The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory

Non-coding RNA RMRP governs RAB31-dependent MMP secretion, enhancing ovarian cancer invasion

Non-coding RNAs (ncRNAs) are frequently dysregulated in various cancers and have been implicated in the etiology and progression of cancer. Ovarian cancer, the most fatal gynecological cancer, has a poor prognosis and a high patient fatality rate due to metastases. In this study, we classified patients with ovarian cancer into three groups based on their ncRNA expression levels. Notably, an ncRNA transcribed by RNA polymerase III, RNA component of mitochondrial RNA processing endoribonuclease (RMRP), is highly expressed in a group with a poor prognosis. Functional assays using SKOV3 and HeyA8 human ovarian cancer cell lines revealed that while RMRP modulation had no significant effect on cell viability, it markedly enhanced cell invasion. Knockdown and ectopic expression experiments demonstrated that RMRP promotes the secretion of matrix metalloproteinase (MMP)-2 and -9, thereby facilitating ovarian cancer cell invasiveness. Transcriptomic analysis further revealed a positive correlation between RMRP expression and genes involved in cellular localization, including RAB31, a member of the Ras-related protein family. Notably, RAB31 knockdown abrogated the pro-invasive effects of RMRP, identifying it as a key downstream effector in SKOV3 and HeyA8 cells. In addition, MechRNA analysis identified RAB31 as a putative RMRP-interacting transcript. These findings establish RMRP as a critical regulator of RAB31-dependent MMP secretion and ovarian cancer cell invasion. Moreover, our results suggest that RMRP could serve as a promising prognostic biomarker for ovarian cancer.

Opportunistic salpingectomy: A Delphi study among Brazilian experts

Brazilian experts evaluated the consensus on opportunistic salpingectomy as a preventive approach against ovarian cancer, highlighting adoption potential and key implementation barriers in clinical practice.

Evaluation of a patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer

INTRODUCTION

A patient decision aid on opportunistic salpingectomy and salpingectomy as a sterilization method has been developed to provide uniform counseling and reduce practice variation. The aim of this study was to evaluate the use of the patient decision aid in daily clinical practice to ensure its effectiveness and usability, as well as its influence on the decision-making process and the decision of opportunistic salpingectomy.

MATERIAL AND METHODS

As part of the STOPOVCA-implementation study, we conducted a multicenter observational study in 16 hospitals between July 2020 and February 2024. Patients who were eligible for opportunistic salpingectomy were invited to use the decision aid while they considered whether or not to undergo opportunistic salpingectomy. Digital questionnaires were used to evaluate the decision aid, the decision process, and patients' decisions 6-8 weeks post-surgery.

RESULTS

425 out of 542 patients participated in the questionnaire. A majority of these 425 patients received (N = 357; 84%) and used the decision aid (N = 347; 82%). Two thirds (N = 234; 67%) of those who used the decision aid stated that it increased their knowledge of opportunistic salpingectomy. Patients considered the decision aid a usable aid, allocating a score of 8.1 out of 10 and would recommend it to other patients facing the decision regarding opportunistic salpingectomy. Patients considered the extent to which they were involved in the decision-making process as high, and the decisional conflict low. The majority of patients who used the decision aid opted for opportunistic salpingectomy (N = 326; 95%). Main reasons for choosing opportunistic salpingectomy were the risk-reducing effect of ovarian cancer (N = 311; 90%) and the lack of functionality of the fallopian tubes after childbearing (N = 320; 92%).

CONCLUSIONS

The patient decision aid was used by a majority of patients who received it. The decision aid was regarded by patients as user-friendly, and it was recommended to be used in the decision-making process for opportunistic salpingectomy. Patients stated that the decision aid provides reliable information and increases patients' knowledge of opportunistic salpingectomy.

Role of DNA methylation and non‑coding RNAs expression in pathogenesis, detection, prognosis, and therapy‑resistant ovarian carcinoma (Review)

Ovarian cancer is the deadliest gynecological cancer globally, with epithelial ovarian cancer (EOC) comprising up to 90% of cases. A molecular characterization linking the histological subtypes with tumor grade in EOC has been suggested. Variations in genetic biomarkers such as BRCA1/2, MSH2, MLH1/6, BRIP1, and RAD51C/D have been studied in EOC. In addition, molecular characteristics, including DNA methylation and RNA transcription, are being explored as potential new biomarkers for the diagnosis and prognosis of this type of neoplasia. The present review focused on the role of DNA methylation and non‑coding RNA expression in the development of ovarian carcinomas and their association with diagnosis, prognosis, and the resistance of cancer cells to radiotherapy and chemotherapy. The present review considered the transition from the DNA structure to the RNA expression in ovarian carcinoma.

Development of a nano-vaccine for high-grade serous ovarian cancer

High-Grade Serous Carcinoma (HGSC) is characterised by aggressive malignant tumours and poor prognosis accounting for 75% of ovarian cancer. Conventional treatments often result in relapse, with a need for innovative therapeutic approaches. This study aimed to develop and evaluate a DNA vaccine targeting the preferentially expressed antigen of melanoma, PRAME, a cancer tumour antigen (CTA) overexpressed in HGSC. PRAME demonstrated the highest differential gene expression between normal fallopian tubes and HGSC tumour tissues in a range of patient datasets. The PRAME DNA was condensed by the cationic cell-penetrating peptide RALA to form nanoparticles (NPs). These self-assembling NPs exhibited a mean hydrodynamic size <150 nm and zeta potential >10 mV at N : P ratios ≥4 with ≤3% free DNA. The NPs successfully transfected NCTC-929 and DC 2.4 cells with PRAME overexpression, with negligible cytotoxicity. Vaccination with the NPs in vivo elevated CD4+ and CD8+ T-cell activation with increased expression of INF-γ and IL-2 cytokines. Vaccination also significantly improved survival rates in a PRAME-expressing tumour model in vivo. This study demonstrated the utility of a PRAME-targeted DNA vaccine for HGSC treatment which warrants further investigation.

Death-ision: the link between cellular resilience and cancer resistance to treatments

One of the key challenges in defeating advanced tumors is the ability of cancer cells to evade the selective pressure imposed by chemotherapy, targeted therapies, immunotherapy and cellular therapies. Both genetic and epigenetic alterations contribute to the development of resistance, allowing cancer cells to survive initially effective treatments. In this narration, we explore how genetic and epigenetic regulatory mechanisms influence the state of tumor cells and their responsiveness to different therapeutic strategies. We further propose that an altered balance between cell growth and cell death is a fundamental driver of drug resistance. Cell death programs exist in various forms, shaped by cell type, triggering factors, and microenvironmental conditions. These processes are governed by temporal and spatial constraints and appear to be more heterogeneous than previously understood. To capture the intricate interplay between death-inducing signals and survival mechanisms, we introduce the concept of Death-ision. This framework highlights the dynamic nature of cell death regulation, determining whether specific cancer cell clones evade or succumb to therapy. Building on this understanding offers promising strategies to counteract resistant clones and enhance therapeutic efficacy. For instance, combining DNMT inhibitors with immune checkpoint blockade may counteract YAP1-driven resistance or the use of transcriptional CDK inhibitors could prevent or overcome chemotherapy resistance. Death-ision aims to provide a deeper understanding of the diversity and evolution of cell death programs, not only at diagnosis but also throughout disease progression and treatment adaptation.

TGF-β signaling in the ovary: Emerging roles in development and disease

The TGF-β superfamily plays a pivotal role in a wide array of cellular processes, including cell proliferation, differentiation, apoptosis, and migration. It is also critically involved in ovarian development and the pathogenesis of various diseases. Within the ovary, follicles act as the primary functional units, housing numerous members of the TGF-β superfamily that regulate follicular development and, consequently, overall ovarian function. Dysregulation of the TGF-β signaling pathway is associated with reproductive disorders and the development of ovarian diseases in female mammals, such as polycystic ovary syndrome (PCOS), premature ovarian aging, ovarian insufficiency, and ovarian cancer. This article highlights the significant contributions of key TGF-β signaling pathway members to follicular development and ovarian disease progression, aiming to deepen the understanding of TGF-β signaling's critical role in reproductive health.

A Case Study of a High-Grade Serous Carcinoma of the Fallopian Tube Transformed into Carcinosarcoma at the Site of Peritoneal Dissemination With Immunohistological Evidence of an Epithelial-Mesenchymal Transition

We report a patient in whom a primary high-grade serous carcinoma (HGSC) of the fallopian tube transformed into a carcinosarcoma at the site of peritoneal dissemination, and immunohistological analysis suggested the involvement of an epithelial-mesenchymal transition (EMT). The patient, a 70-year-old woman, had an abdominal mass palpated on admission, and a laparotomy was performed after a close examination. The resected right fallopian tube was cystically dilated, and a solid mass was observed in its lumen. The histological diagnosis was HGSC of the right fallopian tube with a papillary or complex tubular structure composed of tumor cells with marked nuclear irregularities. p53 was overexpressed, and no mesenchymal tumor component was observed. The resected left-sided abdominal mass of the omentum was a solid with a long diameter of 100 mm. Microscopically, the tumor exhibited a mixture of HGSC and high-grade sarcoma with nonspecific differentiation. Furthermore, a heterologous chondrosarcoma was subsequently observed from the high-grade sarcoma. The HGSC component was E-cadherin positive. The high-grade sarcoma component was positive for EMT-related proteins such as zinc finger E-box-binding homeobox 1 (ZEB1) and twist family bHLH transcription factor 1 (TWIST1). The chondrosarcoma component was ZEB1 positive and TWIST1 negative. p53 overexpression was found in all 3 components. The tumor of the omentum suggested that an EMT phenomenon was involved in the tumorigenesis. In this scenario, the primary HGSC of the fallopian tube with obvious invasion demonstrated that the conversion from carcinoma to sarcoma by EMT occurs only with peritoneal dissemination.

