Ginekologia Polska

Molecular classification of endometrial carcinoma, is it the new era of precision medicine?

For many years endometrial cancer has been subdivided into oestrogen - dependent (type I) and oestrogen - independent (type II), according to classical Bokhman classification. Histopathological evaluation including type and grade of tumour, along with clinical factors have been considered as very important prognostic factors that impact treatment decision. However, histologically similar tumours may have different outcomes. Recent molecular findings and new histopathological parameters have given new concept on risk stratification. The Cancer Genome Atlas Research Network (TCGA) of tumours have brought new insights into endometrial cancer management. Four molecular subgroups have been described: POLE ultramutated (POLE mut), p53 mutant (p53abn), mismatch repair deficient (MMRd) and non-specific molecular profile (NSMP). This new subdivision has been recently introduced in the European risk stratification system.

Ovarian serous cystadenoma mimicking polycystic ovarian morphology in prepubertal girl: a case report and literature review

Precocious puberty (PP) in girls is defined as the appearance of clinical signs of puberty before the age of eight. While central precocious puberty (CPP) is commonly idiopathic, peripheral precocious puberty (PPP) can be linked to estrogen-producing ovarian cysts or tumors. This study presents a rare case of ovarian serous cystadenoma mimicking polycystic ovarian morphology (PCOM) in a prepubertal girl, contributing to persistent hormonal disturbances and symptoms of PP. The objective is to highlight the diagnostic challenges and management strategies for such cases. A retrospective case review was performed, detailing the clinical course, diagnostic imaging, laboratory findings, treatment decisions, and histopathological results. A literature review was conducted using the EMBASE and MEDLINE databases to compare this case with previously reported instances of ovarian cystadenoma associated with precocious puberty. A 15-year-old girl presented with persistent ovarian cysts and PP symptoms first noted at the age of 5. Initial imaging revealed enlarged ovaries with a polycystic appearance. Despite treatment with a GnRH analog, hormonal abnormalities persisted, with increasing estrogen and androgen levels. MRI demonstrated progressive ovarian enlargement with cystic transformation. Surgical intervention was performed at age 15, and histopathological examination confirmed serous cystadenoma. Following surgery, hormonal levels normalized, and clinical symptoms resolved. This case illustrates an unusual presentation of ovarian serous cystadenoma mimicking PCOM and contributing to persistent precocious puberty. Given the diagnostic challenge, a multidisciplinary approach involving endocrinologists and gynecologists is essential. Early recognition, close monitoring, and appropriate surgical intervention are crucial to managing such rare cases effectively.

NMR-based serum metabolomics in patients with low-differentiated serous ovarian cancer

In this pilot study the proton Nuclear Magnetic Resonance (¹H NMR)-based metabolomics was applied to explore the serum metabolomes of the patients with high-grade serous ovarian carcinoma (HGSOC) and the patients with benign gynaecological disease and to identify the characteristic biomarkers. We analyzed serum samples from 17 HGSOC patients and 14 control patients with benign gynecological conditions. Serum metabolites were profiled using 1H NMR spectroscopy, and multivariate data analyses, including Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA), were performed to identify discriminating metabolites. The multivariate analysis revealed the lower levels of the lipid compounds, choline, branched-chain amino acids, 3-hydroxybutyrate (3HB), acetoacetate, and the higher level of lactate in the sera of the HGSOC patients compared to the control group. NMR-based metabolomic analysis can serve as a supporting method for the detection of ovarian cancer and may be useful as an adjunct to molecular diagnostics.

Extremely late recurrence of adult granulosa cell tumor in the retroperitoneal space 27 years after surgery manifesting as a liver tumor

Prehabilitation in gynecological oncology – are we ready to implement the program in polish oncological centers?

Significance of apparent diffusion coefficient in the diagnosis of endometrial carcinoma and its pathohistological features

MR differentiation between endometrial cancer, hyperplasia, and the normal endometrium using ADC values and their correlation with the pathohistological characteristics of endometrial cancer. The retrospective study included 131 patients, 55 with endometrial cancer, 21 with hyperplasia, and 55 patients with normal endometrium. Mean ADC values were obtained by measuring the region of interest (ROI) in the corresponding part of the endometrium. The mean ADC values of endometrial cancer (0.646 ± 0.112 × 10⁻³ mm²/s) were significantly lower than those of endometrial hyperplasia (1.660 ± 0.394 × 10⁻³ mm²/s) and normal endometrium (1.503 ± 0.312 × 10⁻³ mm²/s) (p0.05), depending on the depth of myometrial invasion (p=0.506; p>0.05), the presence of metastases in lymph nodes (p=0.202; p>0.05), and lymphovascular invasion (p=0.366; p>0.05). Regarding the FIGO stage, the only significant difference in ADC values was obtained for stage 4b (p=0.023; p<0.05). ADC values below 1.120 × 10⁻³ mm²/s with 100% sensitivity and 94.5% specificity indicate the presence of cancer, with a positive predictive value of 94.8% and a negative predictive value of 100%. The ADC is a useful diagnostic tool in the differentiation between endometrial cancer and hyperplasia with high sensitivity and specificity, but its use in differentiating pathohistological characteristics of endometrial cancer is not possible.

The impact of mismatch repair (MMR), p53, and LCAM-1 immunohistochemical expression on prognosis in low-risk endometrial cancer

To investigate the relationship between mismatch repair (MMR) deficiency, TP53, and L1 cell adhesion molecule (L1CAM) immunohistochemical staining and their impact on progression-free survival (PFS) and overall survival (OS) in low-risk endometrial cancer. A total of 253 low-risk endometrial cancer patients were retrospectively screened. Immunohistochemical stains were applied to tumor tissue samples to assess MMR deficiency, TP53, and L1CAM expression, and survival analysis were performed. The expected PFS time was 78.6 months for the MMR-proficient group and 70.3 months for the MMR-deficient group (p = 0.011). OS was 71.6 months for the MMR-proficient group and 68.2 months for the MMR-deficient group (p = 0.755). L1CAM overexpression was associated with a poorer PFS, 62.7 months compared to 77.7 months (p = 0.039). However, there was no statistically significant difference in OS, 58.5 months versus 72.1 months, respectively (p = 0.242). p53 abnormal (p53-abn) staining was associated with a worse prognosis in terms of PFS, 62.8 months versus 77.7 months (p = 0.035), and OS, 43.4 months versus 73 months, respectively (p < 0.001), compared to patients with wild-type staining. No significant statistical relationship was observed in survival times concerning tumor diameter, grade, and lymphadenectomy status. In a multivariate analysis, MMR deficiency emerged as an independent poor prognostic factor for PFS, while p53-abn was identified as an independent poor prognostic factor for OS. p53-abn staining was associated with a poor prognosis for both PFS and OS in low-risk endometrial cancer patients. Meanwhile, MMR deficiency and L1CAM positivity were found to be associated solely with a poorer prognosis for PFS.

FIGO 2023 — too soon or just in time? Evolution or a revolution? Review of the newest endometrial cancer staging classification

The FIGO staging system is an integral part of the therapeutic and treatment process in female genital tumors. It cements the knowledge gained to date to plan patient treatment prognosis and the course of the disease and compare treatment outcomes between centers in the most individualized yet systematic way. In response to these assumptions, the FIGO Committee on Gynaecological Oncology updated the endometrial cancer staging classification in June 2023. The new endometrial cancer staging classification includes multiple clinicopathological prognostic factors and molecular findings for the first time. In this review, we summarize the differences between the new and the old FIGO classification and comment on its everyday real-world application.

Prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer

Non-endometrioid endometrial cancers (non-EEC) have different management from endometrioid endometrial cancers. The purpose of this study was to investigate the prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer and discuss the current literature with the findings. The study included two hundred-three patients with non-EEC who underwent surgical treatment and follow-up between January 1996 and December 2018 in a University Hospital Gynecologic Oncology Center. The patients were divided into three groups according to whether omentectomy was performed and the presence of omental metastasis. The patient's demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion (LVSI), myometrial invasion, lymph node involvement, and survival outcomes were compared between the groups. The study included 203 patients. Twenty-five patients (12%) had omental metastases. LVSI was reported in 57.3%, 88.0%, and 43.2% of the non-omentectomy, no-omental metastasis, and omental metastatic groups, respectively (p = 0.001). The 5-year disease-free survival (DFS) and overall survival (OS) rates according to the tumor grade, peritoneal cytology, and lymphadenectomy were also compared and were found to be statistically similar. The five-year OS rates were 70.6% for the group without omental metastases and 16.2% for the group with omental metastases, respectively (p = 0.001). In the group of omentectomy, the five-year DFS rates were 62.2% in cases without omental metastasis and 13.0% in cases with omental metastasis (p = 0.001). The five-year OS rates of 86.3% and DFS rates of 80.0% in the group without omentectomy. In non-endometrioid tumors, the survival rate was better in the group that did not undergo omentectomy. Based on these results, we can say that omentectomy may not be necessary for non-endometrioid tumors whose omentum is found to be normal in intraoperative visual examination.

Could soluble L1 cell adhesion molecule (sL1CAM) in serum be a new biomarker for endometrial cancer?

The aim of this study is to evaluate the place of serum soluble L1 cell adhesion molecule (sL1CAM) level in the diagnosis of endometrial cancer and its relationship with clinicopathological features. This cross-sectional study was performed with 146 patients who underwent endometrial biopsy and whose pathology results were reported as benign endometrial changes (n = 30), endometrial hyperplasia (n = 32) or endometrial cancer (n = 84). The sL1CAM level between the groups was compared. The relationship between clinicopathological features and serum sL1CAM was evaluated in patients with endometrial cancer. The mean serum sL1CAM level in patients with endometrial cancer was significantly higher than in patients without cancer. The sL1CAM value was statistically significantly higher in the group with endometrial cancer, than the group with endometrial hyperplasia (p < 0.001) and the group with benign endometrial changes (p < 0.001). There was no statistically significant difference in terms of sL1CAM between the group of patients with endometrial hyperplasia and the group of patients with benign endometrial changes (p = 0.954). sL1CAM value in type 2 endometrial cancer was statistically significantly higher than Type1 (p = 0.019). High sL1CAM level in patients with type 1 cancer was associated with poor clinicopathological features. However, no correlation was observed between clinicopathological features and serum sL1CAM level in type 2 endometrial cancers. Serum sL1CAM may be an important marker for evaluating the diagnosis and prognosis of endometrial cancer in the future. There may be a relationship between increased serum sL1CAM level in type 1 endometrial cancers and poor clinicopathological features.

Expression pattern of circadian rhythm-related genes and its potential relationship with miRNAs activity in endometrial cancer

The circadian clock is an autonomous oscillator that controls key aspects of cell physiology, including metabolism, transcriptional state, and cell signaling. Disturbances of circadian rhythms lead to disruption of cell and tissue homeostasis, which promotes carcinogenesis. The aim of the study was to determine the expression of circadian rhythm-related genes in endometrial cancer and to select miRNAs involved in the regulation of their expression. 50 endometrial tissue samples were collected from patients who underwent hysterectomy: 40 diagnosed with endometrial cancer and 10 without cancer. Expression profile of circadian rhythm-related genes was evaluated using microarrays and validated with RT-qPCR. MicroRNA expression was assessed using microarrays. Then mirTAR tool was used to identify miRNAs involved in the expression regulation of circadian rhythm-related genes. CLOCK expression is disrupted in endometrial cancer, which may be due to miR-15b, miR-331-3p and miR-200a overexpression. Elevated NPAS2 and CSNK1D levels may be associated with miR-432 silencing. In addition, high miR-874 and miR-200a expression may be potentially responsible for the reduction of PER3 level. Change of CLOCK, CSNK1D, NPAS2 and PER3 expression may suggest that circadian rhythms are disrupted in endometrial cancer. A possible mechanism of the observed changes may be related to miRNAs activity.

