RESUMEN
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Carcinoma de Células Pequeñas , Hipercalcemia , Neoplasias Ováricas , Humanos , Femenino , Hipercalcemia/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/complicaciones , Carcinoma de Células Pequeñas/diagnóstico por imagen , Carcinoma de Células Pequeñas/complicaciones , Ultrasonografía/métodos , Diagnóstico Diferencial , Persona de Mediana EdadRESUMEN
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Asunto(s)
Neoplasias Ováricas , Teratoma , Humanos , Teratoma/diagnóstico por imagen , Teratoma/complicaciones , Teratoma/cirugía , Femenino , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/cirugía , Torsión Ovárica/diagnóstico por imagen , Torsión Ovárica/complicaciones , Ultrasonografía/métodos , Diagnóstico Diferencial , Ovario/diagnóstico por imagen , AdultoRESUMEN
Pregnancy luteoma is a benign ovarian tumour that presents during pregnancy and regresses spontaneously post partum. The mass may secrete androgenic hormones which can result in virilisation of mother and female foetus. Clinical presentation of pregnancy luteoma is varied from asymptomatic to significant virilisation. We present two cases of ovarian luteomas identified incidentally at caesarean section. The first case had marked hirsutism, while the second case had mild acne. Both foetuses were male and appeared unaffected at birth. Where maternal virilisation is identified during pregnancy, differential diagnoses including pregnancy luteoma should be considered.
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Luteoma , Neoplasias Ováricas , Complicaciones Neoplásicas del Embarazo , Virilismo , Humanos , Femenino , Embarazo , Luteoma/diagnóstico , Luteoma/complicaciones , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/complicaciones , Virilismo/etiología , Adulto , Complicaciones Neoplásicas del Embarazo/diagnóstico , Diagnóstico Diferencial , Cesárea , Hirsutismo/etiología , MasculinoRESUMEN
Ovarian cancer (OC) is a leading cause of death among gynaecological malignancies. The haemostatic system, which controls blood flow and prevents clotting disorders, paradoxically drives OC progression while increasing the risk of venous thromboembolism (VTE). MicroRNAs (miRNAs) have emerged as crucial in understanding VTE pathogenesis. Exploring the connection between cancer and thrombosis through these RNAs could lead to novel biomarkers of cancer-associated thrombosis (CAT) and OC, as well as potential therapeutic targets for tumour management. Thus, this study examined the impact of eight plasma miRNAs targeting the tissue factor (TF) coagulation pathway-miR-18a-5p, -19a-3p, -20a-5p, -23a-3p, -27a-3p, -103a-3p, -126-5p and -616-3p-in 55 OC patients. Briefly, VTE occurrence post-OC diagnosis was linked to shorter disease progression time (log-rank test, p = 0.024) and poorer overall survival (OS) (log-rank test, p < 0.001). High pre-chemotherapy levels of miR-20a-5p (targeting coagulation factor 3 (F3) and tissue factor pathway inhibitor 2 (TFPI2)) and miR-616-3p (targeting TFPI2) predicted VTE after OC diagnosis (χ2, p < 0.05). Regarding patients' prognosis regardless of VTE, miR-20a-5p independently predicted OC progression (adjusted hazard ratio (aHR) = 6.13, p = 0.005), while miR-616-3p significantly impacted patients' survival (aHR = 3.72, p = 0.020). Further investigation is warranted for their translation into clinical practice.
