Introduction: Peroxisome proliferator-activated receptors (PPARs) have been proposed as a medical treatment against endometriosis in preclinical and clinical studies. Their effect seems to be triggered through the suppression of angiogenesis. In the present study, we used a transgenic animal model with a loss of expression of PPAR-alpha receptors to examine their effect on the course of surgically induced endometriotic lesions. Methods: Ten C57BL/6 mice that served as controls and 10 B6;129S4-PPARa^{tm1Gonz/J t} transgenic mice characterized by absolute loss of expression of PPAR-alpha receptors were used for induction of endometriosis with a previously described surgical technique. Results: Five animals (50%) exhibited abundant endometriotic crypts in the control group whereas only one (10%) animal in the transgenic experimental group had a similar pathological image. Neo-vascularization significantly differed among the two groups (p=0.034) favoring the control group as it was extremely limited in half of the PPAR-alpha null animals. The median inflammation score was 2.5 (1-4) in the P B6;129S4-PPARa^tm1Gonz/J group, whereas it was minimal, 1 (0-2), in the C57BL/6 group. However, these differences were not statistically significant (p=0.101). The fibroblastic activity was also very limited in the PPAR-alpha-deficient model, whereas animals belonging to the control group exhibited an intermediate increase of this index (p=0.022). Conclusion: Surgically induced endometriotic implants in animals with loss of expression of PPAR-alpha receptors exhibit significant differences in their pathology compared to lesions induced in control animals. This information suggests that PPAR-alpha receptors have a significant impact on the course of the disease, indicating that they may serve as potential targets for future medical therapies.

Background: Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and adjuvant chemotherapy is a therapeutic choice for women with advanced ovarian cancer. Whether NACT affects the tumor’s molecular profile has not been determined. Methods: This was a retrospective study of patients with advanced-stage epithelial ovarian cancer treated with NACT at oncology departments affiliated with the Hellenic Cooperative Oncology Group (HeCOG). Tumor molecular profiling was performed on formalin-fixed and paraffin-embedded (FFPE) tumor pre- and post-NACT tissues. Homologous recombination deficiency (HRD), tumor-infiltrating lymphocytes (TILs), tumor molecular alterations, and tumor mutational burden (TMB) via next-generation sequencing analysis were assessed. Results: Overall, tumors from 36 patients were assessed, and molecular profiling was evaluated in 20 paired tumor samples. HRD positivity exhibited no significant change between pre- and post-NACT tumors. The BRCA1/2 mutational status remained constant, irrespective of the treatment administration. Pre-NACT tumors tended to exhibit a lower percentage of intratumoral TILs compared to post-NACT tumors (p = 0.004). Differences in the mutation profile between pre- and post-treatment tissue were observed in 33.33% (6/18) of the cases. The mean tumor cell content (TCC) (p-value: 0.0840) and the mean genomic instability score (p-value: 0.0636) decreased slightly numerically after therapy. A moderate inverse relationship was observed between the pre-NACT TMB and the chemotherapy response score (p-value: 0.038), indicating this correlation is statistically significant. Conclusion: This study provides insights into the effect of NACT on the tumor molecular landscape. While BRCA1/2 and HRD status remained stable, an increase in TIL proportion and changes in the mutational profiles were observed post-treatment.

Background/Objectives: Accurate preoperative characterization of ovarian masses is essential for appropriate clinical management, particularly for borderline ovarian tumors (BOTs), which are less common and often difficult to distinguish from benign or malignant lesions on ultrasound. Although expert subjective ultrasound assessment achieves high diagnostic accuracy, limited availability of highly trained sonologists restricts its widespread application. Artificial intelligence-based approaches offer a potential solution; however, the low prevalence of BOTs restricts the development of robust deep learning models due to severe class imbalance. This study aimed to develop a Convolutional Neural Network (CNN)-based classifier enhanced with Generative Adversarial Networks (GANs) to improve the discrimination of ovarian masses as benign, malignant, or BOT using ultrasound images. Methods: A total of 3816 ultrasound images from 636 ovarian masses were retrospectively analyzed, including 390 benign lesions, 202 malignant tumors, and 44 BOTs. To address class imbalance, a Deep Convolutional GAN (DCGAN) was used to generate 2000 synthetic BOT images for data augmentation. A three-class ensemble CNN model integrating VGG16, ResNet50, and InceptionNetV3 architectures was developed. Performance was assessed on an independent test set and compared with a baseline model trained without DCGAN augmentation. Results: The incorporation of DCGAN-generated BOT images significantly enhanced classification performance. The BOT F1-score increased from 68.4% to 86.5%, while overall accuracy improved from 84.7% to 91.5%. For BOT identification, the final model achieved a sensitivity of 88.2% and specificity of 85.1%. Class-specific AUCs were 0.96 for benign lesions, 0.94 for malignant tumors, and 0.91 for BOTs. Conclusions: DCGAN-based augmentation effectively expands limited ultrasound datasets and improves CNN performance, particularly for BOT detection. This approach demonstrates potential as a decision support tool for preoperative assessment of ovarian masses.

