Yanpeng Tian

Endometrial mesonephric-like adenocarcinoma: Clinicopathologic features, treatment, and outcomes

Endometrial mesonephric-like adenocarcinoma (MLA) is a rare subtype of uterine corpus endometrial carcinoma (UCEC) first described in 2016. The clinicopathological features, treatment options, and prognosis of endometrial MLA remain poorly understood. In this study, we retrospectively analyzed the clinicopathological characteristics, molecular features, treatment regimens, and outcomes of 11 patients diagnosed with endometrial MLA. The most prevalent symptom observed was postmenopausal bleeding. Notably, 78% (7 out of 9) of patients were diagnosed at advanced FIGO stages (II-IV), with four cases presenting with distant metastasis upon initial examination. Multivisceral metastases were identified in three cases, with lung metastases being the most common, occurring in 45% of patients. The median progression-free survival (PFS) was 16 months (95% confidence intervals: 6-26). All tumors tested negative for progesterone receptors (PR), while 91% of patients (10 out of 11) were negative for estrogen receptors (ER). Most patients exhibited positive immunohistochemical staining for "mesonephric-like" markers, including GATA-binding protein 3 (GATA-3), thyroid transcription factor-1 (TTF-1), and CD10. Furthermore, 91% of patients showed a wild-type p53 immunostaining pattern. Among the 11 patients, five underwent KRAS mutation testing, revealing KRAS mutations in all tested individuals (p.G12D in 2/5, p.G12A in 1/5, p.G12V in 1/5, and p.G13D in 1/5). These findings indicate that 78% of endometrial MLA patients were diagnosed at an advanced stage and suggest that this subtype may exhibit more aggressive behavior compared to endometrial endometrioid carcinoma. The consistent presence of KRAS mutations in patients who underwent testing highlights the potential role of KRAS in the initiation and progression of endometrial MLA, positioning it as a promising therapeutic target.

Molecular classification and fertility-sparing outcomes in endometrial cancer and atypical endometrial hyperplasia

Molecular classification has emerged as a critical tool for guiding personalized treatment in endometrial cancer (EC) and atypical endometrial hyperplasia (AEH). This retrospective study aimed to assess the impact of molecular classification on fertility-sparing treatment outcomes in patients diagnosed with EC and AEH who underwent fertility preservation therapy between 2006 and 2021. Patients were categorized into four molecular subtypes using immunohistochemistry (IHC) and Sanger sequencing, based on the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE): POLE-ultramutated, mismatch repair (MMR) deficient (MMRd), p53 abnormal (p53abn), and p53 wild-type (p53wt). All patients were evaluated for oncological prognosis and fertility outcomes, with a total of 103 patients included in the analysis. Recurrence rates exhibited significant differences among the molecular classifications, with the lowest recurrence rate observed in the p53wt subtype (19.7%), followed by MMRd (30.4%), POLE-ultramutated (66.7%), and p53abn (71.4%) subtypes. Multivariate Cox regression analysis indicated that the p53abn subtype was a significant risk factor for recurrence following conservation therapy when compared to the p53wt subtype. Additionally, there was a notable disparity in standard surgical treatment due to treatment failure, with operation rates of 7.5%, 19.2%, 66.7%, and 57.1% for the p53wt, MMRd, POLE-ultramutated, and p53abn subtypes, respectively. Regarding fertility outcomes, the p53wt group demonstrated the highest pregnancy rate after achieving a complete response compared to the other subtypes; however, no significant differences were observed in overall pregnancy outcomes. The ProMisE molecular classification holds significant prognostic value for patients with EC and AEH undergoing fertility-sparing treatment. Among the molecular subtypes, p53wt appears to be the most favorable for fertility-preserving interventions. This study provides essential insights into reproductive outcomes for this patient population.

Anti-NMDA Receptor Encephalitis: Retrospective Analysis of 15 Cases, Literature Review, and Implications for Gynecologists

Background. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare form of autoimmune encephalitis caused by anti-NMDA receptor antibodies. This disease mainly affects women of childbearing age and is commonly associated with ovarian teratoma. However, the relationship between anti-NMDA receptor encephalitis and ovarian teratoma and the role of anti-NMDA receptor antibody in the relationship remain unclear. Objectives. This study aimed to describe 15 cases of anti-NMDA receptor encephalitis (5 with ovarian teratoma), review literature, and reinforce the gynecologist's knowledge of this disorder. Methods. Clinical data of 15 patients from January 2015 to December 2020 admitted to The Second Hospital of Hebei Medical University were collected and analyzed. The diagnosis of anti-NMDA receptor encephalitis was based on the presence of anti-NMDA receptor antibodies in cerebrospinal fluid (CSF) and/or serum. Laparoscopic teratoma removal was performed in patients with ovarian teratoma. All patients had received immunotherapy. In addition, a review of the literature was performed to reinforce the gynecologist's knowledge of this disorder. Results. A total of 15 patients with anti-NMDA receptor encephalitis were screened, of whom 5 patients were confirmed with ovarian teratoma by pathology. The most common symptoms of anti-NMDAR encephalitis with teratoma are fever (5/5, 100%), seizure (5/5, 100%), mental and behavioral disorders (4/5, 80%), and decreased consciousness (4/5, 80%). Conversely, the most common symptoms of patients without teratoma were neuropsychiatric symptoms, including headache (6/10, 60%) and mental and behavioral disorders (7/10, 70%). All patients underwent immunotherapy, including steroids, intravenous immunoglobulin (IVIG), plasma exchange, and cyclophosphamide, and 4 out of 5 patients with ovarian teratomas underwent surgical treatment. All patients had a good outcome after systemic, surgical, and immunotherapy treatment. No patient who underwent surgical treatment developed a recurrence. Conversely, 2 of 10 patients without teratoma developed an anti-NMDA receptor encephalitis recurrence. Conclusions. Patients with anti-NMDA encephalitis show severe mental and neurological symptoms. Resection of teratoma is beneficial to the relief or disappearance of symptoms and has a good prognosis. This disorder should be fully recognized by gynecologists, who play an important role in diagnosis and treatment.