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Gagliardi T, Adejolu M, deSouza NM. Diffusion-Weighted Magnetic Resonance Imaging in Ovarian Cancer: Exploiting Strengths and Understanding Limitations. J Clin Med 2022; 11:1524. [PMID: 35329850 PMCID: PMC8949455 DOI: 10.3390/jcm11061524] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
Detection, characterization, staging, and response assessment are key steps in the imaging pathway of ovarian cancer. The most common type, high grade serous ovarian cancer, often presents late, so that accurate disease staging and response assessment are required through imaging in order to improve patient management. Currently, computerized tomography (CT) is the most common method for these tasks, but due to its poor soft-tissue contrast, it is unable to quantify early response within lesions before shrinkage is observed by size criteria. Therefore, quantifiable techniques, such as diffusion-weighted magnetic resonance imaging (DW-MRI), which generates high contrast between tumor and healthy tissue, are increasingly being explored. This article discusses the basis of diffusion-weighted contrast and the technical issues that must be addressed in order to achieve optimal implementation and robust quantifiable diffusion-weighted metrics in the abdomen and pelvis. The role of DW-MRI in characterizing adnexal masses in order to distinguish benign from malignant disease, and to differentiate borderline from frankly invasive malignancy is discussed, emphasizing the importance of morphological imaging over diffusion-weighted metrics in this regard. Its key role in disease staging and predicting resectability in comparison to CT is addressed, including its valuable use as a biomarker for following response within individual lesions, where early changes in the apparent diffusion coefficient in peritoneal metastases may be detected. Finally, the task of implementing DW-MRI into clinical trials in order to validate this biomarker for clinical use are discussed, along with the trials that include it within their protocols.
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Affiliation(s)
- Tanja Gagliardi
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Margaret Adejolu
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
| | - Nandita M. deSouza
- Department of Imaging, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (T.G.); (M.A.)
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK
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2
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Serous Borderline Tumor in Transgender Female-to-Male Individuals: A Case Report of Androgen Receptor-Positive Ovarian Cancer. Case Rep Radiol 2021; 2021:8861692. [PMID: 34194862 PMCID: PMC8203387 DOI: 10.1155/2021/8861692] [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: 05/21/2020] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Ovarian cancer is the most fatal gynecologic malignancy. The incidence of ovarian cancer among female-to-male transsexuals receiving treatment with testosterone is unknown, and few cases have been reported in the literature. We report a recent case in our institution, a 23-year-old female-to-male transsexual patient who received testosterone supplementation. The patient underwent a pelvic magnetic resonance imaging to study an ovarian complex cyst that revealed the presence of a bilateral ovarian tumor with imaging features of borderline serous tumor. These masses were surgically removed and the pathology report confirmed the diagnosis associated with noninvasive peritoneal implants and the presence of numerous androgen receptors in the tumor cells. Although there is still insufficient data to validate a direct correlation between hormonotherapy and ovarian cancer in these patients, this case may reinforce previous reports on this association and highlights the relevance of radiological follow-up and bilateral salpingo-oophorectomy as part of gender reassignment surgery.
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3
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Lecointre L, Bund V, Sangnier E, Ouldamer L, Bendifallah S, Koskas M, Bolze PA, Collinet P, Canlorbe G, Touboul C, Huchon C, Coutant C, Faller E, Boisramé T, Gantzer J, Demarchi M, Lavoué V, Akladios C. Status of Surgical Management of Borderline Ovarian Tumors in France: are Recommendations Being Followed? Multicentric French Study by the FRANCOGYN Group. Ann Surg Oncol 2021; 28:7616-7623. [PMID: 33904003 PMCID: PMC8521578 DOI: 10.1245/s10434-021-09852-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 11/22/2022]
Abstract
Background Borderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines. Methods This retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy. Results The study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%; p < 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%. Conclusion The current standards for BOT management seem to be well applied.