Background and Objectives: Tubal reanastomosis is an alternative option for women seeking fertility after sterilization. Thus, anastomosis healing quality and peri-tubal adhesions play a crucial role. TISSEEL^® fibrin sealant may enhance tissue repair and reduce foreign-body reaction. We evaluated the effect of TISSEEL^®, used alone or with sutures, on anastomotic healing and adhesion formation in a rat uterine horn model. Materials and Methods: Thirty female Wistar rats were randomized to Suture, TISSEEL^®, or Suture + TISSEEL^® groups (n = 10 each). After bilateral uterine horn transection, reanastomosis was performed with sutures alone, fibrin sealant alone, or combined sutures and sealant. On postoperative day 14, reanastomosis segments were collected for blinded histologic assessment and evaluation of modified Ehrlich–Hunt score parameters (inflammation, fibrosis, neovascularization and collagen production). Intra-abdominal adhesions were also macroscopically assessed. Results: Two animals died perioperatively and 56 uterine horns were included in the final analysis (Suture n = 18, TISSEEL^® n = 18, Suture + TISSEEL^® n = 20). The distribution of inflammation and fibrosis severity grades, as assessed by the modified Ehrlich–Hunt scoring system, did not differ significantly between the study groups (p = 0.208 and p = 0.652, respectively). In contrast, high-grade neovascularization (grades 3–4) was more common in TISSEEL^® groups (77.8% TISSEEL^®, 80.0% Suture + TISSEEL^®, 33.3% Suture, p = 0.004), while increased collagen deposition was also more common in the TISSEEL^® groups (p = 0.011), after binary analysis. Severe adhesions were more common in the Suture group (66.7% vs. 11.1% in the TISSEEL^® group and 30.0% in the Suture + TISSEEL^® group, p = 0.037). Conclusions: TISSEEL^®, alone or as an adjunct to sutures, improves neovascularization and collagen production and is associated with milder adhesions without increased inflammation or fibrosis. The use of fibrin sealant TISSEEL^® may be a useful tool in tubal reconstructive surgery.

Background: Uterine serous carcinoma (USC) represents a rare but aggressive subtype of endometrial cancer, accounting for a disproportionate number of disease-related deaths. Although molecular classification has improved risk stratification, prognostic heterogeneity highlights the need for new prognostic markers. Methods: We retrospectively analyzed 83 patients with USC treated at our institution between 1 January 2015 and 31 December 2023. Clinicopathological characteristics, treatment strategies, molecular biomarkers accessed by immunohistology (TP53, ER, PR, HER2, and MMR status), and survival outcomes were collected. Patients were first staged by FIGO 2009 and retrospectively reclassified by FIGO 2023. Disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan–Meier and Cox regression analyses. Results: The majority of patients were presented with advanced disease (FIGO stage IIIC-IV). TP53 mutations were found in 88% of cases, HER2 amplification in 18%, and ER expression in 57.8%. ER-positive patients showed significantly improved DFS in the adjuvant setting compared with ER-negative patients, whereas no significant associations were observed for first-line PFS or OS in multivariable analyses. HER2 amplification was not associated with inferior survival in our cohort. The advanced stage remained an independent predictor of worse OS. Conclusions: USC is a biologically heterogeneous disease, and its treatment should be guided by its molecular profile. ER expression identifies a subset of patients with improved DFS, suggesting potential prognostic relevance in this high-risk histology.

Polycythemia vera (PV) is one of the three main classic disorders of Philadelphia-negative myeloproliferative neoplasms (MPNs), with the other two being essential thrombocythemia (ET) and primary myelofibrosis (PMF). PV may develop (15%) in women of childbearing age (15–45 years), with an anticipated rate of roughly 0.3 per 100,000 people, although maintaining a male to female ratio predominance of about 2:1 and a peak prevalence in the sixth and seventh decades of life. Without always being presented with its actual clinical manifestations due to pregnancy itself, and most commonly due to iron deficiency, PV can be frequently missed and therefore belatedly diagnosed. We describe the case of a primipara woman in her 40s, without risk factors for thrombosis, who developed a portal vein occlusion 1.5 month postpartum after C-section and who had a delayed diagnosis of PV.