Abstract. Hormone-producing malignancies are rare in children or adolescent patients: Only 0.1% of all ovarian tumors and 4-5% of granulosa cell tumors occur in the sexually non-active ages. Granulosa cell tumors (GCTs) are sex cord-stromal tumors of the ovary, representing 7-8% of all ovarian neoplasms. A total of 95% of all GCTs are adult-type, and only 5% are diagnosed as juvenile-type GCT. A majority of children with juvenile-type GCT present with isosexual precocious pseudopuberty due to excessive estrogen production, although virilizing, testosterone-producing, juvenile-type GCTs are rare, occurring only in 2-3% of cases. The present case study reports on a case of a virilizing, juvenile-type GCT in a 14-year-old girl, along with a review of the literature.

Purpose: In the developed world, endometrial cancer is one of the most common malignant gynecological cancer types. Due to the highly available diagnostic modalities and patient education, the early detection of the tumor leads to high overall survival.Methods: In this study we analyzed the reliability of preoperative MRI findings in the staging of early stage endometrial cancer, as well as the clinical characteristics of patients underwent radical hysterectomy and the histopathologic evaluation of their tumor, with the retrospective data of radical hysterectomies performed in our hospital between 2010 and 2019.Results: The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI regarding stage were 94.7, 63.3, 94.8, 83.8, and 83.8%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of the myometrial invasion were 69.8, 80.0, 60.8, 64.3, and 77.5%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of lymph node metastases were 78.1, 28.6, 82, 11.1, and 93.6%, respectively.Conclusions: Based on our results, MRI is the method of choice in terms of evaluating overall staging, as well as myometrial invasion, as its specificity and negative predictive value are relatively high. However, systematic lymphadenectomy showed improved cancer-related survival and recurrence-free survival. Our studies showed that the diagnosis of lymph node metastases is difficult with MRI modality since hyperplastic and metastatic nodes cannot easily differentiate, leading to a high percentage of false-positive results. Therefore, other imaging modalities may be used for more accurate evaluation. New findings of our study were that the role of the radiologist’s expertise in the evaluation of MR imaging plays an essential role in lowering false-negative and false-positive results. Therefore, findings evaluated by a radiologist with high-level expertise in gynecological imaging can complement the clinical findings and help substantially define the needed treatment.

Abstract. Ovarian malignancies are rare in pregnancy; however, the incidence of abnormal adnexal masses diagnosed during pregnancy is increasing. The most common masses are ovarian cysts, and only 3-6% of those are malignant. The majority of ovarian masses are diagnosed at an early stage by routine ultrasound examinations. Malignant germ cell tumors are the most common ovarian malignancies associated with pregnancy, while the incidence of epithelial ovarian cancer is only 1:12,000-1:50,000 of pregnancies. The diagnosis and management of ovarian cancer during pregnancy remain unclear due to the rare occurrence and scant data on this condition. We herein report the case of 23-year-old woman with an extremely large ovarian papillary mucinous cystadenocarcinoma diagnosed during pregnancy, identified on ultrasound and magnetic resonance imaging, and treated by surgical resection followed by adjuvant chemotherapy with carboplatin and paclitaxel.

Objectives:The aim was to assess the clinical usefulness and diagnostic performance by additional measurement of CA 125 in combination with ultrasound findings for preoperative assessment of adnexal masses. Methods: This was a retrospective study assessing 215 adnexal masses in 215 women pre-and postmenopausal over a 24-month period in Gynecological Oncology Unit. Seventy-three (34%) women were premenopausal and 142 (66%) women were premenopausal. Patients were evaluated with transvaginal ultrasound according to the Gynecologic Imaging Report and Data System (GI-RADS) classification. Serum concentration of CA 125 was measured before surgical procedure. The definitive diagnosis was confirmed by pathological examination of the excised lesions. Ovarian cancer is the fifth more common type of cancer in women and the forth cause of cancer death in women. Gynecological ultrasound is one of the main investigation methods that allows the identification and detailed description of pelvic adnexal masses at first, because of its potential in reconstructing highly definitive images and its simple application, although it is an extremely operator dependent technique.A 67 year old woman was referred to our gynecological consultation because of lower abdominal pain and a suspected right ovarian cancer.By transvaginal ultrasound and Colour Doppler imaging a solid mass in the retrouterine area was found, dimension of 78x44x40mm, adherent to the posterior face of the uterus and to the right ovarium. Part of the mass, 4 cm diameter, was seen to be intensely vascularised; the remaining part wasn't and it was suspected to be a fecaloma. It was evaluated through the IOTA international scale. The ultrasound examination showed a positive sliding sign. The vascularised mass was indeed suspected to be originating from the lower part of the bowel, the inner layer of the sigma. The mass had been surgically resected, as well as the anterior part of the rectum and the uterus with the adnexals on both sides. The diagnosis was of lower bowel Adenocarcinoma, poorly differentiated, G3, and ulcerate.Transvaginal ultrasound and Colour Doppler allow detailed study of the pelvic organs and both play a central role in differential diagnosis of pelvic undifferentiated masses. Moreover, it provides proper and accurate tools for surgical pre operation evaluation.Supporting information can be found in the online version of this abstract Hormone-producing malignancies are rare in children or adolescent patients: Only 0.1% of all ovarian tumours and 45% of granulosa cell tumours occur in the sexually non-active ages. Granulosa cell tumours (GCTs) are sex cord-stromal tumours of the ovary, representing 78% of all ovarian neoplasms. A total of 95% of all GCTs are adult-type, and only 5% are diagnosed as juvenile-type GCT. A majority of children with juvenile-type GCT present with isosexual precocious pseudopuberty due to excessive estrogen production, although virilising, testosterone-producing, juvenile-type GCTs are rare, occurring only in 2% of cases. We ...

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