The analysis of the prognostic value of the neutrophil/ lymphocyte ratio and the platelet/lymphocyte ratio among advanced endometrial cancer patients

About 20% of endometrial cancer (EC) patients have advanced disease (FIGO III & IV) at the moment of diagnosis. An attempt to evaluate the prognostic value of biochemical markers of inflammation and classic endometrial cancer prognostic factors in the group of advanced EC (aEC) patients has been made in this study. Records of 266 patients treated in the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch between the year 2006 and 2018 were included in the study. Follow-up ranged from 1 to 138 months. Progression free survival (PFS) and overall survival (OS) have been set as endpoints. Tests such as: chi-squared, Fisher, log-rank, Mann-Whitney, Kruskal-Wallis and Cox proportional hazard ratio were used in the statistical analyses. In the analysed group high total platelet count (PLT) before operative treatment and high levels of white blood cells (WBC), PLT, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) before adjuvant therapy (AT) have been significantly associated with shorter PFS and OS. After setting the cut-off values of NLR and PLR a statistically significant correlation between those parameters and PFS as well as OS has been shown. Multivariate analysis has indicated that NLR is an independent prognostic factor of the course of aEC. NLR and PLR correlate significantly with OS and PFS in aEC. NLR is an independent prognostic factor in this group. It is possible to distinguish 3 risk groups, among aEC patients, based on NRL and PLR.

Platelet to lymphocyte and neutrophil to lymphocyte ratios in endometrial pathologies

Aim of this study was to evaluate the relationship between platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and endometrial pathologies. The database of our institution was reviewed. Cases with endometrial pathology including endometrial cancer (EC), endometrial hyperplasia with atypia and without atypia, normal endometrial findings, between January 2015 to January 2020, were collected. Their CBC results and clinicopathologic data were determined. The relation between the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and endometrial pathologies was evaluated. NLR was significantly higher in patients with endometrial cancer compared to other endometrial pathologies including endometrial hyperplasia with and without atypia and patients with normal endometrial findings. NLR cut-off value was determined 3.55 to discriminate cancer among other endometrial pathologies. PLR had not a significant difference between the endometrial pathologies. NLR seems to be an effective and simple marker to discriminate endometrial cancer among endometrial pathologies by contrast with PLR.

Sentinel lymph node mapping in endometrial cancer after 2020 ESGO-ESTRO-ESP consensus update: what will happen in the next few years?

Comprehensive endometrial cancer staging requires mandatory lymph node status assessment. However, some randomized clinical studies show that full lymphadenectomy may have no therapeutic benefit in patients presented with early-stage disease. Sentinel lymph node mapping can be considered in patients at low to intermediate risk for nodal metastases and is an acceptable alternative to systemic lymphadenectomy for lymph node staging in FIGO stage I/II patients. Similarly, patients with serious comorbidities who might not tolerate a standard systemic lymphadenectomy may benefit from the procedure. Sentinel lymph node detection rates depend on cancer stage, histology, and technique used. The procedure is most performed with the use of radioactive technetium colloid (99mTc) combined with a blue dye or indocyanine green. Recently, more interest is also paid to new nanoparticles including carbon, superparamagnetic iron oxide, and mannose tracer agents. Growing interest in sentinel lymph node mapping technique has led to design increasing number of research projects regarding various mapping approaches in different endometrial cancer populations. Much attention has been paid to a non-invasive sentinel lymph node mapping technique e.g., radiomics. This article reviews the latest research on sentinel lymph node mapping perspectives in endometrial cancer patients.

Adipocyte related peptides — galanin and resistin in endometrioid type endometrium cancer

The aim of (this) study was to investigate concentrations of galanin and resistin in patients with endometrioid type endometrium cancer. A total of 85 patients (52 Endometrioid type Endometrium Cancer patients and 33 healthy controls) were included in the study. Serum galanin and resistin levels were measured by an enzyme-linked immunosorbent assay (ELISA). It was found that the sensitivity and specificity of galanin at the cut off level of 0,37 ng/mL, was 82.96% and 68.78% respectively (AUC = 0.795, CI:0.691-0.898, p 0.27 ng/mL, increased the risk of having endometrioid type endometrium cancer 5.6 fold (95% CI: 1.939-16.282, p = 0.001). On the other hand, according to adjusted Odds Ratio results of the multiple logistic regression analysis, effect of interaction between galanin and resistin on having endometrioid type endometrium cancer was statistically significant. Increased galanin concentration > 0.37 ng/mL with increased resistin concentration > 0.27 ng/mL had adjusted Odds Ratio = 27.182 times greater risk of having endometrioid type endometrium cancer (95% CI: 6.653 to 111.109, p < 0.001). Increased galanin and resistin levels, either separately or together with, seemed to increase the risk of endometrioid type endometrium cancer other than different risk factors.

The struggle against endometrial cancer: ten years of experience of a tertiary center

We aimed to investigate the clinical and pathological factors of our patients who were diagnosed with endometrial cancer in terms of prognosis. With this study, we present our 10 years of surgical experience in endometrial carcinoma cases. Four hundred twelve patients with endometrial carcinoma who applied to our center between 2010-2019 and that we followed up were evaluated retrospectively. Most of the tumors were low-grade endometrioid malignancies. Non-endometrioid types accounted for 12.1% of cases. Lymph node dissection was performed in 395 of 412 patients (95.9%). 66 (16.01%) of the 412 patients died during the follow-up period in the study sample. Higher OS and DFS rates were associated with endometrioid histological types, FIGO stage, absence of lymphovascular space invasion, lower grade and less than 50% myometrial invasion (p < 0.05). 5-year OS at stage 1, 2, 3, 4 was found as 88.9 ± 2.2%, 65.5 ± 10.8%, 49.4 ± 0.79% and 23.7 ± 0.97% respectively. 5-year DFS at stage 1, 2, 3, 4 was found as 84.1 ± 2.6%, 65.5 ± 10.8%, 47.7 ± 0.78% and 23.7 ± 0.97% respectively. In univariate analysis, Age, tumor histology, FIGO stage, histological grade, LVSI, positive peritoneal cytology, cervical involvement, myometrial invasion and not receiving adjuvant therapy were defined as prognostic factors. Age, grade, FIGO stage, myometrial invasion, histological type, LVSI involvement, cervical involvemet, positive peritoneal cytology and not receiving adjuvant therapy are important prognostic factors for progression-free survival and overall survival in patients diagnosed with endometrial cancer.

Are IgG antibodies to heat shock proteins HSP27 and HSP60 useful markers in endometrial cancer and cervical cancer?

Heat shock proteins are overexpressed in many human malignancies. The role of heat shock proteins as a therapeutic target in cancer as well as their association with drug resistance were widely documented. The aim of this study was to evaluate the concentration of IgG class HSP27 and HSP60 antibodies in serum of patients with endometrial and cervical cancer, as well as to analyse the variability of concentrations of the examined antibodies depending on the cancer stage. The study included 59 women with adenocarcinoma of the endometrium and 36 women with cervical cancer, the control group consisted of 54 healthy women. The concentrations of IgG class antibodies against the tested heat shock proteins were determined by an immunoenzymatic assay (ELISA) using commercial assays. In both endometrial and cervical cancer, the serum concentration of IgG anti-HSP27 antibody was significantly higher than in the healthy control group. The concentration of IgG anti-HSP60 antibody in endometrial cancer, cervical cancer and healthy control was similar. The median IgG anti-HSP27 antibody serum concentration of endometrial cancer patients was not correlated with FIGO-stage. In cervical cancer inverse correlation between concentration of this antibody and FIGO stage was observed. The median IgG anti-HSP60 antibody concentration in serum of endometrial cancer patients was lower in FIGO stage I and II compared to FIGO stage IV and in FIGO stage IA compared to FIGO stage IB. Concentrations of examined antibodies correlated positively with each other, both in the group of women with cancer and in the group of healthy women. The strongest correlations were found in the group of patients with endometrial cancer. Concentration of anti-HSP27 antibody could help in detection of cervical and endometrial cancer. We need to look for the cut-off point in large cohort studies. Anti-HSP27 and anti-HSP60 antibodies should be further evaluated for their potential usage as biomarkers in cervical and endometrial cancer as they shown some correlation with stage of disease.

Clinicopathologic characteristics and prognosis comparison of the uterine high grade endometrial carcinomas

Grade 3 endometrioid adenocarcinomas (G3 EAC), type two endometrial carcinomas (Type 2 EC), and also uterine carcinosarcomas (UCS) are considered as high-grade endometrial adenocarcinomas. The aim of this study was to compare the clinicopathologic features and survival of patients with UCS, G3 EAC, Type2 EC. We included two hundred and thirty-five patients in this study. Patients were divided into three groups according to the type of tumor as uterine G3 EAC (group 1, n = 62), Type 2 EC (serous, clear and mixed types; group 2, n = 93), and UCS (group 3, n = 80). We compared the groups according to age, initial symptom, surgical approach, stage, myometrial invasion (MI), lymph node invasion (LNI), lymphovascular space invasion (LVSI), adjuvant therapy, and survival. When comparing the survival outcomes the Kaplan-Meier analysis was performed. The groups were similar according to age, menopausal status, nulliparity, initial symptoms, stage, LVSI, and LNI. Positive cytology was determined significantly more in group 3. There was a significant difference between the groups in terms of myometrial invasion degree. Optimal cytoreduction was similar among the groups. The primary adjuvant treatment was chemotherapy for UCS and Type2 EAC whereas radiotherapy was the main adjuvant treatment for G3 EAC. There were no significant differences among the groups according to overall survival (OS) (p = 0.290). Although the survival difference among the groups can not be revealed, these patients have different clinical and pathological features and they should be considered as different groups.

Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population. Endometrial cancer patients' archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not. There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively). Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients.

Increased osteopontin expression in endometrial carcinoma is associated with better survival outcome

Osteopontin (OPN) is a key extracellular matrix protein that is involved in cancer progression. The aim of the current study is to investigate the relation of OPN immunostaining in endometrial carcinoma with clinicopathological parameters. Archival 71 endometrial carcinomas and 30 non-neoplastic endometrial tissues were obtained from the Department of Pathology at King Abdulaziz University Jeddah, Saudi Arabia. Tissue microarrays were constructed. Tissue sections were stained using anti-human OPN monoclonal antibody. Immunostaining results were recorded and analysed. In non-neoplastic endometrial tissues, high (increased) OPN immunostaining was observed in 100%. In endometrial carcinoma, high (increased) OPN immunostaining was seen in 64.8% of cases. High (increased) OPN immunostaining was more frequent in non-neoplastic tissues than in endometrial carcinoma (p < 0.001). OPN immunostaining showed no association with histological type, FIGO tumour grade, tumour size, myometrial invasion, lymphovascular invasion, surgical resection margin or lymph node metastasis. On the other hand, high (increased) OPN immunostaining was associated with better overall survival [Log Rank (Mantel-Cox) = 4.385, p = 0.003]. In endometrial carcinoma, immunohistochemical staining of OPN could be a helpful tool in the prediction survival pattern. OPN immunostaining showed no association with most clinicopathological features. Further investigations both clinical and molecular are needed to explore the downstream of OPN in endometrial carcinoma.

mTOR inhibitor in the treatment of TFE-positive advanced maligmnant PEComa of the uterus: a case report and literature review

The pre- and intra-operative diagnoses of malignant uterine vascular perivascular epithelioid cell tumors (PEComas) can be challenging, for which the literature is limited. Some cases have been shown to have TSC gene mutations or rearrangements of the MiT factor family, resulting in variable responses to mTOR inhibitors. We report a case of a TFE-positive malignant PEComa of the uterus with pulmonary metastases that responded favorably to the mTOR inhibitor, everolimus. A 52-year-old female underwent a total hysterectomy 5 years ago for suspected sub-serosal or broad ligament fibroids. The intraoperative pathologic diagnosis was leiomyosarcoma of the uterus and the postoperative diagnosis was malignant PEComa of the uterus. The patient declined genetic testing and further treatment. In December 2020 the patient presented with a pelvic mass and underwent open abdominal mass resection and pelvic adhesiolysis. The pathologic findings confirmed recurrent malignant PEComa of the uterus. The pulmonary lesions gradually progressed during the follow-up period, so treatment with everolimus was initiated. Close follow-up evaluation for nearly 3 years showed disease remission without recurrence or progression. The patient described herein had a TFE-positive uterine malignant PEComa with lung metastasis and responded well to the mTOR inhibitor, everolimus. Close follow-up in the last 3 years showed remission without recurrence or progression.

