Friday, October 09, 2026

 

Rare ovarian cancer diagnosed during early pregnancy highlights diagnostic challenges



“Ovarian cancer during pregnancy is uncommon, and high-grade serous carcinoma diagnosed during early gestation is particularly rare”



Impact Journals LLC

High-grade serous carcinoma of the ovary presenting as a complex cystic mass at 10 weeks of gestation: A case report

image: 

Figure 4. High-power view of high-grade serous carcinoma, demonstrating marked nuclear pleomorphism, coarse chromatin, prominent nucleoli, and frequent atypical mitotic figures (Hematoxylin and Eosin stain, 400X magnification).

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Credit: Copyright: © 2026 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.






“Ovarian cancer during pregnancy is uncommon, and high-grade serous carcinoma diagnosed during early gestation is particularly rare.”

BUFFALO, NY — October 8, 2026 — A new case report was published in Volume 13 of Oncoscience on September 24, 2026, titled “High-grade serous carcinoma of the ovary presenting as a complex cystic mass at 10 weeks of gestation: A case report.”

The report describes a rare case of high-grade serous ovarian carcinoma diagnosed in a 35-year-old woman at just 10 weeks of pregnancy. The case highlights the challenges of identifying ovarian malignancy during early gestation, when symptoms can resemble normal pregnancy-related changes, and underscores the importance of early evaluation, appropriate imaging, and multidisciplinary decision-making.

The case report was led by first author Chanderdeep Sharma from the All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India. Corresponding author Shri Ram Rundla is also affiliated with the same institution.

Ovarian cancer during pregnancy is uncommon, with an estimated incidence ranging from one in 12,000 to one in 47,000 pregnancies. High-grade serous carcinoma (HGSC), an aggressive form of epithelial ovarian cancer, is particularly rare during early pregnancy. Diagnosis can be difficult because symptoms such as abdominal bloating, discomfort and nausea may overlap with normal pregnancy-related changes. These challenges can delay recognition of a potentially serious malignancy.

In the reported case, the patient presented with lower abdominal pain and progressive abdominal distension lasting approximately two weeks. She had previously delivered two children and had no reported personal or family history of malignancy. Clinical examination identified a palpable pelvic mass, prompting further investigation.

Ultrasonography confirmed a viable pregnancy and revealed a large, 10 × 13 cm complex solid-cystic mass in the left adnexa, the region surrounding the ovary. The mass contained internal septations and solid components and was accompanied by ascites, an abnormal accumulation of abdominal fluid, and omental nodularity. These findings raised concern for ovarian malignancy.

Laboratory testing also showed an elevated cancer antigen 125 (CA-125) level of 332 U/mL. Although CA-125 may rise naturally during early pregnancy and cannot independently establish an ovarian cancer diagnosis, its elevation alongside suspicious imaging findings supported the need for further evaluation.

Given the concern for advanced malignancy, the clinical team performed contrast-enhanced computed tomography after counselling the patient about potential maternal benefits and fetal risks and obtaining informed consent. The scan confirmed the complex adnexal mass, ascites and peritoneal nodularity, suggesting possible spread beyond the ovary.

The case was reviewed by a multidisciplinary team involving gynecologic oncology, radiology and anesthesia specialists. The clinicians considered the suspected advanced disease, the potential threat to maternal health and the implications of treatment for the ongoing pregnancy. After detailed counselling and discussion of available options, the patient, who had completed her reproductive plans, chose definitive surgical management.

During staging laparotomy, surgeons identified a large solid-cystic tumor arising from the left ovary, along with ascites and multiple nodules involving the omentum and peritoneum. Intraoperative frozen-section analysis suggested epithelial ovarian carcinoma. The surgical team subsequently performed a total abdominal hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy, removing the uterus, both ovaries and fallopian tubes, and part of the omentum.

Final histopathological examination confirmed high-grade serous carcinoma, classified as FIGO stage IIIB. The tumor showed characteristic malignant features, including marked nuclear abnormalities and frequent atypical cell divisions. Immunohistochemical testing demonstrated strong nuclear positivity for WT1, a marker that supported the diagnosis of serous ovarian carcinoma.

