Differentiation of Borderline Epithelial Ovarian Tumors from Benign and Malignant Epithelial Ovarian Tumors by MRI Scoring

INTRODUCTION: The distinction between benign and borderline epithelial ovarian tumors is important because treatment and follow-up strategies differ OBJECTIVE: We aimed to evaluate benign, borderline, and malignant epithelial ovarian tumors using MRI features and contributed to the preoperative evaluation. METHODS: MRIs of 81 patients (20 bilateral), including 31 benign, 27 borderline, and 23 malignant, who had pelvic imaging between 2013-2020, were evaluated retrospectively. The evaluation was made blindly to the pathology result by two radiologists with MRI scoring and features that we determined. MRI evaluation was performed with T1 TSE, T2 TSE, fat-suppressed T2 TSE, and before and after contrast T1 fat-suppressed and non-fat-suppressed TSE images. The numbers and findings obtained in scoring were evaluated by Chi-Square, ordinal logistic regression, and 2 and 3 category ROC analysis. RESULTS: The total score varied between 7 and 24. Among the three groups, a significant difference was found in terms of T1, T2 signal intensity (p <0.01), size (p = 0.055), solid area (p <0.001), septa number (p <0.05), ovarian parenchyma (p = 0.001), ascites (p <0.001), peritoneal involvement (p <0.001), laterality (p <0.001), contrast enhancement pattern (p <0.001). On the other hand, no significant difference was found in terms of wall thickness, lymph node involvement and endometrial thickness (p> 0.05). Cut-off values were found as 11.5 and 18.5 in the 3-category ROC analysis performed for the score (VUS: 0.8109). Patients with a score below 11.5 were classified as benign, those between 11.5-18.5 as borderline, and those over 18.5 as malignant. CONCLUSION: The differentiation of borderline tumors from benign and malignant tumors by MRI scoring will contribute to the preoperative diagnosis.

The research progress on synchronous endometrial and ovarian carcinoma.

Synchronous endometrial and ovarian carcinoma (SEOC) is the most common combination of primary double cancer in the female reproductive system. The etiology and pathogenesis of SEOC remain unclear, and clinically, it is often misdiagnosed as metastatic cancer, affecting the formulation of treatment plans and prognosis for patients. This article provides a review of its epidemiology, pathological and clinical characteristics, risk factors, pathogenesis, diagnosis, treatment, and prognosis.

A novel combination of niraparib and anlotinib in platinum-resistant ovarian cancer: Efficacy and safety results from the phase II, multi-center ANNIE study.

Background: Patients with platinum-resistant recurrent ovarian cancer (PROC) face poor prognosis and limited treatment options. Single-agent antiangiogenics and poly (ADP-ribose) polymerase (PARP) inhibitors both show some activities in platinum-resistant diseases. The ANNIE study aimed to evaluate the efficacy and safety of the novel combination of the PARP inhibitor niraparib and the antiangiogenic anlotinib in patients with PROC. Methods: ANNIE is a multicentre, single-arm, phase 2 study (ClinicalTrials.gov identifier NCT04376073) conducted at three hospitals in China. Eligible patients had histologically confirmed epithelial ovarian, fallopian tube, or primary peritoneal cancer that recurred within 6 months of last platinum-based chemotherapy. Patients with prior PARP inhibitor exposure were excluded. The enrolled patients received oral niraparib 200 mg or 300 mg (baseline body weight-directed) once daily continuously and anlotinib 10 mg (12 mg before protocol amendment) once daily on days 1-14 of each 21-day cycle until disease progression or intolerable toxicity. The primary endpoint was objective response rate (ORR). Findings: Between May 22, 2020, and April 22, 2021, 40 patients were enrolled and treated. Thirty-six patients underwent post-baseline tumour assessments. By data cut-off (January 31, 2022), median follow-up was 15.4 months (95% CI 12.6-17.7). Intention-to-treat ORR was 50.0% (95% CI 33.8-66.2), including one complete response and 19 partial responses. Median (95% CI) progression-free survival and overall survival were 9.2 months (7.4-11.9) and 15.3 months (13.9-not evaluable), respectively. Drug-related, grade ≥3 TEAEs were reported in 26 (68%) patients. There were no treatment-related deaths. Interpretation: Niraparib plus anlotinib showed promising antitumour activity in patients with PROC. This oral combination warrants further investigation as a potential novel, convenient treatment option for patients with PROC. Funding: Zai Lab (Shanghai) Co., Ltd; Jiangsu Chia Tai-Tianqing Pharmaceutical Co., Ltd; the National Natural Science Foundation of China (No. 82102783).

