Folate receptor alpha in ovarian cancer tissue and patient serum is associated with disease burden and treatment outcomes.

BACKGROUND: Survival rates for ovarian cancer remain poor, and monitoring and prediction of therapeutic response may benefit from additional markers. Ovarian cancers frequently overexpress Folate Receptor alpha (FRα) and the soluble receptor (sFRα) is measurable in blood. Here we investigated sFRα as a potential biomarker. METHODS: We evaluated sFRα longitudinally, before and during neo-adjuvant, adjuvant and palliative therapies, and tumour FRα expression status by immunohistrochemistry. The impact of free FRα on the efficacy of anti-FRα treatments was evaluated by an antibody-dependent cellular cytotoxicity assay. RESULTS: Membrane and/or cytoplasmic FRα staining were observed in 52.7% tumours from 316 ovarian cancer patients with diverse histotypes. Circulating sFRα levels were significantly higher in patients, compared to healthy volunteers, specifically in patients sampled prior to neoadjuvant and palliative treatments. sFRα was associated with FRα cell membrane expression in the tumour. sFRα levels decreased alongside concurrent tumour burden in patients receiving standard therapies. High concentrations of sFRα partly reduced anti-FRα antibody tumour cell killing, an effect overcome by increased antibody doses. CONCLUSIONS: sFRα may present a non-invasive marker for tumour FRα expression, with the potential for monitoring patient response to treatment. Larger, prospective studies should evaluate FRα for assessing disease burden and response to systemic treatments.

Cardiovascular Mortality in Ovarian Cancer Patients: An Analysis of Patient Characteristics Using the SEER Database.

Background and Objectives: Cardiovascular disease (CVD) is a major contributor to the high mortality rate among individuals with ovarian cancer. Nevertheless, there is limited understanding regarding the specific patient attributes that might impact the risk of CVD in this group. Materials and Methods: A retrospective cohort study was performed using the SEER database to analyze primary ovarian cancer cases from 2000 to 2019. Multivariable logistic regression analysis was employed to identify patient characteristics linked to cardiovascular mortality. Results: The cohort included 41,930 cases of patients who were alive, 54,829 cases of cancer-related deaths, 3003 cases of cardiovascular-related deaths, and 10,238 cases with other causes of death. Poorly differentiated cancer cells and distant metastasis were associated with a higher risk of cardiovascular mortality. Logistic regression analysis identified age, year of diagnosis, race, laterality, and staging as significant risk factors for cardiovascular cause of death. The risk of cardiovascular cause of death was lower in patients aged 31-60 and higher in those aged over 60 years old, and the risk also increased with a later year of diagnosis. Patients who were not white were at a higher risk of cardiovascular cause of death. Additionally, bilateral ovarian cancer and distant staging disease were linked to elevated risks of cardiovascular cause of death. Conclusion: Cardiovascular mortality is a significant concern in ovarian cancer patients, and several patient characteristics are associated with an increased risk. Our study suggests that targeted interventions to improve cardiovascular health in high-risk patients, such as those with comorbidities or an advanced stage at diagnosis, may improve survival in this population.

Macrophages in ovarian cancer and their interactions with monoclonal antibody therapies.

The unmet clinical need for effective treatments in ovarian cancer has yet to be addressed using monoclonal antibodies (mAbs), which have largely failed to overcome tumour-associated immunosuppression, restrict cancer growth, and significantly improve survival. In recent years, experimental mAb design has moved away from solely targeting ovarian tumours and instead sought to modulate the wider tumour microenvironment (TME). Tumour-associated macrophages (TAMs) may represent an attractive therapeutic target for mAbs in ovarian cancer due to their high abundance and close proximity to tumour cells and their active involvement in facilitating several pro-tumoural processes. Moreover, the expression of several antibody crystallisable fragment (Fc) receptors and broad phenotypic plasticity of TAMs provide opportunities to modulate TAM polarisation using mAbs to promote anti-tumoural phenotypes. In this review, we discuss the role of TAMs in ovarian cancer TME and the emerging strategies to target the contributions of these cells in tumour progression through the rationale design of mAbs.

An Evaluation of the Effectiveness of Image-based Texture Features Extracted from Static B-mode Ultrasound Images in Distinguishing between Benign and Malignant Ovarian Masses.

