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Introduction: Primary small bowel carcinoma in pregnant women is extremely rare. Small bowel cancer is difficult to diagnose because of its rarity, lack of specific clinical symptoms, and particular anatomical features. We experienced a case of primary small bowel adenocarcinoma with ovarian metastasis during pregnancy. This is the first reported case of a patient with small bowel adenocarcinoma whose pregnancy continued to term and ended in delivery. Case Presentation: A 32-year-old pregnant woman developed abdominal pain, and imaging examination revealed an ovarian tumor at 29 weeks of gestation. We performed laparotomy and resected the ovarian tumor, which was initially suspected to be primary ovarian cancer. The patient continued the pregnancy to term. A detailed examination of the abdominal cavity during cesarean delivery at 37 weeks revealed that the primary lesion was located in the small bowel. Conclusion: It is important to recognize that the small bowel may be the primary site of metastatic ovarian cancer. Detailed and careful examination is necessary to diagnose small bowel cancer during pregnancy.

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OBJECTIVE: To develop a multiparametric magnetic resonance imaging (mpMRI)-based radiomics nomogram and evaluate its performance in differentiating primary mucinous ovarian cancer (PMOC) from metastatic ovarian cancer (MOC). METHODS: A total of 194 patients with PMOC (n = 72) and MOC (n = 122) confirmed by histology were randomly divided into the primary cohort (n = 137) and validation cohort (n = 57). Radiomics features were extracted from axial fat-saturated T2-weighted imaging (FS-T2WI), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging (CE-T1WI) sequences of each lesion. The effective features were selected by minimum redundancy maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) regression to develop a radiomics model. Combined with clinical features, multivariate logistic regression analysis was employed to develop a radiomics nomogram. The efficiency of nomogram was evaluated using the receiver operating characteristic (ROC) curve analysis and compared using DeLong test. Finally, the goodness of fit and clinical benefit of nomogram were assessed by calibration curves and decision curve analysis, respectively. RESULTS: The radiomics nomogram, by combining the mpMRI radiomics features with clinical features, yielded area under the curve (AUC) values of 0.931 and 0.934 in the primary and validation cohorts, respectively. The predictive performance of the radiomics nomogram was significantly superior to the radiomics model (0.931 vs. 0.870, P = 0.004; 0.934 vs. 0.844, P = 0.032), the clinical model (0.931 vs. 0.858, P = 0.005; 0.934 vs. 0.847, P = 0.030), and radiologists (all P < 0.05) in the primary and validation cohorts, respectively. The decision curve analysis revealed that the nomogram could provide higher net benefit to patients. CONCLUSION: The mpMRI-based radiomics nomogram exhibited notable predictive performance in differentiating PMOC from MOC, emerging as a non-invasive preoperative imaging approach.

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Brain metastasis is a rare complication of ovarian cancer, always found at the advanced stage. Even though different multimodal approaches are available, including surgical intervention and radiotherapy, there are no official guidelines for handling this serious complication. Poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors are a group of medications initially used for maintenance therapy in platinum-sensitive recurrent ovarian cancer. Niraparib has shown some efficacy in patients with brain metastasis due to its unique properties of penetrating the blood-brain barrier. Here, we present the case of a 51-year-old patient with advanced ovarian cancer with no germline breast cancer susceptibility gene (BRCA) mutations. Despite undergoing surgery and multiple rounds of chemotherapy, the patient's condition worsened, culminating in brain metastasis. Given her neurological issues, radiotherapy was not an option, prompting the initiation of a 300 mg dose of niraparib. To date, only sporadic case reports in the literature have described patients with ovarian cancer treated with niraparib and complicated by brain metastasis. Our case is unique because it is the first case of a patient with the endometrioid type of ovarian cancer.

