Identification of salt-inducible kinase 3 as a novel tumor antigen associated with tumorigenesis of ovarian cancer.

Existence of humoral immunity has been previously demonstrated in malignant ascitic fluids. However, only a limited number of immunogenic tumor-associated antigens (TAAs) were identified, and few of which are associated with ovarian cancer. Here, we identified salt-inducible kinase 3 (SIK3) as a TAA through screening of a random peptide library in the phage display system. Overexpression of SIK3 markedly promoted cell proliferation, attenuated p21(Waf/Cip1) and p27(Kip) expressions in low-grade OVCAR3 cells, and permitted the cells to grow in mice. Decrease in SIK3 expression in high-grade SK-OV3 cells consistently demonstrated its tumorigenic potency by modulating the protein levels of cell cycle regulators. When the expressions of SIK3 and CA125 were compared in cancer tissues, immunohistochemical (IHC) studies indicated that cytoplasm-localized SIK3 was highly expressed in 55% of the ovarian cancer samples. In contrast, it was rarely detected in adenomyosis, leiomyoma and normal ovary tissues, showing its higher specificity (97%) to CA125 (65%) in ovarian cancer. Moreover, experiments using pharmacological inhibitors to block SIK3-induced p21(Waf/Cip1) expression revealed that activation of c-Src and phosphoinositide-3-kinase were critically required for its biological activity, suggesting that they are the downstream signaling mediators of SIK3. These data were further supported by IHC studies, showing coexpression of c-Src with SIK3 in 85% of the ovarian tumor samples stained positive for SIK3. Collectively, our findings indicate that SIK3 is a novel ovarian TAA. Overexpression of SIK3 promotes G1/S cell cycle progression, bestows survival advantages to cancer cells for growth and correlates the clinicopathological conditions of patients with ovarian cancer.

Anti-tumor activity of histone deacetylase inhibitors and the effect on ATP-binding cassette in ovarian carcinoma cells.

INTRODUCTION: Ovarian cancer is of worldwide importance, and has a significantly high mortality rate due to therapy failure. Drug resistance might be one of most importance factors. Histone deacetylase inhibitors (HDACi) have been reported to be a new class of promising anti-tumor agents, thus this study aimed to investigate the effect of HDAC on the chemo-resistance genes of human ovarian carcinoma cell lines. METHODS: The expressions of ATP binding cassette (ABC) transporter genes, multidrug-resistant protein (MDR1) and multidrug resistance-associated proteins (MRP1 and 2) of ovarian cancer cell lines OC-109 and SK-OV-3 after HDACi treatment were determined. RESULTS: HDACi, including sodium butyrate (NaB), suberoylanilide hydroxamic acid (SAHA) and trichostatin A (TSA) reduced ovarian cancer cell viability from 4.4% to 68.8%, in both dose- and time-dependent manners. The effect of HDACi on MDR1, MRP1, and MRP2 showed induced expression of MDR1 mRNA, but reduced mRNA expression of MRP1 and MRP2. CONCLUSIONS: The effect of HDACi on the reduced viability of ovarian cancer cell lines, concomitant with the induced expression of MDR1 and reduced expression of MRP1 and 2, might provide additional benefits in the management of ovarian cancers in the future.

Anti-fas activating antibody enhances trophoblast outgrowth on endometrial epithelial cells by induction of P38 MAPK/JNK-mediated apoptosis.

In species with hemochorial placentation, such as the mouse and human, trophoblast cells of the implanting blastocyst induce apoptosis and displace endometrial epithelial cells (EEC) to cross the luminal epithelium of the endometrium. Since Fas and Fas ligand (FasL) are expressed in EEC and trophoblast cells respectively and mitogen-activated protein kinases (MAPKs) mediate Fas-induced apoptosis, the roles of Fas/FasL and MAPK signaling in trophoblast-EEC interactions were studied. By co-culturing BeWo trophoblast spheroids with RL95-2 EEC monolayers to mimic blastocyst-endometrial interactions, we found that trophoblast spheroid outgrowth on EEC was significantly enhanced by anti-Fas activating antibody. Since anti-Fas activating antibody had no effect on spheroid expansion on EEC-free culture surfaces, its enhancing effect on spheroid outgrowth on EEC may be mediated by acting on EEC to facilitate trophoblast-induced EEC apoptosis and displacement. Valyl-alanyl-aspartyl-[O-methyl]-fluoromethylketone (VAD-FMK) staining showed that the percentage of apoptotic EEC at the spheroid-EEC interface was markedly increased by anti-Fas activating antibody. Moreover, the pancaspase inhibitor benzyloxycarbonyl-VAD-FMK was able to suppress the enhancing effect of anti-Fas activating antibody on spheroid expansion on EEC. Upon anti-Fas activating antibody stimulation, both p38 MAPK and c-Jun NH(2)-terminal kinase (JNK) were activated. Furthermore, the anti-Fas activating antibody-enhanced EEC apoptosis and spheroid expansion on EEC were significantly inhibited by the p38 MAPK inhibitor SB203580 and JNK inhibitor SP600125. Our results establish that anti-Fas activating antibody could activate p38 MAPK and JNK to induce EEC apoptosis, thereby promoting trophoblast outgrowth on EEC.

