Uterine involvement in epithelial ovarian cancer and its risk factors

Background Epithelial ovarian cancer (EOC) is an extremely aggressive and lethal carcinoma. Specific data that identify high-risk groups with uterine involvement are not available. Thus, this study aimed to evaluate a gross number of women with EOC to obtain the frequency of uterine involvement and its risk factors. Methods This retrospective observational study was conducted on 1900 histologically confirmed EOC women, diagnosed and treated in our tertiary hospital from March 2009 to September 2020. Data including their demographic, medical and pathological findings were collected. Results From 1900 histologically confirmed EOC women, 347 patients were eligible for participations. The mean age of study patients was 51.31 ± 11.37 years with the age range of 25 to 87 years. Uterine involvement was detected in 49.6% (173) of the patients either macroscopic (47.4%) or microscopic (52.6%) types. Uterine involvement was significantly associated with having AUB (P-value = 0.002), histological type of ovary tumor (P-value < 0.001), ovarian cancer stage (P-value < 0.001), and abnormal CA-125 concentration (P-value = 0.004). Compared to the other study patient, the patients with metastatic uterine involvement had significantly higher stage (p-value< 0.001), higher grade of ovary tumor (p-value = 0.008), serous histological type (p-value< 0.001), and a higher level of CA-125 concentration (p-value< 0.001). on the other hand, the patients with synchronous uterine cancer were significantly younger (p-value = 0.013), nulliparous (p-value< 0.001), suffered from AUB symptoms (p-value< 0.001) and had endometroid histological type (p-value = 0.010) of ovary cancer in comparison to other study patients. Conclusion Considering the high prevalence of uterine involvement in EOC patients, ultrasound evaluation and/or endometrium biopsy assessment should be done before planning any treatment.

Peritoneal gliomatosis: a case report

Peritoneal gliomatosis is the mature neuroglial tissue in peritoneum, this is commonly associated with immature teratoma. Can be associated with ascites alone or ascites and pleural effusion in which case it is called pseudo Meigs syndrome, the lymph node invasion has been described. In the imaging studies such computed tomography they can be show as multiple peritoneal nodules, the positron emission tomography has shown utility in cases of doubt of recurrence of mature teratoma without evidence of primary tumor with elevated tumor marker. The initial treatment depends on the treatment of the teratoma, reserving the surgical treatment of the peritoneal gliomatosis in the presence of complications related to the implants. A 21-year-old woman without chronic degenerative disease story with clinical presentation of abdominal distension, a CT scan is performed that shows a right ovary tumor; a laparotomy was performed in which ascites and peritoneal nodules were evidenced suggesting the presence of carcinomatosis. Histopathological study demonstrated peritoneal gliomatosis.

Tumor de células de la granulosa juvenil de ovario. Presentación inusual. Reporte de un caso

Granulose cell tumors represent 2% of ovarian tumors. They are classified as adult type and juvenile type. The juvenile type is associated with precocious pseudopuberty, irregular menstruation or nonspecific symptoms such as abdominal pain and palpable mass. More than 95% are confined to the ovary. A case of a 31-year-old patient is described. The patient consulted for 6-month evolution of increased abdominal volume and weight loss. Right ovary tumor was diagnosed. Tumor excision by gynecological laparotomy with positive frozen cut biopsy and surgical staging were performed. Pathological anatomy reported stromal tumor, and sexual cords suggestive of malignant juvenile granulose cell tumor. Immunohistochemistry reported positive inhibin B. It was concluded as stage IIIA2. This is a rare neoplasm with variable behavior. Accurate diagnosis is based on histological and immunohistochemical studies. Key words: Granulosa, Cell tumor, Juvenile granulosa cell tumor, Ascites, Diagnosis.

Pure primary yolk sac tumor of the endometrium tends to occur at a younger age: A case report and literature analysis

We present a case of primary yolk sac tumor of the endometrium. This rare tumor occurred in a 43-year-old woman with a pure primary yolk sac tumor. The tumor resembled yolk sac tumor morphology of the ovary. Tumor cells expressed SALL4, AFP, GPC-3, and AE1/AE3 and were focal positive for PAX8. EMA, ER, and PR, among others, were negative. We further analyzed 29 reported cases of this rare tumor in the literature. In total, 17 of 30 patients (57%) had pure endometrial yolk sac tumor, and 13 (43%) had a concomitant somatic neoplasm (endometrial adenocarcinoma was the most common). Although the average age was 52 years (range: 24–87 years), patients with pure yolk sac tumor were younger than those with concomitant somatic tumors, with a mean age of 44.41 years (24–68 years) versus 61.92 years (28–87 years), P = 0.008. Patients with endometrial yolk sac tumor combined with somatic tumor tend to have a slightly higher stage and a poor prognosis.

Prevalence and clinical characterization of MMR-D/MSI extra-colonic cancers among germline PMS2 mutation carriers.

