Journal of International Medical Research

NLRC5 promotes cell migration and invasion by activating the PI3K/AKT signaling pathway in endometrial cancer

Objective NOD-like receptor family caspase recruitment domain family domain-containing 5 (NLRC5) is involved in the development of cancer. Our objective was to explore the role of NLRC5 in the progression of endometrial cancer (EC). Methods The roles of NLRC5 in migration and invasion of AN3CA EC cells were examined by cell wound-healing assay, Transwell migration, and invasion analysis. Overexpression of NLRC5 was achieved with NLRC5 plasmid, and knockdown of NLRC5 was achieved using small interfering (si)RNA-NLRC5 in AN3CA cells. The expression of NLRC5 was detected by immunohistochemical, western blot, and quantitative real-time PCR. LY294002 was used to inhibit the phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway. Results NLRC5 was downregulated in EC tissue compared with normal endometrium. Overexpression of NLRC5 led to upregulation of cell migration and invasion in AN3CA cells and expression of matrix metallopeptidase (MMP)-9. Inhibition of NLRC5 restricted migration and invasion of AN3CA cells and expression of MMP9. Overexpression of NLRC5 promoted the activation of PI3K/AKT signaling pathway. Inhibiting PI3K/AKT signaling pathway by using LY294002 blocked the positive role of NLRC5 in migration and invasion of AN3CA cells and expression of MMP9. Conclusions These results demonstrate that NLRC5 promotes EC progression by activating the PI3K/AKT signaling pathway.

Biomarker cystatin B expression correlates with pathogenesis in cervical cancer

Objective Cervical cancer (CC) is one of the most common gynecologic malignancies worldwide. Although rapid improvements have been made regarding its prevention and treatment, little is known about disease pathogenesis and the clinical relevance of reliable biomarkers. The present study evaluated the expression of cystatin B (CSTB) as a potential biomarker of CC. Methods Tissue microarray analysis and immunohistochemical staining were performed to detect CSTB expression, while CSTB mRNA and protein expression levels of freshly isolated CC tissue were measured by quantitative real-time PCR and western blot, respectively. Bioinformatics were used to analyze the CSTB co-expression network and functional enrichments. Results We observed high CSTB mRNA and protein expression levels in CC tissues, which was confirmed by tissue microarray in a comparison with paired adjacent non-cancerous cervical tissue samples. CSTB gene enrichments and associations with co-expressed genes were also observed. Further analysis showed that elevated CSTB expression was associated with pathological progress in CC. Conclusion Our data demonstrate that CSTB has the potential to be used as a tissue biomarker with clinical value in patients with CC, which may aid the development of intervention strategies.

High-risk human papillomavirus infection among Nigerian women: A systematic review and meta-analysis

Objective We conducted a systematic review and meta-analysis to determine the prevalence of high-risk human papillomavirus (hrHPV) infection and its associated risk factors among Nigerian women. Methods Databases including PubMed, Web of Science, Scopus, and CINAHL were searched for studies published between 01 January 2001 and 31 December 2022, that had reported hrHPV infection and associated risk factors among women in Nigeria from ages of 25 to 65 years. Results Of the 136 records initially retrieved, 18 were eligible for analysis. The prevalence of hrHPV genotypes was 25%, and for hrHPV 16 and 18, were 9% and 10%, respectively. The prevalence of hrHPV among HIV+ve women was 71%. The most common risk factors for hrHPV were age at coitarche and multiple sex partners. Conclusion hrHPV prevalence is high in women in Nigeria and common among those HIV+ve. Rapid screening for hrHPV genotypes is recommended, and multivalent HPV vaccines should be considered for women.

Spontaneous arterial thrombosis in a patient with advanced ovarian clear cell cancer: a case report and literature review

Patients with ovarian cancer are often in a hypercoagulable state and have a high risk of venous thrombosis, including deep vein thrombosis and pulmonary embolism. However, arterial thrombosis is relatively rare in ovarian cancer. We report a case a 46-year-old woman with ovarian clear cell carcinoma who developed arterial and venous thrombosis in the lower extremities as the first manifestation. Her arterial thrombosis-related ischemic symptoms were not responsive to anticoagulant treatment of low-molecular-weight heparin, but improved after neoadjuvant chemotherapy and surgery. Therefore, we hypothesize that the optimal therapy for arterial thrombosis in ovarian cancer is treatment for the underlying disease (i.e., ovarian cancer). A thorough investigation is required to determine the relationships between arterial thrombosis and ovarian cancer and antithrombotic treatments for ovarian cancer related-arterial thrombosis.

Retroperitoneal dermoid cyst complicated with uterine adenomyoma: a case report and literature review

Pelvic masses frequently originate from the pelvic cavity and are often associated with uterine, ovarian, or intestinal disorders. This report describes the case of a patient with a pelvic mass diagnosed as a retroperitoneal dermoid cyst at our hospital. We analyzed this case and conducted a literature review, to mitigate the risk of misdiagnosis and enhance the treatment of retroperitoneal masses.

Expression and clinical value of EIF3CL in serous ovarian cancer

Objectives This study aimed to explore the expression of eukaryotic translation initiation factor 3 subunit C-like in serous ovarian cancer samples (both paraffin-embedded and fresh samples) and evaluate its clinical value in patients with serous ovarian cancer. Methods Twenty-five fresh serous ovarian cancer tissues and their paired paratumor tissues were subjected to reverse transcription–quantitative polymerase chain reaction assay to detect eukaryotic translation initiation factor 3 subunit C-like messenger RNA expression. In addition, 135 paraffin-embedded serous ovarian cancer samples and 36 paratumor samples were assessed for eukaryotic translation initiation factor 3 subunit C-like protein expression using immunohistochemistry. Results Both protein and messenger RNA expression levels of eukaryotic translation initiation factor 3 subunit C-like were higher in serous ovarian cancer samples than in paratumor samples, and its high expression was associated with poor overall survival in patients with serous ovarian cancer. In addition, multivariate Cox regression analysis showed that high expression of eukaryotic translation initiation factor 3 subunit C-like was an independent poor prognostic factor for patients with serous ovarian cancer. Conclusions Eukaryotic translation initiation factor 3 subunit C-like is upregulated in serous ovarian cancer samples, and it may be recommended as a useful poor prognostic biomarker in patients with serous ovarian cancer.

Ovarian hemangioma: A rare case report

Ovarian hemangioma is an extremely rare benign tumor in clinical practice. We report the case of a postmenopausal woman presenting with vaginal bleeding, in whom imaging revealed a right adnexal mass. Surgical excision of the adnexa was performed, and pathological examination confirmed a right ovarian hemangioma. Concurrent findings included endometrial polyps and cervical polyps.

Spontaneous ovarian hyperstimulation syndrome mimicking ovarian cancer in a nonpregnant woman: A case report and literature review

Spontaneous ovarian hyperstimulation syndrome is an extremely rare condition, especially in nonpregnant women who do not exhibit exogenous ovarian stimulation. Herein, we present a case of spontaneous ovarian hyperstimulation syndrome in a 28-year-old nonpregnant woman who presented with life-threatening multiorgan dysfunction. Initial imaging studies and tumor marker assessment suggested the presence of a malignant ovarian tumor, posing substantial diagnostic challenges. The patient underwent emergency surgery due to severe hemorrhagic shock. Intraoperative findings revealed irregular and deformed ovaries; however, histologic examination showed luteinizing hemorrhagic cysts, leading to a diagnosis of spontaneous ovarian hyperstimulation syndrome. This case highlights the importance of considering spontaneous ovarian hyperstimulation syndrome in the differential diagnosis of ovarian enlargement with ascites, even in the absence of pregnancy or ovarian stimulation. It also underscores the critical role of expert radiological interpretation in such complex cases.

Squamous cell carcinoma of the cervix associated with choriocarcinomatous differentiation: a case report and review of the literature

The morphology of the choriocarcinomatous variant of cervical squamous cell carcinoma (SCC) suggests an undifferentiated aggressive biological behaviour and a poor outcome, for which standard treatment has not been established. In addition, cases are rarely reported, with only five cases of patients with cervical carcinoma with choriocarcinoma reported previously in the literature. This current case report describes in detail a patient who was diagnosed with cervical SCC mixed with choriocarcinomatous differentiation. The case report includes details of the diagnosis, pathology, short tandem repeat genotyping, treatment and follow-up of this patient. As there is no standard treatment for this variant, the patient underwent surgery followed by radiotherapy. Unfortunately, 4 months after therapy discontinuation, radiological evaluation and laboratory tests documented a recurrence of the disease and the patient died. This report also systematically reviews the literature on cervical cancer associated with choriocarcinomatous differentiation and the five previous cases. It provides the most up-to-date summary of this disease, including its clinical manifestations, histopathology, diagnosis, treatment and prognosis.

Anticoagulation therapy for a rare case of pseudo-Meigs’ syndrome complicated by massive ascites in the postpartum period

Most persistent symptoms of pseudo-Meigs’ syndrome (PMS) are alleviated by surgical tumor removal. The present case report suggests that PMS may present with ascites and hypercoagulation and that emergency anticoagulation can improve the patient’s condition. We herein describe a postpartum woman with an acute presentation including abdominal pain, ascites, postpartum hemorrhage, and degeneration of a large uterine fibroid. Initial evaluation revealed unexpected massive ascites, pleural effusion, a highly elevated D-dimer level, and a moderately elevated CA125 level. Following anticoagulation therapy, the ascites, abdominal pain, and pleural effusion resolved. There was no recurrence of these symptoms during follow-up, although the large degenerating uterine fibroid and mildly elevated serum CA125 level persisted. Postoperatively, pathological analysis confirmed leiomyoma, the patient’s CA125 level returned to normal, and the ascites resolved, meeting the diagnostic criteria for PMS. Further studies are needed to determine whether a hypercoagulable state is common in pregnant patients with PMS and to develop strategies to improve outcomes.

Primary ovarian leiomyosarcoma: a case report

Primary ovarian sarcoma is a rare malignancy, with primary ovarian leiomyosarcoma being even rarer because of the lack of smooth muscle in the ovaries. We herein report a case of primary ovarian leiomyosarcoma in a woman in her late 50s who presented with a 6-month history of abdominal pain. Imaging revealed a pelvic mass. The patient underwent surgery and was diagnosed with ovarian leiomyosarcoma. One month postoperatively, she began gemcitabine and docetaxel chemotherapy and continued this treatment for 6 months. Eight months postoperatively, however, recurrence was detected in the pelvic cavity. This case is reported with the aim of raising awareness about this rare disease.

Heterotopic pregnancy: a case report of intrauterine hydatidiform mole with tubal pregnancy

We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy.

Computed tomography–based radiomics modeling to predict patient overall survival in cervical cancer with intensity-modulated radiotherapy combined with concurrent chemotherapy

Objective The objective of this study was to develop a predictive model combining radiomic characteristics and clinical features to forecast overall survival in cervical cancer patients treated with intensity-modulated radiotherapy and concurrent chemotherapy. Methods In this retrospective observational study, 159 patients were divided into a training group (n = 95) and a validation group (n = 64). Radiomic characteristics were extracted from contrast-enhanced computed tomography scans. The least absolute shrinkage and selection operator regression analysis was used to filter the extracted radiomic characteristics and reduce the dimensionality of the data. A radiomic score was calculated from the selected features, and multivariate Cox regression models were established to analyze overall survival. A nomogram combining radiomic score and clinical features was developed, and its reliability was assessed using the area under the receiver operating characteristic curve. Results Four radiomic characteristics and two clinical features were extracted for overall survival analysis. A nomogram combining these factors was developed and validated, showing good performance with a high C-index. Patients were categorized as low-risk or high-risk for overall survival based on a cut-off value. Conclusions Our model combining computed tomography–extracted radiomic characteristics and clinical features shows good potential for evaluating overall survival in cervical cancer patients treated with intensity-modulated radiotherapy and concurrent chemotherapy.

BRCA mutation status and pathological characterization of breast cancer in Zhoushan Islands, China

Objective To investigate BRCA1/ 2 gene mutations and their relationship with clinicopathological features in patients with breast cancer in Zhoushan Islands. Methods High-throughput whole-exome gene sequencing was used to detect BRCA1/ 2 mutations in 776 breast cancer patients in Zhoushan Islands. Results The BRCA1/ 2 mutation rate of breast cancer patients in Zhoushan Islands was 4.38% (34/776). BRCA1 mutations were significantly correlated with age, molecular type, and family history of breast and ovarian cancers. BRCA2 mutations were most commonly found in invasive lobular carcinoma. Moreover, the BRCA2 mutation rate of cancers with molecular type luminal B (receptor protein–tyrosine kinase [HER2]-negative) was also relatively high. Conclusion The rate of BRCA1/ 2 mutations in breast cancer patients from Zhoushan Islands is approximately 4.38%, and BRCA1 mutation is related to age, molecular type, and family history of breast and ovarian cancers.

A rare case of chronic complete uterine inversion in a postmenopausal woman: a case report and literature review

Uterine inversion is a rare condition that refers to the collapse of the fundus into the uterine cavity and occurs in puerperal and non-puerperal conditions. Non-puerperal uterine inversion is particularly infrequent. Diagnosing non-puerperal uterine inversion is often challenging because it resembles vaginal or cervical tumors and pelvic organ prolapse. Furthermore, this condition alters the anatomical structure of pelvic organs, thereby complicating diagnosis and treatment, and potentially leading to misdiagnosis with grave consequences. We report a case of a postmenopausal woman who presented with irregular vaginal bleeding and dysuria for 2 months. Preoperative enhanced pelvic magnetic resonance imaging suggested a benign tumor combined with uterine inversion, which was subsequently confirmed during surgery. A laparoscopic attempt to reposition the uterus failed, leading to successful repositioning via an abdominal incision and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy. A histopathological examination showed a submucosal leiomyoma, which was smaller than that typically reported in other cases. We also conducted a review of previous cases to offer empirical guidance for the diagnosis and treatment of this rare condition.

Ovarian serous carcinoma with stomach metastasis: a rare case report and literature review

Ovarian cancer is a common tumor among women. It is often asymptomatic in the early stages, with most cases already at stage III to IVE at the time of diagnosis. Direct spread and lymphatic metastasis are the primary modes of metastasis, whereas hematogenous spread is rare. An initial diagnosis of ovarian cancer that has metastasized to the stomach is also uncommon. Therefore, clear treatment methods and prognostic data for such metastasis are lacking. In our hospital, we encountered a patient with an initial imaging diagnosis of a gastric tumor and a history of an ovarian tumor with endoscopic abdominal metastasis. Based on the characteristics of the case, the two tumors were considered to be the same. After chemotherapy, a partial response was observed in the stomach and pelvic lesions, suggesting the effectiveness of the treatment. Through three treatments of recurrence, gastroscopy confirmed the stomach to be a metastatic site. Therefore, determining the primary source of advanced tumors is crucial in guiding treatment decisions. Clinicians must approach this comprehensively, relying on thorough evaluation and personal experience.

Diagnostic roles of neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein, and cancer antigen 125 for ovarian cancer

Objective To compare the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein (CRP) level, and cancer antigen 125 (CA125) level for ovarian cancer (OC). Methods Data of 72 patients with OC, 50 patients with benign ovarian disease, and 46 healthy controls were retrospectively analyzed, and receiver operating characteristic analysis was performed. Results The platelet count was higher in patients with a tumor diameter of ≥10 vs. <10 cm. The absolute lymphocyte count was significantly higher in patients with stage I/II OC than in those with multiple and stage III/IV OC. The absolute monocyte count, NLR, MLR, and CA125 were significantly higher in patients with multiple and stage III/IV OC than in those with single and stage I/II OC. The NLR, PLR, MLR, fibrinogen, D-dimer, CRP, and CA125 were useful for distinguishing between the OC and healthy control groups. Conclusions Our analysis showed that the following combinations have practical diagnostic value in OC: NLR + PLR + MLR + CA125, NLR + PLR + MLR + CA125 + CRP, NLR + MLR +PLR + CA125 + CRP + fibrinogen, and NLR + MLR + PLR + CA125 + CRP + fibrinogen + D-dimer.