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MicroARNs , Neoplasias Ováricas , Tromboplastina , Humanos , Femenino , Neoplasias Ováricas/sangre , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/genética , MicroARNs/sangre , MicroARNs/genética , Tromboplastina/metabolismo , Tromboplastina/genética , Persona de Mediana Edad , Pronóstico , Anciano , Trombosis/sangre , Trombosis/etiología , Tromboembolia Venosa/sangre , Tromboembolia Venosa/etiología , Tromboembolia Venosa/genética , Adulto , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/genética , Regulación Neoplásica de la Expresión GénicaRESUMEN
OBJECTIVES: In ovarian and other cancers, low muscle mass and density are associated with poorer clinical outcomes. However, screening for cancer-related sarcopenia (typically defined as low muscle mass) is not routinely conducted. The European Working Group on Sarcopenia in Older People (EWGSOP) recommends an algorithm for sarcopenia screening and diagnosis in clinical settings, with sarcopenia based on muscle strength and mass, and severity on physical performance. We explored the application of the EWGSOP2 algorithm to assess sarcopenia in six ovarian cancer patients receiving neoadjuvant chemotherapy. METHODS: We assessed sarcopenia risk with the SARC-F screening questionnaire (at risk ≥4 points), muscle strength with a handgrip strength test (cut point <16 kg) and five times sit-to-stand test (cut point >15 s), muscle mass by skeletal muscle index (SMI in cm2/m2 from a single computed tomography [CT] image; cut point <38.5 cm2/m2), and physical performance with a 4-m gait speed test (cut point ≤0.8 m/s). RESULTS: Of six participants, none were identified as "at risk" for sarcopenia based on SARC-F scores. Two participants were severely sarcopenic based on EWGSOP2 criteria (had low muscle strength, mass, and physical performance), and five participants were sarcopenic based on muscle mass only. DISCUSSION: Ovarian cancer patients with low muscle mass during neoadjuvant chemotherapy may not be identified as sarcopenic based on the EWGSOP2 diagnostic algorithm. While lacking a universally accepted definition for cancer-related sarcopenia and cancer-specific recommendations for the screening, diagnosis, and treatment of sarcopenia, ovarian cancer clinicians should focus on the diagnosis and treatment of low muscle mass and density.
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Terapia Neoadyuvante , Neoplasias Ováricas , Sarcopenia , Humanos , Femenino , Sarcopenia/diagnóstico , Sarcopenia/etiología , Sarcopenia/inducido químicamente , Terapia Neoadyuvante/efectos adversos , Terapia Neoadyuvante/métodos , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico , Anciano , Persona de Mediana Edad , Fuerza de la Mano , Fuerza Muscular , Músculo Esquelético/patología , Algoritmos , Quimioterapia Adyuvante/efectos adversos , Estadificación de NeoplasiasRESUMEN
Pseudo-Meigs syndrome is a rare syndrome characterized by hydrothorax and ascites associated with pelvic masses, and patients occasionally present with elevated serum cancer antigen-125 (CA125) levels. Hydropic leiomyoma (HLM) is an uncommon subtype of uterine leiomyoma characterized by hydropic degeneration and secondary cystic changes. Rapidly enlarging HLMs accompanied by hydrothorax, ascites, and elevated CA125 levels may be misdiagnosed as malignant tumors. Here, we report a case of HLM in a 45-year-old Chinese woman who presented with ascites and hydrothorax. Preoperative abdominopelvic CT revealed a giant solid mass in the fundus uteri measuring 20 × 15 × 12 cm. Her serum CA125 level was elevated to 247.7 U/ml, while her hydrothorax CA125 level was 304.60 U/ml. The patient was initially diagnosed with uterine malignancy and underwent total abdominal hysterectomy and adhesiolysis. Pathological examination confirmed the presence of a uterine hydropic leiomyoma with cystic changes. After tumor removal, the ascites and hydrothorax subsided quickly, with no evidence of recurrence. The patient's serum CA125 level decreased to 116.90 U/mL on Day 7 and 5.6 U/mL on Day 40 postsurgery. Follow-up data were obtained at 6 months, 1 year, and 2 years after surgery, and no recurrence of ascites or hydrothorax was observed. This case highlights the importance of accurate diagnosis and appropriate management of HLM to achieve successful outcomes.
