Giant Mucinous Ovarian Neoplasm in a Young Woman: Case Report and Review of the Literature

Case Report | DOI: https://doi.org/10.31579/2690-4861/1180

Giant Mucinous Ovarian Neoplasm in a Young Woman: Case Report and Review of the Literature

  • M. Pietschmann 1*
  • B. Schmalfeldt 1
  • D. Dum 2
  • K. Baradaran-Salimi 3
  • S. Reuter 1,4

1Clinic for Gynecology, University Medical Center Hamburg, Eppendorf, Germany. 

2Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

3Clinic of Radiology, University Medical Center Hamburg, Eppendorf, Germany.

4Institute for Experimental Surgery, University Medical Center Rostock, Rostock, Germany.

*Corresponding Author: Maximilian Pietschmann, MD Resident Physician, Clinic for Gynecology, University Medical Center Hamburg, Eppendorf, Germany.

Citation: M. Pietschmann, B. Schmalfeldt, D. Dum, K. Baradaran-Salimi, S. Reuter, (2026), Giant Mucinous Ovarian Neoplasm in a Young Woman: Case Report and Review of the Literature, International Journal of Clinical Case Reports and Reviews, 37(5); DOI:10.31579/2690-4861/1180

Copyright: © 2026, Maximilian Pietschmann. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 23 September 2026 | Accepted: 19 October 2026 | Published: 23 October 2026

Keywords: case report; mucinous ovarian neoplasm; fertility preservation; borderline tumor; adenocarcinoma

Abstract

Introduction:

Mucinous ovarian neoplasms are rare and can reach extraordinary dimensions before they are detected. Their management, especially in young women, requires a delicate balance between oncologic safety and the preservation of fertility.

Case Presentation:

We present the case of a 23-year-old woman with a massive abdominal tumor measuring up to 40 cm. Imaging revealed a predominantly cystic adnexal mass with solid components and secondary compression of adjacent structures, resulting in grade III hydronephrosis. Surgical exploration via a midline laparotomy confirmed a large right ovarian tumor, which was completely resected through right unilateral adnexectomy with fertility-preserving surgery. Final Histopathology showed parts of a moderately differentiated adenocarcinoma with an expansile growth pattern arising from a mucinous borderline tumor within a mucinous cystadenoma (pT1a, G2) with p53 mutation, while all staging biopsies were negative. Following multidisciplinary tumor board discussion, adjuvant carboplatin-based chemotherapy with ovarian protection was initiated as an individualized treatment decision considering the invasive histology, tumor grade, and the presence of a pathogenic TP53 mutation. Clinical follow-up two years after diagnosis showed no evidence of disease recurrence.

Conclusion:

This case highlights the importance of individualized treatment strategies, particularly given the rarity of mucinous ovarian neoplasms in young women, that incorporate histopathologic and molecular findings into therapeutic decision-making.

Introduction

Mucinous ovarian tumors represent a heterogeneous group of epithelial ovarian neoplasms ranging from benign cystadenomas to borderline tumors and invasive carcinomas (Cheasley et al., 2019; P. Morice, Gouy, & Leary, 2019). Primary mucinous ovarian carcinomas are rare, accounting for 3–5% of all epithelial ovarian cancers, and are typically diagnosed at an early stage due to their large size and mass-related symptoms (Babaier & Ghatage, 2020; Perren, 2016). 

The pathogenesis of mucinous ovarian carcinoma is thought to follow a stepwise progression from benign cystadenoma to mucinous borderline tumor and finally to invasive carcinoma (Cheasley et al., 2019). While KRAS mutations represent the most frequently reported molecular alteration in mucinous ovarian tumors, alterations involving TP53 are observed predominantly in invasive carcinomas and may reflect tumor progression. However, the prognostic and predictive significance of TP53 alterations in early-stage mucinous ovarian carcinoma remains incompletely understood (Perren, 2016). 

