Medicine

Ten years’ disease-free survival of advanced epithelial ovarian cancer treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy

Abstract Rationale: One of the most distinctive features of epithelial ovarian cancer is tendency to disseminate into peritoneal cavity to form peritoneal carcinomatosis, indicating advanced disease with poor prognosis. Patient concerns: A fifty-year-old patient had a chief complaint of an abdominal distension lasting 1 month. Diagnoses: The patient was diagnosed with advanced epithelial ovarian cancer with peritoneal carcinomatosis by computed tomography scan, tumor markers, endoscopy examination, and pathology. Interventions: The patient was treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy followed by 8 cycles of systemic chemotherapy. Outcomes: Till March 9, 2020, the patient has disease-free survival over 10 years. Lessons: The application of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy combined with systematic chemotherapy may improve survival dramatically for the patients with epithelial ovarian cancer and peritoneal carcinomatosis and should be considered as an option of a relatively new regime.

Solitary vulvar metastasis from early-stage endometrial cancer

Abstract Rationale: Endometrial cancer (EC) is the most common gynecological malignancy in developed countries. It is usually diagnosed at early-stage and presents a favorable prognosis. Conversely, advanced or recurrent disease shows poor outcome. Most recurrences occur within 2 years postoperatively, typically in pelvic and para-aortic lymph nodes, vagina, peritoneum, and lungs. Vulvar metastasis (VM) is indeed anecdotal probably because of the different regional lymphatic drainage from corpus uteri. Patient concerns: A 3 cm, reddish, bleeding lesion of the posterior commissura/right labia was found in a 74-year-old woman treated with radical hysterectomy, surgical staging, and adjuvant radiotherapy 1 year before for a grade 2 endometrioid type, International Federation of Gynecology and Obstetrics Stage IB. Vulvar biopsy confirmed the EC recurrence. Pelvic magnetic resonance imaging and positron emission tomography excluded other metastases so VM was radically resected. Diagnosis: Postoperative histopathology confirmed the diagnosis of grade 2 EC VM. Interventions: A radical excision of VM was performed. Outcomes: Patient died from a severe sepsis 27 months after first surgery. Lessons: Vulvar metastases can show different appearance, occurring as single or diffuse lesions on healthy or injured skin. The surgical approach seems not to influence the metastatic risk, but tumor seeding and vaginal injuries should be avoided. Whether isolated or associated with recurrence in other locations, vulvar metastases imply poor prognosis despite radical treatment. Therefore, any suspected vulvar lesion arisen during EC follow-up should be biopsied and monitored closely, despite that the vulva represents an unusual metastatic site.

Fertility preservation techniques in cervical carcinoma

Astract The usefulness of this review is to highlight how a fertility preservation (FP) approach is currently feasible for patients diagnosed with uterine cervical cancer. To this regard, a fertility sparing surgery has just overcome its traditional limits, gained acceptance within the major gynecologic oncology societies thanks to the ability to identify the “ideal” candidates to this conservative treatment. On the other hand, the use of other FPs for oocyte and ovarian cortex cryopreservation is still extremely debated. In fact, the existing risk of tumor spreading during oocyte retrieval necessary for oocyte cryostorage for patients’ candidates for neo-adjuvant therapy, as well as the potential hazard of cancer cell dissemination after ovarian tissue replacement in cases of non-squamous type cervical carcinomas should not be underestimated. Therefore, in consideration of the encountered limitations and the need to ensure adequate reproductive health for young uterine cervical cancer survivors, translational research regarding the FP has progressively collected innovative insights into the employment of stemness technology. In this context, the property of ovarian stem cells obtained from the ovarian cortex to generate functional oocytes in women could represent a promising therapeutic alternative to the current procedures for a novel and safer FP approach in cancer survivors.

Ultrasound examination assisted clinical diagnosis of Leydig cell tumor of ovary: An extremely rare case report

Introduction: Leydig cell tumor (LCT) is a sex cord-stromal tumor, which is a clinically rare ovarian tumor. It is characterized by endocrine hormonal changes and usually occurs in postmenopausal women. Patient concerns: We report the clinical case of a 38-year-old female of childbearing age with LCT of the right ovary who presented with significantly decreased menstrual flow and elevated androgen levels, with persistent hypoechoic areas in the ovary as demonstrated by transvaginal ultrasound. Diagnosis: The transvaginal ultrasound suggested the presence of a hypoechoic area in the right ovary with elevated androgens, interstitial tumor of the ovarian sex cord may be considered. Interventions: The patient underwent laparoscopic right adnexectomy. Outcomes: Postoperative pathology confirmed the morphology and immunohistochemistry of the right adnexa consistent with LCT, and no areas of malignant transformation were found on multiple sections of the surgical specimen. The patient had normal androgen levels at postoperative day 2, day 45 and month 3. There was no sign of recurrence. Conclusion: This case suggests that when women of childbearing age have abruptly decreased menstrual flow with increased testosterone, clinicians should pay attention to intra-ovarian occupying lesions and consider the possibility of LCT. In such cases, ultrasound examination can determine the presence, location, shape and size of occupying ovarian lesions and play an important role in the diagnosis of condition.

Primary ovarian endometrial stromal sarcoma after hysterectomy associated with multiple organ invasion: A case report

Rationale: Endometrial stromal sarcoma (ESS) is a rare disease in patients with uterine malignancies, accounting for <1%. Low-grade endometrial stromal sarcoma (LGESS) accounts merely 0.2% of gynecologic malignant tumor. Primary low-grade extrauterine endometrioid stromal sarcomas (LGEESS) is even more uncommon, with only a few documented case reports. We report a case of primary LGEESS exhibiting widely invasion in multiple organs after hysterectomy, which is the first case reported in Jiangsu Province of China. Patient concerns: A 42-year-old nulliparous female with dysgnosia presented with a moderate amount of irregular vaginal bleeding, abdominal pain and distension, and frequent urination for 2 days. Her surgical history included a total hysterectomy and bilateral salpingectomy for uterine fibroids 6 years ago. Ultrasonography and the abdominal and pelvic computed tomography scan detected some solid polycystic masses in the pelvic and abdominal cavities. Diagnoses: The histopathology of the specimen confirmed the diagnosis of LESS in the absence of florid endometriosis. The patient was diagnosed with primary extrauterine endometrial stromal sarcoma at FIGO stage III. Interventions: Surgery and histopathology were performed. Outcome: After surgery, the patient was maintained on leuprorelin acetate microspheres with sustained release for injection at 3.75 mg once every 4 weeks while refusing further radiotherapy. Lessons: The diagnosis of primary LGEESS is challenging mainly because of their unforeseen location and nongynecologic signs and symptoms. Total hysterectomy and bilateral salpingo-oophorectomy are recommended to LGESS, while additional resection for extrauterine disease depends on disease extent and resectability.

Incidence and non-genetic risk factors of irinotecan-induced severe neutropenia in Chinese adult inpatients

To analyze the incidence and nongenetic risk factors of irinotecan-induced severe neutropenia in the hospital, and provide additional reference and help for clinical treatment. A retrospective analysis of patients who received irinotecan based chemotherapy from May 2014 to May 2019 in Renmin Hospital of Wuhan University was conducted. Univariate analysis and binary logistic regression analysis with the forward stepwise method were used to assess the risk factors associated with severe neutropenia induced by irinotecan. Of the 1312 patients treated with irinotecan-based regmines, only 612 patients met the inclusion criteria, and 32 patients developed irinotecan-induced severe neutropenia. In the univariate analysis, variables associated with severe neutropenia were tumor type, tumor stage, and therapeutic regimen. In the multivariate analysis, irinotecan plus lobaplatin, lung cancer or ovarian cancer, tumor stage T2, T3, and T4, were identified as risk factors that contributed independently to irinotecan-induced severe neutropenia (P < .05), respectively. The results showed that the incidence of irinotecan–induced severe neutropenia was 5.23% in the hospital. The risk factors included tumor type (lung cancer or ovarian cancer), tumor stage (T2, T3, and T4) and therapeutic regimen (irinotecan plus lobaplatin). Therefore, for patients with these risk factors, it might be advisable to actively consider optimum management to reduce the occurrence of irinotecan–induced severe neutropenia.

Methodology of dose calculation for external beam radiation combined with high dose rate brachytherapy in the era of 3-dimensional treatment planning system

Abstract Intracavitary application of brachytherapy (BT) sources followed by external beam radiation is essential for the local treatment of carcinoma of the cervix, postate, and nasopharynx. Dose distribution of external beam radiation plus BT can be challenging for the planning system because of their dose calculation by 2 different treatment planning system (TPS). The aims of this study were to introduce a novel iterative method of dose calculation preformed in the Pinnacle plan and evaluate a combined dose distribution for external beam radiation and BT. Because it is often the goal of the planner to produce plan with uniform dose throughout the target volume and normal tissue, we present an Iridium-192 calculation program using American Association of Physicists in Medicine Task Group 43 formula and export it to other commercialized TPS though the combined dose distribution of external beam radiation and BT can be shown. To illustrate such an improved procedure, we present the treatment plans of 2 patients treated with external beam radiation plus BT. Dose distribution of the single BT source were calculated with the Plato post loading TPS and the program model, and the results of 2 methods were similar. A nasopharyngeal case and a cervical case were shown in Pinnacle with this program. The total dose distribution of BT combined with EBRT was showed in compute tomography images. And the corresponding dose volume histogram figures could be displayed correctly in Pinnacle TPS. We demonstrated a novel iterative method of dose calculation preformed in the Pinnacle plan to produce a combined dose distribution for external beam radiation and BT. We used it to evaluate the dose of target volume and normal tissues in the treatment of external beam radiation plus BT.

The maximum standardized uptake value and extent of peritoneal involvement may predict the prognosis of patients with recurrent ovarian cancer after primary treatment

Abstract We investigated the effect of the maximum standardized uptake value (SUVmax) and peritoneal dissemination derived from 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging on prognosis in patients with recurrent ovarian cancer. We retrospectively analyzed 145 patients with suspected recurrent ovarian cancer who had undergone 18F-FDG PET/CT scans after cytoreductive surgery and chemotherapy. The degree of peritoneal spread was classified as localized (1–3 FDG foci) or diffuse (>3 FDG foci). Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values for predicting recurrence. A total of 145 patients were retrospectively reviewed in this study. 29 patients were excluded as their follow-up results were not available. One hundred sixteen patients were included in the final analysis. The median duration of progression-free survival was 14 months. 18F-FDG PET/CT detected peritoneal carcinomatosis in 82 patients. With a cut-off SUVmax of 2.0 obtained from the ROC curve analysis, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SUVmax of peritoneal carcinomatosis for predicting recurrence were 77.6%, 87.5%, 65.1%, 97.4%, and 38.9%, respectively. The area under the curve was 0.85. In a multivariate analysis, significant independent prognostic variables were SUVmax of peritoneal disease, peritoneal dissemination, and CA125 levels. In patients with peritoneal involvement, the Kaplan-Meier survival curves showed significantly longer PFS in those with localized disease. SUVmax of peritoneal disease is valuable in predicting the recurrence of ovarian cancer. SUVmax of peritoneal disease, peritoneal dissemination and CA125 level could be used as independent prognostic factors for ovarian cancer patients.

Association between C-reactive protein level and subsequent risk of ovarian cancer

Abstract Background: Though studies have shown association between C-reactive protein (CRP) level and the risk of ovarian cancer (OC), there have been some inconsistencies. The current metaanalysis was conducted to study the relationship between CRP and OC. Patients and methods: Three electronic databases of PubMed, Embase, and Cochrane Library were searched for prospective studies of OC from inception till May 2018. Relative risk (RR) was summarized using random-effects model, and the results of sensitivity, subgroup analyses, and publication biases were also calculated. Results: A total of 13 cohorts involving 1,852 OC patients were included for the final meta-analysis. The summary RRs indicated that high CRP was associated with an increased risk of all invasive OC (RR:1.36; 95% confidence interval [CI]:1.03–1.80; P = .032), while moderate CRP showed no significant impact on the risk of all invasive OC compared with low CRP (RR:1.17; 95% CI:0.97–1.41; P = .107). High (RR: 1.42; 95% CI: 0.85–2.37; P = .183) or moderate (RR: 1.29; 95% CI: 0.94–1.77; P = .119) CRP levels showed little or no effect on serous OC. Similarly, no significant differences for the comparisons of high versus low (RR: 1.82; 95% CI: 0.27–12.42; P = .540) or moderate versus low (RR: 0.72; 95% CI: 0.31–1.69; P = .455) CRP levels for the risk of mucinous OC were observed. Moreover, high (RR: 0.58; 95% CI: 0.13–2.54; P = .471) or moderate (RR: 0.81; 95% CI: 0.44–1.47; P = .484) CRP levels were not associated with the risk of endometrioid OC compared with low CRP levels. Conclusion: High CRP levels were associated with increased risk of invasive OC. The risk of other OC types with CRP levels showed no association.

Epidural abscess formation after chemoradiation therapy for esophageal cancer

Abstract Rationale: Esophageal cancer is one of the leading causes of death worldwide; the treatments vary according to the stage at diagnosis. Advanced esophageal cancer is usually treated by concurrent chemoradiation which is associated with complications including esophagitis, esophageal stricture or perforation, radiation pneumonitis, and/or cardiac toxicity. Herein, we describe epidural abscess, which is a very rare but severe complication that can occur after concurrent chemoradiation therapy for advanced esophageal cancer. Patient concerns: A 75-year-old man developed a fever during concurrent chemoradiation therapy for advanced esophageal cancer, which progressed to neurological deficit and paraplegia. Enhanced chest computed tomography and C-spine magnetic resonance imaging were performed. Diagnosis: Chest computed tomography revealed a poorly enhanced necrotic change in the cervical esophageal cancer, with mottled dirty material and fluid collection. C-spine magnetic resonance imaging revealed a prevertebral abscess with pyogenic spondylitis at the C6–T2 level. In addition, an anterior epidural abscess at the C6–7 level compressed the spinal cord. Interventions: The patient underwent emergency anterior cervical discectomy and decompression corpectomy. Outcomes : After surgery, the neurological symptoms gradually improved. Lessons: Pyogenic spondylitis with an epidural abscess is a rare but life-threatening complication that can develop after concurrent chemoradiation therapy for advanced esophageal cancer. Rapid, accurate diagnosis and prompt surgical treatment are important to ensure a favorable long-term prognosis and a good quality of life.

Antenatal diagnosis and management of pregnancy luteoma: A case report and literature review

Background: Pregnancy luoteomas are tumor-like ovarian lesions that emerge during pregnancy and spontaneously regress after delivery. Antenatal diagnosis is infrequently reported, and unnecessary surgery appears to be common in literature reports. Case summary: A 28-year-old primigravida with bilateral adnexal masses was discovered at 32 + 5 weeks during prenatal ultrasound evaluation. Combined with clinical presentation, auxiliary examinations including blood test, magnetic resonance imaging, gastroscopy, and consultation of multi-disciplinary team, we successfully made a diagnosis of pregnancy luteoma and provided conservative management recommendations. A cesarean section was conducted on this patient at 34 + 2 weeks of gestation due to fetal distress. The newborn was small for gestational age but normal in appearance. We performed biopsies of the adnexal masses, which were confirmed to be pregnancy luteomas using both intraoperative frozen section and final pathological diagnosis. Serum testosterone, cancer antigen 125, and alpha-fetoprotein levels gradually declined and normalized on postoperative day 28. The masses significantly decreased in size as shown by ultrasonic and magnetic resonance imaging examination on postoperative day 7, with the ovaries returning to their normal size by postoperative day 30. Conclusion: Prenatal diagnosis of pregnancy luteoma poses a challenge, requiring hormonal examinations, ultrasound, magnetic resonance imaging, and gastrointestinal endoscopy for identification. Caution must be exercised to avoid overtreatment. While additional cases are needed to summarize the imaging features and effects of excess hormones on the both mother and fetus, further research is necessary for a comprehensive understanding.

Diagnosis and rescue of malignant hyperthermia induced by anesthesia during radical surgery in a cervical cancer patient using the National Remote Emergency System: A case report

Rationale: Malignant hyperthermia (MH) is a rare yet serious medical complication that typically arises following general anesthesia or the administration of specific anesthetics. Due to the infrequency of MH, anesthesiologists often lack sufficient expertise in identifying and managing it, leading to misdiagnosis and inappropriate treatment. There is an urgent need to enhance the diagnosis and management of MH through the utilization of relevant tools. Patient concerns: In this case, a 52-year-old woman underwent radical cervical cancer surgery under general anesthesia, with no family or significant medical history. She experienced a gradual increase in end-tidal carbon dioxide (ETCO2) to a maximum of 75 mm Hg and a rise in body temperature from 36.5 to 37.5 °C in a very short period, as well as a blood gas analysis showing a pH of 7.217. Diagnosis: The anesthesiologist immediately used The WeChat applet-based National Remote Emergency System for Malignant Hyperthermia (MH-NRES), and the score was 40, which indicated that the patient was very likely to have MH. Interventions: We immediately discontinued sevoflurane and switched total intravenous anesthesia to maintain general anesthesia, with a rapid intravenous infusion of dantrolene sodium. Outcomes: The ETCO2 and the temperature quickly dropped to normal, followed by successful completion of the surgery, and the patient was discharged 8 days after surgery. Lessons: The experience can provide a basis use of MH-NRES and improve the ability of anesthesiologists to deal with intraoperative MH as well as increase the survival probability of patients.

Precision identification of endometrial malignancy and precancerous lesions: Development of a machine learning model incorporating multidimensional clinical and imaging parameters

To develop and validate a machine learning (ML) model integrating multidimensional clinical, pathomic, and ultrasound radiomic parameters for precise identification of endometrial malignancy and precancerous lesions, with a focus on addressing the diagnostic needs of younger patients pursuing fertility preservation. This retrospective study enrolled patients with suspected endometrial lesions from a single institution. Clinical baseline data (e.g., age, body mass index, menopausal status), pathomic features (e.g., cellular atypia, gland density), and ultrasound radiomic parameters (e.g., endometrial thickness, resistance index) were collected. Key predictors were selected using Pearson correlation, SHapley Additive exPlanations analysis, and least absolute shrinkage and selection operator regression. Seven ML models were constructed and optimized via 5-fold cross-validation. Model performance was evaluated using metrics such as ROC-AUC, sensitivity, specificity, and precision–recall performance in training (70%) and testing (30%) sets. A total of 1221 patients (854 in training, 367 in testing) were included. Seven variables including age, body mass index, menopausal status, cellular atypia, gland density, endometrial thickness, and resistance index emerged as robust predictors. Among the 7 ML models, the random forest model showed superior performance, with receiver operating characteristic area under curve of 0.98 in the training set and 0.96 in the testing set (95% confidence interval [CI]: 0.93–0.98). It had balanced sensitivity (0.89, 95% CI: 0.75–0.96) and specificity (0.86, 95% CI: 0.82–0.90) in the testing set. It maintained stability across varying risk thresholds and cost-benefit ratios, outperforming other models in precision–recall balance. Integration of multidimensional data via ML, particularly the random forest model, enhances the precision of endometrial malignancy detection. This approach enables personalized risk stratification, supporting targeted management for younger patients and advancing patient-centered care.

Reproductive and oncological outcomes of fertility-sparing surgery in patients with stage I epithelial ovarian cancer: A systematic review and meta-analysis

Objective: We meta-analyzed available evidence on fertility, survival, and cancer recurrence in patients with stage I epithelial ovarian cancer (EOC) after fertility-sparing surgery (FSS). Methods: We systematically reviewed PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials to identify studies reporting reproductive and oncological outcomes of patients with stage I EOC who underwent FSS. Random-effects models were used to calculate pooled rates of disease outcomes, along with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were conducted to identify sources of heterogeneity in the data. Results: We included 23 observational retrospective studies involving 1126 patients. The pooled pregnancy rate was 30% (95% CI, 0.26–0.34), while the pooled natural conception rate was 26% (95% CI, 0.20–0.33). The pooled live birth rate was 27% (95% CI, 0.22–0.32). The pooled rate of EOC recurrence was 12% (95% CI, 0.09–0.14), which did not differ significantly from the rate among patients who underwent radical surgery (odds ratio, 0.77; 95% CI, 0.45–1.33). Conclusions: FSS is associated with good oncological outcomes but less than satisfactory reproductive outcomes. All in all, the procedure appears to be a safe alternative to radical surgery for EOC patients who want to preserve fertility.

A new nonsense mutation of PTCH1 gene in mother and daughter with late-onset nevus basal cell carcinoma syndrome: Case report

Rationale: Nevoid basal cell carcinoma syndrome (NBCCS) is a rare clinical disease characterized by a disproportionate number of basal cell carcinoma to sun exposure and skin types. Patched 1 (PTCH1) gene is proposed to be implicated in the pathogenesis of NBCCS. This study aimed to investigate whether PTCH1 gene is the causative gene in Chinese patients with NBCCS. Patient concerns: Here we detected the first nonsense mutation in PTCH1 gene by Sanger sequencing of blood samples from a mother and her second daughter (NM000264: exon14: c.2080C>T: p.Q694X). Diagnoses: Both of the mother and her second daughter had ovarian mature teratomas. Interventions: The mother received liquid nitrogen cryotherapy, surgical resection, and radiation therapy, while her second daughter was treated with a GX-III multifunctional ion surgical therapy machine and surgery. Outcomes: New rashes continued to appear and contractures of the right eyelid healed in the mother, while her second daughter had multiple pitting depressions on the palms and soles of both hands and feet. Conclusion: We detected a new mutation in PTCH1 gene in 2 patients with NBCCS, and both of them had ovarian mature teratomas, which are related to NM000264: exon14: c.2080C>T: p.Q694X.

Well-differentiated papillary mesothelial tumor of the peritoneum in a young woman: A case report with molecular insights

Rationale: Well-differentiated papillary mesothelial tumor (WDPMT) is an uncommon, slow-growing neoplasm that is often an incidental finding in the peritoneum of women of reproductive age. It can be misdiagnosed as malignant mesothelioma on routine histology, potentially leading to unnecessary aggressive therapy. The role of modern molecular techniques in resolving this diagnostic dilemma and guiding conservative management warrants emphasis. Patient concerns: A 32-year-old woman presented with vague abdominal discomfort. Imaging revealed bilateral ovarian cysts and significant pelvic free fluid. Diagnoses: Laparoscopy identified multiple small peritoneal nodules. Initial frozen-section histology suggested malignant mesothelioma. Definitive diagnosis of WDPMT was established through comprehensive immunohistochemistry (retained BAP1 expression) and next-generation sequencing, which revealed a low tumor mutational burden and a pathogenic GPR124 mutation. This genetic profile distinct from malignant mesothelioma. Interventions: After definitive diagnosis and thorough counseling, the patient opted against cytoreductive surgery or systemic therapy. A strategy of active surveillance with serial imaging and tumor marker assessment was implemented. Outcomes: The patient remained asymptomatic with no evidence of disease recurrence or progression 24 months after diagnosis. Lessons: This case highlights that a definitive distinction between WDPMT and malignant mesothelioma is paramount, as it dictates a radically different management strategy. Integration of immunohistochemistry (particularly BAP1) and molecular profiling is essential for accurate diagnosis and can prevent overtreatment. For appropriately selected patients with WDPMT, conservative management with active surveillance represents a safe and effective approach, underscoring the value of precision medicine in guiding patient-centric care.

Ovarian cancer causing hyperprolactinemia: A case report and narrative review

The most common cause of hyperprolactinemia is prolactinoma. In addition, it is necessary to exclude potential physiological and pharmacological factors as well as health disorders to determine the cause of hyperprolactinemia. However, few studies have linked elevated prolactin (PRL) levels to ovarian cancer (OC). OC cells can ectopically release PRL, which then attaches to PRL receptors (PRLRs) in ovarian tissue and initiates signaling cascades that induce OC carcinogenesis. Therefore, we can consider PRL as a biomarker or tumorigenesis factor for OC. Furthermore, both PRL and PRLRs are potential therapeutic targets. A 50-year-old female presented with complaints of breast enlargement, soreness, and hyperprolactinemia, in addition to advanced OC. Hyperprolactinemia along with advanced high-grade serous ovarian carcinoma. Due to the patient’s fear of confined spaces, magnetic resonance imaging of the pituitary gland under general anesthesia was prescribed to rule out pituitary pathology. Magnetic resonance imaging was not performed due to the deterioration of the underlying condition, and the patient died 2.5 years after the diagnosis of OC. Hyperprolactinemia caused by OC is a rare condition for which there is a lack of literature and case studies. PRL produced by OC tissue binds to PRLRs in an autocrine or paracrine manner, initiating signaling cascades that induce OC tumorigenesis. In combination with other biomarkers, PRL may serve as a biomarker for OC. To establish the relation between OC and elevated PRL levels, additional large-scale population studies are required, with diagnostic and treatment procedures coming first.

Cervical adenocarcinoma misdiagnosed as a nabothian cyst during pregnancy: A case report and review of the literatures

Rationale: The incidence of cervical adenocarcinoma is increasing, particularly in women of reproductive age, and presents a unique diagnostic and therapeutic challenge when encountered during pregnancy. Distinguishing malignant cervical lesions from benign entities such as nabothian cysts can be particularly difficult due to overlapping clinical and imaging features, leading to potential delays in diagnosis and management. Patient concerns: A 38-year-old multiparous woman at 7 weeks’ gestation was referred to a tertiary hospital for an abnormal Papanicolaou smear showing atypical glandular cells of undetermined significance and positive for high-risk human papillomavirus (HPV) type 18 infection. She was asymptomatic, with no vaginal bleeding, pelvic discomfort or other suggestive symptoms. Diagnoses: Initial imaging and colposcopic findings suggested a nabothian cyst. However, 4 weeks later, atypical cytological findings and HPV 18 positivity prompted further surveillance. At 26 weeks’ gestation, cervical biopsy confirmed moderately differentiated HPV-associated cervical adenocarcinoma. Magnetic resonance imaging staged the disease as International Federation of Gynecology and Obstetrics stage IB1. Interventions: After multidisciplinary consultation, the patient underwent classical cesarean section followed by type 3 radical hysterectomy, bilateral salpingectomy, pelvic lymphadenectomy and ovarian transposition at 29 weeks 6 days gestation. Magnesium sulfate and corticosteroids were administered for fetal neuroprotection and lung maturation. Outcomes: Pathology confirmed a 1.5 cm cervical adenocarcinoma without lymphovascular space invasion, parametrial extension or lymph node metastasis. The patient has remained disease-free for 4 years under regular oncological surveillance. Lessons: This case highlights the diagnostic complexity of cervical adenocarcinoma in pregnancy, particularly when lesions mimic benign cervical pathology. Persistent atypical cytology and high-risk HPV positivity warrant thorough evaluation, including colposcopic biopsy, despite pregnancy. A multidisciplinary approach is essential for optimal maternal and fetal outcomes.

First case report of lorlatinib in the treatment of ALK-fusion-positive lung adenocarcinoma with ovarian metastasis: Clinicopathological and molecular characterization

Background: Ovarian metastasis from anaplastic lymphoma kinase (ALK)-positive lung adenocarcinoma is exceedingly rare. Reporting such cases is vital for understanding its clinical management. Patient concerns: A 49-year-old woman presented with a 10-day history of amenorrhea and lower abdominal pain. Diagnoses: Imaging revealed bilateral ovarian masses and liver nodules. Liver biopsy and genetic testing confirmed the diagnosis of stage IV EML4-ALK fusion-positive lung adenocarcinoma with ovarian and hepatic metastases. Interventions: First-line treatment with the third-generation ALK inhibitor lorlatinib (100 mg, once daily) was initiated. Outcomes: The patient achieved a partial response with significant lesion regression and normalized tumor markers, sustained for over 12 months. No severe adverse events occurred. Lessons: This case underscores the importance of molecular profiling in diagnosing metastatic tumors and confirms lorlatinib as a highly effective first-line therapy for ALK-positive non-small cell lung cancer with atypical metastases.

Exploring the mechanism of Stephania tetrandra S. Moore in the treatment of cisplatin resistance against ovarian cancer through integration of network pharmacology and molecular docking

Cisplatin resistance is a major contributor to treatment failure in ovarian cancer (OC). This study investigates the mechanisms of action and therapeutic targets of Stephania tetrandra S. Moorefor cisplatin-resistant OC. OC datasets were obtained from the gene expression omnibus database, and differentially expressed genes were identified through weighted gene co-expression network analysis. Cisplatin resistance-related targets were screened using the GeneCards, OMIM, and MsigDB databases, while active components of S tetrandra were retrieved from the TCMSP, ETCM, and BATMAN databases. Commonly shared genes between these 2 sets were selected for further analysis. A protein–protein interaction network was constructed using the STRING database, and 4 machine learning algorithms were integrated to identify core targets. Binding affinities were evaluated by molecular docking with AutoDock Vina. Molecular dynamics simulations were then conducted to assess the stability of the ligand-target complexes. We performed ADMET analysis to assess the pharmacokinetic properties and drug-likeness of S tetrandra . Machine learning algorithms further identified 8 core targets including threonine tyrosine kinase (TTK), AURKA, B-cell lymphoma 2, vitamin D receptor, NFKB1, cyclin dependent kinase 1, DNMT1, and SMAD7. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses revealed that these targets were significantly enriched in pathways such as the PI3K-AKT, cell cycle regulation, p53 signaling pathway, and platinum resistance pathway. Receiver operating characteristic curve analysis demonstrated diagnostic potential for all genes except SMAD7 (AUC = 0.603 < 0.7). Immune infiltration analysis indicated a positive correlation between AURKA/TTK expression and M0/M1 macrophage infiltration ( P  <.05). Molecular dynamics simulations demonstrated that hesperidin, cissamine and tetrandrine exhibited strong binding affinities toward AURKA, vitamin D receptor, and TTK. Future studies are encouraged to focus on the experimental validation of these compounds and delve deeper into the possible mechanisms of drug resistance, aiming to improve their therapeutic effectiveness and real-world applicability.

Incidentalomas discoveries during staging and surveillance for colorectal cancer patients

This study attempted to evaluate the incidence of incidentalomas based on computed tomography (CT) in colorectal cancer (CRC) patients. CRC patients who obtained plan or enhanced CT for the whole abdominal and pelvis were included at the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Incidentalomas, including uterine tumors, adrenal gland tumors, renal cancer, pancreatic tumors, prostatic tumors, ovarian tumors, upper-tract urothelial cancer, and gallbladder tumors, were assessed based on all radiology reports by radiologists and surgeons. Moreover, the clinical characteristics of all patients were collected. A total of 7053 CRC patients (mean age, 62.6 ± 12.3; 4139 male) were finally included, 255 (3.6%) patients had an incidentaloma. The proportions of uterine tumors, adrenal gland tumors, renal cancer, pancreatic tumors, and prostatic tumors were 1.3% (92/7053), 1.1% (77/7053), 0.7% (46/7053), 0.1% (15/7053), and 0.1% (10/7053), respectively. Ovarian tumors, upper-tract urothelial cancer, and gallbladder tumors all had an incidence of <0.1%. The prevalence of incidentalomas in CRC patients was 3.6% (255/7053). The most common incidentalomas was uterine tumor, followed by adrenal gland tumor, and renal cancer. These findings highlighted the importance of careful evaluation of abdominal and pelvic CT scans in CRC patients, as timely detection and management of incidentalomas might optimize treatment strategies and improve patient outcomes.

Causal validation of the relationship between air pollution and ovarian cancer: A bidirectional Mendelian randomization study and meta-analysis

In recent years, an increasing number of observational studies have reported the impact of air pollution on ovarian cancer. However, a Mendelian randomization (MR) study to explore the causal relationship in ovarian cancer has not yet been conducted. This study, based on 2-sample MR, conducts MR analysis by examining 5 air pollution indices with ovarian cancer data from 2 different sources. Subsequently, a meta-analysis of the primary inverse-variance weighted results is performed, followed by multiple corrections on the meta-analysis thresholds to ensure accuracy. Finally, a reverse causality verification of the positive air pollution indices with ovarian cancer is conducted through MR analysis. The MR analysis was conducted using 5 air pollution indices and ovarian cancer data from the Finngen R10 and OpenGWAS databases. A meta-analysis was then performed on the inverse-variance weighted results from both sets of analyses. Multiple corrections were applied to the significance threshold of the meta-analysis results, revealing an odds ratio value of 1.544 (95% confidence interval: 1.180–2.020, P = .0077). Additionally, the positive air pollution index, nitrogen dioxide, showed no reverse causality with ovarian cancer in both data sources. Nitrogen dioxide is a risk factor for ovarian cancer and may increase the risk, accelerating the onset and progression of the disease.

Evaluation of the diagnostic efficacy of multi-layer spiral CT scan combined with ultrasound examination for struma ovarii: A case–control study

This case–control study aimed to improve the accuracy of imaging diagnosis of struma ovarii by analyzing the ultrasound (US) and computed tomography (CT) features, along with clinical characteristics of patients diagnosed in our hospital, and by reviewing relevant literature. A retrospective analysis was conducted on the US and CT findings of 32 patients with suspected struma ovarii in our hospital between September 2012 and December 2024. Pathological results were used as the gold standard to analyze the sensitivity, accuracy, and specificity of ultrasonography, CT, and combined US and CT examinations. Thirteen cases were positive and 19 cases were negative on CT; 12 cases were positive and 20 cases were negative on ultrasonography; and 13 cases were positive and 19 cases were negative on combined ultrasonography and CT. The sensitivity, specificity, and accuracy of the combined US and CT examinations (85.71%, 90.63%, and 94.44%, respectively) were higher than those of the individual US and CT examinations ( P  < .05). Our study suggests that US can effectively distinguish between fat and calcification, whereas CT can clearly display enhancement of the cyst wall and septum, especially the significantly enhanced nodules on the wall. The combined use of ultrasonography and CT can improve the diagnostic accuracy for this disease.

Construction and accuracy assessment of an efferocytosis-related prognostic model for ovarian cancer: A diagnostic accuracy study

The study aimed to investigate the prognostic significance of efferocytosis-related genes in ovarian cancer (OC) with regard to cancer development, progression, invasion, and metastasis. OC cohorts were assembled from bioinformatics repositories. Utilizing consensus clustering analysis, distinct clusters were delineated based on the intersection of OC-related genes and efferocytosis-related genes. A prognostic signature specific to efferocytosis in OC was developed using data from The Cancer Genome Atlas, validated against the gene expression omnibus database, and subjected to independent prognostic analysis. Subsequently, a nomogram model was formulated. Moreover, investigations encompassed the immune microenvironment, immunotherapy, mutation profiling, drug sensitivity assessments, drug prediction models, and molecular docking analyses. Finally, quantitative reverse transcription polymerase chain reaction (qRT-PCR) assays were employed to ascertain the mRNA expression levels of key genes. Five key genes, FCGBP, BTN3A3, WDR91, SLC25A45, and BTNL3, were identified as significantly associated with OC. Both datasets and qRT-PCR demonstrated elevated expression levels of FCGBP and WDR91 in OC. Notably, AFLATOXIN B1 exhibited strong binding affinity to SLC25A45, ciclopirox to BTN3A3, and irinotecan to WDR91. The risk score, age, and stage were identified as independent prognostic factors, with the nomogram displaying efficacy in predicting OC patient survival. Variations in the immune cell infiltration profiles, including naive B cells, and expression levels of 6 immune checkpoint genes, such as CTLA4, were notable. High tumor mutation burden scores were associated with improved survival outcomes. Additionally, significant differences in the IC50 values of 123 anticancer drugs were observed between the 2 risk groups. This findings of this study highlight the efficacy of the efferocytosis-associated risk model in predicting the survival outcomes of OC patients, thus providing a novel reference for prognostic prediction in OC patients.

Evolution of an ovarian endometriotic cyst into clear cell carcinoma with squamous differentiation across two pregnancies: A case report

Rationale: Ovarian clear cell carcinoma (OCCC) during pregnancy is exceedingly rare, particularly when accompanied by squamous differentiation, with only a limited number of cases reported in the English literature to date. Patient concerns: A 33-year-old female, during the first pregnancy, identified endometriotic cysts. However, during the second pregnancy, the patient was subsequently diagnosed with OCCC. Diagnoses: In this case, histological examination reveals a tumor demonstrating tubular cystic, papillary, and solid growth patterns. Glandular areas with extensive squamous differentiation are observed, along with papillary regions containing hyalinized fibrovascular cores. Tumor cells exhibit cuboidal morphology with clear cytoplasm and hobnail appearance, showing significant atypia. The periphery demonstrates endometrial endometriosis progressing to atypical endometriosis and subsequent malignant transformation. Immunohistochemical analysis shows positive expression of P504S and NapsinA in tumor cells, thereby excluding ovarian endometrioid carcinoma. The findings are consistent with a definitive diagnosis of OCCC. Interventions: Following the detection of the ovarian mass, left adnexectomy was performed. After definitive diagnosis of OCCC, pregnancy termination was pursued, followed by total hysterectomy, right adnexectomy, and pelvic lymph node dissection. Outcomes: Postoperative follow-up at 6 months revealed no evidence of recurrence. Lessons: This case highlights an ovarian cyst that measured 8 cm during the second pregnancy but was only 2 cm in diameter during the first pregnancy, ultimately diagnosed as clear cell carcinoma. Although ovarian malignancies during pregnancy are rare, benign-appearing cysts should not be overlooked. Increased vigilance is warranted to ensure timely diagnosis and appropriate management of such rare but clinically significant presentations.

Adult granulosa cell tumor of the ovary incidentally discovered and ruptured during cesarean section: A case report

Rationale: Ovarian granulosa cell tumor is a rare sex cord-stromal malignancy (2%–5% of ovarian carcinomas). Its diagnosis and management become particularly challenging when this tumor is associated with pregnancy and complicated by intraoperative rupture. Patient concerns: A 40-year-old multiparous woman underwent emergency cesarean section for fetal distress at 39 weeks. A previously unidentified 2 cm left ovarian cyst was discovered and incidentally ruptured during cystectomy. Diagnoses: Histopathology analysis revealed the diffuse nests of monomorphic cells exhibiting nuclear grooves and Call-Exner bodies. Immunohistochemistry analysis was positive for FOXL2, inhibin, and vimentin, confirming adult granulosa cell tumor classified as International Federation of Gynecology and Obstetrics IC1. Interventions: Initial cystectomy was performed. The patient subsequently underwent a postpartum fertility-sparing, including laparoscopic staging procedure, which included left salpingo-oophorectomy and omentectomy; no residual disease was identified. Outcomes: No evidence of recurrence was detected during follow-up. The patient retained fertility potential and declined adjuvant therapy. Lessons: Systematic adnexal evaluation during cesarean sections is essential for detecting occult ovarian neoplasms, emphasizing the importance of multidisciplinary collaboration and accessible intraoperative frozen section analysis, particularly in resource-limited settings.

Analysis of the clinical characteristics and surgical methods of high-grade squamous intraepithelial lesions of the cervix in postmenopausal women: A retrospective case study

The purpose of this study was to thoroughly evaluate the clinical features and surgical options for high-grade squamous intraepithelial lesions (HSIL) in postmenopausal women. A total of 308 patients diagnosed with HSIL through colposcopic cervical biopsy and endocervical curettage were included. Their clinical characteristics, surgical treatments, and postoperative pathology were analyzed. Key findings include: 1. Patients with positive preoperative thinprep cytologic test (TCT) results and postoperative pathology indicating HSIL or squamous cell carcinoma (≥HSIL) were significantly more frequent than those with negative preoperative TCT results (P < .05). 2. Univariate analysis indicated significant impacts of TCT, human papillomavirus (HPV) type, transformation zone (TZ) location, and surgical technique on postoperative pathology (P < .05). 3. Logistic regression analysis confirmed significant influences of TCT, HPV type, TZ location, and surgical method on postoperative pathology outcomes (P < .05), showing that each unit increase in TZ raised the probability of ≥HSIL in postoperative pathology by 49.7%. In surgical comparisons, cold knife conization (CKC) and extrafascial hysterectomy resulted in 8.379 and 4.427 times higher probabilities of ≥HSIL in postoperative pathology, respectively, compared to loop electrosurgical excision procedure (LEEP). 4. Surgical methods significantly influenced margin results (P < .05). After LEEP, 17.5% of cases had positive margins, compared to 9.4% after CKC, and 3.7% after extrafascial hysterectomy, indicating the highest rate of positive surgical margins occurred with LEEP. 1. Combined TCT and HPV screening is crucial for cervical cancer prevention, early detection, and management in postmenopausal women. Women with positive results for both TCT and HPV should undergo colposcopic cervical biopsy and endocervical curettage. 2. For patients with TZ3, CKC is the recommended surgical option. 3. CKC is the preferred treatment for postmenopausal women with HSIL, as it effectively diagnoses and treats the lesion, showing superior outcomes in managing postmenopausal HSIL.

TIM-3 expression in tumor and stromal cells are associated with the prognosis in patients with epithelial ovarian cancer

T-cell immunoglobulin and mucin domain-containing molecule 3 (TIM-3) has been reported to be overexpressed and associated with poor prognosis in solid tumors. However, its features and prognostic value in epithelial ovarian cancer (EOC) remain undetermined. In this study, we aimed to characterize TIM-3 expression and its prognostic significance in patients with EOC. A total of 134 EOC patients and 20 healthy controls from North China were included. TIM-3 mRNA and protein expression in EOC tumor tissues and benign ovarian tissues were detected by real-time quantitative PCR and immunohistochemistry. The distribution of TIM-3 protein in different regions of EOC tissue (tumor cells and the tumor microenvironment) were evaluated by multicolor immunofluorescence. Associations between their expression and clinicopathological parameters as well as survival analyses were performed. The results showed that high expression levels of TIM-3 mRNA were significantly associated with shorter progression-free survival (PFS; P  < .001, hazard ratio [HR] = 1.57, 95% confidence interval [CI] = 1.29–1.91) and overall survival (OS; P  = .013, HR = 1.31, 95% CI = 1.06–1.63) durations in EOC patients. High TIM-3 expression levels in tumor cells had shorter PFS (HR = 1.62, 95% CI = 1.09–2.46, P  = .018) and OS (HR = 1.81, 95% CI = 1.19–2.75, P  = .006) compared with those low TIM-3 expression levels. Similarly, TIM-3 in the tumor microenvironment was also an independent factor that affected the clinical outcome of EOC patients (PFS: HR = 1.99, 95% CI = 1.29–3.08, P  = .002; OS: HR = 2.13, 95% CI = 1.37–.30, P  = .001). These findings indicated that IM-3 may be a potential biomarker for predicting prognosis and immunotherapy efficacy in patients with EOC, exerting different roles on tumor cells and tumor microenvironment.

Mendelian randomization analysis unveiling the genetic connection: How psychiatric disorders heighten cancer risk

The potential links between psychiatric disorders and cancer risk have attracted significant attention in recent years. However, the causal relationships between these conditions remain unclear. To assess causality, a Mendelian randomization analysis was conducted using single nucleotide polymorphisms from large-scale European genome-wide association studies (GWAS). The inverse variance weighted (IVW) method was applied as the primary method for causal estimation, with additional sensitivity analyses performed to evaluate potential pleiotropic effects. IVW estimates revealed that bipolar disorder was associated with an increased risk of prostate cancer (odds ratio (OR) = 1.07; 95% confidence interval (CI): 1.003–1.15; P  = .04). Genetically predicted depression was causally linked to a significantly higher risk of breast cancer (OR = 2.49; 95% CI: 1.26–4.9; P  = .008), particularly in estrogen receptor-positive (ER+) breast cancer (OR = 2.82; 95% CI: 1.17–6.81; P  = .02). Schizophrenia was associated with a significantly higher risk of multiple cancer types, including lung cancer (OR = 1.16; 95% CI: 1.03–1.3; P  = .01), breast cancer (OR = 1.05; 95% CI: 1.02–1.09; P  = .002), ER+ breast cancer (OR = 1.06; 95% CI: 1.02–1.09; P  = .002), endometrial cancer (OR = 1.05; 95% CI: 1.002–1.1; P  = .04), and ovarian cancer (OR = 1.08; 95% CI: 1.03–1.13; P  = .0007). No significant pleiotropy of the instrumental variables was observed. This psycho-oncology study, characterized by minimal pleiotropic effects, provides genetic evidence supporting an increased incidence of various cancers associated with psychiatric disorders. These findings suggest that underlying psychiatric processes may contribute to cancer development.

Pseudo-pseudo Meigs syndrome in a patient with overlap syndrome: A case report and literature review

Rationale: Pseudo-pseudo Meigs syndrome (PPMS), characterized by pleural effusion, ascites, and elevated cancer antigen-125 (CA-125) levels, is a rare complication of autoimmune diseases, particularly of systemic lupus erythematosus-systemic sclerosis (SLE-SSc) overlap syndrome. Patient concerns: A 39-year-old female presented with progressive symptoms, including finger swelling (since 13 years), skin hardening (since 10 years), bilateral second toe ulceration (since 3 months), and abdominal distention (since 1 month). During treatment for pulmonary arterial hypertension (PAH), she developed significant ascites with elevated CA-125 levels. Diagnoses: Comprehensive clinical evaluation and laboratory tests confirmed SLE-SSc overlap syndrome. Subsequently, contrast-enhanced abdominal magnetic resonance imaging and multidisciplinary consultation established the diagnosis of PPMS, attributed to both active disease and possible medication effects. Interventions: Management included optimization of immunosuppressive therapy and discontinuation of PAH medications (Sildenafil and Ambrisentan). Outcomes: Complete resolution of ascites was achieved, and the patient maintains stable condition under regular outpatient follow-up. Lessons: This case emphasizes the importance of considering PPMS in autoimmune disease patients with unexplained ascites and elevated CA-125 levels, while suggesting a potential association between PAH medications and PPMS development.

Advanced stage, elevated mFIB-4 score, and MMR gene loss as independent predictors of oncological outcomes in endometrioid endometrial cancer: A retrospective observational study

This study aimed to evaluate the association between noninvasive liver fibrosis and steatosis scores (including the aspartate transaminase to alanine transaminase ratio to platelet ratio index, aspartate transaminase-platelet ratio index [APRI], Fibrosis-4 index, modified Fibrosis-4 index [mFIB-4], and hepatic steatosis index) as well as ultrasonographic steatosis scores (USS), with histopathological features of endometrioid-type endometrial cancer (EC) and their potential impact on survival outcomes. This retrospective observational study included 415 patients diagnosed with endometrioid-type EC who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Preoperative metabolic scores, including aspartate transaminase to alanine transaminase ratio to platelet ratio index, APRI, Fibrosis-4 index, mFIB-4, and hepatic steatosis index, were calculated from blood samples. USS and the diagnosis of metabolic dysfunction-associated fatty liver disease were based on liver imaging and metabolic criteria. Disease-free survival and overall survival were analyzed; significance was set at P  < .05. Analysis showed that patients with body mass index <30 kg/m 2 had higher rates of deep myometrial invasion (44.8% vs 27.3%, P  = .014), serosal invasion (6.9% vs 0.6%, P  = .017), lympho-vascular space invasion (34.5% vs 15.8%, P  = .002), and MSH6 loss (9.8% vs 1.4%, P  = .014) compared to obese patients. USS correlated with age, myometrial invasion depth, and PMS2 loss. Myometrial invasion >1/2 was more frequent in patients with mFIB-4 > 0.19 (37.5% vs 29%, P  = .048). Lower APRI (≤0.19) was related to the higher rate of cervical stromal invasion (15.8% vs 9.1%, P  = .027), lympho-vascular space invasion (29.7% vs 17.7%, P  = .002), adnexal involvement (11.3% vs 5.6%, P  = .026), and lymph node metastasis (24.1% vs 12.8%, P  = .009). Multivariable analysis showed advanced stage (HR = 5.172, P  < .001) and presence of at least one mismatch repair gene defect (HR = 2.936, P  = .011) independently predicted poor disease-free survival. Advanced stage (HR = 7.519, P  < .001) and a high mFIB-4 score (HR = 2.281, P  = .020) independently predicted worse overall survival. In conclusion, advanced stage remains the most significant independent predictor of poor oncological outcomes in endometrioid-type EC. Furthermore, this study highlights the prognostic relevance of metabolic dysfunction in this patient group. Noninvasive liver fibrosis markers (particularly mFIB-4 and APRI) were significantly associated with adverse histopathological features and survival outcomes, suggesting their potential role in risk stratification and prognosis assessment in endometrioid-type EC.

Association between the oxidative balance score and gynecologic cancers from the National Health and Nutrition Examination Survey: An observational study

This study aimed to examine the potential correlations between the oxidative balance score (OBS) and gynecological cancers susceptibility. A cross-sectional design was employed, utilizing datasets from the National Health and Nutrition Examination Survey spanning 2 decades from 1999 through 2018. Our investigation demonstrated that OBS exhibited significant protective correlations with gynecologic cancers (odds ratio [OR]=0.985, 95% confidence interval [CI]: 0.974–0.997, P =.011), specifically cervical cancer (OR=0.974, 95% CI: 0.952–0.996, P =.019) and ovarian cancer (OR=0.950, 95% CI: 0.912–0.990, P =.015). The protective correlations of OBS with gynecologic, cervical, and ovarian cancers displayed a dose–response relationship with elevated OBS levels, yielding ORs of 0.765 (95% CI: 0.614–0.952, P =.017), 0.474 (95% CI: 0.289–0.777, P =.003), and 0.397 (95% CI: 0.167–0.942, P =.036), respectively, in the uppermost quartile. The OBS demonstrates significant protective correlations with gynecological cancers, with notably marked effects identified in cervical and ovarian cancers. These observations provide innovative perspectives regarding the pathogenesis of gynecological neoplasms and carry important ramifications for clinical prevention and public health interventions.

Association between estimated pulse wave velocity and gynecological cancer risk and mortality: Insights from NHANES 2003 to 2016

Arterial stiffness is measured by pulse wave velocity (PWV), which has a well-established correlation with a number of health consequences. Nevertheless, it is still unknown how estimated pulse wave velocity (ePWV) and the risk and mortality of gynecological cancer (GC) are related. This study examined the association between ePWV and GC risk and mortality using data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2016. We initially performed a cross-sectional study in which we separated participants into 3 groups based on their ePWV tertiles in order to assess the relationship between ePWV and GC risk. A survival analysis was conducted to examine the relationship between ePWV and mortality risk in patients with GC. Multivariable logistic regression, Cox proportional hazards models and restricted cubic splines (RCS) were performed for analysis. A total of 19,590 participants were included in the study, with 464 diagnosed with GC (238 cervical cancer, 88 ovarian cancer, and 157 uterine cancer). Compared to the lowest ePWV group, the highest ePWV group had a 70% increased risk of GC (odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10–2.62). RCS analysis revealed a nonlinear positive association between ePWV and GC risk (P for nonlinear = .044). The predictive value of ePWV for GC risk was 59.1% (area under the curve (AUC): 0.591, 95% CI: 0.567–0.616). Among GC patients, the highest ePWV group had a 6.45-fold increased risk of death compared to the lowest ePWV group (hazard ratio (HR): 6.45, 95% CI: 1.32–31.53). RCS analysis further showed a linear positive association between ePWV and mortality in GC patients (P for nonlinear = .131). The predictive value of ePWV for mortality risk in GC patients was 80.6% (AUC: 0.806, 95% CI: 0.756–0.855). Higher levels of ePWV are associated with an increased risk of GC and higher mortality in GC patients, although ePWV exhibits relatively poor discriminatory ability for GC risk. ePWV may serve as a useful predictor of both cancer risk and prognosis, highlighting its potential as a clinical marker for identifying at-risk individuals and improving patient management.

Primary ovarian leiomyoma with calcification: A case report

Rationale: Primary ovarian leiomyoma is a rare benign tumor. The exact histological origin and pathogenesis of primary ovarian leiomyoma are still unclear, while its preoperative imaging diagnosis is often challenging and prone to misdiagnosis. The study aims to elucidate the diagnosis of primary ovarian leiomyoma and to distinguish it from fibroma. Patient concerns: A 34-year-old female was admitted to the hospital with complaints of pelvic mass found for one year. One years ago, the patient went to a local hospital for examination due to irregular menstruation. Diagnoses: The ultrasound report of the patient showed ovarian teratoma. The postoperative pathological results showed ovarian leiomyoma and calcification. Interventions: The patient underwent laparoscopic right ovarian leiomyoma resection. Outcomes: The patient was discharged home three days after surgery. At the most recent follow-up (five months after operation) of the patients, ultrasound was performed and no abnormal echoes were suggested in the adnexal region. Lessons: In the diagnosis of primary ovarian leiomyoma, our case emphasizes the importance of microscopic features as an effective approach to distinguish it from ovarian fibroma, leiomyosarcoma, and stromal tumors. Additionally, personalized treatment should be considered based on the patient age and fertility needs.

Parthenolide reverses cisplatin-resistant in ovarian cancer: An observational network pharmacology and molecular docking study

Background: Ovarian cancer (OV) is the most prevalent and lethal gynecologic malignancy globally. Cisplatin remains the first-line chemotherapeutic regimen for OV; however, chemotherapy resistance poses a persistent clinical challenge in gynecologic oncology. Parthenolide, a naturally derived phytochemical, exhibits broad-spectrum antitumor activity. Recent studies suggest that parthenolide may reverse cisplatin-resistance in OV when used in combination therapy. This study aims to elucidate the molecular targets and mechanisms underlying parthenolide-mediated reversal of cisplatin-resistance by integrating network pharmacology and molecular docking approaches. Methods: Platinum-resistant and control OV gene expression datasets were retrieved from the gene expression omnibus database. Differentially expressed genes (DEGs) were identified using the limma R package. Cellular enrichment patterns in platinum-resistant and control samples were analyzed via single-sample Gene Set Enrichment Analysis (ssGSEA). Weighted Gene Co-Expression Network Analysis (WGCNA) was employed to identify modules associated with differentially enriched cell types. A protein-protein interaction network of overlapping genes from DEGs and WGCNA-identified genes was constructed to pinpoint hub genes. Receiver operating characteristic (ROC) curves assessed the diagnostic utility of hub genes. Molecular docking and binding pocket analysis were performed to explore parthenolide-protein interactions. Results: A total of 3582 DEGs were identified between platinum-resistant and control samples, enriched in biological processes (e.g., cell junction assembly), cellular components (e.g., collagen-containing extracellular matrix), and molecular functions (e.g., signaling receptor activation). WGCNA revealed 331 genes correlated with differentially enriched cell types. Subsequent overlap analysis identified 266 immunity-related genes in platinum-resistant OV. Hub genes, including apolipoprotein E, demonstrated diagnostic value via ROC analysis. Molecular docking highlighted β2-microglobulin, brain-derived neurotrophic factor, cellular communication network factor 2, and activator protein-1 as parthenolide targets, with binding pocket analysis identifying critical interaction residues. Conclusions: This study identifies candidate genes linked to cisplatin-resistance and delineates molecular mechanisms by which parthenolide may counteract resistance, supporting its clinical application in OV therapy.

The clinical characteristics and surgical management experience of ovarian fibroma/fibrothecoma in premenopausal women

This study aims to analyze the clinical characteristics and discuss appropriate surgical strategy of ovarian fibroma/fibrothecoma in premenopausal women. A review of the patients’ medical records was undertaken at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, from January 2015 to December 2023. Altogether, 286 cases were identified. The mean age was 47.73 years (14–89 years) and premenopausal women accounted for 51.40% (147/286). The proportion of patients appeared similar across all age decades from 21 to 70. Of these patients, 204 (71.33%) underwent surgeries due to the presence of a pelvic mass with a mean diameter of 6.25 cm (1.2–37 cm). The tumor size in premenopausal women (n = 81) was significantly smaller than that in postmenopausal women (n = 123; 4.78 cm vs 7.21 cm). Of these 81 premenopausal patients, 66 (81.48%) women underwent laparoscopy and 15 (18.52%) underwent laparotomy. The tumor size in the laparotomy group was significantly larger than that in the laparoscopy group (7.89 cm vs 4.08 cm). Tumorectomy and unilateral salpingo-oophorectomy served as the main surgical approaches in the laparoscopy and laparotomy group, respectively. Besides, 82 patients were diagnosed incidentally with a mean age of 36.82 years and an average diameter of 0.76 cm (0.2–2.3 cm), among which 66 (80.49%) were premenopausal and 85.37% lesions were on the ovarian surface. All premenopausal patients were alive with no recurrence after surgery. Ovarian fibroma/fibrothecoma may occur at an earlier age than conventionally estimated. Laparoscopic tumorectomy remains the preferred surgery for patients at reproductive age. A thorough and meticulous intraoperative examination is essential to identify and remove the early-stage lesion on the ovarian surface.

Malignant transformation of struma ovarii into follicular thyroid carcinoma: A case report

Rationale: Struma ovarii is a rare form of mature cystic teratoma, with malignant transformation reported in approximately 5% to 10% of cases. Transformation into follicular thyroid carcinoma (FTC) is extremely uncommon; as a result, no standardized guidelines exist for treatment or prognosis for such cases. Patient concerns: A 54-year-old woman with cholelithiasis presented with upper abdominal discomfort. A lower abdominal mass was incidentally detected during evaluation. Diagnoses: Transvaginal ultrasonography revealed a 12-cm multilocular cystic tumor in the right ovary. Magnetic resonance imaging and computed tomography findings suggested a mature cystic teratoma with potential for malignant transformation. Exploratory laparotomy was performed, and intraoperative frozen section analysis confirmed malignant transformation. Interventions: The patient subsequently underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymph node biopsy, and omentectomy. Histopathological examination revealed tumor cells demonstrating cribriform proliferation, accompanied by eosinophilic structures, extensive necrosis, and venous invasion. These findings supported the diagnosis of FTC arising within struma ovarii. Outcomes: Postoperatively, the patient underwent routine follow-up, including serum thyroglobulin tests and imaging studies every 3 months. At 1 year, the patient showed no signs of tumor recurrence and remained in good clinical condition. Lessons: Malignant transformation of struma ovarii into FTC is an extremely rare condition and necessitates thorough histopathological evaluation for accurate diagnosis. This case highlights the diagnostic and therapeutic challenges associated with such tumors.

Prediction of postoperative adjuvant therapy efficacy based on perioperative indicators in patients with mid- to late-stage endometrial cancer

Surgery is one of the primary treatments for mid-to-late-stage endometrial cancer. However, patient responses to adjuvant therapy vary significantly, making the prediction of postoperative adjuvant therapy response crucial for these patients. This study aims to analyze the perioperative clinical and laboratory indicators of patients with mid- to late-stage endometrial cancer, identify key factors influencing the efficacy of adjuvant therapy, and construct a predictive model to provide a reference for clinical decision-making. This study retrospectively enrolled 260 mid-to-late-stage endometrial cancer patients who received postoperative adjuvant therapy and categorized them into effective and ineffective groups based on treatment response. Univariate analysis was performed to compare demographic and tumor characteristics between the 2 groups. Significant factors identified in the univariate analysis were classified into 2 categories (clinical variables and laboratory variables) and further analyzed using multivariate logistic regression and random forest analysis to identify the most influential predictors. A response prediction model was then constructed. Patients were stratified into high- and low-response groups based on the model’s risk score for survival analysis. The effective group showed significantly better outcomes than the ineffective group in terms of obstetric history, FIGO stage, tumor grade, surgical approach, hospital stay, and postoperative complications. The final analysis identified the number of positive lymph nodes, high-risk histological type, surgical approach, albumin level, and neutrophil-to-lymphocyte ratio as the most significant predictive factors. The constructed response prediction model achieved an area under the curve of 0.795, with sensitivity and specificity of 0.799 and 0.670, respectively. The low-response group exhibited significantly worse overall survival and progression-free survival than the high-response group. By analyzing clinical and laboratory variables, this study identified key factors influencing the efficacy of postoperative adjuvant therapy in mid-to-late-stage endometrial cancer patients and developed a predictive model with strong discriminative ability. The findings may provide valuable references for individualized clinical treatment and help improve patient prognosis.

Unilateral hyperreactio luteinalis of the ovary during pregnancy mimics ovarian malignancy: A case report

Rationale: Hyperreactio luteinalis (HL) involving a unilateral ovary is extremely rare, and the clinical presentation of HL can mimic that of ovarian malignancy, resulting in potential misdiagnosis and unnecessary surgical interventions. Patient concerns: A 34-year-old female (gravida 6, para 1), pregnant for 6 weeks according to her menstrual records, presented with nausea and abdominal distension. Diagnoses: Ultrasonography revealed unilateral ovarian enlargement with multilocular cysts and ascites. Cancer antigen 125 (CA125) was elevated at 337.6 U/mL, raising suspicion of ovarian malignancy. Interventions: Surgery was performed due to the initial impression of malignancy. Intraoperative frozen section examination revealed multiple luteinized cysts, confirming HL. Outcomes: The final diagnosis of HL was established, and unnecessary radical surgical procedures were avoided. The patient has followed up for >3 years, and there are no abnormalities in her serum CA125 and gynecological ultrasound results. Lessons: HL can mimic as ovarian malignancy, when encountering pregnant women with ovarian enlargement, elevated CA125 levels, and ascites, HL should be considered as a potential differential diagnosis. This awareness is crucial for accurate diagnosis and appropriate management, helping to avoid unnecessary surgical interventions.

Palliative surgery treatment in patients with complete malignant bowel obstruction retrospective cohort study

Background: Malignant bowel obstruction (MBO) is a condition secondary to intra-abdominal metastatic spread of advanced stage tumors. In this study, we aimed to evaluate the results of in the patients who were diagnosed with complete MBO and underwent palliative surgery treatment and to bring them to the attention of physicians. Methods: The patients who were treated for cancer and who were consulted from the surgery clinic due to MBO symptoms between January 2022 and December 2023 were identified and recorded. The age of the patients included in the study, computed tomography findings, oral food intake at the time of diagnosis and after treatment, nasogastric tube removal, symptom relief, hospital readmissions, total length of hospital stay, development of complications, hospital stay, and survival rates of the patients were compared. Results: The average age of the 24 patients in the study (13 females and 11 males) were 64.2 ± 10.07 years (range: 45–80). All patients underwent surgical treatment. In terms of the primary diagnosis of the patients, 12 patients (50%) had colorectal, 4 patients (16.6%) gastric, 3 patients (12.5%) ovarian, and 2 patients (8.3%) bladder cancers, while 2 patients (8.3%) had intra-abdominal spread of lung tumor and 1 patient (4.1%) had cancer of small intestine origin. In the evaluation of the level of obstruction in patients, it was observed that 11 patients (45.8%) had small intestine, 7 patients (29.1%) had colon obstruction while 6 patients (25%) developed colon and small intestine obstruction together. The length of stay in the hospital was 8.8 ± 5.5 days, recovery from nasogastric tube was 100%, the rate of restoring the oral food intake was 79%, and the rate of readmission to the hospital with the same complaints was 25%. Conclusion: The aim of palliative treatment is to increase the quality of life by eliminating the symptoms that impair the patient’s quality of life. According to our results, palliative surgery treatment in appropriate patients had positive effects on the patient’s quality of life. Further studies are needed to develop a common algorithm that would facilitate physicians’ decision-making in the selection of medical or palliative surgical treatment.

Elevated N-Myc downstream-regulated gene 3 expression indicates poor survival in epithelial ovarian cancer

N-Myc downstream-regulated gene 3 (NDRG3), a member of the NDRG family, plays an important role in the development, progression, invasiveness, and metastasis of multiple tumor types. This study focuses on NDRG3 expression in epithelial ovarian cancer (EOC) and the correlation between NDRG3 expression and prognostic indicators. First, the LinkedOmics database was used to analyze the expression of genes associated with NDRG3, and then gene ontology and Kyoto encyclopedia of genes and genomes (KEGG) functional enrichment analyses and methylation analysis of NDRG3-related genes were performed to identify co-expressed genes. A protein–protein interaction network was constructed using the STRING database. Subsequently, quantitative polymerase chain reaction was performed to determine the mRNA expression level of NDRG3 in 22 fresh EOC tissue samples. In addition, immunohistochemistry was performed to detect the expression of NDRG3 protein in 110 EOC microarray samples. Cox regression and Kaplan–Meier survival analyses were performed to assess the prognostic value of NDRG3. Bioinformatics analysis showed that NDRG3 had a broad impact on the transcriptome and that genes that were co-expressed with NDRG3 were primarily involved in organ- or tissue-specific immune response, response to chemokine, interleukin-1 production, and other related pathways. The KEGG pathway analysis suggested that genes co-expressed with NDRG3 were also enriched in signaling pathways, including the interleukin-17 signaling pathway. The mRNA expression levels of NDRG3 were significantly higher in EOC tissues than in paracancerous nontumor tissues (P < .01). NDRG3 expression in EOC was correlated with distant metastasis (P = .02), tumor–node–metastasis stage (P = .03), and patient prognosis (P = .01). Moreover, the disease-free survival and overall survival times of EOC patients decreased with increasing NDRG3 expression. High NDRG3 expression and lymph node metastasis were identified as independent prognostic factors in 110 EOC patients. NDRG3 plays a key role in ovarian cancer progression. High NDRG3 expression is correlated with multiple clinicopathologic features of EOC and may be an indicator of a poor prognosis in EOC.

Clinicopathological pitfalls associated with benign uterine mesenchymal tumors: A single-center experience

Diagnosis of uterine mesenchymal tumors continues to be challenging because of their nonspecific clinicopathological presentation. Several studies have focused on the underdiagnosis/undertreatment of hidden uterine sarcomas. However, few have examined the overdiagnosis/overtreatment of benign uterine mesenchymal tumors that masquerade as uterine sarcomas. We report 4 cases of benign uterine mesenchymal tumors that were preoperatively diagnosed as having malignant potential and underwent extensive surgery. The patients had cotyledonoid-dissecting leiomyomas, uterine tumors resembling ovarian sex-cord tumors, metastasizing leiomyomas, and torsion of a subserosal uterine leiomyoma. The patients’ ages ranged from 42 to 59 years (median 51.5). All 4 cases were suspected of having a malignant tumor based on preoperative clinical imaging, and 1 case was suspected of having a malignant tumor based on preoperative imaging and pathological evaluations of biopsy. All patients underwent surgery, including a hysterectomy. One of the 4 patients (25%) underwent lymphadenectomy, and 1 (25%) underwent partial lung resection. All patients survived without evidence of disease. Overall, detailed pre- and intraoperative clinical and pathological evaluations may be insufficient for diagnosis. Physicians should be aware of the diversity of uterine mesenchymal tumors, the difficulty in diagnosing them, and how to avoid these pitfalls.

Real-world data of docetaxel-induced liver injury among hospitalized patients in Wuhan, China: A retrospective analysis

This study aims to analyze the risk factors of docetaxel-induced liver injury to provide evidence for the clinical prevention and treatment of docetaxel-induced liver injury. A retrospective analysis of patients who received docetaxel chemotherapy regimen from January 2017 to April 2018 in Renmin Hospital of Wuhan University was conducted. Univariate analysis and multivariate logistic regression analysis with the forward stepwise method were used to assess the risk factors associated with liver injury induced by docetaxel. Receiver-operator characteristic curve analysis was performed to calculate the area under the receiver-operator characteristic curve (AUC). In the study, 223 (7.88%) patients were diagnosed as docetaxel-induced liver injury, among which the patients with ovarian cancer had the highest incidence rate (8.33%). By logistic regression analysis, hepatitis B virus carrier, diabetes, docetaxel plus nedaplatin, docetaxel plus capecitabine, docetaxel plus epirubicin, and docetaxel plus cyclophosphamide chemotherapy regimens, were independently associated with drug-induced liver injury during receiving chemotherapy, respectively. Among them, diabetes and docetaxel plus cyclophosphamide were protective factors, but the others were risk factors. Further analysis by the risk score and AUC showed that those factors contributed to an AUC of 0.693 (95% confidence interval = 0.660–0.727), with a predictive sensitivity of 70.9% and specificity of 61.6%. Docetaxel-induced liver injury with a relatively higher incidence should be addressed among ovary cancer patients. The predominant risk factors of docetaxel-induced liver injury included hepatitis B virus carrier and docetaxel combination regimens, and the protective factor was diabetic patients. Among these therapeutic combination regimens, docetaxel plus epirubicin, docetaxel plus nedaplatin, and docetaxel plus capecitabine could significantly increase the occurrence of docetaxel-induced liver injury during hospitalization respectively, while docetaxel plus cyclophosphamide regime might be safer. Therefore, for patients with these risk factors, it might be advisable to actively consider optimum management to reduce the occurrence of docetaxel-induced liver injury during hospitalization, particularly hepatic function test.

Bilateral ovarian cystic teratomas with a left Sertoli Leydig cell tumor: A case report

Rationale: Ovarian mature cystic teratoma (MCT) is the most common ovarian germ cell tumor, and it is typically unilateral, although bilateral MCTs have been observed. Sertoli Leydig cell tumors (SLCTs) are rare ovarian tumors that can cause hyperandrogenemia. When patients have these 2 tumors at the same time, it is highly challenging to diagnose them. Patient concern: A 32-year-old female patient who complained of a pelvic mass for 1 year and amenorrhea for 6 months with high testosterone and 17-hydroxyprogesterone levels was suspected of having a malignant ovarian tumor. Transvaginal ultrasound revealed mixed lesions in the bilateral adnexal areas, and the nature of the left slightly hyperechoic mass was not determined. Diagnoses: On the basis of the patient’s laboratory examination, imaging examination and pathological examination, she was diagnosed with hyperandrogenemia and bilateral MCTs with a left SLCT. Interventions: The patient underwent laparoscopic surgery to remove bilateral ovarian neoplasms. Outcomes: Testosterone levels decreased to 1.51 nmol/L on the 1st day after fertility-sparing bilateral ovarian tumor resection and to 0.73 nmol/L on the 5th day. Lessons: In conclusion, we reported a case of bilateral MCTs with left SLCT. The patient examinations supported the diagnosis of this rare disease. Once ovarian SLCT is diagnosed, the tumor should be surgically removed immediately, and the subsequent treatment plan should be selected according to the immunohistochemical results.

Laparoscopic treatment of giant ovarian cystic tumors in children: Case report

Rationale: Ovarian cystic tumors are common in adult women. However, cases of ovarian cystic tumors approximately 30 cm in diameter are rarely reported in adult women and even rarer in children. Here, we report a rare case of a giant ovarian cystic tumor in a 13-year-old girl. Patient concerns: A 13-year-old girl was admitted to hospital with abdominal pain and distension for 7 days. The parents felt anxious about the child’s abdominal lesions and requested laparoscopic surgery. Diagnoses: After evaluation at our hospital, abdominal color ultrasound and enhanced computer tomography revealed a large sac-like fluid density shadow with clear edges in the abdomen, approximately 38 cm × 35 cm × 24 cm in size. We performed a laparoscopic resection of the cystic ovarian tumor, which was pathologically confirmed as a benign ovarian tumor. Interventions: Subsequently, laparoscopic exploration revealed a huge cystic tumor originated from the right ovary with a clear boundary between the tumor and the right ovary. Outcomes: Laparoscopic surgery was used to remove the lesion, and the postoperative recovery and follow-up were uneventful. Lessons: Cases of ovarian cystic tumors with a diameter of approximately 30 cm are very rare in pediatric patients. Laparoscopic surgery is an essential method for the diagnosis and treatment of giant ovarian cystic tumors and can be used as a first-line treatment.

Management strategy of primary ovarian mucinous carcinoid tumor: A rare case report

Rationale: Primary ovarian carcinoid tumors are rare neoplasms, first reported in 1939, with approximately 30 cases reported thus far. It is categorized into insular, trabecular, strumal, and mucinous types. Mucinous forms are extremely rare, comprising < 2% of all primary ovarian carcinoid tumors. Patient concerns: A 40-year-old gravida 3, para 0 woman visited our clinic with a 3-month history of lower abdominal pain. Ultrasound and abdominal pelvic computed tomography revealed a large, poorly enhancing soft tissue mass in the right adnexa (about 9.4 × 7.0 × 6.8 cm sized). Laparoscopic surgery was performed to a definitive diagnosis, including right salpingo-oophorectomy, left ovarian biopsy, and ascites washing cytology. Diagnosis: The patient was diagnosed with primary ovarian mucinous carcinoid tumor and received related treatment. Outcomes: After treatment, the patient symptoms improved, and he was discharged. Lessons: Approximately 40% of primary ovarian carcinoid tumors with insular morphology present in pure form, and mucinous forms are extremely rare. At present, the main diagnostic methods in cases of primary ovarian mucinous carcinoid tumor include macroscopic examination, histopathology and imaging examination. The main treatment modalities for primary ovarian mucinous carcinoid tumor are surgery. postoperative chemotherapy remains controversial.

Primary clear cell adenocarcinoma of the seminal vesicle with ovarian homology: A rare case report

Rationale: Primary seminal vesicle adenocarcinoma is a rare type of male reproductive system tumor, primarily manifesting as papillary adenocarcinoma. Meanwhile, clear cell adenocarcinoma (CCA) is a common malignancy in the female reproductive system. Therefore, the occurrence of CCA in the seminal vesicle, showing ovarian homology, is even rarer. This pathological type of seminal vesicle cancer has been seldom reported. Patient concerns: A 43-year-old male patient presented to the outpatient clinic with a decade-long history of intermittent hemospermia accompanied by a 2-month sensation of dragging in the left lower abdomen. Following an MRI scan that indicated a seminal vesicle mass, he was admitted for further treatment. Diagnosis: The MRI revealed 2 abnormal signal mass lesions located between the left side of the pelvic cavity, the prostate, and the left seminal vesicle, primarily exhibiting long T1 and long T2 cystic characteristics. The CT scan with enhancement showed mixed density mass shadows in the left seminal vesicle area of the pelvic cavity, with mild arterial phase enhancement and continued enhancement in the portal phase. Physical examination revealed mild tenderness in the lower left abdomen. Digital rectal examination detected a hard mass above the left prostate, with no bloodstain on the glove, and no other significant abnormalities were observed. Routine urinalysis and biochemistry did not reveal any notable abnormalities. Tumor markers were all within normal ranges. Interventions: The tumor was completely excised laparoscopically and sent for pathological examination. Nine days postoperatively, the patient was successfully discharged. Outcomes: Postoperative pathology indicated primary CCA of the seminal vesicle. During a 20-month follow-up via telephone, the patient reported a generally good condition without significant discomfort. Lessons: CCA occurring in the seminal vesicle is extremely rare, and radical surgical excision is the primary treatment method.

Development and evaluation of an ovarian cancer prognostic model based on adaptive immune-related genes

The adaptive immune system plays a vital role in cancer prevention and control. However, research investigating the predictive value of adaptive immune-related genes (AIRGs) in ovarian cancer (OC) prognosis is limited. This study aims to explore the functional roles of AIRGs in OC. Transcriptomic, clinical-pathological, and prognostic data for OC were downloaded from public databases. Differential expression analysis, univariate, and Lasso Cox regression analyses were utilized to construct a risk signature. Kaplan–Meier survival analysis, enrichment analysis, somatic mutation analysis, immune infiltration analysis, and drug sensitivity analysis were performed to characterize differences between high-risk and low-risk groups. Independent prognostic factors were identified through multivariate Cox regression analysis to construct a nomogram. Expression of signature-related AIRGs was validated using in OC cells and tissues. A total of 109 AIRGs significantly associated with overall survival (OS) in OC were identified, of which 15 were selected to construct the risk signature: AP1S2, AP2A1, ASB2, BTLA, BTN3A3, CALM1, CD3G, CD79A, EVL, FBXO4, FBXO9, HLA-DOB, LILRA2, MALT1, and PIK3CD. This signature stratified the OC cohort into high-risk and low-risk groups, which exhibited significant differences in prognosis, gene expression, mutation profiles, immunotherapy response, and drug sensitivity. Specifically, the low-risk group showed better prognosis, higher tumor mutational burden, greater response to immunotherapy, increased M1 macrophage and T follicular helper (Tfh) cell infiltration, and higher sensitivity to cisplatin and gemcitabine. The nomogram, integrating the AIRG-derived risk signature with age and clinical stage, demonstrated superior performance in predicting OC prognosis compared to other factors. Moreover, the differential expression of signature-related AIRGs were further confirmed in OC cells and tissue as compared to the normal cells or tissues. Our findings highlight the significant association between AIRGs and the prognosis of OC. The prognostic model developed using AIRGs demonstrates strong predictive capabilities.

MR imaging diagnosis of small-cell carcinoma of the ovary, hypercalcemic type: A case report and literature review

Rationale: Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare and aggressive gynecological tumor. We retrospectively analyzed the clinical manifestations and imaging findings of this patient and analyzed the relevant literature, with the aim of improving the ability of radiologists to differentiate SCCOHT from other ovarian tumors. Patient concerns: We report a case of 36-year-old woman who was diagnosed with SCCOHT. MRI suggested a malignant tumor of the left ovary. The immunohistochemical markers shows SMARCA4 negativity. Notably, hypercalcemia was not detected. Microscopically, it was consistent with the large-cell variants. Lessions: Despite its rarity, SCCOHT should still be considered in the differential diagnosis of ovarian malignancies. When a young female patient presents with a large unilateral tumor on MRI with a predominant solid component and significant enhancement on the contrast enhanced scans, along with hypercalcemia, SCCOHT should be considered.

Adult-type granulosa cell tumor with pleural effusion: A rare case report

Rationale: Adult granulosa cell tumors (AGCTs), representing the most prevalent subtype of sex cord-stromal tumors in the ovary, predominantly manifest in perimenopausal and postmenopausal women. A notably uncommon clinical manifestation of AGCTs is the concomitant development of pleural effusion, a condition that may be erroneously attributed to more prevalent etiologies such as cardiac insufficiency, pulmonary infections, or other malignant processes. Consequently, the occurrence of pleural effusion in association with AGCTs is atypical and warrants heightened clinical vigilance for such rare presentations. This article presents a detailed case report, aiming to enhance the timely identification and management of this condition, thereby optimizing patient prognosis. Patient concerns: A 60-year-old postmenopausal woman presented with a 1-month history of persistent chest tightness and dyspnea. Initial chest radiography demonstrated a right-sided pleural effusion. Thoracentesis was performed, providing transient symptomatic relief; however, the effusion persisted without complete resolution. Further diagnostic evaluation with computed tomography imaging revealed the presence of a pelvic mass, which necessitated surgical intervention for definitive management. Diagnoses: Histopathological analysis of the surgical specimen confirmed the diagnosis of an adult granulosa cell tumor originating from the left ovary. Interventions: Postoperative evaluation demonstrated a marked reduction in pleural effusion, with complete resolution achieved during the recovery period. Outcomes: Throughout the follow-up surveillance, no evidence of tumor recurrence has been detected. Lessons: This case highlights the pivotal role of multidisciplinary collaboration in addressing complex clinical scenarios. Furthermore, it emphasizes the imperative for early detection and prompt intervention in cases of pelvic masses among postmenopausal women, underscoring the potential for improved clinical outcomes through timely and coordinated management.

Extremely rare mucinous adenocarcinoma of the small bowel causing bilateral metastatic Kukenberg tumors of the ovaries: A case report

Rationale: Small bowel adenocarcinoma (SBA) is an extremely rare tumor that is not fully understood, SBA accounts for less than 5% of gastrointestinal cancers, Krukenberg tumors account for a lower proportion of all ovarian tumors, close to 2%. Stomach is the most common primary site of Krukenberg tumor. The phenomenon of bilateral ovarian Kukenberg tumor caused by implantation and metastasis of small bowel cancer is extremely rare, with few literature reports and limited clinical diagnosis and treatment data. We present a case of a 55-year-old woman with bilateral Kukenberg’s tumor caused by small bowel cancer implantation and share our views on the diagnosis and treatment of this case. Patient concerns: A 55-year-old woman presented with vaginal bleeding and persistent lower abdominal pain after fatigue 10 days ago. Pelvic ultrasound at a local hospital revealed 2 solid masses in her pelvis, and she came to our hospital for further diagnosis and treatment. The results of colonofiberscope examination and histopathological examination confirmed intramucosal adenocarcinoma in the small intestine. Diagnoses: The results of colonofiberscope examination and histopathological examination confirmed intramucosal adenocarcinoma in the small intestine. Contrast-enhanced computed tomography showed multiple cystic space-occupying lesions in the pelvic cavity, and the possibility of ovarian tumor was considered. Interventions: Radical treatment of right half colon cancer and pelvic mass resection were performed under general anesthesia. Combined with intraoperative and postoperative pathological examination, the diagnosis was mucinous adenocarcinoma of the small intestine stage IV (pT4N1M1). Bilateral ovarian metastasis, metastatic cancer (3/19): lymph nodes around the small intestine (3/12), lymph nodes around the colon (0/7). Outcomes: He is currently receiving chemotherapy, the chemotherapy regimen is XELOX regimen. The specific drugs were oxaliplatin and capecitabine. Lessons: SBA is often difficult to diagnose due to few specific symptoms and is usually detected at stage IV. Bilateral ovarian Kukenberg tumor caused by small bowel cancer implantation metastases is extremely rare, and clinicians must be vigilant for women with fewer specific symptoms of gastrointestinal discomfort and conduct further diagnostic studies to avoid delayed diagnosis and treatment.

Causal relationship between amino acids and ovarian cancer in the European population: A bidirectional Mendelian randomization study and meta-analysis

In recent years, an increasing number of observational studies have reported the impact of amino acids on ovarian cancer. However, Mendelian randomization studies have not yet been conducted to explore the causal relationship between them in the context of ovarian cancer. This study conducted Mendelian randomization (MR) analysis of 20 amino acids in relation to ovarian cancer data from 2 different sources within the European population, using a two-sample MR approach. The primary results from the inverse variance weighting analysis were then subjected to a meta-analysis, followed by multiple testing correction for the meta-analysis thresholds. Finally, reverse causality testing was performed on the positively associated amino acids and ovarian cancer. MR analyses were conducted for 20 amino acids with ovarian cancer data from both the Finngen R10 and Open genome-wide association study databases. The inverse variance weighted results from these 2 analyses were then combined through meta-analysis, with multiple corrections applied to the significance thresholds of the meta-analysis results. The findings showed that only cysteine had a significant association with ovarian cancer, with an (odds ratio) odds ratio value of 0.507 (95% confidence interval: 0.335–0.767, P = .025). The P-value of the combined MR and meta-analysis, after multiple testing correction, was 0.025, indicating statistical significance (P < .05). Additionally, cysteine did not show a reverse causal relationship with ovarian cancer in either data source. Cysteine is a protective factor for ovarian cancer, potentially reducing the risk of ovarian cancer and slowing the progression of the disease.

Carcinoid tumor arising from a mature cystic teratoma of the ovary: A case report

Rationale: Carcinoid tumors arising from mature cystic teratomas of the ovary (MCTO) are exceptionally rare and often misdiagnosed as benign teratomas on imaging studies, which can lead to delayed or inappropriate treatment. The purpose of this study is to raise awareness of this rare condition by presenting a case of a carcinoid tumor originating from MCTO, highlighting its unique imaging features and clinical presentation, and discussing the importance of accurate preoperative diagnosis. Patient concerns: A 59-year-old woman was admitted to the hospital following an ultrasound physical examination that revealed an anterior uterine parenchymal mass. She exhibited no obvious abnormal clinical symptoms. Diagnosis: CT and MRI of the pelvis revealed a cystic-solid soft tissue mass with small calcified foci and a significant cystic fatty component. There was a marked enhancement of the solid component in the pelvis off to the right, leading to the consideration of a teratoma. Interventions: The final clinical preoperative diagnosis was an ovarian teratoma. Pelvic tumor resection was performed after the exclusion of contraindications to surgery. Postoperative pathology revealed a carcinoid tumor arising from MCTO. Limitations: This study is limited by the fact that it reports a single case, which makes it difficult to generalize the findings to a larger population. Additionally, the rarity of this condition means that there is limited literature available for comparison, which could provide a broader understanding of the potential challenges in diagnosing similar cases. The retrospective nature of the case also restricts the ability to conduct a more extensive analysis of potential risk factors. Outcomes: The patient did not receive adjuvant therapy post-surgery. During the 36-month follow-up period, the tumor showed no signs of recurrence or metastasis. The follow-up was concluded without further complications, indicating a favorable outcome. Lessons: Mature cystic teratoma is a common ovarian tumor, but its association with carcinoid tumors is very rare and prone to preoperative misdiagnosis. The imaging presentation of this case is characteristic and has significant diagnostic implications for this disease.

The effect of preoperative laboratory values on prognostic factors following cytoreduction surgery in ovarian cancer: Neutrophil lymphocyte ratio, platelet lymphocyte ratio, and lymphocyte monocyte ratio

In cancer patients, prognostic markers are needed to improve the management and clinical course of both the cancer itself and surgery therefor. Elevated systemic inflammatory markers are associated with morbidity and mortality in most cancer types. In this study, we aimed to determine the prognostic value of inflammatory markers such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) in patients undergoing cytoreductive surgery for ovarian cancer. The data of 188 patients who underwent surgery for ovarian cancer between December 2022 and December 2023 were retrospectively analyzed. Receiver operating characteristic (ROC) curves were constructed to evaluate the correlation between complications and the inflammatory prognostic factors NLR, PLR, and LMR. Optimal cutoff values were determined as the points where the Youden index (sensitivity + specificity − 1) was maximal. Patients were compared according to the presence of complications. As a result of the ROC curve analysis, patients were divided as high and low NLR and PLR groups. The difference of preoperative and postoperative inflammatory prognostic factors was compared according to the presence of complications. In this study in which a total of 90 patients were evaluated, the cutoff value for NLR was 2.04 (areas under the ROC curve: 0.655; P < .05) and the cutoff value for PLR was 145.3 (areas under the ROC curve: 0.740; P < .05) according to the presence of complications. In the group with complications, lymphopenia and thrombocytosis were more common preoperatively, while patients were more anemic postoperatively (P < .05). Patients in the high NLR group were younger and received less neoadjuvant chemotherapy. In the high PLR group, the number of patients receiving neoadjuvant chemotherapy was lower, and although the patients were more anemic and lymphopenic, higher rates of neutrophilia and thrombocytosis were observed. The analysis of preoperative and postoperative NLR, PLR, and LMR differences revealed an increase in NLR and PLR values and a decrease in LMR values (P < .05). The preoperative systemic inflammatory biomarkers NLR and PLR may be considered as prognostic predictors of poor postoperative outcomes. Therefore, consideration of these biomarkers may have an important role in clinical course management.

Malignant transformation of ovarian mature cystic teratoma with rupture, elevated serum CA199, CA12, CEA: A case report

Rationale: Reports of mature cystic teratomas (MCTs) with associated complications and changes in serum cancer antigen levels are rare. Herein, we report a rare case of MCT with associated complications (rupture and malignant transformation), high levels of serum cancer antigens (CA19-9, CA12, and CEA), and surgical therapy. Patient concerns: An 81-year-old woman was referred to our emergency department because of diffuse abdominal pain and distension for 20 days. Diagnoses: Imaging findings, including transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, revealed a complex solid cystic mass in the lower abdomen. Preoperative laboratory test results showed high levels of serum cancer antigens (CA19-9, CA12, and CEA) in MCT. Histopathological examination of the specimen revealed a MCT with rupture and malignant transformation. Interventions: The patient underwent a total abdominal hysterectomy, bilateral oophorectomy, and partial omentectomy. The patient did not undergo chemotherapy after surgery. Outcomes: The follow-up period was 12 months. The patient recovered well without focal local recurrence or distant metastasis after the surgery. Lessons: The study aims to report a new case of MCT with associated complications (rupture and malignant transformation) and changes in serum cancer antigen levels. Although this tumor presents as a complex solid cystic mass, detection of the intratumoral fat component is a key diagnostic imaging feature. A high level of serum cancer antigen may indicate the malignant transformation of MCT. In this case, surgery was an effective treatment for the MCT.

Study on correlation between CXCL13 and prognosis and immune characteristics of ovarian cancer

Ovarian cancer (OC) has a limited immunotherapeutic response; hence, this study aimed to investigate the relationship between CXC-chemokine ligand 13 (CXCL13) expression and overall survival (OS) rate, key immune pathways, degree of immune cell infiltration, and progressive disease (PD)-1 checkpoint blockade. A total of 703 differentially expressed genes were obtained from “The Cancer Genome Atlas” (TCGA) database based on the immune and stromal scores of 379 OC patients for getting the targeted gene CXCL13. The association between CXCL13 and OS in OC patients, biological function annotation of CXCL13, and its correlation with immune components were assessed. The results indicated that upregulated CXCL13 expression was positively correlated with better OC patient prognosis. CXCL13 expression was associated with 6 immune-related pathways, 10 immune cells, and PD-1 expression of OC micro-environment. Moreover, high expression of CXCL13 was related to a better tumor response and more extended tumor-stable stage after PD-1 blocking therapy in IMvigor210. The study concluded that CXCL13 could be a prognostic marker and a potential immunotherapy target for OC patients, especially PD-1 checkpoint blockade.

