Clinical characteristics of patients with reproductive dysfunction and benign ovarian neoplasms

The study reports on the analysis of the anamnestic data of2044 women with reproductive disorders who underwent operative interventions for tumors and tumorlike masses of the ovaries during the period of 1989-1999 in the Research Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences. A high incidence rate о f complicated anamnesis and the coexisting somatic and extragenital diseases was revealed. The data are presented concerning the status of menstrual and reproductive function of the patients examined.

Brenner tumors

Brenner tumors are rare ovarian neoplasms composed of ovarian transition cells surrounded by dense fibrous tissue. Most of them are small tumors (<2 cm), detected incidentally in asymptomatic women. Its predominantly fibrous content results in relatively low signal on T2 weighted images, establishing differential diagnosis with ovarian fibroma and thecoma. Their imaging features are very similar, the differentiation is based on secondary characteristics, such as signs or symptoms of estrogen excess and the presence of a second ovarian neoplasm, which has been reported in up to 30% of patients with Brenner tumor. Although originally thought to be universally benign, there have been scattered reports in the past decades of borderline and malignant forms of Brenner tumors.

CLINICOPATHOLOGICAL STUDY OF OVARIAN NEOPLASMS – AN INSTITUTIONAL PERSPECTIVE

Objective: The objective of the study was to know the frequency and histomorphological patterns of ovarian neoplasms concerning age. Methods: A 2-year retrospective study was done in the pathology department, GITAM Institute of Medical Sciences and Research. Data were retrieved from laboratory records, H & E slides of ovarian biopsies of diagnosed neoplasms were screened. Results: During the study period, 70 ovarian neoplasms were reported. Ovarian tumors were categorized according to the WHO classification. In this study surface, epithelial tumors were most common at 87.14% followed by germ cell tumors at 11.42% and sex cord-stromal tumors at 1.42%. Serous cystadenoma was the most common benign surface epithelial tumor. Conclusion: Histopathology is the gold standard for diagnosing ovarian neoplasms. Newer diagnostic techniques such as immunohistochemistry and morphometric analysis help decide management and prognosis.

Biomarkers in Ovarian Pathology: From Screening to Diagnosis. Review of the Literature

Background: Ovarian cancer has a low incidence, but high mortality due to a habitual diagnosis in advanced cancer stages. Currently, used biomarkers have good sensitivity, but low specificity. Aim: To determine the usefulness of the biomarkers and algorithms used up to now in the screening, diagnosis, response to treatments and identification of recurrence in patients with ovarian masses. Methodology: Systematic search of publications in English in the Medline-PubMed database with the terms: “biomarkers”, “tumour”, “tumour biomarkers”, “marker”, “tumour marker”, “ovarian cancer”, “ovarian”, “Neoplasms”, “cancer”, CA-125 Antigen; Human Epididymis-specific Protein E4; Risk of Malignancy Index (RMI); Risk of Ovarian Malignancy Algorithm (ROMA); Ovarian Neoplasms. Original articles, clinical trials, reviews, systematic reviews and meta-analyses, published between January 2000 and November 2020, were selected to determine the usefulness (among others) of CA 125 and HE4 antigen in ovarian cancer. Results: Finally, 39 transcendental publications were selected to write this article to determine the usefulness of tumour markers and algorithms in ovarian cancer. Conclusions: The usefulness of the tumour markers antigen CA125 and antigen HE4 individually or as a basis for decision-making algorithms has low specificity; however, there is little evidence that confirms their usefulness as markers in ovarian cancer screening.

Aurora-A kinase is differentially expressed in the nucleus and cytoplasm in normal Müllerian epithelium and benign, borderline and malignant serous ovarian neoplasms

Background Aurora-A kinase is important for cellular proliferation and is implicated in the tumorigenesis of several malignancies, including of the ovary. Information regarding the expression patterns of Aurora-A in normal Müllerian epithelium as well as benign, borderline and malignant epithelial ovarian neoplasms is limited. Methods We investigated Aurora-A expression by immunohistochemistry in 15 benign, 19 borderline and 17 malignant ovarian serous tumors, and 16 benign, 8 borderline, and 2 malignant ovarian mucinous tumors. Twelve fimbriae from seven patients served as normal Müllerian epithelium controls. We also examined Aurora-A protein expression by western blot in normal fimbriae and tumor specimens. Results All normal fimbriae (n = 12) showed nuclear but not cytoplasmic Aurora-A immunoreactivity by immunohistochemistry. Benign ovarian tumors also showed strong nuclear Aurora-A immunoreactivity. Forty-eight percent (13/27) of borderline tumors demonstrated nuclear Aurora-A immunoreactivity, while the remainder (52%, 14/27) lacked Aurora-A staining. Nuclear Aurora-A immunoreactivity was absent in all malignant serous tumors, however, 47% (8/17) demonstrated perinuclear cytoplasmic staining. These results were statistically significant when tumor class (benign/borderline/malignant) was compared to immunoreactivity localization or intensity (Fisher Exact Test, p < 0.01). Western blot analysis confirmed the greater nuclear Aurora-A expression in control Müllerian epithelium compared to borderline and malignant tumors. Conclusion Aurora-A kinase is differentially expressed across normal Müllerian epithelium, benign and borderline serous and mucinous ovarian epithelial neoplasms and malignant serous ovarian tumors., with nuclear expression of unphosphorylated Aurora-A being present in normal and benign neoplastic epithelium, and lost in malignant serous neoplasms. Further studies of the possible biological and clinical implications of the loss of nuclear Aurora-A expression in ovarian tumors, and its role in ovarian carcinogenesis are warranted.