Identification and validation of a seven cuproptosis-associated lncRNA signature to predict the prognosis of endometrial cancer

Objective Endometrial cancer (EC) is one of the most prevalent cancers in women. Long non-coding RNAs (lncRNAs) are potential diagnostic biomarkers in patients with EC. Methods We obtained clinical information and transcriptome data for 552 patients with EC from The Cancer Genome Atlas database. Cuproptosis-associated lncRNAs were obtained through Pearson’s correlation analysis. Univariate and multivariate Cox regression analyses were applied and a signature predicting overall survival (OS) among patients with EC was constructed. We also analyzed the tumor immune microenvironment and drug sensitivity. The results were validated by quantitative real time-polymerase chain reaction, and 5-ethynyl-2′-deoxyuridine and wound-healing assays. Results Seven cuproptosis-associated lncRNAs related to prognosis were screened out and a signature was constructed. OS was significantly superior in the low-risk group. In addition, patients in the low-risk group had more CD8+ T cell infiltration, a stronger type II interferon response, and greater cisplatin sensitivity. Expression levels of some of the lncRNAs were significantly increased by cuproptosis. Furthermore, silencing of lncRNA AC084117.1 significantly inhibited the proliferation and migration of EC cells. Conclusion We constructed a seven cuproptosis-associated lncRNA signature to predict the prognosis of patients with EC with good predictive power.

High FGF18 expression levels predict poor prognosis in endometrial carcinoma patients and promote tumor growth and metastasis

Objective To investigate if fibroblast growth factor 18 (FGF18) expression plays an important role in endometrial carcinoma (EC). Methods The clinicopathological associations and prognostic value of FGF18 expression were retrospectively analyzed in 190 patients with EC. FGF18 expression was stably knocked down in EC cell lines. Changes in cell proliferation, migration, and invasion rates were examined via cell behavior experiments. Tumor growth was investigated using a xenograft mouse model. RNA sequencing (RNA-seq) was performed to identify differentially expressed genes (DEGs) in HEC-1-B cells after FGF18 knockdown, followed by pathway enrichment analysis of the DEGs. Results High FGF18 expression levels were closely correlated with EC clinicopathological features, such as histological subtype, FIGO stage, depth of myometrial invasion, and tumor size. Moreover, EC patients with high FGF18 expression levels had poorer overall survival. FGF18 knockdown in EC cells revealed its role in promoting tumor cell proliferation, migration, and invasion in vitro, as well as tumor growth in vivo. RNA-seq of HEC-1-B cells revealed that the DEGs were enriched in signaling pathways related to cell proliferation and migration. Conclusions Overexpression of FGF18 may serve as a prognostic biomarker for EC patients and is a potential therapeutic target for treating this disease.

Long non-coding RNA (lncRNA) HOXB-AS3 promotes cell proliferation and inhibits apoptosis by regulating ADAM9 expression through targeting miR-498-5p in endometrial carcinoma

Objective Long non-coding RNA (lncRNA) expression is closely related to the pathogenesis and progression of various tumors. In this study, we investigated the mechanisms of lncRNA HOXB cluster antisense RNA 3 (HOXB-AS3), miRNA(miR)-498-5p, and disintegrin and metalloproteinase domain-containing protein 9 (ADAM9) in endometrial carcinoma (EC) cells. Methods The expression levels of lncRNA HOXB-AS3 in EC tissues and cells were detected using RT-qPCR assays. The effects of HOXB-AS3 knockdown on EC cell proliferation and apoptosis were measured using CCK-8 assays, colony formation assays, and flow cytometry. In addition, putative miR-498-5p binding sites were identified in HOXB-AS3 and ADAM9. The targeted relationships were further verified using dual-luciferase reporter and RNA pull-down assays. Results HOXB-AS3 expression was upregulated in EC tissues and cells. EC cell proliferation and viability decreased significantly in HOXB-AS3 knockdown groups. A putative miR-498-5p binding site in HOXB-AS3 was verified. Inhibition of miR-498-5p rescued the effects of HOXB-AS3 knockdown on cell proliferation and apoptosis. Finally, ADAM9 was verified as a direct target gene of miR-498-5p. Conclusions Our results suggest that lncRNA HOXB-AS3 is highly expressed in EC tissues and cells. Downregulation of HOXB-AS3 inhibits cell proliferation and promotes apoptosis in EC cells. HOXB-AS3 can upregulate ADAM9 expression by sponging miR-498-5p.

Right diaphragm metastasis of endometrial cancer: a case report

A diaphragmatic tumor is usually caused by metastasis from lung cancer, malignant mesothelioma, and malignant thymoma. Endometrial cancer is rarely involved in metastasis to the diaphragm. A right anterior mediastinal tumor was found in a 60-year-old woman who was initially diagnosed with endometrial carcinoma. There was initially no relationship between the right anterior mediastinal tumor and endometrial carcinoma. Radical curative surgery was performed for endometrial carcinoma. The endometrial carcinoma stage was IA. The patient was admitted to the Department of Thoracic Surgery 6 months after the curative surgery. Intraoperative exploration showed a tumor growing in the right diaphragm. Right diaphragmotomy was performed. Immunohistochemistry showed metastasis of endometrial carcinoma to the diaphragm. Endometrial cancer solitary metastasis to the diaphragm is rare. Clinicians should be aware of this possibility. Surgical treatment followed by a pathological examination is the most useful method for determining the diagnosis of a diaphragmatic tumor due to metastasis of endometrial cancer.

Expression of IL17A in endometrial carcinoma and effects of IL17A on biological behaviour in Ishikawa cells

Objective A growing body of evidence suggests chronic inflammation triggers the process of endometrial carcinogenesis. Interleukin (IL) 17A is an important proinflammatory factor involved in the tumour angiogenesis processes of many solid tumours. This study aimed to characterize the function of IL17A in endometrioid-type endometrial carcinoma. Methods Levels of IL17A in human endometrial tissues were analysed by immunohistochemistry. In vitro proliferation and migration were analysed in Ishikawa cells treated with IL17A, using cell counting kit-8, wound healing and transwell assays. Western blots were used to analyse levels of oestrogen receptor (ER)α and ERβ proteins in Ishikawa cells treated with IL17A. Results IL17A levels were significantly higher in endometrial carcinoma tissues than in endometrial hyperplasic tissues. Significantly increased proliferation and migration was observed in Ishikawa cells treated with IL17A versus controls. Investigation of the molecular mechanism revealed that IL17A treatment upregulated the ERα/ERβ protein ratio in Ishikawa cells. Conclusions IL17A may be an important proinflammatory factor involved in promoting endometrial carcinogenesis.

Endometrial adenocarcinoma metastatic to the pituitary gland: a case report and literature review

Pituitary metastases are rare, and metastatic pituitary lesions originating from endometrial adenocarcinoma are extremely rare. These lesions can be mistaken for pituitary adenomas and their diagnosis can be very difficult. Pituitary metastases mostly affect the posterior lobe and patients may develop diabetes insipidus. Patients with endometrial cancer complicated with diabetes, including poor glycemic control, may also suffer from thirst, making it more difficult to diagnose diabetes insipidus. A 68-year-old woman who was being followed-up for primary endometrial adenocarcinoma was admitted for gradually worsened polyuria and polydipsia. Her laboratory findings were compatible with diabetes insipidus. Magnetic resonance imaging revealed thickening of the pituitary stalk, involvement of the superior pituitary gland, and disappearance of hyperintensity in the posterior lobe, indicating pituitary metastasis. Increased urine output and oral fluid intake in a patient with a diagnosis of carcinoma may indicate possible pituitary metastasis, and the hormonal insufficiency should be corrected to improve the patient’s quality of life.

Mature cystic teratoma arising from the fimbrial end of the left fallopian tube. a case report

We present a rare case of a woman with a mass containing soft tissue, fat, and calcified components attached to the fimbrial end of the left fallopian tube. A 38-year-old nulligravida woman who visited our clinic for infertility counseling had mild abdominal discomfort and a palpable mass in the lower abdomen. Multiple examinations were performed. Preoperatively, we considered that the patient had teratoma or teratocarcinoma of the left ovary. On exploratory laparotomy, we found that she had a mass with protuberances and a bulbous projection at one surface that was attached to the fimbrial end of the left fallopian tube. A histopathological examination showed a mature cystic teratoma that arose from the fimbrial end of the fallopian tube. Obstetricians should be aware of this abnormality. Early detection of this abnormality is advantageous for infertility counseling and planning of less invasive surgery in the hospital.

Collision carcinoma of endometrial adenocarcinoma and primary serous fallopian tube carcinoma: a case report

Collision carcinoma is a rare malignancy that generally occurs in cervical, esophageal, pulmonary, and squamous cell cancers. Few studies have been reported involving endometrial adenocarcinoma and fallopian tube carcinoma. We reported the case of a 58-year-old woman who presented because of irregular vaginal bleeding for more than 1 month. Cervical biopsy suggested moderately differentiated cervical adenocarcinoma, and the patient underwent radical hysterectomy under general anesthesia. However, postoperative pathology and immunohistochemical results indicated a collision tumor comprising endometrial adenocarcinoma (grade I) and primary serous fallopian tube carcinoma. According to the treatment principle of multiple primary tumors, a regimen of paclitaxel combined with carboplatin was administered. The patient also underwent local pelvic radiotherapy to treat lymph node metastasis. One month later, the patient developed brain metastases and died.

Sister Mary Joseph’s nodule as the first presenting sign of advanced fallopian tube carcinoma: A case report

Fallopian tube carcinoma has a rare incidence and dismal prognosis. Sister Mary Joseph’s nodule is an intra-abdominal tumor that metastasizes to the umbilicus. To date, fewer than 10 cases of fallopian tube carcinoma with Sister Mary Joseph’s nodule have been reported, with most of them exhibiting a very poor prognosis. Herein, we described a case of fallopian tube carcinoma with Sister Mary Joseph’s nodule. A 57-year-old woman was referred to the Affiliated Hospital of Shandong Second Medical University in May 2020 owing to a mass in the middle of her umbilicus. She was first diagnosed with an umbilical mass and underwent a resection of the umbilical mass, which revealed adenocarcinoma, most likely of reproductive origin. One month after the first surgery, she underwent laparoscopic cytoreductive surgery, and pathological examination revealed fallopian tube adenocarcinoma with pelvic lymph node metastasis. She was diagnosed with fallopian tube carcinoma (stage IIIC) and then underwent 10 cycles of chemotherapy. She achieved a complete response, and no recurrence or progression has been reported until now. The overall survival time exceeded 50 months. Thus, for patients with umbilical masses, physicians should consider the possibility of Sister Mary Joseph’s nodule. When a malignancy is suspected in the abdominal or pelvic cavity but the physical examination and imaging studies reveal no abnormality, laparoscopic surgery should be used for determining the primary tumor. For patients with fallopian tube carcinoma and Sister Mary Joseph’s nodule, surgery and adjuvant chemotherapy can achieve good results.

Fallopian tube serous adenocarcinoma with dizziness as the initial symptom: a case report

Paroxysmal vertigo as the presenting symptom of a fallopian tube tumor is rare among patients. We present a patient who was finally diagnosed with fallopian tube serous adenocarcinoma with subacute cerebellar degeneration. We analyzed the patients’ clinical, pathological, and imaging data. We conclude that the possibility of paraneoplastic neurological syndrome should be considered when conventional treatment is ineffective for a fallopian tube tumor and other neurological diseases are excluded.

Tumor-like ovarian endometriosis with pregnancy decidua reaction: A case report and review of the literature

We describe a case of bilateral ovarian tumor-like lesions detected during pregnancy. It is important to highlight that these masses were not detected for the first time during pregnancy; the patient had already been aware of them 2 years prior, during pregnancy preparation, when an ultrasound examination revealed bilateral space-occupying ovarian lesions. These lesions did not exhibit any increase in size during regular follow-ups until pregnancy. At 17 weeks of gestation, fetal ultrasound showed significant enlargement of the bilateral ovarian lesions. The patient underwent pelvic magnetic resonance imaging, which revealed cystic masses in both the ovaries with septations and multiple nodular and flocculent projections on the walls and septations, exhibiting features resembling malignant tumors. The cystic fluid within each cyst predominantly showed slightly short T1 and long T2 signal characteristics. The final diagnosis of lesions occupying the ovarian space was endometriotic cysts with a decidual reaction associated with pregnancy, which was confirmed on postoperative pathological examination. Subsequently, at 19 weeks of gestation, the patient underwent a “laparoscopic excision of the left ovarian lesion and right ovarian lesion stripping.” The patient recovered well postoperatively and successfully delivered a baby at 39 weeks of gestation. Endometriosis with decidual reaction during pregnancy is rare and ectopic decidual tissue can easily be confused with neoplastic lesions using imaging results. In addition, clinicians must remain vigilant about the special conditions that ectopic decidual tissue may cause, such as cyst rupture, massive hemorrhage, dystocia, and even fetal death.

Successful treatment of advanced ovarian cancer with anlotinib: a case report

Ovarian cancer remains the most lethal gynecological malignant tumor, with relapse occurring in approximately 70% of advanced cases. Anlotinib is an oral small-molecule multi-targeted tyrosine kinase inhibitor that can resist neoangiogenesis and inhibit tumor growth. Previous research demonstrated clinical antitumor activity of anlotinib in various cancers. We report the case of an elderly woman with advanced ovarian cancer who received anlotinib after failure of multiple-line chemotherapy. A partial response was observed after six cycles of anlotinib monotherapy, with a reduction in the size of the metastases and significantly decreased serum CA125 levels from 1832.7 U/mL to 118.7 U/mL. She continued to take anlotinib, with a progression-free survival time of more than 4 months. Only mild hypertension was observed during the treatment. Anlotinib monotherapy may be a novel therapeutic option for patients with advanced ovarian cancer.

Multiple injections of indocyanine green for improving the outcomes of lymphatic-venous anastomosis reconstruction of lymphatic return under microscopy: A case report

This study explores effective treatment methods for chronic secondary lymphedema after radical cervical cancer surgery combined with pelvic lymphadenectomy. In cases where conservative treatment was ineffective, we investigated whether multiple injections of indocyanine green can effectively improve the outcomes of lymphatic-venous anastomosis under microscopy. Preoperative lymphatic imaging was used to localize functional vessels, guiding distal left lower limb lymphatic reconstruction. Intraoperatively, supermicroscopy (40×) and real-time indocyanine green imaging enabled eight end-to-end anastomoses between 0.5- and 1.3-mm lymphatic capillaries and subcutaneous veins. Each anastomosis took ≤30 min, with intraoperative lymphangiography confirming patency. Immediate postoperative lymphatic diversion to veins was observed. By day 3, reconstructed pathway efficiency reached 83% of the healthy side, with visual analog scale pain scores decreasing from 5 to 2. At 3–6 months, mid-thigh and calf circumferences reduced progressively; ultrasound confirmed edema resolution and complete cessation of exudation. High-precision multipoint supermicrosurgical anastomosis achieved anatomical and functional reconstruction of chronic secondary lymphedema, overcoming traditional size and functional limitations. Innovations included multipoint design to prevent reobstruction and dynamic imaging-guided precision. This case establishes a radical treatment strategy for chronic secondary lymphedema.

Mixed sex cord–stromal tumor (gynandroblastoma) with malignant morphology involving both ovaries: a case report

Mixed sex cord–stromal tumors, which consist of poorly differentiated Sertoli cells and Leydig cells and juvenile granulosa cell tumor tissue, are extremely rare. Most of these tumors are unilateral and stage I at the time of diagnosis; nonetheless, according to the available relevant English-language literature, these tumors maintain a malignant potential. We herein report a case involving a 15-year-old girl diagnosed with a mixed sex cord–stromal tumor (gynandroblastoma with juvenile granulosa cell tumor component). Left salpingo-oophorectomy was initially performed, and the diagnosis of a juvenile granulosa cell tumor was established. Right salpingo-oophorectomy was performed 1 year later, at which time the specimen showed a different growth pattern involving epithelioid cells and tubules, resembling a Sertoli–Leydig cell tumor. Immunohistochemical staining was performed and the specimen was compared with that obtained 1 year earlier. We concluded that the tumors were linked and most likely constituted a gynandroblastoma (mixed form of sex cord–stromal tumor). Although this is an extremely uncommon ovarian tumor, it should be considered when diverse tumor morphology is identified. Bilateral metachronous involvement of the ovaries is possible. The grade of the Sertoli–Leydig cell component may influence the prognosis of such a tumor.

First-line maintenance therapy with niraparib in advanced platinum-sensitive ovarian cancer: two ‘long responder’ case reports and review of the current literature

The standard of care for newly diagnosed advanced ovarian cancer is surgical cytoreduction plus platinum-based chemotherapy; however, recurrent disease frequently occurs after treatment. Poly(ADP-ribose) polymerase (PARP) inhibitors as first-line maintenance therapy have been demonstrated to significantly reduce the risk of disease progression or death in patients with advanced ovarian cancer who have a complete or partial response to first-line platinum-based chemotherapy. Niraparib is the only PARP inhibitor that offers a significant progression-free survival benefit compared with placebo in this patient population regardless of the homologous recombination status. However, predictive factors for treatment responses and approaches to dose optimization remain to be investigated. In this study, two Chinese patients with newly diagnosed advanced ovarian cancer exhibited long-term responses to niraparib treatment, and hematological toxicity was successfully managed by dose adjustment. The literature on clinical trials and real-world experience on the efficacy, tolerability, and dose individualization of niraparib treatment in Western and Chinese patients was also reviewed. Future research is warranted to identify the characteristics of ‘long responders’ to niraparib treatment.

