vital consideration.

CLINICAL DIAGNOSIS AND TREATMENT OF SMALL OVARIAN TUMOR IN POSTMENOPAUSAL WOMEN

Objective： To investigate the clinical symptom, ultrasonographic scan finding, serum CA125 value, histopathological type and treatment of small ovarian tumor （〈5 cm） in postmenopausal women. Methods： Retrospective analysis was carried out for 52 clinical materials of ovarian tumor cases in women more than one year after menopausal between Jan 1997 and Dec 2004. The largest diameter of the ovarian mass is less than 5 cm. Results： There were 11 ovarian cancers and 1 borderline ovarian tumor among 52 small ovarian tumors （23.1%）. 10 ovarian cancers were epithelial neoplasms and 2 were sex cord-stromal tumors, and 8 cases were in late stage according to FIGO staging system （33.3%）. Compared with benign tumor, there is no significant difference in the onset age, interval after menopausal and duration of history. The main clinical feature is abdominal symptoms, such as abdominal pain and distension in the malignant cases. The patients with benign tumors often showed the ovarian mass during the annual screening or admitted into hospital for other causes. The ultrasonography finding and serum CA125 level showed much difference between benign and malignant cases. Unilocular smooth-walled ovarian cysts mostly were found in benign tumor and the CA125 values were always less than 35 U/ml; but the solid or complex sonographic structures （multilocular, or with a papillary projections on the wall） often indicated a high risk of cancer, especially there was ascites in the pelvic cavity. Serum CA125 level in many cancer cases was elevated （〉35 U/ml）, over 300 U/ml in more than half of the patients. Surgery is still the first choice to treat ovarian cancer, and chemotherapy would be an auxiliary method. Till now, 3 ovarian cancer patients died of complications of cancer and 2 cases had recurrence. Conclusion： Small ovarian tumor in postmenopausal women has a comparatively low malignant occurrence but more in later stage. Many are epithelial carcinoma. If there is complex or parenchymal sonographic structure accompanied with a high serum CA125 level, operation should be considered, while it can be followed up when the ultrasound shows a smooth cyst with normal CA125 value.

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 m L. 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 d.CONCLUSION Robotic-assisted resection of ovarian tumors is a simple, safe, and effective surgical procedure for selected patients.