Torsion and ruptured ovarian cystadenocarcinoma with internal bleeding complicated with retroperitoneal hematoma after tumor transection: A case report

Rationale: Ovarian tumor torsion is a critical gynecological emergency, predominantly affecting women of reproductive age, with benign teratomas being the most common culprits. In contrast, malignant ovarian tumors, such as mucinous cystadenocarcinoma, infrequently present with torsion due to their invasive and angiogenic characteristics. The occurrence of torsion in malignant tumors complicates diagnosis and management, particularly when associated with complications like congestion, infarction, and internal bleeding. This report details a rare case of primary ovarian mucinous cystadenocarcinoma presenting with acute torsion and significant internal bleeding. Our study highlights the diagnostic challenges and the urgent need for clear treatment guidelines, addressing an important gap in the existing literature regarding the management of torsion malignant ovarian tumors. By documenting this case, we aim to contribute to the understanding of this rare condition and provide insights that may help clinicians in similar scenarios. Patient concerns: A 51-year-old postmenopausal woman presented with acute abnormal pain. Transvaginal ultrasound examination showed an 8-cm heterogeneous right ovary mass without ovarian blood flow on color Doppler. Diagnoses: Laparoscopy revealed torsion and rupture of the right ovarian tumor with 900 mL hemoperitoneum. The patient underwent right salpingo-oophorectomy complicated by continuous oozing and hematoma formation in the infundibular ligament. Unexpectedly, histopathology revealed a mucinous cystadenocarcinoma of the right ovary, pT1c2. Intervention: The patient underwent staging surgery and prophylactic hyperthermic intraperitoneal chemotherapy. Outcome: After 4 years of follow-up, no tumor recurrence or metastasis was found. Lessons: Currently, there are no effective preoperative diagnostic and treatment guidelines for ruptured malignant ovarian tumors with torsion. The possibility of malignancy should be considered, and frozen section biopsy should be considered during surgery. Full detorsion before tumor resection to avoid incomplete pedicle coagulation and bleeding. Specimen removal by in-bag morcellation in minimally invasive surgery to prevent complications related to residual fragments of the specimen or dissemination of an occult malignancy.

Predictive impact of clinical factors on chemosensitivity in advanced high-grade serous ovarian carcinoma according to chemotherapy response score

The use of neoadjuvant chemotherapy (NAC) as a first-line therapy for advanced high-grade serous ovarian carcinoma (HGSOC) has increased. However, several studies have reported NAC-induced platinum resistance. This study aimed to evaluate the predictive impact of clinical factors on chemotherapy response score (CRS) and to select patients who would respond well to NAC. This multicenter retrospective (study included patients treated between January 2016 and December 2021). International Federation of Gynecology and Obstetrics stage IIIC and IV HGSOC patients were eligible. Institutionally strict complete resectability criteria were used in the present study. Pathological slides were scored according to the CRS criteria. Among 172 patients with HGSOC, 87 (50.6%) had stage IIIC disease and 85 (49.4%) had stage IV disease. And 35 (20.4%) had CRS1, 103 patients were CRS2 (59.9%), and 34 patients were CRS3 (19.7%). Compared with CRS1, simultaneous metastases to distant lymph nodes and solid organs confirmed by imaging were associated with a 75% reduction in CRS2 (odds ratio = 0.25; 95% confidence interval: 0.09–0.70; P = .008). And breast cancer susceptibility gene 1/2 mutation was positively (odds ratio = 8.41; 95% confidence interval: 2.25–31.52; P = .002) associated with CRS3 compared to CRS1. Patients with CRS3 had significantly longer progression-free survival (PFS), with median PFS of 9.8, 14.8, and 27.0 months for CRS of 1, 2, and 3, respectively (P < .001). Overall survival was also prolonged in patients with CRS3 (P < .001). Germline breast cancer susceptibility gene 1/2 mutation was a predictor of CRS3 and a good prognostic factor for the survival rate. Simultaneous metastasis to distant lymph nodes and solid organs is a predictor of CRS1. CRS inversely correlated with PFS and overall survival.

Diagnosis of a large cystic teratoma of accessory ovary complicated with torsion by ultrasound: A case report

Rationale: An accessory ovary complicated by cystic teratoma and torsion is extremely rare and requires prompt diagnosis and surgical treatment. However, evidence for effective preoperative imaging diagnosis has barely been reported. Our study presented a case in which preoperative ultrasound reasonably suspected ovarian tumor torsion and an accessory ovary, and laparoscopic surgery was strategically performed. Patient concerns: An 18-year-old girl had persistent pain in the lower right abdomen for over 7 hours accompanied by nausea and vomiting, and she had a 14.1 × 10.1 × 9.0 cm hypo-echoic cystic lesion containing a 6.4 × 4.9 × 3.0 cm solid component accompanied by the whirlpool sign on the right side of the pelvis. Additionally, a hyper-echoic ovary with a size of 2.5 × 1.4 cm and a normal ovary appearance of 2.4 × 0.8 cm were detected on the right side of the adnexal area by ultrasound. Diagnosis: The cystic lesion was a large accessory ovarian cystic teratoma, complicated by torsion. The hyperechoic ovary appears as accessory ovarian stromal edema and the normal ovary appearance is eutopic. Interventions: Single-port laparoscopic resection of the ovarian lesion, release of the ovarian torsion, and oophoroplasty were performed. Outcomes: Postoperative recovery was unremarkable. Antral follicles were detected in both eutopic and accessory ovaries by ultrasound 20 days and 4 months after surgery. In addition, during the second postoperative ultrasound follow-up, the accessory ovary showed no difference in echo compared to the normal ovary, except for a slightly larger volume. Lessons: Clinical manifestations of accessory ovarian tumors combined with torsion are similar to those of eutopic ovarian torsion, and timely surgery is required.

Magnetic resonance imaging evaluation of gynecological mass lesions: A comprehensive analysis with histopathological correlation

Evaluating gynecological mass lesions and reviewing their morphological characteristics based on their imaging appearance on magnetic resonance imaging (MRI), and correlating the MRI findings with histopathological findings, was the central theme of our study. This observational cross-sectional study was conducted on 60 female patients with clinically suspected gynecological mass lesions upon physical examination and/or ultrasonography, referred for MRI at a tertiary care hospital over a 1-year period between June 2022 and July 2023. A broad spectrum of differential diagnoses of gynecological masses was observed. In our study, the ratio of benign versus malignant disease was 1.6:1, with 37 benign and 23 malignant masses identified. The most common benign masses were uterine fibroids (n = 14; 23.3%), followed by endometriosis (n = 8; 13.3%), and ovarian dermoid cysts (n = 4; 6.6%). Among the malignant lesions, cervical cancer was the most common (n = 11; 18.3%), followed by endometrial carcinoma (n = 7; 11.6%), ovarian carcinoma (n = 3; 5%), and vaginal carcinoma (n = 2; 3%). Benign lesions mostly appeared hypo- to isointense on T1-weighted imaging and iso- to hyperintense on T2-weighted imaging, while malignant lesions appeared isointense on T1-weighted and hyperintense on T2-weighted imaging. Hemorrhage and fat were well appreciated on MRI and aided in diagnosis. T2 shading was present in 7 out of 8 endometriotic cysts, demonstrating a specificity of 100% and a sensitivity of 83%. For determining parametrial invasion in cervical carcinoma, MRI showed an accuracy of 91%, specificity of 100%, and positive predictive value, negative predictive value, and sensitivity of 100%, 75%, and 88%, respectively. In cases of endometrial carcinoma, MRI demonstrated a sensitivity and specificity of 87% and 91%, respectively, with a positive predictive value of 87% and a negative predictive value of 91% for identifying myometrial invasion greater than 50%. Compared to other modalities, MRI provided substantial information regarding uterine and adnexal masses and surrounding structures, facilitating accurate staging of lesions.

Uterine tumors mimicking ovarian sex cord tumors with rhabdoid differentiation: a clinicopathologic study of 4 cases: A case series analysis

Rationale: Uterine tumors resembling ovarian sex cord tumors (UTROSCT) with rhabdoid features are uncommon mesenchymal neoplasms exhibiting diverse histological patterns, including significant rhabdoid morphology. A thorough comprehension of their clinicopathologic features is crucial for precise diagnosis and effective management. Patient concerns: This study presents 4 cases of UTROSCT with rhabdoid features, diagnosed in patients aged 31 to 58. Varied recurrence patterns were observed, including similar recurrent lesions to the primary tumors with subsequent mortality, initial invasion and lymph node metastasis, and presence of only primary tumor. Diagnoses: Histopathological examination revealed diverse morphological patterns, prominently featuring rhabdoid differentiation. Immunohistochemical analysis showed expression of hormone receptors, sex cord, smooth muscle, and epithelial markers, notably WT1, CD56, and CD99. Molecular analysis identified ESR1-NCOA2 fusions and ESR1 and NCOA2/3 rearrangements, indicating a potential association between these genetic alterations and extensive rhabdoid differentiation. Interventions: Various treatments were administered post-recurrence, including chemotherapy and targeted therapies. However, poor clinical outcomes were observed in all cases. Outcomes: Despite aggressive treatments, including chemotherapy and targeted therapies, poor clinical outcomes were observed, highlighting the aggressive nature of UTROSCT with significant rhabdoid differentiation. Lessons: This case series emphasizes the importance of detailed pathological reporting, comprehensive molecular testing, and thorough tumor staging in UTROSCT cases with rhabdoid features. Enhanced understanding of the clinicopathologic characteristics of UTROSCT with rhabdoid differentiation is crucial for accurate diagnosis, prognostication, and management strategies.

Development and validation of nomograms to predict survival of primary cervical lymphoma: A surveillance, epidemiology, and end results (SEER) database analysis

Due to the rarity of primary cervical lymphoma (PCL), the long-term survival of patients with cervical lymphoma and factors influencing survival are unknown. This study aimed to compare the survivals of patients with PCL and those with other cervical tumors and construct a clinical prediction model to assess the prognosis of patients with PCL. Patients with PCL from the Surveillance, Epidemiology, and End Results database were allocated randomly in a 7:3 ratio to the training and validation sets. Cox proportional hazard and Fine-Gray models were used to verify independent factors influencing overall survival (OS) and disease-specific survival (DSS), and nomograms were constructed. Receiver operating characteristic curve analysis and decision curve analysis (DCA) were used to test the performance and clinical utility of the models, respectively. We included 206 patients with PCL. The areas under the curves (AUCs) and DCA showed that all models had clinical benefits; The models constructed in this study had a predictive performance for patients with PCL. It can guide clinicians to rationalize the treatment plan for patients.

Mirvetuximab soravtansine: A breakthrough in targeted therapy for platinum-resistant ovarian cancer

Ovarian cancer, ranked as the second leading cause of gynecologic malignancy-related deaths globally, poses a formidable challenge despite advances in early detection and treatment modalities. This paper explores the efficacy and safety of mirvetuximab soravtansine, the first folate receptor alpha (FRα)-targeting antibody-drug conjugate, in platinum-resistant ovarian cancer expressing FRα. A review of 4 key studies involving 453 participants consistently demonstrates mirvetuximab soravtansine’s clinically meaningful antitumor activity and favorable safety profile. Clinical implications emphasize mirvetuximab soravtansine’s pivotal role in targeted therapy, especially for high FRα-expressing tumors, potentially reshaping platinum-resistant ovarian cancer management. The combination therapy approach introduces a novel dimension, suggesting enhanced therapeutic outcomes. Even in heavily pretreated patients, mirvetuximab soravtansine’s favorable tolerability positions it as a viable option. The reliability of archival tissue for FRα assessment simplifies patient selection, streamlining accessibility to targeted therapies. However, identified gaps, including limited diversity in patient populations, sparse quality of life data, and the need for long-term safety information, indicate areas for future research. Exploration of additional biomarkers predicting mirvetuximab soravtansine responsiveness is essential for personalized treatment.

Uterine tumors resembling ovarian sex cord tumors: A retrospective analysis of 7 cases from a single institution

To investigate the clinicopathological features, diagnosis, surgical treatment and prognosis of uterine tumors similar to ovarian sex cord tumors (UTROSCT). The clinical data, surgical approach, histopathological, and immunohistochemical features of 7 cases of UTROSCTs were retrospectively reviewed and followed up. All 4 patients were premenopausal women. The most common clinical presentation was menorrhagia (n = 4) followed by postmenopausal lower abdominal mass (n = 2) and postmenopausal bleeding (n = 1). Gynecological ultrasonography suggested uterine fibroids in 4 cases, adenomyosis with uterine fibroids in 2 cases, and an intrauterine mass in 1 case. Pelvic MRI was performed preoperatively in only 2 cases, and both indicated uterine fibroid degeneration, including 1 patient with suspected malignancy. Preoperative serum tumor markers were measured in 6 patients, and only 1 patient had elevated CA125 levels, up to 158 U/mL. Total hysterectomy with bilateral adnexectomy or salpingectomy was the most common treatment pattern (n = 6). The tumors were located within the myometrium (n = 4), submucosa (n = 1), and isthmus to external cervical os (n = 1), with a range of 2 to 12 (mean = 8) cm. Edema and degeneration were observed in 2 cases, and necrosis in 1 case. Postoperative follow-up ranged from 31 to 82 (mean = 43) months. Unfortunately, 1 patient died at 54 months of follow-up without undergoing hysterectomy. The remaining 6 cases showed no tumor recurrence or metastasis after surgery. Histological examination revealed a tumor composed of epithelioid tumor-like cells arranged in cords, trabeculae, and nests. All 7 tumors showed expression of 2 sex cord differentiation markers. Furthermore, all tumors expressed the smooth muscle marker, while epithelial marker CK (4/7). endometrial stromal marker CD10(0/7). The Ki-67 proliferation index was found to be <5% (5/7). The option of total hysterectomy may be considered for women who do not have any fertility requirements. However, for young women who desire to maintain their reproductive capacity, surgery to preserve the uterus may be an alternative, although it necessitates careful postoperative monitoring. In terms of follow-up monitoring, MRI is more suitable than ultrasound. The diagnosis of UTROSCT heavily relies on histopathological examination and immunohistochemical analysis.

Diagnostic accuracy of shear wave elastography for endometrial cancer: A meta-analysis

Background: This meta-analysis aimed to identify the accuracy of shear wave elastography (SWE) in the diagnosis of endometrial cancer (EC). Methods: We searched the PubMed, Cochrane Library, and chinese biomedical literature database from inception to September 30, 2022. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 software. We calculated summary statistics for sensitivity (Sen), specificity (Spe), positive and negative likelihood ratio (LR+/LR−), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curves. Results: Eight studies that met all the inclusion criteria were included in this meta-analysis. A total of 432 patients with EC and 548 with benign endometrial lesions were assessed. All endometrial lesions were histologically confirmed by SWE. The pooled Sen was 0.91 (95% confidence interval [CI] = 0.83–0.95); the pooled Spe was 0.90 (95% CI = 0.86–0.93); the pooled LR+ was 9.10 (95% CI = 6.20–13.35); the pooled negative LR− was 0.10 (95% CI = 0.05–0.20); the pooled DOR of SWE in the diagnosis of EC was 90.73 (95% CI = 36.62–804.5). The area under the SROC curve was 0.95 (95% CI = 0.93–0.97). No evidence of publication bias was found (t = 0.98, P = .37). Conclusion: Our meta-analysis indicates that SWE may have high diagnostic accuracy in the differential diagnosis of benign and malignant endometrial lesions. Thus, SWE may be a useful tool for the diagnosis of EC.

CX3CR1 is a potential biomarker of immune microenvironment and prognosis in epithelial ovarian cancer

Immunotherapy is less efficient for epithelial ovarian cancer and lacks ideal biomarkers to select the best beneficiaries for immunotherapy. CX3CR1 as chemokine receptor mainly expressed on immune cell membranes, and combined with its unique ligand CX3CL1, mediates tissue chemotaxis and adhesion of immune cells. However, the immune functional and prognostic value of CX3CR1 in epithelial ovarian cancer has not been clarified. A comprehensive retrospective analysis was performed by using the online database to identify the underlying immunological mechanisms and prognostic value of CX3CR1. The Human Protein Atlas, gene expression profiling interactive analysis, and TISIDB (an integrated repository portal for tumor-immune system interactions) database showed that CX3CR1 expressed higher in epithelial ovarian cancer than that in normal ovarian tissue. Four hundred twenty-two cases from Gene Expression Profiling Interactive Analysis and 1656 cases from Kaplan–Meier plotter database showed higher expression of CX3CR1 (above median) was associated with unfavorable overall survival. TIMER, UALCAN, and TISIDB database were applied to validate CX3CR1 negative impact on overall survival. In addition, correlation analysis showed that the expression level of CX3CR1 was positive association with infiltrating levels of B cells (R = 0.31, P = 3.10e−12), CD8+ T cells (R = 0.26, P = 7.93e−09), CD4+ T cells (R = 0.11, P = 1.41e−02), macrophages (R = 0.32, P = 4.29e−13), dendritic cells (R = 0.27, P = 2.98e−09), and neutrophil (R = 0.25, P = 3.25e−08) in epithelial ovarian cancer. Therefore, CX3CR1 involved in reshaping the immune microenvironment for epithelial ovarian cancer and maybe a potential immunotherapy target and prognostic marker for ovarian cancer.

Nongestational ovarian choriocarcinoma with bilateral teratoma: A rare case report and literature review

Introduction: Trophoblastic neoplasms are often associated with pregnancy, and nongestational trophoblastic neoplasms are extremely rare. Nongestational ovarian choriocarcinoma (NGCO) is a highly aggressive germ cell-derived tumor frequently presenting with early hematogenous metastasis. Patient concerns: Herein, we report a case of a 28-year-old unmarried woman with regular menstruation who experienced vaginal bleeding 1 week after her last menstrual cycle. Doppler ultrasound revealed bilateral adnexal masses and elevated serum human chorionic gonadotropin (hCG) levels. The patient was initially misdiagnosed as presenting an ectopic pregnancy. Diagnosis: The final pathology confirmed an International Federation of Gynecology and Obstetrics stage IA NGCO with bilateral mature teratoma of the ovary. This is an extraordinary instance of ovarian choriocarcinoma which emerged without any prior gestation, and the patient’s lack of a history of pregnancy made the diagnosis ignored. Interventions: After initial surgery and 1 cycle of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, a laparoscopic fertility-preserving comprehensive staging surgery was performed. Two cycles of chemotherapy with BEP were administered as supplemental therapy postsurgery, and leuprorelin was administered to protect ovarian function. Outcomes: Menstruation resumed 4 months after chemotherapy completion, and tumor indicators were within the normal range. No signs of recurrence were observed at the 36-month follow-up. Conclusion: NGCO should be considered if a female patient exhibits irregular vaginal bleeding and masses in the adnexal area. The present case and our literature review also highlighted that fertility-sparing surgery and multidrug chemotherapy are effective methods for treating NGCO.

Polymorphisms in miR-17-92 cluster promoter region is associated with risk and prognosis of endometrial cancer

Accumulating researches have reported that miR-17-92 cluster expression has strong association with tumorigenesis. In this study, we investigated the effects of 2 genetic polymorphisms in the promoter region of the miR-17-92 cluster and the risk and prognosis of endometrial cancer in northern Chinese women. Two polymorphisms (rs9588884 and rs982873) in the promoter of miR-17-92 cluster were genotyped by polymerase chain reaction and ligase detection reaction (PCR-LDR) in398 EC patients and 420 controls. The levels of miR-17-92 mRNA were investigated in 65EC tissues by real-time quantitative polymerase chain reaction (RT-qPCR). The impact of genetic features on the risk and clinical outcomes of EC was analyzed. The prognostic value of hsa-miR-17 and hsa-miR-20a in EC patients was assessed using the Kaplan–Meier plotter database. The results showed that a significant decrease in risk of EC with rs9588884 (GG vs CC: OR = 0.49, 95% CI = 0.32–0.78, P = .002; G vs C: OR = 0.75, 95% CI = 0.62–0.91, P = .005, respectively). Similarly, association was found between rs982873 and a decreased risk of EC (CC vs TT: OR = 0.53, 95% CI = 0.34–0.82, P = .004; C vs T: OR = 0.77, 95% CI = 0.63–0.94, P = .010, respectively). Moreover, survival analysis showed that the CG or GG genotype of rs9588884 may significantly increase overall survival (OS) compared with the CC genotype in the 5-year follow-up (HR = 0.49, 95% CI = 0.29–0.82 and HR = 0.36, 95% CI = 0.16–0.83, respectively). RT-qPCR results showed that the expression level of miR-17-92 mRNA in EC tissues with the rs9588884 GG genotype was significantly lower than those with the GC + CC genotype (P = .030). However, there was no significant difference in the prognosis and expression level of miR-17-92mRNA in tissues of EC patients with different genotypes of rs982873 (P = .343). In addition, analysis using Kaplan–Meier plotter database showed that high hsa-miR-20a expression was significantly correlated with poor OS in EC patients (HR = 1.63, 95% CI = 1.02–2.61, P = .039). The genetic polymorphisms rs9588884 and rs982873 in the promoter of miR-17-92 cluster decreased EC risk. Both rs9588884 and the expression level of hsa-miR-20a mRNA may be associated with its clinical outcome in EC patients.

Comparison of survival outcome of open, total laparoscopic, and laparoscopy-assisted radical vaginal hysterectomy for stage IB2 cervical cancer patients: A multicenter retrospective study

The aim of this study was to compare survival outcomes of 3 different radical hysterectomy (RH) types, namely total abdominal radical hysterectomy (TARH), total laparoscopic radical hysterectomy (TLRH), and laparoscopy-assisted radical vaginal hysterectomy (LARVH), in patients with FIGO stage IB2 cervical cancer. We retrospectively identified a cohort of patients who underwent RH for cervical cancer between 2010 and 2017. Patients with stage IB2 cervical cancer were included and were classified into TARH, TLRH, and LARVH treatment groups. Survival outcomes were estimated by the Kaplan–Meier method and compared with the log-rank test. Cox proportional hazards models were fit to estimate the independent association of RH technique with outcome. 194 patients were included in this study: 79 patients in the TARH group, 55 in the TLRH group, and 60 in the LARVH group. No significant differences were found in clinicopathological characteristics between the 3 RH groups. On comparing survival outcomes with TARH, both TLRH and LARVH showed no significant difference in terms of 5-year overall survival (TARH vs TLRH, P = .121 and TARH vs LARVH, P = .436). Conversely, compared to the TARH group, 5-year progression-free survival (PFS) was significantly worse in the TLRH group (P = .034) but not in the LARVH group (P = .288). Multivariate analysis showed that TLRH surgical approach (hazard ratio, 3.232; 95% confidence interval, 1.238–8.438; P = .017) was an independent prognostic factor for PFS in patients with IB2 cervical cancer. Our study suggests that in patients with FIGO stage IB2 cervical cancer, among the minimally invasive RH approaches, TLRH and LARVH, only TLRH approach was associated with worse PFS when compared with the TARH approach.

Efficacy and safety of PD-1/PD-L1 immune checkpoint inhibitors in the treatment of recurrent ovarian cancer: A systematic review and meta-analysis

Background: Recurrent ovarian cancer (OC) presents a significant therapeutic challenge with limited treatment success. Programmed cell death protein 1 (PD-1/PD-L1) immune checkpoint inhibitors have emerged as a potential treatment avenue, necessitating a systematic review and meta-analysis to evaluate their efficacy and safety. Methods: Adhering to preferred reporting items for systematic reviews and meta-analyses guidelines, we conducted a comprehensive literature search across PubMed, Embase, Web of Science, and Cochrane Library, culminating in the inclusion of studies focusing on the treatment of recurrent OC with PD-1/PD-L1 inhibitors. Studies were evaluated using the Newcastle-Ottawa Scale and analyzed using fixed or random effects models depending on heterogeneity levels. Results: Our search yielded 1215 articles, with 6 meeting the inclusion criteria for final analysis. Studies varied in size and reported median age, overall survival (OS), progression-free survival (PFS), and adverse events. The meta-analysis showed improved Objective Response Rates (ORR), Disease Control Rate (DCR), and PFS in patients treated with PD-1/PD-L1 inhibitors. The overall adverse event rate was 17.9%, indicating a need for careful patient selection and monitoring. No significant publication bias was detected, enhancing the reliability of our findings. Conclusions: PD-1/PD-L1 inhibitors offer a promising treatment option for recurrent OC, improving ORR, DCR, and PFS. However, the higher incidence of adverse events necessitates a cautious approach to their use. Future research should focus on long-term outcomes, biomarker identification, and optimal combination therapies.

Advances in precision therapy of low-grade serous ovarian cancer: A review

Low-grade serous ovarian carcinoma (LGSOC) is a rare subtype of ovarian cancer that accounts for approximately 6% to 10% of serous ovarian cancers. The clinical treatment of LGSOC is similar to that of high-grade serous ovarian carcinoma, however, its clinical and molecular characteristics are different from those of high-grade serous ovarian carcinoma. This article reviews the research on gene diagnosis, surgical treatment, chemotherapy, and biological therapy of LGSOC, providing reference for clinical diagnosis and treatment of LGSOC. Surgery is the cornerstone of LGSOC treatment and maximum effort must be made to achieve R0 removal. Although LGSOC is not sensitive to chemotherapy, postoperative platinum-based combination chemotherapy remains the first-line treatment option for LGSOC. Additional clinical trials are needed to confirm the clinical benefits of chemotherapy and explore new chemotherapy protocols. Hormone and targeted therapies may also play important roles. Some patients, particularly those with residual lesions after treatment, may benefit from hormone maintenance therapy after chemotherapy. Targeted therapies, such as MEKi, show good application prospects and are expected to change the treatment pattern of LGSOC. Continuing to further study the genomics of LGSOC, identify its specific gene changes, and combine traditional treatment methods with precision targeted therapy based on second-generation sequencing may be the direction for LGSOC to overcome the treatment bottleneck. In future clinical work, comprehensive genetic testing should be carried out for LGSOC patients to accumulate data for future scientific research, in order to find more effective methods and drugs for the treatment of LGSOC.

Impact of sentinel lymph node assessment on the outcomes of patients with advanced endometrial cancer: A meta-analysis

Background: Sentinel lymph node (SLN) assessment is used to treat early endometrial cancer; however, its application in advanced endometrial cancer remains controversial. Therefore, we assessed the effects of SLN assessment and lymphadenectomy (LND) on the prognosis (survival rate and primary outcome) of patients with advanced endometrial cancer. Methods: Pertinent studies were selected from PubMed, Embase, Web of Science, and the Cochrane Library until March 19, 2022. Relevant studies were strictly screened according to the inclusion and exclusion criteria. Data from the included studies were extracted and their quality was evaluated. Then RevMan5.4 software was used for the meta-analysis. Results: Four retrospective studies were included, which enrolled 7181 patients; 492 were treated with SLN and 6689 with LND. In terms of overall survival, there was no significant difference between the 2 groups (odds ratio = 1.14, 95% confidence interval: 0.92–1.41, I 2 = 0%, P = .39). Conclusions: SLN assessment is an alternative to LND as a treatment modality for advanced endometrial cancer.

Laparoscopic transabdominal-sacrococcygeal approach for resection of Altman type III sacrococcygeal teratoma in adult women: A case report

Introduction: Adult sacrococcygeal teratoma (SCT) is a rare disease that is not easily detected or easily missed, and its treatment is based on surgery, including transabdominal, transsacral, or a combination of both, but there are no clear guidelines for diagnosis and treatment. We share a case of Altman type III SCT in order to provide more reference protocols for the diagnosis and treatment of adult SCT, and more importantly to increase our understanding of different types of SCT cases in adults. Patient concerns: Our patient was a 31-year-old adult woman who underwent complete surgical resection of a cystic mature teratoma of the right ovary 8 years ago and is currently 13 months postpartum without menstruation, usually with a feeling of anal bulge, with symptoms such as constipation. Diagnosis: We diagnosed SCT by vaginal ultrasonography, computed tomography and magnetic resonance imaging (MRI); benign tumors were considered in the results of serum tumor markers. Interventions: We chose the surgical approach of laparoscopic transabdominal-sacrococcygeal approach to completely remove the patient SCT and coccyx. Outcomes: The location of SCT is concealed and the clinical symptoms are not obvious. Vaginal ultrasonography, CT and MRI can not only improve the diagnostic rate of SCT, but also understand the size and mass of SCT, providing an exact basis for clinicians to select the laparoscopic transabdominal-sacrococcygeal approach. Conclusion: Our sharing increases the reports of rare cases of teratoma with the same histological findings in different organ tissues of the same patient at different times, whether this occurs incidentally requires more case reports and further basic research; in addition, the laparoscopic transabdominal-sacrococcygeal approach is a safe and effective surgical approach for the treatment of Altman type III SCT in adults; finally, this case reminds us that SCT may not affect pregnancy and pregnancy outcomes and provides a reference for the selection of interventions for SCT with pregnancy.

Single-cell transcriptomics reveals comprehensive microenvironment and highlights the dysfuntional state of NK cells in endometrioid carcinoma

Endometrioid endometrial cancer (EEC) is one of the most common gynecologic malignancies. The interaction between cancer cells and the cells in the tumor microenvironment (TME) plays a crucial role in determining disease progression and response to treatment. To better understand the diversity in the TME of ECC, we conducted a comprehensive analysis using single-cell RNA sequencing across 21 samples, including 16 ECC and 5 adjacent normal tissues. We primarily focused on tumor-infiltrating natural killer (NK) cells and their cell–cell interactions with other immune cell types. We identified a CD56dim_DNAJB1 NK cells subset, which had low cytotoxic capability and high stress levels, suggesting a dysfunctional state. This subset showed strong interactions with tumor-associated macrophages through several ligand–receptor pairs. Additionally, we observed that tumor-infiltrating LAMP3+ dendritic cells may inhibit CD8+ T cells or attract regulatory T cells to the tumor area. These dendritic cells also had impaired activation effects on NK cells within the TME. Our study provides valuable insights into the role of NK cells in cancer immunity and highlights the potential of targeting specific NK cell subsets for therapeutic purposes.

Associations between gut microbiota and gynecological cancers: A bi-directional two-sample Mendelian randomization study

Growing evidence has suggested that gut microbiota is associated with gynecologic cancers. However, whether there is a causal relationship between these associations remains to be determined. A two-sample Mendelian randomization (MR) evaluation was carried out to investigate the mechanism associating gut microbiota and 3 prevalent gynecological cancers, ovarian cancer (OC), endometrial cancer, and cervical cancer as well as their subtypes in individuals of European ancestry. The Genome-wide association studies statistics, which are publically accessible, were used. Eligible instrumental single nucleotide polymorphisms that were significantly related to the gut microbiota were selected. Multiple MR analysis approaches were carried out, including inverse variance weighted, MR-Egger, Weighted Median methods, and a range of sensitivity analyses. Lastly, we undertook a reverse MR analysis to evaluate the potential of reverse causality. We sifted through 196 bacterial taxa and identified 33 suggestive causal relationships between genetic liability in the gut microbiota and gynecological cancers. We found that 11 of these genera could be pathogenic risk factors for gynecological cancers, while 19 could lessen the risk of cancer. In the other direction, gynecological cancers altered gut microbiota composition. Our MR analysis revealed that the gut microbiota was causally associated with OC, endometrial cancer, and cervical cancer. This may assist in providing new insights for further mechanistic and clinical studies of microbiota-mediated gynecological cancer.

The analysis of preoperative or intraoperative factors in predicting the escalation of surgical pathological staging of patients with clinical stage I endometrioid carcinoma: A retrospective clinical study

To retrospectively analyze the preoperative and intraoperative influencing factors in predicting the escalation of surgical pathological staging in patients with clinical stage I endometrioid carcinoma. Patients with clinical stage I endometrioid carcinoma at Women’s Hospital, School of Medicine, Zhejiang University, between January 2002 and December 2015 were enrolled in this study. Due to preoperative or intraoperative surgical exploration, the patients with one or more preoperative or intraoperative high-risk factors underwent total hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy, totaling 535 cases. The preoperative and intraoperative influencing factors that could lead to the escalation of postoperative surgical pathological staging were further analyzed. 1. There were 535 patients diagnosed with clinical stage I endometrioid carcinoma before surgery, 125 patients were upgraded with postoperative pathological staging, for a rate of 23.36%. 2. Kaplan–Meier survival curve analysis showed that the prognosis in postoperative surgical pathological staging upgraded cases was worse than that in nonupgraded cases. The tumor-free survival and overall survival rates in the 2 groups were significantly different (P < .001). 3. Univariate analysis showed that preoperative degree of myometrial infiltration, intraoperative visual myometrial infiltration depth, massive size of tumor (diameter ≥ 4 cm) and preoperative abnormal serum cancer antigen 125 (CA125) level were associated with the escalation of surgical pathological staging (P < .05). Multivariate analysis indicated that massive size of tumor and preoperative serum abnormal CA125 level were independent predictors of whether postoperative pathological staging would be upgraded (P < .05). 4. The receiver operating characteristic curve drawn with the massive size of tumor and/or the preoperative serum CA125 level abnormality could be used to predict the probability of postoperative pathological upstaging. The results showed that the area from the combination of the 2 factors under the receiver operating characteristic curve was 0.723 (95% confidence interval, 0.672–0.773), suggesting that the combination of massive size of tumor and abnormal preoperative serum CA125 level may serve as an influencing factor for predicting the postoperative pathological staging upgrades. The clinical stage I endometrioid carcinoma patients with massive size of tumor and abnormal preoperative serum CA125 level need to be fully evaluated to ensure appropriate management as soon as possible, since they are more likely to experience postoperative pathological staging upgrades.

Association between the quantitative characteristics of dual-energy spectral CT and cytoreduction surgery outcome in patients with advanced epithelial ovarian cancers: A prospective observational study

This study aimed to explore the association between the quantitative characteristics of dual-energy spectral CT and cytoreduction surgery outcome in patients with advanced epithelial ovarian carcinoma (EOC). In this prospective observational study, patients with advanced EOC (federation of gynecology and obstetrics stage III–IV) treated in the Department of Gynecological Oncology at our Hospital between June 2021 and March 2022 were enrolled. All participants underwent dual-energy spectral computed tomography (DECT) scanning 2 weeks before cytoreductive surgery. The quantitative data included peritoneal cancer index (PCI) determined by DECT, CT value at 70 keV, normalized iodine concentration, normalized water concentration, effective atomic number (effective-Z), and slopes of the spectral attenuation curves (slope λ Hounsfield unit). Fifty-five participants were included. The patients were 57.2 ± 9.8 years of age, and 72.7% were menopausal. The maximal diameter of tumors was 8.6 (range, 2.9–19.7) cm, and 76.4% were high-grade serous carcinomas. Optimal cytoreduction was achieved in 43 patients (78.2%). Compared with the optimal cytoreductive group, the suboptimal cytoreductive group showed a higher PCI (median, 21 vs 6, P < .001), higher 70 keV CT value (69.5 ± 16.6 vs 57.1 ± 13.0, P = .008), and higher slope λ Hounsfield unit (1.89 ± 0.66 vs 1.39 ± 0.60, P = .015). The multivariable analysis showed that the PCI (OR = 1.74, 95%CI: 1.24–2.44, P = .001) and 70 keV CT value (OR = 1.07, 95%CI: 1.01–1.13, P = .023) were independently associated with a suboptimal cytoreductive surgery. The area under the receiver operating characteristics curve of PCI and 70 keV CT value was 0.903 (95%CI: 0.805–1.000, P = .000) and 0.740 (95%CI: 0.581–0.899, P = .012), respectively. High PCI and 70 keV CT value are independently associated with suboptimal cytoreductive surgery in patients with advanced EOC. The PCI determined by DECT might be a better predictor for suboptimal cytoreduction.

Exploring the significance of tumor volume in endometrial cancer: Clinical pathological features, prognosis, and adjuvant therapies

To assist clinicians in formulating treatment strategies for endometrial cancer (EC), this retrospective study explores the relationship between tumor volume and clinical pathological features, as well as prognosis, in patients undergoing staging surgery. Preoperative pelvic MRI examinations were conducted on 234 histologically confirmed EC patients. The ITK-SNAP software was employed to manually delineate the region of interest in the MRI images and calculate the tumor volume (MRI-TV). The analysis focused on investigating the relationship between MRI-TV and the clinical pathological features and prognosis of EC patients. Larger MRI-TV was found to be associated with various adverse prognostic factors (G3, deep myometrial invasion, cervical stromal invasion, lymphovascular space invasion, lymph node metastasis, advanced international federation of gynecology and obstetrics staging, and receipt of adjuvant therapy). The receiver operating characteristic curve indicated that MRI-TV ≥ 8 cm3 predicted deep myometrial invasion, and MRI-TV ≥ 12 cm3 predicted lymph node metastasis. Penalized spline (P-spline) regression analysis identified 14 cm3 of MRI-TV as the optimal prognostic cutoff value. MRI-TV ≥ 14 cm3 was an independent prognostic factor for overall survival and disease-free survival. For patients with MRI-TV ≥ 14 cm3, the disease-free survival rate with adjuvant therapy was superior to that of the sole staging surgery group. This study demonstrates a significant correlation between MRI-TV and clinical pathological features and prognosis in EC. For patients with MRI-TV ≥ 14 cm3, staging surgery followed by adjuvant therapy was superior to sole staging surgery.

Research progress in intratumoral heterogeneity and clinical significance of ovarian cancer

Intratumoral heterogeneity has been a hot topic of cancer research in recent years, which has become a part of resolving cancer metastasis, recurrence and drug resistance. Intratumoral heterogeneity shows that cells undergo different division and proliferation during the process of tumor development, and their genomic cells exist in the process of tumor development. Protein and epigenetic changes can lead to differences in proliferation, migration and invasion, sensitivity and pharmacological prognosis of tumor cells, promote sustainable development and development of cancer cells, produce greater adaptability, and lead to metastasis, recurrence and drug resistance of malignant tumors. In recent years, the molecular mechanism and clinical application of intratumoral heterogeneity have captivated widespread attention from researchers. In the era of precision medicine, oncologists attempt to improve the clinical efficacy of targeted tumor therapy via intratumoral heterogeneity. In this article, recent advances in the study of intratumoral heterogeneity, molecular mechanism of intratumoral heterogeneity, systematic evolution and quantification and clinical significance of tumor heterogeneity were reviewed.

Factors influencing the supportive care needs of female patients with genital cancer in South Korea

Genital cancers are particularly important compared to other cancers because of the psychological impact they have on the individual. This study investigated the complexity in illness and quality of life among female genital cancer patients and determined the effects of these factors on supportive care needs to provide evidential data for the development of nursing intervention strategies to reduce supportive care needs in female genital cancer patients. This cross-sectional study collected data from July 22 to August 17, 2021. The study subjects were 103 female outpatients and inpatients aged 19 years or older who were treated for cervical cancer, endometrial cancer, ovarian cancer, or other female genital cancers such as vulvar cancer and vaginal cancer in a university hospital in Korea. The data were analyzed with t-tests and Scheffé’s test using SPSS 26.0. The factors affecting supportive care needs were examined using hierarchical regression. The average age of the subjects was 56.41 (±9.91) years. Cervical cancer was the most common diagnosis at 42.7%, followed by ovarian cancer at 34.0%, and endometrial cancer at 21.4%. The factors affecting supportive care needs included a middle school education or below (β = 0.21, P = .028), unemployment (β = 0.23, P = .018), complexity in illness (β = 0.32, P < .001), and quality of life (β = −0.68, P < .001). Developing a strategy for managing the complexity in illness and quality of life caused by various variables including disease stage and type of treatment is necessary to reduce the supportive care needs of female genital cancer patients. Improving their quality of life through effective communication with healthcare providers is essential.

Magnetic resonance imaging for the diagnosis of malignant mixed Mullerian tumor of ovary: Two case reports

Rationale: Malignant mixed Mullerian tumor (MMMT) is also known as carcinosarcoma, mostly occurring in the uterus, and occurred in ovary is very rare. The disease is highly aggressive. Two cases of MMMT of ovary and their imaging characteristics were collected in our study. Patient concerns: A 77-year-old and an 80-year-old woman were admitted to the obstetrics and gynecology department of our hospital on June 22, 2019, and December 10, 2019, respectively. The first patient presented with abdominal distension with poor appetite without obvious triggers. Another patient had been menopausal for 18 years and presented with vaginal bleeding with dull pain in the left lower abdomen without obvious cause. Diagnoses: Both patients underwent pelvic magnetic resonance imaging plain and enhanced scan after admission, which indicated pelvic mass. Postoperative pathology confirmed MMMT in the adnexal region. Interventions: Both patients underwent total hysterectomy and bilateral adnexectomy. Outcomes: Postoperatively, the first patient developed complications such as renal failure and gastrointestinal bleeding and was sometimes unconscious. Symptomatic treatment was not effective, and the patient died about 1 month after discharge. The other patient recovered well after surgery, and imaging examinations confirmed no evidence of regrowth of the tumor during an average 36-month follow-up. Lessons: The disease is highly malignant and progresses rapidly. The elevation of CA125 should be taken seriously. The imaging findings of MMMT has certain characteristics. Multi-sequence magnetic resonance imaging may help to distinguish this disease from other pelvic tumors. Once found, surgical treatment is needed as soon as possible, followed by postoperative adjuvant radiotherapy and chemotherapy.

Exploration of the effect and mechanism of Scutellaria barbata D. Don in the treatment of ovarian cancer based on network pharmacology and in vitro experimental verification

The mortality rate of ovarian cancer is the highest among gynecological cancers, posing a serious threat to women health and life. Scutellaria barbata D. Don (SBD) can effectively treat ovarian cancer. However, its mechanism of action is unclear. The aim of this study was to elucidate the mechanism of SBD in the treatment of ovarian cancer using network pharmacology, and to verify the experimental results using human ovarian cancer SKOV3 cells. The Herb and Disease Gene databases were searched to identify common targets of SBD and ovarian cancer. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, and Protein-Protein Interaction (PPI) network analyses were performed to identify the potential molecular mechanisms behind SBD. Finally, the molecular docking and main possible pathways were verified by experimental studies. Cell proliferation, the mRNA expression level of key genes and signaling pathway were all investigated and evaluated in vitro. A total of 29 bioactive ingredients and 137 common targets in SBD were found to inhibit ovarian cancer development. The active ingredients identified include quercetin, luteolin, and wogonin. Analysis of the PPI network showed that AKT1, VEGFA, JUN, TNF, and Caspase-3 shared centrality among all target genes. The results of the KEGG pathway analysis indicated that the cancer pathway, PI3K-Akt signaling pathway, and MAPK signaling pathways mediated the effects of SBD against ovarian cancer progression. Cell experiments showed that quercetin, luteolin, and wogonin inhibited the proliferation and clone formation of SKOV3 cells and regulated mRNA expression of 5 key genes by inhibiting PI3K/Akt signaling pathway. Our results demonstrate that SBD exerted anti-ovarian cancer effects through its key components quercetin, luteolin and wogonin. Mechanistically, its anti-cancer effects were mediated by inhibition of the PI3K/Akt signaling pathways. Therefore, SBD might be a candidate drug for ovarian cancer treatment.

Construction of monocyte-related prognosis model based on comprehensive analysis of bulk RNA-seq and single-cell RNA-seq in high-grade serous ovarian cancer

High-grade serous ovarian cancer (HGSOC) is a common subtype of ovarian cancer with high mortality. Finding a new biomarker is useful for the diagnosis and treatment of HGSOC. The scRNA and bulk RNA data were obtained from The Cancer Genome Atlas and Gene Expression Omnibus databases. The monocyte-related clusters were identified and annotated by Seruat and SingleR package. The Kaplan–Meier and receiver operating characteristic curve was used to determine the prognosis. The differentially expressed genes were determined by limma. The single sample Gene Set Enrichment Analysis, Gene Set Enrichment Analysis, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes were used for the enrichment function. The correlation between drug activity and gene expression was assessed by rcellminer and rcellminer Data package. We identified 9 cell types and obtained 37 differentially expressed marker genes of monocyte. A2M, CD163, and FPR1 were screened out as hub genes and used to construct risk model in HGSOC through univariate and multivariate cox analysis. Single sample Gene Set Enrichment Analysis showed risk score was related to B cell and T cell signal pathways, and further analysis showed most immune checkpoint genes expressions were upregulated in high-risk score group. The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis exhibited that hub gene related genes were involved in signal receptor binding and cytokine-cytokine interaction. Low A2M expression and high expression of CD163 and FPR1 were associated with poor prognosis. Gene Set Enrichment Analysis revealed that A2M promoted tumor development through enhancing immune cell related signal pathways, while CD163 and FPR1 inhibited tumor development through activated carcinogenic signal pathways. Drug sensitivity analysis revealed that these hub genes could be potential therapeutic targets for the treatment of HGSOC. We constructed a risk model for the overall survival and explored the potential mechanism of monocyte in HGSOC.

MMP-3 gene regulates the carcinogenesis and metabolic process of ovarian cancer, evidence from a Chinese population: Observational study and meta-analysis

The current investigation aims to explore the relationship between matrix metalloproteinase-3 (MMP-3) gene polymorphism and ovarian cancer (OC) risk. Two hundred forty pathologically confirmed OC patients and 390 healthy controls participated in the present investigation. Polymerase chain reaction-restriction fragment length polymorphism was applied to investigate the present polymorphism. At the same time, the meta-analysis was also performed to comprehensively explore the relationship. Three genotypes (5A/5A, 5A/6A, and 6A/6A) were observed for MMP-3 gene polymorphism. 6A/6A genotype and 6A allele displayed significant increase in OC patients (all P < .05). Meta-analysis found that no significant results (all P > .05). In conclusion, our results indicate that MMP-3 gene polymorphism contributes increased risk to OC for southern Chinese population. And meta-analysis indicates that MMP-3 gene polymorphism contributes no risk to OC in other populations.

Ovarian cancer disease burden decreased in the United States from 1975 to 2018: A joinpoint and age-period-cohort analysis

Ovarian cancer (OC) is the leading cause of gynecological cancer-related deaths in the United States. The purpose of this study was to evaluate long-term trends in OC incidence and incidence-based mortality rates (IBM) in the U.S. from 1975 to 2018 and to assess the effects of age, period, and cohort factors on OC incidence and mortality using an age-period-cohort model. We obtained data from the U.S. OC incidence/mortality data from the Surveillance, Epidemiology, and End Results database from 1975 to 2018. Joinpoint regression analysis was used to determine long-term trends and transitions, and an age-period-cohort model was used to quantify the effects of age, period, and cohort parameters on incidence and mortality. In addition, 1990 to 2019 U.S. OC data obtained from the Global Burden of Disease study served as a potential validation set. Between 1975 and 2018, 80,622 new cases of OC and 60,218 deaths from OC were reported in the U.S. The average annual percent change for OC incidence was −1.33 (95% CI: −1.64 to −1.02, P < .001), with a significant decrease in incidence at a rate of 7.80% (95% CI: −11.52 to −3.92) per year from to 2015–2018. IBM reached its peak for the U.S. population in 1994, with an age-standardized mortality rate of 6.38 (per 100,000 people). IBM rose first, peaked in 1986, and then declined at a rate of 0.39% (95% CI: −0.66 to −0.12) and 2.48% (95% CI: −3.09 to −1.85) per year from to 1986–2007 and 2007–2018, respectively. In addition, age-period-cohort model analysis showed the highest risk of OC incidence in 1980 to 1984 and the highest risk of OC death in 1985–1989. This study reported a significant decline in OC morbidity and mortality in the U.S. since 1986. In addition, this study analyzed the changes in trends in OC incidence and mortality by race/ethnicity in the U.S. Monitoring trends in OC incidence and mortality by race/ethnicity can help in the development of targeted prevention and treatment measures.

Pulmonary cryptococcosis masquerading as lung metastasis in gynecologic cancers: Two case reports

Rationale: Pulmonary cryptococcal infections occur mainly in immunocompromised individuals, such as those with malignancies. Preoperative diagnosis of pulmonary cryptococcosis (PC) can be challenging for both clinicians and radiologists because of nonspecific clinical manifestations and variable radiologic features, as it is easily misdiagnosed as metastatic lung cancer. Patient concerns: In case 1, a 76-year-old woman with a history of cervical cancer presented with lung nodules detected on chest computed tomography (CT) 13 months after completing concurrent chemoradiotherapy. In case 2, a 56-year-old woman with a history of ovarian cancer presented with pulmonary nodules on chest CT 19 months after completing chemotherapy. Both patients were clinically asymptomatic, and tumor markers were not elevated. Diagnoses: In case 1, chest CT revealed multiple enhanced nodules with lobulated margins in the left lower lobe, and positron emission tomography (PET)-CT showed uptake in the nodule with a standardized uptake value of 3.7. In case 2, chest CT revealed several nodules in the right upper lobe abutting the right major fissure, and PET-CT revealed fluorodeoxyglucose uptake in the nodules. Pathology revealed granulomatous inflammation with cryptococcal infection, and mucicarmine and periodic acid-Schiff staining confirmed cryptococcal infection in both cases. Interventions: Presumptive diagnoses of lung metastases were made in both cases and thoracoscopic lobectomy was performed. Postoperatively, the patients received antifungal therapy with fluconazole. Outcomes: PC was differentially diagnosed and effectively managed. The patients remained disease-free for both PC and gynecological cancers during subsequent follow-ups. Lessons: Recognition that PC can mimic lung metastasis is important for managing gynecological cancers. PC should be considered in the differential diagnosis when single or multiple nodules are detected on chest radiography without elevation of tumor markers in patients with gynecological cancer.

Unexpected rare uterine carcinosarcoma with neuroendocrine differentiation: Reflections on clinical diagnosis and treatment of a case report

Rationale: Uterine carcinosarcoma (UCS) is a rare and highly invasive malignant tumor.It exhibits an ectopic growth pattern of the uterus,and its histological features are biphasic differentiation of malignant epithelial components (cancer) and malignant mesenchymal components (sarcoma). The pathological pattern of high-component neuroendocrine differentiation is extremely rare. Due to the inherent heterogeneity of tumors, it increases the difficulty of accurate identification and diagnosis. The author introduces a rare case of primary endometrial carcinosarcoma (heterologous) with small cell neuroendocrine carcinoma (SCNEC) components. There is limited literature on this rare pathological differentiation pattern and a lack of guidelines for the best treatment methods, which prompts reflection on the diagnosis, optimal treatment strategies, and how preoperative diagnosis can affect patient prognosis for endometrial carcinosarcoma with neuroendocrine differentiation. Patient concerns: The patient is an elderly woman who presents with abnormal vaginal bleeding after menopause. Transvaginal ultrasound examination shows that the uterus is slightly enlarged, and there is a lack of homogeneous echogenicity in the uterine cavity. Subsequently, a hysteroscopic curettage was performed, and a space-occupying lesion was observed on the anterior wall of the uterine cavity. Diagnoses: Preoperative endometrial biopsy revealed SCNEC of the endometrium. The patient underwent radical hysterectomy, and the postoperative pathological results showed that UCS (heterologous) was accompanied by SCNEC components (about 80%). Intervention: The patient received radical hysterectomy, followed by adjuvant chemotherapy. Outcome: After 7 months of follow-up, no tumor recurrence or metastasis was found at the time of writing this article. Lessons: The histological type of UCS (heterologous) with cell neuroendocrine carcinoma components is rare and highly invasive, with a high misdiagnosis rate in preoperative biopsy. There are currently no effective treatment guidelines for this type of case. The unusual appearance of SCNEC components in this case poses a challenge for both pathologists and surgeon. The rare differentiation pattern of this case exposes the complexity of its management and the necessity of prospective trials to determine the optimal treatment plan.

Causal relationship between endometrial cancer and risk of breast cancer: A 2-sample Mendelian randomization study

Several studies have confirmed the important role of endometrial cancer (EC) in the development and progression of breast cancer (BC), and this study will explore the causal relationship between EC and BC by 2-sample Mendelian randomization analysis. Pooled data from published genome-wide association studies were used to assess the association between EC and BC risk in women using 5 methods, namely, inverse variance weighting (IVW), MR-Egger, weighted median (WME), simple multimaximetry (SM) and weighted multimaximetry (WM) with the EC-associated genetic loci as the instrumental variables (IV) and sensitivity analyses were used to assess the robustness of the results. The statistical results showed a causal association between EC and BC (IVW: OR = 1.07, 95% CI = 1.01–1.32, P  = .02; MR-Egger: OR = 1.21, 95% CI = 0.71–1.51, P  = .11; weighted median: OR = 1.05, 95% CI = 0.97–1.31, P  = .19; simple plurality method: OR = 0.98, 95% CI = 0.81–1.15, P  = .78; weighted plurality method: OR = 0.98, 95% CI = 0.81–1.14, P  = .75), and the results of the sensitivity analyses showed that there was no significant heterogeneity or multiplicity, and the results were stable. EC is associated with an increased risk of developing BC. The results of this MR analysis can be used as a guideline for screening for BC in women with EC and to help raise awareness of screening for early detection and treatment.

Ichthyosis uteri complicated by endometrial adenocarcinoma with transitional cell differentiation: A case report

Rationale: Ichthyosis uteri is a rare pathological condition characterized by the replacement of the endometrial lining by stratified squamous epithelium. Yet its occurrence with endometrial adenocarcinoma is very rare. Patient concerns: A 68-year-old woman has been experiencing sporadic, minor vaginal hemorrhages for a few months. The gynecological evaluation revealed a uterine enlargement and imaging demonstrated an irregular mass within the uterus. Diagnosis: Endometrial adenocarcinoma with transitional cell differentiation; ichthyosis uteri with dysplasia. Interventions: Radical hysterectomy with pelvic lymphadenectomy was performed followed by postoperative radiotherapy. Outcomes: Postoperative follow-up at 8 months showed a favorable outcome without signs of recurrence and metastasis. Lessons: Adequate pathological sampling is crucial to identifying the accompanying lesions of ichthyosis uteri. Finding molecular alterations in various pathological morphologies is important to understand the evolution of disease.

Association between immune cells and endometrial cancer: A bidirectional Mendelian randomization study

Background: The prognostic significance of tumor-infiltrating immune cells in endometrial cancer is a subject of ongoing debate. Recent evidence increasingly suggests that these immune cells and cytokines, abundant in endometrial cancer tissues, play a pivotal role in stimulating the body inherent anti-tumor immune responses. Methods: Leveraging publicly accessible genetic data, we conducted an exhaustive 2-sample Mendelian randomization (MR) study. This study aimed to explore the causal links between 731 immunophenotypes and the risk of endometrial cancer. We thoroughly assessed the robustness, heterogeneity, and potential horizontal pleiotropy of our findings through extensive sensitivity analyses. Results: Our study identified 36 immunophenotypes associated with endometrial cancer risk. Specific immunophenotypes, such as the percentage of Naive-mature B-cells in lymphocytes (OR = 0.917, 95% CI = 0.863–0.974, P  = .005), and HLA DR expression on CD14-CD16 + monocytes (OR = 0.952, 95% CI = 0.911–0.996, P  = .032), exhibited a negative correlation with endometrial cancer. Conversely, CD127 expression on CD45RA + CD4 + in Treg cells (OR = 1.042, 95% CI = 1.000–1.085, P  = .049), and CM CD4+%T in T cell maturation stages (OR = 1.074, 95% CI = 1.012–1.140, P  = .018) showed a positive correlation. Reverse MR analysis linked endometrial cancer to 4 immunophenotypes, including a positive correlation with CD127-CD8br %T cell of Treg (OR = 1.172, 95% CI = 1.080–1.270, P  = .0001), and negative correlations with 3 others, including CM CD4+%T cell (OR = 0.905, 95% CI = 0.832–0.984, P  = .019). Conclusion subsections: Our findings underscore a significant causal relationship between immunophenotypes and endometrial cancer in bidirectional MR analyses. Notably, the CM CD4+%T immunophenotype emerged as potentially crucial in endometrial cancer development.

Systemic sclerosis complicating endometrial adenocarcinoma: A case report

Rationale: Systemic sclerosis (SSc) is a rare systemic autoimmune disease, and it is even more uncommon to encounter it alongside a neoplasm. Patient concerns: A 55-year-old female patient presented to our clinic with a 7-year history of cyanosis affecting multiple fingers bilaterally, accompanied by Raynaud’s phenomenon, mild pain, numbness, and morning stiffness. One and a half years ago, she was diagnosed with endometrial adenocarcinoma (Federation International of Gynecology and Obstetrics stage IIIa) for frequent abdominal pain and abnormal vaginal bleeding. Diagnoses: Following a comprehensive physical examination and laboratory tests, she was diagnosed with SSc according to the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria. Interventions: Although we discussed potential treatment options and prognosis with her, she ultimately declined therapy. Outcomes: She was lost to follow-up. Lessons: A shared pathophysiological process may underlie the development of both SSc and malignancy, possibly driven by persistent chronic inflammation and immune dysregulation.

Dosimetry study of Auto-VMAT planning and Manual-VMAT planning based on Pinnacle3 9.10 in radiotherapy for cervical cancer [RETRACTED]

The purpose of this study was to compare the dose distribution characteristics of automatic volume-modulated arc therapy (Auto-VMAT) planning and manual volume-modulated arc therapy (Manual-VMAT) planning of Philips Pinnacle3 9.10 planning system, to provide a basis for optimal radiation therapy planning for cervical cancer. Ten patients with cervical cancer in our hospital from September to December 2018 were selected, and 2 treatment plans, Auto-VMAT plan and Manual-VMAT plan, were designed using Pinnacle3 9.10 planning system, respectively, to evaluate the maximum dose Dmax, mean dose Dmean, homogeneity index of the target area according to the dose volume histogram, the conformability index, plan optimization time, monitor units (MUs), organ at risk and other indicators. The results were that the Auto-VMAT plan was superior to the Manual-VMAT plan for target area Dmean, conformability index, and homogeneity index, with statistically significant differences (P .05); rectal V40, V50, and Dmean in the Auto-VMAT plan, bladder V40, V50, and Dmean, small bowel V30, V40, V50 and Dmean, and right and left femoral V50 and Dmean were all lower than the Manual-VMAT plan, and the difference was statistically significant (P < .05); the mean optimization time for the Auto-VMAT and Manual-VMAT plans was 47 minutes and 35 minutes, respectively, an increase of 34%. The average number of MUs was 519 MUs and 374 MUs, respectively, an increase of 28%. This study concluded that the Pinnacle3 9.10-based Auto-VMAT plan was clinically feasible and significantly superior to the Manual-VMAT plan in terms of improved target area uniformity and conformability and reduced organ endangerment dose while reducing the impact of human factors on the quality of plan design.

The impact of surgery–radiotherapy interval on prognosis in high-risk endometrial cancer patients: A single-center retrospective analysis

This study aims to investigate the impact of surgery–radiotherapy (S–RT) interval on the prognosis of high-risk endometrial cancer (EC) patients receiving postoperative adjuvant therapy. It evaluates the effect of different interval times on disease-free survival (DFS) to provide clinical treatment recommendations. This retrospective study included 150 high-risk EC patients who underwent surgery at our hospital between February 2021 and February 2023. Patients were categorized into 3 groups based on the S–RT interval: short interval (1–4 weeks), medium interval (5–8 weeks), and long interval (&gt;8 weeks). Baseline data, treatment characteristics, and follow-up data were collected and analyzed. Primary outcomes included DFS and the effect of S–RT interval on DFS. Kaplan–Meier method was used for survival analysis, and multivariate Cox regression model – adjusting for key confounding factors such as age, Fédération Internationale de Gynécologie et d'Obstétrique stage, pathological type, deep myometrial invasion, lymphovascular space invasion (LVSI), and lymph node metastasis – was applied to evaluate independent prognostic factors. The 2-year DFS rate for the short interval group was 55%, significantly higher than the medium interval group (49%) and long interval group (24%), with statistically significant differences between the groups ( P  &lt; .001). Cox regression analysis indicated that the S–RT interval is an independent prognostic factor for DFS, with the long interval (&gt;8 weeks) group showing a significantly increased risk of recurrence compared to the short interval group (HR = 1.9, 95% CI: 1.4–2.5, P  &lt; .001). Pathological features such as deep myometrial invasion, LVSI positivity, and lymph node metastasis were also independent prognostic factors. The timing of postoperative radiotherapy initiation significantly affects prognosis in high-risk EC patients, even after adjusting for key clinical and pathological variables. Delayed radiotherapy (&gt;8 weeks) markedly increases recurrence risk. These findings suggest that shortening the S–RT interval may improve DFS. However, the results need to be validated in larger sample sizes and multi-center prospective studies before generalization.

A case of endocervical adenocarcinoma of the gastric type that was repeatedly misdiagnosed: A case report and literature review

Rationale: Gastric-type endocervical adenocarcinoma (GAS) is non-human papillomavirus-associated cervical cancer and the location of the lesions is in the cervical canal mostly. Patient concerns: Vaginal discharge is mistakenly thought to be caused by uterine fibroids. Misdiagnosis leads to disease progression. Diagnoses: Magnetic resonance imaging is an auxiliary tool and pathology is the gold standard for the diagnosis. Interventions: Surgery and supplementary radiotherapy and chemotherapy ± targeted therapy are the main treatment methods. Outcomes: GAS with high malignant degree poor prognosis and insidious development, tends to develop toward the cervical canal and is lack of specific tumor markers, so it is easy to misdiagnosis and missed diagnosis. Lessons: This case highlights the importance of improving the understanding of GAS. And when patients perform vaginal discharge, cervical canal hypertrophy, and cervical cancer screening negative, clinicians ought to be highly alert to GAS.

Development and clinical evaluation of an ultrasound-based predictive model for early diagnosis of endometrial cancer

Early-stage endometrial cancer frequently shares overlapping clinical presentations and sonographic features with benign endometrial disorders, making early detection challenging. This retrospective study evaluated clinical characteristics, symptom profiles, and ultrasonographic parameters in patients with endometrial lesions who underwent standardized transvaginal ultrasound and histopathological confirmation. A total of 257 patients were included, of whom 189 had benign endometrial lesions and 68 were diagnosed with early-stage endometrial cancer. Univariate analyses demonstrated significant differences between groups in age, body mass index, hemoglobin levels, reproductive status, symptom patterns, and multiple ultrasound features, particularly endometrial thickness, endometrial–myometrial junction integrity, vascular density, and vascular distribution. Variables showing statistical significance were incorporated into a multivariate logistic regression model, which identified age, postmenopausal status, abnormal uterine bleeding, endometrial thickness ≥12 mm, disruption of the endometrial–myometrial junction, moderate to marked vascularity, and central or mixed vascular distribution as independent predictors of early-stage malignancy. The resulting predictive model demonstrated excellent discrimination, yielding an area under the receiver operating characteristic curve of 0.902 (95% confidence interval: 0.860–0.944), with 84.3% sensitivity and 82.0% specificity at the optimal cutoff. These findings highlight the value of integrating clinical and ultrasound-derived indicators to improve early risk stratification and support timely diagnostic decision-making in patients with suspected endometrial cancer.

A novel ferroptosis-related microRNAs signature for predicting prognosis in endometrial cancer: An observational study

Ferroptosis plays an important role in various cancer processes and is regulated by microRNAs. This study aimed to establish a prognostic model based on ferroptosis-related microRNAs (FermiRNAs) to predict the prognosis of endometrial cancer (EC). Tumor transcriptomes and corresponding clinical data of 544 EC patients were downloaded from the cancer genome atlas database, and the ferroptosis database (FerrDb) was used to identify ferroptosis-related genes (mRNAs). FermiRNAs in EC were selected based on their correlation with ferroptosis-related genes. Univariate and multivariate Cox regression analyses were conducted to construct a prognostic model based on the miRNA signature. EC patients were grouped into high- and low-risk categories based on the risk score of the prognostic model. Kaplan–Meier survival analysis and time-dependent receiver operating characteristic (ROC) curves were used to evaluate the prognostic value of risk scores. A predictive nomogram was then established. Finally, we compared the proportion of infiltrating immune cells and the expression of potential immune checkpoints between the 2 groups to understand the tumor immune microenvironment associated with signature FermiRNAs. A prognostic model based on the 2 FermiRNAs (miR-4635 and miR-3131) was developed. Kaplan–Meier survival analysis indicated that patients with high-risk scores had worse overall survival ( P  &lt; .001). ROC curves showed that the area under curve values of the prognostic model were 0.621, 0.712, and 0.696 for 1, 3, and 5 years, respectively, indicating good predictive ability. ROC curves also indicated that the prognostic model had a better capability to predict the prognosis of patients with EC than the other clinical factors. A predictive nomogram suggested that the risk model could offer independent prognostic evaluation with high accuracy. The tumor immune microenvironment, including infiltrating immune cells and immune checkpoints, showed several differences between patients with high- and low-risk scores. In an external validation cohort (213 EC patients from the clinical proteomic tumor analysis consortium dataset), 2 FermiRNAs were confirmed to be associated with EC prognosis in the same manner. A novel ferroptosis-related miRNA prognostic model is useful for predicting the prognosis of patients with EC.

Cardiac metastasis in endometrial carcinoma: A rare case report

Rationale: Endometrial carcinoma (EC) is a frequently occurring cancer in the female reproductive system. Nevertheless, the occurrence of cardiac metastasis in cases of EC is uncommon and represents a significant risk to women’s health. Patient concerns: A 58-year-old female patient experienced abnormal vaginal bleeding for over 8 months and was eventually diagnosed with stage IVC (FIGO 2023) endometrial cancer characterized by mismatch repair deficiency that had spread to the heart. Diagnoses: Stage IVC (FIGO 2023) mismatch repair deficiency EC with cardiac metastasis. Interventions: After a thorough discussion with the multidisciplinary team, a detailed noninvasive treatment strategy was established: the initial phase involved 6 cycles of induction therapy using a combination of paclitaxel and carboplatin along with tislelizumab, resulting in a partial response. This was followed by 3 cycles of maintenance therapy with tislelizumab as a standalone treatment. Outcomes: Following the maintenance treatment, the cardiac metastasis was entirely eliminated. The patient experienced a progression-free survival duration of 9 months. Lessons: For patients with EC who have metastasized to rare sites such as the heart, comprehensive management guided by multidisciplinary team consultation is crucial, as it can significantly prolong survival.

N6-methylandenosine-related lncRNAs have the prognostic predictive ability for patients with endometrial cancer

Endometrial carcinoma (EC) ranks as the fourth most common cancer among women, with increasing morbidity and mortality rates in recent years. Identifying reliable biomarkers for prognosis and therapeutic targets is crucial for improving the outcomes of EC patients. In this study, we identified 1560 m6A-related lncRNAs using Pearson correlation coefficient based on the cancer genome atlas datasets and GENCODE annotation. Through univariate Cox regression analysis, 187 m6A-related lncRNAs were found to be related to EC prognosis. Using least absolute shrinkage and selection operator Cox analysis, we constructed an m6A-related lncRNA prognostic signature (m6A-LPS) comprising 12 m6A-related lncRNAs. The m6A-LPS demonstrated robust prognostic ability, and the nomogram incorporating m6A-LPS, age, and pathological grade effectively predicted overall survival of EC patients. Furthermore, EC patients in the low-risk group exhibited higher immune cell infiltration and lower tumor purity. A competing endogenous RNA (ceRNA) network was constructed to elucidate the potential function of these m6A-related prognostic lncRNAs. Our study establishes the m6A-LPS as a stable and reliable prognostic tool for EC patients. These findings may contribute to the identification of novel biomarkers and therapeutic targets, offering insights into the molecular mechanisms underlying EC pathogenesis.

The clinicopathologic features of uterine inflammatory myofibroblastic tumor: A case report

Rationale: Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue neoplasm with low malignant potential. These patients present with a certain probability of malignant potential. The management of IMT has not been standardized, especially for the patients with fertility needs. Patient concerns and Diagnoses: Thirteen patients with IMT who attended in the Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine were enrolled between 2019 and 2023. The data of the clinical and pathological features was analyzed. Interventions and Outcomes: The mean age of the patients was 45.31 ± 12.80 years. Seven of the 13 cases (53.85%) had abnormal uterine bleeding. Five of them (38.46%) had a rapidly growing mass, and 2 of them (15.38%) had no obvious symptoms. With regard to surgical strategies, 7 patients underwent hysterectomy, and 6 patients underwent mass resection only. All the patients were alive with no evidence of disease at an average of 9.58 months of follow-up. One of them gave birth to a full-term male infant at 40 weeks of gestation after hysteroscopic resection, without recurrence. Lessons: Uterine inflammatory myofibroblastic tumor can be diagnosed by the anaplastic lymphoma kinase overexpression. Complete excision under hysteroscopy or laparoscopy seems to be effective and safe. Because there is a certain risk of recurrence and metastasis, conservative surgery should be performed carefully to preserve fertility in patients who can undergo close follow-up.

Development and validation of a prognostic model for endometrial carcinoma using causal genes identified by Mendelian randomization

Endometrial carcinoma (EC) remains an ambiguous pathogenesis. This study aimed to investigate the potential of causal genes in predicting EC prognosis. The prognostic biomarkers of EC were identified using univariate Cox regression analyses based on data from The Cancer Genome Atlas Uterine Corpus Endometrial Carcinoma (TCGA-UCEC). Mendelian randomization (MR) analyses were conducted to infer causal relationships, utilizing expression quantitative trait loci (eQTLs) derived from prognostic genes as exposures, and a dataset from European populations with EC as outcomes. Single nucleotide polymorphisms (SNPs) that significantly influenced gene expression (eQTLs) were selected as instrumental variables. The inverse variance weighted (IVW) method was employed as the primary analytical approach. Sensitivity analyses were performed to ensure robustness of the findings. Causal genes with potential prognostic significance were further evaluated using multivariate Cox regression analysis, Kaplan–Meier (KM) overall survival curves, and receiver operating characteristic (ROC) curve analysis. Additionally, results from gene ontology (GO) and gene set enrichment analysis (GSEA) of differentially expressed genes (DEGs), along with immune infiltration analyses in the high- and low-risk groups, are presented. 18 genes exhibiting a negative correlation with EC demonstrated a protective effect, whereas 9 genes identified as risk factors for EC exerted an adverse effect on the disease. A prognostic model was developed consisting of 8 genes selected from 27 genes. According to the KM overall survival curve data, ECs classified with high-risk ratings exhibited significantly poor prognoses ( P  &lt; .0001). The ROC curve analysis indicated that the area under the curve (AUC) for this risk model in predicting the 1-, 3-, and 5-year EC survival rates were 0.704, 0.735, and 0.766, respectively. Furthermore, GO and GSEA results of DEGs in both the high- and low-risk groups revealed strong associations with pathways related to cell motility and immune response, among others. In addition, an analysis of immune cell infiltration demonstrated significant differences between the high- and low-risk groups. A prognostic model for EC using causal genes identified using MR has good sensitivity and specificity. These findings provide new insights into ECs pathogenesis and suggest promising strategies for the diagnosis and treatment of ECs.

Primary squamous cell carcinoma of the endometrium: A case report

Rationale: Primary squamous cell carcinoma of the endometrium (PSCCE) has a low incidence and is relatively rare. The treatment for this disease is currently not well-defined. Here, we report a case of a 56-year-old female patient. Based on a review of previous literature, we summarized the treatment options for this rare disease and presented our insights. Patient concerns: A 55-year-old patient presented with postmenopausal vaginal bleeding. Transvaginal ultrasonography demonstrated uterine cavity hydrocele and abnormal echo. Diagnostic hysteroscopy was performed, and pathological results revealed PSCCE. Diagnosis: The patient was diagnosed with primary squamous cell carcinoma of the endometrium (stage IA). Interventions: The patient underwent laparoscopic total hysterectomy and bilateral adnexectomy, combined with pelvic and para-aortic lymph node dissection. Then she received external beam radiotherapy and brachytherapy. Outcomes: The patient has been undergoing regular follow-up and so far, no recurrence of the tumor has been detected. Lessons: Primary squamous cell carcinoma of the endometrium is rare, no definitive treatment protocol has been established. Early diagnosis is important for prognosis.

Key genes and associated mechanisms of PCOS and EC comorbidity: A bioinformatics analysis

Endometrial cancer (EC) is a major reproductive system tumor and a common cancer in women. Polycystic ovary syndrome (PCOS) is one of the most prevalent female reproductive endocrine disorders. The incidence of EC is significantly higher in individuals with PCOS. This study seeks to elucidate the organic correlations and interaction mechanisms between the 2 diseases through series of exploration of key genes with a bioinformatics analysis. The PCOS sample data and the EC single-cell dataset were downloaded from the gene expression omnibus database. The EC sample data were retrieved from the cancer genome atlas public database. The random survival forest method was employed to identify key genes associated with the prognosis of PCOS and EC comorbidity. Corresponding analyses on functional pathway enrichment, regulatory networks, and immune micro-environment are conducted. From a bioinformatics perspective, the association and interaction mechanisms between PCOS and EC comorbidity were explored to provide research and development references for the prevention and control of PCOS and EC comorbidity. Five key genes associated with the prognosis of PCOS and EC comorbidity were identified using the random survival forest method. The identified genes are SYTL1, PARVG, ID4, IL1RN, and S100A9. The abnormal expression of these key genes has impacted various enrichment pathways, including the TGF-β signaling-pathway, motif regulatory networks (such as motif cisbp__M4556), and miRNA regulatory networks, which encompass genes such as ATM, BARD1 and BRCA1. Furthermore, these also influence the immune cell microenvironment, such as T cells regulatory. Collectively, these key genes play a significant role in the occurrence and progression of comorbidities through the pathways mentioned above. The dysregulation of key genes (SYTL1, PARVG, ID4, IL1RN, S100A9) in the context of PCOS-EC comorbidities, along with their associated enrichment pathways, including the TGF-β signaling-pathway and immune microenvironment, plays a significant role in the occurrence and progression of EC.

Identification and validation of a novel defined stress granule-related gene signature for predicting the prognosis of ovarian cancer via bioinformatics analysis

Ovarian cancer (OC) is a malignant gynecological cancer with an extremely poor prognosis. Stress granules (SGs) are non-membrane organelles that respond to stressors; however, the correlation between SG-related genes and the prognosis of OC remains unclear. This systematic analysis aimed to determine the expression levels of SG-related genes between high- and low-risk groups of patients with OC and to explore the prognostic value of these genes. RNA-sequencing data and clinical information from GSE18520 and GSE14407 in the Gene Expression Omnibus (GEO) and ovarian plasmacytoma adenocarcinoma in The Cancer Genome Atlas (TCGA) were downloaded. SG-related genes were obtained from GeneCards, the Molecular Signatures Database, and the literature. First, 13 SG-related genes were identified in the prognostic model using least absolute shrinkage and selection operator (LASSO) Cox regression. The prognostic value of each SG-related gene for survival and its relationship with clinical characteristics were evaluated. Next, we performed a functional enrichment analysis of SG-related genes. The protein-protein interactions (PPI) of SG-related genes were visualized using Cytoscape with STRING. According to the median risk score from the LASSO Cox regression, a 13-gene signature was created. All patients with OC in TCGA cohort and GEO datasets were classified into high- and low-risk groups. Five SG-related genes were differentially expressed between the high- and low-risk OC groups in the GEO datasets. The 13 SG-related genes were related to several important oncogenic pathways (TNF-α signaling, PI3K–AKT–mTOR signaling, and WNT–β-catenin signaling) and several cellular components (cytoplasmic stress granule, cytoplasmic ribonucleoprotein granule, and ribonucleoprotein granule). The PPI network identified 11 hub genes with the strongest interactions with ELAVL1. These findings indicate that SG-related genes (DNAJA1, ELAVL1, FBL, GRB7, MOV10, PABPC3, PCBP2, PFN1, RFC4, SYNCRIP, USP10, ZFP36, and ZFP36L1) can be used to predict OC prognosis.

Evaluating the potential of GSPT2 and CIRBP as biomarkers in endometrial cancer: Multicenter RT-PCR and IHC study

Endometrial cancer (EC) is a prevalent gynecological malignancy that imposes significant health and economic burden on women worldwide. The aim of this study was to investigate the expression levels of G1 to S phase transition 2 (GSPT2) and cold-inducible RNA-binding protein (CIRBP) in endometrial cancer tissues relative to normal endometrial tissues and to evaluate their potential as biomarkers for diagnosis and prognosis. We conducted a prospective analysis involving RNA extraction, real-time polymerase chain reaction (RT-PCR), and immunohistochemistry (IHC) to assess gene expression and protein localization. Our findings revealed that GSPT2 was significantly overexpressed ( t  = 2.754, P  = .008611), whereas CIRBP was underexpressed ( t  = 3.344, P  = .001647) in EC tissues. Survival analysis demonstrated that high GSPT2 expression correlated with poor overall survival (OS) ( P  &lt; .0001), in contrast to high CIRBP expression, which was associated with improved OS ( P  &lt; .0001). Additionally, GSPT2 expression was positively correlated with aggressive pathological features, including higher tumor grading and International Federation of Gynecology and Obstetrics (FIGO) staging, Lymphovascular Space Invasion (LVSI) ( P  &lt; .05), while CIRBP showed negative correlations with these characteristics ( P  &lt; .05). These results underscored that high GSPT2 expression should be closely associated with EC progression and poor prognostic, while CIRBP exert a protective effect. The potential of GSPT2 as a poor prognostic marker and CIRBP as a favorable prognostic marker suggest their utility in guiding treatment decisions. Despite limitations such as a relatively small sample size and the lack of functional experiments, our study highlights GSPT2 and CIRBP as promising biomarkers for early diagnosis and targeted therapy in endometrial cancer. Future research should focus on larger cohorts and functional validations to further elucidate the roles of these biomarkers in clinical practice and personalized medicine approaches.

Recurrent thrombotic events in a patient with endometrial cancer: A case report of Trousseau syndrome

Rationale: Trousseau syndrome is a well-recognized paraneoplastic syndrome that manifests as thrombosis in patients with malignancies. It is particularly associated with mucin-producing adenocarcinomas and is known to lead to significant morbidity and mortality due to its thrombotic complications. The underlying mechanisms involve a hypercoagulable state induced by cancer-related factors, which necessitates vigilant monitoring and management. Patient concerns: In this case, we report a 53-year-old woman with endometrial cancer who experienced recurrent thrombotic events. Her background history included breast cancer and 5-months hypertension in drug treatment. Diagnoses: Aging examination showed bilateral pulmonary artery thrombosis and multiple acute cerebral infarctions in both cerebral and cerebellar hemispheres. Laboratory examinations revealed an increased D-dimer level. Interventions: The patient was treated with rivaroxaban for anticoagulation for 1-month. Outcomes: Cerebral infarction occurred again, and the D-dimer level increased again. After adjustment to low-molecular-weight heparin treatment, the patient’s condition was stable, and no new infarction was found on follow-up brain magnetic resonance imaging. Lessons: This case underscores the complexities involved in managing thrombotic complications in patients diagnosed with Trousseau syndrome. It illustrates that thrombotic events may persist even with appropriate anticoagulant therapy, which can lead to a poor prognosis for affected patients. Nevertheless, it also emphasizes the importance of proactive monitoring and tailored management strategies, which can significantly reduce the incidence of thrombotic events and improve patient outcomes.

An effective and validated prognostic model for uterine corpus endometrial cancer based on gene main effects and gene–gene interactions

Uterine corpus endometrial carcinoma (UCEC) poses a significant to women’s health. Accurate prediction of prognosis plays a crucial role in facilitating clinical decision-making processes. Therefore, this study aimed to develop a robust prognostic model based on gene expression profile. Gene expression profile of 546 UCEC samples of The Cancer Genome Atlas were retrieved. A multi-step strategy was employed to develop and validate a prognostic model predicting all-cause mortality rates. Receiver operating characteristic curve and decision curve analysis were performed to assess the predictive accuracy and net benefit of the model. Besides, model-associated immunological features were explored. The UCEC Prognostic Model (TUPM) performed well in identifying patients at high mortality risk. Patients with risk scores above the upper quartile had significantly decreased overall survival compared to patients with risk scores below the lower quartile (HR = 12.56, CI95: 4.629–34.09, P = 6.76E−7), indicating a prominent discriminability. The model accurately predicted patient survival from 1 to 5-year (area under the curve [AUC]1-year = 0.766, AUC2-year = 0.816, AUC3-year = 0.764, AUC4-year = 0.783, AUC5-year = 0.814) and provided excellent calibration. Meanwhile, The UCEC Prognostic Model encompassing transcriptome scores yielded a higher net clinical benefit than the baseline model that only included patient age and clinical stage. Furthermore, the prolonged survival in the low-risk group may be associated with increased infiltration of follicular T cells and regulatory T cells in the tumor microenvironment. We have developed a robust prognostic model for UCEC that may provide preliminary evidence for individualized management and treatment modality decision.

The expression and relationship of VEGF and MVD in type I endometrial cancer

Background: In recent years, with the improvement of people’s living standards, the incidence rate of endometrial cancer shows a rising and younger trend in the world. Early stage endometrial cancer patients have a good prognosis after surgical treatment, but late stage patients have a poor prognosis. Therefore, if biological indicators related to the occurrence and development of endometrial cancer with high sensitivity and specificity can be found, it will provide clinical reference for predicting the prognosis of endometrial cancer and evaluating treatment effectiveness. Vascular endothelial growth factor (VEGF) is a positive regulator of angiogenesis, while microvascular density (MVD) is a quantitative indicator of angiogenesis. This study investigates the expression of VEGF and MVD in endometrial cancer and normal endometrial tissue, and explores their roles in the formation and development of endometrial cancer. Method: Immunohistochemical technique (SP method) was used to detect the expression of VEGF and MVD in paraffin sections of 38 cases of endometrial cancer and 20 cases of normal endometrium. Statistical analysis was conducted using statistical software SPSS 17.0. Results: The positivity of VEGF in the endometrial cancer group was significantly higher than that in the normal endometrial group. The expression level of MVD in the endometrial cancer group was significantly higher than that in the normal endometrial group. In endometrial cancer, the expression of VEGF is positively correlated with MVD (R = 0.811, P &lt; .001). Conclusion: The expression levels of VEGF and MVD are significantly increased in endometrial cancer, and both are positively correlated in endometrial cancer. MVD is related to the surgical pathological staging, lymph node metastasis, and depth of muscle wall infiltration of endometrial cancer, indicating that local neovascularization and rich blood supply play an important role in the occurrence and development of endometrial cancer. VEGF is related to the depth of muscle wall infiltration in endometrial cancer, but not to surgical pathological staging and lymph node metastasis. It is considered that other angiogenic factors besides VEGF play a role in regulating angiogenesis during surgical pathological staging and lymph node metastasis of endometrial cancer.

Aberrant expression of UBE2C in endometrial cancer and its correlation to epithelial mesenchymal transition

Ubiquitin-conjugating enzyme E2C (UBE2C), its overexpression promotes tumor progression, is a key component of the ubiquitin conjugating proteasome complex. Epithelial-mesenchymal transition, which is lost epithelial features and gained mesenchymal features in some epithelial cancers, is involved in epithelial cancers’ invasiveness and metastasis. The aim of this study is to detect the expression of UBE2C, WNT5α, and E-cad in endometrial cancer (EC) and their clinical significance. The expression of UBE2C, WNT5α, and ZEB1 in 125 cases EC tissues were detected by immunohistochemistry. Patients clinicopathological, demography, and follow-up data were also collected. Positive rates of expression of UBE2C and ZEB1 were significantly higher in EC tissues when compared with the control tissues. The positive expression of UBE2C and ZEB1 were positively associated with tumor stages, local lymph node metastasis, and International Federation of Gynecology and Obstetrics (FIGO) stages. The positive rate of expression of WNT5a was significantly lower in EC tissues when compared with the control tissues. And positive expression of E-cad was inversely related to tumor stages, lymph node metastasis stages, and FIGO stages. Kaplan–Meier analyses demonstrated that positive expression of UBE2C or ZEB1 for EC patients had unfavorably overall survival time when compared with patients with negative expression of UBE2C or ZEB1. And EC patients with positive expression of WNT5a had favorably overall survival time when compared with EC patients with negative expression of WNT5a. Multivariate analysis demonstrated that positive expression UBE2C, WNT5α, and ZEB1, as well as FIGO stages were independent prognostic factors for EC patients. UBE2C, ZEB1, and WNT5a should be considered promising biomarkers for EC patients’ prognosis.

Current status of anxiety following total hysterectomy in endometrial cancer patients: A cross-sectional study

The aim of this study was to evaluate the prevalence of anxiety in endometrial cancer patients undergoing total hysterectomy and to analyze socio-demographic and clinical factors contributing to anxiety, with the goal of informing targeted psychological support and interventions in clinical settings. The study employed a cross-sectional survey design, including 74 patients who underwent total hysterectomy between January 2019 and January 2024 at our hospital. Data were collected through a combination of face-to-face interviews and self-administered questionnaires, conducted by specially trained research assistants or nurses to ensure standardized data collection. Anxiety levels were assessed using the Self-Assessment Scale for Anxiety, categorizing patients into no anxiety, mild anxiety, moderate anxiety, and severe anxiety based on standard scores. Results indicated that 33.78% of the 74 patients experienced varying levels of anxiety: 18.92% had mild anxiety, 12.16% had moderate anxiety, and 2.70% had severe anxiety. Univariate analysis showed significant associations between anxiety and factors such as education level, living arrangement, social support, tumor size, and International Federation of Gynaecology and Obstetrics (FIGO) stage. Multivariate logistic regression analysis further confirmed that low education level (OR = 1.866, P = .014), unstable living conditions (OR = 2.285, P = .016), inadequate social support (OR = 2.806, P = .044), larger tumor size (OR = 3.328, P = .021), and advanced FIGO stage (OR = 3.762, P = .01) were independent predictors of postoperative anxiety. This study revealed a high prevalence of anxiety among postoperative endometrial cancer patients and identified key influencing factors, including low educational attainment, unstable living arrangements, insufficient social support, larger tumors, and advanced disease stage. These findings underscore the importance of healthcare professionals focusing on high-risk groups to effectively reduce anxiety, improve mental health, and enhance quality of life. Strategies such as enhanced health education, establishment of support groups, provision of psychological counseling, and comprehensive mental health assessments are recommended to address the psychological needs of these patients.

Postpartum choriocarcinoma – a rare cause of delayed postpartum hemorrhage: Four case reports and literature review

Background: Delayed postpartum hemorrhage is rare, with an incidence of 0.5% to 2.0% in all pregnancies. The most important causes are placental remnants, infections, and placental bed subinvolution. Postpartum choriocarcinoma, a highly malignant complication of pregnancy, is a rare condition that can be easily misdiagnosed as other common causes, such as gestational remnants, and delays the diagnosis. Methods: Four patients visited our clinic complaining of delayed postpartum hemorrhage, combined with respiratory and neurological symptoms in 2 cases. Two cases were confirmed by histopathological examination and in addition, medical history, elevated human chorionic gonadotropin (hCG) level, and imaging findings help confirm the diagnosis of delayed postpartum hemorrhage caused by postpartum choriocarcinoma in other cases. Individualized combination chemotherapies were prescribed. In the light of massive cerebral metastasis in case 2, intrathecal methotrexate injection combined with whole-brain radiotherapy was prescribed. Results: Due to the absence of routine monitoring of β-hCG following full-term delivery, there was widespread metastasis at the time of diagnosis. Three patients got complete remission and there is no sign of recurrence. One patient had relapse and widespread metastasis and died at home 6 months after the last chemotherapy. Conclusion: It is important to be aware of the possibility of choriocarcinoma in patients with delayed postpartum hemorrhage. Clinicians should improve the recognition of choriocarcinoma following full-term delivery, emphasize the monitoring of β-hCG, comprehensively analyze the general condition of patients, and conduct standardized and individualized chemotherapy protocols.

Adult granulosa cell tumors of bilateral ovaries with pure cystic presentation

Granulosa cell tumors (GCTs) are rare, hormonally active sex cord-stromal tumors that generally present as solid unilateral ovarian lesions. It's quite uncommon that they present as pure bilateral ovarian cysts. Histopathology remains the gold standard for making a diagnosis of GCTs. However, as the differential diagnosis is difficult, cystic GCTs are frequently misdiagnosed as benign or other cystic tumors either prior to surgery or during pathologic diagnosis. Accordingly, herein, we describe a fairly rare case of bilateral ovarian cystic GCTs, along with a review of the related literature. A 43-year-old woman presented with abdominal distension and chronic pain since 1 day. The patient had a history of dysmenorrhea. Physical examination revealed palpable bilateral adnexal tumors; ultrasonography revealed cystic and septate masses with a maximum diameter of 7.8 and 10.7 cm, respectively, in the bilateral ovaries. Hormonal analysis revealed that the blood estradiol levels were elevated. Postoperative pathological and immunohistochemical examinations of the surgical specimens revealed a final diagnosis of cystic adult GCTs of the ovaries. The patient first underwent laparoscopic bilateral ovarian cystectomy. On the basis of the final pathological diagnosis report, abdominal total hysterectomy, bilateral oophoro-salpingectomy, and partial omentectomy were then performed. Microscopic examination revealed that there were no residual CGT cells. The patient's federation international of gynecology and obstetrics (FIGO) Stage was IB period. The surgeries were successful. The tumor was a FIGO Stage IB tumor, and the patient did not require any additional treatment. The patient had been followed-up regularly for 2 years after surgery; she did not experience any complications and remained disease-free. Cystic GCTs should be considered in the differential diagnosis if a female patient shows bilateral ovarian cysts. They are extremely rare ovarian malignant tumors that must be differentiated from other ovarian tumors, especially purely cystic tumors and benign cysts. Although pathological and immunohistochemical findings are important for making the diagnosis, the varying histopathological features on microscope make diagnosis difficult, including tumor cells with luteinization or free cell clusters. The current case highlights the importance of physicians being aware of and suspecting cystic CGTs in similar cases, along with knowing the characteristics of GCTs for the diagnosis and differential diagnosis.