Traditional vs novel out-of-office method for collecting cytology and HPV DNA — a comparative study

The integration of high-risk human papillomavirus (HPV) detection into cervical cancer screening in Poland aims to improve early detection, yet challenges in coverage and adherence persist. Innovative approaches, like sampling for HPV testing and cytology outside medical settings, have been proposed. This study assesses the feasibility and agreement of results between traditional and novel sampling methods. A cohort of 50 women aged 25-74 underwent HPV DNA and liquid-based cytology sampling both in-office using standard method and outside the medical setting by trained personnel. Samples were analyzed for HPV DNA using Real-Time PCR and cytology according to the Bethesda System. Cytology and HPV DNA positivity rates showed substantial agreement between methods, with almost perfect agreement for high-risk HPV types. Visual assessment of the cervix was successfully conducted in all cases. Preliminary results suggest remote sampling for HPV DNA and cytology is a viable alternative to traditional methods, with the effectiveness in detecting HPV and cytological abnormalities comparable to this reported in literature, offering potential benefits for individuals with mobility limitations or logistical barriers to attending medical appointments. The study highlights the potential role of remote sampling for HPV DNA and cytology in enhancing cervical cancer screening accessibility and adherence. Implementation of such methods could improve coverage, particularly among underserved populations. Further research is needed to validate and optimize these approaches for broader clinical use.

Possible deferral of diagnostic and therapeutic procedures for patients with abnormal screening tests results in cervical cancer secondary prevention in current SARS-CoV-2 pandemic Interim guidelines of the Polish Society of Gynecologists and Obstetricians and the Polish Society of Colposcopy and Cervical Pathophysiology

The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pan-demic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnor-malities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence.

Logistic regression analysis of ultrasound features for predicting borderline ovarian tumours in young women aged ≤ 40 year

To determine the ability of sonographic characteristics to distinguish borderline ovarian tumours (BOT) from benign and malignant tumours in young women by using logistic regression analysis. 147 patients with ovarian masses were analysed retrospectively. We recorded and compared the available preoperative serum CA125 and CA199 levels, ultrasound and pathological findings from patient records to distinguish BOT from benign and malignant tumours using single-factor and multiple stepwise logistic regression analyses. Seventy-six women aged ≤ 40 years diagnosed with BOT, 31 women with malignant tumours, and 40 women with benign cystadenomas were included. The significant features identified in the single-factor analysis were CA125 and CA199 levels, tumour size, multilocularity, presence of solid components within cysts, colour Doppler flow, presence of microcystic pattern (MCP), and proportion of the maximum solid area covering < 50% of the inner surface within the cyst (p < 0.05). The latter two ultrasound features were identified as independent predictors for differentiating BOT from benign and malignant tumours in the logistic regression analysis. The area under the receiver operating curve (AUC) was 0.893 and 0.904, respectively. The corresponding sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 89.5%, 94.1%, and 73.9%, respectively, while the corresponding values were 93.4%, 76.3%, 88.7%, and 85.3%, respectively. Combining both ultrasonic features of the microcystic pattern and the proportion of the maximum solid area covering < 50% of the inner surface within the cystic region appears to be the optimal method for characterizing BOT.

Juvenile granulosa cell tumor: 20 years’ experience of a Tertiary Center

The aim of this study is to share of the 20-year experience of a tertiary center about juvenile granulosa cell tumor (JGCT) and describe clinic manifestations, treatment, and outcome of patients who diagnosed JGCT. Five patients who diagnosed juvenile granulosa cell tumor between 2000 and 2020 were included in the study. The demographics, clinical findings and outcomes were retrospectively evaluated. Of the 5 patients in our study, one was in the premenarcheal girl. The common complaint in all of our patients was abdominal swelling. In preoperative imaging methods, all patients had unilateral adnexal mass and no signs in favor of metastasis. All patients were staged according to FIGO classification for ovarian tumors; 3 of patients had stage IA disease, one of patients had stage IC1 and one of patients had stage IC2. All patients underwent different surgecal procedures which is appropriate for their clinical manifestations. In addition to surgery 2 patients received adjuvant chemotherapy. The median follow-up period of the patients was 60 mounts and recurrence was observed in two patients who were reoperated. We have no patients who died due to this disease. Possible diagnosis of juvenile granulosa cell tumor should be kept in mind in a patient of young age with unilateral adnexal mass with benign features.

Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results

Possible discrepancies between the cervical smear, biopsy histology and loop electrosurgical excision procedure (LEEP) results of the same patient is a matter of debate in the literature. In this study, we investigate the degree to which these results differ, and the clinical reasons for these differences. With a retrospective design, cervical smear, cervical biopsy and LEEP results of patients were compared in terms of consistency. One hundred sixty-four patients who underwent till LEEP procedure due to pathologic initial smear and biopsy results between January 2015 and March 2020 were included in the study. Exact diagnosis discrepancy and high grade squamous intraepithelial lesion (HSIL) discrepancy were 78.9% and 50.0% between smear and cervical biopsy, 64.6% and 31.7% between cervical smear and LEEP and 43.8% and 28.1% between cervical biopsy and LEEP results, respectively. Age did not affect the consistency rates of pathologic results between smear-biopsy (p = 0.408) and biopsy-LEEP (p = 0.590). However, the probability of the consistency of smear and LEEP results exhibited a statistically significant linear relation with age (OR = 1.043, p = 0.015). HPV infections did not affect the discrepancy between smear-biopsy (p = 0.533), smear-LEEP (p = 1.000) and biopsy-LEEP (p = 0.529). Smear technique has a serious discrepancy and under-diagnosis problem when its results are compared with biopsy and LEEP. The consistency between smear and LEEP results appears to improve with age. When HSIL is evaluated in terms of detection, this discrepancy decreases. A smear test can detect HSIL and carcinoma with a higher accuracy than low-grade lesions.

Measurement of HE4 six months after first-line treatment as optimal time in identifying patients at high risk of progression advanced ovarian cancer

The objective of the study was to assess the usefulness of determining HE4 and CA125 in ovarian cancer patients, to indicate which of the measurements may be optimal in the prognosis, depending on the treatment scheme. The concentrations of CA125 and HE4 were performed in 70 patients with advanced ovarian cancer during I-line therapy and after treatment. The subjects were divided based on the treatment scheme: group I - primary surgery and adjuvant chemotherapy, II- neoadjuvant therapy, and surgery. Multivariate analysis showed that HE4 levels six months after treatment was significantly higher in patients with disease progression. ROC analysis in the group of patients treated with neoadjuvant therapy showed that the cut-off values indicating relapse for HE4 and CA125 after six months of follow up, were > 90.4 pmol/L, > 25.6 IU/mL, respectively. In the group of patients not treated with neoadjuvant therapy, the cut-off points differentiating patients with progression were: HE4 > 79.1 pmol/L, CA125 > 30.7 IU/mL. We demonstrated significantly higher HE4 and CA125 at both 6- and 12-months follow-up in patients treated with neoadjuvant therapy. In both groups of patients, the cut-off points were lower than those proposed by the manufacturer of the kits. Measurement of HE4 six months after treatment may be useful in identifying patients at high risk of progression, especially when CA125 levels may be non-specifically elevated. The cut-off values indicating relapse for HE4 and CA125 after six months of follow up may be lower than the normal range.

Ovarian teratoma-associated anti- Anti-N-methyl-D-aspartate receptor encephalitis: a clinical analysis of 5 cases

To analyse the clinical features, diagnosis, treatment, and prognosis of anti-N-methyl-D-aspartic acid receptor (NMDAR) encephalitis associated with ovarian mature teratomas. Retrospectively analysed the clinical-laboratory data of five patients with anti-NMDAR encephalitis combined with ovarian teratoma at a single centre between March 2016 and June 2019. The mean age of the patients was 22.40 ± 2.89 years (range, 19-26 years). Five patients had premonitory fever symptoms, clinical manifestations of mental disorder or convulsions for starting, with varying degrees of involuntary movement. Brain MRI and electroencephalography lacked specificity, and cerebrospinal fluid resistance NMDAR antibody detection was the key to diagnosis. All patients experienced good outcomes in response to immunotherapy combined with ovarian tumour resection, with a median follow-up time of 36 months (range, 16-55 months). The MRS value of five patients decreased significantly half a year after surgery, and no encephalitis or ovarian tumour relapses were reported. Anti-NMDA encephalitis caused by ovarian teratoma is mostly a non-specific clinical manifestation of neurological and mental abnormalities, which can be easily misdiagnosed and delayed, and doctors should fully recognise the disease, early diagnosis, and timely surgical intervention to improve the prognosis of patients.

The role of selected molecular factors in ovarian cancer metastasis

The main reason for treatment failure in ovarian cancer is chemoresistance and the presence of metastasis. Ascites, whichallows the physical movement of cancer cells, the lymphovascular pathway, and several molecular factors and signalling axes, are involved in metastasis. Ascites, with the involvement of cytokines and chemokines, MAPK/STAT1 and NOTCH as well as CXCL12/CXCR4 signaling pathways and circulating anoikis induces cancer dissemination, in particular to the peritoneum and omentum. The spread of lymphatic and bloodstream cancer cells is a multi-stage process. Tumour infiltration of the stroma and lymphovascular space (LVSI) produces biologically active cancer-associated fibroblasts and macrophages (CAFs, TAMs) that secrete numerous cytokines, chemokines and growth factors, inhibit NK function, induce epithelial-mesenchymal transition (EMT), resulting in an increase of the metastatic potential of cancer cells and the formation of cancer stem cells (CSCs). Overexpression of some genes, and microRNAs, in LVSI-(LMGS) associated with metastasis has been identified. The role of extracellular vesicles (EVs) transporting metastasis-associated factors has been described as has the role of cancer stem cells (CSCs) in chemotherapy resistance and metastasis. Sirtuins, enzymes involved in metastasis formation, have also been detected. Certain types of microRNAs (miR-509-3p, microRNA-506-3p) and melatonin have been shown to inhibit metastasis.

Role of adipokines in ovarian cancer epidemiology and prognosis

Ovarian cancer is one of the most serious problems in modern oncological gynecology. The link between obesity (expressed in BMI, WHR, waist circumference, body weight) and ovarian cancer has been poorly studied. Obesity is defined as an excessive accumulation of bodily fat, exceeding its physiological needs and adaptability. Study results suggest a link between specific histological types of ovarian cancer with increased patients' BMI. Adipose tissue is hormonally active and secretes biologically active proteins called adipokines. Resistin and leptin may show proliferative and anti-apoptotic effects. There is currently increasing attention to adipokine levels in ovarian cancer research. The influence of adiponectin on the secretion of angiogenic factors by ovarian cancer cells has been shown. It has been proven that leptin is associated with a worse prognosis for patients treated with platinum compounds combined with paclitaxel/docetaxel. The relation has been observed between the level of resistin and the growth of neoplastic cells, their spread and the resistance to chemotherapy. The level of AdipoR1 may be independent prognostic factor in the case of epithelial ovarian cancer. The role of adipokine in the neoplasm development requires further investigation, in the view of fact that results of current research are still inconclusive. Considering increasing number of people suffering from obesity as well as the current analysis results, it is necessary to extend experimentation on the influence of obesity on the development and prognosis of ovarian cancer.

Primary non-Hodgkin’s lymphoma masquerading as cervical cancer

Genital tract lymphomas are rare entities that can be diagnosed at advanced stages. The uterine cervix is not generally infiltrated by lymphoma. Nevertheless it can be seen as a consequence of either a systemic disease or primary disease. The infrequency of primary cervical lymphoma makes the diagnosis challenging.

COLPOSCOPY PROTOCOLS 2020

The Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynecologists and Obstetricians provide comprehensive guidelines for colposcopy practice in secondary cervical cancer prevention in Poland. This part of the guidelines, developed by the clinical experts of the Working Group No. 1 (WG1), concerns the colposcopy protocols with the main aim of algorithmizing the procedure, together with all procedure-related processes. The detailed analysis of strong scientific evidence and an extensive literature review of current international colposcopic recommendations were carried out, with also a broad investigation of recently ongoing dynamic changes in national health systems. The attention to colposcopic limitations also occurring in Polish conditions was kept. The overriding goal was the recommended obligatory minimal colposcopy approach introduction. To enhance the standard of colposcopy, adjustment of a precolposcopic assessment, a performance technique, types of used biopsies, as well as the procedure documentation was made. Elements of the risk-based stratification for the increased risk of developing cervical cancer was also included if it was applicable for that part of the guidelines. Comprehensive colposcopy guidelines are a step towards the ongoing era of a precision medicine in cervical cancer prevention in Poland.

