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.

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.

The diagnostic value of multiple tumor markers in malignantovarian neoplasms

Objective:To study the diagnostic value of multiple tumor markers in malignant ovarian neoplasm.Methods:Sera obtained from 430 patients with ovarian masses (110 cases were malignant ovarian tumors,320 cases were benign ovarian tumors) before operation,and from 50 healthy women as control.Serologic examination of tumor markers included CA125,TSGF,SA,CEA,AFP,HCG and Fer.Results:The serum levels of CA125,TSGF,SA and Fer in patients with ovarian cancer were higher than those in patients with benign ovarian tumors (P<0.05),also in control group (P<0.05).In the diagnostic value of application for malignant ovarian neoplasm,CA125,TSGF and SA were better than the others.The sensitivity,specificity and accuracy in diagnosis of ovarian cancer were 86.4%,82.8%and 83.7% respectively for CA125 alone,78.2%,81.3%and 80.5% for TSGF alone,74.5%,81.9%and 80.0% for SA alone,whereas 95.5%,45.6%and 58.4% for multiple tumor markers combined in which 1 or more indices showed positive,93.6%,80.6%and 84.0% for that in which 2 or more indices showed positive,and 87.3%,90.3%and 89.5% for that in which 3 or more indices show positive.Conclusion:multiple tumor markers examination could improve the diagnosis of ovarian cancer,and examination of CA125,TSGF and SA combined is most ideal.

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.

Case Report <i>ex Vivo</i>Oocyte Collection to Maintain Fertility in a Patient with Micropapillary Serous Borderline Ovarian Tumor

Background: Approximately 11% of cancer cases are diagnosed in people of childbearing age. Borderline ovarian tumors (BOTs) make up 10%-15% of all ovarian epithelial malignancies. More than one-third of all BOTs occur in women under 40 years of age. Maintaining the fertility of cured patients is the common goal of both oncologists and reproductologists. Aim: Giving young women diagnosed with a prognostically worse type of BOT and after bilateral adnexectomy the possibility to have their genetically own children by the method of ex vivo oocyte collection. Case Presentation: A 34-year-old nulligravid woman with BOT underwent right laparoscopic salpingo-oophorectomy. Histologically, a serious borderline tumor with a micropapillary pattern and a tumor locus on the ovarian surface were found. Due to histopathology, the oncologist recommended re-staging surgery: laparotomy, left salpingo-oophorectomy, omentectomy and hysterectomy. The patient refused a hysterectomy as she was planning to get pregnant with her partner. To maintain her fertility, controlled hormonal hyperstimulation and ex vivo aspiration of follicles from the ovary after salpingo-oophorectomy was performed. Ex vivo follicle expiration yielded 10 oocytes. 9 mature oocytes were fertilized by ICSI. The 6 embryos of the highest quality were individually frozen by vitrification. Cryoembryotransfer will be scheduled with the consent of the oncologist. Conclusion: This method is suitable for young women with BOT after bilateral salpingo-oophorectomy in whom ex vivo oocyte collection prevents possible leakage of tumor cells into the abdominal cavity, unlike during the conventional in vivo collection prior to surgery.

Survey of the management of borderline ovarian tumors in the United Kingdom

Borderline ovarian tumors （BOTs） represent approxi-mately 10% of ovarian neoplasms and are a heteroge-neous group of tumors with variable biological behav-iour. The majority present with disease confned to the ovary and have an excellent prognosis after surgical removal. A small proportion subsequently has recur-rent disease or progression to invasive cancer. Tumor recurrence can occur up to 20 years after surgical resection. There are no robust clinical, histological or molecular markers that distinguish high risk cases and no satisfactory treatment for patients with progressive disease. This results in great variability in management in different centres. We conducted a national survey on the management of borderline ovarian tumors in cancer centres representing different regions in the United Kingdom. In this article we review the literature for the current concepts in diagnosis, treatment and follow up of BOTs and we report the results of the survey of current practice in the United Kingdom. On that basis we provide recommendations for the management of patients with BOTs.