Peutz-Jeghers syndrome: Skin manifestations and endocrine anomalies (Review).

Peutz-Jeghers syndrome (PJS), a rare autosomal dominant serine/threonine kinase 11 (STK11)/ liver kinase B1 (LKB1) gene-related genodermatosis, is characterized by oral hyperpigmentation (OHP); multiple gastro-intestinal mucosal benign hamartomatous polyps causing local bleeding, occlusion, intussusception, post-resection small bowel syndrome, associated increased risk of small intestinal cancer (incidence during the third decade); and 76% cumulative higher risk than the global population of developing non-gastrointestinal tumors (female predominance) including ovarian/testicular neoplasia, pancreatic and gynecologic (breast, uterus, ovarian) cancers. Suggestive PJS-associated OHP requires STK11 genetic testing. Abdominal pain in an OHP patient may be related to PJS-associated polyps. Other features include focal depigmentation followed by hyperpigmentation, and xeroderma pigmentosum-like lesions. The severity of the dermatological findings is correlated with gastrointestinal polyps. The STK11 gene is linked to reserve of primordial follicles, polycystic ovary syndrome, female fertility, and spermatogenesis. PJS is associated with 2 types of ovarian sex-cord stroma tumors (SCSTs): annular tubules (SCTATs) and pure Sertoli cell tumors. SCSTs accounts for 8% of ovarian cancer and SCTATs represents 2% of SCST, which may be associated with the overproduction of progesterone. PJS-SCTAT vs. non-PJS-SCTAT reveals bilateral/multifocal, small tumors with a benign behavior vs. a unique ovarian, large tumor with increased malignant/metastasis risk. Male precocious puberty is due to large cell calcifying Sertoli cell tumors (LCCSCTs). Notably, 30-40% of LCCSCTs are caused by PJS or Carney complex. PJS-LCCSCT is not aggressive, but it may be bilateral/multifocal, with the ultrasound hallmark being micro-calcifications. Testicular, intra-tubular large cell hyalinizing Sertoli cell tumor is the second testicle neoplasia in PJS. The skin and mucosal lesions are useful markers of PJS, assisting with the early identification of hamartomatouspolyps and initiation of serial surveillance of ovarian, or testicular neoplasia.

Educational Case: High-Grade Serous Carcinoma of the Ovary.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1.

Quiste gigante de ovario / Giant cyst of ovary

RESUMEN Históricamente, se describen como tumores de gran tamaño aquellos que pesan más de 12 Kg, entre ellos los ginecológicos y los de ovario; sobre todo antes del advenimiento de la ecografía y en poblaciones de mala situación socioeconómica y nivel cultural, como en los países del continente africano. Se presentó un caso de quiste gigante del ovario, en una paciente de 45 años de edad, que fue atendida en el Servicio de Cirugía General del Hospital Municipal de Bocoio, provincia de Benguela, República de Angola, en el año 2015. Se presentó por un aumento de tamaño del abdomen de varios años de evolución Se le diagnosticó una masa quística dependiente de ovario, por ultrasonografía por no contar con otro medio de diagnostico imagenologico. Se confirmó a través de una laparotomía exploradora la presencia de una tumoración quística gigante del ovario de 20 kg de peso. Esta patología es poco frecuente en la actualidad debido al desarrollo de la Cirugía y de los medios de diagnósticos que permiten su detección precoz. El estudio anatomopatológico ulterior informó un cistoadenoma seroso de ovario izquierdo. La evolución de la paciente fue favorable. Se consideró un caso interesante por lo infrecuente, la poca existencia de reporte de estos casos en la literatura, sobre todo en Cuba, lo que contribuye a aportar conocimientos a la comunidad médica (AU).