Blockade of interleukin 6 accelerates acinar cell apoptosis and attenuates experimental acute pancreatitis in vivo.

BACKGROUND: It remains unclear whether interleukin (IL) 6 plays a role in initiating either the inflammatory or antiapoptotic responses in severe acute pancreatitis. This study examined the effect of neutralizing antibody against IL-6 on the induction of pancreatic acinar cell apoptosis and attenuation of the severity of severe acute pancreatitis. METHODS: Experiments were conducted on laboratory mice with severe acute pancreatitis induced by lipopolysaccharide injection following six injections of caerulein at intervals of 6 h. Neutralizing monoclonal anti-IL-6 antibody was administered either 5 min or 2 h after the first caerulein injection. Apoptosis in pancreatic sections was determined by the terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick-end labelling method. RESULTS: Administration of caerulein and LPS induced an increase in serum amylase and IL-6 levels, severe acute pancreatitis, pancreatitis-associated lung injury, and phosphorylation of signal transducer and activator of transcription (STAT) 3 in the pancreas. A neutralizing antibody against IL-6 effectively suppressed these responses. Application of IL-6 neutralizing antibody caused the induction of apoptosis in the pancreatic acinar cells of mice with acute pancreatitis. CONCLUSION: Blocking IL-6 suppresses STAT-3 activation in the pancreas and consequently attenuates the severity of severe acute pancreatitis by promotion of pancreatic acinar cell apoptosis.

Radical hysterectomy: past, present, and future.

After an analysis of 3,441 radical hysterectomies performed in our department, we found, after modification of the operative technique in 1983, the more lateral the excision the less the recurrence rate. The recurrence rate for Stage 1b-2a and Stage 2b patients comparing the years before 1983 to the years after decreased to 12.4% from 15.7% (158/1,006 vs 268/2,163; p = 0.009) in Stage 1b-2a and 24.6% from 55.8% (38/68 vs 47/191; p = 0.0007) in Stage 2b, respectively. With the modern trend of aspiring for an easier lifestyle, most physicians practice earlier. Therefore only very few physicians study radical hysterectomy. As the skill of surgery needs a longer period of education and training, it may only interest physicians who work with medical professionals as part of a team at a medical center. In the future, we should provide gynecological residents not only with a training program using the classic textbooks, but also with different points of view on changes and developments in radical hysterectomy. We hope to promote an attitude of offering patients access to different choices and opportunities of therapy. Radical hysterectomy is in fact a treatment option for patients with bulky cervical lesions and Stage 2b in particular.

Improved early detection of cervical intraepithelial lesions by combination of conventional Pap smear and speculoscopy.

PURPOSE: To evaluate the efficacy of the addition of speculoscopy to a Pap smear in cervical cancer screening. METHODS: All women were screened using the Pap smear plus speculoscopy (PapSure) and colposcopy in the multicenter trial. The final diagnosis of each patient was based on a histological evaluation of the colposcopic target biopsy. Results were analyzed using a proportional compare test, sensitivity, specificity and predictive value with significant value determined at less than 0.05. RESULTS: Of 1,717 eligible cases, 26 cases had LGSIL and 16 cases had HGSIL. Of the Pap smears, five cases had LSIL and 14 cases had HGSIL. Of the combination of the PapSure, 23 cases had LGSIL and 16 cases had HGSIL. The sensitivity of the Pap smear to that of PapSure was calculated at 45.2% and 92.9%, respectively (p < 0.001). The estimated cost to detect a cervical lesion using PapSure is less than that of the Pap smear. CONCLUSION: The addition of speculoscopy along with a Pap smear screening results in early detection of cervical lesions in comparison to the Pap smear alone. This screening combination is also more cost-effective and requires fewer visits to the clinic in comparison to a Pap smear screening alone.