The relationship between the expression of hK6 in ovarian neoplasm and the clinicopathologic variables and prognosis

Objective: The aim of this study was to approach the relationship between the expression of human kallikrein 6 (hK6) in ovarian neoplasm and the clinicopathologic variables and prognosis for finding a new tumor marker for ovarian cancer. Methods: Through immunohistochemistry to examine the expression of hK6 in 19 cases with benign, 11 cases with borderline and 45 cases with malignant ovarian neoplasms and statistically analyzed whether the expression of hK6 correlated with the clinicopathologic variables and prognosis in patients with ovarian cancer. Results: The positive rate of hK6 in ovarian cancer tissues (60.0%) was significantly higher than that in the benign (15.8%) and borderline (27.3%) ovarian neoplasm tissues (P < 0.01). The expression of hK6 in low-grade ovarian cancer tissues was higher than that in high-grade (68.4% vs 14.3%; P < 0.05); hK6 in late–stage (stage III) was more frequently expressed than that in early-stage (stage I or II) (76.7% vs 26.7%; P < 0.01); and it significantly higher in ovarian carcinomas with lymph node metastases than those without lymph node metastases (77.8% vs 33.3%; P < 0.01 ); moreover, the expression of hK6 in the cancer tissues that the patients died or their pathogenetic condition recurred or their tumor metastasized within 3 years after surgery was higher (75.0%) than that in the cancer tissues that the pathogenetic condition of the patients was stable (42.9%; P < 0.05). Conclusion: The expression of hK6 in ovarian cancer tissues was higher than that in the benign and borderline ovarian neoplasm tissues, and high hK6 expression correlated with late–stage, low-grade, node metastasis and poor prognosis of patients. hK6 could potentially be a novel tumor marker for ovarian cancer that can predict the prognosis of the patients.

Human ovarian neoplasm cell CD147 stimulates production and activation of matrix metalloproteinases in co-cultures with mouse fibroblasts

Objective: To investigate the expression of CD147 on human ovarian neoplasm cell lines and its influence on production and activation of matrix metallproteinases(MMPs). Methods: The expression of CD147 on different human ovarian neoplasm cell lines was studied by western blotting. Co-culture was carried out to investigate the stimulative effect of the positive expression CD147 cell HO-8910 on the production of MMPs of fibroblast cell in vitro. Zymography and immune blotting were used to study the production and activity of positive MMPs, at the time, to explore the relation between CD147 and MMPs. Results: CD147 was positively presented in 2 ovarian neoplasm cell lines(HO-8910,3-AO), but in SKOV3, TC-1,NIN3T3 cell was negative. MMP-2 and MMP-9 were detected by HO-8910 cell line, mouse fibroblast cell and co-culture cells; but the expression in co-culture cell is obviously higher than individual cultures of each type alone.CD147 stimulated MMPs in dose-dependent manner. Conclusion: CD147 causes increased production and activation of MMP-2, MMP-9.CD147 is probably a indirect marker of some ovarian cancer cells with invasion and metastasis.

Accuracy of Intraoperative Frozen Section in the Diagnosis of Ovarian Neoplasms

Objective: The aim of the work is to evaluate the accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms in Zagazig University. Design: A prospective cross sectional cohort study. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The most appropriate area thought to be representative of lesion was chosen. The number of sections frozen was depended on the type and size of the tumor. Seven to eight μm sections were obtained and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). The diagnosis obtained by intraoperative frozen section based on cellularity and cell morphology was compared with final histopathological diagnosis in terms of diagnostic sensitivity, to differentiate between benign and malignant lesions. Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: There was no statisticaly significant differencre in the studied patients as regard the clinical data, macroscopic and intraoperative picture, while there was statisticaly significat association as regard the laterality of the ovarian masses. The validity of frozen section in the diagnosis of benign tumour was 100% with 100% accuracy, specificity, positive predictive value, negative predictive value, while sensitivity & negative prediction for borderline tumour and specificity & positive prediction of malignant tumour were 100%, specifecity for borderline tumours was 95% while the positive predictive value was 33.3% with 96% accuracy for both malignant and borderline tumours. Conclusion: Intraoperative frozen section is accurate for rapid diagnosis of ovarian tumors. It can help surgeons avoid under-treatment or overtreatment of patients. Our study was designed prospectively using a small number of patients. The door is open to larger studies using a larger number of patients to be performed in order to substantiate our results.

