Desfechos reprodutivos e de sobrevida em adolescente tratada com cirurgia preservadora de fertilidade por tumor borderline de ovário em estádio avançado: relato de caso e revisão da literatura / Reproductive and survival outcomes in an adolescent treated with fertility- sparing surgery for advanced stage borderline ovarian tumor: case report and review of the literature

Existem poucos dados na literatura sobre os resultados obstétricos e oncológicos de adolescentes com tumores borderline de ovário em estádio avançado trata- das com cirurgia preservadora da fertilidade. Uma adolescente de 15 anos com diagnóstico de tumor borderline de ovário estádio IIIc foi inicialmente tratada com tumorectomia ovariana bilateral e quimioterapia adjuvante com esquema de platina/taxano (seis ciclos). Durante o seguimento, foi submetida a outras três tumorectomias devido a tumor borderline de ovário (duas vezes) e cistadenoma ovariano (uma vez). Outra recidiva de tumor borderline de ovário ocorreu seis anos após o diagnóstico inicial, quando ela estava grávida; foi tratada com tumorecto- mia realizada durante a cesariana. Em sua última consulta ambulatorial, a mulher de 27 anos não apresentava evidência da doença e tinha um filho saudável. Mesmo em estádio avançado, a cirurgia de preservação da fertilidade foi segura e factível nessa paciente com tumor borderline de ovário.

There are few data in the literature regarding obstetric and oncological outcomes of adolescents with advanced-stage borderline ovarian tumors treated with fertility spa- ring surgery. A 15 years old adolescent who was diagnosed with a stage IIIc borderline ovarian tumor, was treated with bilateral ovarian tumorectomies and adjuvant chemotherapy with platinum/taxane regimen (six cycles). During follow up she was submitted to other three tumorectomies due to borderline ovarian tumor(twice) and ovarian cysta- denoma (once). Another borderline ovarian tumorrecurren- ce occurred six years after initial diagnosis, when she was pregnant; treated with tumorectomy performed during ce- sarean section. At her last outpatient visit, the 27-year-old woman had no evidence of disease and a had healthy child. Even at an advanced stage, fertility sparing surgery was safe and feasible in this patient with borderline ovarian tumor.

Survival rate, recurrence rate, and complications of routine appendectomy for patients with borderline and malignant mucinous ovarian tumor: A systematic review and meta-analysis / Philippine Journal of Obstetrics and Gynecology

Objective@#The objective of the study is to determine the survival rate, recurrence rate, and complication rate among patients diagnosed with borderline and malignant mucinous ovarian tumor (MOT) who underwent complete surgical staging with appendectomy.@*Methodology@#Eligibility criteria – A search of published literature was conducted in the electronic databases of MEDLINE (PubMed), Cochrane, and Google Scholar through 2000–2022, using a search strategy based on the PIO framework. Information of sources – The citations were identified with the use of a combination of the following text words: “mucinous ovarian tumors,” “MOT,” “appendectomy,” and “pseudomyxoma peritonei.” All retrospective studies with histopathologic diagnosis of borderline or malignant MOTs with patients who underwent appendectomy during primary surgery, including encompassing data on survival rate, recurrence rate, and/or incidence of complications (postoperative infections, appendectomy site leakage, hemorrhage, abscess, peritonitis, bowel perforation, and intestinal obstruction) that matched the terms set by the researchers were retrieved. Risk of bias – For the methodological quality of the individual clinical trials, the Jadad scale was used, which is based on the three following subscales: randomization (2, 1, or 0), blinding (2, 1, or 0), and dropouts/withdrawals (1 or 0). Guidelines for Cochrane collaboration were used to assess the risk bias. Synthesis of results – Review Manager version 5.3 (RevMan 5.4.1) was used by the researcher to perform the systematic review and meta-analysis of included studies.@*Results@#There were eight retrospective studies included in this study. The random interval for survival rate is 64.9%–99.7% with a P < 0.1. The prediction interval for recurrence rate is 0%–100% with 95% confidence interval. The odds of complications occurring are <0.69–2.99 times with 95% confidence interval, with mean effect size is 0.083, and with a 95% confidence interval is 0.027–0.23.@*Conclusion@#The mean prevalence of abnormal histology of the appendix in patients diagnosed with borderline and malignant MOTs and underwent appendectomy during primary surgery is 3%–13%. There is no statistically significant difference in survival rate of patients who were diagnosed with borderline and malignant MOTs with or without appendectomy during primary surgery. The prediction interval for recurrence rate is 0%–100% with 95% confidence interval. There is no significant difference between the rate of complications in patients who underwent appendectomy and those without.

