Objective: To compare the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA)- Logistic Regression 1 and 2 (LR1 and LR2) and the Assessment of Different Neoplasias in the Adnexa (ADNEX) model in discriminating between benign and malignant ovarian new growths Methods: The study was a prospective validation study. It included all patients admitted at the Gynecology ward of the Philippine General Hospital for elective surgery for ovarian new growths. Demographic information and clinical data were recorded for eligible patients. Two-dimensional ultrasonography with Doppler studies were performed. Ovarian new growths were classified based on IOTA LR1, LR2 and ADNEX model. Correlation of the ultrasound findings with the histopathology report and final staging based on Federation of Gynecology and Obstetrics (FIGO) classification was done. Results: Sixty seven (67) patients were included in the final analysis. The mean age was 43 years old (range of 17-78). There were sixteen (16) nulligravid patients (22%). Eighteen (18) out of the 67 patients (27%) had malignant ovarian masses on histopathology. The IOTA LR1 had an area under the curve (AUC) of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 92% (95%CI, 84-100). The IOTA LR2 had an AUC of 0.88, sensitivity of 61% (95%CI, 39-84) and specificity of 96% (95%CI, 90-100). The IOTA ADNEX had an AUC of 0.96, sensitivity of 89% (95%CI, 74-100) and specificity of 76% (95%CI, 63-88). Sensitivity and specificity of IOTA ADNEX for the diagnosis of specific malignant subtypes were as follows: Borderline, 80% and 76%, Stage I, 100% and 100, Stage II-IV, 86% and 100%. Accuracy values were not computed for the metastatic cancer since there was only one case seen. There was no significant difference in the accuracy values of IOTA ADNEX with or without CA 125. Conclusion In conclusion, IOTA LR1, LR 2 and ADNEX models were all useful tools in discriminating between benign and malignant ovarian masses. IOTA LR1 had the highest accuracy in differentiating between benign and malignant ovarian masses.
Ultrasonography

A three-cell type malignant mixed germ cell tumor of the ovary is very rare neoplasm. Presently, there has been no reported incidence of the three-cell type mixed germ cell tumor in the literature. Malignant germ cell tumors comprise less than 5% of all ovarian neoplasms. Mixed germ cell tumors, most of which have only two elements.

This is a case report of a 22-year old, nulligravid, who presented with hypogastric pain and increased abdominal girth. Clitoromegaly was noted at puberty. Patient has normal secondary sexual characteristics and menarche. A large multi-separated cystic abdominopelvic mass was seen on ultrasound. Intraoperatively, the left ovary was transformed into a solid tumor measuring 13.5cm x 7cm x 7cm, dangling separately from the left fallopian tube, such that a left oophorectomy. The uterus was hypoplastic. A thin, white, fibrous tissue inferior to the right fallopian tube was seen, which may represent the right ovary, signifying gonadal dysgenesis. For the purposes of staging, peritoneal fluid cytology, bilateral lymph node dissection infracolic omentectomy, liverand para-aortic lymph node palpation were also performed. Final histopatholic diagnosis was malignant mixed germ cell tumor comprising three element, andodermal sinus tumor (70%), dysgerminoma (25%) and embryonal carcinoma (5%). Patients was diagnosed to have malignant mixed germ cell tumor, left ovary, stage IA; hypoplastic uterus; gonadal dysgenesis, right. Adjuvant chemotherapy was advised due to the aggressive nature of the predominant cell type. Reproductive function is further compromised in the presence of the hypoplastic uterus and gonadal dysgenesis.

Human ; Female ; Young Adult ; Dysgerminoma ; Carcinoma, Embryonal ; Gonadal Dysgenesis ; Ovarian Neoplasms ; Turner Syndrome ; Uterus ; Ovariectomy