Objective To describe the clinical and ultrasound characteristics of ovarian carcinosarcoma. Methods This was a retrospective multicenter study. Patients with a histological diagnosis of ovarian carcinosarcoma, who had undergone preoperative ultrasound examination between 2010 and 2019, were identified from the International Ovarian Tumor Analysis (IOTA) database. Additional patients who were examined outside of the IOTA study were identified from the databases of the participating centers. The masses were described using the terms and definitions of the IOTA group. Additionally, two experienced ultrasound examiners reviewed all available images to identify typical ultrasound features using pattern recognition. Results Ninety‐one patients with ovarian carcinosarcoma who had undergone ultrasound examination were identified, of whom 24 were examined within the IOTA studies and 67 were examined outside of the IOTA studies. Median age at diagnosis was 66 (range, 33–91) years and 84/91 (92.3%) patients were postmenopausal. Most patients (67/91, 73.6%) were symptomatic, with the most common complaint being pain (51/91, 56.0%). Most tumors (67/91, 73.6%) were International Federation of Gynecology and Obstetrics (FIGO) Stage III or IV. Bilateral lesions were observed on ultrasound in 46/91 (50.5%) patients. Ascites was present in 38/91 (41.8%) patients. The median largest tumor diameter was 100 (range, 18–260) mm. All ovarian carcinosarcomas contained solid components, and most were described as solid (66/91, 72.5%) or multilocular‐solid (22/91, 24.2%). The median diameter of the largest solid component was 77.5 (range, 11–238) mm. Moderate or rich vascularization was found in 78/91 (85.7%) cases. Retrospective analysis of ultrasound images and videoclips using pattern recognition in 73 cases revealed that all tumors had irregular margins and inhomogeneous echogenicity of the solid components. Forty‐seven of 73 (64.4%) masses appeared as a solid tumor with cystic areas. Cooked appearance of the solid tissue was identified in 28/73 (38.4%) tumors. No pathognomonic ultrasound sign of ovarian carcinosarcoma was found. Conclusions Ovarian carcinosarcomas are usually diagnosed in postmenopausal women and at an advanced stage. The most common ultrasound appearance is a large solid tumor with irregular margins, inhomogeneous echogenicity of the solid tissue and cystic areas. The second most common pattern is a large multilocular‐solid mass with inhomogeneous echogenicity of the solid tissue. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

ObjectiveInfections are a threat to frail patients as they have a higher risk of developing serious complications from bloodstream pathogens. The aim of this study was to determine which factors can predict or diagnose bloodstream infections in patients with an underlying gynecologic malignancy.Materials and MethodsBetween July 2016 and December 2017, 68 patients visiting the emergency room with an underlying gynecologic malignancy were evaluated. Variables concerning underlying disease, invasive procedures, and laboratory and clinical parameters were analyzed. Patients were divided into three groups based on their blood and urine specimens (positive blood specimens, positive urine specimens, and no positive specimens; patients who had both positive blood and urine specimens were included in the group of positive blood specimens). Risk factors for surgical site infections, recent (<30 days) surgery, and chemotherapy were studied separately.Results68 patients were included in the analysis. Mean age was 55.6 years (standard deviation 14.1). 44% of patients had ovarian cancer, 35% cervical cancer, 12% endometrial cancer, and 9% had other cancer types. In total, 96% of all patients had undergone surgery. Patients who had been treated with chemotherapy were at a higher risk of developing bloodstream infection (P=0.04; odds ratio (OR)=7.9). C reactive protein, bilirubin, and oxygen saturation (SO2) were significantly different between patients with an underlying infection and those who had none. Only C reactive protein maintained its significance in a linear model, with a cut-off of 180 mg/L (linear regression, P=0.03; OR=4).ConclusionsChemotherapy is a risk factor for the development of bloodstream infections in patients with an underlying gynecologic malignancy; C reactive protein could be a useful tool in making this diagnosis.

ObjectiveTo evaluate the ability of subjective assessment and ADNEX model to discriminate between benign and malignant adnexal tumors and between metastatic and primary ovarian tumors in patients with a personal history of breast cancer.MethodsThis is a retrospective single‐center study including patients with personal history of breast cancer who underwent surgery for an adnexal mass from 2013 to 2020. All patients had been examined with transvaginal or transrectal ultrasound using a standardized examination technique and all images were stored and retrieved for this paper. The specific diagnosis suggested by the original ultrasound examiner in the original ultrasound report was analyzed. The ADNEX model risk was calculated for each mass and the higher relative risk was considered for the analysis of ADNEX in predicting the type of specific tumor. Final histology was considered the reference standard.Results202 women with a history of breast cancer who underwent surgery for an adnexal mass were included in the study. At histology, 93/202 masses (46%) were benign, 76/202 (37.6%) primary malignant (4 borderline tumors and 68 invasive) and 33/202 (16.4%) metastases. The original ultrasound examiner correctly classified 79/93 (84.9 %) benign adnexal masses, 72/76 (94.7%) primary ovarian malignancies and 30/33 (90.9%) metastatic tumors. Subjective ultrasound evaluation had a sensitivity of 93.6% and specificity of 84.9%, while the ADNEX model presented a higher sensitivity (98.2%) but a minor specificity (78.5%), with a similar accuracy (89.6% vs 89.1%) in discriminating between benign and malignant ovarian masses. Sensitivity and specificity in distinguishing metastatic and primary tumors (including benign, borderline and invasive) were 51.5% and 88.8% for the subjective evaluation and 63.6% and 84.6% for the ADNEX model, respectively, with a similar accuracy (82.7% vs 81.2%).ConclusionsA similar performance of subjective assessment and ADNEX model in discriminating between benign and malignant adnexal masses was observed in this series of patients with personal history of breast cancer. Both subjective assessment and ADNEX model demonstrated good accuracy and specificity in discriminating between metastatic and primary tumors, but sensitivity was low.This article is protected by copyright. All rights reserved.

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