A cross-sectional study of immunohistochemical evaluation of surface epithelial ovarian tumors

Background: Ovarian cancer is one of the most common malignancies in female patients. In recent years, immunohistochemistry (IHC) has emerged as an important tool in the diagnosis of ovarian tumors. The study aimed to assess estrogen receptors (ERs), progesterone receptors (PRs), Her-2-neu, and Ki-67 by IHC in surface epithelial ovarian tumors and to correlate the findings with different variables. Materials and Methods: It was a cross-sectional study. Oophorectomy/salpingo-oophorectomy/cystectomy specimens were included in this study. IHC was done on 10% neutral buffer formalin-fixed paraffin-embedded tissue sections by using Dako FLEX Ready to use mouse monoclonal antibodies and DakoEnvisionTM FLEX/ HRP detection reagent. Results: The study includes 81 cases of surface epithelial ovarian tumors (a benign serous tumor [20], a benign mucinous tumor [18], a borderline mucinous tumor [5], low-grade serous carcinoma [8], high-grade serous carcinoma [19], mucinous carcinoma [7], endometrioid carcinoma [2], borderline Brenner tumor [1], and malignant Brenner tumor [1]. ER had higher expression in malignant cases (51.33%) than in benign cases (15.8%). PR had higher expression in malignant tumors (54.05%) incomparable to benign (18.42%) and borderline tumors (16.66%). PR had higher expression in high grade. Expression of Her-2-neu positivity was found to be 29.7% out of the total 81 cases. Her-2-neu was found in 11 high-grade tumors among 31 malignant cases. CA-125 levels were significantly higher in malignant ovarian tumors (P = 0.0143). Proliferation activity was considered low if proliferation index (PI) <10% and high if PI >10%. The study showed high PI in malignant tumors. Conclusion: Expression of these marks in adjunct to H&E diagnosis may prove beneficial in differentiating benign, borderline, and malignant cases, in which a diagnosis of borderline cases based on sole H & E is doubtful.

A comparative study of International Ovarian Tumor Analysis simple rules and different levels of physicians in judging benign and malignant ovarian tumors / 中华超声影像学杂志

Objective:To explore the value of different levels of sonographers and International Ovarian Tumor Analysis (IOTA) simple rules in judging benign and malignant ovarian tumors.Methods:The ultrasound images of 182 patients treated in Beijing Tiantan Hospital, Capital Medical University from January 2017 to November 2020 with ovarian tumors were retrospectively analyzed. The ovarian tumors were diagnosed by two senior sonographers and two junior sonographers without knowing the pathological diagnosis. Another junior sonographer trained in IOTA terminology and simple rules applied IOTA simple rules to diagnose 182 ovarian tumors. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnosis of ovarian tumors by senior sonographers, junior sonographers and IOTA simple rules were calculated using the postoperative pathological diagnosis as the gold standard. The Kappa value was calculated for the consistency between different levels of sonographers and the IOTA simple rules and pathological diagnosis.Results:Of the 182 cases, 61 cases were pathologically benign and 121 cases were pathologically malignant. The diagnostic sensitivity, specificity and accuracy of senior sonographers were 93.4%, 99.2%, 97.2%, respectively, Kappa value was 0.938. The diagnostic sensitivity, specificity, and accuracy of junior sonographers were 80.3%, 90.0%, 86.8%, respectively, Kappa value was 0.704. The diagnostic sensitivity, specificity and accuracy of IOTA simple rules(When an uncertain tumor was classified as malignant) were 95.0%, 73.5%, 80.7%, respectively, Kappa value was 0.614. The diagnostic sensitivity, specificity and accuracy of IOTA simple rules(when an uncertain tumor was excluded) were 94.2%, 90.9%, 92.0%, respectively, Kappa value was 0.834.Conclusions:IOTA simple rules is a very useful diagnostic tool for junior sonographers to judge benign and malignant ovarian tumors. When IOTA simple principle is judged as an uncertain case, it is recommended to refer to experienced senior sonographers for further diagnosis.