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Affiliation(s)
- Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. .,Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Eva Sangnier
- Department of Gynecology, Hôpitaux Universitaires de Reims, Reims, France
| | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, Tours, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, Paris, France
| | - Martin Koskas
- Department of Gynecology, Hôpital Bichat, AP-HP, Paris, France
| | | | - Pierre Collinet
- Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU, Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, Paris, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, Poissy, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, Dijon, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Martin Demarchi
- Medical Oncology Department, Centre Paul Strauss, Strasbourg, France
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Rennes, France
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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4
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An Unusual Ovarian Mucinous Borderline Tumor with a Large Solid Component. Case Rep Radiol 2019; 2019:1402736. [PMID: 31240146 PMCID: PMC6556328 DOI: 10.1155/2019/1402736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022] Open
Abstract
Herein, we report magnetic resonance imaging (MRI) findings of a mucinous borderline tumor of the ovary, which we observed as a mainly solid tumor with large solid components in the lower pelvic cavity. The appearance of ovarian epithelial tumors on imaging is often complex. Cystic to solid appearing masses may be observed, and they often resemble epithelial carcinoma. Due to mucinous or hemorrhage components of packed small or microcystic components, MRI depicts slightly high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Mucinous borderline tumor of the ovary with a large solid component is very rare, but it is clinically important to recognize the possibility of mucinous borderline tumor to avoid unnecessary surgical intervention.
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5
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Oral E, Aydin O, Kumbak BA, İlvan S, Yilmaz H, Tustas E, Bese T, Demirkiran F, Arvas M. Concomitant endometriosis in malignant and borderline ovarian tumours. J OBSTET GYNAECOL 2018; 38:1104-1109. [DOI: 10.1080/01443615.2018.1441815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Engin Oral
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Ovgu Aydin
- Department of Pathology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Banu Aygun Kumbak
- Department of Obstetrics and Gynecology, İstanbul Aydin University, İstanbul, Turkey
| | - Sennur İlvan
- Department of Pathology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Handan Yilmaz
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Esra Tustas
- Umraniye Education and Research Hospital, İstanbul, Turkey
| | - Tugan Bese
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Fuat Demirkiran
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
| | - Macit Arvas
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, İstanbul University, İstanbul, Turkey
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6
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Bilyk O, Coatham M, Jewer M, Postovit LM. Epithelial-to-Mesenchymal Transition in the Female Reproductive Tract: From Normal Functioning to Disease Pathology. Front Oncol 2017; 7:145. [PMID: 28725636 PMCID: PMC5497565 DOI: 10.3389/fonc.2017.00145] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022] Open
Abstract
Epithelial-to-mesenchymal transition (EMT) is a physiological process that is vital throughout the human lifespan. In addition to contributing to the development of various tissues within the growing embryo, EMT is also responsible for wound healing and tissue regeneration later in adulthood. In this review, we highlight the importance of EMT in the development and normal functioning of the female reproductive organs (the ovaries and the uterus) and describe how dysregulation of EMT can lead to pathological conditions, such as endometriosis, adenomyosis, and carcinogenesis. We also summarize the current literature relating to EMT in the context of ovarian and endometrial carcinomas, with a particular focus on how molecular mechanisms and the tumor microenvironment can govern cancer cell plasticity, therapy resistance, and metastasis.
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Affiliation(s)
- Olena Bilyk
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Mackenzie Coatham
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Michael Jewer
- Department of Oncology, University of Alberta, Edmonton, AB, Canada.,Department of Anatomy and Cell Biology, Western University, London, ON, Canada
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7
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Kamiyama H, Shimazu A, Makino Y, Ichikawa R, Hobo T, Arima S, Nohara S, Sugiyama Y, Okumura M, Takei M, Miura H, Namekata K, Tsumura H, Okada M, Takase M, Matsumoto F. Report of a case: Retroperitoneal mucinous cystadenocarcinoma with rapid progression. Int J Surg Case Rep 2015; 10:228-31. [PMID: 25884614 PMCID: PMC4430186 DOI: 10.1016/j.ijscr.2015.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/08/2015] [Accepted: 04/03/2015] [Indexed: 10/30/2022] Open
Abstract
INTRODUCTION Retroperitoneal mucinous cystic neoplasms are uncommon, and little is known about the etiology of the disease. Malignant forms of these are extremely rare. Here, we report a case of primary retroperitoneal mucinous cystadenocarcinoma (PRMC), which demonstrated unexpectedly aggressive progression despite finding only a limited area of adenocarcinoma. PRESENTATION OF CASE A 62-year-old woman with a complaint of abdominal discomfort was admitted to the hospital. Abdominal CT and MRI showed multiple large retroperitoneal cysts dislocating the right kidney nearly to the center of the abdomen. Transabdominal resection of the cysts was performed. Those cysts contained 1100ml of mucinous fluids in total. Cytological examination of those fluids revealed no malignant cells. The cyst wall was lined with mucinous epithelial cells, and contained some ovarian-type stroma. Also, there was a focal area of adenocarcinoma in the cyst wall, and the lesion was diagnosed as primary retroperitoneal mucinous cystadenocarcinoma. Eight months later, the patient developed lumbar bone metastasis. Chemotherapy with S-1, an oral fluoropyrimidine, and docetaxel had been begun immediately; however, the disease had rapidly spread in the retroperitoneum. Eventually, the patient died of the disease 15 months after surgery. DISCUSSION Retroperitoneal mucinous cystic neoplasms are considered to be metaplasia of embryonal coelomic epithelium. Complete excision without rupture is essential. However, variance of biological aggressiveness might exist in PRMCs. CONCLUSION Retroperitoneal mucinous cystadenocarcinoma is a rare tumor, and it is urgently necessary to elucidate the etiology of an effective therapy for the disease.
