Introduction: Actinomyces are commensal bacteria that colonize various sites in the human body. Under certain predisposing conditions, they can proliferate and cause granulomatous inflammation in different tissues. Pelvic actinomycosis is an extremely rare condition; its significance lies in the fact that it can be easily misdiagnosed as gynecological malignancy based on clinical manifestations and imaging findings. According to the literature, this type of inflammatory disease is a common mimic of ovarian cancer. Objective and methods: This paper aims to provide a comprehensive overview of the characteristics of pelvic actinomycosis through a literature review and the description of two cases collected between 2023 and 2024 at Azienda Ospedaliera Universitaria Santa Maria della Misericordia in Udine Italy.

Endometriosis is linked to an increased risk of epithelial ovarian cancer (EOC), especially clear cell and endometrioid subtypes. The extent and prognostic significance of this link are still not fully understood. This systematic review and meta-analysis compiles existing evidence on ovarian cancer risk, histotype distribution, and survival outcomes in women with endometriosis. Systematic search up to August 2025 METHODS OF STUDY SELECTION: A systematic search of PubMed and Google Scholar was performed up to August 2025. Studies reporting ovarian cancer risk estimates or survival outcomes in endometriosis-associated ovarian cancer (EAOC) were included. Random-effects models generated pooled odds ratios (OR), hazard ratios (HR), and standardized incidence ratios (SIR). Risk analyses included >500,000 women; survival analyses >10,000. Sixty-seven studies met inclusion criteria. Endometriosis increased ovarian cancer risk (OR 1.82, HR 3.03, SIR 1.62). EAOC patients were younger, more often premenopausal, and more frequently diagnosed with early-stage (OR 0.29) and low-grade tumors (OR 1.71). Clear cell and endometrioid histotypes predominated. Overall survival was significantly better in EAOC (HR 0.48); recurrence and mortality were lower, while platinum resistance was similar. Endometriosis confers an increased relative but still low absolute risk of ovarian cancer. EAOC exhibits distinct clinicopathologic features and improved survival compared with non-EAOC. These findings support personalized counseling and emphasize the need for phenotype-based risk stratification and molecular markers of malignancy transformation.

Background: Paraneoplastic neurological syndromes (PNSs) are rare immune-mediated disorders associated with malignancies and may precede the diagnosis of the underlying tumor. Ovarian cancers, including both epithelial tumors and teratomas, have been associated with a spectrum of antibody-mediated neurological syndromes, although their clinical implications remain poorly defined. Objective: To describe three cases of PNS associated with ovarian malignancies and to provide a narrative review of the literature focusing on their diagnostic and clinical implications. Methods: We report three patients managed at our institution who developed paraneoplastic neurological syndromes in association with ovarian cancer. In parallel, a narrative review of the literature was conducted through PubMed and Google Scholar to identify studies published between 2020 and 2025 reporting PNS in ovarian malignancies. Relevant studies were selected and analyzed qualitatively, with emphasis on timing of onset, clinical presentation, antibody profiles, treatment strategies, and outcomes. Results: Eighteen studies were included, the majority of which were case reports. In most cases, neurological symptoms preceded the diagnosis of ovarian cancer, highlighting their potential role as an early clinical indicator of malignancy. Cerebellar degeneration was the most frequent presentation, often associated with anti-Yo antibodies, while encephalitis was more commonly linked to anti-NMDAR antibodies. Our clinical cases illustrate the heterogeneity of presentation and the complexity of diagnosis and management, requiring a multidisciplinary approach. Across studies, outcomes were variable, with partial improvement or stabilization observed in most cases following oncologic and immunomodulatory treatment. Conclusions: Paraneoplastic neurological syndromes may represent an early clinical clue to ovarian malignancy. Increased awareness among clinicians is essential to prompt appropriate diagnostic evaluation and timely oncologic management. Further research is needed to clarify the role of onconeural antibodies in early detection and disease monitoring.