Fei Liu

Evolution of an ovarian endometriotic cyst into clear cell carcinoma with squamous differentiation across two pregnancies: A case report

Rationale: Ovarian clear cell carcinoma (OCCC) during pregnancy is exceedingly rare, particularly when accompanied by squamous differentiation, with only a limited number of cases reported in the English literature to date. Patient concerns: A 33-year-old female, during the first pregnancy, identified endometriotic cysts. However, during the second pregnancy, the patient was subsequently diagnosed with OCCC. Diagnoses: In this case, histological examination reveals a tumor demonstrating tubular cystic, papillary, and solid growth patterns. Glandular areas with extensive squamous differentiation are observed, along with papillary regions containing hyalinized fibrovascular cores. Tumor cells exhibit cuboidal morphology with clear cytoplasm and hobnail appearance, showing significant atypia. The periphery demonstrates endometrial endometriosis progressing to atypical endometriosis and subsequent malignant transformation. Immunohistochemical analysis shows positive expression of P504S and NapsinA in tumor cells, thereby excluding ovarian endometrioid carcinoma. The findings are consistent with a definitive diagnosis of OCCC. Interventions: Following the detection of the ovarian mass, left adnexectomy was performed. After definitive diagnosis of OCCC, pregnancy termination was pursued, followed by total hysterectomy, right adnexectomy, and pelvic lymph node dissection. Outcomes: Postoperative follow-up at 6 months revealed no evidence of recurrence. Lessons: This case highlights an ovarian cyst that measured 8 cm during the second pregnancy but was only 2 cm in diameter during the first pregnancy, ultimately diagnosed as clear cell carcinoma. Although ovarian malignancies during pregnancy are rare, benign-appearing cysts should not be overlooked. Increased vigilance is warranted to ensure timely diagnosis and appropriate management of such rare but clinically significant presentations.

Cadonilimab Combined with Chemotherapy with or without Bevacizumab as First-Line Treatment in Recurrent or Metastatic Cervical Cancer (COMPASSION-13): A Phase 2 Study

Abstract Purpose: Immune checkpoint inhibitors (ICI) have been a potential treatment option for patients with cervical cancer in several clinical studies. We investigated the safety and efficacy of cadonilimab, a bispecific antibody targeting PD-1 and CTLA-4, plus standard therapy for the first-line treatment of R/M CC (recurrent and/or metastatic cervical cancer). Patients and Methods: Eligible patients were assigned to 3 cohorts: cohort A-15 (cadonilimab 15 mg/kg every 3 weeks (Q3W) plus chemotherapy), cohort A-10 (cadonilimb 10 mg/kg Q3W plus chemotherapy), and cohort B-10 (cadonilimab 10 mg/kg Q3W plus chemotherapy and bevacizumab). They received the corresponding treatments until disease progression, unacceptable toxicity, withdrawal of consent, or investigator decision. The primary objective was safety; the secondary endpoints included objective overall response (ORR), duration of response, disease control rate, progression-free survival, and overall survival. This study is registered with ClinicalTrials.gov (NCT04868708). Results: As of February 13, 2023, treatment-related adverse events (TRAE) occurred in 45 (100.0%) patients. Grade ≥3 TRAEs were reported in 33 (73.3%) patients. Immune-related adverse events (irAE) occurred in 29 (64.4%) patients and grade ≥3 irAEs were observed in 9 (20.0%) patients. Seven (15.6%) of 45 patients permanently discontinued cadonilimab treatment due to TRAEs. One death due to hemorrhagic shock occurred in cohort B-10. Among 44 patients who underwent at least one post-baseline tumor assessment, the ORR was 66.7% in cohort A-15, 68.8% in cohort A-10, 92.3% in cohort B-10, and 79.3% in cohorts A-10 and B-10 combined. Conclusions: Cadonilimab combined with standard therapy was acceptable, with encouraging antitumor activity in patients with R/M CC.