Frontiers in Medicine

Glomerular disease associated with cancer: a case series of paraneoplastic nephrotic syndrome

The association between glomerular diseases and malignancies has been recognized since the 1920s. A diverse spectrum of glomerular lesions can occur in various neoplasms, including both hematologic malignancies and solid tumors. This study presents a case series of paraneoplastic nephrotic syndrome (PNS) associated with three solid tumors: ovarian cancer, pancreatic neuroendocrine tumor (NET), and bladder cancer. The occurrence of PNS is rarely reported in association with these malignancies. Notably, all patients achieved complete or partial remission without receiving corticosteroids or immunosuppressant therapy. These observations accentuate the critical role of malignancy in the pathogenesis of glomerulopathy and underscore the therapeutic primacy of oncological control in such patients.

Triple-negative ovarian apocrine carcinoma arising in a giant mature cystic teratoma: Case Report and Case Review

Background Mature cystic teratoma (MCT) of the ovary is one of the most common benign ovarian neoplasms in women of reproductive age. Malignant transformation is rare, occurring in approximately 1–2% of cases, and transformation into apocrine carcinoma is exceptionally uncommon. To date, only four such cases have been reported. Case presentation We describe a 68-year-old woman with a giant ovarian tumor that had been slowly growing for over 40 years. Imaging revealed a 35 cm cystic mass, consistent with malignant degeneration and serum CA-125 was elevated (559 U/mL). The patient underwent exploratory laparotomy with complete removal of a 11 kg right ovarian tumor. Histopathological examination revealed a mature cystic teratoma of the ovary with malignant transformation into high-grade apocrine carcinoma. The tumor involved the cyst wall multifocally and showed no capsular rupture. Immunohistochemistry showed AR and EGFR positivity, ER and PR negativity, and HER2 score 2+ (FISH negative). The PET-CT showed 2 pericaval lymph nodes possible reactive after surgery. The postoperative course was uneventful, and from the outset the patient refused a comprehensive staging with hysterectomy, omentectomy and lymphadenectomy. At 6-month follow-up, CA-125 remained normal (<8 U/mL), with no evidence of recurrence. Conclusion Ovarian apocrine carcinoma arising in MCT is exceedingly rare. Complete surgical excision remains the cornerstone of treatment, as no standard systemic therapy has been established. Further accumulation of similar cases is essential to better understand the biological behavior and optimize management of this rare tumor type.

Case Report: A rare case of serous cystadenocarcinoma of the ovary with a benign teratoma in the other ovary

Synchronous ovarian tumors of different histogenesis are rare. High-grade serous carcinoma (HGSC) is an aggressive epithelial malignancy that primarily affects postmenopausal women, whereas mature cystic teratoma is a benign germ cell tumor usually seen in younger patients. Their occurrence in contralateral ovaries poses significant diagnostic challenges. A 57-year-old postmenopausal woman presented with abdominal distension, discomfort, and ascites. Imaging revealed a solid-cystic right ovarian mass with peritoneal involvement and a left adnexal lesion showing fat–fluid levels suggestive of a dermoid cyst. CA-125 was markedly elevated, and ascitic cytology confirmed malignant epithelial cells. She underwent a hysterectomy with bilateral salpingo-oophorectomy and omentectomy. Histopathology showed high-grade serous carcinoma in the right ovary with tubal and cervical stromal invasion, while the left ovary contained a benign mature cystic teratoma. Immunohistochemistry supported Müllerian origin (WT-1+, PAX8+, p53 mutant pattern, and high Ki-67). The tumor was staged as FIGO IIIC. Postoperative platinum-based chemotherapy resulted in significant clinical improvement, CA-125 reduction, and no recurrence at 9 months. This synchronous presentation underscores the importance of correlating imaging, cytology, extensive sampling, and immunohistochemistry to distinguish independent tumors from bilateral carcinoma. Accurate diagnosis enables appropriate oncologic management while avoiding overtreatment of benign lesions.

Primary ovarian CIC-rearranged sarcoma in a child: a rare case report and review of the literature

Introduction CIC-rearranged sarcoma (CRS) is a rare type of high-grade undifferentiated small round cell sarcoma characterized by a range of possible CIC gene rearrangements. It develops predominantly in the deep soft tissues of the limbs and trunk in young individuals (total range, 0.5–83 years; mean, 27–37 years; median, 24.5–33 years), and less commonly in bone and viscera. The occurrence of this sarcoma in the female reproductive tract is very rare, and it has not yet been described in the ovary. Case presentation We report a CRS case that arose from the left ovary in a 5-year-old girl. Histologically, the tumor was lobulated or leaf-shaped, with a fibrotic septum composed of closely arranged small- to medium-sized round cells and short spindle-shaped cells. In addition, the neoplastic cells exhibited multifocal membrane positivity for CD99 and diffuse positivity for WT1, TLE1, FLI‑1, P53, INI-1, and Calretinin, CD56 focal positive, while it was negative for ETV4. Fluorescent in situ hybridization analysis showed CIC-positive split signals. Conclusion CRSs are highly aggressive tumors. Rare CRSs have been reported in the female genital tract, and they are often difficult to diagnose. Especially in cases with atypical morphology and immunohistochemistry, it is necessary to integrate molecular features in the diagnosis of undifferentiated neoplasms.

Time intervals in the pathway to diagnosis and treatment of patients with breast and gynecological cancer

BackgroundBreast and gynecological cancer have a high prevalence and a significant impact on public health. It is important to note that the time intervals until diagnosis and treatment influence the prognosis. The objective was to describe the delay in the diagnosis of breast and gynecological cancer and to identify the variables related to the patient, healthcare and the disease that intervene in the time interval until diagnosis and treatment.MethodsWe conducted a retrospective study (2014–2023) following a cohort of women with breast and gynecological cancer, from the onset of symptoms to the start of treatment. The study included 722 women from 30 general practice clinics in Albacete, Spain, and data were obtained from both primary care and hospital settings.ResultsAmong breast cancer patients, 150 (25.7%) had been diagnosed through screening, and among those diagnosed with cervical cancer, 14 (37.8%), it was not possible to calculate some time intervals. In breast cancer the variables associated with a total time interval (from first symptoms to start of treatment) of more than 90 days were: age over 50 and symptoms other than a breast lump. In gynecological cancer, the related variables were: no family history and having attended the health center for the first consultation. In the diagnostic interval (from first consultation to diagnosis), the variables associated with a duration of more than 30 days were: presenting with fewer than two risk factors in breast cancer and first consultation at the health center in gynecological cancer.ConclusionMost patients with breast and/or gynecological cancer are diagnosed in the early stages of the disease, except in the case of ovarian cancer. Most breast and cervical tumors are not diagnosed through screening. The time interval that most influences the total interval is the diagnostic interval, which includes the primary care interval. The treatment interval is high in most tumors, exceeding the recommended time. The results provide useful information for proposing improvements in access to diagnostic and therapeutic resources, as well as preferential referral circuits to improve early detection and prognosis of the disease.