Massas anexiais: descrição e interpretação ultrassonográfica por IOTA / Adnexal masses: IOTA ultrasound description and interpretation

Este artigo visa apresentar ao médico ginecologista (clínico e/ou cirurgião), de forma prática, a normatização internacional da prática da ultrassonografia ginecológica para avaliação das massas anexiais. Desde 2000, o grupo europeu IOTA (International Ovarian Tumor Analysis) vem colhendo dados e difundindo conhecimento nessa área, de forma a padronizar o exame ultrassonográfico. Quais descritores ecográficos devem ser valorizados, como devem ser descritos e medidos, como aplicar o estudo Doppler e como interpretar a presença ou ausência desses descritores ecográficos na diferenciação das massas anexiais benignas de malignas, inferindo o risco de malignidade das massas, tudo isso está bem definido.(AU)

The main aim of this article is to present to gynecologists (clinicians and/or surgeons) the practical international gynecological ultrasound standardization for adnexal masses assessment. Since 2000, European group IOTA (International Ovarian Tumor Analysis) has been collecting data and disseminating knowledge in order to standardize ultrasound examination. It is already well-defined which ultrasound features should be described and measured, how power/color Doppler have to be applied and how the presence or absence of these features can differentiate benign from malign masses, inferring tumors malignancy risk.(AU)

Preoperative differentiation of benign and malignant non-epithelial ovarian tumors: clinical features and tumor markers / Diferenciação pré-operatória de tumores ovarianos não epiteliais benignos e malignos: características clínicas e marcadores tumorais

Abstract Objective To evaluate the role of clinical features and preoperativemeasurement of cancer antigen 125 (CA125), human epididymis protein(HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. Methods One hundred and nineteen consecutive women with germ cell, sex cordstromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Results Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, amongmalignant, fourwere immatureteratomas. Themost common tumors in the sex cordstromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign andmalignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Conclusion Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant caseswere diagnosed at initial stages with good prognosis. Themeasurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Resumo Objetivo Avaliar o papel das características clínicas e a medida pré-operatória dos níveis séricos de CA125, HE4, e CEA em mulheres com tumores de ovário não epiteliais benignos e malignos. Métodos Cento e dezenovemulheres consecutivas comtumores ovarianos de células germinativas, do cordão sexual-estroma, e miomas ovarianos foram incluídas neste estudo. Os níveis pré-operatórios dos biomarcadores foram medidos, a cirurgia e a análise histopatológica foram realizadas. Informações sobre tratamento e recorrência da doença foram obtidas dos prontuários médicos das pacientes. Resultados Nossa amostra incluiu 71 mulheres com tumores de células germinativas (64 benignos e 7 malignos), 46 com tumores do cordão sexual-estroma (32 benignos e 14 malignos), e 2 com leiomiomas ovarianos. Entre os tumores benignos de células germinativas, 63 eram teratomas maduros, e, entre os malignos, quatro eram teratomas imaturos. Os tumores mais comuns do grupo do cordão sexual-estroma foram fibromas (benignos) e tumores de células da granulosa (malignos). Os níveis séricos dos biomarcadores não diferiram entre os tumores de ovário não epiteliais benignos e malignos. A cirurgia preservadora de fertilidade foi realizada em 5 (71,4%) mulheres com tumores malignos de células germinativas. Onze (78,6%) mulheres com tumores do cordão sexual-estromamalignos foram tratadas comcirurgia preservadora de fertilidade. Cinco (71,4%)mulheres com células germinativas e apenas 1 (7,1%) com tumor do cordão sexual-estroma foram tratadas com quimioterapia. Uma mulher com tumor de células germinativas recidivou e morreu da doença. Uma mulher com tumor do cordão sexual-estroma recidivou. Conclusão Os tumores de ovário não epiteliais foram benignos namaioria dos casos e os malignos foram diagnosticados em estágios iniciais, com bom prognóstico. A medida dos níveis séricos de CA125, HE4, e CEA não foram úteis no diagnóstico préoperatório desses tumores.

Xanthomatous oophoritis, a rare pathology: case report with review of literature

Xanthomatous oophoritis is a rare chronic inflammation of ovary characterized histologically with infiltration of lipid laden foamy macrophages, lymphocytes, plasma cells leading to tissue destruction. Though exact cause is not known, uterine artery embolization, gloves dusting powder and altered lipid metabolism are hypothesized to cause the pathology. A 28-year-old parous lady with history of multiple laparotomies, known case of hypothyroidism under treatment and history of adequately treated pulmonary tuberculosis was diagnosed to have right ovarian dermoid cyst, while undergoing investigation for secondary infertility. On examination she had pallor, healthy abdominal scar, and small tender fixed mass in right fornix on internal examination. She was subjected to laparotomy and right salpingo oophorectomy with left salpingectomy was performed. Histopathological examination of the resected specimen revealed to be xanthomatous oophoritis of right ovary. As this condition mimics tuberculosis and malignancy, clinical assessment, investigation and intra operative findings with the suspicion of inflammatory aetiology help to limit the extent of surgery. Hence, this case is presented for its rare occurrence as well as its need to be differentiated from other conditions like tuberculosis and malignancy of ovary.

