Life

Serous Papillary Adenofibroma Cyst of the Ovary in a Young Woman: Case Report and Literature Review

Background: Serous papillary adenofibroma cyst (SPAC) of the ovary is a rare benign epithelial tumor that can mimic borderline or malignant ovarian neoplasms. Reports in young women are particularly scarce. Purpose: The aim of this study is to present a rare clinical case of ovarian SPAC in a young woman and to review the existing literature, highlighting diagnostic challenges and implications for fertility-preserving management. Methods: We present a clinical case of ovarian SPAC in a 41-year-old woman and conducted a narrative literature review. The search was performed in PubMed, Scopus, and Web of Science to identify reports published between 2000 and 2025. Additional relevant articles were also identified through manual screening of reference lists from selected papers. Results: MRI revealed a well-encapsulated septated cystic lesion with solid nodular components and post-contrast enhancement. Tumor markers, including CA 19-9, were elevated. Laparoscopic surgery with intraoperative frozen section confirmed the diagnosis of SPAC, allowing fertility-preserving management. Histopathology established the final diagnosis. Conclusions: This case emphasizes the importance of considering SPAC in the differential diagnosis of complex adnexal masses. Early recognition and intraoperative frozen section can guide conservative surgical strategies, avoiding overtreatment and preserving reproductive potential in young patients.

Endothelial Dysfunction Markers in Ovarian Cancer: VTE Risk and Tumour Prognostic Outcomes

Ovarian cancer (OC) presents daunting lethality rates worldwide, with frequent late-stage diagnosis and chemoresistance, highlighting the need for improved prognostic approaches. Venous thromboembolism (VTE), a major cancer mortality factor, is partially driven by endothelial dysfunction (ED). ED’s pro-inflammatory state fosters tumour progression, suggesting a VTE-independent link between ED and cancer. Given this triad’s interplay, ED markers may influence OC behaviour and patients’ prognosis. Thus, the impact of ED-related genes and single-nucleotide polymorphisms (SNPs) on OC-related VTE and patient thrombogenesis-independent prognosis was investigated. NOS3 upregulation was linked to lower VTE incidence (χ2, p = 0.013), while SELP upregulation was associated with shorter overall survival (log-rank test, p = 0.048). Dismissing patients with VTE before OC diagnosis, SELP rs6136 T allele carriers presented lower progression-free survival (log-rank test, p = 0.038). Nevertheless, due to the SNP minor allele underrepresentation, further investigation is required. Taken together, ED markers seem to exhibit roles that depend on the clinical context, such as tumour-related thrombogenesis or cancer prognosis. Validation with larger cohorts and more in-depth functional studies are needed for data clarification and potential therapeutic strategies exploitation to tackle cancer progression and thrombosis in OC patients.

A Narrative Review of Clinical and Molecular Criteria for the Selection of Poor Candidates for Optimal Cytoreduction in Epithelial Ovarian Cancer

Objective: The objective of this paper is to define “poor candidates” and to conduct an analysis of preoperative selection criteria, considering factors related to the patient, tumor burden, and histopathological characteristics, in the case of patients with advanced epithelial ovarian cancer (EOC) FIGO III-IV with a low probability of optimal cytoreduction. Methodology: The authors of this narrative review conducted an analysis of articles published over a 20-year period (2005–2025), with the following selection criteria for the topics of the papers: advanced epithelial ovarian cancer (FIGOIII-IV), surgical indications in advanced ovarian cancer, poor candidates for surgery, and dependence between surgery and histopathologic and molecular type of EOC. They used using PubMed, Science Direct, and Scopus as databases. The results of the analysis were organized into three large chapters that grouped patient-related factors, tumor burden-specific factors, and histopathological criteria. Results: The authors identify a series of criteria with a high risk of unfavorable postoperative evolution, which led to delayed chemotherapy treatment and suboptimal management. These criteria are related to the patient’s field (ECOG > 3, Charlson Comorbidity Index (CCI) > 2, BMI > 25–30, hypoalbuminemia, hypokalemia), imaging or intraoperative factors predictive for residual tumor, and histopathological or genetic factors (presence of BRCA mutation favors optimal cytoreduction even in cases with high tumor burden; in the case of low-grade serous ovarian carcinoma, surgical intervention is recommended even if there are suboptimal resection criteria, accepting resection > 1 cm due to the poor response to specific chemotherapy treatment). Conclusions: Considering all these aspects, patient selection for primary debulking surgery (PDS) or NACT (neoadjuvant chemotherapy) and interval debulking surgery (IDS) should be conducted in oncological surgery centers highly specialized in gynecological neoplasms, thus ensuring an optimal therapeutic pathway for patients with EOC.