Deli Zhao

Predictive value of MR imaging IVIM and T2 mapping in malignant transformation of endometriosis

This study aims to explore the value of MRI intravoxel incoherent motion (IVIM) combined with T2 mapping in predicting the malignancy of endometriosis (EM) and construct a noninvasive preoperative risk assessment model. A retrospective analysis was conducted on 156 patients with pathologically confirmed EM or endometriosis - associated ovarian cancer, who were divided into the benign group (102 cases) and the malignant transformation group (54 cases). Two observers independently measured the IVIM parameters (D, D * , f) and T2 values to construct single-parameter and multi-parameter joint models. The receiver operator characteristic curve was used to evaluate the diagnostic efficacy, and logistic regression was used to analyze the independent predictors. The values of D, f, and T2 in the malignant transformation group were significantly lower than those in the benign group (all P  < .05), while there was no statistically significant difference in D * value. The area under curve (AUC) of D, f, T2, and the combined model D + f + T2 were 0.737, 0.701, 0.773, and 0.874, respectively. The optimal cutoff values of D, f, and T2 were 1.10 × 10⁻³ mm 2 /s, 37.30 %, and 119.65 ms, respectively. Values lower than these may indicate a risk of malignant transformation of EM. Logistic regression confirmed that D, D * , and T2 were independent predictors of EM malignancy. IVIM combined with T2 mapping can non-invasively and quantitatively assess the risk of malignant transformation of EM. The combined model of parameters of two sequences has good potential for clinical promotion.

A rare large cell variant of small-cell carcinoma of the ovary, hypercalcemic type in a postmenopausal woman: Case report

Rationale: Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is an extremely rare and aggressive ovarian malignancy associated with SMARCA4 mutation, accounting for less than 0.01% of ovarian tumors. It predominantly affects young females and is characterized by poor prognosis. Here, we report a unique case of SCCOHT with a special pathological classification of large cell variant type in a 59-year-old postmenopausal woman, an age that is rare for this disease. Patient concerns: A 59-year-old female patient presented with lower abdominal pain. A hard and restricted mass was palpated at the back of the uterus during pelvic physical examination. MRI examination showed a huge solid mixed-signal mass shadow in the right adnexal area, with a size of 10 × 7 × 7 cm. Diagnoses: Postoperative histopathological and immunohistochemical analyses demonstrated abundant large cells under microscopic examination and a loss of BRG1 protein expression, leading to the diagnosis of large cell variant of SCCOHT in right ovary. Genetic testing confirmed a mutation in the SMARCA4 gene (exon 6, c.1103del p.[Q368Rfs*43]). Interventions: The patient underwent pelvic tumor cytoreductive surgery and pelvic adhesion release surgery, and the implanted lesions in the pelvic cavity were resected during the operation. Outcomes: The patient underwent extensive surgical resection and completed 6 cycles of TC chemotherapy (paclitaxel + carboplatin). Despite the postoperative pathological stage reached Stage II, during the 18-month follow-up after the operation, no evidence of tumor progression or recurrence was observed. Lessons: SCCOHT is a highly malignant tumor associated with a generally poor prognosis, particularly for tumors at stage II or higher. Nevertheless, the favorable prognosis observed in this case suggests that the traditional understanding may require reevaluation. Whether there is a correlation between the age of onset of SCCOHT and the prognosis remains to be elucidated through systematic clinical research in the future.