Clinical Profile of Patients Presenting with Ovarian Tumors at a Tertiary Care Teaching Hospital in Jharkhand, India

Introduction: Ovary is a common site for tumors, both benignand malignant which causes great morbidity and mortality.The study was undertaken to analyse the clinical profile andhistologic pattern of ovarian tumors.Material and methods: A prospective observational study ofcases presenting with ovarian tumors was done over a periodof 14 months from December 2016 to January 2018.Results: Ovarian tumors accounted for 3.32% of allgynecologic admissions (68/2045) during the study period.There were 50 benign (73.52%) and 18 malignant tumors(26.47%). Age of patients ranged from 12-72 years. Mostof the cases were in the reproductive age group. Surfaceepithelial tumors dominated other types (81.25%). Mucinouscystadenoma was the commonest (35.93%) benign tumorfollowed by serous cystadenoma (23.43%), dermoid cyst(15.6%) and granulosa cell tumor (1.56%). Commonestmalignant tumor was serous cystadenocarcinoma (15.6%),followed by mucinous cystadenocarcinoma (6.25%) andKrukenberg tumor (1.56%). Clinical symptoms and signs werevague but were present for more than one year in majority.Significant number of malignant tumors presented at earlierage (30-50 years) and in later stages (stage 3).Conclusion: Among malignant tumors, younger age ofpresentation, relatively long duration of symptoms for morethan 1 year, and advance stage of disease was more common.This emphasizes the need for early attention to symptoms andsigns and proper evaluation with detailed investigations forexclusion of ovarian malignancy in all age groups.

Histomorphological Spectrum of Ovarian Lesions in a Tertiary Care Institute in Gujarat with Special Emphasis on Ovarian Tumors

Introduction: Ovarian cancer is the third most common cancer among women of India. Microscopic examination is the goldstandard for diagnosing ovarian tumors and plays an important role in determining prognosis.Purpose: The aim of the study is to assess the frequency of non-neoplastic and neoplastic lesions in ovarian specimens andbiopsies and to study the histomorphological spectrum, gross features, and age distribution of the ovarian tumors.Materials and Methods: The present study was an observational retrospective study conducted over a period of 1 year(February 2019–January 2020) in the Department of Pathology in a Tertiary Care Hospital in South Gujarat. A total of cases (8ovarian biopsies and 82 ovarian specimens) were analyzed. Tumors were classified according to the WHO classification 2014.Results: Of 90 cases, eight were of non-neoplastic lesions, 13 were tumor-like lesions, and nine neoplastic lesions. Amongneoplastic lesions, 43 cases (62.3%) were benign, 3 (4.4%) were borderline, while 23 (33.3%) cases were malignant.Histopathologically, surface epithelial tumors (76.7%) were the most common subtype followed by germ cell tumors (13.3%)and then sex cord tumors (10%). Malignant surface epithelial tumors constitute 78.2% of the total malignant ovarian tumors. Themost common neoplastic lesion was serous cystadenoma. 30–39 years age group was the most common age group overall inovarian tumors. Benign tumors were most common in the 30–39 years age group, while malignant tumors were most commonin the 60–69 years age group. Bilaterality was seen in 10 (16.4%) of 61 gross specimens of ovarian tumors.Conclusion: The frequency of malignant ovarian tumors was higher in our institute. Accurate histopathological diagnosis isessential for management and determining prognosis

Evaluation of risk of malignancy index in adnexal masses at a tertiary hospital: a prospective study