A preliminary study on the immune responses of HPV16-E7 by combined intranasal immunization with lymphotoxin

Human papillomavirus (HPV) ranks the first cause of cervical cancer. Cervical cancer has high prevalence rates in women around the world. The HPV-E7 oncoprotein is expressed in cervical cancer and is a target of developing immunotherapies against HPV-associated tumors. However, the antigenicity of this protein is low. Due to this reason, potent adjuvants are required to enhance its therapeutic efficacy. This preliminary study aims to evaluate whether lymphotoxin (LT) could act as an effective immune adjuvant for HPV infection in mice models. Intranasal immunization was used to explore the effect of HPV-E7 and/or LT immune response. After the third intranasal immunization, the titer for the HPV-E7 antibody was detected in serum and vaginal washing fluid. Also, we assessed the expression of chemokine ligand 13 (CXCL13) and Peripheral Node Addressin (PNAd) in the lymph nodes after intranasal immunization with immunohistochemical analysis. compared to HPV-E7 immunization, intranasal immunization with HPV-E7 plus LT significantly increased HPV-E7-specific serum IgG and vaginal IgA titers. Furthermore, the combined use of HPV-E7 and LT strongly induced E7-specific CTL responses. LT can be effective for intranasal immunized HPV-E7 to improve E7-specific immune responses to HPV infection. It is new approach to eradicate chronic HPV infection capable of inducing an effective anti-infection method.

Presence of human papilloma virus in Caucasian women living in the central Europe diagnosed with vulvar intraepithelial neoplasia

The role of human papilloma virus (HPV) in the development of cancerous states of female reproductive tract has been widely debated. However, the information about presence of HPV in the Caucasian women living in the central Europe diagnosed with vulvar intraepithelial neoplasia (VIN) is missing. So far, no recommendation was made to complete HPV detection in time of vulvar biopsy or after the results of positive VIN are obtained. We aimed to assess the presence of HPV in women with vulvar intraepithelial neoplasia diagnosed at the Department of Gynecology, Obstetrics and Oncological Gynecology in Bytom, Poland. The retrospective examination of 120 consecutive vulvar biopsies obtained from women with persistent vulvar itching was done. Only patients with diagnosis of VIN were included in the further analysis. HPV DNA was detected using HPV Linear Array Genotyping Test including 14 HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). Out of 120 vulvar samples retrieved, 18 women were positive for VIN, including15 usual VIN (uVIN) and three differentiated type (dVIN ). 10 samples were eligible for DNA detection. HPV DNA was found in two women with uVIN (HPV 16 and 51). It is advisable to recommend HPV genotyping in women with VIN, regardless of their age and histologic type. The incidence of HPV infection in Caucasian women from the central Europe with VIN should be further studied.

Efficacy and prognostic factors of concurrent chemoradiotherapy in patients with stage Ib3 and IIa2 cervical cancer

We investigated the efficacy, side effects, and prognostic factors of concurrent chemoradiotherapy for patients with stage Ib3-IIa2 cervical cancer. We conducted a retrospective analysis of clinicopathologic data from 73 patients with stage Ib3-IIa2 cervical cancer who received concurrent chemoradiotherapy from January 2008 to December 2013 in our hospital. Overall response and disease control rates were used to evaluate short-term outcomes; the 3-year and 5-year disease-free survival and overall survival were used to evaluate long-term efficacy. Toxicity reactions and prognostic factors were recorded. With concurrent chemoradiotherapy, overall response and disease control rates were 91.78% and 97.26%, respectively. The 3-year disease-free and overall survival were 80.82% and 83.56%; the 5-year disease-free and overall survival were 75.34% and 79.45%, respectively. All side effects were tolerated and potentially alleviated by symptomatic treatment. Tumor pathological type, differentiated degree, primary tumor size and squamous cell carcinoma antigen levels before and after treatment were closely related to survival (univariate analysis; p < 0.05). Pathological type, primary tumor size and squamous cell carcinoma antigen levels one month after treatment were independent prognostic factors for long-term outcome (multivariate analysis). Short- and long-term efficacy of concurrent chemoradiotherapy for stage Ib3-IIa2 cervical cancer is well-determined and tolerable. Patients with adenocarcinomas, tumor diameter ≥ 5 cm and squamous cell carcinoma antigen levels ≥ 1.5 ng/mL (one month after treatment) had poor prognosis and should be assessed further.

Human papilloma virus-related premalignant and malignant lesions of the cervix and anogenital tract in immunocompromised women

The number of immunocompromised patients is rising, and immunodeficiency is an independent risk factor for the development of premalignant and malignant lesions of the cervix and anogenital tract. The aim of this review was to summarize and update data on human papilloma virus (HPV) infections and HPV-based anogenital lesions detected in patients who were immunocompromised due to both organ transplantation and human immunodeficiency virus (HIV) infection. The incidence of HPV infections among solid organ recipients and HIV positive females is reported to be significantly higher when compared with age-matched healthy controls- i.e. higher by up to 65% and 46.6% respectively, vs 38% in the controls. These infections are also more often chronic, high risk HPV and multitype. Data suggest that HPV infections in these patients might not only occur more frequently, but that the course of the infection might also lead to faster oncogenesis. However, the treatment options for malignancies are limited; and this implies the need for intense primary and secondary prevention regimens. As infections with HPV types other than 16 and 18 and multitype infections are particularly frequently discovered in immunocompromised patients, they would probably benefit most from a nonavalent vaccine. Gynecological screening should be performed annually, including cervical smears and/ or HPV testing. In the group of non-responders, self-sampling methods should be considered.

Vulval squamous cell cancer — does precursor lesion margin status affect recurrence-free survival after optimal surgical resection for early-stage disease?

Vulval cancer accounts for around 4% of all gynaecological malignancies and most tumours ( > 90%) are of a squamous cell histotype. Most lesions arise on a background of differentiated VIN (dVIN) or lichen sclerosus (LS). Surgical treatment has undergone a paradigm shift with less radical surgery being attempted to preserve vulval structure and function, without compromising oncological outcome. In this single site retrospective analysis, we consider the data from a tertiary oncology unit, to assess progression-free survival based on the presence of a precursor lesion at the margin of resection.123 patients with FIGO stage 1 vulvar SCC (n = 33 1A, n = 90 1B) were included. One Hundred Five patients (85%) had an associated precursor lesion (dVIN and/or LS). Within the follow-up period, 33 patients (26.8%) had invasive recurrence, of which 24 (72.7%) had surgical resection margins which were positive for a precursor lesion. In patients with an acceptable microscopically clear invasive resection margin of > 2 mm the presence of a precursor lesion at the margin conveyed a higher risk of malignant recurrence when compared to those with completely clear margins (HR = 2.42; 95% CI 1.14-5.16). This study adds to the available literature emphasising the clinical significance of dVIN or LS at the surgical margin of optimally resected disease. In those who have marginal involvement of a precancerous lesion, increased surveillance should be considered. Future work should explore the need for additional adjuvant therapy in this cohort.

Irisin — a new biomarker for endometrial cancer?

Irisin is an adipomyokine that has an inhibitory effect on inflammation and possesses anticancer activity. It inhibits cancer cell proliferation, metastasis, and invasion through various signaling pathways associated with carcinogenesis. It has been described to be associated with a number of malignancies in various locations. It has been recognized that it may be a biomarker and prognostic factor in some malignancies. In addition, studies indicate irisin's possible role in treating malignant lesions. In material including 129 cases of endometrial cancer and normal endometrium in a control group of 18 women with uterine myomas. There were no statistical differences in irisin protein expression. There were also no differences in irisin expression according to clinical stage, type, and histopathological differentiation. Further clinical studies are needed to evaluate irisin activity in endometrial cancer.

Metformin in selected malignancies in women

The results of preclinical, epidemiological and clinical studies have shown that metformin, the main drug used in the treatment of type 2 diabetes, has antitumor activity. Metformin reduces the incidence of malignant neoplasms in various locations, including gynaecological tumours. It lowers morbidity, has a positive effect on the course of the disease and reduces mortality. The mechanism of the antitumor action of metformin is pleiotropic and involves several signalling pathways, including AMPK/mTOR (mitogen activated protein kinase/mammalian target rapamycin), STAT3 (signal transducer and activator of transcription) and numerous factors: NF-KB (nuclear factor kappa), HIF-1 alpha (hypoxia inducible factor 1), IGF-1 (insulin-like growth factor-1), which affect cell proliferation and apoptosis. In addition, metformin eliminates CSCs (cancer stem cells) that are associated with cancer progression, metastasis and resistance to treatment. The effect of metformin in breast and endometrial cancer is favourable in the vast majority of studies. The results of studies on ovarian and cervical cancer promote metformin as a candidate in the combination treatment of these cancers. More results from meta-analyzes and clinical trials are awaited. It is clearly recognized that metformin as an antidiabetic in women with type 2 diabetes has an advantage over other antidiabetics due to its anticancer activity.

Adjuvant therapy for early endometrial cancer — who benefits the most from a radiation therapy?

Since 1990s the number of patients diagnosed with endometrial cancer (EC) has doubled. The standard treatment method for treating early endometrial cancer is surgery. Some patients require a subsequent adjuvant therapy. In early endometrial cancers its application is limited to the populations with a high risk of recurrence. The aim of this study was to assess the effectiveness of early endometrial cancer treatment based on an analysis of 5-year follow up of EC patients. The analysis consisted in a retrospective non-randomized interventional study of patients treated for early endometrial cancer (FIGO stage IA, IB, II). Its end point was either local (small pelvis) or distant recurrence of the disease. Intervention involved an adjuvant treatment applied in selected patients according to the current guidelines for EC treatment. There was no randomization for adjuvant and non-adjuvant EC treatment. The study included a total of 419 patients treated for EC from 2010 to 2012. The analysis revealed that 108 patients (25.8%) were diagnosed with the recurrent disease. Out of 112 patients treated for stage IA endometrial cancer 32 (28.6%) experienced recurrence. Out of 216 patients at FIGO Stage IB, recurrence was diagnosed in 38 (17.6%). In the group of 91 patients treated for FIGO stage II, EC the recurrence was diagnosed in 38 (41.2%) cases. Early EC treatment results were unsatisfactory and should be improved. The best outcomes were achieved in patients with IA stage of EC who received a radiation therapy.

Baseline data on distribution of human papillomavirus (HPV) genotypes in cervical samples of gynecological patients before implementation of population-based HPV vaccination program in Poland

Free-of-charge vaccination against human papillomavirus (HPV) of 12-13-year-old teenagers was introduced on the 1st of June 2023 in Poland. Data on baseline HPV genotype cervical distribution are crucial to evaluate potential changes after full implementation of the vaccination program. We aimed at evaluating the status of HPV infection and distribution of HPV genotypes in cervical cytology of gynecological patients tested in one of the largest HPV laboratories in Poland. Data on all HPV tests performed in ALAB Laboratoria Sp. z o. o. in Poland in 2018-2021 were analyzed, focusing on tests that identified genotypes: 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 70, 73, 81, 82, 83, 89. Distribution of HPV genotypes was assessed among HPV-positive women. Among 11.151 medical records retrieved in women with valid HPV test results, 5.681 were positive (50.9%), of whom 2.929 were infected with a single genotype (51.6%). At least one high-risk (HR) genotype was detected in 4.351 women (76.6%). Among all HPV-positive women, the most common HR genotypes were HPV-16, HPV-31 and HPV-66 (24.0%, 11.3%, 11.3%, respectively). HPV-53 was the most prevalent among non-HR types (10.5%). HPV-16 followed by HPV-31 and HPV-66 were the most frequent genotypes in the studied cohort. These results may be compared with the same methodology after full roll-out of HPV vaccination program in the future to track potential changes in HPV genotype distribution.

Evaluating the risk of malignancy in adnexal masses: validation of O-RADS and comparison with ADNEX model, SA, and RMI

To evaluate the diagnostic value of Ovarian-adnexal Reporting and Data System (O-RADS), and to compare it with Assessment of Different NEoplasias in the adnexa (ADNEX) model, Subjective Assessment (SA), and Risk of Malignancy Index (RMI) in differentiating benign and malignant adnexal masses (AMs). Ultrasound characteristics of 445 patients included in the study were retrospectively analyzed and evaluated using diagnostic models. The diagnostic performances of ultrasound diagnostic models were measured by assessing, receiver-operating characteristic curves, sensitivities, positive predictive values, positive likelihood ratios, specificities, negative predictive values, and negative likelihood ratios. Kappa values were used to evaluate inter-reviewer agreement (IRA). Of the 445 AMs, 265 were benign and 180 were malignant. The area under the curve (AUC) of O-RADS (0.941), ADNEX model (0.925), and SA (0.931) were higher than RMI (0.815) (all p 0.05), and there was no statistical significance among them (p > 0.05). The specificity of O-RADS, ADNEX model, SA, and RMI was 90.2%, 90.6%, 90.2%, and 92.5%, respectively, with no statistical significance (p > 0.05). All four ultrasound diagnostic methods showed better IRA. O-RADS, ADNEX model and SA have better diagnostic value in differentiating benign and malignant AMs than RMI.

