OBJECTIVES: International Ovarian Tumor Analysis (IOTA) working group proposed a logistic regression (IOTA LR2) model. It is served as a risk prediction model for benign and malignant adnexal tumors. This study aims to compare the diagnostic efficiency between the IOTA LR2 model and doctors' subjective assessment on diagnosing benign and malignant adnexal mass. METHODS: The ultrasonographic images of 616 adnexal masses were retrospectively analyzed by the senior doctors' group and the junior doctors' group using the IOTA LR2 model and subjective assessment. The postoperative pathological diagnosis was used as the gold standard to compare the diagnostic efficiency of the 2 methods. RESULTS: The area under the curves of subjective assessment and IOTA LR2 model for diagnosing malignant adnexal masses were 0.86 and 0.90 for the senior doctors' group and 0.79 and 0.88 for the junior doctors' group, respectively. The sensitivity and specificity of subjective assessment for diagnosing the malignant adnexal masses were 81.0% and 91.3% for the senior doctors' group and 70.1% and 88.7% for the junior doctors' group, respectively. The sensitivity and specificity of the IOTA LR2 model for diagnosing the malignant adnexal masses were 79.6% and 88.1% for the senior doctors' group, and 79.6% and 81.7% for the junior doctors' group, respectively.There were no significant difference in the sensitivities between the senior doctors' group and junior doctors' group using the IOTA LR2 model and the senior doctors' group using subjective assessment (both P>0.05). CONCLUSIONS The diagnostic efficiency of the IOTA LR2 model is equal to the senior doctors' experiences. This model can help junior doctors to reduce the missed diagnosis of malignant adnexal masses.
Adnexal Diseases/pathology* ; Diagnosis, Differential ; Female ; Humans ; Ovarian Neoplasms/diagnostic imaging* ; Retrospective Studies

OBJECTIVE: The objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data. METHODS: The study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated. RESULTS: A total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety of factors, including age, residence, hospital stratification, premium range, and various comorbidities had significant impact on the progression (p < 0.05). Among them, age, urbanization of residence, hospital stratification, premium range, post-endometriosis childbearing, pelvic inflammation, and depression all had independent, significant impact (p < 0.05). The validated C-index was 0.69. CONCLUSION: For a woman diagnosed with endometriosis, increased age, residing in a highly urbanized area, low or high income, depression, pelvic inflammation, and absence of childbearing post-endometriosis all put her at high-risk to develop ovarian cancer. The findings may be of help to gynecologists to identify high-risk patients.
Cohort Studies* ; Comorbidity ; Dataset ; Depression ; Diagnosis ; Endometriosis* ; Female ; Humans ; Inflammation ; Inpatients ; Insurance* ; International Classification of Diseases ; Multivariate Analysis ; National Health Programs ; Ovarian Neoplasms* ; Risk Factors* ; Taiwan ; Urbanization

There has been significant progress in the understanding of the pathology and molecular biology of rare ovarian cancers, which has helped both diagnosis and treatment. This paper provides an update on recent advances in the knowledge and treatment of rare ovarian cancers and identifies gaps that need to be addressed by further clinical research. The topics covered include: low-grade serous, mucinous, and clear cell carcinomas of the ovary. Given the molecular heterogeneity and the histopathological rarity of these ovarian cancers, the importance of designing adequately powered trials or finding statistically innovative ways to approach the treatment of these rare tumors has been emphasized. This paper is based on the Rare Ovarian Tumors Conference for Young Investigators which was presented in Tokyo 2015 prior to the 5th Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG).
Consensus ; Diagnosis ; Female ; Humans ; Molecular Biology ; Mucins ; Ovarian Neoplasms* ; Ovary ; Pathology ; Population Characteristics ; Rare Diseases ; Research Personnel*

OBJECTIVETo explore the genetic etiology for two Chinese families affected with hypergonadotropic amenorrhea and normal number of antral follicles.

METHODSPeripheral venous blood samples were collected from the families for the extraction of genomic DNA. Mutations of FSHR and LHCGR genes were screened using PCR and Sanger sequencing. Suspected pathogenic mutations were verified in other members of the families. Bioinformatics software and NCBI were used to analyze the pathogenicity of the mutations.

RESULTSTwo previously unreported homozygous mutations, c.419delA and c.1510C>T of the FSHR gene were found in the probands of family I and II, respectively. Pedigree and bioinformatics analysis suggested that both mutations were pathogenic. Literature review suggested that both families were affected with resistant ovary syndrome rather than premature ovarian failure.

CONCLUSIONTwo novel mutations of the FSHR gene have been identified, which have enriched the spectrum of FSHR gene mutations and provided a basis for genetic counseling and direction for reproduction.