Synchronous Mucinous Borderline Tumor of the Ovary and Low-Grade Appendiceal Mucinous Neoplasm

We present a rare case of synchronous mucinous borderline tumor of the ovary and low-grade appendiceal mucinous neoplasm (LAMN). We performed a left adnexectomy to diagnose the left ovarian borderline malignancy and an ileostomy because of the swollen appendix during the operation. It was diagnosed as left ovarian mucinous borderline malignancy and LAMN. LAMN causes peritoneal dissemination, ovarian metastasis, and peritoneal pseudomyxoma. The appendix and ovary are close to each other anatomically and can metastasize if there is a tumor in either. For ovarian mucinous tumors, it is necessary to search the gastrointestinal tract, especially the appendix, as the primary lesion. For appendix tumors, it is necessary to search for the ovary. Since LAMN may be associated with borderline ovarian malignancies, as in this case, there is a possibility of the duplication of tumors when searching for ovarian mucinous tumors as the primary tumor and if ovarian tumors are found. Since LAMN and mucinous ovarian tumors have similar histological features, immunohistochemical staining is useful for their differentiation because they show different immunostaining patterns.

Expression and significance of tumor suppressor gene p16 in human ovarian neoplasm

To observe the relationship between tumor suppressor gene p16 expression and ovarian cancer occurrence and development. Metbods: Using ABC immunohistochemistry method, we investigated the expression of p16 in 72 cases of ovarian neoplasm. Results: The positive rates of p16 in malignant, benign, borderline tumors and normal ovarian tissue were 7. 89%, 60.00%, 66. 67% and 83. 33%, respectively (P<0.01). In the cases whose tumors were more malignant and poorly differentiated, and who relapsed and died, the positive stainings were not discovered. Conclusiou: p16 is well related with the occurrence and development of malignant ovarian tumor.

TGF-β-regulated different iron metabolism processes in the development and cisplatin resistance of ovarian cancer

The impact of different iron metabolism processes(DIMP)on ovarian cancer remains unclear.In this study,we employed various gene chips and databases to investigate the role of DIMP in the initiation and development of ovarian cancer.cBioPortal was used to determine mutations in DIMP-associated genes in ovarian cancer.Kaplan-Meier plotter was used to examine the influence of DIMP on the prognosis of ovarian cancer.By analyzing 1669 serous ovarian cancer cases,we identified a range of mutations in iron metabolism genes,notably in those coding for the transferrin receptor(19%),melanotransferrin(19%),and ceruloplasmin(10%)in the iron import process,and glucose-6-phosphate isomerase(9%),hepcidin antimicrobial peptide(9%),metal regulatory transcription factor 1(8%),and bone morphogenetic protein 6(8%)in the iron regulation process.Compared to the unaltered group,the group with gene alterations exhibited a higher tumor mutation burden count(43 vs.54)and more advanced histologic grade(78.19%vs.87.90%).Compared to the normal ovarian counterparts,a reduction in expression was observed in 9 out of the 14 genes involved in iron utilization and 4 out of the 5 genes involved in iron export in ovarian cancer;in contrast,an increase in expression was observed in 2 out of the 3 genes involved in iron storage in ovarian cancer.Furthermore,in cisplatin-resistant cells compared to cisplatin-sensitive ones,the expression of all genes in iron storage and 13 out of 14 genes in iron import was decreased,while that of 8 out of the 10 genes in iron utilization was increased.In addition,survival curve analysis indicated that a higher expression in the majority of genes in the iron import process(12/21),or a reduced expression in most genes in the iron export process(4/5)correlated with poor progression-free survival.Additionally,TGF-βcould regulate the expression of most iron metabolism-associated genes;particularly,expression of genes involved in the iron storage process(2/2)was inhibited after TGF-β1 or TGF-β2 treatment.In conclusion,DIMP plays multifaceted roles in the initiation,chemo-resistance,and prognosis of ovarian cancer.Therapeutically targeting DIMP may pave the way for more tailored treatment approaches for ovarian cancer.

