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Oppong B, Gyabaah S, Amponsah GM, Quansah A, Darkwa EA. Peritoneal tuberculosis masquerading as an ovarian malignancy in a young female: A case report. Clin Case Rep 2024; 12:e8617. [PMID: 38464570 PMCID: PMC10923695 DOI: 10.1002/ccr3.8617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/01/2024] [Accepted: 02/10/2024] [Indexed: 03/12/2024] Open
Abstract
The clinical manifestations of peritoneal tuberculosis are quite variable, nonspecific and mimic many diseases and pathological conditions such as lymphoma, and ovarian malignancy. Due to this clinical overlap and limited accuracy of diagnostic tests, more awareness of this disease is required to enable early diagnosis and prompt treatment. This is a case of a 25-year-old female with no known chronic illness who presented with worsening generalized abdominal pains and distension of 2 months duration. There was an associated significant weight loss of 17 kg. She was initially diagnosed with ovarian malignancy based of ultrasound findings and elevated CA-125 levels. However, further evaluation later was consistent with peritoneal tuberculosis for which she was treated. Her symptoms resolved completely after 6 months of anti-tuberculosis treatment. Diagnosis of abdominal TB remains challenging as it is non-specific. Its features and clinical manifestation overlap with other conditions such as ovarian malignancy. A high index of suspicions and judicious application of the available diagnostic test is need for prompt diagnosis. No single test can effectively diagnose peritoneal TB, but a combination of history, and radiological, immunologic, molecular, and cytologic tests are important.
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Affiliation(s)
- Bright Oppong
- Komfo Anokye Teaching Hospital Kumasi Ghana
- School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | | | - Gorden Manu Amponsah
- Komfo Anokye Teaching Hospital Kumasi Ghana
- School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Ato Quansah
- Komfo Anokye Teaching Hospital Kumasi Ghana
- School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
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Azcona L, Heras M, Arencibia O, Minig L, Marti L, Baciu A, Cespedes J, Niguez I, Gil-Ibanez B, Díaz-Feijoo B, Melero LM, Marcos Sanmartin J, Garcia-Villayzan J, Gomez B, Montesinos M, Herrero S, Gilabert-Estelles J, F Chereguini M, Gorostidi M, Zapardiel I. Prognostic factors in young women with epithelial ovarian cancer: the Young Ovarian Cancer-Care (YOC-Care) study. Int J Gynecol Cancer 2024; 34:285-292. [PMID: 38086566 DOI: 10.1136/ijgc-2023-004882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVE To determine oncological outcomes and to identify prognostic factors in women aged <45 years with epithelial ovarian cancer. METHODS A multicenter retrospective study was performed of patients treated for epithelial ovarian cancer aged <45 years between January 2010 and December 2019. RESULTS A total of 998 patients with epithelial ovarian cancer from 55 different institutions in Spain were collected. The median age of the study population was 40.8 years (range 35.6-43.4). The grouped International Federation of Gynecology and Obstetrics (FIGO) stage distribution was 508 (50.9%) patients in initial stages (I and II) and 490 (49.1%) with advanced stages (III and IV). Three hundred and twenty-five (32.6%) patients presented with recurrent disease after a median follow-up of 33.1 months (range 16.1-66.4). The type of staging surgery (incomplete vs complete), type of initial treatment modality (primary cytoreduction vs interval surgery), and amount of residual disease were all significantly associated with overall survival. Tumor rupture was noted in 288 (27.9%) cases, but it was not associated with oncologic outcomes (p=0.11 for overall survival). In the multivariate analysis, the response based on radiological findings (HR 3.24, 95% CI 2.14 to 4.91 for partial response; HR 6.93, 95% CI 4.79 to 10.04 for progression), neoadjuvant chemotherapy (HR 1.42, 95% CI 1.04 to 1.94), and FIGO stage (HR 1.68, 95% CI 1.40 to 2.02) were identified as independent prognostic factors associated with worse oncologic outcomes (p<0.001). CONCLUSION The partial and progression radiology-based response after chemotherapy, neoadjuvant chemotherapy, and advanced FIGO stage are independent prognostic factors associated with worse oncological outcomes in women aged <45 years with epithelial ovarian cancer.