Significant successes in machine learning approaches to image analysis for various applications have energized strong interest in automated diagnostic support systems for medical images. The evolving in-depth understanding of the way carcinogenesis changes the texture of cellular networks of a mass/tumor has been informing such diagnostics systems with use of more suitable image texture features and their extraction methods. Several texture features have been recently applied in discriminating malignant and benign ovarian masses by analysing B-mode images from ultrasound scan of the ovary with different levels of performance. However, comparative performance evaluation of these reported features using common sets of clinically approved images is lacking. This paper presents an empirical evaluation of seven commonly used texture features (histograms, moments of histogram, local binary patterns [256-bin and 59-bin], histograms of oriented gradients, fractal dimensions, and Gabor filter), using a collection of 242 ultrasound scan images of ovarian masses of various pathological characteristics. The evaluation examines not only the effectiveness of classification schemes based on the individual texture features but also the effectiveness of various combinations of these schemes using the simple majority-rule decision level fusion. Trained support vector machine classifiers on the individual texture features without any specific pre-processing, achieve levels of accuracy between 75% and 85% where the seven moments and the 256-bin LBP are at the lower end while the Gabor filter is at the upper end. Combining the classification results of the top k (k = 3, 5, 7) best performing features further improve the overall accuracy to a level between 86% and 90%. These evaluation results demonstrate that each of the investigated image-based texture features provides informative support in distinguishing benign or malignant ovarian masses.

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis.

INTRODUCTION: Electrochemotherapy involves the use of transient tumor permeabilization via electric pulses in combination with low-dose chemotherapeutic agents. It has recently emerged as an alternative treatment modality in vulvar cancer. The aim of this meta-analysis was to ascertain the effectiveness of electrochemotherapy in the context of palliative care. METHODS: The following databases were searched: MEDLINE, Scopus, and Cochrane Database, to identify all registered articles pertaining to palliative vulvar cancer treatment with electrochemotherapy from inception until August 2019, in line with PRISMA guidelines. A single-proportion meta-analysis was performed for the outcomes of overall response, complete response, partial response, stable disease, and progressive disease raterespectively, using the random-effect model. Sensitivity analysis was performed to address heterogeneity. RESULTS: Four studies were included totaling 104 women. The studies were of moderate quality. Pooled results from four studies rendered a summary proportion of 78.8% (95% CI 70.4% to 86.1%) for the outcome of overall response. The median age ranged between 68 and 85 years. The sample size per study ranged between eight and 61 women. The tumors' histological types included: squamous-cell carcinoma (96.2%), Paget's disease (2.9%), and malignant melanoma (0.9%). A total of 65 patients (62.5%) presented with a single nodule, whilst 39 patients (37.5%) presented with multiple nodules. Eighty-nine women (85.6%) were previously submitted to other treatment modalities. The overall response rate ranged from 73.2% to 80.9%. The pooled proportion for the outcomes of complete and partial response rate was 48.7% (95% CI 30.74% to 61.5%) and 30.2% (95% CI 21.7% to 39.4%), respectively. The follow-up ranged from 1 to 51 months. No severe adverse effects were reported. The safety profile of electrochemotherapy was favorable. CONCLUSIONS: Electrochemotherapy is an effective and minimally invasive treatment modality in the palliative care management of patients with vulvar cancer. The effective control of vulvar tumors by electrochemotherapy may contribute to improvement of quality-of-life. In light of the moderate quality of evidence, a multi-center cooperation is warranted to confirm its palliative benefit.

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy.

