Journal of Nippon Medical School

Oncologic Outcomes of Fertility-Sparing Surgery versus Radical Surgery for Stage I Epithelial Ovarian Cancer

Treatment of Carcinosarcoma of the Fallopian Tube Mimicking Ovarian Cancer: A Case Report and Genetic Analysis

Carcinosarcoma of the fallopian tube is an exceptionally rare gynecological neoplasm. It tends to have high metastatic potential, to frequently recur, and has a poor prognosis. For these reasons, treatment is difficult and there is no standardized therapy schedule for this disease. Here, we report a case of carcinosarcoma of the fallopian tube mimicking ovarian cancer, initially presenting as a rupture of a growth and subsequent hemoperitoneum. The 55-year-old woman underwent cytoreductive surgery and postoperative conventional platinum-based combination therapy. The anti-angiogenic drug bevacizumab was added, and no evidence of disease was found on follow-up images or tumor markers 51 months after surgical resection. We describe a rare case of carcinosarcoma of the fallopian tube, include an in-depth histopathological review with genetic analysis, and propose treatment with a platinum-based combination therapy including bevacizumab.

Pseudo-Meigs Syndrome Caused by a Giant Uterine Leiomyoma with Cystic Degeneration: A Case Report

Pseudo-Meigs syndrome is defined as secondary accumulation of ascites and hydrothorax associated with a pelvic tumor other than benign ovarian tumors such as fibroma, which usually resolve after surgical removal of the tumor. Here we report a case of pseudo-Meigs syndrome caused by a giant uterine leiomyoma, which was initially suspected to be ovarian cancer. A 37-year-old nulliparous woman presented with a 5-month history of abdominal distension and anorexia. Abdominal ultrasonography revealed a giant cystic lesion and solid mass in the peritoneal cavity, along with plentiful ascites. Chest X-ray images showed a small pleural effusion on the right side. The patient was referred to our hospital for treatment of suspected ovarian cancer and peritonitis carcinomatosis. Although serum CA125 level was elevated (up to 331.8 U/mL), magnetic resonance imaging showed a giant sub-serosal uterine leiomyoma with cystic degeneration (27 × 15 × 13 cm). A small dermoid cyst was also detected in the right ovary. Ascites was drained and the patient underwent myomectomy and ovarian cystectomy. The patient had a degenerated leiomyoma with no pathological evidence of malignancy. Because symptoms disappeared postoperatively and serum CA125 returned to normal, without recurrence of ascites, pseudo-Meigs syndrome was diagnosed.

Laparoscopic Resection of a Large Mucinous Cystic Neoplasm of the Liver: A Case Report

Use of Tocilizumab to Treat Arthritis Associated with Mixed Connective Tissue Disease Complicated by Ovarian Teratoma: A Case Report

Mixed connective tissue disease (MCTD) is characterized by mixed features of systemic lupus erythematosus, systemic sclerosis, and polymyositis/dermatomyositis and is rare in children. Here, we report a case of MCTD in a 10-year-old girl who presented at our hospital with arthralgia, Raynaud's phenomenon, and fatigue. Blood tests were positive for anti-U1-ribonucleoprotein (RNP) antibodies and for rheumatoid factors (RFs) IgG-RF and anti-galactose-deficient IgG. Levels of myogenic enzymes and hypergammaglobulinemia were elevated. Macrophages were prominent in bone marrow, with scattered phagocytic macrophages. MCTD was diagnosed based on the patient's symptoms and laboratory findings. Methylprednisolone pulse therapy combined with oral tacrolimus was administered, which led to resolution of symptoms. Three months after pulse therapy, arthralgia worsened and methotrexate was administered. Arthralgia improved but did not resolve. Magnetic resonance imaging performed to investigate the hip pain revealed a mature ovarian teratoma, which was surgically removed. Because the pain persisted and interfered with her daily life, she was treated with tocilizumab for joint pain relief, which decreased the pain level. Tocilizumab is a candidate for additional treatment of juvenile idiopathic arthritis-like arthritis associated with childhood-onset MCTD.

Development and Clinical Application of a Deep Learning–Based AI Support Model for Endometrial Cancer Cytology

The global increase in endometrial cancer, including in Japan, and a shortage of pathologists and cytotechnologists have increased the diagnostic burden, emphasizing the need for an AI-based diagnostic support model that uses deep learning. We evaluated the clinical application of an improved AI-supported endometrial cytology model. Using YOLOv5x and YOLOv7 models evaluated by mean average precision (mAP), we compared two datasets-one annotated for both benign and malignant cell clusters, and one for malignant only. In addition, using the Two One-Sided Tests (TOST) procedure, we assessed the correlation between AI diagnostic accuracy and the level of difficulty perceived by human diagnosticians. Finally, we used Gradient-weighted Class Activation Mapping (Grad-CAM) to visualize and enhance the interpretability of the AI model's decision-making process. The YOLOv5x model with both benign and malignant annotations had the highest malignant mAP, 0.798, as compared with YOLOv7. The TOST analysis showed no significant difference in perceived diagnostic difficulty between cases that were correctly and incorrectly diagnosed by the AI model, indicating consistent AI accuracy regardless of case difficulty. Grad-CAM visualizations clarified the AI model's decision-making basis; in some cases, the model appeared to focus on regions that differed from those typically attended to by human diagnosticians. The AI support model showed high and consistent accuracy in endometrial cytological analysis, regardless of diagnostic difficulty as perceived by human diagnosticians. Grad-CAM visualizations revealed diagnostic patterns, and the AI occasionally focused on regions different from those emphasized by human diagnosticians. This study advanced a real-time microscope-integrated AI system toward clinical application.

Effectiveness and Long-term Outcomes of Nerve-Sparing Radical Hysterectomy for Cervical Cancer

Radical hysterectomy (RH) is a type of radical surgery for cervical cancer. Urinary dysfunction due to RH worsens postoperative quality of life of patients with cervical cancer. Nerve-sparing RH (NSRH) technique has been used as an effective means to conserve urinary function. However, few reports have examine long-term outcomes after NSRH. This study describes the details and long-term outcomes of our nerve-sparing technique. Sixty-one patients underwent radical hysterectomy in a 5-year period during which nerve-sparing technique was introduced; of these, 31 patients underwent NSRH and 30 underwent conventional RH. We retrospectively examined their medical records and compared postoperative urinary function and treatment outcomes between these two groups. The median time required for urinary residual volume to fall to ≤50 mL after removal of the urinary catheter was 6 days (range, 2-20 days) in the NSRH group and 13.5 days (range, 3-46 days) in the RH group. The results were significantly better in the NSRH group (p < 0.05). The mean follow-up period was 2456.3 days (range, 48-4,213 days). Analysis of curability revealed no significant difference between the two groups in local recurrence or long-term survival rates. The 5-year survival rate was 0.861 in the NSRH group and 0.782 in the RH group; the 10-year survival rate was 0.861 in the NSRH group and 0.679 in the RH group. NSRH significantly improved postoperative urinary function without worsening local recurrence rates or long-term outcomes.