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Devins KM, Young RH, Oliva E. Sex Cord-Stromal Tumors of the Ovary: An Update and Review. Part I - Pure Ovarian Stromal Tumors. Adv Anat Pathol 2024; 31:215-230. [PMID: 38369847 DOI: 10.1097/pap.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
In two separate reviews, we review the time-honored but still frequently challenging features of ovarian sex cord-stromal tumors, and also emphasize new developments including unusual morphologic appearances that, despite the relative rarity of many of the tumors, result in a disproportionate number of differential diagnostic problems, variant immunohistochemical profiles, and specific molecular and syndromic associations. These neoplasms are also of historical interest as current knowledge is still based in significant part on the contributions of 2 giants of gynecologic pathology, Dr Robert Meyer and Dr Robert E. Scully. In part I, we present the major clinical, pathologic, and genomic features of the pure ovarian stromal tumors including comments on differential diagnosis and briefly note significant historical contributions. In part II we will discuss pure sex cord and sex cord-stromal tumors.
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Affiliation(s)
- Kyle M Devins
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Bo J, Sun M, Wei C, Wei L, Fu B, Shi B, Fang X, Dong J. MRI combined with clinical features to differentiate ovarian thecoma-fibroma with cystic degeneration from ovary adenofibroma. Br J Radiol 2024; 97:1057-1065. [PMID: 38402483 DOI: 10.1093/bjr/tqae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE To explore the value of magnetic resonance imaging (MRI) and clinical features in identifying ovarian thecoma-fibroma (OTF) with cystic degeneration and ovary adenofibroma (OAF). METHODS A total of 40 patients with OTF (OTF group) and 28 patients with OAF (OAF group) were included in this retrospective study. Univariable and multivariable analyses were performed on clinical features and MRI between the two groups, and the receiver operating characteristic (ROC) curve was plotted to estimate the optimal threshold and predictive performance. RESULTS The OTF group had smaller cyst degeneration degree (P < .001), fewer black sponge sign (20% vs. 53.6%, P = .004), lower minimum apparent diffusion coefficient value (ADCmin) (0.986 (0.152) vs. 1.255 (0.370), P < .001), higher age (57.4 ± 14.2 vs. 44.1 ± 15.9, P = .001) and more postmenopausal women (72.5% vs. 28.6%, P < .001) than OAF. The area under the curve of MRI, clinical features and MRI combined with clinical features was 0.870, 0.841, and 0.954, respectively, and MRI combined with clinical features was significantly higher than the other two (P < .05). CONCLUSION The cyst degeneration degree, black sponge sign, ADCmin, age and menopause were independent factors in identifying OTF with cystic degeneration and OAF. The combination of MRI and clinical features has a good effect on the identification of the two. ADVANCES IN KNOWLEDGE This is the first time to distinguish OTF with cystic degeneration from OAF by combining MRI and clinical features. It shows the diagnostic performance of MRI, clinical features, and combination of the two. This will facilitate the discriminability and awareness of these two diseases among radiologists and gynaecologists.
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Affiliation(s)
- Juan Bo
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
| | - Mingjie Sun
- Faculty of Graduate Studies, Wannan Medical College, Wuhu, Anhui 241002, China
| | - Chao Wei
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Longyu Wei
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Baoyue Fu
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Bin Shi
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Xin Fang
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Jiangning Dong
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
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Hu X, Li W, Li X, Li D, Cai J, Wang P. 18F-FDG PET/CT features of Meigs syndrome induced by ovarian sex cord stromal tumors: a retrospective clinical study. Sci Rep 2024; 14:347. [PMID: 38172241 PMCID: PMC10764332 DOI: 10.1038/s41598-024-51186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/01/2024] [Indexed: 01/05/2024] Open
Abstract
The objective of this study was retrospectively to analyze the clinical characteristics and 18F-FDG PET/CT findings in Meigs syndrome (MS) patients. A total of 21 patients with MS induced by ovarian stromal tumors and 69 patients with pseudo-MS caused by ovarian cancer (OC-PMS) were subjected to evaluation using 18F-FDG PET/CT. Visual and semi-quantitative methods were employed to analyze the PET/CT findings. Visual analysis included recording whether the density of the primary tumor was uniform, whether there were cystic changes and calcifications, and the location of serous fluid accumulation. Semi-quantitative analysis involved the measurement of the tumor size, SUVmax, and SUVmean. No significant difference was observed in the size and density of primary tumors between the MS group and the OC-PMS group. However, the SUVmax and SUVmean of tumors in the MS group were found to be significantly lower than those in the OC-PMS group. The amount of serous cavity effusion caused by ovarian sex cord stromal tumors was found to be unrelated to the size of the tumor, SUVmax, and SUVmean but was positively correlated with the level of Ca125. MS patients have both benign ovarian tumors and ascites and/or pleural effusion, which may be accompanied by elevated Ca125 levels. This should be considered as one of the differential diagnoses for ovarian cancer. Understanding the PET/CT features of MS can facilitate the attainment of an accurate diagnosis before surgery.
