Akitoshi Yamamura

Live Birth Outcomes After Extended or Repeated High‐Dose Medroxyprogesterone Acetate Therapy for Fertility‐Sparing Management of Endometrial Neoplasia: A Single‐Center Retrospective Case Series

ABSTRACT Aim To clarify live birth outcomes among women receiving extended or repeated high‐dose medroxyprogesterone acetate (MPA) therapy for fertility‐sparing management of atypical endometrial hyperplasia or endometrioid carcinoma grade 1. Methods We conducted a single‐center retrospective case series of 53 patients undergoing MPA therapy between 2005 and 2023. Patients were stratified into three groups: (i) complete response (CR) within 6 months (standard group), (ii) CR after extended treatment beyond 6 months (extended group), and (iii) CR after MPA retreatment for first intrauterine recurrence (retreatment group). Primary outcome was the live birth rate (LBR). Secondary outcomes included the effect of initial reproductive intentions, interval from CR to conception, recurrence rates, and recurrence‐free interval (RFI). Results LBRs were 33% (10/30) in the standard group, 8% (1/12) in the extended group, and 17% (2/12) in the retreatment group. Among eight patients undergoing MPA retreatment for a second or subsequent recurrence, none achieved live birth. Patients with an initial desire for prompt conception had significantly higher LBRs than those without (38% vs. 5%, p < 0.01). Median time from CR to conception leading to live birth was 12 months. Patients achieving live birth had significantly longer RFIs than those without ( p < 0.01). Conclusions Live birth is most likely when CR is achieved within 6 months of MPA therapy; nonetheless, extended or repeated MPA treatment may still result in live birth. These findings suggest the importance of appropriate patient selection and careful monitoring during extended or repeated therapy and attempting conception promptly in fertility‐sparing management of endometrial neoplasia.

A Rare Case of Ovarian Serous Borderline Tumor Recurrence with Muscle Metastasis

BACKGROUND Ovarian serous borderline tumors (SBTs) generally have a favorable prognosis, with a very low recurrence rate. However, in rare cases, they can recur as invasive low-grade serous carcinoma (LGSC) after a prolonged follow-up period. Here, we report a case of LGSC originating from SBT that recurred 23 years after the initial surgery, with metastasis to the quadratus lumborum muscle - an exceptionally rare site of metastasis. CASE REPORT A 50-year-old woman, initially diagnosed with stage IIIC SBT and treated with complete tumor resection 23 years prior, presented with an asymptomatic recurrence detected by an elevated serum cancer antigen 125 (CA125) level. Contrast-enhanced computed tomography (CT) revealed multiple nodules suspected of peritoneal dissemination and a tumor infiltrating the quadratus lumborum muscle, suggesting recurrent SBT. A CT-guided needle biopsy confirmed that the tumor within the quadratus lumborum was a recurrence of SBT. Complete cytoreductive surgery was performed with the assistance of an orthopedic surgeon. Histopathological examination revealed progression to LGSC with cytoplasmic expression of the BRAF proto-oncogene (BRAF) V600E, indicating the presence of the BRAF V600E mutation, which is a characteristic feature of both SBT and LGSC. A retrospective review of CT images taken 10 years prior to the recurrence diagnosis showed a peritoneal tumor with calcification attached to the ileocecum, suggesting that the patient had remained asymptomatic for more than a decade after the actual onset of recurrence. CONCLUSIONS This case illustrates a rare instance of recurrent SBT with metastasis to the quadratus lumborum muscle. Given the exceptionally slow progression of recurrent SBT, long-term follow-up with CT imaging and serum CA125 monitoring is crucial for timely intervention and appropriate management upon recurrence.