An update on nanoformulations with FDA approved drugs for female reproductive cancer

Female reproductive cancers, including ovarian, cervical, breast, gestational trophoblastic and endometrial cancer, present significant challenges in therapy and patient prognosis. Conventional chemotherapy often lacks selectivity, leading to systemic toxicity and reduced treatment efficacy. Nanotechnology has emerged as a promising approach to improve drug delivery and therapeutic outcomes. Encapsulation of FDA-approved drugs within nanocarriers such as liposomes, polymeric nanoparticles, and lipid nanoparticles enables controlled drug release, reduces off-target effects, and enhances drug accumulation at tumor sites. This targeted delivery minimizes damage to healthy tissues and improves patient survival rates. Additionally, nanoformulations facilitate combination therapy, overcoming drug resistance and maximizing therapeutic efficacy. Despite promising results, challenges like scalability, reproducibility, and regulatory approvals hinder widespread clinical applications. Developing personalized nanoformulations tailored to individual patient profiles offers potential for precision cancer therapy. This study explores the role of nanoformulations in enhancing the therapeutic potential of FDA-approved drugs for treating female reproductive cancers.

Extended sub-chronic exposure to heavy metal mixture induced multidrug resistance against chemotherapy agents in ovarian cancer cells

Recent scientific findings suggest that persistent, minimal quantity exposure to heavy metals combinations can instigate negative reactions across various cell types, tissues, and organs. However, the interplay between heavy metals present in blood and cancerous cells remains largely unclear. We aimed to examine the capability of a Pb, Cd, and Co at very low concentrations blend to trigger multidrug resistance against chemotherapeutic remedies such as cisplatin, 5-fluorouracil, and doxorubicin in the NIH-Ovcar3 human ovarian cancer cell line. Additionally, we sought to dissect the molecular mechanisms bolstering this resistance. Our results illustrate that consistent administration of the heavy metal mixture at extraordinarily low concentrations fosters pronounced chemotherapy resistance in Ovcar3 cells via cross resistance. This resistance endured and was propagated through ensuing cell generations. We observed that ATP-binding cassette (ABC) membrane transporters, specifically P-gp/ABCB1, BRCP/ABCG2, and ABCC1-type cellular detoxification functions, were markedly overexpressed, playing a crucial role in multidrug resistance. This finding supports the molecular evidence of the acquired multidrug resistance phenotype and provides preliminary insights into the potential resistance mechanism. We also found decreased mortality rates in the resistant ovarian cancer cells, with the mitochondrial apoptosis pathway activating at a reduced rate post-chemotherapy relative to the non-resistant control cells. Furthermore, multidrug-resistant cells exhibited increased motility and enhanced wound-healing abilities, hinting at a higher metastatic potential. These findings suggest that analysing P-gp, BRCP, and ABCC1 multidrug resistance gene expression and/or protein levels within biopsy samples from ovarian cancer patients at risk of heavy metal exposure could prove advantageous in determining chemotherapy dosage and prolonging patient lifespan.

Cellular origins of mucinous ovarian carcinoma

Mucinous ovarian carcinoma (MOC) is a rare histotype of epithelial ovarian cancer. Its origins are obscure: while many mucinous tumours in the ovary are metastases from the gastrointestinal tract, MOC can occur as an ovarian primary; however, the cell of origin is not well established. In this review we summarise the pathological, epidemiological, and molecular evidence for the cellular origins of MOC. We propose a model for the origins of the various tumours of the ovary with mucinous differentiation. We distinguish Müllerian from gastrointestinal-type mucinous differentiation. A small proportion of the latter arise from teratoma and a distinct terminology has been proposed. Other gastrointestinal mucinous tumours are associated with Brenner tumours and arise from their associated benign lesions, Walthard nests. The remaining mucinous tumours develop either through mucinous metaplasia in established Müllerian tumours or with even greater plasticity through gastrointestinal metaplasia of epithelial or mesothelial ovarian inclusions. This model remains to be validated and mechanistically understood and we discuss future research directions. © 2025 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Risk Factors for Recurrence in Serous Borderline Ovarian Tumors and Early-Stage Low-Grade Serous Ovarian Carcinoma

BACKGROUND

Tumor recurrence significantly impacts the quality of life and fertility of patients with serous borderline ovarian tumors (SBOT) and early-stage low-grade serous ovarian carcinoma (LGSOC). This study aims to characterize recurrence patterns, identify independent risk factors for recurrence, and develop a nomogram to predict recurrence-free survival (RFS).

METHODS

We conducted a retrospective case-control study to investigate recurrence in patients undergoing fertility-sparing surgery (FSS) and radical surgery (RS). Logistic regression and Cox regression were used to identify risk factors. Kaplan-Meier analysis was applied to evaluate RFS. A nomogram was developed based on identified variables to predict RFS.

RESULTS

Tumor capsule disruption and micropapillary were associated with higher recurrence risk in the FSS group. Non-invasive implants were associated with higher recurrence risk in the RS group. The nomogram prediction model was developed based on identified risk factors. The area under the curve (AUC) for RFS predictions was 0.74 (95% CI: 0.62-0.85) at 3 years and 0.78 (95% CI: 0.67-0.89) at 5 years for the FSS group and 0.87 (95% CI: 0.76-0.98) at 3 years and 0.81 (95% CI: 0.65-0.97) at 5 years for the RS group.

CONCLUSIONS

We identified the risk factors for recurrence of SBOT and early-stage LGSOC following FSS and RS procedures and developed a predictive model for forecasting RFS. This model provides valuable guidance for patients and clinicians in predicting recurrence risk for patients.

On the Quest for Biomarkers: A Comprehensive Analysis of Modified Nucleosides in Ovarian Cancer Cell Lines

Ovarian carcinoma is a gynecological cancer with poor long-term survival rates when detected at advanced disease stages. Early symptoms are non-specific, and currently, there are no adequate strategies to identify this disease at an early stage when much higher survival rates can be expected. Ovarian carcinoma is a heterogeneous disease, with various histotypes originating from different cells and tissues, and is characterized by distinct somatic mutations, progression profiles, and treatment responses. Our study presents a targeted metabolomics approach, characterizing seven different ovarian (cancer-) cell lines according to their extracellular, intracellular, and RNA-derived modified nucleoside profiles. Moreover, these data were correlated with transcriptomics data to elucidate the underlying mechanisms. Modified nucleosides are excreted in higher amounts in cancer cell lines due to their altered DNA/RNA metabolism. This study shows that seven different ovarian cancer cell lines, representing different molecular subtypes, can be discriminated according to their specific nucleoside pattern. We suggest modified nucleosides as strong biomarker candidates for ovarian cancer with the potential for subtype-specific discrimination. Extracellular modified nucleosides have the highest potential in the distinguishing of cell lines between control cell lines and themselves, and represent the closest to a desirable, non-invasive biomarker, since they accumulate in blood and urine.

Proteomic analysis reveals potential biomarker candidates in serous ovarian tumors - a preliminary study

Introduction

Ovarian serous cystadenocarcinoma (SCA), a deadly gynecologic cancer, often goes undetected until the late stages. Tissue proteomics unveils disease heterogeneity, enhancing tumor classification and enabling personalized treatments tailored to individual expression profiles.

Material and methods

Tissue samples from 46 serous ovarian tumors were quantified using label-free liquid chromatography-tandem mass spectrometry. We identified 80 proteins differentiating SCA from borderline tumors, 277 distinguishing SCA from benign tumors, and 195 between borderline and benign tumors. Ingenuity pathway analysis revealed increased cell proliferation and RNA processing in SCA and borderline tumors compared to benign tumors, with SCA showing greater oxidative phosphorylation than borderline tumors.

Results

Our comparative analysis indicates that upregulated (ASS1 - argininosuccinate synthase 1, CAPS, PPA1, BCAT1, MCM4) and downregulated proteins (MUC5B, SLC4A1, tenascin-XB - TNXB, carbonic anhydrase 1, hemoglobin β) may offer a robust panel for distinguishing SCA from benign and borderline ovarian tumors, potentially aiding in early diagnosis and disease monitoring. The cancer-associated proteins pyridoxal dependent decarboxylase domain containing 1 (AUC: 0.83, 95% CI: 0.66-1), GFPT1 (AUC: 0.84, CI: 0.70-0.89), and HYOU1 (AUC: 0.84, CI: 0.70-0.98) significantly differentiated between low-grade (LGSCA) and high-grade serous cystadenocarcinoma (HGSCA). Low-grade SCA showed significantly greater levels of MZB1 (log2 fold change (FC): -1.951, p-value: 0.0258), CRABP2 (FC: -2.34, p-value: 0.0016), and BCAM (FC: -1.945, p-value: 0.0197) than borderline cancers.

