Use of tumor markers to distinguish endometriosis-related ovarian neoplasms from ovarian endometrioma

Potential Efficacy of Inflammatory Response Markers for the Detection of Ovarian Cancer in Patients with Endometrioma

Background

This study evaluated the effectiveness of preoperative inflammatory response markers in distinguishing clear cell carcinoma (CCC) and endometrioid carcinoma (EC) from ovarian endometrioma.

Methods

Patients with stage I ovarian cancer with histology CCC/EC or endometrioma who underwent surgery at our institution between 2010 and 2021 were included. Preoperative inflammatory response markers evaluated were white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, D-dimer, neutrophil/lymphocyte ratio (NLR), platelet count/lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The tumor markers CA125 and CA19-9 were analyzed. The median values of these markers were compared between the CCC/EC and the endometrioma groups. The areas under the curve (AUC) in Receiver Operating Characteristic analysis were compared.

Results

Fifty patients with stage I CCC/EC and 247 patients with endometrioma were included in the study. Inflammatory response markers were significantly higher in CCC/EC cases than in endometrioma cases (P < 0.01). Tumor markers demonstrated higher specificity than inflammatory response markers. The AUCs of CRP, ESR, D-dimer, NLR, and SII were significantly higher than those of CA125 and CA19-9 (P < 0.01). The values of NLR, PLR, and SII in four cases of ovarian cancer with preoperative suspected endometrioma were higher than the cut-off value.

Conclusion

Inflammatory response markers may be useful for the detection of stage I ovarian cancer. Notably, the NLR or SII, calculated using a complete blood count, appears particularly efficient. Combining tumor and inflammatory response markers may enhance diagnostic accuracy in distinguishing ovarian cancer from endometrioma.

Rectus Abdominis Muscle Endometriosis: A Unique Case Report with a Literature Review

Introduction and importance: Extrapelvic endometriosis, confined exclusively to the body of the rectus abdominis muscle, is a rare form of abdominal wall endometriosis. While its etiopathology remains unclear, it is often diagnosed in healthy women who present with atypical symptoms and localization unrelated to any incision site, or in the absence of a history of endometriosis or previous surgery. Presentation of the case: Here, we describe a unique case of intramuscular endometriosis of the rectus abdominis muscle in a healthy 39-year-old Caucasian woman. The condition was located away from any prior incisional scars and presented without typical symptoms or concurrent pelvic disease, making diagnostic imaging unclear. After partial surgical resection of the endometriotic foci, the diagnosis was confirmed histologically. Progestogen-based supportive medication was initiated to prevent the need for additional surgeries and to reduce the risk of recurrence. After 6 years of follow-up and continued progestogen treatment, the patient remains symptom-free and has shown no recurrence of the disease. Clinical discussion: Endometriosis of the rectus abdominis muscle exhibits specific characteristics in terms of localization, etiopathology, symptomatology, and diagnostic imaging, suggesting that it should be considered a distinct clinical entity. Conclusions: Although rare, primary endometriosis of the rectus abdominis muscle should be included in the differential diagnosis for women of childbearing age. Early diagnosis is essential to avoid delayed recognition, tissue damage, and to minimize the risk of recurrence or malignant transformation. Given the increasing frequency of gynecologic and laparoscopic surgeries worldwide, it is crucial to establish standardized reporting protocols, follow-up timelines, and imaging assessments during specific phases of the menstrual cycle. Standardization will help raise awareness of this disease, and further our understanding of its pathogenesis, risk factors, recurrence patterns, and potential for malignant transformation-factors that are still not fully understood.

Endometrioid adenocarcinoma arising from abdominal wall endometriosis: A case report and literature review

Endometriosis, affecting 6%-10% of women of reproductive age, can lead to severe symptoms such as chronic pelvic pain and infertility. Among its rarer manifestations is abdominal wall endometriosis (AWE), which has been increasingly reported following cesarean deliveries. This case discusses a 39-year-old woman who presented with a 13-year history of cyclical pain at her cesarean section scar, exacerbated over the last year by the development of a painful abdominal mass. Medical evaluations indicated endometriosis at the scar, with further investigations including ultrasound and magnetic resonance imaging showing involvement of the rectus abdominis muscle. Elevated tumor markers HE4 and CA-125, along with a biopsy, confirmed adenocarcinoma. The patient underwent extensive surgical treatment, including the resection of the mass, hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pathology confirmed moderately differentiated infiltrative adenocarcinoma originating from endometriosis. Despite the absence of postoperative chemotherapy, the patient showed no recurrence, emphasizing the effectiveness of comprehensive surgical management. This case highlights the critical importance of recognizing the potential for malignant transformation in AWE, particularly following cesarean deliveries, and underscores the necessity for vigilant monitoring and personalized treatment strategies. The management of AWE, especially when malignant transformation is suspected, necessitates a multidisciplinary approach similar to that used in ovarian cancer, focusing on rigorous surgical intervention and the potential for adjuvant therapies.