Detection of HPV infection by analyzing the changes in structure of peripheral blood lymphocytes specifically induced by HPV E7 antigen.

PURPOSE: Detection of human papilloma virus (HPV) infection in clinical practice was examined based on the observation that peripheral blood lymphocytes exposed in vitro to antigenic or mitogenic stimulation change their intracellular structures as measured by polarization of fluorescent light emitted by labeled cells. MATERIALS AND METHODS: A total of 47 women were enrolled in this study. They were classified into four groups based on the results of HPV-DNA detection in cervical tissues by the Hybrid Capture II kit (Digene, Gaithersburg, MD, USA) and pathological examination. Ten women with no HPV-DNA detection were used as a normal control group. Fifteen women without pathological diagnosis in the cervical tissues had HPV-DNA detection. Ten women with CIN lesions had 80% HPV-DNA detection. Twelve women with invasive squamous cell carcinoma had 100% HPV detection. Peripheral blood lymphocytes derived from all women were collected and then exposed to HPV-E7 antigen and PHA mitogen. RESULTS: The positive response rate of HPV-E7 antigen was ten percent (1/10) in the normal control group, 73.3% (11/15) in the HPV infectious women, 50% (5/10) in the CIN women, and 91.7% (11/12) in the cervical cancer patients. The overall sensitivity rate of blood tests was 77.1% and the specificity rate was 57.8% when the Hybrid Capture II HPV Test kit was used as the standard detection method for cervical tissue. CONCLUSIONS: The results showed that peripheral blood lymphocytes derived from patients with cervical lesions might be another choice to be used as a screening method to detect HPV infection compared with conventional methods.

Extramammary Paget's disease found by abnormal vulvar brush sampling.

INTRODUCTION: Doctors are usually reluctant to perform a vulvar biopsy on a patient with non-specific chronic vulvitis--especially because of the rarity of vulvar malignancy in young women--until the lesion is suspected of being malignant. Therefore, most cases of extramammary Paget's disease (EMPD) were originally misdiagnosed as chronic and recurrent vulvar lesions. Late diagnosis of invasive lesions occurring in elderly females have resulted in cases of death. CASE: A 37-year-old patient showed an extended lesion on the vulva and perineum. In addition, abnormal cells were found from a vulvar scrape smear, and a following punch biopsy was used to diagnose and determine the extension of the disease. CONCLUSION: Diagnosis and demarcation of EMPD remain difficult due to the multifocal lesions and subtle nature of the disease. Brush sampling taken from suspicious areas can be a guide for multiple biopsies to demarcate the lesion before major surgery. A brush biopsy is presented as a first-step method to detect vulvar malignancy.

Cross [2 + 2] cycloaddition of bicyclic alkenes with alkynes mediated by cobalt complexes: a facile synthesis of cyclobutene derivatives.

Bicyclic alkenes 1a-e and 5 undergo [2 + 2] cycloaddition with a variety of alkynes PhC(triple bond)CPh, (TMS)C(triple bond)CH, HC(triple bond)C(CH(3))(2)OH, (TMS)C(triple bond)CCO(2)Et, PhC(triple bond)CCH(3), C(2)H(5)C(triple bond)CC(2)H(5), CH(3)C(triple bond)CC(3)H(7), and CH(3)C(triple bond)CC(2)H(5) in the presence of Co(PPh(3))(2)I(2), PPh(3), and Zn powder in toluene to afford the corresponding exo-cyclobutene derivatives 3a-m, 6, and 8a-g in fair to excellent yields. The yield of this cycloaddition is highly sensitive to the cobalt catalyst, solvent, ligand, and temperature used. A mechanism involving a metallacyclopentene intermediate is proposed to account for this cobalt-catalyzed cyclization.

Establishment and characterization of a cell line, MT-213-VGH, isolated from a mixed müllerian tumor of the uterus.