INTRODUCTION: Gestational trophoblastic neoplasia represents a rare placental malignancy spectrum that is treated with single- or multi-agent chemotherapy. This disease often impacts women of childbearing age, making post-chemotherapy fertility and obstetrical outcomes an important consideration. We aimed to ascertain the pregnancy rates and obstetric outcomes in women with gestational trophoblastic neoplasia after undergoing treatment with chemotherapy. METHODS: A systematic literature review was conducted to identify studies that reported post-chemotherapy fertility and obstetric outcomes among women with gestational trophoblastic neoplasia. We performed a single-proportion meta-analysis for the outcomes of conception/pregnancy rate, term live birth rate, first and second trimester spontaneous abortions rate, stillbirth rate, premature delivery rate, and fetal/neonatal malformation rate. RESULTS: A total of 27 studies were included in the analysis. The median age ranged between 25.5 and 33.1 years. The pregnancy rate among women with a desire to conceive, comprising a total of 1329 women and 1192 pregnancies, was 86.7% (95% CI 80.8% to 91.6%). The term live birth rate in 6752 pregnancies was 75.84% (95% CI 73.4% to 78.2%). The adverse pregnancy outcomes were seemingly comparable to those of the general population apart from a minor increase in the stillbirth rate. The pooled proportion for the outcome of malformation rate was 1.76% (95% CI 1.3% to 2.2%). The repeat mole rate in 6384 pregnancies was 1.28% (95% CI 0.95% to 1.66%). Subsequent sub-group analysis indicated that neither multi-agent chemotherapy nor conception within 12 months post-chemotherapy increased the adverse obstetric events risk or fetal malformations. CONCLUSIONS: Nearly 90% of patients desiring future fertility after chemotherapy for gestational trophoblastic disease were able to conceive. In addition, adverse pregnancy outcomes were similar to that in the general population. Multi-agent chemotherapy does not seemingly increase the malformation rate.

Prognostic implications of histological tumor regression (Böhm's score) in patients receiving neoadjuvant chemotherapy for high grade serous tubal & ovarian carcinoma.

OBJECTIVE: Primary objective of this study was to determine prognostic significance of Bohm's histopathological regression score in patients who received neoadjuvant chemotherapy (NACT) for treatment of high grade serous (HGS) tubal & ovarian carcinoma. METHODS: This was a retrospective cohort study of patients who received NACT between 2010 and 2015. The 3 point histopathological regression score of Böhm was used to classify chemotherapy response. Survival outcomes between the 3 different subgroups was analysed and compared with standard clinico-pathological variables using the Cox proportional hazards model and log-rank test. RESULTS: Study cohort comprised 111 patients. Chemotherapy response score (CRS) 3 was observed in 47 (42.4%) and CRS 1and CRS 2 in 22 (19.8%) and 42 (37.8%) women respectively. Women with CRS score of 1 and 2 combined showed a three-fold increased risk of progression on both univariate and multivariate assessment (HR 3.54; C.I 2.19-5.72, p < 0.001). The median overall survival for patients with CRS 1 was 34 months, CRS 2 was 30 months and 47 months for CRS 3. CRS 1 and 2 combined was the only variable that held significance in prediction of reduced overall survival on multivariate assessment (HR 3.26, C.I 1.91-5.54, p 0.0006). CRS 1 and 2 were also associated with 5.15-fold increased risk of relapse within 6 months of completion of chemotherapy (Odds ratio OR 5.15, C.I 0.07-0.47, p - 0.002). CONCLUSION: CRS is an independent prognosticator of survival and reliable predictor of relapse within 6 months in advanced high grade serous tubal and ovarian carcinoma patients receiving NACT.

Prognostic value of serum HE4 levels and risk of ovarian malignancy algorithm scores at the time of ovarian cancer diagnosis.

OBJECTIVES: The aim of this study is to assess whether the pretreatment serum HE4 levels or the Risk of Ovarian Malignancy Algorithm (ROMA) scores at the time of initial diagnosis are associated with progression-free survival (PFS) and disease-specific survival (DSS) in patients with ovarian cancer receiving either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery. METHODS: A survival analysis of 101 cases of invasive ovarian cancer recruited in a previous diagnostic accuracy study was conducted from 2005 to 2009 at the University Hospital KU Leuven, Belgium. Serum HE4 levels (pM) and ROMA scores (%) were obtained before primary treatment. Dates of death were obtained by record linkage with patient hospital files. Progression was evaluated according to the Response Evaluation Criteria in Solid Tumors. Adjusted hazards ratios (HRs) were estimated using multivariable Cox regression. RESULTS: Eighty patients (79%) with invasive ovarian cancer underwent primary debulking surgery, whereas 21 (21%) received neoadjuvant chemotherapy. The median DSS was 3.72 years (95% confidence interval [CI], 3.19-4.07). Fifty-two patients (51%) died of disease, and 74 patients (73%) had progressive disease during follow-up. On univariable analysis, elevated pretreatment HE4 levels and ROMA scores were related to worse prognosis. However, after the adjustment for classic prognostic variables, HE4 levels (log2-transformed) and ROMA scores were unrelated to DSS (log-2 HE4: adjusted HR, 1.01; 95% CI, 0.84-1.21 and ROMA: adjusted HR per 10% increase, 0.96; 95% CI, 0.84-1.12) and PFS (log-2 HE4: adjusted HR, 0.98; 95% CI, 0.84-1.13 and ROMA: adjusted HR per 10% increase, 0.98; 95% CI, 0.88-1.11). CONCLUSIONS: Pretreatment HE4 levels and ROMA scores are not independent prognostic factors for DSS and PFS after multivariable adjustment in patients with ovarian cancer.