Investigating the influence of primary uterine tumor site on pelvic and para-aortic lymph node metastatic pattern and evaluating the risk factors for lymph node metastases in endometrial carcinoma: A retrospective study

To assess the metastatic pattern in pelvic and para-aortic lymph nodes in relation with the primary uterine tumor site and to evaluate risk factors for lymph node metastases. 212 patients with endometrial cancer who underwent surgical treatment from December 2014 to December 2019 were selected. The clinical and pathological data were retrospectively analyzed. The factors and uterine primary tumor site related to lymph node metastasis were analyzed by univariate and multivariate analysis. Among the 212 patients with endometrial cancer, 17 cases had lymph node metastasis, and thus the metastasis rate was 8.02%. Univariate analysis revealed that lymph node metastasis was significantly correlated with Federation of Gynecology and Obstetrics stage, depth of myometrial invasion, tumor size, pathological grade, and lymphovascular space invasion (P &lt; .05) and was not correlated with age, pathological type, and cervical involvement (P &gt; .05). Primary uterine tumor site (fundus, horns, body or lower uterine segment) with or without cervical involvement was associated with different lymph nodes’ metastatic sites. The lymph node metastatic pathways of endometrial cancer mainly include obturator lymph nodes and para-aortic lymph nodes, and skip metastasis may occur; endometrial carcinoma may jump and metastasize to para-aortic lymph nodes, specially when the lesion is located in the uterine fundus and uterine horns (cornua of uterus); there is a significant correlation between the location of lymph node metastasis and the location of primary uterine malignant tumor.

Laparoscopy with transverse-abdominal extra-fascial hysterectomy for early-stage endometrial carcinoma, obesity, and large uterus: A case report

Rationale: Removal of a large uterus poses a challenge in minimally invasive surgery for patients with early-stage endometrial cancer. This manuscript presents 3 cases performed the improved surgical procedure with minimal trauma. Patient concerns: Three patients with obesity (Body Mass Index: 31.93, 30.06, and 51.82 kg/m2) and large uterus (7.3 × 8.0 × 7.6 cm, 8.5 × 8.9 × 8.5 cm, and 8.3 × 10.1 × 6.9 cm) visited our hospital because of vaginal bleeding, and received dilation and curettage. Pathological examination revealed endometrial carcinoma. Diagnoses: Endometrial carcinoma, obesity. Intervention: Laparoscopy and transverse-abdominal extra-fascial hysterectomy were performed. First, we performed bilateral adnexectomy, pelvic lymph node dissection, and para-aortic lymph node sampling, and exposed and separated the para-uterine tissue and bladder before cutting off the uterus from the vagina through laparoscopy. Second, we made a 10 cm suprapubic transverse incision in the lower abdomen, clamped the vagina using right-angle forceps to follow the principle of tumor-free technique, placed the uterus in a surgical bag for retrieval the uterus immediately from the incision. Outcome: All 3 patients underwent intestinal recovery for 24 hours post operation; 50 mL blood was lost during the operation with a well-healing wound and no complication. Till date, there has been no recurrence or metastasis in any of them. Lessons: Improving the surgical procedure could enhance safety and ease of operation even in cases of obesity and a large uterus.

Clinicopathological correlations of endometrioid and clear cell carcinomas in the uterus and ovary

Endometrioid carcinoma (EC) and clear cell carcinoma (CC) are associated with endometrial tissue hyperplasia and endometriosis, and they occur in the endometrium and ovaries. However, detailed differences between these tumors based on immunostaining are unclear; therefore, in this study, we aimed to analyze the clinicopathological correlations between these tumors using immunostaining and to develop new treatments based on histological subtypes. Immunohistochemistry was used to investigate differentially expressed hypoxia-associated molecules (hypoxia-inducible factor-1 subunit alpha [HIF-1α], forkhead box O1, prostate-specific membrane antigen, signal transducer and activator of transcription 3 [STAT3], hepatocyte nuclear factor 1β [HNF-1β], aquaporin-3, and vimentin [VIM]) between these carcinomas because of the reported association between CC and ischemia. Immunostaining and clinicopathological data from 70 patients (21 uterine endometrioid carcinomas [UECs], 9 uterine cell carcinomas, 20 ovarian endometrioid carcinomas [OECs], and 20 ovarian cell carcinomas [OCCs]) were compared. HIF-1α and prostate-specific membrane antigen expression levels were higher in UEC and OCC than in uterine cell carcinomas and OEC. STAT3 was slightly overexpressed in UEC. Additionally, forkhead box O1 expression was either absent or significantly attenuated in all ECs. VIM and AQ3 were highly expressed in UEC, whereas HNF-1β expression was higher in OCC. UEC, OEC, and OCC were more common in the uterine fundus, left ovary, and right ovary, respectively. Ovarian endometriosis was strongly associated with EC. Our findings suggest that UEC and OCC share a carcinogenic pathway that involves HIF-1α induction under hypoxic conditions via STAT3 expression, resulting in angiogenesis. Furthermore, the anatomical position of carcinomas may contribute to their carcinogenesis. Finally, aquaporin-3 and VIM demonstrate strong potential as biomarkers for UEC, whereas HNF-1β expression is a crucial factor in CC development. These differences in tumor site and histological subtypes shown in this study will lead to the establishment of treatment based on histological and immunohistological classification.

Four differentially expressed exosomal miRNAs as prognostic biomarkers and therapy targets in endometrial cancer: Bioinformatic analysis

Endometrial cancer (EC) is one of the most common gynecological malignancies worldwide. Accumulated evidence has demonstrated exosomes of cancer cells carry microRNAs (miRNAs) to nonmalignant cells to induce metastasis. Our study aimed to find possible biomarkers of EC. Data for miRNA expression related with exosome from EC patients were downloaded from The Cancer Genome Atlas database, and the miRNA expression profiles associated with exosomes of EC were downloaded from the National Center for Biotechnology Information. We used different algorithms to analyze the differential miRNA expression, infer the relative proportion of immune infiltrating cells, predict chemotherapy sensitivity, and comprehensively score each gene set to evaluate the potential biological function changes of different samples. The gene ontology analysis and Kyoto encyclopedia of genome genomics pathway analysis were performed for specific genes. A total of 13 differential miRNAs were identified, of which 4 were up-regulated. The 4 miRNAs, that is hsa-miR-17-3p, hsa-miR-99b-3p, hsa-miR-193a-5p, and hsa-miR-320d, were the hub exosomal miRNAs that were all closely related to the clinic phenotypes and prognosis of patients. This study preliminarily indicates that the 4 hub exosomal miRNAs (hsa-miR-17-3p, hsa-miR-99b-3p, hsa-miR-193a-5p, and hsa-miR-320d) could be used as prognostic biomarkers or therapy targets in EC. Further studies are required to make sure of their real feasibility and values in the EC clinic and the relative research.

The prognostic value of vascular endothelial growth factor in endometrial cancer: A protocol for systematic review and meta-analysis

Background: A large number of studies have shown that high expression of vascular endothelial growth factor (VEGF) in cancer tissues is associated with poor prognosis of various cancers. However, this finding in endometrial cancer is controversial. Therefore, this meta-analysis aimed to explore the effects of VEGF on survival in patients with endometrial cancer. Methods: Four databases of PubMed, Medline, Web of Science, and China National Knowledge Infrastructure were searched to collect literature that met the inclusion criteria. The association between high VEGF expression and survival outcomes and clinicopathological features of patients with cancer was evaluated by calculating the combined hazard ratio (HR), odds ratio (OR), and 95% confidence interval (CI). The Begg test was used to assess publication bias. Results: A total of 11 studies were included, involving 1251 patients. The results showed that compared with low VEGF expression, high VEGF expression was significantly associated with shorter overall survival (HR = 2.44, 95% CI = 1.15–5.16, I2 = 80%, P = .02) and disease-specific survival (HR = 7.87, 95% CI = 1.70–36.44, I2 = 64%, P = .008) but not with disease-free survival (HR = 1.45, 95% CI = 0.70–3.02, I2 = 68%, P = .32). In addition, VEGF expression is higher in patients with advanced stage (OR = 3.70, 95% CI = 2.22–6.19, P &lt; .001), lower histological differentiation (OR = 2.08, 95% CI = 1.22–3.55, P = .007), and lymph node metastasis (OR = 5.42, 95% CI = 2.35–5.11, P &lt; .001). Conclusion: High VEGF expression can predict poor prognosis and poor clinicopathological features in patients with endometrial cancer, and it may be a valuable new indicator to evaluate the prognosis of patients with endometrial cancer.

Comprehensive pan-cancer analysis of expression profiles and prognostic significance for NUMB and NUMBL in human tumors

NUMB has been initially identified as a critical cell fate determinant that modulates cell differentiation via asymmetrical partitioning during mitosis, including tumor cells. However, it remains absent that a systematic assessment of the mechanisms underlying NUMB and its homologous protein NUMBLIKE (NUMBL) involvement in cancer. This study aimed to investigate the prognostic significance for NUMB and NUMBL in pan-cancer. In this study, using the online databases TIMER2.0, gene expression profiling interactive analysis, cBioPortal, the University of ALabama at Birmingham CANcer data analysis Portal, SearchTool for the Retrieval of Interacting Genes/Proteins, and R software, we focused on the relevance between NUMB/NUMBL and oncogenesis, progression, mutation, phosphorylation, function and prognosis. This study demonstrated that abnormal expression of NUMB and NUMBL were found to be significantly associated with clinicopathologic stages and the prognosis of survival. Besides, genetic alternations of NUMB and NUMBL focused on uterine corpus endometrial carcinoma, and higher genetic mutations of NUMBL were correlated with more prolonged overall survival and disease-free survival in different cancers. Moreover, S438 locus of NUMB peptide fragment was frequently phosphorylated in 4 cancer types and relevant to its phosphorylation sites. Furthermore, endocytosis processing and neurogenesis regulation were involved in the functional mechanisms of NUMB and NUMBL separately. Additionally, the pathway enrichment suggested that NUMB was implicated in Hippo, Neurotrophin, Thyroid hormone, and FoxO pathways, while MAPK, Hippo, Rap1, mTOR, and Notch pathways were related to the functions of NUMBL. This study highlights the predictive roles of NUMB and NUMBL in pan-cancer, suggesting NUMB and NUMBL might be served as potential biomarkers for diagnosis and prognosis in various malignant tumors.

Development and validation of a prognostic prediction model for endometrial cancer based on CD8+ T cell infiltration-related genes

Endometrial cancer (EC) is the most common gynecologic malignancy with increasing incidence and mortality. The tumor immune microenvironment significantly impacts cancer prognosis. Weighted Gene Co-Expression Network Analysis (WGCNA) is a systems biology approach that analyzes gene expression data to uncover gene co-expression networks and functional modules. This study aimed to use WGCNA to develop a prognostic prediction model for EC based on immune cell infiltration, and to identify new potential therapeutic targets. WGCNA was performed using the Cancer Genome Atlas Uterine Corpus Endometrial Carcinoma dataset to identify hub modules associated with T-lymphocyte cell infiltration. Prognostic models were developed using LASSO regression based on genes in these hub modules. The Search Tool for the Retrieval of Interacting Genes/Proteins was used for protein–protein interaction network analysis of the hub module. Gene Set Variation Analysis identified differential gene enrichment analysis between high- and low-risk groups. The relationship between the model and microsatellite instability, tumor mutational burden, and immune cell infiltration was analyzed using The Cancer Genome Atlas data. The model’s correlation with chemotherapy and immunotherapy resistance was examined using the Genomics of Drug Sensitivity in Cancer and Cancer Immunome Atlas databases. Immunohistochemical staining of EC tissue microarrays was performed to analyze the relationship between the expression of key genes and immune infiltration. The green-yellow module was identified as a hub module, with 4 genes (ARPC1B, BATF, CCL2, and COTL1) linked to CD8+ T cell infiltration. The prognostic model constructed from these genes showed satisfactory predictive efficacy. Differentially expressed genes in high- and low-risk groups were enriched in tumor immunity-related pathways. The model correlated with EC-related phenotypes, indicating its potential to predict immunotherapeutic response. Basic leucine zipper activating transcription factor-like transcription factor(BATF) expression in EC tissues positively correlated with CD8+ T cell infiltration, suggesting BATF’s crucial role in EC development and antitumor immunity. The prognostic model comprising ARPC1B, BATF, CCL2, and COTL1 can effectively identify high-risk EC patients and predict their response to immunotherapy, demonstrating significant clinical potential. These genes are implicated in EC development and immune infiltration, with BATF emerging as a potential therapeutic target for EC.

Refining of cancer-specific genes in microsatellite-unstable colon and endometrial cancers using modified partial least square discriminant analysis

Despite similarities in microsatellite instability (MSI) between colon and endometrial cancer, there are many clinically important organ-specific features. The molecular differences between these 2 MSI cancers are underexplored because the usual differentially expressed gene analysis yields too many noncancer-specific normally expressed genes. We aimed to identify cancer-specific genes in MSI colorectal adenocarcinoma (CRC) and MSI endometrial carcinoma (ECs) using a modified partial least squares discriminant analysis. We obtained a list of cancer-specific genes in MSI CRC and EC by taking the intersection of the genes obtained from tumor samples and normal samples. Specifically, we obtained publically available 1319 RNA sequencing data consisting of MSI CRCs, MSI ECs, normal colon including the rectum, and normal endometrium from The Cancer Genome Atlas and genome-tissue expression sites. To reduce gene-centric dimensions, we retained only 3924 genes from the original data by performing the usual differentially expressed gene screening for tumor samples using DESeq2. The usual partial least squares discriminant analysis was performed for tumor samples, producing 625 genes, whereas for normal samples, projection vectors with zero covariance were sampled, their weights were square-summed, and genes with sufficiently high values were selected. Gene ontology (GO) term enrichment, protein–protein interaction, and survival analyses were performed for functional and clinical validation. We identified 30 cancer-specific normal-invariant genes, including Zic family members (ZIC1, ZIC4, and ZIC5), DPPA2, PRSS56, ELF5, and FGF18, most of which were cancer-associated genes. Although no statistically significant GO terms were identified in the GO term enrichment analysis, cell differentiation was observed as potentially significant. In the protein–protein interaction analysis, 17 of the 30 genes had at least one connection, and when first-degree neighbors were added to the network, many cancer-related pathways, including MAPK, Ras, and PI3K-Akt, were enriched. In the survival analysis, 16 genes showed statistically significant differences between the lower and higher expression groups (3 in CRCs and 15 ECs). We developed a novel approach for selecting cancer-specific normal-invariant genes from relevant gene expression data. Although we believe that tissue-specific reactivation of embryonic genes might explain the cancer-specific differences of MSI CRC and EC, further studies are needed for validation.

Analysis of the correlation between gut microbiome imbalance and the development of endometrial cancer based on metagenomics

Endometrial cancer (EC) is the most prevalent gynecologic malignancy, with a higher risk in obese women, suggesting the potential involvement of gut microbiota in the progression of EC. However, there is no direct evidence of a connection between EC and the human gut microbiota. Using metagenomic sequencing, we investigated the relationship between gut microbiome imbalance and cancer development in patients with EC. In this prospective case–control study, we included 15 patients with EC based on endometrial biopsy in the case group and 15 women admitted to the hospital for female pelvic floor issues during the same time who did not have endometrial lesions from January 2023 to June 2023 in control group. The microbiota structure of EC cases and controls without benign or malignant endometrial lesions during the same time period was analyzed using metagenomic sequencing technology. We employed Alpha diversity analysis to reflect the richness and diversity of microbial communities. Statistical algorithm Bray-Curtis was utilized to calculate pairwise distances between samples, obtaining a beta diversity distance matrix. Subsequently, hierarchical clustering analysis was conducted based on the distance matrix. The results showed that the composition of bacterial colonies in both groups was dominated by Firmicutes , which had a higher proportion in the control group, followed by Bacteroidetes in the control group and Proteobacteria and Bacteroidetes in the case group. The abundance of Klebsiella ( P  = .02) was significantly higher, and the abundance of Alistipes ( P  = .04), Anearobutyricum ( P  = .01), and bacteria in Firmicutes such as Oscillospira and Catenibacterium was markedly lower in the case group than in the control group. These results demonstrated conclusively that a gut microbiome imbalance was associated with the development of EC.

Cancer-specific functional profiling in microsatellite-unstable (MSI) colon and endometrial cancers using combined differentially expressed genes and biclustering analysis

Microsatellite-unstable (MSI) cancers have distinct genetic and clinical features from microsatellite-stable cancers, but the molecular functional differences between MSI cancers originating from different tissues or organs have not been well studied because the application of usual differentially expressed gene (DEG) analysis is error-prone, producing too many noncancer-specific normally functioning genes. To maximize therapeutic efficacy, biomarkers reflecting cancer-specific differences between MSI cancers of different tissue origins should be identified. To identify functional differences between MSI colon and endometrial cancers, we combined DEG analysis and biclustering instead of DEG analysis alone and refined functionally relevant biclusters reflecting genuine functional differences between the 2 tumors. Specifically, using The Cancer Genome Atlas and genome-tissue expression as data sources, gene ontology (GO) enrichment tests were performed after routinely identifying DEGs between the 2 tumors with the exclusion of DEGs identified in their normal counterparts. Cancer-specific biclusters and associated enriched GO terms were obtained by biclustering with enrichment tests for the preferences for cancer type (either colon or endometrium) and GO enrichment tests for each cancer-specific bicluster, respectively. A novel childness score was developed to select functionally relevant biclusters among cancer-specific biclusters based on the extent to which the enriched GO terms of the biclusters tended to be child terms of the enriched GO terms in DEGs. The selected biclusters were tested using survival analysis to validate their clinical significance. We performed multiple sequential analyses to produce functionally relevant biclusters from the RNA sequencing data of MSI colon and endometrial cancer samples and their normal counterparts. We identified 3066 cancer-specific DEGs. Biclustering analysis revealed 153 biclusters and 41 cancer-specific biclusters were selected using Fisher exact test. A mean childness score over 0.6 was applied as the threshold and yielded 8 functionally relevant biclusters from cancer-specific biclusters. Functional differences appear to include gland cavitation and the TGF-β receptor, G protein, and cytokine pathways. In the survival analysis, 6 of the 8 functionally relevant biclusters were statistically significant. By attenuating noise and applying a synergistic contribution of DEG results, we refined candidate biomarkers to complement tissue-specific features of MSI tumors.

Folate intake and the risk of endometrial cancer: A dose–response meta-analysis

Background: The relationship between folate intake and risk of endometrial cancer (EC) is debatable. The goal of this study was to examine the relationship between folate consumption and EC and then conduct a dose–response analysis in accordance with this. Methods: Up until February 1, 2024, we conducted a thorough search using PubMed, EMBASE, the Cochrane Library, and Web of Science. Stata 14 software was used to analyze the findings of the article. The study protocol was registered in PROSPERO (CRD42024505943), and the meta-analysis was conducted in accordance with PRISMA guidelines. Results: Nine case-control studies and 6 cohort studies were included, comprising 379,570 participants and 8660 EC cases. The highest level of folate consumption was associated with a 10% reduction in the occurrence of EC (relative risk [RR] = 0.90, 95% confidence intervals [CIs]: 0.78–1.05, I 2 = 63.2%) compared to the lowest level of intake. The association exhibited a statistically significant linear trend (P = .231), with a combined RR of 0.974 (95% CI: 0.968–0.981) for each daily intake of 50 µg folate. Conclusion: Folate intake may reduce the risk of EC.

Identification of immunogenic cell death-related subtypes used for predicting survival and immunotherapy of endometrial carcinoma through a bioinformatics analysis

Immunogenic cell death (ICD) is a unique phenomenon that can trigger comprehensive, adaptive immune responses through damage-associated molecular patterns, offering a promising avenue for tumor immunotherapy. However, the role of ICD-related genes and their correlation with endometrial carcinoma (EC), the most prevalent gynecologic malignancy, remains unclear. This study examined genetic, transcriptional, and clinical data of EC obtained from the Cancer Genome Atlas database. Unsupervised clustering analysis was utilized to identify distinct ICD clusters based on the expression of ICD-related genes. Regarding the different clusters, their survival analysis, assessment of the immune microenvironment, immune cell infiltration, immune checkpoint analysis, and tumor mutation burden analysis were performed. Furthermore, an ICD risk signature was established using univariate Cox regression and least absolute shrinkage and selection operator analysis. The Chi-square test was employed to investigate the relationship between the ICD score and clinical features. Multiple computational analytical tools were used to assess immune annotation, somatic mutations, tumor mutation burden, and response to immunotherapy and chemotherapy drugs in different ICD score groups. Two ICD clusters were identified, indicating that the ICD-high cluster was associated with improved prognosis, abundant immune cell infiltration, and enrichment of pathways related to immunologic activation. Moreover, the ICD risk signature showed predictive value for the immune microenvironment, immunotherapy response, chemotherapy susceptibility, and prognosis in EC. Our findings offer novel insights into personalized treatment strategies for EC patients.

RNF144A as a potential risk gene for endometrial carcinoma: Insights from Mendelian randomization, bulk RNA sequencing, single-cell RNA, and experimental analysis

Endometrial carcinoma (EC) is a prevalent gynecological malignancy that poses a significant threat to women’s health worldwide. However, its pathogenesis and underlying mechanisms remains unclear. In this study, expression quantitative trait loci data, Mendelian randomization analysis, and differential expression analysis were performed to identify potential targets. A prognostic risk signature was subsequently constructed for EC patients based on the expression of these genes. Four bioinformatics algorithms, including generalized linear model, extreme gradient boosting, support vector machine, and random forest, were used to identify hub genes in EC. The expression of ring finger protein 144A (RNF144A) was validated using quantitative real-time polymerase chain reaction. Cellular proliferation and migration ability were evaluated using CCK-8 and Transwell assays, respectively. The genes RNF144A, ketohexokinase, and Rab interacting lysosomal protein like 2 were identified as potential targets for EC. Their differential expression was observed in EC patients, and Mendelian randomization analysis revealed a negative correlation between these genes and the development of EC. Mechanistic analyses suggested a strong association between these genes and the tumor immune microenvironment. The constructed risk signature was significantly associated with the prognosis, age, cancer stage, and grade of EC patients. Furthermore, based on interacted model algorithms, RNF144A was identified as a hub gene in EC. It was found to be significantly downregulated in EC samples, and its expression was positively correlated with the stage and grade of EC patients. In vitro experiments showed that overexpression of RNF144A significantly promoted cell growth and migration in EC cells. In conclusion, this study provides insights into the molecular mechanisms underlying EC progression and identifies preliminary candidate biomarkers for the development of EC treatment strategies.

Investigating the genetic causal relationship between breast cancer and endometrial cancer: A two-sample Mendelian randomization study

Observational studies have consistently shown a correlation between breast cancer (BC) and endometrial cancer (EC). Despite these findings, the causal relationship between these cancers has not been clearly defined. This research employed a bidirectional two-sample Mendelian randomization to explore the genetic causality between BC and EC. Genetic instruments for BC were derived from the Breast Cancer Association Consortium genome-wide association studies summary statistics, while for EC, data were sourced from the Endometrial Cancer Association Consortium, the Epidemiology of Endometrial Cancer Consortium, and the UK Biobank. The primary analytical method was inverse-variance weighted. Additional analyses, such as MR-Egger and weighted median, were conducted to validate the robustness of our findings from multiple perspectives. The MR-Egger intercept test was conducted to examine potential pleiotropy, whereas Cochrane Q test was implemented to assess heterogeneity. A leave-one-out analysis was conducted to assess the sensitivity of the observed association. Our analysis identified a bidirectional genetic causal relationship between estrogen receptor-positive breast cancer (ER+BC) and EC. Inverse-variance weighted analysis indicated an odds ratio of 1.0686 (95% confidence interval: 1.0029–1.1386, P = .0403) from ER+BC to EC and an odds ratio of 1.0692 (95% confidence interval: 1.0183–1.1225, P = .0071) from EC to ER+BC. No significant horizontal pleiotropy was detected. This study confirms a bidirectional genetic link between ER+BC and EC, suggesting shared genetic etiologies and possibly linked pathophysiological pathways. Understanding the genetic interplay between ER+BC and EC can enhance strategies for the precise prevention and screening of these prevalent cancers, potentially leading to improved clinical outcomes and management of secondary primary malignancies.

The correlation between APOE expression and the clinical characteristics and prognosis of patients with endometrial cancer

To analyze the expression of apolipoprotein E (APOE) in endometrial cancer and its influence on the long-term prognostic survival of endometrial cancer patients. The specimens of tumor tissues and adjacent normal tissues from 96 endometrial cancer patients from January 2013 to December 2015 were included in this study. Immunohistochemistry was used to measure the expression of APOE in tumor tissues and adjacent normal tissues. Statistical analysis was used to examine the correlation between APOE expression and the clinicopathological characteristics and survival of patients. Kaplan–Meier survival curve was drawn to study the effects of APOE on the prognosis of patients. The positive rate of APOE in endometrial cancer tissue was higher than that in adjacent normal tissues. The expression level of APOE in endometrial cancer was correlated with histological grade, lymph node metastasis, and FIGO stage (P &lt; .05). Lymph node metastasis and APOE were independent risk factors affecting the prognosis and survival of patients (P &lt; .05). The results of Kaplan–Meier survival analysis showed that the survival time of APOE high expression group was shorter than that of low APOE expression. APOE is overexpressed in endometrial cancer tissues, and its expression level can provide important information for clinical diagnosis and treatment.

Ovarian dysgerminoma detected by 18F-FDG PET/CT technique

Abstract Introduction: Ovarian dysgerminoma (OD) mostly affect young women, have a rapid growth rate, and could result in complications such as rupture, hemoperitoneum or torsion, and acute abdomen. However, there have been no reports of OD on 18F-FDG PET/CT imaging. Patient concerns: A 21-year-old female patient was admitted to our hospital on February 6, 2016, due to “reduced menstrual flow with abdominal distension for 3 months”. Diagnosis: Color Doppler ultrasound showed a large solid mass in the abdomen and pelvis. Serum carbohydrate antigen 125 (CA125) was elevated significantly. Subsequent computed tomography (CT) of chest showed a large effusion in the right thoracic cavity. Abdominal CT scan revealed the presence of a solid mass occupying a large space in the middle and lower abdomen, suggesting that it derived from the left ovary. Then, she underwent 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET)/CT examination for further diagnosis and staging. PET/CT showed a large occupying lesion in the abdomen. The maximum standardized uptake (SUVmax) of 18F-FDG was 15.8. No obvious hypermetabolic metastases were observed in the other parts of the body. Postoperative pathology and immunohistochemistry confirmed the ovarian dysgerminoma. Interventions: The patient underwent surgery. Chemotherapy was successfully carried out post-operation. Outcomes: Fortunately, the patient is responding well to treatment and the postoperative recurrence-free survival time has been more than 3 years. Conclusion: OD usually occurs in young women and is characterized by large solid pelvic mass. The 18F-FDG PET/CT scan shows abnormally increased metabolism of the tumor. Because of the high metabolic characteristics, 18F-FDG PET/CT may be of great significance in the diagnosis and staging of OD.

Bibliometric and visualized analysis of the top-100 highly cited articles on immunotherapy for endometrial cancer

Background: Immunotherapy is a promising method for the treatment of endometrial cancer (EC). We aimed to conduct a comprehensive bibliometric study of the top 100 most-cited publications on immunotherapy for EC and provide a reference for future research. Methods: Global publications on immunotherapy for EC published from 1985 to the present in the Web of Science core database were retrieved. We focused on the study of the top 100 most-cited articles by extracting information such as year, country, journal, author, institution, literature, and keywords. Microsoft Excel, VOSviewer, and R were used to perform descriptive statistics and visual analyses. Results: The top 100 most-cited articles were published between 2002 and 2022, including 70 original papers and 30 reviews. The total frequency of citations per article ranges from 15 to 287. Developed countries dominated these publications, with the United States contributing the most (50 articles). According to Bradford Law, 6 journals, including Gynecologic Oncology and the Journal of Clinical Oncology, are highly recommended. Santin A. D. from Yale University and Makker.V. from Memorial Sloan Kettering Cancer Center have made positive contributions. Among the top ten most-cited articles, 7 focused on clinical trials exploring the efficacy of immunotherapy drugs, of which 4 were lenvatinib combined with pembrolizumab for the treatment of advanced EC. The immune-microenvironment, immune antitumor mechanisms, immunomodulatory drugs, especially anti-pd-1/pd-l1 checkpoint inhibitors, and their clinical trials are the focus of current research. Conclusion: The attention of researchers from different countries to EC immunotherapy, especially immunosuppressants, has brought a breakthrough in this field. A large number of clinical trials have evaluated the efficacy and safety of immune agents, and immune combination therapy (especially targeted therapy) shows positive therapeutic promise. Immunodrug sensitivity and adverse events remain urgent issues. The key to promoting the development of EC immunotherapy is to select the best patients according to the molecular classification and immunophenotype such as tumor mutation load, MMR status, pd-l1 expression, tumor infiltrating immune cells to truly achieve accurate and personalized treatment. More new and influential EC immunotherapies, such as adoptive cell immunotherapy, still need to be explored in future clinical practice.

A novel epithelial–mesenchymal transition-related lncRNA signature predicts prognosis and immune status in endometrioid endometrial cancer

The pathogenesis and progression of endometrial cancer (EC) are associated with epithelial–mesenchymal transition (EMT) and long noncoding RNAs (lncRNAs). In the present study, we aimed to identify an EMT-related lncRNA signature and evaluate its prognostic value in EC. We obtained the expression profile of lncRNAs and clinical information of patients with endometrioid EC from The Cancer Genome Atlas database (N = 401). We identified a signature of 5 EMT-related lncRNAs and calculated the risk score of each patient. Next, we validated the independence of the prognostic value of the EMT-related lncRNA signature. Furthermore, we performed Gene Set Enrichment Analysis to identify potential molecular function and Kyoto Encyclopedia of Genes and Genomes pathways related to the EMT-related lncRNA signature. Tumor microenvironment analysis and immune checkpoint blockade (ICB) response prediction were also assessed. Survival analysis revealed that the high-risk group, based on the EMT-related lncRNA signature, had a poorer prognosis than the low-risk group in the training, testing, and entire sets. The predictive value of the EMT-related lncRNA signature was independent of age, The International Federation of Gynecology and Obstetrics stage, tumor grade, and body mass index. Time-dependent receiver operating characteristic curves also demonstrate the prognostic accuracy of this risk model. Gene Set Enrichment Analysis showed that cytokine-cytokine receptor interaction, glycolysis/gluconeogenesis, and IL-17 signaling pathway were significantly enriched. Furthermore, tumor microenvironment analysis indicated a significant negative correlation between the immune score and EMT-related lncRNA signature risks core, while the low-risk group was more likely to respond to ICB therapy than the high-risk group. A reliable EMT-related lncRNA signature of endometrioid EC was identified that could be utilized as an independent prognostic biomarker to predict patient survival outcomes and provide references for the option of ICB therapy.

Perioperative management of a patient with a giant ovarian tumor

Giant ovarian tumors are very rare. Patients with large ovarian tumors appear similar to pregnant women and morbidly obese patients. The management of such patients is associated with significant mortality. Therefore, additional clinical research is essential to understanding the perioperative complications of this disease. We report the perioperative management of a patient with a giant ovarian tumor that contained 23 L of fluid who underwent tumor resection. Given the infrequency of these giant ovarian tumors, a detailed anesthetic plan and postoperative respiratory support strategy were tailored to address the patient's hemodynamic and respiratory risks, as well as to minimize potential complications, including supine hypotensive syndrome, re-expansion pulmonary edema, and postoperative intestinal ileus. To prevent supine hypotensive syndrome, the patient used a mild left-sided position (10∼20°) after admission until the tumor was removed. In order to prevent re-expansion pulmonary edema (RPE), the intraoperative ventilator mode was set to pressure-controlled ventilation (PCV), with the addition of 8 cmH2O positive end-expiratory pressure (PEEP). The airway pressure was lower while maintaining a certain tidal volume. In the ICU, in the ventilator mode, we use pressure support ventilation as well as PEEP and adjust it according to the patient's spontaneous breathing situation and blood gas analysis to prepare for further detach from the respirator and extubation. And we prevent the occurrence of postoperative intestinal ileus by placing the abdominal binder after the operation. Mucinous cystadenoma of the left ovary. The patient underwent exploratory laparotomy with debulking of the left ovarian mass, transabdominal hysterectomy with bilateral salpingo-oophorectomy, complete omentectomy with appendectomy, and pelvic lymphadenectomy. After surgery, the patient experienced intestinal distention. Up to now, the patient has recovered well. A multidisciplinary approach is essential. Knowing the possibility of complications and choices for management can lead to favorable outcomes in such rare cases. This case reminds us that postoperative complications such as postoperative intestinal ileus may be fatal.

Prognostic significance of preoperative prognostic nutritional index in ovarian cancer

The prognostic significance of preoperative prognostic nutritional index (PNI) in ovarian cancer (OC) is uncertain, and this study is aimed to clarify the prognostic significance. We used 4 common databases for conducting a systematic review and meta-analysis, and eligible studies were included in the analysis. The association of preoperative PNI with overall survival (OS), progression-free survival (PFS), and clinicopathological parameters was analyzed. A total of 2050 patients with OC receiving the surgical treatment were analyzed in this study. Patients with low PNI tended to have a shorter OS (hazard ratio [HR] = 1.82, 95% CI = 1.30-2.55, P < .01) and PFS (HR = 1.91, 95% CI = 1.53-2.39, P < .01) compared with those with high PNI. Besides, low PNI was significantly associated with more advanced International Federation of Gynecology and Obstetrics stage (P < .01), the occurrence of ascites (P < .01), larger residual tumor (P < .01), insensitive to chemotherapy (P < .01), and higher CA125 (P < .01) compared with high PNI in OC. Low preoperative PNI is associated with shorter OS, shorter PFS, and worse clinicopathological parameters in OC. Low preoperative PNI is an unfavorable prognostic indicator of patients with OC.

Microcystic, elongated and fragmented (MELF) pattern in endometrial carcinoma: clinicopathologic analysis and prognostic implications

To assess the clinical value of microcystic, elongated, and fragmented (MELF) pattern in Chinese patients with endometrial endometrioid carcinoma. A total of 189 patients with endometrial endometrioid carcinoma were retrospectively analyzed in Peking University Third Hospital from January 2017 to December 2019. We analyzed the association of MELF pattern with the histopathologic data and prognosis of the patients, while immunohistochemistry was performed. The frequency of MELF pattern was 17.99% (34/189). MELF pattern was associated significantly with tumor size, myometrial invasion, histological grade, International Federation of Gynecology and Obstetrics stages, lymphovascular space invasion, and lymph node metastasis. According to multivariate logistic regression analysis, lymphovascular space invasion [95% confidence interval 1.021–48.485, P = .048] was a significant predictor of lymph node involvement. However, MELF pattern was not a significant predictor (95% confidence interval 0.054–2.279, P = .400). Loss of expression for mismatch repair proteins was observed in 10 MELF + cases (29.41%) and 54 MELF− cases (34.84%), respectively. All patients were followed up for 36.8 ± 8.9 months (18–54 months). Only 1 patient with MELF pattern was diagnosed with vaginal recurrence 28 months after the surgery. MELF pattern was associated with adverse histologic findings in endometrial endometrioid carcinomas. However, MELF pattern was statistically not a valuable predictor of lymph node metastasis and it needs more studies to show whether MELF pattern has an impact on the prognosis of patients with endometrial endometrioid carcinoma. MELF pattern may be important for identifying those patients who need comprehensive staging surgery.

LINC01589 serves as a potential tumor-suppressor and immune-related biomarker in endometrial cancer: A review

Currently, increasing attention is being paid to biomarkers in endometrial cancer. Immune infiltration of the tumor microenvironment has been shown to significantly affect the overall survival (OS) of uterine corpus endometrial carcinoma (UCEC) patients. LINC01589 is a long non-coding RNA (lncRNA) that is rarely reported in cancer and is assumed to play a role in immune regulation. We therefore evaluated the role of LINC01589 in UCEC using the Cancer Genome Atlas (TCGA) database. We analyzed the expression of LINC01589 using the gene expression profiles of LINC01589 in the UCEC projects in TCGA. Comparisons between the differentially expressed genes (DEGs) of the cancer and adjacent normal tissues of the UCEC projects revealed that LINC01589 expression was decreased in UCEC tissues. A multivariate cox regression analysis indicated that LINC01589 upregulation could serve as an independent prognostic factor for survival. Furthermore, there was a positive correlation between LINC01589 expression and B cell, T cell, NK cell, monocytic lineage, and myeloid dendritic cell infiltration in UCEC patients. In addition, 5 clusters of hub genes were detected by comparison of different expression levels of LINC01589 in the UCEC groups. The analysis of the reactome pathway using gene set enrichment analysis (GSEA) revealed immune-related pathways, including CD22-mediated B cell receptor (BCR) regulation and antigen-activated BCRs, leading to the generation of second messengers and complement cascade pathways that were significantly enriched in the high LINC01589 expression group. Thus, LINC01589 may serve as a prognostic biomarker, as it is associated with immune infiltration in UCEC.

Significance analysis of PAX8 expression in endometrial carcinoma

To analyze the expression and prognostic value of paired-box 8 (PAX8) expression in uterine corpus endometrial carcinoma (UCEC) by bioinformatics. The expression of PAX8 gene in UCEC was analyzed by R language and immunohistochemistry. The correlation between PAX8 expression and clinicopathological features was analyzed by R language. The prognostic factors was analyzed by univariate/multivariate regression. The survival curve of patients was analyzed by Kaplan–Meier Plotter (K–M Plotter). The diagnostic value of PAX8 in UCEC was analyzed by receiver operating characteristic curve, and the relationship between PAX8 expression and methylation was analyzed by Ualcan. The relationship between methylation and prognosis was analyzed by MethSurv database. The expression of PAX8 in cancer tissues was significantly higher than that in normal tissues. The expression of PAX8 was related to clinical stage, age, histological type, histologic grade, tumor invasion and disease-specific survival event. Univariate/multivariate regression analysis showed that clinical stage, tumor invasion, and PAX8 expression were the influence factors of overall survival (OS), while histologic grade and PAX8 expression were the influence factors of disease-specific survival, and patients with low expression had a longer OS. The area under the curve of receiver operating characteristic curve was 0.81 for PAX8 diagnosis of UCEC. PAX8 was hypomethylated in cancer tissue, and patients with hypermethylated PAX8 had a longer OS. The high expression of PAX8 induced by hypomethylation may play an important role in the occurrence and prognosis of UCEC.

Diabetes mellitus and endometrial carcinoma: Risk factors and etiological links

The presence of diabetes mellitus (DM) has a critical influence on the occurrence and development of endometrial cancer (EC) and is associated with a poor prognosis. Patients with DM are twice as likely to progress to EC, probably because a high-glucose environment contributes to the growth and invasiveness of EC cells. In this review, we focus on the etiological links between DM and EC and provide an overview of potential biological mechanisms that may account for this relationship, including hyperglycemia, insulin resistance, hyperinsulinemia, glycolysis, chronic inflammation, obesity, and activation of signaling pathways involved in EC. Furthermore, we discuss the pharmacological management of EC associated with DM. Early treatment with metformin is expected to be an effective adjuvant alternative for EC in the future. This knowledge is important for further opening up preventive and therapeutic strategies for EC by targeting glucose metabolism.

Efficacy of cisplatin combined with topotecan in patients with advanced or recurrent ovarian cancer as second- or higher-line palliative chemotherapy

Abstract The aim of this study was to evaluate the outcomes of patients with advanced or recurrent ovarian cancer treated with cisplatin combined with topotecan as second- or higher-line palliative chemotherapy. We retrospectively reviewed the medical records of patients with advanced or recurrent ovarian cancer, who were treated with cisplatin (50 mg/m2 on day 1) and topotecan (0.75 mg/m2 on days 1–3). Treatment response, progression-free survival (PFS) and overall survival (OS) were analyzed, and laboratory data were reviewed to evaluate toxicities. Thirty one patients were treated with cisplatin and topotecan. The objective response rate (ORR) was 22.6%, and the disease control rate (DCR) was 61.3%. The median PFS was 3.7 months (95% confidence interval [CI], 2.3–5.2 months) and the median OS was 44.5 months (95% CI, 35.5–53.5 months). The ORR (33.3% vs. 0%; P = .012) was significantly better in the platinum-sensitive group compared to the platinum-resistant group. The median PFS was significantly longer in the platinum-sensitive group compared to the platinum-resistant group (7.7 vs 2.5 months; P &lt; .001), and the median OS was also significantly longer in the platinum-sensitive group (46.6 vs 19.3 months; P &lt; .001). Almost all of the patients reported some degree of hematological toxicity. A high rate of grade 3–4 neutropenia (87.1%) was observed. Grade 3–4 thrombocytopenia (41.9%) and febrile neutropenia (19.4%) were also seen. The results showed that cisplatin combined with topotecan, as second- or higher-line palliative chemotherapy for patients with advanced or recurrent ovarian cancer, might be effective, especially in the platinum-sensitive group. However, attention should be paid to the high hematological toxicity associated with this drug combination.

Evaluation of the efficiency and safety of adjuvant chemotherapy alone for patients with advanced endometrial carcinoma: A protocol for systematic review and meta-analysis

Background: Endometrial cancer is a tumor that affects many women. Essentially, patients who have high-risk endometrial cancer tend to have a disproportionately high rate of metastasis as well as relapse than the general population. Regardless of complete resection, individuals who are having stages III or IV cancer appear to be at substantial risk of recurrence, either locally or distantly. Chemotherapy and radiation therapy are examples of systemic adjuvant treatment. However, the ideal scheduling strategy remains a mystery. Undertaking this research can help in examining the efficacy as well as safety of adjuvant chemotherapy alone in patients with advanced endometrial cancer in the future. Methods: To recognize all randomized controlled trials evaluating the efficacy and safety of adjuvant chemotherapy alone in those patients with advanced endometrial carcinoma, a comprehensive systematic review along with meta-analysis were undertaken in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang, China National Knowledge Infrastructure (CNKI), and Chinese Biological Medical Database (CBM). In accordance with traditional Cochrane methodology, 2 independent authors will review search results, choose studies for inclusion, extract study characteristics and outcome data, and examine the risk of bias in the researches they pick. The P values and the I² statistic shall be employed in determining the levels of heterogeneity. Meanwhile, the heterogeneity will be explored via the use of sensitivity analyses, and the meta-analysis will be conducted utilizing the RevMan 5.3 software package. Results: Patients with advanced endometrial cancer will benefit from this research since it will offer a high-quality synthesis of existing information on the utilization of adjuvant chemotherapy alone. Conclusion: The outcomes of the proposed investigation will summarize the current evidence of adjuvant chemotherapy alone for patients with advanced endometrial carcinoma.

Isolated splenic metastasis of endometrial cancer 12 years after treatment

Abstract Rationale: The spleen is an uncommon metastatic organ for malignant solid tumors because of its special anatomy and microenvironment. Isolated splenic metastasis of endometrial cancer is an extremely rare clinical event, with only 17 cases reported in literature. Patient concerns: We report the case of a 58-year-old woman with abdominal distension and nausea for 7 months who had undergone surgery and chemotherapy for endometrioid adenocarcinoma 12 years previously. A space-occupying lesion in the upper pole of the spleen was observed on an abdominal ultrasound. Diagnosis: The spleen was resected, and splenic metastasis of endometrial adenocarcinoma was histologically confirmed. Interventions: Splenectomy was performed, and no lymph nodes or other metastases were observed. The patient received postoperative chemotherapy with 6 cycles of docetaxel and carboplatin. Outcomes: The patient recovered well 11 months postoperatively, with no evidence of recurrence or metastatic disease. Lesson: Since the time interval between the diagnosis of primary endometrial cancer and splenic metastasis may be very long, it may be necessary to monitor the recurrence of endometrial cancer after primary treatment.

Uterus didelphys complicated with endometrial carcinoma

Abstract Rationale: The incidence of uterine malformations is low (4%–7%). Currently, the National Comprehensive Cancer Network clinical practice guidelines in oncology recommend minimally invasive surgery for early endometrial cancer. Minimally invasive surgery for the treatment of uterine didelphys with endometrial cancer is rare due to the large size of the uterus. To date, only 2 such patients have been reported to have undergone laparoscopy. Whether such patients can be treated with minimally invasive surgery needs to be further explored. Patient concerns: A 40-year-old woman with uterine didelphys was hospitalized for menorrhagia in the past 2 months. Diagnosis: Endometrial adenocarcinoma was found in both the uterus and cervix using fractional dilation and curettage. Interventions: The patient underwent laparoscopic surgery. Postoperative adjuvant radiotherapy and chemotherapy were administered. Outcomes: There was no sign of recurrence during routine follow-up. Lessons: The use of a uterine manipulator to lift either side of the uterus could help to expose the narrow ipsilateral para-uterine field. It is difficult to remove the uterus entirely through the vagina, making it necessary to select appropriate cases wherein screening is performed to check if the vagina is loose, and the uterus is of appropriate size. Minimally invasive surgery may be feasible for suitable patients.

Fortuitously detected primary ovarian carcinoid tumor: A case report

Rationale: Carcinoid tumors, derived from the cells of the disseminated neuroendocrine system, are rare, slow-growing neuroendocrine neoplasms that display a relatively indolent disease course. The majority of carcinoids are found within the gastrointestinal tract and bronchopulmonary system. Primary ovarian carcinoids are rare and account for merely 1% of all carcinoid tumors. We describe our experience of a rare case of primary ovarian carcinoid, presenting as chronic constipation, with no other carcinoid symptoms such as flushing, diarrhea, and wheezing. Patient concerns: A 51-year-old postmenopausal woman with chronic constipation visited the clinic for routine check-up of her preexisting uterine fibroids. She had undergone hemorrhoidectomy 3 years ago. Physical examination revealed a soft abdomen without direct or rebound tenderness. Transvaginal ultrasonography revealed two subserosal fibroids, which had increased in size compared with previous ultrasonographic findings. A 3 cm hyperechoic mass was also detected in the right ovary. Her blood and urine tests were unremarkable, with no ascites in the pelvic cavity. She had a normal CA-125 level of 5.5 units/mL. Diagnosis, interventions, and outcomes: The patient underwent a robot-assisted hysterectomy and right salpingo-oophorectomy because of enlarging fibroids and the right ovarian mass. Subsequently, based on the pathological and immunohistochemical findings, she was diagnosed with a primary ovarian carcinoid. The mass consisted of the insular and trabecular types of tumor cells. It was positive for pan-cytokeratin and synaptophysin, and the Ki-67 proliferation index was less than 1%. A follow-up positron emission tomography-computed tomography revealed no distant metastasis. Six months postoperatively, the patient was doing well without any signs of recurrence. Lessons: Primary ovarian carcinoids without teratoma components are rare. It is crucial to make an accurate diagnosis based on the immunohistochemical staining results. Diagnosis in the early stages of the disease are associated with a favorable prognosis, but regular follow-up is mandatory.

Identification of an eight-m6A RNA methylation regulator prognostic signature of uterine corpus endometrial carcinoma based on bioinformatics analysis

Abstract N6-methyladenosine (m6A) methylation is proved to play a significant role in human cancers. This study aimed to explore the association between m6A ribonucleic acid (RNA) methylation regulators and uterine corpus endometrial carcinoma (UCEC), and build a prognostic signature of m6A regulators for UCEC. RNA-seq transcriptome data and clinicopathological data of UCEC were downloaded from the Cancer Genome Atlas database. We compared the expression of 23 m6A-regulators in tumor tissues and nontumor tissues. Then we classified the data into 3 clusters by consensus clustering analysis. Several regulators were picked out as the prognostic signature of patients with UCEC based on least absolute shrinkage and selection operator Cox regression analysis. Additionally, we established a predictive nomogram to calculate survival times. Finally, we used receiver operating characteristic curve, univariate Cox regression analysis, and multivariate Cox regression analysis to further verify the prognostic value of the risk signature consisting of m6A regulators. The expression of 18/23 m6A regulators was significantly different in UCEC compared with normal samples. Gene ontology functional analysis of these regulators revealed that they were mainly participated in RNA splicing, stabilization, modification, and degradation. LRPPRC, IGFBP2, KIAA1429, IGFBP3, FMR1, YTHDF1, METTL14, and YTHDF2 were selected to construct the risk signature and predictive nomogram. The results of receiver operating characteristic curve, univariate Cox regression analysis, and multivariate Cox regression analysis for the risk signature showed a good predictive performance for UCEC. The risk signature of 8-m6A regulators has potential prognostic value for patients with UCEC.

Comparison of the outcomes between laparoscopic surgery and conventional open surgery in treating patients with stage II endometrial carcinoma

Abstract Background: Endometrial carcinoma is a prevalent form of cancer. In fact, its incidence ranks fourth among European and North American females. Moreover, it is the most common gynecological malignant disease. Laparotomy, bilateral salpingo-oophorectomy, total abdominal hysterectomy, etc were common methods adopted in conventional open surgery. Recent developments in laparoscopic surgery (LPS) has made it more effective. The present study aims to compare the outcomes between LPS and a conventional open surgical procedure to treat stage II endometrial carcinoma patients. Methods: A comprehensive search will be conducted on Cochrane library, PubMed, Web of Science, EMBASE, and China National of Knowledge Infrastructure to collect LPS and conventional open surgery in treating stage II endometrial carcinoma. The search will consider all articles published since the inception of the databases till July 2021. A pair of scholars will perform independent screening of the literature and extracted data to evaluate the bias risk in the selected studies. Afterwards, RevMan5.3 software will be used to conduct a meta-analysis. Conclusion: This study will conduct a meta-analysis to compare the clinical efficacy of LPS and conventional open surgery in the treatment of stage II endometrial carcinoma.

Diagnostic and prognostic factors, and two nomograms for endometrial cancer patients with bone metastasis

Abstract Patients with endometrial cancer (EC) who develop bone metastasis (BM) always imply a poorer prognosis. However, reliable predictive models associated with BM from EC are currently limited. We retrospectively analyzed data on 54,077 patients diagnosed with primary EC in the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was used to determine independent predictors of BM from EC. Univariate and multivariate Cox regression analyses were used to determine independent prognostic factors for EC with BM. Based on independent predictors and prognostic factors, we constructed a diagnostic nomogram and prognostic nomogram separately. Besides, calibration curves, receiver operating characteristic curves, and decision curve analysis were used to evaluate the models. A total of 54,077 patients with EC from the Surveillance, Epidemiology, and End Results database were included in this study, 364 of whom had BM. Multivariate analysis in the logistic model showed that lung metastasis, liver metastasis, brain metastasis, N stage, T stage, histologic grade, and race were risk factors for BM from EC. Multivariate analysis in the Cox model showed that liver metastasis, brain metastasis, chemotherapy, surgery, and histologic type had a significant effect on overall survival. Moreover, the receiver operating characteristic curve, calibration curve, and decision curve analysis indicated the good performance of both diagnostic and prognostic nomograms. Two clinical prediction model was constructed and validated to predict individual risk and overall survival for EC with BM, respectively. Diagnostic nomogram and prognostic nomogram are complementary, improving the clinician's ability to assess the patient's prognosis and enhancing prognosis-based decision making.

NAD(P)H: quinone oxidoreductase 1 gene rs1800566 polymorphism increases the risk of cervical cancer in a Chinese Han sample

Abstract Recently, 2 studies from Thai and American investigated the relationship between NAD(P)H: quinone oxidoreductase 1(NQO1) gene rs1800566 polymorphism and cervical cancer risk and generated contrary results. However, no Chinese reports have addressed this relationship until now. To explore the association between NQO1 gene rs1800566 polymorphism with cervical cancer, we performed a study in a Chinese Han sample. Using a unmatched case-control design, we enrolled 450 cervical cancer patients and 568 controls in the Central Hospital of Wuhan from January 2010 to December 2016. The genotypes were determined by sequencing polymerase chain reaction product. Hardy-Weinberg equilibrium was assessed using the Chi-square test. The univariate and multi-variate logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the association between the NQO1 gene rs1800566 polymorphism and cervical cancer susceptibility. The Chi-square test indicated that significant allele and genotype distributions differences were observed between case group and control group (P  &lt;  .001). The logistic regression indicated that TT genotype was associated with higher risk of cervical cancer compare with those with the CT or CC genotype (TT vs CC: OR = 2.82, 95%CI: 1.91–4.17, P &lt; .001; TT vs CT: OR = 2.02, 95%CI: 1.36–3.01, P &lt; .001). The effects of NQO1 show dominant model (TT/CT vs CC: OR = 1.67, 95%CI: 1.30–2.15, P &lt; .001) and recessive model (TT vs. CT/CC: OR = 2.43, 95%CI: 1.68–3.52, P &lt; .001). The significant relationship between NQO1 rs1800566 polymorphism and cervical cancer risk was also found in stratified analyses. The cross-over analysis indicated that there are potential interactions between genetic factors and human papillomavirus infection/ contraceptive oral use for the risk of cervical cancer. NQO1 gene rs1800566 polymorphism is associated with elevated risk of cervical cancer in Chinese Han women. The interactions between rs1800566 polymorphism and human papillomavirus infection/ contraceptive oral use further reinforce this association.

Identification of prognostic tumor-infiltrating immune cells in endometrial adenocarcinoma

Abstract To identify prognostic tumor-infiltrating immune cells of endometrial adenocarcinoma. The gene expression profiles of endometrial adenocarcinoma were downloaded from the Cancer Genome Atlas (TCGA). The abundance of tumor-infiltrating immune cells in endometrial adenocarcinoma samples was calculated by CIBERSORT algorithm. Kaplan–Meier analysis was used to identify prognostic tumor-infiltrating immune cells. This study identified 22 kinds of tumor-infiltrating immune cells. Macrophages M0 and CD8 T cells were prognostic factors of endometrial adenocarcinoma. The abundance of macrophages M0 (P = .038) was significantly correlated with better prognosis of endometrial adenocarcinoma. In contrast, the abundance of CD8 T cells (P = .049) was associated with poor prognosis of endometrial adenocarcinoma. Tumor-infiltrati macrophages M0 and CD8 T cells were prognostic factors of endometrial adenocarcinoma.

TWIST1 expression and clinical significance in type I endometrial cancer and premalignant lesions

Abstract The aim of this study was to assess the correlation of TWIST1 expression with clinical parameters and the prognosis of type I endometrial cancer (EC). This retrospective study enrolled 345 patients. Immunohistochemical staining was performed on 55 normal endometrium (NE) samples, 27 atypical hyperplasia (AH) samples, and 263 type I EC samples. The association between TWIST1 staining and clinical characteristics and survival was evaluated by univariate and multivariate analyses. We found significantly higher TWIST1 expression in patients with AHs and type I ECs than NEs, but there was no significant difference between TWIST1 expression in AHs and type I ECs. Aberrant TWIST1 expression was significantly associated with clinical parameters, indicating poor prognosis and shorter patient survival. Pearsons Chi-Squared test showed that high TWIST1 expression was significantly associated with a shorter disease-free survival and overall survival. More importantly, multivariate analysis showed that high TWIST1 expression, in addition to myometrial invasion, lymph vascular space invasion, and lymph node metastasis, was an independent predictor of worse DFS in patients with type I ECs. Our findings suggest that TWIST1 might be useful in diagnosing ECs and predicting prognosis in patients with AHs and type I ECs.

High L1CAM expression predicts poor prognosis of patients with endometrial cancer

Abstract Backgroud: Previous studies have reported that the levels of L1 cell adhesion molecule (L1CAM) indicate poor prognosis of patients with various solid tumors. However, the prognostic significance of L1CAM in endometrial cancer has remained controversial. Herein, we conducted a systematic review and meta-analysis to evaluate the prognostic value of L1CAM in endometrial cancer. Methods: All studies related to the association between L1CAM expression and clinical characteristics of endometrial cancer were identified by searching the PubMed, MEDLINE, EMBASE, and Web of Science databases. Primary outcomes of the meta-analysis were the hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS). Secondary outcomes were odds ratios (ORs) for clinicopathological characteristics. Publication bias and sensitivity analysis were conducted to ensure reliability of the results. Results: Overall, 17 studies encompassing 7146 patients were eligible for the meta-analysis. Results showed L1CAM overexpression to be significantly associated with decreased overall survival (HR = 2.87, 95% CI; 1.81–4.55, P &lt; .001) and disease-free survival (HR = 3.32, 95% CI; 1.99–5.55, P &lt; .001) in patients with endometrial cancer. High L1CAM expression was also related to adverse clinicopathological characteristics. Conclusion: This systematic review demonstrated that high L1CAM expression is correlated with poor survival outcomes and adverse clinicopathological parameters in patients with endometrial cancer.

ER-positive endocervical adenocarcinoma mimicking endometrioid adenocarcinoma in morphology and immunohistochemical profile

Abstract Rationale: Usual-type endocervical adenocarcinoma (ECA), high-risk HPV associated, is the most common type of glandular carcinoma in the endocervix. Mucin-depleted usual-type ECA is 1 end of morphological lineage of usual-type ECA and morphologically may show endometrioid features, which could cause diagnostic challenge with uterine endometrioid adenocarcinoma (EEC) and primary endometrioid ECA, especially in the setting of small biopsy and endocervical curettage (ECC). Patient concerns: A 37-year-old women presented with dyspareunia for 1 year, showing atypical glandular cell on a liquid-based Pap TCT examination and positive for HPV16 detection. ECC showed EEC in another hospital based on its “endometrioid” morphology and immunohistochemical profiles (ER/PR/PAX8 strongly positive, though p16 also strongly positive). Diagnoses: The specimen of hysterectomy in our hospital displayed a lesion confined to the uterine cervix showing the same morphology and immunohistochemical profiles as ECC. Finally, we successfully performed HPV RNAscope and detected high-risk human papilloma virus (HPV) E6/E7 mRNA particles in tumor cells in situ, which warranted usual-type ECA with mucin-depleted feature, a rare deviation of usual-type of ECA. Interventions: The patient underwent total hysterectomy with lymph node dissection. Outcomes: To date, 14 months after surgery, the patient is well without recurrence or distant metastasis, and undergoes regular reexamination. Lessons subsections: We report a rare case of mucin-depleted usual-type ECA showing overlapping morphological and immunohistochemical profiles with EEC. The pathological diagnosis was confirmed by high-risk HPV RNAscope detection which is superior than immunohistochemistry to identify usual-type ECA, warranting an important role in assisting the diagnosis of morphological vague cases.

Identification of iron metabolism-related predictive markers of endometriosis and endometriosis-relevant ovarian cancer

Endometriosis is associated with ovarian cancers, mainly endometrioid and clear-cell carcinomas. Iron metabolism has been shown to play a role in endometriosis. Therefore, it is vital to explore the relationship between iron metabolism and ovarian cancer and to identify novel markers for diagnostics and therapeutics. The endometriosis dataset GSE51981 and the ovarian cancer dataset GSE26712 were obtained from the gene expression omnibus database, and differentially expressed genes were identified. Iron metabolism genes were obtained from molecular signatures database, and hub genes from the 3 datasets were obtained. Seven hub genes were identified by bioinformatic analysis, and 3 hub genes (NCOA4, ETFDH, and TYW1) were further selected by logistic regression, which were verified in an independent endometriosis dataset (GSE25628) and ovarian cancer dataset (GSE14407), showing good predictive diagnostic value (area under the receiver operating characteristic curve of 0.88 and 0.9, respectively). Gene Ontology, gene set enrichment analysis, and immune infiltration analysis further confirmed the related functions, pathways, and immune relationship between iron metabolism and ovarian cancer. This study highlights the potential of targeting iron metabolism in the prevention of potential ovarian cancer and in the further exploration of endometriosis and endometriosis-relevant ovarian cancer therapeutics.

Atypical polypoid adenomyoma follow-up and management

Abstract Background: Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer. Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed. Methods: This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018. Results: We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33–57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11–39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15–67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9–29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0–23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65–52.92%; P &lt; .05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed. Conclusion: This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies.

Construction of an aging-related risk signature in high-grade serous ovarian cancer for predicting survival outcome and immunogenicity

Studies have shown that aging significantly impacts tumorigenesis, survival outcome, and treatment efficacy in various tumors, covering high-grade serous ovarian cancer (HGSOC). Therefore, the objective for this investigation is to construct an aging-relevant risk signature for the first time, which will help evaluate the immunogenicity and survival status for patients with HGSOC. Totaling 1727 patients with HGSOC, along with their mRNA genomic data and clinical survival data, were obtained based on 5 independent cohorts. The Lasso-Cox regression model was utilized to identify the aging genes that had the most significant impact on prognosis. The risk signature was developed by integrating the determined gene expression and accordant model weights. Additionally, immunocytes in the microenvironment, signaling pathways, and immune-relevant signatures were assessed based on distinct risk subgroups. Finally, 2 cohorts that underwent treatment with immune checkpoint inhibitor (ICI) were employed to confirm the effects of identified risk signature on ICI efficacy. An aging signature was constructed from 12 relevant genes, which showed improved survival outcomes in low-risk HGSOC patients across discovery and 4 validation cohorts (all P &lt; .05). The low-risk subgroup showed better immunocyte infiltration and higher enrichment of immune pathways and ICI predictors based on further immunology analysis. Notably, in the immunotherapeutic cohorts, low-risk aging signature was observed to link to better immunotherapeutic outcomes and increased response rates. Together, our constructed signature of aging has the potential to assess not only the prognosis outcome and immunogenicity, but also, importantly, the efficacy of ICI treatment. This signature provides valuable insights for prognosis prediction and immunotherapeutic effect evaluation, ultimately promoting individualized treatment for HGSOC patients.

Adenomyoma recurrence 7 years after laparoscopic supracervical hysterectomy: A case report and literature review

Rationale: Adenomyosis, a gynecological condition characterized by endometrial tissue within the uterine myometrium, often leads to menstrual pain and heavy bleeding, significantly affecting the quality of life. The primary treatment for adenomyosis and leiomyomas is hysterectomy. However, in rare instances, these conditions can recur in the cervical stump following a hysterectomy. Here, we present a case of cervical adenomyoma development after a prior laparoscopic supracervical hysterectomy. Patient Concerns: A 47-year-old woman sought medical attention due to increased vaginal bleeding. Diagnoses: She had undergone a laparoscopic supracervical hysterectomy 7 years earlier to address uterine myoma and adenomyosis. Just 1 month posthysterectomy, a pelvic ultrasound revealed the presence of a cervical stump measuring approximately 4.0 × 4.0 cm. Subsequent follow-up ultrasounds documented the gradual growth of the cervical mass. Two years ago, a recurrent myoma was identified, and the patient experienced intermittent vaginal bleeding. Over 7 years, the cervical mass increased from 4 to 7 cm. Preadmission pelvic ultrasonography confirmed the existence of cervical adenomyoma measuring 7 × 6 cm. Interventions: Consequently, the patient underwent a laparoscopic trachelectomy. Intraoperatively, an enlarged cervix, approximately 7 × 6 cm in size, containing adenomyoma was observed. A gross examination of the specimen indicated hypertrophic muscle tissue and hemorrhagic foci. Subsequent histopathological examination confirmed the presence of adenomyoma. Outcomes: Remarkably, the patient exhibited no recurrence over the subsequent 8 months. Lessons: The case presented here highlights the potential occurrence of cervical adenomyoma following a supracervical hysterectomy. Management options include hormone therapy and surgical excision. Furthermore, annual follow-up comprising ultrasound and pap smear evaluations is recommended for patients with supracervical hysterectomies to detect and address possible recurrences.

Prevalence and cognitive factors influencing high-risk HPV infection and cervical diseases in women aged 18–45 in Shijiazhuang city

This study aimed to investigate the prevalence of high-risk human papillomavirus (HPV) infection and the awareness levels regarding cervical diseases among women aged 18–45 in Shijiazhuang city. The objectives were to determine the incidence rates of high-risk HPV infections, analyze the patterns of cervical disease occurrence, and identify the factors influencing awareness within this demographic. A total of 544 women aged 18–45 participated in the study, with 102 testing positive for high-risk HPV infection. A structured questionnaire was administered to evaluate awareness of high-risk HPV and cervical diseases. The survey collected data on infection prevalence, subtype distribution, incidence rates, knowledge levels, and factors affecting awareness related to high-risk HPV infections and cervical health. Among the 544 women screened, 102 (18.75%) were diagnosed with high-risk HPV. HPV-16 emerged as the most prevalent subtype, followed by HPV-52 and HPV-58. Of the positive cases, 38 displayed no signs of intraepithelial neoplasia or malignant lesions, while 38 had atypical squamous epithelium, predominantly associated with HPV-52. Low-grade intraepithelial neoplasia was observed in 15 cases, and high-grade neoplasia was found in 11 cases, both primarily linked to HPV-16. Awareness levels varied, with 87 participants demonstrating low knowledge and 15 showing higher awareness. Logistic regression analysis identified education, occupation, residence, and access to scientific knowledge as significant factors influencing awareness and infection risk (P &lt; .05). The prevalence of high-risk HPV infection among women aged 18–45 in Shijiazhuang city is relatively low, with HPV-16 being the predominant subtype. HPV-16 was strongly associated with cervical epithelial neoplasia and cervical cancer. Targeted educational interventions, particularly for populations with lower education levels and those in rural areas, are recommended to enhance awareness and improve the prevention and control of HPV-related infections and cervical diseases.

Core targets of bisphenol A in cervical cancer revealed by network toxicology and molecular docking

This study aimed to investigate the molecular mechanisms underlying BPA(Bisphenol A)–induced cervical cancer, to identify core targets and signaling pathways, and to provide a theoretical basis for disease prevention and therapeutic intervention. The chemical structure of BPA was obtained from PubChem(Public Chemical Database), and its toxicity profile was evaluated using ProTox-3.0. Potential BPA-associated targets were predicted using multiple databases and subsequently standardized. Differentially expressed genes (DEGs) in cervical cancer were identified from Gene Expression Omnibus datasets using the R programming language and integrated with Weighted Gene Co-expression Network Analysis (WGCNA) to determine key module genes. The cervical cancer-related target set was then established. Common targets between BPA and cervical cancer were identified using Venn diagram analysis, and a protein–protein interaction (PPI) network was constructed to screen for core targets. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed to explore biological functions and pathways. Target gene expression was validated across multiple datasets, and molecular docking analysis was conducted using Cavity-Based Dock 2 (CB-Dock2). BPA exhibits endocrine toxicity and matrix metalloproteinase-mediated tissue damage, with 3 core targets identified across databases. In cervical cancer, 803 up-regulated and 1092 down-regulated DEGs were screened (|log 2 FC| ≥1, adjusted P  &lt;.05). WGCNA identified the turquoise module (normal group R  = 0.98, P  = 5 × 10 −12 ; cancer group r  = −0.98, P  = 5 × 10 −12 ), overlapping with 1110 DEGs. Nineteen common targets of BPA and cervical cancer were enriched in gene expression negative regulation and cancer pathways (hypergeometric test, false discovery rate (FDR) &lt;0.05). PPI analysis confirmed Estrogen Receptor 1 (ESR1) and (Poly [ADP-ribose] Polymerase 1 (PARP1) as core targets: ESR1 was down-regulated (GSE122697: log 2 FC = −2.8, P  &lt;.0001; The Cancer Genome Atlas (TCGA): log 2 FC = -2.6, P  &lt;.0001), PARP1 up-regulated (GSE122697: log 2 FC = 3.1, P  &lt;.0001; TCGA: log 2 FC = 2.9, P  = .0012). Both showed progressive expression changes with lesion advancement (GSE63514: ESR1 log 2 FC = -4.2, PARP1 log 2 FC = 4.5, P  &lt;.0001). Molecular docking revealed stable binding of BPA to ESR1 (−8.3 kcal/mol) and PARP1 (−8.5 kcal/mol, root-mean-square deviation [RMSD] &lt;2.0 A). BPA may promote cervical carcinogenesis by interacting with ESR1 and PARP1 to regulate key cancer-related pathways. These targets may serve as potential biomarkers and therapeutic intervention points. Further experimental validation is required to confirm these findings.

Clinicopathologic characteristics and survival outcomes of patients with high-grade neuroendocrine cervical cancer

This study aims to evaluate the clinicopathologic characteristics and survival of patients with high-grade neuroendocrine cervical cancer in a consecutive cohort from a single center. We retrospectively reviewed clinical data of cervical cancer patients admitted to our hospital between 2010 and 2023. The clinicopathologic and immunohistochemical features and treatment outcomes were summarized. Progression-free survival (PFS) and overall survival (OS) were estimated using a Cox proportional hazards regression model. A total of 5782 patients with cervical cancer were treated in our hospital; 54 (0.93%) of these patients were diagnosed with high-grade neuroendocrine carcinoma. Compared with patients with other histological subtypes, patients with high-grade neuroendocrine cervical cancer were significantly more likely to be diagnosed before 40 years of age ( P  = .043). The 5-year PFS rate was 65.6% (95% confidence interval [CI]: 55.4–75.8%) for stage I disease, dropping markedly to 19.3% (95% CI: 7.9–30.7%) for stages II–III. Similarly, the 5-year OS rate was 69.0% (95% CI: 59.0–79.0%) for stage I, compared with 23.9% (95% CI: 10.0–37.8%) for stages II–IV. According to multivariate analyses, patients with lymph node involvement exhibited significantly worse PFS (adjusted hazard ratio = 7.26; 95% CI: 1.62–32.61; P  &lt; .01) and OS (adjusted hazard ratio = 7.98; 95% CI: 1.82–34.87; P  &lt; .01) than patients without lymph node involvement. High-grade neuroendocrine cervical carcinoma is a rare and aggressive malignancy whose prognosis is critically dependent on the International Federation of Gynecology and Obstetrics stage. Early diagnosis, achievable through regular human papillomavirus screening followed by systematic colposcopy and biopsy, is important. Furthermore, comprehensive molecular profiling of mutations and the transcriptome is essential to inform personalized management strategies.

The effect of refined psychological pain nursing combined with IMB nursing on the pain, sleep and quality of life of patients after cervical cancer surgery

To explore the effect of refined psychological pain nursing combined with information-motivation-behavioral (IMB) care model on the pain, sleep and quality of life of patients after cervical cancer surgery, so as to provide reference and basis for the nursing of patients after cervical cancer surgery. The clinical data of 798 postoperative cervical cancer patients who were nursing in our hospital from January 2018 to December 2022 were included in this retrospective study and divided into the control group (n = 382) and observation group (n = 416) according to the different care methods. The control group used refined psychological pain nursing, and on this basis, the observation group used IMB nursing to observe and compare the differences in pain, sleep and quality of life between the 2 groups. There was no significant difference in pain between the 2 groups before nursing (P &gt; .05). After nursing, the pain of both groups was significantly improved. The scores of NRS, VAS, and PSEQ of the observation group were significantly better than those of the control group (P &lt; .001). After nursing, the quality of life scores such as emotion, cognition, society, and overall health were significantly higher in the observation group than those of the control group, while physical, fatigue, nausea, vomiting, and pain were significantly lower than those of the control group (P &lt; .05). The negative emotion score of the observation group was significantly lower than that of the control group (P &lt; .001). The residual urine volume and urinary tract infection rate of the observation group were significantly lower than those of the control group (P &lt; .05). The bladder function was significantly better than that of the control group (P &lt; .05). The analgesic effect of refined psychological pain nursing combined with IMB nursing on patients after cervical cancer surgery is better than that of refined psychological pain nursing alone, which can promote pain recovery and further improve the quality of life and sleep quality of patients.

Recurrent cotyledonoid dissecting leiomyoma of the uterus: A case report

Rationale: Cotyledonoid dissecting leiomyoma (CDL) is an exceptionally rare and morphologically unusual benign uterine leiomyoma. Its malignant-mimicking radiographic and intraoperative features pose a significant diagnostic challenge, often leading to misinterpretation and potentially overtreatment. This case is reported for its rarity and to highlight the critical importance of pathological recognition. Patient concerns: A 23-year-old female presented with a recurrent pelvic mass detected during a routine follow-up examination 2 years after the initial surgical resection of a uterine mass. The patient was asymptomatic. Diagnoses: Histopathological examination of both the initial and recurrent masses confirmed the diagnosis of CDL. The specimens exhibited characteristic features including intramural dissecting growth and an exophytic, cotyledon-like nodular appearance. Interventions: The patient underwent surgical excision for both the primary uterine mass and the recurrent pelvic mass. Outcomes: The patient recovered well postoperatively with no complications. No evidence of disease was found at the most recent follow-up visit. Lessons: This case represents the first documented instance of recurrent CDL in China and only the second reported globally. It underscores that recurrence, although exceedingly rare, is a possible outcome for CDL. Pathological confirmation is paramount to achieve an accurate diagnosis, avoid a misdiagnosis of malignancy, and prevent unnecessary radical surgery or adjuvant therapy, thus preserving fertility and quality of life in young patients.

Primary diffuse large B-cell lymphoma of the fallopian tube treated with a combination of surgery and chemotherapy

Abstract Rationale: Primary female genital tract lymphomas are sporadic neoplasms, accounting for 0.2% to 1.1% of all cases of extranodal lymphoma. The most common genital localizations are the cervix, the uterine corpus and the ovary, while primary lymphomas of the fallopian tube are quite unusual. According to literature searching in PubMed, this is the first reported case of primary diffuse large B-cell lymphoma of the fallopian tube. Patient concerns: A 52-year-old woman presented with a more than 2 months history of intermittent lower abdominal pain. The gynecological examination showed that the uterus, as big as 3 months of pregnancy, had weak activity and no tenderness. The uterine rectum lacuna was like a hard nodule of about 3 × 2 cm, and an irregular solid mass was fixed and inactive in the right adnexa. Diagnoses: In accordance with Ann Arbor staging system, a stage IE primary diffuse large B-cell lymphoma of fallopian tube was diagnosed for this patient, based on the tumor pathology, the results of bone marrow biopsy and computed tomography (CT) scan. Interventions: After gynecological/urinary ultrasound, blood test, pelvic contrast enhanced CT scan and CT angiography of iliac artery, exploratory laparoscopy and following hysterectomy with bilateral salpingo-oophorectomy were performed. After the surgery, the patient was treated with combined Rituximab and chemotherapy and got complete response (CR). Outcomes: After the operation and R-CHPOP, following up for more than 1 year so far, the patient has no tumor recurrence and is still in good condition. Lessons: It is very difficult to diagnose the primary diffuse large B-cell lymphoma of fallopian tube, not only because of its rarity, but also because of its non-specific clinical manifestations. It easily be treated as late ovarian cancer by gynecologist. So the pathology diagnosis and surgeons’ decision is very important. Because lymphoma is pretty sensitive to chemotherapy and easy to get complete response, so we no need to do an operation like ovarian cancer and should put chemotherapy as a primary method for lymphomas of the female genital tract.

Expression of ACTR3 in cervical cancer and impact on immune cell infiltration and prognosis: A comprehensive analysis based on bulk RNA-Seq and single-cell RNA-Seq

Background: PI3K/Akt/mTOR pathway is crucial in some cancers, but its relation with tumor-infiltrating immune cells in cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) is unanalyzed. This study aimed to determine if ACTR3 overexpression affects CC survival and explore its impact on the tumor immune microenvironment. Methods: Research investigated ACTR3 expression levels related to PI3K/Akt/mTOR pathway and its influence on tumor immunology and clinical outcomes. Methods included RNA-seq data analysis, immune cell infiltration evaluation, survival analysis, gene enrichment analysis, and single-cell RNA-seq data integration. ACTR3 expression in cervical cancer specimens was evaluated by immunohistochemistry. Results: Least absolute shrinkage and selection operator (LASSO) Cox regression identified ten key genes including ACTR3 with prognostic value. High ACTR3 expression correlated with poor outcomes, suggesting it as a prognostic biomarker. The prognostic model was validated by time-dependent receiver operating characteristic (ROC) curves for 1-, 3-, and 5-year survival. A nomogram combining ACTR3 expression and clinical parameters estimated patient survival. Single-cell RNA sequencing showed ACTR3-expressing immune cells in CESC include dendritic cells (DCs), T cells, and tissue stem cells. Conclusion: This research elucidated a distinct signature linked to the PI3K/Akt/mTOR signaling pathway, particularly focusing on ACTR3, which plays a role in both the onset and advancement of CESC. Moreover, ACTR3 has the potential to act as a prognostic biomarker for patients diagnosed with CESC, thereby offering novel perspectives for the development of clinical therapeutic approaches.

Awareness of cervical cancer, practice of cervical cancer screening and its associated factors among reproductive-aged women in Shankharapur Municipality of Kathmandu district, Nepal: A cross-sectional study

Despite being preventable, cervical cancer is one of the leading causes of death among reproductive-aged women in Nepal. Despite various initiatives by the Government of Nepal, awareness about cervical cancer and its prevention remains limited, and the uptake of cervical cancer screening among reproductive-aged women is still low. This study aimed to assess awareness of cervical cancer, practice of cervical cancer screening, and its associated factors among reproductive-aged women in Shankharapur Municipality of Kathmandu district. A descriptive cross-sectional study was conducted among 245 reproductive-aged women (30–49 years) in the selected wards of Shankharapur Municipality in 2023. A multistage sampling technique was used to select the participants. Descriptive analysis was carried out using number, percentage, mean and standard deviation. A multivariate logistic regression analysis was performed to determine the factors associated with practice of cervical cancer screening. All the tests were set at 95% confidence interval and variables with P -value &lt; .05 were considered as statistically significant. The mean (± SD) age of participants was 37.4 ± 5.9 years. More than half (57.4%) reported good health status, and 44.5% could reach the nearest health facility within 30 minutes. Most (87.3%) had heard of cervical cancer, but only 40.2% had ever undergone screening. Awareness of symptoms (61.2%), risk factors (47.0%), and preventive measures was limited, with 44.9% unaware of preventive measures. Factors significantly associated with screening practice included age (adjusted odds ratios [AOR] = 1.95), self-rated health status (AOR = 5.31), travel time to health facility (AOR = 10.85), awareness of symptoms (AOR = 1.44), risk factors (AOR = 2.09), and preventive measures (AOR = 1.28). Although awareness of cervical cancer was high, but actual screening uptake remained low. To improve screening coverage, targeted community-based awareness programs, cervical cancer screening counseling by healthcare providers and Female Community Healthcare Volunteers, and enhanced service accessibility through mobile health camps are recommended. Additionally, future research should include qualitative studies exploring healthcare providers’ perspectives and barriers related to the delivery and uptake of cervical cancer screening services.

A rare case of cardiac metastatic uterine intravenous leiomyomatosis: A case report

Intravenous leiomyomatosis (IVL) originating from the uterus with extension into the cardiac chambers is an extremely rare clinical entity, and cases involving severe right-sided cardiac involvement are particularly uncommon; this report aims to document this rare presentation and its management for clinical reference. A patient presented with clinical manifestations of right heart dysfunction, and auxiliary examinations identified severe cardiac involvement secondary to uterine IVL. The patient was diagnosed with uterine intravenous leiomyomatosis with extensive extension into the right cardiac chambers, complicated by very severe tricuspid regurgitation. A combined multidisciplinary surgical approach was performed, including resection of the right atrial mass, tricuspid annuloplasty ring implantation, exploration and resection of the inferior vena cava lesion, total hysterectomy, and bilateral salpingo-oophorectomy. The surgical intervention was successful, and the patient achieved a favorable clinical recovery with good postoperative condition. This is the first reported case detailing this rare and severe presentation of uterine IVL with extensive right cardiac extension. Recognition of this unusual manifestation of IVL is critical for timely diagnosis and the formulation of a comprehensive surgical treatment strategy. Multidisciplinary collaboration is essential for the successful management of such complex cases.

The causal effect of cytokine cycling levels on the risk of cervical cancer: A bidirectional 2-sample Mendelian randomization study

Increasing evidence suggests that inflammatory protein factors are closely associated with the underlying mechanisms of cervical cancer. Therefore, 2-sample Mendelian randomization (MR) analysis was performed to assess the potential correlation between circulating inflammatory protein levels and cervical cancer risk. A 2-sample MR study, using genetic variants related to inflammatory proteins as instrumental variables, was conducted to improve the accuracy of cervical cancer diagnosis. By analyzing 14,824 individuals, 91 plasma proteins having strong association with single nucleotide polymorphisms were chosen as instrumental variables, with cervical cancer (909 cases and 238,249 controls) serving as outcome variables. The analysis of causal effects was completed using random effect inverse variance weighted, weighted median/mode, and MR-Egger. Sensitivity analysis was performed using Cochran Q test, funnel plots, leave-one-out analyses, MR-Egger intercept tests, as well as reverse MR analysis. Our analysis showed that C-C motif chemokine ligand 19 (CCL19), monocyte chemotactic protein-3 (MCP-3), and interleukin-12 (IL-12) was related to the risk of cervical cancer. Additionally, the inverse variance weighted method indicated that both CCL19 (OR: 1.479, 95% CI: 1.207–1.813, P  = .0002) and IL-12 (OR: 1.171, 95% CI: 1.019–1.345, P  = .0253) significantly increased the risk of cervical cancer. Nevertheless, MCP-3 levels may protect individuals from developing cervical cancer (OR, 0.647; 95% CI: 0.442–0.947, P  = .0253). Furthermore, consistent outcomes were achieved in the sensitivity analysis. In our study, MR analysis of 91 inflammatory proteins revealed potential causal associations between CCL19, MCP-3, IL-12, and the etiology of cervical cancer. We believe that related inflammatory proteins will provide potential treatment opportunities for clinical interventions in cervical cancer.

Risk factors for hrHPV infection with cervical lesions patient in Anhui Province of China from 2021 to 2024: A retrospective study

The association between high-risk HPV (hrHPV) infection and cervical cancer or precancerous lesions has been extensively established, highlighting the importance of preventing hrHPV infection in cervical lesions patients. This study aims to investigate the risk factors associated with hrHPV infection in patients with cervical lesions and develop a nomogram model for predicting the risk of infection. The study involved 154 patients with cervical lesions, all of whom underwent human papillomavirus (HPV) gene typing. Retrospectively analyze the HPV genotyping and assess the prevalence of HPV infection in patients. The patients with cervical lesions were separated into hrHPV (n = 100) and non-hrHPV group (n = 54) based on the results of HPV genotyping tests. Univariate and multivariate regression analyses were employed to identify independent risk factors and develop nomogram model. The performance of the nomogram model were evaluated using ROC analysis. There were a total of 114 patients who tested positive for HPV, comprising 100 hrHPV and 14 low-risk HPV. The most common types of HPV are HPV 16 (65.00%), followed by HPV 52 (3.00%) and HPV 58 (3.00%). Univariate and multivariate analyses showed that age of first sexual intercourse (odds ratio [OR] = 3.312), miscarriage (OR = 7.115), menopause (OR = 2.508), cervicitis (OR = 2.710), number of sexual partners (OR = 5.259) were identified as significant risk factors for hrHPV infection. The nomogram model shows an area under the curve value of 0.861 (95% confidence interval = 0.795–0.927), with a sensitivity of 95.6% and specificity of 92.3%. These findings indicate the significant practical value of the clinical risk nomogram model. Age of first sexual intercourse, miscarriage, menopause, cervicitis, and number of sexual partners were identified as risk factors for hrHPV infection in patients with cervical lesions. This nomogram model holds significant clinical value.

Prognostic nomograms for locally advanced cervical cancer based on the SEER database: Integrating Cox regression and competing risk analysis

Locally advanced cervical carcinoma (LACC) remains a significant global health challenge owing to its high recurrence rates and poor outcomes, despite current treatments. This study aimed to develop a comprehensive risk stratification model for LACC by integrating Cox regression and competing risk analyses. This was done to improve clinical decision making. We analyzed data from 3428 patients with LACC registered in the Surveillance, Epidemiology, and End Results program and diagnosed them between 2010 and 2015. Cox regression and competing risk analyses were used to identify the prognostic factors. We constructed and validated nomograms for overall survival (OS) and disease-specific survival (DSS). Multivariate Cox regression identified key prognostic factors for OS, including advanced International Federation of Gynecology and Obstetrics stage, age, marital status, ethnicity, and tumor size. Notably, International Federation of Gynecology and Obstetrics stages IIIA, IIIB, and IVA had hazard ratios of 2.227, 2.451, and 4.852, respectively, significantly increasing the mortality risk compared to stage IB2. Ethnic disparities were evident, with African Americans facing a 39.8% higher risk than Caucasians did. Competing risk analyses confirmed the significance of these factors in DSS, particularly tumor size. Our nomogram demonstrated high predictive accuracy, with area under the curve values ranging from 0.706 to 0.784 for DSS and 0.717 to 0.781 for OS. Calibration plots and decision curve analyses further validated the clinical utility of this nomogram. We present effective nomograms for LACC risk stratification that incorporate multiple prognostic factors. These models provide a refined approach for individualized patient management and have the potential to significantly enhance therapeutic strategies for LACC.

Effects of air-heated blankets on hypothermia and quality of recovery in patients undergoing radical resection for endometrial cancer: A randomized trial

Background: Perioperative hypothermia is a common complication in patients undergoing major abdominal surgery. The aim of this study was to explore the effects of air-heated blankets on perioperative hypothermia and quality of recovery in patients undergoing radical resection for endometrial cancer. Methods: A total of 80 patients who underwent radical resection for endometrial cancer were enrolled and randomly divided into the control group (Group C) and experimental group (Group A) (n = 40). Routine nursing measures were used in Group C. Patients in Group A were continuously kept warm with an air-heated blanket (38°C) from the induction of anesthesia until the end of surgery. The core body temperature, intraoperative blood loss, extubation time, eye-opening time and post-anesthesia care unit (PACU) stay were recorded. The incidence of hypothermia, postoperative agitation, shivering, postoperative nausea and vomiting and delayed awakening was observed. Results: The incidence of hypothermia was significantly lower in group A (2.5% vs 45%, P = .001), and the body temperature 30 minutes after the induction of anesthesia and 1 hour after the beginning of the operation were significantly higher than that in the group C (P &lt; .05). Intraoperative blood loss was reduced in group A that in the group C (135.8 ± 38.8 vs 155.8 ± 48.7 mL, P &lt; .046). The extubation time, eye-opening time, and PACU stay were shorter in group A that in the group C (all P &lt; .05). The incidence of postoperative shivering was lower than that in Group C (2.5% vs 20%, P &lt; .024). Conclusion: The use of air-heating blanket could reduce the incidence of intraoperative hypothermia and postoperative shivering, shorten the extubation time and eye-opening time, and reduce intraoperative blood loss in patients undergoing radical resection for endometrial cancer.

A bidirectional Mendelian randomization analysis of the causal relationship between immune cells and high-grade squamous intraepithelial lesion

High-grade squamous intraepithelial lesions (HSIL), critical precursors to cervical cancer, are associated with persistent human papillomavirus infection and immune dysregulation, yet the causal role of specific immune cell phenotypes remains unclear. To investigate bidirectional causal relationships, we performed a 2-sample Mendelian randomization (MR) analysis using European genome-wide association study data: 731 immune cell phenotypes and HSIL. Instrumental variables ( P  &lt; 1 × 10⁻⁵) were selected under MR assumptions, with inverse-variance weighted as the primary method. Forward MR (immune cells to HSIL) identified 67 phenotypes nominally associated ( P  &lt; .05); after FDR correction (FDR &lt; 0.20), IgD on transitional B cells were protective, while increased CD3 on CD39+ Tregs elevated risk. Reverse MR (HSIL to immune cells) indicated HSIL causally reduces naïve CD4− CD8− T cell, HVEM on effector memory CD8+ T cells, FSC-A on lymphocyte and FSC-A on T cells (FDR &lt; 0.20). This study provides genetic evidence for causal roles of specific immune phenotypes in HSIL pathogenesis, suggesting immunotherapeutic targets, while revealing HSIL-induced immune exhaustion patterns.

Prevalence and influencing factors of depressive and anxiety symptoms in cervical cancer patients during the peri-chemoradiotherapy period: A systematic review meta-analysis

Background: To systematically evaluate the prevalence and influencing factors of depressive and anxiety symptoms in cervical cancer patients during the peri-chemoradiotherapy period. Methods: A comprehensive search was conducted in PubMed, EMBASE, Web of Science, The Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP Information, and China Biology Medicine disc for studies published from database inception to December 31, 2024. The focus was on the prevalence of depressive and anxiety symptoms in cervical cancer patients during the peri-chemoradiotherapy period. Two researchers independently screened the literature, assessed quality, and extracted data. Meta-analysis was performed using Review Manager 5.4 software. Results: A total of 26 studies were included, involving 5681 participants. The meta-analysis showed that the prevalence of depressive symptoms was 46% (95% CI [36–55%]), anxiety symptoms was 45% (95% CI [39–51%]), and comorbid depressive and anxiety symptoms was 26% (95% CI [21–32%]). Factors influencing anxiety included educational level (OR = 1.92, 95% CI [1.02–3.59], P  = .04), cancer stage (OR = 6.80, 95% CI [3.09–14.98], P  &lt; .05), and financial status (OR = 3.19, 95% CI [1.70–5.99], P  &lt; .05). Factors influencing depression included marital status (OR = 2.90, 95% CI [1.43–5.87], P  &lt; .05), educational level (OR = 2.89, 95% CI [1.32–6.31], P  &lt; .05), number of chemotherapy cycles (OR = 6.57, 95% CI [2.21–19.55], P  &lt; .05), cancer stage (OR = 2.65, 95% CI [1.41–5.00], P  &lt; .05), financial status (OR = 3.19, 95% CI [1.30–7.86], P  &lt; .05), family care (score) (OR = 4.24, 95% CI [2.02–8.87], P  &lt; .05), social support (score) (OR = 2.83, 95% CI [1.42–5.62], P  &lt; .05), and frequency of health education (OR = 3.44, 95% CI [1.06–11.08], P  &lt; .05). Conclusion: Educational level, cancer stage, financial status, marital status, number of chemotherapy cycles, family care, social support, and frequency of health education are significant factors influencing depressive and anxiety symptoms in cervical cancer patients during the peri-chemoradiotherapy period. Clinical healthcare providers should enhance psychological nursing and monitor psychological status to reduce depression and anxiety levels.

