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Takeyama N, Sasaki Y, Ueda Y, Tashiro Y, Tanaka E, Nagai K, Morioka M, Ogawa T, Tate G, Hashimoto T, Ohgiya Y. Magnetic resonance imaging-based radiomics analysis of the differential diagnosis of ovarian clear cell carcinoma and endometrioid carcinoma: a retrospective study. Jpn J Radiol 2024; 42:731-743. [PMID: 38472624 PMCID: PMC11217043 DOI: 10.1007/s11604-024-01545-z] [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] [Received: 10/23/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To retrospectively evaluate the diagnostic potential of magnetic resonance imaging (MRI)-based features and radiomics analysis (RA)-based features for discriminating ovarian clear cell carcinoma (CCC) from endometrioid carcinoma (EC). MATERIALS AND METHODS Thirty-five patients with 40 ECs and 42 patients with 43 CCCs who underwent pretherapeutic MRI examinations between 2011 and 2022 were enrolled. MRI-based features of the two groups were compared. RA-based features were extracted from the whole tumor volume on T2-weighted images (T2WI), contrast-enhanced T1-weighted images (cT1WI), and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator (LASSO) regression with tenfold cross-validation method was performed to select features. Logistic regression analysis was conducted to construct the discriminating models. Receiver operating characteristic curve (ROC) analyses were performed to predict CCC. RESULTS Four features with the highest absolute value of the LASSO algorithm were selected for the MRI-based, RA-based, and combined models: the ADC value, absence of thickening of the uterine endometrium, absence of peritoneal dissemination, and growth pattern of the solid component for the MRI-based model; Gray-Level Run Length Matrix (GLRLM) Long Run Low Gray-Level Emphasis (LRLGLE) on T2WI, spherical disproportion and Gray-Level Size Zone Matrix (GLSZM), Large Zone High Gray-Level Emphasis (LZHGE) on cT1WI, and GLSZM Normalized Gray-Level Nonuniformity (NGLN) on ADC map for the RA-based model; and the ADC value, spherical disproportion and GLSZM_LZHGE on cT1WI, and GLSZM_NGLN on ADC map for the combined model. Area under the ROC curves of those models were 0.895, 0.910, and 0.956. The diagnostic performance of the combined model was significantly superior (p = 0.02) to that of the MRI-based model. No significant differences were observed between the combined and RA-based models. CONCLUSION Conventional MRI-based analysis can effectively distinguish CCC from EC. The combination of RA-based features with MRI-based features may assist in differentiating between the two diseases.
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Affiliation(s)
- Nobuyuki Takeyama
- Department of Radiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan.
- Department of Radiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan.
| | - Yasushi Sasaki
- Department of Obstetrics and Gynecology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, Kanagawa, 227-8501, Japan
| | - Yasuo Ueda
- Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan
| | - Yuki Tashiro
- Department of Radiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan
| | - Eliko Tanaka
- Department of Radiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan
- Department of Radiology, Kawasaki Saiwai Hospital, 31-27 Ohmiya-Tyo, Saiwai-Ku, Kawasaki City, Kanagawa, 212-0014, Japan
| | - Kyoko Nagai
- Department of Radiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan
| | - Miki Morioka
- Department of Obstetrics and Gynecology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, Kanagawa, 227-8501, Japan
| | - Takafumi Ogawa
- Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan
| | - Genshu Tate
- Department of Pathology and Laboratory Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan
| | - Toshi Hashimoto
- Department of Radiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-Ku, Yokohama-City, 227-8501, Japan
| | - Yoshimitsu Ohgiya
- Department of Radiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan
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Rodrigues S, Braga M, Félix A, Cunha TM. Clear cell carcinoma of the ovary: Clues for radiologists to perform a correct diagnosis. Curr Probl Diagn Radiol 2024; 53:271-279. [PMID: 37925237 DOI: 10.1067/j.cpradiol.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