Borderline tumour recurrence: how quickly does the tumour grow?

This abstract describes a case of the growth of a serous borderline tumour recurrence and cyst to papillary projection ratio with associated ultrasound images. The aetiology, presentation and management of such cases are explored and compared to the literature.

Adnexal Masses in Pregnancy: A Single-Centre Prospective Observational Cohort Study.

OBJECTIVE: To prospectively determine the nature of adnexal masses diagnosed during pregnancy and investigate whether ultrasound was a reliable means of assessing these. METHODS: A single-centre prospective observational cohort study was conducted in a large tertiary referral hospital in London. Pregnant women with an adnexal mass detected at or prior to the 12-week routine ultrasound received a detailed ultrasound by a level II ultrasound practitioner at the time of detection; at 12 weeks; 20 weeks; and 6 weeks postpartum. The following outcomes were recorded: subjective impression of the mass; International Ovarian Tumor Analysis simple rules classification; resolution and intervention rate; and the incidence of complications related to the mass. RESULTS: A total of 28,683 pregnant patients were scanned and an adnexal masses was detected in 277 patients, yielding an incidence of 1%. 274 participants were included in the analysis. Subjective impression was as follows: simple 75.9%; dermoid 29.1%; endometrioma 6.6%; haemorrhagic 3.3%; para-ovarian 2.6%; torted simple 0.7%; decidualized endometrioma 0.4%; fibroma 0.4%; theca luteal 0.4%; and borderline ovarian tumour: 0.7%. There was a significant reduction in the volume at each scan (p < 0.0001). Approximately 74.2% of the masses resolved spontaneously. Surgery was performed in 14/274: 2 antenatally, 6 at caesarean section, and 6 postpartum. In 5/247 (2%), there were complications due to the mass. Using IOTA simple rules, 272/274 (99.3%) (p < 0.0001) were classifiable. Only 1/274 (0.4%) had malignant features as per IOTA (p = 0.05). As there were no confirmed malignancies, the accuracy of IOTA simple rules could not be calculated. CONCLUSIONS: Adnexal masses in pregnancy are uncommon and the majority spontaneously resolve. Malignancy is rare, as are complications. In the absence of concerns regarding malignancy or cyst accident, there is no need for additional monitoring of these masses during pregnancy.

Artificial Intelligence in Ultrasound Diagnoses of Ovarian Cancer: A Systematic Review and Meta-Analysis.

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.

A comparison between an ultrasound based prediction model (LR2) and the risk of ovarian malignancy algorithm (ROMA) to assess the risk of malignancy in women with an adnexal mass.

OBJECTIVE: The identification of novel biomarkers led to the development of the ROMA algorithm incorporating both HE4 and CA125 to predict malignancy in women with a pelvic mass. An ultrasound based prediction model (LR2) developed by the International Ovarian Tumor Analysis (IOTA) study offers better diagnostic performance than CA125 alone. In this study we compared the diagnostic accuracy between LR2 and ROMA. METHODS: This study included women with a pelvic mass scheduled for surgery and enrolled in a previous prospective diagnostic accuracy study. Experienced ultrasound examiners, general gynecologists and trainees supervised by one of the experts performed the preoperative transvaginal ultrasound examinations. Serum biomarkers were taken prior to surgery. Accuracy of LR2 and ROMA was estimated at completion of this study and did not form part of the decision making process. Final outcome was histology of removed tissues and surgical stage if relevant. RESULTS: In total 360 women were evaluated. 216 women had benign disease and 144 a malignancy. Overall test performance of LR2 (AUC 0.952) with 94% sensitivity and 82% specificity was significantly better than ROMA (AUC 0.893) with 84% sensitivity and 80% specificity. Difference in AUC was 0.059 (95% CI: 0.026-0.091; P-value 0.0004). Similar results were obtained when stratified for menopausal status. CONCLUSION: LR2 shows a better diagnostic performance than ROMA for the characterization of a pelvic mass in both pre- and postmenopausal women. These findings suggest that HE4 and CA125 may not play an important role in the diagnosis of ovarian cancer if good quality ultrasonography is available.

