Elzarkaa AA, et al. J Gynecol Oncol. 2017 Dec;29:e47. https://doi.org/10.3802/jgo.2018.29.e47

Ovarian cancer is the sixth most common malignancy, with a 35% survival rate across all stages at 10 years. Ultrasound is widely used for ovarian tumour diagnosis, and accurate pre-operative diagnosis is essential for appropriate patient management. Artificial intelligence is an emerging field within gynaecology and has been shown to aid in the ultrasound diagnosis of ovarian cancers. For this study, Embase and MEDLINE databases were searched, and all original clinical studies that used artificial intelligence in ultrasound examinations for the diagnosis of ovarian malignancies were screened. Studies using histopathological findings as the standard were included. The diagnostic performance of each study was analysed, and all the diagnostic performances were pooled and assessed. The initial search identified 3726 papers, of which 63 were suitable for abstract screening. Fourteen studies that used artificial intelligence in ultrasound diagnoses of ovarian malignancies and had histopathological findings as a standard were included in the final analysis, each of which had different sample sizes and used different methods; these studies examined a combined total of 15,358 ultrasound images. The overall sensitivity was 81% (95% CI, 0.80–0.82), and specificity was 92% (95% CI, 0.92–0.93), indicating that artificial intelligence demonstrates good performance in ultrasound diagnoses of ovarian cancer. Further prospective work is required to further validate AI for its use in clinical practice.

The aim of this study was to examine a possible association between the levels of total serum cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipoprotein(a), and the development of severe preeclampsia. We measured the levels of these lipoproteins in a prospective observational longitudinal cohort study that recruited 50 third-trimester pregnant women with mild preeclampsia at the time of recruitment. Two assessments were performed; the first measurement was at 29–31 weeks of pregnancy (at recruitment), and the second took place 4 weeks later. Patients with BMI 30, those < 20 years of age and those > 35 years of age were not included in the study. Eight mildly preeclamptic women developed severe preeclampsia within 4 weeks. In these patients, lipoprotein(a) level showed a twofold increase. A serum lipoprotein(a) level > 40.5 mg/dL in a mildly preeclamptic patient predicted the development of severe preeclampsia later on in the pregnancy, whereas a serum lipoprotein(a) level > 52.5 mg/dL was a marker of severity with high sensitivity and specificity. We suggest through our results that that lipoprotein(a) level correlates with the severity of the disease.

Myometrial cysts of the uterus are extremely rare. Uterine leiomyomas commonly undergo degenerative changes, which can lead to variable imaging features. Diffuse hydropic change is an unusual form that presents a considerable diagnostic challenge to both radiologists and pathologists. A 27-year old nulliparous patient admitted to our hospital for antenatal care and left sided pelvic pain. Transvaginal ultrasonographic examination revealed a 20cm intramural cystic lesion in the left region of the corpus uteri suspicious of degenerated myoma. Repeated aspiration was done. Spontaneous abortion occurred in the first trimester. Rapid distension of the abdomen despite repeated aspirations occurred. MRI revealed degenerated myoma. Ultrasound performed one day before surgery revealed a turbid content instead of the clear fluid. Laparotomy was performed revealing a huge interstitial myoma with bloody collection inside so, myomectomy was performed. Histopathology showed hydropic degenerated myoma. Although fibroids usually have a characteristic sonographic appearance, degenerating myomas have variable patterns and can pose a diagnostic dilemma. Extensive cystic degeneration can mimic an ovarian tumour

Primary presacral clear cell carcinoma (CCC) of Müllerian origin is extremely rare. Malignant transformation of endometriosis is a known phenomenon, though typically involving the ovaries or pelvic peritoneum. Retroperitoneal presentation, especially decades after definitive surgery, is exceedingly uncommon. A 60‐year‐old woman presented with a large retroperitoneal/presacral pelvic mass leading to hydronephrosis, 20 years after total abdominal hysterectomy and bilateral salpingo‐oophorectomy for endometriosis. MRI showed a cystic‐solid mass with mural nodularity. Surgical exploration revealed dense retroperitoneal adhesions with involvement of the rectosigmoid and the appendix. En bloc resection was performed in posterior exenterative fashion. Histopathology confirmed clear cell carcinoma arising from endometriotic foci, fulfilling Sampson's criteria. Postoperative management included adjuvant paclitaxel‐carboplatin chemotherapy. The patient recovered uneventfully and was scheduled for ileostomy reversal. This case illustrates the potential late malignant transformation of endometriosis into Müllerian CCC even decades after hysterectomy and oophorectomy. Endometriosis‐associated carcinoma should be considered in the differential diagnosis of retroperitoneal pelvic masses, particularly in women with prior endometriosis.