ABSTRACT Through the history those tumors weighting more than 12 kg have been described as great size tumors, among them the gynecological and the ovarian ones, especially before the appearance of the ultrasonography, and among populations of bad socio-economic situation and low cultural level, like in the countries of the African continent. The authors presented the case of a giant ovarian cyst in a patient aged 45 years, who assisted in the Service of General Surgery of the Municipal Hospital of Bocolo, province of Benguela, Republic of Angola, in 1915. She arrived to the consultation due to an increase of the abdominal size of several years of evolution. By ultrasonography because there was no other mean of imaging diagnosis, the diagnosis was an ovary-dependent cystic mass. Using laparoscopy it was confirmed the presence of a giant cystic tumor of the ovary of 20 kg weight. This disease is few frequent nowadays due to the development of Surgery and diagnostic means allowing a precocious detection. The subsequent anatomopathologic study informed a serous cystadenoma of the left ovary. The patient had a satisfactory evolution. The case was considered interesting given its infrequency, the scarce existence of reports of cases like this in the literature, especially in Cuba, contributing with knowledge for the medical community (AU).

Moody Mares-Is Ovariectomy a Solution?

Unwanted behaviour in mares is a commonly presenting problem to the veterinarian. This behaviour may range from the mare being uncooperative or aggressive when handled on the ground, kicking, bucking or rearing when ridden or being aggressive towards other horses. This purpose of the study was to evaluate whether bilateral ovariectomy in mares with unwanted behaviour improved the mare's behaviour and/or rideability from the owner's perspective. The mares were grouped and compared statistically based on their histological classification as having either "normal" or neoplastic ovaries. This study is a retrospective case series report of twenty-eight ovariectomized mares. A semi-quantitative value (1-10) pre- and post-ovariectomy for A) behaviour on ground/in stable and B) rideability was given, based on the owner's observations. The horses were grouped based on their histopathologic diagnosis as "Normal ovaries" or "Neoplasia". Following ovariectomy, rideability improved, with a score of ≥5 in 80% (8/10) of mares with normal ovaries and in 57% (8/14) of mares with ovarian neoplasm. A behavioural improvement of ≥5 was observed in 40% (4/10) of mares with normal ovaries, and in 43% (6/14) of mares with ovarian neoplasm. A significant difference was observed between the semi-quantitative value pre- and post-ovariectomy in both groups. No difference was observed in change in behaviour and rideability score between the group with normal ovaries and neoplastic ovaries. Mares with unwanted behaviour not obviously related to the oestrus cycle and to painful conditions may benefit from ovariectomy to alter their behaviour and rideability.

Educational Case: Yolk Sac (Endodermal Sinus) Tumor of the Ovary.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.

Canine ovarian dysgerminoma / Disgerminoma ovariano canino

ABSTRACT: This research aimed to describe a clinical case of ovarian dysgerminoma in a bitch, by showing clinical, ultrasound, surgical and pathological findings. The research also sought to emphasize the importance of establishing an early and definitive diagnosis through histopathology, establishing appropriate protocols for each patient. Ovarian tumors have a low incidence in dogs and cats. Dysgerminomas are a type of ovarian germ cell tumor. They develop in dogs of variable age, that may present clinical signs of hormonal imbalance such as persistent estrus, or pyometra. Prognosis is good in animals that undergo surgery and show no evidence of metastasis. This article presents a clinical case of a 6-year-old English Bulldog with persistent estrus for 2 months, and slightly depressed mental state. Ultrasound revealed the presence of a mass on the left ovary and uterine content. Ovariohysterectomy was performed and the mass was submitted to histopathological exam, which diagnosed an ovarian dysgerminoma.

RESUMO: Neste trabalho descrevem-se caso clínico, achados de ultrassom, cirúrgicos e patológicos de disgerminoma ovárico em cadela. Os tumores ováricos têm baixa incidência em cães e gatos. Nesta categoria estão os tumores das células germinativas, a partir das quais se desenvolvem os disgerminomas. Acomete cadelas de idades variáveis, que podem apresentar sinais clínicos indiciando alterações hormonais, como cio persistente, ou piometra. O prognóstico em animais tratados cirurgicamente, sem evidência de metástase, é bom. Esta pesquisa relata um caso clínico em cadela, raça Bulldog Inglês, de 6 anos de idade, com presença de cio persistente por dois meses. O ultrassom revelou a presença de massa ao nível do ovário esquerdo e escasso conteúdo uterino. Foi realizada ovariohisterectomia e a peça cirúrgica foi enviada para anatomia patológica, que diagnosticou disgerminoma ovarico. Após a resolução do caso, ressalta-se a importancia do diagnóstico clinico e histopatológico precoce para estabelecer protocolos de tratamento adequados.