Conclusions

Argininosuccinate synthase 1 and TNXB showed potential as markers of disease progression. Elevated ASS1 was observed in borderline, LGSCA, and HGSCA tumors compared to benign tumors, while TNXB levels progressively declined from benign to borderline, LGSCA, and HGSCA tumors. Our study pinpoints critical biomarkers in serous ovarian tumors for HGSCA progression.

A Noninvasive Menstrual Blood-Based Diagnostic Platform for Endometriosis Using Digital Droplet Enzyme-Linked Immunosorbent Assay and Single-Cell RNA Sequencing

Endometriosis is marked by the ectopic growth, spread, and invasion of endometrial tissue beyond the uterus, resulting in recurrent bleeding, pain, reproductive challenges, and the formation of nodules or masses. Despite advancements in detection methods like ultrasound and laparoscopy, these techniques remain limited by low specificity and invasiveness, underscoring the need for a highly specific, noninvasive in vitro diagnostic method. This study investigates the potential of using menstrual blood as a noninvasive diagnostic sample for endometriosis by targeting genetic and inflammatory markers associated with endometriosis lesions. A novel digital droplet enzyme-linked immunosorbent assay (ddELISA) was developed, leveraging SiO2 nanoparticles for the femtomolar-sensitive detection of inflammatory cytokines (OPN, IL-10, IL-6) in menstrual blood. Single-cell RNA sequencing revealed differentiation patterns across endometrial tissues and menstrual blood, affirming that menstrual blood replicates key inflammatory and immune properties of endometriosis. Furthermore, endometriosis menstrual blood endometrial cells derived from human menstrual blood displayed similar properties to endometrial stromal cells in endometriosis lesions, validating menstrual blood as a suitable in vitro diagnostic sample. In contrast to traditional ELISA, ddELISA supports multi-target detection with enhanced sensitivity and reduced processing time, allowing precise biomarker analysis from minimal sample volumes. Our ddELISA-based approach shows promise as a rapid, accessible, and accurate diagnostic tool for endometriosis, with potential for practical clinical application.

The potential for opportunistic salpingectomy to reduce ovarian cancer in women undergoing non-gynecologic surgery

Background

We sought to estimate the impact, acceptance, and additional cost of opportunistic bilateral salpingectomy (OBS) or bilateral salpingo-oophorectomy (BSO) during certain non-gynecologic procedures on the incidence of high grade serous ovarian cancer (HGSOC).STUDY DESIGN: US population and institutional data were reviewed for three common laparoscopic non-gynecologic surgeries: Cholecystectomy (CCY), Ventral Hernia Repair (VHR), and Bariatric Surgical Procedures (BSP). Additionally, institutional review was performed on all patients, aged 35-75, undergoing these procedures from July 2016 to June 2019 to determine candidacy for OBS or BSO. Patients with history of hysterectomy or tubal sterilization were excluded. Baseline population risk (1.4%) and estimated risk reduction associated with OBS (65%) and BSO (98%) were applied to determine the impact OBS or BSO would have on incidence if applied as standard of care. Separately, patients were surveyed regarding acceptance of concurrent risk reducing procedure. Cost effective analysis (CEA) was performed using multiple models which evaluated participation of Surgery, OB/GYN, and both.

Results

For the institutional review, 765 cases were identified, with 417 eligible. Extrapolating the percentage of eligible female patients from our institution undergoing CCY (63 %), VHR (57 %), and BSP (81 %) to reported annual US cases, resulted in eligible cases as follows: CCY (472,500), VHR (199,500-285,000), and BSP (184,680). Therefore, we estimate 466,891---513,488 eligible patients per year. Assuming 20,400 new ovarian cancer (OC) cases annually, between 4,248 and 4,839 cases would be eliminated (20.8-23.7 % reduced incidence). Fifty-nine patients were surveyed (13 AA, 2H) with acceptance rate of 81 %. CEA revealed that multiple models for institution of this practice would favor implementing risk reducing surgery, with OBS performing better than BSO.

Conclusion

Over half of female patients undergoing three common non-gynecologic abdominal surgeries could benefit from OBS or BSO. If logistics can be arranged between surgeons and their patients, incidence of OC could be reduced by at least 20-25%.

Biobanking and gynecologic oncology - Special considerations, challenges and opportunities

Biobanks of gynecological tissues occupy a critical niche in oncologic research. They are essential components of contemporary research strategies on gynecologic malignancy by integrating clinical, molecular and longitudinal biospecimen data. They also implement protocols for quality control, regulate sample and data sharing, provide ethical and regulatory oversight, and establish governance mechanisms to regulate their function. Gynecologic tissue biobanks also face some unique challenges. The broad heterogeneity of disease entities encompassed under this domain include common and rare malignancies, each with unique molecular subtypes that must be integrated into biobank information systems. Specimen acquisition extends beyond conventional tissues to include cervicovaginal microbiomes and ascitic fluid. Thus, gynecologic tissue biobanks should develop tailored collection strategies and the establishment of dedicated gynecologic tissue repositories that enable the aggregation of rare specimens through collaborative networks. This article emphasizes the need for high-quality annotation of biospecimens, the incorporation of multi-omics approaches to enhance the translational approaches, challenges associated with integration of high dimensional datasets, the role of biobank networks, and various ethical and cultural considerations concerning gynecologic biobanks. Emerging technologies that integrate multi omics, spatial biology and liquid biopsies now offer enhanced opportunities that augment classical specimen collection and should be integrated into standardized protocols.

The challenge of managing isolated STIC lesions: A single-center experience

Objectives

High-grade serous carcinoma (HGSC) arise from serous tubal intraepithelial carcinoma (STIC) lesions, a precursor that develops from the fallopian tube epithelium. Patients with incidental isolated STIC lesions found on salpingectomy specimen have up to 25% risk of developing HGSC or peritoneal carcinomatosis in the future, yet there is no established consensus to guide management.

Methods

This retrospective case series includes patients diagnosed with isolated STIC lesions between April 2017 and January 2024. Patient data was extracted from clinical and pathological databases.

Results

During the study period, 10 patients were diagnosed with an isolated STIC lesion. The fallopian tubes were removed either as part of a hysterectomy for endometrial cancer (n = 3); a prophylactic risk-reducing surgery for BRCA1 or BRCA2 mutation (n = 3); or a benign gynecologic condition (n = 4). The median age of the patients was 64 years (range: 53-80). Among patients who underwent genetic testing (n = 9), only three were found to have a deleterious germline mutation in BRCA1 or BRCA2. The patients either received adjuvant chemotherapy (n = 5) or underwent active surveillance (n = 5). One surveillance patient was managed with completion bilateral oophorectomy and omentectomy. Median number of chemotherapy cycles was four (range 4-6 cycles). The median follow-up was 27 months (range: 5-83 months). One patient under active surveillance was diagnosed with peritoneal carcinomatosis 5 years after initial diagnosis of STIC whereas none recurred in the chemotherapy group.

Conclusion

The wide variety of treatment approaches we observed highlights a need for more data on this entity to support management guidelines.

Estimating high-grade serous fallopian tubal carcinoma in the era of tubal hypothesis

In the era of the serous tubal intraepithelial carcinoma hypothesis, investigation continues as to what proportions of high-grade serous tubo-ovarian carcinomas originate in the distal fallopian tube versus in the ovary. In this retrospective cohort study of 118,619 patients with high-grade serous tubo-ovarian carcinoma identified in the Commission-on-Cancer's National Cancer Database from 2004 to 2021, a diagnosis shift from high-grade serous ovarian carcinoma to high-grade serous fallopian tubal carcinoma occurred from 2004 to 2018 that the proportional distribution of high-grade serous fallopian tubal carcinoma increased 6.1-fold from 4.5% in 2004 to 27.6% in 2018 (p-trend < .001). This rapid diagnosis shift from high-grade serous ovarian carcinoma to high-grade serous fallopian tubal carcinoma reached a plateau at 2018, followed by steady proportional distribution of high-grade serous fallopian tubal carcinoma among the high-grade serous tubo-ovarian carcinomas for 4 consecutive years (27.6% in 2018 to 28.0% in 2021, p-trend = .801). The average rate of tubal carcinomas during this post-plateau period was 27.7%. In conclusion, the diagnosis shift in the primary site of high-grade serous tubo-ovarian carcinoma from the ovary to the fallopian tube may have ended in the late 2010s. After the implementation of College of American Pathologists diagnosis criteria, 1 in 3 to 4 high-grade serous tubo-ovarian carcinomas were classified as of fallopian tube origin.

The Role of Killer Ig-like Receptors in Diseases from A to Z

Killer Ig-like Receptors (KIRs) regulate immune responses, maintaining the balance between activation and inhibition of the immune system. KIRs are expressed on natural killer cells and some CD8 T cells and interact with HLA class I molecules, influencing various physiological and pathological processes. KIRs' polymorphism creates a variability in immune responses among individuals. KIRs are involved in autoimmune disorders, cancer, infections, neurological diseases, and other diseases. Specific combinations of KIRs and HLA are linked to several diseases' susceptibility, progression, and outcomes. In particular, the balance between inhibitory and activating KIRs can determine how the immune system responds to pathogens and tumors. An imbalance can lead to an excessive response, contributing to autoimmune diseases, or an inadequate response, allowing immune evasion by pathogens or cancer cells. The increasing number of studies on KIRs highlights their essential role as diagnostic and prognostic biomarkers and potential therapeutic targets. This review provides a comprehensive overview of the role of KIRs in all clinical conditions and diseases, listed alphabetically, where they are analyzed.