Following an uneventful postoperative recovery, the patient received adjuvant chemotherapy with paclitaxel and carboplatin. At the reported one-year follow-up, she remained disease-free and continued regular surveillance.

The case also raises important considerations about treatment timing during pregnancy. Surgical intervention for suspected ovarian malignancy during pregnancy is generally postponed until the second trimester when feasible. However, when imaging suggests advanced malignancy and maternal health may be at risk, intervention during the first trimester may be necessary. The authors emphasize that such decisions require individualized assessment, informed consent and coordination among relevant specialists.

The report also discusses the potential role of hereditary cancer susceptibility. High-grade serous ovarian carcinoma is frequently associated with alterations involving TP53, while inherited BRCA1 and BRCA2 mutations can influence cancer risk and treatment options. Genetic counselling and BRCA testing were recommended for the patient because of her relatively young age at diagnosis. However, testing could not be performed because of logistical constraints, leaving her genetic status unknown.

“Early imaging, appropriate surgical planning, and multidisciplinary decision-making are essential for optimal maternal outcomes.”

As a single-patient case report, the findings cannot establish how frequently high-grade serous ovarian carcinoma occurs during pregnancy or determine which treatment approach produces the best outcomes across different clinical circumstances. Nevertheless, the case provides an example of the diagnostic and treatment decisions involved when a potentially advanced ovarian malignancy is discovered during early gestation.

Overall, the report underscores the importance of thoroughly evaluating suspicious adnexal masses during pregnancy, particularly when complex imaging features, ascites and elevated tumor markers raise concern for malignancy. Early recognition, coordinated specialist care and individualized treatment planning may be essential to protecting maternal health in these uncommon and challenging clinical situations.

DOI: https://doi.org/10.18632/oncoscience.675                 

Correspondence to: Shri Ram Rundla – shriram.rundla@gmail.com, (ORCID 0009-0003-9896-9206)

Abstract video: https://www.youtube.com/watch?v=gVfKMuhZqoM

Keywords: high-grade serous carcinoma, ovarian cancer, pregnancy, complex adnexal mass, WT1

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Human milk offers a window into mammary gland function—and its links to infant growth




NYU Langone Health / NYU Grossman School of Medicine





A study led by researchers at NYU Grossman School of Medicine identified shared molecular patterns in human milk that link maternal nutrition, mammary gland biology, and infant growth.

Researchers analyzed thousands of molecular measurements from human milk collected across three geographically and nutritionally diverse populations of mothers. They identified shared patterns in milk composition associated with both maternal nutritional status and infant growth, and asked whether these patterns could also provide insight into the mammary gland functional state.

Published online October 8 in the journal Science, the study examined this state, which involves three interconnected aspects of mammary gland function: milk synthesis and secretion, epithelial barrier and tissue remodeling, and immune and repair activity. Milk synthesis and secretion describe how mammary cells produce the components of milk and release them into milk; barrier and tissue-remodeling functions regulate what passes between the bloodstream and milk while reshaping the milk-producing tissue; and immune and repair activity helps protect the gland and restore tissue after stress or injury. 

By mapping molecular patterns in milk onto these biological processes, the researchers asked not only what is present in milk, but also what its composition may reveal about the function of the mammary gland that produces it.

“Human milk gives us a rare, non-invasive window into the biology of the lactating mammary gland,” said Liat Shenhav, PhD, senior author of the study and an assistant professor at NYU Grossman School of Medicine, with appointments in the Institute for Systems Genetics, the Department of Microbiology, and the Department of Obstetrics and Gynecology. “By looking at molecular patterns across diverse populations, we can begin to identify shared features of mammary function and understand how maternal nutritional and metabolic state relates to milk composition and infant growth.”

Despite its central role, how the functional state of the gland shapes milk composition—and how that variation relates to infant growth—remains poorly understood. Human milk contains thousands of nutrients, metabolites, proteins, immune factors, and other molecules, but research has often examined these components one at a time rather than as an integrated biological system. 

