Yusuke Matoba

Hysteroscopic Photodynamic Diagnosis Using 5-Aminolevulinic Acid: A High-Sensitivity Diagnostic Method for Uterine Endometrial Malignant Diseases

To examine the diagnostic accuracy of hysteroscopic photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5ALA) in patients with endometrial cancer and premalignant atypical endometrial hyperplasia. A single-center, open-label, exploratory intervention study. University Hospital in Japan. Thirty-four patients who underwent hysteroscopic resection in the Department of Obstetrics and Gynecology at Keio University Hospital. Patients were given 5ALA orally approximately 3 hours before surgery and underwent observation of the uterine cavity and endometrial biopsy using 5ALA-PDD during hysteroscopic resection. Specimens were diagnosed histopathologically and the diagnostic sensitivity and specificity of hysteroscopic 5ALA-PDD for malignancy in the uterine cavity was determined. Red (R), blue (B), and green (G) intensity values were determined from PDD images, and the relationships of histopathological diagnosis with these values were used to develop a model for objective diagnosis of uterine malignancy. Three patients were excluded from the study because of failure of the endoscope system. A total of 113 specimens were collected endoscopically. The sensitivity and specificity of 5ALA-PDD for diagnosis of malignancy in the uterine cavity were 93.8% and 51.9%, respectively. The R/B ratio in imaging analysis was highest in malignant lesions, followed by benign lesions and normal uterine tissue, with significant differences among these groups (p <.05). The R/B and G/B ratios were used in a formula for prediction of malignancy based on logistic regression and the area under the receiver operating characteristic curve for this formula was 0.838. At a formula cutoff value of 0.220, the sensitivity and specificity for diagnosis of malignant disease were 90.6% and 65.4%, respectively. To our knowledge, this is the first study of the diagnostic accuracy of 5ALA-PDD for malignancies in the uterine cavity. Hysteroscopic 5ALA-PDD had higher sensitivity and identifiability of lesions. These findings suggest that hysteroscopic 5ALA-PDD may be useful for diagnosis of minute lesions.

Reirradiation for Recurrent Cervical Cancer Within the Previous Radiation Field Using a Bioabsorbable Spacer: A Case Report

ABSTRACT Reirradiation for cervical cancer recurrence in previously irradiated fields is challenging due to dose limitations. To our knowledge, this is the first case report describing successful reirradiation using a bioabsorbable spacer for vaginal cuff recurrence after initial concurrent chemoradiotherapy (CCRT) and hysterectomy. A 70‐year‐old woman with cervical cancer Stage IIIC2r initially received CCRT and chemotherapy. Three years later, uterine recurrence led to hysterectomy. Eighteen months post‐surgery, vaginal cuff recurrence was diagnosed by imaging and tumor biopsy. A bioabsorbable spacer was surgically placed around the vaginal cuff tumor via an open abdominal approach. Reirradiation (55 Gy in 22 fractions) was started 23 days postoperatively. Use of the spacer provided adequate dose reduction to the small bowel, sigmoid colon, and rectum, with the rectal D1cc reduced to 37.9 Gy. Mild paralytic ileus occurred, but resolved conservatively, and there were no severe complications. The patient remains disease‐free at 6 months post‐treatment. In this case, bioabsorbable spacer placement allowed safe reirradiation for cervical cancer vaginal cuff recurrence. This technique may represent a promising approach for selected patients with in‐field recurrent cervical cancer, although further accumulation of cases and longer follow‐up are required.

Targeting Galectin 3 illuminates its contributions to the pathology of uterine serous carcinoma

Abstract Background Uterine serous cancer (USC) comprises around 10% of all uterine cancers. However, USC accounts for approximately 40% of uterine cancer deaths, which is attributed to tumor aggressiveness and limited effective treatment. Galectin 3 (Gal3) has been implicated in promoting aggressive features in some malignancies. However, Gal3’s role in promoting USC pathology is lacking. Methods We explored the relationship between LGALS3 levels and prognosis in USC patients using TCGA database, and examined the association between Gal3 levels in primary USC tumors and clinical-pathological features. CRISPR/Cas9-mediated Gal3-knockout (KO) and GB1107, inhibitor of Gal3, were employed to evaluate Gal3’s impact on cell function. Results TCGA analysis revealed a worse prognosis for USC patients with high LGALS3. Patients with no-to-low Gal3 expression in primary tumors exhibited reduced clinical-pathological tumor progression. Gal3-KO and GB1107 reduced cell proliferation, stemness, adhesion, migration, and or invasion properties of USC lines. Furthermore, Gal3-positive conditioned media (CM) stimulated vascular tubal formation and branching and transition of fibroblast to cancer-associated fibroblast compared to Gal3-negative CM. Xenograft models emphasized the significance of Gal3 loss with fewer and smaller tumors compared to controls. Moreover, GB1107 impeded the growth of USC patient-derived organoids. Conclusion These findings suggest inhibiting Gal3 may benefit USC patients.