Research progress in endometriosis-associated ovarian cancer

Endometriosis-associated ovarian cancer (EAOC) is a unique subtype of ovarian malignant tumor originating from endometriosis (EMS) malignant transformation, which has gradually become one of the hot topics in clinical and basic research in recent years. According to clinicopathological and epidemiological findings, precancerous lesions of ovarian clear cell carcinoma (OCCC) and ovarian endometrioid carcinoma (OEC) are considered as EMS. Given the large number of patients with endometriosis and its long time window for malignant transformation, sufficient attention should be paid to EAOC. At present, the pathogenesis of EAOC has not been clarified, no reliable biomarkers have been found in the diagnosis, and there is still a lack of basis and targets for stratified management and precise treatment in the treatment. At the same time, due to the long medical history of patients, the fast growth rate of cancer cells, and the possibility of eliminating the earliest endometriosis-associated ovarian cancer, it is difficult to find the corresponding histological evidence. As a result, few patients are finally diagnosed with EAOC, which increases the difficulty of in-depth study of EAOC. This article reviews the epidemiology, pathogenesis, risk factors, clinical diagnosis, new treatment strategies and prognosis of endometriosis-associated ovarian cancer, and prospects the future direction of basic research and clinical transformation, in order to achieve stratified management and personalized treatment of ovarian cancer patients.

New insights about endometriosis-associated ovarian cancer: pathogenesis, risk factors, prediction and diagnosis and treatment

Previous studies have shown that the risk of malignant transformation of endometriosis in premenopausal women is approximately 1%, significantly impacting the overall well-being and quality of life of affected women. Presently, the diagnostic gold standard for endometriosis-associated ovarian cancer (EAOC) continues to be invasive laparoscopy followed by histological examination. However, the application of this technique is limited due to its high cost, highlighting the importance of identifying a non-invasive diagnostic approach. Therefore, there is a critical need to explore non-invasive diagnostic methods to improve diagnostic precision and optimize clinical outcomes for patients. This review presents a comprehensive survey of the current progress in comprehending the pathogenesis of malignant transformation in endometriosis. Furthermore, it examines the most recent research discoveries concerning the diagnosis of EAOC and emphasizes potential targets for therapeutic intervention. The ultimate objective is to improve prevention, early detection, precise diagnosis, and treatment approaches, thereby optimizing the clinical outcomes for patients.

Spontaneously ruptured endometriomas presenting with symptoms and imaging findings worrisome for carcinomatosis: A case report

INTRODUCTION AND IMPORTANCE

Endometriomas are the most common presenting subtype of endometriosis. Although most endometriomas are asymptomatic, patients can rarely present acutely with spontaneous rupture causing diffuse peritonitis and severe systemic inflammatory response.

CASE PRESENTATION

Here we describe a case of ruptured endometriomas in a 26-year-old nulligravid female with a history of heavy menses, progressive abdominal distension, and a recent urinary tract infection. The patient presented to the emergency department with upper abdominal pain radiating to her back with associated nausea. Computed tomography (CT) scan demonstrated diffuse ascites with a large, multilobulated, and multicystic septated mass arising in the right pelvis and extending into the lower abdomen. Findings were concerning for peritoneal carcinomatosis and the patient was admitted for evaluation. She developed progressive signs of sepsis and was emergently brought to the operating room for surgical exploration on hospital day (HD) number two. She was found to have ruptured pelvic cysts arising from both ovaries with diffuse contamination of the abdomen by cyst contents and bilateral salpingo-oophorectomy (BSO) was performed. Final pathology demonstrated benign bilateral endometriomas.

CLINICAL DISCUSSION

Endometrioma rupture is extremely rare and imaging findings may appear to represent disseminated peritoneal malignancy. CT findings demonstrating a pelvic mass with concurrent ascites should raise clinical suspicion for ruptured endometrioma, particularly in younger patients.

CONCLUSION

Prompt surgical exploration and complete resection of pathologic tissue may be necessary for diagnosis and treatment in some patients with clinical deterioration related to perforated endometriomas. Combined oral contraceptives are recommended in the postoperative period.

ncRNA-mediated low expression of P2RY14 correlates with poor prognosis and tumor immune infiltration in ovarian carcinoma

Background

Ovarian cancer (OV) has been puzzling clinicians because of its poor prognosis. More and more evidence show that the G protein coupled receptor P2RY14 plays a key role in the initiation and progression of various types of human cancer. The purpose of our study is to explore the correlation between P2RY14 and the prognosis of ovarian cancer patients and the relevant mechanism.