Effectiveness of Lactobacillus therapy in women with cervical human papillomavirus infection: A systematic review and meta-analysis

Objective This study evaluated the therapeutic efficacy of Lactobacillus in women with cervical human papillomavirus infection. Specifically, it aimed to assess the impact of Lactobacillus therapy on human papillomavirus clearance and cervical lesion resolution in clinical settings. Methods A literature search was conducted in October 2024 using PubMed, EBSCO, Google Scholar, and ScienceDirect. Eligible studies included randomized controlled trials and quasi-randomized controlled trials investigating Lactobacillus therapy for human papillomavirus infection. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Risk of bias was assessed using the risk of bias 2.0 and ROBINS-I (Risk Of Bias In Non-randomized Studies – of Interventions) tools. Data were analyzed using a random-effects model with 95% confidence intervals, and heterogeneity was evaluated using the I 2 statistic. A subgroup analysis was performed based on the method of administration (oral vs. vaginal). Results Five studies were included in the meta-analysis. Among 326 participants assessed for lesion resolution, Lactobacillus therapy showed a statistically significant improvement (relative risk = 1.93, 95% confidence interval: 1.47–2.53, p < 0.00001; I 2  = 0%). Similarly, among the 262 participants assessed for viral clearance, the treatment showed a statistically significant effect (relative risk = 1.39, 95% confidence interval: 1.00–1.94, p = 0.05; I 2  = 33%). Conclusion In patients with low-grade squamous intraepithelial lesions/atypical squamous cells of undetermined significance cervical lesions, Lactobacillus therapy administered over a minimum duration of 6 months may serve as an adjuvant treatment for human papillomavirus infection.

5-Methylcytosine methylation predicts cervical cancer prognosis, shaping immune cell infiltration

Background Epigenetics, encompassing DNA and RNA modifications, has emerged as a prominent area of research in the post-genomic era. Numerous studies have elucidated the impact of epigenetics on tumor regulation. However, the methylation patterns of 5-methylcytosine in cervical cancer as well as its role in the tumor microenvironment and immunotherapy remain poorly understood. Methods Utilizing a comprehensive dataset encompassing samples from 306 patients with cervical cancer from The Cancer Genome Atlas and Gene Expression Omnibus repositories, we conducted an in-depth analysis to evaluate the potential association between the modification patterns of 5-methylcytosine and the infiltration of cells within the tumor microenvironment, taking into account 11 regulators of 5-methylcytosine modification. Subsequently, we employed stepwise regression and Least Absolute Shrinkage and Selection Operator Cox regression to quantify 5-methylcytosine modification patterns in patients with cervical squamous cell carcinoma and endocervical adenocarcinoma, yielding the 5-methylcytosine score. Our study explored the link between the 5-methylcytosine score and clinical characteristics as well as prognostic outcomes in patients with cervical squamous cell carcinoma and endocervical adenocarcinoma. Results A comprehensive analysis of 306 patients with cervical cancer revealed two distinct 5-methylcytosine modification patterns, henceforth labeled as 5-methylcytosine clusters A and B. These clusters exhibited distinct immunological profiles and biological attributes, with 5-methylcytosine cluster A exhibiting a higher degree of immune cell infiltration. Utilizing univariate Cox regression analysis, we identified 367 genes regulated by 5-methylcytosine that were significantly correlated with patient prognosis. This analysis further stratified the samples into three distinct genomic subtypes. Survival analyses indicated that patients belonging to gene cluster C exhibited more favorable survival outcomes than those belonging to gene clusters A and B. Intriguingly, most 5-methylcytosine regulatory factors had higher expression levels in gene cluster B than in gene cluster A. Gene set enrichment analysis of a single sample revealed elevated immune cell infiltration within gene cluster B, indicating a stronger immune response in this cluster. The 5-methylcytosine score feature was utilized to determine the 5-methylcytosine modification pattern in cervical cancer, revealing that patients with low 5-methylcytosine scores exhibited better survival rates, whereas those with high scores had increased mutation frequencies and better treatment responses. Conclusions This research underscores the key role of 5-methylcytosine modification patterns in cervical cancer. Analysis of these patterns will deepen our understanding of the cervical cancer tumor microenvironment, paving the way for the development of more refined and effective immunotherapy strategies.

Risk factors for positive cervical cytology during early pregnancy screening and awareness of positive cytological results in Japan: a report from the Pregnant Women Health Initiative

Objective Cervical cancer screening rates are low in Japan. Therefore, when a woman is pregnant, this is a good opportunity to visit an obstetrics and gynecology clinic to have cervical cytology. This study aimed to clarify the association between cervical cancer screening and the management of pregnant women’s health. Methods We prospectively examined the relationships between cervical cytological results during prenatal checkups and the following factors: participant’s background, cytological sampling instruments, and awareness of cytological results. Results Of the 2725 participants, 71 showed abnormal results defined as atypical squamous cells of undetermined significance or higher grade (ASC-US+). ASC-US+ detection rates were higher in smokers, younger participants, those with a low education, those without cancer screening in the past 2 years, and those who received cytology using a spatula or brush. A multivariable logistic regression analysis identified smoking (adjusted odds ratio: 2.99 [95% confidence interval: 1.41–6.33]) and a spatula/brush (adjusted odds ratio: 2.46 [95% confidence interval: 1.09–5.53]) as independent variables associated with detecting ASC-US+. Among the participants, 39.4% (28/71) self-reported “no abnormalities,” despite obtaining an ASC-US+ result. Conclusions Pre-pregnancy smoking and cytological sampling tools may contribute to detecting ASC-US+. Patients with detected abnormalities need accurate information and reliable follow-up.

Adenomatoid tumor of the uterus: analysis of misdiagnosed cases and a literature review

Adenomatoid tumors are rare, specific, benign tumors of the reproductive tract that originate from mesenchymal tissue. A patient was diagnosed with uterine fibroids 1 year previously when a mass of approximately 30 mm was found in the left adnexal region during a physical examination. At 1 year of follow-up, ultrasound showed that the mass in the left adnexal area had greatly increased to 61 × 45 × 50 mm. Contrast-enhanced pelvic magnetic resonance imaging (MRI) was performed before surgery and suggested a borderline tumor. Histopathology suggested signet ring cell carcinoma, and an immunohistochemical examination suggested a uterine adenomatoid tumor. Our suspicion of a borderline tumor was based mainly on the following features: the mass had increased in size within 1 year, the cancer antigen 125 concentration had increased, and several lymph nodes in the pelvic and groin regions showed positive signals on MRI enhancement. Uterine adenomatoid tumors are challenging to diagnose, especially adenomatosis with signet ring cells. However, the accuracy of diagnosing this disease can be greatly improved by combining ultrasound and MRI. This article describes the most comprehensive and reliable imaging features of ultrasound and MRI, which play an important role in diagnosing uterine adenomatoid tumors and provide useful information for clinicians.

Successful treatment of a rare giant accessory cavitated uterine mass: a case report

An accessory cavitated uterine mass (ACUM) is a very rare obstructive genital malformation characterized by pelvic pain and severe dysmenorrhea. It is easily mistaken for other obstructive genital malformations in women, such as cystic uterine adenomyosis or cystic degeneration of uterine fibroids. This case report describes a 30-year-old patient with a huge uterine cornual mass. Successful resection was performed by surgical excision, and the lesion was diagnosed as an ACUM. Given the rarity of a giant ACUM, this report also includes a brief review of the relevant literature.

Imaging characteristics of uterine smooth muscle tumors of uncertain malignant potential: a case report and literature review

Uterine smooth muscle tumors of uncertain malignant potential (STUMPs) are rare tumors of the uterine myometrium that are often misdiagnosed, owing to limited knowledge of their characteristics on ultrasonography (US) and magnetic resonance imaging (MRI). We report a woman in her mid-30s who was hospitalized because of a pelvic tumor. A 6-cm mass was found in her lower left abdomen. US and MRI revealed a well-demarcated mass in the left adnexal area, with both cystic and solid elements, visible blood flow within the septa, a strong signal across >50% of the volume on T2-weighted imaging (T2WI), and a strong signal on diffusion-weighted imaging (DWI). After hysterectomy and bilateral salpingectomy, immunohistochemical examination confirmed STUMP. A review of the literature revealed characteristic imaging features of STUMP. Ultrasonography reveals STUMP as a solitary, well-circumscribed lesion with isoechoic or mixed echogenicity, the absence of posterior shadowing, and variations in blood flow. STUMP is characterized by strong signal intensity on T2WI, small areas of strong signal on T1WI, and non-enhancing cystic areas on contrast-enhanced MRI scans. Early diagnosis is crucial for the management and treatment of STUMP, and here we have summarized the imaging features of the lesion, thereby providing a valuable diagnostic reference.

Inhibitory effect of human interleukin-24 on the proliferation, migration, and invasion of cervical cancer cells

Objective This study aimed to identify significantly differentially expressed genes (DEGs) related to cervical cancer by exploring extensive gene expression datasets to unveil new therapeutic targets. Methods Gene expression profiles were extracted from the Gene Expression Omnibus, The Cancer Genome Atlas, and the Genotype-Tissue Expression platforms. A differential expression analysis identified DEGs in cervical cancer cases. Weighted gene co-expression network analysis (WGCNA) was implemented to locate genes closely linked to the clinical traits of diseases. Machine learning algorithms, including LASSO regression and the random forest algorithm, were applied to pinpoint key genes. Results The investigation successfully isolated DEGs pertinent to cervical cancer. Interleukin-24 was recognized as a pivotal gene via WGCNA and machine learning techniques. Experimental validations demonstrated that human interleukin (hIL)-24 inhibited proliferation, migration, and invasion, while promoting apoptosis, in SiHa and HeLa cervical cancer cells, affirming its role as a therapeutic target. Conclusion The multi-database analysis strategy employed herein emphasized hIL-24 as a principal gene in cervical cancer pathogenesis. The findings suggest hIL-24 as a promising candidate for targeted therapy, offering a potential avenue for innovative treatment modalities. This study enhances the understanding of molecular mechanisms of cervical cancer and aids in the pursuit of novel oncological therapies.

Epidemiological investigation on the cervical health of lesbians in Beijing, China

Objective To investigate human papillomavirus (HPV) infection status and influencing factors among lesbians. Methods In August to October 2018, 300 lesbians were recruited in Beijing using snowball sampling. Sociodemographic characteristics, behavioural indices and HPV status were measured. Colposcopy was performed on participants with HPV genotypes 16 and 18 and on participants with other high-risk HPV subtypes and positive ThinPrep (TCT) results. Results The overall HPV-positive rate was 25%. High number of sexual partners, smoking, drinking, not using condoms and using sex toys during intercourse were identified as HPV infection risk factors. Of the HPV subtypes detected, 84% were high-risk HPV subtypes. The colposcopy results showed that 20 participants (80%) with HPV 16 and HPV 18 had cervical intraepithelial neoplasia I (CIN I) or above lesions. The colposcopy results also showed that 16 participants (64%) infected with other high-risk types of HPV virus and who had positive TCT results had CIN I or above lesions. Conclusions The cervical health of lesbians should not be neglected, and appropriate health education should be improved for this group.

Aggressive angiomyxoma in pregnancy: a case report and literature review

Aggressive angiomyxoma is an interstitial tumour that is often misdiagnosed and is likely to recur. There have been few reported cases of angiomyxoma in pregnant women. We report a case of a woman who was previously diagnosed with a tumour in her vulva that increased in size during both of her pregnancies and spontaneously decreased postpartum. Local excision was performed and a gonadotropin-releasing hormone agonist was administered. According to a literature review, aggressive angiomyxoma is associated with good maternal and child outcomes. Caesarean section is not the delivery method of choice, but it is indicated if the tumour is preventing vaginal birth. Treatment for angiomyxoma is mainly postpartum local resection supplemented by hormone therapy. This tumour frequently recurs and patients should undergo long-term follow-up.

Efficacy and safety of hyperthermic intraperitoneal intraoperative chemotherapy plus surgery in advanced ovarian cancer patients

Objective This study aimed to evaluate the efficacy and safety of hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC) in patients with advanced ovarian cancer. Methods A total of 200 patients with advanced ovarian cancer were enrolled in this retrospective study and randomly allocated to two groups (research registry number: 11353). On the first day after abdominal closure, routine treatment was performed in the non-HIPEC group, whereas HIPEC was performed in the HIPEC group. The surgical outcomes, overall survival, progression-free survival, side effects, and quality of life of patients were compared between the two groups, and the risk factors for overall survival and progression-free survival were analyzed. Results The basic information of the patients showed no significant difference between the two groups (p > 0.05). There was no significant difference in the time from surgery to first flatus, postoperative hospital stay, abdominal pain, bleeding, leakage, or other blood indices between the two groups (p   >   0.05); however, the symptoms of ileus and pelvic abscess appeared more frequently in the non-HIPEC group (p   <   0.05). HIPEC, tumor size, N stage, T stage, and vascular invasion were significant indicators, while HIPEC, tumor size, vascular invasion, N stage, and T stage were independent prognostic factors. The 3-year survival rate of the HIPEC group (42%) was higher than that of the non-HIPEC group (21%) (p   <   0.001). The progression-free survival curve of the HIPEC group was superior to that of the non-HIPEC group (p  <  0.001), and the recurrence rate of the HIPEC group (25%) was lower than that of the non-HIPEC group (49%) (p  <  0.001). Conclusions HIPEC can reduce the possibility of perioperative complications such as intestinal obstruction and pelvic abscess, and the overall survival and progression-free survival curves were better in the HIPEC group.

A case report of retroperitoneal leiomyosarcoma originating from the right ovarian vein and invading the right renal vein and inferior vena cava

A woman in her early 50s was admitted to our hospital with a right retroperitoneal tumor that had been detected >1 year ago. Imaging studies revealed a mass in the right middle and lower retroperitoneum, which involved the upper portion of the right fallopian tube and caused dilated hydronephrosis of the right renal pelvis and calyces. Initial diagnosis suggested benign intraventricular smooth muscle neoplasia. She underwent surgical resection of the right retroperitoneal tumor, along with thrombectomy of the right renal vein and inferior vena cava, as well as artificial revascularization of the right renal vein. Postoperative pathology confirmed retroperitoneal smooth muscle sarcoma. She received postoperative chemotherapy with ifosfamide and doxorubicin as well as anticoagulation therapy with rivaroxaban. One year later, follow-up imaging revealed multiple nodules in the right middle and lower abdomen, a blurred nodule in the tail of the pancreas, and a dilated pancreatic duct in the distal pancreas, raising suspicion of metastasis.

Involvement of increased arginase-1 + group 2 innate lymphoid cells and myeloid-derived suppressor cells in endometrial carcinoma: A pilot study

Background Endometrial carcinoma is a prevalent gynecologic malignancy with a relatively low survival rate. Emerging studies have demonstrated that crosstalk between group 2 innate lymphoid cells (ILC2s) and myeloid-derived suppressor cells drives tumor progression. The immunopathological mechanisms underlying endometrial carcinoma are not yet fully understood. Methods This study assessed the frequency of innate lymphoid cells and myeloid-derived suppressor cells as well as related inflammatory mediators in peripheral blood, carcinoma tissue, and para-cancerous tissue of patients with endometrial carcinoma. Results Patients with endometrial carcinoma exhibited decreased levels of interleukin-22 and interferon-γ and increased levels of interleukin-25. Infiltration of ILC2s and monocytic myeloid-derived suppressor cells was elevated, while ILC3 levels were reduced. Functional analysis showed enhanced arginase-1 expression in ILC2s obtained from patients with endometrial carcinoma. Both arginase-1 + ILC2s and monocytic myeloid-derived suppressor cells were significantly associated with poorer progression-free survival. A direct correlation between arginase-1 + ILC2s and monocytic myeloid-derived suppressor cells suggests a synergistic role in endometrial carcinoma progression. Conclusion Our study indicates that the collaborative effects of ILC2s and myeloid-derived suppressor cells promote type II immunity and may contribute to the progression of endometrial carcinoma. Elevated levels of arginase-1 + ILC2s and monocytic myeloid-derived suppressor cells are associated with a poor prognosis in patients with endometrial carcinoma.