Adolescent ; Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; China ; Female ; Humans ; Male ; Molecular Sequence Data ; Mutation ; Ovarian Diseases ; diagnosis ; genetics ; Pedigree ; Receptors, FSH ; genetics ; Young Adult

BACKGROUND: Pyometra should be treated with caution in elderly patients because it may indicate a malignancy in the post-menopausal period and can result in life-threatening complications such as septicemia or pan-peritonitis. METHODS: We retrospectively analyzed the clinical features of 30 patients aged ≥65 years who received treatment for pyometra between January 2010 and December 2014. RESULTS: The 30 patients (age: median, 74 years; range, 66-88 years) were evaluated. They presented with vaginal discharge (n=17), vaginal bleeding (n=8), abdominal pain (n=6), or fever (n=3). The most common accompanying systemic disease was hypertension (n=15), followed by diabetes mellitus (n=10). Of the 30 cases, seven were associ- ated with gynecologic malignancy (cervical cancers, n=3; endometrial cancers, n=3; and ovarian cancer, n=1); and 14, with gynecologic benign diseases (uterine myoma, n=5; cervical intraepithelial neoplasia, n=4; tubo-ovarian abscess, n=3; endometrial polyp, n=1; uterine prolapse, n=1). All the patients were treated with cervical dilatation and drainage. Fifteen patients underwent gynecologic surgery with antibiotic therapy, and 15 received empirical antibiotic treatment alone. Two women experienced spontaneous perforation of pyometra. Pyometra is considered a complication of benign and malignant gynecologic disease, until proven otherwise. CONCLUSION: In elderly patients with comorbidities, pyometra might induce severe complications such as pan-peritonitis or sepsis. Early accurate diagnosis is important to determine an appropriate individualized treatment to reduce morbidity and mortality.
Abdominal Pain ; Abscess ; Aged* ; Cervical Intraepithelial Neoplasia ; Comorbidity ; Diabetes Mellitus ; Diagnosis ; Drainage ; Endometrial Neoplasms ; Female ; Fever ; Genital Diseases, Female ; Gynecologic Surgical Procedures ; Humans ; Hypertension ; Labor Stage, First ; Mortality ; Myoma ; Ovarian Neoplasms ; Peritonitis ; Polyps ; Postmenopause ; Pregnancy ; Pyometra* ; Retrospective Studies ; Sepsis ; Uterine Hemorrhage ; Uterine Prolapse ; Vaginal Discharge

Symptoms of a peritoneal progression from ovarian cancer are nonspecific such as abdominal pain, abdominal distention and more. Many imaging studies and serum CA-125 help diagnosis. However, it is difficult to exclude the instances of the diffuse peritoneal diseases that mimic carcinomatosis. The elevated CA-125 level usually correlates with the peritoneal carcimatosis, but it is often found in other peritoneal diseases. Therefore, the pathologic confirmation is necessary because of other mimicking diseases. In our case, CA-125 levels were elevated. Abdominal computed tomography finding was suspected a peritoneal tuberculosis but the pathologic result was the peritoneal carcimatosis, eventually.
Abdominal Pain ; Carcinoma* ; Diagnosis ; Ovarian Neoplasms ; Peritoneal Diseases ; Peritonitis, Tuberculous*

Epithelial borderline ovarian tumors (BOT) are distinctive from benign tumors and carcinoma. They occur in younger women more often than carcinoma, and there is some difficulty making correct diagnosis of BOT. Two subtypes of BOT, serous and mucinous borderline tumor have different characteristics and very different clinical behavior. Serous borderline tumor (SBT) with micropapillary pattern shows more incidence of extra ovarian disease and often coexists with invasive implant. SBT with micropapillary pattern in advanced stage has showed a worse prognosis than typical SBT. Huge mucinous borderline tumors have histologic heterogeneity, and the accuracy of frozen section diagnosis is relatively low. Extensive sampling is required to reach a correct pathological diagnosis. Mucinous adenoma (intestinal type) also runs the risk of recurrence after cystectomy, or intraoperative rupture of cyst. Laparoscopic procedure for BOT has not increased the risk of recurrence. Fertility preserving procedures are generally accepted, except in advanced stage SBT with invasive implants. Only cystectomy shows a significant risk of recurrence. Re-staging surgery and full staging surgery is not necessary for all BOT. We should not attempt to treat them uniformly, by the single diagnosis of "borderline tumor". It depends on histologic type. Close communication with the pathologist is necessary to gain more detail and ask more pathological samples in order to make the optimal treatment strategy for each individual patients.
Adenoma ; Cystectomy ; Diagnosis* ; Female ; Fertility ; Frozen Sections ; Humans ; Incidence ; Laparoscopy ; Mucins ; Ovarian Diseases ; Population Characteristics ; Prognosis ; Recurrence ; Rupture