Methods

First, the differentially expressed gene P2RY14 was screened from The Cancer Genome Atlas (TCGA) database. Explored possible P2RY14 related miRNAs and lncRNAs through multiple public databases, predicted and analyzed the expression level of candidate miRNAs and candidate lncRNAs that can bind to candidate miRNAs in OV through StarBase database. The TIMER database was used to comprehensively analyze the expression of tumor infiltrating immune cells, and to analyze the correlation between the expression level of P2RY14 and the level of immune cell infiltration in OV or the expression level of immune checkpoints.

Results

Patients with P2RY14 overexpression had better overall survival (OS) and progression-free interval (PFI). In the Targetscan database, 22 upstream miRNAs that may bind to P2RY14 were predicted. According to the regulatory network constructed by the Cytoscape software, correlation analysis and the role of miRNAs in the prognosis of OV, we first determined that the candidate miRNAs were miR-34c-5p. Then, we predicted the upstream lncRNAs of miR-34c-5p in the StarBase database, the expression level of these lncRNAs in OV in the Gene Expression Profiling Interactive Analysis (GEPIA) database, and the role in prognosis. We determined that LINC00665 is the most potential lncRNA upstream of ovarian cancer miRNA (hsa-miR-34c-5p)-P2RY14. Then, we analyzed the results in the Timer database, suggesting that P2RY14 expression was positively correlated with CD8⁺T Cell, CD4⁺T Cell, Macrophage, Neutral and Dendritic cells, and negatively correlated with B cells. Meanwhile, P2RY14 was positively correlated with CD274 and PDCD1.

Conclusions

P2RY14 can be used as a new predictive biomarker of ovarian cancer. Intervention of P2RY14 can affect the prognosis of ovarian cancer by affecting LINC00665-miR-34c-5p-P2RY14 axis. These findings provide a potential target for the development of anti-cancer strategies for ovarian cancer.

Multivariate logistic regression analysis of the correlation between five biomarkers and ovarian cancer in patients with intermediate-risk: A prospective cross-sectional study

Objective: To find potential diagnostic biomarkers for ovarian cancer (OC), a prospective analysis of the expression of five biomarkers in patients with intermediate-risk and their correlation with the occurrence of OC was conducted.

Method: A prospective observational study was carried out, patients who underwent surgical treatment with benign or malignant ovarian tumors in our hospital from January 2020 to February 2021 were included in this study, and a total of 263 patients were enrolled. Based on the postoperative pathological results, enrolled patients were divided into ovarian cancer group and benign tumor group (n = 135). The ovarian cancer group was further divided into a mid-stage group (n = 46) and an advanced-stage group (n = 82). The basic information of the three groups of patients was collected, the preoperative imaging data of the patients were collected to assess the lymph node metastasis, the preoperative blood samples were collected to examine cancer antigen 125 (CA125), carbohydrate antigen 19–9 (CA19–9), Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and the postoperative pathological data were sorted and summarized.

Result: The average during of disease in the advanced ovarian cancer group was 0.55 ± 0.18 years higher than the benign tumor group (0.43 ± 0.14 years), p < 0.001. In the advanced ovarian cancer group, the ratio of patients with the tumor, node, metastasis (TNM) stage IV (64.63%), with tumor Grade stage II and III (93.90%), and without lymph node metastasis (64.63%) was respectively more than that in the mid-stage group (accordingly 0.00, 36.96, 23.91%) (p < 0.001); The ratio of patients with TNM grade III in the mid-stage group (73.91%) was more than that in the advanced group (35.37%) (p < 0.001). The levels of the five biomarkers: CA19-9, CA125, NLR, PLR, and BDNF were different among the three groups (p < 0.001).

Conclusion: CA19-9, CA125, NLR, PLR, BDNF are five biomarkers related to the occurrence of ovarian cancer and are risk factors for it. These five biomarkers and their Combined-Value may be suitable to apply in the diagnosis and the identification of ovarian cancer in patients with intermediate-risk.

Clear cell carcinoma arising from abdominal wall endometriosis-a report on two cases and literature review

Background

Malignant transformation of abdominal wall endometriosis is extremely rare. Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis. To date, approximately, thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide.

Case presentation

We report two cases of clear cell carcinoma developing postoperatively in the anterior abdominal wall in women with a history of extensive endometriosis. Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma. These histological features satisfied Sampson’s criteria which are required for diagnosing malignant endometriosis. Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery.

Conclusion

Clear cell carcinoma arising from the abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize. Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking. Clinicians must have a high index of suspicion for malignant endometriosis of the abdominal wall, particularly in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis. By presenting our case, we expect to raise awareness and study of this rare endometriosis-related neoplasm.