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Antígeno Ca-125 , Leiomioma , Síndrome de Meigs , Neoplasias Ováricas , Neoplasias Uterinas , Humanos , Femenino , Leiomioma/diagnóstico , Leiomioma/complicaciones , Persona de Mediana Edad , Antígeno Ca-125/sangre , Síndrome de Meigs/diagnóstico , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/patología , Diagnóstico Diferencial , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/patología , Neoplasias Ováricas/sangre , Ascitis/etiología , Ascitis/diagnóstico , Hidrotórax/etiología , Hidrotórax/diagnóstico , Histerectomía , Proteínas de la MembranaRESUMEN
OBJECTIVE: Patients with ovarian clear cell carcinoma (OCCC) often present with thrombosis. While cancer patients with concomitant thrombosis were generally reported to have worse prognoses than those without, the association between thrombosis and prognosis has not been elucidated in OCCC. This study aimed to determine how the co-occurrence of thrombosis affects OCCC prognoses. METHODS: We retrospectively examined 115 patients with OCCC who were diagnosed and treated at the University of Tokyo Hospital between 2009 and 2019. RESULTS: Of 115 patients with OCCC, thrombosis was present in 12.5% of 80 patients and in 42.8% of 35 patients who had OCCC stage I/II and stage III/IV, respectively. In stage I/II, the 5-year progression-free survival was 20.6% and 91.8% among patients with thrombosis and among those without, respectively, while the corresponding 5-year overall survival rates were 50.0% and 94.1%. Therefore, the outcomes were significantly poorer among patients with thrombosis (p < 0.0001 and p < 0.0001, respectively). In stage III/IV, the 5-year progression-free survival was 26.7% and 52.8% among patients with thrombosis and among those without, respectively, while the corresponding 5-year overall survival rates were 32.0% and 62.2%. Similarly, the outcomes were significantly poorer among patients with thrombosis (p = 0.0139 and p = 0.369, respectively). CONCLUSION: We determined that thrombosis is more likely to develop in advanced OCCC stages than in early stages, and its co-occurrence is associated with a poor prognosis, regardless of disease stage.
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Adenocarcinoma de Células Claras , Estadificación de Neoplasias , Neoplasias Ováricas , Trombosis , Humanos , Femenino , Persona de Mediana Edad , Neoplasias Ováricas/patología , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/complicaciones , Trombosis/patología , Estudios Retrospectivos , Anciano , Adenocarcinoma de Células Claras/patología , Adenocarcinoma de Células Claras/mortalidad , Adenocarcinoma de Células Claras/complicaciones , Pronóstico , Adulto , Comorbilidad , Anciano de 80 o más Años , Tasa de Supervivencia , Supervivencia sin ProgresiónRESUMEN
Neuromyelitis optica spectrum disorder (NMOSD) is a clinical syndrome characterized by attacks of acute optic neuritis and transverse myelitis. We report a case with paraneoplastic NMOSD that improved after immunosuppressive therapy, surgical resection, and chemotherapy. A 48-year-old woman initially presented with gradual binocular visual loss over the course of one week. The patient was evaluated using magnetic resonance imaging (MRI), computed tomography (CT), visual evoked potential (VEP), pathological biopsy, immunohistochemistry, and autoimmune antibody testing. The brain MRI findings were normal. The VEP revealed prolonged P100 latencies in the right eye and an absence of significant waves in the left eye. Positive serum AQP4-IgG antibodies were found. The patient was diagnosed as NMOSD. Then the patient responded well to treatment with methylprednisolone. An ovarian tumor was found in the patient using abdominal MRI and CT. The tumor was surgically resected, and a pathological biopsy revealed that it was ovarian dysgerminoma. The patient received four rounds of chemotherapy after surgery. One month after the final chemotherapy treatment, a positron emission tomography (PET) scan revealed no tumor. The vision of the patient gradually recovered and serum AQP4 was negative. Furthermore, we summarized the characteristics of patients diagnosed with paraneoplastic NMOSD associated with ovarian neoplasms in previous studies. This is a characteristic case of overlapping NMOSD and ovarian dysgerminoma, demonstrating the importance of tumor therapy in cases of paraneoplastic NMOSD.
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Neuromielitis Óptica , Neoplasias Ováricas , Humanos , Femenino , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico , Persona de Mediana Edad , Neuromielitis Óptica/diagnóstico , Neuromielitis Óptica/inmunología , Neuromielitis Óptica/etiología , Neuromielitis Óptica/complicaciones , Acuaporina 4/inmunología , Disgerminoma/diagnóstico , Disgerminoma/complicaciones , Disgerminoma/patología , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Imagen por Resonancia MagnéticaRESUMEN
A 27-year-old nulliparous woman presented with a feeling of fullness in the lower abdomen and abdominal pain. A left ovarian tumor, uterus didelphys, left renal agenesis, and left vaginal atresia were observed on imaging. The ovarian tumor was presumed to have caused the abdominal pain, and an abdominal left adnexectomy was performed. After 3 months, she reported severe lower abdominal pain during menstruation. Transvaginal ultrasonography revealed uterine enlargement. After 17 days, the patient presented with abdominal pain and fever. She was diagnosed with peritonitis due to infection and left uterine hematometra. Because she did not improve with antibiotic treatment, left laparoscopic hysterectomy was performed. Subsequently, she did not experience the lower abdominal pain. Appropriate diagnosis and treatment based on the morphology of the reproductive tract and symptoms must be considered in patients with Herlyn-Werner-Wunderlich syndrome. Treatment must permit the outflow of menstrual blood.