MLN4924 inhibits cell proliferation by targeting the activated neddylation pathway in endometrial carcinoma

Objective To explore the neddylation pathway, found to be highly activated in various cancers, as a potential therapeutic target in endometrial carcinoma, one of the three most frequent malignant tumours in the female reproductive system. Methods Data from The Cancer Genome Atlas were analysed using online servers. Expression levels of key neddylation genes were validated by reverse-transcription polymerase chain reaction and western blots of tumour and adjacent tissues. Underlying mechanisms and the effects on cell activities of the neddylation pathway-specific inhibitor, MLN4924, were investigated in endometrial cancer cell lines. Results Key neddylation enzymes, ubiquitin conjugating enzyme E2 M ( UBC12), ubiquitin conjugating enzyme E2 F ( UBE2F), ring-box 1 ( RBX1) and ring finger protein 7 ( RBX2), were significantly overexpressed in endometrial carcinoma tissues versus normal tissues, but only UBE2F and RBX2 positively correlated with patient survival. MLN4924 significantly suppressed proliferation and colony formation in EC cells by inducing DNA re-replication, cell cycle arrest and apoptosis. Mechanism study revealed that MLN4924 induced the accumulation of cullin-RING ligase substrates in vitro. Conclusions The neddylation pathway was identified to play an important role in endometrial cancer. The neddylation specific inhibitor, MLN4924, may be a potential therapeutic drug for endometrial carcinoma.

Rare case of uterine neoplasm: cervical sarcoma with endometrial carcinoma

Multiple primary malignant tumors (MPMTs) refer to two or more primary malignant neoplasms that simultaneously or successively occur in one or more organs in the same individual. Cervical sarcoma concomitant with endometrial carcinoma is rare. A 46-year-old woman was admitted because of increased menstrual volume for 4 years and irregular vaginal bleeding with discharge for 6 months. The diagnosis of endometrial carcinoma at stage II was made on the basis of results of ultrasound, pelvic magnetic resonance imaging, and hysteroscopic curettage. Extensive total abdominal hysterectomy + bilateral adnexectomy + bilateral ovarian arteriovenous high ligation + pelvic adhesion separation + pelvic lymphadenectomy +abdominal aortic lymphadenectomy via the abdomen were performed. Postoperative diagnosis of cervical sarcomas with endometrial carcinoma in stage IIIC1 was made according to the results of pathology and immunohistochemistry. Six cycles of cisplatin-epirubicin-isocyclophosphamide treatment were provided after the operation. Most clinical manifestations of cervical sarcomas are abnormal vaginal bleeding. Use of preoperative imaging and hysteroscopy is difficult for diagnosing cervical sarcomas, and postoperative pathological examinations and immunohistochemical diagnosis are mainly used instead. The possibility of MPMTs should be considered for endometrial carcinoma, especially if the cervical lesion is larger than that of the uterine cavity.

Smoking exposure and cervical cancer risk: Integrating observational and genetic evidence

Objective To investigate the relationship between smoking exposure and cervical cancer risk by integrating observational and genetic evidence. Methods We analyzed data from the National Health and Nutrition Examination Survey (1999–2018) and performed a genetic instrumental variable analysis using genome-wide association studies data. Smoking exposure was assessed using self-reported status and serum cotinine concentrations. Logistic regression models were used to evaluate observational associations, while inverse variance weighting was used for genetic analysis. Results Observational analysis showed that current smokers had a significantly higher cervical cancer risk than nonsmokers and former smokers (adjusted odds ratio = 3.05, 95% confidence interval: 1.61–5.78, p < 0.001). Higher serum cotinine concentrations were also positively associated with cervical cancer risk. Genetic analysis further supported a causal link between smoking exposure and cervical cancer. Conclusions Smoking exposure significantly increases cervical cancer risk, emphasizing the importance of smoking cessation for prevention of cervical cancer. Incorporating tobacco control into cervical cancer prevention strategies could reduce disease burden.

Recurrent steroid cell tumor not otherwise specified with elevated testosterone and prolactin concentrations and impaired glucose metabolism: a case report

Steroid cell tumor not otherwise specified (SCT-NOS) is a rare type of sex cord-stromal tumor with malignant potential. A 19-year-old woman underwent laparoscopic bilateral cystectomy, and postoperative pathology showed bilateral ovarian SCT-NOS. She had recurrence of the right tumor 8 years after the surgery, with shortened menstrual cycles, elevated testosterone and prolactin concentrations, and impaired glucose metabolism. We performed a laparoscopic right salpingo-oophorectomy. Testosterone and prolactin concentrations rapidly decreased and returned to the normal range after surgery. Subsequently, she had regular menstrual cycles and good glycemic control. The findings in our case suggest that there is a possibility of late recurrence in SCT-NOS. Therefore, we suggest that the postoperative follow-up period should be 10 years for this condition.

Clinical characteristics and laparoscopic surgical outcomes of ovarian dermoid cysts complicated by spontaneous rupture: nine cases and a literature review

Objective To clarify the clinical characteristics and laparoscopic surgical outcomes of dermoid cysts complicated by spontaneous rupture. Methods This was a single-center retrospective observational study of patients with dermoid cysts treated between January 2005 and December 2021. Results Among 1205 cases of dermoid cysts, spontaneous rupture occurred in nine and torsion occurred in 83 cases. No obvious triggers for rupture were identified, except for one postpartum case with fundal uterine pressure maneuver. Rupture was identified by computed tomography (CT) in six cases. Patients with ruptured cysts had significantly higher serum C-reactive protein (CRP), cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma antigen (SCC) levels compared with patients with uncomplicated dermoid cysts or cysts with torsion. Laparoscopic management was possible except for one case with severe adhesion, which required laparotomy. Two patients required prolonged postoperative administration of antibiotics due to refractory chemical peritonitis. Conclusion Combined use of CT imaging and elevated levels of CRP, CA125, CA19-9, and SCC may help to differentiate cyst rupture from torsion. Laparoscopic surgery may be a feasible option; however, prompt laparotomic conversion should be considered in cases with difficult adhesiolysis. Refractory chemical peritonitis may occur after successful surgical management.

hMSH2 coordinated with the expression of E2F1 promotes platinum response in epithelial ovarian cancer

Objective To explore underlying mechanisms that regulate hMSH2 expression and drug susceptibility in epithelial ovarian cancer (EOC). Methods Using data from the Cancer Genome Atlas (TCGA) we used bioinformatical analysis to predict transcription factors (TFs) that potentially regulate hMSH2. RT-qPCR, Western blot, and luciferase assays were undertaken using ovarian cancer cell lines to verify the identified TF. Expressions of the TF were modulated using overexpression or knockdown, and the corresponding cellular responses to cisplatin were examined. Results The TF, E2F1, was found to regulate the hMSH2 gene. The expression level of E2F1 correlated with cisplatin susceptibility in vitro. Kaplan-Meier analysis of 77 patients with EOC showed that low E2F1 expression was associated with worse survival. Conclusions To our knowledge, this is the first report of E2F1 regulated MSH2 expression playing a role in drug resistance of platinum-based treatments for patients with EOC. Further work is need to confirm our results.

A rare case of sclerosing stromal tumor of the ovary presenting in pregnancy: a case report and review of the literature

Sclerosing stromal tumor of the ovary (SSTO) is a rare benign neoplasm of the ovary, accounting for about 6% of all sex cord stromal ovarian tumors. Only 17 cases of SSTO occurring during pregnancy have been reported to date. We report a case of SSTO occurring during pregnancy and review the existing literature. A 32-year-old pregnant woman was found to have a 10-cm solid mass in the right adnexa, and a large volume of ascites fluid was detected by ultrasound examination in the second trimester. The patient underwent abdominal puncture to relieve her symptoms in the second trimester, and a partial right oophorectomy and cesarean section were performed at 39 weeks of gestation. Final pathology confirmed the diagnosis of SSTO. Both the mother and baby were well at 6 months of postpartum follow-up. Clinical symptoms, and hormone and imaging examinations are all helpful in making a differential diagnosis of SSTO, but the unique histopathological and immunohistochemistry findings remain the main diagnostic features. Pregnant women with SSTO usually undergo enucleation or unilateral oophorectomy, which generally does not have adverse pregnancy outcomes.

Primary squamous cell carcinoma of the ovary accompanied by transition of a mucinous borderline ovarian tumor

This report describes a woman with a rare primary squamous cell carcinoma of the ovary accompanied by transition of a mucinous borderline ovarian tumor. A woman in her late 40s was referred for abdominal discomfort, which worsened during defecation. Pelvic magnetic resonance imaging showed a multiloculated cystic lesion in the left adnexa measuring approximately 7.5 × 9.5 × 7.0 cm. An intraoperatively obtained frozen biopsy sample of the mass in the left ovary was positive for malignancy, resulting in a surgical staging operation. The tumor was composed of squamous cell carcinoma and mucinous borderline tumor. There was no evidence of capsular invasion or invasion of other internal organs, including pelvic and para-aortic lymph nodes (0/41). Immunohistochemistry showed that the tumor was diffusely positive for cytokeratin 7, cytokeratin 20, Ki-67, and P40 but negative for P16. After a debulking operation, the patient has been monitored regularly without adjuvant therapy owing to final surgical staging of the tumor as stage IA.

Remarkable effects of infliximab on severe radiation-induced side effects in a patient with uterine cervical cancer: a case report

Pelvic radiotherapy is a powerful treatment for a broad range of cancers, including gynecological, prostate, rectal, and anal cancers. Despite improvements in the delivery of ionizing beams, damage to non-cancerous tissue can cause long-term effects that are potentially severe, affecting quality of life and daily function. There is an urgent need for new strategies to treat and reverse the side effects of pelvic radiotherapy without compromising the antitumor effect. A woman with severe radiation-induced intestinal side effects was treated with the tumor necrosis factor-alpha inhibitor infliximab with a dose of 5 mg/kg every 4 to 6 weeks. With infliximab treatment, a remarkable improvement in her bowel health was observed. The patient’s late bowel toxicity was reduced from Grade 2 to Grade 0 (RTOG/EORTC Late Radiation Morbidity Scale). Although it is necessary to proceed cautiously because of the risk of serious side effects from immunosuppressants, our case suggests that infliximab can be used to treat symptoms of chronic bowel dysfunction after radiotherapy.

Extratesticular gliomatosis peritonei after mesenteric teratoma: a case report and literature review

Mesenteric teratoma is a rare extragonadal teratoma. Gliomatosis peritonei (GP) is mature glial tissue implanted into the peritoneum's surface and is mainly accompanied by ovarian teratoma. Only a few cases of gliomatosis have occurred in the extraperitoneum. We present a rare case of a 3-year-old boy who presented with extratesticular GP after excision of an immature mesenteric teratoma at 2 months old. After the extratesticular mass was excised, we found ductile tissue on the surface of the terminal spermatic cord and epididymis. Some ductile tissue of the epididymis was removed and sent to a laboratory for a pathological examination. The mass and the ductile tissue of the epididymis had a hard consistency. The pathological diagnosis was extratesticular gliomatosis. Complete surgical resection of the teratoma and GP is helpful for identifying the presence of malignant lesions and for preventing malignant transformation. However, characteristics of GP lesions are extensive and they are difficult to completely remove. Moreover, GP is usually benign. Therefore, the residual GP tissue was not completely removed in our case. The child is still in good health, but requires lifelong follow-up. In conclusion, we report our experience of a rare case of extraperitoneal GP from an extragonadal teratoma.

Immature ovarian teratoma in a 20-year-old woman: A case report

Immature ovarian teratomas are a rare subtype of germ cell tumours characterized by the presence of embryonic elements, particularly primitive neuroepithelium, and they typically affect young women. We report the case of a 20-year-old woman who presented with a growing abdominal mass that turned out to be a grade II immature teratoma after adnexectomy. This article reviews the clinical presentation, imaging features, and some of the main problems that arise in the management of immature ovarian teratomas.

MYL9 promotes squamous cervical cancer migration and invasion by enhancing aerobic glycolysis

Objective This study explored the mechanism of squamous cervical cancer (SCC) progression. Methods Reverse transcription-quantitative polymerase chain reaction and western blotting were used to evaluate the expression of myosin light chain 9 ( MYL9) in SCC tissues and cell lines. Furthermore, Transwell and Boyden assays were used to assess the function of MYL9 in SCC progression. In addition, the levels of lactate and aerobic glycolysis were used to explore the detailed mechanism of MYL9 in SCC. Results The mRNA and protein levels of MYL9 were elevated in SCC tissues, and MYL9 knockdown inhibited the migration and invasion of SCC cell lines. A mechanistic study demonstrated that MYL9 promotes SCC migration and invasion by enhancing aerobic glycolysis and increasing the activity of the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway. Conclusions MYL9 was upregulated in SCC, and it enhanced JAK2/STAT3 pathway activity and promoted metastasis and glycolysis in SCC.

Computed tomography-based texture assessment for the differentiation of benign, borderline, and early-stage malignant ovarian neoplasms

Objective This study was performed to examine the value of computed tomography-based texture assessment for characterizing different types of ovarian neoplasms. Methods This retrospective study involved 225 patients with histopathologically confirmed ovarian tumors after surgical resection. Two different data sets of thick (5-mm) slices (during regular and portal venous phases) were analyzed. Raw data analysis, principal component analysis, linear discriminant analysis, and nonlinear discriminant analysis were performed to classify ovarian tumors. The radiologist’s misclassification rate was compared with the MaZda (texture analysis software) findings. The results were validated with the neural network classifier. Receiver operating characteristic curves were analyzed to determine the performances of different parameters. Results Nonlinear discriminant analysis had a lower misclassification rate than the other analyses. Thirty texture parameters significantly differed between the two groups. In the training set, WavEnLH_s-3 and WavEnHL_s-3 were the optimal texture features during the regular phase, while WavEnHH_s-4 and Kurtosis seemed to be the most discriminative features during the portal venous phase. In the validation test, benign versus malignant tumors and benign versus borderline lesions were well-distinguished. Conclusions Computed tomography-based texture features provide a useful imaging signature that may assist in differentiating benign, borderline, and early-stage ovarian cancer.

Prognostic significance of autophagy-related genes Beclin1 and LC3 in ovarian cancer: a meta-analysis

Objective Beclin1 plays a central role in the activation of the autophagy signaling pathway. Beclin1 and LC3-related proteins are involved in the initial steps of autophagy, which are closely related to the occurrence and development of tumors. The current meta-analysis aimed to clarify the correlation between expression of Beclin1 and LC3 and prognosis of ovarian cancer. Methods We searched PubMed, Embase, The Cochrane Library, Web of Science, and CNKI using predefined selection criteria. Pooled hazard ratios and relative risks with 95% confidence intervals were used to evaluate the correlation between autophagy-related genes Beclin1 and LC3 and overall survival (OS), progression-free survival (PFS), and International Federation of Gynecology and Obstetrics (FIGO) stage. Results In total, 1497 patients from 10 articles were enrolled in this meta-analysis. Expression of Beclin1 was significantly correlated with improved OS and PFS, and increased expression of Beclin1 was correlated with early FIGO stage, but not with lymph node metastasis or histological grade. No association was found between LC3 expression and prognosis in patients with ovarian cancer. Conclusions Expression of Beclin1 is an independent risk factor for the progression of ovarian cancer. Thus, Beclin1 is a promising indicator in predicting prognosis in patients with ovarian cancer.

A mature cystic teratoma adherent to the vaginal wall: a case report

We present the case of a woman diagnosed with a teratoma adherent to the vaginal wall. The patient had been misdiagnosed with an ovarian teratoma 8 years previously at her local hospital, but no mass was found in the pelvic cavity during cesarean section. She therefore attended our institution for further examination. Transvaginal ultrasonography, magnetic resonance imaging (MRI), and computed tomography (CT) revealed a large mass on the left side at the bottom of the pelvis, near the side of the vagina, mainly composed of greasy and cystic elements. Gynecological examination showed the mass protruding into the left side of the vaginal wall. The patient therefore underwent vaginal wall incision. During surgery, we found a mass adherent to the vaginal wall, located on the left front of the rectum. Surgery was completed successful with no complications. This case highlights the need for careful preoperative evaluation of teratomas with unusual locations. MRI and CT may be useful for identifying the origin of the tumor and determining its relationship with the surrounding tissues. Surgery should be based on the characteristics and anatomical location of the tumor to minimize damage to other tissues and organs.

Effects of naringin on reversing cisplatin resistance and the Wnt/β-catenin pathway in human ovarian cancer SKOV3/CDDP cells

Objective Ovarian cancer is one of three malignant tumors of the female reproductive system. Our previous studies showed that the traditional Chinese medicine naringin significantly inhibited the proliferation of platinum-resistant ovarian cancer cells in vitro, and that the mechanism may be related to the NF-κB pathway. Methods The MTT assay was used to detect the sensitivity of SKOV3 and SKOV3/CDDP cells to cisplatin, the effect of different naringin concentrations on the proliferation of SKOV3/CDDP cells, and the reversal of cisplatin resistance in naringin-treated SKOV3/CDDP cells. Western blotting was used to detect β-catenin, c-Myc, and cyclin D1 protein levels in the different cell lines. Results MTT results showed that different concentrations of naringin inhibited the proliferation of SKOV3 and SKOV3/CDDP cells, and that the inhibition increased with increasing concentrations and prolonged incubation times. Western blotting revealed that compared with controls (SKOV3/CDDP-0), β-catenin, c-Myc and cyclin D1 proteins levels were significantly decreased in SKOV3/CDDP-C, SKOV3/CDDP-N 20, and SKOV3/CDDP-CN 20 cells, suggesting that naringin inhibited the proliferation of SKOV3/CDDP cells in a concentration and time dependent manner. Conclusions Non-cytotoxic naringin reduced the expression of β-catenin, c-Myc, and cyclin D1 in SKOV3/CDDP cells and partially reversed cisplatin resistance in SKOV3/CDDP CN 20 cells.