Establishment of Multiple Parameter Reference Intervals for Different Age Groups in Qingdao, China

In this article, we have explored the establishment of multiple parameter reference intervals for different age groups in Qingdao, China. According to the age of subjects, the healthy adult population of different ages in Qingdao was randomly selected as the research object. According to the age of subjects, they were divided into 18–24-year-old, 25–39-year-old, 40–49-year-old, 50–64-year-old, and >65-year-old groups, respectively. The sample size of each age group was 120 male and female samples, and 60 male and female samples of >65-year-old subjects were selected. The data of subjects were collected, a questionnaire survey was completed, serum samples were collected, and the parameters of male and female groups of different ages in Qingdao were compared. The parameters of the male and female groups were compared in the same age group. The reference intervals of parameters of the male and female groups were compared in different ages. There were significant differences in the levels of FBG, AST, BUN, Cr, Hb, FT3, TT3, FT4, TT4, VB12, PROG, CYFRA 21-1, and SCC among men of different ages (P < 0.05). Among them, the levels of FBG, AST, BUN, VB12, CYFRA 21-1, and SCC in >65-year-old men were significantly higher than those in 18–24-years-old men, and the levels of Hb, FT3, TT3, FT4, TT4 in >65-year-old men were significantly lower than those in 18–24-year-old men (P < 0.05). There were significant differences in FBG, ALT, AST, BUN, Cr, Hb, TSH, FT3, TT3, FT4, TT4, VB12, CYFRA 21-1, anti-TPO, and ferritin levels among women of different ages (P < 0.05). Among them, the levels of FBG, ALT, AST, BUN, and ferritin in women aged >65 were significantly higher than those in women aged 18–24 (P < 0.05). The levels of FBG, ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4, TT4, and VB12 in women aged 50–64 were significantly higher than those in women aged 25–39, and the levels of TSH were significantly lower than those in women aged 25–39 and significantly higher than those of the female population aged 40–49 (P < 0.05). The levels of ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4 and ferritin in males aged 18–24 were significantly higher than those in females, while the levels of TSH, VB12 in males aged 18–24 were significantly lower than those in females (P < 0.05). The levels of FBG, ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4 and ferritin in males aged 25–39 were significantly higher than those in females, while the levels of TSH, VB12, CYFRA 21-1 in males aged 25–39 were significantly lower than those in females (P < 0.05). The levels of FBG, ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4, CYFRA 21-1 and ferritin in males aged 40-49 were significantly higher than those in females, and the levels of VB12, anti-TG, anti-TPO in males aged 40-49 were significantly lower than those in females (P < 0.05). The levels of FBG, ALT, BUN, Cr, FT3, TT3 and ferritin in males aged 50-64 were significantly higher than those in females, while the levels of VB12, anti-TG in males aged 50-64 were significantly lower than those in females (P < 0.05). The levels of Cr, Hb and ferritin in males >65 years old were significantly higher than those in females (P < 0.05). The reference intervals of various parameters are different among different ages and genders. The establishment of multiparameter reference intervals for different age groups in Qingdao, China, is of great significance for the early diagnosis and evaluation of various diseases in Qingdao, China, so as to reduce the missed diagnosis rate of diseases and improve people's quality of life.

The Search for Biomarkers in Endometriosis: a Long and Windy Road

Endometriosis is a complex and chronic estrogen-dependent disease, affecting a significant proportion of women of reproductive age. Despite the long interest and extensive research, the pathogenesis of the disease is still debated. Although available non-invasive diagnostic methods have adequate accuracy, an invasive approach by laparoscopy is often necessary to obtain histological confirmation. In this scenario, the search for an accurate, reliable, cost-effective, clinically applicable non-invasive biomarker plays a crucial role in a potentially early diagnosis and, in this way, shape the future management of the disease. Considering these elements, the current review aims to summarize the most significant and novel results about biomarkers for the diagnosis and follow-up of women affected by endometriosis.

A Review of the Clinical Characteristics and Novel Molecular Subtypes of Endometrioid Ovarian Cancer

Ovarian cancer is one of the most common gynecologic cancers that has the highest mortality rate. Endometrioid ovarian cancer, a distinct subtype of epithelial ovarian cancer, is associated with endometriosis and Lynch syndrome, and is often accompanied by synchronous endometrial carcinoma. In recent years, dysbiosis of the microbiota within the female reproductive tract has been suggested to be involved in the pathogenesis of endometrial cancer and ovarian cancer, with some specific pathogens exhibiting oncogenic having been found to contribute to cancer development. It has been shown that dysregulation of the microenvironment and accumulation of mutations are stimulatory factors in the progression of endometrioid ovarian carcinoma. This would be a potential therapeutic target in the future. Simultaneously, multiple studies have demonstrated the role of four molecular subtypes of endometrioid ovarian cancer, which are of particular importance in the prediction of prognosis. This literature review aims to compile the potential mechanisms of endometrioid ovarian cancer, molecular characteristics, and molecular pathological types that could potentially play a role in the prediction of prognosis, and the novel therapeutic strategies, providing some guidance for the stratified management of ovarian cancer.