Yuji Takei

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.

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.

Adjuvant Chemotherapy for Endometrial Cancer (ACE) trial: A randomized phase II study for advanced endometrial carcinoma

AbstractThis study evaluated the feasibility and efficacy of three postoperative adjuvant chemotherapy regimens for endometrial cancer. Endometrioid cancer patients with intermediate‐risk stage I and II or high‐risk stage III and IV disease were randomly assigned to receive six cycles of either paclitaxel‐epirubicin‐carboplatin (TEC), paclitaxel‐anthracycline (doxorubicin)‐carboplatin (TAC), or dose‐dense paclitaxel‐carboplatin (ddTC). The primary end‐point was the completion rate (CRate) of six cycles of treatment. The secondary end‐points were progression‐free survival (PFS) and overall survival (OS). One hundred and one patients were treated as follows: 33 received TEC, 33 TAC, and 35 ddTC. The CRates for TEC, TAC, and ddTC were 94%, 64%, and 69%, respectively (P = .005). The TEC CRate was significantly higher than for the other two groups. However, the PFS and OS outcomes were not statistically different between the three groups. The 2‐year survival rates were 94%, 97%, and 97% for TEC, TAC, and ddTC, respectively. When compared to the current standard treatments for endometrial cancer, TEC is a promising candidate for a phase III trial based on its significantly superior CRate and equivalent PFS and OS. This study is registered with UMIN Clinical Trials Registry (UMIN000008911).

A patient with a mucinous borderline ovarian tumor after fertility‐sparing surgery in whom puncture fluid cytology on oocyte retrieval led to a diagnosis of recurrence

AbstractThe patient was an unmarried nulliparous 21‐year‐old female who was referred to our hospital with an abdominal mass. Bilateral ovarian tumors with a solid component were detected and both were suspected to be ovarian cancer. Since the patient strongly wished to preserve fertility, we performed left salpingo‐oophorectomy, right cystectomy, and omentectomy. A postoperative histopathological examination revealed that the bilateral ovarian tumors were mucinous borderline tumors. The patient selected oocyte cryopreservation. Oocyte retrieval from the right ovary was performed 2 years after surgery, and six oocytes were obtained. The puncture of a small cyst revealed mucinous fluid, not normal follicular fluid; therefore, puncture fluid cytology was performed. A recurrent mucinous borderline ovarian tumor was suspected. Right salpingo‐oophorectomy was performed and a recurrent mucinous borderline ovarian tumor was diagnosed. Puncture fluid properties need to be considered when there is an opportunity for oocyte retrieval after fertility‐sparing surgery.

Prognostic impact of lymphadenectomy in patients with advanced ovarian clear cell carcinoma: an ancillary analysis of the JGOG3017-A4 study

Abstract Background Systematic pelvic and aortic lymphadenectomy in stage IIB–IVB patients with epithelial ovarian cancer, undergoing complete abdominal macroscopic resection with normal lymph nodes, was revealed to have no prognostic significance for survival in the LION trial. However, the proportion of patients with ovarian clear cell carcinoma (OCCC) in the LION trial was only 2.2%, so the significance of systematic retroperitoneal lymphadenectomy in patients with OCCC remains unclear. Methods We conducted an ancillary analysis of 619 patients enrolled in a randomized phase III trial (JGOG 3017) in patients with OCCC. Of these, 89 were stage IIB to IVB, underwent a complete macroscopic resection, and had no grossly enlarged lymph nodes intraoperatively. Patients were divided into two groups: group A with lymphadenectomy and group B without lymphadenectomy. The Kaplan–Meier method was used to calculate progression-free survival (PFS) and overall survival (OS) and the log-rank test and Cox proportional hazard model were used to compare the two groups. Results Among the 89 patients, 77 (86.5%) underwent a lymphadenectomy (group A), while 12 (13.5%) did not (group B). Three-year PFS were 62.3% in group A and 58.3% in group B ( p  = 0.7705). Three-year OS were 73.0% in group A and 65.6% in group B ( p  = 0.6346). No significant differences were observed between two groups. Conclusion This study did not demonstrate a definitive survival benefit from systematic lymphadenectomy in advanced OCCC patients with complete resection and clinically negative nodes. Given the small sample size, these results should be interpreted with caution and regarded as exploratory.