Puerarin induces platinum-resistant epithelial ovarian cancer cell apoptosis by targeting SIRT1

Objective Previous investigations indicated the anticancer activity of puerarin. The current study aimed to evaluate the effect and molecular mechanisms of puerarin in chemotherapy-resistant ovarian cancer cells. Methods We examined the effects of puerarin in platinum-resistant epithelial ovarian cancer cells in vitro and in vivo. We also analyzed the molecular mechanism underlying Wnt/β-catenin inhibition and sirtuin 1 (SIRT1) regulation following puerarin treatment. Results Our study demonstrated that puerarin effectively inhibited cell growth in vitro and in vivo by increasing apoptosis in ovarian cancer cells. More importantly, puerarin sensitized cisplatin-resistant ovarian cancer cells to chemotherapy. Puerarin treatment decreased SIRT1 expression, which attenuated the nuclear accumulation of β-catenin to inhibit Wnt/β-catenin signaling. In addition, SIRT1 overexpression diminished the effects of puerarin treatment on cisplatin-resistant ovarian cancer cells. Further analysis supported SIRT1/β-catenin expression as a candidate biomarker for the disease progression of epithelial ovarian cancer. Conclusions Puerarin increased the apoptosis of platinum-resistant ovarian cancer cells. The mechanism is partly related to the downregulation of SIRT1 and subsequent inhibition of Wnt/β-catenin signaling.

HE4 might be a more useful tumor biomarker to detect malignancy in patients with ovarian endometrioma when malignancy is suspected

Objective To analyze the utility of carbohydrate antigen (CA)125 and human epididymis protein 4 (HE4) to detect malignancy in women with ovarian endometriosis, when ovarian cancer is suspected and ultrasonography results are inconclusive. Methods Women who underwent surgery between 2015 and 2019 for ovarian endometriosis or for adnexal masses, with a final diagnosis of ovarian carcinoma (clear cell and endometrioid) were included in this retrospective study. The women were divided into three groups: ovarian endometriosis (OE), ovarian carcinoma without endometriosis (OC), and ovarian carcinoma with endometriosis (OC + E). Adnexal masses were assessed preoperatively by transvaginal ultrasonography according to the International Ovarian Tumor Analysis (IOTA) simple rules, and CA125 and HE4 blood levels were obtained. Results Of 208 women, 45 had malignancy, 16 in the OC + E group and 29 in the OC group. According to transvaginal ultrasonography, 13 were classified as undetermined risk of malignancy: OC group: 3, OE group: 3, and OC + E group: 7. When we compared the tumor biomarkers, significant differences in HE4 but not in CA125 levels were found between the groups. Conclusions When ovarian malignancy is suspected in patients with ovarian endometriosis, HE4 is a more useful tumor biomarker to diagnose OC when ultrasonography results are inconclusive.

Coexistence of genital tuberculosis and ovarian serous cystadenofibroma in a young female patient: a case report

Most cases of female genital tuberculosis (TB) are asymptomatic and are thus difficult to diagnose. Coexistence of genital TB and ovarian serous cystadenofibroma (OSCAF) is rare and easily ignored or misdiagnosed. We report a 26-year-old woman with coexistence of genital TB and OSCAF, and with an adnexal mass detected by B-ultrasound. Laparoscopic biopsy of diffuse miliary white nodules was performed on the surface of the peritoneum and both fallopian tubes. Right ovarian cystectomy was performed. Postoperative pathology showed that the right ovarian mass was a benign serous cystadenofibroma, and both fallopian tubes and miliary white nodules on the surface of pelvic organs showed chronic granulomatous inflammation. Polymerase chain reaction for Mycobacterium tuberculosis and acid-fast bacilli culture were positive in biopsies of the fallopian tubes, omentum, and peritoneum. The patient received anti-TB treatment after surgery. Six months after the operation, the patient had no abdominal pain and no major changes in menstruation. Our findings suggest that a timely operation is required for patients with an adnexal mass. During surgery, even if the lesion is similar to a malignant tumor, the surgical approach needs to be cautiously chosen for young patients without children. The patient’s postoperative fertility must be taken into consideration.

Expression of CUE domain containing 2 protein in serous ovarian cancer tissue: predicting disease-free and overall survival of patients

Objective The aim of this study was to predict disease-free (DFS) and overall (OS) survival of cancer patients through expression of CUE domain containing 2 (CUEDC2) protein. Methods In this retrospective study, we investigated CUEDC2 expression in 75 serous ovarian cancer tissues and 34 tubal fimbria tissues by immunohistochemistry. Chemoresistance was analyzed using clinical follow-up data. Results CUEDC2 expression scores were 1.35 ± 0.60, 1.54 ± 0.57, 1.78 ± 0.71, and 2.13 ± 0.27 for International Federation of Gynecology and Obstetrics (FIGO) stages I, II, III, and IV tissues, respectively, indicating that CUEDC2 expression increased with stage and that scores differed between patients with early and advanced cancers. We found no differences in CUEDC2 expression for tissues with low, medium, and high differentiation. CUEDC2 expression was unrelated to patient age, pathological grade, or presence or absence of lymph node metastasis, but was related to tumor stage. For CUEDC2-positive patients, median DFS and OS survival were 32.6 and 54.3 months, respectively. For CUEDC2-negative patients, median DFS and OS were 51.9 and 63.5 months, respectively. Expression of CUEDC2 was correlated with DFS but not OS. Conclusion CUEDC2 is highly expressed in ovarian cancer tissues and is related to tumor stage and DFS.

Transcriptome sequencing identifies genes associated with invasion of ovarian cancer

Objective To identify key genes in ovarian cancer using transcriptome sequencing in two cell lines: MCV152 (benign ovarian epithelial tumour) and SKOV-3 (ovarian serous carcinoma). Methods Differentially expressed genes (DEGs) between SKOV-3 and MCV152 were identified. Candidate genes were assessed for enrichment in gene ontology function and Kyoto Encyclopaedia of Genes and Genomes pathway. Candidate gene expression in SKOV-3 and MCV152 cells was validated using Western blots. Results A total of 2020 upregulated and 1673 downregulated DEGs between SKOV3 and MCV152 cells were identified that were significantly enriched in the cell adhesion function. Upregulated DEGs, such as angiopoietin 2 ( ANGPT2), CD19 molecule ( CD19), collagen type IV alpha 3 chain ( COL4A3), fibroblast growth factor 18 ( FGF18), integrin subunit beta 4 ( ITGB4), integrin subunit beta 8 ( ITGB8), laminin subunit alpha 3 ( LAMA3), laminin subunit gamma 2 ( LAMC2), protein phosphatase 2 regulatory subunit Bgamma ( PPP2R2C) and spleen associated tyrosine kinase ( SYK) were significantly involved in the extracellular matrix-receptor interaction pathway. Downregulated DEGs, such as AKT serine/threonine kinase 3 ( AKT3), collagen type VI alpha 1 chain ( COL6A1), colony stimulating factor 3 ( CSF3), fibroblast growth factor 1 ( FGF1), integrin subunit alpha 2 ( ITGA2), integrin subunit alpha 11 ( ITGA11), MYB proto-oncogene, transcription factor ( MYB), phosphoenolpyruvate carboxykinase 2, mitochondrial ( PCK2), placental growth factor ( PGF), phosphoinositide-3-kinase adaptor protein 1 ( PIK3AP1), serum/glucocorticoid regulated kinase 1 ( SGK1), toll like receptor 4 ( TLR4) and tumour protein p53 ( TP53) were involved in PI3K-Akt signalling. Expression of these DEGs was confirmed by Western blot analyses. Conclusion Candidate genes enriched in cell adhesion, extracellular matrix–receptor interaction and PI3K-Akt signalling pathways were identified that may be closely associated with ovarian cancer invasion and potential targets for ovarian cancer treatment.

A case of a vaginal Brenner tumor without a gland mimicking a borderline tumor: unusual morphology and diagnostic pitfalls

Brenner tumor is a rare neoplasm of the vagina. This tumor is diagnosed according to the criteria of ovarian tumors. We report here a 64-year-old postmenopausal woman with a 2.0-cm sessile vaginal polyp for 9 years. Microscopic examination showed unusual features of no gland appearing in the tumor, but the other two characteristic components of transitional islands and dense fibrous stroma were observed. The tumor was diagnosed as a vaginal Brenner tumor on the basis of the definition proposed by the World Health Organization classification of female reproductive organ tumors. In our case, part of the epithelial nests of the Brenner tumor showed basaloid cell differentiation with peripheral palisading, and irregular papillary hyperplasia was observed around the epithelial nests similar to a borderline tumor. However, no mitotic activity or nuclear atypia was present in either the epithelial or stromal components. The presence of epithelial nests requires attention in the medical history of the patient. Our patient did not have a history of primary urothelial carcinoma. Our patient’s benign vaginal Brenner tumor with different morphological characteristics supports the current notion that Walthard nests might act as possible precursor lesions.

Clinicopathological analysis of primary carcinoid tumour of the ovary arising in mature cystic teratomas

Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. Methods This retrospective case series analysed the data from patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. Results The study enrolled four patients. Histopathological analysis of the tumours identified the following subtypes: insular ( n = 1), trabecular ( n = 1) and strumal ( n = 2). All four primary ovarian carcinoid tumours originated from a mature teratoma. The morphology of the primary ovarian carcinoids was similar to other neuroendocrine tumours. Strumal carcinoids were composed of different proportions of thyroid tissue intimately admixed with carcinoid tumour. Tumour tissue was arranged in insular and/or trabecular patterns. The nucleus of tumour cells displayed exquisite chromatin without obvious mitotic figures. Tumour tissues were positively stained for neuroendocrine markers chromogranin A, synaptophysin and CD56 to varying degrees. Strumal carcinoid tumours were cytokeratin 19 positive and thyroid transcription factor 1 negative. No recurrence or metastasis occurred during follow-up (12–71 months). Conclusion Primary ovarian carcinoid tumours arising in mature cystic teratomas are rare. Diagnosis and differential diagnosis should be confirmed by clinical features, histopathological characteristics and specific immunophenotyping.

Ovarian adult-type granulosa cell tumor concomitant with simple endometrial hyperplasia: a case study with selected immunohistochemistry

Ovarian adult-type granulosa cell tumors are often associated with endometrial hyperplasia or even uterine cancer. Herein, we present a case report of a 65-year-old female patient who had undergone curettage of the uterine cavity several times due to abnormal and irregular uterine bleeding. Owing to recurrent episodes of vaginal bleeding as well as ineffective pharmacological treatment of simple endometrial hyperplasia without atypia, the patient underwent a laparoscopically-assisted vaginal hysterectomy. Owing to an enlarged right ovary with bluish color, intra-operative pathological examination was immediately performed. Surprisingly, an ovarian adult-type granulosa cell tumor was diagnosed, and the surgery was extended to pelvic lymphadenectomy and omentectomy. Immunohistochemical staining with selected antibodies (Arginase 2, Nidogen 2, BAF250a/ARID1A, GPR30, SF-1/NR5A, and 1LRH-2E1/NR5A2) was also performed. In conclusion, in cases of recurrent vaginal bleeding concomitant with endometrial hyperplasia, the existence of rare ovarian tumors connected with extensive estrogenic stimulation must be taken into account. Immunostaining with selected antibodies (Arginase 2, Nidogen 2, ARID1A, or GPR30) may help elucidate the possible molecular mechanisms associated with the BAF250a/development of various ovarian/endometrial abnormalities.

Allele-specific expression mediates primary resistance to poly (ADP-ribose) polymerase inhibitor therapy in a case of BRCA1/2 double-germline mutant gastric cancer

Breast cancer gene 1 and 2 ( BRCA1 and BRCA2) are human tumor suppressor genes. BRCA mutations increase the risk for breast, ovarian, and gastric cancer. However, double heterozygosity for BRCA1 and BRCA2 mutations in gastric cancer have not been reported and their clinical significance is unclear. In this study, a 52-year-old Chinese male patient with gastric cancer was chosen for analysis. A tumor tissue biopsy and blood sample were collected, and next-generation sequencing-based deep panel sequencing was performed on the IlluminaNextSeq-500 platform. Comprehensive genomic alterations of 450 cancer-related genes and 47 tumor susceptibility genes were analyzed. Here, we report for the first time a case of gastric cancer that carried both BRCA1 S1841Vfs*2 and BRCA2 Q1886* heterozygous mutations. Unfortunately, the patient was resistant to olaparib treatment. Further RNA analysis revealed that only the wild-type alleles of BRCA1 and BRCA2 were expressed, although genetic BRCA1 and BRCA2 mutations were present in the patient. This genetic finding may explain the mechanism for primary resistance to olaparib observed in the BRCA1/2-mutated patient.

Assessment of the relationship between vitamin D levels and uterine fibroids in Turkish women: A retrospective case–control study

Objective Uterine fibroids are prevalent in women of reproductive age and can cause various health issues. This study aimed to explore the association between vitamin D levels and the development of uterine fibroids in Turkish women, a topic on which contradictory findings have been reported. Methods This retrospective case–control study was conducted at Osmaniye State Hospital, Turkey, from September 2022 to September 2023. The study group comprised women diagnosed with uterine fibroids, while the control group included women who did not have uterine fibroids. Both groups were compared based on their vitamin D levels, sociodemographic characteristics, obstetric health, clinical characteristics, and imaging findings. The primary focus of the study was on the correlation between vitamin D levels and the presence of uterine fibroids. Results The study group involved 954 women with uterine fibroids, and the control group comprised 668 control women. The sociodemographic characteristics of the groups were not significantly different (p > 0.05). However, the median vitamin D level in the study group (9.9 ng/mL) was significantly lower than that in the control group (16.1 ng/mL, p < 0.001). Furthermore, patients with multiple uterine fibroids had significantly lower vitamin D levels than those with a single fibroid (p = 0.032). Women with three or more fibroids had even lower levels of vitamin D than those with fewer than three fibroids (p < 0.001). Conclusion The findings indicate a marked association between lower vitamin D levels and the presence of uterine fibroids. Patients with a higher number of fibroids had lower vitamin D levels. These results suggest a potential link between vitamin D deficiency and the development of uterine fibroids. However, more prospective studies are required to determine the exact role of vitamin D in the development and progression of uterine fibroids.

The correlation between women’s various gynaecological diseases to ovarian cancer in Sulaimaniyah City, Iraq

Objective To assess the relationship between benign gynaecological disorders and ovarian cancer (OC). Methods This retrospective observational study enrolled female patients with histologically-confirmed primary OC. Clinical and demographic data were collected using a questionnaire. Blood samples were analysed for tumour biomarker levels including cancer antigen (CA)-125, CA19-9, carcinoembryonic antigen, β human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH) using enzyme-linked immunosorbent assays. Results A total of 100 female patients were enrolled in the study. Of these, 44 patients had simple ovarian cysts (44%), 22 had uterine fibroids (22%), 15 had adenomyosis (15%), 13 had pelvic inflammatory disease (13%) and six had endometriosis (6%). There was a significant association between high grade serous OC histology with both benign ovarian and uterine diseases. There was a significant association between both adenomyosis and uterine fibroids and high grade OC. There was also a significant association between endometriosis and stages III/IV OC. With regard to tumour biomarkers, there was a significant association between β-hCG and LDH biomarkers and benign uterine tumours. Conclusion Benign gynaecological diseases are accompanied by the high risk of the development of OC. Common benign gynaecological diseases associated with OC were uterine fibroids and adenomyosis.