Malignant Brenner Tumor of the Ovary: A Critical Reappraisal

Malignant Brenner tumors (MBTs) are rare epithelial tumors of the ovary, most likely arising from benign and borderline Brenner tumors. MBTs may be misdiagnosed as other primary carcinomas or nonepithelial tumors of the ovary as well as metastatic carcinomas. Accurate diagnosis usually requires clinical-radiologic correlation, extensive sampling, and immunohistochemical studies. Treatment is not standardized and may include surgery with or without chemotherapy. More than half of MBTs are diagnosed at stage I, with 47.7% and at least 20% recurrence and mortality rates, respectively. Awareness of key diagnostic features and pitfalls is essential to differentiate MBT from its mimics and ensure optimal clinical management. This comprehensive review includes classification, etiopathogenesis, historical overview, epidemiology, clinical features, treatment, prognosis, gross pathology, key morphologic features, ancillary testing, and differential diagnostic considerations for ovarian MBTs.

An umbrella review of meta-analyses regarding the incidence of female-specific malignancies after fertility treatment

IMPORTANCE

Understanding the potential risks associated with fertility treatments (FTs) can guide clinical decision and patient counseling.

OBJECTIVE

To investigate the validity of the association between the development of female-specific malignancies including ovarian, endometrial, breast, and cervical cancer after FT.

DATA SOURCES

A search of systematic reviews and meta-analyses was performed from inception to April 2022 within several databases: Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, and PubMed.

STUDY SELECTION AND SYNTHESIS

The inclusion criteria required the incidence of each cancer subgroup to be stated in both the defined treatment group (controlled ovarian stimulation and/or in vitro fertilization [IVF] or intracytoplasmic sperm injection) and the control group (no-FT, general population). From 3,129 identified publications, 11 meta-analytical reviews consisting of 188 studies were selected for synthesis.

MAIN OUTCOME

The primary outcome of interest was incidence of each subgroup of cancer in the "FT" group compared with the "no-FT" group.

RESULTS

A statistically significant increase in incidence of ovarian (1,229/430,611 in FT group vs. 27,358/4,263,300 in no-FT group) cancer (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.00-1.45) and borderline ovarian tumors (117/414,729 in FT group vs. 934/2,626,324 in no-FT group) (OR, 1.87; 95% CI, 1.18-2.97) was observed. The incidence of ovarian cancer was higher with FT and IVF specifically (OR, 1.65; 95% CI, 1.07-2.54). For borderline ovarian tumors, the incidence was higher, not only with FT overall and IVF, but also according to the fertility drug regimen applied: clomiphene citrate (CC) only (OR, 1.99; 95% CI, 1.02-3.87), human menopausal gonadotropin only (OR, 3.46; 95% CI, 1.39-8.59), and CC and human menopausal gonadotropin combined (OR, 3.79; 95% CI, 1.47-9.77). When using the threshold for statistical significance, the meta-analyses relevant to ovarian cancers remained statistically significant (random-effects method). However, none of the examined associations could claim either strong or highly suggestive evidence.

CONCLUSION AND RELEVANCE

An observed association between ovarian cancer (including borderline ovarian tumors) and FT has been demonstrated. The association between FT and female-specific malignancy remains a contentious topic because there have been contradictory outcomes among meta-analyses. This umbrella review interrogates existing systematic reviews and meta-analyses on this topic and concludes that a statistically significant increase in the incidence of ovarian cancer and borderline ovarian tumors is associated with FT. These findings have a significant clinical impact because it helps to inform and provide effective counseling for patients undergoing FT.

Detection of Genomic Copy Number Variations in Ovarian Cancer in the Peripheral Blood System

Ovarian cancer has an incidence of 11 [...].

Prognostic and Predictive Value of Systemic Inflammatory Markers in Epithelial Ovarian Cancer

Background and Objectives: Epithelial ovarian cancer (EOC) remains a significant global health challenge. While traditional prognostic factors are well established, emerging biomarkers continue to gain attention. Materials and Methods: This retrospective study evaluated the impact of systemic inflammatory markers on progression-free survival (PFS) and overall survival (OS) in 154 EOC patients. Pre-treatment neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and systemic inflammatory index (SII) were calculated and categorized into low and high groups. Univariate and multivariate analyses were conducted to identify independent prognostic factors, while logistic regression analysis was used to determine predictors of platinum resistance. Results: In the univariate analysis, elevated NLR and PLR were associated with poorer PFS and OS. However, these markers did not maintain statistical significance in the multivariate analysis. Although SII demonstrated a trend toward worse outcomes, it did not reach statistical significance. Histopathological type, PLR, and surgical approach were identified as independent predictors of platinum resistance. Conclusions: Our findings indicate that systemic inflammatory markers may hold prognostic value in EOC; however, further validation through larger prospective studies is necessary.

Cell Migration in Endometriosis Responds to Omentum-Derived Molecular Cues Similar to Ovarian Cancer

Endometriosis is common and poses significant morbidity of lasting impact to young, pre-menopausal women, while ovarian cancer is a lethal gynecologic condition. Both conditions need better treatment. The human omentum is an apron of adipose tissue in the abdominopelvic cavity, the same space in which endometriosis and ovarian cancer manifest. We aim to determine molecular cues emitted by the omentum that aid the trans-coelomic spread of endometriosis and ovarian cancer in the abdomen-pelvic/peritoneal space. Endometriosis and ovarian cancer patients were prospectively recruited. Primary cell cultures of surgically-resected omentum, endometriosis and ovarian cancer were generated, and conditioned media (CM) from the omentum was derived. They were used for in vitro assays to evaluate the effect of the omentum on cell migration, angiogenesis and proliferation in endometriosis and ovarian cancer. Omental CM promoted cell migration in primary cultures of endometriosis and ovarian cancer. Omental CM contained high levels of HGF, SDF-1a, MCP-1, VEGF-A, IL-6 and IL-8. The observed cell migration was blocked by c-MET inhibition, suggesting that HGF/c-MET signaling mediates cell migration in endometriosis and ovarian cancer. Furthermore, PTTG1 was consistently upregulated in the migrated cells in both endometriosis and ovarian cancer. The omentum provides a favorable environment for trans-coelomic spread of endometriosis and ovarian cancer. HGF, c-MET and PTTG1 are potential therapeutic targets for inhibiting the abdomen-pelvic/peritoneal spread of endometriosis and ovarian cancer.

Ovarian cancer and its management through advanced drug delivery system

Ovarian cancer is the deadliest gynecological cancer, often being diagnosed at a late-stage when the disease is already advanced. This makes it known as the ''silent killer'' due to its high mortality rate among women. The ovary itself is composed of three main types of cells epithelial cells, germ cells, and stromal cells. Over 90% of all occurrences of ovarian cancer are epithelial ovarian carcinoma. Ovarian cancer is responsible for 2.5% of cancer in women. The primary signs include stomach bloating, trouble eating or feeling full rapidly, fatigue, and discomfort during intercourse. The management of ovarian cancer is improved by advanced drug delivery systems because they increase therapeutic targeting, reduce side effects, and overcome drug resistance. Accurate distribution to cancer cells is made possible by methods such as ligand-functionalized nanomedicines, dual-targeted nano-drugs, drug conjugates, antibody-drug conjugates and peptide/folate drug conjugates. These technologies enhance individualized and successful ovarian cancer treatment outcomes by maximizing chemotherapy efficacy, extending drug release, and lowering toxicity.

Aggressive Serous Carcinomas of the Female Reproductive Tract: Cancer-Prone Cell States and Genetic Drivers

In 2025, gynecological cancers are projected to account for approximately 10% of cancer-related deaths in women. High-grade serous ovarian carcinoma (HGSC) and serous endometrial carcinoma (SEC) are the most lethal gynecological cancer subtypes. Both malignancies commonly have TP53 mutations, alterations of the RB1 pathway, and numerous secondary mutations. Both carcinoma types consist of poorly differentiated and highly heterogeneous cell populations at the time of detection. Latent development and rapid progression of HGSC and SEC impede the identification of definitive cells of origin and genetic drivers. Here, we review our current knowledge about cancer-prone cell states and genetic drivers. We also discuss how emerging transcriptomic and genetic tools applied to contemporary model systems may facilitate the identification of novel targets for timely detection and therapeutic intervention.