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INTRODUCTION: Mucinous ovarian cancer (MOC) represents a rare entity of ovarian malignant neoplasms. The true incidence could be as low as 3% of all ovarian cancers. The aim of this study is to compare and understand the clinicopathological characteristics of patients with mucinous ovarian cancer, report on the survival rates and evaluate the role of gastrointestinal (GI) endoscopy as part of the peri-operative investigations and the impact it has on the survival rates. METHODOLOGY: This is a retrospective data collection on patients with MOC operated in Nottingham gynaecological oncology centre over a 10-year period. Data were analysed using SPSS software. RESULTS: 43 cases were included in the final analysis. The median maximal tumour diameter was 180 mm. 32 (74.5 %) and 11 (25.5 %) women presented with unilateral and bilateral tumours respectively. 30 patients (69.7 %) presented with stage 1 disease, 1 (2.3 %) presented with stage 2 disease, 7 women (16.4 %) had stage 3 disease and 1 woman (11.6 %) had stage 4 disease. 41 women had staging surgical procedures and 2 women had limited surgery due to poor performance status. After final histology, 5 cases found to have metastatic disease to the ovary rather than primary MOC. 14 women had GI endoscopy as part of their investigation. The total estimated cost of the endoscopies that have been performed is £5635. Primary GI cancer was diagnosed in 1 case during the endoscopy (1 case of gastric cancer). The 5-year overall survival of the women included in this study is 62.8 %. The 5-year overall survival of the women in the endoscopy and non-endoscopy groups was 60 % and 64.3 % respectively (p-value: 0.767). CONCLUSION: The findings of this study show that the survival rates of patients treated for mucinous ovarian cancer in our centre are similar to other published studies. Our findings do not support the routine use of GI endoscopy in the peri-operative investigations of every patient with MOC due to the non-statistically significant difference in the overall survival.

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Primary small bowel adenocarcinoma (SBA) is a rare gastrointestinal cancer with a low incidence of ovarian metastasis. Differential diagnosis of metastatic and primary ovarian cancer is often challenging. The present study reported the case of a 45-year-old woman with jejunal adenocarcinoma who presented with right ovarian, left ovarian, abdominopelvic implant and local recurrent bowel wall metastases successively after primary tumor resection. The ovarian masses of the patient originated from SBA, which was confirmed by immunohistochemical results. Following four comprehensive evaluations by an experienced multidisciplinary team (MDT) during the disease period, the patient underwent four operations, 28 cycles of chemotherapy, 24 cycles of targeted therapy and maintenance therapy for 8 months. As of February 2023, the patient has survived for 73 months and has a high quality of life. It is suggested that when a patient with SBA presents with an ovarian mass, the differential diagnosis between metastatic ovarian cancer and primary ovarian cancer mainly relies on immunohistochemistry. After a comprehensive evaluation by an experienced MDT, surgical resection is the primary treatment for advanced SBA, thus demonstrating some benefits for patients.

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Colorectal metastasis is rare and can be confused with primary colorectal cancer. We report the case of a 63-year-old patient who presented with synchronous metastasis of the rectosigmoid junction and ovarian cancer. Initially thought to be a Krukenberg tumor, the diagnosis of metastasis from ovarian origin was confirmed through an immunohistochemical study of the colonic biopsy.