Immune pathway through endometriosis to ovarian cancer

Endometriosis is an estrogen-dependent inflammatory disease,defined by the presence of functional endometrial tissue outside of the uterine cavity.This disease is one of the main gynecological diseases,affecting around 10%-15%women and girls of reproductive age,being a common gynecologic disorder.Although endometriosis is a benign disease,it shares several characteristics with invasive cancer.Studies support that it has been linked with an increased chance of developing endometrial ovarian cancer,representing an earlier stage of neoplastic processes.This is particularly true for women with clear cell carcinoma,low-grade serous carcinoma and endometrioid.However,the carcinogenic pathways between both pathologies remain poorly understood.Current studies suggest a connection between endometriosis and endometriosis-associated ovarian cancers(EAOCs)via pathways associated with oxidative stress,inflammation,and hyperestrogenism.This article aims to review current data on the molecular events linked to the development of EAOCs from endometriosis,specifically focusing on the complex relationship between the immune response to endometriosis and cancer,including the molecular mechanisms and their ramifications.Examining recent developments in immunotherapy and their potential to boost the effectiveness of future treatments.

Gonadotropin-releasing hormone agonists cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients

Background Recently, conservative surgery is acceptable in young patients with borderline ovarian tumor and ovarian cancer. The preservation of these patients＇ future fertility has been the focus of recent interest. This study aimed to observe the effect of gonadotropin-releasing hormone agonists （GnRHa） cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients. Methods Sixteen patients who were treated with fertility preservation surgery for borderline ovarian tumor and ovarian cancer and then administered GnRHa during chemotherapy in Peking University People＇s Hospital from January 2006 to July 2010 were retrospectively analyzed. This group was compared with a control group of 16 women who were treated concurrently with similar chemotherapy （n=5） without GnRHa or were historical controls （n=11）. The disease recurrence, the menstruation status and reproductive outcome were followed up and compared between the two groups. Results There were no significant differences between both groups regarding age, body weight, height, marriage status, classification of the tumors, stage of the disease, as were the cumulative doses of each chemotherapeutic agent. One （1/16） patient in the study group while 2 （2/16） patients in the control group relapsed 2 years after conclusion of the primary treatment （P 〉0.05）. All of the 16 women in the study group compared with 11 of the 16 patients in the control group resumed normal menses 6 months after the termination of the treatment （P 〈0.05）. There were 4 spontaneous pregnancies in the study group while 2 in the control group, all of the neonates were healthy. Conclusions GnRHa administration before and during chemotherapy in borderline ovarian tumor and ovarian cancer patients who had undergone fertility preservation operation may bring up higher rates of spontaneous resumption of menses and a better pregnancy rate. Long-term follow up and large scale clinical studies are required.

EZH2 Contributes to Anoikis Resistance and Promotes Epithelial Ovarian Cancer Peritoneal Metastasis by Regulating m6A

Objective:Histone modification has a significant effect on gene expression.Enhancer of zeste homolog 2(EZH2)contributes to the epigenetic silencing of target chromatin through its roles as a histone-lysine N-methyltransferase enzyme.The development of anoikis resistance in tumor cells is considered to be a critical step in the metastatic process of primary malignant tumors.The purpose of this study was to investigate the effect and mechanism of anoikis resistance in ovarian adenocarcinoma peritoneal metastasis.Methods:In addition to examining EZH2 protein expression in ovarian cancer omental metastatic tissues,we established a model of ovarian cancer cell anoikis and a xenograft tumor model in nude mice.Anoikis resistance and ovarian cancer progression were tested after EZH2 and N6-methyladenosine(m6A)levels were modified.Results:EZH2 expression was significantly higher in ovarian cancer omental metastatic tissues than in normal ovarian tissues.Reducing the level of EZH2 decreased the level of m6A and ovarian cancer cell anoikis resistance in vitro and inhibited ovarian cancer progression in vivo.M6a regulation altered the effect of EZH2 on anoikis resistance.Conclusion:Our results indicate that EZH2 contributes to anoikis resistance and promotes ovarian adenocarcinoma abdominal metastasis by m6A modification.Our findings imply the potential of the clinical application of m6A and EZH2 for patients with ovarian cancer.