OBJECTIVE: To establish a cell line from a woman with malignant mixed müllerian tumor of the uterus and to examine the biologic properties of this cell line (MT-213-VGH). STUDY DESIGN: Cells were cloned by the limiting dilution method. Histologic staining of mixed müllerian (mesodermal) tumor (MMMT) cells was performed with May-Grünwald-Giemsa and hematoxylin and eosin stain. After more than 20 passages, cells were used to estimate the population-doubling time and colony-forming efficiency of MMMT cells. The cell line exhibited considerable variation in the degree of sensitivity to diverse chemotherapy drugs in vitro. RESULTS: MMMT cells containing antigens for vimentin and myoglobin were detected, but those for CA-125, carcinoembryonic antigen, cytoskeleton, desmin, epithelial membrane antigen and fibronectin were not found. In addition, MT-213-VGH cells contained a mucinous substance; its chromosome model number is 45. This cell line showed differential sensitivities to chemotherapeutic agents, such as bleomycin, cisplatin, 5-fluorouracil and vinblastine. CONCLUSION: The establishment and availability of the number cell line MT-213-VGH for a malignant mixed müllerian tumor of the uterus should assist in research on new methods of managing this type of gynecologic cancer.

Identifying local tumor variables for operable node-negative, margin-free patients with bulky cervical carcinoma of FIGO stage IB, IIA and IIB without adjuvant therapies.

PURPOSE: To identify local risk factors for FIGO IB, IIA and IIB bulky cervical squamous cell carcinoma (tumor size > or = 4 cm) patients with node-negative, margin-free tumors treated by radical hysterectomy, pelvic lymph node and para-aortic lymph node dissections without adjuvant therapies. MATERIALS AND METHODS: Thirty-four patients were recruited between 1976 and 1989 because they all declined any postoperative adjuvant therapy. The pathology reports showed that all the specimen margins were free from cancer cells with no para-aortic or pelvic lymph node metastases. The survival interval was calculated starting from the time of surgical intervention to the time of death or the end of this study in the year 2000. RESULT: Tumor variables including cell differentiation, depth of stromal invasion, parametrial invasion, vaginal invasion, uterine body invasion, age, and FIGO stage were analyzed. Only vaginal invasion showed statistical significance for decreasing patient disease-free survival in both univariate and multivariate analyses with p values of 0.003 and 0.002, respectively. CONCLUSION: For node-negative and margin-free patients with bulky cervical squamous cell carcinoma with operable stage IB and IIB, surgical intervention alone could suffice when no vaginal invasion is noted plus an 85% survival rate could be achieved. A prospective pilot study should be initiated although this study showed an excellent survival rate which is perhaps due to the limited number of cases.

Power Doppler angiographic appearance and blood flow velocity waveforms in invasive cervical carcinoma.

OBJECTIVES: The aim of this study was to investigate the effectiveness of transvaginal power Doppler angiography in predicting cervical malignancy by detecting intratumoral blood flow and to understand the relationship between squamous cell carcinoma (SCC) serum levels and intratumoral blood flow analysis of invasive cervical carcinoma before treatment. METHODS: Thirty-eight patients with cervical carcinoma (35 with stages Ia to IVb invasive carcinoma, 3 with cervical carcinoma in situ) were enrolled for the evaluation of tumor flow using transvaginal ultrasound accompanied with power Doppler angiography before surgery. The pulsatility, resistance index, and vascular index of tumor flow were measured. Thirty patients with proven healthy cervices were used as the control group. Pretreatment SCC serum levels were obtained in 34 women with cervical carcinoma. RESULTS: The pulsatility index and resistance index were significantly lower in the study group than in the control group (P < 0.0001). The vascular index was also significantly lower in the study group than in the control group (P < 0.0001). There were no significant differences among patients with SCC type and non-SCC type cervical carcinoma (P > 0.05) among the six parameters. There was no significant correlation between the pretreatment SCC serum levels with any of the six parameters obtained from the intratumoral blood flow analysis in the SCC group. CONCLUSIONS: Transvaginal ultrasound with power Doppler angiography is a valuable diagnostic tool for differentiating benign tumors of the cervix from malignant ones. Intratumoral blood flow of the cervix supplied us with practical diagnostic information before surgery and may aid in early prediction and management of cervical carcinoma. The use of transvaginal ultrasound with power Doppler angiography in the grading of vascularity ratio within cervical masses provided more sonographic characteristics among the different subclassifications of cervical cancer and is more useful than color Doppler imaging in the visualization of sonographic morphology.

Ruptured metastatic ovarian carcinoma presenting as acute abdomen.