Clinical significance of CXCL17 in cervical cancer

As an acknowledged inflammatory cytokine, CXCL17 is also participated in various malignancies, including pancreatic ductal adenocarcinoma, lung cancer, colon cancer, and thyroid carcinoma. Nevertheless, it is still unclear whether CXCL17 is correlated with tumorigenesis and advancement of cervical cancer. The aim of this study was to study the clinical significance of CXCL17 in cervical cancer patients and its associations with epithelial-to-mesenchymal transition (EMT) markers. The present study analyzed the CXCL17 expression pattern in cervical cancer and investigated its correlation with clinicopathological parameters in 80 cervical cancer cases. Furthermore, the correlation between CXCL17 and EMT markers were evaluated. The results showed CXCL17 expression was positive in 67.50% (54/80) cases. Our results revealed CXCL17 expression was significantly correlated with lymph node metastasis and clinical stage ( P  &lt; .05). GPR35 expression was significantly enhanced in cervical cancer tissues. More importantly, CXCL17 expression was correlated with snail or vimentin expression. Simultaneously, CXCL17 expression had a negative correlation with E-cadherin expression. These results demonstrated the close correlation between CXCL17 expression and EMT markers. Our findings revealed that CXCL17 promotes advancement of cervical cancer via influence of some critical EMT markers.

Machine learning models for the prediction of uterine fibroids

In this cross-sectional study, we developed and validated a predictive model for uterine fibroid risk using routine physical examination indicators and 5 machine learning algorithms: logistic regression, random forest, k-nearest neighbors, categorical boosting (CatBoost), and light gradient boosting machine. The primary dataset consisted of health examination records from the MJ Health Screening Center in Beijing, China (2013–2023), while an independent external validation dataset (2024) was used to assess generalizability. LASSO regression identified 13 significant predictors, including age, body mass index, total cholesterol, diastolic blood pressure, and marital status. Among the models, CatBoost demonstrated the best performance, achieving an area under the curve of 0.808 in the internal validation dataset and 0.821 in the external validation dataset, indicating strong predictive capability and robustness. SHapley additive exPlanations analysis revealed that age and body mass index were the most critical predictors, and that total cholesterol was a key predictive feature; its implications for lipid metabolism are further discussed in the main text. Despite its strengths in area under the curve, specificity, and sensitivity, the model exhibited limitations in precision (0.475) and moderate accuracy (0.742), indicating challenges in controlling false-positive rates. The results indicate that the model is a potentially effective screening tool for identifying high-risk individuals who may benefit from further diagnostic evaluation. While this study validates the feasibility of using routine health examination data combined with the CatBoost algorithm for early risk assessment of uterine fibroids, it also highlights the need for cautious interpretation of the model’s predictions in clinical practice. Future research should focus on multicenter, large-scale studies to enhance the model’s generalizability and incorporate additional predictive factors to optimize performance.

Survival rates and predictors in gestational choriocarcinoma: Is chemotherapy always the answer?

Gestational choriocarcinoma is a highly malignant form of gestational trophoblastic neoplasia characterized by early vascular invasion and a strong tendency for widespread metastasis. To date, there is no consensus in the FIGO recommendations regarding when chemotherapy should be initiated following diagnosis. This study aimed to evaluate the impact of chemotherapy on survival and develop machine learning (ML) prognostic models for patients with gestational choriocarcinoma. We analyzed data from the SEER database [2000–2020]. Patients with histologically confirmed GC arising from the placenta were included, while those with other malignancies or missing key data were excluded. We conducted a Cox regression analysis for prognostic factors and developed ML models (using 5 algorithms) to predict 5-year survival rates. A validation method incorporating the area under the curve of the receiver operating characteristic curve was used to validate the accuracy and reliability of the ML models. We also investigated the role of multiple therapeutic options using the Kaplan–Meier survival analysis. This study included 732 patients with a median age of 32 years (54.5% ≥30 years); most were White (66.4%), and 44.3% had metastatic disease at diagnosis. Of these, 283 received chemotherapy, 116 underwent surgery alone, and 333 underwent both surgery and chemotherapy. Survival analysis showed no significant differences in survival between the treatment modalities. Multivariate Cox regression analysis identified older age, metastasis, and marital status as significant prognostic factors. Among the ML models, Random Forest Classifier achieved the highest performance. Feature importance analysis identified age, marital status, and metastasis as the most influential survival factors. The study suggests that chemotherapy may not have benefit for survival. Further multicenter prospective studies are needed to evaluate the importance of chemotherapy initiation.

Identification of radiotherapy-sensitive genes for predicting prognosis, immune microenvironment, and drug sensitivity in uterine carcinosarcoma patients

Background: Uterine carcinosarcoma is a rare gynecological malignancy characterized by high invasiveness and poor prognosis. At present, common treatment methods include surgery, chemotherapy, and radiotherapy. Radiotherapy can induce tumor cells to produce reactive oxygen species through ionizing radiation, leading to damage to intracellular DNA and mediating tumor cell death. Based on this, we identified a novel radiotherapy sensitive gene for predicting the prognosis, immune microenvironment, and drug sensitivity of uterine carcinosarcoma patients. Methods: The Cancer Genome Atlas database was used to obtain genetic and clinical information of patients with uterine carcinosarcoma. A risk scoring model was built using Lasso regression model. In order to enhance the predictive ability of the model, a column chart for prediction was created and calibration curves were used. Gene set enrichment analysis was used to evaluate pathway enrichment in patients with different risk cohorts. Finally, we investigated drug sensitivity between high-risk and low-risk cohorts. Results: We found that the survival rate of patients who received radiotherapy was significantly higher than that of patients who did not receive radiotherapy. In the constructed risk scoring model, high-risk patients have a worse prognosis. Pathway enrichment indicates that high-risk patients are enriched in regulating tumor cell growth, metabolism, and angiogenesis pathways, which may be a reason for poor prognosis in high-risk patients. High risk and low-risk patients have different sensitivities to different drugs. The 1, 3, and 5-year survival values predicted by the receiver operating characteristic curve were 0.82, 0.93, and 0.96, respectively, indicating the reliability of our prediction model. Finally, multiple regression analysis showed that the radiation therapy sensitive genes SSBP2, ELAVL3, and CST1 in the model can independently affect the prognosis of patients with uterine carcinosarcoma. Patients with high expression of SSBP2 have a better prognosis than those with low expression, while patients with high expression of ELAVL3 and CST1 have a poorer prognosis. Conclusion: We have developed a scoring method for uterine carcinosarcoma based on the effectiveness of radiotherapy. This method can evaluate the prognosis of patients with uterine carcinosarcoma and has certain guiding significance for the clinical treatment of subsequent uterine carcinosarcoma patients.

Identification and experimental validation of copper metabolism-related genes in cervical cancer

Cervical cancer is a common malignancy which is very harmful to women’s health worldwide. Copper metabolism has become research highlight and is expected to be new therapeutic target of cancers, but the copper metabolism related genes connect with cervical cancer remain unclear. This study identified and experimentally verified the copper metabolism-related genes in cervical cancer. First, the gene expression profile of cervical cancer was downloaded from the Gene Expression Omnibus database to identify significantly differentially expressed genes of cervical cancer, and these genes were intersected to copper metabolism data set to screened out copper metabolism related genes in cervical cancer. Then gene ontology and Kyoto Encyclopedia of Gene and Genomes enrichment analysis were conducted, the protein-protein interactions were analyzed using the online database STRING11.0. The Cancer Genome Atlas database was used to validate the screening genes and analyze their diagnostic value. Cervical tissue samples from 8 patients with cervical cancer as the experimental group and 10 patients with benign uterine fibroids as the control group were collected, mRNAs was extracted and quantitative real time polymerase chain reaction was used to verify the selected genes. The Human Protein Atlas database was used to verify the expression of the selected genes, and their immune infiltration was studied based on the The Cancer Genome Atlas database. MiRNA-hub gene network, transcription factor-hub gene network and chemical-hub gene network were constructed by us to accurately investigate the molecular mechanism and potential drugs underlying copper metabolism related genes we screened out in cervical cancer. Aquaporin1 and cyclin-dependent kinases1 were the copper metabolism-related genes in cervical cancer we screened out by bioinformatics methods and then validated by clinical samples. Aquaporin1 and cyclin-dependent kinases1 could play an important role in the mechanism of cervical cancer and could be targets of cervical cancer concerning copper metabolism.

Granular cell tumor of the vulva: Case report and systematic review of the literature

Rationale: Granular cell tumor (GCT) of the vulva is an exceptionally rare female genital tract tumor. The majority of these are benign and there are no standardized surgical techniques for the special site to reduce tension of the wound. Patient concerns: A 47-years-old Chinese woman experienced a nodule on her right vulva with itch sometimes in late 2018. Diagnoses: Magnetic resonance imaging showed a high possibility of vulvar cancer. While Chest X-ray, abdominal sonography, and cystoscopy examination were unremarkable. Interventions: The patient underwent local complete resection of vulvar tumor under general anesthesia on March 24, 2022. The resection scope was approximately 4 cm × 3 cm × 3 cm. Due to the large surgical incision, Z-plasty was performed to achieve the primary closure for decreasing wound tension and improving aesthetic reduction. Outcomes: The final pathological diagnosis was benign GCT of the vulva and surgical margins were uninvolved. At 8 months follow-up, no new lesions were detected. Lessons: Surgery with negative resection margins is the mainstay for benign GCT of the vulva, while Z-plasty is appropriate for decreasing the tension of the wound and improving aesthetic reduction.

A novel disulfidptosis-related lncRNA signature to predict prognosis and immune response of cervical cancer

Disulfidptosis, a new identified form of regulated cell death, has been implicated in cancer. However, the mechanisms through which disulfidptosis-related long noncoding RNAs (lncRNAs) predict prognosis in cervical cancer (CC) remain unclear. Here, we identified disulfidptosis-related genes and lncRNAs in the cancer genome atlas database. Least absolute shrinkage and selection operator and Cox regression analyses were used to construct a prognostic risk signature based on optimal disulfidptosis-related lncRNAs. The prognostic performance of the signature was evaluated using Kaplan–Meier survival analysis and receiver operating characteristic curves. Correlation between the risk signature, gene mutation landscape, tumor immune microenvironment, and immunotherapy or chemotherapy sensitivity was determined. Additionally, the expression levels of disulfidptosis-related lncRNAs in CC were validated by quantitative PCR. A total of 403 disulfidptosis-related lncRNAs were identified, among which 9 disulfidptosis-related lncRNAs were used to construct a prognostic risk signature that classified patients with CC into high-risk and low-risk groups. Kaplan–Meier, receiver operating characteristic curves, and the concordance index demonstrated that the risk signature exhibited good sensitivity and specificity. The low-risk group exhibited improved survival outcomes and increased sensitivity to immunotherapy, whereas the high-risk group showed heightened sensitivity to to bexarotene, bicalutamide, embelin, FH535, and pazopanib. Quantitative PCR results indicated that ILF3-DT and PPP1R14B-AS1 were downregulated in CC tissues, whereas RUSC1-AS1 was upregulated. In conclusion, we developed a novel prognostic risk signature based on 9 disulfidptosis-related lncRNAs, which may serve as an independent predictor of immunotherapy response and chemotherapy sensitivity in CC.

Clinical pathological analysis of primary small cell neuroendocrine carcinoma of the cervix: A retrospective study

To explore the clinical and pathological features of primary small cell neuroendocrine carcinoma of the cervix. Clinical data of 4 patients with primary small cell neuroendocrine carcinoma of the cervix were collected, and the clinical features, histopathological characteristics, immunohistochemical staining results, treatment, and prognosis were summarized and analyzed. The relevant literature was reviewed and summarized. The age of the 4 patients ranged from 48 to 62 years, with an average age of 54.3 years. Patients 1, 2, and 3 sought medical attention because of irregular vaginal bleeding, whereas patient 4 presented with lower abdominal pain and discomfort. Histologically, all 4 cases were small-cell neuroendocrine carcinomas. Immunophenotyping: tumor cells were diffusely strongly positive for P16, and expressed 2 or more neuroendocrine markers, with positive rates of CD56 100% (4/4), synaptophysin (SYN) 100% (4/4), and chromogranin (CgA) 50% (2/4). The first and second cases were positive for TTF-1, epithelial marker panCK was positive, and Ki-67 proliferation index was &gt;70% in all cases. This is a relatively rare and highly malignant cervical tumor with strong invasiveness and a poor prognosis. This may be related to human papillomavirus infection. A definitive diagnosis can be made based on the histopathological morphology and immunophenotype.

Platelet-derived growth factor (PDGF) and its impact in fibroid pathogenesis: A narrative review

Uterine fibroids, also known as leiomyomas, are benign tumors of the uterus that disproportionately affect women of reproductive age, often leading to significant clinical symptoms such as abnormal bleeding, pelvic pain, and infertility. Although hormones like estrogen and progesterone have long been established as major contributors to fibroid development, recent advances have shed light on the critical role of growth factors in modulating tumor growth and fibrosis. Among these, platelet-derived growth factor (PDGF) has emerged as a key mediator of cellular proliferation, extracellular matrix deposition, and angiogenesis within fibroid tissues. PDGF exists in several isoforms (AA, BB, AB, CC, DD) and signals through PDGF receptors α and β, activating downstream pathways such as PI3K/AKT, RAS/MAPK, and JAK/STAT. These signaling events promote not only smooth muscle cell proliferation but also fibrotic remodeling by stimulating collagen and fibronectin production. PDGF also interacts with other pathways (particularly transforming growth factor-beta and sex hormones) to amplify fibroid growth and resistance to apoptosis, reinforcing a fibrotic, hormone-responsive microenvironment. Elevated expression of PDGF and its receptors in fibroids compared to normal myometrium supports its central role in pathogenesis.

Expression and clinicopathological significance of KAI1, MACC1, and AGR2 in cervical squamous cell carcinoma

Colon cancer metastasis-associated protein 1 (MACC1) was initially identified in colorectal cancer and is linked to metastasis and prognosis in various malignant neoplasms. Anterior gradient homology protein 2 (AGR2) has emerged as a significant prognostic indicator for multiple cancers, while anti-cancer 1 (KAI1), recognized as a tumor metastasis suppressor gene, plays a critical role in cancer progression. Despite their individual associations with metastasis and prognosis across different cancer types, the interactions among MACC1, AGR2, and KAI1 specifically in cervical squamous cell carcinoma remain poorly understood. Therefore, this study aimed to investigate the relationships between MACC1, AGR2, and KAI1 within the context of cervical squamous cell carcinoma, while also examining their correlations with clinicopathological features and overall survival (OS) outcomes in affected patients. Immunohistochemistry was used to detect the expression of MACC1, AGR2, and KAI1 in 106 cases of cervical squamous cell carcinoma. At the same time, the clinicopathological parameters and postoperative survival information were collected. In cervical squamous cell carcinoma, the detection rates of MACC1 and AGR2 were found to be significantly elevated, whereas the detection rate of KAI1 was notably reduced when compared to control tissues. Furthermore, the positive detection rates of MACC1 and AGR2 exhibited a positive correlation with tumor grade, tumor-node metastasis classification, and lymph node metastasis (LNM) stage, while demonstrating a negative correlation with OS. Conversely, the positive detection rate of KAI1 was negatively associated with tumor grade, tumor-node metastasis classification, and LNM stage. Patients within the KAI1 positive subgroup experienced a significantly extended OS in comparison to those in the KAI1 negative subgroup. Additionally, multivariate analysis indicated that the positive expression of MACC1, AGR2, and KAI1, alongside tumor stage and LNM stage, could serve as independent prognostic indicators for OS in individuals diagnosed with cervical squamous cell carcinoma. MACC1, AGR2, and KAI1 may represent potential metastatic and prognostic biomarkers, as well as promising therapeutic targets for squamous cell carcinoma of the cervix.

Discriminant study of cervical squamous cells based on computer image analysis

This study aimed to explore a discriminant method for cervical squamous epithelial cells based on computer image analysis to establish a foundation for artificial intelligence diagnosis of cervical cancer. A total of 1682 cells were captured from 53 Papanicolaou smears, and computer image analysis was used to test the chromatics and geometric structural parameters of the above cells. Stepwise discriminant analysis was used to establish the discriminant function, and the discriminant effects of the function were evaluated. The chromaticity and geometric features of the cell images had significantly different among low-grade cells (LGC), atypical squamous cells of undetermined significance, and high-grade cells (HGC), as well as between subclassifications within LGC and HGC ( P  &lt; .05). Stepwise discriminant analysis was used to create functions for classifying cells into the categories LGC, atypical squamous cells of undetermined significance, and HGC, as well as subclassifications within LGC and HGC. Functions combined with chromatics and geometry features have a good discriminant effect on cervical squamous cells. The discriminant coincidence rates indicate that this method can be an appropriate reference approach for the classification and diagnosis of cervical squamous epithelial cells, and its potential applications are presented in a tentative study on automated image analysis systems for cytological fields.

Uterine cervical adenomyoma: Case report and literature review

Rationale: Cervical adenomyoma is a rare benign tumor that is easily confused with malignant diseases of the cervix, including malignant and benign cervical diseases. Misdiagnosis results in mistakes in therapy. This study aims to enhance the understanding of cervical adenomyoma through a case report, including clinical symptoms, physical examination, and surgical photos, at the same time a systematic review of cervical adenomyoma will be done, thereby helping to avoid clinical misdiagnosis. Patient concerns: A 39-year-old woman with a cervix mass about 3 × 3 cm. The root of the tumor was located in the cervical canal, and contact bleeding was positive. The pap smear and human papillomavirus test were normal. The menstrual cycle was normal. Ultrasonography revealed that the uterus and bilateral ovaries were normal. There is no relevant family history. Cervical hyperplasia or cervical myoma was considered before surgery. Diagnoses: The patient was diagnosed with cervical adenomyoma. Interventions: Hysteroscopy was taken, and histopathology was taken after surgery. Outcomes: Histopathology revealed that the lesions were mixed cervical glands with smooth muscles. Lessons: Through the case report, we gain a better understanding of the diagnosis of cervical adenomyoma. Histopathology and immunohistochemical staining were conducive to diagnose cervical adenomyoma. A review of existing literature helps distinguish it from other benign and malignant cervical tumors, thereby reducing misdiagnosis.

Correlation analysis between vaginal microecology and high-risk human papillomavirus (HR-HPV)-positive cervical squamous intraepithelial lesions (SIL)

This study is aimed to investigate the correlation between vaginal microecology and high-risk human papillomavirus (HR-HPV)-positive cervical squamous intraepithelial lesions (SIL) using the regression analysis. Patients (n = 372) with HR-HPV-positive from January 2020 to June 2022 were recruited after preliminary confirmation by colposcopy, HPV test, and typing, as well as loop electrosurgical excision procedure. Based on the pathological results, the recruited subjects were divided into 3 groups, that is, negative for intraepithelial lesion or malignancy, low-grade SIL, and high-grade SIL (HSIL). Finally, the clinical factors, virological data, and vaginal microecological changes of the 3 experimental groups were analyzed. Age was identified as a significant risk factor for HSIL, with an OR of 1.048 (95% CI: 1.006–1.094 and P = .026). Various HR-HPV types (HPV16, HPV18, and HPV52) were closely associated with HSIL, with multiple infections significantly increasing the risk (odds ratio, OR: 5.810, P = .04). The changes in the vaginal microecology were strongly associated with HSIL, including elevated pH (&gt;4.5), reduced hydrogen peroxide levels, and increased bacterial vaginosis (BV) prevalence. BV demonstrated a sensitivity of 66.10% and a specificity of 70.31% for predicting HSIL. Furthermore, decreased Lactobacillus levels (OR: 3.20, P &lt; .001) showed their protective role, while elevated sialidase activity (OR: 5.610, P = .002) emerged as a significant risk factor. Accordingly, the key independent predictors for low-grade SIL and HSIL included age, infection type, pH, microbiome density, BV, and sialidase activity. The mixed infection of HPV16, HPV18, HPV52, and HPV resulting in cervical SILs could be closely related to the vaginal microecology.

Advancing understanding of HIFU in uterine fibroids: A meta-review on postoperative recovery and surgical wound healing

Background: This meta-analysis provides a novel perspective on postoperative wound recovery after uterine fibroid surgery, focusing on pain, menstrual blood loss, fibroid volume, complications, and quality of life. Methods: A comprehensive search for relevant studies was performed in the PubMed, Web of Science, China National Knowledge Infrastructure, the Cochrane Library, Embase, and Google Scholar databases. Various combinations and permutations of the keywords “uterine fibroid” and “high-intensity focused ultrasound (HIFU)” were used to retrieve studies. Articles published until April 2024 were eligible for inclusion. The titles and abstracts of all retrieved articles were screened to assess their relevance. Subsequently, the full texts of the selected articles were reviewed to determine their eligibility for inclusion in the meta-analysis. Results: The analysis reveals that HIFU can minimize pain and improve the quality of life of patients with uterine fibroids. Specifically, the observational group treated with HIFU experienced reduced pain, decreased menstrual blood loss, fibroid volume, and complications. Conclusion: Our findings serve as valuable reference points for clinicians in treating uterine fibroids.

Risk factors for pregnancy-related uterine rupture following laparoscopic myomectomy: A systematic review and meta-analysis

Background: To systematically evaluate risk factors associated with pregnancy-related uterine rupture following laparoscopic myomectomy (LM) and provide evidence-based guidance for clinical decision-making. Methods: A comprehensive search of PubMed, Embase, Web of Science, and other databases was conducted to identify observational studies published up to March 31, 2025. Relevant data on risk factors for post-LM uterine rupture during pregnancy were extracted, and meta-analysis was performed using RevMan 5.4. Results: Eleven high-quality studies encompassing 188,769 patients were included. Meta-analysis revealed that larger fibroid size (MD = 0.54; 95% confidence intervals [CI]: 0.29–0.79), elevated prepregnancy body mass index (BMI) (MD = 2.93; 95% CI: 2.20–3.66), earlier gestational age (MD=−3.01; 95% CI: −4.94 to −1.08), history of pregnancy (odds ratio [OR] = 2.82; 95% CI: 1.82–4.37), scarred uterus (OR = 2.49; 95% CI: 1.04–5.97), and prior uterine surgery (OR = 7.05; 95% CI: 2.43–20.40) were significantly associated with increased risk of uterine rupture (all P &lt; .05). No statistically significant associations were observed for age, preconception BMI, blood transfusion, and other evaluated factors. Conclusion: Pregnancy-related uterine rupture after LM is associated with multiple factors, including fibroid size, elevated BMI, and placental abnormalities. Careful preoperative risk assessment, optimization of suturing techniques, and enhanced pregnancy monitoring are recommended to mitigate risk.

A histone acetylation-based predictive model for immunotherapy response and combinatorial targeting in cervical cancer

Histone acetylation, a fundamental component of epigenetic modification, plays a pivotal role in the progression, treatment, and prognosis of numerous cancers. In this study, we systematically investigated, for the first time, the clinical value of histone acetylation (HAT) modification in the prognostic assessment of cervical cancer. Utilizing the GSE44001 and The Cancer Genome Atlas-CESC databases, a HAT-associated prognostic model comprising 7 pivotal genes was formulated through Lasso-Cox regression analysis. The integration of multiple bioinformatics algorithms (including Cibersort, ESTIMATE, ssGSEA, and TIDE) has enabled the profound delineation of immune microenvironmental characteristics among disparate risk groups. Utilizing molecular docking technology, we conducted a screening process that identified 2 potential target drugs. The prognostic model’s predictive efficacy was successfully validated in an independent cohort. The analysis has revealed that the high-risk group exhibits a pronounced immunosuppressive phenotype. The study identified 2 additional factors that contribute to the prognosis of cervical cancer: CPE and PGK1. These factors have been shown to be significantly associated with poor clinical outcomes. In addition, we have identified 2 drugs that may target CPE and PGK1, namely Z-LLNle-CHO and OSU-03-012. The discovery of these drugs has opened up a new potential pathway for overcoming resistance to immunotherapy. This study addresses a significant research gap concerning HAT in the prognostic assessment of cervical cancer. Furthermore, it offers a crucial molecular basis for clinical decisions regarding individualized therapeutic interventions.

Primary vaginal adenocarcinoma as a radiation-associated secondary malignancy: A case report and comprehensive literature review

Rationale: Primary vaginal adenocarcinoma (PVA) is an exceptionally rare malignancy, with most cases historically linked to in utero diethylstilbestrol (DES) exposure. Non–DES-associated PVA following definitive chemoradiotherapy for cervical cancer is extremely uncommon, and no standardized management protocol exists. This case illustrates a rare instance of radiation-associated PVA and highlights therapeutic considerations in previously irradiated pelvic fields. Patient concerns: A 53-year-old postmenopausal woman presented with intermittent vaginal bleeding occurring 5 years after radical hysterectomy and adjuvant chemoradiotherapy for stage IIA2 cervical squamous cell carcinoma. Diagnoses: Colposcopy-guided biopsies of the vaginal anterior wall revealed glandular architecture with cytological atypia. Immunohistochemistry demonstrated CK7(+), CK8/18(+), CEA(+), PAX8(−), ER(−), PR(−), p16 patchy weak negative, and wild-type p53. Systemic workup excluded metastatic disease, supporting the diagnosis of PVA (non–DES-associated, radiation-related). Interventions: In view of prior pelvic irradiation, the multidisciplinary team recommended dose-adjusted paclitaxel–cisplatin combination chemotherapy. Six cycles were administered, tailored to minimize cumulative toxicity. Outcomes: At 6-month follow-up, imaging studies confirmed complete clinical remission, with no locoregional recurrence or distant metastases. Lessons: This report underscores the potential for radiation-induced secondary vaginal adenocarcinoma in cervical cancer survivors, even after prolonged remission. Vigilant long-term surveillance, including annual vaginal cytology and targeted biopsies, is critical for early detection. Individualized therapeutic strategies – integrating prior treatment history, immunohistochemical profiling, and consideration of molecular alterations – are essential for optimizing outcomes in this rare patient population.

Acupuncture treatment of postoperative urinary retention in cervical cancer: Systematic evaluation and meta-analysis

Background: To evaluate the efficacy of acupuncture treatment of postoperative urinary retention after cervical cancer using meta-analysis. Methods: Computer searches were performed on 8 common Chinese and English databases such as PubMed, EMbase, Web of Science, China National Knowledge Infrastructure, Wanfang (Wanfang Data Knowledge Service Platform), VIP (China Science and Technology Journal Database), China Biomedical Literature Database and Cochrane Library, as well as Clinical Trials for the treatment of urinary retention after cervical cancer with acupuncture. A randomized controlled trial of postoperative urinary retention after cervical cancer from the time of library construction to 01/2024. The quality of the included literature was evaluated using the Cochrane Risk of Bias Assessment Tool. Meta-analysis and risk of bias analyses were performed using RevMan 5.4, regression and sensitivity analyses were performed using Stata 17.0. Results: A total of 31 randomized controlled trials with 2179 patients were included in the study. Interventions included filiform needling, embedding needle, electroacupuncture, moxibustion, warm acupuncture, etc. The results showed that acupuncture treatment increased clinical efficiency [relative risk = 1.32, 95% confidence intervals [CI] (1.20, 1.45), P &lt; .00001], reduced residual urine volume [standardized mean difference = −3.21, 95% CI (−4.00, −0.40), P &lt; .00001], and shortened the time to return to spontaneous urination [MD = −1.96, 95% CI (−3.02, −0.91), P = .0003] and indwelling catheter time [mean difference (MD) = −3.76, 95% CI (−5.66, −1.86), P = .0001], and improved maximum urine flow rate [MD = 4.57, 95% CI (0.70, 8.44), P = .02] and bladder compliance [MD = 10.04, 95% CI (8.14, 11.93), P &lt; .00001]. Conclusion: Acupuncture treatment promotes recovery in patients with postoperative urinary retention after cervical cancer, but high-quality studies need to be included to further compare different acupuncture interventions.

Dosimetric study on the effect of minimum distance between optimization structures and planning target volume on small intestine dose in cervical cancer VMAT plans

Cervical cancer radiotherapy often faces challenges in managing gastrointestinal toxicities, particularly due to the dose received by the small intestine. This study investigates the impact of optimization structure margins (1.2–2.4 cm) on reducing small intestine dose and improving plan quality in patients with mean small intestine doses (D mean_INT ) exceeding 25 Gy. A total of 27 cervical cancer patients treated with volumetric modulated arc therapy were retrospectively analyzed. Iterative constraint adjustments were applied to optimization structures at varying distances from the planning target volume (PTV). Five optimization margins (0.6, 1.2, 1.8, 2.4, and 3.0 cm) were created by volumetrically excluding small intestine regions proximal to PTV, with iterative dose constraints. Each plan was named RrIi, where r represents the cutting distance of the optimization structure and i represents the iteration number (ranging from 4–8). Results demonstrated that all optimized plans achieved significant reductions in D mean_INT compared to the original plans (ORI group), with reductions ranging from 1.21 to 1.83 Gy ( P  &lt; .001). The R_1.2I_5.5 protocol achieved the most favorable balance, reducing D mean_INT by 1.23 Gy, corresponding to a 15% to 22% relative risk reduction for Grade ≥ 2 enteritis. Smaller margins (1.2 cm) effectively reduced intermediate-high-dose regions (e.g., V 40Gy ), while larger margins (2.4 cm) better controlled low-dose regions (e.g., V 15Gy ), supporting tailored clinical decision-making based on patient characteristics. In conclusion, optimization structure margins of 1.2 to 2.4 cm provide a clinically meaningful framework for reducing small intestine dose while preserving PTV coverage, advancing cervical cancer radiotherapy planning.

The impact of narrative nursing intervention on nursing outcomes of patients undergoing laparoscopic uterine fibroid surgery: A retrospective study

This study aims to analyze the impact of narrative nursing intervention methods on patients undergoing laparoscopic uterine fibroid surgery. A retrospective analysis was conducted on 234 patients with uterine fibroids who underwent laparoscopic surgery in the gynecology department from January 2023 to December 2024. Patients were divided into a narrative nursing group and a control group based on whether they received a narrative nursing intervention. The nursing effects of the 2 groups of patients were compared and analyzed, including negative emotions, nursing satisfaction, and postoperative recovery. There were 114 patients in control group and 120 in narrative nursing intervention group. The self-rated anxiety scale, self-rated depression scale, Hamilton anxiety scale, and Hamilton depression scale of patients in the narrative nursing group after nursing were significantly lower than those in the control group (P &lt; .05). Patient satisfaction in the narrative nursing group was significantly higher than in the control nursing group (P &lt; .05). The average hospitalization time and hospitalization costs of patients in the narrative nursing group were significantly lower than those in the control nursing group (P &lt; .05). The narrative nursing group had higher nursing satisfaction (P &lt; .05). Narrative nursing intervention has good application value in patients undergoing laparoscopic uterine fibroid surgery. Patients who adopt narrative nursing intervention have better postoperative recovery effects, can alleviate postoperative anxiety and depression, and improve patient nursing satisfaction.

Posttreatment squamous cell carcinoma antigen: A prognostic marker for patients with advanced cervical cancer treated with bevacizumab–paclitaxel–cisplatin therapy

Cervical cancer is a leading cause of cancer-related mortality in women, with poor prognosis when diagnosed at advanced stages. Bevacizumab, an anti-vascular endothelial growth factor agent, has shown promising results in the treatment of metastatic cervical cancer. The combination of bevacizumab with paclitaxel and cisplatin (TP) as first-line chemotherapy is associated with improved survival rates in patients with metastatic cervical cancer. In this study, we aimed to evaluate the effectiveness and safety of first-line chemotherapy with bevacizumab and TP in patients with advanced cervical cancer in South Korea and investigate the clinical value of posttreatment plasma levels of squamous cell carcinoma antigen (SCC Ag) as an independent prognostic factor for survival. This retrospective study included 33 patients with metastatic cervical cancer who received bevacizumab and TP as first-line chemotherapy between January 2016 and December 2022 at the Gyeongsang National University Hospital. First-line therapy with bevacizumab and TP significantly improved progression-free and overall survival (OS) [26.3 (95% confidence interval (CI), 18.3–34.3) and 39.9 (95% CI, 23.8–56) months, respectively]. Patients who achieved normalization of posttreatment SCC Ag levels had significantly longer OS compared to those who did not [69.1 (95% CI, 17.6–120.6) vs 18.4 (95% CI, 10.9–25.9) months, respectively (hazard ratio 12.4; P &lt; .001)]. The treatment regimen was well-tolerated, with most patients reporting manageable side effects. First-line chemotherapy with bevacizumab and TP demonstrated efficacy and tolerability in Korean patients with metastatic cervical cancer. Additionally, normalization of posttreatment SCC antigen levels serves as a potential prognostic marker for patients undergoing this type of chemotherapy.

Persistent and severe hypotension during radical transabdominal ovarian cancer surgery: A case report

Rationale: In radical surgery for ovarian cancer (OC), hypotension that is difficult to correct is usually rare unless there is significant blood loss. We recently encountered a patient who developed persistent and severe hypotension during radical transabdominal OC surgery. Patient concerns: A patient was 52 years old with a history of hypertension and well-controlled preoperative blood pressure (BP). A total of 2000 mL of ascites was drained and blood loss was 300 mL when the operation proceeded to 5.5 hours. The patient’s cardiopulmonary function and blood gas analysis showed no significant abnormalities. Diagnoses: persistent and uncorrectable hypotension. Interventions: There was no significant edema in the patient’s head or face, nor did the surgeon observe noticeable edema in her intestinal walls or other organs. No oozing was seen at the surgical site. Fluid resuscitation and vasopressor administration were continued. As BP control further deteriorated, blood counts, coagulation, and biochemical electrolyte analyses revealed severe hypoalbuminemia (13.5 g/L) and coagulation dysfunction. Outcomes: After intravenous human serum albumin (HSA) and fresh frozen plasma therapy, her hypoalbuminemia and coagulation were gradually corrected. Lessons: Based on this case, we suggest that in OC patients experiencing mild intraoperative bleeding and minimal heart rate variation but persistent refractory hypotension, hypoalbuminemia should be considered even if preoperative biochemical tests (including serum albumin levels) are normal. Confirming hypoalbuminemia warrants HSA administration to alleviate hypovolemic shock symptoms. Additionally, it is important to be cautious of potential coagulation issues with albumin use, possibly requiring plasma infusion to address coagulopathy.

Is age a determinant in cervical cancer screening in women aged 18 to 29?: An observational study

This study aims to analyze the impact of aging on cervical cancer screening among women aged 20 to 29. Specifically, it examines the occurrence of abnormal histological results and Cervical Intraepithelial Neoplasia (CIN) (+) lesions within these age groups. We retrospectively analyzed women aged 18 to 29 (&lt;30) who underwent cervical cancer screening through cytology between 2014 and 2024. A total of 842 women who visited the gynecology outpatient clinic were included, and their Pap smear, colposcopy, and loop electrosurgical excision procedure/conization results were reviewed. Patients were divided into 2 age groups (18–25 and 26–29) for comparative analysis. Among the 842 women who underwent cytological evaluation: 744 (88.4%) had normal results, 51 (6.1%) were diagnosed with atypical squamous cells of undetermined significance (ASC-US), 31 (3.7%) with low-grade squamous intraepithelial lesion (LSIL), 8 (1.0%) with atypical squamous cells – cannot exclude high-grade lesion (ASC-H), 4 (0.5%) with High-Grade Squamous Intraepithelial Lesion (HSIL), and 4 (0.5%) with Atypical Glandular Cells (AGC). HPV (Human Papillomavirus) testing was performed on 75 women, and 40 (53.3%) tested positive for HPV. Colposcopy was conducted on 53 women, revealing CIN + lesions in 38 cases, while conization confirmed CIN + lesions in 23 cases. Colposcopy results revealed the presence of CIN 1, CIN 2, and CIN 3 lesions in both age groups. However, CIN 3 lesions were observed less frequently in the &gt; 26 age group. Similarly, conization results showed a lower incidence of CIN 3 lesions in women older than 26. Women aged 18 to 25 had a higher likelihood of CIN 3 diagnosis. These findings emphasize the importance of considering age in the diagnosis of CIN (+) lesions during cervical cancer screening.

Treatment of advanced cervical cancer with Cinobufacini and Paclitaxel–Cisplatin combination: A meta-analysis

Background: Standard treatments for advanced cervical cancer, such as paclitaxel–cisplatin combination (TP) chemotherapy, are often limited by reduced efficacy and significant toxicity. Cinobufacini (Huachansu), a traditional Chinese medicine, has demonstrated potential in enhancing the effectiveness of conventional cancer therapies. Methods: A systematic search of Web of Science, PubMed, Cochrane, Embase, China National Knowledge Infrastructure, and other databases was conducted up to July 30, 2024. Studies included were randomized controlled trials comparing cinobufacini combined with TP chemotherapy to TP chemotherapy alone in patients with advanced cervical cancer. The outcomes were clinical response rate, Karnofsky Performance Status, myelosuppression, platelet count, and incidences of vomiting and diarrhea. Data analysis was performed using RevMan 5.3, and risk ratios (RRs) and mean differences (MDs) were calculated with 95% confidence intervals (CIs). Heterogeneity was assessed using the I 2 statistic, and sensitivity analysis was performed to ensure robustness. Results: Six randomized controlled trials involving 814 participants were included. Cinobufacini combined with TP chemotherapy significantly improved the clinical response rate (RR 1.22, 95% CI [1.05–1.41], P = .009) and KPS (MD 7.37, 95% CI [6.40–8.34], P &lt; .00001). The intervention also reduced myelosuppression (RR 0.53, 95% CI [0.41–0.68], P &lt; .0001), platelet count decline (MD −94.25, 95% CI [−96.96 to −91.52], P &lt; .00001), vomiting (RR 0.58, 95% CI [0.45–0.76], P &lt; .0001), and diarrhea (RR 0.60, 95% CI [0.39–0.92], P = .02). Heterogeneity was moderate for the clinical response rate but reduced after sensitivity analysis, with stable overall effect estimates. Conclusion: Cinobufacini combined with TP chemotherapy significantly improves clinical outcomes and reduces treatment-related adverse effects. These findings suggest that cinobufacini may be a valuable adjunctive therapy in enhancing the efficacy and reducing the toxicity of TP chemotherapy, though further large-scale studies are needed to confirm its efficacy and safety.

The treatment of intravascular leiomyomatosis with different clinical manifestations: Two case reports

Rationale: Intravascular/intravenous leiomyomatosis (IVL) is a rare benign smooth muscle cell tumor with malignant biological behavior. The early diagnosis of IVL is challenging, and the range of treatment options is extensive. Patient concerns: Herein, we present 2 cases of IVL that present markedly different clinical presentations. These cases underscore the importance of vigilance in the diagnosis of IVL. A further objective of this study is to demonstrate the similarities and differences in treatment modalities. Patient 1 was registered for lower abdominal discomfort and a palpable pelvic mass, with a high preoperative suspicion of IVL. Patient 2 was characterized by severe vaginal bleeding during menstruation, accompanied by a palpable uterine mass, and an initial diagnosis of uterine adenomyosis or fibroids, with suspicion of IVL. Diagnoses: Both patients’ diagnoses were confirmed as IVL by histopathology. Interventions: Removal of the uterine lesion combined with bilateral salpingo-oophorectomy was performed in the former case, whereas total hysterectomy and bilateral salpingo-oophorectomy were performed in the latter case. Both were treated postoperatively with Qiu empirical formula, a traditional Chinese medicine herbal decoction. Outcomes: No recurrence was observed in either patient. Lessons: In the 2 cases examined in this study, following initial evaluation by imaging and complete resection of the lesion by surgical treatment initially, the patients demonstrated a more favorable prognosis following the application of herbal preparations in the long-term postoperative follow-up period. Our work provides additional information for clinicians to further study and better understand specific types of leiomyosarcoma.

Uterine intermural adenosarcoma arising from adenomyoma: A case report and review of literature

Rationale: Intramural adenosarcoma of the uterine myometrium is an uncommon gynecologic malignancy, often diagnosed postoperatively, and may arise from pre-existing benign lesions such as adenomyoma. Patient concerns: A 46-year-old woman presented with irregular vaginal bleeding during the postmenstrual period for 3 months. She had a prior history of adenomyoma resection and breast cancer treated with tamoxifen. Diagnoses: Pelvic ultrasonography suggested multiple uterine myomas. Histopathological and immunohistochemical analyses of the resected specimen confirmed low-grade malignant uterine adenosarcoma originating from adenomyoma. Interventions: The patient underwent a lower abdominal hysterectomy with bilateral adnexectomy. Outcomes: Postoperative recovery was uneventful. No adjuvant therapy was administered, and the patient remains under regular oncology follow-up without recurrence to date. Lessons: This case highlights the potential for malignant transformation of adenomyoma into intramural adenosarcoma and underscores the importance of thorough histopathological evaluation in patients with recurrent or atypical uterine masses.

One case report of low-segment giant uterine fibroids removed combined with cesarean section for delivery

Rationale: Large uterine fibroids in specific locations (e.g., lower uterus) pose significant controversy regarding removal during cesarean section (C-section) due to surgical difficulty, bleeding risk, and maternal/fetal safety concerns. This case addresses the challenge of a huge fibroid completely blocking the birth canal, preventing standard C-section. Patient concerns: A 35-year-old woman at 35 + 1 weeks presented with poorly controlled hypertension for 9 weeks, diagnosed as chronic hypertension with superimposed preeclampsia and a large uterine fibroid. Diagnoses: Chronic hypertension accompanied by preeclampsia, pregnancy with uterine fibroids. Interventions: After failed medical management (antihypertensives and antispasmodics) and onset of labor, an innovative “reverse-sequence cesarean myomectomy” (RCM) was performed with patient consent. This involved removing the giant lower uterine segment fibroid before delivering the fetus via C-section, utilizing a tourniquet. Outcomes: The RCM procedure was successful. The fibroid was removed, the baby delivered, and the C-section completed with only 400 mL blood loss. Both mother and infant had good outcomes, avoiding fetal removal difficulty and massive hemorrhage. Pathology confirmed leiomyoma. The approach utilized post-myomectomy uterine contraction for hemostasis and prevented the need for secondary surgery. Lessons: This case demonstrates that RCM is a safe, feasible, and innovative strategy for extreme cases where huge, strategically located fibroids (e.g., lower uterus) completely obstruct the birth canal. Its core advantages are: (1) solving the “unable to remove fetus” dilemma; (2) reducing bleeding risk via reverse timing (tumor first) and tourniquet; (3) avoiding a second surgery. RCM provides a valuable new option for managing these complex, high-risk pregnancies.

Intraplacental choriocarcinoma coexisting with fetomaternal hemorrhage and fetal intrahepatic portosystemic venous shunt in a term pregnancy: A case report

Rationale: Intraplacental choriocarcinoma (IC) coexisting with fetomaternal hemorrhage (FMH) in term pregnancy is rare and life-threatening for the mother and baby. The limited knowledge of this disease leads to delayed or missed diagnosis. This case report aims to illustrate how to avoid missed diagnosis through a more complicated case by the presence of fetal intrahepatic portosystemic venous shunt (IPSVS). Patient concerns: A 39-week pregnant woman presented to our hospital with decreased fetal movements. Diagnoses: Prenatally, the ultrasound examination identified the presence of IPSVS. FMH was diagnosed immediately after delivery, and the diagnosis was subsequently revised to IC with FMH 41 days postpartum when the mother developed symptoms of vaginal bleeding. Interventions: The mother received chemotherapy. Surveillance was conducted through measurements of beta human chorionic gonadotropin (β-hCG) and computed tomography imaging. The infant underwent β-hCG testing and ultrasound examinations for IPSVS. Outcomes: Following 6 cycles of chemotherapy, the mother’s β-hCG levels normalized, with complete resolution of pulmonary metastases. The infant’s β-hCG test results were negative, and no significant change was observed in the IPSVS. Lessons: IC coexisting with FMH is rare. Enhancing the understanding of the manifestations of this disease is vital for its early diagnosis. When unexplained FMH occurs, a systematic investigation into potential etiologies is necessary, and clinicians should remain vigilant for the possibility of IC. This case underscores the importance of thorough placental pathological examination and postpartum HCG monitoring for patients with FMH.

Knowledge of cervical cancer prevention and HPV vaccination: A survey among 961 college students in Hangzhou, China

The human papillomavirus (HPV) vaccine is the primary prevention for cervical cancer, which has not yet been added to the planned immunization in our country. However, the attitude and perceptions of college students towards HPV vaccination are unknown. We investigated the knowledge of and attitude towards HPV vaccination and cervical cancer among college students aged 18 years and older. A total of 961 college students in Hangzhou City, Zhejiang Province voluntarily participated in our study by filling out a self-administered questionnaire on HPV vaccination and knowledge of cervical cancer prevention. The age of all the college students was 24.69 ± 4.59 years, including 394 males (41%) and 567 females (59%). A logistic regression model was used to analyze the factors influencing the injection of the HPV vaccine among 961 college students. A total of 96.15% (924/961) of the college students said they had heard of the HPV vaccine, 84.60% (813/961) of the college students were willing to receive the HPV vaccine, and 56.08% (318/567) of the female college students had HPV vaccination. Logistic regression analysis showed that major, educational level, place of household registration, and mother’s education significantly influenced HPV vaccination (P &lt; .05). Increasing the knowledge and the coverage of HPV vaccine is important for cervical cancer prevention. Adding courses on the HPV vaccine in high schools and colleges, increasing HPV vaccine consultation clinics in community hospitals, developing more HPV vaccines and reducing the costs may be effective measures.

Postoperative clearance of high-risk human papillomavirus for patients with high-grade squamous intraepithelial lesion: Conization versus hysterectomy

To compare the clearance rate of high-risk human papillomavirus (HR-HPV) in patients with high-grade squamous intraepithelial lesion (HSIL) after 2 different treatments (conization vs hysterectomy), and investigate the influencing factors. A retrospective cohort was established in HSIL patients with HR-HPV infection treated with conization or hysterectomy from July 2020 to May 2022. Age matching (1:1) was conducted between conization group and hysterectomy group. Chi-square test and t-test were employed to compare baseline and clinical characteristics between the 2 groups (conization vs hysterectomy). In addition, univariate and multivariate logistic regression analyses were conducted to compare the influencing factors for HR-HPV clearance at 6 months after surgery. The HR-HPV clearance rates at 6 months were 70.6% and 73.8% in conization group and hysterectomy group in the matched groups, respectively (P = .755). Similarly, at 12 months, the clearance rates were 78.6% and 76.5% in the matched groups, respectively (P = .844). Considering different age groups among all patients, the HR-HPV clearance rates were 81.8%, 72.9%, 73.5%, and 53.6% in the 20 to 30-year, 31 to 40-year, 41 to 50-year and 51 to 60-year groups at 6 months, respectively, and the clearance rates were 87.5%, 80.6%, 84.5% and 52.9% at 12 months, respectively. For HSIL, the postoperative HPV clearance rates were similar between the 2 groups (conization vs hysterectomy), conization is enough to resect the lesion and eliminate HPV. In addition, we should pay attention to the postoperative HR-HPV status in the older population of the 2 groups.

Risk of cervical squamous cell carcinoma associated with a single nucleotide polymorphism in the RAD18 gene in the Chinese population and its significance as a predictive biomarker

RAD18 is a crucial mismatch repair gene associated with the post-replication repair, and genetic variations in RAD18 gene are closely related to tumorigenesis. We selected 6 RAD18 SNP and performed mismatch amplification PCR on 650 cases of CIN III, 580 cervical squamous cell carcinoma (CSCC), and 1320 healthy controls. The RAD18 rs250403 GG and G allele (AG + GG) genotype risk in CIN III and CSCC were significantly increased. The results showed a significant correlation between the GG genotype of rs615967 and the risk of CIN III and CSCC. Carriers of the G allele (AG + GG) at RAD18 rs615967 also had an increased risk. More noteworthy was that the RAD18 rs250403 (A/G) and rs615967 (A/G) haplotypes associated with high risk of CIN III and CSCC were AG-GG, GG-AA, GG-AG, and GG-GG. Clinical data analysis further showed that the polymorphisms of RAD18 rs250403 and rs615967 were significantly correlated with prognostic indicators such as family history of tumor, differentiation grade, lymph node metastasis, and vascular involvement. RAD18 protein expression was significantly decreased in CSCCs with the rs615967-AG and rs615967-GG genotype. In summary, the 2 genetic polymorphisms of the RAD18 were associated with susceptibility and prognosis in CIN III and CSCC, and specific high-risk haplotypes of these 2 SNPs could serve as genetic predictive biomarkers.

SMARCA4-deficient undifferentiated uterine sarcoma: A case report and literature review

Rationale: SMARCA4-deficient undifferentiated uterine sarcoma (SDUS) is a rare, sporadic malignant tumor of mesenchymal origin of the uterus, which has highly aggressive and poor prognosis. In this case, we described a malignant tumor formed in the uterus occurring in a SMARCA4 deletion type and discussed its clinical characteristics, differential diagnosis, treatment and related literature analysis. Patient concerns: A 61-year-old patient underwent diagnostic scraping at a local hospital for irregular vaginal bleeding for 2 months. The postoperative pathology suggested endometrial malignancy. A subsequent pelvic ultrasound at our hospital revealed that the endometrium was not clear, and a slightly hypoechoic mass of 7 + cm was seen in the uterine cavity. This mass had an irregular shape and unclear demarcation from the myometrium. Furthermore, the presence of abundant blood flow signals was detected in and around the uterine cavity. Diagnoses: The patient was ultimately diagnosed with stage IB SDUS by postoperative routine pathology and immunohistochemistry. Interventions: The patient underwent a single-port laparoscopic total hysterectomy, bilateral adnexectomy and pelvic lymph node dissection. Outcomes: The patient has undergone 3 cycles of postoperative platinum-based chemotherapy combined with docetaxel and epirubicin, and during the follow-up period, the patient remained in good overall condition without evidence of disease progression. Lessons: SDUS is a rare uterine sarcoma which cannot be underestimated and warrants careful clinical follow-up and histological evaluation.

Identification and validation of hub genes in uterine corpus endometrioid carcinoma: An observational study from TCGA and GEO

Uterine corpus endometrioid carcinoma (UCEC) is a prevalent malignant tumor of the female reproductive system. Despite advancements in molecular biology and treatment strategies, the underlying molecular mechanisms of UCEC tumorigenesis remain incompletely understood. This study aimed to identify differentially expressed genes (DEGs) associated with UCEC pathogenesis, and to determine potential prognostic biomarkers and immunotherapy targets for UCEC. RNA expression datasets and clinical data from UCEC patients were collected from the UCSC Xena database and The Cancer Genome Atlas database. Principal component analysis and LIMMA methods were employed to screen 177 UCEC tissues and 24 normal endometrial tissues. Gene ontology enrichment analysis revealed that up-regulated DEGs were primarily involved in tissue development, cell cycle regulation, and epithelial development. Subsequently, weighted gene co-expression network analysis (WGCNA) identified DEGs in the blue modules that were significantly positively correlated with UCEC, while DEGs in the black modules were significantly negatively correlated with UCEC. Among the identified DEGs through WGCNA, 16 genes were selected, and further Kaplan–Meier analysis demonstrated that 5 of these genes (AURKA, CCNE1, IQGAP3, TTK, and UBE2C) were significantly negatively correlated with overall survival (OS) and considered as hub genes. The expression of these hub genes was validated using GEO datasets and immunohistochemistry (IHC) analysis from the human protein atlas. Additionally, the calculation of immune scores for immune infiltration, immune cell infiltration, and immune cell regulation across the 5 hub genes revealed potential immunotherapeutic targets and strategies. This comprehensive investigation provides insights into the molecular mechanisms underlying UCEC development, identifies 5 promising prognostic biomarkers and immunotherapy targets, and offers guidance for UCEC treatment approaches.

Causal association between uterine fibroids and cardiovascular disease: A Mendelian randomization study

Uterine fibroids (UF), the most common benign tumors in women, have been associated with cardiovascular disease (CVD) in observational studies, yet causal inference remains unclear due to confounding. This Mendelian randomization (MR) study leveraged genetic variants as instrumental variables (IVs) to evaluate the causal relationship between genetically predicted UF and CVD risk. Exposure data were derived from a UK Biobank genome-wide association study of 462,933 Europeans (5168 UF cases). Outcome data for CVD subtypes were obtained from FinnGen and EBI consortia (sample sizes: 180, 862–977, 323). Fourteen independent single-nucleotide polymorphisms strongly associated with UF (P &lt; 5 × 10⁻⁶) were selected as IVs, pruned for linkage disequilibrium (r 2&lt;0.001; F-statistic &gt; 10). The inverse-variance-weighted method was used for primary analysis, supplemented by sensitivity approaches (weighted median, MR-Egger, MR-PRESSO). Robustness was evaluated via Cochran Q test (heterogeneity), MR-Egger intercept (pleiotropy), and leave-one-out analysis. Genetically predicted UF showed no causal effects on ischemic heart disease (OR = 2.00E−02, 95% CI: 2.21E−04 to 2.47E+00, P = .11), heart failure (OR = 5.20E−01, 95% CI = 1.03E−02 to 2.57E+01, P = .74), venous thromboembolism (OR = 1.65E+00, 95% CI: 1.13E−03 to 2.41E+03, P = .89), or stroke (OR = 3.70E−01, 95% CI = 1.82E−03 to 7.48E+01, P = .71). Sensitivity analyses confirmed consistency (all P &gt; .05), with no heterogeneity (Cochran Q P &gt; .05) or horizontal pleiotropy (MR-Egger intercept P &gt; .05). Leave-one-out analysis indicated stable estimates. This MR study found insufficient evidence to support a causal link between UF and CVD, contrasting previous observational reports.

Development of a nomogram for predicting positive margins after cold knife conization in patients with high-grade squamous intraepithelial lesions

The objective was to develop a nomogram for predicting positive margins after cold knife conization (CKC) in patients with high-grade squamous intraepithelial lesion (HSIL). This retrospective study included patients who underwent CKC at Baoding No. 1 Central Hospital between December 2013 and March 2024. Patients were divided into training (between December 2013 and December 2022) and validation (between January 2023 and March 2024) sets. The least absolute shrinkage and selection operator regression was applied to filter and select relevant variables. Multivariable logistic regression was used for nomogram construction. The model performance was evaluated using various methods, including receiver operating characteristics, decision curve analysis, and calibration analysis. The training and validation sets included 985 and 227 patients, respectively. Age (OR = 1.046, 95% CI: 1.028–1.064, P &lt; .001), cervical intraepithelial neoplasia quadrants by punch biopsy (OR = 1.561, 95% CI: 1.348–1.808, P &lt; .001), HSIL type (OR = 1.711, 95% CI: 1.102–2.657, P = .017), and gland involvement (OR = 1.552, 95% CI: 1.073–2.247, P = .020) were associated with positive margins and used for nomogram construction. The predictive model yielded area under the curves of 0.744 and 0.754 in the training and validation sets, respectively. Decision curve analysis indicated a net benefit when using the nomogram, and the calibration curves demonstrated a good fit. This study constructed a nomogram model for predicting positive margins after CKC in patients with HSIL. This nomogram may enable early and accurate patient evaluation, potentially improving clinical outcomes.

A retrospective study on the relationship between delirium and long-term cognitive function in elderly women following cervical cancer surgery

This study aimed to investigate the relationship between postoperative delirium and long-term cognitive function in elderly women undergoing cervical cancer surgery, providing insights into the long-term effects of postoperative cognitive alterations. A retrospective analysis was conducted on 120 elderly women (≥60 years) who underwent cervical cancer surgery over the past decade. Patients were categorized into a postoperative delirium group (n = 45) and a non-delirium group (n = 75) based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, with initial screening using the confusion assessment method. Cognitive function was assessed preoperatively, and at 1 year and 3 years postoperatively using the Mini-Mental State Examination (MMSE). Multivariate logistic regression analysis was performed to identify independent predictors of long-term cognitive decline, adjusting for potential confounders such as age, underlying health status, psychiatric history, and psychological distress. Postoperative delirium occurred in 37.5% (45/120) of patients. One year after surgery, MMSE scores were significantly lower in the delirium group (P &lt; .05), and this difference persisted at 3 years (P &lt; .05). Univariate regression analysis identified postoperative delirium, older age, poorer health status, psychiatric history, preoperative psychotropic drug use, longer hospital stay, pain scores, and psychological distress as significant risk factors for cognitive decline at both time points. Multivariate analysis confirmed that postoperative delirium (P &lt; .001), age (P &lt; .05), poorer health status (P &lt; .05), psychiatric history (P &lt; .001), preoperative psychotropic drug use (P &lt; .05), and psychological distress (P &lt; .001) were independent predictors of long-term cognitive decline. Length of hospital stay and pain scores were not significant in the multivariate model (P &gt; .05). Postoperative delirium is a strong and persistent risk factor for long-term cognitive decline in elderly women following cervical cancer surgery. Psychiatric history and psychological distress further exacerbate cognitive deterioration. These findings highlight the urgent need for improved perioperative cognitive assessment and management strategies to reduce the long-term impact of postoperative delirium in this high-risk population.

Recurrence complicated with peritoneal dissemination after single-port gasless myomectomy for cellular uterine leiomyoma: A case report and literature review

Rationale: Cellular uterine leiomyomas (CL) represent the prevailing subtype among uterine leiomyomas. In this study, we report a case of recurrent peritoneal disseminated uterine fibroids 2 years after single-port laparoscopic gasless myomectomy. This article endeavors to examine the potential limitations of the aforementioned surgical procedure and outline the distinguishing features of recurrent cases with primary postoperative pathology as CL. Additionally, it aims to provide a summary of previous retrospective studies on CL and propose the existence of immunohistochemical molecules that may serve as predictors for the postoperative recurrence of cellular uterine fibroids. The ultimate objective is to enhance clinicians’ comprehension of the disease. Patient concerns: Two years ago, the patient underwent a single-port gasless laparoscopic myomectomy for uterine fibroids. Gynecological color Doppler ultrasound conducted 3 months ago revealed recurrence of uterine fibroids, and the patient experienced abdominal distension, mild urinary frequency, and constipation for the past month. Diagnoses: After the second surgical procedure, a comprehensive pathological examination and immunohistochemical analysis of both the uterine mass and metastatic lesions revealed that the definitive diagnosis was CLs. Interventions: The patient underwent the total hysterectomy, bilateral salpingectomy, pelvic adhesiolysis, omental mass resection, mesenteric mass resection, and pelvic peritoneal mass resection. All specimens were sent for rapid frozen examination and showed to be leiomyomas. Outcomes: The patient was discharged from the hospital on the 10th day after the operation. At the date of writing the article, the patient had no recurrence for 1 year and 5 months. Lessons: The single-port gasless approach did not achieve the desired reduction in fibroid recurrence, as anticipated by the surgeon. The act of pulling the tumor towards the abdominal incision for resection, on the contrary, may serve as an iatrogenic factor contributing to postoperative recurrence of CL into peritoneal dissemination leiomyomatosis. The single-port gasless assisted bag may be a more suitable option for myomectomy. The utmost effort should be made to prevent the potential recurrence of myoma caused by iatrogenic factors.

Dosimetric evaluation of image-guided adaptive radiotherapy for locally advanced cervical cancer

This study evaluates the dosimetric benefits of off-line adaptive radiotherapy (ART) planning during radiotherapy for locally advanced cervical cancer. Forty-four patients in our hospital were included. The patients were monitored by cone-beam CT (CBCT), and the secondary CT scanning was performed timely. The ART2 planning was performed based on tumor regression and compared with the initial radiotherapy planning (ART1). The mean time of the secondary CT scanning was the thirteen fractions, and the mean gross tumor volume (GTV) decreased by 23.3%. The ART2 compared with the ART1 planning, significantly reduced the mean dose of PGTV (defined as the GTV with 5 mm expansion all directions)-D2%, V110, and PTV-V110 by 1.9 Gy, 9.2%, and 3.4%, whereas there was no significant difference in tumor target D98%, D50%, and V100 between the two groups. The HI of PGTV and planning target volume (PTV) was significantly lower in the ART2 planning. For the comparison of OARs dosimetric parameters, the ART2 planning was significantly decreased the mean dose of rectum-Dmean (2 Gy), D1cc (0.6 Gy), V30 (7.3%) and V40 (5.9%), bladder-D1cc (1.1 Gy), left femoral head-Dmean (1.2 Gy), V40 (1.3%) and right femoral head-Dmean (1.3 Gy), but significantly increased the small intestinal-V30 (2.5%). Other OARs dosimetric parameters were similar between two plannings. The Off-line ART planning can adapt for the changes in the target volume, and further decrease the target volume hotspot area/dose and OARs irradiation dose in locally advanced cervical cancer patients. And the clinical benefit of ART still needs to be verified in clinical trials.

Vaginal stump rupture due to sexual activity leading to small intestine vaginal hernia and intestinal necrosis in a woman after cervical cancer surgery: A case report

Rationale: Radical hysterectomy is the standard surgical procedure for early-stage cervical cancer, and postoperative adjuvant chemoradiotherapy is administered based on pathological high-risk and intermediate-risk factors. After treatment of cervical cancer, all focus is placed on postoperative recurrence, metastasis and menopausal symptoms, and almost no one pays attention to the recovery of vaginal elasticity and sexual activity of reproductive-age women. Due to frequent surgery and radiation therapy for cervical cancer patients, the length and elasticity of the vagina are reduced. Cervical cancer patients need to be aware of issues related to sexual activity, such as vaginal shortening or shrinking, the impact of cancer on sexuality, and when to restore sexual activity after surgery. Patients who receive this information can better cope with these changes. We report a clinical case with the aim of sharing our experiences and calling for an emphasis on the recovery of vaginal stump and vaginal elasticity and sexual activity guidance after radical hysterectomy. Patient concerns: A 48-year-old woman with cervical cancer who underwent radical hysterectomy 6 years ago was admitted to the gastrointestinal surgery ward urgently, having shown severe upper abdominal pain accompanied 6 hours after sex activity. Diagnoses: Small bowel vaginal hernia with intestinal necrosis was diagnosed. Interventions: Urgent surgery was performed to resect the necrotic small intestine and repair the vaginal stump and pelvic floor. Outcomes: After surgery, she recovered well and is currently under regular follow-up for cervical cancer. Lessons: It is crucial to regularly guide and follow-up on patients’ sexual behavior during the follow-up period after cervical cancer surgery. Gynecologists should fully inform the time for restoring sexual relations after cervical cancer surgery. Nursing staff should be guided to avoid premature and excessive sexual activity to the vaginal cuff to prevent rupture and other potential complications. Effective medical intervention should be implemented as early as possible for patients with vaginal sac rupture after cervical cancer surgery. Current research on sexual activity after cervical cancer surgery has many limitations and more detailed studies are needed. A specific questionnaire to assess sexual activity and a clinical study to determine the appropriate medication to restore vaginal elasticity are expected.

Intestinal perforation in recurrent cervical cancer following bevacizumab and pembrolizumab therapy: A case report

Rationale: Since the advent of immunotherapy in clinical practice, it has profoundly transformed the paradigm of cancer treatment and has been rapidly adopted in clinical settings. Concurrently, the combination of immunotherapy with anti-angiogenic therapy has shown great promise in clinical research. The inevitable joint application brings about a greater number of adverse reactions. These adverse reactions are often perplexing, with the uncertainty of whether they stem from immunotherapy, anti-angiogenic therapy, or both. This is a case report of adverse reactions occurring when immune drugs and anti-vascular drugs are used together. This case is analyzed to provide a warning for adverse reactions in the clinical application of anti-angiogenic therapy combined with immunotherapy. Patient concerns: A 52-year-old cervical cancer patient with metastases had abdominal pain and fever post-treatment with bevacizumab, pembrolizumab, and chemotherapy, suggesting intestinal perforation. Diagnoses: After 2 chemotherapy cycles with bevacizumab and pembrolizumab, the patient had fever up to 39°C and abdominal pain. Exam showed tenderness, rigidity, and weak bowel sounds. Blood tests revealed leukocytosis and neutrophilia. Imaging indicated pneumoperitoneum and possible intestinal obstruction. Interventions: Emergency laparotomy revealed a small intestine perforation with strictures, leading to resection and ileostomy due to edema. Outcomes: The postoperative recovery was good. We consider intestinal perforation caused by bevacizumab. Therefore, the patient was subsequently discontinued from bevacizumab and continued to receive paclitaxel, cisplatin and pembrolizumab. At present, the patient has finished chemotherapy and is receiving pembrolizumab maintenance therapy with no significant gastrointestinal adverse reactions. Lessons: Anti-angiogenic drugs and immunotherapy drugs each have their own side effects, and the occurrence of adverse reactions becomes more complex when used in combination. In the clinical process of combined medication, more attention should be paid to adverse reactions, early identification of severe adverse reactions, and active management.

Screening and identification analysis of core markers for leukemia and cervical cancer: Calmodulin 3 as a core target

Leukemia is a type of malignant tumor affecting hematopoietic system. Cervical cancer is a malignant tumor of female reproductive tract. The relationship between Calmodulin 3 (CALM3) and leukemia, cervical cancer remains unclear. Leukemia dataset GSE26294 and cervical cancer dataset GSE173097 profiles were downloaded from gene expression omnibus. Principal component analysis, differentially expressed genes (DEGs) screening, weighted gene co-expression network analysis (WGCNA), functional enrichment analysis, gene set enrichment analysis, immune infiltration analysis, protein–protein interaction network construction and analysis, survival analysis were performed. Gene expression heatmaps were plotted. Comparative Toxicogenomics Database (CTD) was used to find diseases most related to core genes. 77 DEGs were identified. According to gene ontology, in biological process category, they were mainly enriched in cell proliferation, immune response, and apoptotic process. In cellular component category, they were mainly enriched in nucleus and Golgi apparatus. In molecular function category, they were mainly enriched in DNA binding, protein binding, transcription factor activity. In Kyoto encyclopedia of gene and genome analysis, they were mainly enriched in cell adhesion molecules, Wnt signaling pathway, cAMP signaling pathway, cGMP-PKG signaling pathway, and basal cell carcinoma. The soft-threshold power in WGCNA was set to 1, generating 6 modules. Finally identifying 3 core genes (CALM3, secreted frizzled-related protein 4, plasminogen). CTD analysis revealed that core genes were related to leukemia, coagulation disorders, vaginal tumors, cervical tumors, autoimmune diseases, and inflammation. CALM3 is lowly expressed in leukemia samples and highly expressed in cervical cancer samples.

Causal association between artificial sweeteners and risk of 15 tumors: A 2-way 2-sample Mendelian randomization analysis

The aim of this study was to apply a 2-sample Mendelian randomization approach, uncovering the causal link between artificial sweetener (AS) intake in cereals, coffee and tea and cancer. For this purpose, the research team obtained and utilized comprehensive data from published genome-wide association studies and selected genetic variants associated with AS as instrumental variables. Through 5 analytical techniques such as inverse variance weighting, MR-Egger, weighted median, simple multiple, and weighted multiple. In this study, the potential risk associations between AS and 15 cancers were comprehensively evaluated, and sensitivity analyses were used to assess the robustness of the results. Statistical results showed that there were causal associations between AS and breast cancer, oral cancer, esophageal cancer, gastric cancer, colorectal cancer, prostate cancer, ovarian cancer, kidney cancer, and lung cancer (inverse variance weighting method: P  &lt; .05). AS was a protective factor for breast cancer, gastric cancer, colorectal cancer, prostate cancer, and kidney cancer, and reduced their incidence. AS is a risk factor for oral cancer, esophageal cancer, ovarian cancer, and lung cancer, which increases the probability of occurrence. Sensitivity analysis showed that there was no significant heterogeneity or pleiotropy, and the results were relatively stable. AS intake was associated with a reduced risk of breast, stomach, colorectal, prostate, and kidney cancers; AS intake was associated with an increased risk of oral, esophageal, ovarian, and lung cancers.

Large uterine fibroid causing DVT and PE: Successful management with mechanical aspiration thrombectomy and hysterectomy: A case report and literature review

Rationale: Uterine leiomyomas, though commonly benign, can occasionally lead to serious complications, including deep vein thrombosis (DVT) and pulmonary embolism (PE). This study aims to highlight the uncommon yet serious association between large uterine leiomyomas and thromboembolism, which is often overlooked in patients without traditional risk factors. It emphasizes the need for awareness, early diagnosis, and timely intervention to prevent complications in patients presenting with unexplained symptoms and pelvic masses. Patient concern: A 38-year-old gravida 5, para 2 woman presented to the emergency room with left lower extremity swelling, pain, and discoloration, accompanied by dyspnea. She had no prior history of DVT or PE and did not have any known risk factors for venous thromboembolism. Diagnosis: The patient was diagnosed with DVT and PE, confirmed by venous duplex ultrasound and abdominal and pelvic computed tomography, which revealed thrombus extension to the left iliac vein. Chest computed tomography angiography confirmed a partially occlusive thrombus in the pulmonary arteries. Intervention: The patient underwent mechanical aspiration thrombectomy, followed by placement of a left iliac stent. Anticoagulation therapy with heparin was initiated post-thrombectomy. On the third day, a right supracervical hysterectomy was successfully performed. After surgery, anticoagulation was continued with heparin, and the patient was later discharged on apixaban for ongoing therapy. Outcomes: The patient made full recovery with no recurrence of thromboembolic events at 11 months posttreatment. Lessons: This case highlights the rare but serious complication of DVT and PE in patients with uterine leiomyomas. Timely intervention with thrombectomy, stent placement, and hysterectomy was effective in resolving the thromboembolic events.

A feasibility study of DNA ploidy analysis, HPV, and TCT for screening of cervical cancer: A retrospective study

The present study aimed to evaluate the application of DNA ploidy analysis, human papillomavirus (HPV-DNA) test, and thin-prep cytologic test (TCT) for mass screening of cervical cancer (CC). A total of 13,830 patients who underwent both TCT and HPV-DNA tests from June 2021 to June 2022 were selected as study participants (10,107 patients from Shandong Provincial Hospital, 2447 patients from First People’s Hospital of Tancheng County, and 1276 patients from Liaocheng People’s Hospital). We also conducted a DNA ploidy analysis and compared the results. A biopsy was performed by colposcopy according to the screening results, and the diagnosis based on the results of the biopsy was regarded as “the golden standard.” The χ2 test was used for group comparison, the Kruskal–Wallis test was used for ordinal data, and the Kappa test was used for consistency analysis. Based on the retrospective analysis of the biopsy results, DNA ploidy analysis, and TCT combined with HPV-DNA test, the accuracy of predicting precancerous cervical lesion was 97.95%, the positive predictive value was 66.72%, and the negative predictive value was 97.30%. The comprehensive detection showed a similar outcome as that for histopathological examination. The study demonstrates that DNA ploidy analysis, when used in conjunction with the HPV-DNA test and TCT, significantly enhances the accuracy of CC screening. DNA ploidy analysis provides a reliable basis for the early detection and accurate prediction of precancerous cervical lesions, supporting its integration into routine CC screening protocols.

Causal relationship between uterine fibroids and cardiovascular disease: A two-sample Mendelian randomization study

Previous studies have indicated that patients with uterine fibroids (UF) may have an elevated risk of cardiovascular disease (CVD), although the causal relationship between UF and CVD remains unclear. In this Mendelian randomization (MR) study, we aimed to investigate the causal association between genetic susceptibility to UF and the risk of developing CVD. We extracted summary statistics for single nucleotide polymorphisms associated with UF and 5 CVDs from multiple databases for further analysis. First, we used linkage disequilibrium score regression to assess the genetic correlation across the genome. Next, we performed univariate MR (UVMR), and to ensure the robustness of our results, we conducted sensitivity analyses using several methods. Additionally, we applied multivariable MR (MVMR) to adjust for potential confounders. The linkage disequilibrium score regression results showed that there was no genetic correlation between UF and coronary heart disease, myocardial infarction (MI), atrial fibrillation, heart failure, cardioembolic stroke (CES). The UVMR revealed a significant association between UF and CES (OR = 1.113, 95% confidence interval [CI]: 1.018–1.218, P = .019, P FDR = .047) and a suggestive causal relationship between UF and MI (OR = 0.943, 95% CI: 0.899–0.989, P = .015, P FDR = .075). In the MVMR analysis, after adjusting for a range of potential confounders, the causal relationships between UF and both CES (OR = 1.104, 95% CI = 1.012–1.205, P = .027) and MI (OR = 0.935, 95% CI = 0.882–0.992, P = .025) remained significant. Our study found that UF increase the risk of CES but decrease the risk of MI, providing a theoretical basis for further research into the underlying mechanisms.

Cytologic features of gastric-type endocervical adenocarcinoma: Three cases report and literature review

Rationale: Cervical gastric-type adenocarcinoma shows gastric differentiation, and the tumor cell morphology appears benign and unrelated to human papillomavirus, which makes cervical gastric-type adenocarcinoma highly susceptible to misdiagnosis as normal glandular epithelium in cytologic diagnosis. Patient concerns: We present 3 cases of gastric-type adenocarcinoma, with the first being a 57-year-old female with abnormal uterine bleeding and fluid drainage. The second patient was a 63-year-old female, and the third was a 59-year-old female with irregular vaginal bleeding after menopause. Diagnosis: The 3 patients were diagnosed with cervical gastric-type adenocarcinoma by combining their history, clinical data, cytopathology, histopathology, and immunohistochemistry. Interventions: Patient 1 underwent total hysterectomy and adnexectomy, but refused radiotherapy and chemotherapy. Patient 2 received a chemotherapeutic regimen, and patient 3 was treated with traditional Chinese medicine. Outcomes: Patient 1 was followed-up for 9 months and is currently in good general condition, while patients 2 and 3 were not followed-up. Lessons: The “drunken honeycomb” cell arrangement is diagnostically important in liquid-based cytology, especially when three-dimensional spheroids are present, and may be a characteristic cytological finding of well-differentiated cervical gastric-type adenocarcinoma.

Parental Perspectives on Human Papillomavirus (HPV) Vaccination in Gulf Cooperation Council Countries: A systematic review

Background: This systematic review aims to synthesize existing research on parental knowledge, attitudes, and barriers to human papillomavirus (HPV) vaccination in the Gulf Cooperation Council (GCC) countries. Methods: Following PRISMA guidelines, this systematic review analyzed parental knowledge, attitudes, and barriers to HPV vaccination in 6 GCC countries. A comprehensive search across multiple electronic databases (Embase, Cumulative Index of Nursing and Allied Health Literature, Scopus, Ovid MEDLINE, Web of Science, and PubMed) was conducted, focusing on studies published between January 2010 and December 2023. Inclusion criteria targeted studies in English or Arabic involving parents in GCC countries, excluding non-research publications and those not using survey techniques. Results: The review included 7 studies from Saudi Arabia, the United Arab Emirates, and Qatar. No study was found in Oman, Bahrain, and Kuwait. The findings highlighted low knowledge and awareness of HPV and the vaccine, with significant variation across studies. According to our review findings, the level of awareness in the 7 studies was found to be low to high. These studies collectively illustrate a range of awareness levels, from as low as 11% awareness of the HPV-cervical cancer link to as high as 68% general awareness of HPV. Attitudes towards vaccination were poor in Saudi Arabia but more positive in the United Arab Emirates and Qatar. Major barriers included safety concerns, lack of information, and cultural beliefs. Conclusion: Despite moderate awareness in some GCC countries, substantial knowledge gaps and vaccine hesitancy persist. Targeted educational campaigns, effective communication strategies, and involvement of community leaders are essential to improve HPV vaccination uptake.

Immunoprognostic analysis of indoleamine 2,3-dioxygenase 1 in patients with cervical cancer

The incidence of cervical cancer is increasing. Immunotherapies show better patient outcomes than monotherapies; however, the mainstay treatment for cervical cancer remains surgery and chemotherapy. Indoleamine 2,3-dioxygenase 1 (IDO1) acts on multiple tryptophan substrates, exhibiting antitumor, immunomodulatory, and antioxidant activities. Despite the association of elevated IDO1 expression with unfavorable outcomes in various cancers, its precise function in cervical cancer remains ambiguous. Here, we explored the prognostic significance of IDO1 in cervical carcinoma. Gene expression datasets were obtained from The Cancer Genome Atlas. Gene Expression Omnibus datasets were used for differential expression and functional correlation analyses. Using Human Protein Atlas alongside Tumor-Immune System Interaction Database, we assessed the association of IDO1 with survival rates. Given the link between cervical cancer prognosis and immune invasion, CIBERSORT was used to assess the connection between immune cells and IDO1, while the percentage of tumor-penetrating immune cells based on IDO1 expression in cervical cancer patients was analyzed using Tumor-Immune System Interaction Database. Incorporating a clinicopathological characteristic-based risk score model with IDO1 risk score, we devised a nomogram to predict cervical cancer patient survival. The effects of IDO1 in immune regulation and its prognostic significance were validated using data from patients with cervical cancer obtained from The Cancer Imaging Archive database. Compared with that in normal cervical tissues, IDO1 expression was significantly upregulated in cervical cancer tissues and significantly correlated with cervical cancer progression and prognosis. IDO1 expression showed a positive association with monocyte and macrophage abundance, while exhibiting a negative correlation with that of endothelial cells and eosinophils. Cox regression analyses highlighted IDO1 as the core immune gene implicated in cervical cancer. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed an association of IDO1 with the metabolic pathways of tryptophan, phenylalanine, and tyrosine. Univariate and multivariate analyses revealed that elevated IDO1 expression correlates markedly with cervical cancer outcomes, suggesting it as a promising therapeutic target. The Cancer Imaging Archive data analysis revealed that the impact of anti-PD1 and CTLA4 therapy is more pronounced in cervical cancer patients exhibiting elevated IDO1 expression. IDO1 is a potential target for immunotherapy for cervical cancer.

Association of MORC2 expression with progression-free survival in cervical cancer patients treated with concurrent chemoradiotherapy

MORC family CW-type zinc finger 2 (MORC2) is a newly identified chromatin remodeling protein, and has been proposed as a prognostic biomarker associated with survival in some types of human cancer, but the role of MORC2 in cervical cancer remains unknown. Here, we investigated the role of MORC2 expression in predicting the survival outcomes of locally advanced cervical cancer patients treated with cisplatin-based concurrent chemoradiotherapy (CCRT). In this retrospectively study, we detected MORC2 immunohistochemical expression on 55 biopsies from patients who underwent CCRT. The association between the MORC2 expression and various clinicopathological characteristics were analyzed, as were association between MORC2 expression and locoregional failure and progression-free survival (PFS) of cervical cancer patients. MORC2 expression was positively associated with pelvic node metastasis and locoregional failure. Higher MORC2 expression was a significant indicator of worse PFS. Our results suggest that MORC2 expression may be a prognostic indicator in patients with locally advanced cervical cancer undergoing CCRT.

Assessment of health literacy and HPV knowledge among university students: An observational study

Health literacy (HL) level is related to promotion of health, improved health behaviors, and early diagnosis of diseases, as well as the appropriate use of health services. Human papillomavirus (HPV) vaccination is the primary method of protection against cervical cancer and recommended for women aged 9 to 27. This study aims to assess the university students’ knowledge about HPV and the association between HL and HPV vaccination. In this cross-sectional and descriptive study, an electronic survey was used. Demographic characteristics and anthropometric measurements of the participants were questioned. HPV Knowledge Scale (HPV-KS) and Turkish Health Literacy Scale (THLS-32) were used to evaluate HPV knowledge and HL. Statistical analyzes were performed with SPSS version 26. A total of 361 university students (74% women), aged 21.98 ± 4.72 years, were included in the study. About 52% of the participants were health sciences students. The total THLS-32 score was 34.68 ± 9.37 (95% CI = 33.71–35.65), and the total adequate/excellent HL level was 51%. The mean HPV-KS score of the participants was 10.28 ± 8.15 (95% CI = 9.44–11.12) of a possible 35. Health sciences students had higher rates of HPV awareness (78% vs 65%; P = .007). General HPV knowledge level was significantly better among women (P &lt; .001), &gt;20 years (P = .002), and those with a family history of cancer (P &lt; .001) and significantly lower among students at prep or first year of school (P &lt; .001). There was a weak, positive relation between THLS-32 and HPV-KS score (R = 0.136; P = .01). Participants with higher levels of HPV knowledge (P = .034) and total HPV-KS score (P = .025) were statistically significantly higher in students with adequate/excellent HL. Our results reveal that knowledge about HPV vaccination is closely related to HL levels. Educational interventions on HL may be considered to increase HPV vaccination rates.

Cervical clear cell carcinoma: Case report and literature review

Rationale: Clear cell carcinoma (CCC) is a highly invasive malignant tumor. CCCs of the female reproductive system occur mostly in the endometrium and ovaries and rarely in the cervix. So, it is difficult to diagnose cervical clear cell carcinoma (CCAC) on imaging. This report helps to further deepen our understanding of CCAC. Patient concerns: A 39-year-old female patient presented with vaginal discharge with no obvious cause, elevated levels of carcinoembryonic antigen (CEA), CA125, CA153, and squamous cell carcinoma antigen (SCC), and underwent ultrasonography (US) CT and MRI examination in our hospital, which showed a mass in the cervix of the uterus, considered of cervical squamous carcinoma. Diagnoses: The cervix biopsy guided by vaginoscope biopsy and immunohistochemistry confirmed CCAC, combined Magnetic Resonance Imaging examination, CCAC with pelvic lymph node metastasis was considered. Interventions and outcomes: The patient refused further treatment and was discharged from hospital. Lessons: CCAC exhibited no specific symptoms, and is slightly different from cervical squamous carcinoma in image features, mainly relying on immunohistochemistry for diagnosis. The reported case raised awareness of CCAC.

Prevalence of human papilloma virus among cervical cancer patients in India: A systematic review and meta-analysis

Background: Cervical cancer, predominantly caused by the human papillomavirus (HPV), is a major health challenge in India, with high morbidity and mortality rates. Given India’s vast geographic and socio-economic diversity, understanding regional variations in HPV prevalence is crucial for developing targeted and effective public health interventions. This systematic review and meta-analysis were conducted to elucidate the prevalence of HPV among cervical cancer patients in India. Methods: A literature search was executed across PubMed, EMBASE, and Web of Science up to December 07, 2023. Observational studies reporting HPV prevalence among cervical cancer patients in India are included. A Modified Newcastle-Ottawa scale was used for quality assessment. A random-effects meta-analysis was used to determine pooled HPV prevalence, and heterogeneity was evaluated using the I² statistic. Subgroup and sensitivity analyses were performed to assess result stability and investigate heterogeneity sources. All statistical analyses were performed using R software version 4.3. Results: The meta-analysis included 17 studies with a total of 2529 cervical cancer cases, of which 1977 were HPV-positive. The pooled HPV prevalence was 85% (95% CI: 71–92%), with substantial heterogeneity (I² = 94%). Subgroup analysis by geographic zones showed notable differences: South (88%, 95% CI: 76–95%), North (73%, 95% CI: 1–100%), East (99%, 95% CI: 1–100%), Central (71%, 95% CI: 54–84%), and West (77%, 95% CI: 0–100%). Sensitivity analysis demonstrated the consistency of the results, and a reanalysis, excluding influential studies, yielded a prevalence of 82% (95% CI: 67–91%). Conclusion: Our analysis reveals a high prevalence of HPV in cervical cancer patients in India, with significant regional variations. The observed heterogeneity highlights the complexity of HPV epidemiology in India and necessitates further research to explore underlying causes and regional characteristics. Future studies should aim to expand geographic representation and deepen understanding of the factors contributing to the variability in HPV prevalence.

Cervical metastasis of breast cancer: A case report and literature review

Rationale: Cervical metastasis of breast cancer is rare and its clinical manifestations are similar to those of primary cervical cancer. It is thus easy to misdiagnose, with diagnosis mainly depending on pathology and immunohistochemistry. There have been few studies on its treatment and there is thus no standard treatment plan. Patient concerns: This is a 64-year-old female patient presented with a 2-month history of abnormal postmenopausal vaginal discharge, who had previous history of breast cancer. Diagnoses: Based on the gynecological examination, imaging results, pathology, and immunohistochemical results, a diagnosis of metastatic carcinoma of the cervix and breast cancer was confirmed. Interventions: She received computed tomography-guided 3-dimensional high-dose-rate brachytherapy in combination with chemotherapy. Outcomes: She achieved complete response locally. This case provides a new local treatment option for patients with inoperable localized cervical metastases. Lessons: We hope that this report and the accompanying review help to enrich the literature pertaining to the treatment of rare cervical metastases, providing a foundation for the improved survival of affected patients.

Development and validation of a nomogram to predict overall survival for cervical adenocarcinoma: A population-based study

This study aimed to develop and validate a nomogram for predicting the overall survival of cervical adenocarcinoma (CAC) patients using a large database comprising patients with different ethnicities. We enrolled primary CAC cases with complete clinicopathological and survival data from the Surveillance, Epidemiology, and End Results program during 2004 to 2015. For training set samples, this work applied the Cox regression model to obtain factors independently associated with patient prognosis, which could be incorporated in constructing the nomogram. Altogether 3096 qualified cases were enrolled, their survival ranged from 0 to 155 (median, 45.5) months. As revealed by multivariate regression, age, marital status, tumor size, grade, International Federation of Gynecology and Obstetrics (FIGO) classification, pelvic lymph node metastasis, surgery, and chemotherapy served as the factors to independently predict CAC (all P &lt; .05). We later incorporated these factors for constructing the nomogram. According to the concordance index determined, this nomogram had superior discrimination over FIGO classification system (all P &lt; .001). Based on calibration plot, the predicted value was consistent with actual measurement. As revealed by time-independent area under the curves, our constructed nomogram had superior 5-year overall survival over FIGO system. Additionally, according to decision curve analysis, our constructed nomogram showed high clinical usefulness as well as favorable discrimination. Our constructed nomogram attains favorable performances, indicating that it may be applied in predicting survival for CAC patients.

Construction of artificial neural network (ANN) based on predictive value of prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) in patients with cervical squamous cell carcinoma

To explore the analytical worth of prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) in patients with cervical squamous cell carcinoma. The clinical data of 539 patients with cervical cancer in the Affiliated Tumor Hospital of Nantong University from December 2007 to October 2016 were analyzed retrospectively. The ROC is used to select the best cutoff values of PNI and NLR, which are 48.95 and 2.4046. Cox regression analysis was used for univariate and multivariate analysis. Survival differences were assessed by Kaplan–Meier (KM) survival method. Finally, a 3-layer artificial neural network (ANN) model is established. In cervical squamous cell carcinoma, the KM survival curve showed that the overall survival (OS) rate of high-level PNI group was significantly higher than that of low-level PNI group (P &lt; .001), while the OS rate of low-level NLR group was significantly higher than that of high-level NLR group (P = .002). In non-squamous cell carcinoma, there was no significant difference in OS between the 2 groups (P &gt; .005). According to Cox multivariate analysis, preliminary diagnosed PNI and NLR were independent prognostic factors of cervical squamous cell carcinoma (P &lt; .001, P = .008), and pathological type and International Federation of Gynecology and Obstetrics (FIGO) stage also had a certain impact on tumor progression (P = .042, P = .048). The increase of PNI and the decrease of NLR will help patients with cervical squamous cell carcinoma live longer. ANN showed that PNI and NLR were of great importance in predicting survival. Preoperative PNI and NLR are independent predictors of cervical squamous cell carcinoma patients related to clinicopathological features, and have particular value in judging prognosis.

GnRHa as a treatment for letrozole-resistant recurrent adult granulosa cell tumors

Abstract Introduction: The optimal management of recurrent ovarian granulosa cell tumors is still unknown, and hormone therapy may be an alternative for chemotherapy-resistant cases. Patient concerns: A 46-year-old woman presented with a third recurrence after primary treatment of granulosa cell tumors. She developed tumor progression and drug-induced nephritis after 6 cycles of combined treatment with cisplatin and paclitaxel for the second recurrence and failed to benefit from chemotherapy, after the third optimal cytoreduction and tumor progression after 6 months of letrozole treatment. Diagnosis: Letrozole-resistant recurrent ovarian granulosa cell tumors Interventions: Intramuscular Diphereline 3.75 mg q28d. Outcomes: Computed tomography showed the metastatic neoplasm resolved. Progression-free survival is 20 months. Conclusion: Hormone therapy may be an alternative to treat recurrent granulosa cell tumors, and gonadotropin-releasing hormone agonists may be a rescue treatment for aromatase inhibitor-resistant cases.