Management of early-stage mucinous ovarian carcinoma in young patients requires careful balancing of oncologic safety and fertility preservation. Fertility-sparing surgery may be considered in selected stage I patients with unilateral disease and appropriate surgical staging (Park et al., 2008; Satoh et al., 2010). However, the rarity of these tumors and the limited evidence regarding prognostic factors, particularly molecular markers such as TP53, make individualized treatment decisions challenging (Babaier & Ghatage, 2020).

We report the case of a 23-year-old woman with a giant mucinous ovarian neoplasm containing adenocarcinoma with expansile growth pattern and a pathogenic TP53 mutation. Despite the remarkable tumor size, fertility-preserving management was successfully achieved. This case highlights the importance of meticulous histopathological evaluation and individualized multidisciplinary treatment planning in young women with rare ovarian malignancies.

Case Presentation

A 23-year-old woman presented to the emergency department with a large abdominal mass extending across the entire abdomen, accompanied by progressively worsening lower abdominal pain, bloating, and marked abdominal distension. A computed tomography (CT) scan of the abdomen previously performed in the United States had revealed a cystic mass with solid components measuring approximately 30 × 40 cm, most likely of ovarian origin. Upon presentation to our emergency department, the patient was in stable condition. Menstrual cycles were regular without abnormal bleeding. Her most recent gynecologic examination six months earlier had been unremarkable. Her medical history was negative for prior surgeries, comorbidities, or relevant familial diseases. Because the CT images from abroad were unavailable, magnetic resonance imaging (MRI) was performed. MRI demonstrated a well-circumscribed abdominal mass measuring 28 × 37 × 13 cm, predominantly polycystic with minor solid components, most consistent with adnexal origin. Secondary findings included grade III right-sided hydronephrosis, displacement of bowel loops and the pancreas, and long-segment compression of the inferior vena cava (Figure 1a and 1b). 

                                                                                Figure 1a                                                                  Figure 1b

Figure 1a: Coronal post contrast MRI [T1-weighted Dixon sequence with fat-suppression]: A large, well circumscribed, predominantly polycystic intra-abdominal tumor [28x37x13cm] with solid components is visible (arrow), causing marked displacement of adjacent abdominal organs toward the periphery.

Figure 1b: Axial MRI [T2-weighted turbo spin-echo sequence]: The tumor demonstrates high T2 signal intensity in its cystic components, consistent with fluid content. The axial view highlights the mass effect on surrounding organs, causing displacement of bowel loops, right-sided grade III hydronephrosis (arrow) and narrowed inferior vena cava.

The discrepancy between the reported CT and MRI dimensions likely reflects differences in imaging modality and measurement technique. Serum tumor markers (CEA: <0,5 μg/L, CA 19-9: 14,9 kU/L, CA 15-3: 14,8 kU/L, CA 125: 22,4 kU/L, β-hCG: <2,0 U/L, AFP: <1,08 kU/L) were all within normal limits. Surgical intervention was indicated due to the subacute abdomen. During a median laparotomy, a macroscopically mobile adnexal tumor extending up to the diaphragm was visualized, accompanied by a markedly dilated right ureter. No additional intra-abdominal abnormalities were identified, the appendix was not suspicious. Due to the solid intracystic components of the tumor, a right-sided adnexectomy was performed. The resected specimen weighed 8,220 g (Figure 2a and 2b). 

                                                                     Figure 2a                                                                          Figure 2b
 

Figure 2a: Intraoperative finding after midline laparotomy with a smooth and mobile adnexal tumor filling the entire abdominal cavity.

Figure 2b: Right adnexa and cystic tumor after removal weighing 8,220 g.