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Background: Ovarian cancer has long been known to be the deadliest cancer associated with the female reproductive system. More than 15% of ovarian cancer patients have a defective BRCA-mediated homologous recombination repair pathway that can be therapeutically targeted with PARP inhibitors (PARPi), such as Talazoparib (TLZ). The expansion of TLZ clinical approval beyond breast cancer has been hindered due to the highly potent systemic side effects resembling chemotherapeutics. Here we report the development of a novel TLZ-loaded PLGA implant (InCeT-TLZ) that sustainedly releases TLZ directly into the peritoneal (i.p.) cavity to treat patient-mimicking BRCA-mutated metastatic ovarian cancer (mOC). Methods: InCeT-TLZ was fabricated by dissolving TLZ and PLGA in chloroform, followed by extrusion and evaporation. Drug loading and release were confirmed by HPLC. The in vivo therapeutic efficacy of InCeT-TLZ was carried out in a murine Brca2-/-p53R172H/-Pten-/- genetically engineered peritoneally mOC model. Mice with tumors were divided into four groups: PBS i.p. injection, empty implant i.p. implantation, TLZ i.p. injection, and InCeT-TLZ i.p. implantation. Body weight was recorded three times weekly as an indicator of treatment tolerance and efficacy. Mice were sacrificed when the body weight increased by 50% of the initial weight. Results: Biodegradable InCeT-TLZ administered intraperitoneally releases 66 µg of TLZ over 25 days. In vivo experimentation shows doubled survival in the InCeT-TLZ treated group compared to control, and no significant signs of toxicity were visible histologically in the surrounding peritoneal organs, indicating that the sustained and local delivery of TLZ greatly maximized therapeutic efficacy and minimized severe clinical side effects. The treated animals eventually developed resistance to PARPi therapy and were sacrificed. To explore treatments to overcome resistance, in vitro studies with TLZ sensitive and resistant ascites-derived murine cell lines were carried out and demonstrated that ATR inhibitor and PI3K inhibitor could be used in combination with the InCeT-TLZ to overcome acquired PARPi resistance. Conclusion: Compared to intraperitoneal PARPi injection, the InCeT-TLZ better inhibits tumor growth, delays the ascites formation, and prolongs the overall survival of treated mice, which could be a promising therapy option that benefits thousands of women diagnosed with ovarian cancer.

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INTRODUCTION AND IMPORTANCE: Secondary metastases to the rectum from primary ovarian cancer are a rare entity and their diagnosis and management are challenging. In this report, we discuss the findings of the case of metastatic ovarian cancer to supraclavicular lymph nodes and the rectum complicated with rectovaginal fistula. CASE PRESENTATION: A 68-year-old woman was admitted for abdominal pain with rectal bleeding. Pelvic examination revealed a left latero-uterine mass. Abdominal-pelvic CT scan showed a tumor mass on the left ovary. A cytoreductive surgery and resection of a non-imaged rectal nodule identified during surgery were performed. The tumor specimens including the rectal metastasis were immunohistochemically confirming a metastatic ovarian cancer using CK7, WT1 and CK20. The patient received chemotherapy and had complete remission. However, she had a recto-vaginal fistula confirmed by imaging and had developed right supraclavicular lymphadenopathy from ovarian cancer later. CLINICAL DISCUSSION: The dissemination of ovarian cancer in the digestive tract can be frequently, through direct invasion, abdominal implantation and lymphatic system. Unusually, ovarian cancer cells may spread to supra-clavicular nodes, because of the connection of the two diaphragmatic stages allowing the lymph flows through the lymphatic vessels. Moreover, rectovaginal fistula is an uncommon complication which can be seen spontaneously or due to certain patient's features. CONCLUSION: In advanced ovarian carcinoma, it is required to properly assess the digestive tract during surgery because imaging can miss metastatic lesions such as our case. The use of immunohistochemistry is recommended to differentiate between primary ovarian carcinoma and secondary metastasis.

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A 53-year-old woman with small-cell lung cancer (SCLC) presented at our hospital complaining of abdominal distention. Blood tests revealed rapidly progressive normocytic anemia and elevated lactate dehydrogenase levels. Pelvic magnetic resonance imaging revealed a left ovarian tumor and ascites. As her symptoms rapidly worsened, she underwent emergency surgery, which revealed a ruptured metastatic ovarian tumor of SCLC. Emergency surgery averted a life-threatening situation in this patient, and subsequent chemotherapy facilitated long-term survival. As seen from literature review, in female SCLC patients, ovarian metastasis and rupture is a rare but possible complication that should be considered because of its life-threatening nature.