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Hematómetra , Útero , Vagina , Humanos , Femenino , Adulto , Síndrome , Vagina/anomalías , Vagina/cirugía , Útero/anomalías , Útero/cirugía , Hematómetra/etiología , Hematómetra/diagnóstico , Riñón/anomalías , Riñón/diagnóstico por imagen , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico , Anomalías Múltiples/cirugía , Histerectomía , Anomalías Congénitas/cirugía , Anomalías Congénitas/diagnósticoRESUMEN
We present a rare case of a 40-year-old nulliparous lady, with no past medical or surgical history, who was diagnosed with metastatic squamous cell carcinoma of the right ovary that originated from a mature cystic ovarian teratoma. Our patient underwent debulking total abdominal hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy followed by postoperative carboplatin and paclitaxel chemotherapy. Rapid disease progression ensued, complicated by severe parathyroid hormone-related protein-induced hypercalcaemia resistant to medical therapy. The patient was treated in a palliative manner and died five months after her diagnosis.
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Carcinoma de Células Escamosas , Hipercalcemia , Neoplasias Ováricas , Teratoma , Humanos , Femenino , Neoplasias Ováricas/patología , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/cirugía , Teratoma/complicaciones , Teratoma/cirugía , Hipercalcemia/etiología , Adulto , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Resultado Fatal , Histerectomía/métodos , Paclitaxel/uso terapéuticoRESUMEN
OBJECTIVE: Ovarian cancer is associated with a high rate of venous thromboembolism. Our objective is to report the incidence of venous thromboembolism in recurrent ovarian cancer, assess the impact on morbidity and mortality, and evaluate predictors of venous thromboembolism. METHODS: A retrospective single institution cohort study was performed. Patients with a diagnosis of recurrent ovarian cancer between 2007 and 2020 and no previous history of venous thromboembolism were identified. Demographic and clinical variables were collected. Univariate and multivariable analyses were performed to identify predictors of venous thromboembolism. RESULTS: Of the 345 patients included in this study, 77 (22.3%) developed a venous thromboembolism. Most (n=56, 72.7%) were actively receiving treatment at the time of diagnosis of venous thromboembolism, of whom 44 (78.6%) had received three or more lines of treatment. In total, 42 (54.5%) were admitted to hospital on diagnosis and one mortality (1.3%) occurred secondary to venous thromboembolism. An intermediate/high risk Khorana score was not predictive of venous thromboembolism (p=0.24). The risk of venous thromboembolism was significantly higher with increasing lines of chemotherapy (odds ratio 1.14, 95% confidence interval 1.02 to 1.28 per line, p=0.026). There was no significant difference in overall survival (62.9 vs 49.1 median months, p=0.29) between patients with and without venous thromboembolism. CONCLUSIONS: More than 20% of patients with recurrent ovarian cancer developed a venous thromboembolism, and most occurred after three or more lines of treatment. The risk of venous thromboembolism was higher with increasing lines of chemotherapy. While venous thromboembolism did not appear to impact survival in this population, nearly half required hospitalization, emphasizing the morbidity of venous thromboembolism and potential impact on healthcare costs. Further studies are needed to improve risk stratification for venous thromboembolism in this high risk population.