Intraoperative frozen-section analysis revealed a mucinous neoplasm but was insufficient to establish a diagnosis of a mucinous borderline ovarian tumor. Due to the architectural complexity and cytological atypia, multiple biopsies were taken from the pelvis, the paracolic gutters, and the diaphragm, and an infracolic omentectomy was performed. The postoperative course was uneventful, with complete resolution of the hydronephrosis. The final pathological findings demonstrated a mucinous adenocarcinoma confined to the right ovary, with negative peritoneal biopsies and no evidence of extraovarian disease. The tumor was confined to the right ovary, with no evidence of surface involvement or extraovarian disease. All extraovarian staging specimens, including biopsies from the pelvis, paracolic gutters, diaphragm, and the omentum, were negative for malignancy. Based on these findings, the tumor was classified as pT1a, corresponding to FIGO stage IA. Extensive histological sampling was subsequently performed: In approximately four tissue blocks, atypical back-to-back glandular formations were identified, showing increased architectural complexity and cytological atypia. These findings fulfilled the diagnostic criteria of a moderately differentiated (G2) mucinous ovarian tumor with an expansile growth pattern. In addition, significant areas of mucinous borderline tumor and extensive components of a mucinous cystadenoma were identified, accounting for the underestimation of the lesion at frozen section analysis (Figure 3). Immunohistochemistry in the adenocarcinoma demonstrated an intestinal phenotype, with focal expression of CK20 and CDX2, while PAX8 and the hormone receptors ER and PR were negative (Talia, Parra-Herran, & McCluggage, 2022). p53 immunohistochemistry showed complete absence of nuclear staining, consistent with a knockout expression pattern. Given the very weak internal positive control, additional molecular analysis of TP53 was performed, which confirmed the presence of a pathogenic TP53 mutation (Yemelyanova et al., 2011). Based on these findings, the final diagnosis was a G2 mucinous adenocarcinoma with a TP53 mutation, arising in a mucinous borderline tumor on the background of a mucinous cystadenoma. Following discussion in the multidisciplinary tumor board, a staging CT of the thorax was recommended which demonstrated no evidence of metastatic disease. Considering the patient’s young age, the mucinous subtype, the early tumor stage, and the negative peritoneal biopsies, a fertility-preserving surgical approach was deemed adequate and aligned with the patient’s preference. Adjuvant chemotherapy with carboplatin (AUC5) was initiated as an individualized treatment decision based on the invasive histology, tumor grading, and additional molecular findings, including a pathogenic TP53 mutation. Given the rarity of early-stage mucinous ovarian carcinoma and the limited evidence regarding the clinical significance of molecular alterations in this setting, the treatment strategy was determined by integrating histopathological findings, molecular characteristics, and patient-specific factors (D. Nasioudis et al., 2019; Zhang et al., 2025). Chemotherapy was combined with ovarian protection using goserelin and add-back therapy with norethisterone acetate/estradiol patches, which she tolerated without complications. The genetic counseling revealed no evidence of hereditary mutations. At two years after diagnosis, the patient remained clinically disease-free, with an unremarkable medical history and clinical and gynecological examination. No tumor markers or radiologic imaging were performed because the patient remained asymptomatic.

Figure 3: Tumor histology. [A] Multilocular mucinous cystadenoma composed of benign cysts (arrow) lined by bland mucinous epithelium. [B] Areas of mucinous adenocarcinoma at low magnification [×10], showing expansile growth with complex, back-to-back arranged glandular structures (arrow). [C] High-power view of the adenocarcinoma [×40] demonstrating marked architectural complexity and pronounced cytological atypia, including enlarged pleomorphic nuclei, prominent nucleoli, and increased mitotic activity (arrow).

Discussion

Mucinous ovarian tumors comprise a spectrum ranging from benign cystadenomas to borderline tumors and invasive carcinomas, and are frequently associated with molecular alterations such as KRAS mutations or, less commonly, BRAF, HER2, and TP53 mutations (Babaier & Ghatage, 2020; Höhn et al., 2021; Perren, 2016). 