Acute abdomen is a challenge to first-line physicians because of frequently missed diagnoses and potential follow-on legal problems. Improving the management of these patients is of paramount importance, not only for saving lives, but also for reducing untoward problems associated with improper management. We present a case of a patient with acute abdomen due to intraperitoneal hemorrhage secondary to rupture of an ovarian tumor. Following emergency surgery, the patient was diagnosed with metastatic ovarian carcinoma. Because of improper preparation of the gastrointestinal tract, the patient underwent repeat exploratory laparotomy for colon carcinoma. Although this situation did not affect the outcome of the patient in this case, we are concerned that the patient did not benefit from a single operation, with primary complete excision of the tumor plus a colostomy. The outcome of patients with pelvic malignancy, especially those with ovarian carcinoma, might be better if initial surgery achieved optimal tumor debulking. This is possible with good preoperative planning and preparation. We emphasize the importance of preoperative preparation in spite of urgently needed care. Furthermore, every first-line physician should communicate the possibility of malignancy to patients and their families.

Treatment of primary pure angiosarcoma of ovary with multiple lung metastases: a case report.

Angiosarcomas rarely involve the female genital tract. There have only been sporadic case reports of angiosarcomas of the cervix, uterus, vagina, parametrium, broad ligament and pelvis, and only 11 well-documented case reports of primary ovarian angiosarcoma in the English language literature to date. We present a case of primary pure ovarian angiosarcoma with lung metastasis that had partial response after chemotherapy with adriamycin and ifosfamide. But pulmonary hemorrhage and respiratory failure resulted in her death 7 months after initial diagnosis.

Accidentally delayed diagnosis of ruptured ovarian carcinoma in a young woman: a care report.

Ovarian carcinoma commonly occurs in postmenopausal women and often presents with an insidious course. Acute abdomen is rarely an initial symptom. When these patients present with abdominal discomfort, the disease has already spread throughout the peritoneal cavity. We present a case of mucinous cystadenocarcinoma in a young woman who presented with acute abdomen and intra-abdominal bleeding. This 24-year-old woman was previously diagnosed with a ruptured left ovarian cystic tumor at a primary clinic. She underwent emergency exploratory laparotomy, followed by unilateral salpingo-oophorectomy at the clinic. No thorough examination of the peritoneal cavity was done during surgery. The diagnosis of mucinous cystadenocarcinoma was accidentally over-looked until one month later when she returned for routine follow-up. Upon referral to our clinic, the patient underwent a repeat laparotomy. The surgicopathologic diagnosis was intraperitoneal carcinomatosis stage IIIC that could not be excised completely, even though rigorous staging surgery including washing cytology, total abdominal hysterectomy, salpingo-oophorectomy, retroperitoneal lymphadenectomy, appendectomy, infracolic omentectomy and excision of any suspicious and removable lesions were performed. This case alerts us to consider the possibility of ovarian malignancy when a young woman presents with an acute abdomen secondary to ruptured ovarian cystic tumor and intraperitoneal hemorrhage. Careful preoperative preparation and thorough intrasurgical examination of the peritoneal cavity along with a prompt pathologic diagnosis of suspicious lesions will prevent missed diagnoses.

Primary malignant lymphoma of the cervix in pregnancy. A case report.

BACKGROUND: Malignant lymphoma arising from the uterine cervix is a very rare entity. Only two such patients have been reported as pregnant at the time of diagnosis. CASE: A 35-year-old woman (negative Pap smear at antenatal clinics) was referred because of the accidental finding of a huge cervical mass during labor. The patient underwent cesarean section because of arrest of cervical dilatation and persistent floating of the fetal head. The final diagnosis of this cervical mass was malignant lymphoma, low grade B cell, after radical abdominal hysterectomy. CONCLUSION: Although labor obstructed by a tumor of the pelvic organs is a relatively rare event and the majority of cases are benign leiomyomas of the uterus or cervix, the risk of pelvic malignancies should be considered. Bimanual examination and pelvic ultrasound and/or color Doppler ultrasound should be applied without hesitancy in any uncertain situation during pregnancy or labor.

Ovarian tumors complicating pregnancy. Emergency and elective surgery.