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Neoplasias Ováricas , Tromboembolia Venosa , Humanos , Femenino , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Estudios Retrospectivos , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/complicaciones , Persona de Mediana Edad , Incidencia , Anciano , Recurrencia Local de Neoplasia/epidemiología , Adulto , Estudios de Cohortes , Factores de RiesgoRESUMEN
PURPOSE: Patients with epithelial ovarian cancer (EOC) have an elevated risk for venous thromboembolism (VTE). To assess the risk of VTE, models were developed by statistical or machine learning algorithms. However, few models have accommodated deep learning (DL) algorithms in realistic clinical settings. We aimed to develop a predictive DL model, exploiting rich information from electronic health records (EHRs), including dynamic clinical features and the presence of competing risks. METHODS: We extracted EHRs of 1,268 patients diagnosed with EOC from January 2007 through December 2017 at the National Cancer Center, Korea. DL survival networks using fully connected layers, temporal attention, and recurrent neural networks were adopted and compared with multi-perceptron-based classification models. Prediction accuracy was independently validated in the data set of 423 patients newly diagnosed with EOC from January 2018 to December 2019. Personalized risk plots displaying the individual interval risk were developed. RESULTS: DL-based survival networks achieved a superior area under the receiver operating characteristic curve (AUROC) between 0.95 and 0.98 while the AUROC of classification models was between 0.85 and 0.90. As clinical information benefits the prediction accuracy, the proposed dynamic survival network outperformed other survival networks for the test and validation data set with the highest time-dependent concordance index (0.974, 0.975) and lowest Brier score (0.051, 0.049) at 6 months after a cancer diagnosis. Our visualization showed that the interval risk fluctuating along with the changes in longitudinal clinical features. CONCLUSION: Adaption of dynamic patient clinical features and accounting for competing risks from EHRs into the DL algorithms demonstrated VTE risk prediction with high accuracy. Our results show that this novel dynamic survival network can provide personalized risk prediction with the potential to assist risk-based clinical intervention to prevent VTE among patients with EOC.
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Aprendizaje Profundo , Registros Electrónicos de Salud , Neoplasias Ováricas , Tromboembolia Venosa , Humanos , Femenino , Tromboembolia Venosa/etiología , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/diagnóstico , Persona de Mediana Edad , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico , Medición de Riesgo/métodos , Anciano , República de Corea/epidemiología , Factores de Riesgo , Algoritmos , Adulto , Redes Neurales de la Computación , Curva ROC , Carcinoma Epitelial de Ovario/complicaciones , Carcinoma Epitelial de Ovario/patología , Carcinoma Epitelial de Ovario/epidemiología , PronósticoRESUMEN
Purpose To evaluate the performance of an automated deep learning method in detecting ascites and subsequently quantifying its volume in patients with liver cirrhosis and patients with ovarian cancer. Materials and Methods This retrospective study included contrast-enhanced and noncontrast abdominal-pelvic CT scans of patients with cirrhotic ascites and patients with ovarian cancer from two institutions, National Institutes of Health (NIH) and University of Wisconsin (UofW). The model, trained on The Cancer Genome Atlas Ovarian Cancer dataset (mean age [±SD], 60 years ± 11; 143 female), was tested on two internal datasets (NIH-LC and NIH-OV) and one external dataset (UofW-LC). Its performance was measured by the F1/Dice coefficient, SDs, and 95% CIs, focusing on ascites volume in the peritoneal cavity. Results On NIH-LC (25 patients; mean age, 59 years ± 14; 14 male) and NIH-OV (166 patients; mean age, 65 years ± 9; all female), the model achieved F1/Dice scores of 85.5% ± 6.1 (95% CI: 83.1, 87.8) and 82.6% ± 15.3 (95% CI: 76.4, 88.7), with median volume estimation errors of 19.6% (IQR, 13.2%-29.0%) and 5.3% (IQR: 2.4%-9.7%), respectively. On UofW-LC (124 patients; mean age, 46 years ± 12; 73 female), the model had a F1/Dice score of 83.0% ± 10.7 (95% CI: 79.8, 86.3) and median volume estimation error of 9.7% (IQR, 4.5%-15.1%). The model showed strong agreement with expert assessments, with r2 values of 0.79, 0.98, and 0.97 across the test sets. Conclusion The proposed deep learning method performed well in segmenting and quantifying the volume of ascites in patients with cirrhosis and those with ovarian cancer, in concordance with expert radiologist assessments. Keywords: Abdomen/GI, Cirrhosis, Deep Learning, Segmentation Supplemental material is available for this article. © RSNA, 2024 See also commentary by Aisen and Rodrigues in this issue.
