Valeria Pînzaru

Introduction

Psoriasis is a chronic immune-mediated inflammatory condition and is considered a potential risk factor for the development of hematologic malignancies, particularly in the context of immunosuppressive therapy and T-cell dysfunction. B-cell non-Hodgkin lymphomas are neoplasms of the lymphatic system with variable clinical manifestations, most commonly presenting with peripheral lymphadenopathy. Primary localization in the soft tissues of the head, with bone invasion, is rare.

Case presentation

We report a rare case of cephalic aggressive NHL Not Otherwise Specified (NOS) in a 63-year-old patient with a history of psoriasis vulgaris and Clear cell carcinoma (T1N0M0, treated in 2021 at the Oncology Institute in Chișinău), who presented with a painless right temporo-parietal mass. MRI revealed a 48×19×50 mm lesion in the temporal soft tissues with extension into the frontal bone. Surgical biopsy and immunohistochemistry (CD20+, CD79a+, CD45+, BCL6-) confirmed the diagnosis of B-cell NHL NOS. In 2022, the patient received 8 induction cycles of immunochemotherapy followed by maintenance therapy with Rituximab. PET/CT evaluation showed a Deauville score of 3, indicating a partial favorable response. Associated comorbidities (psoriasis, type 2 diabetes mellitus, hypertension) required multidisciplinary monitoring.

Conclusions

This case illustrates an unusual cranial localization of aggressive B-cell lymphoma NOS and highlights the potential link between psoriasis and lymphoproliferative risk, as previously suggested in the medical literature.

Introduction

Ovarian cancer continues to be the most lethal gynecologic malignancy, with high-grade serous ovarian carcinoma representing the most common and aggressive histological subtype. Although estrogen receptor and progesterone receptor have established prognostic and therapeutic relevance in other hormone-dependent cancers, such as breast carcinoma, their role in high-grade serous ovarian carcinoma remains insufficiently characterized and requires further elucidation.

Materials and methods

A retrospective study was conducted on 40 cases of high-grade serous ovarian carcinoma diagnosed between 2022 and 2024 at two medical institutions in Chișinău, Republic of Moldova. Estrogen receptor and progesterone receptor expression was evaluated by immunohistochemistry, employing the Allred scoring system (range: 0–8). Clinical and pathological data were collected, including patient age, menopausal status, tumor grade, FIGO stage, CA-125 serum levels, and tumor laterality. Statistical analysis comprised descriptive statistics, Student’s t-test, Kruskal-Wallis test, Spearman’s rank correlation, Mann-Whitney U test, and Chi-square test. A p-value < 0.05 was considered statistically significant.

Results

Estrogen receptor positivity was detected in 60% of cases (Allred scores 4-8), exhibiting a diffuse nuclear staining pattern, whereas progesterone receptor positivity was observed in 50% of cases (scores 2–6) with focal or mosaic staining. Four immunoprofiles were identified: ER+/PR+ (35%), ER+/PR− (25%), ER−/PR+ (15%), and ER−/PR− (25%). A significant positive correlation was found between ER and PR expression (ρ = 0.472, p = 0.001). Elevated CA-125 levels were significantly associated with advanced FIGO stage (H = 15.52, p = 0.0014), higher tumor grade (H = 4.15, p = 0.041), and PR negativity. Bilateral ovarian involvement showed a strong correlation with advanced disease (ρ = 0.658, p < 0.00001). The ER−/PR+ immunoprofile was predominantly associated with the most advanced FIGO stages. No significant differences in estrogen receptor or progesterone receptor expression were observed between premenopausal and postmenopausal patients.

Conclusions

Hormone receptor expression in high-grade serous ovarian carcinoma exhibits significant associations with key clinicopathological parameters, including CA-125 levels, tumor grade, FIGO stage, and tumor laterality. Notably, loss of progesterone receptor expression correlates with more aggressive tumor behavior. Hormonal receptor profiling using the Allred scoring system may provide valuable insights for prognostic stratification and aid in therapeutic decision-making in serous ovarian carcinoma. Further investigations involving larger patient cohorts and comprehensive molecular characterization are warranted to validate and expand upon these findings.