Background: The discrimination between benign and malignant adnexal masses is important in deciding clinical management and optimal surgical planning. The aim of the study was to evaluate the effectiveness of risk of malignancy index (RMI) to identify cases with high potential of ovarian malignancy at a tertiary hospital.Methods: This prospective study was conducted over a period of two years from September 2017 to August 2019 at obstetrics and gynecology department of M. K. C. G. Medical College and Hospital, Berhampur. A total case of 130 patients with adnexal masses who underwent surgical treatment were included as histopathological report was taken as gold standard to calculate accuracy of RMI.Results: Of the total masses, 85 (65.4%) were benign and 45 (34.6%) were malignant. The mean age of patients was 41.03±14 years. The best cut off value for the RMI-3 was 225 with highest area under the ROC curve 87%, sensitivity of 75.55%, specificity of 98.82%, PPV of 97.14%, NPV of 88.42% and an accuracy of 90.76%.Conclusions: The present study demonstrated that RMI was a reliable method in detecting malignant ovarian tumors. The RMI is a simple and practically applicable tool in preoperative discrimination between benign and malignant adnexal masses in non-specialized gynecologic departments, particularly in developing countries.

Diagnosis and management of benign ovarian tumors at the Ignace Deen Maternity Hospital of Conakry University Hospital in Guinea

Background: Benign ovarian tumors are a common reason for consultation and intervention in gynecology. The objective of this was to describe the clinical, ultrasonographic, histological and therapeutic aspects of benign ovarian tumors in the department.Methods: This is a retrospective and descriptive study of three years and six months from January 1, 2016, to June 30, 2019, which focused on the records of women-operated during this period of benign ovarian tumors.Results: The incidence of benign ovarian tumors was 12.58%. The circumstances of discovery were dominated by disorders of the menstrual cycle (35.05%) followed by infertility (20.78%), the sensation of a pelvic mass (19.48%), and pelvic pain. (15.58%). The ultrasound report was in favor of a serous cyst in 74% of cases, a mucoid cyst in 14% of cases, a dermoid cyst in 9% and an endometriotic cyst in 3%. Histology revealed a serous cystadenoma in 70.13% of the cases, a mucinous cystadenoma in 16.88% of the cases, a mature poly tissue teratoma in 9.09% of the cases and an endometrial cyst in 3.90 % of the cases. Cystectomy was the most performed surgical procedure (71%).Conclusions: Benign ovarian tumors are common in our practice. The most common histological forms were serous and mucinous cystadenomas. Conservative treatment has been practiced in the majority of cases.

Clinical Study on Findings of Ultrasound and Computed Tomography Scan in the Diagnosis of Ovarian Mass Lesions

Background: Ultrasonography (USG) is a simple and noninvasive diagnostic tool that gives lots of data to accurately characterize most of the ovarian mass lesions with a sensitivity and specificity of 88–96% and 90–96%, respectively. However, the presence of significant variability in the terminology and definition of USG findings has led to the need for more standardization and uniformity in adnexal USG. Computed tomography (CT) scan is used primarily in patients with ovarian malignancies, either to assess disease extent before surgery or as a substitute for second-look laparotomy. Moreover, spiral CT has several advantages such as its rapidity and possibility of identifying all potential sites of peritoneal implants or lymphadenopathy as well as of the primary tumor site. Aim of the Study: The study was to the clinical findings of both USG and CT scan of abdomen and pelvis in the accurate diagnosis of ovarian mass lesions. Materials and Methods: A total of 104 patients with mass lesions of the ovary were included and subjected to USG and CT scan of abdomen and pelvis. Transabdominal and transvaginal USG studies were undertaken in all the patients. USG findings and CT scan findings were observed recorded and analyzed. Ovarian pathologies were categorized as benign, malignant, and metastasized and the results of CT and USG were compared. Observations and Results: A total of 104 patients with ovarian mass lesions attending the Radiology Department of a Tertiary Teaching Hospital in Kerala were included in the study; patients were aged between 18 and 68 years with a mean age of 42.46 ± 5.70 years. Patients aged between 19 and 58 years accounted for more than 80% of the entire subjects. Hemorrhagic cyst was the most common mass lesion diagnosed in this study and accounted for 28 (26.92%) patients. Tubo-ovarian abscess accounted for 19/104 (18.26%) of the total cases. This was followed by mucinous cystadenoma 17/104 (16.34%), serous cystadenoma in 13/104 (12.50%) cases, polycystic ovarian disease in 11/104 (10.57%), mature cystic teratoma in 7/104 (6.73%), simple cyst in 6 (5.76%), Brenner tumor in 2/104 (1.92%), and endometrioma in 1/104 (0.96%) patients. Conclusions: CT scan and USG are two excellent noninvasive methods to differentiate ovarian mass lesions from benign and malignant lesions and both imaging techniques seemed to be comparable in differentiating malignant from benign ovarian tumors. CT scan was more sensitive than USG, but sonography is more specific than CT scan in diagnosis of malignant lesions. USG has high positive predictive value as compared to CT scan to diagnose malignant lesions.