Ovarian clear cell carcinoma (OCCC) is an uncommon high-grade primary epithelial ovarian cancer, covering about 10-12 % of all ovarian malignancies. It has a strong association with endometriosis. OCCC diagnosis, at advanced stages, has an aggressive biological behaviour, and the therapeutic strategies for ovarian OCCC are somehow different from other ovarian carcinomas. Therefore, early diagnosis of these tumours is of extreme importance. As some ovarian tumours subtypes have distinguishing features, it is possible to differentiate them based on their imaging characteristics, which can guide patient management and help the clinicians and pathologists in their diagnosis. A large mass on one side of the ovary that is mostly cystic, with a focal or multifocal irregular eccentric growing solid mural nodules or projections protruding into the cystic space, may suggest clear cell carcinoma of the ovary diagnosis. The solid nodules usually have an intermediate signal on T2-weighted images. The cystic component can be either single or multilocular, and the contents may contain protein or blood. CT scanning is still the preferred method for preoperative staging and postoperative restaging, and radiologists are crucial in identifying this type of tumour. We reviewed the imaging files of patients with surgically proven clear cell carcinoma at the specimens, and our findings agree with previous studies. This paper aims to perform a comprehensive revision of OCCC's radiological and clinic-pathological features and assist radiologists in recognizing OCCC and narrowing down the possibilities of differential diagnosis.
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Affiliation(s)
- Susana Rodrigues
- Department of Radiology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto.
| | - Miguel Braga
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Ana Félix
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, NOVA Medical School, Lisbon, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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3
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Radzynski L, Boyer L, Kossai M, Mouraire A, Montoriol PF. Pictorial essay: MRI evaluation of endometriosis-associated neoplasms. Insights Imaging 2023; 14:144. [PMID: 37673827 PMCID: PMC10482819 DOI: 10.1186/s13244-023-01485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/08/2023] [Indexed: 09/08/2023] Open
Abstract
Endometriosis is a frequent pathology mostly affecting women of young age. When typical aspects are present, the diagnosis can easily be made at imaging, especially at MRI. Transformation of benign endometriosis to endometriosis-associated neoplasms is rare. The physiopathology is complex and remains controversial. Endometrioid carcinoma and clear cell carcinoma are the main histological subtypes. Our goal was to review the main imaging characteristics that should point to an ovarian or extra-ovarian endometriosis-related tumor, especially at MRI, as it may be relevant prior to surgical management.Key points• Transformation of benign endometriosis to endometriosis-associated neoplasms is rare.• MRI is useful when displaying endometriosis lesions associated to an ovarian tumor.• Subtraction imaging should be used in the evaluation of complex endometriomas.
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Affiliation(s)
- Louise Radzynski
- Department of Radiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Louis Boyer
- Department of Radiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Myriam Kossai
- Department of Pathology, Cancer Center of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Mouraire
- Department of Pathology, Cancer Center of Clermont-Ferrand, Clermont-Ferrand, France
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4
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Lu J, Zhao S, Ma F, Li H, Li Y, Qiang J. Whole-tumor ADC histogram analysis for differentiating endometriosis-related tumors: seromucinous borderline tumor, clear cell carcinoma and endometrioid carcinoma. Abdom Radiol (NY) 2023; 48:724-732. [PMID: 36401131 DOI: 10.1007/s00261-022-03742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the feasibility of whole-tumor apparent diffusion coefficient (ADC) histogram analysis for improving the differentiation of endometriosis-related tumors: seromucinous borderline tumor (SMBT), clear cell carcinoma (CCC) and endometrioid carcinoma (EC). METHODS Clinical features, solid component ADC (ADCSC) and whole-tumor ADC histogram-derived parameters (volume, the ADCmean, 10th, 50th and 90th percentile ADCs, inhomogeneity, skewness, kurtosis and entropy) were compared among 22 SMBTs, 42 CCCs and 21 ECs. Statistical analyses were performed using chi-square test, one-way ANOVA or Kruskal-Wallis test, and receiver operating characteristic curves. RESULTS A significantly higher ADCSC and smaller volume were associated with SMBT than with CCC/EC. The ADCmean was significantly higher in CCC than in EC. The 10th percentile ADC was significantly lower in EC than in SMBT/CCC. The 50th and 90th percentile ADCs were significantly higher in CCC than in SMBT/EC. For differentiating SMBT from CCC, AUCs of the ADCSC, volume, and 50th and 90th percentile ADCs were 0.97, 0.86, 0.72 and 0.81, respectively. For differentiating SMBT from EC, AUCs of the ADCSC, volume and 10th percentile ADC were 0.97, 0.71 and 0.72, respectively. For differentiating CCC from EC, AUCs of the ADCmean and 10th, 50th and 90th percentile ADCs were 0.79, 0.72, 0.81 and 0.85, respectively. CONCLUSION Whole-tumor ADC histogram analysis was valuable for differentiating endometriosis-related tumors, and the 90th percentile ADC was optimal in differentiating CCC from EC.