Across 1,543 human milk samples from three cohorts in Canada, Pakistan and Burkina Faso, the researchers combined multiple molecular layers—including metabolites, proteins, micronutrients (e.g., vitamins), macronutrients (e.g., carbohydrates), and human milk oligosaccharides — with growth data and computational approaches including machine learning, a form of artificial intelligence. 

In two randomized nutritional trials, maternal supplementation promoted recovery or stability among infants at higher risk for poor growth. Multi-omic analyses – which integrate information across several molecule types, such as proteins and metabolites, to provide a complete picture of a biological system - also revealed a shared pattern of milk composition associated with both maternal supplementation and infant growth.

The researchers then examined which molecules most consistently contributed to these shared nutrition-growth patterns. Their analysis identified seven candidate biomarkers linked to maternal nutritional status, infant growth and biological programs related to mammary gland function. Together, these markers captured aspects of mammary biology that extend beyond established measures of blood-milk barrier permeability.

Four of the markers—C2, C3, C4 and C5—were short-chain acylcarnitines, molecules that help cells process nutrients for energy. The remaining three were lysine, an amino acid; 6′ sialyllactose, a human milk oligosaccharide; and selenium, a mineral. Together, the seven biomarkers captured complementary aspects of mammary biology, including milk synthesis, tissue remodeling, and immune response activity.

Short-chain acylcarnitines showed the strongest links across mammary functional domains, with C5 emerging as a particularly prominent signal. Higher C5 levels were associated with reduced milk synthesis signatures and with biological patterns related to tissue remodeling and immune activity.

Because C5 emerged as a central metabolic signal, the researchers examined nutritional factors that might help explain variation in acylcarnitine levels. Acylcarnitine metabolism depends on coenzyme A (CoA), a central molecule in energy and lipid metabolism synthesized from pantothenic acid, or vitamin B5. Drawing on associations across cohorts and established metabolic biology, the researchers propose that low vitamin B5 availability may constrain CoA-dependent metabolism and contribute to altered acylcarnitine profiles, including accumulation of C5.

“Our findings demonstrate the intimate link between maternal nutrition, metabolic health and mammary function, highlighting the importance of an integrative approach to supporting maternal and infant health,” said first author Dr. April Jauhal of the Shenhav lab at NYU Grossman School of Medicine. "One plausible route linking maternal nutrition to mammary metabolism in our data is via the pantothenic-CoA-C5 metabolic pathway, and we are currently investigating the functional role of this pathway in mammary biology and lactation.”

Because human milk can be collected repeatedly, it provides a non-invasive way to study mammary gland biology over time. Viewing milk as a window into mammary gland biology also places lactation within a broader continuum of maternal physiology that begins during pregnancy. During gestation, the mammary gland undergoes extensive hormonal differentiation, tissue and immune remodeling, and metabolic programming, while its major functional phenotype—lactation—becomes apparent only after delivery.

In this sense, the mammary gland can be viewed as a postnatal maternal-infant interface: an organ programmed during pregnancy that subsequently connects maternal biology and nutrition with the developing infant. Like the placenta during pregnancy, it sits at a critical interface between mother and child—but human milk provides a way to study that interface repeatedly and non-invasively after delivery.

Building on this work, the Shenhav Lab is now developing an integrated computational and experimental framework to test potential nutritional bottlenecks that may constrain mammary metabolism and milk production, including the vitamin B5–coenzyme A–C5 pathway. The lab is also studying colostrum and transitional milk to understand how mammary functional states emerge during the transition from pregnancy to mature lactation, and whether early molecular changes in milk reflect the emergence of mammary metabolic, barrier, and secretory function.

The study is one of two complementary papers published in Science arising from the International Milk Composition (IMiC) Consortium, an international research effort conducted in collaboration with Meghan Azad of the University of Manitoba and funded by the Gates Foundation.

IMiC brought together more than 1,000 mother-infant pairs and profiled more than 25,000 molecular features in human milk. While the NYU Grossman School of Medicine-led study asked what milk composition can reveal about mammary gland function and its relationship with infant growth, the companion study asked a complementary question: Which components of human milk can be changed through maternal nutrition?