Bevacizumab combined with chemotherapy for ovarian cancer

Abstract Background: The impact of bevacizumab (an anti-vascular endothelial growth factor therapy) remains uncertain, which has been the focus of studies on the management of ovarian cancer (OC). We performed a protocol for systematic review and meta-analysis to assess the efficacy and safety of bevacizumab combined with chemotherapy in OC. Methods: The presentation of methods and results in this systematic review was performed according to the evaluation guidelines for health care interventions provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. This study will use the Cochrane Library, Web of Science, PubMed, Embase, Allied and Complementary Medicine Database, China Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Ongoing Clinical Trials Database. The risk of bias of included studies is estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting, and other bias by Cochrane Collaboration's tool. All analyses were performed with Review Manager (RevMan) software, version 5.3. Results: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. Conclusion: Bevacizumab combined with chemotherapy may improve progression-free survival and overall survival in patients with OC.

The effect of folate intake on ovarian cancer risk

Abstract Background: Previous publications studied the correction about folate intake and ovarian cancer risk, with inconsistent results. This meta-analysis aimed to explore the association between folate intake and ovarian cancer risk using the existing published articles. Method: We searched for relevant studies in electronic databases of PubMed, Web of Science, Embase, Cochrane, and Wanfang databases from inception to May 31, 2020. The overall relative risk (RR) and its 95% confidence intervals (95% CI) were pooled using a random-effect model. Results: A total of 12 articles with 6304 ovarian cancer cases were suitable for the inclusion criteria. The evaluated of the ovarian cancer risk with total folate intake and dietary folate intake were reported in 6 articles and 10 articles, respectively. Overall, highest category of dietary folate intake compared with lowest category had nonsignificant association on the risk of ovarian cancer (RR = 0.90, 95% CI = 0.77–1.06). The association was not significant between total folate intake and ovarian cancer risk (RR = 1.06, 95% CI = 0.89–1.27). The results in subgroup analyses by study design and geographic location were not changed either in dietary folate intake analysis or in total folate intake analysis. Conclusion: Our meta-analysis demonstrates that folate intake had no significant association on the risk of ovarian cancer. Study design and geographic location were not associated with ovarian cancer while some other related factors were not investigated due to the limited information provided in each included study. Therefore, further studies are needed to verify our results.

First-degree family history of prostate cancer is associated the risk of breast cancer and ovarian cancer

Abstract The evidence for associations between family history of prostate cancer and the risk of breast cancer and ovarian cancer is inconclusive. The first systematic review and meta-analysis of studies was conducted to assess the risk of breast cancer and ovarian cancer associated with a family history of prostate cancer. A literature search was conducted using MEDLINE, Embase and Web of science databases up to January 31, 2019. Data were screened and extracted independently by 2 reviewers. The pooled risk ratio (RR) and its 95% confidence interval (CI) were calculated using random-effects models. The GRADE approach was used to assess the quality of evidence. Nine observational studies including 8,011,625 individuals were included in the meta-analysis. The meta-analysis showed that family history of prostate cancer in first-degree relatives was associated with an increased risk of breast cancer (RR 1.12, 95%CI 1.09 to 1.14) with moderate quality evidence, subgroup analysis showed consistent results. Compared with no family history of prostate cancer, history of prostate cancer in first-degree relatives was associated with a slight risk of ovarian cancer (1.10, 95%CI 1.01 to 1.20) with moderate quality evidence. Family history of prostate cancer among sibling was associated with a 17% increased risk of ovarian cancer (95% CI 1.03 to 1.34), however, no significant association was found between family history of prostate cancer among parent and risk of ovarian cancer (RR 1.19, 95% CI 0.84 to 1.70). This review demonstrates that women with a family history of prostate cancer in first-degree relatives was associated with an increased risk of breast cancer and ovarian cancer. These findings may aid in screening, earlier detection and treatment of women with a family history of prostate cancer in first-degree relatives.

Adenylate kinase 7 is a prognostic indicator of overall survival in ovarian cancer

Abstract Ovarian cancer (OC), a common malignant heterogeneous gynecological tumor, is the primary cause of cancer-related death in women worldwide. Adenylate kinase (AK) 7 belongs to the adenylate kinase (AK) family and is a cytosolic isoform of AK. Recent studies have demonstrated that AK7 is expressed in several human diseases, including cancer. However, there is a scarcity of reports on the relationship between AK7 and OC. Here, we compared the expression of AK7 in normal and cancerous ovarian tissues from The Cancer Genome Atlas database and used the c2 test to assess the correlation between AK7 levels and the clinical symptoms of OC. Finally, the prognostic significance of AK7 in OC was determined using the Kaplan–Meier analyses and Cox regression and performed gene set enrichment analysis to detect any relevant signaling pathways. We found that AK7 levels were substantially downregulated in OC than that in normal ovarian tissues (P &lt; .001). Low AK7 levels were related to the patients’ age (P = .0093) in OC. The median overall survival (OS) of patients with low AK7-expressing OC was shorter than patients with high AK7-expressing OC (P = .019). The Cox regression analysis (multivariate) identified low AK7 levels were independently related to the prognosis of OC (HR 1.34; P = .048). Our study demonstrated that the downregulated levels of AK7 could serve as an independent prognostic indicator for the OS in OC. Additionally, gene set enrichment analysis revealed that EMT, apical junction, TGF-b signaling, UV response, and myogenesis were associated in the low AK7 expression phenotype (NOM P &lt; .05).

Treatment of high risk human papillomavirus infection in low grade cervical squamous intraepithelial lesion with mild local thermotherapy

Abstract Introduction: Mild local hyperthermia at 44°C has been proven efficacious in the treatment of cutaneous warts induced by human papillomavirus (HPV), while its effect on cervical intraepithelial neoplasia (CIN) caused by high risk type of HPVs has not been reported. Patient concerns: Three patients with low grade CIN and positive high risk HPV types (HPV 16, 31, 52, 56, 58) are reported in this study. Diagnosis: The diagnosis was based on identification of HPV types and abnormal cytological findings. Interventions: The 3 patients were treated with local hyperthermia from ceramic heating (surface temperature, 44°C) to cervix. The treatment was delivered once a day for 3 consecutive days, plus two similar treatments 10 ± 3 days later, with each session lasting 30 minutes. HPV and cytology test were performed 3 months thereafter. Outcomes: All the 3 patients recovered to normal cytological findings. Two of the patients were negative for HPV, the remaining patient with pre-treatment HPV 56 and 58 positivity changed to HPV58 positive alone. Conclusion: This pilot observation inspires that mild local hyperthermia be recommended as a new method in the treatment of CIN patients with persistent HPV infection, once validated by qualified RCT.

Breast and cervical cancer mortality in the western Amazon

Abstract Among the main types of neoplasms in the female population, breast and cervical cancers are the most important due to their high morbidity and mortality rates. The mortality has been proportionally higher in developing countries. Analysis of the trend of cancer mortality in Brazil revealed a considerable difference in the pattern of deaths between the regions. To analyze the trend of mortality due to breast and cervical cancers in women. Retrospective study of a series of death cases, using secondary data from the mortality information system (SIM) of the Ministry of Health. The deaths were identified as the underlying cause of breast and cervical cancers, including malignant neoplasms of the uterus without other specifications, occurring from 1980 to 2014. Thus, the annual standardized age-specific mortality rates by the world population were applied. For trend analysis, regression models were utilized in which the mortality rates were considered dependent variables and years the independent variable. Polynomial regression models and a Prais–Winsten regression model were adopted. Cervical cancer presented a mortality rate ranging from 2.15 to 10.69 per 100,000 women from 1980 to 2014, with a tendency for stability. Breast cancer mortality rate varied from 3.81 to 11.47 per 100,000 women from 1981 to 2014, indicating a growing trend. There is a significant increase in the mortality rate for breast cancer and stability of cervical cancers in the State of Acre from 1980 to 2014, evidencing a concern in their care and monitoring. Above all, guaranteed access, especially to the population of women at social risk, and the search for effective screening should be emphasized in the formation of the care line and the Health Care Network in the State of Acre.

Histopathological findings in hysterectomy for cervical stenosis in postmenopausal women: A retrospective case series

Objective: To analyze the histopathological findings in postmenopausal women who underwent hysterectomy for postsurgical cervical stenosis, evaluating the incidental findings of preinvasive or invasive uterine and cervical disease. Methods: Retrospective case series of postmenopausal women who underwent hysterectomy for postsurgical cervical stenosis at Gynecological Oncology Unit of Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico Aviano—National Cancer Institute from January 2014 to January 2021. Results: During the study period, 36 women underwent hysterectomy for postsurgical cervical stenosis at our institution. Cervical stenosis occurred 10.2 ± 5.6 years from the onset of menopause. In particular, 26 (72.2%) patients underwent a single loop electrosurgical excision procedure or carbon dioxide (CO2)-laser conization before the onset of stenosis. The remaining 10 (27.8%) women had multiple surgical excision before the onset of stenosis. At the final histopathological analysis, 17 (47.2%) patients had a preinvasive or invasive gynecological disease. In particular, 9 cases of cervical disease (including 1 case of endocervical squamous cell carcinoma pT1a) and 6 cases of endometrial hyperplasia emerged. Also, 2 cases of tubo-ovarian diseases were found. Conclusions: Postsurgical cervical stenosis is a challenging clinical condition, especially in women treated for cervical intraepithelial neoplasia or microinvasive cervical cancer. As shown, cervical stenosis can prevent an adequate gynecological follow-up and a prompt diagnosis of malignancies. Therefore, postmenopausal women with cervical stenosis should be carefully counseled, and hysterectomy could be a reasonable option, especially in those cases in which a conservative approach is not feasible, failed, or is not accepted by the patient.

Spontaneous reduction of transvaginal small bowel evisceration after abdominal hysterectomy for cervical cancer

Abstract Rationale: Transvaginal evisceration of the small bowel is an extremely rare condition after hysterectomy, which requires urgent surgical intervention to prevent serious bowel morbidity and mortality. Patient concerns: A 65-year-old woman presented with sudden-onset severe abdominal pain and a mass protruding through the vagina. The past surgical history was significant, with an abdominal hysterectomy for cervical cancer performed 11 weeks prior to presentation. Diagnosis: Pelvic examination revealed prolapsed small-bowel loops (18-20 cm in length). Pelvic computed tomography scan confirmed the presence of transvaginal evisceration of the small bowel. Interventions: Bowel reduction and urgent laparotomy were the selected treatment approaches for a detailed inspection and thorough washing of the intrα-abdominal cavity. A Foley catheter was inserted in the emergency room, with the subject in the lithotomy position. The prolapsed bowel loops spontaneously reduced without manual reduction, and the vault defect was repaired transvaginally. Outcomes: The patient experienced no postoperative complications and remained disease-free for 9months postoperatively. Lessons: Transvaginal evisceration of the small bowel should be considered a surgical emergency. A multidisciplinary approach to prompt case management involving clinicians in gynecology, general surgery, and emergency medicine is vital for preventing serious consequences. Hysterectomy is the most frequently performed gynecological surgical procedure, and evisceration occurs most often after hysterectomy. Therefore, patients should be informed about this rare but possible hysterectomy complication.

Mendelian randomization analysis to explore the relationship between cathepsins and malignant ovarian tumors

Cysteine cathepsins are a family of lysosomal proteases that are often overexpressed in several human malignancies and haves been linked to cellular genomic alterations, disturbances in genomic stability, and the onset and spread of cancer. Recent studies have shown alterations in cysteine cathepsins in malignant ovarian tumors. However, it remains unclear whether there is a causal relationship between ovarian cancer, and its subtypes, and the cathepsin family. This study utilized two-sample Mendelian randomization (MR) analysis to examine this potential causal relationship. Genetic instruments derived from publicly available genetic summary data were used for the analyses. For MR analysis, the inverse-variance weighted method, weighted median method, and MR-Egger regression were employed. Multivariate MR analysis was performed concurrently. Univariate MR analysis indicated a strong correlation between decreased incidence of low-grade serous ovarian cancer and elevated levels of cathepsin L2 (odds ratio = 0.803, 95% confidence interval = 0.685–0.942, P = .007), whereas clear cell ovarian cancer showed a strong correlation with elevated levels of cathepsin H (odds ratio = 1.149, 95% confidence interval = 1.036–1.274, P = .008). Multivariate analysis, adjusted for 9 different cathepsins as covariates, confirmed the genetic relationships between cathepsin L2 and low-grade serous ovarian cancer and between cathepsin H and clear cell ovarian cancer. Our results suggest a causal relationship between cathepsins and ovarian malignancy and its subtypes. Cathepsin L2 has a protective effect on low-grade serous ovarian cancer, whereas cathepsin H is an adverse risk factor for clear cell ovarian cancer.

Research progress on correlative prediction factors and prediction models of endometriosis associated ovarian carcinoma

Background: Endometriosis is a common benign disease in women of childbearing age, with a malignant change rate of about 1%. Endometriosis associated ovarian cancer (EAOC), which usually occurs in the ovaries, is a serious threat to women’s health. Early identification of high-risk groups of EMs malignant transformation is of great significance for the prevention and treatment of EAOC. However, there is still a lack of specific and sensitive prediction factors. In recent years, scholars at home and abroad have used traditional statistical methods and machine learning to explore EAOC related prediction factors and prediction models. This paper mainly reviews and evaluates the diagnosis and prediction model of EAOC. Methods: Studies were identified by searching the CNKI, PubMed and Web of Science Core Collection, (WOSCC) till 2023, Data which met the inclusion criteria of clinical studies were evaluated about the quality. This paper analyzes and summarizes the prediction factors and prediction models in the literature. Results: After screening, 7 relevant studies were finally obtained. Prediction factors included: age, menstruation, menopausal status, course of disease, infertility associated with endometriosis, history of single estrogen use during menopause, serological indexes: human epididymis protein 4, carbohydrate antigen 125(CA125), ovarian malignancy risk algorithm, indications for ultrasound examination: cyst shape, structure and blood flow signal, etc. Prediction models: Alignment diagram, Multivariate logistic regression model, Gail model, Gradient Boosting Decision Tree and Lasso-logistics regression. Conclusion: Related models were in good agreement with the actual situation, and have good sensitivity and specificity. The relevant prediction factors and prediction models were summarized to provide reference and new thinking for the research of prediction models in the field of EAOC, in order to develop standardized long-term management strategies for high-risk groups of EAOC and realize the advance of the diagnosis threshold of patients with EAOC.

Comparative analysis of doublet chemotherapy regimens plus bevacizumab in patients with recurrent ovarian cancer

Among all gynecological malignancies, ovarian cancer is the predominant cause of mortality. Hence, various chemotherapy protocols have been established for managing metastatic ovarian cancer cases. The present study aimed to assess and compare the efficacy of dual chemotherapy regimens plus bevacizumab in patients diagnosed with recurrent platinum-sensitive epithelial ovarian cancer. This was a retrospective observational study. Data on the clinical, pathological, radiological, and treatment characteristics of the patients were recorded. Survival analyses were performed using the Kaplan–Meier method. Moreover, multivariate Cox regression analysis was conducted. Data of a total of 198 patients with a median follow-up duration of 18.7 months after bevacizumab treatment were analyzed. Serous carcinoma was found to be the most common pathological subtype in the analyzed patients, accounting for 85.8% of all cases. In total, 46.5% (n = 92), 38.4% (n = 76) and 15.2% (n = 30) patients had received gemcitabine plus carboplatin, paclitaxel plus carboplatin (PC), and gemcitabine plus cisplatin combined with bevacizumab, respectively. The complete response rate was 18.7%, partial response rate was 56.1%, stable disease rate was 6.6%, and progressive disease rate was 18.7%. The patients received bevacizumab treatment at a median of 9 cycles and doublet chemotherapy at a median of 7 cycles. The median progression-free survival was 11.9 (95% CI: 9.2–14.5) months, and the median overall survival (OS) was 24.7 (95% CI: 19.9–29.4) months. The results showed that a history of surgery prior to bevacizumab treatment was a significant factor affecting OS (P = .006). Patients who had received gemcitabine plus carboplatin with bevacizumab (28 months) had significantly better OS than patients who had received paclitaxel plus carboplatin (20.1 months) and gemcitabine plus cisplatin (17 months) (P = .009). Doublet chemotherapy regimens plus bevacizumab are safe and effective against recurrent platinum-sensitive epithelial ovarian cancer. Gemcitabine plus carboplatin with bevacizumab was superior to other treatment regimens in terms of OS outcomes.

Adult-type granulosa cell tumor associated with elevated luteinizing hormone: Two rare case reports

Introduction: Adult-type granulosa cell tumors (AGCTs), which account for 2% to 5% of all malignant ovarian tumors, are rare sex cord-stromal tumors that usually secrete excess estrogens, but they can also secrete androgens. Patient concerns: We report 2 patients of childbearing age with AGCT who presented with the complaint of abnormal menstruation and elevated luteinizing hormone (LH), and mildly elevated testosterone. Diagnosis: The ovarian tumors had hormonal activity. Interventions: The 2 patients underwent laparoscopic left adnexectomy. The second patient underwent 4 cycles of chemotherapy with paclitaxel and carboplatin as adjuvant treatments. Outcomes: Their postoperative pathology confirmed AGCTs. Also, their menstrual cycle returned to normal, with normal serum LH and testosterone levels. There was no sign of recurrence. Conclusion: The cases suggest that elevated serum LH levels may be a sign of unknown tumors in cases of oligomenorrhea or secondary amenorrhea. It is useful to evaluate the serum levels of inhibin B and anti-Müllerian hormone to improve the early recognition of ovarian granulosa cell tumors.

Mature cystic teratoma of the ovary with a grossly visible, completely developed intestinal loop: A case report and review of the literature

Rationale: The mature cystic teratoma of the ovary (MCTO), is composed of mature differentiated elements, thus showing highly differentiated tissue and highly morphological heterogeneity. Although gastrointestinal epithelium can be identified in 7% to 13% of cases of MCTO, the occurrence of visible, functional, and fully developed loop tissue is rare in clinical practice. Patient concerns: A 17-year-old female patient presented with persistent abdominal pain. Diagnosis: The patient was diagnosed with MCTO where a visible, functional intestinal loop was observed during laparoscopic surgery. Microscopy of the intestinal structure indicated a well-organized, intact layer of intestinal wall. Interventions: An emergency single-port laparoscopic excision of the right ovarian cyst and histopathology were performed. Outcomes: After 2 years of follow-up, there were no signs of recurrence in the patient. Lessons: The immune signature of CK7−/CK20+ is characteristic of tumors of gastrointestinal origin and can be used to distinguish tumors associated with mature cystic teratoma. Besides, gynecologists should keep an eye on the possibility of malignant transformation malignant transformation of MCTO.

Mining of clinical and prognosis related genes in the tumor microenvironment of endometrial cancer: A field synopsis of observational study

Endometrial cancer (EC) is the sixth most common malignant tumor in women worldwide, and its morbidity and mortality are on the rise. The purpose of this study was to explore potential tumor microenvironment (TME)-related biomarkers associated with the clinical features and prognosis of EC. The Estimating Stromal and Immune Cells in Malignancy Using Expression Data (ESTIMATE) algorithm was used to calculate TME immune and stromal scores of EC samples and to analyze the relationship between immune/stromal scores, clinical features, and prognosis. Heat maps and Venn maps were used to screen for differentially expressed genes (DEGs). The ESTIMATE algorithm revealed immune score was significantly correlated with overall survival and tumor grade in patients with EC. A total of 1448 DEGs were screened, of which 387 were intersecting genes. Gene Ontology (GO) analysis revealed that the biological processes (BP) related to intersecting genes mainly included T cell activation and regulation of lymphocyte activation. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that the intersecting genes were closely related to immune-related signaling pathways. Thirty core genes with more than 7 nodes were identified using protein–protein interaction (PPI) analysis. Six independent prognostic genes of EC were identified using Kaplan–Meier survival analysis and multivariate Cox analysis, namely CD5, BATF, CACNA2D2, LTA, CD52, and NOL4, which are all immune-infiltrating genes that are closely related to clinical features. The current study identified 6 key genes closely related to immune infiltration in the TME of EC that predict clinical outcomes, which may provide new insights into novel prognostic biomarkers and immunotherapy for patients with EC.

Bone marrow function in cervical cancer patients after concurrent chemoradiotherapy using 99mTc-SC SPECT/CT: A cross-sectional retrospective study

99m Tc-sulfur colloid ( 99m Tc-SC) single-photon computed emission tomography/computed tomography (SPECT/CT) bone marrow (BM) scintigraphy is a key diagnostic tool for distinguishing active red BM from inactive yellow BM. Although previous research has documented that it could reduce the volume of ABM irradiated at higher doses, the role of SPECT/CT parameters in assessing BM function in different pelvic regions and in predicting hematologic toxicity (HT) remains underexplored. This study aimed to investigate the value of 99m Tc-SC SPECT/CT imaging for assessing BM function and its predictive role for HT in patients with cervical cancer undergoing concurrent chemoradiotherapy (CRT). In this retrospective study, 40 patients with stage IB2-IVA cervical cancer underwent 99m Tc-SC SPECT/CT before and within 2 weeks after CRT. Patients were stratified into BM suppression (BMS) and non-BMS groups based on grade ≥ 3 HT. Semi-quantitative uptake ratios (R, liver-normalized) and their changes (ΔR) across 5 pelvic sites (L4, L5, sacrum, ilium, pubis) were compared. Analyses incorporated False Discovery Rate correction for multiple comparisons, non-parametric sensitivity tests, and effect size reporting. Predictive performance for HT was assessed using receiver operating characteristic curves and internally validated via leave-one-out cross-validation. CRT induces a spatially heterogeneous suppression of BM function, predominantly affecting the lumbosacral region. Elevated semi-quantitative uptake on pretreatment 99m Tc-SC SPECT/CT, particularly in the lumbosacral region, exhibits potential as a biomarker for predicting severe HT. These findings underscore the promise of functional imaging for personalized risk stratification, pending validation in larger, prospective, multi-institutional cohorts. Post-CRT reduction in BM uptake (ΔR) was significantly more substantial within the lumbosacral spine (L4, L5, Sacrum) compared to the pelvic bones (Ilium, Pubis), with a moderate overall effect (partial η 2  = 0.156). Patients who developed grade ≥ 3 HT (BMS group) exhibited significantly higher pretreatment R values and greater ΔR declines in the lumbosacral spine compared to the non-BMS group, with large effect sizes (e.g., Cohen d up to −1.05). Pretreatment R values at L4 (area under the curve [AUC] = 0.769), L5 (AUC = 0.767), and sacrum (AUC = 0.793) were significant predictors of grade ≥ 3 HT, a finding affirmed by leave-one-out cross-validation (cross-validated AUCs: 0.724, 0.737, and 0.752, respectively).

Development of a 4-miRNA prognostic signature for endometrial cancer

To develop an effective uterine corpus endometrial carcinoma (UCEC) risk assessment tool to monitor treatment outcomes. Limma package was used to analyze differentially expressed microRNAs (miRNAs) between UCEC tissues and normal tissues in the TCGA database. According to univariate Cox risk regression, least absolute shrinkage, and selection operator (LASSO) Cox analysis were performed to screen prognostic miRNAs and construct a risk scoring model. The prognostic performance of signature was evaluated by Kaplan–Meier and receiver operating characteristic. Multivariate Cox regression analysis was used to determine the independent prognostic factors of UCEC. Nomogram was constructed according to age, clinical stage, and risk score. A 4-miRNA signature based on miR-31-5p, miR-34a-5p, miR-26a-1-3p and miR-4772-3p was established. Risk scores of each patient were calculated by the 4-miRNA signature. After z-score, the patients were divided into high- and low-risk groups. The overall survival of high-risk patients was significantly shorter than that of low-risk patients, pointing to the high performance and independence of the 4-miRNA signature in predicting UCEC prognosis. The nomogram showed a high accuracy in predicting overall survival of UCEC patients. We developed a 4-miRNA signature that could effectively predict the prognosis of UCEC.

Upregulated keratin 15 links to the occurrence of lymphovascular invasion, stromal cervical invasion as well as unfavorable survival profile in endometrial cancer patients

Keratin 15 (KRT15) overexpression links with tumor initiation, metastasis, and poor survival in several solid carcinomas. While its clinical relevance is scarcely reported in endometrial cancer (EC). Therefore, the current study aimed to investigate the abnormal expression of KRT15 and its correlation with clinical characteristics, survival in EC patients. Totally, 135 surgical EC patients were enrolled. KRT15 protein expression in formalin-fixed and paraffin-embedded tumor and adjuvant tissues was detected by immunohistochemical staining; meanwhile, KRT15 mRNA expression in fresh-frozen tumor and adjacent tissues was detected by reverse transcription-quantitative polymerase chain reaction. KRT15 protein and mRNA expressions were higher in tumor tissue compared with adjacent tissue (both P &lt; .001). Elevated KRT15 protein expression was correlated with the occurrence of lymphovascular invasion (P = .010) and more advanced International Federation of Gynecology and Obstetrics stage (P = .018); meanwhile, elevated KRT15 mRNA expression was linked with more advanced International Federation of Gynecology and Obstetrics stage (P = .038) and marginally associated with the occurrence of stromal cervical invasion (P = .052). Besides, KRT15 protein and mRNA expressions were not correlated with other clinical features (all P &gt; .05). KRT15 protein high was marginally correlated with poor accumulating disease-free survival (DFS) (P = .091) and overall survival (OS) (P = .059); meanwhile, the correlation of KRT15 mRNA expression with accumulating DFS (P = .212) and OS (P = .092) was even weaker. However, multivariate Cox’s regressions showed that tumor KRT15 protein (high vs low) was independently correlated with poor DFS (P = .045) and OS (P = .043). KRT15 is abnormally increased in EC tissue, meanwhile, its upregulation links to the occurrence of lymphovascular invasion, stromal cervical invasion, and poor prognosis in EC patients.

Fertility-preserving treatment in patients with early-stage endometrial cancer

Abstract Background: Endometrial cancer (EC) is the second most common malignancy of the female reproductive system worldwide, and the standard treatment for early-stage EC potentially leads to permanent infertility. The objective of this study was to investigate the efficacies of different methods on fertility preservation in patients with early-stage EC. Methods: We searched the major online databases (PubMed, Embase, The Cochrane Library, and Web of Science) to collect the research literature on fertility preservation therapy in patients with early-stage well-differentiated EC aged ≤ 40 years from January 1999 to October 2019. The inclusion was performed using the R software (version R3.5.3) meta-analysis of a single rate. The efficacy of the following three fertility preservation treatments was evaluated from four aspects, the complete remission rate (CRR), recurrence rate (ReR), pregnancy rate (PregR), and live birth rate (LBR): a) taking oral progestin only therapy, b) hysteroscopic resection combined with progestin/levonorgestrel-releasing intrauterine system (LNG-IUS)/GnRH-a, c) LNG-IUS or combined with progestin/GnRH-a. Results: A total of 23 articles were included in this study, including 446 patients with early-stage EC. In the group that took oral progestin only (n = 279), CRR, ReR, PregR, and LBR were 82% (95% confidence interval [CI], 74%–92%, P = .01), 38% (95% CI, 31%-45%, P = .35), 70% (95% CI, 62%–79%, P = .68), and 63% (95% CI, 55%–73%, P = .55), respectively. Hysteroscopic resection combined with progestin/LNG-IUS/GnRH-a therapy group (n = 96) achieved a CRR, ReR, PregR, and LBR of 95% (95% CI, 90%–100%, P = .42), 16% (95% CI, 6%–39%, P = .03), 84% (95% CI, 73%–96%, P = .39), and 72% (95% CI, 59%–87%, P = .28), respectively. LNG-IUS or combined with progestin/GnRH-a therapy group (n = 91) achieved a CRR, ReR, PregR, and LBR of 69% (95% CI, 54%–89%, P &lt; .01), 30% (95% CI, 19%–49%, P = .36), 48% (95% CI, 18%–100%, P &lt; .01), and 36% (95% CI, 10%–100%, P &lt; .01), respectively. Conclusion: It is safe and effective for young patients with early-stage EC to receive oral progestin, hysteroscopic resection combined with progestin/LNG-IUS/GnRH-a, LNG-IUS, or progestin/GnRH-a. INPLASY Registration number: DOI 10.37766/inplasy2020.12.0137

Prediction of surgery type for uterine fibroids using machine learning algorithms and hormone values

This study aimed to develop and externally validate machine learning (ML)-based models to characterize surgical classification patterns between hysterectomy and myomectomy using fibroid characteristics and female sex hormone profiles. This multicenter study included 600 women with uterine fibroids (UFs) who presented to 3 hospitals. Of these, 362 (60.3%) underwent hysterectomy, while 238 (39.7%) underwent myomectomy. Statistical analyses and ML models were applied to both groups. ML model development was performed using individual and combined inputs of female sex hormones together with fibroid characteristics. Five ML classification algorithms were evaluated, including support vector machines, decision trees, random forests, k-nearest neighbors, and logistic regression. In total, 2555 model–input combinations were tested. The performance of the selected best-performing model was further evaluated using an independent, blinded external validation cohort comprising 30 cases. Women in the hysterectomy group had significantly higher mean age, follicle-stimulating hormone, luteinizing hormone, UF number, UF volume, uterine volume, disease duration, gravidity, parity, and prolactin (PRL) levels compared with the myomectomy group (all P  &lt; .001). In contrast, estradiol and anti-Müllerian hormone levels were significantly lower in the hysterectomy group ( P  &lt; .001). Across all modeling experiments, 2012 of 2555 model–input combinations achieved perfect classification performance (accuracy = 100%) when sex hormone profiles and UF characteristics were jointly used as inputs. Models using UF number alone also demonstrated high predictive performance, with accuracy reaching up to 96%. Agreement between algorithmic predictions and final surgical decisions was observed in 97% of cases, with one discordant case identified at a clinically borderline threshold. ML models trained on hormone profiles and fibroid characteristics were able to reproduce prevailing surgical classification patterns, largely reflecting strong baseline separability driven by age- and menopause-associated hormonal profiles, with consistent performance observed in an independent blinded validation cohort. These findings support the feasibility of quantitatively modeling routine decision structures, while highlighting the need for further validation in clinically heterogeneous and ambiguous cases.

Identification of dephosphorylation related genes prognostic signature in cervical squamous cell carcinoma and endocervical adenocarcinoma

Protein phosphorylation and dephosphorylation play critical regulatory roles in eukaryotic cell metabolism and cancer progression. Although phosphatase-mediated dephosphorylation has been shown to influence multiple signaling pathways in cervical cancer, the prognostic and predictive value of phosphorylation/dephosphorylation-related genes in cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) has remained poorly explored. This study aimed to develop and validate a prognostic signature of CESC based on dephosphorylation-related genes. Gene expression data and clinical characteristics of patients with CESC were obtained from The Cancer Genome Atlas database. A prognostic signature was constructed using least absolute shrinkage and selection operator regression and multivariate Cox regression analyses. Kaplan–Meier survival analysis and receiver operating characteristic curves were used to evaluate the predictive performance of the signature. Six genes were selected to construct a prognostic signature from a pool of 425 dephosphorylation-related genes. Genetic alteration analysis of 291 CESC patients, conducted using the cBioPortal database, revealed that 278 (95.5%) patients harbored alterations in at least one of these 6 genes. Among 278 patients, a total of 28 mutations were detected across 6 genes. The prognostic signature demonstrated strong predictive power, with an area under the receiver operating characteristic curve of 0.802. A 6-gene dephosphorylation-related prognostic signature was successfully developed and validated as an independent predictor of overall survival in patients with CESC. This signature may aid clinicians in the early identification of high-risk patients and in guiding personalized treatment strategies.

Cervical angiofibroma of soft tissue: A rare case report with literature review

Rationale: Angiofibroma of soft tissue (AFST) is a rare benign fibrous tumor recently included in the 2020 WHO classification of soft tissue and bone tumors. Currently, there are limited reports on AFST, and pathologists lack sufficient understanding of its clinical and pathological characteristics. There is scarce literature available on AFST in the cervical region. Patient concerns: We presented a case of a 49-year-old woman who was admitted to our hospital for emergency treatment due to vaginal bleeding and fatigue. Ultrasound revealed a 63 × 27 mm hypoechoic mass extending from the cervical opening to the external opening, with a hemoglobin level of 58.0 g/L on blood routine. Diagnoses: The tissue exhibited a pale-yellow mucinous appearance with distinct tissue boundaries and a fibrous capsule under a microscope. HE staining revealed spindle-shaped fibroblast-like cells with a consistent morphology, thin-walled branching small blood vessels, and dilated blood vessels. Regions with abundant cells and areas with sparse cells were alternately distributed and migrated gradually. Immunohistochemical analysis indicated positive expression of P53, desmin, progesterone receptor, estrogen receptor, epithelial membrane antigen, vimentin, CD68, CD163 in the tumor, but negative expression of P16, S-100, smooth muscle actin, CD117, CD10, STAT-6. CD34 was negative in the tumor cells but positive in the vascular endothelium. The Ki-67 index value was 5%. Pathological examination confirmed a soft tissue angiofibroma of the cervix. Interventions: Emergency hysteroscopic surgery was performed following infusion of 3 units of packed red blood cells. A local excision of the cervical mass was performed. Outcomes: A 1-month follow-up ultrasound showed no abnormal mass in the cervical canal, and there have been no signs of recurrence to date. Lessons: Cervical angiofibroma of soft tissue is a rare tumor with a benign clinical manifestation, minimal local recurrence, and no significant metastatic potential. Treatment primarily involves local resection with a focus on achieving negative surgical margins. By presenting this case, we aim to enhance the diagnostic and differential diagnostic capabilities of pathologists in identifying uterine tumors and preventing misdiagnosis.

Alveolar rhabdomyosarcoma of cervix: A case report

Rationale: Alveolar rhabdomyosarcoma (ARMS) is a rare and highly aggressive malignant soft tissue tumor. ARMS is associated with a poor prognosis, especially in adults, occurring in the uterine cervix infrequently. To date, only 6 cases have been reported in the literature. We discuss the challenges in diagnosing and managing cervical ARMS and highlights the need for ongoing research into optimal treatment strategies for this malignancy. Patient concerns: A 51-year-old female was diagnosed with advanced-stage ARMS. Positron emission tomography and computed tomography scans indicated a high metabolism mass in the uterus region, along with multiple lymph nodes enlargement in the pelvic, para-aorta and mediastinal regions. Cervical biopsy and segmental curettage revealed a small cell malignant tumor with poor differentiation. Histological and immunohistochemical examination confirmed ARMS. Diagnoses: The final diagnosis was cervical ARMS, staged IV according to the Intergroup Rhabdomyosarcoma Studies Group based on the imaging and histology results. Interventions: The patient underwent radical hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy. Postoperatively, the patient received a series of chemotherapy regimens including VAC† (vincristine, epirubicin, cyclophosphamide), EP (etoposide and cisplatin), VIP (etoposide, ifosfamide, cisplatin), gemcitabine and bevacizumab, gemcitabine and docetaxel, pertuzumab and lenvatinib and radiotherapy. Conclusion: ARMS has low incidence with unique clinical pathological characteristics. The biological behavior is more aggressive and the prognosis is worse in ARMS. Further research is necessary to refine treatment protocols and improve survival rates for this aggressive tumor.

Uterine carcinosarcomas: A case series of 9 cases from a low-income country

Rationale: Uterine carcinosarcomas (UCS) are rare aggressive biphasic tumors classified as a subtype of high-grade uterine carcinomas. However, these tumors have particular histopathological features and clinical behavior with worse prognosis than high-grade uterine carcinomas. Patient concerns: The incidence of UCS is increasing and more studies are required to elucidate their clinical and histopathological characteristics. Herein, we report clinicopathological features of 9 cases of UCS in a low-income country. Diagnoses: We retrospectively collected all cases of UCS at our Pathology Department over a period of 4 years. The diagnosis was performed on formalin-fixed, paraffin-embedded and hematoxylin and eosin–stained surgical specimens. Interventions: Nine surgically treated cases of UCS have been registered, representing 12.67% of all uterine malignancies with a mean age of 58.88 years (range: 50–65 years). Abdominal pain and metrorrhagia were the main clinical presentations. The epithelial component of UCS was often a serous carcinoma (66.66%) and patients presented with large tumors (mean size of 9.24 cm, range of 5–19 cm), with advanced FIGO stages (stages III–IV) in 5/9 patients (55.55%). Outcomes: Follow-up data were available in 5/9 patients among which only 2 were alive 2 and 25 months after the surgical treatment (overall survival of 40%). Lessons: UCS are rare and aggressive uterine tumors with very poor prognosis especially in low-income countries.

Adult granulosa cell tumor of the testis with malignant tendency: A case report with genetic analysis using high-throughput sequencing

Background: The adult granulosa cell tumor of the testis is a rare sex-cord/stromal tumor, with a potentiality for late recurrence and metastasis. Because of its rarity, this tumor is poorly understood, particularly in terms of its molecular features. As a result, it is necessary to register each occurrence in order to study the evolution of this rare malignancy and develop therapeutic strategies. Methods: A 50-year-old man discovered a painless right testicular mass unexpectedly, and the mass steadily expanded for 2 months. Ultrasonography showed a 5.2 cm × 4.0 cm × 3.6 cm mass in the right testicle. A right radical orchiectomy was performed on September 7, 2016. The pathologic diagnosis was a testicular adult granulosa cell tumor. The post-computed tomography scans and bone scintigraphy ruled out distant metastases. A high-throughput sequencing of 520 cancer-related genes revealed FOXL2 C134W, CDKN2A E87Gfs*24, TP53 S183*, TERT c.-124C &gt; T, and H3F3A K28R mutations in this case. Because the patient stated he would be unable to return to the hospital for a follow-up appointment on time, he elected to have 4 cycles of adjuvant chemotherapy BEP (bleomycin, etoposide, and cisplatin) after the right radical orchiectomy. Results: The patient has not had a clinical recurrence or metastasis in 6 years. Conclusion: Surgery together with adjuvant chemotherapy may be useful treatment options for these individuals with malignant tendencies who are unable to visit the hospital for a follow-up appointment on time. Adult testicular granulosa cell tumors have a relatively complex genetic profile; their etiology is linked to a number of common driver genes, including TERT, CDKN2A, TP53, and H3F3A.

Correlations between endometriosis, lipid profile, and estrogen levels

To explore the association between serum lipids and the occurrence and development of endometriosis using a retrospective review of clinical data. A total of 177 patients who underwent laparoscopic or open surgery due to benign ovarian masses, 117 patients with endometriosis (53 stage III and 64 stage IV), and 60 patients with benign ovarian masses without endometriosis were selected from the gynecology department of Maternal and Child Health Hospital of Hubei Province, between January 1, 2020, and October 30, 2022, to search for endometriosis occurrence by retrospectively analyzed the patients clinical data Risk factors for development and to explore the relationship between blood lipids and endometriosis. The scores of estradiol (E2), carbohydrate antigen 125 (CA125), and pain in the endo - and non-endometriosis groups were significantly different (P &lt; .05), but there was no significant correlation between these 3. There were significant differences (P &lt; .05) in E2, triglyceride (TG), CA125, and the size of the masses between patients with stage III and IV endometriosis. TG, E2, and CA125 were found to be valuable as separate indicators for the prediction of endometriosis, and the 3 indicators could improve the accuracy of the diagnosis of endometriosis when combined. Triglycerides may be positively correlated with the severity of endometriosis. The combination of TG, E2 and CA125 can improve the accuracy of the diagnosis of endometriosis staging.

The potential mechanism of Guizhi Fuling Wan effect in the treatment of cervical squamous cell carcinoma: A bioinformatics analysis investigation

As a global malignancy with high mortality rate, targeted drug development for Uterine Cervical Neoplasms is an important direction. The traditional formula Guizhi Fuling Wan (GFW) is widely used in gynecological diseases. However, its potential mechanism of action remains to be discovered. We retrieved GFW and cervical squamous cell carcinoma (CSCC) targets from public databases. The protein–protein interaction network was obtained by string computational analysis and imported Cytoscape_v3.9.0 to obtain the core network and the top 10 Hub genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes were used for enrichment analysis of the core network, and then molecular docking to verify whether the selected signaling pathway binds well to the core node. Finally, clinical prognostic analysis and expression differences of Hub genes were validated using the Cancer Genome Atlas database and R language. Our search yielded 152 common targets for GFW and CSCC. The interleukin-17 signaling pathway, tumor necrosis factor signaling pathway, and Toll-like signaling pathway were then selected for further molecular docking from the hub genes enrichment analysis results, which showed good binding. Among the Hub genes, JUN, VEGFA, IL1B, and EGF had a poor prognosis for CSCC. In conclusion, this study illustrates that GFW can have adjuvant therapeutic effects on CSCC through multiple targets and multiple pathways, providing a basis for further research.

Analysis of the current state of cervical cancer prevention awareness and its influencing factors among rural women in Luohe City

The purpose of this cross-sectional study was to identify the current awareness about cervical cancer prevention among rural women in Luohe City as well as its potential influencing factors. Meanwhile, these data were expected to provide a theoretical basis for Luohe future cervical cancer prevention and therapy. Based on geographical distribution, 40 villages in Luohe City were randomly selected, and questionnaires were given to women in each village. In this study, a total of 4665 questionnaires were distributed, and 4561 valid questionnaires were returned, with a recovery rate of 97.98%. The average score was 4.06 ± 2.46 out of 10. It was found that women had a high awareness rate of cervical cancer screening (55.25%) but a low awareness rate of human papillomavirus (HPV) and HPV vaccine (10.17%). Moreover, univariate and multivariable analyses showed that age &gt; 45 years, low household income, low education level, being a farmer, spouse unemployment, no pregnancy or birth delivery history, no family or personal history of cervical disease, and no previous complimentary 2-cancer screening (i.e., breast cancer and cervical cancer) were all factors influencing the cognitive level of rural women in Luohe City (P &lt; .05). However, ethnicity, marital status, and spouse education level were not correlated with cognitive level (P &gt; .05). In conclusion, low awareness of cervical cancer prevention among rural women in Luohe was correlated with individual, family, and social factors. So it was recommended to cultivate the rural population knowledge, optimize screening strategies, and conduct targeted cervical cancer prevention and treatment in rural regions.

Testosterone elevation in ovarian adult granulosa cell tumor: A case report and review of the literature

Rationale: Adult granulosa cell tumors (AGCT) mainly secret estrogen, but few androgens. It is rarer to have amenorrhea and hyperandrogenemia as clinical features. Here, we report a rare case of right side AGCTs with amenorrhea and hyperandrogenemia in a 19-year-old female. Patient concerns: The 19-year-old patient was admitted to our hospital due to amenorrhea for more than 1 year, and discovery of pelvic mass for 4 months. The gynecological ultrasound and computed tomography (CT) cannot define the nature of the mass. Surprisingly, an elevation in testosterone levels was also measured. Diagnosis and interventions: The present patient underwent laparoscopic right salpingo-oophorectomy and partial omentectomy and biopsy of the peritoneum. Outcomes: After the surgery, the testosterone value was down to normal. The patient menstrual cramps on August 13, 2021. Her clitoris is smaller than the front. Up to August 1, 2022, there was no obvious sign of recurrence. Lessons: Androgen-secreting AGCT is rare. We hope that this case can strengthen gynecologists’ early diagnosis and treatment of this disease and improve the prognosis.

Analysis of adverse events and quality of life in high-grade serous ovarian cancer patients with Olaparib maintenance therapy: A single-center study in China

Olaparib showed good efficacy and tolerability in the maintenance treatment of patients with initial therapy or high-grade serous recurrent ovarian cancer patients. This study aimed to analyze adverse events (AEs) of patients taking Olaparib and the quality of life (QoL) with Olaparib in 1 center of China. The study included 98 patients who received Olaparib and 210 patients without Olaparib from July 2018 to October 2021 for high-grade serous ovarian cancer in the Gynecology Oncology Department of Jiangsu Provincial Hospital. Information of clinicopathologic characteristics was collected from medical records. Then, we used the QLQ-C30 and Quality of Life Ovarian Cancer 28 Questionnaire (QLQ-OV28) to determine the QoL of 98 patients with and 210 patients without Olaparib. Among all 98 patients with Olaparib, 66 patients in first-line and 32 patients in more than second-line treatment. Regarding the best objective response with Olaparib maintenance in 78 patients with partial remission from most recent chemotherapy, 3 (3.84%) patients showed complete response (CR) and 6 (7.69%) showed as partial response (PR), whereas stable disease was observed in 42 patients (53.84%) and 27 patients (34.6%) showed as progression disease. AEs of Grade 3 and more were: anemia in 16 patients (16.32%), neutropenia in 20 patients (20.40%), thrombocytopenia in 4 patients (4.08%), and headache in 4 patients (4.08%). Dose reduction and drug discontinuation accounted for 73.40% and 20.40%, respectively. Olaparib as maintenance therapy increased QoL on all functioning domains and several symptom domains. Consistent with previous clinical trials, Olaparib maintenance therapy was proved safe and effective. Most patients may experience Grade 1 and 2 AEs. Olaparib maintenance therapy can increase QoL in several domains.

Aberrant serum and tissue levels of Beclin1 and mechanistic target of rapamycin (mTOR) proteins in epithelial ovarian cancer

Beclin1 and mechanistic target of rapamycin (mTOR) can be used as tumor markers of epithelial ovarian cancer. This study aimed to assess the association of Beclin1 and mTOR expression with clinicopathological and prognostic data in epithelial ovarian cancer patients. Serum and tissue samples from 45 epithelial ovarian cancer patients and 20 controls were analyzed by enzyme-linked immunosorbent assay and immunohistochemistry for Beclin1 and mTOR expression. The online datasets from gene expression profiling interactive analysis (n = 426), Kaplan–Meier plotter (n = 398), cBioPortal (n = 585), and UALCAN (n = 302) were also analyzed. Beclin1 expression was associated with low-grade differentiation (P = .003), earlier clinical stage (P = .013), fewer local lymph node metastases (P = .02) and lower serum Beclin1 level (P = .001). mTOR expression was associated with high-grade differentiation (P = .013), advanced clinical stage (P = .021), ascites (P = .028), and higher serum mTOR level (P = .001). The online datasets showed that a high mTOR expression level (HR = 1.44; 95% CI = 1.08–1.92; P = .013) was associated with a poor overall survival of 426 patients. Beclin1 was mutated in 1.8% and mTOR was mutated in 5% of epithelial ovarian cancer patients. Serum Beclin1 and mTOR levels were able to predict tumor differentiation, clinical stage, lymph node metastasis, and ascites in epithelial ovarian cancer patients.

Efficacy of cisplatin combined with vinorelbine as second- or higher-line palliative chemotherapy in patients with advanced ovarian cancer

The aim of this study was to assess the therapeutic efficacy of a cisplatin and vinorelbine combination as second- or higher-line palliative chemotherapy in patients with advanced ovarian cancer. We retrospectively reviewed the medical records of patients with advanced ovarian cancer who were treated with cisplatin (60 mg/m2 on day 1) and vinorelbine (25 mg/m2 on days 1 and 8) every 3 weeks between January 2004 and March 2021. Treatment responses, progression-free survival (PFS), and overall survival (OS) were assessed; laboratory data were reviewed to determine toxicity. Thirty-two patients with advanced ovarian cancer were treated with a combination of vinorelbine and cisplatin. The objective response rate (ORR) was 18.8% and the disease control rate was 75.1%. The median PFS was 4.13 months (95% confidence interval [CI], 2.4–5.8 months). The median OS was 56.9 months (95% CI, 50.5–63.7 months). The ORR (42.9% vs 9.1%; P = .035) was higher in the platinum-sensitive group than in the platinum-resistant group. The median PFS tended to be longer in the platinum-sensitive group (5.3 vs 3.8 months; P = .339) and the median OS was significantly longer in the platinum-sensitive group than in the platinum-resistant group (69.6 vs 24 months; P &lt; .001). All patients developed hematological toxicities, with 56% experiencing grade 3 to 4 neutropenia. Two (6.2%) patients developed febrile neutropenia, but no treatment-related death occurred. This combination therapy may be effective in patients with heavily treated advanced ovarian cancer, particularly in platinum-sensitive patients.

Combination therapy of oral cyclophosphamide and bevacizumab for patients with recurrent ovarian and peritoneal cancer

Chemotherapy for patients with recurrent cancer aims to obtain survival benefits, relieve symptoms, and improve quality of life. We used oral cyclophosphamide and bevacizumab (BEV) combination therapy in recurrent ovarian and peritoneal cancer cases, where standard chemotherapy was infeasible. Subsequently, we evaluated the safety and efficacy of this treatment. Between August 2014 and June 2020, patients received the following regimen: oral cyclophosphamide 50 mg daily and intravenous cyclic BEV 15 mg/kg every 3 weeks. Data from 2 facilities were retrospectively analyzed. Twenty-two patients were enrolled (20 with ovarian cancer and two with peritoneal cancer). The median follow-up period and age were 18.9 months (range, 5.0–51.5) and 60 years (range 37–81), respectively. Sixteen patients had platinum resistance. The median number of previous chemotherapy regimens was 2.5 (range 0–5). The median implementation cycle was five (range 2–14). Eighteen patients discontinued treatment due to side effects (3 patient) and disease progression (15 patient). Grade 2 toxicities included neutropenia (1 patient), proteinuria (1 patient), hypertension (2 patient), and esophagitis (1 patient). Two patients had complete response and one had a partial response. Five patients had stable disease. The response rate in platinum-sensitive recurrence was 33.3%, and 7.1% in platinum-resistant recurrence, and a clinical benefit was found in 8 (36.3%) patients. The median PFS and overall survival from cyclophosphamide and BEV initiation was 5.3 months (range, 0.8–23.5) and 9.2 months (range, 4.8–51.5), respectively. The combination of oral cyclophosphamide and BEV does not have a high response rate, but is well-tolerated and can be used safely in patients who are difficult to treat after second-line chemotherapy. Data from 2 facilities were retrospectively analyzed.

The clinical validity of miR-126 as a prognostic marker in epithelial ovarian cancer

Background: Ovarian cancer is the leading cause of gynecological cancer related death in females worldwide. Our previous study demonstrated that decreased expression of microRNA (miR-126) promoted ovarian cancer angiogenesis and invasion by targeting VEGF-A. This study aimed to evaluate the clinical validity of miR-126 as a prognostic marker for epithelial ovarian cancer (EOC). Patient concerns: The patients with EOC ranged in age from 27 to 79 years, with a mean age of 57 years. Diagnosis: All patients had never had chemotherapy or biotherapy, and the diagnoses were confirmed pathologically in all cases Methods: MiR-126 levels in EOC tissue and normal ovaries were determined by qRT-PCR. Its prognostic value was analyzed using the Cox proportional hazards regression model. Survival curves were drawn using the Kaplan–Meier method. Results: In this study, we found that compared to normal tissues, miR-126 expression was lower in EOC tissues, particularly in omental metastases. Though in our previous study we found that miR-126 may inhibit proliferation and invasion in EOC cell lines, but in this study patients with elevated miR-126 expression exhibited poor overall survival and relapse free survival. Multivariate Cox regression analysis showed that miRNA-126 was an independent prognostic factor for poor relapse-free survival (P = .044). Receiver operating characteristic analysis showed that the area under the curve of miR-126 was 0.806 (95% confidence interval, 0.669-0.942). Conclusion: In this study, we established miR-126 as a potential independent biomarker for predicting recurrence in patients with EOC.

Fibrothecoma of broad ligament with minor sex cord elements: Case report and brief literature review

Rationale: Sex cord-stromal tumors are always found in ovary, but the occurrence of this kind of tumor at extraovarian locations is extremely rare. Up to now, the case concerning fibrothecoma of broad ligament with minor sex cord elements has not been reported, and it is extremely challenging to diagnose before surgery. In this case report, we summarized pathogenesis, clinical features, laboratory finding, imaging studies, pathology, and therapeutic schedule of this tumor, with the aim of raising awareness and attention to this type of disease. Patient concerns: A 45-year-old Chinese woman was referred to our department with intermittent lower abdominal pain for about 6 years. On examination, both ultrasonography and computed tomography revealed she had a right adnexal mass. Diagnosis: Based on the results of histology and immunohistochemistry, the final diagnosis was confirmed as fibrothecoma of broad ligament with minor sex cord elements. Interventions: This patient underwent laparoscopic unilateral salpingo-oophorectomy with excision of the neoplasm. Outcomes: Eleven days post-treatment, the patient complained that the symptoms of abdominal pain was disappeared. There is no evidence of disease recurrence 5 years after laparoscopic surgery according to the consequences of radiologic examination Conclusion: The natural history of this kind of tumor is uncertain. Although main treatment of this neoplasm might be surgical resection and good prognosis can be achieved, we believe that long-time follow-up is extremely important in all patients diagnosed as fibrothecoma of broad ligament with minor sex cord. Laparoscopic unilateral salpingo-oophorectomy with excision of the tumor should be recommended to these patients.

Effect of within-endobag method during laparoscopic ovarian cystectomy of dermoid cyst: A retrospective study

This study aimed to evaluate the effect of within-endobag cystectomy during and after laparoscopic ovarian cystectomy in patients with dermoid cysts. We retrospectively analyzed 84 patients with ovarian dermoid cysts who underwent laparoscopic ovarian cystectomy. In 30 patients, the affected ovary was placed in an endobag before cystectomy and cystectomy was performed within an endobag (within-endobag group), while the remaining 54 patients underwent standard cystectomy without this step (without-endobag group). After cystectomy, the cyst wall was placed in an endobag and was removed from the abdomen. Compared with the without-endobag group, the within-endobag group had a significantly lower rate of cyst content spillage (23.3% vs 72.2%, P &lt; .001) and significantly shorter operation times when the cysts ruptured (23.4 ± 8.6 minutes vs 51.2 ± 28.6 minutes, P &lt; .001). Whereas there was no significant difference in operation time in the absence of cyst rupture between 2 groups (21.2 ± 8.8 minutes vs 31.1 ± 17.4 minutes, P = .111). In patients with cyst rupture, according to the cyst size increase, the operation time was significantly prolonged without-endobag, whereas no significant prolongation was observed in within-endobag cystectomy. Except for operation time, there were no significant differences in cyst length, pain on the first day after surgery, hemoglobin loss, hospital stay, and inflammatory markers (C-reactive protein and white blood cell counts) in both ruptured and unruptured cases between the 2 groups. There were no postoperative complications in the within-endobag group, but 2 cases of perioperative complications occurred in the without-endobag group. No chemical peritonitis due to spillage of the cyst contents was observed in either group. Laparoscopic ovarian cystectomy performed within-endobag can reduce both the spillage rate of cyst contents and operation time regardless of cyst size in patients with ruptured cysts. Therefore, this technique is a good surgical option for the laparoscopic ovarian cystectomy of large dermoid ovarian cysts.

A bibliometric analysis of global research trends of inflammation in cervical cancer: A review

Cervical cancer is a common malignant tumor and a leading cause of death in women worldwide. It plays a crucial role in tumorigenesis and progression of cervical cancer. A total of 1606 references on inflammation in cervical cancer were retrieved from the Web of Science Core Collection and visual analysis was performed using VOSviewer. Inflammation in cervical cancer has attracted the attention of researchers. Even though China is the country that publishes the most papers, with the most of the top-ranking institutions, there is no extensive collaboration and exchange of papers by Chinese scholars. PLOS One is a popular journal on inflammation in cervical cancer. Instead, authors from other countries perform better, for example, the Sjoerd H. Van Der Burg is the most widely cited author and “M2 macrophages induced by prostaglandin E2 and IL-6 from cervical carcinoma are switched to activated M1 macrophages by CD4 + Th1 cells” (Moniek Heusinkveld, Leiden University Medical Center) is the most cited article of inflammation in cervical cancer. Keywords associated with “apoptosis,” “HPV,” “NF-κB,” and “oxidative stress have been used in many studies, and keywords associated with “apoptosis,” “human papillomavirus (HPV),” “NF-κB,” and “oxidative stress” are involved in many studies, and there may be more research ideas in the future. From the perspective of precision medicine, more substantive research articles can promote scientific value, strengthen communication and cooperation, produce more extensive research results, and greatly promote the clinical diagnosis and treatment of cervical cancer. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Whether specific genetic feature predicted immunotherapy efficacy: A case report

Rationale: Blockade of programmed death protein 1 (PD-1), have been observed to have quite good efficacy in recurrent and metastatic cervical cancer. Generally, we believe that the biomarkers of PD-1 inhibitors are programmed cell death-ligand 1, tumor mutational burden, high microsatellite instability, or deficient mismatch repair. However, in the case reported below, we observed that the patient with negative existing predictive biomarkers have significant benefits after zimberelimab monotherapy, indicating that there were other biomarkers that may predict immunotherapy efficacy. However, currently, no one has explored and studied the other potential biomarkers of PD-1 inhibitors. Patient concerns: A 51-year-old patient, diagnosed with cervical adenocarcinoma nearly 11 years ago, requested treatment. Diagnoses: The next-generation sequencing has shown PIK3CA E545K, SMAD4 1309-1G, and ALK E717K gene mutations, receptor tyrosine kinase 2 (ErbB-2) amplification, microsatellite stability, and low tumor mutational burden of 6.3 mutations per megabase. And immunohistochemistry revealed that the tumor was programmed cell death-ligand 1 negative. Intervention: Zimberelimab monotherapy was accepted as third-line treatment. Outcomes: The patient had received zimberelimab for nearly 10 months, the best tumor response was PR (Response Evaluation Criteria in Solid Tumours) and no noticeable adverse reactions were observed. Lessons: PIK3CA-E542K, ErbB2 amplification, and SMAD4 mutations could be potential biomarkers for PD-1 inhibitors, but a single instance is insufficient to validate the hypotheses. A larger number of patients or more clinical data will be necessary to determine whether these gene mutations are appropriate biomarkers for patients when treatment with PD-1 inhibitors.

Sigmoid colonic metastasis from a squamous cell carcinoma of the cervix: A rare case report with literature review

Rationale: As the third most common cancer in women, cervical cancer usually spreads to adjacent organs. Distant metastasis from the cervix to the gastrointestinal tract is an extremely rare occurrence. Patient concerns: Herein, we present a rare case of a 57-year-old woman who was treated by hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy for squamous cell carcinoma (SCC) of the uterine cervix. A metastatic location in the sigmoid colon was revealed after 8 years causing an acute intestinal obstruction in this patient. Diagnoses: Final surgical pathology showed an invasive lesion with squamous differentiation in full thickness of the colon wall from mucosa to serosa. Meanwhile, the results of immunohistochemistry (IHC) showed the cancer cells were positive for CK5/6, P63, P40, and P16 confirming the diagnosis of metastatic sigmoid colonic carcinoma originating from SCC of the uterine cervix. Interventions: Sigmoid colon resection with lymph node dissection followed by adjuvant chemotherapy (paclitaxel, carboplatin, and paprillizumab) was performed on the patient. Outcomes: The patient was disease-free 16 months after surgery. Lessons subsections: SCC is one of the rare malignant tumors of the gastrointestinal tract occurring as either a primary or secondary lesion. However, the secondary SCC of the colon has a poorer prognosis compared with the primary SCC. Therefore, colonic metastasis must be considered in the differential diagnosis of acute intestinal obstruction, especially in patients with the medical history of SCC in other organs.

Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization

Abstract To explore the optimal way to manage patients with high-grade squamous intraepithelial lesion (HSIL) and positive margin by identifying the risk factors for its recurrence and residue. A retrospective study was conducted on 267 cases of a pathologically confirmed HSIL with positive margin following conization by loop electrosurgical excisional procedure (LEEP) between January 2010 and December 2015. One hundred two cases were selected for regular follow-up every 6 months, and 165 cases were selected for a second surgery (repeat cervical conization or hysterectomy) within 3 months of initial LEEP. We analyzed the association between recurrent or residual diseases and these factors: age, menopausal status, ThinPrep cytologic test (TCT) results, high-risk human papillomavirus (HR-HPV) infection, pathological grades of the margin, number of involved margins, and glandular involvement. The recurrence rate among 102 cases who underwent follow-up was 17.6% (18/102). The factors: atypical squamous cells of undetermined significance cannot exclude HSIL (ASC-H) or higher lesions in the pre-LEEP TCT (P = .038), persistent HR-HPV infection at the 6th month post-LEEP (P = .03), HSIL-positive margin (P = .003), and multifocal-involved margin (P = .002) were significantly associated with recurrent disease, while age, menopause, and pre-LEEP HR-HPV infection were not associated with recurrent disease (P &gt; .05). The residual rate among 165 patients who underwent a second surgery was 45.5% (75/165), of which 15 cases were residual cervical cancer. The factors: menopause (P = .02), ≥ASC-H in pre-LEEP TCT (P = .04), pre-LEEP HR-HPV infection (P = .04), ≥HSIL-positive margin (P &lt; .001), and multifocal-involved margin (P &lt; .001) significantly increased the risk of residual disease. No correlation existed between residual disease and age or glandular involvement (P &gt; .05). For patients with a positive margin after LEEP, regular follow-up or second surgery should be selected according to fertility requirement and pathological characteristics of the positive margin, as well as TCT and HR-HPV infection condition.

Cervical cancer screening varies by HPV vaccination status among a National Cohort of privately insured young women in the United States 2006–2016

Abstract Human papillomavirus (HPV) vaccination in young women is low. Women aged 21 to 65 years in the United States (U.S.) have not reached the Healthy People 2020 objective of 93% for cervical cancer screening. The main aim of this study was to investigate the association between HPV vaccination status and cervical cancer screening among privately insured women aged 21 to 26 years in the U.S. This was a retrospective cohort study using the IBM MarketScan database (2006–2016). The study population included 190,982 HPV-vaccinated women and 763,928 matched unvaccinated women. Adjusted incidence rate ratio (IRR) and the 95% confidence intervals (CIs) were obtained using the generalized estimating equations models with a Poisson distribution. Among a total of 954,910 women included in the analysis, age (mean [SD]) was 23.3 [1.6] years. During 967,317 person-years of follow-up, a total of 475,702 incidents of cervical cancer screening were identified. The incidence density rates of cervical cancer screening were 461 per 1000 person-years (PY) for unvaccinated women and 787 per 1000 PY for those who received 3 doses of the HPV vaccine. After adjusting for other covariates, the IRR of cervical cancer screening was 34% higher among HPV-vaccinated women with at least one vaccine dose than unvaccinated women (adjusted IRR = 1.34, 95% CI: 1.33–1.35; P &lt; .0001). The IRR of cervical cancer screening varied by the dose of HPV vaccination. There was evidence of a linear dose–response relationship between the number of HPV vaccine doses and cervical cancer screening (P-trend &lt; .0001). Compared with unvaccinated women, the IRR of cervical cancer screening were 14%, 39%, and 60% higher among those who received 1, 2, and 3 doses of the HPV vaccine, respectively. In this large retrospective cohort study of privately insured women, HPV-vaccinated women were more likely to be screened for cervical cancer compared with unvaccinated women.

FANCI may serve as a prognostic biomarker for cervical cancer

Abstract Background: DNA damage is a fundamental process that plays a considerable role in generating protein diversity. FANCI, loaded on the altered chromatin, plays a vital role in DNA damage. Abnormal FANCI expression is potentially associated with carcinogenesis.However, the biological role of FANCI in cervical cancer is yet to be determined. Methods: We analyzed FANCI expression via multiple gene expression databases. Genes co-expressed with FANCI and its regulators were identified using LinkedOmics. The correlations between FANCI and cancer immune infiltrates were investigated via Tumor Immune Estimation Resource (TIMER). Results: FANCI was found upregulated with amplification in tumor tissues of multiple cervical cancer cohorts. High FANCI expression was associated with poorer overall survival (OS). Functional network analysis suggested that FANCI regulates spliceosome, DNA replication, and cell cycle signaling via pathways involving several cancer-related kinases and the E2F family. In additional, FANCI expression was positively correlated with infiltrating levels of CD4+ T and CD8+ T cells, and neutrophils. FANCI expression also showed strong correlations with diverse immune marker sets in cervical cancer. Conclusion: These findings suggested that FANCI is correlated with prognosis of and immune infiltration in cervical cancer, laying a foundation for further study of the immune regulatory role of FANCI in cervical cancer.

Prognostic value of microRNA-21 in epithelial ovarian carcinoma

Abstract Backgroud: The expression of microRNA-21 has been shown to be associated with the prognosis in patients with malignant tumors. However, its prognostic value in epithelial ovarian carcinoma (EOC) remains controversial. This meta-analysis aimed to synthesize available data to clarify the association between microRNA-21 expression levels and clinical prognosis in EOC patients. Methods: Eligible literatures were searched from Embase, Google Scholar, PubMed, Web of Science, Medline, Cochrane Library, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese BioMedical Database and Wanfang Database to identify eligible studies. Papers in English or Chinese published from their inception to November 2020 will be included. Methodological quality for each eligible trial will be assessed by using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios or hazards ratios with corresponding 95% confidence intervals were pooled to estimate the prognosis value of microRNA-21 by using Stata 14.0 and Review Manager 5.3 software. Results: This study will provide a high-quality evidence-based medical evidence of the correlations between microRNA-21 expression and overall survival and disease-free survival. Conclusion: The findings of this systematic review will show the effect of high expression of microRNA-21 on the prognosis of EOC patients. Trial registration number: INPLASY2020110064

Clinicopathological characteristics and prognostic risk factors of cervical cancer patients aged ≤35 years old

We aimed to explore the clinicopathological characteristics and prognostic risk factors of cervical cancer in patients aged ≤35 years. A total of 256 cervical cancer patients treated at Anhui Medical University Affiliated Maternity and Child Health Hospital and The First Affiliated Hospital of Anhui Medical University from January 2016 to October 2018 were divided into ≤35-year-old (n = 136) and &gt;35-year-old (n = 120) groups. Their clinicopathological characteristics and 3-year cumulative disease-free survival (DFS) and overall survival (OS) rates were compared. The factors influencing the 3-year cumulative DFS rate of patients in the ≤35-year-old group were analyzed using univariate and multivariate Cox regression models. The human papillomavirus (HPV) infection rate, incidence rate of contact vaginal bleeding, depth of cervical interstitial infiltration, and incidence rates of parametrial metastasis and vascular infiltration were all significantly higher in the ≤35-year-old group than in the &gt;35-year-old group. The 3-year cumulative DFS rates of all patients and those with HPV infection and contact vaginal bleeding were significantly lower in the ≤35-year-old group than in the &gt;35-year-old group (69.12% vs. 77.50%, 68.29% vs. 80.85%, and 66.04% vs. 81.48%) (log-rank χ2 = 7.429, 4.339, and 4.276, P &lt; .05). Depth of cervical interstitial infiltration &gt;4 mm, parametrial metastasis, lymph node metastasis, and vascular infiltration were independent risk factors for the prognosis of cervical cancer patients aged ≤35 years (P &lt; .05). Cervical cancer aged ≤35 years have a worse postoperative prognosis than those aged &gt;35 years, which is affected by the depth of cervical interstitial infiltration &gt;4 mm, parametrial metastasis, lymph node metastasis, and vascular infiltration. Therefore, it is necessary to identify more effective treatment methods for young patients with cervical cancer to improve the therapeutic effect and reduce the risk of recurrence and metastasis.

Impact of ovary-sparing treatment planning on plan quality, treatment time and gamma passing rates in intensity-modulated radiotherapy for stage I/II cervical cancer

Background: This study aimed to investigate the impact of ovary-sparing intensity-modulated radiotherapy (IMRT) on plan quality, treatment time, and gamma passing rates for stage I/II cervical cancer patients. Methods: Fifteen stage I/II cervical cancer patients were retrospectively enrolled, and a pair of clinically suitable IMRT plans were designed for each patient, with (Group A) and without (Group B) ovary-sparing. Plan factors affecting plan quality, treatment time, and gamma passing rates, including the number of segments, monitor units, percentage of small-area segments (field area &lt; 20 cm2), and percentage of small-MU segments (MU &lt; 10), were compared and statistically analyzed. Key plan quality indicators, including ovarian dose, target dose coverage (D98%, D95%, D50%, D2%), conformity index, and homogeneity index, were evaluated and statistically assessed. Treatment time and gamma passing rates collected by IBA MatriXX were also compared. Results: The median ovarian dose in Group A and Group B was 7.61 Gy (range 6.71–8.51 Gy) and 38.52 Gy (range 29.84–43.82 Gy), respectively. Except for monitor units, all other plan factors were significantly lower in Group A than in Group B (all P &lt; .05). Correlation coefficients between plan factors, treatment time, and gamma passing rates that were statistically different were all negative. Both Groups of plans met the prescription requirement (D95% ≥ 45.00 Gy) for clinical treatment. D98% was smaller for Group A than for Group B (P &lt; .05); D50% and D2% were larger for Group A than for Group B (P &lt; .05, P &lt; .05). Group A plans had worse conformity index and homogeneity index than Group B plans (P &lt; .05, P &lt; .05). Treatment time did not differ significantly (P &gt; .05). Gamma passing rates in Group A were higher than in Group B with the criteria of 2%/3 mm (P &lt; .05) and 3%/2 mm (P &lt; .05). Conclusion: Despite the slightly decreased quality of the treatment plans, the ovary-sparing IMRT plans exhibited several advantages including lower ovarian dose and plan complexity, improved gamma passing rates, and a negligible impact on treatment time.

Clinicopathological characteristics and treatment of patients with high-grade endometrial stromal sarcoma

Abstract To investigate the clinicopathological characteristics of patients with high-grade endometrial stromal sarcoma (HG-ESS). The clinicopathological characteristics, treatments, and prognostic information of consecutive HG-ESS patients were collected from medical records and then evaluated. A total of 40 women were included in the analysis. The immunohistochemical profiles indicated that HG-ESS tumors tend to be locally or weakly positive for vimentin (100%) and CD10 (72.0%) but mostly negative for desmin (7.7%) and AE1/AE3 (9.1%). The progression-free survival intervals and the clinical benefit rates of patients receiving radiotherapy and/or chemotherapy were slightly longer and higher than those receiving simple observation (progression-free survival: 6 and 5 months vs 2 months; clinical benefit rate: 83.3% and 75.0% vs 28.6%). The 1-year disease-specific survival (DSS) rate was 62.7%. Tumor size, myometrial invasion, lymphovascular space invasion, cervical involvement, Federation International of Gynecology and Obstetrics (FIGO) stage, and residual disease all significantly affected the DSS rate (P &lt; .001, =.002, &lt;.001, =.004, &lt;.001, and &lt;.001, respectively). For patients with stage I disease, the 1-year DSS rate was as high as 91.7%, in contrast to 66.7%, 26.7%, and 0% for those with stage II, III, and IV disease, respectively. HG-ESS is associated with an adverse prognosis. FIGO stage could effectively predict the prognosis of patients with this lethal disease. Immunohistochemical markers, vimentin+/CD10+ (local or very weak), in combination with desmin-/AE1/AE3-, may be helpful for improving the diagnostic accuracy of this lethal condition. The therapeutic roles of adjuvant chemotherapy and radiotherapy warrant further investigation.

Causal effect of C-reaction protein and endometrial cancer: Genetic evidence of the role of inflammation in endometrial cancer

Consensus remains elusive regarding the relationship between C-reactive protein (CRP) levels and endometrial cancer (EC). Our study sought to elucidate the causal association between CRP and EC, aiming to contribute to the understanding of this complex interplay. We primarily utilized the random-effects inverse variance-weighted method. This approach served as the foundation for our analysis, complemented by 3 additional techniques, including Mendelian randomization-Egger, weighted-median, and weighted mode. A series of sensitivity analyses were also conducted to affirm the stability and reliability of our results. Employing the inverse variance-weighted method, our findings indicated that a one-unit increment in log-transformed CRP concentrations (mg/L) was associated with a relatively 9.7% increased risk of overall EC (odds ratio [OR] = 1.097, 95% confidence interval [CI]: 0.996–1.208, P = .061), an 11% higher risk of endometrioid endometrial cancer (OR = 1.110, 95% CI: 1.000–1.231, P = .049) and a 25% increased risk of non-endometrioid cancers (OR = 1.250, 95% CI: 1.005–1.555, P = .045). Sensitivity analyses did not reveal evidence of horizontal pleiotropy in the analysis of CRP and overall EC, endometrioid endometrial cancer, or non-endometrioid cancers (P &gt; .05). In the reverse analysis, our data demonstrated that EC exert no reverse effect on CRP levels. Our study suggested causal relationships between CRP and an elevated risk of EC and its subtypes, which contribute to the ongoing discourse on the role of inflammation, as indicated by CRP levels, in the etiology of EC and its variants.

Whole genome sequencing in high-grade cervical intraepithelial neoplasia patients from different ethnic groups in China

Cervical cancer (CC) is the fourth most common cancer in women worldwide. It develops through precancerous lesions (cervical intraepithelial neoplasia (CIN), graded from low-grade (CIN1) to high-grade (CIN2-3)). It is well established that precancerous and cancerous cervical lesions are caused by a persistent infection with high-risk types of the human papilloma virus (hrHPV). To have a deeper understanding of the pathogenesis of CIN and CC, we systematically analyzed the landscape of genomic alterations and HPV integration profiles in high-grade CIN2/3. We performed deep whole genome sequencing on exfoliated cervical cells and matched peripheral blood samples from a cohort of 51 Chinese patients (of whom 35 were HPV+) with high-grade CIN from 3 ethnic groups and constructed strict integrated workflow of genomic analysis. In addition, the HPV types and integration breakpoints in the exfoliated cervical cells from these patients were examined. Genomic analysis identified 6 significantly mutated genes (SMGs), including CDKN2A, PIK3CB, FAM20A, RABEP1, TMPRSS2 and SS18L1, in 51 CIN2/3 samples. As none of them had previously been identified as SMGs in the Cancer Genome Atlas cervical squamous cell carcinoma and endocervical adenocarcinoma (TCGA-CESC) cohort, future studies with larger sample size of CINs may be needed to validate our findings. Mutational signature analysis showed that mutational signatures of CINs were dramatically different from CCs, highlighting their different mutational processes and etiologies. Moreover, non-silent somatic mutations were detected in all of the CIN2/3 samples, and 88% of these mutations occurred in genes that also mutated in CCs of TCGA cohort. CIN2 samples had significantly less non-silent mutations than CIN3 samples (P = .0006). Gene ontology and pathway level analysis revealed that functions of mutated genes were significantly associated with tumorigenesis, thus these genes may be involved in the development and progression of CC. HPV integration breakpoints occurred in 28.6% of the CIN2/3 samples with HPV infection. Integrations of common high risk HPV types in CCs, including HPV16, 52, 58 and 68, also occurred in the CIN samples. Our results lay the groundwork for a deeper understanding of the molecular mechanisms underlying the pathogenesis of CC and pave the way for new tools for screening, diagnosis and treatment of cervical precancerous and cancerous lesions.

Meta-analysis of clinical efficacy of electroacupuncture versus conventional treatment for postoperative urinary retention in cervical cancer

Background: To conduct a meta-analysis on the clinical efficacy of electroacupuncture in the treatment of postoperative urinary retention in cervical cancer, and to provide a theoretical basis for the promotion of electroacupuncture in the treatment of this disease. Methods: Computer searches of the Cochrane library, Web of science, PubMed, Embase, Chinese Biomedical Literature Database, Wanfang database, Wipu database, and China National Knowledge Infrastructure Database database were conducted to find randomized controlled trials on electroacupuncture for postoperative urinary retention recovery in cervical cancer, all from the time of database creation to October 2022. Two evaluators independently evaluated the quality of the included literature and extracted the data. Data were combined and analyzed using RevMan 5.4. Results: A total of 21 Randomized controlled trials with 1532 patients, 789 in the treatment group and 743 in the control group, were included. One descriptive analysis was performed and 20 Meta-analyses were performed. Meta-analysis results showed that: The electroacupuncture group was more effective than the control group in promoting recovery from urinary retention after cervical cancer, with a statistically significant difference [relative risk (RR)] = 1.32, 95% confidence interval (CI 1.26, 1.39), P &lt; .00001; The duration of indwelling catheterization was reduced in the electroacupuncture group compared with the control group, with a statistically significant standard mean difference = −1.43, 95% CI (−1.62, −1.24), P &lt; .00001; The healing rate in the electroacupuncture group was higher than that in the control group, with a statistically significant difference [RR] = 1.92, 95% CI (1.59, 2.30), P &lt; .00001; The rate of urinary tract infection in the electroacupuncture group was lower than that in the control group, with a statistically significant difference [RR] = 0.22, 95% CI (0.10, 0.45), P &lt; .00001. The incidence of urinary retention was lower in the electroacupuncture group than in the control group, and the difference was statistically significant [RR = 0.26, 95% CI (0.18, 0.39), P &lt; .01]. Conclusion: Electroacupuncture can promote the recovery of urinary retention after cervical cancer surgery, and can improve the healing rate of patients after surgery, reduce the occurrence of urinary tract infection and shorten the duration of indwelling catheterization.

Association of LncRNA PCBP1-AS1 with cancer occurrence and development: A review

Long-stranded noncoding RNAs (LncRNAs) are noncoding RNAs &gt;200 nucleotides in length. Polycytidine binding protein 1 antisense LncRNA is abbreviated as LncRNA polycytosine binding protein 1 antisense1 (PCBP1-AS1). Since studies in recent years have revealed the importance of PCBP1-AS1 in human genetic analysis, it is an important member of the LncRNA family. Genetically engineered group analysis of PCBP1-AS1 regulates the progression of cancer in biology. Therefore, it may be an important RNA in the regulation of human cancer. This article summarizes the molecular mechanism and clinical role of PCBP1-AS1 in various tumor types. Taking “PCBP1-AS1” and “cancer” as keywords, this paper analyzed the relationship between PCBP1-AS1 and various tumors by searching PubMed and Geen Medical, and summarized the related regulatory mechanism of PCBP1-AS1. PCBP1-AS1 is a valuable tumor-associated LncRNA that plays different biological roles in different cancers. Overall, it can both promote and inhibit the development of cancer. For example, abnormally high expression in castration-resitant prostate cancer, hepatocellular carcinoma, cervical cancer, glioma, and colorectal cancer promotes the proliferation and progression of these cancers; in contrast, PCBP1-AS1 inhibits cancer proliferation, metastasis, invasion, and recurrence when highly expressed in vulvar squamous cell carcinoma, Hodgkin lymphoma, and lung adenocarcinoma. PCBP1-AS1 regulates the development of multiple tumors, and the specific mechanism needs to be further investigated, which may become a new tumor marker and potential therapeutic target.

Inadvertent hypothermia in patients undergoing brachytherapy under monitored anesthesia care: A prospective observational cohort study

Brachytherapy, which is often performed under anesthesia, is one of the main treatment options for cervical cancer. It is unclear whether hypothermia and its associated negative outcomes are encountered during this procedure. This prospective observational cohort study aimed to investigate the prevalence and adverse effects of hypothermia during serial brachytherapies under deep sedation for cervical cancer. Female patients over the aged &gt; of 18 years who underwent were taken to serial brachytherapy sessions under deep sedation on alternate dates at most twice a week for the treatment of cervical cancer were included. A total of 23 female were screened for initial and post-procedural hypothermia using infrared thermometers without contact to the skin at forehead between July and October 2022 at tertiary education and research hospital. Hypothermia was detected in 2 2 (8.7%) of the 23 patients and 5 5 (5.4%) of the 92 sessions. A negative correlation was found between the anesthesia time and post-procedural body temperature values (r = −0.385, P &lt; .001). It was observed that there was a decrease in body temperature of at most −1.3 degrees and at least −0.1 degrees during the sessions. A decrease of ≥ 0.4°C was detected in any session in 16 (69.9%) of the 23 patients. A decrease of ≥ 0.4°C was detected in 34 (37%) of the 92 sessions. Involuntary hypothermia may occur during brachytherapy sessions performed under sedation. Institutions should encourage routine temperature monitoring and active warming to prevent hypothermia and adverse outcomes.

Analysis of HPV prevalence among individuals with reproductive tract infections in a Chinese population

The previous research has found that human papillomavirus (HPV) infection is the main cause of cervical cancer, but it is still unclear whether HPV infection, as well as the HPV genotypes, are related to reproductive tract infections in the Chinese population. Patients who underwent HPV screening at Shandong Maternal and Child Health Hospital were selected, and the HPV infection status was analyzed among patients with cervical lesions, bacterial vaginosis, cervical inflammation, fungal vaginitis, and pelvic infections. SPSS 22 statistical analysis was used to analyze the differences in HPV infection types and rates between the control group and the experimental group. The HPV infection rate of bacterial vaginosis (χ2 = 13.4; P &lt; .001) and fungal vaginitis (χ2 = 3.3; P &lt; .045) are both significantly different from the control group. The single HPV infections reveals significant differences from control group in bacterial vaginosis (χ2 = 7.3; P = .004), fungal vaginitis (χ2 = 4.5; P = .023), and cervical lesions (χ2 = 58.8; P &lt; .001). In the bacterial infection group, HPV51 (1.9%; χ2 = 6.0; P = .008) and HPV58 (4.7%; χ2 = 3.3; P = .044) showed significant differences in infection compared to the control group. In the fungal infection group, HPV39 (2.7%; χ2 = 4.7; P = .032) showed a significant difference in infection compared to the control group. Cervical lesions, bacterial vaginosis, fungal vaginitis, and cervical lesions among Chinese population exhibit age-specified distribution. HPV infection rate in bacterial vaginitis, fungal vaginitis and cervical lesions was higher than that in normal group. HPV52 and HPV16 infection are different, and HPV39 is different between bacterial vaginitis and fungal vaginitis.

Observation of hemostatic effectiveness and safety of ultrasound-CT guided 3D intracavitary and interstitial brachytherapy in the treatment of larger cervical cancer with bleeding: A retrospective study

Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women. This study explored the effectiveness and safety of ultrasound-CT guided 3D intracavitary and interstitial brachytherapy (US-CT-3D-IGBT) in the treatment of larger cervical cancer with bleeding. A retrospective study was conducted on 31 patients with larger cervical squamous cell carcinoma (tumor short diameter &gt;4 cm) with vaginal bleeding. US-CT-3D-IGBT was used to deliver a single high-dose prescription of high-risk clinical target volume (HR-CTV) 1000 to 1200 centigray (cGy) to the cervical tumor, followed by conventional intensity-modulated radiation therapy (IMRT) synchronous chemoradiotherapy (45–50 gray (Gy)/25–28 fraction(f)) with weekly cisplatin 25 mg/m2. After external radiotherapy, simple intracavitary brachytherapy (BT) combined with manual interstitial BT was administered at 30 Gy/5F or 28 Gy/4F. Within 24 hours after high-dose 3D-IGBT, bleeding stopped in 2 patients (6.4%), and bleeding was reduced in a total of 11 patients (35.4%) within 48 hours. A total of 29 patients achieved hemostasis within 72 hours, with an effective rate of 93.5%. The remaining 2 patients reached the clinical hemostasis requirement on the 4th and 5th day. All patients experienced a significant reduction in vaginal bleeding after the initial BT, with an average reduction of 66 mL (160–20 mL). US-CT-3D-IGBT is effective in rapidly controlling bleeding in patients with larger cervical cancer (tumor short diameter &gt;4 cm), and the treatment is relatively safe and feasible.

The feasibility of using the compound kushen injection to treat cervical cancer based on network pharmacology and transcriptomics

Background: To investigate the molecular targets and mechanisms of compound kushen injection (CKI) in the prevention and treatment of cervical cancer based on network pharmacology and transcriptomics. Methods: In this study, we used network pharmacology methods to screen for effective compounds, integrated the results of network pharmacology and RNA-seq to comprehensively screen and predict target genes, analyze the biological functions and signaling pathways of target genes, and construct a PPI network to screen for hub genes. The results were further verified by biological experiments, molecular docking, RT-PCR, and western blot analysis. Results: The results showed that the hub genes CXCL2, anti-vascular endothelial growth factor, hexokinase 2 are therapeutic targets of CKI for the treatment of Cervical Cancer. These targets were significantly enriched in pathways mainly including pathways in cancer, cell cycle, MAPK signaling pathways, etc. In vitro cell experiments showed that CKI could effectively inhibit the proliferation of cancer cells, promote apoptosis, and induce cell cycle arrest. RT-PCR and western blot experiments showed that the expression of hub genes was significantly decreased. The compounds have good binding activity to hub genes. Conclusion: CKI, based on its active ingredients and through multiple targets and multiple pathways, can stop the growth of cervical cancer cells at a certain phase of the cell cycle and cause apoptosis, which proved CKI’s effect in treating cervical cancer.

Serum CXCL8 and CXCR2 as diagnostic biomarkers for noninvasive screening of cervical cancer

Background: Cervical cancer (CC) is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer-related death in women. Identifying new biomarkers for the early detection of CC is an essential requirement in this field. CXCL8 was originally discovered because of its role in inflammation by binding to CXCR1 and CXCR2; however, it is now known to play an important role in cancer. In this study, we aimed to evaluate the expression levels of potential biomarkers (CXCL8, CXCR1, and CXCR2) and to explore their diagnostic potential in CC. Methods: The expression levels of serum CXCL8, CXCR1, and CXCR2 were investigated by kit method on Immulite-1000 in 30 healthy volunteers, 30 precancerous patients and 70 CC patients. Results: The results indicated that the expression of CXCL8 and CXCR2 was significantly higher in the serum of CC patients than in healthy volunteers, similar to the well-established tumor marker (squamous-cell cancerantigen [SCC]). Receiver operating characteristic analyses showed that the combination of CXCL8, CXCR2, and SCC had the highest diagnostic sensitivity and area under the curve value. Meanwhile, the positive predictive value and negative predictive value were not very low. Moreover, high concentrations of CXCL8 and CXCR2 are associated with an increased risk of CC. Conclusions: In conclusion, our data demonstrated that combined serum CXCL8, CXCR2, and SCC measurements are helpful for CC diagnosis and can be used as potential biomarkers for the early detection of CC. Cytokines, such as CXCL8 and CXCR2, can be easily measured in most university hospital laboratories and in some private laboratories with a routine test.

Meta-analysis of the efficacy and safety of Xihuang Pills/capsules in adjuvant treatment of uterine cervical neoplasms

Background: Xihuang Pills/Capsules have a longstanding history of utilization in traditional Chinese medicine (TCM) for treating cancer. Nevertheless, a comprehensive investigation is required regarding the specific impacts and safety of Xihuang Pills/Capsules in individuals with uterine cervical neoplasms. Thus, conducting a meta-analysis is essential to evaluate the clinical effectiveness of combining Xihuang Pills/Capsules with Western medicine in patients with cervical neoplasms. Methods: The research involved searching 5 English and 4 Chinese databases for randomized controlled trials (RCTs) investigating the use of Xihuang Pills/Capsules in conjunction with Western medicine for treating uterine cervical neoplasms. Subsequently, statistical analysis was carried out using Review Manager software (version 5.3). Results: This research encompassed 10 RCTs involving 937 patients. The findings revealed that the combination of Xihuang Pills/Capsules with Western medicine treatment led to improvements in various aspects of the patients’ condition. Specifically, there was an enhancement in the short-term efficacy rate (risk ratio [RR] = 1.14, 95% confidence interval [CI]: 1.06–1.22, P = .0003), Karnofsky performance score (KPS) (mean difference [MD] = 5.90, 95% CI: 0.54–11.26, P = .03), survival rates, CD3+, CD3 + CD4+, CD3 + CD8+, CD3–CD56 + cells, and immunoglobulin M in patients with uterine cervical neoplasms. Moreover, the combination treatment resulted in a reduction of adverse reactions, including gastrointestinal reactions (RR = 0.52, 95% CI: 0.42–0.64, P &lt; .00001), radiation proctitis (RR = 0.47, 95% CI: 0.33–0.68, P &lt; .0001), myelosuppression (RR = 0.41, 95% CI: 0.26–0.64, P &lt; .0001), as well as carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) levels. Additionally, the treatment exhibited an inhibitory effect on white blood cells (WBCs) and platelets (PLTs). Conclusion: The amalgamation of Xihuang Pills/Capsules with conventional anti-tumor therapy proves to be both effective and safe in the treatment of cervical neoplasms. However, further validation through high-quality RCTs is necessary to substantiate these findings.

Correlates of cervical cancer prevention advocacy and cervical cancer screening in Uganda: Cross-sectional evaluation of a conceptual model

An approach to increasing cervical cancer (CC) screening is to empower women who have been screened to act as advocates and encourage other women they know to get screened. We examined correlates of CC screening advocacy and CC screening uptake among constructs in our conceptual model of factors driving engagement in advocacy. A cross-sectional, correlational analysis was conducted with survey data from 40 women (index participants) who had recently screened for CC, and 103 female members of their social network (alter participants) who had not been screened. Variables measured included CC prevention advocacy, as well as internalized CC stigma, sharing of CC screening result, CC knowledge, healthy bodily intake (i.e., diet; alcohol and cigarette use) and self-efficacy related to CC service utilization and CC prevention advocacy, which were hypothesized to be associated with advocacy. Bivariate and multivariable regression analyses, controlling for clustering, were conducted. Among index participants, greater engagement in advocacy was positively correlated with CC knowledge, sharing of CC screening result, and CC service utilization self-efficacy. Women who had screened positive and received treatment for precancerous lesions reported greater CC prevention advocacy, CC knowledge and healthy living, compared to those who screened negative. In multiple regression analyses, CC screening was positively associated with CC prevention advocacy and being age 36 or older, and CC prevention advocacy was also positively associated with CC service utilization self-efficacy. These findings support the validity of our conceptual model regarding factors associated with engagement in CC prevention advocacy among women screened for CC. The strong association between CC prevention advocacy and both CC screening uptake and CC service utilization self-efficacy suggests the potential value of advocacy promotion among women who have been screened, as well as for increasing screening uptake.