Autophagy-related long non-coding RNA signature for ovarian cancer

Objective Ovarian cancer (OC) affects nearly 22,000 women annually in the United States and ranks fifth in cancer deaths, largely because of being diagnosed at an advanced stage. Autophagy is the cellular process of self-degrading damaged or degenerate proteins and organelles. Long non-coding RNAs (lncRNAs) are a group of RNA molecules whose transcripts are greater than 200 nt but are not translated into proteins. However, just a small number of autophagy-related lncRNAs have been explored in depth. Methods We used RNA sequencing data from The Cancer Genome Atlas (TCGA) and autophagy datasets to identify dysfunctional autophagy-related lncRNAs and provide potential useful biomarkers for OC diagnosis and prognosis. Results Seventeen differentially expressed lncRNAs (AC010186.3, AC006001.2, LBX2-AS1, SNHG17, AC011445.1, AC083880.1, MIR193BHG, AC025259.3, HCG14, AC007114.1, AC108673.2, USP30-AS1, AC010336.5, LINC01132, AC006333.2, LINC00665 and AC027348.1) were selected as independent prognostic factors for OC patients. Functional annotation of the data was performed through gene set enrichment analysis (GSEA). The results suggested that the high-risk group was mainly enriched in specific tumor-related and metabolism pathways. Conclusion Based on the online databases, we identified novel autophagy-related lncRNAs for the prognosis of ovarian cancer.

Comparison of paclitaxel liposomes combined with carboplatin versus paclitaxel combined with carboplatin in the treatment of advanced ovarian cancer

Objective To compare the efficacy of paclitaxel liposomes combined with carboplatin and paclitaxel combined with carboplatin in the treatment of advanced ovarian cancer and assess their effects on serum human epididymis protein 4 (HE4), CA125, CA199, matrix metalloproteinase-2 (MMP2), MMP-7, and MMP-9 levels. Methods In this observational study, 102 patients with advanced ovarian cancer were assigned to receive paclitaxel liposomes combined with carboplatin (Group A) or paclitaxel combined with carboplatin (Group B). Clinical efficacy; serum HE4, CA125, CA199, MMP-2, MMP-7, and MMP-9 levels; and the occurrence of adverse reactions were compared between the groups. Results The overall response rate was significantly higher in Group A than in Group B. After chemotherapy, serum HE4, CA125, CA199, MMP-2, MMP-7, and MMP-9 levels were lower in Group A than in Group B. The incidence of myalgia, dyspnea, nausea and vomiting, facial flushing, peripheral neuropathy, and skin rash was lower in Group A than in Group B. Conclusion Paclitaxel liposomes combined with carboplatin displayed better efficacy in the treatment of advanced ovarian cancer than paclitaxel combined with carboplatin, which might be attributable to reductions in serum marker levels and the occurrence of adverse events.

A retrospective study of the effects of uterine manipulators on prognosis in patients with cervical cancer

Objective This retrospective study investigated the effects of uterine manipulator use during minimally invasive radical hysterectomy on prognosis in patients with cervical cancer. Methods We collected clinical data on 762 patients with stage IA2 to IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy in Chinese PLA General Hospital from 2009 to 2019. Kaplan–Meier analysis and log-rank tests were used to compare the 5-year overall survival rates between patients treated with and without a uterine manipulator. Results Patient demographics did not differ between the two groups. In addition, the incidence of lymphovascular space invasion, tumor size, pathologic types, the International Federation of Gynecology and Obstetrics stage, the histologic grade, and the rate of lymphatic metastases did not differ between the groups. Meanwhile, perioperative clinical indicators were similar in the groups. Furthermore, no significant differences in 5-year survival rates and survival curves were recorded between the groups among both all patients (84.5% vs. 85.6%) and early-stage patients (89.1% vs. 89.2%). Conclusions The use of uterine manipulators during minimally invasive radical hysterectomy for cervical cancer did not affect clinicopathological markers or increase the risk of death.

The prognostic values of matrix metalloproteinases in ovarian cancer

Objective To investigate the prognostic significance of 23 matrix metalloproteinase ( MMP) genes in patients diagnosed with ovarian carcinoma. Methods The prognostic significance of 23 MMP genes in patients diagnosed with ovarian carcinoma was investigated using the Kaplan–Meier plotter (KM plotter), which uses the gene expression data and overall survival information of patients with ovarian cancer that were downloaded from the Gene Expression Omnibus, Cancer Biomedical Informatics Grid and The Cancer Genome Atlas cancer datasets. The correlation between mRNA levels of individual MMPs (MMP2, MMP9, MMP10, MMP12, MMP13 and MMP25) and clinicopathological features (histological subtype, pathological grade and clinical stage) were investigated. The MMP protein level profiles in normal ovarian tissues and ovarian cancer tissues were examined using the Human Protein Atlas database. Results The results showed that high mRNA levels of MMP2 and MMP13 were associated with a worse overall survival in patients with ovarian cancer, whereas high mRNA levels of MMP9, MMP10, MMP12 and MMP25 were associated with a better overall survival. The protein levels of MMP2, MMP9, MMP10 and MMP25 in ovarian cancer tissues were elevated compared with normal ovarian tissues. Conclusions This study demonstrated that MMPs can be a reliable prognostic biomarker for ovarian cancer.

HPV infection status among women of all ages in Jinshan District, Shanghai

Objective We explored the prevalence of human papillomavirus (HPV) infection among women in Jinshan District, Shanghai. Methods We analyzed all HPV testing samples sent from our unit between December 2023 and April 2024. We reported the HPV prevalence overall, by age, and by subtype. Results In total, 3788 women aged 16 to 90 years had HPV test results. The prevalence of infection with any HPV subtype was 17.9%. The HPV prevalence by age group was: ≤30 years, 15.4%; 31–40 years, 14.7%; 41–50 years, 17.0%; 51–60 years, 22.4%; >60 years, 31.0%. Among HPV-positive women, 80.6% had infection with one subtype, 16.4% had dual infection, and 3.1% had three or more subtypes detected. We found 640 cases (16.9%) of infection with high-risk HPV subtypes and 191 cases (5.04%) of infection with low-risk HPV subtypes. The most common high-risk subtypes were HPV 52, 53, 58, and 16; the most common low-risk subtypes were HPV 81, 70, and 42. Conclusion We detected ≥1 HPV subtype among most women in our study. The prevalence of HPV was lowest in younger women and highest in women age >60 years. Tailored strategies for older women are needed to prevent HPV infection and cervical cancer.

Lymphocyte and macrophage infiltration in omental metastases indicates poor prognosis in advance stage epithelial ovarian cancer

Objective To investigate the prognostic value of immune cells within omental metastases originating from advanced epithelial ovarian cancer (EOC). Methods We performed immunohistochemical analysis to determine the levels of CD4+/CD8+ tumor-infiltrating lymphocytes (TILs) and CD68+ tumor-associated microphages (TAMs) in omental specimens from 100 patients with advanced EOC. Significant prognostic factors, including immune cells and clinical parameters, were assessed by Kaplan–Meier survival analysis and Cox models. Results Cox regression analysis showed that elevated levels of CD68+ TAMs and intra-islet CD4+ TILs in omental metastases were the main risk factors associated with worse survival outcomes for advanced EOC. Moreover, the survival analysis of relationships between omental immune cells and favorable clinical predictors revealed additional prognostic stratification information. Conclusion Omental immune cells (TAMs and TILs) provide alternative prognostic factors in advanced EOC. In contrast to markers of the EOC tumor microenvironment at the primary site, elevated CD68+ TAMs and intra-islet CD4+ TILs in omental metastases serve as negative prognostic markers in advanced EOC and imply an unfavorable outcome.

Clinical analysis of 52 adolescent patients with ovarian masses ≥10 cm in diameter

Objective To investigate the clinical characteristics and treatment of large ovarian masses in adolescents. Methods Adolescents with large ovarian masses (≥10 cm in diameter) who were treated in Beijing Obstetrics and Gynecology Hospital from March 2010 to December 2018 were retrospectively assessed. Results Fifty-two female patients (mean age: 16.17±2.04 years [11–19 years]) were included and 19 (36.5%) presented with abdominal pain. The blood flow signal rate in ultrasonography was significantly different among benign, borderline and malignant ovarian masses, unlike strong echo, dotted echo and septation rates. Carbohydrate antigen 125 positivity rates were significantly different among pathological types and the endometriotic cyst group showed the highest value (75.0%). Alpha-fetoprotein positivity rates were also different among pathological types. For ovarian cystectomy, 14 and 32 patients underwent laparotomy and laparoscopy, respectively. Mass diameters were significantly higher in the laparotomy group and the operative duration was significantly shorter in the laparoscopy group. There were no significant differences in intraoperative blood loss or postoperative recurrence rates between the two groups. Conclusion Teratomas constitute the greatest group of large ovarian masses in adolescents. Benign tumors should be treated by laparoscopic resection, while borderline or malignant tumors require individualized treatment of tumors and fertility-sparing treatments.

Anaplastic carcinoma showing rhabdoid features combined with ovarian mucinous borderline cystadenoma: a case report and literature review

Anaplastic carcinoma in an ovarian tumor (ACOT) is rare. There have been a few controversial cases illustrating the clinical characteristics and prognostic factors of ACOT, which are not well known. A 60-year-old Chinese woman presented with a large pelvic tumor. A transvaginal ultrasound examination showed a large single ovarian cystic tumor with mural nodules and ascites. A gross ovarian mass with a size of approximately 20 × 10×15 cm3 was found. The content of the ovarian cyst was light yellow and chocolate-like, and a large grayish mural nodule of approximately 10 cm was found on the cyst wall. Histological diagnosis of ovarian mucinous borderline cystadenoma with a mural nodule of anaplastic carcinoma showing rhabdoid features and International Federation of Gynecology and Obstetrics (FIGO) stage IIIa was made. Fifteen months after surgery, the patient had received six courses of paclitaxel and carboplatin. She is still alive without any recurrence of the tumor. Findings from the present case suggest that patients with ACOT and FIGO stage IIIa would benefit from surgery and chemotherapy of paclitaxel and carboplatin. We also review the clinical features and survival rate of patients with ACOT using the Surveillance, Epidemiology, and End Result database, and summarize previously reported treatments.

Relative clinical utility of simultaneous 18F-fluorodeoxyglucose PET/MRI and PET/CT for preoperative cervical cancer diagnosis

Objective To investigate the utility of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) for the preoperative diagnosis of cervical cancer. Methods We retrospectively analyzed 114 patients who were diagnosed with cervical cancer and underwent PET/MRI (n = 59) or PET/computed tomography (PET/CT) (n = 65) before surgery. The maximal standardized uptake value (SUVmax) and mean SUV (SUVmean) were determined for regions of interest in the resultant radiographic images. Results Relative to PET/CT, 18F-FDG PET/MRI exhibited higher specificity and sensitivity in defining the primary tumor bounds and higher sensitivity for detection of bladder involvement. The SUVmax and SUVmean of PET/MRI were remarkably higher than those of PET/CT as a means of detecting primary tumors, bladder involvement, and the lymph node status. However, no significant differences in these values were detected when comparing the two imaging approaches as a means of detecting vaginal involvement or para-aortic lymph node metastasis. Conclusions These outcomes may demonstrate the capability of 18F-FDG PET/MRI to clarify preoperative cervical cancer diagnoses in the context of unclear PET/CT findings. However, studies directly comparing SUVs in different lesion types from patients who have undergone both PET/MRI and PET/CT scans are essential to validate and expand upon these findings.

Non-Peutz–Jeghers syndrome-associated ovarian sex cord tumor with annular tubules treated by radiotherapy: a case report and literature review

There are no standard treatment options for metastatic and recurrent non-Peutz–Jeghers syndrome (PJS)-associated sex cord tumor with annular tubules (SCTAT). The effects of chemotherapy and/or radiotherapy are still not well-defined. Herein, we present a case of a metastatic and recurrent non-PJS-associated SCTAT showing high serum estradiol and progesterone concentrations after surgery and chemotherapy. Radiotherapy (50 Gy/25 fractions) triggered a sharp reduction in the sizes of the metastatic and recurrent masses, and estradiol and progesterone concentrations. Accordingly, we consider that radiotherapy might be effective and safe for metastatic and recurrent SCTAT. The roles of radiotherapy in non-PJS SCTAT should be further validated in large-scale prospective clinical trials.

Clinical analysis of 12 cases of ovarian cystic mature teratoma with malignant transformation into squamous cell carcinoma

Objective This study aimed to examine the clinicopathological characteristics, treatment, and prognostic factors in 12 cases of malignant transformation of mature cystic teratoma of the ovary (MCTO). Methods We performed a retrospective study of 12 patients with malignant transformation of MCTO who were admitted to the Affiliated Hospital of Qingdao University from 2003 to 2019. We examined case records, clinical parameters, and biological assessments. Results The median age of the patients was 56.5 years and seven of them were postmenopausal. The average tumor size was 18.5 cm. All patients had pelvic masses at their first hospital visit. Nine of the patients had discomfort in the lower abdomen, two presented with a lower abdominal palpable mass, and three were complicated by fever. The median follow-up time was 73 months (12‒193 months). Ten patients survived with a disease-free status and two died. Conclusions There is a low incidence of malignant transformation of MCTO, and its most common histological type is squamous cell carcinoma. Age and tumor size are important factors in malignant transformation of teratomas. While there is a lack of treatment guidelines for malignant transformation of MCTO, early diagnosis and treatment may be beneficial for these patients.

Failure of multiple surgical procedures and adjuvant chemotherapy in early-stage steroid-cell ovarian tumor treatment: a case report and literature review

Ovarian steroid-cell tumors (SCTs) are a rare subgroup of sex-cord tumors of the ovary, accounting for less than 0.1% of all ovarian tumors. Not otherwise specified (NOS) tumors are the most common subtype. More than half of patients with SCTs-NOS show hyperandrogenic symptoms. The primary treatment for SCTs is surgery, as most cases are early-staged and benign. Because of the low incidence of metastatic disease, there is insufficient reliable information on the role of adjuvant therapy and the most effective treatment regimen. In this report, a rare case of a recurrent SCT-NOS in a 36-year-old female patient without endocrine symptoms is presented, highlighting the significance of appropriate pathological evaluation and immunohistochemical testing for the accurate diagnosis of this malignancy, particularly in the case of hormonally “silent” tumors. The metastatic tumor described here showed no response to four courses of adjuvant chemotherapy after several debulking surgeries. Based on the clinical findings, the neoplastic etiology should always be considered during the resection of ovarian tumors to prevent possible disease dissemination due to inappropriate surgical techniques.

High HOXA9 gene expression predicts response to chemotherapy and prognosis of high-grade serous ovarian cancer patients

Objective High-grade serous ovarian cancer (HGSOC) is a deadly malignancy. Homeobox protein A9 ( HOXA9) is linked with serous papillary histotype differentiation, and inappropriate HOXA9 expression is a step in ovarian cancer that induces aberrant differentiation. This study aimed to reveal the significance of HOXA9 in HGSOC. Methods HOXA9 mRNA and protein expression were examined by quantitative PCR and immunohistochemistry, respectively. The chi-square test was used to evaluate associations between HOXA9 expression and clinical characteristics. The prognostic value of HOXA9 was calculated by the Kaplan–Meier method. The Kaplan–Meier Plotter database was used to assess the prognostic value of HOXA9. Results The mRNA and protein expression of HOXA9 were significantly upregulated in chemotherapy-resistant HGSOC compared with chemotherapy-sensitive HGSOC. The chi-square test showed that high HOXA9 expression was significantly related with grade, clinical stage, and residual disease. High HOXA9 expression was significantly associated with poor prognosis. The Kaplan–Meier Plotter database further confirmed these results. Cox hazard regression showed that high HOXA9 expression was an independent prognostic factor for survival in HGSOC patients. Conclusion This study showed that HOXA9 expression was associated with chemotherapy resistance and poor outcomes in HGSOC patients. High HOXA9 expression might be a prognostic indicator for HGSOC.

Trends in bacterial resistance among perioperative infections in patients with primary ovarian cancer: A retrospective 20-year study at an affiliated hospital in South China

Background We aimed to analyze the epidemiological and drug-resistance trends among bacterial cultures from perioperative infections in patients with primary ovarian cancer. Methods Medical and bacteriological records for patients with ovarian cancer patients who developed perioperative infections after primary cytoreductive surgery from 1999 to 2018 were reviewed retrospectively. Results The incidence of perioperative infections and the culture-positive percentage among patients in the first 10 years were 20.2% and 29.3%, respectively, and the equivalent rates in the second 10 years were 18.0% and 33.5%. The most commonly isolated pathogens in both year-groups were Escherichia coli and Enterococcus spp., but the respective percentages differed between the groups. Some strains of Staphylococcus aureus and Enterococcus spp. in the second 10-year group were resistant to linezolid and vancomycin, and ciprofloxacin resistance among Gram-negative bacteria isolates also increased in this group. However, resistance of Gram-negative bacteria to imipenem and meropenem was low among in both groups. Conclusion The pathogen distribution in perioperative infections in patients with primary ovarian cancer undergoing cytoreductive changed slightly from 1999 to 2018, and the antibiotic resistance of the main isolated pathogens increased. These results indicate the importance of periodic bacterial surveillance of surgical infections in these patients.

