Sholanki Halder

Synchronous Presentation of Gastric‐Type Adenocarcinoma In Situ of Cervix and Vagina in a Young Adult Female: A Precursor Seldom Seen

ABSTRACT Synchronous human papillomavirus‐independent gastric‐type adenocarcinoma in situ affecting both cervical and vaginal epithelium constitutes an ultrarare preinvasive disease. The diagnostic complexity arises from asymptomatic presentation and skip lesions that obscure the true extent of the disease. We report the case of a 26‐year‐old woman diagnosed with atypical glandular cells during routine cervical cancer screening. Sequential conizations consistently demonstrated gastric‐type adenocarcinoma in situ with persistently positive surgical margins. Post‐conization colposcopic assessment and histopathology revealed extensive multifocal disease involving residual cervix and vaginum. Considering the substantial disease burden and potential for occult invasion, surgical intervention was undertaken, including type B1 radical hysterectomy, bilateral salpingectomy, bilateral ovarian tissue cryopreservation, total vaginectomy, and vaginal reconstruction. At 20 months of follow‐up, the patient remains completely disease‐free with no evidence of recurrence.

Survival impact and prognostic factors of secondary cytoreduction in platinum-sensitive recurrent ovarian cancer: a systematic review and trial-level meta-analysis

Secondary cytoreductive surgery is considered for selected patients with recurrent ovarian cancer. Although evidence supports its impact on progression-free survival, its effect on overall survival remains controversial. This study aims to identify patient sub-groups that benefit most from secondary cytoreductive surgery. A systematic review and trial-level meta-analysis of randomized controlled trials published through March 2025 was conducted. The primary end points were pooled hazard ratio (HR) for overall survival and progression-free survival comparing secondary cytoreductive surgery plus chemotherapy versus chemotherapy alone. Sub-group analyses were performed based on histology, platinum-free interval, number of recurrent lesions, individualized model or Arbeitsgemeinschaft Gynäkologische Onkologie score, and residual disease status. Three randomized controlled trials involving 1249 patients were included in this meta-analysis. Patients with favorable validated selection scores (positive Arbeitsgemeinschaft Gynäkologische Onkologie or individualized model ≤4.7) showed significantly improved overall survival (HR 0.79, 95% confidence interval [CI] 0.66 to 0.96). Complete resection was associated with significantly better overall survival (HR 0.53, 95% CI 0.43 to 0.64) and progression-free survival (HR 0.51, 95% CI 0.42 to 0.61) than patients who had residual disease. A progression-free survival benefit was also observed in the non-high-grade serous histology (HR 0.52, 95% CI 0.38 to 0.72). In patients with a platinum-free interval of 6 to 12 months (SOC-1, 6-16 months), there was a significant trend toward improved overall survival (HR 0.70, 95% CI 0.55 to 0.91). Secondary cytoreductive surgery significantly improves progression-free survival and provides an overall survival benefit in carefully selected patients, particularly, those with a high likelihood of complete resection, favorable surgical selection scores, and a shorter platinum-free interval (<16 months). These findings highlight the critical role of patient selection and surgical completeness in optimizing outcomes for recurrent ovarian cancer.

Paraneoplastic hypercalcaemia induced by ovarian clear-cell carcinoma in a young nullipara: implications for early detection and management

Paraneoplastic hypercalcaemia, an uncommon manifestation in ovarian malignancies, exhibits the commonest association with clear cell carcinoma among epithelial ovarian neoplasms. Patients presenting with severe hypercalcaemia of malignancy are considered oncological emergencies, necessitating prompt and aggressive intervention. We present a case of ovarian clear-cell carcinoma (OCCC) that manifests with severe hypercalcaemia as one of its primary clinical features, posing significant challenges to precise diagnosis and preoperative optimisation. The necessity for aggressive fluid resuscitation, calciuresis and meticulous electrolyte monitoring led to an arduous course in perioperative management. Normalisation of the serum calcium levels was promptly noted following primary cytoreductive surgery. This case underscores the importance of including OCCC in the differential diagnosis of unexplained hypercalcaemia, particularly in women presenting with symptoms suggestive of ovarian malignancy. This also emphasises the critical need for early recognition of these paraneoplastic manifestations, facilitating timely diagnosis and treatment initiation, potentially improving prognostic outcomes.