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Affiliation(s)
- Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China
| | - Wenxin Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China
| | - Xiaotian Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China
| | - Dandan Li
- Department of Obstetrics, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, 563000, China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China.
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China.
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Lu B, Liu C, Qi J, He W, Shi T, Zhu Y, Huang B. Comparison of contrast-enhanced ultrasound, IOTA simple rules and O-RADS for assessing the malignant risk of sonographically appearing solid ovarian masses. J Gynecol Obstet Hum Reprod 2023; 52:102564. [PMID: 36868504 DOI: 10.1016/j.jogoh.2023.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/02/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To explore the diagnostic accuracy of ovarian solid tumors by 2D ultrasound and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS We retrospectively evaluated the CEUS characteristics of prospectively enrolled 16 benign and 19 malignant ovarian solid tumors. We performed International Ovarian Tumor Analysis (IOTA) simple rules and Ovarian-Adnexal Reporting and Data System (O-RADS) for all lesions, and evaluated their characteristics on CEUS. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of IOTA simple rules, O-RADS and CEUS in the diagnosis of ovarian solid malignancies were calculated. RESULTS The combination of time to wash-in earlier than or equal to the myometrium, time to PI earlier than or equal to the myometrium and the intensity at peak were higher than or equal to myometrium with sensibility of 0.947, specificity of 0.938, and PPV of 0.947, NPV of 0.938 which were higher than IOTA simple rules and O-RADS. According to the definition of ovarian solid tumor, the diagnostic accuracy of O-RADS 3 and CEUS were both 100%, CEUS improved the accuracy of O-RADS 4 from 47.4% to 87.5%, the accuracy of solid smooth CS 4 in O-RADS 5 and CEUS were both 100%, CEUS improved the accuracy of solid irregular in O-RADS 5 from 70% to 87.5%. CONCLUSION For ovarian solid tumors that are difficult to distinguish between benign and malignant, the introduction of CEUS on the basis of 2D classification criteria can significantly improve the diagnostic accuracy.
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Affiliation(s)
- Beilei Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai 200072, PR China
| | - Jiuling Qi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China.
| | - Wanyuan He
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China.
| | - Tingyan Shi
- Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, 200032 PR China
| | - Yuli Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China.
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Muacevic A, Adler JR, Kamaretsos E, Paraoulakis I, Ziogas AC, Kontogeorgis G, Grapsidi V, Gerokostas EE, Kontochristos V, Thanasas I. Surgical Treatment of a Rare Case of Ovarian Fibroma Associated With Elevated CA125 Levels in a Patient of Reproductive Age: A Case Report. Cureus 2023; 15:e34097. [PMID: 36843723 PMCID: PMC9946278 DOI: 10.7759/cureus.34097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
Small ovarian fibromas (< 10cm) associated with elevated serum CA125 levels are rarely encountered, particularly in women of reproductive age. We report a rare case diagnosed in a 35-year-old patient after adnexectomy for a solid ovarian mass of approximately 5cm in maximum diameter, accompanied by elevated serum CA125 levels. In preoperative evaluation, no signs of inflammation from the genital tract were found, and no medical history of endometriosis, uterine leiomyomas, or non-gynecological cancer was reported. Intraoperative frozen section biopsy of surgical specimen obtained from the ovarian tumor had negative evaluation for malignancy. Histological examination of the surgical specimen confirmed the diagnosis of ovarian fibroma. The postoperative course was uneventful. Two months after surgery, the blood serum CA125 levels were within normal ranges. The patient is assessed at regular intervals in the gynecology outpatient clinic. In this paper, based on the data of the modern literature, a brief review of this rare nosological entity is made.