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Affiliation(s)
- Jing Lu
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Shuhui Zhao
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.,Department of Radiology, Xinhua Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Fenghua Ma
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.,Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai, 200011, People's Republic of China
| | - Haiming Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.,Department of Radiology, Shanghai Cancer Center, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Yong'ai Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.
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Angelina YA, Tjokroprawiro BA. Advanced Stage Clear Cell Ovarian Carcinoma Mimicking Uterine Sarcoma Without Gross Residual Tumor During Primary Surgery: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231166623. [PMID: 37056468 PMCID: PMC10088404 DOI: 10.1177/11795476231166623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
Background: Clear cell ovarian carcinoma is rare and accounts for 1%-12% of ovarian epithelial carcinomas, depending on ethnicity. The prevalence of clear cell ovarian carcinoma in Asian, White, and Black women is 11.1%%, 4.8%, and 3.1%, respectively. Magnetic resonance imaging (MRI) shows that clear cell ovarian carcinomas are typically unilocular cyst-solid (34.9%) or multilocular-solid (41.4%); only 23.7% are solid with papillary projections. MRI can detect clear cell ovarian carcinoma with a sensitivity and specificity of 90% and 87%, respectively. Notably, sometimes ovarian masses have a solid feature and should be differentiated from uterine masses. Clear cell ovarian carcinoma has a better prognosis compared to serous carcinoma when diagnosed at an early stage, but it has a poorer prognosis at an advanced stage. The absence of a residual tumor is a favorable prognostic factor in patients with advanced-stage clear cell ovarian carcinoma. Herein, we present a case in which clear cell ovarian carcinoma was misdiagnosed as uterine sarcoma because imaging showed a mass with a solid uterine-like and necrotic area. In the present case, cytoreductive surgery was performed to remove the entire tumor and its infiltration to the sigmoid colon and left ureter. Hence, the patient had a better prognosis. Case report: A 57-year-old Indonesian woman presented to our hospital (Dr. Soetomo General Hospital) with post-menopausal bleeding, a large solid pelvic mass, and abdominal discomfort. The patient was diagnosed with uterine sarcoma due to the solid feature observed during ultrasonography and MRI. During the surgery, the mass was observed to originate from the left ovary, and primary debulking surgery with a multidisciplinary team was performed with zero residual tumor tissue. The tumor was histopathologically confirmed as clear cell carcinoma. Conclusion: MRI of clear cell ovarian carcinoma can be misdiagnosed as uterine sarcoma due to its solid feature. Additionally, the enlarged mass distorts the anatomical landmarks. Surgery with no residual tumor improves the prognosis for advanced-stage clear cell ovarian carcinoma.