Prognostic models for predicting overall and cancer-specific survival of patients with initially diagnosed metastatic cervical squamous cell carcinoma: A study based on SEER database

Cervical squamous cell carcinoma (CSCC) is the most common histological type of cervical cancer (CC). And mCSCC is the end stage of CSCC. The aim of this study was to develop prognostic nomograms that provide better predictions for overall survival (OS) and cancer-specific survival (CSS) in mCSCC patients. Data from patients with initially diagnosed mCSCC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The nomograms for OS and CSS were constructed based on Cox regression analysis. The validation of the newly established nomograms was evaluated by concordance index (C-index), calibration curves, and decision curve analyses (DCAs). A total of 2198 patients with mCSCC were included and randomly split into training (n = 1539) and validation (n = 659) cohorts in a 7:3 ratio. Multivariate analyses revealed that the prognostic variables significantly related to the OS and CSS were marital status, T stage, brain metastasis, lung metastasis, tumor size, number of positive lymph nodes, chemotherapy, and radiotherapy. The nomograms were constructed based on these factors. The C-index value of the nomograms for predicting OS and CSS was 0.714 and 0.683, respectively. The calibration curves of the nomograms showed good consistency between nomogram prediction and actual survival for both OS and CSS, and the DCAs showed great clinical usefulness of the nomograms. The mCSCC patients were classified into low- and high-risk groups based on the scores from the nomograms. In the validation cohort, mCSCC patients with low-risk had much higher OS and CSS than those with high-risk. We constructed nomograms for predicting the OS and CSS of patients with initially diagnosed mCSCC. Our models had satisfactory predictive performance and could be useful in survival prediction for mCSCC.

The diagnostic value of lncRNA HOTAIR for cervical carcinoma in vaginal discharge and serum

There is a lower incidence of cervical carcinoma compared with other common carcinomas, however, the mortality rate of cervical carcinoma is higher, suggesting that the treatment and prognosis of cervical carcinoma are relatively poor. Therefore, cervical carcinoma patients urgently need to find new diagnostic markers for early detection and treatment. One hundred and fifty cervical carcinoma and 100 benign cervical disease patients from 2019 January to 2021 December in Tianjin Central Hospital of Gynecology Obstetrics were selected and 100 healthy women were as normal group. The expression of HOX transcript antisense RNA (HOTAIR) in cervical carcinoma and paracancerous tissue, serum sample was measured by realtime PCR assay. The receiver operating characteristic of HOTAIR for cervical carcinoma was analyzed. The study found that the expression level of HOTAIR in primary cervical carcinoma is closely related to tumor metastasis and prognosis. The expression level of HOTAIR in paracancerous tissue was significantly lower than that in cancer tissue, and the expression level of HOTAIR in vaginal discharge and serum was higher than that in cervical carcinoma patients which was positively correlated with tumor malignancy, meanwhile, HOTAIR was significantly reduced after surgery 3 months both in vaginal discharge and serum. In order to examine the diagnostic efficiency of HOTAIR for cervical carcinoma, we found that the area under curve of vaginal discharge was 0.9723, sensitivity was 92%, specificity was 98%, the area under curve of serum was 0.8518, sensitivity was 79%, and specificity was 94% by receiver operating characteristic analysis. The accuracy were 92.7% and 89.3% in vaginal discharge and serum via certified by cervical carcinoma and benign cervical disease patient and healthy people. The above results show that the diagnostic performance of HOTAIR in vaginal discharge is higher than that of serum, and it is expected to become a marker for cervical carcinoma diagnosis and treatment.

Decreasing expression of HIF-1α, VEGF-A, and Ki67 with efficacy of neoadjuvant therapy in locally advanced cervical cancer

Background: Neoadjuvant chemotherapy (NACT) before radical hysterectomy has been widely used for locally advanced cervical cancer (LACC); However, its efficacy is yet to be determined. Methods: Effective and predictive biomarkers, which may aid in predicting the chemotherapy responses, were explored in this study. Initially, the expression of HIF-1α, VEGF-A, and Ki67 was detected in 42 paired (pre-NACT and post-NACT) LACC tissues, as well as 40 nonneoplastic cervical epithelial tissues by immunohistochemistry. Then, the correlation of the expression of HIF-1α, VEGF-A, Ki67 with the efficacy of NACT, as well as factors that affect the efficacy of NACT was analyzed. Results: A clinical response occurred in 66.7% (28/42) of the patients, including 57.1% (16/28) with a complete response and 42.9% (12/28) with a partial response; While 33.33% (14/42) were non-responders, including 42.9% (6/14) with stable disease and 57.1% (8/14) with progressive disease. HIF-1α, VEGF-A, and Ki67 were overexpressed in LACC tissues compared to nonneoplastic tissues (P &lt; .01, respectively); While the expression of HIF-1α, VEGF-A, and Ki67 was significantly decreased after NACT (P &lt; .01, respectively). What’s more, in the response group, HIF-1α, VEGF-A, and Ki67 expression were significantly decreased after chemotherapy in the post-chemotherapy cervical cancer tissues compared with the pre-chemotherapy cervical cancer tissues (all P &lt; .05). Additionally, patients with lower histological grade and lower expression of HIF-1α, VEGF-A, and Ki67 were more responsive to NACT (P &lt; .05, respectively); Moreover, the histological grade [P = .025, HR (95% CI): 0.133 (0.023–0.777)], HIF-1α [P = .019, HR (95% CI): 0.599 (0.390–0.918)], and Ki67 [P = .036, HR (95% CI): 0.946 (0898–0.996)] were independent risk factors affecting the efficacy of NACT in LACC. Conclusion: Expression of HIF-1α, VEGF-A, and Ki67 were significantly decreased after NACT, and decreasing expression of HIF-1α, VEGF-A, and Ki67 were related to good response to NACT, suggesting HIF-1α, VEGF-A, and Ki67 may be implicated in evaluating the efficacy of NACT in LACC.

Association between gut microbiota, plasma metabolites, and ovarian cancer: A Mendelian randomization study

Numerous studies have demonstrated a correlation between alterations in gut microbiota (GM) and levels of body metabolites in ovarian cancer (OC). However, the specific causal relationships underlying these associations remain unclear. This study utilized summary statistics of GM from the MiBioGen consortium, along with an unprecedented dataset comprising 1091 blood metabolites and 309 metabolite ratios from the UK Biobank, in conjunction with OC data from the FinnGen Consortium R9 release. We conducted bidirectional Mendelian randomization (MR) analyses to investigate the causal relationships between GM and OC. Additionally, a two-step MR approach was employed to identify potential mediating metabolites. Our analysis revealed significant associations between 6 specific microbiota taxa and OC. Furthermore, we identified several plasma metabolites that act as mediators of the association between GM and OC. In the two-step MR analysis, we observed a negative correlation between 4-methoxyphenol sulfate and pregnenetriol disulfate levels with OC. The genus Lachnospiraceae UCG008 potentially increases the risk of OC by decreasing 4-methoxyphenol sulfate levels, while the genus Howardella may elevate the risk of OC by reducing pregnenetriol disulfate levels, with mediation proportions of 22.35% and 4.23%, respectively. Additionally, levels of dilinoleoyl-GPE (18:2/18:2) and N-acetylkynurenine (2) were positively correlated with OC. The inhibitory effect of the genus Ruminococcus 1 on OC may be mediated through 1,2-dilinoleoyl-GPE (18:2/18:2) and N-acetylkynurenine (2), with mediation proportions of 10.15% and 11.32%, respectively. Our findings highlight the complex relationship among GM, plasma metabolites, and OC. The identified associations and mediation effects offer valuable insights into potential therapeutic approaches targeting GM for the management of OC.

Neoadjuvant chemotherapy in advanced epithelial ovarian cancer by histology: A SEER based survival analysis

To evaluate the prognostic effect of neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer (EOC) patients with different histological subtype. Stage III/IV EOC patients diagnosed between 2010 and 2018 were identified from the surveillance, epidemiology, and end results database (SEER) database and stratified by histological subtype. Kaplan–Meier analysis was used for the assessment of overall survival (OS) cause-specific survival (CSS) before and after matching for baseline characteristics between NACT and primary debulking surgery (PDS) groups. Cox proportional risk model was conducted to identify independent prognostic factors. A total of 13,582 patients were included in the analysis. Of them, 9505 (74.50%) received PDS and 3253 (25.50%) received NACT. Overall, an inferior OS and CSS was observed among patients with high-grade serous carcinoma (HGSC) receiving NACT, while NACT served as a protective factor in clear cell carcinoma and carcinosarcoma in both original cohorts and adjusted cohorts. For other histo-subtypes, PDS showed survival benefit over NACT in certain cohorts of models. Prognostic effect of NACT in advanced EOC differed from pathological subtypes. Although it served as a risk factor for HGSC, patients with less common subtypes may benefit from NACT.

Ovarian remnant syndrome with paraintestinal ovarian serous cystadenofibroma arose 30 years after bilateral salpingo-oophorectomy: A case report

Rationale: Ovarian cystadenofibroma is a relatively rare benign ovarian tumor. Ovarian remnant syndrome (ORS) is a rare complication of bilateral salpingo-oophorectomy (BSO). We report a rare case of ORS with paraintestinal ovarian serous cystadenofibroma that developed 30 years after total abdominal hysterectomy and BSO in a 73-year-old woman. Patient concerns: A 73-year-old woman complained of long-term lower abdominal discomfort. Diagnosis: She was diagnosed with a cystic lesion in the lower abdomen on transabdominal ultrasonography. Further diagnostic imaging and laboratory tests could not exclude a diagnosis of malignancy. Interventions: The patient underwent laparoendoscopic single-site surgery. We found one cystic lesion 5 cm in size with multiple septa that was adhered to the small bowel. We consulted a general surgeon for tumor resection. Dissection was performed and the specimen was then removed from the umbilical wound. Outcomes: Histopathological examination revealed an ovarian serous cystadenofibroma. The postoperative recovery was uneventful. Lessons: Patients with lower abdominal pain after a previous hysterectomy and BSO should be examined with transabdominal sonography for ORS.

Follicular carcinoma originating from struma ovarii: A case report

Introduction: Follicular carcinoma originating from struma ovarii is a clinically rare low-grade malignant tumor. The pathological diagnosis of ovarian thyroid follicular carcinoma is predominantly based on the infiltrative growth and vascular involvement of tumor cell nests of different sizes in the ovarian parenchyma. Patient concerns: Here we present a case of this malignancy in which the bilateral ovaries, right oviduct wall, myometrial surface, omentum, and bladder reflex were extensively involved Microscopically, the thyroid follicles in this case showed infiltrative growth of nodules of different sizes in the ovarian stroma. Diagnosis: The epithelial layer of the follicles was atypical, but with no nuclear features of papillary thyroid carcinoma such as nuclear groove and nuclear pseudoinclusions. Immunohistochemistry showed positive expression of thyroglobulin, thyroid transcription factor-1, and cytokeratin19, with a Ki-67 index of 5% +. Immunohistochemical results combined with microscopic morphology allowed a diagnosis of follicular carcinoma originating from struma ovarii. Interventions: After exclusion of contraindications to surgery, the patient underwent surgical exploration on July 26, 2022, during which frozen pathological examination was performed. Outcomes: The patient recovered well and was discharged. At the first follow-up visit in October 2022, the patient had an excellent survival. Conclusion: The analysis of the microscopic morphological characteristics and immunohistochemistry deepened our understanding of the pathological characteristics of ovarian and thyroid follicular carcinoma, and further provides a diagnostic reference for other clinicians who will encounter these conditions in the future.

Long non-coding RNA FOXP4-AS1 is a prognostic biomarker and associated with immune infiltrates in ovarian serous cystadenocarcinoma

Abstract Background: FOXP4-AS1 expression participates in multiple signal pathways and has been previously reported in colorectal cancer, cervical cancer, and other cancer cells. However, its role on prognosis and immune infiltrates in ovarian serous cystadenocarcinoma (OVs) remains unclear. The purpose of our study was to investigate the expression of FOXP4-AS1 in OVs and its association with immune infiltrates, and determined its prognostic roles in OVs. Methods: Using The Cancer Genome Atlas (TCGA) database, we retrieved FOXP4-AS1 expression and clinical information for 376 patients with OVs. Wilcoxon rank sum test was used to compare the expression of FOXP4-AS1 in OVs and normal ovarian tissue. Logistic regression was used to analyze the relationship between clinicopathologic features and FOXP4-AS1. Gene Set Enrichment Analysis (GSEA), and single sample Gene Set Enrichment Analysis (ssGSEA) was conducted to investigate the enrich pathways and functions and quantify the extent of immune cells infiltration for FOXP4-AS1. Kaplan–Meier method was used to generate survival curves, and Cox regression was used to analyze the relationship between FOXP4-AS1 and survival rate. Results: High FOXP4-AS1 expression was significantly correlated with tumor FIGO stage (P = .026). Multivariate survival analysis showed that FOXP4-AS1was an independent prognostic marker for overall survival (OS; hazard ratio [HR]: 0.638; 95% confidence interval [CI]:0.467–0.871; P = .001) and disease-specific survival (DSS; HR: 0.649; CI: 0.476–0.885; P = .006). GSEA showed that High FOXP4-AS1 expression may active programmed cell death 1 (PD-1) signaling, the cytotoxic T lymphocyte-associated antigen-4 (CTLA4) pathway, the B cell receptor signaling pathway, apoptosis, fibroblast growth factor receptor (FGFR) signaling, and the Janus-activated kinase signal transducers and activators of transcription (JAK-STAT) signaling pathway. FOXP4-AS1 expression was negatively correlated with markers of immune cells, including aDC, cytotoxic cells and neutrophils. Conclusion: High FOXP4-AS1 expression has the potential to be a prognostic molecular marker of favorable survival in OVs.

Correlation analysis and clinical significance of CA125, HE4, DDI, and FDP in type II epithelial ovarian cancer

Abstract Ovarian cancer is one of the common female malignant tumors. The early diagnosis and treatment of ovarian cancer has been a research hotspot. Therefore, we aimed to investigate the correlations between the levels of carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), D-dimer (DDI), and fibrinogen degradation product (FDP) in patients with type II epithelial ovarian cancer. From January 2018 to January 2019, a total of 952 patients who underwent initial surgery for epithelial ovarian cancer were enrolled in this study. Peripheral venous blood was taken before operation, and the levels of CA125, HE4, DDI, and FDP were tested. The correlations between the levels of CA125, HE4, DDI, and FDP and other clinical indicators (such as presence or absence of chemotherapy, surgical conditions) were analyzed. The level of DDI or FDP was statistically associated with age, chemotherapy, Figo staging, surgical procedure, HE4 level, and CA125 level, respectively. Moreover, the Figo staging was statistically correlated with the levels of HE4 and CA125. Besides, we found the levels of CA125 and HE4 were positively correlated with the levels of DDI and FDP. The levels of CA125 and HE4 are the traditional detection indexes for patients with type II epithelial ovarian cancer, and these 2 indicators reflected the degree of disease and prognosis. The levels of DDI and FDP were closely related to the levels of CA125 and HE4 in type II epithelial ovarian cancer, and they also helped to assess the prognosis of epithelial ovarian cancer. Further larger-scale prospective cohort studies are warranted to determine these associations in the future.

Mesonephric-like adenocarcinoma of the ovary

Abstract Rationale: Mesonephric-like adenocarcinoma (MLA) from ovary is a very rare tumor which derives from mesonephric duct remnant of the female genital tract. Only six cases have been reported so far in the English literature. Patient concerns: A 29-year-old female patient was referred to the local hospital with a 20-day history of abdominal discomfort. Diagnoses: Pelvic ultrasound examination revealed a solid and cystic mass measuring 10 cm in diameter in the right adnexal area and a cystic mass measuring 5 cm in the left adnexal area. Postoperative pathology in the local hospital revealed suspected malignancy of the right ovary, and she was then transferred to our institution for definite diagnosis. The tumor mass was finally diagnosed as a primary MLA arising from the right ovary by histological and immunohistochemical examination in our institution. Interventions: The patient underwent laparoscopic right adnexectomy and removal of left ovarian cyst in the local institution. Then, she underwent a complete staging surgery including a total hysterectomy, left adnexectomy, pelvic plus para-aortic lymphadenectomy, and omentectomy in our hospital. In addition, she received four cycles of combination chemotherapy with carboplatin plus paclitaxel. Outcomes: There is no evidence of recurrence with 13 months of follow-up till now, and we are still following-up this patient. Lessons: MLA is an extremely uncommon malignancy with difficult diagnosis, unclear treatment and poor prognosis. Familiarizing with the clinical features and optimal management of this rare tumor may increase awareness of the disease among clinicians and pathologists, thus avoiding the misdiagnosis and mistreatment.

Dysregulated expression of circular RNAs serve as diagnostic and prognostic markers in ovarian and cervical cancer

Abstract Introduction: Recent studies have reported a connection between non-coding RNAs such as circular RNAs (circRNAs) and the prognosis of various cancers. However, the mechanism of circRNA in ovarian cancer and cervical cancer has not been consistent. We evaluated the diagnostic and prognostic roles of circRNAs in ovarian and cervical cancer by meta-analysis. Methods: Pooled hazard ratios with 95% confidence intervals were to estimate overall survival. Diagnostic efficacy was estimated by sensitivity, specificity and area under curve. Results: By searching PubMed, Embase, the Web of Science databases, and other sources, we obtained a total of 22 studies with 2059 patients from Asia population. High expression levels of oncogenic circRNAs were significantly associated with poor prognoses both in ovarian and cervical cancer. However, elevated expression levels of tumor-suppressor circRNAs were linked with favorable survival time in ovarian cancer. As for diagnostic role, the area under the curve value in ovarian cancer and cervical cancer is 0.89 and 0.93, respectively. Conclusions: CircRNAs have the prospect of becoming a promising biomarker for diagnosis and prognosis of ovarian and cervical cancer. Accordingly, circRNAs might be novel indicators and targets of therapy for ovarian and cervical cancer.

Germinal ovarian tumors in reproductive age women

Abstract MOGCTs (malignant ovarian germ cell tumors) are rare tumors that mainly affect patients of reproductive age. The aim of this study was to evaluate the fertility and survival outcomes in young women with MOCGTs treated with fertility-sparing surgery (FSS). From 2000 to 2018, data from 28 patients of reproductive age with a diagnosis of MOGCT at the University of Bari were collected. Most received FSS, and in patients treated conservatively, the reproductive outcome and survival were investigated. Data of patient demographics, clinical presentation, oncology marker dosage, staging, type of surgery, histological examination, survival, and reproductive outcome were collected from hospital and office charts. All informed consent was obtained from all patients. The median age was 24 (range: 9–45 years). The majority of the patients had stage IIIC. Twenty-four woman received FSS consisting of unilateral ovariectomy and omentectomy, whereas only 4 women, based on their stage (IIIC), received a radical surgery (hysterectomy with bilateral adnexectomy, lymphadenectomy, and omentectomy). Our study shows that FSS in MOGCTs can produce good results both on reproductive outcomes and on survival. Indeed, in our group, there was only 1 case of exitus as result of recurrence. Furthermore, patients after FSS maintained normal ovarian function and 5 of 5 women who tried to get pregnant succeeded spontaneously. The median follow-up was 90 months (range 3–159). Conservative surgery for MOGCTs should be considered for women of reproductive age who wish to preserve fertility.

Feasibility of neoadjuvant and adjuvant intraperitoneal chemotherapy in patients with advanced epithelial ovarian cancer

Abstract Intraperitoneal (IP) chemotherapy is believed to prolong the survival of patients with advanced ovarian cancer after primary debulking surgery. However, there is little knowledge about IP chemotherapy in the setting of neoadjuvant chemotherapy, and there are contradictory conclusions about adjuvant IP chemotherapy. Here, we evaluated the feasibility of neoadjuvant and adjuvant IP chemotherapy in patients with advanced epithelial ovarian cancer (AEOC). We retrospectively reviewed the data of 114 patients with AEOC who received neoadjuvant chemotherapy followed by laparoscopic conservative interval debulking surgery (NACT + LIDS) in our institution from January 1, 2009 to December 31, 2017. The median overall survival (OS) was 56 months and the median disease-free interval (DFI) was 14 months for the entire study population. Neoadjuvant IP chemotherapy cycles were crucial for the treatment of no gross residual (R0) disease (hazard ratio [HR] = 0.446, 95% confidence interval [CI] = 0.245–0.811), which was independently associated with OS of the entire study population (HR = 9.589, 95% CI = 3.911–23.507). In addition, residual disease and body mass index (BMI) were the prognostic factors for DFI (HR = 6.022, 95% CI = 3.632–9.986; HR = 1.085, 95% CI = 1.012–1.163). However, adjuvant IP cycles along with BMI were the determining factors for DFI in the R0 group (HR = 0.703, 95% CI = 0.525–0.941; HR = 1.130, 95% CI = 1.025–1.247), and were associated with OS in the R0 group (HR = 0.488, 95% CI = 0.289–0.824). The OS and DFI Kaplan-Meier curves stratified by adjuvant IP chemothearpy cycles within the R0 group were statistically significant (P = .024 and P = .033, respectively). Our results showed improvement in patients with AEOC in terms of survival, thus suggesting the feasibility of neoadjuvant and adjuvant IP chemotherapy.

Ovarian metastasis in women with cervical carcinoma in stages IA to IIB

Cervical cancer is one of the common malignancies that afflict women worldwide. In rare cases, cervical cancer leads to ovarian metastasis (OM), resulting in poor outcomes. We conducted a systematic review and meta-analysis to evaluate the incidence and risk factors of OM in patients with adenocarcinoma (ADC) or squamous cell carcinoma (SCC) of the cervix. We searched articles focused on OM in cervical carcinoma in PubMed, Embase, and the Cochrane Central Register of Controlled Trials. A meta-analysis was performed including selected publications. Pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated using random-effects models. The heterogeneity was evaluated by the I test. I > 50% was considered high heterogeneity. A total of 12 studies with 18,389 patients with cervical cancer in International Federation of Gynecology and Obstetrics stages IA to IIB were included in the meta-analysis. The overall incidence of OM was 3.61% among patients with ADC and 1.46% among patients with SCC (ADC vs SCC: OR 3.89, 95% CI 2.62-5.78; P 40 years (OR 1.79, 95% CI 1.02-3.13), bulky tumor (OR 2.65, 95% CI 1.77-3.95), pelvic lymph node involvement (PLNI; OR 9.33, 95% CI 6.34-13.73), lymphovascular space involvement (LVSI; OR 4.38, 95% CI 1.86-10.31), parametrial invasion (PMI; OR 7.87, 95% CI 5.01-12.36), and corpus uteri invasion (CUI; OR 7.64, 95% CI 2.51-23.24). PLNI, LVSI, and PMI were the leading risk factors, contributing to OM with respective population attributable fractions of 64.8%, 58.8%, and 51.5%. The incidence of OM is relatively low in ADC and SCC patients. Risk factors for OM include PLNI, LVSI, PMI, bulky tumor, CUI, or age over 40 years, with the first 3 contributing more to risk of OM.

Cytoreductive surgery for advanced stage ovarian cancer in the second trimester of pregnancy—a case report and literature review

Abstract Rationale: Advanced stage ovarian cancer is rarely encountered in pregnant women, due to the high number of ultrasound imagistic studies performed during this period. The clinical course of patients diagnosed with advanced stage ovarian cancer is similar in pregnant and nonpregnant women. Patient concerns: We present the case of a 27-year-old woman initially submitted to emergency surgery for ovarian cyst torsion in the ninth week of gestation, at that moment ovarian cystectomy being performed. Diagnoses: The histopathological studies demonstrated the presence of a moderately differentiated epithelial ovarian cancer. Interventions: Although the interdisciplinary team decided for staging surgery followed by platinum-based chemotherapy beginning from the second trimester of pregnancy, both the patient and her family refused this strategy and opined for total hysterectomy en bloc with bilateral adnexectomy. Surprisingly, intraoperatively both ovaries had a tumoral aspect, whereas peritoneal carcinomatosis nodules were found in the Douglas pouch. Therefore, the neoplastic process was staged as a IIIC epithelial ovarian cancer, a total hysterectomy with bilateral adnexectomy, Douglas pouch peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection being performed. Outcomes: The patient was discharged in the sixth postoperative day and was confined to the oncology service in order to be submitted to the standard taxanes and platinum based chemotherapy. Lessons: Although ovarian cancer has been rarely reported during pregnancy, this diagnostic should be taken in consideration whenever persistent adnexal masses are encountered.

Activity of regorafenib in advanced pretreated soft tissue sarcoma

Abstract Background: Regorafenib, a multitargeted tyrosine kinase inhibitor, proved to be active in patients with soft tissue sarcomas (STS). Methods: We conducted an open-label, non-randomized, single-center phase II study in advanced pretreated STS patients. Patients received regorafenib 160 mg daily on days 1 enrule 21 of a 28-day cycle. The primary endpoint was the progression-free survival (PFS) at 8 weeks. Toxicity was registered. Results: Between April 2015 and November 2016, 21 patients were enrolled in the trial. A total of 13 out of 21 evaluable patients (61.9%) were progression-free at 8 weeks. Median PFS was 3.8 months (95% CI: 2.1–9.4). Median overall survival was 14.8 months (95% CI: 7.7–27.8). In the intention-to-treat population, we reported a PFS of 66.7% at 3 months (95% CI: 40.4–83.4) and 16.7% at 12 months (95% CI: 4.1–36.5). As per the RECIST criteria, the response rate was 4.7% (1 partial response out of 21 evaluable patients) with a clinical benefit rate of 61.9%; no complete response was observed. Treatment was well tolerated. Conclusion: Regorafenib shows signs of clinical activity in patients with advanced STS. Clinical Trial Registration: ClinicalTrials.gov NCT02307500.

Adenoid cystic carcinoma of the Bartholin’s gland is easily misdiagnosed: A case report and literature review

Rationale: Adenoid cystic carcinoma (ACC) often occurs in the major and minor salivary glands and other sites containing secretory glands, while ACC of the Bartholin’s gland (BG-ACC) in the vulva is rare and easily misdiagnosed. Patient concerns: A 58-year-old female was referred to our hospital for further valuation of a mass occurring on the left side of her vulva. In the other hospital, the beginning of the period, local ultrasound showed a vulva mass, which was suspected to be a Bartholin’s gland cyst. Mixed neoplasms were considered in some biopsies. When transferred to our hospital, virtuous tumors were considered by ultrasound and magnetic resonance imaging. Pathology initially considered benign hyperplastic active tumor or borderline tumor. Diagnoses: Histological, immunochemical, and molecular tests confirmed a diagnosis of BG-ACC, negative surgical margin, without lymphatic metastasis. Interventions: Extended excision of the mass at left labia majora plus left inguinal lymph node dissection was performed. Outcomes: The patient received surgery therapy, no recurrence was observed during a 18-month follow-up period. Lessons: Due to its lack of specific characteristics in clinical, ultrasound and imaging, it is easy to be misdiagnosed, Due to its rarity and nonspecific clinical, radiologic and ultrasonographic manifestations, BG-ACC can be easily misdiagnosed. And its pathomorphological features overlap with other benign and malignant tumors occurring at vulva, BG-ACC can be easily misdiagnosed, and diagnosis by puncture biopsy is extremely difficult. Use of paraffin sections to identify tumor growth characteristics, combined with immunohistochemical findings, is the key to the diagnosis of ACC. In rare sites, MYB gene split are helpful in making a definite diagnosis.

Multiple genetic variants predict the progression-free survival of bevacizumab plus chemotherapy in advanced ovarian cancer

Abstract Bevacizumab (BV) plus chemotherapy is broadly used in advanced ovarian cancer (OC). However, the efficacy of BV-based regimens for advanced OC patients is not satisfactory. Therefore, it is urgent to explore the predictive genetic biomarkers for BV. Tumor tissues from advanced OC patients receiving BV-based regimens were analyzed with a 150-gene targeted panel for next generation sequencing. The associations between gene alterations or clinicopathology features and progression-free survival (PFS) were analyzed by Kaplan–Meier curves or Cox regression. The association of the genetic alteration in potential predictive genes and expressions of 11 vascular endothelial growth factor-related genes were analyzed in The Cancer Genome Atlas cohort using 292 OC cases. Sixty two Chinese advanced OC patients treated with BV-based therapy were included. The median PFS of was 6.9 months, and objective response rate was 14.5%. In multivariate Cox regression analysis, the status of endothelial growth factor receptor (EGFR) (hazard ratio = 6.39, 95% confidence interval [CI] 2.25–18.13, P &lt; .001) and human epidermal growth factor receptor 2 (HER2) (hazard ratio = 3.58, 95% CI 1.27–10.08, P = .016) were significantly correlated with PFS. MYC Proto-Oncogene amplification seemed to have a positive trend (hazard ratio = 0.21, 95% CI 0.05–1.02, P = .052). Moreover, EGFR and HER2 alterations were not prognostic factors of overall survival for OC in The Cancer Genome Atlas OC cohort. The vascular endothelial growth factor-related signature analysis indicated vascular endothelial factor A expression was upregulated with EGFR alterations (P = .034) which may be involved in BV resistance, and HER2 alterations were associated with hypoxia inducible factor 1 subunit alpha overexpression significantly (P = .029). EGFR or HER2 alterations are negative predictors of PFS for OC patient treated with BV plus chemotherapy. Therefore, the clinicians may consider to use alternative regimens such as anti-EGFR or anti-HER2 targeted therapy instead of BV-based regimens on these patients when standard care fail.

Metastatic serous borderline tumor with micro-invasive ovarian carcinoma presenting as a breast lump

Abstract Rationale: Breast metastasis from serous borderline tumor with micro-invasive carcinoma of ovary is a very rare condition. The breast lump as the only clinical presentation is rarely seen in ovarian carcinoma, which may lead to be misdiagnosed, and the mechanism of breast metastasis from ovarian tumors in early stage still needs to be explored. Differentiation from primary breast cancer and extramammary malignancy is crucial because the treatment and prognosis are significantly different. Patient concerns: A 33-year-old female presented with a painless, movable, 1.0 × 1.0 cm lump in the upper outer quadrant of the right breast for a month. Diagnoses: Breast metastasis of serous borderline tumor with micro-invasive ovarian carcinoma confirmed by pathology and immunohistochemistry. Interventions: The patient underwent lumpectomy, bilateral ovarian tumor stripping operation and prophylactic chemotherapy. Outcomes: No signs of recurrence have been detected in 1.5 years of follow-up. Lessons: Distant metastasis may occur in early stage of ovarian carcinoma. It is important to determine the origin of the primary tumor and develop an effective treatment strategy for patients. Imaging findings and pathological diagnostic criteria are important to accurately differentiate between metastasis and primary breast lesions, which may improve the patient's outcomes.

Low EIF2B5 expression predicts poor prognosis in ovarian cancer

Abstract Ovarian cancer has the highest mortality among gynecological cancers. Although ovarian cancer usually responds well to chemotherapy, most patients still have a poor prognosis. EIF2B5 is a crucial molecule in posttranscriptional modifications involved in tumor progression, and here we investigated the prognostic role of EIF2B5 in ovarian cancer. We examined the differential expression of EIF2B5 mRNA in ovarian cancer by exploring The Cancer Genome Atlas (TCGA) database. The chi square test was used to identify a clinical correlation. Survival analysis and Cox regression model were performed to determine the association between EIF2B5 expression and overall survival (OS) in ovarian cancer patients. As a result, Low EIF2B5 expression was found in ovarian cancer tissues and correlated with survival status. Survival analysis showed that ovarian cancer patients with low EIF2B5 expression had a short OS. Moreover, Cox regression analysis indicated that low EIF2B5 expression was an independent risk factor for a poor prognosis in ovarian cancer. Additionally, according to gene set enrichment analysis, mesenchymal transition, angiogenesis, coagulation, and bile acid metabolism were differentially enriched in ovarian cancer with high EIF2B5 expression. In conclusion, Low EIF2B5 expression is an independent risk factor for a poor prognosis in ovarian cancer patients.

Primary malignant melanoma of the vagina: A case report of a rare disease that is difficult to diagnose

Rationale: Malignant melanoma is a rare cancer that accounts for approximately 1% of all cancers. Primary malignant melanoma of the female genital tract accounts for approximately 3% to 7% of all malignant melanomas, and 0.3% to 0.8% of all melanomas in women. It affects postmenopausal women ages 60 to 80 years. Various hormonal factors, including puberty, pregnancy, menopause, oral contraceptive use, and human papillomavirus infection are associated with primary malignant melanoma of the vagina. Patient concerns: Symptoms often include vaginal bleeding, discharge, and pain; however, it can also present as pigmented or nonpigmented lesions, making diagnosis challenging. Diagnoses: Diagnosis involves detailed history, physical examination, and imaging (CT, MRI, and positron emission tomography). Immunohistochemical staining for markers, such as human melanoma black-45 and Melan-A, is crucial for confirmation. The diagnosis was made through careful physical examination, imaging studies, and immunohistochemistry. Interventions: The treatment includes wide local excision, radical surgery, radiotherapy, chemotherapy, and immunotherapy. The prognosis of primary malignant melanoma of the vagina is usually poor owing to late diagnosis, and the 5-year survival rate is 5% to 25%. Outcomes and lessons: To consider the possibility of primary malignant melanoma of vagina, postmenopausal women, particularly those who with human papillomavirus infection, should be performed thorough examination regardless of symptoms of vaginal bleeding or discharge.

Adjustment and coping in spousal caregivers of cervical cancer patients in Ghana: A qualitative phenomenological study

Cervical cancer is a common and significant health issue for women worldwide. To address the dearth of research on male partners’ experiences when their significant others are diagnosed with cervical cancer, we aim to explore the unique challenges and perspectives encountered by men in these circumstances. The study adopted interpretive phenomenological analysis to qualitatively assess the experiences of males with partners diagnosed of cervical cancer. A phenomenological research design with purposive sampling technique was used to recruit and collect data from 38 participants until saturation occurred. Face to face interviews were conducted using a developed semi-structured interview guide. The data collected was analyzed using content analysis after verbatim transcription was done. The study resulted in the identification of 2 main themes, and 10 subthemes. These themes focused on the multifaceted impact of cervical cancer on spousal caregivers’ lives and the coping and support mechanisms utilized by spouses of cervical cancer patients. The findings indicated that men faced several challenging experiences as a result of their spouses’ condition and revealed the strategies they employed to cope with the stress of caring for their wives. Almost every man adopted a strategy to cope with the condition of their wives. This study would assist other men to understand the psychological, social, emotional, and spiritual experiences the men went through to appreciate and adopt their coping strategies whenever they go through such challenges.

GnRH analogue followed by surgery in treatment of vaginal leiomyoma-a case report

Abstract Rationale: Vaginal leiomyoma is a rare type of leiomyoma that occurs on the wall of vagina. Treatment for vaginal leiomyoma is varied and is based on the location and size of the leiomyoma. Patient concerns: In this case, a 24-year-old newly married Chinese woman complained of dyspareunia. The physical examination revealed a solid mass on the anterior wall of vagina. It almost filled up the whole vagina cavity. Diagnosis: Transvaginal ultrasound showed a tumor on the anterior wall of vagina. Pelvic computed tomography (CT) and magnetic resonance imaging (MRI) also confirmed the tumor on vaginal wall. Fine needle aspiration biopsy confirmed fibrous and smooth muscle tissue in the tumor, and immunohistochemical examination found the estrogen receptor (ER) and progesterone receptor (PR) were positive. Interventions: 6 courses of gonadotropin-releasing hormone (GnRH) analogue were given before the patient underwent complete surgical resection through vagina. Outcome: No postoperative complications occurred, and the patient was discharged from the hospital 3 days after surgery. Follow-up after 3 months revealed negative symptoms of genitourinary system. No sign of recurrence was found. Conclusion: In this case, vaginal leiomyoma was diagnosed with help of imagological examinations like ultrasound, CT, and MRI, as well as pathological examination like fine needle aspiration biopsy. Preoperative GnRH analogue treatment can ensure smooth surgical procedure, and reduce blood loss during surgery.

Primary vaginal malignant melanoma

Abstract Rationale: Primary vaginal malignant melanoma is a sporadic and very aggressive tumor that is treated through surgery or radiotherapy combined with chemotherapy. Since most cases are diagnosed at an advanced stage, the operation range is extensive, the quality of life is poor, and the prognosis is gloomy. Patient concerns: A 58-year-old woman presented irregular water-like leukorrhea for 1 month after 6 years of menopause. Positron emission tomography-computed tomography revealed a 3.1 × 2.6 × 3.2 mass on the middle and lower part of the right vaginal wall. A gynecological examination revealed a 2 to 3 cm exophytic black mass in the lower-right part of the vaginal orifice. This mass was 2 cm from the urethral orifice. Furthermore, the mucosa of the anterior inferior vaginal wall had blackened and thickened, and there were some scattered black dots at the medial labia minora. Diagnosis: Due to the patient's symptoms with radiographic findings, the postmenopausal woman was diagnosed with primary vaginal malignant melanoma. Interventions: Surgery was done to remove the mass. The patient also underwent inguinal lymph node dissection, received immunotherapy, and was treated with nivolumab. Outcomes: After a 6-month follow-up period, the patient underwent a routine gynecological examination with negative radiological results. Moreover, no local recurrence or distant metastases were found. Lessons: This patient showed a good response to immunotherapy. With this treatment method, the prognosis is better for advanced-stage women, especially those who cannot endure the surgery. Local lesion resection and inguinal lymph node dissection combined with immunotherapy are recommended. The case reported here may help treat similar clinical cases.

Dedifferentiated liposarcoma found in ovary: A rare case report

Rationale: Dedifferentiated liposarcoma (DL) of the ovary is a rare mesenchymal tumor which is difficult to diagnose before surgery. The diagnose of DL was depended on the morphology, Immunohistochemical stains, and fluorescence in situ hybridization after the complete surgical resection. Patient concerns: We report a case of 63-year-old postmenopausal female who presented with a large pelvic mass and was initially thought to be an original ovarian tumor. However, it was subsequently considered to be a DL arising from the mesentery and developing in ovary. Diagnosis: Ovarian DL. Interventions: Bilateral salpingo-oophorectomy. Outcomes: Until now, there is no recurrence symptoms represented in the patient after surgery for 12 months. Lessons: DL happening in ovary is rare. In this case, the exact origin of the mass still remains ambiguous because of the lack of morphological evidence. Although retroperitoneum is the most common area of DL origin, we for long suspect that the mass was initially derived from mesentery and developed in ovary. A long-term may help confirm the exact origin of the tumor. Complete surgical resection plays an important role in the treatment.

Characteristics of pathogenic bacteria and pharmacological surveillance of postoperative hospital-acquired infections in gynecologic malignancies: A single-center observational study

Postoperative hospital-acquired infection in gynecologic malignancies is a severe complication, and improper treatment can affect the recovery and survival of patients. In this study, we analyzed the characteristics and distribution of pathogenic bacteria and their drug resistance in postoperative nosocomial infections in gynecologic malignancies to provide reliable guidance for clinical pharmacological monitoring. A total of 103 patients with postoperative infection following a gynecologic malignant tumor matching the inclusion criteria were selected from those who visited the gynecologic oncology department of Ganzhou Cancer Hospital/Ganzhou Cancer Center. On the day of hospital infection diagnosis, the patients’ secretions were collected and subjected to bacterial culture and drug-sensitivity tests before administering antibacterial medications. Furthermore, the distribution of pathogenic bacteria and drug-resistance characteristics of hospital infections were analyzed. A total of 127 pathogenic strains were cultured from 103 patients. The urinary tract, surgical incision site, genital tract, and pelvis were the primary infection targets, with the infection rates of 31.07%, 26.21%, 18.45%, and 11.65%, respectively. While 87.80% of Escherichia coli strains were resistant to ampicillin and methicillin/sulfamethoxazole, 100.00% and 60.00% of Klebsiella pneumoniae demonstrated resistance to ampicillin and tetracycline, respectively. All Staphylococcus epidermidis strains resisted cefotaxime, ceftriaxone, cefazolin, cefuroxime, erythromycin, benzocillin, and penicillin, while 83.34% of them showed resistance to ampicillin and methicillin/sulfamethoxazole. All Staphylococcus aureus strains were resistant to penicillin. Postoperative hospital-acquired infections following gynecologic malignancies are characterized by a diverse array of pathogenic bacteria with high drug resistance. A comprehensive assessment of the infectious condition is required with the assistance of a clinical pharmacist, accompanied by a scientific and suitable treatment plan for the patient based on the results of the drug-sensitivity test and monitoring of adverse reactions during treatment. The treatment strategy can be modified at any time during the treatment after considering pathogenic evidence and adverse drug effects to improve clinical efficacy.

Clinicopathological features, prognosis, and fertility outcomes in Chinese Han women treated for ovarian yolk sac tumor: A retrospective case series study from two tertiary-care academic medical centers

Objective: Ovarian yolk sac tumor (YST) is a very rare malignant tumor in young women. This study aimed to explore the clinicopathological prognostic characteristics and reproductive outcomes of Chinese Han patients. Methods: To describe a case series study, we reviewed the clinicopathological data of 50 YST patients treated from 2 tertiary medical academic medical centers from January 2009 to December 2019. The Akaike information criterion was used to select variables. The influence of relevant characteristics on prognosis factors was analyzed by the Cox proportional hazard model. Results: The median follow-up time was 64.5 months (range from 3 to 124 months). The median age was 22.7 years (3 to 34 years). Abdominal pain (54.0%) or mass (42.0%) were the most common clinical symptoms in the early stage of diagnosis. The tumors were located bilaterally in 4 cases. 27 patients, 7 patients, 13 patients, and 3 patients were in stage I, II, III, and IV, respectively. Twenty-one stage I patients and 12 stage II to IV patients underwent fertility-preserving surgery. Of the 50 patients who received postoperative chemotherapy, 49 received the BEP regimen. At the last follow-up, 92% of the patients were still alive. The overall survival rate and disease-free survival rate were 91.6% and 90.6%, respectively. Recurrence occurred in 7 (14%) patients with a median survival time of 16.7 months (range from 3 to 50 months). Six patients had recurrence in the abdominal space. The percentage of Ki67 (P = .01) and tumor size (P = .03) were 2 important prognostic factors in multivariate analysis. In terms of survival outcomes, fertility-preserving surgery can be equivalent to radical surgery. Sixteen patients tried to conceive, and 6 patients with advanced-stage succeeded in 10 pregnancies. Of these, 6 patients successfully gave birth to 6 healthy babies. Conclusions: The diagnosis of YST of childbearing age is very rare. Because the failure of primary treatment is related to the residual disease after salvage surgery, the fertility and survival results of patients undergoing fertility-preserving surgery are promising.

Primary vaginal Ewing sarcoma with uterine fibroid

Abstract Rationale: Extra osseous Ewing sarcoma (ES), an uncommon malignant neoplasm, accounts for about 15% of Ewing sarcoma, which mainly affects paravertebral region, lower extremity, chest wall, retroperitoneum, pelvis, and hip. Here is a 54-year-old woman of primary vaginal Ewing sarcoma with uterine fibroid, which has been fewly known or reported. Patient concerns: The patient was admitted to our hospital because of vaginal pain. Her uterus showed as parallel position and enlarged as about 3 months of pregnancy size. Diagnosis: Magnetic resonance imaging (MRI) and ultrasonography (US) demonstrated 2 heterogeneous masses in the vagina and uterus, respectively. Ultrasound-guided puncture biopsy revealed a malignant tumor in the right lateral vaginal wall. Interventions: The patient was treated by hysterectomy, bilateral salpingo-oophorectomy, and tumors excision, with the subsequent treatment of chemotherapy. Outcomes: The patient recovered well without local recurrence for &gt;1 year. Lessons: Primary vaginal Ewing sarcoma is extremely rare. The treatments of uterine fibroid include uterine artery embolization and surgical options, While wide local excision followed by adjuvant chemotherapy and/or radiotherapy should be recommended for the vaginal ES.

The effect of Jing Si herbal tea on cancer-related fatigue in gynecologic cancer patients: A randomized controlled trial

Background: Cancer-related fatigue (CRF) is a persistent, distressing, subjective sense of physical, emotional, or cognitive tiredness or exhaustion disproportionate to recent activity and interferes with normal functioning. Jing Si herbal tea (JSHT) has shown several pharmacological actions in preclinical and clinical models. We aimed to investigate the effect of JSHT on alleviating CRF in patients with gynecological cancer. Methods: A randomized controlled trial was conducted at our hospital from March 1, 2021 to December 31, 2023. Participants aged 20 to 80 years with gynecologic cancer and moderate-to-severe CRF were randomly categorized into 2 groups. The intervention group was given JSHT twice daily for 6 weeks, while the control group was given a placebo for 3 weeks and JSHT for the following 3 weeks. The primary outcomes were fatigue and quality of life, which were evaluated using the brief fatigue inventory-total (BFI-T) and functional assessment of cancer therapy-general 7 scale. The secondary outcomes included white blood cells and differential counts. Results: Among the 19 participants, there was no significant difference in CRF (BFI-T) and quality of life (functional assessment of cancer therapy-general 7) improvement between the intervention group (n = 9) and the control group (n = 10). However, both groups showed significant improvements in BFI-T: global fatigue score, BFI-T: fatigue intensity, and BFI-T: fatigue interference after treatment ( P  &lt; .05). The difference in monocyte count was statistically significant after treatment in both groups ( P  &lt; .001), with the intervention group showing a significant decrease in monocyte count compared to the control group at the beginning of cycle 2 ( P  &lt; .05). Conclusion: Both intervention and control groups improved fatigue and decreased monocyte counts. Further research is needed to explore these findings and their clinical relevance.

Clinicopathological features and prognostic value of B7x expression in female reproductive system malignancies: A meta-analysis

Background: B7x is overexpressed in female reproductive system malignancies. The aim of this study was to evaluate the predictive value of B7x expression in the clinicopathological characteristics and prognosis of female reproductive system malignancies. Methods: PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched for studies focused on the role of B7x expression in the clinicopathological features and prognosis of female breast cancer and malignant tumors of reproductive system, published up to April 2024. STATA 14.0 were used to perform the meta-analysis. Results: A total of 36 eligible studies involving 2451 women with malignancy of the reproductive system were included in this meta-analysis. The results showed that in terms of clinicopathological features, B7x was closely related to lymph node status (odds ratio [OR] = 2.80, 95% confidence interval [CI] = 1.54–5.11, P  = .001), tumor differentiation (OR = 2.95, 95% CI = 1.91–4.57, P  &lt; .001), and FIGO stage (OR = 3.88, 95% CI = 3.04–4.94, P  &lt; .001) of female reproductive system malignant tumor patients. In terms of prognosis: B7x expression is strongly associated with shorter PFS in female reproductive system malignancies (HR = 1.30, 95% CI = 1.17–1.45, P  &lt; .001). B7x may be a new target for immunotherapy and a biomarker for predicting poor prognosis in female malignant tumors of reproductive system. Conclusion: In summary, B7x is closely associated with clinicopathological features and poor prognosis of malignant tumors of the female reproductive system.

Retrospective analysis of surgical outcomes and prognosis in elderly patients with gynecologic cancers

With the progressive aging of the population, the number of elderly patients with gynecologic malignancies is steadily increasing. Due to the presence of multiple comorbidities and diminished postoperative recovery capacity, this population is associated with considerable variability in surgical outcomes, highlighting the urgent need for optimized perioperative management. This study aimed to investigate key factors influencing postoperative recovery quality and 1-year prognosis in elderly patients with gynecologic cancers, in order to provide evidence for individualized clinical management. A total of 132 elderly patients (aged ≥ 65 years) who underwent surgical treatment for gynecologic malignancies at our hospital between January 2023 and May 2024 were retrospectively enrolled. Based on postoperative recovery quality and recurrence/survival status within 1 year, patients were categorized into a good prognosis group (n = 68) and a poor prognosis group (n = 64). Baseline characteristics, intraoperative parameters, postoperative recovery indicators, and long-term outcomes were compared between the 2 groups. Logistic regression analysis was performed to identify independent risk factors associated with poor prognosis. There were no statistically significant differences in baseline characteristics between the 2 groups, indicating good comparability. The proportion of laparoscopic surgeries was higher in the good prognosis group, and both intraoperative blood loss and operative time were significantly lower compared to the poor prognosis group (P &lt; .05). The incidence of postoperative complications was significantly higher in the poor prognosis group (40.6% vs 19.1%, P = .006), along with prolonged hospital stay and delayed functional recovery (P &lt; .05). One-year recurrence and overall survival rates also differed significantly between the groups (recurrence: 32.8% vs 10.3%, P = .002; survival: 71.9% vs 91.2%, P = .004). Multivariate logistic regression analysis identified intraoperative blood loss &gt; 500 mL (OR = 2.36, P = .019) and postoperative complications (OR = 3.12, P = .003) as independent predictors of poor prognosis. The postoperative prognosis of elderly patients with gynecologic cancers is influenced by multiple factors, among which intraoperative bleeding control and complication management are critical intervention points. Preoperative risk assessment, surgical optimization, enhanced perioperative care, and structured postoperative rehabilitation should be emphasized to improve recovery quality and long-term survival in this high-risk population.

Primary radical hysterectomy vs chemoradiation for IB2-IIA cervical cancer

Abstract Background: To compare the clinical outcomes of radical hysterectomy (RH) with chemoradiotherapy (CRT) in women with stage IB2-IIA cervical cancer. Methods: Based on articles published up to December 2017, a literature search of PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese National Knowledge Infrastructure (CNKI) databases was conducted to identify eligible studies. Overall survival (OS), progression-free survival (PFS) with hazard ratios (HRs), and toxicities with odds ratios (ORs) were analyzed. Results: In total, 7 studies comprising 687 patients were identified for this meta-analysis. RH showed a significant trend toward improved survival outcomes compared with those of CRT, regardless of OS (HR = 0.49, 95% confidence interval [CI] 0.36–0.67, P &lt; .001); or PFS (1.61, 95% CI 1.15–2.26, P = .005) for IB2-IIA cervical cancer. Subgroup analysis revealed that stage IB2 cervical cancer patients obtained better OS (HR = 0.36, 95% CI 0.23–0.56, P &lt; .001; heterogeneity: P = .32, I 2 = 13%). However, a higher incidence of grade 3/4 genitourinary abnormalities was evident with RH (OR = 2.3, 95% CI 1.42–3.87, P = .021). Conclusion: Our study suggested that RH had distinct advantages over CRT for carcinoma of the uterine cervix with FIGO stage IB2-IIA, especially for IB2 cervical cancer.

Fertility-preserving local excision under a hysteroscope with combined chemotherapy in a 6-year-old child with clear cell adenocarcinoma of the cervix

Abstract Introduction: Clear cell adenocarcinoma of the cervix (CCAC), a rare and more severe type of gynecological cancer, is especially rare in pediatric patients. Traditionally, surgery following chemotherapy (CT) and radiation therapy is the preferred treatment for CCAC; however, patients have poor 5-year survival rates than other types of cervical cancers. Patient concerns: A 6-year-old girl with a history of vaginal discharge for 18 months was diagnosed with CCAC by histological examination. Her parents refused the traditional treatment of radical hysterectomy and lymph node dissection because of her young age. Diagnosis: The patient's tests revealed negative human papilloma virus and negative methylated paired box 1 gene results. The tumor mass histopathology revealed stage IIA1 CCAC that originated from the cervix. Interventions: Tumor mass excision with preservation of the cervix by electrosurgical biopsy under hysteroscopy was performed. Four cycles of docetaxel and oxaliplatin CT were administered every 3 weeks. Outcomes: No signs of recurrence were observed in the 28 months after final treatment and diagnosis on magnetic resonance imaging, color ultrasonic imaging, and gynecological examination. Serologic tumor biomarkers were also within normal ranges. Conclusions: This is the first reported CCAC case in which the primary treatment included electrosurgical biopsy of the polypoid mass under hysteroscopy, followed by CT without traditional treatment: radical surgery with pelvic and/or lymphadenectomy for fertility preservation. This is a new treatment approach for young CCAC patients without the use of surgery.

Preventive effect of memory foam position pads on intraoperative pressure-induced skin injuries in gynecological malignancy patients undergoing lithotomy positioning

This study explores the effect of memory sponge body position pad on pressure injury of compressed skin in patients undergoing lithotomy. From October 2021 to March 2022, 94 adult patients with gynecological malignancies who underwent elective general anesthesia surgery in our hospital and were in the lithotomy position during the operation were selected as the research objects. According to the different kinds of nursing, they were divided into 47 cases in the control group and 47 cases in the experimental group. The control group used silicone gel pads, and the experimental group used memory sponge pads. The incidence of pressure injury (PI), postoperative comfort contact area and average pressure of pressure part, and the surface microenvironment of the pressure part were compared between the 2 groups. Compared with the control group (17.02%), the incidence of PI in the observation group (2.13%) was significantly lower (P &lt; .05); Compared with the control group (12.77%, 17.02%, 21.28%), the incidence of limb numbness (0.00%), waist muscle pain (4.26%) and neck and shoulder pain (6.38%) in the observation group were significantly lower (P &lt; .05); Compared with the control group, the contact area of the compressed part in the observation group increased significantly and the average pressure decreased significantly after anesthesia, after positioning, during and after operation (P &lt; .05); Compared with the pressure for 1 hour, the humidity and temperature of the feet, buttocks, and shoulders of the 2 groups were significantly higher after 2 hours of pressure, while the humidity and temperature of the feet, buttocks, and shoulders were significantly lower in the observation group compared to the control group (P &lt; .05). The memory sponge position pad can prevent the occurrence of PI on the compressed skin of patients undergoing lithotomy and can also improve the postoperative comfort of patients and the surface microenvironment of the compressed part, which has high clinical reference value.

Transrectal dual-plane ultrasound with contrast enhancement in primary vaginal fibroma diagnosis: A case report

Rationale: Superficial vaginal fibroblastoma (SCVM), a rare benign mesenchymal tumor, is notoriously challenging to diagnose due to its asymptomatic presentation and location. Typically seen on ultrasound as a well-defined, homogeneous, medium-echogenic mass with abundant vascularity, it is often missed by conventional transvaginal ultrasound (TVUS) with end-fire probes, which inadequately assess the vaginal canal. To address this, we employed a novel integrated approach using transrectal biplane ultrasound (TRBU) and contrast-enhanced ultrasound (CEUS). This strategy significantly advances the early and accurate diagnosis of vaginal fibromas. Patient concerns: A 54-year-old female with no obvious symptoms presented for evaluation of a vaginal wall mass detected during a routine physical examination. Diagnosis: TRBU revealed a 30 mm-diameter hypoechoic mass on the left vaginal wall. CEUS demonstrated a hyperperfused mass with a capsular appearance, which was presumed to be benign. The patient’s HPV test was negative, and laboratory investigations showed tumor markers within normal ranges. Interventions: The patient underwent vaginal lesion resection, which was confirmed histopathologically as a vaginal soft tissue fibrous tumor. Following pathological departmental discussion, the lesion was favored to be a vaginal superficial myofibroblastoma. Outcomes: The patient had an uneventful postoperative recovery, and telephone follow-up confirmed no evidence of recurrence to date. Lessons: This case highlights the essential role of combining TRBU and CEUS in diagnosing indeterminate vaginal masses. The high-resolution imaging of TRBU, complemented by the real-time quantitative microvascular perfusion data from CEUS, allows for a thorough and nuanced evaluation. This combined approach delivers critical insights for accurate diagnosis and subsequent surgical decision-making.

Relationship between dietary diversity and oral frailty in elderly gynecologic tumor patients

This study explores the relationship between dietary diversity and oral frailty in elderly gynecologic tumor patients. A total of 180 gynecologic tumor patients treated in our hospital from January 2021 to December 2024 were selected. Patients were divided into an oral frailty group (n = 71) and a non-oral frailty group (n = 109) based on the occurrence of oral frailty ( ≥ 4). Influencing factors were analyzed using univariate and binary logistic regression analysis. The correlation between variables was assessed with Pearson correlation analysis. The predictive value of Dietary Diversity Score (DDS) for the occurrence of oral frailty in elderly gynecologic tumor patients was evaluated using the receiver operating characteristic curve, and the dietary intake of patients with different oral frailty statuses was observed. The average DDS score among the 180 patients was 3.96 ± 1.39. There was no statistically significant difference in DDS among patients with different general characteristics (P &gt; .05). Similarly, there was no statistically significant difference in general characteristics between the oral frailty group and the non-oral frailty group (P &gt; .05). However, a statistically significant difference was observed between DDS and smoking status (P &lt; .05). Binary logistic regression analysis indicated that DDS was a significant factor influencing the occurrence of oral frailty in elderly gynecologic tumor patients (P &lt; .05). Receiver operating characteristic analysis showed that the area under the DDS predictive curve was 0.883, with a standard error of 0.025 (95% confidence interval: 0.834–0.932, P &lt; .001); the Youden index was 0.60, with a sensitivity of 70.42% and specificity of 89.91%. The optimal cutoff value was 4.5. There was no statistically significant difference in the intake of eggs, fish, milk, and dairy products (P &gt; .05), while there were statistically significant differences in the intake of meat, legumes, yogurt, vegetables, and fruits (P &lt; .05). Pearson linear correlation analysis showed that Oral Frailty Index-8 was negatively correlated with vegetable intake, fruit intake, and DDS (r = −0.300, −0.233, −0.338, respectively; P &lt; .05). Increased severity of oral frailty in elderly gynecologic tumor patients is associated with reduced dietary diversity.

Distribution patterns of lymph node metastasis in early stage invasive cervical cancer

The spatial distribution of lymph node (LN) metastasis was analyzed to provide data for an evidence-based approach to radiotherapy field design, particularly for guiding intensity-modulated radiation therapy. A total of 1886 postoperative patients were retrospectively reviewed. Pelvic LNs were classified as common iliac nodes, external iliac nodes, internal iliac nodes/obturator nodes, and deep inguinal nodes. The distribution of LN metastasis in these subgroups was calculated, and the distribution patterns of LN metastasis according to the pathologic types were investigated.We identified 392 eligible patients with LN metastasis. The frequency and number of external iliac node metastasis were higher in the left side in both single subgroup (P < .01) and cosubgroup (P = .04) analyses, whereas few differences were found in other subgroups. Among patients with squamous cell carcinoma, left external iliac node metastasis was observed in 102 (15.13%) patients, whereas right metastasis was observed in 65 (9.64%) patients, and the difference was significant (P < .01).The present results indicated uneven distribution of LN metastasis in the different subgroups, which could help surgeon focus on the dissection of the left subgroups, and help oncologists define margins, refine target volumes for radiation, and improve the accuracy of postoperative radiotherapy especially in patients with squamous cell carcinoma.

A case report of two pelviscopic resections of fibrothecomas originating from the left ovary with recurrence after ten years

Rationale: Fibrothecomas are benign ovarians tumors. These are solid sex-cord-stromal tumors, accounting for 1% to 4.7% of all ovarian neoplasms. Their recurrence rate is known to be only 2% following ovarian sparing local mass excision. We report an uncommon case of 2 pelviscopic resections of fibrothecomas originating from the left ovary with recurrence after 10 years in a 34-year-old woman. Patient concerns: A 34-year-old married woman was diagnosed with 41 mm sized left ovarian recurrent fibrothecoma. We performed mass excision pelviscopically the first time 10 years ago. She gave birth to her second baby at 7 years after the first surgery. Ten years after the first surgery, fibrothecoma recurred on the same ovary with size larger than before. Diagnoses: At the time of its first occurrence 10 years ago, the ultrasound scan revealed a 34 × 23 mm-sized solid hypoechoic mass with well-demarcated margins and minimal Doppler flows. Ultrasound findings at the time of recurrence 10 years later showed the same findings, with its size increased to 41 × 40 mm. Final pathologic findings showed left ovarian fibrothecoma. Interventions: After her admission to the hospital, we performed pelviscopic removal of left ovarian fibroma. Microscopic examination revealed predominantly bland spindle cells with collagenous stroma, showing fascicular and storiform growth. Outcomes: Surgeries were successful. The patient had been followed-up regularly for 3 years after last surgery. She did not experience any complications. She remained disease-free. Lessons: Repetitive local mass excision appears to be an effective surgical option in women of reproductive age. Although there is a sufficient possibility of recurrence several years to decades after only mass excision, mass excision is more appropriate than total oophorectomy in women of childbearing age. Pelviscopic surgery is recommended.

Stepwise local stitching ultrasound image algorithms based on adaptive iterative threshold Harris corner features

Abstract Herein, a Harris corner detection algorithm is proposed based on the concepts of iterated threshold segmentation and adaptive iterative threshold (AIT–Harris), and a stepwise local stitching algorithm is used to obtain wide-field ultrasound (US) images. Cone-beam computer tomography (CBCT) and US images from 9 cervical cancer patients and 1 prostate cancer patient were examined. In the experiment, corner features were extracted based on the AIT–Harris, Harris, and Morave algorithms. Accordingly, wide-field ultrasonic images were obtained based on the extracted features after local stitching, and the corner matching rates of all tested algorithms were compared. The accuracies of the drawn contours of organs at risk (OARs) were compared based on the stitched ultrasonic images and CBCT. The corner matching rate of the Morave algorithm was compared with those obtained by the Harris and AIT–Harris algorithms, and paired sample t tests were conducted ( t  = 6.142, t  = 31.859, P  &lt; .05). The results showed that the differences were statistically significant. The average Dice similarity coefficient between the automatically delineated bladder region based on wide-field US images and the manually delineated bladder region based on ground truth CBCT images was 0.924, and the average Jaccard coefficient was 0.894. The proposed algorithm improved the accuracy of corner detection, and the stitched wide-field US image could modify the delineation range of OARs in the pelvic cavity.

Clinicopathological characteristics and outcomes of metachronous rectal cancer in patients with a history of cervical cancer with and without remote radiotherapy

AbstractThe purpose of this study was to report the clinicopathological characteristics and treatment outcomes of 45 rectal cancer patients who have a history of cervical cancer with or without remote radiotherapy. Twenty-nine patients (64.4%) with a history of cervical cancer treated with pelvic radiotherapy were classified as group A, 16 (35.6%) patients with a history of cervical cancer not treated with radiotherapy were classified as group B. The median duration between radiotherapy for cervical cancer and rectal adenocarcinoma diagnosis was 18 years. At the time of rectal cancer diagnosis, 5 (17.2%) patients presented stage I disease, 15 (51.7%) had stage II, 1 (3.4%) had stage III, and 8 (27.6%) had stage IV. The patients in group A had older age, higher rates of gross ulcerative lesions, low hemoglobin levels, and a lower rate of lymph node metastases. The patients with secondary rectal cancer developed after radiotherapy for cervical cancer usually presented with abnormal abdominal symptoms, such as proctitis, cystitis, or rectal fistula. Higher colostomy rate was found in this group of patients due to severe pelvic fibrosis or proctitis.

Hand metastasis in a patient with cervical cancer

Abstract Introduction: Acrometastasis is infrequent and generally indicates a wider spread of metastasis with poor prognosis. The diagnosis is challenging, as it might mimic an infectious, inflammatory, or metabolic disease. Acrometastasis are most commonly found in patients with lung, gastrointestinal, kidney, and breast cancer. Only 3 cases of cervical cancer associated with hand metastasis have been reported in the literature. Patient concerns: Herein, we report a 58-year-old patient with locally advanced cervical cancer and recurrence in the right thumb as presentation of widespread disseminated disease. She initially presented with adenocarcinoma of the uterine cervix and was treated with concurrent chemoradiation followed by high-dose rate brachytherapy. Six months later, she developed an insidious onset of pain and swelling in the right thumb, erythema, and edema, mimicking cellulitis. Diagnosis: A biopsy of the soft tissues of the thumb was performed, and the histopathology indicated metastasis of adenocarcinoma to the bone and soft tissues. Interventions and outcomes: The patient rejected further treatment and died of progressive disease 4 months after the diagnosis of the recurrence. Conclusion: Metastases in unusual sites are a diagnostic challenge, and there is no standardized treatment. Timely diagnosis and treatment can improve the prognosis of these patients and might preserve their quality of life.

Changes of diamine oxidase and D-lactate in human breast and gynecologic cancers after chemotherapy

This study investigates the changes in diamine oxidase (DAO) and D-lactate levels in cancer patients undergoing chemotherapy and their clinical significance in evaluating intestinal barrier function. Breast and gynecologic cancer patients who received chemotherapy between January 2020 and December 2023 were enrolled from our hospital. Blood samples were taken before chemotherapy, within 3 days after chemotherapy, and before the next course of chemotherapy. The level of plasma DAO and D-lactate were measured by enzyme-linked immunosorbent assay (ELISA). After chemotherapy, nutritional markers such as albumin (ALB) and prealbumin (PAB) were evaluated. Anorexia, vomiting, nausea and diarrhea were evaluated during the chemotherapy cycle. There were no notable differences in serum DAO and D-lactate levels before chemotherapy among different tumor types, tumor stage and chemotherapy type. Serum DAO and D-lactate levels after chemotherapy were significantly elevated compared to their levels before chemotherapy (P &lt; .05). The plasma DAO and D-lactate levels in cancer patients before the next course of chemotherapy were higher than those observed before the initial treatment, but the difference failed to achieve statistical significance (P &gt; .05). The levels of DAO before chemotherapy were higher in patients with diarrhea and anorexia after chemotherapy than those without diarrhea and anorexia (P &lt; .05). The levels of D-lactate before chemotherapy were notably elevated in patients with vomiting, diarrhea and nausea after chemotherapy than those without vomiting, diarrhea and nausea (P &lt; .05). Monitoring serum levels of DAO and D-lactate in cancer patients undergoing chemotherapy can serve as indicators for evaluating gastrointestinal dysfunction and nutritional status.

Clinicopathological risk factors in the light of the revised 2018 International Federation of Gynecology and Obstetrics staging system for early cervical cancer with staging IB

Abstract To validate the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer on the survival of patients who underwent radical hysterectomy for 2009 FIGO stage IB carcinomas. We retrospectively identified and reviewed 251 patients treated with radical hysterectomy for 2009 FIGO stage IB cervical carcinomas from January 2011 to December 2016. The re-staged IB cohort consisted of 2018 FIGO stage IB1 (tumor size &lt;2 cm), IB2 (2–3.9 cm), IB3 (≥4 cm), and IIIC1p (any pelvic nodal metastasis) cervical cancer. The univariate log-rank test and multivariate Cox regression models were performed for all potential clinic pathological risk factors based on cancer stage. On re-staging the 251 patients with 2009 FIGO stage IB using the 2018 FIGO staging system, 96 patients (38.2%) had stage IB1, 109 patients (43.4%) had stage IB2, 28 patients (11.2%) had stage IB3, and 18 patients (7.2%) had stage IIIC1p. The 5-year overall survival (OS) rates of patients with 2018 FIGO stage IB1, IB2, IB3, and IIIC1p were 97.9%, 92.7%, 78.6%, and 61.1%, respectively. The 5-year progression-free survival rates were 97.9%, 92.7%,63.7%, and 20.8%, respectively. Factors significantly affecting OS and disease-free survival were 2018 FIGO stage≥IB3, histologic grade 2–3, and lymph node involvement. The revised 2018 FIGO staging system seemed to accurately reflect the survival rate, with a distinct statistical tendency for poorer 5-year disease-free survival and OS rates with increasing stage. Women with positive lymph nodes in this classification were classified as having stage IIIC disease, which can achieve more realistic survival results than the previous staging system. The prognostic discrimination of histologic grade should be considered when revising the staging system in the future.

Diagnostic accuracy of novel folate receptor-mediated staining solution detection (FRD) for CIN2+

Abstract Background: Early detection and diagnosis of high-grade cervical intraepithelial neoplasia grade 2 or higher (CIN2+) is critical for a good prognosis and appropriate treatment. The chief aim of our study was to evaluate the diagnostic performance of folate receptor-mediated staining solution detection (FRD) for CIN2+. Methods: We conducted a systematic review and meta-analysis by searching the PubMed and EMBASE databases for studies published until May 2020, which assessed the diagnostic accuracy of FRD, human papilloma virus (HPV) testing, and ThinPrep cytology test (TCT) for the detection of CIN2+. Bivariate models were used to compare the diagnostic performance of FRD, HPV, and TCT. Results: Six studies involving 2817 patients were included in this meta-analysis. The pooled specificity of FRD was higher than that of HPV and TCT for detecting CIN2+ (0.65, 0.12, and 0.39, respectively). The summary area under the receiver operating characteristic curve values using FRD, HPV, and TCT for detecting CIN2+ were 0.79, 0.95, and 0.77, respectively, indicating that FRD was superior to TCT. The diagnostic odds ratios of FRD, HPV, and TCT were 6 (95% CI: 5–7), 3 (95% CI: 2–5), and 3 (95% CI: 2–4), respectively, demonstrating that FRD had good diagnostic accuracy. Conclusion: FRD showed good diagnostic accuracy and higher specificity than HPV and TCT for detecting CIN2+. Based on our results, we propose that FRD could be a candidate for cervical screening, especially in underdeveloped countries.

SIRT2 expression exhibits potential to serve as a biomarker for disease surveillance and prognosis in the management of cervical cancer patients

Abstract This study aimed to compare the sirtuin 2 (SIRT2) expression between tumor tissue and adjacent tissue, and to investigate the association of tumor SIRT2 expression with clinical characteristics and survival profiles in cervical cancer patients. One hundred ninety-one cervical cancer patients were reviewed in this retrospective study. All patients underwent surgical resection and had well-preserved tumor tissue and adjacent tissue, which were obtained for SIRT2 expression detection by immunohistochemistry (IHC). Clinical parameters were obtained. Disease free survival (DFS) and overall survival (OS) were calculated. Both SIRT2 expression by IHC score (P &lt; .001) and the percentage of SIRT2 high expression (defined as IHC score &gt;3) (P &lt; .001) were declined in tumor tissue compared with paired adjacent tissue. In addition, SIRT2 expression in tumor tissue was negatively correlated with tumor size (P = .047), lymph node metastasis (P = .009) and FIGO stage (P = .001). And the DFS (P = .007) as well as OS (P = .008) were better in patients with SIRT2 high expression compared with patents with SIRT2 low expression. Univariate Cox's proportional hazards regression model analyses revealed that high SIRT2 expression in tumor tissue was a predictive factor for more prolonged DFS (P = .009) and OS (P = .011), while multivariate Cox's proportional hazards regression model analysis disclosed that it lacks independent predictive value for DFS (P = .084) or OS (P = .132). SIRT2 expression exhibits potential to serve as a biomarker for disease surveillance and prognosis in the management of cervical cancer patients.

CTLA-4 rs5742909 polymorphism and cervical cancer risk

Abstract Background: Number of studies have been performed to evaluate the relationship between the cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) gene variant rs5742909 polymorphism and cervical cancer risk, but the sample size was small and the results were conflicting. This meta-analysis was conducted to comprehensively evaluate the overall association. Methods: PubMed, Web of Science, Embase, China Biology Medical Literature database, China National Knowledge Infrastructure, WanFang, and Weipu databases were searched before July 31, 2018. The strength of associations was assessed using odds ratios (ORs) and 95% confidence intervals (CIs). All of the statistical analyses were conducted using Review Manager 5.3 and Stata 14.0. Results: Eleven studies involved 3899 cases and 4608 controls. Overall, significant association was observed between the CTLA-4 gene variant rs5742909 polymorphism and cervical cancer (T vs C: OR = 1.40, 95% CI = 1.12–1.76; TT vs CC: OR = 2.22, 95% CI = 1.13–4.37; TT vs CT+CC: OR = 1.96, 95% CI = 1.03–3.74; TT+CT vs CC: OR = 1.47, 95% CI = 1.14–1.90). In subgroup analysis by ethnic group, a statistically significant association was observed in Asians (T vs C: OR = 1.56, 95% CI = 1.22–1.99), but not in Caucasians (T vs C: OR = 1.19, 95% CI = 0.87–1.62). The sensitivity analysis confirmed the reliability and stability of the meta-analysis. Conclusion: our meta-analysis supports that the CTLA-4 gene variant rs5742909 polymorphism might contribute to individual susceptibility to cervical cancer in Asians.

Apatinib combined with chemotherapy or concurrent chemo-brachytherapy in patients with recurrent or advanced cervical cancer

Abstract Objective: Apatinib mesylate is a novel vascular endothelial growth factor receptor 2 (VEGFR-2) inhibitor, which has exhibited good safety and efficacy in several types of solid tumors. The present study aimed to assess the clinical efficacy and safety of apatinib combined with chemotherapy and concurrent chemo-brachytherapy (CCBT) in patients with recurrent and advanced cervical cancer. Methods: A total of 52 patients with first diagnosed recurrent or untreated International Federation of Gynecology and Obstetrics stage IVB cervical cancer admitted at Shandong Cancer Hospital and Institute between July 2016 and May 2018 were analyzed in the current randomized controlled trial. The patients were randomly divided into 2 groups: the apatinib-treated group and the control group. Patients with recurrent cervical cancer in the apatinib-treated group were administered apatinib and carboplatin-paclitaxel as first-line chemotherapy. Patients with advanced cervical cancer were administered apatinib in combination with CCBT. In control group, patients with recurrent cervical cancer were treated with chemotherapy alone while patients with advanced cervical cancer received CCBT. Results: The progression-free survival was significantly prolonged in apatinib group compared with control group (10.1 months; 95% confidence interval (CI), 8.42–11.79 vs 6.4 months; 95% CI, 3.88–8.92; P &lt; .01; hazard ratio (HR), 0.44; 95% CI, 0.25–0.78; P &lt; .01). The objective response rate in apatinib group was obviously higher than that in control group (64.3% vs 33.3%, P &lt; .05). Proteinuria, hand–foot syndrome, mucositis, and hypertension in all Grades were statistically more common in apatinib group than in control group. Apatinib did not obviously aggravate other radiotherapy or chemotherapy side effects. Conclusion: Apatinib exhibited promising clinical efficacy in cervical cancer patients, resulting in an improved response rate and prolonged progression-free survival compared with the control group, and had manageable side effects. Our study revealed that apatinib combination therapy, adenocarcinoma, and bone metastasis

Clinical profile and treatment outcome of collision carcinoma in cervix

Abstract A collision tumor is defined by co-existence of two adjacent tumors which are histologically distinct. Little is known about the clinical manifestation, treatment, and prognosis of cervical collision cancer. The objective of the study was to investigate the management and prognosis of patients with cervical collision cancer. We retrospectively reviewed and enrolled patients with cervical collision carcinoma from 2010 to 2018 in two institutions (West China Hospital and West China Second University Hospital). The clinical presentation, pathology, treatment, and prognosis of patients with collision carcinoma of the uterine cervix were retrospectively reviewed. Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. A total of 24 patients were included in this study. The proportion of cervical collision carcinoma was 0.4% in the cervical carcinoma cohort (24/6015). The median age of the patients with cervical collision cancer was 42 years. The most common presenting symptom was cervical contactive bleeding. There were 23 patients classified as International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IIB. All patients except one received radical hysterectomy, in which 21 patients received bilateral salpingo-oophorectomy (BSO) and pelvic lymphadenectomy in addition. There were 16 patients who received adjuvant chemotherapy or chemoradiotherapy. The median follow-up time was 21 months. No patient death was observed. Recurrence only occurred in two patients. The 5-year OS rates and PFS rates were 100% and 91.7%, respectively. This study revealed that cervical collision cancer was a type of rare cervical cancer with good prognosis. Cervical collision cancer responded well to the same treatment methods as the cervical squamous cell carcinoma and was associated with few recurrence and long survival.

Evaluation of multiple screening methods for cervical cancers in rural areas of Xinjiang, China

Abstract This study is to evaluate the screening methods of cervical cancers for rural females in Kash bachu, Xinjiang, China. A total number of 3000 married females were surveyed, and subjected to the gynecological examination. In these subjects, 1993 females received the careHPV (human papillomavirus) test, while 1007 females underwent the visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). The subjects positive for careHPV detection were subjected to Cervista, Cobas 4800, and Aptima HPV detection, and Thinprep Cytologic Test (TCT). The subjects positive for 1 detection only received colposcopy cervical biopsy. A total of 569 subjects received the cervical biopsy, and the positive rate was 2.3% (69/3000), while the detection rate for CIN (cervical intraepithelial neoplasia) II and above levels was 1.13% (34/3000). Receiver operator characteristic (ROC) curve analysis showed that, the area under the curve (AUC) value for the careHPV test was 0.671, which was higher than the VIA/VILI (0.619), suggesting higher diagnostic value for the careHPV test. For the Cervista, Cobas 4800, Aptima HPV detection, and TCT methods, the highest AUC value was observed for the TCT method, indicating that the TCT method is the most valuable for the cervical cancer screening. The diagnostic value of careHPV test is superior to the VIA/VILA detection method. The TCT method has the greatest value for the cervical cancer screening. The Cervista HPV detection method should be considered where the conditions are limited.

Weekly versus triweekly cisplatin-based concurrent chemoradiotherapy in the treatment of locally advanced cervical carcinoma

Abstract Background: Radiotherapy concurrent with cisplatin is the standard regimen used for treatment of locally advanced cervical carcinoma. In this meta-analysis, survival, recurrence, compliance, and acute adverse effects were compared between weekly and triweekly cisplatin-based concurrent chemoradiotherapy regimens for treatment of cervical cancer. Methods: A systematic search for relevant studies was conducted using PubMed, Cochrane Library, EMBASE, and Medline databases. Fixed- or random-effects models were used for pooled analysis. The endpoints were overall survival, recurrence, compliance, and acute adverse effects reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Eight randomized controlled trials met the inclusion criteria. No significant differences were observed between the 2 arms with respect to recurrence, survival, and acute adverse effects (all P &gt; .05). However, the triweekly cisplatin regimen was associated with significantly lower incidence of local recurrence (OR, 1.72; 95% CI, 1.07–2.78; P = .03), radiotherapy completion (OR, 2.08; 95% CI, 0.99–4.38; P = .05), and anemia (OR, 2.10; 95% CI, 1.01–4.37; P = .05), while a weekly cisplatin regimen was associated with a lower risk of leukopenia (OR, 0.57; 95% CI, 0.42–0.92; P = .00) and thrombocytopenia (OR, 0.55; 95% CI, 0.31–0.97; P = .04). Conclusions: Triweekly cisplatin-based chemotherapy significantly reduced local recurrence with tolerable toxicity and might be the optimal regimen in concurrent chemoradiotherapy for locally advanced cervical carcinoma.

Surgical excision of giant vulvar angiofibroma: A case report and a review of literature

Rationale: Cellular angiofibroma (CA) is a rare tumor of the soft tissue classified as a benign fibroblastic/myofibroblastic tumor. Considering this, the literature regarding CA mainly, but not exclusively, comprises single case reports and case series. Here, we report a case of giant CA of the vulva with comprehensive literature review. Patient concerns: We present a case of a massive vulvar CA arising in 53-year-old woman with no notable medical or surgical history. The mass has grown considerably over time, causing pain and difficult urination, defecation, and movement. The patient had normal regular menstrual cycle with no previous contraception use. Vaginal examination exposed a right-sided large tender vulvar mass with normal-looking vagina. Diagnoses: Pelvic magnetic resonance imaging with contrast revealed a large right vulvar heterogeneously enhancing soft tissue mass measuring 13.1 × 10.9 × 10.7 cm expending the left vulva, with internal and peripheral voids resembling feeding vessels. The mass was surgically removed, and subsequent histopathology showed skin-covered dermal-based lesion composed of fibroblast-like bland and spindle cell proliferation with thin-walled blood vessels of various sizes. Immunohistostaining of CD34 and smooth muscle antigen were both positive, while desmin was found to be negative. A diagnosis of vulvar angiofibroma was made based on the clinical scenario, imaging, and histopathology. Interventions: Mass vulvectomy was performed starting with a circumferential incision at the base of the mass and structural dissection to separate the mass from the vulvar wall. The incision was successfully closed, and subcuticular stitches were applied to the skin. Outcomes: The patient’s complaints were significantly relieved with no postoperative complications and the patient is being followed regularly in an outpatient setting. Lessons: Due to its extremely benign nature of CA, and the implausible ability of its recurrence, it was decided to surgically excise it. Despite its rarity, it can be readily identified at its earlier stages preventing the vexing and exasperating symptoms accompanied with increased size as mentioned.

Comparison of target agent treatment strategies for platinum-resistant recurrent ovarian cancer: A Bayesian network meta-analysis

Background: We aimed to compare 7 newer immunotherapies and targeted therapies for platinum-resistant relapsed ovarian cancer. Methods: We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library electronic databases for phase III trials involving platinum-resistant recurrent ovarian cancer (PRrOC) patients treated with immunotherapy or targeted therapy in combination with chemotherapy. The quality of the included trials was assessed using the GRADE method. The primary outcome of comparison was progression-free survival, and secondary outcomes included overall survival and safety. Results: This analysis included 7 randomized phase III controlled trials, encompassing 2485 PRrOC patients. Combining bevacizumab plus chemotherapy and lurbinectedin demonstrated statistically significant differences in progression-free survival compared to all other regimens of interest. However, no statistically significant differences were observed in the overall survival. Nivolumab and mirvetuximab exhibited fewer serious adverse events than the other regimens of interest. Conclusions: Our findings indicate that bevacizumab combined with chemotherapy and lurbinectedin monotherapy has significant efficacy in patients with PRrOC. For patients with PRrOC who have exhausted treatment options, nivolumab and mirvetuximab may be considered as alternatives because of their better safety profiles.

A CARE-compliant article: A case report of retroperitoneal endometrial stromal sarcoma with multiple pulmonary metastases and literature review

Rationale: Endometrial stromal sarcoma is an extremely rare mesenchymal neoplasm occurring in the extrauterine. Retroperitoneal endometrial stromal sarcoma with multiple pulmonary metastases, in particular, is extremely rare. Patient concerns: Forty-seven-year-old woman (gravida 3, para 2), was referred to our institution with complaints of fever. Diagnoses: Ultrasound and computed tomographic imaging of the abdomen identified the presence of masses in the pelvic region. Additionally, computed tomographic scans and X-ray evaluations of the thorax detected dispersed masses in both the lungs and pelvic area. Histopathological analysis of the pelvic region indicated the presence of low-grade endometrial stromal sarcoma. A computed tomography-guided pneumocentesis was conducted to further characterize the pulmonary lesions, confirming the diagnosis of low-grade endometrial stromal sarcoma. Interventions: The patient underwent tumor resection, subsequent treatment with Medroxyprogesterone acetate for 6 months, received microwave ablation for multiple lung metastases, PARP1 inhibitor for 4 courses, and has been undergoing chemotherapy (epirubicin/ifosfamide) up to the present time. Outcomes: Partial remission was obtained after the above treatment and this patient is now still alive maintaining for 3 years. Lessons: The identification and management of this disease remain a significant challenge due to its low prevalence. Further research involving a larger number of cases is necessary to ensure consistency in diagnosis and to establish effective treatment guidelines.

Analysis of risk factors for recurrence after laparoscopic myomectomy: A retrospective study

At present, there is unclear on the risk factors of recurrence after myomectomy. In this study, we hope to provide reference for the choice of treatment for patients with uterine fibroids and provide basis for the subsequent prediction of recurrence. From October 2020 to October 2022, we enrolled 240 patients with uterine fibroids in Hubei Maternal and Child Health Hospital. According to the inclusion criteria, the collected clinical data of these patients were analyzed and divided into 2 groups according to whether there was recurrence 6 months after surgery(a recurrence group [52 cases] and a non-recurrence group [78 cases]). We compared and analyzed the relevant factors. Univariate analysis showed that there was no significant relationship between fibroid diameter, postoperative pregnancy, contraceptive method, hyperlipidemia, diabetes, endometriosis and postoperative recurrence ( P  &gt; .05). While, age, number of pregnancies, number of fibroids, type of fibroids, body mass index, endometrial hyperplasia or endometrial polyp were significantly correlated with postoperative recurrence ( P  &lt; .05). Multivariate Logistic regression analysis demonstrated that body mass index &gt; 24, number of pregnancies &gt; 2, multiple myoma, intermyoma and endometrial hyperplasia were independent risk factors for postoperative myoma recurrence ( P  &lt; .05). Body mass index &gt; 24, number of pregnancies &gt; 2, multiple fibroids, intermyowall fibroids, and endometrial hyperplasia are all independent risk factors for recurrence after laparoscopic myomectomy in patients with uterine fibroids. Patients with these independent risk factors should be closely reviewed. If they have multiple independent risk factors and have no fertility requirements are present, hysterectomy may be recommended.

Unraveling the causal nexus between serum lactate levels and cancer risk: A Mendelian randomization study

Lactate, traditionally regarded as a metabolic byproduct, has emerged as a potential signaling molecule involved in tumorigenesis. Although numerous observational studies have linked serum lactate levels to various tumors, establishing a direct causal relationship remains challenging. We conducted a 2-sample Mendelian randomization (MR) analysis using genetic instrumental variables to assess the causal effects of serum lactate levels on the risk of various cancer types. The primary analytical method used in this investigation was the random inverse-variance weighted (IVW) method, supported by auxiliary methods such as MR-Egger, weighted median, simple mode, and weighted mode, with the IVW method enabling the meta-analysis of their combined effects. To obtain exposure data, we extracted genome-wide association studies (GWAS) data on metabolite levels from the Canadian Longitudinal Study on Aging and the UK Biobank cohorts. Concurrently, GWAS data for 17 types of cancer were obtained from the IEU Open GWAS project and the GWAS Catalog project. Sensitivity analyses were performed using the Cochran Q test, MR-Egger intercept test, MR-PRESSO, and the leave-one-out method. Our MR analysis identified a causal relationship between serum lactate and endometrial cancer (odds ratio [OR]IVW = 1.1217, 95% confidence interval [CI] = 1.0264–1.2258, P = .0112), melanoma (ORIVW = 1.0015, 95% CI = 1.0006–1.0024, P = .0010), and prostate cancer (ORIVW = 0.9578, 95% CI = 0.9319–0.9844, P = .0020). Notably, elevated lactate levels were identified as a risk factor for endometrial cancer and melanoma, while having a protective effect against prostate cancer. However, this observed relationship was not replicated in other cancer types. Our study, using GWAS data, establishes a causal link between circulating lactate and the risk of endometrial cancer, melanoma, and prostate cancer. The identification of these associations suggests the potential utility of lactate as a biomarker for these cancers or as a target for cancer prevention strategies.

Treatment of primary squamous cell carcinoma of the endometrium and review of previous literature: A case report

Rationale: Primary squamous cell carcinoma of the endometrium (PSCCE) has been occasionally reported. Treatment of this disease poses a challenge to clinicians because of its rarity. Herein, we report the case of a 56-year-old woman with typical clinical manifestations and a pathological diagnosis classified by molecular typing as having high microsatellite instability (MSI-H) PSCCE. Based on a review of the previous literature, we summarized the treatment options for this rare disease and proposed new opinions. Patient concerns: A 56-year-old woman was admitted to our hospital with irregular vaginal bleeding and lower abdominal swelling. Diagnosis: The patient was diagnosed with squamous cell carcinoma of the endometrium (stage IIIC1; MSI-H). Interventions: The patient underwent total abdominal hysterectomy, bilateral salpingo-ovariectomy (bso), and pelvic lymph node dissection. Following the surgery, the patient received adjuvant chemoradiotherapy. Outcomes: The patient was followed up regularly. No recurrence or metastasis has been reported to date. Lessons: Curettage specimens may show only well-differentiated squamous epithelium, which is indistinguishable from normal squamous epithelium. It is difficult to infer from the histological morphology that the curettage specimens originate from the uterine cavity, which makes it difficult to diagnose PSCCE before the operation. We suggest that when an imaging examination indicates a tumor in the uterine cavity, even if multiple curettage specimens indicate normal or well-differentiated squamous epithelium, it indicates the possibility of PSCCE.