Prediction of homologous recombination deficiency from cancer gene expression data

Objective Homologous recombination deficiency (HRD) is the main mechanism of tumorigenesis in some cancers. HRD causes abnormal double-strand break repair, resulting in genomic scars. Some scoring HRD tests have been approved as companion diagnostics of polyadenosine diphosphate-ribose polymerase (PARP) inhibitor treatment. This study aimed to build an HRD prediction model using gene expression data from various cancer types. Methods The cancer genome atlas data were used for HRD prediction modeling. A total of 10,567 cases of 33 cancer types were included, and expression data from 5128 out of 20,502 genes were included as predictors. A penalized logistic regression model was chosen as a modeling technique. Results The area under the curve of the receiver operating characteristic curve of HRD status prediction was 0.98 for the training set and 0.93 for the test set. The accuracy of HRD status prediction was 0.93 for the training set and 0.88 for the test set. Conclusions Our study suggests that the HRD prediction model based on penalized logistic regression using gene expression data can be used to select patients for treatment with PARP inhibitors.

Distinct clinicopathological features of ovarian endometriosis after long-term exposure to mifepristone

Objective Mifepristone has been used to treat endometriosis, but it can cause a constellation of endometrial alterations. Our study investigated the effects of long-term mifepristone on ovarian endometriosis. Methods We retrospectively analyzed the clinicopathological changes of ovarian endometriosis in 11 Chinese patients after long-term low-dose mifepristone therapy and compared these alterations with those observed in eutopic endometrium and adenomyosis side-by-side. Immunohistochemistry was applied to investigate estrogen receptor (ER), progesterone receptor (PR), and Ki67 expression in eutopic and ectopic endometrium. Results Nearly all patients had a pelvic mass and elevated serum CA125 levels. The ovarian lesions were grossly solid, cystic-solid, or cystic. They had a grayish–reddish appearance and a fleshy, honeycomb-like cut surface. The ovarian lesions shared morphological features with the uterine endometrium, and they were characterized by dilated, crowding endometrial glands with non-physiological changes. Immunostaining revealed consistent staining for ER and PR and a low Ki67 index in both eutopic and ectopic endometrium. Conclusions Our findings suggest that ovarian endometriosis can mimic an endometrioid borderline tumor after long-term mifepristone administration. Careful histological assessment and related clinical information are critical for the correct interpretation of these rare entities.

Primary high-grade serous cancer arising from uterosacral ligament endometriosis: two case reports

Although high-grade serous cancer (HGSC) accounts for >70% of ovarian epithelial cancers, it is rarely associated with endometriosis. No previous study has reported an association between the malignant transformation of uterine ligament endometriosis and HGSC. Here, we reported two cases of Chinese female patients with HGSC arising from endometriosis in the uterosacral ligament. They had a long-term history of endometriosis and dysmenorrhea. Both were diagnosed with HGSC at stage IIB. They underwent operations and six cycles of chemotherapy with paclitaxel and carboplatin and have remained disease-free to date. Genomic analysis showed no known/suspected pathogenic variations or somatic homologous recombination deficiency in the two cases. In conclusion, these rare cases of HGSC from endometriosis might indicate a new origin of ovarian type II carcinoma. Patients with a long-term history of endometriosis and sudden aggravation of dysmenorrhea or vaginal bleeding should be aware of the possibility of endometriotic malignant transformation.

A case report of appendiceal adenocarcinoma without gastrointestinal evidence mimicking primary ovarian cancer

Metastatic tumours to the ovary comprise 10–25% of ovarian malignancies and may originate from various primary sites. Here, the case of a 49-year-old female patient who presented with periumbilical nodules and abdominal bloating is reported. She was found to have bilateral ovarian tumours with peritoneal carcinomatosis and ascites. Primary ovarian cancer was suspected while no contributory gastrointestinal lesion was detected by imaging studies and endoscopic examinations. Three cycles of neoadjuvant chemotherapy were administered, followed by interval debulking surgery. Appendiceal cancer was highly suspected based on analysis of a frozen section obtained during surgical debulking. Following the pathology investigation, the patient was finally diagnosed with primary appendiceal adenocarcinoma. She underwent chemotherapy comprising irinotecan and fluorouracil. Due to disease progression despite several chemotherapy regimens, the patient declined further treatment and was lost to follow-up 1 year after the debulking surgery. Metastatic tumours to the ovary may mimic primary ovarian cancers and often present with nonspecific manifestations. Therefore, meticulous exploration of the primary site is warranted if the diagnosis is clinically suspicious.

BRCA1/BRCA2 mutation spectrum analysis in South Asia: a systematic review

Objective Breast cancer (BC) is the most common form of cancer among Asian females. Mutations in the BRCA1/ BRCA2 genes are often observed in BC cases and largely increase the lifetime risk of having BC. Because of the paucity of high-quality data on the molecular spectrum of BRCA mutations in South Asian populations, we aimed to explore these mutations among South Asian countries. Methods A systematic literature search was performed for the BRCA1 and BRCA2 gene mutation spectrum using electronic databases such as PubMed, EMBASE, and Google Scholar. Twenty studies were selected based on specific inclusion and exclusion criteria. Results The 185delAG (c.68_69del) mutation in exon 2 of BRCA1 was the most common recurrent mutation and founder mutation found. Various intronic variants, variants of unknown significance, large genomic rearrangements, and polymorphisms were also described in some studies. Conclusions The South Asian population has a wide variety of genetic mutations of BRCA1 and BRCA2 that differ according to countries and ethnicities. A stronger knowledge of various population-specific mutations in these cancer susceptibility genes can help provide efficient strategies for genetic testing.

Occult vaginal cancer recurrence after hysterectomy: a case report and literature review

Vaginal cancer is a rare disease of the lower genital tract. We present the case of a 54-year-old woman with occult vaginal cancer after hysterectomy for cervical intraepithelial neoplasia (CIN) III. Despite persistently negative cytology and colposcopy results, a lesion was finally detected by vagino-recto-abdominal examination and she underwent radical parametrectomy and lymph node dissection. We consider the possibility that transabdominal suturing of the vaginal cuff after hysterectomy may reduce the ability to detect subsequent vaginal lesions, and discuss the benefits of a vaginal suture approach. We recommend that suturing the vagina apex transvaginally instead of transabdominally would benefit patients during follow-up.

Fucoxanthin may inhibit cervical cancer cell proliferation via downregulation of HIST1H3D

Objective To investigate the role of fucoxanthin, reported to have significant anticancer effects, and histone Cluster 1 H3 Family Member D (HIST1H3D; implicated in tumorigenesis) in cervical cancer. Methods The half maximal inhibitory concentration (IC50) of fucoxanthin against HeLa and SiHa cervical cancer cells was determined. Differentially expressed genes (DEGs) in SiHa cells treated with IC50 fucoxanthin were screened by high-throughput techniques and subjected to signal enrichment. Following identification of HIST1H3D as a candidate gene, HIST1H3D-knockdown models were created via transfection with a short hairpin HIST1H3D payload. Impacts on cell proliferation, cell-cycle distribution, colony formation, and apoptosis were studied. Results The fucoxanthin IC50 was 1 445 and 1 641 µM (Hela and SiHa cells, respectively). Chip results revealed 2 255 DEGs, including 943 upregulated and 1 312 downregulated genes, in fucoxanthin-treated versus untreated SiHa cells. Disease and function analysis indicated that these DEGs are primarily associated with cancer and organismal injuries and abnormalities, and online integrated pathway analysis showed that the DEGs were mainly enriched in p53 signalling. HIST1H3D was significantly downregulated in response to fucoxanthin. Inhibition of HIST1H3D mRNA significantly reduced cell proliferation and colony formation, significantly augmented the percentage of apoptotic HeLa and SiHa cells, and cells were arrested in G0/G1 cell cycle phase. Conclusion The results suggest that HIST1H3D may be an oncogene in cervical carcinogenesis and a potential fucoxanthin target in treating cervical cancer.

Negative emotions and their management in Chinese convalescent cervical cancer patients: a qualitative study

Objective The aim of the study was to understand the experience of negative emotions and coping styles of patients with cervical cancer during the rehabilitation period. Methods A descriptive qualitative research method was used. Purposive sampling was used to recruit participants. Semi-structured interviews were conducted with 18 cervical cancer patients and the data were analysed using content analysis. Results The analysis identified three relevant themes. Theme 1: Negative emotions in convalescent cervical cancer patients mainly comprised fear of recurrence, worries about sex and feelings of inferiority. Theme 2: Patients used positive and negative coping styles to manage negative emotions. Theme 3: Patients expressed a strong need for rehabilitation information. Conclusions Patients with cervical cancer exhibited negative emotions during the rehabilitation period. To help these patients, medical staff should develop an understanding of their needs by communicating more with patients and providing them with targeted care to help them return to society more quickly.

Effect of neoadjuvant chemotherapy followed by surgery for FIGO stage I–II cervical cancer: a meta-analysis

Objective In this meta-analysis, we aimed to evaluate the oncological outcomes of preoperative neoadjuvant chemotherapy followed by radical surgery compared with radical surgery alone for treatment of International Federation of Gynecology and Obstetrics (FIGO) stage I–II cervical cancer. Method We searched for studies comparing the safety and efficacy of neoadjuvant chemotherapy plus surgery versus surgery alone in treatment outcomes of locally advanced cervical cancer. Meta-analysis was used to calculate the pooled odds ratios with corresponding 95% confidence intervals (CI). Results Sixteen studies were included in our analysis. Pooled analysis of overall survival rate [odds ratio (OR) = 1.09, 95% CI: 0.83–1.43] and progression-free survival rate (OR = 1.10, 95% CI: 0.77–1.57) showed that preoperative neoadjuvant chemotherapy did not have a benefit compared with surgery alone in terms of survival rates. The pooled results for postoperative parameters indicated that preoperative neoadjuvant chemotherapy followed by radical surgery was associated with a high rate of vascular space involvement (OR = 0.25, 95% CI: 0.17–0.35) and parametrial infiltration (OR = 0.60, 95% CI: 0.45–0.79). Conclusions This meta-analysis indicated that surgery following neoadjuvant chemotherapy for FIGO stage I–II cervical cancer and surgery alone had similar oncological outcomes.

An 8-gene DNA methylation signature predicts the recurrence risk of cervical cancer

Objective This study examined the predictive utility of DNA methylation for cervical cancer recurrence. Methods DNA methylation and RNA expression data for patients with cervical cancer were downloaded from The Cancer Genome Atlas. Differentially methylated genes (DMGs) and differentially expressed genes were screened and extracted via correlation analysis. A support vector machine (SVM)-based recurrence prediction model was established using the selected DMGs. Cox regression analysis and receiver operating characteristic curve analysis were used for self-evaluation. The Gene Expression Omnibus (GEO) database was applied for external validation. Functional enrichment was determined using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. Results An eight-gene DNA methylation signature identified patients with a high risk of recurrence (area under the curve = 0.833). The SVM score was an independent risk factor for recurrence (hazard ratio [HR] = 0.418; 95% confidence interval [CI] = 0.26–0.67). The independent GEO database analysis further supported the result. Conclusion An eight-gene DNA methylation signature predictive of cervical cancer recurrence was identified in this study, and this signature may help identify patients at high risk of recurrence and improve clinical treatment.

A practical method of using the anatomical space of the vesicouterine ligament for laparoscopic radical hysterectomy: a retrospective cohort study

Objective To investigate the practicality of a new method using anatomical spaces for performing standard laparoscopic radical hysterectomy (LRH) without ureteral injury in patients with cervical cancer. Methods Clinicopathological characteristics and perioperative complications were retrospectively analysed in 440 patients with stages IB1 to IIB cervical cancer. The patients were assigned to two of the following groups: LRH by our method of using anatomical landmarks (anatomical space group, n = 217) and the traditional method (traditional group, n = 223). Results The mean operative duration and time of vesicouterine ligament (VUL) dissection were significantly shorter (173.87 ± 30.39 vs. 210.83 ± 44.55 minutes; 32.75 ± 7.23 vs. 43.48 ± 11.22 minutes), and blood loss was less in the anatomical space group compared with the traditional group. The rate of the intraoperative complication of ureteral injury was also significantly lower in the anatomical space group compared with the traditional group (0 vs. 5). Conclusions LRH by the anatomical method, using the axillary space and other potential spaces as anatomical landmarks, results in less blood loss and reduced ureteral injury compared with the traditional method. This method is safe and practical for separating the ureter from the VUL in patients with cervical cancer.

Prognostic factors affecting survival and recurrence in patients with early cervical squamous cell cancer following radical hysterectomy

Objective This study aimed to investigate the clinical and histological features affecting the survival of patients with early cervical squamous cell cancer treated with radical hysterectomy. Methods We retrospectively analyzed clinical and histological data for patients with stage IB-IIA cervical cancer treated by radical hysterectomy at Zhejiang Cancer Hospital from August 2008 to January 2013. Results A total of 1435 patients were included in the study. Cox regression analysis identified tumor size >4 cm, lymphovascular space involvement (LVSI), lymph node ratio (LNR), and squamous cell carcinoma antigen (SCC-Ag) >2.65 ng/mL as independent prognostic risk factors. Among 1096 patients without high pathological risk factors, the 5-year local recurrence rates for SCC-Ag ≤2.65 and >2.65 ng/mL were 6.6% and 25.7%, respectively. Among 332 patients with lymph node positivity, the overall survival rates for LNR ≤0.19 and >0.19 were 87.8% and 55.6%, respectively. Conclusions LVSI, tumor size >4 cm, LNR >0.19, and SCC-Ag >2.65 ng/mL may predict a poor prognosis in patients with early cervical squamous cell cancer treated with radical hysterectomy. SCC-Ag >2.65 ng/mL may be a useful prognostic factor guiding the use of postoperative radiotherapy in patients without pathologic risk factors.

RETRACTED: Effects of clean intermittent self-catheterization on late bladder dysfunction after radical hysterectomy in cervical cancer

To identify the benefits of clean intermittent self-catheterization in women who have late bladder dysfunction caused by radical hysterectomy in cervical cancer. Thirty women who underwent radical hysterectomy with late bladder dysfunction were recruited. A nursing intervention program focusing on clean intermittent self-catheterization and a drinking plan was implemented. We recorded urinary times during the day and night, post-voiding residual urine volume, positive catheter specimen of urine rate, and quality of life instruments for patients with cervical cancer . All patients were able to satisfactorily manage clean intermittent self-catheterization following video-based operational training. Bladder function was significantly increased after 3-month intervention compared with before the intervention. Urinary times during the day and night, and post-voiding residual urine volume were greatly decreased post-intervention compared with pre-intervention. The rate of a positive catheter specimen of urine test significantly decreased over time. There was significant improvement in quality of life in five dimensions between weeks 1 and 12 following the intervention. Patients are able to learn the technique of clean intermittent self-catheterization without any difficulty. This technique is effective together with a drinking plan to decrease late bladder dysfunction caused by radical hysterectomy in cervical cancer.

Association between serum iron levels and the risk of cervical cancer in Chinese: a meta-analysis

Objectives To evaluate the association between serum iron levels and cervical cancer risk in Chinese populations. Methods A literature search was conducted using the PubMed, WanFang, and SinoMed databases up to April 30, 2019. Pooled standard mean differences (SMD) and 95% confidence intervals (CI) were analyzed using R software with a random-effects model. Results Data from nine studies comprising 454 cervical cancer patients and 880 controls were used in the analysis. Our results demonstrated that serum iron levels in cervical cancer patients were significantly lower than those in controls in Chinese populations (summary SMD = −1.24, 95%CI = −1.37 to −1.10; I2 = 93.4%). No publications bias was detected. Sensitivity analysis indicated that no single study had a significant effect on the overall SMD. Conclusions Our findings show that serum iron levels are lower in patients with cervical cancer than in control individuals. However, further high-quality studies are necessary to clarify the role of serum iron levels in cervical cancer risk.

Second recurrence of aggressive vulvar angiomyxoma: a case report

Aggressive angiomyxoma is a rare benign tumor with diverse clinical and radiologic presentations, making its differential diagnosis challenging. Here we report the second recurrence of an aggressive angiomyxoma of the vulva in a 33-year-old woman who presented with pain and swelling. Clinical examination revealed a well-circumscribed large palpable mass extending from the inferior part of the right labia major into the right side of the gluteus. A second recurrence of aggressive angiomyxoma was suspected based on the patient’s history, clinical examination, and magnetic resonance imaging report, and the patient underwent surgical resection with a negative margin. Histological evaluation of the extracted lesion confirmed the diagnosis of aggressive angiomyxoma. At the 1-year follow-up, the patient was recurrence-free. The present report urges more awareness regarding the aggressiveness of angiomyxoma of the vulva. Closer attention should be given to margin-free removal of such tumors, and patients should be routinely followed up for at least 2 years postoperatively for early diagnosis of recurrence, thereby reducing the risk of morbidity.

