Current Medical Research and Opinion

Primary NK/T cell lymphoma in the uterus: report of an unusual case

Natural killer/T-cell lymphoma (NKTCL) is a highly invasive non-Hodgkin lymphoma (NHL) characterized by extranodal onset, commonly observed in the nose and nasopharynx. NHL in the female reproductive system is rare, mostly secondary, occurring in the ovaries, cervix, uterine body, and endometrium. The prognosis of this disease is extremely poor, with most patients dying within a few months of diagnosis. Owing to its rarity, the prognostic factors are difficult to ascertain. Here, we report a case of extranodal NK/T-cell lymphoma in the uterus related to pregnancy. A 31-year-old woman sought treatment for continuous vaginal discharge after cesarean section, however, anti-inflammatory treatment had no effect. A lump was found on the anterior wall of the uterus on transvaginal ultrasonography, so uterine lesion resection was performed. Owing to pathological misdiagnosis as uterine fibroids, treatment was delayed for 10 months. After readmission with a clear diagnosis, radiotherapy, chemotherapy, and autologous stem cell transplantation were done, and the disease was put into completely remission. Primary uterine NKTCL is rare, and special attention should be given to women infected with Epstein-Barr Virus (EBV) during their pregnancy and post-partum period, especially patients with abnormal uterine bleeding, vaginal discharge, fever, or high LDH.

Environmental toxin exposure in polycystic ovary syndrome women and possible ovarian neoplastic repercussion

Pulmonary metastasis from adult-type granulosa cell tumor of the testis: a rare case report and literature review

Adult-type granulosa cell tumor of the testis is an extremely rare sex cord-stromal tumor. While most AGCTs are considered indolent with low metastatic potential, a small subset may exhibit aggressive behavior. Due to the rarity of this tumor, optimal management strategies and prognostic markers remain unclear. We present a rare case of adult-type granulosa cell tumor of the testis with pulmonary metastases and review the clinical features, treatments, and outcomes of previously reported metastatic cases. A 33-year-old man presented with a four-month history of left testicular enlargement. Partial orchiectomy revealed AGCT with a low proliferative index (Ki-67 ∼ 10%) and a negative FOXL2 mutation. One month later, he developed a local recurrence with elevated Ki-67 (∼60%) and vascular invasion. PET/CT revealed multiple pulmonary metastases. The patient received four cycles of BEP chemotherapy and achieved a partial response. However, early disease progression followed. Second-line treatment with tislelizumab, nab-paclitaxel, carboplatin, and anlotinib led to temporary stabilization. Salvage chemotherapy with doxorubicin, ifosfamide, and dacarbazine failed, and the patient died two months later. A review of 11 additional metastatic AGCT cases showed that patients with resectable metastases had favorable outcomes, while those with distant metastases responded poorly to systemic therapy. Although adult-type granulosa cell tumor of the testis is generally indolent, some cases may behave aggressively. Tumor size, vascular invasion, and proliferative index may correlate with metastatic potential. Patients who undergo complete resection of metastatic lesions tend to achieve better outcomes, whereas responses to systemic therapy are generally poor. Early identification of high-risk features and consideration of retroperitoneal lymph node dissection may improve prognosis in selected patients.

To create an algorithm assessing the risk of ovarian cancer in primary care using generalized additive 2 model (GA 2 M) and traditional methods

We aimed to evaluate models designed to support the exploration and early detection of potential Ovarian Cancer (OC) using either Machine Learning (ML) techniques or traditional methodologies, using primary care data. This evaluation aimed to facilitate appropriate and timely referrals to specialists. The Health Search database, containing healthcare records of 1 million adults, was used to predict OC cases among patients aged 18+ without prior OC diagnosis from 1 January 2002, to June 2021. GA Comparing the predictive performances of the three models, the AUC and AP for GA The GA

Government’s bold initiatives: tackling cervical cancer in India with determination and commitment

Beyond breast cancer: role of selective estrogen receptor modulators in reducing systemic malignancies: evidence from population-based data