A risk prediction nomogram of endometrial carcinoma and precancerous lesions in postmenopausal women: A retrospective study

This study aimed to develop a risk prediction nomogram for endometrial carcinoma and precancerous lesions in postmenopausal women to provide postmenopausal patients with more information on disease probability, work out personalized medical plans, and reduce unnecessary invasive clinical examinations. We enrolled 340 patients who underwent hysteroscopy at Beijing Maternity Hospital between March 2016 and July 2018. The patients were divided into the low-risk (275 patients) and high-risk (65 patients) groups, according to the results of the pathological examinations. Binary logistic analysis was performed to evaluate the 20 potential risk factors for endometrial cancer and precancerous lesions in postmenopausal women and to screen for certain risk factors using the Statistical Package for the Social Sciences version 26.0. Using R 4.0.3, we built a prediction nomogram that incorporated the selected factors. The discrimination, calibration, and clinical usefulness of the prediction model were assessed using the concordance (C)-index, calibration plot, and decision curve analysis. Internal validation was assessed using bootstrapping validation. Predictors included in the prediction nomogram included obesity, vaginal bleeding, family history of gynecological malignancies, endometrial thickness ≥ 1.15 cm, and color Doppler flow imaging blood flow. The model displayed good discrimination, with a C-index of 0.853, and good calibration. Decision curve analysis showed that the model was clinically useful, with a benefit range of 2% to 93%. A high C-index value of 0.844 could still be reached in the interval validation. Obesity, vaginal bleeding, family history of gynecological malignancies, endometrial thickness ≥ 1.15 cm, and color Doppler flow imaging blood flow were independent risk factors for endometrial cancer and precancerous lesions. Thus, the prediction nomogram can be conveniently used to facilitate individual risk prediction in patients with endometrial cancer and precancerous lesions.

Identification of two immune subtypes and four hub immune-related genes in ovarian cancer through multiple analysis

Immune classification of ovarian cancer (OV) becomes more and more influential for its immunotherapy. However, current studies had few immune subtypes of OV. It is urgent to explore the immune subtypes and deeper hub immune-related genes (IRGs) of OV for follow-up treatment. A total number of 379 OV samples were obtained from UCSC online website. Single sample gene set enrichment analysis of 29 immune gene sets was used for identifying immune subtypes of OV and gene set variation analysis were used for exploring the hallmarks and Kyoto Encyclopedia of Genes and Genomes pathways of immune types. Two immunity subtypes (Immunity_H and Immunity_L) were identified by single sample gene set enrichment analysis. The OV patients in Immunity_H group had longer overall survival compared with those in Immunity_L group. The Immunity_H had higher stromal score, immune score and estimate score and the tumor purity had the adverse tendency. Besides, the gene set variation analysis enrichment results showed positive relationship between improved immunoreaction and pathways correlated to classical signaling pathway (PI3K/AKT/MTOR, P53, TNFA/NFkB signaling pathways) and immune responses (T/B cell receptor signaling pathways and primary immunodeficiency). Furthermore, 4 hub IRGs (CCR5, IL10RA, ITGAL and PTPRC) were jointly dug by weighted gene co-expression network construction and Cytoscape. Our team also explored the mutations of 4 hub IRGs and PTPRC showed nearly 7% amplification. Besides, 8 immune-checkpoint genes had higher expression in Immuity_H group compared with Immuity_L group, except CD276. The correlation between PD-1/PD-L1 and 4 hub IRGs were explored and gene set enrichment analysis were conducted to explore the underlying mechanisms of PTPRC in OV. Finally, western-blotting showed PTPRC could regulate immune checkpoint PD-L1 expression via JAK-STAT signaling pathway. In a word, 2 immune subtypes and 4 hub IRGs of OV were identified by multiple analysis.

Postmenopausal giant uterine adenomyoma with adipose metaplasia: A case report and literature review

Rationale: Uterine adenomyomas (UAs) are common benign tumors, usually not exceeding 280 g or the weight of the uterus at 12 weeks gestation. Postmenopausal giant UAs of diameter larger than 20 cm are rare, as well as steatosis, but curable by surgical excision. Few cases of postmenopausal giant UAs have been reported. Patient concerns: Herein, we report a case of a 70-year-old female patient who presented with a giant pelvic tumor of about 20 cm × 18 cm × 20 cm with postmenopausal vaginal bleeding, and whose radiographic manifestations did not exclude the possibility of uterine malignancy. Diagnoses: Histopathology confirms an adenomyoma with partial adipose metaplasia. Interventions: We did an open laparotomy of hysterectomy, bi-adnexectomy, and pelvic adhesion release for the patient. Outcomes: Pathology revealed adenomyoma with adipose metaplasia. The patient recovered well and was discharged on postoperative day 7 with satisfactory follow-up.

Value of preoperative staging of endometrial carcinoma with contrast-enhanced ultrasonography

Abstract Introduction: Endometrial carcinoma (EC) is the most common gynecologic carcinoma in developed countries and accounts for nearly 5% of carcinoma cases and more than 2% of deaths due to female carcinomas worldwide. Because of this reported risk, it is very important to diagnose and stage it accurately. Therefore, we investigated the staging accuracy of EC with contrast-enhanced ultrasonography (CEUS). Due to a lack of studies on the use of CEUS in staging EC, we performed a systematic review and meta-analysis. Method: We searched PubMed, EMBASE, Cochrane Library, Scopus, Web of science, China National Knowledge Infrastructure (CNKI), and CBM for studies on CEUS in EC diagnosis. Our search keywords were “ultrasonic angiography,” “endometrial neoplasms,” and their synonyms. The studies were screened according to the inclusion and exclusion criteria, and 4 tabular data were extracted. Quality evaluation was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scale. Statistical analysis was done with Stata version 15.1. A random effect model was selected to calculate the pooled sensitivity and specificity. The summary receiver operating characteristic (SROC) curve was obtained, and the area under the curve was calculated. Result: Fifteen studies with 685 patients were included in this quantitative synthesis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (OR) of CEUS in the diagnosis of EC was 0.81 (95% confidence interval, .76–.85), .90 (.87–.92), 8 (5.8–11.1), .21 (.16–.28), and 38 (22–67), respectively. The area under the curve was 0.93 (.90–.95). Conclusion: CEUS has a high sensitivity and specificity in the diagnosis of EC. It can be considered as an effective and feasible method for EC staging.

Pregnancy with giant ovarian dysgerminoma

Dysgerminoma is an extraordinarily rare neoplasm arising from the malignant germ cells of the ovary. Early antenatal diagnosis and proper management of the neoplasm to improve maternal-neonatal results are the considerable challenges facing the gyne-oncologist. We summarize the clinical features and discuss treatment strategies of the ovary dysgerminoma (OD). Besides, we also review the literature on OD in PubMed, Web of Science Core Collection, Library of Congress, and LISTA from 1939 to 2019 to evaluate its clinical characteristics, feto-maternal compromise, management, and fertility outcome. A 25-year-old pregnant woman reported lower abdominal pain and vomiting. The patient was diagnosed as right OD. She received a cesarean section due to severe abdominal pain, delivered a healthy girl at 38 C 4 weeks of gestation, and accepted fertility-preserving surgery. However, the patient refused chemotherapy postoperatively. The patient was followed up 42 days, 3 months, and 6 months after surgery, and no tumor recurrence was observed. OD has non-specificity characteristics, including age, symptoms, image date, and tumor marks. However, these abnormal indicators may provide some evidence for accurate antenatal diagnosis. The management strategies should be considered comprehensively on an individual basis, and fertility-preserving surgery should be carried out in the second trimester if further pregnancy is desired. Adjuvant chemotherapy needs to be applied to the treatment of OD patients with The International Federation of Gynecology and Obstetrics (FIGO) stages II, III, and IV and timely chemotherapy is suggested if there are several weeks before the expected date of delivery. The overall prognosis of OD patients is excellent.

Epithelioid trophoblastic tumor with lung metastasis: A case report and literature review

Rationale: Epithelioid trophoblastic tumor (ETT) is an extremely rare variant of gestational trophoblastic neoplasms (GTNs). The biological behavior and therapeutic schedule of ETT remains to be defined which frequently poses diagnostic and therapeutic challenges. Although ETT is a relatively indolent malignancy tumor, the therapeutic efficacy and survival rate decrease significantly when presented with metastases. The lung is the most common site of ETT metastasis. Patient concerns: A 39-year-old female patient presented with irregular vaginal bleeding and slight distention pain in lower abdomen. Diagnoses: The patient was diagnosed ETT with lung metastasis after surgery and immunohistochemical staining. Interventions: A total abdominal hysterectomy plus bilateral salpingectomy and histopathology were performed. The patient received 3 cycles of etoposide, methotrexate, actinomycin-D/etoposide, cisplatin (EMA/EP) regimen chemotherapy after surgery. Due to the presence of lung metastasis, she received pulmonary lesion resection and another cycle of postoperative chemotherapy. Outcomes: The patients showed a good response to treatment initially. However, the patient did not complete the full initial treatment for family reasons and had signs of recurrence after 2.5 months. The serum β-hCG level gradually elevated and the lung imaging showed that the lesion area gradually expanded. After 15 months of follow-up, the patient declined further treatment due to a lack of presenting symptoms. Lessons: The diagnosis of ETT should be taken into consideration in patients with abnormal vaginal bleeding and low levels of β-hCG. Patients with metastatic disease should be treated with complete surgical resection and intensive combination chemotherapy to maximize the opportunity for cure. Targeted biological agents might be potential therapeutic strategies for chemotherapy-resistant or recurrent patients.

Efficiency and safety evaluation of prophylaxes for venous thrombosis after gynecological surgery

In this study, we investigate the incidence of venous thrombosis (VT), and evaluate the effectiveness and safety of 3 major thromboprophylaxes and the potential risk factors for VT in women undergoing surgery for a gynecological malignancy. We performed a randomized controlled trial of 307 patients undergoing laparoscopic surgery for gynecological malignancies at a single institution from January 2016 to October 2017. Patients were divided into 3 groups: one receiving a half dose of low-molecular-weight heparin sodium injection (FLUXUM, Alfa Wassermann, Italy) delivered by injection, one receiving a full dose of FLUXUM, and a third group receiving an Argatroban injection. None of the patients in our study developed a pulmonary embolism, bleeding, or infectious complications. There were no statistical differences in the rate of deep venous thrombosis (DVT) (0%, 0%, and 2.38%) and the superficial venous thromboembolism (SVT) (15.66%, 8.97%, and 18.6%) among the 3 groups. None of the patients developed symptomatic VT. The effect of treatment on alanine aminotransferase and aspartate aminotransferase differed between the groups, with a minimal effect in the Argatroban group, and all 3 methods resulted in minimal impairment of renal function. Decreased hemoglobin, elevated levels of D-dimer, and prothrombin time were closely related to thrombogenesis. In conclusion, the incidence of postoperative thrombosis in gynecological malignancy among these Chinese people is not as low as we had originally presumed. Argatroban is not more effective than Parnaparin as a direct thrombin inhibitor, but it has less influence on liver function, which is beneficial for patients undergoing chemotherapy. Hemoglobin, D-dimer, and prothrombin time may be used to predict or detect thrombogenesis.

Correlation between single nucleotide polymorphisms of DACH1 gene microRNA binding site and susceptibility of patients with endometrial cancer

To study the relationship between single nucleotide polymorphism (SNP) of the 3 primer untranslated region (UTR) variants of the cell fate determination factor Dachshund 1(DACH1) gene and the susceptibility of patients with endometrial cancer (EC). Genomic DNA was extracted from the peripheral venous blood of 235 EC patients and 235 healthy controls, and the DACH1 gene rs9285274, rs9529895, rs17088351, and rs59352399 loci were analyzed by Sanger sequencing. Patients progression-free survival (PFS) was recorded after 3 years follow-up from October 2016 to October 2019. Carriers of the C allele of the DACH1 gene rs9529895 locus had a significantly lower risk for EC than T allele carriers (odds ratio = 0.56, 95%confidence interval: 0.38-0.84, P < .01). The correlation between DACH1 gene rs9529895 locus SNP and the risk for EC was affected by age, body mass index, smoking, drinking, and diabetes. Age, and rs9285274, rs9529895, and rs59352399 locus SNP were the best models for predicting the risk for EC. The accuracy rate was 57.02%, and the Cross-validation Consistency was 10/10 (x = 4.33, P = .04). The DACH1 gene rs9529895 locus C allele (TC+CC) carriers had significantly higher PFS than the TT genotype carriers (P = .04). The DACH1 gene was expressed in decreased amounts in the cancer tissues of EC patients, and the DACH1 mRNA expression level in the CC genotype, TC genotype, and TT genotype of rs9529895 locus was also decreased (P = .02). DACH1 gene rs9529895 locus SNP is significantly related to the risk for EC and PFS of EC patients. The possible mechanism behind this relationship is that the DACH1 gene rs9529895 locus SNP affects DACH1 expression level.

TikTok, YouTube, and Bilibili as sources of information on uterine fibroids: A content and quality analysis

Uterine fibroids, the most common monoclonal benign tumors of the uterine smooth muscle, show an increasing incidence with age. Currently, social media platforms such as TikTok, YouTube, and Bilibili are increasingly becoming important channels for disseminating health information. However, the quality and reliability of content related to uterine fibroids on these platforms are often unsatisfactory. This study aims to systematically evaluate the quality and content characteristics of uterine fibroid-related videos on 3 major short-video platforms – TikTok, YouTube, and Bilibili – using validated assessment tools. A total of 300 videos (100 per platform) uploaded between 2020 and 2025 were included. Video quality was assessed using the The Journal of the American Medical Association benchmark criteria, modified DISCERN instrument, and Global Quality Score. Content features, uploader identity, presentation format, and engagement metrics were also analyzed. Statistical analyses included nonparametric tests and Spearman correlation. Bilibili consistently outperformed TikTok and YouTube in all quality metrics (The Journal of the American Medical Association, DISCERN, Global Quality Score), though overall video quality across platforms was moderate. Video duration was positively correlated with quality scores (ρ ≈ 0.33 for DISCERN). No significant associations were found between engagement metrics (likes/comments) and professional quality ratings. Key content features such as animated demonstrations, source attribution, and inclusion of recent research advances were significantly associated with higher quality. Overall, content across all platforms exhibits deficiencies. However, videos related to uterine fibroids on Bilibili demonstrate relatively fewer shortcomings, while notable quality disparities persist among the different platforms. Content creators should prioritize videos of 2 to 10 minutes with evidence-based features to improve reliability. Viewers are advised to focus on content depth and source credibility rather than superficial engagement metrics. Enhanced platform regulation and public awareness are urgently needed.

Clinicopathological characteristics and prognostic value of POLE mutations in endometrial cancer

Abstract Background: The aim of this meta-analysis was to assess the clinicopathological features and to confirm prognostic value of POLE exonuclease domain mutations (EDM) in endometrial carcinoma patients. Methods: The PubMed, Web of Science, the data of China National Knowledge Infrastructure, and Wan fang Medical Network were systematically searched for relevant articles without a cut-off date. The keywords for the search were “endometrial cancer,” “endometrial carcinoma,” “EC,” “POLE mutations,” “POLE exonuclease domain mutations,” “POLE-mutant,” “clinical characteristics” “prognostic.” Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by using Review manager 5.3 and Stata 14.0 statistical software. Results: Six cohort studies assessing 179 EC patients with POLE EDMs were included. The results indicated a favorable progression-free survival in POLE-mutant patients (HR = 0.32; 95% CI: = [0.09–1.18]). Furthermore, the overall survival was great in patients with POLE-mutant (HR = 0.68; 95% CI = [0.41–1.13]). It was shown that a significantly higher incidence of POLE mutations with Federation of International of Gynecologists and Obstetricians (FIGO) I group compared to FIGO II-IV group (pooled ORs: 0.34, 95% CI: [0.12–0.94], P = .04), POLE-mutant EC was not significantly associated with histology (OR = 0.56,95% CI: 0.29–1.23), tumor grade (OR = 1.22,95% CI:0.85–1.74), lymph-vascular space invasion (OR = 0.40,95% 0.06–2.42), depth of myometrial invasion (OR = 0.70,95% CI: 0.41–1.18), lymph node status (OR = 0.41, 95% 0.04–4.50), and European Society for Medical Oncology risk groups (OR = 0.68,95% CI: 0.37–1.26). Conclusion: This meta-analysis has confirmed POLE EDMs may serve as a predictive biomarker of favorable prognosis. Further studies are needed to explore the appropriate clinical utility of POLE EDMs in EC.

Primary transitional cell carcinoma of the fallopian tube

Abstract Introduction: Primary transitional cell carcinoma (TCC) of the fallopian tube is an extremely rare tumor. Patient concerns: A 79-year-old woman presenting with vaginal discharge. Diagnosis: Pelvic magnetic resonance imaging revealed a predominantly solid mass with a lobulated contour, measuring 5.5 cm × 4.6 cm, in the left ovary. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Pathological analysis revealed a high-grade TCC, measuring 7.5 cm × 4 cm, in the left fallopian tube (International Federation of Gynecology and Obstetrics stage IIB). Intervention: Forty-three months postoperation, recurrence was diagnosed as peritoneal metastasis. The patient underwent 6 cycles of palliative chemotherapy consisting of cisplatin and gemcitabine, the recommended regimen for TCC of the urinary tract. Outcome: The patient has survived for 27 months without recurrence after palliative chemotherapy, 76 months after diagnosis. Conclusion: It is rare that primary TCC of the fallopian tube responds to a urinary tract treatment regimen for TCC, even when followed up for an extended period. More research is warranted to determine which treatment regimen will benefit patients the most.

Machine learning developed a fibroblast-related signature for predicting clinical outcome and drug sensitivity in ovarian cancer

Ovarian cancer (OC) is the leading cause of gynecological cancer death. Cancer-associated fibroblasts (CAF) is involved in wound healing and inflammatory processes, tumor occurrence and progression, and chemotherapy resistance in OC. GSE184880 dataset was used to identify CAF-related genes in OC. CAF-related signature (CRS) was constructed using integrative 10 machine learning methods with the datasets from the Cancer Genome Atlas, GSE14764, GSE26193, GSE26712, GSE63885, and GSE140082. The performance of CRS in predicting immunotherapy benefits was verified using 3 immunotherapy datasets (GSE91061, GSE78220, and IMvigor210) and several immune calculating scores. The Lasso + StepCox[forward] method-based predicting model having a highest average C index of 0.69 was referred as the optimal CRS and it had a stable and powerful performance in predicting clinical outcome of OC patients, with the 1-, 3-, and 5-year area under curves were 0.699, 0.708, and 0.767 in the Cancer Genome Atlas cohort. The C index of CRS was higher than that of tumor grade, clinical stage, and many developed signatures. Low CRS score demonstrated lower tumor immune dysfunction and exclusion score, lower immune escape score, higher PD1&amp;CTLA4 immunophenoscore, higher tumor mutation burden score, higher response rate and better prognosis in OC, suggesting a better immunotherapy response. OC patients with low CRS score had a lower half maximal inhibitory concentration value of some drugs (Gemcitabine, Tamoxifen, and Nilotinib, etc) and lower score of some cancer-related hallmarks (Notch signaling, hypoxia, and glycolysis, etc). The current study developed an optimal CRS in OC, which acted as an indicator for the prognosis, stratifying risk and guiding treatment for OC patients.

An unusual coincidence of giant cervical leiomyoma and incidental ovarian granulosa cell tumor: A case report

Rationale: Leiomyomas are the most common benign tumors of smooth muscle origin in women. They are most frequently found in the submucosal tissue of the uterine corpus; however, they also occur in other areas of the uterus, including the cervix. Their size usually varies between 0.5 to 1.0 cm; however, they can reach great dimensions. A strong correlation between the onset and growth of leiomyomas and estrogen levels was observed. Granulosa cell tumor (GCT) is an infrequent sex cord-stromal ovarian neoplasm. Despite their malignancy, GCTs have a good long-term prognosis. In this study, we present a unique case of coincidence of 2 tumors: leiomyoma of rare location (cervix uteri) and extraordinary size (9, 04 cm diameter) with an adult granulosa cell tumor. Patient concerns: A 67-year-old Caucasian woman was transported from an emergency ward to a gynecological surgery department due to a massive vaginal hemorrhage. Diagnoses: Preliminary examination showed a presence of an enormous uteri cervix tumor. Interventions: Initially, the patient underwent physical and ultrasound examinations. To prevent further bleeding, an urgent surgery (hysterectomy) with bilateral salpingo-oophorectomy was performed. Outcome: Postoperative histopathological examination revealed a cervical leiomyoma and the incidental occurrence of an adult GCT in the right ovary. Lessons: This case shares an interesting coincidence between a rare variant of leiomyoma and GCT. The study suggests that the potential reason for this can be estrogen secreted by the GCT, which causes the enormous size of the patient’s cervical leiomyoma and the severe vaginal bleeding. Therefore, we advise it is important in abnormal cases to search for other hidden explanations, as in cases of GCT.

Deciphering age-specific molecular features in cervical cancer and constructing an angio-immune prognostic model

Cancer incidence is increasingly seen in younger individuals. Molecular distinctions between young and elderly patients at onset are understudied. This study used public databases to explore genomic, transcriptomic, and immune-related features across age groups in cervical cancer. Additionally, it aims to create a prognostic model applicable across diverse age cohorts, enabling precise patient stratification, and personalized therapies. Gene mutations, expression data, and clinicopathological information were obtained from 317 cervical cancer patients. These patients were divided into a young group and an old group based on the median age of onset. The characteristics of differential gene mutation, gene expression, and immune cells analysis were analyzed by R software. Finally, the prognostic model was constructed by univariate Cox, least absolute shrinkage and selection operator, and multivariate Cox regression analyses of angiogenic and immune gene sets. Its validity was further confirmed using an additional 300 cervical squamous cell carcinoma and endocervical adenocarcinoma tissues. Cervical cancer patients at elderly onset age exhibit a significantly higher frequency of NOTCH1 and TP53 driver mutations compared to young patients, along with a notably higher tumor mutational burden. However, there were no significant differences between the 2 groups in terms of genomic instability and age-related mutational signatures. Differential gene expression analysis revealed that the young group significantly upregulated interferon-alpha and gamma responses and exhibited significantly higher activity in multiple metabolic pathways. Immune microenvironment analysis indicated enrichment of dendritic cells and natural killer cells in the young group, while transforming growth factor-β signature was enriched in the elderly group, indicating a higher degree of immune exclusion. A multigene prognostic model based on angiogenesis and T cell immune gene sets showed excellent prognostic performance independent of clinical factors such as age. High-risk groups identified by the model exhibit significant activation of tumor-promoting processes, such as metastasis and angiogenesis. Our study reveals distinct patterns in cancer-driving mechanisms, biological processes, and immune system status between young and elderly patients at onset with cervical cancer. These findings shed light on the age-specific underlying mechanisms of carcinogenesis. Furthermore, an independent molecular prognostic model is constructed to provide valuable references for patient stratification and the development of potential drug targets.

Responses of metastatic primary fallopian tube carcinoma to pembrolizumab and nab-paclitaxel

Abstract Rationale: Primary fallopian tube carcinoma (PFTC) is an extremely rare but invasive malignancy with a dismal prognosis. Very few data exist on the salvage treatment for patients with PFTC. Here we report a case showing an impressive response to immunotherapy combined with chemotherapy, which have never been reported before on patients with metastatic PFTC. Patient concerns: A 42-year-old woman, who was diagnosed with PFTC in 2010, had been failed of multiple systemic therapies and antiangiogenic therapy because of the disease recurrence and progression. Diagnosis: Metastatic primary fallopian tube carcinoma. Interventions: The patient underwent surgery in May 2010 and had multi-line chemotherapies plus an anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody for about 9 years. Due to treatment failure the patient accepted the immunotherapy with the checkpoint inhibitor, pembrolizumab, combined with nab-paclitaxel from December 2018 to April 2019. Outcomes: The patient showed a complete response after 6 cycles, treatment. Thus far, the patient is taking pembrolizumab as maintenance and remains in good health. Lessons: Pembrolizumab combined with chemotherapy for treatment of PFTC may provide a positive antitumor effect in multiple metastatic lesions, but more clinical evidence is needed to confirm the efficacy and safety.

Recurrent squamous cell carcinoma arising in ovary mature cystic teratoma: A case report

Rationale: Malignant transformation of mature cystic teratoma is very rare, of which squamous cell carcinoma (SCC) is the most common type. Prognosis of SCC arising in mature cystic teratoma of the ovary is very poor. Our experience may provide new ideas for the treatment of this disease. Patient concerns: The patient was a 56-year-old woman and was admitted for a lower abdominal pain. She underwent a laparoscopic surgery with 4 cycles of chemotherapy and had achieved a complete response; 10 months after the completion of initial treatment, her cancer relapsed. She underwent a cytoreductive surgery with concurrent chemoradiotherapy and has achieved a complete response again. Diagnoses: This patient was initially diagnosed with ovarian cancer (stage IIIB) arising from malignant transformation of mature teratoma; 10 months after the completion of initial treatment, she was diagnosed with recurrent ovarian cancer. Interventions: This patient was initially treated with laparoscopic bilateral salpingo-oophorectomy. After histopathological confirmation that she had ovarian cancer, she underwent laparoscopic total hysterectomy and omentectomy with 4 cycles of chemotherapy. After her ovarian cancer recurred, she underwent open cytoreductive surgery and concurrent chemoradiotherapy. Outcomes: The patient achieved complete response after both initial and relapsed treatment. Lessons: Optimal cytoreduction and concurrent chemoradiotherapy may be an option to improve the prognosis of patients with recurrent SCC arising in ovary mature cystic teratoma.

Successful diagnosis of asymptomatic choriocarcinoma by ultrasonography during a viable pregnancy: A rare case report

Background: Gestational choriocarcinoma occurs very rare in conjunction with pregnancy and it is camouflage for diagnosis. Methods: We present a rare case of asymptomatic choriocarcinoma in a viable pregnancy that was successfully diagnosed by ultrasonography and had timely treatment. Results: According to the ultrasonography, early diagnosis and treatment monitoring of choriocarcinoma during a viable pregnancy was administered and the newborn was discharged. Conclusion: Choriocarcinoma in pregnancy is camouflaged, and its clinical presentation varies widely. Despite an asymptomatic status, metastasis can occur, and ultrasonography is important for early diagnosis and treatment monitoring.

Pathological discrimination between luteinized thecoma associated with sclerosing peritonitis and thecoma

Background: Similarities between luteinized thecoma associated with sclerosing peritonitis (LTSP) and thecoma, cause difficulty in clinical differential diagnoses. To improve the situation, we selected 10 specified molecular pathological markers that are frequently used in clinical pathology of ovarian sex cord-stromal tumors to determine whether they exert a discriminatory effect. Methods: Applying immunohistochemistry, we analyzed the expression of alpha-1,6-mannosylglycoprotein 6-beta-n-acetylglucosaminyltransferase B (MGAT5B), nuclear receptor coactivator 3 (NCOA3), proliferation marker protein Ki-67 (MKI67), estrogen receptor, progesterone receptor, Vimentin, receptor tyrosine-protein kinase erbB-2, Catenin beta-1 (β-Catenin), CD99 antigen (CD99) and Wilms tumor protein (WT1) in 102 cases of diseases containing 11 LTSP and 91 thecoma. Whole-exome sequencing and fluorescence in situ hybridization were used to examine the MGAT5B-NCOA3 fusion gene in LTSP. Statistical analysis was performed using t test, one-way analysis of variance test, and post hoc test. Results: Six significant markers were verified for the discrimination between LTSP and thecoma, containing 4 upregulating indicators MGAT5B, NCOA3, MKI67, β-Catenin, and 2 downregulating markers CD99 and WT1 in luteinized cells. In addition, the MGAT5B-NCOA3 fusion gene was identified in LTSP for the first time with significantly rich expression compared to thecoma. Conclusions: We verified 6 significant molecular pathological markers containing MGAT5B, NCOA3, MKI67, β-Catenin, CD99, and WT1 and identified MGAT5B-NCOA3 fusion gene in LTSP; this work will help clinicians to discriminate between medical conditions and treat patients accurately.

The difference of transcriptome of HPV-infected patients contributes more to the occurrence of cervical cancer than the mutations of E6 and E7 genes in HPV16

Human papillomavirus (HPV) E6 and E7 genes are biomarkers and drivers of the progression of cervical cancer (CxCa). The aim of this study was to investigate the relationship between HPV16 E6, E7 gene mutations and the occurrence and development of CxCa. Cervical exfoliated cells and clinical data of patients with cervical diseases were collected. Sample DNA was extracted, the E6 and E7 gene fragments were amplified by PCR, and the mutations were detected by Sanger sequencing and compared with standard sequences. Microarray was used to sequence the transcriptome of cells. Data of transcriptome analyzed and visualized using R software and its packages. Analysis of clinical characteristics demonstrated the association of HPV16 infection with CxCa (P &lt; .05). Sanger sequencing results showed that the mutation sites of E6 gene included T178G/A, T350G, A131C, and T241G; among these, A131C and T241G were synonymous mutations. The mutation sites of E7 gene included A647G, T846C, G666A, T843C, and T760C, and all of them were synonymous mutations except A647G. There was no significant difference in the distribution of HPV16 E6, E7 mutations among CxCa, cervical intraepithelial neoplasia, and infection groups (P &gt; .05). Compared with the non- CxCa group, gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis of differentially expressed genes (DEGs) showed more significant enrichment of DEGs in the biological processes, pathways, and diseases closely related to cancer. Compared with the non-mutation group, the DEGs in the E6, E7 gene mutation group were significantly enriched in the events related to infection and immunity. To summarize, HPV16 may be associated with the occurrence and development of CxCa, but HPV16 E6 and E7 gene mutations have little effect on the occurrence and development of CxCa. Individual differences may have a greater effect on the progression of CxCa.

Exploring the gut-inflammation connection: A Mendelian randomization study on gut microbiota, inflammatory factors, and uterine fibroids risk

This study employs Mendelian randomization (MR) approach to investigate the potential causal association between genetic variants associated with gut microbiota, inflammatory factors, and the risk of uterine fibroids development. We extracted data on 211 types of gut microbiota, 91 inflammatory factors, and uterine fibroids occurrence from genome-wide association studies and applied the inverse-variance weighted (IVW) method for analysis. To further assess the robustness of our MR analysis, we conducted sensitivity tests including Cochrane’s Q test, the MR-Egger intercept test, the MR-PRESSO global test, and a leave-one-out analysis. IVW analysis identified a potential causal association between 14 types of gut microbiota and 8 inflammatory factors with the risk of uterine fibroids. When using 91 inflammation-related proteins as the outcome variable, 13 proteins demonstrated a potential causal association with uterine fibroids risk (IVW, all P &lt; .05). Additionally, the MR-Egger intercept and MR-PRESSO global tests indicated no evidence of horizontal pleiotropy (P &gt; .05), and the leave-one-out analysis confirmed the robustness of the results. This MR approach suggests that specific gut microbiota and inflammatory factors may have a causal association with the development of uterine fibroids, shedding light on the pathogenesis of uterine fibroids and potentially identifying targets for future therapeutic interventions.

Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) with sarcomatous features without recurrence after extended radical surgery

Abstract Rationale: The malignant potential and the appropriate treatment of uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is controversial. Although these tumors generally have benign outcomes, several reports have described recurrences, metastases, and deaths associated with this disease. Patient concerns: A 57-year-old Japanese woman (gravida 2, para 2) was referred to our hospital for the evaluation and treatment of uterine fibroids. Magnetic resonance imaging revealed a right ovarian mass and multiple fibroids in the uterine myometrium. Diagnoses: The patient was diagnosed with UTROSCT with sarcomatous features. Interventions: She initially underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by second-stage surgery comprising pelvic and para-aortic lymphadenectomy and subtotal omentectomy. Outcomes: No postoperative recurrence was observed in the patient in 36 months. Lessons: In this case, extended radical surgery prevented the development of recurrent disease in a patient with UTROSCT with sarcomatous features. These clinicopathological findings suggest that UTROSCT is associated with several risk factors, including older age, presence of necrosis, lymphovascular invasion, significant nuclear atypia, and significant mitotic activity. This lesion type should be considered malignant and treated with curative intent.

Sentinel lymph node mapping in early-stage cervical cancer

Abstract Background: The value of sentinel lymph node (SLN) mapping for early-stage cervical cancer remains controversial. Therefore, we collected data to investigate the feasibility and diagnostic accuracy of SLN in patients with early-stage (IA-IIA) cervical cancer. Methods: We searched Embase, PubMed, and the Cochrane Library databases issued before June 1, 2020. The sample size of the selected study was at least 10 patients with early-stage (IA-IIA) cervical cancer, the pooled detection rates and the separate detection rate (overall detection rate, bilateral detection rate) using blue dye with Tc, technetium 99 (Tc) and indocyanine green (ICG) technique of early-stage cervical cancer was reported. R-3.6.1 software was used to evaluate pooled detection rate and sensitivity. Results: Two thousand one hundred sixty-four patients included for analysis in 28 studies ranging from 12 to 405 patients. The combined overall detection rate of SLN mapping was 95% with a 72% pooled bilateral detection rate. The sensitivity of the combined overall detection rate of SLN mapping was 94.99% as well as a sensitivity of 72.43% bilateral detection rate. The overall detection rate of SLN was 96% for blue dye with Tc, 95% for Tc, 98% for ICG technique. The bilateral detection rate of SLN was 76% for blue dye with Tc, 63% for Tc, 85% for ICG technique. The sensitivity of the overall detection rate of SLN mapping was 97.76% as well as a sensitivity of 84.96% bilateral detection rate of ICG technique. Conclusion: In early-stage cervical cancer, overall detection rate of SLN mapping is elevated while bilateral detection rate is lower. The overall detection rate (98%) as well as bilateral rate (85%) of ICG seems to be a better SLN mapping technique among the method of SLN mapping (using blue dye with Tc, Tc or ICG). We believe SLN mapping may be considered contemporary technique which could provide additional benefits over traditional pelvic lymphadenectomy. While promising results in SLN mapping has been found, larger patient samples, including randomized studies, are required at the same time.

Comprehensive analysis of the expression and prognosis for S100 in human ovarian cancer

Abstract S100 family members are frequently deregulated in human malignancies, including ovarian cancer. However, the prognostic roles of each individual S100 family member in ovarian cancer (OC) patients remain elusive. In the present study, we assessed the prognostic roles and molecular function of 20 individual members of the S100 family in OC patients using GEPIA, Kaplan–Meier plotter, SurvExpress, GeneMANIA and Funrich database. Our results indicated that the mRNA expression levels of S100A1, S100A2, S100A4, S100A5, S100A11, S100A14, and S100A16 were significantly upregulated in patients with OC, and high mRNA expression of S100A1, S100A3, S100A5, S100A6, and S100A13 were significantly correlated with better overall survival, while increased S100A2, S100A7A, S100A10, and S100A11 mRNA expressions were associated with worse prognosis in OC patients. In stratified analysis, the trends of high expression of individual S100 members were nearly the same in different pathological grade, clinical stage, TP53 mutation status, and treatment. More importantly, S100 family signatures may be useful potential prognostic markers for OC. These findings suggest that S100 family plays a vital role in prognostic value and could potentially be an S100-targeted inhibitors for OC patients.

Intrauterine device found in an ovarian tumor

Intrauterine devices (IUDs) are one of the most common and effective methods of contraception worldwide. Migration of an IUD to an extrauterine site is a rare complication. The aim of this study was to report an extremely rare case in which an IUD was found in an ovarian tumor. A 63-year-old Chinese woman presented with vaginal bleeding and lower abdominal pain during hospitalization due to pneumonia. Preoperative imaging showed bilateral cystic masses in the adnexal region, and ring hyperdensity was found in the right ovarian mass. Endometrial thickening and multiple uterine leiomyomas were found on ultrasonography. Hysteroscopy showed partial septate uterus and a small endometrial polyp. Bilateral ovarian cystadenomas with perforation of the IUD into the right ovarian tumor were considered based on preoperative imaging and the patient's medical history. Furthermore, early endometrial carcinoma was suspected. The patient underwent hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A stainless steel ring IUD was confirmed within the right ovarian tumor during the operation. The pathology results demonstrated bilateral ovarian serous cystadenofibromas with focal epithelial proliferation and endometrial atypical hyperplasia with malignant transformation. The patient has been followed up for 7 months, and there has been no recurrence at present. The presence of an IUD within an ovarian tumor is extremely rare. This is the second reported case in the English literature describing an extrauterine IUD within an ovarian tumor. The correlation between ovarian cancer tumorigenesis and IUD translocation is unclear and requires further investigation.

Primary ovarian carcinoid

Carcinoid tumor is one of the most frequent neuroendocrine tumors, and the majority of which are usually observed in the lungs and gastrointestinal tract. The prevalence of ovarian carcinoids is merely 0.1% in ovarian neoplasms and 1% in carcinoid tumors. We described 2 rare cases in our hospital of primary ovarian carcinoid (POC), causing carcinoid syndrome (CS) of the diarrhea, constipation, and carcinoid heart disease. Besides, we also reviewed related literatures about its origin, variant, clinical manifestation, diagnosis methods, pathological features, treatment strategies and prognosis from 2009 to 2019. Case 1 was a 61-year-old postmenopausal woman and presented with diarrhea, abdominal pain, enlargement, bloating and dizziness. Case 2 was a 49-year-old patient who complained of constipation, abdominal pain, bloating, and headache. Both patients were diagnosed as primary ovarian carcinoid, insular type. Total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy, pelvic lymphadenectomy, and appendectomy without chemotherapy were performed in case 1. Cervix resection, right salpingo-oophorectomy, appendectomy, and pelvic lesion resection with chemotherapy was conducted in case 2. Both patients achieved satisfactory treatment effects. The follow-up period was 18 and 17 months in case 1 and case 2, respectively. Case 1 encountered carcinoid heart disease and received percutaneous transluminal coronary angioplasty (PTCA) postoperatively. Case 2 suffered multiple metastases postoperatively. However, after effective treatment, both patients were in good condition during follow-up duration. POC is an extraordinarily rare disease, and commonly with a satisfactory outcome. TAH+BSO with or without postoperative chemotherapy has been considered as an acceptable treatment strategy for POC patients.

Novel mutations of maternal effect gene thyroid hormone receptor interactor 13 involved in biparental complete hydatidiform mole

Rationale: Biparental complete hydatidiform mole (BiCHM) is a rare form of molar pregnancy, frequently associated with familial recurrence, whose mechanism was historically unclear. It is classically diploid with biparental inheritance, but manifests as a complete hydatidiform mole (CHM). Cytogenetic studies suggested a link to maternal mutations in imprinted genes NOD-like receptor family, pyrin domain containing 7 or Kelch helper domain containing 3-like within the oocyte. This case reports a novel gene association. Patient concerns: A 43-year-old woman presented with a history of recurrent abnormal pregnancies: 2 CHM and 1 spontaneous abortion following an intracytoplasmic sperm injection (ICSI)-assisted conception. Diagnoses: Short tandem repeat polymorphism analysis of products of conception (including both CHM and the aborted ICSI pregnancy) revealed all 3 were biparental triploids derived from the patient and her husband. Whole-exome sequencing of the patient’s family identified that the patient carries compound heterozygous mutations (c.-82G &gt; A [paternally inherited] and c.*106G &gt; A [maternally inherited]) in the autosomal recessive gene thyroid hormone receptor interactor 13 ( TRIP13 ), confirmed by Sanger sequencing. Interventions: Given the genetic findings and history of recurrent BiCHM, ovarian donation or adoption was recommended as the treatment strategy to achieve a normal pregnancy. Outcomes: The genetic diagnosis was established, informing future reproductive counseling and management options. Lessons: To our knowledge, this is the first report linking biallelic TRIP13 mutations to recurrent BiCHM, indicating its potential role in the pathogenesis. ICSI-assisted reproduction did not improve pregnancy outcomes. Ovarian donation or adoption was recommended.

Integrative network analysis identifies an immune-based prognostic signature as the determinant for the mesenchymal subtype in epithelial ovarian cancer

Epithelial ovarian cancer (EOC) has been classified into four molecular subtypes, of which the mesenchymal subtype has the poorest survival. Our goal is to develop an immune-based prognostic signature by incorporating molecular subtypes for EOC patients. The gene expression profiles of EOC samples were collected from seven public datasets as well as an internal retrospective validation cohort, containing 1192 EOC patients. Network analysis was applied to integrate the mesenchymal modalities and immune signature to establish an immune-based prognostic signature for EOC (IPSEOC). The signature was trained and validated in eight independent datasets. Seven immune genes were identified as key regulators of the mesenchymal subtype and were used to construct the IPSEOC. The IPSEOC significantly divided patients into high- and low-risk groups in discovery (OS: P < .0001), 6 independent public validation sets (OS: P = .04 to P = .002), and an internal retrospective validation cohort (OS: P = .025). Furthermore, pathway analysis revealed that differences between risk groups were mainly activation of mesenchymal-related signalling. Moreover, a significant correlation existed between the IPSEOC values versus clinical phenotypes including late tumor stages, drug resistance. We propose an immune-based signature, which is a promising prognostic biomarker in ovarian cancer. Prospective studies are needed to further validate its analytical accuracy and test the clinical utility.

Ovarian microcystic stromal tumor with significant bizarre nuclei

Abstract Rationale: Ovarian microcystic stromal tumor is a relatively rare tumor type, which is characterized by morphology with microcyst structure, solid cellular areas, and hyalinized fibrous stroma. The most reported tumors were stage I with good prognosis. Patient concerns: We report a case of a 33-year-old woman with primary ovarian microcystic stromal tumor with significant bizarre nuclei. We describe the clinical, histopathological, and immunohistochemical findings and review the English literatures. So far, as we know, the patient presented here is a rare case of ovarian microcystic stromal tumor with prominent bizarre nuclei accounting for about 50% of the tumor cells. Diagnoses: She was diagnosed with ovarian microcystic stromal tumor with significant bizarre nuclei. Interventions: The right ovarian tumor was resected laparoscopically on October 19, 2018. Outcomes: Up to now, the patient is free of disease at 19 months of follow-up. Lessons: This is a rare case of ovarian microcystic stromal tumor with obvious bizarre nuclei. This report will contribute to expand the morphological spectrum of ovarian microcystic stromal tumor.

Clinical characteristics and survival outcomes of patients with both primary breast cancer and primary ovarian cancer

Abstract Breast cancer and ovarian cancer are closely related. The major common risk factors of these 2 types of cancer are likely genetic factors. However, few studies have shown any common characteristics in patients who have both types of these 2 cancers. The purpose of this retrospective study is to explore the clinical characteristics and survival outcomes of patients with both primary breast cancer and primary ovarian cancer. A cohort of patients who had a history of both primary breast cancer and primary ovarian cancer were enrolled, and they received treatment in the Peking Union Medical College Hospital between January 1, 2010, and December 31, 2018. Both descriptive statistics analysis and survival analysis were performed for analysis. A total of 114 patients with both primary breast cancer and primary ovarian cancer were included in the study. The median (range) follow-up was 129.5 (20–492) months. The average interval time between the diagnosis of 2 types of cancer was 79.4 months in patients having ovarian cancer firstly and was 115.9 months in patients having breast cancer firstly. The 5- and 10-year overall survival (OS) rates were 91.5% and 81.7% for patients with ovarian cancer following breast cancer, respectively, and 90.6% and 87.5% for patients with breast cancer following ovarian cancer, respectively. Multivariate analysis revealed that independent predictors of OS were the age of diagnosis of the first tumor and the time interval between two types of tumor in patients with ovarian cancer following breast cancer. Most breast cancer or ovarian cancer occurred within 5 years after being diagnosed with the first tumor, and the interval time was significantly shorter in patients with previous ovarian cancer. The prognosis is likely positively correlated to the interval time between the occurrences of two types of cancer.

Primary ovarian small cell carcinoma of hypercalcemic type in a pregnant woman

Abstract Rationale: Ovarian small cell carcinoma of hypercalcemic type (OSCCHT) is a relatively rare and highly fatal gynecological malignancy of unknown histogenesis, affecting mainly girls and young women. OSCCHT occurring during pregnancy is an uncommon event, and preoperative diagnosis of this malignancy is much more difficult in pregnant than non-pregnant women. The aim of this study was to describe a rare case of primary OSCCHT in a pregnant woman and to review the current literature. Patient concerns: Here we present a case of OSCCHT in a 21-year-old patient in the 32nd week of gestation, who had abdominal pain and irregular vaginal bleeding for 5 hours. Because placental abruption, stillbirth, and hemorrhagic shock were suspected, she subsequently underwent diagnostic laparotomy. During the hysterotomy delivery and exploratory laparotomy, we found a dead fetus in the uterus and a large tumor mass arising from her left ovary. Plasma-based detection showed that the patient had a slightly elevated parathyroid hormone (PTH) level and normal serum calcium. After surgery, her serum PTH levels returned to normal. Diagnosis and interventions: The patient was initially treated with surgery. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as the following additional procedures: appendectomy, sigmoidectomy, debulking of extra-ovarian tumor, lymph node dissection, and peritoneal biopsies. The patient, who was in the third trimester of pregnancy, was diagnosed with OSCCHT that was confirmed to be Stage III. She was recommended chemotherapy after surgery, but she declined chemotherapy. Outcomes: Unfortunately, the patient died 5 months after surgery. Lessons: OSCCHT is a very rare and highly aggressive tumor type. The clinical symptoms of this tumor are nonspecific, and pathological examination remains the gold standard for diagnosis. Most patients are diagnosed with advanced stage disease and do not respond to chemotherapy. The prognosis of OSCCHT is generally poor, and no treatment guidelines are available as yet. For pregnant woman, OSCCHT is especially harmful to the mother and may indirectly lead to the death of the fetus.

Sertoli-Leydig cell tumor in two siblings with DICER1 syndrome

Abstract Rationale: DICER1 syndrome is an autosomal-dominant tumor predisposition syndrome associated with numerous cancerous and noncancerous conditions. The most common sex cord-stromal tumor associated with DICER1 syndrome is Sertoli-Leydig cell tumor of the ovary (SLCT), which is extremely unusual and accounts for &lt; 0.5% of all ovarian neoplasms. SLCT predominantly affects adolescents and young female adults. To date, there are only a few case reports of ovarian SLCT with underlying germline DICER1 mutations. The diagnosis and treatment of this rare malignancy remains challenging in the clinic mainly due to its rarity and varied presentation. Patient concerns: A 21-year-old Chinese girl (proband) was admitted in hospital for experiencing a lower abdominal pain and irregular vaginal bleeding for half a year. She was initially diagnosed with abdominal cavity mass prior to surgical operation. The other 20-year-old patient is the younger sister of the proband, who was diagnosed with ovarian cysts and had irregular menstruation and amenorrhea for 4 months. The elder sister underwent an uncomplicated bilateral ovarian tumor resection. Given a high degree of malignancy, comprehensive staged fertility-preserving surgery, including left adnexectomy, omentectomy, pelvic, and para-aortic lymphadenectomy, was performed. Since the other patient requested to maintain her fertility, tumor resection was only conducted in the right ovary. Diagnoses: The elder sister was diagnosed as poorly differentiated SLCT accompanied with heterologous stage IC rhabdomyosarcoma (RMS) based on its typical pathology features and molecular characteristics from immunohistochemistry (IHC) staining. The younger sister was diagnosed as poorly differentiated SLCT. Targeted next-generation sequencing (NGS) detected DICER1 mutation in the plasma samples and postoperative tumor tissues of both patients. Interventions: Both patients underwent surgical tumor resection, followed by combination chemotherapy with bleomycin, etoposide, and cisplatin for 4 cycles. Outcomes: Patients received the above clinical interventions but eventually died from disease recurrence. The elder sister died from disease relapse after one and a half years postsurgery. The younger sister had a relapse of the disease 1 year later, but she refused the comprehensive staged surgery and died from disease relapse quickly. Lessons: Ovarian SLCT patients with DICER1 mutations and a family history have a high degree of malignancy and are associated with a poor prognosis. With ongoing research efforts on DICER1 mutations, genetic screening and counselling on a regular basis is recommended for predicting potential future cancer risk of individuals with DICER1 syndrome family history.

Big data-based identification of methylated genes associated with drug resistance and prognosis in ovarian cancer

Abstract It is imperative to further the understanding of the drug resistance mechanisms of ovarian cancer (OC) and to identify useful biological markers for prognosis prediction. Cormine, cBioportal, and The Cancer Genome Atlas databases were used to search microarray data of gene methylation related to OC, drug resistance in OC, and prognosis, and to analyze methylated genes potentially inducing the drug resistance in OC. Fifty-five DNA-methylated genes significantly associated with drug resistance in OC were screened, and the regulatory mechanisms underlying changes in methylation levels of these genes were systematically integrated. Enrichment and annotation of biological processes indicated that most of the above DNA-methylated genes were significantly associated with cell proliferation and cell cycle. In addition, pathway enrichment demonstrated that the above DNA-methylated genes were significantly associated with PI3K-AKT and P53 signaling pathways. Among the 55 genes, 4 were significantly associated with OC prognostic disease-free survival, namely bromodomain containing 4, PDZ domain containing 1 (PDZK1), phosphatase and tensin homolog, and TNF receptor superfamily member 10c; 5 were significantly related to overall survival, namely bromodomain containing 4, PDZK1, PIK3C2B, Rh associated glycoprotein, and DYRK; among them, the degree of methylation of TNF receptor superfamily member 10c, PDZK1, and Rh associated glycoprotein genes was significantly correlated with mRNA expression. Furthermore, PDZK1, Rh associated glycoprotein, and TNF receptor superfamily member 10c genes showed significant hypomethylation in drug-resistance tissues of OC, and their mRNAs had significantly high expression. The association between the methylation of these 55 genes and OC and drug resistance in OC, in addition to bioinformatics analyses clarify the important mechanisms of gene methylation in the development, progression, and drug resistance of OC.

Efficacy of weekly paclitaxel for the treatment of advanced ovarian cancer

This study aims to assess the efficacy and safety of weekly paclitaxel (WP) for the treatment of advanced ovarian cancer (AOC). This study will systematically search bibliographic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science, CINAHL, PSYCINFO, Allied and Complementary Medicine Database, CNKI, WANGFANG, and Chinese Biomedical Literature Database) and other literature sources from inception to the March 1, 2020 without language and publication time limitations. Two authors will independently complete all literature selection, data collection, and study quality evaluation. Any disagreements will be solved by a third author through discussion. We will analyze data by RevMan V.5.3 software. This study will systematically generate a comprehensive summary on the efficacy and safety of WP for the treatment of AOC. This study may provide beneficial evidence of WP for the treatment of AOC. INPLASY202040193.

Utilization of virtual low-keV monoenergetic images generated using dual-layer spectral detector computed tomography for the assessment of peritoneal seeding from ovarian cancer

Abstract This study aimed to compare the quality of virtual low-keV monoenergetic images vs conventional images reconstructed from dual-layer spectral detector computed tomography (SDCT) for the detection of peritoneal implants of ovarian cancer. Fifty ovarian cancer patients who underwent abdominopelvic SDCT scans were included in this retrospective study. Virtual monoenergetic images at 40 (VMI40) and 50 keV (VMI50), and two conventional images were reconstructed using filtered back projection (FBP) and iterative model reconstruction (IMR) protocols. The mean attenuation of the peritoneal implant, signal-to-noise ratio (SNR), contrast-to-noise ratio relative to ascites (CNRA) and adjacent reference tissues (e.g., bowel wall, hepatic, or splenic parenchyma [CNRB]) were calculated and compared using paired t tests. Qualitative image analysis regarding overall image quality, image noise, image blurring, lesion conspicuity, was performed by two radiologists. A subgroup analysis according to the peritoneal implant region was also conducted. VMI40 yielded significantly higher mean attenuation (183.35) of SNR and CNR values (SNR 11.69, CNRA 7.39, CNRB 2.68), compared to VMI50, IR, and FBP images (P &lt; .001). The mean attenuation (129.65), SNR and CNR values (SNR 9.37, CNRA 5.72, CNRB 2.02) of VMI50 were also significantly higher than those of IR and FBP images (P &lt; .001). In the subgroup analysis, all values were significantly higher on VMI40 regardless of the peritoneal implant region (P &lt; .05). In both readers, overall image quality and image blurring showed highest score in VMI50, while image noise and lesion conspicuity showed best score in IMR and VMI40 respectively. Inter-reader agreements are moderate to almost perfect in every parameter. The low-keV VMIs improved both quantitative assessment and lesion conspicuity of peritoneal implants from ovarian cancer compared to conventional images.

Analysis of magnetic resonance imaging features of ovarian thecoma

Abstract To investigate the magnetic resonance imaging (MRI) findings in ovarian thecoma and improve preoperative diagnostic accuracy. Retrospective analysis was performed on 45 patients with surgically and pathologically confirmed ovarian thecoma. Patients were grouped into those with maximum lesion diameter ≥5 cm and &lt;5 cm. Diagnostic scores (up to 6 points) were evaluated on the basis of MRI performance. The ≥5 cm group contained 36 cases (cystic necrosis, 32 cases) with the following findings: T1WI: isointense signal, 22 cases; slightly hypointense signal, 14 cases; T2WI: isointense signal, 6 cases; slightly hypointense signal, 21 cases; slightly hyperintense signal, 9 cases; Diffusion-weighted imaging (DWI): hyperintense signal, 23 cases; mixed hyperintense signal, 13 cases; slight enhancement on dynamic enhanced scans; pelvic fluid accumulation, 31 cases. The diagnostic score evaluations yielded 6 points in 31 cases, 5 points in 1 case, 4 points in 2 cases, and 3 points in 2 cases. The &lt;5 cm group contained 9 cases (cystic necrosis, 3 cases) with the following findings: T1WI: isointense signal, 3 cases; slightly hypointense signal, 6 cases; T2WI: isointense signal, 2 cases; slightly hypointense signal, 4 cases; slightly hyperintense signal, 3 cases; DWI, hyperintense signal; slight enhancement in 8 cases and significant enhancement in 1 case; pelvic fluid accumulation, 4 cases. The diagnostic score evaluations yielded 6 points in 3 cases, 5 points in 1 case, 4 points in 4 cases, and 3 points in 1 case. (iii) Incidence of pelvic fluid accumulation and cystic necrosis differed depending on the size of the lesion (P = .007, .000). Larger lesions show hyperintense or mixed hyperintense signals on DWI along with pelvic fluid and cystic necrosis; whereas, smaller lesions show a hyperintense signal on DWI, cystic necrosis is rare. MRI characteristics along with the patient age and laboratory findings can improve the accuracy of preoperative diagnosis of these lesions.

Type II enteropathy-associated T cell lymphoma in the duodenum

Abstract Introduction: Enteropathy-associated T-cell lymphoma (EATL) is a very rare form of lymphoma in the gastrointestinal tract. The proximal jejunum and ileum are the most common sites of EATL, whereas EATL rarely arises in the duodenum, and EATL involving metastasis of the bilateral ovaries is even rarer. Patient concerns: A 43-year-old female suffered from upper abdominal pain and weight loss for 3 months. Diagnosis: Type II EATL. Interventions: The patient was initially treated with chemotherapies, including 4 cycles of the CHOP-E and 2 cycles of the DHAP+ chidamide chemotherapy regimens. However, the patient did not respond well to chemotherapy. Surgical treatment of the duodenal obstruction, with perforation of small intestine and the duodenum, was performed successively. Outcomes: The patient died of septic shock only 1 day after the surgery for the second perforation. Her overall survival was 11 months from the time of initial diagnosis. Conclusion: This case suggests that EALT is highly invasive and its clinical course is very aggressive. Intestinal perforation, intestinal obstruction, or involvement of extraintestinal organs may occur in EALT patients. Additionally, EALT patients respond poorly to chemotherapy and have an extremely unfavorable prognosis.

Contribution of xeroderma pigmentosum complementation group D gene polymorphisms in breast and ovarian cancer susceptibility

Abstract Background: The role of xeroderma pigmentosum complementation group D (XPD) gene polymorphisms in breast and ovarian cancer development has long been controversial and existing data were inconsistent. Here, we conducted a comprehensive systemic review and meta-analysis to better clarify the association. Methods: Relevant case-control studies published in electronic data base from October 1999 to September 2019 were assessed. The statistical analyses of the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (95%CIs) were calculated by using Revman 5.2 software (Cochrane Collaboration, Copenhagen). Results: 31 articles including 38 case-control studies and 2 XPD polymorphisms (rs1799793 and rs238406) were analyzed. The results showed statistical significance in heterozygous mutants among Asian population for rs1799793 (GA vs GG + AA: OR = 1.38, 95%CI = 1.21–1.56), and Caucasian population for rs238406 (CA vs AA + CC: OR = 0.63, 95%CI = 0.49–0.80), while the rest comparisons including overall groups and subgroups stratified by cancer types and ethnicity failed to indicate any association with breast and ovarian cancer risk. Conclusions: The current meta-analysis suggested no concrete correlation of XPD rs1799793(G/A) and rs238406(C/A) polymorphisms with breast cancer or ovarian cancer susceptibility. However, it indicated that heterozygous genotypes might share different pathophysiologic mechanism from not only homozygous wildtypes but also homozygous mutants. More case–control studies with well-adjusted data and diverse populations are essential for validation of our conclusion.

True hermaphroditism with dysgerminoma

Abstract Introduction: True hermaphroditism is a rare and usually sporadic disorder. It is defined by the presence of both ovarian and testicular tissues together as ovotestis. Patient concerns: In this study, we reported a rare true hermaphroditism case with dysgerminoma. A 49-year-old woman developed masses in both inguinal regions for 30 years. Recently 3 months, the patient found that the size of mass in her left inguinal region was significantly increased. Diagnosis: After surgical resection, the results of immunohistochemical examination in left mass revealed a dysgerminoma with positive expression of placental alkaline phosphatase and octamer-binding transcription factor 3/4, and right mass was a cryptorchidism. Chromosomal analysis revealed the karyotype 46, XY. Combined immunohistochemical and karyotype analysis, a diagnosis of true hermaphroditism with dysgerminoma was made. Interventions: Radiotherapy combined with chemotherapy after tumor resection was used to improve her prognosis. Hormone replacement therapy with conjugated estrogen and medroxyprogesterone acetate were used to maintain her female characteristics. Outcomes: The patient underwent hormonal replacement and has been well for 6 months. Conclusion: The positive expression of placental alkaline phosphatase and octamer-binding transcription factor 3/4 could be 2 diagnosis markers of dysgerminoma. Surgery combined with radiotherapy and chemotherapy could improve the prognosis of dysgerminoma. Moreover, hormone replacement therapy with conjugated estrogen and medroxyprogesterone acetate was very helpful to maintain the female characteristic of patients with true hermaphroditism.

Effect of shikonin on the proliferation and apoptosis of human ovarian cancer cell SKOV3

Abstract Background: This study will investigate the effect of shikonin on the proliferation and apoptosis of human ovarian cancer cell SKOV3 (HOCC-SKOV3). Methods: We will retrieve potential studies from inception to the March 1, 2020 in Cochrane Library, MEDLINE, EMBASE, Scopus, Cumulative Index to Nursing and Allied Health Literature, WANGFANG, and China National Knowledge In-frastructure. There are not restrictions related to the language and publication status. This study will include case-controlled studies (CCSs) or randomized controlled studies (RCSs) that examine the effect of shikonin on the proliferation and apoptosis of HOCC-SKOV3. Two researchers will independently identify literatures, extract data, and appraise study quality. Any disagreements will be resolved by discussion with another researcher. RevMan 5.3 software will be placed to perform statistical analysis. Results: This study will summarize the present evidence to test the effect of shikonin on the proliferation and apoptosis of HOCC-SKOV3. Conclusion: It will provide evidence to investigate the effect of shikonin on the proliferation and apoptosis of HOCC-SKOV3, and will supply reference for further study. Systematic review registration: INPLASY202040146.

Anlotinib combined with etoposide for platinum-resistant recurrent ovarian cancer

Abstract Introduction: Platinum-resistant ovarian cancer is characterized by its poor prognosis and limited treatment options. Angiogenesis plays a fundamental role in the development of drug-resistance in ovarian cancer. Anlotinib, a novel oral multi-targeted tyrosine kinase inhibitor which targets a board spectrum of angiogenesis-associated growth factor receptors, has shown promising anti-tumor efficacy in clinical trials. Herein, we report a case of ovarian cancer treated with anlotinib plus etoposide after secondary cytoreductive surgery. Patient concerns: A 45-year-old female with primary platinum-resistant ovarian cancer who progressed rapidly after the first cytoreductive surgery, the second cytoreductive surgery, and several lines of treatment. The patient refused to receive intravenous chemotherapy any more. Diagnosis: Primary platinum-resistant ovarian cancer. Interventions: The oral combination treatment of anlotinib (12 mg, qd) and etoposide (100 mg, qd) were delivered. Outcomes: Finally, the patient was responsive to the orally treatment of anlotinib combined with etoposide. The patient has been alive with no evidence of disease progression for 18 weeks. Conclusion: Our case suggests that oral treatment of anlotinib combined with etoposide which is acceptable and convenient, may be an additional option for the management of platinum-resistant ovarian cancer.

Primary hepatoid carcinoma of the ovary

Abstract Introduction: Hepatoid carcinoma of the ovary (HCO) is a rare disease that originates from the ovarian surface epithelium. It is histologically characterized as hepatocellular carcinoma (HCC) with a hepatocyte-rich granular cytoplasm. Patient concerns: A 65-year-old female patient was admitted with complaints of indigestion, abdominal bloating, and pain. Diagnosis: The patient showed an elevated level of serum alpha-fetoprotein (AFP) with abdominal bloating and pain. After surgery and histopathology analysis, she was finally diagnosed with HCO, Figo stage IC. Interventions: After cytoreductive surgery, she underwent adjuvant chemotherapy with carboplatin and paclitaxel. Although the disease was diagnosed at an early stage, it recurred 6 months after completion of adjuvant chemotherapy. Elevation of serum AFP level and removal of a mass from the lumbar vertebra confirmed the recurrence of this disease. Subsequently, the patient underwent radiation therapy and palliative chemotherapy. Outcomes: She died 31 months after the diagnosis due to disease progression. Conclusion: The aggressive nature of HCO was clearly observed in this case despite early diagnosis and treatment. Further studies are needed to understand the proper treatment and prognostic factors of HCO.

Malignant risk of pelvic mass after hysterectomy for adenomyosis or endometriosis

Abstract Pelvic mass onset following a hysterectomy due to benign disease is not rarely seen. Appropriate diagnosis and treatment are of great importance. This study aims to analyze the clinicopathological features of patients who have received surgery for pelvic mass following hysterectomy due to gynecological benign disease, especially endometriosis or adenomyosis. This study retrospectively analyzed the patients undergone reoperation for pelvic mass subsequently to hysterectomy from January 2012 to December 2016 in a tertiary teaching hospital. A total of 247 patients were enrolled in this study. There is a significant difference between the patients with or without a history of endometriosis/adenomyosis. Multivariate analysis showed that the pelvic mass had a higher risk of being ovarian endometrioid carcinoma, ovarian clear cell carcinoma, ovarian endometriosis, and ovarian physiological cysts in patients with a history of adenomyosis/endometriosis. The pathology of the subsequent pelvic mass inclines to be benign, includes ovarian endometriosis, ovarian physiological cysts, and pelvic encapsulated effusion. Postoperative adjuvant therapy for those received hysterectomy due to endometriosis/adenomyosis, like gonadotropin releasing hormone agonists (GnRHa), may contribute to the prevention of benign pelvic mass. Patients with a history of hysterectomy due to endometrisos/adenomyosis tend to have a shorter time interval between hysterectomy and pelvic malignant tumors onset.

Prognostic significance of lymphocyte monocyte ratio in patients with ovarian cancer

Abstract Background: This study aimed to systematically assess the prognostic value of lymphocyte monocyte ratio (LMR) in patients with ovarian cancer through performing a meta-analysis. Methods: Web of Science, PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure databases were searched for potentially eligible studies. The baseline characteristics and relevant data were extracted. Hazard ratios with 95% confidence intervals (CIs) were combined to assess the prognostic value of LMR in patients with ovarian cancer. Results: Nine studies enrolling 2809 patients were included. The pooled hazard ratios of lower LMR for overall survival and progression free survival in patients with ovarian cancer were 1.71 (95% CI, 1.40–2.09) and 1.68 (95% CI, 1.49–1.88), respectively. Subgroup analysis and sensitivity analysis were also performed. No significant publication bias was found. Conclusion: Our results suggested that lower LMR was associated with poorer overall survival and progression free survival in patients with ovarian cancer. The findings may assist prognosis evaluation and future research on therapies based on modulating host immune response in ovarian cancer.

Application of comprehensive care of familial warmth and weakness in patients with gynecological tumor chemotherapy Induced weakness

Gynecological tumors pose a serious threat to the physical and mental health of middle-aged women, and chemotherapy is currently one of the main systemic treatment methods. Comprehensive care is of great significance in improving self-care efficiency and quality of life. To explore the impact of family-based comprehensive care of frailty and warmth based on the Belief, Attitude, Subjective Norm, and Enabling Factors model on frailty patients after gynecological tumor chemotherapy. This retrospective study selected 80 patients with gynecological malignancies who were admitted to the gynecology ward of the Affiliated Hospital of Jiangnan University from June 2023 to March 2024. According to different nursing methods, 80 patients were divided into control group (40 cases, conventional nursing) and intervention group (40 cases, combined nursing of family warmth and weakness based on conventional nursing). The main evaluation indicators include frailty index, self-care efficacy, quality of life, and related biochemical indicators. All indicators were evaluated at admission and 1 week after each chemotherapy session. Compared with the control group, the incidence of frailty in the intervention group was significantly reduced ( P  &lt; .05), while self-care efficacy and quality of life scores were significantly higher in the intervention group than in the control group ( P  &lt; .05). C-reactive protein and white blood cell count significantly decreased, while hemoglobin levels significantly increased ( P  &lt; .05). There was no statistically significant difference in the length of hospital stay and chemotherapy interval between the 2 groups ( P  &gt; .05). Family-based comprehensive care of warmth and weakness can effectively reduce the level of weakness in gynecological cancer patients after chemotherapy, improve their self-care efficacy and quality of life, and also have a certain effect on improving related biochemical indicators. It is a comprehensive care model worth promoting in clinical practice.

Bioinformatic analysis of differentially expressed profiles of lncRNAs and miRNAs with their related ceRNA network in endometrial cancer

Increasing evidence suggests that long non-coding riboneucleic acids (lncRNAs), as competing endogenous RNA (ceRNA), play a key role in the initiation, invasion, and metastasis of cancer. As a new hypothesis, the lncRNA-micro RNA (miRNA)-messenger RNA (mRNA), ceRNA regulatory network has been successfully constructed in a variety of cancers. However, lncRNA, which plays a ceRNA function in endometrial cancer (EC), is still poorly understood. In this study, we downloaded EC expression profiling from The Cancer Genome Atlas database and used the R software “edgeR” package to analyze the differentially expressed genes between EC and normal endometrium samples. Then, differentially expressed (DE) lncRNAs, miRNAs and mRNAs were selected to construct a lncRNA-miRNA-mRNA prognosis-related regulatory network based on interaction information. The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were performed on the genes in the network to predict the potential underlying mechanisms and functions of lncRNAs in EC. Kaplan–Meier method and the log-rank test were used for survival analysis. Based on the “ceRNA hypothesis,” we constructed a co-expression network of mRNA and lncRNA genes mediated by miRNA in the process of tumor genesis. Furthermore, we successfully constructed a dysregulated lncRNA-associated ceRNA network containing 96 DElncRNAs, 27 DEmiRNAs, and 74 DEmRNAs. Through Kaplan–Meier curve analysis, we found that 9 lncRNAs, 3 miRNAs, and 12 mRNAs were significantly correlated with the overall survival rate of patients among all lncRNAs, miRNAs, and mRNAs involved in ceRNA (P &lt; .05). Our research provides a new perspective for the interaction among lncRNAs, miRNAs, and mRNA and lays the foundation for further research on the mechanism of lncRNAs in the occurrence of EC.

A rare cause of sudden chest pain and dyspnea

Abstract Rationale: Chilaiditi syndrome is a rare disorder characterized by a broad spectrum of (gastro-intestinal) symptoms caused by interposition of a segment of bowel between the liver and the diaphragm. Most cases present with abdominal symptoms and the morbidity tend to increase with age. Patient concerns: Here we present a rare case of Chilaiditi syndrome. An elderly postmenopausal woman developed unresolved postoperative respiratory symptoms and chest pain. Chest auscultation revealed considerable attenuation of respiratory sounds. She showed postoperative increase in D-dimer level and sudden onset of dyspnea. Diagnoses: Considering the presence of atelectasis in the middle and lower lobes of the right lung, bedside fiberoptic bronchoscopy was performed immediately to rule out bronchial phlegm embolism. However, no phlegm embolism was found in the left lung, and a small amount of yellow–white mucus was seen in the upper lobe of the right lung. Due to external pressure, the lumen of the middle and lower lobes of the right lung was obviously narrowed. Interventions: The patient was placed in a semi-sitting position and a tube was passed through the anus to decompress the intestinal cavity; in addition, she received potassium supplementation. Outcomes: The patient's symptoms improved markedly. Chest and semi-supine abdominal plain radiographs showed enhanced lung markings, shadows in the left lower lung lobes, elevation of the right diaphragm, and small amount of pneumoperitoneum. The patient recovered after 5 days of continuous treatment and was discharged. Lessons: Emergency computed tomographic pulmonary angiography may facilitate the diagnosis of Chilaiditi syndrome, especially in the postoperative setting. Occurrence of Chilaiditi syndrome in this patient was likely associated with surgical factors. Appropriate investigations and clear identification of etiology are essential for successful treatment.

Ovarian carcinosarcoma with lung metastasis characterized by persistent fever: A case report and literature review

Rationale: Ovarian carcinosarcoma (OCS) is a rare malignant tumor prone to distant metastasis. Primary manifestations include pelvic and/or abdominal pain, bloating, and compression. Nevertheless, it is uncommon for OCS to present primarily with persistent fever. This is the first reported case of OCS with lung metastasis characterized by persistent fever. Patient concerns: A 61-year-old female patient complaining of abdominal pain and fever was admitted to our hospital. Computed tomography showed an irregular, slightly low-density mass on the left side of the uterus and multiple solid nodules in both lungs. Diagnoses: She underwent cytoreductive surgery for pathologically confirmed stage IVB OCS. Interventions: She was administered chemotherapy after cytoreductive surgery. Given the patient’s history of persistent fever and progressively enlarged pulmonary nodules, a pulmonary abscess was considered as a possible diagnosis. Following antibiotic therapy, the patient’s high body temperature did not decrease; however, following nonsteroidal anti-inflammatory drug therapy, it quickly decreased. These symptoms were eventually considered the consequence of neoplastic fever caused by lung metastases. Outcomes: Owing to the rapid progression of the disease, the patient ultimately died. Lessons: This study suggests that, for patients with pelvic and/or abdominal pain, bloating, and pelvic masses, especially those with suspicious lesions in other organs accompanied by fever of unknown origin, a diagnosis of cancer or sarcoma with metastasis should be considered after ruling out infectious fever.

Clinicopathological analysis of ovarian sertoli-leydig cell tumor with postmenopausal vaginal bleeding as the first symptom

Abstract Rational: Ovarian sertoli-leydig cell tumor (OSLCT) is extremely rare. We reported a OSLCT case in whom postmenopausal vaginal bleeding was the first symptom. Patient concerns: The patient came to our hospital due to postmenopausal vaginal bleeding. Diagnoses: Serum tumor markers and color Doppler ultrasound for her pelvic cavity were negative. The patient was finally diagnosed with left OSLCT by pathology. It was difficult to make a definite diagnosis before operation, the diagnosis of OSLCT required postoperative pathology in the patients. Interventions: the patient underwent laparoscopic hysterectomy+bilateral adnexectomy+lysis of pelvic adhesions. Outcomes: Postoperative laboratory examinations were normal. The patient was discharged from our hospital on the seventh day after operation and came to our hospital for follow-up check in April 2020. Physical and laboratory examinations were normal. Lessons: OSLCT can show different endocrine abnormalities, which are related to the various types of tumor tissues. Missed diagnosis and misdiagnosis are likely to occur in the patients who only have elevated serum testosterone. For the menopausal women with elevated serum testosterone, ovarian tumor shoule be highly suspected after excluding adrenal gland-related diseases.

Disseminated ovarian granulosa cell tumor after laparoscopic surgery

Abstract Rationale: Granulosa cell tumors (GCT) have an incidence of 0.6 to 0.8/100,000. Short-term relapsed ovarian GCT is extremely rare. Herein, this report aims to present 2 rare cases of disseminated ovarian GCT and analyze the causes of recurrence. Patient concerns: The 2 patients presented with abdominal pain. Diagnosis: Both the patients were diagnosed with relapsed ovarian GCT (IIIc stage) in the adult type. Interventions: The 2 patients had a medical history of surgery for ovarian GCT by using laparoscopic with power morcellators (LPM). They experienced relapsed ovarian GCT postoperatively. Subsequently, they received a repeated operation through a laparotomy approach. Numerous malignant metastasis neoplasms were detected at the port-sites. Then, tumor resection was performed. Outcomes: The postoperative pathologies of both case 1 and case 2 reported ovarian GCT (IIIc stage) in adult type. The 2 patients presented disease-free survival for more than 33 months follow-up period. Lessons: The application of LPM may be a risk factor of disseminated ovarian GCT. However, laparoscopic surgery is still an optimal treatment strategy for ovarian tumors. Besides, gynecologists should comply with the tumor-free principle during surgery.

Malignant transformation arising from mature ovarian cystic teratoma

Abstract Malignant transformation arising in mature cystic teratoma (MT-MCT) is a rare neoplasm of the ovary. Herein, we aimed to evaluate the clinicopathological features and treatment outcome of the Han Chinese women with MT-MCT. In this retrospective study, the clinical data of patients who had been surgically treated from January 2000 to November 2019 and in whom the diagnosis of MCT was confirmed based on the pathology were included. Fourteen patients with MT-MCT from a total of 569 cases (2.46% incidence) of MCT were reviewed. The mean age of patients with MT-MCT was 51.3 (range, 31–71) years, while the mean age of patients with MCT was 45.3 (range, 17–62) years. Upon gross examination, the mean size of MT-MCT was 14.0 (range, 11–25) cm, whereas the mean size of MCT was 7.5 (range, 4–10) cm. Primary surgical staging was performed in all cases. Complete cytoreduction and suboptimal surgical resection were performed in 12 (85.7%) and 2 (14.3%) cases, respectively. Thirteen patients with malignant transformation of squamous cell carcinoma (SCC) whose Federation International of Gynecology and Obstetrics stage was &gt;1 received chemotherapy, comprising carboplatin and paclitaxel. Response to the chemotherapy regimen was complete in 12 patients; 1/12 patients died within the median follow-up period of 16.5 months. The 5-year overall survival rate and disease-free survival rates were 31.2% and 31.6%, respectively. From the data generated, we conclude that the rate of MT-MCT increases with age. The MT-MCT was much higher in women of postmenopausal age than in younger women. We described our experience of successfully treating patients with malignant transformation of SCC with primary surgical staging and adjuvant chemotherapy (cisplatin, paclitaxel, bleomycin, and etoposide) that might improve survival in patients with advanced-stage disease.

Ovarian dysgerminoma in pregnancy

Abstract Rationale: Although dysgerminomas are relatively uncommon among all ovarian neoplasms, representing for only about 2%, they account for 32.8 percent of malignant ovarian germ cell tumors. Their association with pregnancy is extremely rare; due to the low frequency of occurrence, there are few recommendations regarding pregnancy management; therefore, it is important to discuss and summarize the treatment strategy. Patient concerns: We present the case of a 25 years patient, gestation 1, para 1, who was hospitalized in the clinic at 38/39 weeks of gestation at the beginning of labor. Following the ultrasound examination, a hypoechogenic lesion on the uterine fundus was found, suggestive of subterranean fibroid. After caesarean section, right adnexectomy was performed; the histopathological examination revealed, unexpectedly, the diagnosis of dysgerminoma. Diagnoses: Dysgerminoma as associated with pregnancy. Interventions: Birth by Caesarean section and right adnexectomy. No other medical complications occurred. Outcomes: The histopathological and immunohistochemical examinations were consistent with the pure dysgerminoma. Oncology was staged AI, with the monitoring of markers and abdominal and pelvic magnetic resonance imaging at 3, 6, 9, and 12 months. Lessons: Dysgerminoma is the most common ovarian malignancy associated with pregnancy with a good fetal maternal outcome. If these tumors are discovered accidentally during caesarean section, tumor markers and magnetic resonance imaging scanning should be done postoperatively to plan optimal treatment.

Low FOXJ2 expression is associated with unfavorable postoperative prognosis of patients with epithelial ovarian cancer

Abstract The forkhead box (FOX) family is a large and diverse group of transcription factors. Forkhead box J2 (FOXJ2) is a member of the FOX family that is aberrantly expressed in a variety of cancers. However, its role in epithelial ovarian cancer (EOC) remains elusive. The purpose of this study was to evaluate the prognostic value of FOXJ2 expression in patients with epithelial ovarian cancer. The current study retrospectively included 151 patients with EOC from January 2013 to September 2016. FOXJ2 expression was analyzed by immunohistochemistry based on tissue microarrays. Then, the prognostic value of FOXJ2 expression and clinical outcomes were evaluated by Kaplan–Meier and cox regression analysis. Low FOXJ2 expression was associated with high International Federation of Gynecology and Obstetrics (FIGO) stage. Kaplan–Meier curves showed that high FOXJ2 expression was associated with improved median overall survival (OS, 57.9 vs 31.9 months; P = .037) and longer median progression-free survival (PFS, 31.8 vs 18.1 months; P = .012). Univariate analysis demonstrated that FOXJ2 expression was significantly correlated with OS and PFS in patients with epithelial ovarian cancer. Multivariate analysis revealed FOXJ2 expression as an independent prognostic factor of progression-free survival of epithelial ovarian cancer patients. Low FOXJ2 expression is a novel adverse prognostic factor of clinical outcome in epithelial ovarian cancer.

LncRNA NEAT1 promotes proliferation of ovarian cancer cells and angiogenesis of co-incubated human umbilical vein endothelial cells by regulating FGF9 through sponging miR-365

Abstract Objective: To uncover the function of lncRNA NEAT1 in ovarian cancer (OC) cells and its mechanism. Methods: The expression patterns of lncRNA NEAT1 and FGF9 in human OC cells and human ovarian epithelial cells was determined. OC cells were transfected with sh-NEAT1, pcDNA3.1-NEAT1, miR-365 mimic, miR-365 inhibitor or pcDNA3.1-NEAT1 + sh-NEAT1 before cell proliferation rate and cell clone formation rate were measured. After the transfected OC cells were co-cultivated with human umbilical vein endothelial cells (HUVECs), Matrigel angiogenesis assay tested angiogenesis of HUVECs; qRT-PCR and Western blot tested the expressions of vascular endothelial growth factor (VEGF), angiogenin 1 (Ang-1) and matrix metalloproteinase 2 (MMP2). Dual-luciferase reporter assay determined the targeted binding of NEAT1 and FGF9 to miR-365. Results: LncRNA NEAT1 and FGF9 are over-expressed in OC cells. Knockdown of NEAT1 or FGF9, or over-expression of miR-365 results in decreased proliferation rate and cell clones as well as inhibited angiogenesis and down-regulated expressions of VEGF, Ang-1 and MMP2. Over-expression of NEAT1 or knockdown of miR-365 can reverse the effect caused by FGF9 knockdown. NEAT1 can down-regulate the expression of miR-365 while up-regulating that of FGF9. Dual-luciferase reporter assay determined that NEAT1 competes with FGF9 for binding to miR-365. Conclusion: LncRNA NEAT1 up-regulates FGF9 by sponging miR-365, thus promoting OC cell proliferation and angiogenesis of HUVECs.

Over-expression of CXCL2 is associated with poor prognosis in patients with ovarian cancer

Abstract Background: In the present study, we aimed to detect the expression of CXCL2 in epithelial ovarian cancer (OC) and explore its clinical significance. Methods: TCGA (The Cancer Genome Atlas) database was adopted to assess the significance of CXCL2. Tissue microarray and immunohistochemical staining were used to detect the expression of CXCL2 in epithelial OC, and its correlation with clinicopathological features and prognosis was statistically analyzed. Results: CXCL2 was highly expressed in epithelial OC tissues compared with the adjacent tissues. Such up-regulation of CXCL2 was significantly correlated with tumor differentiation (P = .001), tumor stage (P = .01), tumor location (unilateral or bilateral) (P = .003), and metastasis (P = .003). Kaplan-Meier and Cox proportional hazards regression analyses showed that high expression of CXCL2 was not an independent predictor of poor prognosis in epithelial OC. Conclusions: Collectively, the high expression of CXCL2 might be related to the invasion and metastasis of epithelial OC.

Development and validation of prediction model for early warning of ovarian metastasis risk of endometrial carcinoma

Ovarian metastasis of endometrial carcinoma (EC) patients not only affects the decision of the surgeon, but also has a fatal impact on the fertility and prognosis of patients. This study aimed build a prediction model of ovarian metastasis of EC based on machine learning algorithm for clinical diagnosis and treatment management guidance. We retrospectively collected 536 EC patients treated in Hubei Cancer Hospital from January 2017 to October 2022 and 487 EC patients from Tongji Hospital (January 2017 to December 2020) as an external validation queue. The random forest model, gradient elevator model, support vector machine model, artificial neural network model (ANNM), and decision tree model were used to build ovarian metastasis prediction model for EC patients. The predictive efficacy of 5 machine learning models was evaluated by receiver operating characteristic curve and decision curve analysis. For screening of candidate predictors of ovarian metastasis of EC, the degree of tumor differentiation, lymph node metastasis, CA125, HE4, Alb, LH can be used as a potential predictor of ovarian metastasis prediction model in EC patients. The effectiveness of the prediction model constructed by the 5 machine learning algorithms was between (area under curve [AUC]: 0.729, 95% confidence interval [CI]: 0.674–0.784) and (AUC: 0.899, 95% CI: 0.844–0.954) in the training set and internal verification set, respectively. Among them, the ANNM was equipped with the best prediction effectiveness (training set: AUC: 0.899, 95% CI: 0.844–0.954) and (internal verification set: AUC: 0.892, 95% CI: 0.837–0.947). The prediction model of ovarian metastasis of EC patients based on machine learning algorithm can achieve satisfactory prediction efficiency, among which ANNM is the best, which can be used to guide clinicians in diagnosis and treatment and improve the prognosis of EC patients.

The clinical significance of HERV-H LTR –associating 2 expression in cervical adenocarcinoma

Abstract HERV-H LTR –associating 2 (HHLA2) is a recently discovered member of the B7-family of immune checkpoint molecules that is overexpressed in several types of cancer. The aim of the present study was to investigate the expression of HHLA2 in cervical adenocarcinoma (AC) and the relationship between its expression and clinicopathological factors to assess its use as a potential marker for AC prognosis. This study included 76 patients diagnosed with cervical AC. Their resected specimens were obtained and a tissue microarray was constructed. Expression of HHLA2 was detected by the immunohistochemistry. Based on the follow-up data, correlation of HHLA2 expression and clinicopathological features, including overall survival (OS) and disease-free survival, was evaluated. Furthermore, we investigated the correlation between the expression of HHLA2 and programmed death ligand 1 (PD-L1). A total of 76 cases of invasive cervical AC were evaluated. High HHLA2 expression was detected in 62 cases (81.6%) and low HHLA2 expression was presented in 14 cases (18.4%). HHLA2 expression showed a significant negative correlation with lymph node metastasis (P = .011). Disease free survival was 75.0% and 49.0% in high-expression and the low expression group, respectively (P = .057). Although there was no statistical significance, an improved OS was observed in the high expression group (83.1% vs 64.9%, P = .479). Further, the expression of HHLA2 and PD-L1 correlated positively (P = .005). Thus, an improved OS was observed in the PD-L1 expression group (90.7% vs 66.2%, P = .037). High expression of HHLA2 is related to tumor progression and prognosis in patients with cervical AC. Therefore, HHLA2 may be a potential biomarker for predicting prognosis of cervical AC.

Immune cells appraising the causal effect of gut microbiota on endometrial cancer: A Mendelian randomization analysis

The intricate relationship between the gut microbiota (GM) and immune-mediated diseases deserves deep exploration. Our study focused on investigating the potential causal link between the recently discovered 885 GM and endometrial cancer (EC), as well as determining the role of immune cells in mediating this relationship. Causal relationship between GM and EC was firstly investigated using a 2-sample Mendelian randomization (MR) analysis. Subsequently, a 2-step MR study was conducted to provide evidence for a mediating role of immune traits in this causal pathway. MR analyses revealed genus Bacillus and Bacillaceae A had a protective effect on EC, while Fusobacterium A and GCA-900199385 sp900320755 showed a positive correlation with EC. Mediation analyses indicated that these GM components influence EC through various immune cell traits as mediators, including IgD+ CD38br %lymphocytes and transitional AC on the B cell panel, DP (CD4+CD8+) % leukocytes on the TBNK panel, and CD25 on memory B cells. Our study suggested added genetic evidence support the causal relationship between GM and EC, with a partial contributing role of immune cells in mediating such effects. Further in-depth functional research is warranted to fully explore the mechanisms of intermediation behind this intricate association.

Diagnostic value of serum human epididymis protein 4, carbohydrate antigen 125 and their combination in endometrial cancer: A meta-analysis

Background: To systematically analyze the value of human epididymis protein 4 (HE4) and carbohydrate antigen 125 (CA125) in the diagnosis of endometrial cancer, so as to provide evidence-based medical evidence for the selection of serum tumor markers in the early screening of endometrial cancer. Methods: We comprehensively searched relevant literature in the Cochrane Library, EMBASE, PubMed, Web of Science, CNKI, VIP, WanFang, and CBM from the date of establishment to November 31, 2021. Quality assessment of diagnostic accuracy studies 2 was applied to evaluate the quality of the included literature. We used Stata 16.0 to calculate the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) and plot summary receiver operating characteristic curve, as well as to assess diagnostic accuracy using the area under the curve (AUC). Results: A total of 25 studies, including 1980 patients and 2345 controls, were included in this meta-analysis. The pooled SEN, SPE, PLR, NLR, DOR, and AUC of HE4 were 0.58 (95% CI 0.52–0.63), 0.95 (95% CI 0.92–0.97), 11.57 (95% CI 6.88–19.48), 0.45 (95% CI 0.39–0.51), 25.92 (95% CI 14.84–45.26), and 0.80 (95% CI 0.76–0.83), respectively. The pooled SEN, SPE, PLR, NLR, DOR, and AUC of CA125 were 0.41 (95% CI 0.34–0.49), 0.91 (95% CI 0.85–0.95), 4.55 (95% CI 2.73–7.58), 0.65 (95% CI 0.57–0.74), 7.03 (95% CI 3.92–12.62), and 0.68 (95% CI 0.64–0.72), respectively. The pooled SEN, SPE, PLR, NLR, DOR, and AUC of HE4 + CA125 were 0.67 (95% CI 0.60–0.73), 0.92 (95% CI 0.87–0.95), 8.59 (95% CI 5.32–13.86), 0.36 (95% CI 0.30–0.44), 23.80 (95% CI 13.86–40.86), and 0.85 (95% CI 0.82–0.88), respectively. Conclusion: This Meta-analysis found that HE4 alone or in combination with CA125 showed better diagnostic efficacy than CA125, regardless of clinical stage and pathological type. HE4 + CA125 had slightly higher diagnostic efficiency than HE4, but did not show significant advantages. While the studies were heterogeneous, the credibility of the findings needs to be further confirmed by more homogeneous, prospective, and large sample size studies.

Differential diagnosis of ovarian endometriosis cyst versus ovarian cystadenoma based on serum lactate dehydrogenase combined with CA-125 and CA19-9: A retrospective cohort study

This study aims to construct and validate a nomogram for the differential diagnosis of ovarian endometriosis cyst versus ovarian cystadenoma. We retrospectively studied the clinical characteristics of patients with ovarian endometriosis cysts and ovarian cystadenomas from January 1, 2021, to June 1, 2022. Independent risk factors for differential diagnosis were investigated using univariate and multivariate logistic regression analyses. Based on these factors, a differential diagnosis of ovarian endometriosis cyst versus ovarian cystadenoma was established. The performance of the nomogram model was assessed by internal validation using bootstrapping resampling. Decision curve analysis (DCA) was performed to evaluate the net clinical benefit of the model. Immunohistochemistry showed that lactate dehydrogenase (LDH) A was overexpressed in ectopic endometrial tissues compared to that in normal endometrial tissues. In multivariate analysis, LDH, CA-125, and CA19-9 were identified as independent risk factors for the differential diagnosis of ovarian endometriosis cyst versus ovarian cystadenoma. LDH levels &gt;135.50 U/L combined with CA-125 levels &gt;25.20 U/mL and CA19-9 levels &gt;13.59 U/mL as single covariates had a high value in the differential diagnosis of ovarian endometriosis cysts versus ovarian cystadenoma. The area under the receiver operating characteristic curve (ROC) of the nomogram constructed using LDH, CA-125, and CA19-9 expression data was 0.873 (95% CI, 0.827–0.920), and the bootstrap-validated concordance index (C-index) was 0.871. Decision curve analysis confirmed that the nomogram model had excellent clinical utility. Based on serum lactate dehydrogenase combined with CA-125 and CA19-9, we constructed and validated a nomogram for the differential diagnosis of ovarian endometriosis cyst versus ovarian cystadenoma to help physicians formulate the optimal treatment strategy.