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Affiliation(s)
- Yoan Alexandria Angelina
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Brahmana Askandar Tjokroprawiro
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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6
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Younis JS. Endometriosis-Associated Ovarian Cancer: What Are the Implications for Women with Intact Endometrioma Planning for a Future Pregnancy? A Reproductive Clinical Outlook. Biomolecules 2022; 12:1721. [PMID: 36421735 PMCID: PMC9688199 DOI: 10.3390/biom12111721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 08/16/2023] Open
Abstract
Endometriosis is a chronic, universal, and prevalent disease estimated to affect up to 1:10 women of reproductive age. Endometriosis-associated ovarian cancer (EAOC) developing at reproductive age is challenging and of concern for women and practitioners alike. This outlook review focuses on the occurrence of EAOC, especially in infertile women or those planning for a future pregnancy, from the perspective of a reproductive endocrinologist, based on recent evidence. Contemporary pathogenesis, genetic profiles, evidence of causality, clinical diagnosis, prognosis, and up-to-date management are discussed. EAOC seems to be merely associated with endometrioma and includes clear-cell and endometrioid ovarian carcinoma. Although endometrioma is frequently found in women of reproductive age (up to 1:18 of women), EAOC appears to be a rare occurrence. These women are of more advanced reproductive age, nulliparous, and hyperestrogenic, with a large-sized unilateral endometrioma (>9 cm) containing solid components and papillary projections. Each case suspected to have EAOC has specific characteristics, and a multidisciplinary discussion and appropriate patient counseling should be conducted to reach an optimal therapeutic plan. Since most of these cases are diagnosed at an early stage with a favorable prognosis, fertility-sparing surgery may be feasible. The pros and cons of fertility preservation techniques should be discussed.
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Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel; ; Tel.: +972-505286981; Fax: +972-46737478
- Azrieli Faculty of Medicine in Galilee, Bar-Ilan University, Safed 1311502, Israel
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7
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Magnetic resonance imaging findings of cystic ovarian tumors: major differential diagnoses in five types frequently encountered in daily clinical practice. Jpn J Radiol 2022; 40:1213-1234. [PMID: 35916971 DOI: 10.1007/s11604-022-01321-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
There are many types of ovarian tumors, and these different types often form cystic masses with a similar appearance, which can make their differentiation difficult. However, with the exclusion of rare ovarian tumors, the number of ovarian tumors encountered in daily practice is somewhat fixed. It goes without saying that magnetic resonance imaging (MRI) is useful for differentiating ovarian tumors. In this review, we summarize the differential diagnoses for each of the five types of MRI findings commonly encountered in daily practice. First, unilocular cystic masses without mural nodules/solid components include benign lesions such as serous cystadenoma, functional cysts, surface epithelial inclusion cysts, paratubal cysts, and endometriosis. Second, multilocular cystic ovarian lesions include mucinous tumors and ovarian metastases. It should be noted that mucinous tumors may be diagnosed as borderline or carcinoma, even if no solid component is observed. Third, cystic lesions with mural nodules that are unrelated to endometriosis include serous borderline tumor and serous carcinoma. Cystic lesions with solid components are more likely to be malignant, but some may be diagnosed as benign. Fourth, ovarian tumors deriving from endometriosis include seromucinous borderline tumors, endometrioid carcinoma, and clear cell carcinoma. These tumors sometimes need to be differentiated from serous tumors. Finally, cystic lesions with lipid contents include teratoma-related tumors. In mature cystic teratoma, mural nodules (called "Rokitansky protuberance" or "dermoid nipple") are sometimes seen, but they do not suggest malignancy. Some of these lesions can be diagnosed accurately by considering their characteristic imaging findings, their changes over time, MRI findings other than those of the primary lesion, and information from other modalities such as tumor markers. To ensure the optimal treatment for ovarian tumors, it is important to estimate the histological type as well as to diagnose whether a lesion is benign or malignant.