Ovarian dysgerminoma causing multifocal metastases in young bitch / Disgerminoma ovariano causando metástases multifocais em cadela jovem

The ovarian neoplasias are unusual in canine species, mainly originated from germinative cells. Among these, dysgerminoma is a rare neoplasm in bitches, predominantly affecting senile and small and medium breeds. They are large, rounded, smooth surface, painless and firm in consistency. The clinical signs commonly demonstrated by patients with this neoplasia are abdominal distension and secondary signs of hyperestrogenism. The diagnosis should be based on the association of history, clinical signs, radiographic, ultrasonographic, cytological, histopathological and immunohistochemical exams. The treatment is the surgical castration and metastases are uncommon. Due to the rarity in bitches, specifically the young animals, this study aimed to describe a case of left ovarian dysgerminoma, of considerable size and adherence in adjacent organs, in a Brazilian Fila, whose showed considerable increase in abdominal volume and progressive weight loss. The diagnosis was confirmed by means of complementary x-ray, ultrasound, histopathological and immunohistochemical tests. Even with the recommended surgical treatment (castration), the patient demonstrated severe respiratory symptoms and increased abdominal volume after two months, and the complementary exams suggested pulmonary and multifocal metastases and the tutor chose euthanasia. As presented by the results, although rare in bitches, dysgerminoma should be included in the differential of ovarian neoplasias, including the young ones.

As neoplasias ovarianas são de ocorrência incomum na espécie canina, principalmente as originadas de células germinativas. Dentre estas, o disgerminoma é uma neoplasia rara em cadelas, acometendo predominantemente fêmeas senis e de raças pequenas e médias. Apresentam-se como massas grandes, arredondadas, de superfície lisa, indolores e de consistência firme. Os sinais clínicos comumente demonstrados por pacientes com este tipo neoplásico incluem distensão abdominal e sinais secundários de hiperestrogenismo. O diagnóstico deve ser baseado na associação do histórico, sinais clínicos, exames radiográficos, ultrassonográficos, citológicos, histopatológicos e imunohistoquímicos. O tratamento de escolha é a castração cirúrgica, sendo que as metástases são incomuns. Perante a raridade em cadelas, em específico as jovens, este relato teve como propósito discorrer um caso de disgerminoma ovariano esquerdo, de tamanho considerável e aderência em órgãos adjacentes, em uma Fila Brasileira, cuja sintomatologia incluiu considerável aumento de volume abdominal e emagrecimento progressivo. O diagnóstico foi confirmado por meio de exames complementares de raios-x, ultrassom, histopatológico e imunohistoquímicos. Mesmo com a instituição dotratamento cirúrgico preconizado (castração), a paciente demonstrou grave sintomatologia respiratória e aumento de volume abdominal após dois meses e, como os exames complementares foram sugestivos de metástases pulmonares e multifocais, o tutor optou pela eutanásia. Diante dos resultados, pode-se admitir que apesar de raro em cadelas, o disgerminoma deve ser incluído no diferencial das neoplasias ovarianas, incluindo as jovens.

Risk of Second Primary Tumors After Childhood and Adolescent Ovarian Malignancies: A SEER Analysis (1973-2011).