They are often multicystic and may reach extraordinary dimensions before diagnosis. Despite their size, most remain confined to the ovary, which contributes to a favorable prognosis when treated at an early stage. Computed tomography is an essential tool in diagnostic evaluation, as it facilitates identification of the primary tumor and assessment of disease extent. Magnetic resonance imaging may provide additional value in differentiating primary mucinous ovarian carcinoma from metastatic mucinous carcinoma. On MRI, these tumors typically present as multilocular cystic lesions with a solid component demonstrating intermediate T2 signal intensity, hyperintensity on diffusion-weighted imaging, and a type 3 enhancement pattern (Laurent, Thomassin-Piana, & Jalaguier-Coudray, 2015; Thomassin‐Naggara et al., 2008). This case is notable because histopathology revealed a moderately differentiated adenocarcinoma with an expansile growth pattern arising from a mucinous borderline tumor within a mucinous cystadenoma. Such progression illustrates the stepwise evolution from benign to borderline to invasive mucinous tumors (Cheasley et al., 2019). The diagnosis of invasive carcinoma requires stromal invasion >5 mm or >10 mm² (Ledermann et al., 2014). Although the more common expansile growth pattern is associated with a better prognosis than the less frequent infiltrative pattern, the presence of a p53 mutation in our patient suggests an increased malignant potential (Lee & Scully, 2000; Leskela et al., 2020; Ryland et al., 2015). There is no universally established grading system for mucinous ovarian carcinoma; in routine clinical practice, grading is often applied analogously to endometrioid ovarian carcinoma, based on architectural patterns and cytologic atypia. However, prognostic relevance appears to be more strongly determined by the pattern of invasion (Leitlinienprogramm Onkologie, 2026) Mucinous ovarian carcinomas are typically characterized by positive cytokeratin-7 expression and absence of WT1, Napsin A, and PR expression. Loss of PR (and ER) expression is particularly useful in distinguishing these tumors from endometrioid carcinomas with extensive mucinous differentiation (Babaier & Ghatage, 2020; Bassiouny et al., 2018). Aberrant p53 expression has been reported in up to 27–57 % of cases (Leskela et al., 2020; Mackenzie et al., 2015; Ryland et al., 2015). Furthermore, histological distinction from metastatic tumors to the ovary is essential (Perren, 2016). The management of mucinous ovarian carcinoma in young women requires individualized strategies. Fertility-sparing surgery with comprehensive staging is considered appropriate in early-stage disease, provided that the contralateral ovary and uterus are uninvolved (Ditto et al., 2015; Park et al., 2008; Satoh et al., 2010). In our patient, staging biopsies were negative, supporting a unilateral adnexectomy. Patients should be counseled regarding a potentially higher risk of adverse prognosis and the need for frequent clinical follow-up (Ditto et al., 2015). Conversely, preservation of fertility and hormonal function is a key component of quality of life in premenopausal women with ovarian carcinoma (Zapardiel, Diestro, & Aletti, 2014). Given the intraoperative findings and the absence of macroscopic extraovarian disease, fertility-preserving unilateral adnexectomy was performed. The final histopathological diagnosis was established only after extensive sampling of the resected specimen. Based on the final histopathology, completion surgery—including omentectomy, appendectomy, and systematic lymphadenectomy—may be considered (Cass et al., 2001; Zapardiel et al., 2014). A retrospective study reported lymph node metastases in 14 of 96 women (15 %) with stage I ovarian carcinoma at the time of surgery; however, all affected patients had grade 3 tumors (Cass et al., 2001). Other studies reported lymph node metastasis rates of only 0–2 % in stage I mucinous ovarian carcinoma (Matsuo et al., 2018; Minig et al., 2017; Dimitrios Nasioudis, Chapman-Davis, Witkin, & Holcomb, 2017). Given the extremely low risk of lymphatic spread in the expansile subtype, we did not recommend secondary lymphadenectomy in this case (Muyldermans et al., 2013). The need for appendectomy and its prognostic relevance in early-stage mucinous ovarian carcinoma remain matters of ongoing debate. A recent meta-analysis of 914 cases of mucinous ovarian neoplasms (borderline and invasive, predominantly early stage) reported histologic appendiceal involvement in 4.9 % of cases. Based on these findings, the authors recommended intraoperative assessment of the appendix; however, appendectomy may be omitted when the appendix appears macroscopically normal and shows no evidence of tumor infiltration (Cheng et al., 2017). A biopsy of a contralateral ovary with a regular macroscopic appearance is unnecessary because the risk of contralateral metastasis is low (Philippe Morice et al., 2001).  In a multicenter retrospective analysis, pregnancy was achieved in 71% of patients. Among those with a history of prior chemotherapy, no increased incidence of congenital anomalies or higher miscarriage rates was observed (Schilder et al., 2002). Completion surgery [oophorectomy and hysterectomy] after childbearing may be discussed, as recurrences can occur in the contralateral adnexa (60–71 % of recurrences) (Philippe Morice et al., 2001; Schilder et al., 2002). However, the recurrence risk in early-stage mucinous ovarian carcinoma is low (0–9 %) (Kajiyama et al., 2011; Schilder et al., 2002; Young et al., 1990). Because grade 3 tumors tend to have higher recurrence rates, fertility-sparing surgery is not recommended in that setting (Park et al., 2008). There is no clear evidence that adjuvant chemotherapy provides a survival benefit in early-stage mucinous ovarian carcinoma. In the present case, adjuvant platinum-based chemotherapy was nevertheless recommended following multidisciplinary tumor board discussion, taking into account the invasive histology, intermediate tumor differentiation, and the presence of a pathogenic TP53 mutation. This decision should therefore be regarded as an individualized, risk-adapted treatment approach rather than evidence-based standard therapy for all patients with stage IA mucinous ovarian carcinoma (Trimbos et al., 2003; Young et al., 1990). A large retrospective study (n = 4811) found no survival benefit from adjuvant chemotherapy in early-stage mucinous carcinoma, even after stratification by substage or tumor grade (D. Nasioudis et al., 2019). Chemotherapy has also not been shown to significantly reduce recurrence rates (Ledermann et al., 2014). However, p53 mutation status was not considered a risk factor in these studies. It is well established that mucinous tumors exhibit greater chemoresistance than serous subtypes (Alexandre et al., 2010). A review of the literature shows that prognosis after fertility-sparing surgery for stage I ovarian carcinoma is excellent, with 5-year and 10-year survival rates of 97–100 % and 93 %, respectively (Satoh et al., 2010; Schilder et al., 2002). Even without adjuvant chemotherapy, 5-year survival in stage IA ovarian carcinoma has been estimated at 94 % (Ahmed et al., 1996). Here, further research is needed regarding the prognostic implications of p53 mutations in relation to recurrence-free survival and treatment outcomes.