Epithelial borderline ovarian tumors (BOT) are distinctive from benign tumors and carcinoma. They occur in younger women more often than carcinoma, and there is some difficulty making correct diagnosis of BOT. Two subtypes of BOT, serous and mucinous borderline tumor have different characteristics and very different clinical behavior. Serous borderline tumor (SBT) with micropapillary pattern shows more incidence of extra ovarian disease and often coexists with invasive implant. SBT with micropapillary pattern in advanced stage has showed a worse prognosis than typical SBT. Huge mucinous borderline tumors have histologic heterogeneity, and the accuracy of frozen section diagnosis is relatively low. Extensive sampling is required to reach a correct pathological diagnosis. Mucinous adenoma (intestinal type) also runs the risk of recurrence after cystectomy, or intraoperative rupture of cyst. Laparoscopic procedure for BOT has not increased the risk of recurrence. Fertility preserving procedures are generally accepted, except in advanced stage SBT with invasive implants. Only cystectomy shows a significant risk of recurrence. Re-staging surgery and full staging surgery is not necessary for all BOT. We should not attempt to treat them uniformly, by the single diagnosis of "borderline tumor". It depends on histologic type. Close communication with the pathologist is necessary to gain more detail and ask more pathological samples in order to make the optimal treatment strategy for each individual patients.
Adenoma ; Cystectomy ; Diagnosis* ; Female ; Fertility ; Frozen Sections ; Humans ; Incidence ; Laparoscopy ; Mucins ; Ovarian Diseases ; Population Characteristics ; Prognosis ; Recurrence ; Rupture

Acute-onset pelvic pain is an extremely common symptom in premenopausal women presenting to the emergency department. After excluding pregnancy in reproductive-age women, ultrasonography plays a major role in the prompt and accurate diagnosis of adnexal causes of acute pelvic pain, such as hemorrhagic ovarian cysts, endometriosis, ovarian torsion, and tubo-ovarian abscess. Its availability, relatively low cost, and lack of ionizing radiation make ultrasonography an ideal imaging modality in women of reproductive age. The primary goal of imaging in these patients is to distinguish between adnexal causes of acute pelvic pain that may be managed conservatively or medically, and those requiring emergency/urgent surgical or percutaneous intervention.
Abscess ; Adnexa Uteri ; Diagnosis ; Emergency Service, Hospital ; Endometriosis ; Fallopian Tube Diseases ; Female ; Humans ; Ovarian Cysts ; Ovary ; Pelvic Pain* ; Pregnancy ; Radiation, Ionizing ; Ultrasonography*

PURPOSE: To report a case of subacute optic neuropathy caused by thiamine (vitamin B1) deficiency. CASE SUMMARY: A 44-year-old woman was referred to the ophthalmology department due to decreased vision which began 10 days prior to presentation. The patient history indicated that she had undergone chemotherapy for ovarian cancer and she had been dependent on total parenteral nutrition for 3 weeks due to nausea and vomiting. Her best corrected vision of the right and the left eyes were 0.15 and 0.2, respectively. Color vision was severely impaired in both eyes without retrobulbar pain. There was marginal blurring on the temporal side of the optic discs of both eyes. The optic nerves were unremarkable on orbital and brain magnetic resonance imaging (MRI). There was high signal intensities in both the mammillary body and periaqueductal gray matter on T2-weighted imaging. In addition, the patient exhibited ataxia along with short-term memory loss. She was diagnosed with Wernicke's encephalopathy. Thiamine was administrated based on the diagnosis, and after 2 days of administration, the patient's vision and neurologic symptoms began to improve. Two weeks later, the patient recovered her vision. CONCLUSIONS: Thiamine deficiency may cause optic neuropathy and can be recovered with early thiamine supplementation. This condition could occur due to deficient oral thiamine administration. We should keep this point in mind and try to prevent or diagnose early.
Adult ; Ataxia ; Brain ; Color Vision ; Diagnosis ; Drug Therapy ; Female ; Humans ; Magnetic Resonance Imaging ; Mamillary Bodies ; Memory, Short-Term ; Nausea ; Neurologic Manifestations ; Ophthalmology ; Optic Nerve ; Optic Nerve Diseases* ; Orbit ; Ovarian Neoplasms ; Parenteral Nutrition, Total ; Periaqueductal Gray ; Thiamine Deficiency ; Thiamine* ; Vomiting ; Wernicke Encephalopathy*