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Ovarian clear cell carcinoma arising in a large endometrioma — A case report with pathological correlation and literature review. Radiol Case Rep 2022; 17:2806-2811. [PMID: 35694637 PMCID: PMC9184296 DOI: 10.1016/j.radcr.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Endometriosis-associated ovarian cancer represents the most common form of malignancy associated with this benign disease. It has a better prognosis than most types of ovarian cancer, with endometrioid adenocarcinoma and clear cell carcinoma as the main histological types. Clinical presentation is usually nonspecific and tumor biomarkers can be misleading, since they can also be elevated in the presence of benign ovarian endometriosis. We report a case of a 52-year-old woman with known ovarian and deep pelvic endometriosis, who developed ovarian clear cell carcinoma within a large endometrioma. The imaging findings highlight the key role of magnetic resonance imaging in detecting suspicious features such as loss of the “T2 shading” sign, loss of high T1 signal of an endometrioma, or the presence of mural nodules. Early detection of these malignancies is fundamental for adequate surgical treatment and overall outcome.
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Sogabe M, Kojima S, Kaya T, Tomioka A, Kaji H, Sato T, Chiba Y, Shimizu A, Tanaka N, Suzuki N, Hayashi I, Mikami M, Togayachi A, Narimatsu H. Sensitive New Assay System for Serum Wisteria floribunda Agglutinin-Reactive Ceruloplasmin That Distinguishes Ovarian Clear Cell Carcinoma from Endometrioma. Anal Chem 2022; 94:2476-2484. [PMID: 35044763 DOI: 10.1021/acs.analchem.1c04302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Wisteria floribunda agglutinin (WFA)-reactive ceruloplasmin (CP) is a candidate marker for ovarian clear cell carcinoma (CCC) reported in our previous paper. Herein, a new measurement system was developed to investigate its potential as a serum marker for CCC. Site-specific glycome analysis using liquid chromatography/mass spectrometry showed that WFA-CP from CCC binds to WFA via the GalNAcβ1,4GlcNAc (LDN) structure. We used mutant recombinant WFA (rWFA), which has a high specificity to the LDN structure, instead of native WFA, to increase the specificity of the serum sample measurement. To improve the sensitivity, we used a surface plasmon field-enhanced fluorescence spectroscopy immunoassay system, which is approximately 100 times more sensitive than the conventional sandwich enzyme-linked immunosorbent assay system. With these two improvements, the specificity and sensitivity of the serum rWFA-CP measurement were dramatically improved, clearly distinguishing CCC from endometrioma, from which CCC originates. This rWFA-CP assay can be used clinically for the serodiagnosis of early-stage CCC, which is difficult to detect with existing serum markers.
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Affiliation(s)
- Maki Sogabe
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Shun Kojima
- Konica Minolta, Inc., No. 1 Sakura-machi, Hino, Tokyo 191-8511, Japan
| | - Takatoshi Kaya
- Konica Minolta, Inc., No. 1 Sakura-machi, Hino, Tokyo 191-8511, Japan
| | - Azusa Tomioka
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Hiroyuki Kaji
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Takashi Sato
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Yasunori Chiba
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Akira Shimizu
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Nana Tanaka
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Io Hayashi
- Department of Obstetrics and Gynecology, Tokai University, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Akira Togayachi
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Hisashi Narimatsu
- Cellular and Molecular Biotechnology Research Institute, National Institute of Advanced Industrial Science and Technology, Central-5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
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Sahin H, Akdogan AI, Smith J, Zawaideh JP, Addley H. Serous borderline ovarian tumours: an extensive review on MR imaging features. Br J Radiol 2021; 94:20210116. [PMID: 34111956 DOI: 10.1259/bjr.20210116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Serous borderline ovarian tumours (SBOTs) are an intermediate group of neoplasms, which have features between benign and malignant ovarian tumours and for which, fertility-sparing surgery can be offered. MRI in imaging of SBOTs is, therefore, crucial in raising the possibility of the diagnosis, in order to present the patient with the most appropriate treatment options. There are characteristic MRI features that SBOTs demonstrate. In addition, recent advanced techniques, and further classification into subtypes within the borderline group have been developed. The aim of this article is to review the MRI features of SBOT and provide the reporter with an awareness of the imaging tips and tricks in the differential diagnosis of SBOT.