Teratoma quístico maduro con transformación maligna: serie de casos / Cystic teratoma with malignant transformation: Series of cases

Resumen OBJETIVO: Describir las características clínicas e histopatológicas de los casos de teratoma maduro con transformación maligna, su tratamiento y supervivencia. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y observacional efectuado entre enero de 2014 y diciembre de 2018 en un servicio de oncología ginecológica. Parámetros de estudio: etapa patológica del tumor, concentraciones de Ca 125, supervivencia y tratamiento. El tamaño de la muestra no permitió aplicar pruebas estadísticas. RESULTADOS: Se estudiaron 147 pacientes con diagnóstico de teratoma maduro, de éstos 4 experimentaron transformación maligna a carcinoma epidermoide y se descartaron 18 por información incompleta. El estudio histopatológico transoperatorio identificó malignidad en 3 de los 4 tumores de ovario. No se practicaron cirugías conservadoras de la fertilidad porque en ninguno de los casos fue necesaria. En 3 de los 4 teratomas maduros con transformación maligna se indicó esquema de quimioterapia coadyuvante. Todas las pacientes permanecen vivas y sin recaída hasta el momento. CONCLUSIONES: El estudio histopatológico transoperatorio es indispensable en todas las lesiones de ovario, incluso las de aspecto quístico. El tratamiento quirúrgico cuidadoso de los tumores malignos de ovario evita su ruptura y cambio en el pronóstico y tratamiento de las pacientes. El tratamiento quirúrgico y médico de una neoplasia poco frecuente, como el teratoma maduro con transformación maligna, mejora la supervivencia y evita subtratamientos o sobretratamientos.

Abstract OBJECTIVE: Describe the clinical and histopathological characteristics of cases of mature teratoma with malignant transformation, its treatment and survival. MATERIALS AND METHODS: Retrospective, cross-sectional and observational study conducted between January 2014 and December 2018 in a gynecological oncology service. Study parameters: pathological stage of the tumor, concentrations of Ca 125, survival and treatment. The sample size did not allow statistical tests to be applied. RESULTS: 147 patients with a diagnosis of mature teratoma were studied of these 4 underwent malignant transformation to squamous cell carcinoma and 18 were ruled out due to incomplete information. The transoperative histopathological study identified 3 of the 4 ovarian tumors as malignant. Fertility conservative surgeries were not performed because in none of the cases was it necessary. In 3 of the 4 mature teratomas with malignant transformation, adjuvant chemotherapy scheme was indicated. All patients remain alive and have no relapse so far. CONCLUSIONS: The histopathological transoperatory study is absolutely necessary for an ovarian tumor, even in cystic ovarian tumors. Carefully management of ovarian tumors is very important, we should prevent a rupture of the malignant tumor because this changes the surgical stage and the prognosis. The surgical and medical treatment of infrequent tumor-like mature teratoma with malignant transformation improves survival and avoid sub treatments or overtreatment.

Correlation between Ultrasound Features and Histopathological Findings in Adnexal Masses – A Study in a Tertiary Care Center in Central India

Background: Ovarian cancer has emerged as one of the most common malignancies affecting women in India. Amultidisciplinaryapproach is needed for the optimal management of patients presenting with adnexal mass wherein the radiologist and thepathologist play an important role in assisting in clinical decision-making. The present study is done to correlate the ultrasoundfindings with the histopathological findings and to study the whole spectrum of adnexal masses.Methods: This is a prospective observational study carried out on 60 patients with adnexal masses and pre-operative ultrasoundassessment and who underwent surgical resection of their masses in a tertiary care center.Results: The pre-menopausal age group was more frequently affected than post-menopausal age group. A large number ofadnexal masses were of ovarian origin. The incidence of neoplastic adnexal masses is much higher than the non-neoplasticmasses. Among the neoplastic adnexal masses majority were ovarian tumors. The incidence of benign ovarian tumors is higherthan malignant tumors. Among the malignant tumors, serous cystadenocarcinoma was the most common tumor. Majorityof the ovarian tumors diagnosed by ultrasonography (USG) as purely cystic in architecture were proven benign tumors onhistopathology. Of the solid-cystic tumors, 50% were benign, and 50% malignant on histopathology solid architecture of thetumors was the least common, and the majority were malignant. USG diagnosis of adnexal masses revealed a sensitivity of94.4%, specificity of 83.3%, positive predictive value of 70.8%, and negative predictive value of 97.2%.Conclusions: USG is a sensitive and specific modality in pre-operative diagnosis of the malignant nature of lesions. Thepresence of solid component in an ovarian mass was a highly accurate predictor of malignancy.