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Endometrial endometrioid type cancer is a common gynaecological cancer for which the standard surgical management includes hysterectomy and bilateral salpingo-oophorectomy. The value of oophorectomy is to remove occult ovarian disease. It is estimated that 5 % of low grade endometrioid adenocarcinoma will have concurrent ovarian involvement (3 % synchronous tumours, 2 % ovarian metastases), of which only 1 % will be microscopic. Ovarian preservation at the time of surgery can be considered, especially in early-stage disease or premenopausal women. We describe a case of metastatic ovarian disease following surgical management of grade 1 endometrial endometrioid adenocarcinoma confined to the endometrium (FIGO stage 1a), in a postmenopausal woman who declined primary oophorectomy. This case was without genetic predisposition and recurred 12 months after initial surgical treatment. This case is incongruent with what has previously been understood for FIGO stage 1a endometrial endometrioid adenocarcinoma and highlights that even disease seemingly confined to the endometrium can metastasise microscopically to the ovaries.

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Treatments for advanced and recurrent ovarian cancer remain a challenge due to a lack of potent, selective, and effective therapeutics. Here, we developed the basis for a transformative anticancer strategy based on anthrax toxin that has been engineered to be selectively activated by the catalytic power of zymogen-activating proteases on the surface of malignant tumor cells to induce cell death. Exposure to the engineered toxin is cytotoxic to ovarian tumor cell lines and ovarian tumor spheroids derived from patient ascites. Preclinical studies demonstrate that toxin treatment induces tumor regression in several in vivo ovarian cancer models, including patient-derived xenografts, without adverse side effects, supportive of progression toward clinical evaluation. These data lay the groundwork for developing therapeutics for treating women with late-stage and recurrent ovarian cancers, utilizing a mechanism distinct from current anticancer therapies.

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Immature teratomas are rare malignant tumors of the ovary. They are made of immature components of germ cell origin. The incidence of immature teratomas is highest in young adults aged 18 to 39. The prognosis heavily depends on the International Federation of Gynecology and Obstetrics (FIGO) staging system and is influenced by factors such as cell type, tumor grade, capsular rupture, and metastatic risk factors. Initial treatment is complete surgical resection. When indicated, platinum-based adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (BEP) is the treatment of choice. Next-generation sequencing of the tumor can influence treatment in the recurrent setting. Temozolomide is an alkylating agent used to target high-grade gliomas. Bevacizumab is a targeted therapy that interferes with the process of angiogenesis by inhibiting vascular endothelial growth factor (VEGF). We report a 36-year-old female who presented with a 17.6cm x 10.5cm x 24.2cm intraabdominal mass and ascites. Upon tumor resection, she was found to have a stage IIIa, grade 2 immature teratoma of the left ovary, with glial tissue being the metastatic cell type. Disease progression continued despite treatment with BEP. She was then treated experimentally with six months of bevacizumab and temozolomide, given its rarity and targeted therapy for glial tissue. Despite monoclonal antibody therapy, the tumor progressed again and was treated with docetaxel and gemcitabine. A repeat CT of the chest, abdomen, and pelvis demonstrated scattered peritoneal implants that were increasing in size. Chromosome analysis was performed and revealed somatic mutations of MLH1, MSH2, MSH6, and PD-L1. The patient has requested a break from chemotherapy but will be treated with direct immunotherapy when she restarts. This case's importance lies in its rarity because fewer than 10 cases of immature teratomas with metastatic glial tissue are noted in the world's literature. Furthermore, this is the first reported case of this cell type being treated with immunotherapy in the world literature.