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Affiliation(s)
- Hilal Sahin
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Asli Irmak Akdogan
- Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jeries Paolo Zawaideh
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Addley
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Gadducci A, Multinu F, Cosio S, Carinelli S, Ghioni M, Aletti GD. Clear cell carcinoma of the ovary: Epidemiology, pathological and biological features, treatment options and clinical outcomes. Gynecol Oncol 2021; 162:741-750. [PMID: 34247767 DOI: 10.1016/j.ygyno.2021.06.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022]
Abstract
Clear cell carcinoma of the ovary is a rare and distinct histotype of epithelial ovarian carcinomas. Women diagnosed with clear cell carcinomas are usually younger and diagnosed at earlier stages than those with the most common high-grade serous histology. Endometriosis is considered a main risk factor for the development of clear cell carcinoma of the ovary, and it can be considered a precursor of of this tumor, as it is identified in more than 50% of patients with clear cell carcinoma. Different molecular pathways and alterations heve been identified in ovarian clear cell carcinoma, including the most common mutations of AT-rich interaction domain 1A [ARID1A] and phosphatidylinositol-4,5-bisphosphate 3-kinase [PIK3] catalytic subunit alpha [PIK3CA]. The prognosis of patients at early stage is favorable, while patients with advanced or recurrent disease experience a poor oncologic outcomes. Despite a lower rate of responses due to an intrinsic chemoresistance, the treatment strategy for advanced disease resembles the treatment of high-grade serous carcinoma, which includes aggressive cytoreductive surgery and platinum-based chemotherapy. For this reason, the role of adjuvant chemotherapy in patients with stage I disease undergoing complete surgical staging is still under debate. Alternative treatments, including biological agents that target different pathways constitute the most promising treatment strategies, and well-designed, collaborative international trials should be designed in order to improve the oncologic outcomes and the quality of life of patients with this aggressive disease.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Francesco Multinu
- Department of Gynecologic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Stefania Cosio
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Silvestro Carinelli
- Division of Pathology and Laboratory Medicine, IRCCS European Institute of Oncology, Milan, Italy
| | - Mariacristina Ghioni
- Division of Pathology and Laboratory Medicine, IRCCS European Institute of Oncology, Milan, Italy
| | - Giovanni Damiano Aletti
- Department of Gynecologic Surgery, IRCCS European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
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Assessing CT imaging features combined with CEA and CA125 levels to identify endometriosis-associated ovarian cancer. Abdom Radiol (NY) 2021; 46:2367-2375. [PMID: 32424610 DOI: 10.1007/s00261-020-02571-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To improve the diagnosis and identification of ovarian clear cell carcinoma (CCC) and ovarian endometrioid carcinoma (EC), we evaluated CT imaging findings and cut-off values for CEA and CA125. METHODS The CT features and tumour markers (tumour size, location, morphology, composition, number of cysts, growth pattern of the mural nodules, mural nodule HWR, enhancement of the mural nodules, ascites, complications, CEA level, CA125 level) of 55 tumours in 52 patients with CCC, confirmed by surgery and pathology at the Yunnan Cancer Hospital from January 1, 2012 to December 30, 2018, were compared with those of 41 tumours in 36 patients with EC. All patients had a long history of endometriosis. Statistical analysis was performed using t test, chi-square test, Mann-Whitney U test, univariate analysis, multivariate logistic regression analysis and receiver-operating characteristic (ROC) curves. RESULTS CCC and EC presented as large oval or irregular mixed cystic-solid masses in the pelvic region, with moderately delayed enhancement of the solid components. There was a statistically significant difference between the number of cysts, the growth pattern of the mural nodules, the presence/absence of ascites, and the levels of CEA and CA125 (P < 0.05). Most CCCs had unilocular cysts, mural nodules that were polypoid structures, and no ascites (46/55, 33/55, 42/55); most ECs had multilocular cysts and broad-based nodular structures and were ascites positive (28/41, 31/41, 21/41). The CEA positive rate was lower in the CCC group than in the EC group (2/52, 3.8% versus 11/36, 30.6%, P < 0.05), and the CA125 positive rate was high in both the CCC and EC groups (44/52, 84.6% versus EC = 35/36, 97.2%, P = 0.118). The ROC curves revealed that when the values of CEA and CA125 were higher than the cut-off values (CEA = 3.270 µg/L, CA125 = 589.400 kU/L), the diagnostic efficiency of CEA was 0.723, and the diagnostic specificity of CEA was as high as 0.903. CONCLUSIONS The number of cysts, growth pattern of the mural nodules, presence/absence of ascites, and levels of CEA and CA125 were useful factors for distinguishing CCC from EC; the best cut-off values of CEA and CA125 for distinguishing CCC from EC were 3.270 and 589.40, respectively. These findings may be helpful for correctly diagnosing and identifying CCC and EC.