Magnetic Resonance Spectroscopy for Risk Stratification of Sonographically Indeterminate Ovarian Neoplasms: Preliminary Study

We aim to assess the additional value of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) for the risk stratification of sonographically indeterminate ovarian neoplasms. A total of 21 patients with diagnosed adnexal masses between 2014 and 2017 were divided into malignant (four serous cystadenocarcinomas, four endometrioid carcinomas, three clear cell carcinomas, and one carcinosarcoma) and benign (four cystadenomas, two teratomas, one fibroma, one endometrioma, and one corpus luteal cyst) groups. An apparent diffusion coefficient (ADC) value of 1.27 × 10−3 mm2/s was considered as the optimal threshold in distinguishing malignant from benign ovarian tumors (sensitivity and specificity: 100% and 77.8%, respectively). Choline peaks were detected in six of seven O-RADS (Ovarian-Adnexal Imaging-Reporting Data System) 4 lesions and corrected all of the DWI false-negative clear cell carcinoma. Based on the presence of the choline peaks, the diagnostic performance of MRS showed a sensitivity of 77.8%, a specificity of 100%, and an accuracy of 85.7%, respectively. In conclusion, MRS could potentially play a complementary role for DWI in tumor characterization, particularly for O-RADS 4 tumors or clear cell carcinomas.

Course of labor and condition of the newborn in women affected by benign ovarian tumors

Annotation. According to various estimations, the incidence of adnexal neoplasms during pregnancy makes up from 0.19% to 8.8%. Most of cases are diagnosed in the first trimester and their incidence gradually decreases as the period of pregnancy grows. Depending on their size and location, ovarian tumors may be related to an adverse obstetrical result caused by mechanical influence. They increase the risk of abortion (from 0 to 6%), preterm labor (from 5.8% to 10.4%) and mechanical impediment to labor. Aim – studying the peculiarities of the course of labor and the condition of the newborn of women affected by benign ovarian tumors. We have conducted a complex examination of 67 pregnant women with benign ovarian tumors and tumor-like growths found before pregnancy or in the first trimester of gestation (basic group) and 50 women presenting no ovarian neoplasms or any other severe gynecological or somatic pathology (reference group). To identify the risk factors, the basic group was divided into 2 subgroups. The condition of fetuses was assessed with the use of automated cardiotocography analysis based on the Dawes/Redman criteria, with the calculation of the short-term variability (STV). The mean and standard deviation (M ± m) were evaluated at a significance level of p <0.05. Categorical variables are presented as the absolute number of cases in the group and the frequency in percent – n (%). Tests for differences between independent samples in the case of quantitative variables were performed using Student’s t test, the Mann-Whitney rank test, and in the case of categorical variables using Fisher’s exact test. The obtained results suggest that the course of labor in women affected by benign ovarian neoplasms is characterized by an increased incidence of complications. A significant difference has been established in the incidence of cesarean sections (35.8% vs 8.0% in the reference group, р<0.05), preterm labor (28.4% vs. 6.0%, р<0.05), fetal distress (19.4% vs. 8.0%, р<0.05) and preterm rupture of membranes (17.9% vs. 6.0%, р<0.05). The incidence of almost all complications of labor in Subgroup 1 significantly exceeds the figures from the reference group and the incidence of preterm labor and fetal distress is also higher in comparison with Subgroup 2. The presence of extragenital pathology is a well-known risk factor for perinatal complications, which is also confirmed by our research. A high level of comorbidity of benign ovarian neoplasms with various extragenital diseases also accounts to a certain degree for gestational complications. Thus, pregnancy in women affected by ovarian tumors implies an increased risk of obstetrical and perinatal complications, in particular, threats of miscarriage and preterm labor. The studies of this issue lack systematization, are often controversial and fragmentary. There has been practically no research on the risk factors for such complications and the ways of their prognostication and prevention.

A new minimally invasive surgical technique for the treatment of ovarian cysts in children

The topical issue of pediatric surgery is the treatment of ovarian cysts based on the development of new technologies for surgical correction of the disease. Aim. To analyze the effectiveness of using a new minimally invasive method for removal of cystic ovarian neoplasms in children. Material and methods. A retrospective analysis of 77 female patients with ovarian cysts, aged from 3 months to 17 years, was carried out. The patients were divided into 3 groups depending on the various surgical techniques used for their treatment. Group I consisted of 32 (41 %) girls who underwent cystectomy according to the new transabdominal technique for removing ovarian cysts in children. Group II included 19 (25 %) children who underwent a laparoscopic surgery. Group III comprised 26 (34 %) children who underwent a hybrid laparoscopy-assisted cystectomy. The following indicators were analyzed: the age of patients, the nature and number of complications of the disease course, the size of cystic neoplasms, the duration of surgical interventions, the number of cases accompanied by cyst contents leaking into the abdominal cavity during surgical manipulations, and the length of hospital stay. Results. The mean age of all patients was 11.23 ± 0.57 years. Planned hospitalizations amounted to 46 (59.7 %) cases. The duration of surgery in group I was almost 1.5 times lower (P < 0.05) than that in patients of group II and 2 times shorter than in children of group III (P < 0.05). Free cyst contents leaking into the abdominal cavity was observed in 35 (91.4 %) patients of Group III, which required additional measures aimed at the abdominal cavity sanation. The proposed minimally invasive transabdominal surgical technique prevented this complication in all 32 patients of Group I. The length of hospital stay did not differ significantly (P > 0.05) between children groups I and II and did not exceed 7.50 ± 0.35 (M ± SEM) days. This indicator was almost 1.5 times higher in Group III patients. Conclusions. The new minimally invasive transabdominal method for removing cystic ovarian neoplasms in children provided minimal trauma with maximum ablasticity and cosmetic effect of the operation. The proposed technique made it possible to prevent the development of intraoperative and postoperative complications, significantly reduce the duration of surgery and the recovery time of patients.