A multicenter prospective external validation of the diagnostic performance of IOTA simple descriptors and rules to characterize ovarian masses.

OBJECTIVES: To evaluate the diagnostic performance of the IOTA (International Ovarian Tumor Analysis group) (clinically oriented three-step strategy for preoperative characterization of ovarian masses when ultrasonography is performed by examiners with different background training and experience. METHODS: A 27-month prospective multicenter cross-sectional study was performed. 36 level II ultrasound examiners contributed in three UK hospitals. Transvaginal ultrasonography was performed using a standardized approach. Step one uses simple descriptors (SD), step two ultrasound simple rules (SR) and step three subjective assessment of ultrasound images (SA) by examiners. The final outcome was findings at surgery and the histological diagnosis of surgically removed masses. RESULTS: 1165 women with adnexal masses underwent transvaginal ultrasonography, 301 had surgery. Prevalence of malignancy was 31% (n=92). SD were able to classify 46% of the masses into benign or malignant (step one), with a sensitivity of 93% and specificity of 97%. Applying SD followed by SR to residual unclassified masses by SD enabled 89% of all masses (n=268) to be classified with a sensitivity 95% of and specificity of 95%. SA was then used to evaluate the rest of the masses. Compared to the risk of malignancy index (RMI), the sensitivity and specificity for the three-step (SD+SR+SA) strategy were 93% (95% CI: 86-97%) and 92% (95% CI: 87-95%) vs. 72% (95% CI: 62-80%) and 95% (95% CI: 91-97%) for RMI, respectively. CONCLUSION: The IOTA three-step strategy shows good test performance on external validation in the hands of ultrasonography examiners with different background training and experience. This performance is considerably better than the RMI.

Gynae-Oncology Surgeons' Preparedness to Undertake Colorectal Procedures during Cytoreductive Surgery for Ovarian Cancer: A Cross Sectional Survey.

Cytoreductive surgery for advanced ovarian cancer commonly involves bowel resection. Although UK gynaecological oncologists are trained in bowel surgery, the degree to which they perform bowel surgery independently varies nationally. A recent joint policy statement from the British Gynaecological Cancer Society (BGCS) emphasises the need for formalised colorectal support. An anonymous, online survey was emailed to BGCS members to assess the status of multidisciplinary working between UK gynaecological oncology and colorectal/general surgical teams. A total of 46 members responded (8.2% response rate). There was a large variety in the involvement of colorectal/general surgical teams in preoperative planning. A total of 13% of respondents had no formalised agreement for intraoperative support, 72.1% of respondents independently performed rectal peritoneal stripping and 60.5% independently performed small bowel resection. This was reduced to 27.9% for right hemicolectomy with primary anastomosis and 16.3% for left hemicolectomy with primary anastomosis. Respondents often involved colorectal support for post-operative complications. The majority of UK gynaecological oncologists involve colorectal/general surgical teams in bowel procedures, more commonly for large bowel procedures compared to small bowel and for left colon compared to right colon procedures. A total of 16.3% of respondents independently performed all surveyed bowel procedures. Future research should examine training and experience within these groups to address this disparity.

A Promising Approach for Primary Cytoreductive Surgery for Advanced Ovarian Cancer: Survival Outcomes and Step-by-Step Description of Total Retroperitoneal en-Bloc Resection of Multivisceral-Peritoneal Packet (TROMP).

(1) Background: A complete tumor resection during primary cytoreductive surgery has been reported to be the most important and perhaps the only independent prognostic factor in advanced ovarian cancers. The goal of complete cytoreduction needs to be weighed against the potential morbidities and long-term survival outcomes. (2) Methods: in this retrospective analysis of a prospectively obtained database, 208 consecutive patients with advanced ovarian cancer who underwent a conventional primary cytoreductive surgery (150 patients) or TROMP technique (58 patients) were included. Progression-free and overall survival rates were calculated using Kaplan-Meier analysis as well as the 95% confidence interval of the hazard ratio between treatment groups. (3) Results: After a median follow-up phase of more than 3 years (range 1-72 months), there are no statistically significant differences between both groups in progression-free and overall survival rates. Albeit, the TROMP group included statistically significant more advanced-stage cases compared to the conventional surgery group. (4) Conclusions: the TROMP technique is a promising tool for successful primary cytoreductive surgery in a selected group of patients with high tumor burdens in order to achieve optimal surgical results and survival outcomes without introducing any additional risks or complications.