1527 Background: PMS2-associated Lynch syndrome (LS) may have a more modest phenotype than that associated with other mismatch repair (MMR) genes ( MLH1, MSH2, MSH6, EPCAM). Recent studies suggest limited extra-colonic cancers, and modified risk-reducing measures can be provided. Understanding the spectrum of risk is of critical importance as some LS-associated cancers do not have effective screening, requiring risk-reducing surgery (endometrial, ovarian). As MMR-deficiency (MMRD)/ microsatellite instability (MSI) is associated with LS pan-cancer, we sought to characterize PMS2-associated malignancies according to MMR/MSI status. Methods: Review of cancer patients (pts) consented to an IRB-approved protocol of tumor/germline next-generation sequencing (NGS) identified 43 germline heterozygous PMS2 mutation carriers. Tumors were evaluated for MSI via MSIsensor and/or corresponding MMR protein expression via immunohistochemical staining (IHC). Clinical variables were correlated with MMR/MSI status, comparing via Chi-square or standard T-test. Results: There were > 10 tumor types; 69.8% (30/43) were extra-colonic cancers (endometrial (n = 4), ovarian (n = 6), small bowel (n = 3), urothelial (n = 2), pancreas (n = 3), prostate (n = 3), breast (n = 3), brain (n = 3), biliary (n = 1), spindle cell sarcoma (n = 1), and hepatoblastoma (n = 1)). 46.5% (20/43) of tumors were MMRD/MSI. 61.5% (8/13) of colorectal cancers (CRC) were MMRD/MSI, compared to 40% (12/30) of extra-colonic tumors. All endometrial and small bowel cancers were MMRD/MSI. Of 6 ovarian cancers, 3 were clear-cell, 1 endometrioid, and 2 high-grade serous (HGS). The only MMRD/MSI ovary tumor was HGS. 73.9% (17/23) of pts with MMRP/MSS tumors had recurrent/metastatic disease vs 30% (6/20) of pts with MMRD/MSI tumors ( p= 0.004). Mean age at diagnosis did not differ significantly between MMRP/MSS and MMRD/MSI groups (49 vs. 57, respectively, p= 0.146). 11.6% (5/43) of pts had a prior cancer, with only one patient having prior CRC. Pts with extra-colonic tumors were less likely to meet clinical pt and family history LS testing criteria than those with CRC (63.3% (19/30) vs. 7.7% (1/13); p< 0.001). Conclusions: While PMS2-related LS may have a more modest clinical phenotype, in this single-institution study, 60% (12/20) of patients with MMRD/MSI tumors presented with extra-colonic cancers. We caution counseling pts with PMS2-associated LS about reduced extra-colonic risk until more complete information about penetrance, spectrum, and age distribution of cancer is available.

Energy Loss of Proton Beam on Ovary Tumor

Proton beam therapy is more effective method than most common radiation (x-rays or photons) therapy and is a new type of irradiation that destroys the tumor or cancer cells in the human body. In the proton therapy, the beam consists of charged nuclei of hydrogen atoms i.e. hydrogen ions or protons. The beam of proton loses the most of its energy to the targeted tissue like ovary tumor cells, with less impact of healthy tissues and organs. This property of a proton beam makes it ideal for clinical applications. When organ safe keeping is our priority then proton beam therapy is the most effective tool to damage nearby affected tissues. For efficient treatment planning in ovary tumor, the maximal energy loss of proton beam in its tissues must be exactly calculated. The method of computer simulation, SRIM is employed for the calculation of energy loss by energized proton beam irradiation on ovary tumor at a depth of 43.3 mm. The stopping power and range data agrees with standard reference data. 65 Mev energy loss is caused by ionization and the energy loss in various layers viz. skin, adipose tissue, soft muscle and ovary are approximately 2.6 MeV, 15 MeV, 7 MeVand 40 MeV respectively, ensuring less injury to healthy cells.

Isoliquiritigenin Inhibits Ovarian Cancer Metastasis by Reversing Epithelial-to-Mesenchymal Transition

The epithelial-to-mesenchymal transition (EMT) plays a prominent role in cancer metastasis. Isoliquiritigenin (ISL), one of the flavonoids in licorice, has been shown to exhibit anticancer activities in many cancer types through various mechanisms. However, it is unknown whether ISL impacts the EMT process. Here, we show that ISL is able to suppress mesenchymal features of ovarian cancer SKOV3 and OVCAR5 cells, evidenced by an apparent morphological change from a mesenchymal to an epithelial phenotype and reduced levels of mesenchymal markers accompanied by the gain of E-cadherin expression. The suppression of EMT is also supported by the observed decrease in cell migration and in vitro invasion upon ISL treatment. Moreover, we show that ISL effectively blocks the intraperitoneal xenograft development of the SKOV3 cell line and prolonged the survival of tumor-bearing mice. These data suggest that ISL inhibits intraperitoneal ovary tumor development through the suppression of EMT, indicating that ISL may be an effective therapeutic agent against ovarian cancer.