Primary ovarian choriocarcinoma occurring in a postmenopausal woman:A case report

BACKGROUND Nongestational ovarian choriocarcinoma(NGOC)is a rare but aggressive neoplasm with limited sensitivity to chemotherapy and a very poor prognosis.Few cases of NGOC have been reported,and there is limited information regarding its clinical features,treatment protocols,or prognosis.CASE SUMMARY A postmenopausal woman in her 5th decade of life visited our clinic because of abnormal vaginal bleeding and an abdominal mass.Although she had been menopausal for more than eight years and her last abortion occurred nine years ago,she had an increased level of serumβ-human chorionic gonadotropin(β-hCG).Thus,an ovarian neoplasm of trophoblastic origin was suspected,and exploratory laparotomy was performed.Based on the patient’s clinical history and the histopathological examination and immunohistochemistry results obtained postoperatively,we concluded that she most likely had primary NGOC.Cytoreductive surgery was performed in combination with adjuvant chemotherapy comprising bleomycin,etoposide,and cisplatin.Serumβ-hCG levels decreased to normal after two cycles,and there was no evidence of recurrence after four cycles of chemotherapy.CONCLUSION Even in postmenopausal women,ovarian choriocarcinoma should be considered in the initial differential diagnosis for an adnexal mass.

EXPRESSION AND SIGNIFICANCE OF BASIC FIBROBLAST GWOWTH FACTOR AND FIBROBLAST GROWTH FACTOR RECEPTOR-1 IN OVARIAN EPITHELIAL NEOPLASM

Objective To study the relevance of expression of basic fibroblast growth factor (bFGF), fibroblast growth factor receptor 1 (FGFR 1) and carcinogenesis and progression of ovarian epithelial neoplasm. Methods Ten cases of normal ovarian tissues and 75 cases of ovarian epithelial neoplasm tissues were detected by immunohistochemical methods: S P for bFGF, FGFR 1,double immunohistochemistry Lab SA for Ki 67 antigen and bFGF. Results The expression level of bFGF, FGFR 1in ovarian epithelium and ovarian epithelial neoplasm showed a step wise increase in the following order:normal <benign <borderline <malignant; The expression level and intensity of bFGF and FGFR 1 were increased with the decrease of differentiation degree and increase of clinical stage in ovarian carcinoma; There was no statistical difference between the expression of bFGF, FGFR 1 in serous cystadenocarcinoma and that of mucinous cystadenocarcinoma; The expression of bFGF was correlated with that of FGFR 1 in neoplastic tissues; There were positive expression rates of bFGF and Ki 67 antigen in ovarian epithelial neoplasm. Conclusion As an important proliferative factor, bFGF plays an important role in carcinogenisis and progression of ovarian epithelial neoplasm.

A Case of Low-Grade Appendiceal Mucinous Neoplasm of Its Difficultly to Distinguish from a Right Ovarian Tumor Due to Postmenopause

We here present a rare case of appendiceal tumor mimicking ovarian tumor in menopause woman. The patient was a 56-year-old woman, G1P1, who presented to our hospital with a right adnexal cyst diagnosed at another hospital. Transvaginal echocardiography showed a cyst in the right adnexal region, and pelvic contrast-enhanced MRI revealed a small cyst in the same region. The left ovary was atrophic and identifiable. It was unclear whether the cyst was contiguous with the gastrointestinal tract. Blood tests showed no elevation of tumor markers. We considered its possibility of a gastrointestinal origin, but since right normal ovary was not found, we thought the tumor was of ovarian origin and decided on a laparoscopic resection of the right adnexa. Intraoperatively, we observed atrophied bilateral normal ovaries, and the pelvic tumor was contiguous to the appendix. Surgeons performed a laparoscopic appendectomy after consultation with us. After resection we searched the abdominal and pelvic cavities, but found no obvious disseminated lesions. The histological diagnosis was low-grade appendiceal mucinous neoplasm (LAMN), a rare benign tumor of the appendix. Appendiceal tumors can be difficult to differentiate from right ovarian tumors due to their close anatomic location in the pelvis. It is possible to determine whether the tumor is of ovarian or appendiceal origin by identifying normal ovaries and the location of the feeding vessels into the tumors. In our case, there were no lesions other than the appendix, but LAMN can metastasize to the ovary, cause pseudomyoxoma peritonei, or be an overlapping tumor with an ovarian tumor. If an appendiceal tumor is diagnosed after surgery for ovarian tumor, the intra-abdominal cavity should be searched for metastasis or dissemination, and a thorough search for ovarian lesions should be performed with the possibility of an overlapping tumor in mind.