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Tan N, Jin KY, Yang XR, Li CF, Yao J, Zheng H. A case of death of patient with ovarian fibroma combined with Meigs Syndrome and literature review. Diagn Pathol 2022; 17:83. [PMID: 36253781 PMCID: PMC9575228 DOI: 10.1186/s13000-022-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Ovarian fibroma is the most common benign pure stromal tumor. It has no specific clinical manifestation, most of which are pelvic or adnexal masses. 10-15% of cases with hydrothorax or ascites, after tumor resection, hydrothorax and ascites disappear, known as Meigs Syndrome. The elevated level of CA125 in a few patients was easily misdiagnosed as ovarian malignant tumor. A case of bilateral Ovarian fibroma associated with Meigs Syndrome is reported and the literature is reviewed in order to improve the understanding of the changes and avoid misdiagnosis.
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Affiliation(s)
- Na Tan
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Kai-Yuan Jin
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiao-Rong Yang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Cheng-Fang Li
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jin Yao
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Hong Zheng
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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Raičević S, Radoman K, Radović S, Vučković L, Vukmirović F. Fibrothecoma in a Virgo Intacta Adolescent with Elevated Levels of CA 125 and B-hCG: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 9:847. [PMID: 35740784 PMCID: PMC9221770 DOI: 10.3390/children9060847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Ovarian fibromas are benign tumors that consist of spindle cells in bundles or storiformly arranged with collagen fibers in the stroma. Thecomas resemble theca interna ovarian cells, and there is lipid material in their cytoplasm. There is an overlap in histological and immunohistochemical characteristics of these two benign tumors, and the term "fibrothecoma" was coined to describe such cases. Their incidence is extremely rare in adolescents. The subject of our study is a 15-year-old, unmarried, virgo intacta patient who was referred to us due to profuse vaginal bleeding and the loss of consciousness. A right ovary ultrasound examination exposed the formation of a hyperechoic tumor with a diameter of 41.2 mm × 29.5 mm. Findings of cancer antigen 125 (CA 125) in the amounts of 621.1 U/mL and 142.87 mIU/mL of the B-human chorionic gonadotropin (B-hCG) serum were determined. After preoperative preparation, we operated on the patient to remove a tumor with a diameter of 37 mm × 30 mm × 22 mm, smooth outer surface, solid cross-section, and yellowish white color. The diagnosis of fibrothecoma was made based on pathohistological examination. An unusual finding of fibrothecoma in a virgo intacta adolescent with profuse vaginal bleeding and increased levels of CA 125 and B-hCG may serve as a basis for broader thinking about the pathology of juvenile bleeding.
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Affiliation(s)
- Saša Raičević
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica 81000, Montenegro
| | - Kristina Radoman
- College of Health Studies, Džona Džeksona 1, Podgorica 81000, Montenegro;
| | - Saša Radović
- Department of Paediatric Surgery, Clinical Center Montenegro, Children’s Diseases Institute, Podgorica 81000, Montenegro;
| | - Ljiljana Vučković
- Department of Pathology, Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica 81000, Montenegro; (L.V.); (F.V.)
| | - Filip Vukmirović
- Department of Pathology, Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica 81000, Montenegro; (L.V.); (F.V.)
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Raji H, Hamid Borsi S, Dargahi MalAmir M, Asadollah Salmanpour AR. Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. BIONATURA 2021. [DOI: 10.21931/rb/2021.06.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P <0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.
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Affiliation(s)
- Hanie Raji
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Hamid Borsi
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrdad Dargahi MalAmir
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Asadollah Salmanpour
- Air Pollution, and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hou YY, Peng L, Zhou M. Meigs syndrome with pleural effusion as initial manifestation: A case report. World J Clin Cases 2021; 9:5972-5979. [PMID: 34368316 PMCID: PMC8316948 DOI: 10.12998/wjcc.v9.i21.5972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor, ascites, and pleural effusion. In postmenopausal women with pleural effusions, ascites, elevated CA-125 level, and pelvic masses, the probability of disseminated disease is high. Nevertheless, the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion. Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation.
CASE SUMMARY A 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month. Two months before admission, the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment. However, the pleural fluid accumulation persisted, and the patient began to experience dyspnea on exertion leading to admission. A computed tomography scan of the chest, abdominal ultrasound, and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass. Serum tumor markers showed raised CA-125. With a suspicion of a malignant tumor, the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma. On the seventh day postoperation, the patient had resolution of the right-sided pleural effusion.