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Current update on malignant epithelial ovarian tumors. Abdom Radiol (NY) 2021; 46:2264-2280. [PMID: 34089360 DOI: 10.1007/s00261-021-03081-0] [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: 01/23/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023]
Abstract
Epithelial ovarian cancer (EOC) represents the most frequently occurring gynecological malignancy, accounting for more than 70% of ovarian cancer deaths. Preoperative imaging plays an important role in assessing the extent of disease and guides the next step in surgical decision-making and operative planning. In this article, we will review the multimodality imaging features of various subtypes of EOC. We will also discuss the role of imaging in the staging, management, and surveillance of EOC.
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Su Y, Deng L, Yang L, Yuan X, Xia W, Liu P. Magnetic resonance imaging for the non-invasive diagnosis in patients with ovarian cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23551. [PMID: 33327306 PMCID: PMC7738010 DOI: 10.1097/md.0000000000023551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In developed nations, ovarian cancer has resulted in the most fatalities from gynecological cancer. Laparoscopy is primarily utilized as the test to diagnose ovarian cancer. Besides being costly, there are surgical risks associated with laparoscopies. At present, clinical practitioners have access to non-invasive tests for diagnosing ovarian cancer. This study aims to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for diagnosing ovarian cancer. METHODS In order to obtain eligible studies, cross-sectional studies or randomized controlled trials are searched in electronic databases. The databases include 5 English databases (PubMed, the Cochrane Library, PsycINFO, EMBASE, and Web of Science) and 3 Chinese databases (China Biomedical Literature Database, China National Knowledge Infrastructure, and WanFang database). The databases are searched from their origin to October 2020. Quality Assessment of Diagnostic Accuracy Studies-2 is used to assess the methodological quality of the selected studies. RevMan 5.3 and SAS NLMIXED software are used to assess the data synthesis, sensitivity analysis, and risk of bias assessment. RESULTS This study evaluates the pooled diagnostic value of MRI for diagnosing ovarian cancer. CONCLUSIONS This study will summarize previously published evidence of MRI in relation to diagnosing ovarian cancer. ETHICS AND DISSEMINATION Since this study does not utilize data from patients, this protocol does not require ethical approval. PROTOCOL REGISTRATION NUMBER DOI 10.17605/OSF.IO/A6SPQ (https://osf.io/a6spq).
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Affiliation(s)
| | | | - Lijun Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province
| | | | - Wei Xia
- Department of Radiology
- Department of Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
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Samiee-Rad F, Ghaebi M, Bajelan A. Bilateral Primary Ovarian Clear Cell Carcinoma in an Iranian Woman: a Case Report. Indian J Surg Oncol 2020; 12:181-185. [PMID: 33994744 DOI: 10.1007/s13193-020-01234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Fatemeh Samiee-Rad
- Faculty of Medical School, Qazvin University of Medical Sciences, Bahonar St, Qazvin, Iran
| | - Mahdi Ghaebi
- General Physician, Qazvin University of Medical Sciences, Bahonar St, Qazvin, Iran
| | - Arezoo Bajelan
- General Physician, Qazvin University of Medical Sciences, Bahonar St, Qazvin, Iran
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