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Ascitis , Aprendizaje Profundo , Cirrosis Hepática , Neoplasias Ováricas , Tomografía Computarizada por Rayos X , Humanos , Femenino , Persona de Mediana Edad , Ascitis/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Anciano , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/complicaciones , Masculino , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/complicaciones , Interpretación de Imagen Radiográfica Asistida por Computador/métodosRESUMEN
Malakoplakia is a rare granulomatous, chronic inflammatory disease generally affecting the urogenital organs, though it can arise in other organs. The clinical manifestations of malakoplakia vary depending on the affected organ. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies on pathology. This report describes a case of pelvic malakoplakia accompanied by an ovarian tumour-cutaneous fistula, initially misdiagnosed as advanced ovarian cancer invading the anterior abdominal wall with left pleural effusion based on imaging studies and increased serum carbohydrate antigen 19-9. The patient underwent left thoracentesis and fluid collection from the fistula tract for cytology, which showed no malignancy. She underwent primary debulking surgery, including removal of the fistula tract from anterior abdominal wall. Histopathological examination revealed malakoplakia coexisting with mucinous cystadenoma of the left ovary. For postoperative management, she received prolonged oral antibiotics for 6 months. There was no evidence of disease recurrence at the 24-month follow-up.
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Fístula Cutánea , Malacoplasia , Neoplasias Ováricas , Humanos , Femenino , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/patología , Malacoplasia/diagnóstico , Malacoplasia/complicaciones , Diagnóstico Diferencial , Fístula Cutánea/diagnóstico , Fístula Cutánea/etiología , Cistoadenoma Mucinoso/diagnóstico , Cistoadenoma Mucinoso/complicaciones , Cistoadenoma Mucinoso/cirugía , Persona de Mediana Edad , PelvisRESUMEN
BACKGROUND: Peutz-Jeghers syndrome (PJS) is characterized by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation on the lips, oral mucosa, nose, fingers, and toes. Synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN-FGT) refers to the occurrence of multifocal mucinous lesions in at least two sites, including the cervix, uterus, fallopian tubes, and ovaries, in the female genital tract. SMMN-FGT and PJS are rare diseases with a very low incidence, especially when occurring simultaneously. CASE PRESENTATION: We report a case in which a woman with a large mass on the left ovary underwent a gynecological surgery and was diagnosed with cervical gastric-type adenocarcinoma and mucinous lesions in the endometrium, bilateral fallopian tubes, and ovary, i.e., SMMN-FGT, by postoperative paraffin pathology. The patient sought medical attention for abdominal distension and enlargement. A gynecological ultrasound revealed a multilocular cystic mass in the pelvis, while serum tumor markers were within normal limits, with mildly elevated carbohydrate antigen 199 and carbohydrate antigen 125 levels. Cervical thin-prep cytology test result was negative. The patient had a family history of PJS with black spots on her skin and mucous membranes since the age of 8 years. She underwent multiple partial small bowel resections and gastrointestinal polypectomy owing to intestinal obstruction and intussusception. She underwent left adnexectomy, hysterectomy, right salpingectomy, greater omental resection, appendectomy and right ovary biopsy, and received six courses of adjuvant chemotherapy with Lopressor plus Carboplatin. Genetic testing revealed a heterozygous serine threonine kinase 11 germline mutation and there were no signs of recurrence during the 18-month follow-up period after treatment. CONCLUSIONS: This is a rare case in which PJS was complicated by SMMN-FGT. Owing to its extreme rarity, there are no guidelines, but reported cases appear to indicate a poor prognosis. We retrospectively reviewed all cases of collisions between PJS and SMMN-FGT and explored the clinical features, pathological characteristics, diagnosis, treatment methods, and prognosis when the two diseases coexisted. The aim is to deepen the clinicians' understanding of this disease for early detection, diagnosis and treatment.