CONCLUSION Despite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125, clinicians should be aware about rare benign syndromes, like Meigs, for which surgery remains the preferred treatment.
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Affiliation(s)
- Ya-Ya Hou
- Department of Obstetrics and Gynaecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Li Peng
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Mei Zhou
- Department of Respiratory Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Palmieri A, ElSahwi K, Hicks V. Meigs syndrome presenting with severely elevated CA-125 level. BMJ Case Rep 2021; 14:14/3/e238931. [PMID: 33653838 PMCID: PMC7929823 DOI: 10.1136/bcr-2020-238931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 64-year-old woman referred to Gynaecological Oncology secondary to the finding of pelvic mass and ascites. Imaging showed multiple pelvic masses, with the largest mass measuring 20 cm in diameter, as well as bilateral pleural effusions and abdominal ascites, suspicious for ovarian carcinoma. Laboratory findings included elevated cancer antigen 125 (CA-125) of 2124 units/mL. The patient underwent an exploratory laparotomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy for pathological evaluation. Postoperatively, the patient had resolution of ascites and pleural effusion. Surgical pathology revealed a 26 cm right ovarian fibroma, confirming the diagnosis of Meigs syndrome. Despite the high suspicion for ovarian carcinoma in patients presenting with elevated CA-125 level, pelvic mass, ascites and pleural effusion, the diagnosis of Meigs syndrome cannot be excluded without pathological evaluation of mass.
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Affiliation(s)
- Alicia Palmieri
- Obstetrics & Gynecology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Karim ElSahwi
- Gynecology Oncology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Verda Hicks
- Gynecology Oncology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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Pietkiewicz D, Horała A, Plewa S, Jasiński P, Nowak-Markwitz E, Kokot ZJ, Matysiak J. MALDI-MSI-A Step Forward in Overcoming the Diagnostic Challenges in Ovarian Tumors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207564. [PMID: 33080944 PMCID: PMC7589662 DOI: 10.3390/ijerph17207564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
Abstract
This study presents the use of matrix-assisted laser desorption and ionization mass spectrometry imaging (MALDI-MSI) directly on the tissue of two ovarian tumors that often present a diagnostic challenge, a low-grade serous borderline ovarian tumor and ovarian fibrothecoma. Different spatial distribution of m/z values within the tissue samples was observed, and regiospecific peaks were identified. Among the 106 peaks in the borderline ovarian tumor five, regiospecific peaks (m/z: 2861.35; 2775.79; 3368.34; 3438.43; 4936.37) were selected using FlexImaging software. Subsequently, the distribution of those selected peaks was visualized on the fibrothecoma tissue section, which demonstrated the differences in the tissue homo-/heterogeneous structure of both tumors. The comparison with the histopathological staining of the ovarian borderline tumor tissue section, obtained during serial sectioning, showed a close correlation of the molecular map with the morphological and histopathological features of the tissue and allowed the identification of different tissue types within the sample. This study highlights the potential significance of MSI in enabling morphological characterization of ovarian tumors as well as correct diagnosis and further prognosis than thus far seen in the literature. Osteopontin, tropomyosin and orosomucoid are only a couple of the molecules investigated using MALDI-MSI in ovarian cancer research. This study, in line with the available literature, proves the potential of MALDI-MSI to overcome the current limitations of classic histopathological examination giving a more in-depth insight into the tissue structure and thus lead to the more accurate differential diagnosis of ovarian tumors, especially in the most challenging cases.
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Affiliation(s)
- Dagmara Pietkiewicz
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland; (D.P.); (S.P.)
| | - Agnieszka Horała
- Gynecologic Oncology Department, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland; (A.H.); (E.N.-M.)
| | - Szymon Plewa
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland; (D.P.); (S.P.)
| | - Piotr Jasiński
- Department of Pathology Gynecological and Obstetric Clinical Hospital, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland;
| | - Ewa Nowak-Markwitz
- Gynecologic Oncology Department, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland; (A.H.); (E.N.-M.)
| | - Zenon J. Kokot
- Faculty of Health Sciences, Calisia University, 13 Kaszubska Street, 62-800 Kalisz, Poland;
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland; (D.P.); (S.P.)