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Beyond traditional endothelium-dependent vessel (EDV), vascular mimicry (VM) is another critical tumor angiogenesis that further forms in many malignant metastatic tumors. However, the existing anti-angiogenesis combined chemotherapeutics strategies are only efficient for the treatment of EDV-based subcutaneous tumors, but remain a great challenge for the treatment of in situ malignant metastatic tumor associated with EDV and VM. Here, we demonstrate a self-assembled nanoparticle (VE-DDP-Pro) featuring self-anti-EDV and -VM capacity enables to significantly enhance the treatment efficacy of cisplatin (DDP) against the growth and metastasis of ovarian cancer. The VE-DDP-Pro is constructed by patching DDP loaded cRGD-folate-heparin nanoparticles (VE) onto the surface of protamine (Pro) nanoparticle. We demonstrated the self-anti-angiogenesis capacity of VE-DDP-Pro was attributed to VE, which could significantly inhibit the formation of EDV and VM by regulating signaling pathway of MMP-2/VEGF, AKT/mTOR/MMP-2/Laminin and AKT/mTOR/EMT, facilitating chemotherapeutics to effectively suppress the development and metastasis of ovarian cancer. Thus, combing with the chemotherapeutics effectiveness of DDP, the VE-DDP-Pro can significantly enhance treatment efficacy and prolong median survival of mice with metastatic ovarian cancer. We believe our self-assembled nanoparticles integrating the anti-EDV and anti-VM capacity provide a new preclinical sight to enhance the efficacy of chemotherapeutics for the treatment malignant metastasis tumor.

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Ovarian cancer is the second most common gynecologic cancer after uterine cancer in the United States. Ovarian cancer ranks sixth in cancer deaths among women, accounting for more deaths than other female reproductive system cancers. Breast metastasis in ovarian cancer is a rare presentation and predicts a poor prognosis and challenging management. Our case is a 42-year-old Chinese woman with high-grade serous ovarian carcinoma that presents with metastasis to the breast during the course of her illness. Genetic evaluation of the ovarian tumor showed two BRCA1 pathogenic variants. Germline pathogenic variant of c.2110_2111DelAA and a somatic variant of c.4071_4096+14del40. Our patient was offered different treatment regimens but showed progression of her disease. The low survival rate and high recurrence rate in ovarian cancer show that we still need to investigate our current approved treatments. Our report aims to shed light on the genetic evaluation of ovarian tumors and treatment options available in refractory cases of progressive ovarian cancer. Furthermore, we explain our investigational therapy regimen and the reasoning behind it.

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Eribulin inhibits microtubule polymerization and suppresses epithelial-mesenchymal transition. Conventional pathology approaches have not identified a precise predictive biomarker for Eribulin. We performed qmIF on pre-treatment tissue from 11 patients (6 TNBC, 5 HGSOC) treated with Eribulin-LF. T-lymphocytes were the dominant immune-subset in TME, with higher levels detected in stroma vs tumor (9% vs 2%). Greater density of CD3+ (p = 0.01) and CD3 + CD8+ (p = 0.03) cells and closer proximity between CD3 + CD8+ and tumor cells was observed in the patients with disease control (PR + SD) vs. progressive disease. QmIF identified an association between TIL infiltration and Eribulin-LF sensitivity, which should be evaluated further in prospective studies.

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Ovarian metastasis (OM) from breast cancer accounts for 3-38% of all ovarian neoplasms and is associated with various characteristic clinical presentations, such as pseudo-Meigs syndrome and Krukenberg tumor. Accurate diagnosis of OM may be challenging, as such lesions are frequently asymptomatic until they reach a large size. Occasionally, metastatic ovarian cancer is detected prior to the diagnosis of the primary tumor. Immunohistochemistry plays an important role in distinguishing primary ovarian tumors from extraovarian tumor metastases and may be helpful for identifying the primary tumor site. We herein report a case of OM from breast cancer masquerading as primary ovarian cancer. However, the correct diagnosis was made based on histopathological and immunohistochemical examinations. The patient had bilateral breast cancer, namely invasive lobular carcinoma of the left breast and ductal carcinoma of the right breast. Due to the presence of bilateral synchronous breast tumors, the possibility that the patient had hereditary breast and ovarian cancer syndrome or other relevant genetic factors was considered. Immunohistochemistry plays a key role in distinguishing between primary ovarian tumors and OM, and it was also important for confirming the metastatic nature of the ovarian lesion and diagnosing the primary tumor in the present study.