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Affiliation(s)
- Leticia Azcona
- Obstetrics and Gynecology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marta Heras
- Obstetrics and Gynecology, Hospital Universitario Santa Cristina, Madrid, Spain
| | - Octavio Arencibia
- Gynecology, University Maternal Hospital Canary Islands, Las Palmas, Spain
| | - Lucas Minig
- Gynecologic Oncology, Valencian Institute of Oncology (IVO), Valencia, Spain
| | - Lola Marti
- Gynecological Oncology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Andreea Baciu
- Gynecology Department, La Paz University Hospital, Madrid, Spain
| | - Juan Cespedes
- Obstetrics and Gynecology, Hospital Universitario de Donostia, San Sebastian, Spain
| | - Isabel Niguez
- Gynecology and Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar-Murcia, Spain
| | - Blanca Gil-Ibanez
- Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Berta Díaz-Feijoo
- Obstetrics and Gynecology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lidia Maria Melero
- Gynecology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Benjamina Gomez
- Gynecology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Manel Montesinos
- Department of Obstetrics and Gynecology, University Hospital La Fe, Valencia, Spain
| | - Sofia Herrero
- Gynecology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Juan Gilabert-Estelles
- Gynecologic Oncology, General University Hospital Consortium of Valencia, Valencia, Spain
| | | | - Mikel Gorostidi
- Obstetrics and Gynecology, Hospital Universitario de Donostia, San Sebastian, Spain
- Systemic Diseases, Biogipuzkoa Health Research Institute, Donostia-San Sebastian, Spain
- School of Medicine, Basque Country University, San Sebastián, Spain
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Horackova K, Janatova M, Kleiblova P, Kleibl Z, Soukupova J. Early-Onset Ovarian Cancer <30 Years: What Do We Know about Its Genetic Predisposition? Int J Mol Sci 2023; 24:17020. [PMID: 38069345 PMCID: PMC10707471 DOI: 10.3390/ijms242317020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Ovarian cancer (OC) is one of the leading causes of cancer-related deaths in women. Most patients are diagnosed with advanced epithelial OC in their late 60s, and early-onset adult OC diagnosed ≤30 years is rare, accounting for less than 5% of all OC cases. The most significant risk factor for OC development are germline pathogenic/likely pathogenic variants (GPVs) in OC predisposition genes (including BRCA1, BRCA2, BRIP1, RAD51C, RAD51D, Lynch syndrome genes, or BRIP1), which contribute to the development of over 20% of all OC cases. GPVs in BRCA1/BRCA2 are the most prevalent. The presence of a GPV directs tailored cancer risk-reducing strategies for OC patients and their relatives. Identification of OC patients with GPVs can also have therapeutic consequences. Despite the general assumption that early cancer onset indicates higher involvement of hereditary cancer predisposition, the presence of GPVs in early-onset OC is rare (<10% of patients), and their heritability is uncertain. This review summarizes the current knowledge on the genetic predisposition to early-onset OC, with a special focus on epithelial OC, and suggests other alternative genetic factors (digenic, oligogenic, polygenic heritability, genetic mosaicism, imprinting, etc.) that may influence the development of early-onset OC in adult women lacking GPVs in known OC predisposition genes.
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Affiliation(s)
- Klara Horackova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 00 Prague, Czech Republic; (K.H.); (M.J.); (P.K.); (Z.K.)
| | - Marketa Janatova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 00 Prague, Czech Republic; (K.H.); (M.J.); (P.K.); (Z.K.)
| | - Petra Kleiblova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 00 Prague, Czech Republic; (K.H.); (M.J.); (P.K.); (Z.K.)
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 00 Prague, Czech Republic
| | - Zdenek Kleibl
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 00 Prague, Czech Republic; (K.H.); (M.J.); (P.K.); (Z.K.)