Adjuvant therapy of moxibustion combined with formula for peritoneal effusion of ovarian malignant tumors / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of adjuvant therapy of moxibustion combined with formula for peritoneal effusion of ovarian malignant tumors.@*METHODS@#Sixty patients with peritoneal effusion of ovarian malignant tumors were randomly divided into an observation group and a control group, 30 cases in each group. The patients in the control group were treated with intravenous infusion of paclitaxel liposome at the first day and cisplatin at the 2nd to 4th day, 21 days as a course of treatment, and 4 courses were given. Based on the treatment of the control group, the patients in the observation group were treated by moxibustion combined with formula. Moxibustion was applied at Mingmen (GV 4), Pishu (BL 20), Shenshu (BL 23), Shenque (CV 8), Guanyuan (CV 4), Zigong (EX-CA 1), Zhongwan (CV 12), Shuifen (CV 9), Qihai (CV 6) and Zhongji (CV 3), each acupoint for 30 min, once a day for 12 weeks. formula was taken twice orally, one dose a day, 2 weeks as a course of treatment, and 6 courses were given. The levels of , , and / in peripheral blood were measured before and after 12-week treatment in the two groups. The changes of peritoneal effusion volume and Karnofsky performance status scale (KPS) score before and after treatment were compared between the two groups, and the clinical efficacy of the two groups was evaluated.@*RESULTS@#The symptom improvement rate was 96.7% (29/30) and overall effective rate was 86.7% (26/30) in the observation group, which were significantly superior to those in the control group [80.0% (24/30) and 56.7% (17/30), 0.05), and the increase in the observation group was significantly higher than that in the control group (<0.05). After treatment, the volume of peritoneal effusion in the two groups was decreased (<0.01), and the reduced volume in the observation group was higher than that in the control group (<0.05). After treatment, KPS scores were increased significantly in both two groups (<0.01), and the increase in the observation group was higher than that in the control group (<0.05). The incidence rate of adverse reactions in the observation group was lower than that in the control group [23.3% (7/30) vs 53.3% (16/30), <0.05].@*CONCLUSION@#Moxibustion combined with formula could effectively improve the immune function, reduce the volume of peritoneal effusion, improve the symptom improvement rate, overall effective rate and the quality of life, and reduce the incidence of adverse reactions in chemotherapy of patients with peritoneal effusion of ovarian malignant tumors.

Intraoperative consultation for ovarian tumors / 영남의대학술지

The primary function of intraoperative frozen consultation is to provide an as accurate and prompt diagnosis as possible during surgery and to guide the surgeon in further management. However, the evaluation of frozen section (FS) is sometimes difficult because of suboptimal tissue quality and frozen artifacts compared with routinely processed tissue section. The pathologist responsible for the FS diagnosis requires experience and good judgment. Ovarian tumors are a heterogeneous group of tumors including primary surface epithelial tumors, germ cell tumors and sex cord-stromal tumors, secondary tumors, and other groups of tumors of uncertain histogenesis or nonspecific stroma. Intraoperative FS is a very important and reliable tool that guides the surgical management of ovarian tumors. In this review, the diagnostic key points for the pathologist and the implication of the FS diagnosis on the operator’s decisions are discussed.

Tumor ovárico virilizante en mujer postmenopáusica: reporte de caso / Ovarian virilizing tumor in postmenopausal woman: case report

Ovarian steroid-producing tumors are infrequent entities and are potentially malignant. Testosterone is the hormone that rises more frequently and is associated mostly with signs of virilization. We present the clinical case of a 67-year-old postmenopausal woman who came to the clinic for alopecia, with high levels of testosterone and ovarian mass by ultrasound. Surgical treatment was indicated. The main diagnostic aspects are presented.

Los tumores productores de esteroides ováricos constituyen entidades infrecuentes y son potencialmente malignos. La testosterona es la hormona que se eleva con más frecuencia y se asocia en su mayoría a signos de virilización. Se presenta el caso clínico de una mujer postmenopáusica de 67 años que acude a consulta por alopecia, con niveles elevados de testosterona y masa ovárica por ecografía. Se indicó tratamiento quirúrgico. Se presentan los principales aspectos diagnósticos.

