Yoshifumi Takahashi

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.

Incidence and risk factors for venous thromboembolism in gynecological cancer: the GOTIC-VTE trial

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.

Increase in creatinine levels associated with niraparib maintenance therapy in ovarian cancer

AbstractAimIn Japan, Niraparib maintenance therapy for primary and recurrent ovarian cancer was approved in September 2020 and is expected to improve the prognosis of ovarian cancer. However, the safety of niraparib maintenance therapy in Japanese patients has not been fully evaluated.MethodsPatients with ovarian cancer (including fallopian tube and peritoneal cancer) treated with niraparib at Jichi Medical University Hospital from September 2020 to August 2022 were enrolled in this study. Patient background, starting dose, rates of interruption, reduction, or discontinuation, adverse events (AEs) during treatment, and estimated glomerular filtration rate (eGFR) trends were retrospectively analyzed.ResultsTwenty‐nine patients received niraparib maintenance therapy during the study period, including 21 with primary cancer and 8 patients with recurrent cancer. Seventeen patients (58.6%) required dose interruptions and 16 patients (55.2%) required dose reductions. Only two patients (6.9%) discontinued treatment due to fatigue and nausea. The most frequent AE was creatinine increases in 18 patients (62.1%, all grades). Although eGFR levels decreased significantly after niraparib therapy compared to before niraparib therapy (59.3 vs. 50.3 mL/min/1.73 m2, p < 0.001), the levels returned to pre‐niraparib initiation levels after discontinuation of niraparib (64.6 vs. 64.6 mL/min/1.73 m2, p = 0.96). Multivariate regression analysis showed that diabetes was independently associated with decreased eGFR (p = 0.013).ConclusionsNiraparib maintenance therapy frequently increased serum creatinine, but the change was reversible. Further studies are needed to determine the effects of niraparib on renal function in Japanese patients.

Severe Lymphorrhea Mimicking Hypovolemic Shock Following Retroperitoneal Lymphadenectomy for Endometrial Cancer: A Case Report

ABSTRACT We present a rare case of severe lymphatic leakage resembling hypovolemic shock following retroperitoneal lymphadenectomy for endometrial cancer. A 62‐year‐old female developed massive lymphorrhea and chylous ascites following total abdominal hysterectomy, bilateral salpingo‐oophorectomy, and pelvic and para‐aortic lymphadenectomy. Immediately postoperatively, massive lymphatic leakage caused hypotension and oliguria necessitating vasopressor support. Conservative management, including fasting and octreotide, was unsuccessful. Lymphangiography with Lipiodol and subsequent embolization using N‐butyl cyanoacrylate were performed but did not achieve hemodynamic stabilization. Re‐laparotomy was undertaken, and indocyanine green injection into the bilateral inguinal lymph nodes, along with oral milk ingestion, enabled precise intraoperative identification of leakage sites. These were successfully ligated with adjunctive fibrin glue and oxidized cellulose. Hemodynamics rapidly improved following repair. Although most lymphatic leakages resolve conservatively, severe cases can cause life‐threatening circulatory failure. This case highlights the importance of a multidisciplinary approach, including interventional radiology and surgical repair, to achieve successful outcomes.

Ovarian vein thrombosis after hysterectomy with bilateral salpingectomy: With versus without oophorectomy