OBJECTIVE: To retrospectively evaluate the different effects and characteristics of ovarian surgery performed under emergency conditions and electively during pregnancy and to search for risk factors contributing to emergency ovarian surgery. STUDY DESIGN: Between 1980 and 1996, 174 patients undergoing adnexal surgery during pregnancy or the puerperium were reviewed at Veterans General Hospital-Taipei. Of these 174 patients, 32 underwent emergency surgery (group A), while 142 patients underwent elective surgery (group B). In order to search for differences between the emergency and elective operations, patients in both groups were analyzed, with particular emphasis on the characteristics and outcome of pregnancy. RESULTS: In contrast to elective operations, there were five distinct aspects of emergency surgery. First, half of them occurred in the first trimester. Second, they contributed to 75% (9/12) of the total fetal wastage and 85.7% (6/7) of spontaneous fetal loss (P = .00016). Third, tumor sizes (11.1 +/- 4.2 cm) were significantly larger than those found (8.3 +/- 3.76 cm) in the elective surgery group (P < .05). Fourth, tumors less than 5 cm never caused symptoms requiring surgery. Fifth, an increasing incidence of completely extirpative surgery and general anesthesia was noted (P < .005). Incidence of tumors greater than 10 cm during pregnancy increased with malignancy (P = .0295) and before emergency surgery (P = .00001). CONCLUSION: We could remove ovarian tumors greater than 10 cm in diameter or with a teratoma component at earlier stages of pregnancy (after the seventh week of gestation) to avoid unpredictable complications. This reduces the risks of malignancy and emergency surgery. There was no evidence of increasing risk of fetal loss when surgery was performed after the seventh week of gestation.

Malignant mixed mesodermal tumor presenting as metastatic lymph node adenosquamous cell carcinoma: a case report.

A solitary inguinal lymph node metastasis from a poorly differentiated adenosquamous cell carcinoma of unknown origin in a 52-year-old female is described. The patient was reported to have had a 2-cm palpable mass in the left inguinal area for three years. She had made regular annual clinic visits for Pap smears since the age of 45 years. Her last visit was eight months prior to a complaint of progressive abdominal distention and dull pain of three months' duration. Physical examination showed a huge pelvic mass, and ultrasound and magnetic resonance imaging of the abdomen showed a 12-cm complex solid mass on the left ovary. The patient underwent a complete excisional biopsy of the left inguinal lymph node. Frozen section pathology revealed a poorly differentiated adenosquamous cell carcinoma. Exploratory laparotomy immediately followed pathologic confirmation of malignancy of the left inguinal lymph node. Complete surgical staging including abdominal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, retroperitoneal lymph node sampling and excisional biopsy was performed for all suspicious lesions. Stage IIIC malignant mixed mesodermal tumor (MMMT) was diagnosed due to positive left inguinal lymph node metastasis. However, the retroperitoneal lymph node and intra-abdominal cavity did not show spread of the tumors, except those confined to the left ovary with adhesion to the cul-de-sac, and sole lymph node metastasis in a left inguinal lymph node. Although we could not prove that the left inguinal lymph node metastasis had been present for the three years that it was palpable without histologic confirmation, we believe that any enlarged inguinal lymph node might be the first hint of underlying malignancy in the pelvic area, lower extremities or perineal area. In cases of a poorly differentiated carcinoma of inguinal lymph nodes of unknown origin, the abdomen should be carefully evaluated.

Ovarian surgery during pregnancy and puerperium: twelve-year experience at the Veterans General Hospital-Taipei.

BACKGROUND: This study was performed in order to assess the surgical effects and characteristics of ovarian tumors during pregnancy and analyze their prognosis. METHODS: Between 1982 and 1993, 121 patients who had undergone ovarian surgery during pregnancy or puerperium were reviewed at the Veterans General Hospital-Taipei. These patients were analyzed with particular emphasis on the length of gestation at the time of surgery, complications related to the stage of pregnancy, surgical and pathologic findings and the outcome of pregnancy. RESULTS: Ovarian tumors were commonly detected during the second trimester (54.5%) and most of them (79.3%) were asymptomatic. The pathologic review found 38 patients (31.4%) with benign teratoma, 16 patients (13.1%) with corpus luteum and four patients (3.3%) with malignancy. There was a significant difference between emergent ovarian surgery and elective ovarian surgery in the spontaneous fetal wastage rate (14.1% vs 1%, p = 0.009). Compared with elective surgery, cases necessitating oophorectomy, with or without salpingectomy, increased significantly during emergency surgery (57% vs 36%, p = 0.03). All ovarian surgeries performed before a gestational age of seven weeks resulted in spontaneous fetal wastage. CONCLUSIONS: Although the majority of the ovarian tumors detected during pregnancy were benign, emergency laparotomy was sometimes required, which led to an increase in the risk of a fetal wastage. Preconception counseling should be emphasized because early removal of non-functional ovarian tumor before conception, especially teratoma, would decrease the incidence of ovarian surgery during pregnancy. Furthermore, elective and well-prepared surgical intervention appears to be a crucial factor for favorable pregnancy outcome.