Ipek Betul Ozcivit Erkan

Unusual synchronous and metachronous association of hematologic neoplasms with gynecologic neoplasms: A case series and literature review

AbstractThe aim of the present study was to evaluate the occurrence of synchronous or metachronous hematologic and gynecologic malignancies. The medical database of the pathology department at a tertiary center was searched from 2016 to 2024 for cases involving both hematologic and gynecologic tumors. A literature search using Google Scholar and PubMed was also conducted between May and June 2024. Articles reporting surgical pathology data were included, while radiologic studies and those lacking pathology data were excluded. Cases involving one gynecologic cancer and one hematologic malignancy were analyzed. Three cases from our center and 25 cases from 15 English‐language articles were identified. The mean age of the cases at diagnosis was 61.4 ± 9.4 years. A total of 19 patients (68%) were diagnosed with synchronous cancers, while the rest had metachronous diagnoses. Endometrial cancer was seen in 20 cases (71.4%): 14 synchronous and five metachronous endometrioid adenocarcinomas, and one unspecified metachronous endometrial cancer. This was followed by five cases of ovarian cancer (17.9%): three synchronous serous ovarian carcinomas, one metachronous serous ovarian carcinoma, and one synchronous ovarian adenocarcinoma. Additionally, there were two cases of cervical cancer (7.1%): one synchronous adenosquamous carcinoma and one metachronous invasive squamous carcinoma, and one case of carcinosarcoma (3.6%). Involvement of more than one site is possible for hematolymphoid cancer, commonly affecting the pelvic or para‐aortic lymph nodes in 16 patients (57.1%), with other sites including the cervix (4 cases, 14.3%), ovary (4 cases, 14.3%), uterus (2 cases, 7.1%), iliac/inguinal lymph nodes (2 cases, 7.1%), fallopian tube (1 case, 3.6%), vagina (1 case, 3.6%), liver (1 case, 3.6%), abdomen (1 case, 3.6%), and appendix (1 case, 3.6%). Two cases were unspecified. Non‐Hodgkin lymphoma (NHL), primarily of B cell lineage, was the most common hematologic malignancy (25 cases, 89.3%, with 22 cases being B cell lineage). In contrast, Hodgkin lymphoma was observed in two cases (7.1%), and acute leukemia in one case (3.6%). Among 21 patients with available follow‐up data, eight died during the follow‐up period. The co‐occurrence of NHL, Hodgkin lymphoma, and acute leukemia with gynecologic cancers is rare. However, during surgery for gynecologic cancers, the potential of synchronous lymphoma should be considered, particularly in cases with unusual retroperitoneal lymphadenopathy.

An alternative for hysteroscopic myomectomy: Ultrasound‐guided single‐step myomectomy for submucous myoma uteri with ring forceps, a retrospective study

AbstractObjectiveHysteroscopic myomectomy is widely regarded as safe and feasible, although achieving single‐session results for larger myomas often requires alternative methods. This study introduces a novel approach: ultrasound‐guided myoma extirpation using ring forceps combined with hysteroscopy.MethodsThis retrospective, single‐center study includes patients who underwent ultrasound‐guided myoma extirpation between 2016 and 2024. Data were collected retrospectively, and myomas were classified according to the International Federation of Gynecology and Obstetrics leiomyoma subclassification system. Under ultrasound guidance, the myoma was extirpated using ring forceps. The pre‐, peri‐, and postoperative outcomes were recorded and analyzed.ResultsA total of 25 patients were included, with a mean age of 44.76 ± 8.09 years. Most patients (92%) were premenopausal, and the primary symptoms were irregular bleeding (76%) and menorrhagia (68%). The median myoma size was 3 cm (interquartile range [IQR]: 2–4 cm). The median operation time was 30 min (IQR: 20–42 min). There was no statistically significant correlation between the duration of the operation and the diameter of the myoma uteri. Most myomas were located in the fundus, left side, or anterior wall (20% each), with 60% classified as type 0. Postoperative assessments revealed no residual myomas in 84% of cases. Uterine perforation and cervical laceration occurred as complications in two cases, while four cases required an additional session. Two patients with infertility achieved full‐term pregnancies post‐surgery.ConclusionThis new, minimally invasive technique might be a feasible option for large myomas, particularly in low‐resource settings. It minimizes the need for multiple sessions, providing reassuring results for patients with suitable indications.