Acute Presentation of Large Size Clear Cell Ovarian Carcinoma as Double Torsed Ovarian Tumor

We report a 46-year-old patient who presented to the emergency department with complaints of acute abdominal pain, nausea, and vomiting. An abdominal CT scan revealed a large (207 × 155 × 182 mm) thin-walled inhomogeneous tumor connected to the uterus and right ovary. Emergency surgery laparotomy was performed. Inside the abdominal cavity, a 30 × 30 cm heterogenous, dark blue tumor in the right adnexa area, torsed two times, weighing 3700 g was found. Histological examination revealed right ovary clear cell carcinoma. We emphasize the rare nature of the histology and presentation of this case report. Ovarian clear cell carcinomas are relatively rare malignancies, presenting in 5 to 10% of ovarian malignant tumors in the west.

Successful treatment of clear cell carcinoma of ovary during pregnancy: a case report

The incidence of malignant ovarian tumor is rare during pregnancy. Most women hope to maintain the pregnancy and preserve fertility thus increasing the need for standard guidelines regarding surgery and chemotherapy for safe oncologic and fetal outcomes. Here we present a 30-years-old primigravida, diagnosed with bilateral ovarian mass during routine ultrasound imaging at 8 weeks of gestation. CA125 was 14.2 U/ml. MRI pelvis taken at 13 weeks showed bilateral complex cystic masses with internal septations. The patient underwent bilateral salphingo-oopherectomy and infracolic omentectomy during 18th week of gestation, the histopathology showing clear cell carcinoma with capsular invasion and microscopic omental deposit thus staged as IIIA. She was planned for adjuvant chemotherapy comprising of paclitaxel and carboplatin during the 21st week along with serial ultrasounds for fetal monitoring. After 5 cycles, at 37 weeks of gestation, she was taken up for elective LSCS followed by completion of surgery for ovarian malignancy, that is, hysterectomy with bilateral pelvic lymphadectomy. Endometrium showed gestational changes with all lymph nodes being negative for tumor deposits. A healthy male child weighing 3.4 kg was delivered. She was given 6th cycle of chemotherapy post-surgery and two years later, mother and baby are doing well and on regular follow up. Thus, the successful treatment of clear cell ovarian carcinoma in this woman with safe pregnancy outcomes can be attributed to timely diagnosis and feasibility of surgery and chemotherapy during second trimester.

ARID1A regulates R-loop associated DNA replication stress

ARID1A is a core DNA-binding subunit of the BAF chromatin remodeling complex, and is lost in up to 7% of all cancers. The frequency of ARID1A loss increases in certain cancer types, such as clear cell ovarian carcinoma where ARID1A protein is lost in about 50% of cases. While the impact of ARID1A loss on the function of the BAF chromatin remodeling complexes is likely to drive oncogenic gene expression programs in specific contexts, ARID1A also binds genome stability regulators such as ATR and TOP2. Here we show that ARID1A loss leads to DNA replication stress associated with R-loops and transcription-replication conflicts in human cells. These effects correlate with altered transcription and replication dynamics in ARID1A knockout cells and to reduced TOP2A binding at R-loop sites. Together this work extends mechanisms of replication stress in ARID1A deficient cells with implications for targeting ARID1A deficient cancers.