STUDY OBJECTIVE: To calculate the incidence of second primary tumors (SPTs) in patients previously diagnosed with malignant ovarian tumors in childhood and adolescence. This is an area of interest given the high survival rate and, thus, the long disease-free period that these patients face. DESIGN AND PARTICIPANTS: We conducted a retrospective study following a cohort of patients between 1973 and 2011. Using the National Cancer Institute's Surveillance, Epidemiology and End-Result (SEER) database, we identified patients with an ovarian malignant tumor diagnosed at 19 years of age or younger. RESULTS: Of the 806 patients included in our study, 28 patients developed an SPT after the diagnosis of malignant ovarian tumor. This cohort had higher risk of solid tumors (standardized incidence ratio [SIR] 1.85, 95% CI 1.15 to 2.83) and lymphohematologic malignancies (SIR 5.28, 95% CI 2.12 to 10.88) compared with the general population. There is a higher incidence of lymphoma (SIR 4.25, 95% CI 1.16 to 10.89) and acute nonlymphocytic leukemia (SIR 19.65, 95% CI 4.05 to 57.42), following initial diagnosis of ovarian malignancy during childhood or adolescence. CONCLUSION: The association between ovarian malignancy during childhood or adolescence and lymphoma has not been previously described. Increased incidence of acute nonlymphocytic leukemia supports previous data, underlying the need for long-term follow-up and surveillance of these patients.

Changing trends in the incidence of ovarian neoplasia and its relationship with the risk factors: a report of 311 cases from north-eastern anatolia region.

OBJECTIVE: Ovarian cancer is one of the most common and lethal gynecologic malignancy. In Turkey, the 8(th) most commonly seen neoplasm is ovarian cancer. The risk factors of ovarian cancer are menstrual reproductive events including gravida, menarche and menopause status, and life style habits such as cigarette smoking and habitat. In this study we aimed to determine the risk factors leading to ovarian cancer in Turkish women population and show the tumor markers in this population. MATERIALS AND METHODS: This study included 311 ovarian neoplasia cases diagnosed at the Pathology Department of Ataturk University in Erzurum over last seven years extending from 2005 to 2013. This study is a retrospective analysis basing on the pathology reports and accesible patient files. Serum tumor markers of the patients were retrospectively reported from their records. Conventional stained preparations existing in our archive examined by two pathologists as well independent of each other, and histopathologic diagnosis and the distribution of the sub-group was revised. RESULTS: A total of 311 patients were included in this study in which patients were diagnosed at the Pathology Department of Ataturk University in Erzurum. Serous cystadenoma is the most common ovarian tumor followed by mucinous cystadenoma, germ cell tumors, and dysgerminoma. All of the tumor markers were significantly normal. CONCLUSION: Upto our knowledge this was the first epidemiological study in Turkey. Analysis of each country's statistical information reflecting its own profile is also important. The relationship between the profiles of patients and types of ovarian neoplasia may give an idea about the risk factors of the disease in its region. Additionally, distribution of tumor markers might be considered for the discriminating of the benign or malign characters of the ovarian neoplasia.

Endometriosis and ovarian cancer risk: a systematic review of epidemiological studies.

BACKGROUND: A possible etiological association between endometriosis and ovarian cancer has been repeatedly reported in the literature. OBJECTIVE: Our aim was to evaluate published epidemiological data on this issue. REVIEW METHODS: We conducted an extensive search of the literature in MEDLINE, of articles ever published until February 2014, using the key-words "endometriosis" and "ovarian" and one of the following terms in the title: "cancer" or "malignancy" or "malignant" or "tumor" or "neoplasia" or "neoplasm" or "transformation." Retrieved papers were checked for further relevant publications. RESULTS: Overall, our search yielded 1 prospective cohort study, 10 retrospective cohort, and 5 case-control studies. A meta-analysis of these studies was not considered to be appropriate, due to differences in data reporting, study design, and adjustment for confounding factors. LIMITATIONS: The main limitation of studies found, with one exception, was the lack of operative confirmation of endometriosis. CONCLUSION: An association of endometriosis with clear-cell and endometrioid ovarian cancer was a consistent finding in most studies. On the other hand, existing epidemiological evidence linking endometriosis with ovarian cancer is insufficient to change current clinical practice. Prospective cohort studies, with prior laparoscopic confirmation, localization, and staging of endometriosis are needed, in order to further clarify this issue.