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Jana Soukupova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 00 Prague, Czech Republic; (K.H.); (M.J.); (P.K.); (Z.K.)
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Serio PADMP, de Lima Pereira GF, Katayama MLH, Roela RA, Maistro S, Folgueira MAAK. Somatic Mutational Profile of High-Grade Serous Ovarian Carcinoma and Triple-Negative Breast Carcinoma in Young and Elderly Patients: Similarities and Divergences. Cells 2021; 10:cells10123586. [PMID: 34944094 PMCID: PMC8700427 DOI: 10.3390/cells10123586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Triple-negative breast cancer (TNBC) and High-Grade Serous Ovarian Cancer (HGSOC) are aggressive malignancies that share similarities; however, different ages of onset may reflect distinct tumor behaviors. Thus, our aim was to compare somatic mutations in potential driver genes in 109 TNBC and 81 HGSOC from young (Y ≤ 40 years) and elderly (E ≥ 75 years) patients. Methods: Open access mutational data (WGS or WES) were collected for TNBC and HGSOC patients. Potential driver genes were those that were present in the Cancer Gene Census—CGC, the Candidate Cancer Gene Database—CCGD, or OncoKB and those that were considered pathogenic in variant effect prediction tools. Results: Mutational signature 3 (homologous repair defects) was the only gene that was represented in all four subgroups. The median number of mutated CGCs per sample was similar in HGSOC (Y:3 vs. E:4), but it was higher in elderly TNBC than it was in young TNBC (Y:3 vs. E:6). At least 90% of the samples from TNBC and HGSOC from Y and E patients presented at least one known affected TSG. Besides TP53, which was mutated in 67–83% of the samples, the affected TSG in TP53 wild-type samples were NF1 (yHGSOC and yTNBC), PHF6 (eHGSOC and yTNBC), PTEN, PIK3R1 and ZHFX3 (yTNBC), KMT2C, ARID1B, TBX3, and ATM (eTNBC). A few samples only presented one affected oncogene (but no TSG): KRAS and TSHR in eHGSOC and RAC1 and PREX2 (a regulator of RAC1) in yTNBC. At least ⅔ of the tumors presented mutated oncogenes associated with tumor suppressor genes; the Ras and/or PIK3CA signaling pathways were altered in 15% HGSOC and 20–35% TNBC (Y vs. E); DNA repair genes were mutated in 19–33% of the HGSOC tumors but were more frequently mutated in E-TNBC (56%). However, in HGSOC, 9.5% and 3.3% of the young and elderly patients, respectively, did not present any tumors with an affected CGC nor did 4.65% and none of the young and elderly TNBC patients. Conclusion: Most HGSOC and TNBC from young and elderly patients present an affected TSG, mainly TP53, as well as mutational signature 3; however, a few tumors only present an affected oncogene or no affected cancer-causing genes.
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Bunyaeva E, Kirillova A, Khabas G, Asaturova A, Mishieva N, Nazarenko T, Abubakirov A, Sukhikh G. Feasibility of in vitro maturation of oocytes collected from patients with malignant ovarian tumors undergoing fertility preservation. Int J Gynecol Cancer 2021; 31:475-479. [PMID: 33649016 DOI: 10.1136/ijgc-2020-001754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In vitro maturation of oocytes collected from oophorectomy samples might be a promising approach in the field of oncofertility. In this study, we evaluate the feasibility of in vitro maturation of oocytes collected from oophorectomy samples in patients with ovarian tumors. METHODS This prospective observational study included 27 patients with malignant ovarian tumors. Patients underwent oophorectomy and ovarian tissue was examined for the presence of immature cumulus-oocyte complexes. These were matured in vitro for 48 hours. Mature oocytes were vitrified or used for fertilization. Serum anti-müllerian hormone (AMH) levels were analyzed in 11 patients and cancer antigen 125 (CA125) levels in 16 patients. RESULTS In this study, 99 cumulus-oocyte complexes were obtained from 17 patients (63%). The mean (SE) age of the patients was 33.47±1.86 years (range 16-44). A total of 14 patients had ovarian cancer (IA-IVB), one patient had ovarian cancer IC and endometrial cancer IA, one patient had endometrial cancer stage IA with metastasis into the ovary, and one patient had cervical cancer stage IIB with metastasis in the ovary. Oocytes were not obtained in 10 patients who had diminished ovarian reserve due to age (>38 years), chemotherapy, or previous surgical treatment. On average, 5.8 cumulus-oocyte complexes were obtained per patient. The maturation rate was 40.4% with an average of 2.8 metaphase II oocytes per patient. As a result of the study, 3 blastocysts in 3 patients and 22 oocytes in 9 patients were vitrified. CONCLUSIONS In vitro maturation of oocytes collected from oophorectomy samples in patients with malignant ovarian tumors may result in oocyte and blastocyst vitrification. However, it should be offered to patients before surgery and chemotherapy. This method might be most beneficial in patients younger than 38 years, with AMH serum levels >1 ng/mL and without a large tumor burden.