The companion study found that supplementation during lactation increased several B vitamins in milk, while many other milk components remained comparatively stable. Together, these studies aim to determine how maternal nutritional and metabolic state during pregnancy and postpartum shapes mammary function, how that state is reflected in human milk, and how these processes relate to infant development.

“The studies show that human milk is neither fixed nor simply a reflection of what a mother eats,” said Dr. Shenhav. “Some components respond to maternal nutrition, while others remain stable or appear to reflect broader biological states within the mammary gland. Understanding that distinction is essential if we want to design interventions that meaningfully support maternal and infant health.”

“Ultimately, we want to understand milk in the context of the biology that produces it,” said Dr. Shenhav. “The mammary gland sits at a critical interface between maternal physiology and the developing infant. By understanding how maternal metabolism influences mammary function and milk composition, we can begin to uncover the biological pathways linking maternal nutritional status with infant growth.”

The study was funded by the Gates Foundation (INV-001734, OPP1179727, and OPP1175213), the National Institutes of Health grant DP2AI185753, the Canadian Institutes of Health Research, the Allergy, Genes and Environment Network, Networks of Centres of Excellence (AllerGen NCE), Health Canada, Environment Canada, the Canada Mortgage and Housing Corporation, the Vital Pakistan Trust; the Burroughs Wellcome Fund; the March of Dimes; and the Alfred E. Mann Foundation.

Along with Drs. Shenhav and Jauhal, study authors from the Shenhav Lab at NYU Langone Health included Bianca Cordazzo-Vargas, Daniel Sunko, and Pratima Niroula of the Institute for Systems Genetics and Department of Microbiology.

Additional study authors were Lishi Deng, Laeticia Celine Toe (also affiliated with Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé in Burkina Faso), Carl Lachat and Trenton Dailey-Chwalibóg in the Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University in Belgium; Ameer Muhammed of the Vaccines and Other Initiatives to Advance Lives (VITAL) Pakistan Trust in Karachi; Aneela Pasha, and Muhammad Imran Nisar in the Department of Paediatrics and Child Health at the Aga Khan University Hospital in Karachi; Yasir Shafiq of the Center of Excellence for Trauma and Emergencies and Community Health Sciences, Aga Khan University; Naveed Iqbal and Waqasuddin Khan  of the CITRIC Center for Bioinformatics and Computational Biology, Department of Paediatrics and Child Health, at Aga Khan; Fyezah Jehan of the Department of Paediatrics and Child Health Medical College, Aga Khan; Andrew Mertens and Alan Hubbard of the Division of Epidemiology, School of Public Health, at University of California Berkeley; Kelsey Fehr and Melissa Manus of the Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Joann McDermid, a consultant from Charlottesville, Virginia; Chi-Hung Shu, Megan Beggs, and Nima Aghaeepour of the Department of Anesthesiology, Pain, and Perioperative Medicine at Stanford University School of Medicine; Daniela Hampel and Setareh Shahab-Ferdows of the Institute for Global Nutrition at the University of California Davis; Kim Lagerborg and Mohit Jain of Sapient Bioanalytics in San Diego; Mark DeBoer of the Department of Pediatrics at the University of Virginia School of Medicine; Jennifer Van Eyk of the Smidt Heart Institute, Advanced Clinical Biosystems Research Institute and Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center in Los Angeles; Natalie Rodriguez of the Office of the Vice-Principal Research and Innovation, University of British Columbia in Vancouver, Canada; Theo Moraes and Padmaja Subbarao of the Translational Medicine Program, Research Institute, at The Hospital for Sick Children in Toronto; Lars Bode in the Department of Pediatrics, Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, Human Milk Institute, University of California San Diego, La Jolla; Lindsay Allen of the Department of Nutrition, University of California Davis; Donna Geddes of the School of Molecular Sciences, The University of Western Australia, Perth, Australia; and Michelle Kay McGuire of the Margaret Ritchie School of Family and Consumer Sciences at the University of Idaho.