Teratoma ovariano parasitário do omento / Parasitic ovarian teratoma of the omentum

Relata-se um caso de teratoma parasitário do omento que se originou de um tumor dermoide do ovário esquerdo. Revisão da literatura revelou 23 casos que ocorreram, na maior parte, no sexo feminino. Em alguns casos, o teratoma maduro do omento demonstrou evidência histológica de estroma ovariano, sendo associado a tumor dermoide do ovário remanescente contralateral, como neste caso. Acredita-se, então, que a autoamputação e reimplante de um tumor dermoide do ovário seja a etiologia mais comum do teratoma omental. Dor abdominal é geralmente o principal sintoma e no exame físico uma massa móvel abdominal ou pélvica é frequentemente encontrada. Tanto a ultrassonografia com doppler de fluxo em cores como a tomografia computadorizada são úteis no diagnóstico, porém a localização omental correta e exata é extremamente difícil. Teratomas maduros do omento podem ser tratados por ressecção simples. Já os teratomas imaturos, tumores potencialmente malignos, requerem tratamento adjuvante...

This is a case report of a parasitic teratoma of the omentum that derived from a dermoid tumor in the left ovary. The review of the literature pointed to 23 cases of teratoma, most of which affecting women. In some cases, as the one herein described, the mature teratoma of the omentum is followed by histologic evidence of stroma of the ovary and associated with dermoid tumor of the remaining contralateral ovary. Self-amputation and reimplantation of a dermoid tumour in the ovary is thus believed to be the most common etiology for teratoma of the omentum Abdominal pain is usually the main symptom, and mobile abdominal or pelvic mass is usually found during physical examination. Both color doppler fluximetry ultrasound and computerized tomography are useful for diagnosis purposes, but the accurate and precise localization of the omentum is of high complexity. Mature teratomas of the omentum can be treated with simple resection. I mmature teratomas, potentially malign tumors, demand adjuvant treatment...

Expression of mullerian inhibiting substance and its receptor in ovarian neoplsia / 대한산부인과학회지

Mullerian inhibiting substance (MIS) is a glycoprotein hormone produced by fetal Sertoli cells that causes regression of the Mullerian ducts in males during sexual differentiation. Cell lines derived from human ovarian epithelium and rodent Leydig cell tumors, which respond to MIS in growth inhibition assays and express the MIS type II receptors (MISR II). But the pathophysiological role of MIS in human ovarian neoplasia development has not yet been fully established. In order to understand its role in pathogenesis of ovarian neoplasia, the expression and localization of the MIS and MISR II were studied in 5 normal ovaries, 11 benign tumors, 9 borderline ovarian malignancies, 40 ovarian malignancies in paraffin embedded tissue and tissue microarrays by using immunohistochemical stain. The results were as follows; 1. The first staining for MIS and MISR II were detected in granulosa cells in primary follicles of normal ovary. Among the growing follicles, larger developing follicles stained more intensely than smaller follicles. 2. In benign ovarian tumors, 8 (72.73%) in MIS and 5 (45.45%) in MISR II out of 11 cases were stained. The intensity scores of staining were 1.18 in MIS and 0.64 in MISR II. 3. In borderline malignancies, 6 (66.67%) in MIS and 7 (77.78%) in MISR II out of 9 cases were stained. The intensity scores of staining were 0.89 in MIS and 1.22 in MISR II. 4. In ovarian malignancies, the expression of MIS and MISR II were 50% (9/18) and 50% (9/18) in epithelial, 92.30% (12/13) and 76.72% (10/13) in germ cell, and 88.9% (8/9) and 100% (9/9) in sex-cord stromal tumors. The intensity scores of MIS and MISR II expression were 0.72 and 0.72 in epithelial, 1.45 and 1.62 in germ cell, and 1.78 and 1.67 in sex-cord stromal tumors. 5. There was significant high expression of MIS and MISR II in non-epithelial (90.91%, 86.36%) than epithelial ovarian cancers (50%, 50%). The scores of expression intensity was also higher in non-elithelial cancers (MIS: 1.67 +/- 0.16 vs 0.72 +/- 0.20, p=0.003, MISR II: 1.64 +/- 0.20 vs 0.72 +/- 0.21, p=0.022). In conlusion, the expression of MIS and MISR II were not different according to the differentiation, but tissue type specific. The frequency of MIS and MISR II expression was higher in non-epithelial cancers, especially in sex-cord stromal tumors. The results of this experiment could be utilized as scientific basis of researches, furthermore clinical applications in diagnosis and treatment of non-epithelial ovarian malignancies.