Conclusion

This report describes the rare occurrence of a giant mucinous ovarian neoplasm in a 23-year-old woman. Despite the extraordinary size of the tumor, the disease was confined to the ovary, enabling fertility-preserving management. The case emphasizes the importance of integrating histopathological and molecular findings into individualized treatment strategies, balancing oncologic safety with fertility preservation. 

Statement of Ethics

Ethical approval is not required for this study in accordance with local and national guidelines, as this manuscript describes a single case report.

Written informed consent was obtained from the patient for publication of the details of her medical case and any accompanying images.

Conflict of interests

The authors have no conflicts of interest to declare.

Funding sources

This study was not supported by any sponsor or funder.

Author Contributions

M.P. contributed to data collection, literature review and manuscript drafting. B.S. supervised the clinical management and critically revised the manuscript. D.D. performed pathological evaluation and contributed to interpretation of histopathological findings. K.B-S. contributed radiological assessment and image interpretation. S.R. supervised the project and critically revised the manuscript. All authors approved the final manuscript.

Data Availability Statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

References

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Dariusz Ziora

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.

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Dr Jelle Lettinga

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.

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Dr Walter F Riesen

Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.

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Dr Rakhi Mishra

Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.

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Hala Al Shaikh

Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD

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Dr Eric S Nussbaum

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

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Pedro Marques Gomes

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

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Anthony Kodzo-Grey Venyo

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

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Katarzyna Byczkowska

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

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Orlando Villarreal

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

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Sing-yung Wu

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

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Layla Shojaie

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

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Mina Sherif Soliman Georgy

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

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Ziemlé Clément Méda

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

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Delcio G Silva Junior

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

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Virginia E. Koenig