Yong Wang

Evolution of an ovarian endometriotic cyst into clear cell carcinoma with squamous differentiation across two pregnancies: A case report

Rationale: Ovarian clear cell carcinoma (OCCC) during pregnancy is exceedingly rare, particularly when accompanied by squamous differentiation, with only a limited number of cases reported in the English literature to date. Patient concerns: A 33-year-old female, during the first pregnancy, identified endometriotic cysts. However, during the second pregnancy, the patient was subsequently diagnosed with OCCC. Diagnoses: In this case, histological examination reveals a tumor demonstrating tubular cystic, papillary, and solid growth patterns. Glandular areas with extensive squamous differentiation are observed, along with papillary regions containing hyalinized fibrovascular cores. Tumor cells exhibit cuboidal morphology with clear cytoplasm and hobnail appearance, showing significant atypia. The periphery demonstrates endometrial endometriosis progressing to atypical endometriosis and subsequent malignant transformation. Immunohistochemical analysis shows positive expression of P504S and NapsinA in tumor cells, thereby excluding ovarian endometrioid carcinoma. The findings are consistent with a definitive diagnosis of OCCC. Interventions: Following the detection of the ovarian mass, left adnexectomy was performed. After definitive diagnosis of OCCC, pregnancy termination was pursued, followed by total hysterectomy, right adnexectomy, and pelvic lymph node dissection. Outcomes: Postoperative follow-up at 6 months revealed no evidence of recurrence. Lessons: This case highlights an ovarian cyst that measured 8 cm during the second pregnancy but was only 2 cm in diameter during the first pregnancy, ultimately diagnosed as clear cell carcinoma. Although ovarian malignancies during pregnancy are rare, benign-appearing cysts should not be overlooked. Increased vigilance is warranted to ensure timely diagnosis and appropriate management of such rare but clinically significant presentations.

HSP90AB1 as the Druggable Target of Maggot Extract Reverses Cisplatin Resistance in Ovarian Cancer

Cisplatin resistance is a crucial factor affecting ovarian cancer patient’s survival rate, but the primary mechanism underlying cisplatin resistance in ovarian cancer remains unclear, and this prevents the optimal use of cisplatin therapy. Maggot extract (ME) is used in traditional Chinese medicine for patients with comas and patients with gastric cancer when combined with other drug treatments. In this study, we investigated whether ME enhances the sensitivity of ovarian cancer cells to cisplatin. Two ovarian cancer cells—A2780/CDDP and SKOV3/CDDP—were treated with cisplatin and ME in vitro. SKOV3/CDDP cells that stably expressed luciferase were subcutaneously or intraperitoneally injected into BALB/c nude mice to establish a xenograft model, and this was followed by ME/cisplatin treatment. In the presence of cisplatin, ME treatment effectively suppressed the growth and metastasis of cisplatin-resistant ovarian cancer in vivo and in vitro. RNA-sequencing data showed that HSP90AB1 and IGF1R were markedly increased in A2780/CDDP cells. ME treatment markedly decreased the expression of HSP90AB1 and IGF1R, thereby increasing the expression of the proapoptotic proteins p-p53, BAX, and p-H2AX, while the opposite effects were observed for the antiapoptotic protein BCL2. Inhibition of HSP90 ATPase was more beneficial against ovarian cancer in the presence of ME treatment. In turn, HSP90AB1 overexpression effectively inhibited the effect of ME in promoting the increased expression of apoptotic proteins and DNA damage response proteins in SKOV3/CDDP cells. Inhibition of cisplatin-induced apoptosis and DNA damage by HSP90AB1 overexpression confers chemoresistance in ovarian cancer. ME can enhance the sensitivity of ovarian cancer cells to cisplatin toxicity by inhibiting HSP90AB1/IGF1R interactions, and this might represent a novel target for overcoming cisplatin resistance in ovarian cancer chemotherapy.