Pelvic inflammatory disease and risk of borderline ovarian tumors: A national population-based case-control study in Sweden

The resemblance between fallopian tube cells and serous borderline ovarian tumors (BOTs) suggests a potential origin link, with salpingitis proposed as a contributing factor in the pathogenesis of BOT. This study aimed to explore the potential association between pelvic inflammatory disease (PID) and the risk of developing BOT. A national population-based case-control study in Sweden included women with BOT between 1999 and 2020 and 10 matched controls. Data from nationwide registers were analyzed using conditional logistic regression, adjusting for age, residential district, educational level and parity. Among 4782 cases and 45,167 controls, 2.0% of cases and 1.3% of controls had a history of PID. Previous PID was associated with an increased risk of BOT overall (aOR, 1.48; 95% CI, 1.19-1.85). Significant association was observed with serous tumors (aOR, 1.76; 95% CI, 1.36-2.29), while not with mucinous tumors (aOR, 0.95; 95% CI, 0.60-1.49). A dose-response relationship between number of PID episodes and serous BOT risk was noted (Ptrend < .001). This study demonstrates that PID is associated with increased risk of serous BOT, with a dose response relationship. The study highlights the potential serious implications of upper reproductive tract infections and inflammation. This underscores the need for further investigation of biological mechanisms and possible impact of PID on serous BOT development.

Oral contraceptive use is associated with a reduction in the physical size of fallopian tube p53 signatures

OBJECTIVE

Oral contraceptives reduce ovarian cancer risk, but the mechanism of risk reduction is not understood. We examined whether oral contraceptive pill (OCP) use influences p53 signatures, which are putative early fallopian tube precursors for high-grade serous ovarian carcinomas.

METHODS

For this retrospective cohort (n = 250) of subjects aged over 50 years who had fallopian tubes removed at the time of a benign gynecologic procedure, we used health records to identify 72 patients who used OCPs for at least 5 years and 178 subjects with no history of OCP use. Immunohistochemistry for p53 was performed on all fallopian tube sections, with 8 individuals removed for lack of identifiable tissue. p53 Signatures were identified and stratified based on size. Logistic regressions were run to estimate the association between OCP use and p53 lesion and lesion size.

RESULTS

There was no difference in the occurrence of p53 lesions with 20 of 70 of OCP users (28.6%) and 57 of 172 of those with no history of OCP use (33.1%). Subjects who used OCPs were more likely to have a small lesion (OR 1.98, 95% CI 1.03 to 3.83) and had decreased risk of having a medium/large lesion (OR 0.38, 95% CI 0.18 to 0.79). A total of 2 serous tubal intraepithelial lesions and 2 serous tubal intraepithelial carcinomas were identified in OCP-naive patients, whereas none were found in those with a history of OCP use.

CONCLUSIONS

OCP exposure was associated with a shift toward smaller p53 lesion size but was not found to be associated with a difference in the number of p53 lesions between OCP-exposed and unexposed patients. Future research should examine whether OCP use reduces proliferation and clonal expansion of p53 signature lesions toward higher risk precursors and, eventually, cancer. There were no serous tubal intraepithelial lesions and serous tubal intraepithelial carcinomas in patients with OCP exposure.

An Assessment of the Effectiveness of Preoperative İmaging Modalities (MRI, CT, and 18F-FDG PET/CT) in Determining the Extent of Disease Spread in Epithelial Ovarian-Tubal-Peritoneal Cancer (EOC)

Background and Objectives: Epithelial ovarian-tubal-peritoneal cancer (EOC) is the most common type of ovarian cancer. Optimal cytoreductive surgery is the most important prognostic factor in its management. When complete cytoreduction is anticipated to be challenging, neoadjuvant systemic chemotherapy (NACT) becomes an alternative. Imaging modalities are utilized in the decision-making process for primary treatment. The purpose of this study is to evaluate the diagnostic performance and accuracy of preoperative MRI, CT, and 18F-FDG PET/CT in detecting the extent of EOC. Materials and Methods: Between 2017 and 2018, 24 patients with primary (with or without neoadjuvant chemotherapy) or recurrent EOC diagnosed at the Department of Gynecologic Oncology, Istanbul University, Istanbul Faculty of Medicine, were enrolled in this study. These 24 women underwent preoperative imaging modalities within 7 days prior to surgery. The results were compared with histopathological findings, considered the gold standard. Results: We evaluated 24 anatomic regions most commonly involved in EOC. The sensitivity of MRI, CT, and PET/CT in detecting ≥ 0.5 cm implants was 95%, 84%, and 86%, respectively. However, when including implants < 0.5 cm, sensitivity decreased significantly to 40%, 38%, and 42%, respectively. The calculated area under the curve (AUC) for tumors, including those < 0.5 cm, was evaluated as weak for all three modalities (MRI: 0.689, CT: 0.678, PET/CT: 0.691), with PET/CT detecting the largest area. For detecting tumors ≥ 0.5 cm, the AUCs were 0.974, 0.921, and 0.923 for MRI, CT, and PET/CT, respectively. The largest AUC was calculated with MRI, and the AUCs for all three methods were evaluated as excellent. Accuracy was comparable among all three imaging modalities, and no statistically significant differences were found (p < 0.05). Conclusions: While imaging modalities are valuable tools for evaluating abdominal spread in epithelial ovarian cancer (EOC), they have demonstrated limited success in detecting miliary disease. The risk of false negatives for miliary tumors on PET/CT may be mitigated by combining it with other imaging modalities such as MRI or CT. Further investigations are necessary to identify more accurate imaging techniques for this challenging clinical scenario.

Correlation analysis of recurrent factors in borderline ovarian tumors undergoing fertility preservation surgery

Objective

To explore the relapse - related factors of fertility preservation surgery for borderline ovarian tumors.

Methods

Patients of childbearing age who underwent fertility preservation surgery for borderline ovarian tumors in Sheng jing Hospital of China Medical University from April 20 1 8 to April 20 2 3 were selected. Clinical data were collected and their clinical characteristics were statistically analyzed. It is to explore the risk factors of postoperative recurrence.

Results

A total of 30 8 patients were included in this study, of which 1 was lost to follow - up and 47 relapsed (4 7/3 0 7, 15. 3 1%). The results of multivariate analysis showed that the pathological features of micro papillary structure, intra operative as cites, bilateral tumors, and the increased ratio of neu tro phil to lymphocyte before surgery are independent risk factors for the recurrence of borderline ovarian tumors.

Conclusion

The prognosis of women of childbearing age with borderline ovarian tumors undergoing conservation function surgery is good. However, patients with high - risk recurrence factors should be paid special attention and closely followed up after surgery.

The relationship between HYDIN and fallopian tubal cilia loss in patients with epithelial ovarian cancer

Introduction

Primary cilia play an important role in the development of cancer by regulating signaling pathways. Several studies have demonstrated that women with BRCA mutations have, on average, 50% fewer ciliated cells compared with general women. However, the role of tubal cilia loss in the development of epithelial ovarian cancer (EOC) remains unclear. Few specific studies have been found in linking HYDIN, a ciliary defect associated gene that encodes HYDIN axonemal central pair apparatus protein, which is involved in the transduction of Hedgehog (Hh) signal and is considered a cancer associated antigen, to ovarian cancer. Therefore, our study aimed to investigate the correlation between HYDIN gene mutations and tubal cilia loss in EOC.

Methods

A whole exome sequencing (WES), immunohistochemistry (IHC), western blot, and reverse transcription quantitative (RT q) PCR were performed in 80 patients with EOC and 50 cases of non ovarian cancer to detect the mutations and expression of tubal ciliary marker, ciliary morphology, and abnormal rate.

Results

We found that the incidence of tubal cilia loss was higher in EOC group with decreased expression of HYDIN compared with the control group (P<0.05).

Discussion

This study suggests that tubal ciliary loss is evident in epithelial fallopian tube carcinoma, and ciliary cells may be involved in the occurrence and development of EOC, and cilia-related gene HYDIN is expected to be a tumor marker for epithelial ovarian cancer.

Clinicopathological and prognostic factor analyses of primary fallopian tube carcinoma and high-grade serous ovarian cancer: a single-institution retrospective study

OBJECTIVE

This study aimed to evaluate and compare the clinicopathologic features of primary fallopian tubal carcinoma (PFTC) and high-grade serous ovarian cancer (HGSOC) and explore the prognostic factors of these two malignant tumors.

METHODS

Fifty-seven patients diagnosed with PFTC from 2006 to 2015 and 60 patients diagnosed with HGSOC from 2014 to 2015 with complete prognostic information were identified at Women's Hospital of Zhejiang University. The clinicopathological and surgical data were collected, and the survival of the patients was followed for 5 years after surgery. The Cox proportional risk model was used to analyze the impact on survival.

RESULTS

For PFTC patients, the mean age was 57 years (range, 35-77 years). The most common clinical manifestations were abnormal vaginal bleeding and/or discharge (61%). A total of 72% of the cases were found at the early stage, and 90% of the tumors were high grade (51 cases). 51% of patients were diagnosed with PFTC before surgery, while the rest were misdiagnosed. Twenty-one patients relapsed. The overall survival (OS) rate was 82%. OS was significantly related to FIGO stage, the preoperative serum CA 125 level, lymphadenectomy, residual tumor size, appendectomy, and the number of cycles of chemotherapy. However, only FIGO stage was an independent prognostic variable for OS. For patients with HGSOC, the OS rate was 67%. OS was significantly related to FIGO stage, residual tumor size, and laterality. However, only residual tumor size was an independent prognostic variable for OS.

CONCLUSIONS

Our study provides important clinicopathologic insights into PFTC and HGSOC. We identified FIGO stage as an independent prognostic factor for PFTC patients and residual tumor size as an independent prognostic factor for HGSOC patients. These findings emphasize the critical role of accurate staging and achieving a residual tumor size of less than 1 cm during surgery. Our research contributes to refining clinical decision-making, supporting the importance of optimal surgical outcomes, and guiding personalized treatment strategies to improve patient prognosis in both PFTC and HGSOC patients.