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Affiliation(s)
- Ekaterina Bunyaeva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Anastasia Kirillova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Grigory Khabas
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexandra Asaturova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Nona Mishieva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Tatiana Nazarenko
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Aydar Abubakirov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Gennady Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, named after Academic V.Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Huang Y, Ming X, Li B, Li Z. Histological Characteristics and Early-Stage Diagnosis Are Associated With Better Survival in Young Patients With Epithelial Ovarian Cancer: A Retrospective Analysis Based on Surveillance Epidemiology and End Results Database. Front Oncol 2020; 10:595789. [PMID: 33425749 PMCID: PMC7787102 DOI: 10.3389/fonc.2020.595789] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/19/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To analyze the potential prognostic factors of epithelial ovarian cancer (EOC) in women aged under 35 compared to those aged 60-79. METHODS Cases were retrospectively obtained from SEER database. Clinical characteristics, such as race, histological type, AJCC stage, laterality of tumors, CA125 results, and surgical strategies, were analyzed in < 35 years group and 60-79 years group. Kaplan-Meier survival curves were used to evaluate overall survival (OS) and cause-specific survival (CSS). Cox proportional hazard model was used to identify the predictors for CSS. RESULTS Sixteen thousand eight hundred forty-seven EOC patients diagnosed in 2004-2015 were identified from SEER database, with 1,015 aged under 35 and 15,833 aged 60-79. In < 35 years group, mucinous (32.2%) was the most common histological type, followed by high-grade serous (26.6%) and endometrioid (18.3%), while in 60-79 years group, high-grade serous (68.3%) represented the leading histological type. Most young women were diagnosed at stage I (57.7%), while most old women were diagnosed at stage (48.1%). Both 5-year OS and 5-year CSS were higher in < 35 years group (5-year OS: 76.00% vs 40.18%, p < 0.001; 5-year CSS: 83.56% vs 55.18%, p < 0.001). The multivariate analysis identified histological type and stage as prognostic factors for CSS in both groups. Endometrioid represented a positive predictor for CSS, while carcinosarcoma and malignant Brenner were related to a worse CSS. (< 35 years group: carcinosarcoma vs endometrioid: HR 5.630, p=0.024; malignant Brenner vs endometrioid: HR 4.005, p < 0.001; 60-79 years group: carcinosarcoma vs endometrioid: HR 3.606, p < 0.001; malignant Brenner vs endometrioid: HR 2.291, p < 0.001). Tumors laterality, CA125 levels, surgery and lymphadenectomy failed to be associated with the CSS in < 35 years group, while found to be independent risk factors in 60-79 years group. CONCLUSION EOC women aged under 35 had a better survival outcome over EOC women aged 60-79, owing to high proportion of endometrioid and mucinous types in histology, as well as early-stage diagnosis. Identification of histological types and gene profiles should be underscored in young EOC patients.
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Affiliation(s)
- Yue Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiu Ming
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Bingjie Li
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center, Chengdu, China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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