Survivin expression at the mRNA level in tumors and the protein concentration in the serum and peritoneal fluid in patients with serous ovarian tumors

Ovarian cancer is one of the gynecological cancers that have the worst prognosis. The expression of the proteins from the IAP family (inhibitor of apoptosis protein), including survivin, is observed in many types of cancer. The aim of the study was to evaluate survivin at the mRNA level in tumors and the protein concentration in the serum and peritoneal fluid of patients with serous ovarian cancer in order to assess the relationship between the concentration of survivin and the histological subtypes of cancer. The study group consisted of 55 women, including patients with serous ovarian cancer (n = 30, nine low-grade serous carcinoma LGSC, 21 high-grade serous carcinoma HGSC), serous cysts (n = 10) and the control group (n = 15). The concentration of protein in the peritoneal fluid and serum was assessed using ELISA tests. The expression of survivin gene BIRC5 in the tumors was assessed using the RT-qPCR method. The data that was obtained indicated that the concentration of survivin was higher in the serum of the women with serous ovarian cancer compared those that had benign tumors (p < 0.05) and the control group (p < 0.001). The survivin concentration was also higher in both the serum and peritoneal fluid in the HGSC group compared to the LGSC group (p < 0.001). The mRNA level was highest in the HGSC group, and there was a statistically significant difference compared to those in the benign tumor group and HGSC group ( p < 0.05). The observed changes prove that the expression level increases significantly in HGSC in both the protein and mRNA levels. Based on these findings, it can be assumed that assessing this parameter could be a useful additional indicator of the progression and differentiation of this type of cancer. However, this requires further research in a larger group of patients and possibly in other types of ovarian cancer.

Self-reported participation in cervical cancer screening among Polish women in 2004–2019

We aimed to assess self-reported participation in cervical cancer screening among Polish women between 2004 and 2019 and to identify the groups with the lowest participation rate. Data on declared participation in cervical cancer screening were obtained from the European Health Interview Survey from 2004 to 2019. In 2019, 86.7% of Polish women aged ≥ 15 years declared that they had ever undergone a Pap test. Compared to 2004, the coverage of ever-screened women improved by 16.6 percentage points. The proxy population coverage was 72.9%. The highest proportion of women who underwent a Pap smear in the last three years was observed among those aged 35-44 years and 25-34 years (84.0% and 83.2%, respectively), and the lowest among women aged ≥ 75 years (20.5%). The proportion screened within the last three years also varied by education (up to lower secondary education 26.4%, up to post-secondary non-tertiary education 62.8%, and the highest level of education 83.7%), urbanization (large cities 66.7%, suburbs, and smaller cities 62.8%, and rural areas 59.0%), income (poorest households 42.5%, wealthiest households 70.6%), and declared health status (best 68.9%, worst 41.4%). The lowest participation in screening was observed in the southeastern regions and the highest in the northwestern regions of Poland. In Poland, in 2019, the approximate coverage of cervical cancer screening was high compared to other European countries and has improved over the last 15 years. A complete screening registry is required to confirm questionnaire-based self-reported data. Targeted interventions should be implemented to address low participation in the identified regions and socioeconomic groups.

Cervical cancer — a preventable (?) disease in Poland

The use of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosing of ovarian tumors

To compare utility of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosis of ovarian tumors. Research was conducted among 456 patients qualified for surgery due to ovarian tumor. Preoperatively, CA125 and HE4 serum levels were estimated, and transvaginal ultrasound was performed. ROMA and RMI values and SA qualifications were obtained. Results were compared with pathomorphological findings. Receiver Operating Characteristic (ROC)-Area Under Curve (AUC) values for CA125, HE4, ROMA, RMI and SA in preoperative diagnosis of malignant lesions were 0.819, 0.909, 0.911, 0.895 and 0.895, respectively. Combinations of biochemical and sonographic methods increased sensitivity in diagnosis of ovarian tumors. Combinations utilizing serum HE4 concentrations were most useful. CA125, HE4, ROMA, RMI and SA proved to be useful in preoperative diagnosis of ovarian tumors. HE4 and ROMA occurred to be the most useful. Ultrasonographic methods are considerably useful in diagnosis of ovarian tumors. RMI and SA present similar overall diagnostic value.

Laparoscopic treatment of a mature teratoma with a fistula into the rectum — a NOTES technique

The immune complex p53 protein/anti-p53 autoantibodies in the pathogenesis of ovarian serous carcinoma

The tests conducted were intended to analyze the concentration of p53 protein and anti-p53 autoantibodies in serum of women with ovarian tumours. The study included patients with diagnosed ovarian cancer: Cystadenoma serosum or Cystadenocarcinoma papillare serosum at IIIc stage (including 10 women who had G1, 14 women who had G2 and 30 women who had G3 staging). Concentrations of parameters were measured by ELISA. The analysis of the obtained results showed statistical significance between the concentration of p53 protein depending on the degree of differentiation of G1 and G3 (p < 0.001) and anti-p53 autoantibodies depending on the degree of differentiation of G1 and G2 (p < 0.05) as well as G2 and G3 (p < 0.01). In addition, the determined p53/anti-p53 autoantibodies ratio was only significant between G1 and G2 (p < 0.05), as was the assessment of the percentage of the tested parameters in the immune complex. Immune system disorders involving the p53 protein and anti-p53 autoantibodies may be one of the immune mechanisms involved in the pathogenesis of ovarian serous cancer.

Clinicopathological factors of pelvic lymph nodes involvement in advanced serous ovarian cancer

Retroperitoneal lymph nodes metastases occur frequently in patients with ovarian cancer. Lymphadenectomy increases risk of perioperative complications. In clinical practice to reduce rate of complications aortocaval lymphadenectomy is omitted and solely resection of pelvic lymph nodes is performed. To establish factors affecting metastases to pelvic lymph nodes in advanced ovarian cancer. A retrospective study among patients with serous advanced ovarian cancer (FIGO IIIB-IVB) was conducted at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw and Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw. All patients underwent surgical treatment including pelvic lymphadenectomy between 2014 and 2017. Data including age, body mass index (BMI), pretreatment CA125 serum level, tumor volume, grading, one-/both-sided tumor, menopausal status, ascites were analysed as possible factors influencing the pelvic lymph nodes involvement. The statistical analysis was performed with Python software. 87 consecutive patients were eligible for the study. Metastases to pelvic lymph nodes were found in 29 (33.33%) patients. Pretreatment serum CA-125 concentration (652 U/mL vs 360.9 U/mL, p < 0.05) and high grade histology corresponded with pelvic nodal involvement. The knowledge of factors influencing metastases to pelvic lymph nodes may help clinicians in proper counselling and tailoring of therapy.

Lack of connection between the uterine cervix and corpus in an adolescent treated in childhood for teratoma of the ovary

Diagnosis and management of vaginal leiomyoma: a case report and literature review

Leiomyomas are benign mesenchymal tumors that consist of smooth muscle cells and varying amounts of fibrous stroma. Uterine leiomyomas are the most common, affecting 20% to 30% of reproductive-age women, but vaginal leiomyomas are rare. Treatments gradually diversify with increased awareness of vaginal leiomyoma, but transvaginal fibroid resection remains the commonly used scheme. Herein, we present the case of a 50-year-old asymptomatic woman who had a mass in the left anterior wall of the vagina discovered by gynecological examination and ultrasound. We used oxytocin diluent injection during surgery to create a water pad in the tissue space and then performed a transvaginal myomectomy. There was little or negligible intraoperative bleeding and no peripheral tissue injury, early or late postoperative complications, incision dehiscence, and no surgical site infection. Transvaginal ultrasonography is the preferred examination for vaginal leiomyomas, and transvaginal myomectomy is the classic treatment method. The formation of a water pad with oxytocin dilution can effectively reduce intraoperative bleeding and shorten surgery time.

Cervical cancer screening in Poland in current SARS-CoV-2 pandemic: Interim guidelines of the Polish Society of Gynecologists and Obstetricians and the Polish Society of Colposcopy and Cervical Pathophysiology - a summary January 2021

The Polish Society of Colposcopy and Cervical Pathophysiology (PTKiPSM) together with the Polish Society of Gynecologists and Obstetricians (PTGiP) issued a final summary of interim guidelines for secondary cervical cancer prevention during the SARS-CoV-2 pandemic based on the analysis of the latest directional publications and the authors' own experiences. The aim of the summary is to facilitate the implementation of the most effective possible screening of cervical precancerous lesions and cervical cancer due to temporary significant limitation of screening as a consequence of the ongoing epidemiological threat. These final guidelines are taking into account the 2020 call of the World Health Organization (WHO) for global epidemiological elimination of cervical cancer. The guidelines supplement the interim guidelines of PTKiPSM and PTGiP announced in March 2020 on the possible deferral of diagnostic and therapeutic procedures in patients with abnormal screening tests results in secondary prevention of cervical cancer in current pandemic.

TLR family gene expression in relation to the HIF1α and the VEGFR pathway activation in endometrial cancer

Malignant neoplasm of the endometrium is the most common malignant neoplasm of the female reproductive system. Toll Like Receptors (TLR) play a significant role in innate and late-immunity against infections or damaged tissues. TLRs are also involved in the development of tumors in their natural microenvironment. TLRs play an important role in angiogenesis, necessary for survival and growth of the tumor. Hypoxia playing a critical role in angiogenesis, carcinogenesis, tumor progression and distant metastasis is primarily mediated through hypoxia inducible factors (HIFs). Vascular endothelial growth factor family proteins (VEGF) are also strongly involved in tumor angiogenesis and their action is strongly associated with TLR receptors. The aim of the study was to correlate the expression of selected TLRs and VEGFR's as well as HIF1α with clinicopathological data of endometrial cancer patients. 123 neoplastic endometrial samples were included in the study. 51 samples of healthy endometrium served as control. The expression of TLR1, TLR2, TLR3, TLR4, VEGFR1 and VEGFR2, VEGF-A and HIF1α was examined after RNA isolation at the mRNA level by Real Time-PCR. We have noted a significant correlation between the expression of selected TLR and VEGFR's and clinical stage as well as pathological grading of endometrial cancer. Received correlations confirm a significant contribution of some TLR expression and the receptor for VEGF in the pathogenesis of epithelial endometrial cancer.

Clinical study of acute toxicity of pelvic bone marrow-sparing intensity-modulated radiotherapy for cervical cancer

To compare the dose volume of the target area and the toxicity of pelvic bone marrow-sparing intensity-modulated radiotherapy (PBMS-IMRT) with routine IMRT in patients undergoing radiochemotherapy for cervical cancer. Forty patients with indications for adjuvant radiochemotherapy after cervical cancer surgery were selected and randomly divided into IMRT (n = 20) and PBMS-IMRT (n = 20) groups to observe and record the toxicity and its severity in the blood, gastrointestinal tract, and genitourinary system. There was no significant difference in the target area conformity index (CI) or homogeneity index (HI) between the two groups (p > 0.05). The pelvic bone V10-V50 in the PBMS-IMRT group were lower than those in the IMRT group (p 0.05). PBMS-IMRT significantly reduced the dose volume of the pelvic bone marrow, thereby reducing the incidence of bone marrow suppression. However, it had no significant impact on the gastrointestinal or genitourinary systems.

Adaptation to cancer among Polish patients with cervical cancer in relation to illness acceptance, life satisfaction, and dispositional optimism

Activating positive coping strategies for cancer in the face of a new, changed health situation, good acceptance of the illness, life satisfaction, and dispositional optimism influence the quality of life of patients and are key factors important in the healing process. The study was conducted among 101 women diagnosed with cervical cancer. The research took place between 2023 and 2024. The diagnostic survey method was used, along with the following research tools: an original questionnaire, the Acceptance of Illness Scale (AIS), the Satisfaction with Life Scale (SWLS), the Life Orientation Test-Revised (LOT-R), and the Mini-Mental Adjustment to Cancer Scale (Mini-MAC). Sperman correlation analysis showed that LOT-R, SWLS and AIS significantly (p 0) correlate with two Mini-MAC strategies: fighting spirit and constructive style. Thus, higher levels of these adaptive coping strategies correspond to higher levels of optimism, life satisfaction, and illness acceptance. The most chosen style by the patients was the constructive style, as opposed to the destructive style, which promotes acceptance of illness, life satisfaction, and dispositional optimism. The determinants influencing acceptance of illness, life satisfaction, and optimism, as well as adaptation to cancer, were age, place of residence, duration of illness, and type of procedure performed.