Ovarian cancer prevention through opportunistic salpingectomy during abdominal surgeries: A cost-effectiveness modeling study

BACKGROUND

There is indication that the fallopian tubes might be involved in ovarian cancer pathogenesis and their removal reduces cancer risk. Hence, bilateral salpingectomy during hysterectomy or sterilization, so called opportunistic salpingectomy (OS), is gaining wide acceptance as a preventive strategy. Recently, it was discussed whether implementation of OS at other gynecologic surgery, e.g., cesarean section, endometriosis excision or myomectomy and even at non-gynecologic abdominal surgery such as cholecystectomy or appendectomy for women with completed family could be feasible. This modeling analysis evaluated the clinical and economic potential of OS at gynecologic and abdominal surgeries.

METHODS AND FINDINGS

A state transition model representing all relevant health states (healthy, healthy with hysterectomy or tubal ligation, healthy with other gynecologic or non-gynecologic abdominal surgery, healthy with hysterectomy and salpingectomy, healthy with salpingectomy, healthy with hysterectomy and salpingo-oophorectomy, ovarian cancer and death) was developed and informed with transition probabilities based on inpatient case numbers in Germany (2019). Outcomes for women aged 20-85 years were simulated over annual cycles with 1,200,000 million individuals. We compared four strategies: (I) OS at any suitable abdominal surgery, (II) OS only at any suitable gynecologic surgery, (III) OS only at hysterectomy or sterilization, and (IV) no implementation of OS. Primary outcome measures were prevented ovarian cancer cases and deaths as well as the incremental cost-effectiveness ratio (ICER). Volume of eligible interventions in strategy I was 3.5 times greater than in strategy III (286,736 versus 82,319). With strategy IV as reference, ovarian cancer cases were reduced by 15.34% in strategy I, 9.78% in II, and 5.48% in III. Setting costs for OS to €216.19 (calculated from average OS duration and operating room minute costs), implementation of OS would lead to healthcare cost savings as indicated by an ICER of €-8,685.50 per quality-adjusted life year (QALY) gained for strategy I, €-8,270.55/QALY for II, and €-4,511.86/QALY for III. Sensitivity analyses demonstrated stable results over a wide range of input parameters with strategy I being the superior approach in the majority of simulations. However, the extent of cancer risk reduction after OS appeared as the critical factor for effectiveness. Preventable ovarian cancer cases dropped to 4.07% (I versus IV), 1.90% (II versus IV), and 0.37% (III versus IV) if risk reduction would be <27% (hazard ratio [HR] > 0.73). ICER of strategies I and II was lower than the 2× gross domestic product per capita (GDP/C) (€94,366/QALY, Germany 2022) within the range of all tested parameters, but strategy III exceeded this threshold in case-risk reduction was <35% (HR > 0.65). The study is limited to data from the inpatient sector and direct medical costs.

CONCLUSIONS

Based on our model, interdisciplinary implementation of OS in any suitable abdominal surgeries could contribute to prevention of ovarian cancer and reduction of healthcare costs. The broader implementation approach demonstrated substantially better clinical and economic effectiveness and higher robustness with parameter variation. Based on a lifetime cost saving of €20.89 per capita if OS was performed at any suitable abdominal surgery, the estimated total healthcare cost savings in Germany could be more than €10 million annually.

Prophylactic salpingectomy as a preventative strategy for ovarian cancer in the general population: a systematic review and meta-analysis

OBJECTIVE

The impact of prophylactic salpingectomy on the prevention of epithelial ovarian cancer (EOC) remains unclear, particularly in Asian populations where data is lacking. In this systematic review and meta-analysis study, we sought to assess whether prophylactic salpingectomy could reduce the incidence of ovarian cancer in the general population of multiple ethnicities.

METHODS

A systematic review and meta-analysis were conducted using PubMed/MEDLINE, EMBASE, the Cochrane Library, and Web of Science to assess the effectiveness of salpingectomy, bilateral salpingectomy (BS), and unilateral salpingectomy (US) in reducing the risk of EOC and evaluating postoperative outcomes.

RESULTS

The final analyses included 6 eligible trials (5,747,056 patients), including 1 cohort study and 5 case-control studies. The analyses of these studies demonstrated that women who underwent salpingectomy had a significantly reduced risk of EOC compared to those who did not receive salpingectomy (odds ratio [OR]=0.63; 95% confidence interval [CI]=0.45-0.89; p=0.007). Five studies (5,746,469 patients) indicated a significant reduction in EOC risk among patients who underwent BS (OR=0.48; 95% CI=0.33-0.69; p<0.001). On the other hand, in the analysis of 4 studies (5,745,887 patients) that examined US, the association with EOC risk was not significant despite the protective trend (OR=0.82; 95% CI=0.64-1.06; p=0.12).

CONCLUSION

Our results indicate BS is an effective strategy for reducing the risk of sporadic EOC, but the results did not lead to the same conclusion for patients who underwent US. When a candidate or patient is undergoing a hysterectomy or has other benign diseases, prophylactic BS may be a safe surgical procedure that carries future benefits in terms of EOC risk.

Optimization of Timing for Risk-Reducing Salpingectomy and Oophorectomy

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov , NCT04251052.

Impact of Race, Ethnicity, Insurance, and Procedural Timing on Sterilization Method

Objective: This study aims to determine if race, ethnicity, insurance status, or procedural timing is associated with type of sterilization procedure. Methods: A retrospective cohort study was performed. The study population included women who underwent elective sterilization at one institution from January 2010 to December 2020. The medical record was reviewed to obtain age, race, ethnicity, procedure type and timing, and insurance status. Race and ethnicity groups included were Asian, non-Hispanic Black, Hispanic, or non-Hispanic White. Timing was divided into peripartum (at the time of cesarean section or before discharge after vaginal delivery) and interval procedures. Multivariate logistic regression was performed to assess the association of procedure type with race, ethnicity, insurance status, and timing. In addition, a sensitivity analysis was performed for procedures after January 1, 2016, to determine if the associations with the above categories differed. Results: A sample of 2,041 individuals received sterilization procedures, and 1,115 were included in the analysis: 70% (782) of sterilizations were performed during the peripartum period, and 60% (670) of women had public insurance. On multivariate analysis, both non-Hispanic Black (odds ratio [OR] 0.54 95% confidence interval [CI] 0.32-0.89) and Asian (OR 0.23 95% CI 0.06-0.72) individuals were less likely to have salpingectomy (SL) when compared with non-Hispanic White individuals. On sensitivity analysis for procedures after January 1, 2016, non-Hispanic Black (OR 0.31 95% CI 0.17-0.56), Hispanic (OR 0.31 95% CI 0.14-0.66), and Asian (OR 95% CI 0.04-0.54) individuals were less likely to have when compared with non-Hispanic White individuals. Conclusion: Tubal ligation is more frequently performed in our health system, and we identified critical disparities in performance of SL for sterilization.

Patient and Surgeon Attitudes Toward Opportunistic Salpingectomy During Nongynecological Surgeries for the Prevention of Ovarian Cancer: A Qualitative Study

BACKGROUND AND OBJECTIVES

Opportunity salpingectomy (OS), or prophylactic removal of the fallopian tubes during an operation for another indication, is broadly accepted as a risk-reduction strategy for ovarian cancer during gynecological operations. However, OS during nongynecological abdominal surgery is rare in the United States. A better understanding of surgeon and patient attitudes and perceived barriers to OS during nongynecological surgeries may facilitate implementation in the United States.

STUDY DESIGN

Qualitative interviews were conducted with general surgeons (n = 10), gynecologic surgeons (n = 10), and patients (n = 20) to assess perspectives and barriers towards OS during nongynecological surgeries. Interviews were transcribed and inductive analysis was carried out to identify themes and categorize responses using NVivo data analysis software.

RESULTS

OS during nongynecological surgery was viewed favorably by most patients and surgeons interviewed. While patients emphasized the importance of raising awareness of OS, both subsets of surgeons highlighted coordination, counseling, and billing barriers that would need to be overcome for efficient implementation.

CONCLUSION

OS was positively accepted by both patients and surgeons in our cohort. Improved attention to the shared barriers to implementation from our study may facilitate OS implementation during nongynecological surgery in the United States.

Feasibility of iodine concentration parameter and extracellular volume fraction derived from dual-energy CT for distinguishing type I and type II epithelial ovarian carcinoma

OBJECTIVES

To investigate the feasibility of using the iodine concentration (IC) parameter and extracellular volume (ECV) fraction derived from dual-energy CT for distinguishing between type I and type II epithelial ovarian carcinoma (EOC).

METHODS

This study retrospectively included 172 patients with EOC preoperatively underwent dual-energy CT scans. Patients were grouped as type I and type II EOC according to postoperatively pathologic results. Normalized IC (NIC, %) values from arterial-phase (AP), venous-phase (VP) and delay-phase (DP) were measured by two observers. ECV fraction (%) was calculated by DP-NIC and hematocrit. Intra-observer correlation coefficient (ICC) was used to assess the agreement between measurements made by two observers. The differences of imaging parameters between the two groups were compared. Logistic regression was used to select independent predictive factors and establish combined parameter. Receiver operating characteristic curve was used to analyze performance of all parameters.