About NYU Langone Health
NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone No. 1 out of 122 comprehensive academic medical centers across the nation five years in a row, and it continues to have the most No. 1– and top 10–ranked specialties among medical centers in the United States, according to U.S. News & World Report. NYU Langone offers a comprehensive range of medical services with one high standard of care across seven inpatient locations, its Perlmutter Cancer Center, and more than 400 outpatient locations in the New York City area and Florida. The system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise.

 

The human gut microbiome shapes vaccine side effects



Summary author: Walter Beckwith



American Association for the Advancement of Science (AAAS)





A person’s microbiome may help determine whether they develop a fever after receiving a vaccination, according to a new study. The findings suggest that the microbiome and potentially diet could one day be targeted to reduce vaccine-related inflammation without compromising the immune protection vaccines provide. Vaccines are a crucial tool for ensuring public health, but people vary widely in their immune responses and side effects. Fever and flu-like symptoms are among the most common adverse reactions to vaccines, particularly mRNA- and lipid nanoparticle-based vaccines. These reactions can discourage future vaccination and contribute to vaccine hesitancy and mistrust. However, not all those who receive a vaccination develop a fever and those who do tend to get a fever across repeated doses, suggesting the importance of individual risk factors for fever. The reasons for this variation are not well understood.

 

In this study, Kelsey Huus and colleagues speculated that the gut microbiome, which is known to influence immune activity, may play a role in driving these reactions. To test this hypothesis, Huus et al. profiled the fecal microbiomes, body temperature, and blood-based immune markers of 171 healthy adults before and after receiving the mRNA vaccination for SARS-CoV-2. The findings showed that certain gut bacteria, especially Lachnospiraceae, produce flagellin, which can activate inflammatory immune pathways and intensify vaccine-related reactions. Those who had greater pre-vaccination intestinal inflammation or higher levels of flagellin expression in the gut tended to develop vaccine-induced fever. What’s more, the authors found that industrialized diets may promote this inflammatory activity. Vegetarian diets tended to correlate with microbiome features that contributed to less fever, while lower consumption of whole plant foods and diets characterized by greater fat or processed-food intake were associated with the inflammatory, fever-associated microbiome. Dietary manipulation altered both microbiome compositions and their associated vaccine responses. Importantly, Huus et al. show that flagellin, inflammation, and diet do not affect antibody responses to vaccines, suggesting that the microbiome-driven inflammation increased vaccine side effects without necessarily affecting immunity. “Diet, microbial ecology, and the metabolic state are not immutable, and people might one day prepare for vaccination as deliberately as the vaccine itself is formulated,” writes Bali Pulendran in a related Perspective.

Classroom phone bans improve learning and student engagement in India



Summary author: Walter Beckwith




American Association for the Advancement of Science (AAAS)





In this Policy Article, Alp Sungu and colleagues report on a large-scale randomized controlled trial evaluating the impacts of classroom phone restrictions on student outcomes in India. The findings show that restricting phone use can support learning, particularly among lower-performing students. Amidst growing concerns about smartphones’ effects on learning, mental health, and peer relationships, phone bans are being increasingly adopted in schools worldwide. However, large-scale experimental evidence supporting whether these bans improve learning or social outcomes is lacking. To address this gap, Sungu et al. performed a randomized controlled trial involving 16,683 students across 10 higher education institutions in Odisha, India – a state where smartphone ownership and use among youth aged 15 to 29 exceeds 70%. The authors measured academic performance, attitudes toward phone restrictions, well-being, motivation, digital use, and online harassment.

 

The findings show that banning smartphones in class improved academic performance, particularly among lower-performing students and first-year undergraduates. Effects were minimal among higher-performing, postgraduate, and STEM students. Removing phones also reduced disparities in GPA, suggesting that restrictions may help close gaps in learning outcomes. Importantly, attendance rates did not change, indicating that the improvement was likely driven by greater attention and more productive classroom dynamics, rather than students simply attending class more often. Students who experienced classroom phone bans became more supportive of the restrictions and more likely to view them as beneficial, while showing less preference for unrestricted phone use. Classroom observations also found less disruptive behavior and fewer off-topic conversations, along with greater teacher engagement. According to Sungu et al., these findings suggest that students may become more receptive to phone restrictions after experiencing a more focused, phone-free classroom environment.

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