Frozen section in the management of ovarian and uterine tumors: the past 5 years in a tertiary centre / Exame de congelação no tratamento de tumores uterinos e do ovário: experiência de 5 anos em um centro terciário

Abstract Objective Intraoperative frozen section (IFS) is a valuable resource, and its use in gynecological pathology has not been sufficiently emphasized. The main goal of the present study is to evaluate the reliability and agreement rates between IFS and the final paraffin section (PS) and determine how reliable IFS is. Methods A retrospective study of all IFSs performed on uterine tumors and suspicious adnexal masses between January 2012 and December 2016 (excluding metastases) at the department of obstetrics and gynecology of the Centro Hospitalar Tondela Viseu. Frozen versus permanent section diagnosis were compared regarding the histologic type of the tumor, and the depth of myometrial invasion. Results A total of 286 cases were eligible for the present study, including 102 (35.7%) IFSs of uterine tumors, and 184 (64.3%) IFSs of ovarian tumors. The overall rate of deferred cases was 5.2% (15/286). The accuracy of the diagnosis in cases of endometrial carcinoma was 96.25% (77/80). Among the ovarian tumors, misdiagnoses occurred in 2 cases (1.1%), corresponding to a borderline tumor (serous type) and a clear cell intracystic adenocarcinoma. Conclusion The IFS analysis plays an important role in selected situations and is associated to a high sensitivity and specificity in cases of ovarian and endometrial tumors. Its high accuracy is almost universally associated with the possibility of obtaining an optimal surgical treatment at the time of the first surgical approach.

Resumo Objetivo O diagnóstico intraoperatório por congelação é umrecurso importante cujo uso empatologia ginecológica não tem sido suficientemente enfatizado. O objetivo do presente estudo foi avaliar as taxas de concordância entre o diagnóstico intraoperatório por congelação e o estudo anatomopatológico definitivo e determinar o quanto o diagnóstico intraoperatório por congelação é um método confiável. Métodos Um estudo retrospectivo de todos os diagnósticos intraoperatórios por congelação realizados em tumores uterinos e massas anexiais suspeitas entre janeiro e 2012 e dezembro de 2016 (excluindo metástases) no serviço de ginecologia e obstetrícia do Centro Hospitalar Tondela Viseu. Comparação do diagnóstico intraoperatório por congelação com o resultado do estudo definitivo em relação ao tipo histológico do tumor e profundidade de invasão miometrial. Resultados Um total de 286 casos foram elegíveis para o estudo, incluindo 102 (35.7%) tumores uterinos e 184 (64.3%) tumores ovarianos. A taxa global de casos deferidos foi de 5.2% (15/286). Entre os tumores uterinos, a acuidade de diagnóstico nos casos de carcinoma endometrial foi de 96.25% (77/80). Entre os tumores ovarianos, não se verificou concordância em 2 casos (1.1%), correspondendo a um tumor borderline do tipo seroso e a um adenocarcinoma de células claras intracístico. Conclusão O diagnóstico intraoperatório por congelação apresenta-se com um importante papel em situações selecionadas, sendo acompanhado de elevada taxa de sensibilidade e especificidade para tumores endometriais e ovarianos. A sua elevada acuidade diagnóstica encontra-se associada à possibilidade de obter um tratamento cirúrgico adequado na primeira abordagem cirúrgica

Primary rhabdomyosarcoma in ovary – Pathologist clinches it all

Sarcomas are extremely complex and heterogeneous group of malignancies. However, exact categorization of the type of sarcoma is essential for the individualized approach for a given patient. It is mandatory that sarcomas should be treated in tertiary care centers with good pathology support and expertise. Here, we present an apt example of a young girl with large abdominal mass which was diagnosed as ovarian rhabdomyosarcoma (RMS). Besides, her excellent response to RMS regimen further reinforces the findings.

Benign Brenner tumor of ovary – A rare case report

Ovarian tumors are common forms of neoplasia in women and it accounts for about 30.0% of female genital cancers. Brenner tumors are subgroup of transitional cell tumors. Benign Brenner tumors are usually unilateral, small and solid. But in our case the tumor was very huge though showing all features of benign Brenner tumor on histopathological examination. For the diagnosis of benign Brenner tumor, radiological investigations are not a reliable tool. Therefore histopathological examination remains gold standard method for final diagnosis of this entity. This case report of large benign Brenner tumor is presented here because of its rarity.