RESULTS

The ICCs for all parameters exceeded 0.75. All parameters in type II EOC were all significantly higher than those in type I EOC (all P < 0.05). VP-NIC exhibited the highest Area under the curve (AUC) of 0.804, along with 80.39% sensitivity and 71.43% specificity. VP-NIC was identified as the independent factor. The sensitivity and specificity of ECV fraction were 78.43% and 71.43%, respectively. The combined parameter consisting of AP-NIC, VP-NIC, DP-NIC, and ECV fraction yielded an AUC of 0.823, with sensitivity of 76.47% and specificity of 77.14%. The sensitivity of the combined parameter was significantly higher than that of AP-NIC (P = 0.049).

CONCLUSION

It is valuable for dual-energy CT IC-based parameters and ECV fraction in preoperatively identifying type I and type II EOC.

CRITICAL RELEVANCE STATEMENT

Dual-energy CT-normalized iodine concentration and extracellular volume fraction achieved satisfactory discriminative efficacy, distinguishing between type I and type II epithelial ovarian carcinoma.

Meta-analysis and network pharmacology studies of the clinical efficacy of Guizhi Fuling capsules/pills combined with dienogest in treating endometriosis

BACKGROUND

Endometriosis (EMs) is a common chronic inflammatory gynecological disease that belongs to the classification of Traditional Chinese Medicine Syndromes "Zheng Jia," and the classic Chinese formula Guizhi Fuling (GZFL) demonstrates significant clinical efficacy in the treatment of this condition. This study aims to investigate GZFL's effect and potential mechanism in EMs.

METHODS

The search reviewed randomized controlled trials in 7 databases from inception to 2024, assessed quality with the Cochrane tool, and analyzed data with STATA 15 by 2 reviewers. In the network pharmacology study, we searched and screened the components and targets of GZFL, subsequently compared these targets to EMs targets, and used bioinformatics techniques to analyze and explore their potential interactions.

RESULTS

Nine randomized controlled trials involving 897 participants were analyzed. Meta-analysis showed that GZFL combined with dienogest significantly enhanced the clinical effectiveness rate (odds ratio = 2.404, 95% confidence intervals [CI], 1.868 to 3.093; P < .001). Specifically, combination therapy with GZFL reduced serum carbohydrate antigen 125 (standardized mean differences [SMD] = -1.65, 95% CI = -2.13 to -1.17, P < .001), estradiol (SMD = -1.54, 95% CI = -1.89 to -1.19, P = .003), matrix metalloproteinases (SMD = -2.636, 95% CI = -2.993 to -2.279, P < .001), pain scores (SMD = -0.88, 95% CI = -1.11 to -0.67, P < .001) and the diameter of ectopic cysts (SMD = -1.7, 95% CI = -2.42 to -0.98, P < .001). Network pharmacology analysis identified 136 components and 145 common targets, focusing on interleukin-6, cellular tumor antigen p53, epidermal growth factor receptor, estrogen receptor alpha, Cyclooxygenase-2, and matrix metalloproteinases-9. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses suggested GZFL modulates hormone receptors and inflammatory responses in EMs treatment.

CONCLUSION

In conclusion, GZFL combination treatment could increase the clinical effectiveness rate of EMs patients, and reduce the serum level of carbohydrate antigen 125, estradiol, matrix metalloproteinases, pain scores, and the diameter of the ectopic cyst. The potential mechanism might be linked to the modulation of hormone receptors and inflammation.

P53 marker expression in epithelial ovarian tumours in a centre in Nigeria - a descriptive study

BACKGROUND

p53 is a tumor suppressor gene. p53 expression in epithelial ovarian tumors (EOTs) is correlated with their biological behavior and predicts patient overall survival. However, there is a dearth of knowledge regarding p53 expression in these tumors among women from southwest Nigeria. Our study aimed to determine the patterns of p53 expression in various types of epithelial ovarian tumours.

METHODS

We conducted a retrospective study of epithelial ovarian tumours. We retrieved formalin-fixed, paraffin-embedded (FFPE) tissue blocks of previously diagnosed epithelial tumors from the departmental archive. We performed immunohistochemical analysis using p53 antibodies. We scored the expression and staining intensity of p53 as follows: negative (0), focal/weakly positive (1 +), and diffuse/strongly positive (2 +) on the basis of the recommended Cytomation scoring system.

RESULTS

The spectrum of p53 expression in the 51 histologically diagnosed cases revealed that 29 cases had no expression, consisting of 21 benign EOTs, two borderline EOTs, and six malignant EOTs. Nine cases exhibited wild-type expression, including six serous carcinomas, two mucinous carcinomas, and one signet ring cell carcinoma. p53 overexpression was observed in 13 patients overall, with 12 having serous carcinomas and one having endometrioid carcinoma. Among the 21 serous carcinoma patients, 28.6% (6 patients) presented with wild-type p53 expression, 57.1% (12 patients) presented with p53 overexpression, and 14.3% (three patients) presented negative p53 expression. There was a significant association between p53 expression and the histological grade of serous carcinoma.

CONCLUSION

Most epithelial ovarian carcinomas in our hospital are high grade, with many serous carcinomas showing either p53 overexpression or loss of expression. This may contribute to the poor patient survival rate.

GATA3 expression in tumor-infiltrating mononuclear inflammatory cells is associated with poor prognostic factors in tubo-ovarian carcinomas

The study investigated the expression of GATA3, a transcription factor involved in immune regulation, in tubo-ovarian carcinomas and its association with clinicopathological factors and prognosis. Immunohistochemical analysis was performed on 91 tubo-ovarian carcinoma samples to determine the presence of GATA3-positive inflammatory cells in the tumor microenvironment. A threshold of 10% or higher was considered a positive expression. The results showed that 46.7% of tubo-ovarian carcinomas exhibited positive expression of GATA3 in inflammatory cells. There was no significant difference in GATA3 expression between patients who received pre-surgical chemotherapy and those who underwent primary surgery. However, high-grade serous carcinomas had a significantly higher proportion of GATA3-positive inflammatory cells compared to other subtypes. Advanced-stage tumors (stage III) had a higher percentage of GATA3-positive inflammatory cells compared to stage II and I tumors. Patients with positive GATA3 expression had a significantly lower disease-free survival rate. However, there was no significant association between GATA3 expression and chemotherapy response score. These findings suggest that increased expression of GATA3 in mononuclear inflammatory cells is associated with higher grade, advanced stage, and increased risk of recurrence in tubo-ovarian carcinoma. This implies that heightened GATA3 expression negatively impacts anti-tumor immunity, tumor growth progression, and invasiveness in tubo-ovarian carcinomas.

Current Science and Practice of Surgical and Nonsurgical Opportunities for Ovarian Cancer Prevention

Due to improved understanding of ovarian cancer pathogenesis, we have an unprecedented chance to decrease the burden of disease by maximizing opportunities for prevention. Innovations in surgical options for prevention stem from the discovery that many cases directly or indirectly arise from the fallopian tube. Surgical prevention with salpingectomy alone decreases risk by ≥50%. Effective hormonal and nonhormonal chemopreventive agents are also available. Risk stratification is key to ensuring that options for prevention are appropriately matched to individual risk profile. This evidence-based review provides a critical appraisal of the translational health research endeavors supporting ovarian cancer prevention in clinical practice.

OVsignGenes: A Gene Expression-Based Neural Network Model Estimated Molecular Subtype of High-Grade Serous Ovarian Carcinoma

BACKGROUND/OBJECTIVES

High-grade serous carcinomas (HGSCs) are highly heterogeneous tumors, both among patients and within a single tumor. Differences in molecular mechanisms significantly describe this heterogeneity. Four molecular subtypes have been previously described by the Cancer Genome Atlas Consortium: differentiated, immunoreactive, mesenchymal, and proliferative. These subtypes may have varying degrees of progression, relapse-free survival, and overall survival, as well as response to therapy. The precise determination of these subtypes is certainly necessary both for diagnosis and future development of targeted therapies within personalized medicine.

METHODS

In this study, we analyzed gene expression data based on bulk RNA-seq, scRNA-seq, and spatial transcriptomic data from six cohorts (totaling 535 samples, including 60 single-cell samples). Differential expression analysis was performed using the edgeR package. The KEGG database and GSVA package were used for pathways enrichment analysis. As a predictive model, a deep neural network was created using the keras and tensorflow libraries.

RESULTS

We identified 357 differentially expressed genes among the four subtypes: 96 differentiated, 33 immunoreactive, 91 mesenchymal, and 137 proliferative. Based on these, we created OVsignGenes, a neural network model resistant to the effects of platform (test dataset AUC = 0.969). We then ran data from five more cohorts through our model, including scRNA-seq and spatial transcriptomics.

CONCLUSIONS

Because the differentiated subtype is located at the intersection of the other three subtypes based on PCA and does not have a unique profile of differentially expressed genes or enriched pathways, it can be considered an initiating subtype of tumor that will develop into one of the three other subtypes.