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Objective Epithelial ovarian cancer (EOC) is common among ovarian cancers. The majority of existing literature shows combined data of stage III and stage IV. Therefore, we aimed to look for whether achieving complete radiological and biochemical response after initial treatment of stage IV epithelial ovarian cancer as a predictor of long-term survival in the Pakistani population. Methods A cross-sectional study was conducted of patients with stage IV epithelial ovarian cancer diagnosed and treated from 2006-2013 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Overall survival was defined as the number of months between patients' diagnosis at the hospital and any cause of death or last follow-up date. Kaplan Meier curve was used to report the overall survival. The log-rank test was used to distinguish the survival difference in complete and no complete response. P-value <0.05 was considered statistically significant. Result A total of fifty patients of stage IV epithelial ovarian carcinoma, with a mean age of 53 ± 2 received neoadjuvant chemotherapy and suitable patients underwent interval-debulking surgery. Among these fifty patients, twenty-one (42%) patients who achieved complete radiological and biochemical response had a median survival of greater than five years. Patients without co-morbidities (46%) and having good performance status (52%) showed better results of the treatment. Patients' tolerance to chemotherapy with good response and fit enough to undergo interval-debulking surgery, achieving complete radiological and biochemical response after initial induction therapy were significantly associated with long-term survival (P<0.05). Conclusion Outcomes of patients who present with stage IV EOC remains dismal. Patients who achieved complete radiological and biochemical response after neoadjuvant chemotherapy and interval-debulking surgery was significantly associated with long-term survival.

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Reports indicate that most metastatic ovarian cancer (MOC) originates from gastrointestinal cancer (GIC). Notably, GICs metastasize to the ovary frequently via 3 main routes including hematogenous spread, lymphogenous spread, and transcoelomic spread. Nonetheless, the mechanism of the progression remains unknown, and only a handful of literature exists on the molecular alteration implicated in MOC from GIC. This work collected existing evidence and literature on the vital molecules of the metastatic pathway and systematically analyzed them geared toward exploring the mechanism of the metastatic pathway of MOC. Further, this review described dominating molecular alteration in the metastatic process from cancer cells detaching away from lesions to arrive at the ovary, including factors for regulating signaling pathways in epithelial-interstitial transformation, invading, and surviving in the circulatory system or abdominal cavity. We interrogated the basis of the ovary as a distant metastatic site. This article provides new insights into the metastatic pathway and generates novel therapeutic targets for effective treatment and satisfactory outcomes in GIC patients.

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Coronavirus disease 2019 (COVID-19) associated coagulopathy is a well-recognized predictor for morbidity and mortality in COVID-19 patients. Both deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in COVID-19 patients. Nonetheless, there are no consensus guidelines on the use of therapeutic coagulation in this group of patients. We herein present a unique case of a confirmed COVID-19 patient with metastatic ovarian cancer who presented with DVT and PE despite being on therapeutic anticoagulation, highlighting the unpredictability of COVID-19 associated coagulopathy. This case study raises the awareness that the thrombophilic state in metastatic malignancies is potentially augmented by COVID-19. We also discuss the complexity of making anticoagulation treatment decision in COVID-19 patients in the absence of evidence-based guidelines.

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A 65-year-old woman was addressed for clinical and biological suspicion of ovarian cancer relapse. 18F-FDG PET/CT revealed massive peritoneal carcinomatosis. Post-chemotherapy PET/CT showed complete metabolic response in initial localizations albeit three new 18F-FDG uptakes appeared in the mesentery and in the retro-hepatic space. Close follow-up (including PET/CT scan) and surgical examination of the abdominal cavity confirmed the absence of malignancy and the benign nature of these lesions, which appeared to be peritoneal fibrosis mimicking persistent carcinomatosis.