Colposcopy in pregnancy

Colposcopy is a method of enhanced diagnostics of cervical dysplasia, aimed at preventing cervical cancer. Its role is the same in and out of pregnancy. It is often performed after obtaining abnormal results of cervical cytology or a test for human papillomavirus (HPV16 and HPV18), or any other abnormal findings such as polyps, or unexplained bleeding from the cervix. However, in pregnancy, the first screening test is still a cytological examination of the cervical smear. Colposcopy allows for the identification of suspicious lesions, which allows for a biopsy to be collected for histopathological evaluation. Biopsy is not recommended during pregnancy except for the detection of lesions suspected of being invasive. Colposcopy is minimally invasive, generally well tolerated and crucial for the early detection of cervical intraepithelial neoplasia (CIN) and other gynecological lesions. In pregnancy, this role is reduced to observing the cervix for the progression of lesions. Pregnancy-related lesions in the cervix sometimes make it difficult to assess the cervix effectively and reliably. Therefore, the experience of the physician performing colposcopy during pregnancy is of great importance. In this review we want to summarize the current data about colposcopy during pregnancy.

Uterine fibroids — why you should choose tailored therapies based on the joint decision of the physician and the patient

Uterine fibroids (UFs) are the most common benign tumors of the myometrium, affecting up to 70% women by age 50. Although many cases remain asymptomatic, symptomatic UFs can significantly reduce quality of life through excessive bleeding, anemia, pelvic pain, infertility, and obstetric complications. Despite the availability of various conservative treatments - including pharmacotherapy, uterine artery embolization, and ultrasound thermoablation - surgical interventions, particularly hysterectomy, remain the dominant approach in many countries. This discrepancy between evidence-based recommendations and routine practice highlights the persistence of a paternalistic model of care, where patients are often excluded from treatment decisions and not informed about alternatives. Emerging concepts such as shared decision making (SDM) and personalized therapy emphasize the need to adapt treatment plans to each woman's clinical profile, reproductive goals, and preferences. SDM fosters trust, better adherence to therapy, and improved acceptance of complications by actively involving patients in choosing their care. The development of modern pharmacological options, like GnRH analogs, further expands possibilities for effective, reversible, fertility-preserving treatments. A paradigm shift toward patient-centered, individualized management is essential to address ethical challenges, reduce unnecessary hysterectomies, and improve outcomes. Implementing SDM and expanding access to conservative therapies require systemic changes in reimbursement, training, and patient education to ensure that care focuses not only on the disease but on the woman as a whole.

Molecular classification in endometrial cancer — are we ready?

Folic acid versus folinic acid during methotrexate treatment for low-risk gestational trophoblastic neoplasia

To evaluate and compare the treatment results of folinic acid (FA) and folic acid (F) added to the chemotherapy protocol to reduce the toxicity due to methotrexate (MTX) in the treatment of low-risk gestational trophoblastic neoplasia (GTN) patients. Patients treated for low-risk GTN at two reference centers between January 2000 and March 2023 were included in this retrospective study. Patients were divided into two groups, MTX/FA and MTX/F. Both groups received 50 mg/day MTX on days 1, 3, 5, 7 of treatment. On days 2, 4, 6, 8 of treatment 0.1 mg/kg folinic acid was administered to the MTX/FA group, and 20 mg/day folic acid was administered to the MTX/F group to reduce MTX toxicity. The groups were compared according to treatment success, resistance, and the development of toxicity. Among 102 low-risk GTN patients included in the study, 64.7% (n = 66) were in the MTX/FA, while the remaining 35.3% (n = 36) were in the MTX/F group. There was no significant difference between MTX/FA and MTX/F groups regarding treatment success, resistance, and toxicity rates (84.8%, 13.6%, 1.6% vs 83.3%, 13.8%, 2.7%), respectively. Replacement of folinic acid with folic acid in low-risk GTN patients to reduce the toxicity that may develop associated with MTX treatment resulted in similar treatment success rates. Still, no significant change was observed regarding toxicity and resistance. There is a need for comprehensive prospective studies to further elucidate this relationship.

Cervical screening during pregnancy — a review of recommendations

Cervical cytology is a vital screening tool used to detect precancerous and cancerous cells in the cervix. The procedure is crucial in preventing cervical cancer by enabling the early detection and treatment of abnormal cells. In the context of pregnancy, cytology remains an essential component of prenatal care. Numerous studies confirmed that cytology was safe for both the mother and the fetus when performed correctly. The interpretation of cytological results during pregnancy requires careful consideration due to physiological changes in the cervix, which may mimic or obscure pathological findings. The review describes physiological changes in cervical cytology during pregnancy, interpretation challenges and the guidelines of international societies in this topic.

Clinical use of the Onclarity test with extended HPV genotyping and phenotyping in patients with suspected squamous intraepithelial lesions

Human papillomavirus (HPV) is the most widespread virus with oncogenic potential that infects humans and there is a need to look for the most effective screening method among the population. Understanding the role of HPV in cervical dysplasia and viruses typing increased the usage of HPV-based cervical cancer screening tests using genotyping. We aim to assess the usefulness the Onclarity Test with extended genotyping and phenotyping of HPV in detecting cervical squamous intraepithelial lesions in 695 subjects who registered for regular cervical screening or due to abnormal LBC result or positive HPV results. Incidence of positive HPV depended significantly on biopsy outcome (p < 0.001). It was the highest for patients with HSIL (92.5%), lower for patients with LSIL (57.9%) and with HPV outcome of biopsy (50.0%). The sensitivity of positive HPV for detecting HSIL was equal to 92.50% (95% CI: 79.61%-98.43%), and specificity equalled 55.26% (95% CI: 43.41-66.69%). Sensitivity of HPV positive for any of 16, 18, 31, 45, 51 or 52 genotypes but not belonging to the P1, P2 or P3 group for detecting HSIL equalled 62.50% (95% CI: 45.80-77.27%), specificity equalled 72.37% (95% CI: 60.91-82.01%). The Onclarity test is characterised by high sensitivity and specificity in detecting CIN2+ lesions. Extended genotyping enables the identification of the most common oncogenic HPV types in the population. It can be used as a basic tool for secondary prevention or together with LBC.

Transvaginal natural orifice transluminal endoscopic surgery-assisted versus transumbilical laparoendoscopic single-site ovarian cystectomy for ovarian mature cystic teratoma. A randomized controlled trial

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single-site surgery (LESS) have shown the prospection as minimally invasive procedures. Here we aimed to compare ovarian cystectomy assisted by vNOTES and by LESS for ovarian mature cystic teratoma (OMCT). A total of 81 premenopausal women with OMCT were randomized to undergo ovarian cystectomy assisted by either vNOTES (n = 41) or LESS (n = 40). The main outcome was the operative time. Secondary outcomes included the length of hospital stay, visual analog scale (VAS) pain scores, abdominal contamination by teratoma contents, and intraoperative and postoperative complications. There were no intergroup differences in age, body mass index, tumor size, or bilaterality of tumor. The operative time for the vNOTES group was significantly shorter than that for the LESS group (68.41 ± 20.92 min vs 85.05 ± 32.94 min, p = 0.008). The highest VAS pain score 24 hours postoperatively was 1.21 ± 0.48 in the vNOTES group and 2.43 ± 0.57 in the LESS group (p < 0.001). Twenty-four of the 40 patients in the LESS group experienced teratoma rupture intraoperatively, leading to abdominal contamination by the teratoma content, while 5 abdominal contamination was observed in the vNOTES group （p = 0.005. No significant differences between the two groups were observed in the other outcomes. vNOTES assisted ovarian cystectomy has short operative time, fast recovery, no scarring, less pain, and low rate of abdominal contamination. Consequently, vNOTES might be superior to LESS for treating OMCTs.

Expression of B7–H4 in endometrial cancer and its impact on patients’ prognosis

The aim of the study was to evaluate the B7-H4 expression in endometrial cancer cells and to investigate its relationship with patient prognosis and clinicopathological features of the disease. We performed a single-center, retrospective cohort study that included endometrial cancer patients treated between 2012 and 2019. B7-H4 expression in specimens obtained from 63 patients was examined by immunohistochemical staining. The evaluation of B7H4 immunoreactivity was assessed using Immunoreactivity Scoring (IRS) system. B7-H4 reactivity was observed in all, except one, endometrial cancer patients (98%). Staining intensity: no reaction in one case, weak in 16 (24%) patients, moderate in 25 (37%), and strong in 22 (35%). Twenty-nine (46%) patients showed B7-H4 immunoreactivity in more than 60% of cells, while, in 18 (29%) cases and 16 (25%) patients, the percentages were 30-60% and < 30% respectively. Median IRS was 2 (range 0-6). We found a significantly worse overall survival (OS) rate for patients with high versus low B7-H4 IRS (p = 0.03), however, in multivariate analysis, the difference in patient survival was close to the significance level (p = 0.052). B7-H4 expression was not related to histopathological type of the tumor, tumor grade, lymph node metastases, or the FIGO stage of the disease. Our result suggests that B7-H4 expression might be a useful prognostic factor in endometrial cancer.

Squamous cell carcinoma evolving from mature cystic teratoma of the ovary

Three natural pregnancies following embolization of both uterine arteries due to pseudoaneurysms associated with the gestational trophoblastic disease — long-term follow-up

Heat shock protein 27 (HSP27) in patients with ovarian cancer

Ovarian cancer remains a very common cause of death among women worldwide. The cause is to be found in too late of a diagnostic process and therapeutic difficulties The presence of heat shock proteins in the serum of ovarian cancer patients is still a new area of study. It is necessary to continue studies on the possibilities for using these markers to predict a patient's response to a specific therapy and to monitor treatment progress. The study included 52 women with ovarian cancer, hospitalised at the Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia. The control group consisted of 25 healthy women. The levels of HSP27 in the studied sera were determined by an immunoenzymatic method (ELISA). The mean concentration of HSP27 in the group of patients with ovarian cancer was significantly higher than in the control group of healthy women. We have shown that mean HSP27 levels in ovarian cancer patients increase with tumour progression and further depend on the clinical stage of the disease (FIGO). Positivity values analysis revealed in all clinical stages of ovarian cancer, excluding stage 1, it was significantly higher than in the control group, and at the 4th stage, it is significantly higher than at the 1st, 2nd, and 3rd stages. However, both for the untreated patients and those patients after chemotherapy, the mean HSP27 levels were significantly higher than in the control group. Our studies indicate a significant contribution of HSP27 to the pathogenesis of ovarian cancer. It seems that serum HSP27 can be a marker for this cancer's development, and a marker for the clinical stage.

A case of late diagnosis and management of 46 XY complete gonadal dysgenesis in adulthood

The relation of CD3, CD4, CD8 and PD-1 expression with tumor type and prognosis in epithelial ovarian cancers

Ovarian cancer is a heterogeneous disease, where chronic inflammation plays a key role in carcinogenesis. In this study, it is aimed to analyze the relationship with prognosis and chemotherapy response to clinicopathologicalnvariables in epithelial ovarian cancers such as proliferation of PD-1 +, CD8 +, CD4 +, CD3 + T-lymphocytes infiltrating the tumor and tumor stroma. Seventy-six cases diagnosed with primary epithelial ovarian tumor from biopsy or surgical resection materials were included in the study. Immunreactivity of CD3, CD4, CD8, PD1 was evaluated immunohistochemically in lymphocytes in tumor infiltrating lymphocytes and stromal lymphocytes. Seventeen (22.4%) of the cases were Type I, 59 (77.6%) of them were Type II ovarian carcinoma. PD-1 positivity was observed in stromal and intraepithelial lymphocytes in 22 (28.9%) of 76 cases. In the presence of PD-1 + T-lymphocytes that infiltrate tumor and stroma, disease-free survival are shorter (p = 0.037). The presence of stromal CD4 + and CD8 + T-lymphocytes was more common in late stage patients (p = 0.012, p = 0.036; respectively). The disease-free and overall survival rate was statistically significantly shorter in the presence of CD8 + T lymphocytes (p = 0.009, p = 0.003; respectively). CD3, CD4 and CD8 may contribute to PD-1 mediated tumor control. Anti PD-1 therapy may be an alternative to chemotherapy in PD-1 positive patients. Identifying patients who do not respond to chemotherapy through PD-1 expression prior to immunotherapy will help develop potential personalized immunotherapy.