Comprehensive analysis of electrochemical biosensors for early ovarian cancer detection

Ovarian cancer is one of the leading causes of mortality among women worldwide. However, early detection can significantly reduce mortality rates and mitigate subsequent complications related to both economic burden and mental well-being. Despite the development in the field of medical diagnosis, the death rates due to ovarian cancer have sharply increased. Among the recent technologies suggested as suitable diagnostic techniques for the early detection of ovarian cancer, biosensor technology has emerged as a cutting-edge technology, with electrochemical biosensors providing one of the most efficient types of biosensors. Therefore, this review discusses the application of electrochemical biosensors as a viable alternative to conventional diagnostic techniques for the timely identification of ovarian cancer, its advantages over other types of biosensors and conventional diagnostic techniques, and the types of electrochemical biosensors.

Serous Tubal Intraepithelial Carcinoma (STIC): A Review of the Literature on the Incidence at the Time of Prophylactic Surgery

BACKGROUND

Serous tubal intraepithelial carcinoma (STIC) is an early-stage cancerous lesion found in the fallopian tubes, often at the fimbrial end. It is strongly associated with high-grade serous carcinoma (HGSC), a highly aggressive type of ovarian cancer. STIC is considered a precursor to many HGSC cases, originating in the fallopian tubes. Its development is frequently linked to mutations in the TP53 gene, leading to the formation of a p53 signature, an early abnormality that may progress to HGSC. This signature is more common in BRCA mutation carriers, explaining the higher incidence of STIC in this group. The aim of this review is to evaluate the literature on the incidence of serous tubal intraepithelial carcinoma in patients (both BRCA-positive and BRCA-negative) undergoing preventive salpingo-oophorectomy, analysing the available data and identifying associations between specific characteristics and the onset of STIC.

METHODS

A comprehensive review of the literature from 2016 to 2023 was conducted using PubMed, focusing on studies analysing the incidence of STIC in BRCA-positive patients undergoing preventive salpingo-oophorectomy. Data on patient characteristics, interventions, outcomes, and incidence of STIC were extracted and analysed.

RESULTS

Nine international studies were included in the review, reporting varying incidences of STIC among patients undergoing salpingo-oophorectomy. The overall incidence of STIC in all the women included in the studies was 7.31%, while that in the BRCA-mutated women was approximately 6.08%. Notably, the presence of the TP53 signature was significantly associated with the occurrence of STIC.

CONCLUSIONS

The etiopathogenesis of STIC involves complex interactions between genetic, environmental, and molecular factors. Further research is needed to fully understand its mechanisms and identify additional risk factors beyond BRCA mutations. Establishing a national database of STIC cases could facilitate future research and improve patient outcomes.

Squamous Cell Carcinoma of the Ovary: A Rare Case

Ovarian squamous cell carcinoma (SCC) is a rare entity among primary ovarian cancers. This type of cancer typically originates from the transformation of mature cystic teratomas, commonly known as dermoid cysts, and occasionally from associations with endometriosis or Brenner's tumors. The typical clinical scenario involves presentation in postmenopausal women, with symptoms arising from tumor growth or metastasis. Herein, we present a case study of SCC arising from a dermoid cyst in the right ovary. Alongside this, we offer a concise review covering the histogenesis, diagnostic approaches, current therapeutic modalities, and prognosis associated with this condition. A 62-year-old woman presented with abdominal pain and fever. Imaging revealed a large mass originating from the right ovary, suspected to be ovarian serous cystadenocarcinoma. Elevated CA 19-9 levels indicated malignancy. The case was discussed in a multidisciplinary tumor board (MTB), leading to diagnostic laparoscopy. Despite initial biopsy results suggesting no malignancy, PET-CT indicated possible ovarian malignancy. Further exploration via exploratory laparotomy confirmed the malignancy through fast-track biopsy. As a result, intraoperatively, a primary debulking surgery was decided. The final diagnosis was primary moderately differentiated squamous ovarian carcinoma, stage IIB, originating from a dermoid cyst. The patient was referred for chemotherapy and is currently under follow-up care. This case underscores the complexity of ovarian cancer diagnosis and the importance of multidisciplinary approaches in treatment decisions. As of now, there are no established treatment guidelines for the effective management of this histotype. More research specifically tailored to this aim, involving global contribution and extended follow-up periods, are essential to establish the best management strategies.

Do we more often opt for conservative management of ovarian tumors after changing the Dutch national guideline on enlarged ovaries? A nationwide cohort study

INTRODUCTION

Increasing evidence shows that conservative management of ovarian tumors classified as benign, based on ultrasound assessment, is safe. Therefore, conservative management has been adopted as the preferred strategy for certain ovarian tumors assessed as benign in the Dutch national guideline on enlarged ovaries in 2013. The aim of this study was to examine whether implementation of this guideline has led to changes in the number of women/100 000 women undergoing surgery for an ovarian tumor in the Netherlands.

MATERIAL AND METHODS

Histopathology reports were requested for all examinations of ovarian and fallopian tube specimens (including cyst enucleations) registered in Palga, the Dutch nationwide pathology databank, from 2011 (before guideline adaptation) and 2019 (after guideline adaptation). Reports on prophylactically removed adnexa, removal for other primary tumors (eg endometrial carcinoma), and for patients under 18 years of age, were excluded from the analysis. Interobserver agreement for the inclusion and classification of reports was assessed using Cohen's Kappa analysis.

RESULTS

A total of 34 932 reports were retrieved, 13 917 of which were included in the analysis. In 2011 and 2019, respectively, 96.3/100 000 vs 68.8/100 000 women aged ≥18 underwent surgery for benign ovarian tumors, and 19.6/100 000 vs 18.3/100 000 for borderline and malignant tumors combined. The number of women/100 000 who had surgery for a benign ovarian tumor per 100 000 women declined by 28.5% (p < 0.001) between 2011 and 2019. The largest difference between 2011 and 2019 was observed in the number of women per 100 000 women who underwent surgery for a serous cystadenoma (-40.7%; 20.8/100 000 vs. 12.3/100 000), followed by endometrioma (-33.2%; 14.7/100 000 vs. 9.8/100 000), simple epithelial cyst (-57.3%; 8.4/100 000 vs. 3.6/100 000), and corpus luteum cyst (-57.0%; 4.0/100 000 vs. 1.7/100 000). Cohen's Kappa for the interobserver agreement was 0.96.

CONCLUSIONS

The number of women/100 000 undergoing surgery for a benign ovarian tumor has substantially decreased in the Netherlands when comparing data before and after implementation of the national guideline in 2013, while the number of women/100 000 undergoing surgery for a malignant or borderline tumor remained the same. These findings suggest successful implementation of the updated guideline, and a measurable effect on increased adoption of conservative management for benign-looking ovarian tumors.

Bilateral Oophorectomy Prevalence Among U.S. Women

Background: Bilateral oophorectomy has been linked to numerous health outcomes, some of which can have a long latency period. Limited data are available on bilateral oophorectomy prevalence among U.S. women. Methods: The National Health Interview Survey fielded measures of bilateral oophorectomy most recently in 2010 and 2015. We pooled these 2 data years to present bilateral oophorectomy prevalence estimates by age-group, race, ethnicity, geographic region, and hysterectomy status. Results: Our study found bilateral oophorectomy was common among older women. Among women aged 70-79 years, 29% reported a bilateral oophorectomy, compared with <1% for women aged 20-29 years. By geographic region, bilateral oophorectomy prevalence among women 20-84 years was 12.3% in the South, 10.8% in the Midwest, 9.4% in the West, and 8.0% in the Northeast. Small numbers limited our ability to generate age-specific estimates for American Indian and Alaska Native women and subgroups of Asian and Hispanic women. Nearly half of women who had a bilateral oophorectomy reported their procedure occurred more than 20 years ago. Among women aged 20-84 years who reported a hysterectomy, 57% reported they also had both of their ovaries removed. Conclusion: Standard measures of incidence rates for ovarian cancer are not adjusted for oophorectomy status. These findings suggest that ovarian cancer incidence rates may be underestimated among older women. Continued monitoring of bilateral oophorectomy prevalence will be needed to track its potential impact on ovarian cancer incidence and numerous other chronic health outcomes.

Pre-ciliated tubal epithelial cells are prone to initiation of high-grade serous ovarian carcinoma

The distal region of the uterine (Fallopian) tube is commonly associated with high-grade serous carcinoma (HGSC), the predominant and most aggressive form of ovarian or extra-uterine cancer. Specific cell states and lineage dynamics of the adult tubal epithelium (TE) remain insufficiently understood, hindering efforts to determine the cell of origin for HGSC. Here, we report a comprehensive census of cell types and states of the mouse uterine tube. We show that distal TE cells expressing the stem/progenitor cell marker Slc1a3 can differentiate into both secretory (Ovgp1+) and ciliated (Fam183b+) cells. Inactivation of Trp53 and Rb1, whose pathways are commonly altered in HGSC, leads to elimination of targeted Slc1a3+ cells by apoptosis, thereby preventing their malignant transformation. In contrast, pre-ciliated cells (Krt5+, Prom1+, Trp73+) remain cancer-prone and give rise to serous tubal intraepithelial carcinomas and overt HGSC. These findings identify transitional pre-ciliated cells as a cancer-prone cell state and point to pre-ciliation mechanisms as diagnostic and therapeutic targets.