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Affiliation(s)
- Hirohiko Kamiyama
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan.
| | - Ai Shimazu
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Yurika Makino
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Ryosuke Ichikawa
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Takahiro Hobo
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Shuei Arima
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Shigeo Nohara
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Yuji Sugiyama
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Masafumi Okumura
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Masahiko Takei
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Hiroyoshi Miura
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Koji Namekata
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Hidenori Tsumura
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Motoi Okada
- Department of Pathology, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Masaru Takase
- Department of Pathology, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
| | - Fumio Matsumoto
- Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama 343-8577, Japan
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8
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Alvarez RM, Vazquez-Vicente D. Fertility sparing treatment in borderline ovarian tumours. Ecancermedicalscience 2015; 9:507. [PMID: 25729420 PMCID: PMC4335965 DOI: 10.3332/ecancer.2015.507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Indexed: 01/24/2023] Open
Abstract
Borderline ovarian tumours are low malignant potential tumours. They represent 10-15% of all epithelial ovarian malignancies. Patients with this type of tumour are younger at the time of diagnosis than patients with invasive ovarian cancer. Most of them are diagnosed in the early stages and have an excellent prognosis. It has been quite clearly established that the majority of borderline ovarian tumours should be managed with surgery alone. Because a high proportion of women with this malignancy are young and the prognosis is excellent, the preservation of fertility is an important issue in the management of these tumours. In this systemic review of the literature, we have evaluated in-depth oncological safety and reproductive outcomes in women with borderline ovarian tumours treated with fertility-sparing surgery, reviewing the indications, benefits, and disadvantages of each type of conservative surgery, as well as new alternative options to surgery to preserve fertility.
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Affiliation(s)
- Rosa Maria Alvarez
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK
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9
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Karmowski M, Sobiech KA, Majda J, Rubisz P, Han S, Karmowski A. Lipid index changes in the blood serum of patients with hyperplastic and early neoplastic lesions in the ovaries. J Ovarian Res 2014; 7:90. [PMID: 25297939 PMCID: PMC4180951 DOI: 10.1186/s13048-014-0090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/21/2014] [Indexed: 11/24/2022] Open
Abstract
Background The authors used the lipid index (WL) to monitor lipid changes before and after surgery. The surgical operation performed was the simultaneous enucleation of a cystic tumor of the hilum ovarii in its entirety (with diagnosis of a simple cyst or teratoma adultum) in groups of 20 patients. Objectives To compare the lipid index WL in the blood serum of patients undergoing surgery treatment at the following times: before and 7 days after surgery, and 6 and 12 months after surgery. Material and methods The research material was the blood serum of women aged about 24 years. The authors divided the patients into 3 groups: two groups of 20 women and a control group. The concentrations of the lipid parameters were measured and the lipid index WL was calculated. Results Statistically significant differences were found between the lipid index of serum from patients with diagnosed ovarian neoplasms and the index of serum from healthy subjects; differences were demonstrated in the postoperative period, particularly 6 and 12 months after surgery. Conclusions The lipid index WL proved useful in diagnosing ovarian neoplasm (simple cysts and teratoma adultum) and in monitoring the postoperative period.