The insolvable problem; survival effect of lymphadenectomy in advanced stage ovarian cancer

In this study, we aimed to evaluate the effect of systemic lymphadenectomy on overall and progression free survival in advanced stage of ovarian cancer. The data of ovarian cancer patients who had been admitted to our clinic between March 2008 and December 2019 were collected retrospectively. The patients who had received neo-adjuvant chemotherapy (NACT), those having undergone interval surgery, those who had non-epithelial ovarian cancer, those with residual tumour larger than 1 cm and those with stage I-IIA were excluded from the study. A total of 241 patients with inclusion criteria were included in the study. While 169 patients (70.1%) had undergone systemic lymphadenectomy (SLND), 72 (29.9%) had not. Lymph node involvement was present in 105 out of 169 patients (62.1%) who had undergone SLND. There was no statistically significant difference between the groups in terms of SLND and lymph node involvement for both progression free survival (PFS) and overall survival (OS) (p = 0.577, p = 0.493, p = 0.481, p = 0.849 respectively). When subgroup analysis was performed according to the residual tumor amount, we could not find any statistically significant difference in both PFS and OS in terms of SLND and lymph node involvement in R0 (complete resection) group (p = 0.057, p = 0.917, p = 0.106 and p = 0.980 respectively). We found similar results for patients in the R1 (optimal resection) group. It was found that performing systemic lymphadenectomy had no effect on both progressive and overal survival. It should be kept in mind that the increasing number of malignant lymph nodes removed could have a therapeutic effect in OS. Large numbers of randomized clinical trials are required to enlighten this debatable issue that has been continuing, particularly in the recent two decades.

Contemporary principles of diagnostic and therapeutic management in cervical and ovarian neuroendocrine tumors

Enhancing knowledge about neuroendocrine neoplasms causes the need to improve management of these tumors. Although these tumors are rare in clinical practice, their biological diversity makes both diagnostics and therapy a challenge for contemporary oncology. The article discusses the latest developments in the diagnostic procedures and methods of treatment of the cervical and ovarian neuroendocrine tumors. Algorithms are presented to understand the differences in therapeutic management in these malignancies.

Comparison of the clinical characteristics and prognosis between clear cell carcinomas and high-grade serous ovarian carcinomas

To compare the clinical characteristics and prognosis of women with clear cell versus high-grade serous ovarian carcinoma. Retrospective analysis of the clinical data of 50 cases patients with ovarian clear cell carcinoma (OCCC) and 103 cases with high-grade serous ovarian carcinoma (HGSOC), who were initially treated and completed standardized therapy in Affiliated Hospital of Qingdao University from January 2013 to December 2017. There were significant differences in age, gravidity (G > 1), chief complaint, with ovarian endometriosis, tumor diameter, unilateral or bilateral, cystic and solid tumor, CA125, HE4, CA199, lactate dehydrogenase (LDH), and FIGO stage between the two groups. The differences in the prognosis between OCCC patients and HGSOC patients with early stage (FIGO I-II) were not statistically significant. The 5-year overall survival and progression-free survival of OCCC patients were significantly worse than those of HGSOC patients with advanced stage (FIGO III-IV) (p < 0.05). FIGO stage and non-R0 resection were independent risk factors affecting the prognosis of patients with ovarian clear cell carcinoma, screening by Cox regression analysis. FIGO stage, the lowest value of CA125, and non-R0 resection were independent risk factors affecting the prognosis of patients with high-grade serous ovarian cancer. The clinical characteristics and prognosis of OCCC are different from those of HGSOC. Ovarian clear cell carcinoma (OCCC) patients have a significantly worse prognosis than those with HGSOC in the advanced stage (FIGO Ⅲ-Ⅳ). Satisfactory tumor resection is an essential factor related to the prognosis of patients with OCCC and HGSOC.

Breast injury as a manifestation of distant-metastatic ovarian cancer: a case report

Diagnostic accuracy of serum human epididymis protein 4 in ovarian cancer patients with different ethnic groups and menopausal status: a meta-analysis and systematic evaluation

We aimed to analyze and evaluate the diagnostic value of serum human epididymis protein 4 (HE4) in ovarian cancer (OC) of patients with different menopausal status. A comprehensive electronic and manual search of the relevant literature was performed through several databases such as CNKI, Wanfang database, VIP database, Chinese biomedical database, web of science, PubMed, EMBASE, and Cochrane database. We collected Chinese and English articles to assess the diagnostic value of HE4 for ovarian cancer in female with different menopausal status. The quality of the studies included in the systematic review was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A total of 14 publications were included in this study and we didn't find publication bias in them. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of HE4 for the diagnosis of ovarian cancer in postmenopausal vs premenopausal female were 0.71 (95% CI, 0.63-0.78) vs 0.78 (95% CI, 0.74-0.81); 0.91 (95% CI, 0.85-0.95) vs 0.90 (95% CI, 0.86-0.93); 11.90 (95% CI, 6.42-22.07) vs 11.03 (95% CI, 6.44-18.89); and 0.30 (95% CI, 0.22-0.39) vs 0.24 (95% CI, 0.20-0.29), respectively. Serum HE4 has greater diagnostic value in detecting ovarian cancer, especially in Asian postmenopausal female.

Advanced ovarian cancer imitating deep infiltrating endometriosis. Radical resection and reconstructive surgery of the anterior abdominal wall

Endometriosis is a disease affecting approximately 10-15% of the female population of reproductive age [1]. A rare location is endometriosis in the scar after caesarean section - CSE (caesarean scar endometriosis) accounting for 0.5-1.0 % of all cases. Although endometriosis is usually a benign condition, its malignant transformation affects 0.7-1% of cases. In women diagnosed with ovarian cancer, foci of endometriosis are present in up to 30% of patients. This paper presents the case of a 36-year-old patient initially diagnosed with extensive endometriosis involving the anterior abdominal wall and the pelvis minor. After biopsy, a diagnosis of advanced low-grade serous ovarian cancer was established. The diagnostic methods used and the extent of surgery with reconstruction of the anterior abdominal wall were described.

Non-obvious diagnosis and breast development in pure gonadal dysgenesis

Pure gonadal dysgenesis is a situation when the karyotype is 46, XY, but for various reasons there is a disorder of differentiation of Wolffian and Mullerian structures and in consequence the phenotype is female. It is known that abdominal gonads and the presence of Y chromosome allow to qualify this condition as a high risk of tumor. In most cases breast development is limited because of lack or low level of estrogen. A 27-year-old patient with differences of sexual development (DSD), was admitted to the Department of Endocrinological Gynecology for a control examination. In the history: dysgerminoma, primary amenorrhea and ambiguous karyotype. The patient has not taken hormonal replacement therapy. The breast development is Tanner stage V.

Recommendations of procedures to follow in the case of ovarian lesions in girls

This study presents current recommendations of the Polish Association of Pediatric Surgeons (PTChD) regarding diagnostics and treatment of ovarian lesions in girls. They are based on many years of the authors' clinical experience as well as a review of international literature and include practical clinical guidelines. The recommendations were formulated in cooperation with the Polish Association of Pediatric Oncology and Hematology (PTOHD), Polish Pediatric and Adolescent Gynecology Section of the Polish Society of Gynecologists and Obstetricians (PTG) and Polish Pediatric Section of the Polish Society of Radiology (PLTR). Only better understanding of prepubertal ovarian biology and natural history of its pathology may help to introduce efficient and safe diagnostic and therapeutic strategies for girls. The prepared document has been supplemented with treatment algorithms.

The usefulness of periostin determination in gynecology and obstetrics

Periostin (POSTN) is a multifunctional glycoprotein that belongs to the group of extracellular matrix (ECM) proteins. Due to the molecular structure, cellular interactions, tissue locations as well functions of POSTN, we realize that its pivotal role is organization and regulation of ECM microenvironment. In available databases there is a lack of data summarizing current knowledge about POSTN expression in the field of gynecology and obstetrics. We conducted a search in PubMed of the National Library of Medicine and Google Scholar. Databases were extensively searched for all original and review articles/book chapters published in English until December 2019 and related to periostin expression. All relevant articles were reviewed and presented as appropriate. In the field of POSTN expression there is only one paper evaluating its involvement in cervical cancer cell metabolism and only two studies analyzing its myometrial commitment: maintenance during pregnancy and induction of parturition in physiology as well control of fibroids biology in pathology. Much more attention has been devoted to the expression of described protein in the endometriosis, and above all in ovarian cancer. Finally, a few studies carried out among pregnant women were presented. In this review study we presented current knowledge about periostin expression in the field of gynecology and obstetrics. Many achieved results are interesting and further studies are needed to verify some hypotheses. Structure, signaling pathways as well many functions of periostin are well-described. However, as it was clearly shown there is a lot of unknown issues which are waiting to be explored.

Folate receptor-mediated cervical staining as an adjunct to colposcopy which can improve the diagnostic accuracy of detecting high grade squamous intraepithelial lesions

Cervical cancer is rated fourth in terms of incidence and cancer-related mortality in women. Cytology-based screening programs and colposcopy provided insufficient rates of detecting cervical intraepithelial neoplasia (CIN) prompting researchers to develop new tools. The aim of this study was to evaluate whether folate receptor-mediated staining is useful in detecting CIN2+ during gynecological examination with colposcopy. In total 96 women with abnormal cytology findings were enrolled. The study was conducted on the Polish population. The diagnostic process consisted of colposcopy, receptor-mediated diagnosis (FRD), and histopathology examination. All women were subjected to the same diagnostic procedure. The patient mean age of 96 women was 38 ± 14.5 years. On colposcopy, high-grade lesions were detected in 83 women. The FRD gave positive results in 63 women. Histopathology revealed 1 case of carcinoma plano epithelial akeratodes, 21 cases of high-grade squamous intraepithelial lesions, 13 cases of low-grade squamous intraepithelial lesions. A total of 61 cases presented no pathology. FRD as an adjunct to colposcopy gave the following test results in detecting CIN2+ lesions: sensitivity - 94.29%, specificity - 46.67%, PPV - 50.77%, NPV - 93.33%, and accuracy - 64.21%. Using both techniques provided better results than using each of the tests alone. FRD is a promising test for the diagnosing CIN2+ cervical pathologies because it can increase the probability of detecting CIN2+ without any additional burden posed on patients. Further studies should be conducted on large and various populations to complement current evidence.

Neoadjuvant chemotherapy in patients with vulvar carcinoma: a systematic review

Neoadjuvant chemotherapy is one of the options of treating patients with vulvar carcinoma. In this systematic review we searched three databases (Medline, EMBASE, Cochrane Library) for literature regarding this method of therapy. Additional sources were also searched. We included primary studies of any design with no language or date restrictions. Fourteen full-text studies were found; due to heterogeneity of data no quantitative synthesis was performed. Quality of evidence was very low, mainly due to population sizes and no available comparative data with other types of treatment. The results were mixed, however some of the studies reported promising results regarding survival and possibility of more conservative surgery. In general chemotherapy was well-tolerated, but in some studies regimens containing bleomycin and methotrexate presented particularly severe toxicity.

Factors limiting the detection of sentinel lymph nodes in early-stage cervical cancer

Sentinel lymph node detection (SLND) has not yet displaced lymphadenectomy, but it is a desired supplementary technique in cervical cancer surgery. The aim of our study was to identify the sources of SLND failure while performing the procedure by injecting blue dye (BD) into the cervix in cases of early-stage cervical cancer (ECC). We analyzed 27 consecutive ECC patients (FIGO IA2-IB1) who underwent hysterectomy with SLND and systematic lymphadenectomy between October 2011 and June 2014. The main inclusion criterion was at least unilateral SLND by BD. Predictors of either unilateral or bilateral staining were identified using multinomial logit models and a decision tree. Overall, bilateral staining was achieved in nine patients (33%). Among the factors analyzed, BMI > 23.5 kg/m2 was the only factor negatively affecting the quality of SLND using BD (p < 0.02) in the univariable multinomial logit model. All patients with BMI < 23.5 kg/m2 and depth of invasion ≥ 15 mm had unilateral mapping. Both obese and overweight patients are unlikely to achieve optimal SLN staining with BD alone. Although some possible reasons are discussed, we believe that further studies are needed to clarify the specific limitations of other dyes currently in use.