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Metaplasia , Síndrome de Peutz-Jeghers , Humanos , Femenino , Síndrome de Peutz-Jeghers/complicaciones , Síndrome de Peutz-Jeghers/diagnóstico , Síndrome de Peutz-Jeghers/patología , Neoplasias de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/diagnóstico , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/complicaciones , Neoplasias Ováricas/patología , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/complicaciones , Adulto , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/complicaciones , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/diagnósticoRESUMEN
Drug-induced immune thrombocytopenia is an adverse reaction marked by accelerated destruction of blood platelets. In cancer therapy, thrombocytopenia has many other causes including bone marrow suppression induced by chemotherapeutic agents, infection, and progression of cancer; drug-induced thrombocytopenia can easily be misdiagnosed or overlooked. Here, we present a case of an ovarian cancer patient with a history of mixed connective tissue disease who underwent surgery followed by treatment with paclitaxel, cisplatin, and bevacizumab. The patient developed acute isolated thrombocytopenia after the sixth cycle. Serum antiplatelet antibody testing revealed antibodies against glycoprotein IIb. After we analyzed the whole therapeutic process of this patient, drug-induced immune thrombocytopenia was assumed, and bevacizumab was conjectured as the most probable drug. Thrombocytopenia was ultimately successfully managed using recombinant human thrombopoietin, prednisone, and recombinant human interleukin-11. We provide a summary of existing literature on immune thrombocytopenia induced by bevacizumab and discuss related mechanisms and triggers for drug-induced immune thrombocytopenia. The present case underscores the potential of bevacizumab to induce immune-mediated thrombocytopenia, emphasizing the need for heightened vigilance towards autoimmune diseases or an autoimmune-activated state as plausible triggers for rare drug-induced immune thrombocytopenia in cancer therapy.
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Bevacizumab , Enfermedad Mixta del Tejido Conjuntivo , Neoplasias Ováricas , Púrpura Trombocitopénica Idiopática , Femenino , Humanos , Antineoplásicos Inmunológicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/efectos adversos , Enfermedad Mixta del Tejido Conjuntivo/complicaciones , Enfermedad Mixta del Tejido Conjuntivo/tratamiento farmacológico , Enfermedad Mixta del Tejido Conjuntivo/inmunología , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/complicaciones , Púrpura Trombocitopénica Idiopática/inducido químicamente , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Púrpura Trombocitopénica Idiopática/inmunología , Púrpura Trombocitopénica Idiopática/diagnósticoRESUMEN
Presented clinical observation of anti-NMDA-receptor encephalitis, which was first described in 2007, is rare and to date has not been sufficiently studied. The disease often manifests with psychopathological symptoms and catatonia, so patients are transferred into a mental healthcare institution and often require intensive care and resuscitation, due to the development of life-threatening respiratory and hemodynamic disorders. Diagnosis is based on detection of autoantibodies to the NR1- and NR2 subunits of the glutamate NMDA receptor in blood serum and cerebrospinal fluid. Pathogenesis-based therapy includes the administration of glucocorticoids and intravenous immunoglobulins, plasmapheresis, as well as the introduction of monoclonal antibodies in also used, and in severe cases, cytostatics are prescribed. The widespread comorbidity of anti-NMDA receptor encephalitis with ovarian neoplasms in women (up to 60%) requires appropriate diagnosis and early removal of ovarian neoplasms when they are detected. With timely diagnosis and adequate treatment strategies, the outcome of this rare disorder is usually positive.
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Encefalitis Antirreceptor N-Metil-D-Aspartato , Autoanticuerpos , Neoplasias Ováricas , Adulto , Femenino , Humanos , Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Encefalitis Antirreceptor N-Metil-D-Aspartato/complicaciones , Autoanticuerpos/sangre , Autoanticuerpos/líquido cefalorraquídeo , Catatonia/etiología , Catatonia/diagnóstico , Inmunoglobulinas Intravenosas/uso terapéutico , Trastornos Mentales/etiología , Trastornos Mentales/diagnóstico , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico , Plasmaféresis , Receptores de N-Metil-D-Aspartato/metabolismoRESUMEN
