Miku Takadera

Preoperative Diagnosis of Small Bowel Metastasis of Ovarian Clear Cell Carcinoma Using Capsule and Double‐Balloon Endoscopy: A Case Report

ABSTRACT We present a rare case of small bowel metastasis of ovarian clear cell carcinoma, successfully diagnosed preoperatively using capsule and double‐balloon endoscopy. The patient was a 62‐year‐old woman who underwent primary surgery for stage IIB ovarian clear cell carcinoma followed by six cycles of adjuvant chemotherapy. Six years later, she developed iron‐deficiency anemia with melena, but conventional upper and lower endoscopy failed to identify the source of bleeding. Subsequent capsule endoscopy revealed a tumor in the distal ileum, and a biopsy was taken using double‐balloon endoscopy. Pathological and immunohistochemical findings supported a diagnosis of recurrent ovarian clear cell carcinoma. Surgical resection was performed, followed by chemotherapy, and the patient remains recurrence‐free. This is the first case of small bowel metastasis of ovarian clear cell carcinoma diagnosed preoperatively with endoscopic biopsy. It highlights the criticality of advanced endoscopic modalities for evaluating unexplained anemia in patients with a history of ovarian cancer.

Endometrial cancer with para‐aortic lymph node metastasis following medroxyprogesterone acetate therapy: A case report

AbstractMedroxyprogesterone acetate (MPA) is a promising fertility‐sparing treatment for early stage endometrial cancer; however, it has a high recurrence rate and is inferior to surgery. Although the site of recurrence is mostly the endometrium, we here report a case of metastatic recurrence to the para‐aortic lymph node with endometrial recurrence despite a careful follow‐up. A 31‐year‐old woman was diagnosed with grade 1 endometrioid carcinoma, stage IA without myometrial invasion. She requested fertility‐sparing treatment and underwent a 48‐week MPA therapy with complete remission. Follow‐up continued with ultrasonography and endometrial biopsy every 3 and 6 months, respectively; however, at 10 months following MPA therapy, cancer recurrence was detected in the endometrium and para‐aortic lymph node, requiring hysterectomy, bilateral adnexectomy, and lymph node dissection, followed by paclitaxel/carboplatin chemotherapy. This case report highlights that lymph node recurrence can develop despite careful follow‐up following complete remission with MPA therapy for stage IA endometrial cancer.