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10
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Anastasi E, Porpora MG, Pecorella I, Bernardo S, Frati L, Benedetti Panici P, Manganaro L. May increased CA125 in borderline ovarian tumor be indicative of a poor prognosis? A case report. Tumour Biol 2014; 35:6969-71. [PMID: 24740561 DOI: 10.1007/s13277-014-1898-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/26/2014] [Indexed: 02/02/2023] Open
Abstract
We present a case of a 58-year-old menopausal woman referred to our hospital for the presence of large pelvic masses diagnosed by clinical examination and pelvic ultrasound. MRI examination showed voluminous bilateral capsulated multilocular ovarian cysts slightly hyperintense on T1-weighted images with thick septa and small papillary projections. CT scan confirmed the MRI findings. Among the ovarian tumor markers analyzed (CA125, HE4, and CA72.4), only Ca125 was slightly increased (48 U/ml). These data were suggestive of mucinous ovarian tumor. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy, appendectomy, and multiple peritoneal biopsies. Pathological examination revealed bilateral borderline mucinous ovarian tumor with superficial atypical implants. Nine months later, the patient complained of left coxofemoral pain and underwent a PET/TC total body that suggested pubic bone metastases. Ovarian tumor markers were analyzed, and a second PET/TC was performed. CA125 was 252 U/ml, HE4 62 pM/L, and CA72.4 > 100 U/Ml. PET/TC was suggestive of peritoneal carcinosis. The patient was readmitted to the hospital. Clinical examination revealed small vaginal nodules. All nodules were excised. Microscopic analysis of all specimens revealed metastatic mucinous adenocarcinoma of intestinal type.The case shows that even a slight CA125 increase in the presence of a borderline ovarian tumor should not be overlooked since it can be indicative of a progressive disease. This case also highlights its additional diagnostic value when serum CA125 analysis is used in conjunction with MRI and CT imaging for the prognosis of mucinous borderline ovarian tumors (mBOTs).
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Affiliation(s)
- Emanuela Anastasi
- Department of Molecular Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy,
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11
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Trillsch F, Ruetzel JD, Herwig U, Doerste U, Woelber L, Grimm D, Choschzick M, Jaenicke F, Mahner S. Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT). J Ovarian Res 2013; 6:48. [PMID: 23837881 PMCID: PMC3708757 DOI: 10.1186/1757-2215-6-48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 06/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgery is the cornerstone for clinical management of patients with borderline ovarian tumors (BOT). As these patients have an excellent overall prognosis, perioperative morbidity is the critical point for decision making when the treatment strategy is developed and the primary surgical approach is defined. METHODS Clinical and surgical parameters of patients undergoing surgery for primary BOT at our institutions between 1993 and 2008 were analyzed with regard to perioperative morbidity depending on the surgical approach (laparotomy vs. laparoscopy). RESULTS A total of 105 patients were analyzed (44 with primary laparoscopy [42%], 61 with primary laparotomy [58%]). Complete surgical staging was achieved in 33 patients at primary surgical approach (31.4%) frequently leading to formal indication of re-staging procedures. Tumor rupture was significantly more frequent during laparoscopy compared to laparotomy (29.5% vs. 13.1%, p = 0.038) but no other intraoperative complications were seen in laparoscopic surgery in contrast to 7 of 61 laparotomies (0% vs. 11.5%, p = 0.020). Postoperative complication rates were similar in both groups (19.7% vs. 18.2%, p = 0.848). CONCLUSIONS Irrespective of the surgical approach, surgical management of BOT has acceptable rates of perioperative complications and morbidity. Choice of initial surgical approach can therefore be made independent of complication-concerns. As the recently published large retrospective AGO ROBOT study observed similar oncologic outcome for both approaches, laparoscopy can be considered for staging of patients with BOT if this appears feasible. An algorithm for the surgical management of BOT patients has been developed.
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Affiliation(s)
- Fabian Trillsch
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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12
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Wasnik AP, Menias CO, Platt JF, Lalchandani UR, Bedi DG, Elsayes KM. Multimodality imaging of ovarian cystic lesions: Review with an imaging based algorithmic approach. World J Radiol 2013; 5:113-25. [PMID: 23671748 PMCID: PMC3650202 DOI: 10.4329/wjr.v5.i3.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/16/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Ovarian cystic masses include a spectrum of benign, borderline and high grade malignant neoplasms. Imaging plays a crucial role in characterization and pretreatment planning of incidentally detected or suspected adnexal masses, as diagnosis of ovarian malignancy at an early stage is correlated with a better prognosis. Knowledge of differential diagnosis, imaging features, management trends and an algorithmic approach of such lesions is important for optimal clinical management. This article illustrates a multi-modality approach in the diagnosis of a spectrum of ovarian cystic masses and also proposes an algorithmic approach for the diagnosis of these lesions.
