Selim Afsar

Primary High‐Grade Ovarian Sertoli–Leydig Cell Tumor With Bilateral Adnexal Involvement in a Patient Diagnosed With Peutz–Jeghers Syndrome

Aim Peutz–Jeghers syndrome is a rare genetic disease with an increased risk of gastrointestinal and extragastrointestinal malignancies. Ovarian involvement of Sertoli–Leydig cell tumors is uncommon and even more rare in Peutz–Jeghers syndrome patients. This case report outlines the importance of primary ovarian Sertoli–Leydig cell tumor with bilateral adnexal involvement in a patient diagnosed with Peutz–Jeghers syndrome. Case A 31‐year‐old female patient diagnosed with Peutz–Jeghers syndrome presented to our clinic with pelvic pain. Ultrasound examination revealed solid masses in both adnexa. Laparoscopic fertility‐preserving surgery was performed. Pathology confirmed the diagnosis of poorly differentiated solid ovarian Sertoli–Leydig cell tumor. Staging surgery was performed, and finally, the patient was referred to oncology for chemotherapy. Conclusion This case report outlines the importance of Sertoli–Leydig cell tumors in the differential diagnosis of adnexal masses in patients with Peutz–Jeghers syndrome. Bilateral adnexal involvement is an unusual presentation of Sertoli–Leydig cell tumors. Despite unusual and different presentations, Sertoli–Leydig cell tumors should not be ignored or overlooked in patients with Peutz–Jeghers syndrome.

Hysteroscopy-Guided Endometrial Sampling Diagnostic Performance in Endometrial Intraepithelial Neoplasia Patients

To compare the diagnostic performance of hysteroscopy-guided versus blind sampling in detecting concurrent endometrial carcinoma in patients with endometrial intraepithelial neoplasia (EIN) and to identify factors associated with missing cancer diagnosis. This is a retrospective cohort study. Integrated academic and community healthcare system in Minnesota and Wisconsin, USA, January 1, 2018, and January 1, 2023. This included 151 patients diagnosed with EIN during endometrial sampling who underwent a hysterectomy within 3 months. Patients with concurrent cancer diagnoses were excluded. Patients diagnosed with EIN using hysteroscopy-directed biopsy were compared to those diagnosed with blind-sampling methods using the pathology results of the subsequent hysterectomy specimen as the gold standard comparator to analyze rates of missed endometrial cancer (EC) diagnosis. The primary outcome was a reduced risk of unanticipated concurrent EC on the final hysterectomy pathology result for patients diagnosed with endometrial intraepithelial hyperplasia via a hysteroscopy-directed biopsy (odds ratios [OR] = 0.44, 95% confidence intervals [CI] = 0.20-0.95, p = .033). In multivariate analysis, body mass index ≥30 and patient age >60 were associated with an elevated risk of EC on final pathology (OR = 4.17, 95% CI = 1.51-11.51, p = .004; OR = 5.56, 95% CI = 1.22-35.21, p < .001), respectively, and diabetes mellitus was the only independent variable associated with a higher risk of EIN on final hysterectomy pathology (OR = 7.01, 95% CI = 1.40-35.04, p = .018). Age, body mass index, and endometrial thickness on pre-biopsy ultrasound were not associated with an increased risk of overlooking concurrent endometrial carcinoma on final hysterectomy pathology on univariate and multivariate analyses. Hysteroscopy-directed biopsy may reduce the risk of missing a concurrent endometrial malignancy during endometrial sampling in women with EIN. The results affirm the superior diagnostic accuracy of hysteroscopy-directed endometrial evaluation.