Raloxifene and bazedoxifene are selective estrogen receptor modulators (SERMs) used to prevent and treat osteoporosis in postmenopausal women. Raloxifene is also known for its preventive effect against invasive breast cancer; however, its effect on other cancer types is unclear. This study investigated the incidence of various cancers in osteoporosis patients receiving SERM therapy to determine its association with the risk of developing specific cancer types. This retrospective cohort study examined the association between SERM use and the incidence of cervical, endometrial, ovarian, and colorectal cancers in postmenopausal women using data from the Korean National Health Insurance Service. Propensity score matching ensured group comparability by analyzing 95,513 participants. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the cancer risk associated with SERM therapy, differentiating between the effects of raloxifene and bazedoxifene. SERM therapy was associated with a reduced risk of cervical (adjusted HR = 0.47, 95% CI = 0.31-0.71), ovarian (adjusted HR = 0.61, 95% CI = 0.42-0.88), and colorectal cancer (adjusted HR = 0.49, 95% CI = 0.42-0.57). No significant risk reduction was observed for endometrial cancer (adjusted HR = 1.05, 95% CI = 0.70-1.59). A comparison between raloxifene and bazedoxifene revealed no significant differences in their cancer prevention effects. SERM therapy administration is associated with a decreased incidence of cervical, ovarian, and colorectal cancers. Notably, the effects of raloxifene and bazedoxifene were consistent. Further investigations are crucial to elucidate the mechanisms underlying these observations and their clinical implications.

Real-world utilization and outcomes of systemic therapy among patients with advanced or recurrent endometrial cancer in the United States

Evaluate systemic therapy utilization patterns and outcomes by line of therapy among patients with advanced/recurrent endometrial cancer (EC) treated in the United States. This retrospective observational study used the Optum Clinformatics Extended Data Mart Date of Death database (1 January 2004-31 December 2019) and included de-identified data from adult patients with advanced/recurrent EC who were treated with first-line (1L) platinum-based chemotherapy and initiated second-line (2L) anti-neoplastic therapy. The index date was the date of 1L therapy initiation. The number and sequence of treatments received and the proportion of patients who received each type of treatment for each line of therapy were evaluated. To account for new drug approvals, patients first treated in 2018 or 2019 were also assessed separately. Among the 1317 patients who met all eligibility criteria, 520 (39.5%) and 235 (17.8%) patients received 3 or 4+ lines of treatment, respectively, during a median total follow-up time of 25.2 months (range, 2.5-173.3 months) following the index date. Chemotherapy, including platinum- and non-platinum-based regimens, was the most common treatment across all lines of therapy: 2L, 80.0%; 3L, 66.2%; 4L+, 80.4%. Overall, 2.5%, 2.3%, and 8.9% of 2L, 3L, and 4L + patients, respectively, received anti-program death 1 (anti-PD-1) immunotherapies. In patients first treated in 2018 and 2019 ( Among patients with advanced/recurrent EC treated with 1L platinum-based therapy in clinical practice, chemotherapy was the most common treatment choice across all lines of therapy. Immunotherapy use was low overall but increased in patients who started treatment in 2018 or 2019. Overall, median TTNT decreased as lines of therapy increased.

Low-risk multivariate index assay scores, physician referral and surgical choices in women with adnexal masses

To assess the use of Multivariate Index Assay (MIA OVA1) by gynecologists and determine referral practices and surgical decision making for women with adnexal masses and low-risk MIA OVA1 scores. Information on patients who received an OVA1 test was collected retrospectively from 22 gynecologic practices through a chart review. Referral patterns were examined for patients with low-risk OVA1 results prior to first surgical intervention. Chart reviews were from a variety of practice and hospital settings representing major geographic regions within the United States. A total of 282 independent patient charts were reviewed. Low-risk results were found for 146 patients (52%). Surgery was performed on 82 (56%) patients with low-risk scores. The referral rate to specialty care was 21% (17/82) for low-risk OVA1 patients. Three low-malignant potential tumors were identified in the low-risk patients, with no cases of invasive malignancy. Eighty-six percent of the surgeries performed on low-risk OVA1 patients were minimally invasive. In 44% of the low-risk OVA1 patients, no surgical intervention was performed. A high proportion of low-risk OVA1 patients were not referred to a gynecologic oncologist prior to surgery, indicating gynecologists may use MIA OVA1 along with clinical and radiographic findings to appropriately retain patients for their care. This practice is safe and may be cost-saving, with patient satisfaction implications.

Chemotherapy treatments, costs of care, and survival for elderly patients diagnosed with cervical cancer: an observational study