Fertility Preserving Surgery Outcomes for Ovarian Malignancy: Data from a Tertiary Cancer Centre in Central London.

Fertility Sparing Surgery (FSS) appears to be a safe means of treating early-stage ovarian cancer based on relatively limited evidence. However, there is currently insufficient evidence to aid women in counselling about their potential fertility outcomes. The aim of this study was to assess the reproductive outcomes and prognosis of women who have undergone FSS for ovarian malignancy. Between 1 June 2008 and 1 June 2018, a retrospective review of a clinical database was conducted to identify all consecutive patients who underwent FSS in a central London gynaecological oncology centre. All patients with a histological diagnosis of ovarian malignancy (excluding borderline ovarian tumours) were eligible. All identified patients were then prospectively called into a follow up and asked to complete a questionnaire about their fertility outcomes. A total of 47 women underwent FSS; 36 were included in this study. The mean age was 30.3 years (95% Confidence Interval [CI]: 27.6 to 33.0 years). During the study period, 17/36 (47.2%) of the women had attempted to conceive following surgery, with a successful live birth rate of 52.9% (9/17). The mean time of recurrence was 125.3 months (95% CI: 106.5−144.1 months). The mean time to death was 139.5 months (95% CI: 124.3−154.8). The cancer grade, tumour stage and use of Assisted Reproductive Technology (ART) were the main factors significantly associated with the risk of recurrence and death. In conclusion, this study suggests that a large proportion of women will not attempt to conceive following FSS. For those who do attempt to conceive, the likelihood of achieving a live birth is high. However, careful counselling about the higher risk of recurrence and worse survival for women with high grade cancer, disease Stage > IA and potentially those who undergo ART is essential before contemplating FFS.

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience.

(1) Background: plastic reconstruction in vulvar surgery can lead to a better treatment outcome than primary closure. This study aims to compare the preoperative parameters (co-morbidities and tumor size) and postoperative results (tumor free margins and wound healing) between the primary closure and reconstructive surgery after vulvar cancer surgery; (2) Methods: this is a retrospective analysis of prospectively collected data from 2009 to 2021 at a tertiary cancer institution; (3) Results: 177 patients were included in the final analysis (51 patients had primary closure PC and 126 had reconstructive surgery RS). About half (49%) of the PC patients had no co-morbidities (p = 0.043). The RS group had a 45 mm median maximal tumor diameter compared to the PC group's 23 mm (p = 0.013). More than 90% of RS and 80% of PC had tumor-free margins (p = 0.1). Both groups had anterior vulvar excision as the most common surgery (52.4% RS vs. 23.5% PC; p = 0.001). Both groups had identical rates of wound healing disorders. In a median follow-up of 39 months; recurrent disease was found in 23.5% of PC vs. 10.3% in RS (p = 0.012). In terms of overall survival there was no significant difference between the both groups; (4) Conclusions: reconstructive vulvar surgery enables enhanced complete resection rates of larger vulvar tumors with better anatomical restoration and a comparable wound recovery in comparison to primary closure. This results in a lower recurrence rate despite the increased tumor volume.

Retraction: Uterine Inversion Secondary to a Large Prolapsed Leiomyoma: Diagnostic and Management Challenges.

[This retracts the article DOI: 10.7759/cureus.7168.].

Trigeminal neuralgia leading to a diagnosis of ovarian cancer: a timely coincidence or a case of paraneoplastic syndrome?

A 51-year-old woman was referred to oral medicine with a 2-month history of progressive paraesthesia of the right lip, chin and oral mucosa. Examination revealed decreased sensation to the right dermatone of the inferior alveolar nerve and allodynia to light touch of the lower lip. An MRI of the head revealed bilateral cisternal trigeminal nerve pathological enhancement. While blood tests suggested a connective tissue disorder as the cause of the trigeminal neuralgia, a subsequent diagnosis of high-grade serous ovarian cancer gave a differential diagnosis of paraneoplastic syndrome.