Shigenori Furukawa

Serum levels of rapid turnover proteins are decreased and related to systemic inflammation in patients with ovarian cancer

Poor nutritional status is common in ovarian cancer. It is well known that the nutritional status of a patient with malignant disease is associated with survival, and that it can be assessed by serum levels of rapid turnover proteins (RTPs), such as retinol binding protein, prealbumin and transferrin. Systemic inflammation, usually observed in the form of elevated C-reactive protein (CRP) or neutrophil/lymphocyte ratio (NLR), occurs by various mechanisms involving numerous pro-inflammatory cytokines. These include interleukin (IL)-17 and other soluble protein mediators, such as soluble IL-2 receptor (sIL-2R) and vascular endothelial growth factor (VEGF). In this study, circulating levels of RTP were decreased in advanced stages of ovarian cancer, and significant inverse correlations were found between RTP levels and serum levels of CRP or NLR. CRP levels were also correlated with serum levels of VEGF and sIL-2R. Moreover, NLR, VEGF and sIL-2R levels, and IL-17 production, were all inversely correlated with RTP levels. These findings indicate that chronic inflammation may be associated with compromised immune function, such as an impaired T-cell response, via various inflammatory proteins, including sIL-2R, VEGF and IL-17. The key mechanisms leading to cancer cachexia, in which nutritional impairment is a major clinical issue, appear to be primarily immune reactions caused by chronic inflammation. Anti-inflammatory treatments may be effective in clinically improving various symptoms associated with these mechanisms.

Two cases of paraovarian tumor of borderline malignancy

Paraovarian tumor of borderline malignancy is rare. Only 13 cases in Japan, including the present cases, and 40 cases overseas have been reported. We report two cases of paraovarian tumor of borderline malignancy. Case 1: A 38‐year‐old woman was found to have a right ovarian cyst. Transvaginal ultrasonography showed a unilocular cystic tumor and a solid part of 8 mm in diameter within the tumor. Malignancy could not be ruled out, therefore the laparotomy was performed. The tumor was paraovarian tumor. Intraoperative rapid histological diagnosis was made and the patient was diagnosed with a serous borderline tumor. There has been no recurrence 1 year after surgery. Case 2: A 30‐year‐old woman was found to have a right hydrosalpinx, or an ovarian cyst, with a solid part inside. Transvaginal ultrasonography showed the solid part within the tumor was 14 × 9 mm. Laparoscopic surgery was performed and we diagnosed the tumor as paraovarian cyst. Histological diagnosis was mucinous borderline tumor. There has been no recurrence 11 months after surgery.

Sclerosing stromal tumor of the ovary treated with 2-incision total laparoscopic cystectomy.

Highlights • Sclerosing stromal tumor (SST) is an extremely rare benign tumor of the ovary and preoperative diagnosis of SST is difficult as it often mimics a malignant tumor.• SST occurs in young women.• Many cases of SST were treated by abdominal oophorectomy and laparoscopic surgery is seldom performed in SST cases.• We report a case of SST of the ovary in an 18-year-old girl who was diagnosed by preoperative imaging and underwent laparoscopic cystectomy.