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13
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Winser A, Ledermann JA, Osborne R, Gabra H, El-Bahrawy MA. Survey of the management of borderline ovarian tumors in the United Kingdom. World J Obstet Gynecol 2012; 1:3-13. [DOI: 10.5317/wjog.v1.i2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Borderline ovarian tumors (BOTs) represent approximately 10% of ovarian neoplasms and are a heterogeneous group of tumors with variable biological behaviour. The majority present with disease confined to the ovary and have an excellent prognosis after surgical removal. A small proportion subsequently has recurrent 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.
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14
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Sobiczewski P, Dańska-Bidzińska A, Rzepka J, Kupryjańczyk J, Gujski M, Bidziński M, Michalski W. Evaluation of selected ultrasonographic parameters and marker levels in the preoperative differentiation of borderline ovarian tumors and ovarian cancers. Arch Gynecol Obstet 2012; 286:1513-9. [PMID: 22821506 PMCID: PMC3490072 DOI: 10.1007/s00404-012-2453-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/02/2012] [Indexed: 12/30/2022]
Abstract
Abstract Objectives In young patients with borderline tumors the fertility-sparing treatment is indicated, thus the preoperative investigation is important. The aim of this study was to perform a comparative assessment of sensitivity and specificity of selected ultrasonographic and clinical parameters for the diagnoses of borderline tumors and ovarian cancers. Methods We retrospectively analyzed 57 patients who underwent surgical treatment in the Maria Sklodowska-Curie Memorial Cancer Center from Jan 01, 2008 to Dec 31, 2009. Ovarian cancers were diagnosed in 41 patients, and borderline ovarian tumors in 16 patients. Statistical model was developed to determine independent predictive factors that would be useful in preoperative differentiation between both tumors. The model included the following factors: menopausal status, tumor morphology, wall thickness (including outgrowths), septal thickness, echogenicity, resistive index, serum CA-125 level, and free fluid in the peritoneal cavity. Results Based on the statistical model developed, independent predictive factors in the differentiation between ovarian cancers and borderline tumors included the menopausal status (P = 0.005), tumor echogenicity (P = 0.047) and the presence of free fluid in the Douglas pouch (P = 0.043). With the cutoff value of 13 (with scores below 13 indicating a borderline ovarian tumor, and scores of ≥13 indicating ovarian cancer), sensitivity was 90.2 % and specificity was 87 %. Conclusions Our proposed model of preoperative evaluation has a sensitivity of 90 % in the differentiation between ovarian cancers and borderline tumors. When combined with intraoperative findings, it allows optimal surgical therapeutic decisions to be made in patients with borderline ovarian tumors.
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Affiliation(s)
- Piotr Sobiczewski
- Gynecologic Oncology Department, The Maria Sklodowska-Curie Memorial Cancer Center, Medical University, 02-781, Warsaw, Poland.
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Singh R, Stockard CR, Grizzle WE, Lillard JW, Singh S. Expression and histopathological correlation of CCR9 and CCL25 in ovarian cancer. Int J Oncol 2011; 39:373-81. [PMID: 21637913 DOI: 10.3892/ijo.2011.1059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 03/30/2011] [Indexed: 01/22/2023] Open
Abstract
Ovarian carcinoma is the most lethal gynecological malignancy among women and its poor prognosis is mainly due to metastasis. Chemokine receptor CCR9 is primarily expressed by a small subset of immune cells. The interactions between CCL25 and CCR9 have been implicated in leukocyte trafficking to the small bowel, a frequent metastatic site for ovarian cancer cells. We have previously shown that ovarian cancer cells express CCR9 and play an important role in cell migration, invasion and survival in the presence of its natural ligand in vitro. In this study, we have evaluated the expression of CCR9 and CCL25 in ovarian cancer cells and clinical samples. Ovarian cancer tissue microarrays from University of Alabama at Birmingham and AccuMax were stained for CCR9 and CCL25. Aperio ScanScope was used to acquire 80X digital images and expression analysis of CCR9 and CCL25. Flow cytometry and the Image stream system were used to conform the expression of CCR9 and CCL25 in ovarian cancer cells. Our results show significantly higher (p<0.001) expression of CCR9 and CCL25 in serous adenocarcinoma followed by serous papillary cystadenoma, endometrioid adenocarcinoma, mucinous adenocarcinoma, cystadenoma, mucinous boderline adenocarcinoma, clear cell carcinoma, granulosa cell tumor, dysgerminoma, transitional cell carcinoma, Brenner tumor, yolk sac tumor, adenocarcinoma and fibroma cases, compared to non-neoplastic ovarian tissue. Similar to tissue expression, CCR9 was also significantly expressed by the ovarian cancer cell lines (OVCAR-3 and SK-OV-3) in comparison to normal adult ovarian epithelial cell. We provide the first evidence that CCR9 and its natural ligand CCL25 are highly expressed by ovarian cancer tissue and their expression correlates with histological subtypes. Expression of this chemokine receptor and its ligand CCL25 within primary tumor tissue further suggests a potential role of this chemokine-receptor axis in ovarian cancer progression.