Retrospective analysis of the diagnostic effectiveness of the sentinel lymph node biopsy (SLNB) in vulvar cancer

Inguinal lymphadenectomy used in the treatment of vulvar cancer often results in complications, such as lymphoedema or abnormal wound healing. Aim of this study was assessment of the diagnostic effectiveness of the sentinel lymph node biopsy (SLNB) procedure in patients treated due to vulvar cancer. Eighty-four patients diagnosed with squamous cell vulvar carcinoma (FIGO I-IV) underwent preoperative lymphoscintigraphy with technetium 99 to map sentinel lymph node. During surgery sentinel lymph nodes were identified and resected, followed by complete bilateral groin lymphadenectomy. Sentinel lymph nodes were mapped with lymphoscintigraphy and biopsied in 84.3% and 90.1% of patients, respectively. False negative predictive value (FNPV) was 9.1% and false negative rate (FNR) was recorded in 16.7% of cases. Patients in advanced stages (FIGO III and IV) had significantly lower rate of lymphatic mapping compared to those in stage I and II (OR = 0.148, p = 0.022). Detection of sentinel lymph node in lymphoscintigraphy for tumor grade 2 and 3 was nearly eight times lower than for grade 1 cancers, however without statistical significance (OR = 0.126, p = 0.058). The use of SLNB should be limited to vulvar cancer patients in early clinical stages.

Radical hysterectomy and its importance in the concept of cervical cancer treatment

The role and place of a radical hysterectomy in the concept of cervical cancer treatment, despite over one hundred years of its traditional use, still excites controversy. To fully understand the value of the surgical treatment, it is worth analysing and understanding the evolutionary path of the radical hysterectomy and the changes that have occurred in this method over the years. This knowledge will allow for a better understanding as to why the choice of therapy between surgery and radiochemotherapy in the early and locally advanced stages of cervical cancer still raise doubts. Both the introduced changes in the scope of surgery and the use of multi-module treatment - surgery with subsequent radiation therapy did not significantly improve the results of cancer treatment, but significantly increased the prevalence of side effects and therapy complications. As cervical cancer most often affects relatively young women, the number of potential years of life after treatment is high. Over 30% of women in Poland with cervical cancer are in the 45-49 years-old age group. From the perspective of these data, obtaining a high therapeutic index, which is defined as the ratio of the number of healed patients to complications and side effects of treatment significantly reducing the quality of life, is very important in the therapy process. Regardless of the classical radical surgery, which has evolved over many years, a new concept of radical hysterectomy based on tissue morphogenesis, called total mesometrial resection (TMMR) with therapeutic Lymph Node Dissection (tLND) with no adjuvant radiotherapy, has recently been proposed. Based on the ontogenetic research and the study of cancerous tumour development, the concept of TMMR was first introduced by M. Höckel in 2001. In the research conducted by the author, encouraging results of the treatment of stages IB1, IB2, IIA1 and IIA2, and selected cases of stage IIB [according to 2009 International Federation of Gynecology and Obstetrics (FIGO)] cervical cancer were obtained.

Predictive values of PD‑L1 expression for survival outcomes in patients with cervical cancer: a systematic review and meta-analysis

Cervical cancer is one of the most common cancers in women worldwide. Although mortality has declined over the past 30 years in high-income areas, it remains a problem in several countries. Given that the prognosis of patients with recurrent or metastatic disease is poor, it is necessary to identify valuable predictive indicators to estimate survival outcomes in patients with cervical cancer. We searched electronic databases such as PubMed, Web of Science, Embase, Ovid MEDLINE, and the Cochrane Central Register of Controlled Trials, and investigated the relationship between Programmed death-ligand 1(PD-L1) expression and prognosis. Chi squared tests and I2 were utilized to assess study heterogeneity, and publication bias was estimated using Begg's funnel plot and Egger linear regression test. Thirteen eligible studies with 1422 patients were included. Generally, high PD-L1 expression was conclusively associated with poor overall survival (OS) (HR: 1.31; 95% CI 1.03-1.66, p = 0.025). However, PD-L1 expression demonstrated no association with progression-free survival (HR: 0.93; 0.73-1.19, p = 0.57). High PD-L1 expression with a sample size over 100 indicated a shorter OS (HR: 1.51; 95% CI 1.13-2.01). High expression of PD-L1 in Asians represented a lower OS (HR: 1.52; 1.14-2.03). Overexpression of PD-L1 in tumor cells (HR: 1.57; 1.29-2.10) and tumor-infiltrating immune cells (HR: 1.75; 1.02-2.99) predicted poor OS. High PD-L1 expression (HR: 4.04; 2.58-6.31) showed a lower effect on OS with a cut-off value of 5%. Our results indicate that high PD-L1 expression could be a valuable biomarker for predicting clinical outcomes in patients with cervical cancer.

Predictors of high-grade residual disease after repeat conization in patients with positive surgical margins

No consensus exists on the subsequent management strategy of patients who exhibit positive surgical margin (PSM) after re-excision of high-grade cervical intraepithelial neoplasia (CIN). The aim of the study is to examine the predictors related to the persistence of high-grade CIN lesions after re-excision, where PSM was left behind. The present retrospective study included patients with PSM who underwent repeated conization due to residual high-grade CIN lesions between January 2005 and December 2019. The SPSS software v20.0 was used for data interpretation and statistical analysis. P values less than 0.05 were accepted as statistically significant. Repeat conization was performed in 91 patients, 43 (47.3%) presented with PSM with high-grade CIN, 6 (6.5%) presented with micro-invasive carcinoma, and 42 (46.2%) presented with clear surgical margin or CIN 1 at the surgical margin. At the time of conization, patients who presented with lesions > 5 mm in repeat cone specimens, exhibited a significantly higher rate of residual disease (p < 0.001). Besides, the involvement of the endocervical margin with high-grade CIN was the predictor of residual disease in repeat cone specimens (p = 0.006). In the cone specimen, the presence of lesion size greater than 5 mm and involvement of the endocervical margin were the predictors of high-grade residual disease after re-excision. Whether it is the first or second procedure, great care must be given to excise the lesion entirely at the time of the conization, preferably in one piece.

Prognostic value of systemic inflammation response index in patients with persistent human papilloma virus infection

Persistent human papilloma virus (HPV) infection is a risk factor for the progression of cervical neoplasia into invasive carcinoma. Many inflammatory markers obtaining from hemogram parameters as platelets, monocytes, lymphocytes, and neutrophils or their ratios are still under investigation in recent decades, especially in the oncology era. Indeed, there have not been enough data about the relationship between these parameters and cervical cancer in the literature. Our primary aim was to investigate the possible relationship between the persistent HPV, which is one of the significant risk factors of cervical cancer, and these inflammatory markers. Further, we can add an easy follow-up parameter in women with persistent HPV infection. The study included patients between 30-65 years old, tested positive for HPV, and afterward had an HPV control test between January 2015 and June 2020. The study included 114 HPV DNA-positive patients. The mean age was 43 (standard deviation 8.7), and 41 of them (36%) had persistent HPV, but the remaining 73 (64%) did not. The baseline neutrophil/lymphocyte ratio (NLR) value was 2.1, platelet/lymphocyte ratio (PLR) was 133, monocyte/lymphocyte ratio (MLR) was 0.28, and systemic inflammation response index (SIRI) was 0.9. All the parameters were significantly higher in the persistent HPV group compared to the non-persistent group. Patients who had 0.65 and under this had a significantly lower risk of persistent HPV. Persistent HPV disease can be predicted with an elevated SIRI, NLR, and other hematologic parameters. So, we can closely follow up with these patients with different algorithms to prevent cervical cancer.

A survey of knowledge, attitudes and awareness of the HPV and HPV vaccine among obstetricians and gynecologists across Poland

The objective of this study was to assess general knowledge regarding human papillomavirus (HPV) and the attitude to primary prevention in form of HPV vaccination (HPVv) among Polish obstetricians and gynecologists (OBGYNs). In addition, we wanted to study the willingness of physicians to promote the HPVv among patients, based on their general attitude to vaccinations as well as HPV-related knowledge. The gynecologists were also asked to assess their patients' awareness of HPV infection. A questionnaire consisting of 25 questions was used to collect the data and with support of the Polish Society of Gynecologists and Obstetricians (PTGiP) and the Polish Society of Colposcopy and Cervical Pathology (PTKiPSM) sent via their mailing lists to all members and beyond. The total amount of 213 fully filled questionnaires were gathered and analyzed using descriptive statistics. Most of the surveyed OBGYNs showed a good knowledge of HPV and HPVv. They were able to correctly identify the high-risk oncogenic HPV types (hrHPV) and admitted to using HPV genotyping in their daily practice and actively promoting HPVv, being in majority supporters of mandatory vaccinations in general. Almost 90% confirmed the importance of informing patients about sexually transmitted diseases (STDs). On the other hand, there was a group of OBGYNs with clearly insufficient knowledge about the HPV and its prevention. General knowledge of Polish physicians about HPV is good, independent of gender and age. The acceptance of all vaccines is high, but the low availability of the HPV vaccines seems to be the biggest problem stopping patients from getting them.

Endocervical polyps in high risk human papillomavirus infections

Human papillomavirus (HPV) positive patients with and without endocervical polyps is compared with respect to HPV genotypes and presence of pre-invasive diseases. To our knowledge, this is the first and largest report in the literature examining the endocervical polyps in HPV positive cases. Clinicopathological data for the first one million screening patients (n = 1060 992) from around the entire country during 2015 and 2016 were targeted for this research. Colposcopy, colposcopic surgical diagnostic procedures and final pathology results of 3499 patients with high-risk (HR) HPV-positive were obtained from reference colposcopy centers. Patients with endocervical polyps (n = 243 [6.9 %]) were accepted as experimental arm while patients without any endocervical polyp (n = 3256 [93.1%]) were regarded as the control group. Age, HPV genotype, Pap smear abnormality, and final pathological results were compared between two groups using Student's t-test and cross-tabulation chi-square test. The incidence of endocervical polyp was found to be 6.9 % in HR HPV-positive women. The most common HPV genotypes observed in both groups were HPV 16 or 18. Abnormal cytology reports (≥ ASC-US) were not significantly different between both groups. However, with respect to final pathological diagnosis, patients with endocervical polyp had significantly lower numbers of pre-invasive diseases (31.3% vs 44.2%; p < 0.10). Endocervical polyps may be more common in patients with HR HPV infections. HPV 18 is observed significantly more, in the HR HPV positive endocervical polyp group. Patients with endocervical polyps do not have increased risk for preinvasive cervical diseases.

Gynecological complications and treatment strategies in patients after hematopoietic stem cell transplantation

In women after hematopoietic stem cell transplantation (HSCT), complications associated with the original disease and therapies used both before and after transplantation often occur, which significantly affects their quality of life. The most common gynaecological complications include secondary cancers, premature ovarian insufficiency (POI), infertility and chronic graft-versus-host disease (cGVHD). Cervical cancer is the most common secondary genital cancer in patients after HSCT. Regular screening and vaccination against HPV (Human Papillomavirus) can significantly reduce the risk for its occurrence. The specific complication after allogeneic hematopoietic stem cell transplantation is graft-versus-host disease (GVHD), the genital form of which can lead to labial and vaginal adhesions, significantly reducing the women's quality of life. The basis of treatment is local steroid therapy and immunosuppression. A consequence of chemotherapy and radiation therapy may be damage to the gonads leading to premature ovarian insufficiency and the onset of menopause symptoms. The basis of treatment is systemic hormone therapy used until middle age when natural menopause is reached. Women after HSCT who are of reproductive age also suffer from infertility. An important role of the doctor is to educate patients about the risk for infertility and to suggest appropriate methods of preserving fertility before starting treatment. The recommended procedure for fertility preservation is cryopreservation of embryos or oocytes. The freezing and retransplantation of ovarian tissue is becoming an increasingly popular method of fertility protection. Preventive examinations and early detection and treatment of gynaecological complications significantly improve the comfort of life and health of women after HSCT.

Rare presentation of mucinous ovarian cancer with aggressive features and unusual metastatic pattern