基于术前CT及临床特征构建卵巢上皮性癌肿瘤间质比预测模型的研究

目的:探讨不同肿瘤间质比(Tumor-stroma ratio,TSR)的卵巢上皮性癌(Epithelial ovarian carcer,EOC)的特征性影像学表现,并基于术前临床及影像特征建立列线图预测模型。方法:收集我院2013年7月-2016年6月经手术病理证实为EOC的患者96例,根据术后组织病理结果将其分为高间质比组(TSR≥50%)和低间质比组(TSR<50%)两组。回顾性分析两组病例术前全腹部增强CT的形态学特征,包括原发灶的单侧或双侧、囊变程度、囊变形态、边界特点、长短径比、体积、平扫CT值、增强幅度、是否存在钙化、腹水、腹膜后淋巴结肿大以及腹膜转移情况。采用单因素及多因素Logistic回归分析筛选出评估EOC TSR的独立影响因子,并以此构建列线图预测模型。通过受试者工作特征(ROC)及曲线下面积(AUC)评估列线图模型的诊断效能,通过决策曲线评估列线图模型的临床适用性。结果:新辅助化疗、肿瘤长短径比、增强幅度、边界特点、囊变形态、是否存在腹膜后淋巴结肿大均是EOC TSR的独立影响因子。据此结果构建列线图,其ROC曲线的AUC值为0.966(95%CI 0.936~0.997),灵敏度为96.1%,特异度为88.9%。结论:高间质比组的EOC在CT上多表现出更高的长短径比、更明显的强化、边界不清、微囊型的囊变形态及腹膜后淋巴结肿大。基于EOC患者的术前CT和临床特征构建的列线图可以无创评估TSR,有助于辅助临床风险分层和治疗决策。

卵巢微乳头亚型浆液性交界性肿瘤临床病理与分子特征分析

目的探讨卵巢微乳头亚型浆液性交界性肿瘤(micropapillary serous borderline tumor,MSBT)的临床病理学特征、免疫表型、分子改变、鉴别诊断、治疗和预后。方法收集14例卵巢MSBT的临床资料,采用免疫组化EnVision法染色分析IMP3的表达,运用qRT-PCR法和Sanger测序法检测BRAF和KRAS的基因突变,分析其临床病理特征并复习相关文献。结果患者年龄27~56岁,平均41.7岁;9例为双侧卵巢肿物;11例术前血清CA125值升高。肿瘤切面呈囊实性,伴囊内乳头状物。14例卵巢MSBT均呈乳头状结构,特征性的细长微乳头直接从囊壁或大的无分支乳头上发散出来,乳头长宽比>5,乳头被覆细胞呈立方至多角形,轻-中度异型性,微乳头区范围均>5 mm。5例伴微浸润;6例伴腹膜非浸润性种植;5例伴腹水均可见异型肿瘤细胞;3例伴淋巴结受累;9例伴砂粒体。免疫表型:ER、PR、CA125、CK7和WT-1均呈阳性,p53野生型,HER2、IMP3均阴性,Ki67增殖指数为5%~30%。分子病理学特征:14例中KRAS基因突变3例(3/14,21.4%),突变位点分别为G12C、G12D和Q70(无义突变);BRAF V600E均未突变;BRAF T559I突变1例(1/14,7.1%)。7例患者行根治性手术,另7例患者行保守性手术,术后均未经特殊治疗。随访时间1~12年,14例患者中5例有复发。结论MSBT形态学特殊,多双侧发病,易伴腹膜种植,易复发,诊断时应与经典型卵巢浆液性交界性肿瘤鉴别。