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Affiliation(s)
- Rajesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
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Abreu R, Dick M, Simões Silva T, Mota F, Bettencourt E. Serous borderline tumor of the fallopian tube presented as an adnexal mass. Arch Gynecol Obstet 2010; 283:349-52. [PMID: 20232206 DOI: 10.1007/s00404-010-1410-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 02/12/2010] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Serous tumors of low malignant potential (STLMP) of the fallopian tube are uncommon and their clinical behavior is poorly understood. CASE The authors report a case of a 25-year-old patient that presented an adnexal mass following prolonged pelvic pain. She underwent an exploratory laparotomy and a solid tumor in the left fallopian tube was detected. Left adnexectomy was performed and the pathologic examination revealed a serous borderline tumor of the fallopian tube. Subsequently, the patient underwent a surgical staging procedure that included infracolic omentectomy, and multiple pelvic and abdominal peritoneal biopsies. The pathologic evaluation of all specimens revealed no malignancy. During a follow-up period of 3 years, no evidence of disease was detected. CONCLUSION Serous borderline tumors of the fallopian tube are diagnosed in the third-fourth decade and are usually discovered incidentally during routine gynecologic examination or during an elective surgery. To date, there are no reports in the literature regarding recurrence or metastatic disease of STLMP of the fallopian tube. Conservative fertility-sparing surgery proved to be a safe and equally effective treatment for patients who wished to preserve their childbearing potential.
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Affiliation(s)
- Rita Abreu
- Gynecology Department, Coimbra University Hospital, Portugal.
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Abstract
OBJECTIVE Borderline ovarian tumors comprise a unique group of noninvasive ovarian neoplasms with characteristic histology and variable tumor biology that typically manifest as low-stage disease in younger women with resultant excellent prognosis. CONCLUSION Borderline tumors are considered to be precursors of low-grade ovarian cancers. Accurate diagnosis and staging facilitate optimal patient management particularly in patients desiring to preserve fertility.
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Smith HO, Arias-Pulido H, Kuo DY, Howard T, Qualls CR, Lee SJ, Verschraegen CF, Hathaway HJ, Joste NE, Prossnitz ER. GPR30 predicts poor survival for ovarian cancer. Gynecol Oncol 2009; 114:465-71. [PMID: 19501895 DOI: 10.1016/j.ygyno.2009.05.015] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 04/30/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES GPR30 is a 7-transmembrane G protein-coupled estrogen receptor that functions alongside traditional estrogen receptors to regulate cellular responses to estrogen. Recent studies suggest that GPR30 expression is linked to lower survival rates in endometrial and breast cancer. This study was conducted to evaluate GPR30 expression in ovarian tumors. METHODS GPR30 expression was analyzed using immunohistochemistry and archival specimens from 45 patients with ovarian tumors of low malignant potential (LMP) and 89 patients with epithelial ovarian cancer (EOC). Expression, defined as above or below the median (intensity times the percentage of positive epithelial cells) was correlated with predictors of adverse outcome and survival. RESULTS GPR30 expression above the median was observed more frequently in EOC than in LMP tumors (48.3% vs. 20%, p=0.002), and in EOC was associated with lower 5-year survival rates (44.2% vs. 82.6%, Log-rank p<0.001). Tumor grade and FIGO stage, the other significant predictors of survival, were used to stratify cases into "high risk" and "low risk" groups. The 5-year survival rate for "low risk" EOC (all grade 1 and Stage I/II, grade 2) was 100%. In "high risk" EOC (all grade 3 and Stage III/IV, grade 2), the difference in 5-year survival by GPR 30 expression was significant (33.3% vs. 72.4%, p=0.001). CONCLUSIONS The novel estrogen-responsive receptor GPR30 is preferentially expressed in "high risk" EOC and is associated with lower survival rates. Further investigation of GPR30 as a potential target for therapeutic intervention in high risk EOC is warranted.
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Affiliation(s)
- Harriet O Smith
- Department of Obstetrics and Gynecology and Women's Health, Division of Gynecologic Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461-2376, USA.
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