Magnetic resonance imaging features of a solitary fibrous tumor of the vulva: a case report

Solitary fibrous tumors (SFTs) are commonly seen in the pleura. SFT involvement of the vulva is rare, and clinical diagnosis is mainly based on histopathological and immunohistochemical analyses. We herein describe the imaging features of a 69-year-old woman with an SFT of the vulva. The SFT was hypointense on T1-weighted images, similar to muscle; however, it showed inhomogeneous hyperintensity predominantly on fat-suppressed T2-weighted images. An area of low signal intensity was evident on T2-weighted images, and the tumor showed progressive enhancement in delayed phases. The tumor also displayed heterogeneous and prolonged, persistent enhancement, and serpentine vessels were present in the peritumoral area as signal voids. Pathological examination confirmed that the lesion was an atypical SFT originating from the vulva, and it was composed of spindle cells and perivascular and stromal hyalinization. This case reveals the characteristic imaging findings of vulvar SFT and their association with the relevant pathological findings, thus contributing to the primary diagnosis and preoperative evaluation of this potentially aggressive tumor.

Epithelioid leiomyosarcoma of the vulva: report of a rare case and literature review

Leiomyosarcoma of the vulva is a rare soft tissue sarcoma that accounts for approximately 1% of all primary vulvar neoplasms, but it is the most common type of vulvar sarcoma. It usually originates from the smooth muscle within erectile tissue or blood vessel walls, the round ligament, the dartos muscle or the arrector pili muscle. No treatment algorithms have been established to date. Surgical resection is preferred for vulvar leiomyosarcoma. Currently, the recommended surgical method is extensive local resection with a safe surgical margin of at least 2 cm. The use of chemoradiotherapy for vulvar sarcoma remains controversial. This case report describes a 39-year-old female that underwent resection of a vulvar mass in January 2019. Postoperative pathological examination indicated that it was an epithelioid leiomyosarcoma. She presented with tumour recurrence after 43 days. Based on the diagnosis, radical right vulvectomy with a tumour margin of 2 cm was performed. The tumour margin was negative. The patient refused to undergo auxiliary radiotherapy and chemotherapy. The follow-up findings do not indicate any signs of recurrence. In order to avoid recurrence, vulvar epithelioid leiomyosarcomas should be completely resected with a margin of 2 cm at the time of first occurrence.

Predictive value of hemoglobin, platelets, and D-dimer for the survival of patients with stage IA1 to IIA2 cervical cancer: a retrospective study

Objective Coagulation indexes may be useful survival biomarkers for cervical cancer. This study evaluated the ability of hemoglobin, red blood cells (RBCs), platelets, and D-dimer levels to predict post-hysterectomy survival outcomes in patients with stage IA1 to IIA2 cervical cancer. Methods In this retrospective study, coagulation-related indexes were compared between the anemia and non-anemia groups. Independent variables were analyzed by the Cox proportional hazards model. Survival was assessed by the Kaplan–Meier method with the log-rank test. Mortality predictions were evaluated by receiver operating characteristic curves. Results Among this study’s 1088 enrolled patients, 152 had anemia. The 10-year overall survival and recurrence-free survival rates were 90.8% and 86.5%, respectively. Hemoglobin, RBC, and the rate of abnormal platelet counts were significantly lower in the anemia group. Abnormal preoperative D-dimer was an independent factor for recurrence-free survival. Receiver operating characteristic curves showed that D-dimer had area under the curve of 0.734 (cut-off value: 0.685, sensitivity: 85.7%, and specificity: 64.0%). Hemoglobin and platelets had areas under the curves of 0.487 and 0.462, respectively. Conclusion Preoperative D-dimer was the most effective prognostic predictor for patients with cervical cancer. The prognosis of patients with cervical cancer was poorer if their D-dimer levels were >0.685 mg/L.

Multiple metastases after surgery for a rare vulvar malignant melanoma combined with immunotherapy: a case report

We herein describe the preoperative and postoperative clinical data of a patient with a rare case of vulvar malignant melanoma and discuss her clinical characteristics and prognosis. After surgical resection and immunotherapy, the patient’s illness continued to worsen. She then received local vulvar radiotherapy. However, further treatment was discontinued because of intolerable complications of radiotherapy, and the patient died about 18 months postoperatively. Management of vulvar malignant melanoma is challenging. No unified, effective, and standardized diagnostic and treatment plan has been established for this disease. Surgery remains the primary treatment modality for locally resectable vulvar malignant melanoma. Radiation therapy and chemotherapy do not benefit survival. Encouragingly, however, immunotherapy and targeted therapy have shown clinical efficacy in metastatic vulvar malignant melanoma.

Adenoid cystic carcinoma of the Bartholin’s gland: a case report and literature review

Objective The present study was performed to explore the clinical features, diagnosis, and treatment of adenoid cystic carcinoma of the Bartholin’s gland. Methods The clinical data of a case of adenoid cystic carcinoma of the Bartholin’s gland were examined, and the clinical manifestation, diagnosis, and treatment were analyzed. Results Adenoid cystic carcinoma of the Bartholin’s gland has a low incidence. The main clinical manifestations are vulvar lumps, dyspareunia, pain, itching, and bleeding. The diagnosis is based on gynecological examination and pathological biopsy, and the treatment is mainly surgical excision. Conclusion Adenoid cystic carcinoma of the Bartholin’s gland is rare and lacks specificity. Pathological biopsy is the gold standard for diagnosis, and surgical resection should be performed for treatment.

Effect of the dwell time deviation constraint on brachytherapy treatment planning for cervical cancer

Objective This study aimed to quantify the effect of the dwell time deviation constraint (DTDC) on brachytherapy treatment for cervical cancer. Methods A retrospective study was carried out on 20 patients with radical cervical cancer. The DTDC values changed from 0.0 to 1.0 by a step size of 0.2. We adjusted the optimization objectives to ensure that all plans were optimized to a high-risk clinical target volume (HRCTV) D90 (the dose to 90% of the HRCTV) = 6 Gy, while keeping the dose to the organs at risk as low as possible. The dose–volume histogram parameters and the dwell time data were compared between plans with different DTDC values. Results The HRCTV volume covered by 150% of the prescription dose gradually increased with increasing DTDC values. As the DTDC value increased from 0.0 to 1.0, the effective dwell point proportion increased from 61.78% to 90.30%. The mean dwell time initially decreased with an increase in the DTDC value, reached the minimum value at DTDC = 0.8, then slightly increased at DTDC = 1.0. Conclusions When using inverse planning simulated annealing optimization for radical cervical cancer cases, the recommended DTDC value is approximately 0.6 if the organ dose needs to be limited.

Embryonic cervical rhabdomyosarcoma complicated with uterine inversion with cerebral venous sinus thrombosis as the first symptom: a case report and literature review

The probability of rhabdomyosarcoma occurring in the cervix is less than 0.5% and may be associated with a pathogenic dicer 1, ribonuclease III ( DICER1) gene variation. Tumour-induced hypercoagulability and high levels of cancer antigen (CA) 125 are risk factors for cerebral venous sinus thrombosis (CVST). In addition, although nonpuerperal uterine inversion is very rare and is usually caused by leiomyomas from the uterus, large cervical masses can also be the cause. This case report describes a 24-year-old woman with uterine inversion caused by an embryonic cervical rhabdomyosarcoma that presented with CVST as her first symptom. The patient underwent laparoscopic total uterus and bilateral salpingectomy, during which the uterus was found to be completely inverted. Postoperative pathology confirmed embryonic cervical rhabdomyosarcoma. The patient quickly developed lung and para-aortic lymph node metastases. Two months later, the patient died of complications. When coagulation indices in patients with tumours are abnormal, especially when the levels of D-dimer and CA125 increase, it is recommended that anticoagulant therapy is administered in a timely manner to prevent the occurrence of CVST. Furthermore, for large cervical tumours, physicians should also be alert to the occurrence of uterine inversion.

Characteristics, complications, and outcomes of early-stage cervical stump carcinoma: laparoscopy versus laparotomy

Objective To compare the characteristics, surgical complications, and overall survival between patients undergoing laparoscopy versus laparotomy for treatment of early-stage cervical stump carcinoma. Methods Patients with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA2 to IIA2 cervical stump carcinoma who underwent laparoscopy or laparotomy in the Obstetrics and Gynecology Hospital of Fudan University from January 2000 to June 2018 were retrospectively reviewed. All patients’ clinical characteristics, pathological features, complications, and follow-up data were retrieved. Results Seventy-two patients were included in the analysis; 58 underwent laparoscopy and 14 underwent laparotomy. With respect to surgical complications, laparoscopy was associated with a significantly lower complication rate, less blood loss, a shorter operative time, and a higher hospitalization fee than laparotomy. Survival was not significantly different between the laparoscopy and laparotomy groups. Conclusions Although survival was not significantly different between the two surgical approaches, the rate of surgical complications was much lower in the laparoscopy than laparotomy group.

Small cell carcinoma of the cervix complicated by syndrome of inappropriate antidiuretic hormone secretion: a case report

Small cell carcinoma of the cervix is a rare malignant tumor in the clinical setting. Clinical manifestations of this tumor are mostly similar to those of normal types of cervical cancer. Small cell carcinoma of the cervix only shows symptoms of neuroendocrine tumors, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH). Most of the hyponatremia caused by SIADH can be managed after removal of the cause. Hyponatremia is a predictor of poor prognosis and can be used as an indicator of partial recurrence. We report a case of small cell carcinoma of the cervix complicated by SIADH. Our patient presented with irregular vaginal bleeding after menopause. After one cycle of chemotherapy, there was trembling of the limbs, and a laboratory examination showed low Na+ and low Cl− levels. After limited water intake, intravenous hypertonic saline, and intermittent diuretic treatment, the patient’s blood Na+ levels returned to normal. After a radical operation, the above-mentioned symptoms disappeared.

Cervical adenofibroma without clinical symptoms: report of a rare case

Adenofibroma is an extremely rare benign biphasic tumour composed of glandular and fibrous tissues. It occurs more often in the endometrium but it can also occur in the cervix and extrauterine sites. This case report describes a 39-year-old asymptomatic woman with cervical adenofibroma. The patient was treated successfully with surgical removal of the tumour. As adenofibromas are very rare, the report is presented with a brief review of the literature.

Modified method of cervical conization with hybrid use of a cold knife and an electric knife for high-grade squamous intraepithelial lesions

Objective To evaluate the feasibility and surgical outcome of the modified method of cervical conization with hybrid use of a cold knife and an electric knife. Methods A retrospective analysis of cervical conization for high-grade squamous intraepithelial lesions was performed between January 2020 and December 2020. Traditional cold knife conization and modified conization were used. The clinical characteristics and surgical outcomes were compared between these methods. Results Ninety-two patients with high-grade squamous intraepithelial lesions were included. Traditional conization was performed in 46 patients, and the modified method was used in 46 patients. There were no differences in clinical characteristics, such as age, menopausal status, and conization height, between the methods. Intraoperative blood loss with the modified method was significantly lower than that with traditional conization (27.6 ± 4.7 vs 51.3 ± 18.3 mL). Postoperative vaginal bleeding requiring emergent measures, such as prolonged gauze compression, sutures, or electrocautery, was significantly less with the modified method than with traditional conization (4.3% vs 17.4%). A median follow-up of 10.2 months showed no significant difference in persistence or recurrence between the methods. Conclusions The modified method of cervical conization with hybrid use of cold and electric knives may be a good alternative to traditional cold knife conization.

Role of cervical cancer screening during prenatal checkups for infectious diseases: A retrospective, descriptive study

Objective This study was conducted to evaluate the status and role of cervical cytology affected by human papillomavirus infection and other infectious diseases screened during routine prenatal checkups. Methods We retrospectively examined medical records containing the screening results for infectious diseases and cervical cancer in women who delivered neonates in our hospital from 2014 to 2017. Results Among 3393 deliveries, 18.8% of women underwent a regular cervical cancer screening within 1 year of becoming pregnant, and 2641 women underwent a cervical cytology screening during this pregnancy. The cytological diagnostic results showed that 2562 women (97.0%) were negative for intraepithelial lesions or malignancy, whereas 79 (3.0%) had abnormal results. Of those with abnormal cytology results, 70 had abnormal cytology that was newly detected in this pregnancy, and 42 had grade ≥1 cervical intraepithelial neoplasia lesions. Spatulas were the most frequently used cytological sampling instruments, followed by cotton swabs. Cervical cytology revealed no major adverse reactions during these pregnancies. Conclusions Our results confirm the importance of screening for infectious diseases during pregnancy. Only 20% of the women underwent a regular pre-pregnancy cervical cytology screening. Cervical cytology screening during pregnancy may currently be playing a crucial role in preventing cervical cancer in Japan.

Ubiquitin C-terminal hydrolase L1 promotes lymph node metastasis in small cell neuroendocrine carcinomas of the cervix

Objective To screen for specific differentially expressed genes in small cell neuroendocrine carcinoma of the cervix (SCNEC) and to further explore their roles and mechanisms in tumor progression. Methods Differentially expressed genes in SCNEC compared with squamous cell carcinoma (SCC) and adenocarcinoma (AC) were screened by microarray and immunohistochemical analyses. The biological functions of the identified genes were examined in a SCNEC cell line using RNA interference and over-expression plasmid-transfection technologies. Co-expression network analysis and immunoprecipitation technology were used to explore the potential mechanisms. Results Compared with SCC and AC, UCHL1 (encoding ubiquitin C-terminal hydrolase L1) was identified as a specific differentially expressed gene in SCNEC, which was positively related to lymph node metastasis (LNM). Migration and invasion of SCNEC tumor cells were induced by UCHL1 over-expression and suppressed by UCHL1 down-regulation, as shown by scratch and transwell invasion assays. Co-expression network analysis suggested that Prospero homeobox protein 1 (PROX1) might interact with UCHL1, and in vivo immunoprecipitation and western blots verified that levels of ubiquitinated PROX1 were significantly decreased following UCHL1 overexpression. Conclusion UCHL1 is a potential biomarker of LNM in SCNEC. UCHL1 might promote SCNEC cell migration and invasion by reducing PROX1 ubiquitination.

Data from small cell neuroendocrine carcinoma of the cervix: FIGO 2018 staging is more accurate than FIGO 2009

Objective To compare the prognostic value of International Federation of Gynecology and Obstetrics (FIGO) 2009 and 2018 staging systems in surgical patients with small cell neuroendocrine carcinoma of the cervix (SCNEC). Methods We re-staged 64 surgical IB–IIA (FIGO 2009) SCNEC patients according to the FIGO 2018 system and refined stage IIIC of FIGO 2018 based on tumor local invasion. The prognostic factors were analyzed, and the advantages of FIGO 2018 were compared with 2009. Results The 5-year overall survival rate (OS) was 78.5% for stage I and 22.2% for stage II (FIGO 2009). In FIGO 2018, there was no difference between stage I and II, and the 5-year OS was 74.1%, 60.2%, and 0% for stage I/II, IIIC1, and IIIC2. After combining stage IIIC with the local invasion stage (T1 was limited to the cervix and vagina; T2 involved the parametrium; T3 involved the pelvic or abdominal cavity), the 5-year OS for stage IIICT1, IIICT2, and IIICT3 was 83.3%, 30.0%, and 0%, respectively. Conclusions For stage II SCNEC patients, FIGO 2009 underestimated the prognosis, while FIGO 2018 was more accurate. For stage IIIC, FIGO 2018 might be more individualized and accurate after combining stage IIIC with tumor local invasion.

Multi-omics analysis: Gut microbial metabolites in ovarian lesions

Objective This study aimed to systematically elucidate the role of gut microbial metabolites in the development and progression of ovarian cancer. Methods Public databases, including GutMgene, were used to screen and integrate gut microbial metabolite–target genes with ovarian cancer–related genes, ultimately identifying 59 key intersection genes. A gut microbiota–metabolite–gene regulatory network was constructed, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, protein–protein interaction network analysis, and evaluations of the drug-likeness and toxicity of key metabolites were performed. Results A total of 72 key genes associated with immune regulation were identified. Enrichment analyses demonstrated that these genes were significantly involved in immune-related processes, including T cell activation and the Toll-like receptor signaling pathway. Protein–protein interaction network analysis identified five core genes: STAT3 , IL6 , TNF , AKT1 , and TP53 . Drug-likeness analysis suggested that metabolites such as butyric acid and indole-3-propionic acid exhibit potential drug-like properties. Conclusion Gut microbiota–derived metabolites may influence ovarian cancer progression and the immune microenvironment by regulating core genes such as TP53 and AKT1 and pathways including Toll-like receptor signaling. These findings provide a potential basis for microbiota-targeted interventions in ovarian cancer.