OBJECTIVES: A high proportion of women with advanced epithelial ovarian cancer (EOC) experience weakness and cachexia. This relationship is associated with increased morbidity and mortality. EOC is the most lethal gynecological cancer, yet no preclinical cachexia model has demonstrated the combined hallmark features of metastasis, ascites development, muscle loss and weakness in adult immunocompetent mice. METHODS: Here, we evaluated a new model of ovarian cancer-induced cachexia with the advantages of inducing cancer in adult immunocompetent C57BL/6J mice through orthotopic injections of EOC cells in the ovarian bursa. We characterized the development of metastasis, ascites, muscle atrophy, muscle weakness, markers of inflammation, and mitochondrial stress in the tibialis anterior (TA) and diaphragm â¼45, â¼75 and â¼90 days after EOC injection. RESULTS: Primary ovarian tumour sizes were progressively larger at each time point while severe metastasis, ascites development, and reductions in body, fat and muscle weights occurred by 90 Days. There were no changes in certain inflammatory (TNFα), atrogene (MURF1 and Atrogin) or GDF15 markers within both muscles whereas IL-6 was increased at 45 and 90 Day groups in the diaphragm. TA weakness in 45 Day preceded atrophy and metastasis that were observed later (75 and 90 Day, respectively). The diaphragm demonstrated both weakness and atrophy in 45 Day. In both muscles, this pre-severe-metastatic muscle weakness corresponded with considerable reprogramming of gene pathways related to mitochondrial bioenergetics as well as reduced functional measures of mitochondrial pyruvate oxidation and creatine-dependent ADP/ATP cycling as well as increased reactive oxygen species emission (hydrogen peroxide). Remarkably, muscle force per unit mass at 90 days was partially restored in the TA despite the presence of atrophy and severe metastasis. In contrast, the diaphragm demonstrated progressive weakness. At this advanced stage, mitochondrial pyruvate oxidation in both muscles exceeded control mice suggesting an apparent metabolic super-compensation corresponding with restored indices of creatine-dependent adenylate cycling. CONCLUSIONS: This mouse model demonstrates the concurrent development of cachexia and metastasis that occurs in women with EOC. The model provides physiologically relevant advantages of inducing tumour development within the ovarian bursa in immunocompetent adult mice. Moreover, the model reveals that muscle weakness in both TA and diaphragm precedes severe metastasis while weakness also precedes atrophy in the TA. An underlying mitochondrial bioenergetic stress corresponded with this early weakness. Collectively, these discoveries can direct new research towards the development of therapies that target pre-atrophy and pre-severe-metastatic weakness during EOC in addition to therapies targeting cachexia.
Asunto(s)
Caquexia , Modelos Animales de Enfermedad , Ratones Endogámicos C57BL , Mitocondrias , Debilidad Muscular , Neoplasias Ováricas , Animales , Caquexia/metabolismo , Caquexia/etiología , Caquexia/patología , Femenino , Ratones , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/patología , Neoplasias Ováricas/complicaciones , Debilidad Muscular/metabolismo , Debilidad Muscular/etiología , Mitocondrias/metabolismo , Mitocondrias/patología , Músculo Esquelético/metabolismo , Músculo Esquelético/patología , Atrofia Muscular/metabolismo , Atrofia Muscular/etiología , Atrofia Muscular/patología , Metástasis de la Neoplasia , Carcinoma Epitelial de Ovario/metabolismo , Carcinoma Epitelial de Ovario/patología , Línea Celular TumoralRESUMEN
BACKGROUND: Guidelines recommend to include exercise and dietary advice in standard care for patients with cancer, based on evidence primarily derived from patients with breast cancer. Its applicability to patients with ovarian cancer is uncertain due to differences in patient characteristics and treatments. The PADOVA trial examined the effectiveness of a combined exercise and dietary intervention on fat-free mass (FFM), physical functioning, and fatigue. METHODS: In total, 81 patients with ovarian cancer were randomised to the exercise and dietary intervention (n = 40) or control (n = 41) group. Measurements were performed before chemotherapy, after chemotherapy, and 12 weeks later. FFM was assessed by bioelectrical impedance analysis, and physical functioning and fatigue were assessed using questionnaires. Intervention effects were assessed on an intention-to-treat basis using linear mixed models. RESULTS: FFM and physical functioning increased, and fatigue decreased significantly over time in both groups. No significant difference between the groups were found for FFM (ß = -0.5 kg; 95% CI = -3.2; 2.1), physical functioning (ß = 1.4; 95% CI = -5.4; 8.3) and fatigue (ß = 0.7; 95% CI = -1.5; 2.8). CONCLUSIONS: During treatment, both groups improved in FFM, physical functioning, and fatigue. The intervention group, however, did not demonstrate additional benefits compared to the control group. This highlights the need for caution when extrapolating findings from different cancer populations to patients with ovarian cancer.