- Correspondence:
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Gomes TA, Campos EA, Yoshida A, Sarian LO, Andrade LALDA, Derchain SF. Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:555-561. [PMID: 32992358 PMCID: PMC10309224 DOI: 10.1055/s-0040-1712993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate the role of clinical features and preoperative measurement 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 cord-stromal, 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, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant 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 cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.
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Affiliation(s)
- Tiago Augusto Gomes
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Elizabeth Aparecida Campos
- Laboratory of Experimental Pathology, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Adriana Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Luís Otavio Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | | | - Sophie Françoise Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
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Strobel SL, Jenison EL, Van Kooten JM, Kitts AN, Britton AJ. Triple negative lobular breast carcinoma metastatic to an ovarian fibrothecoma. J Histotechnol 2020; 43:200-203. [PMID: 32508260 DOI: 10.1080/01478885.2020.1773638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A postmenopausal woman with lobular breast carcinoma metastatic to a large ovarian fibrothecoma is presented. The two metastatic tumor nodules were grossly subtle and could have been overlooked in the background of the large ovarian stromal tumor. Thorough sampling of the tumor for histologic examination and supporting immunohistochemical stains were important in establishing the diagnosis. Differential diagnostic considerations are discussed.
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Affiliation(s)
- Stephen L Strobel
- Department of Pathology, Bon Secour Mercy St. Vincent Hospital , Toledo, OH, USA
| | - Eric L Jenison
- Department of Gynecologic Oncology, Bon Secour Mercy St. Vincent Hospital , Toledo, OH, USA
| | - Jessica M Van Kooten
- Department of Gynecologic Oncology, Bon Secour Mercy St. Vincent Hospital , Toledo, OH, USA
| | - Alyssa N Kitts
- Department of Gynecologic Oncology, Bon Secour Mercy St. Vincent Hospital , Toledo, OH, USA
| | - Andrew J Britton
- Department of Pathology, Bon Secour Mercy St. Vincent Hospital , Toledo, OH, USA
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Abstract
Ovarian sex cord-stromal tumors are uncommon tumors and clinically differ from epithelial tumors. They occur across a wide age range and patients often present with hormone-related symptoms. Most are associated with an indolent clinical course. Sex cord-stromal tumors are classified into 3 main categories: pure stromal tumors, pure sex cord tumors, and mixed sex cord-stromal tumors. The rarity, overlapping histomorphology and immunoprofile of various sex cord-stromal tumors often contributes to diagnostic difficulties. This article describes the various types of ovarian sex cord-stromal tumors and includes practical approaches to differential diagnoses and updates in classification.
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Affiliation(s)
- Krisztina Z Hanley
- Department of Pathology, Emory University Hospital, Rm H-187, 1364 Clifton Road, Northeast, Atlanta, GA 30322, USA.
| | - Marina B Mosunjac
- Department of Pathology, Grady Memorial Hospital, 80 Jesse Hill Jr Dr SE, Atlanta, GA 38303, USA
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15
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Tarlovskaya EI, Kamardina NA, Mazalov KV. [Demons-Meigs syndrome or cardiomyopathy: a difficult case of a differential diagnosis]. ACTA ACUST UNITED AC 2019; 59:64-68. [PMID: 31995727 DOI: 10.18087/10.18087/cardio.n447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/21/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022]
Abstract
The article presents an overview of the data related to Demons-Meigs syndrome and the clinical situation associated with a complex differential diagnosis between myocarditis with the formation of secondary cardiomyopathy and Demons-Meigs syndrome. A variety of clinical symptom complexes that are associated with Demons-Meigs syndrome is discussed. The concepts of classical and non-classical, full and incomplete Demons-Meigs syndrome are considered. The current views on the pathogenesis of the syndrome and the mechanism of the formation of ascites and pleural effusion are given.
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Affiliation(s)
- E I Tarlovskaya
- IFM FSBEI HE "Privolzhsky Research Medical University" MOH Russia
| | - N A Kamardina
- Clinical Hospital №4 of the Federal health care institution Volga district medical centre of Federal medical-biological agency
| | - K V Mazalov
- Clinical Hospital №4 of the Federal health care institution Volga district medical centre of Federal medical-biological agency
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16
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Su MH, Cho SW, Kung YS, Lin JH, Lee WL, Wang PH. Update on the differential diagnosis of gynecologic organ-related diseases in women presenting with ascites. Taiwan J Obstet Gynecol 2019; 58:587-591. [DOI: 10.1016/j.tjog.2019.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 02/07/2023] Open
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