Brachytherapy facilitates closure of malignant vesicovaginal fistulas: A case report and literature review

Rationale: Malignant vesicovaginal fistula (MVF) usually result from the progression of bladder cancer or cervical cancer. Since the fistula openings are filled with malignant tumors, there are currently no effective treatment options or valuable research findings to achieve fistula healing, making it a difficult and intractable issue in clinical practice. In this report, we present an innovative and practical procedure to address this issue. Patient concerns: A patient with recurrent cervical cancer after treatment presented with persistent vaginal bleeding. On physical examination, the vagina was found to be filled with tumors that bled on palpation, and a large, hard mass was palpable in the abdomen. Diagnoses: The initial magnetic resonance imaging revealed that the patient’s lower abdomen and pelvic cavity were filled with tumors, the bladder was invaded by the tumor, and a vaginal fistula was present. Interventions: Sequential chemotherapy in combination with immunotherapy was carried out to facilitate the tumor downgrading, allowing subsequent interstitial brachytherapy conducted. Outcomes: Following a dose delivery of 24 to 40 Gy in 4 fractions over 2 weeks, the MVF was found unexpectively completely closed, and the hallmark symptom of urine leakage from the vargina resolved. Lessons: This case highlights the potential of brachytherapy as a promising and effective treatment modality for MVF. Further studies are warranted to validate these findings and establish standardized protocols.

Laparo-endoscopic single-site surgery vs conventional laparoscopic surgery for endometrial cancer

Abstract Objective: To systematically review and evaluate the safety, advantages and clinical application value of laparo-endoscopic single-site surgery (LESS) for endometrial cancer by comparing it with conventional laparoscopic surgery (CLS). Methods: We conducted a systematic review of the published literature comparing LESS with CLS in the treatment of endometrial cancer. English databases including PubMed, Embase, Ovid, and the Cochrane Library and Chinese databases including Chinese National Knowledge Infrastructure, Wanfang and China Biology Medicine were searched for eligible observational studies up to July 10, 2019. We then evaluated the quality of the selected comparative studies before performing a meta-analysis using the RevMan 5.3 software. The complications, surgical time, blood loss during surgery, postoperative length of hospital stay and number of lymph nodes removed during surgery were compared between the 2 surgical approaches. Results: Four studies with 234 patients were finally included in this meta-analysis. We found that there was no statistically significant difference in complications between the 2 surgical approaches [odds ratio (OR): 0.63, 95% confidence interval (CI): 0.18–2.21, P = .47, I 2 = 0%]. There was no statistically significant difference in blood loss between the 2 surgical approaches [mean difference (MD): –61.81, 95% CI: –130.87 to –7.25, P = .08, I 2 = 74%]. There was no statistically significant difference in surgical time between the 2 surgical approaches (MD: –11.51, 95% CI: –40.19 to 17.16, P = .43, I 2 = 81%). There was also no statistically significant difference in postoperative length of hospital stay between the 2 surgical approaches (MD: –0.56, 95% CI: –1.25 to –0.13, P = .11, I 2 = 72%). Both pelvic and paraaortic lymph nodes can be removed with either of the 2 procedures. There were no statistically significant differences in the number of paraaortic lymph nodes and total lymph nodes removed during surgery between the 2 surgical approaches [(MD: –0.11, 95% CI: –3.12 to 2.91, P = .29, I 2 = 11%) and (MD: –0.53, 95% CI (–3.22 to 2.16), P = .70, I 2 = 83%)]. However, patients treated with LESS had more pelvic lymph nodes removed during surgery than those treated with CLS (MD: 3.33, 95% CI: 1.05–5.62, P = .004, I 2 = 32%). Conclusion: Compared with CLS, LESS did not reduce the incidence of complications or shorten postoperative hospital stay. Nor did it increase surgical time or the amount of bleeding during surgery. LESS can remove lymph nodes and ease postoperative pain in the same way as CLS. However, LESS improves cosmesis by leaving a single small scar.

Construction of prognostic risk prediction model of endometrial carcinoma based on bioinformatics analysis

This study developed a prognostic risk prediction model for endometrial carcinoma (EC) by integrating data from The Cancer Genome Atlas and Gene Expression Omnibus for bioinformatics analysis. The relevant data of EC were downloaded from The Cancer Genome Atlas database and the GSE17025 dataset of the Gene Expression Omnibus database. Based on the R language, the differentially expressed genes (DEGs) and weighted gene co-expression network analysis were used to identify the gene modules with the strongest correlation with clinical features, and intersected with the DEGs of GSE17025 dataset. Subsequently, univariate and multivariate Cox regression analyses were conducted to construct and validate a prognostic risk prediction model for EC. Weighted gene co-expression network analysis identified 6 gene modules, with the turquoise module exhibiting the strongest correlation with EC prognosis and survival. By intersecting with DEGs from GSE17025 dataset, 65 candidate genes were identified. Univariate Cox regression revealed 19 genes significantly associated with overall survival, and multivariate Cox regression identified 5 prognostic genes. A 5-gene risk prediction model, including PDZ domain containing ring finger 3, KN motif and ankyrin repeat domains 4, prion protein, phosphoserine aminotransferase 1, and Annexin A1, was constructed. Kaplan–Meier survival curve analysis demonstrated that patients in the high-risk group had significantly lower overall survival compared to the low-risk group ( P  &lt; .001). The ROC curve confirmed the model’s robust prognostic predictive performance. This study presents a 5-gene prognostic risk prediction model for EC, including PDZ domain containing ring finger 3, KN motif and ankyrin repeat domains 4, prion protein, phosphoserine aminotransferase 1, and Annexin A1, which can effectively predict patients’ prognosis and provide a reference for the clinical diagnosis and targeted therapy of EC.

Cesarean scar pregnancy with molar pregnancy: A case report and literature review

Rationale: Cesarean scar pregnancy with molar pregnancy is a rare but high-risk pregnancy complication characterized by the implantation of a fertilized egg in the uterine scar following cesarean section, accompanied by pathological manifestations of a hydatidiform mole. This paper reports a clinical case of hydatidiform mole in a cesarean scar and reviews the literature to understand its diagnosis and treatment strategies. Patient concerns: We reported a 33-year-old woman who presented to our hospital with intermittent vaginal bleeding for over 2 months following uterine curettage. Diagnoses: Transvaginal ultrasonography, serum human chorionic gonadotropin, pelvic magnetic resonance imaging, and histological examination confirmed the disease. Interventions: The patient underwent bilateral uterine arterial embolization, suction evacuation, and transabdominal surgery. Outcomes: Postoperative histological examination of the tissue revealed hydatidiform moles. Lessons: Molar pregnancy in the cesarean scar is difficult to differentiate from normal cesarean scar pregnancy with serum human chorionic gonadotropin, sonogram, or magnetic resonance imaging. This case demonstrates the diagnosis and treatment strategy for cesarean scar pregnancy with molar pregnancy.

Serum high-density lipoprotein level and prognosis of ovarian cancer

This study aimed to investigate the prognostic value of serum high-density lipoprotein (HDL) level in patients with ovarian cancer. This study enrolled 152 patients diagnosed with ovarian cancer and 119 patients with benign ovarian tumors. The associations of patient characteristics and disease with survival were determined using Cox regression analysis, t tests, analysis of variance for multiple-group comparisons, and chi-square tests. The potential association between HDL levels and the clinical characteristics of the disease was also analyzed. The diagnostic value of HDL was estimated using receiver operating characteristic curve analysis and calculation of the area under the curve. Progression-free survival and overall survival were determined using the Kaplan–Meier method, and their associations with patient and pathological variables, including HDL, were determined using the log-rank test. The median serum HDL was 1.15 mm measured in 152 patients with ovarian cancer and 1.30 mm in 119 patients with benign ovarian tumors (P = .000054). The receiver operating characteristic curve analysis yielded an area under the curve of 0.735 for serum HDL levels. Serum HDL levels were significantly associated with tumor pathological types (non-serous vs serous, P &lt; .05). No association was observed between serum HDL levels and patient age, age at menarche or marriage, number of children, tumor grade, or clinical stage (P &gt; .05). Patients with high serum HDL levels had a longer progression-free survival and overall survival than those with low serum HDL levels. Serum HDL levels are an independent prognostic factor for ovarian cancer.

Associations between non-coding RNAs genetic polymorphisms with ovarian cancer risk: A systematic review and meta-analysis update with trial sequential analysis

Background: This systemic review and meta-analysis seeks to systematically analyze and summarize the association between non-coding RNA polymorphisms and ovarian cancer risk. Methods: We searched PubMed, Web of Science and CNKI for available articles on non-coding RNA polymorphisms in patients with ovarian cancer from inception to March 1, 2023. The quality of each study included in the meta-analysis was rated according to the Newcastle–Ottawa Scale. Odds ratios (ORs) with their 95% confidence intervals (95% CI) were used to assess associations. Chi-square Q-test combined with inconsistency index (I2) was used to test for heterogeneity among studies. Lastly, trial sequential analysis (TSA) software was used to verify the reliability of meta-analysis results, and in-silico miRNA expression were also performed. The meta-analysis was registered with PROSPERO (No. CRD42023422091). Results: A total of 17 case-control studies with 18 SNPs were selected, including 2 studies with H19 rs2107425 and HOTAIR rs4759314, and 5 studies with miR-146a rs2910164 and miR-196a rs11614913. Significant associations were found between H19 rs2107425, miR-146a rs2910164, and miR-196a rs11614913 and ovarian cancer risk. Three genetic models of H19 rs2107425 (CT vs TT (heterozygote model): OR = 1.36, 95% CI = 1.22–1.52, P &lt; .00001; CC + CT vs TT (dominant model): OR = 1.12, 95% CI = 1.02–1.24, P = .02; and CC vs CT + TT (recessive model): OR = 1.23, 95% CI = 1.16–1.31, P &lt; .00001), 2 genetic models of miR-146a rs2910164 (allele model: OR = 1.75, 95% CI = 1.05–2.91, P = .03; and heterozygote model: OR = 0.33, 95% CI = 0.11–0.98, P = .05), 3 genetic models of miR-196a rs11614913 (allele model: OR = 0.70, 95% CI = 0.59–0.82, P &lt; .0001; dominant model: OR = 1.62, 95% CI = 1.18–2.24, P = .0001; and recessive model: OR = 0.70, 95% CI = 0.57–0.87, P = .03) were statistically linked to ovarian cancer risk. Subgroup analysis for miR-146a rs2910164 was performed according to ethnicity. No association was found in any genetic model. The outcomes of TSA also validated the findings of this meta-analysis. Conclusion: This study summarizes that H19 rs2107425, miR-146a rs2910164, and miR-196a rs11614913 polymorphisms are significantly linked with the risk of ovarian cancer, and moreover, large-scale and well-designed studies are needed to validate our result.

Diagnostic value of CA125, HE4, and systemic immune-inflammation index in the preoperative investigation of ovarian masses

This study aimed to ascertain the diagnostic accuracy of CA125, HE4, systemic immune-inflammation index (SII), fibrinogen-to-albumin ratio (FAR), prognostic nutritional index (PNI), and their combination for ovarian cancer (OC) to discover an optimal combined diagnostic index for early diagnosis of OC. A thorough investigation was conducted to ascertain the correlation between these markers and the pathological characteristics of OC, thereby providing a foundation for early identification and treatment of this disorder. One hundred seventy patients with documented OC and benign ovarian tumors (BOTs) treated at Hebei General Hospital between January 2019 and December 2022 were included in this retrospective study. Data analysis was conducted using IBM SPSS Statistics version V26.0, MedCalc Statistical Software version 19.4.0, and the R Environment for Statistical Computing software (R Foundation for Statistical Computing). Isolated CA125 showed the best application value for differentiating benign ovarian tumors from OC when the defined variables were compared separately. The combination of CA125, HE4, FAR, SII, and PNI displayed a greater area under the operating characteristic curve curve than any one of them or other combinations of the 5 variables. Compared to CA125 alone, the combination of CA125, HE4, FAR, SII, and PNI showed a slight gain in sensitivity (83.91%), negative predictive value (83.91%), accuracy (85.88%), and a decrease in negative likelihood ratio (0.180%). Higher preoperative CA125, HE4, SII, and FAR levels, and lower PNI levels predicted a higher probability of advanced OC progression and lymph node metastasis. FAR has better application value than other inflammation-related markers (PNI and SII). This study suggests that preoperative serum SII, PNI, and FAR may be clinically valuable markers in patients with OC. FAR has better application value than other inflammation-related markers (PNI and SII). As we delve deeper into the inflammatory mechanisms associated with tumors, we may discover more effective combinations of tumor and inflammatory biomarkers.

Teratomas from past to the present: A scientometric analysis with global productivity and research trends between 1980 and 2022

There is currently no bibliometric study on teratomas in the literature. This study aims to analyze the published articles on teratomas to provide an overview of the subject, determine global productivity, and identify current research trends. Additionally, data on different components of scientific output (countries, journals, institutions, authors) were analyzed. A total of 4209 articles published on teratomas between 1980 and 2022 were analyzed using various bibliometric and statistical methods. Bibliometric network visualization maps were used to determine trending topics, citation analyses, and international collaborations. Spearman correlation coefficient was used for correlation analysis. The top 3 countries that made the most contributions to the literature were the USA (1041, 24.7%), Japan (501, 11.9%), and India (310, 7.3%). The top 3 active institutions were the University of California System (n = 78), University of London (64), and Harvard University (62). The top 3 productive journals were the Journal of Pediatric Surgery (n = 141), Pediatric Surgery International (n = 70), and Journal of Pediatric Surgery Case Reports (69). The most productive author was Ulbright TM. (n = 18). The most studied topics from past to present were ovarian cancer/ovarian teratoma/ovarian torsion, mature cystic teratoma/dermoid cyst, sacrococcygeal teratoma, germ cell tumors, immature teratoma, malignant transformation, mediastinal teratoma/mediastinum, neonate/newborn/infant, prenatal diagnosis, testis/testicular cancer/teratoma, ultrasonography/ultrasound, magnetic resonance imaging, chemotherapy, growing teratoma syndrome, surgery, retroperitoneal teratoma/retroperitoneum, laparoscopic surgery/laparoscopy, children/child, and fetal surgery/fetus. We identified trend research topics in the field of teratomas in recent years, including mature cystic teratoma, ovarian teratoma/neoplasm, ovarian cancer, ovarian torsion, growing teratoma syndrome, recurrence, pediatric, testicular cancer, anti-n-methyl-d-aspartate receptor encephalitis, immature teratoma, retroperitoneal, struma ovarii, and carcinoid. The research leadership in the development of teratoma literature was determined by countries with major economies such as the USA, Japan, India, the UK, China, Turkey, South Korea, and other European countries (France, Germany, Italy).

Research progress on human papillomavirus-negative cervical cancer: A review

Cervical cancer is the fourth most common cancer in women worldwide. The vast majority of cervical cancers are associated with human papillomavirus (HPV) infection, but a small proportion of cervical cancers occur independently of HPV infection, with different subtypes having varying rates of occurrence. Despite the presence of false negatives in current testing, improving the accuracy of detection is crucial for studying the pathogenesis of HPV-negative cervical cancer and improving the prognosis of these patients. Existing research suggests that HPV-negative cervical cancer has a different pathogenesis from HPV-positive cervical cancer, although the exact mechanism is not yet clear. It is currently believed to be associated with the immune microenvironment, certain tumor gene mutations, and some long noncoding RNAs. This article provides an overview of the latest research progress on HPV-negative cervical cancer, including possible reasons, pathogenesis, pathological features, and clinical characteristics, aiming to provide new insights for diagnosis, treatment, and prognosis improvement.

Comparison of the efficacy of 5% versus 8% acetic acid concentrations for detecting premalignant and malignant lesions in colposcopy

Although preventable; cervical cancer remains a significant cause of morbidity and mortality worldwide, especially in developing countries; thus, early diagnosis and treatment are essential to prevent its development into invasive cancer. Based on the screening results, diagnostic colposcopy was performed to evaluate women with abnormal Papinocalaou test results, high-risk human papillomavirus DNA positivity, or suspected cervical cancer. Therefore, this study aimed to determine the optimal acetic acid concentration (5% or 8%) for detecting cervical precancerous/cancerous lesions during colposcopy evaluation. This study included 607 patients admitted to our obstetrics and gynecology clinic. The medical records of the patients were obtained from the colposcopy registry in the hospital information system and retrospectively analyzed. The cases were divided into 2 groups according to the acetic acid concentrations (5% and 8%) used during colposcopy and examined. The duration of acetic acid application was 2 to 4 minutes. The probability of developing ≥ CIN2 was low in patients with negative for intraepithelial lesion or malignancy smear results in both groups, but increased in the high-grade squamous intraepithelial lesions/atypical squamous cells group with the 8% acetic acid concentration (P &lt; .0001; P = .012). The probabilities of pathological detection of ≥ CIN2 in the 5% and 8% acetic acid groups were 17.3% and 46.6%, respectively (P &lt; .0001). The enhancement of the efficiency of colposcopy should focus on improving the detectability of precancerous lesions. Given that this study compared the effectiveness of acetic acid concentration in colposcopy diagnostics, it can be considered a leading study in this field.

Metastasis of endometrial adenocarcinoma masquerading as a primary rectal cancer: A rare case report with literature review

Rationale: The majority of rectal malignancies are primary tumors, secondary tumors are unusual. The rectal metastasis of endometrial carcinoma is reported to be extremely rare, especially in the absence of endometriosis. Patient concerns: Herein we present a rare case of a 68-year-old postmenopausal woman with a history of endometrial adenocarcinoma, metastasizing to the rectum 5 years after a hysterectomy and bilateral salpingo-oophorectomy treatments with pelvic lymphadenectomy were performed. Diagnoses: Histological examination of the rectal neoplasm revealed an invasive lesion in submucosal and muscular layers without definitely invaded evidence in the serous membrane and there was also no obvious endometriosis. The results of immunohistochemistry showed the cancer cells were positive for CK7, estrogen receptor, progesterone receptor, and negative for CK20, villin, confirming the diagnosis of metastatic rectal adenocarcinoma originating from uterine endometrial adenocarcinoma. Meanwhile, the results of immunohistochemical staining showed positive expression of MSH2, MSH6, and negative expression of MLH1 and PMS2, hinting at microsatellite instability which may be related to Lynch syndrome. Interventions: The Dixon operation with lymph node dissection was performed. Chemotherapy was also performed on this patient for the next 6 months. Outcomes: The patient was followed up for the next 6 months after surgery and no recurrence was documented until now. Lessons subsections: Though rectal and endometrial adenocarcinoma could share some similar morphologic features, different immunohistochemical profiles could be revealed between them. Most endometrial carcinoma in the colon or rectum develop from endometriosis. Secondary rectal cancer with endometrial origination in the absence of endometriosis and serosal implants was extremely rare. Therefore, we should pay more attention to this rare but possible presentation for appropriate diagnosis and treatment of these patients.

High-risk HPV-associated ovarian squamous cell carcinoma: A case report and literature review

Rationale: Ovarian squamous cell carcinoma (OSCC) is an exceedingly rare subtype, and high-risk human papillomavirus (HPV)-related OSCC is even rarer. Patient concerns: An 8-cm diameter ovarian cyst was detected during a routine B-ultrasound examination, and the patient underwent laparoscopic surgery. Postoperative pathological examination revealed HPV-16-related OSCC involving adjacent uterine tissue. The patient received postoperative radiotherapy and chemotherapy. Diagnoses: High-risk HPV-related OSCC. Interventions: No. Outcomes: The patient was finally diagnosed with high-risk HPV-related OSCC and underwent surgical treatment. Lessons subsections: In patients with high-grade cervical intraepithelial neoplasia who have undergone cervical conization and maintained annual HPV negativity, the possibility of high-risk HPV-related OSCC should be considered, despite its extreme rarity. Vigilance is essential in the presence of ovarian cysts even after HPV clearance.

Different clinical diagnosis end up in the same pathological diagnosis of intravascular leiomyomatosis: Two case reports

Rationale: Intravascular/intravenous leiomyomatosis (IVL) is a peculiar variant of uterine leiomyoma that is classified as a histologically benign smooth muscle tumor with a biological behavior similar to that of a malignant tumor. It is characterized by the proliferation of leiomyomas spreading along the uterine and extrauterine venous circulation. Patient concerns: Herein, we present 2 cases of IVL who had completely different clinical manifestations to stress the need for constant vigilance of IVL diagnosis and the understanding of uterine leiomyoma heterogenicity. Case 1 was registered for fever without specific triggering factors, irregular menstruation and clinically diagnosed uterine diverticula, while no information about fibroids was mentioned. Case 2 was characterized by an aggressively growing abdominal mass. With a large space-occupying lesion in the right abdominopelvic cavity and no imaging evidence of involvement of the iliac vein or above vein, the patient was initially diagnosed with multiple myomata. Diagnoses: Both patients’ diagnoses were confirmed as IVL by histopathology. To our knowledge, the mass of case 1 is the minimum IVL in the English literature. Interventions: Subtotal hysterectomy with bilateral salpingectomy was performed on the former, while total hysterectomy with bilateral salpingectomy was performed on the latter. Outcomes: Both patients were comfortable, and no relapse occurred. Lessons: Two cases in the study showed 2 different proceeding stages of the same disease and corroborated multiple pathogeneses, which have been mentioned in the available literature on IVL. Our work provides both supplement for clinical data to facilitate further research and better understanding of special types of fibroids to clinicians.

Uterine torsion with degeneration and infarction of giant leiomyoma in a postmenopausal woman: A case report

Rationale: Uterine torsion and giant leiomyoma are both rare diseases. Uterine torsion combined with giant leiomyoma with degeneration or infarction is easy to be misdiagnosed. We wrote this case to increase the accuracy and timeliness of medical staff’s diagnosis and treatment of uterine fibroids combined with uterine torsion. Patient concerns: We present a case of uterine torsion with degeneration and infarction of giant leiomyoma in a 66-year-old postmenopausal woman, who had a lump in her pelvis 10 years ago and suffered from acute abdominal pain half a day before hospitalization. Diagnosis: The patient was considered as uterine torsion with huge abdominal mass by computed tomography and enhanced magnetic resonance imaging, and finally diagnosed as uterine torsion with giant leiomyoma through surgery and pathological examination. Interventions and outcomes: The patient underwent exploratory laparotomy. In addition to the removal of huge uterine fibroids, the hysterectomy with double appendages was conducted. The histopathologic analysis showed “(Uterine tumor) leiomyoma with extensive edema, degeneration, infarction and calcification.” The patient recovered well after operation and kept healthy in the follow-up to date. Lessons: Although uterine torsion is extremely rare, early diagnosis and treatment are essential to prevent serious complications.

Twin pregnancy with incomplete hydatidiform mole and coexistent normal live fetus: A case report and review of the literature

Rationale: A pregnancy with incomplete mole is very rare case. Hydatidiform mole (HM) with live fetus is associated with a risk of a wide variety to maternal and fetal complications. The incidence of a normal live fetus and an incomplete mole such as the case we describe is extremely rare. Patient concern: We report a case of multiparous 34-year-old at Culiacan Mexico woman with incomplete mole coexisting with normal fetus, pregnant 35.3 weeks who presented anemia grade II. Diagnosis: The initial diagnosis of the mole was by ultrasound. Interventions: KERR-type cesarean section and bilateral tubal occlusion. The newborn was morphologically normal, and she did not require intervention or treatment. Outcomes: The newborn was feminine, morphologically normal, weighing 2380 g and 47 cm, APGAR score 8 to 9, delivered prematurely, and there was a large placental plate. The blood loss on surgery was estimated at 1000 mL. Histopathology report of an incomplete hydatidiform mole, negative for malignancy. Histopathology diagnostic was confirmed by immunohistochemistry staining for p57KIP2. Lessons: Although the incidence of this pregnancy is very rare, early recognition, diagnosis and divulge of the cases of medical community is very important for patient care.

Mature solid teratoma of the uterine cervix: A rare case report and review of the literature

Rationale: Most of the mature teratomas are found in the ovaries. Extragonadal teratomas are extremely rare. To date, there are only a handful of reports of uterine cervical teratomas documented in the English literature. Patient concerns: Herein we describe a rare case of a 40-year-old patient who was presented to our hospital for a cervical polypoid mass, which was finally confirmed to be mature solid teratoma in uterine cervix. Diagnoses: Histological examination of the polypoid mass was found to consist of ciliated pseudostratified columnar respiratory epithelium, intestinal epithelium and smooth muscle tissue, adipose tissue and mature glial component, epidermis, and skin adnexa. Meanwhile, no history of abortion, dilatation, and curettage was present in this patient, so implantation of fetal tissue was excluded. Therefore, we make a diagnosis of uterine cervical mature teratoma. Interventions: Tumorectomy was performed after discovering the cervical polypoid mass. Outcomes: The patient had been followed-up for next 3 months after surgery and no recurrence was documented until now. Lessons: Though teratomas of the uterine cervix are extremely rare, more attention should be paid on this rare but possible tumor for appropriate treatment in these patients.

Aggressive angiomyxoma of the vagina: A case report and literature review

Rationale: Aggressive angiomyxoma (AAM) is an exceptionally rare mesenchymal tumor that predominantly manifests in the female genital organs during the reproductive age. Its rarity alone makes it a fascinating subject for study. The diagnosis of AAM necessitates differentiation from other benign or mesenchymal tumors and can be confirmed through immunohistochemistry (IHC) staining. Surgical resection is the primary treatment, and adjuvant treatment can be used as hormonal therapy with gonadotropin-releasing hormone agonists, selective estrogen receptor modulators, and aromatase inhibitors. Patient concerns: A 44-year-old premenopausal Korean woman presented with a growing perineal mass and frequent urination. Diagnoses: Histopathological findings confirmed AAM, with IHC staining showing estrogen receptor, progesterone receptor, actin and desmin positivity, and CD34 and S100 negativity. Interventions: The mass was excised transvaginally under general anesthesia. Outcomes: The patient showed no signs of recurrence 6 months postoperatively. Lessons: AAM in the vagina is a rare tumor that requires differential diagnosis using IHC staining. Previously, we reviewed reported cases and confirmed the feasibility and effectiveness of surgery as the main treatment. This might reassure us about the potential successful treatment of AAM. Adjuvant hormonal therapy with gonadotropin-releasing hormone agonists, selective estrogen receptor modulators, and aromatase inhibitors can further reduce the risk of recurrence.

Development and assessment of an RNA editing-based risk model for the prognosis of cervical cancer patients

RNA editing, as an epigenetic mechanism, exhibits a strong correlation with the occurrence and development of cancers. Nevertheless, few studies have been conducted to investigate the impact of RNA editing on cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC). In order to study the connection between RNA editing and CESC patients’ prognoses, we obtained CESC-related information from The Cancer Genome Atlas (TCGA) database and randomly allocated the patients into the training group or testing group. An RNA editing-based risk model for CESC patients was established by Cox regression analysis and least absolute shrinkage and selection operator (LASSO). According to the median score generated by this RNA editing-based risk model, patients were categorized into subgroups with high and low risks. We further constructed the nomogram by risk scores and clinical characteristics and analyzed the impact of RNA editing levels on host gene expression levels and adenosine deaminase acting on RNA. Finally, we also compared the biological functions and pathways of differentially expressed genes (DEGs) between different subgroups by enrichment analysis. In this risk model, we screened out 6 RNA editing sites with significant prognostic value. The constructed nomogram performed well in forecasting patients’ prognoses. Furthermore, the level of RNA editing at the prognostic site exhibited a strong correlation with host gene expression. In the high-risk subgroup, we observed multiple biological functions and pathways associated with immune response, cell proliferation, and tumor progression. This study establishes an RNA editing-based risk model that helps forecast patients’ prognoses and offers a new understanding of the underlying mechanism of RNA editing in CESC.

Two cases of uterine leiomyosarcoma misdiagnosed as intravenous leiomyomatosis before surgery: A case report

Rationale: Intravenous leiomyomatosis (IVL) and uterine leiomyosarcoma (ULMS) share overlapping imaging features, leading to frequent preoperative misdiagnosis. Accurate differentiation is critical for appropriate surgical management. Patient concerns: Case 1 is a 48-year-old woman with intermittent vaginal bleeding. Case 2 is a 52-year-old woman with exertional dyspnea for 8 months. Diagnoses: Preoperative computed tomography venography suggested IVL in both cases. Final pathology showed case 1 for low-grade endometrial stromal sarcoma with vascular invasion and case 2 for ULMS. Interventions: Case 1 under hysterectomy, bilateral salpingoo-opherectomy, ureteral replantation, tumor resection. Case 2 under resection of uterus, adnexa, right kidney, and intravascular tumor. Outcomes: Both cases showed a fine postoperative condition with no severe adverse reactions. Lessons: Intraoperative pathology is essential for distinguishing ULMS from IVL when imaging is inconclusive.

Endometrioid adenofibroma of ovary: A case report and review of literature

Rationale: Endometrioid adenofibroma is a benign epithelial neoplasm of the ovary, most of which are often unilateral. The symptoms of endometrioid adenofibroma are often nonspecific and misleading. Therefore, a full understanding of the characteristics, diagnosis, and treatment methods of this disease is of great importance. In this study, we report a 34-year-old woman who was found with an unidentified mass on the right ovary during the physical examination 3 years ago with nosymptoms or signs. Patient concerns: A 34-year-old Chinese female was found with an unidentified 6 cm mass on the right ovary for 3 years that presented with no symptoms or signs. Diagnosis: Pelvic ultrasound revealed a 6 cm cystic solid mixed mass on the right ovary. Through histological and immunohistochemical examinations, the tumor mass was finally diagnosed as endometrioid adenofibroma of ovary. Interventions: To confirm the diagnosis, the ovarian tumor was laparoscopically resected. Outcomes: The patient returned to hospital after 3 months with no recurrence or postoperative complications. Lessons: Endometrioid adenofibroma is a benign epithelial neoplasm of the ovary. Complete surgical resection is required and rare cases can recur. Postsurgical pathologic and immunohistochemical testing can confirm a diagnosis of endometrioid adenofibroma. It is important to understand of the key points of differential diagnosis of the disease due to the different prognosis and clinical treatment.

Cost-effectiveness analysis of immune checkpoint inhibitors combined with targeted therapy and chemotherapy for HPV/HIV-related cervical cancer

Background: To systematically assess the cost-effectiveness of immune checkpoint inhibitors compared to the current standard therapy for human papillomavirus (HPV) and human immunodeficiency virus (HIV)-related cervical cancer. Methods: A partitioned survival model spanning a 20-year period was created to evaluate the cost and effectiveness of atezolizumab combined with bevacizumab and chemotherapy (ABC), and pembrolizumab combined with bevacizumab and chemotherapy (PBC) vs bevacizumab combined with chemotherapy (BC), based on clinical data from the BEATcc and KEYNOTE-826 trials. Royston-Parmar models were used for survival estimation. Costs and health state utilities were sourced from existing literature and publicly accessible databases. Cumulative costs (in US dollars), life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured and compared. The evaluation was from the US healthcare payer perspective, with the willingness-to-pay threshold set at $100,000 to $150,000. Deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and scenario analyses were conducted. Results: The base-case analysis showed QALYs of 2.05 for BC, 3.18 for PBC, and 2.85 for ABC. PBC increased life-years by 1.76 and ABC by 1.18, with PBC showing the highest effectiveness. Total costs were $272,377 for BC, $715,472 for ABC, and $694,239 for PBC; severe adverse event (SAE) costs were $6189 for BC, $7603.31 for ABC, and $13,640 for PBC, indicating BC had the lowest SAE costs. The ICERs compared to BC were $372,151/QALY for PBC and $553,995/QALY for ABC. Given that the willingness-to-pay threshold was $100,000 to $150,000/QALY, both PBC and ABC exceed this threshold and were not considered cost-effective. BC had the lowest QALYs and the lowest costs, making it the least expensive option and the most cost-effective choice. DSA results indicated that drug prices and utility values were the main factors affecting cost-effectiveness. PSA confirmed BC as the most cost-effective option within a willingness-to-pay threshold of $0 to $300,000, primarily because it was the least costly. Conclusions: Immune checkpoint inhibitors significantly improve survival benefits for patients. However, their addition is costly and unlikely to be cost-effective for HPV/HIV-related metastatic cervical cancer.

Magnetic resonance imaging for the non-invasive diagnosis in patients with ovarian cancer

Abstract Background: In developed nations, ovarian cancer has resulted in the most fatalities from gynecological cancer. Laparoscopy is primarily utilized as the test to diagnose ovarian cancer. Besides being costly, there are surgical risks associated with laparoscopies. At present, clinical practitioners have access to non-invasive tests for diagnosing ovarian cancer. This study aims to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for diagnosing ovarian cancer. Methods: In order to obtain eligible studies, cross-sectional studies or randomized controlled trials are searched in electronic databases. The databases include 5 English databases (PubMed, the Cochrane Library, PsycINFO, EMBASE, and Web of Science) and 3 Chinese databases (China Biomedical Literature Database, China National Knowledge Infrastructure, and WanFang database). The databases are searched from their origin to October 2020. Quality Assessment of Diagnostic Accuracy Studies-2 is used to assess the methodological quality of the selected studies. RevMan 5.3 and SAS NLMIXED software are used to assess the data synthesis, sensitivity analysis, and risk of bias assessment. Results: This study evaluates the pooled diagnostic value of MRI for diagnosing ovarian cancer. Conclusions: This study will summarize previously published evidence of MRI in relation to diagnosing ovarian cancer. Ethics and dissemination: Since this study does not utilize data from patients, this protocol does not require ethical approval. Protocol registration number: DOI 10.17605/OSF.IO/A6SPQ (https://osf.io/a6spq)

A case report of ovarian granulosa cell tumor in patient with polycystic ovarian syndrome

Abstract Rationale: Granulosa cell tumors (GCTs) account for less than 2% of all ovarian malignancies and are the second most common ovarian sex cord stromal tumors after fibroma/thecomas. GCTs occur most frequently in postmenopausal women with a peak age of 50 to 55, are usually diagnosed in their early stages, and have a good prognosis. GCTs usually present with features of hyperestrogenism, with an average size is 10 to 15 cm. Patient concerns: A 31-year-old nulligravida diagnosed with polycystic ovarian syndrome (PCOS) 10 years prior, had a 20-mm mass in her right ovary found on ultrasonography 2 years ago. She had been taking dienogest 2 mg for 2 years for a misdiagnosed endometrioma, but over a 2-year course, the mass increased to 50 mm. Diagnoses: An ultrasound scan revealed a 47 × 37-mm round solid mass in the right ovary with a spongiform appearance and little vascularity. The pathologic findings showed an adult-type granulosa cell tumor with necrosis and hemorrhage. The tissue stained positive for inhibin-α, Wilms’ tumor-1, CD56, and negative for cytokeratin 7. Interventions: We finally performed right salpingo-oophorectomy, endometrial biopsy, peritoneal biopsy, and partial omentectomy. The pathological findings were adult-type granulosa cell tumor. The International Federation of Gynecology and Obstetrics staging was IA. The patient did not require additional treatment. Outcomes: Surprisingly, her normal menstruation returned 2 weeks after the operation, and she had a normal pregnancy and parturition. The patient had been followed-up regularly for 3 years following the surgery. The patient has not experienced any complications and has remained disease-free. Lessons: GCTs should be considered in the differential diagnosis if a female patient with PCOS and amenorrhea shows a unilateral small solid mass. They are extremely rare malignant ovarian tumors that must be differentiated from other benign ovarian tumors, especially endometriomas and dermoid cysts. It was difficult for us to suspect a granulosa cell tumor because the patient already had PCOS symptoms such as mild hirsutism and amenorrhea. This case highlights the importance of physicians being aware of and suspicious for GCTs in similar cases, along with knowing their characteristics in considering possible differential diagnoses.

Effect of molecular targeted agents in chemotherapy for treating platinum-resistant recurrent ovarian cancer

Abstract This study aimed to investigate the effect of molecular targeted agents (MTAs) in chemo on platinum-resistant recurrent ovarian cancer (ROC). We performed this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements. Randomized controlled trials reporting data about platinum-resistant ovarian cancer treated by MTAs were included. The endpoints for the present study included overall survival and progression-free survival. We analyzed 9 randomized controlled trials including 3631 patients with ROC. The pooled analysis indicated that a combination of MTAs with chemo could markedly increase objective response rate in those patients (P = .012). Nevertheless, the survival rate of those patients was not markedly changed (P = .19). Besides, the combination of MTAs with chemo dramatically aggravated the occurrence of adverse events (P &lt; .05). Moreover, it resulted in the termination of treatment (P = .044) in those patients, but it had no effect on fatal adverse events (P = .16). Our results indicated that the combination of MTAs with chemo notably improved objective response rate in patients with platinum-resistant ROC, but its benefit did not translate into survival benefits.

Prognostic similarity between ovarian mucinous carcinoma with expansile invasion and ovarian mucinous borderline tumor

Abstract There is a similarity of histological features and survival between ovarian mucinous carcinoma (MC) with expansile invasion and ovarian mucinous borderline tumor (MBT). The aim of this study was to compare the clinical outcomes of MC with expansile invasion with those of MBT based on the 2020 World Health Organization (WHO) criteria. A pathological review was performed on patients with MC, ovarian MBT, and seromucinous borderline tumors that underwent surgery at our hospital between 1984 and 2019. Clinicopathological features were compared retrospectively between MC with expansile invasion and MBT. Among 83 cases of MC, 85 cases of MBT, and 12 cases of seromucinous borderline tumor, 25 MC cases with expansile invasion and 98 MBT cases were included through review. MC cases with expansile invasion were diagnosed with advanced International Federation of Gynecology and Obstetrics (FIGO) stages more frequently (P = .02) than that of MBT cases. In addition, patients with MC with expansile invasion received adjuvant chemotherapy more often (P &lt; .01) than that of patients with MBT. There were no statistically significant differences in recurrence rate (P = .10) between MC with expansile invasion and MBT. Progression-free survival (PFS) was worse in MC cases with expansile invasion than that in MBT cases (P = .01). However, a multivariate analysis for PFS showed that histological subtype, FIGO stage, and adjuvant chemotherapy were not an independent prognostic factor. The prognostic outcome of MC with expansile invasion might mimic those of MBT. These results showed ovarian borderline tumor treatment could be applied to MC treatment.

Diagnostic value of serum human epididymis protein 4 and cancer antigen 125 in the patients with ovarian carcinoma

Abstract Background: Ovarian carcinoma (OC) is considered among the most prevalent triggers of cancer-related deaths in women. Many studies have demonstrated that human epididymis protein 4 (HE-4) as well as cancer antigen 125 (CA-125) are over-expressed in various malignant tumors, such as lung, liver, endometrial, gastric, breast, as well as ovarian cancers. Nonetheless, the overall diagnostic value of serum HE-4, in addition to CA-125 n patients experiencing OC, is still largely undetermined. Therefore, the current study intends to investigate the general diagnostic significance of HE-4 along with CA-125 in patients with OC. Methods: We aim to systematically search retrospective or prospective study for potential eligible studies from electronic databases, such as MEDLINE, EMBASE, Cochrane Library, Web of Science, as well as Chinese National Knowledge Infrastructure. We will relevant articles evaluating the general diagnostic significance of HE-4 and CA-125 in patients with OC from these databases. We will define our search in English and Chinese. Likewise, we will use 2 independent authors to extract the required data, using the Quality Assessment of Diagnostic Accuracy Studies-2 tool to evaluate he procedural quality of all included literature. We will use the appropriate statistical method to complete data analyses. Results: The present study aims to investigate the general diagnostic significance of HE-4 and CA-125 in patients suffering from OC. Conclusion: The present study will systematically summarise current evidence of HE-4 in combination with CA-125 in relation to diagnosing OC. Ethics and dissemination: Ethical approval will not be required. Protocol registration number: DOI 10.17605/OSF.IO/YQPC7 (https://osf.io/yqpc7/).

Factors associated with Pap test screening among South Korean women aged 20 to 39 years

The number of hospital visits with cervical cancer as the chief complaint among South Korean women aged 20 to 39 has increased by 1.2 times between 2016 and 2020, indicating a need for active screening for the disease. This study aimed to investigate the status of the Papanicolaou (Pap) test and identify factors influencing Pap test experience among South Korean women aged 20 to 39 years. An online questionnaire survey was conducted over 5 days starting from November 19, 2021. A total of 338 participants who were randomly sampled by age completed the survey. Data were analyzed using descriptive statistics, t test, χ 2 test, and logistic regression. The mean age of the participants was 29.9 years, and participants with and without Pap test experience accounted for 60.7% and 39.3% of the total, respectively. There were significant differences in age, marital status, employment status, smoking status, experience of coitus, awareness of the National Cancer Screening Program, and human papillomavirus (HPV) vaccination status according to the Pap test experience (P &lt; .05) of the participants. Pap test attitude, Pap test self-efficacy, cervical cancer knowledge, HPV knowledge, and cancer prevention behavior scores were significantly higher in the Pap test experience group than in the no Pap test experience group (P &lt; .05). Logistic regression analysis showed that experience of coitus (odds ratio [OR] = 10.46, 95% confidence interval [CI]: 4.54–24.11), marital status (OR = 5.96, 95% CI: 2.25–15.77), awareness of the National Cancer Screening Program (OR = 4.39, 95% CI: 1.66–11.58), HPV vaccination (OR = 2.62, 95% CI: 1.35–5.09), employment status (OR = 2.22, 95% CI: 1.08–4.59), and self-efficacy (OR = 1.09, 95% CI: 1.01–1.19) were the influencing factors in the Pap test experience group. To improve the Pap test screening rate among South Korean women aged 20 to 39, reinforcement strategies and intervention programs that involve age-specific approaches must be established.

Ovarian high-grade serous carcinoma with elevated β-human chorionic gonadotropin

Abstract Rationale: Human chorionic gonadotropin (hCG) is a glycoprotein hormone secreted by the syncytiotrophoblasts of the placenta. However, hCG (particularly β-hCG) is also expressed in many normal nontrophoblastic tissues. Here, we report the case of a 50-year-old woman diagnosed with ovarian high-grade serous carcinoma with elevated β-hCG, which was insensitive to chemotherapeutic drugs and had a poor prognosis. Patient concerns: A 50-year-old woman with abdominal distention was admitted to our hospital. Pelvic computed tomography and magnetic resonance imaging were highly suggestive of multiple metastases of ovarian cancer. Surprisingly, an elevation in β-hCG levels was also measured. Diagnosis and interventions: The patient underwent laparoscopic examination and was diagnosed with high-grade serous ovarian carcinoma. After 2 prior chemotherapies with paclitaxel and carboplatin, the patient underwent cytoreductive surgery and continued receiving chemotherapy. However, recurrent lesions were observed during the period of chemotherapy, and the level of β-hCG increased. Alternative chemotherapy with liposomal doxorubicin was administered, but it also had a poor therapeutic effect. Outcomes: The progression was rapid with a continuous increase in β-hCG levels, and the patient died 9 months after surgery. Lessons: Gynecologists should be aware of women with ovarian carcinoma with an elevated β-hCG level, which suggests a poor prognosis.

Nurse-led exercise and cognitive-behavioral care against nurse-led usual care between and after chemotherapy cycles in Han Chinese women of ovarian cancer with moderate to severe levels of cancer-related fatigue

Abstract Women with ovarian cancer are reported to fatigue over time. Moderate to severe levels of cancer-related fatigue is fluent in Han Chinese patients with cancer. Comprehensive Cancer Network guidelines are recommending exercise and cognitive behavioral therapy to reduce cancer-related fatigue. Exercise is an easy, cost-effective, and non-pharmacological approach. The objective of the study was to evaluate the effectiveness of nurse-led exercise and cognitive-behavioral care against nurse-led usual care in Han Chinese women of ovarian cancer regarding cancer-related fatigue, depressive symptoms, and sleep quality. Han Chinese women with moderate to severe levels of cancer-related fatigue have received 30 minutes, 5 times/week nurse-led exercise and 60 min/week cognitive-behavioral care (EC cohort, n = 118) or nurse-led usual care regarding educations and recommendations only (UC cohort, n = 126) or have not received nurse-led exercise, cognitive-behavioral care, educations, and recommendations (NC cohort, n = 145) between and after chemotherapy cycles. The Piper Fatigue Scale, the Zung Self-rating Depression Scale, and Pittsburgh Sleep Quality Index questionnaires were evaluated at the start and the end of non-pharmacological treatment. At the end of treatment as compared to the start of treatment, only women of EC cohort had decrease Piper Fatigue Scale (5.40 ± 1.49/woman vs 6.06 ± 1.49/woman, P &lt; .0001, q = 4.973) and Zung Self-rating Depression Scale score (48.67 ± 4.24/woman vs 49.93 ± 4.29/woman, P = .001, q = 3.449). Also, at the end of treatment, as compared to the start of treatment, only women of EC cohort have increased Pittsburgh Sleep Quality Index score (14.76 ± 2.18/woman vs 13.94 ± 2.90/woman, P = .045, q = 3.523). Only exercise and cognitive-behavioral care were successful in a decrease in the numbers of women with depression (the Mandarin Chinese version of the Zung Self-rating Depression Scale score &gt;53, 32 vs 16, P = .015). Nurse-led exercise and cognitive-behavioral care can help Han Chinese women with ovarian cancer to decrease cancer-related fatigue and depression. Also, it can improve the quality of sleep. Evidence Level: 4. Technical Efficacy: Stage 5.

Ovarian clear cell cancer associated with Trousseau syndrome: A case report and literature review

Rationale: Trousseau syndrome is known as patients with tumors have a combination of multiple thrombi with systemic organ infarction. The incidence of ovarian clear cell cancer associated with Trousseau syndrome is relatively low. We report the case of a 41-year-old woman diagnosed with ovarian clear cell cancer with deep vein thrombosis and cerebral infarction who had a poor prognosis. Patient concerns: A 41-year-old woman was brought to our hospital with abdominal pain. Abdominal computerized tomography scan suggested large mass of ovarian origin which was considered an ovarian tumor with pelvic metastasis and peritoneal metastasis. Laboratory analyses indicated an elevated levels of serum tumor marker carbohydrate antigen 125 was 321.9 U/mL and the level of D-dimer was 16.71 mg/L. Diagnosis: The patient underwent pelvic mass aspiration was diagnosed with ovarian clear cell cancer. B-ultrasound revealed thrombosis of the lower limbs. Interventions: She underwent 2 neoadjuvant chemotherapies, along with anticoagulation therapy. However, it had a poor therapeutic effect, and the patient suffered from acute cerebral infarction that worsened. Outcomes: Chemotherapy and anticoagulation failed to stop the tumor and blood clot progression. The patient died 2 months after cerebral infarction without surgical treatment. Lessons: Gynecologists should be aware of the need for clinical suspicion of the risk of thrombosis during the treatment period of ovarian cancer and make careful decisions

Analysis on clinical association of uterine scar diverticulum with subsequent infertility in patients underwent cesarean section

Abstract To evaluate the relationship between uterine cesarean scar diverticulum (CSD) and subsequent infertility in patients who underwent cesarean section, and determine the effects of pelvic fluid-releasing inflammations on infertility. A retrospective analysis was designed among patients with CSD who were admitted to our hospital from January 1, 2018 to December 31, 2019. A total of 60 patients with CSD and uterine fibroids or benign ovarian tumors who underwent cesarean section were included, and divided into the CSD group and control group. Baseline characteristics of all patients were collected, and the pelvic adhesion scores and the percents of tubal patency were evaluated. Furthermore, the postoperative clinical outcomes were followed up. The levels of inflammatory factors in pelvic fluid were tested using Elisa kits. Preoperative data indicated that the size of the uterine scar diverticulum was (1.68 ± 0.52) cm, the pelvic adhesion scores were higher in CSD group than control group (4.67 ± 0.90 vs 0.47 ± 0.90, P &lt; .05), and 21 of 30 patients with unobstructed fallopian tubes. The levels of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in patients with CSD were obviously higher than control group (P &lt; .05). After the follow-up, the data displayed that no CSD was found in all patients, the time of menstrual period in patients with CSD was shortened to 7.80 ± 1.27 days, and the myometrial thickness at uterine scar was significantly increased (P &lt; .05). Additionally, the pregnancy rate was increased, and 12 of 30 patients were repregnant. Correlation analysis showed that the levels of inflammatory factors (tumor necrosis factor-α, interleukin-1β, interleukin-6), the size of uterine scar diverticulum, and the myometrial thickness at uterine scar were significantly correlated with subsequent infertility (r = 0.307, 0.083, 0.147, 0.405, 0.291, P &lt; .05). Uterine scar diverticulum repair could improve menstrual prolongation, increased the thickness of myometrium and repregnant rate. Subsequent infertility was positively correlated with uterine scar diverticulum and the levels of inflammatory factors.

Prognostic signature of ovarian cancer based on 14 tumor microenvironment-related genes

Abstract Background: Ovarian cancer is one of the lethal gynecological diseases in women. However, using tumor microenvironment related genes to identify prognostic signature of ovarian cancer has not been discussed in detail. Methods: The mRNA profiles of 386 ovarian cancer patients were retrieved from The Cancer Genome Atlas. Univariate Cox regression and LASSO Cox regression analyses were performed and 14 optimized prognostic genes related to tumor microenvironment were identified. Results: The multivariate Cox hazards regression showed risk score was an independent prognostic signature for ovarian cancer. Nomogram model could reliably predict the patients’ survival. Furthermore, M1 macrophages, M2 macrophages, and follicular helper T cells, differentially expressed between the high- and low-risk groups, were found to be associated with the risk score. Conclusion: CTL-associated antigen 4 (CTLA4) and indoleamine 2,3-Dioxygenase 1 (IDO1), which were previously shown to be important immune checkpoints, probably contribute to the immunosuppressive microenvironment aberration. This study may shed light on the prognosis of ovarian cancer.

Ovarian dysgerminoma with pseudo-Meigs syndrome

Abstract Rationale: Dysgerminoma is a rare malignant tumor of the ovary, more frequently occurring in young women. The main signs of pseudo-Meigs syndrome (PMS) are ascites and hydrothorax accompanying benign or malignant ovarian tumors (no fibroma or fibroma-like tumor). Patient concerns: A 19-year-old woman with fever and chest tightness for 2 days. Diagnoses: Pectoral-abdominal computed tomography (CT) scan and contrast-enhanced magnetic resonance imaging revealed a large amount of right pleural effusion, a small amount of ascites, and a huge abdominopelvic mass measuring about 29.2cm × 11.8cm × 8.4 cm in the left ovary. The result of hydrothorax examination was consistent with the diagnosis of exudative pleural effusion. In addition, Rivalta-test showed a positive result and lactate dehydrogenase was elevated. The histopathological diagnosis was a giant germ cell tumor, which was consistent with dysgerminoma in terms of both morphology and immunophenotype. Based on these findings, a diagnosis of malignant ovarian neoplasm with PMS was made. Interventions: Surgical resection of the tumor was performed. Outcomes: The patient recovered well after operation, and the pleural effusion and abdominal ascites vanished. No recurrence was observed during the 1-year follow-up period. Lessons: Ovarian dysgerminoma with PMS is a rare malignant tumor of the ovary, which often occurs in young women. It should be considered in differential diagnosis of patients with a pelvic mass, ascites and pleural effusion. Early diagnosis and surgical treatment are beneficial to prolonged survival.

Treatment of primary vaginal malignant melanoma and review of previous literature: A case report

Introduction: Primary vaginal malignant melanoma is a rare gynecological malignant tumor with high malignancy and poor prognosis. Because of its insidious incidence, it is generally diagnosed in the late stage, and the 5-year survival rate is only 5% to 25%. Due to the rarity of this disease and the limited number of related cases reported in the literature, there is currently no unified standard for its diagnosis and treatment. Therefore, the treatment of this disease has always been a difficult problem in clinical practice. Patient concerns: A 56-year-old woman was admitted to our hospital with discomfort in the lower abdomen. Diagnosis: The final diagnosis of this patient was vaginal malignant melanoma (T4N1M0). Interventions: The patient underwent extensive hysterectomy, bilateral adnexectomy, pelvic lymph node resection, and total vaginectomy. Following the surgery, the patient received adjuvant chemotherapy. Outcomes: The patient was followed up regularly. No recurrence or metastasis has been reported to date. Conclusion: The treatment of primary vaginal malignant melanoma is still dominated by surgery, while radiotherapy and chemotherapy are controversial. Immunotherapy and targeted therapy highlight certain advantages in advanced patients, which still need to be verified by large sample studies, We provide a case of postoperative adjuvant chemotherapy for vaginal malignant melanoma. So far, no signs of disease recurrence have been found. As the price of chemotherapy drugs decreases, it is economically convenient and acceptable for most patients, but its effectiveness needs to be observed in large-scale clinical trials.

A novel biomarker, MRPS12 functions as a potential oncogene in ovarian cancer and is a promising prognostic candidate

Abstract Ovarian cancer (OC) is the leading cause of gynecological cancer deaths. Extraordinary histologic and genetic heterogeneity presents as great hurdle to OC's diagnosis and treatment. MRPS12 (Mitochondrial Ribosomal Protein S12), encoding a 28S subunit protein, controls the decoding fidelity and susceptibility to aminoglycoside antibiotics. Our study aims to investigate the clinical significance and potential mechanism of MRPS12 in OC. Oncomine, Tumor Immune Estimation Resource database (TIMER), and GEPIA databases were utilized to explore the expression level of MRPS12 in OC and normal tissues. Kaplan–Meier plotter was used to evaluate the influence of MRPS12 expression on OC patients’ survival. The potential biologic function and immune infiltration of MRPS12 in OC were analyzed by GSEA (Gene set enrichment analysis) and TIMER database, respectively. MRPS12 was significantly highly expressed in OC (P &lt; .05) compared with normal ovarian tissues. Its overexpression was also significantly related with poor overall survival in advanced FIGO stage (III+IV) patients, in serous OC and in those patients with TP53 mutation (P &lt; .05). GSEA showed that HALLMARK_G2M_CHECKPOINT, BIOCARTA_CELLCYCLE_PATHWAY, HALLMARK_PI3K_AKT_MTOR_SIGNALING, BIOCARTA_P53_PATHWAY were significantly enriched in high-MRPS12-expression phenotype. MRPS12 expression was positively correlated with the infiltration of macrophages and neutrophils in OC. These results reveal that MRPS12 could function as a potential oncogene and serve as a promising prognostic candidate in OC.

Characterization and clinical significance of the CADM1/HER2/STAT3 axis in serous ovarian tumors

Abstract The subtypes of serous ovarian tumors (SOTs), including benign serous cystadenoma, serous borderline tumor (SBT), low-grade serous ovarian carcinoma (LGSC), and high-grade serous ovarian carcinoma (HGSC), remain poorly understood. Herein, we aimed to characterize the cell adhesion molecule 1 (CADM1)/signal transducer and activator of transcription 3 (STAT3)/human epidermal growth factor receptor 2 (HER2) axis and identify its clinical significance in patients with serous cystadenoma, SBT, LGSC, and HGSC. The immunohistochemical expression of CADM1, HER2, and STAT3 was assessed in 180 SOT specimens, and its association with clinical data was determined. High levels of CADM1 expression were detected in 100% of serous cystadenomas and 83.33% of SBTs, while a loss of CADM1 expression was observed in 44% of LGSCs and 72.5% of HGSCs. Relative to the levels in benign cystadenomas and SBTs, higher levels of HER2 and STAT3 expression were observed in LGSCs and aggressive HGSCs. Furthermore, the expression profile of the CADM1/HER2/STAT3 axis was significantly associated with histologic type, International Federation of Gynecology and Obstetrics stage, and lymph node metastasis in patients with SOT. Our study identified the changes in the CADM1/HER2/STAT3 axis that were closely associated with the clinical behavior of SOTs. These molecular data may provide new insights into SOT carcinogenesis and aid in the diagnosis and treatment of patients with SOT.

Effect of traditional Chinese medicine (TCM) on survival, quality of life, and immune function in patients with ovarian carcinoma

Abstract Background: Traditional Chinese medicine (TCM) has been widely applied as promising adjunctive drugs for ovarian carcinoma (OC) in China and other Asian countries. However, its exact clinical efficacy and safety is still not well investigated. In this study, we aimed to summarize the efficacy of TCM on survival, quality of life (QoL), and immune function in patients with OC through the meta-analysis. Methods: Relevant clinical trials of TCM for the treatment OC patients will be searched in Cochrane Library, Web of Science, Google Scholar, PubMed, Medline, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Database from their inception to November 2020. Two researchers will perform data extraction and risk of bias assessment independently. The clinical outcomes, including overall survival (OS), QoL, immune function, tumor markers, and adverse events, were systematically evaluated by using Review Manager 5.3 and Stata 14.0 statistical software. Results: The results of this study will provide high-quality evidence for the effect of TCM on survival, QoL and immune function in patients with OC. Conclusion: The conclusions of this meta-analysis will be published in a peer-reviewed journal, and draw an objective conclusion of the efficacy of TCM on survival, QoL, and immune function in patients with OC. Trial registration number: INPLASY2020110104.

Evaluation of cervical length and optimal timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia

Abstract To evaluate the change of cervical length and the best timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia (CIN). This was a retrospective study including patients under 40 years with fertility desire treated by cervical conization for CIN. To assess the cervical length, the patients were divided into 2 groups according to different surgery procedure: loop electrosurgical excision procedure (LEEP) and cold knife conisation (CKC). Patients with cervical length &lt; 2.5 cm in CKC group were divided into 2 groups according to whether receiving cervical cerclage. Trans-vaginal ultrasound examination was used to measure cervical length by fixed professional sonographers. In LEEP group, the cervical length preoperative was significantly longer than 3 months postoperatively (3.03 ± 0.45 cm vs 2.84 ± 0.44 cm, P = .000). In CKC group, the cervical length preoperative was significantly longer than 3 and 6 months postoperatively (2.90 ± 0.41 cm vs 2.43 ± 0.43 cm and 2.68 ± 0.41 cm, respectively, P = .000). Cervical length was significantly longer at 12 and 9 months after cerclage compared to that without cerclage. Eighteen patients got pregnant in LEEP group, among which one was pregnant at 5 months postoperatively and had premature delivery. There was 1 inevitable abortion and 1 preterm birth among 39 pregnant patients from CKC group. Patients who have fertility desire with CIN were recommended for pregnancy at 6 and 9 months after LEEP and CKC, respectively. Cerclage effectively prolonged cervical length in patents with that less than 2.5 cm to prevent cervical incompetence.

Clinical outcomes of fetal ovarian masses diagnosed by prenatal ultrasonography and literature review

With the advancement of prenatal examination technology, more and more fetus with ovarian masses are diagnosed. However, whether such children need intervention measures after delivery, there is no more unified diagnosis and treatment measures in the world. In this study, postnatal data and clinical outcome of fetal diagnosed with ovarian masses were analyzed. We also combined with relevant literature to explore the postpartum intervention measures and timing of such children. A total of 57 cases of abdominal masses from the reproductive system were included in the study. These children were diagnosed with ovarian masses after birth. We collected from 2012 to 2020, the prenatal examination revealed the presence of abdominal masses from the reproductive system, and diagnosis was confirmed by imaging examinations after childbirth. We counted the fetal period data of these children, compared the changes in the postnatal pathology and intervention measures. A total of 57 cases of ovarian masses were diagnosed prenatally, 1 case was lost to follow-up, and 56 cases were finally included in the study. After birth a total of 21 cases of ovarian masses were treated conservatively, of which 18 cases resolved spontaneously during the follow-up process, with an average follow-up period of 30.88 ± 18.16 weeks. There were statistically significant differences in the nature and the maximum diameter of the mass between the two groups receiving conservative treatment or surgical treatment after delivery (P &lt; .05).Univariate and multivariate Logistic regression analysis showed that there were significant differences in the nature and diameter of the mass between two groups (P &lt; .05). In addition, we divided the children undergoing postpartum surgery into a laparoscopic surgery group and a conventional open surgery group. Through data analysis, we found that there were statistically significant differences in the age of operation, operation time, and hospitalization days in the two groups of these children (P &lt; .05). Children diagnosed with ovarian masses prenatally generally have a good prognosis. For these children, the treatment plan should be developed according to the child general condition. If child with ovarian mass is treated with surgery, the preservation of ovarian tissue should be emphasized regardless of the size, nature, and torsion of the mass.

Intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar in patients with pelvic locoregional recurrence of cervical cancer

Abstract The treatment of recurrent cervical cancer, especially pelvic locoregional recurrence, is very challenging for gynecologic oncologists. This study investigated the efficacy and safety of intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar, a novel modified recombinant human endostatin, in patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.This phase 2 study was conducted between May 2018 and May 2019 at a single center in the Qinghai-Tibet Plateau and enrolled 31 patients with pelvic locoregional recurrence of cervical cancer following surgical treatment. All patients were treated with IMRT-based CCRT for 6 weeks and intravenous infusions of Endostar (15 mg/m2), which were administered on days 1 to 7 of CCRT, followed by rest for 4 weeks. After resting, chemotherapy with cisplatin (70 mg/m2) plus paclitaxel (135–175 mg/m2) was given every 3 weeks for a total of 4 treatments.Thirty-one patients were evaluable for the primary endpoint. The mean age was 50.03 years (SD 7.72). The objective response rate was 67.74% and the disease control rate was 83.87% (48.39% achieved a complete response, 19.35% a partial response, 16.13% had disease stabilization, and 16.13% had progressive disease). The most common adverse events were nausea, vomiting, alopecia, neutropenia, and leukopenia; most events were grade 1 or 2 in intensity. Grade 3 toxicities included thrombocytopenia and neutropenia in 2 patients each, and leukopenia in 4 patients. No cases of grade 4 acute toxicity were observed. IMRT-based CCRT with Endostar infusions is effective and safe. Our results support the use of this treatment for patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.

The efficacy and safety of platinum-based chemotherapy for ovarian cancer in pregnancy: A protocol for systematic review and meta-analysis

Background: Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to lack of high level evidence. Therefore, we performed a protocol for systematic review and meta-analysis to evaluate the efficacy and safety of platinum-based chemotherapy for the treatment of ovarian cancer during pregnancy. Methods: This systematic review has been registered in PROSPERO (CRD42022370709), which will be conducted in accordance with preferred reporting items for systematic review and meta-analysis protocols 2015 statement. We will search 7 electronic databases to identify relevant studies from inception to October, 2022, which includes PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. The Cochrane Handbook for systematic reviews of interventions will be performed to assess a broad category of biases in the included studies. The Grading of Recommendations Assessment, Development and Evaluation system will be used to judge the overall quality of evidence supporting outcomes in this work. Data are analyzed with the Review Manager Version 5.3 software. Results: The results of this meta-analysis would be submitted to peer-reviewed journals for publication. Conclusion: This paper will provide high-quality synthesis to assess the efficacy and safety of platinum-based chemotherapy for ovarian cancer in pregnancy.

BRCA2 gene mutation in cancer

Breast cancer susceptibility gene 2 (BRCA2) is the main gene associated with hereditary breast cancers. However, a mutation in BRCA2 has also been found in other tumors, such as ovarian, pancreatic, thyroid, gastric, laryngeal, and prostate cancers. In this review, we discuss the biological functions of BRCA2 and the role of BRCA2 mutations in tumor progression and therapy.

A case report of small cell ovarian neuroendocrine carcinoma combined with immunochemotherapy

Background: Small cell ovarian neuroendocrine (NE) carcinoma is a rare NE tumor with a low incidence, poor prognosis, and no standardized treatment. To date, there have been no clear reports on the efficacy or prognosis of combined immunological and chemotherapy-based approaches in patients with this type of tumor. Methods: We administered the immune checkpoint inhibitor tirelizumab (PD-1 mab), in combination with etoposide and cisplatin chemotherapy (EP), to a patient with small cell ovarian NE carcinoma to examine its efficacy and safety. Results: The evaluation of efficacy was PR for every 2 courses of application, and immunomaintenance therapy was administered after 6 courses of treatment. Conclusion: Our studies indicate that tirelizumab combined with EP, may be an effective treatment for small cell ovarian NE carcinoma.

Effect of telephone-based health education intervention models on cervical cancer screening compliance

Abstract Background: Screening is an effective strategy for preventing and controlling the cervical cancer. Unfortunately, women are often less likely to adhere to cervical cancer screening procedures. Related research shows that the telephone-based health education model can improve the compliance of screening. At present, however, this practice is lack of persuasion. Therefore, this study makes a systematic meta-analysis on whether the telephone-based health education model can improve the compliance of screening by women. Methods: Retrievals will be made on PubMed, Web of Science, the Cochrane Library, EMBASE, and some clinical trial registration websites, and information on related randomized controlled trials (RCTs) will collected. After 2 researchers independently screen the literatures, they will extract the data and evaluate the bias risk contained in the collected studies, before meta-analysis is carried out with RevMan 5.3 software. Results: The available evidence will be systematically reviewed in terms of compliance with cervical cancer screening. Conclusion: The findings of this study will produce comprehensive evidence to identify whether the telephone-based health education model can improve women's compliance with cervical cancer screening.

Severe vaginal bleeding due to vaginal metastasis from renal cell carcinoma with inferior vena cava tumor thrombus

Abstract Rationale: Renal cell carcinoma (RCC) is the most common type of kidney cancer and is the second most common urologic neoplasm. Vaginal metastasis from RCC is extremely rare clinically. Patient concerns: A 56-year-old woman presented with intermittent vaginal bleeding that had persisted for 1 month. Enhanced computed tomography examination suggested a vaginal mass (3 × 2 × 2 cm), right kidney tumor (15 × 12 × 10 cm), and an inferior vena cava tumor thrombus. During gynecologic examination, the mass was necrotic and caused uncontrollable vaginal bleeding. Diagnoses: Based on clinical and imaging examinations and the pathology, she was diagnosed as vaginal metastasis from RCC. Interventions: The patient received percutaneous transcatheter arterial embolization to stop uncontrollable vaginal bleeding, and then treated with targeted therapy. Outcomes: Vaginal bleeding disappeared after interventional embotherapy. However, disease progressed, and the patient died 9 months later. Lessons: In cases of vaginal bleeding, the possibility of metastatic renal cell carcinoma should be considered. Percutaneous transcatheter arterial embolization is an effective and novel treatment for uncontrollable vaginal bleeding caused by vaginal metastasis of RCC.

Human chorionic gonadotropin elevation in gliomatosis peritonei complicated with immature teratoma: A case report and review of the literature

Rationale: Gliomatosis peritonei (GP) refers to the implantation of glial tissue on the visceral and parietal peritoneal surface, often associated with immature teratoma. It is a rare condition and the pathogenesis is not fully understood. In addition, the indistinguishable radiological appearance of immature and mature teratomas, and limited pathology samples make an accurate diagnosis difficult in most cases. More importantly, patients are also at risk of recurrence after surgery. This report aims to describe the process of diagnosis and treatment of GP with immature teratoma. Patient concerns: The patient, a 38-year-old woman presented with GP complicated with immature teratoma after laparoscopic ovarian cyst excision. Diagnoses: On physical examination, a 15 cm-pelvic mass, with poor mobility, was palpated. And tumor marker demonstrated a moderate increase in α-fetoprotein and carbohydrate antigen 125. We suspected malignancy according to the comprehensive preoperative evaluation, the postoperative pathology revealed an immature teratoma of the left ovary and complicated with gliomatosis peritonei. Three months after the second surgery, possible recurrence of immature teratoma was considered and the patient underwent the third laparotomy. But the postoperative pathology indicated mature teratoma and mature glial components in the pelvic lesions. Interventions and outcome: The patient underwent 2 more surgical resections after the initial resection and 3 cycles of bleomycin, etoposide, and cisplatin regimen chemotherapy. She was regularly followed up in the outpatient after surgery, and no recurrence has been reported in the pelvic cavity till date. Lesson: The case illuminated that the primary diagnosis of GP complicated with immature teratoma is critical but highly challenging for both gynecologists and pathologists and more attention should be paid to “GP complicated with immature cystic teratoma” patients to avoid inappropriate treatment.

Squamous cell carcinoma in mature cystic teratoma of the ovary induced by human papillomavirus 16 infection: A case report and literature review

Rationale: Mature cystic teratoma is the most common ovarian germ cell tumor. The malignant transformation of ovarian mature cystic teratoma (MCT) is very rare, but the prognosis is poor. We present a case of ovarian mature cystic teratoma with human papillomavirus infection and malignant transformation into ovarian squamous cell carcinoma (SCC). The occurrence of this case may prove that high-risk human papillomavirus infection is a pathogenic factor inducing malignant transformation of mature cystic teratoma to SCC. Patient concerns: A 38-year-old woman with a solid cystic mass of 8 cm on the right ovary, and human papillomavirus (HPV) test of her cervix showed HPV-16 infection. Diagnosis: The transvaginal ultrasound was performed, and there was a cystic solid mass of 5.9 × 4.5 × 5.5 cm in the right adnexal area with unclear cystic fluid and rich blood flow signals in the capsule wall. HPV test of cervix showed HPV-16 infection. Diagnostic suspicion: cystic teratoma. Intervention: The patient signed an laparoendoscopic surgery was performed to remove the right ovarian mass. Intraoperative pathology consultation revealed the malignant transformation of mature teratoma of the right ovary and the formation of squamous or adeno-SCC. We performed laparoscopic comprehensive surgical staging (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, pelvic and para-aortic lymph node dissection) were made. Outcomes: The operation was successful and the postoperative recovery was smooth, was discharged 7 days after operation. Now the patient is recovering well and is continuing chemotherapy as planned. Conclusion: HR-HPV infection might be a causal factor for inducing malignant transformation of ovarian MCT to SCC, and the Jumping metastasis of lymph nodes may be the characteristic of SCC-MCT, but further verification is still needed.

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as treatment for upper vaginal leiomyoma

Abstract Introduction: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging technique in the area of minimally invasive surgery. Vaginal leiomyoma is a rare benign tumor, with only a few cases being reported in the literature. we demonstrate a novel approach for excision of a vaginal leiomyoma via vNOTES. To ensure reproducibility and replicability akin to a standardized procedure, we have provided a step-by-step video description of the use of vNOTES for upper anterior vaginal myomectomy. Patient concerns: A 35-year-old female (G2P0A2) presented with a tumor in the upper anterior vaginal wall, which gradually increased in size. Diagnosis: A vaginal examination revealed a swollen area approximately 3-cm in diameter on the upper anterior vaginal wall. The swelling was mobile and solid. All other vitals were normal. Transvaginal ultrasound detected a 3.0 × 3.4 cm hypoechogenic mass on the superior vaginal wall, and a preoperative diagnosis of the vaginal tumor was confirmed. Interventions: The upper vaginal leiomyoma treated using transvaginal natural orifice transluminal endoscopic surgery. Outcomes: The procedure lasted for 20 min, and the postoperative course was uneventful. Conclusions: vNOTES can be a promising alternative to traditional vaginal surgery for upper vaginal disease due to advantages such as excellent exposure, easy access and precise suturing. However, more studies are needed to assess its long-term efficacy.

Clinical analysis and literature review of a case of ovarian clear cell carcinoma with PIK3CA gene mutation: A case report

Rationale: Ovarian clear cell carcinoma (OCCC) is an uncommon malignant form of 5 subtypes of ovarian cancer, accounting for approximately 5% to 25% of all ovarian cancers. OCCC is usually diagnosed at a young age and an early stage. More than 50% of patients are associated with endometriosis. It shows less sensitivity to platinum-based chemotherapies, high recurrence, and poor prognosis, especially late. However, platinum-based chemotherapies remain the first-line treatment. Meanwhile, new treatment modalities have been explored, including immune checkpoint inhibitors and PI3K-AKT-mTOR pathway inhibitors. Patient concern: A 48-year-old Chinese woman, Gravida2 Para1, complained of irregular and painful vaginal bleeding for 4 months. Diagnosis: The patient was diagnosed with stage IC ovarian clear cell carcinoma that presented with a mutation of the phosphatidylinositol 4,5-bisphosphate 3-kinase alpha subunit (PIK3CA) gene. Intervention: We performed an early diagnosis and complete surgical resection of the tumor with platinum-based chemotherapy. Outcome: This patient with mutation of the PIK3CA gene was sensitive to platinum-based chemotherapy, showed a significant downwards trend in tumor markers, and was in good health within the year of follow-up. Lessons: This study described an OCCC case that presented with a PIK3CA mutation and was successfully managed with careful and complete resection of the tumor. This patient with mutation of the PIK3CA gene was sensitive to platinum-based chemotherapy, showed a significant downwards trend in tumor markers, and did not have recurrence after a year of follow-up, indicating a reasonably good prognosis. Therefore, surgery plus platinum drug chemotherapy is still the best strategy for OCCC treatment. In addition, it is recommended for such patients to undergo genetic testing as much as possible to predict the clinical treatment effect.

Identification of prognosis-related hub genes of ovarian cancer through bioinformatics analyses and experimental verification

Ovarian cancer (OC) is a lethal and highly prevalent disease in women worldwide. The disease is often diagnosed in late stages, which leads to its rapid progression and low survival rate. This study aims to identify new prognostic genes for OC. Based on 2 datasets from the National Center for Biotechnology Information Gene Expression Omnibus public database, we constructed 2 Weighted Gene Co-expression Network Analysis networks. Then, we selected and intersected 2 key modules to screen key genes. Enrichment analyses were performed, and a protein-protein interaction network was constructed. The cytoHubba plugin of Cytoscape and survival analysis were used to screen hub genes related to prognosis. The expression of hub genes was analyzed by GEPIA and verified by quantitative Real-Time PCR. Gene alteration frequency analysis, gene set variation analysis, immune infiltration analysis, drug sensitivity analysis, tumor mutation burden, and neoantigen analyses were conducted to determine the prognostic value and molecular mechanisms of the hub genes. In total, 214 key genes were selected from 2 Weighted Gene Co-expression Network Analysis networks, and 3 hub genes, namely ALDH1A2, CLDN4, and GPR37, were identified as prognostic candidates through cytoHubba and survival analysis. Three hub genes were significantly associated with overall survival of OC patients. GEPIA and quantitative Real-Time PCR indicated that ALDH1A2 expression was significantly downregulated, while expression of CLDN4 and GPR37 was upregulated in OC samples compared with normal samples. CIBERSORT showed that 3 hub genes were closely associated with the infiltrating immune cells. GDSC showed that hub genes expression influenced IC50 values of chemotherapeutic drugs. OC patients with high expression of ALDH1A2 and CLDN4 had lower TMB and low ALDH1A2 expression could produce a larger number of neoantigens. In conclusion, the 3 hub genes (ALDH1A2, CLDN4 and GPR37) identified through bioinformatics analyses in the present study may serve as OC prognosis biomarkers. The study findings offer valuable insights into OC progression and mechanisms.

Is ovarian cystectomy for atypical ovarian endometrioma safe?: A single center study

Ovarian atypical endometriosis (AE) is a premalignant lesion, and its potential to progress to endometriosis-associated ovarian cancer emphasizes its significance. However, the true risk of malignancy in AE remains unclear. Therefore, this study aimed to investigate the clinical outcomes of ovarian AE after ovarian cystectomy. We retrospectively reviewed the medical records and histopathological reports of 41 patients who had been diagnosed with ovarian AE between January 2011 and April 2020. We reviewed age, obstetric history, age at menarche, preoperative CA 125 level, C-reactive protein level, erythrocyte sedimentation rate, endometriosis stage, mean follow-up duration, postoperative hormonal therapy, and prognosis, including recurrence of endometriosis and malignant transformation. Among 41 patients with pathologically diagnosed ovarian AE, 26 were followed up after cystectomy only. The average follow-up period was 58.27 ± 33.22 months in cystectomy only patients. The mean age of the patients with cystectomy only versus that of patients with endometriosis-associated ovarian carcinoma was 32.73 ± 6.10 versus 48.29 ± 4.35 (P &lt; .01) years. The preoperative CA 125 level was 115.63 ± 219.06 versus 225.75 ± 163.39 (P &lt; .051) U/mL. Patients with endometriosis-associated ovarian carcinoma or other diseases and those who underwent oophorectomy were excluded. After surgery, hormone therapy was administered to 22 of 26 patients, and the remaining 4 patients were followed up without additional treatment. Endometriosis recurrence occurred in 5 patients, 1 of whom underwent second-line laparoscopic ovarian cystectomy. However, no malignant transformations were observed. Ovarian AE has a low possibility of malignant transformation. Conservative treatment is recommended after appropriate ovarian cystectomy, such as enucleation.

Increased expression of MMP17 predicts poor clinical outcomes in epithelial ovarian cancer patients

Ovarian cancer has the highest fatality rate among female reproductive system cancers, which is due to lack of biomarker for diagnosis and prognosis. We aimed to evaluate the role of matrix metalloproteinase 17 (MMP17) in ovarian cancer tumorigenesis and prognosis. Based on the epithelial ovarian cancer (EOC) in The Cancer Genome Atlas database, we determined the expression of MMP17 using the Wilcoxon rank-sum test. The biological functions of MMP17 were evaluated using the Metascape database and Gene Set Enrichment Analysis. The association between MMP17 and immune cell infiltration was investigated by single sample Gene Set Enrichment Analysis. Logistic analysis was applied to study the correlation between MMP17 expression and clinicopathological characteristics. Finally, Cox regression analysis, Kaplan–Meier analysis, and nomograms were used to determine the predictive value of MMP17 on clinical outcomes in EOC patients. The expression of MMP17 was much higher in EOC patients than in pericarcinomatous tissues (P &lt; .001). MMP17-associated differentially expressed genes were significantly enriched in cell extracellular matrix (ECM) degrading and corresponding pathways in the high MMP17 expression phenotype. MMP17 has a high sensitivity and specificity for EOC diagnosis, with an area under the curve of 0.988. MMP17 expression was found to be an independent risk factor for overall survival (hazard ratio [HR]: 1.488, P &lt; .001), progression-free interval (HR: 1.347, P &lt; .01), and disease-specific survival (HR: 1.548, P &lt; .01). Increased MMP17 expression in EOC may contribute to carcinogenesis by degrading ECM and provide diagnostic and prognostic value for clinical outcomes.

Synchronous surgery and immediate reconstruction of double primary cancers of the ovary and breast

Introduction: There has been an ongoing debate about the benefits and risks between synchronous surgery and two independent surgery of ovary tumor removal and breast reconstruction. Here we report a synchronous oncological surgery and immediate postmastectomy reconstruction of double primary cancers of the ovary and breast. Patient concerns: A 58-year-old woman presented with a right breast lump and ascites. Diagnosis: Computed tomography (CT) indicated synchronous breast and ovarian cancer with multiple metastases. Double primary mammary and ovarian cancer was confirmed after a series of evaluations, such as core needle biopsy of the breast tumor. Interventions and outcomes: Synchronous surgery and immediate reconstruction of double primary cancers of the ovary and breast were performed. Post-operative results showed complete resection of ovarian tumor, no post-operative complication, and excellent life quality. Conclusion: Synchronous surgery is warranted as a treatment option for selected cases of double primary cancer. The surgery not only achieved complete removal of one cancer and reduction of the other but also reached excellent breast reconstruction and body shape recovery.

Pelvic masses after surgery for immature ovarian teratoma: A 10-year experience of Western China

There are debates on the management of immature ovarian teratoma and its recurrence. This study aimed to report the incidence of pelvic masses after surgery for immature ovarian teratoma and to identify prognostic factors of disease-free survival after surgery, discussing aspects of primary treatment and postoperative management. Data on the diagnosis and treatment of patients with immature teratomas were collected. Follow-up data were acquired from clinic visits and telephone interviews. Disease-free survival was defined as the time interval between the initial surgery for immature ovarian teratoma and the diagnosis of a new pelvic mass. Survival curves were drawn using the Kaplan-Meire method, and multivariate analysis was performed using the Cox proportional hazard regression model using PASW statistics software. The estimated 5-year disease-free survival and overall survival were 74.3% (95%CI 63.9%–84.7%) and 96.5% (95%CI 91.6%–100.0%), respectively. The incidence of growing teratoma syndrome and immature teratoma relapse at a median follow-up of 46 months were 20.0% and 7.7%, respectively. Two patients died of repeated relapses or repeated growing teratoma syndrome. Rupture of initial lesions (RR 4.010, 95%CI 1.035–5.531), lymph node dissection (RR 0.212, 95%CI 0.051–0.887) and adjuvant chemotherapy (RR 0.143, 95%CI 0.024–0.845) were independent prognostic factors for disease-free survival. The development of growing teratoma syndrome is more prevalent than relapse after treatment of immature ovarian teratomas. Lymph node dissection and chemotherapy are recommended to reduce recurrence. Close surveillance and active surgical intervention are important for the diagnosis and appropriate management of new pelvic masses.

Does protracted chemotherapy have an influence on the clinical outcomes in advanced epithelial ovarian cancer?

In epithelial ovarian cancer, first-line adjuvant chemotherapy is necessary, and patients sometimes require protraction; however, there are only a few recent studies to show its influence. In this study, we investigated whether the protraction of the total period of first-line chemotherapy has a negative influence on the survival outcomes. Of the 101 patients we recruited from February 2011 to February 2021, 70 (69.3%) and 31 (30.7%) were classified into the not protracted and protracted groups, respectively. They underwent surgery and adjuvant chemotherapy for epithelial ovarian cancer. Protraction was defined as the overall duration of the first-line chemotherapy being more than 20 days longer than intended. Number of patients who underwent additional treatments such as bevacizumab or poly(adenosine diphosphate ribose) polymerase inhibitors or pembrolizumab was compared between both groups. Kaplan–Meier survival analysis and Cox regression analysis were used for survival outcomes. There was no significant difference for additional treatments. The progression-free survival (PFS) in the total follow-up period in the protracted group was significantly shorter than that in the not protracted group (P = .037); however, the difference in the overall survival between the 2 groups was not significant (P = .223). For the PFS, the hazard ratio of protraction was 1.646 in the univariate analysis (95% confidence interval, 1.020–2.658; P = .041). Excessive protraction of chemotherapy over 20 days or more can result in significantly shorter PFS within 5 years. A better therapeutic strategy is required for patients requiring protracted first-line chemotherapy in advanced epithelial ovarian cancer.

High-quality nursing care on psychological disorder in ovarian cancer during perioperative period: A systematic review and meta-analysis

Background: This study aimed to explore the effect of high-quality nursing care (HQNC) on psychological disorder in patients with ovarian cancer (OC) during the perioperative period (PPP). Methods: A literature search was performed at the Cochrane Library, PUBMED, Excerpt Medica Database, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database from their inception until March 1, 2022. Two authors independently performed study selection, data collection, and methodological quality evaluation. The outcomes were anxiety (as measured by the Self-rating Anxiety Scale), depression (as measured by Self-rating Depression Scale), length of hospital stay, and rate of patient satisfaction. Results: Eight trials involving 742 patients with OC were included in this study. Results of the data analysis showed that patients who received HQNC had a more promising effect on anxiety relief (mean difference, −9.00; random 95% confidence interval, −11.36 to −6.63; P &lt; .001) and depression decrease (mean difference, −7.62; random 95% confidence intervals, −8.45 to −6.78; P &lt; .001) than patients who underwent routine nursing care. Conclusion: This study summarized the latest evidence of HQNC on psychological disorder relief in patients with OC during perioperative period. These findings showed that HQNC may benefit patients with anxiety and depression.

Can adjuvant chemotherapy improve the prognosis of adult ovarian granulosa cell tumors?

Abstract Adult granulosa cell tumors (aGCTs) are rare ovarian neoplasms with a relatively favorable prognosis. They follow an indolent course, characterized by a prolonged natural history and a tendency to late recurrences, Around a quarter of patients develop recurrence and More than 70% of women with recurrence die from their disease, The percentage of patients received chemotherapy increases over time, whether adjuvant chemotherapy improve the prognosis of aGCTs is equivocal? The purpose of this review is to summarize the previously published evidence to evaluate whether adjuvant chemotherapy improve the prognosis of aGCTs to provide guidance for clinical practice. EMBASE, PubMed, Web of Science, WanFang Data and Chinese National Knowledge Infrastructure are searched up to December 2020, used the search strategy of ovar* and granulosa cell* and (tumor* or tumour* or malignan* or cancer* or carcinom* or neoplasm*) and chemotherapy. The screening process was conducted strictly based on inclusion and exclusion criteria. Clinical studies based on human including randomized controlled trial, quasi-randomised controlled trials, nonrandomised trials cohort study and case control study were included without restriction of time. The percentage of patients received chemotherapy increases over time, but the benefit of adjuvant chemotherapy is lack of high-grade evidence of prospective study, based on the current retrospective studies, we still do not have the evidence to confirm the survival benefit of adjuvant chemotherapy in early stage, advanced stage or recurrent aGCT with no residual tumor, but for inoperable disseminated disease or disease with suboptimal cytoreduction, adjuvant chemotherapy maybe an Optable options. Multinational prospective randomised controlled trials are urgently needed to validate the role of adjuvant chemotherapy. Further research on molecular mechanisms and developing novel targeted medicines may improve the survival of aGCTs.

Sister Mary Joseph nodule as cutaneous manifestations of metastatic ovarian cancer

Abstract Rationale: The Sister Mary Joseph's nodule is an umbilical nodule resulting from the metastasis of malignant tumors in the pelvic and/or abdominal cavity. Sister Mary Joseph's nodules are very rare, and the morphology of the skin lesions is not specific and is easily misdiagnosed. Here, we report a case of cutaneous manifestations of metastatic ovarian cancer. Patient concerns: The patient was admitted to our hospital because of abdominal distention, and a nodule was found in the umbilicus. A computerized tomography scan of the entire abdomen showed nodular soft tissue in the subcutaneous fat space of the umbilical area and multiple pelvic masses, which were suspected metastases of peritoneal and omentum ovarian cancer. Interventions: To confirm the pathological diagnosis, posterior fornix puncture was performed. Pathological biopsy showed adenocarcinoma. Histological examination revealed a mass arising from high-grade serous carcinoma of the ovary. The patient received 2 cycles of chemotherapy with paclitaxel liposomes and carboplatin and underwent interval debulking surgery. Postoperative pathology was consistent with high-grade serous carcinoma of the ovary. Cancer involvement was observed in umbilical lesions. After the operation, the patient was given 6 cycles of chemotherapy with paclitaxel liposomes and carboplatin. Outcomes: The patient underwent follow-up until October 2020. A computerized tomography scan of the entire abdomen showed that the lymph nodes in the abdominal cavity were larger than before, suggesting a platinum-sensitive relapse. After receiving the same regimen of chemotherapy, carbohydrate antigen 125 dropped to the normal range, and consolidated treatment was administered for 3 cycles. Owing to her BRCA1 mutations, olaparib was administered for maintenance treatment. Until now, she had been in the outpatient clinic for regular follow-up visits. Lessons: The umbilicus remains an infrequently examined area, which cannot be underestimated and warrants careful clinical follow-up and histological evaluation, as appropriate.

Effect of combined intravenous–inhalation anesthesia on postoperative cognitive dysfunction after laparoscopic radical resection of cervical cancer

Abstract Objective To evaluate the effect of combined intravenous–inhalation anesthesia (CIVIA) on postoperative cognitive dysfunction (POCD) after laparoscopic radical resection of cervical cancer. Methods By using a predefined standardized study protocol, we conducted a systematic review of randomized controlled trials (RCTs) with meta-analysis, searching the following data bases: PubMed, Embase, Web of Science, and Cochrane Library. Results This systematic review evaluated the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer. Conclusion This systematic review provided up-to-date evidence to evaluate the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer. OSF Registration number: DOI 10.17605/OSF.IO/82FNA.

Effects of arsenic trioxide combined with platinum drugs in treatment of cervical cancer

Abstract Introduction: Cervical cancer is the second largest tumor disease threatening female reproductive tract health. AS2O3 is a multi-directional and multi-target anti-cervical cancer drug. It can be combined with platinum drugs to treat cervical cancer. The literatures of AS2O3 combined with platinum drugs related to cervical cancer have shown inconsistent results, and there is currently no high quality of systematic review to evaluate the effects of AS2O3 combined with platinum drugs in cervical cancer patients. Methods and analysis: English and Chinese literature about AS2O3 combined with platinum drugs treatment for cervical cancer published before August 31, 2020 will be systematic searched in PubMed, Embase, Web of Science, Cochrane Library, Open Grey, Clinicaltrials.gov, Chinese Clinical Trial Registry, WANFANG, VIP Chinese Science and Technology Journal Database, CNKI, Chinese biomedical document service system (SinoMed). Only randomized controlled trials (RCTs) of patients with cervical cancer will be included. Literature screening, data extraction, and the assessment of risk of bias will be independently conducted by 2 reviewers, and the 3rd reviewer will be consulted if any different opinions existed. Clinical total effective rate, adverse events, SCCAg, CYFRA21-1, quality of life, and immune function will be evaluated. Systematic review and meta-analysis will be produced by RevMan 5.3 and Stata 14.0. This protocol reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement. Results: The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the fourth quarter of 2021. Conclusion: Efficacy and safety of AS2O3 combined with platinum drugs in the treatment of cervical cancer will be assessed. The results will be published in a public issue journal to provide evidence-based medical evidence for Obstetrician and Gynecologists to make clinical decisions. Ethics and dissemination: Ethical approval is not required as the review is a secondary study based on published literature. The results of the study will be published in peer-reviewed publications and disseminated electronically or in print. Protocol registration number: INPLASY202080130.

Bibliometric analysis of the 100 most cited articles on cervical cancer radiotherapy

To identify the 100 most cited research articles on cervical cancer radiotherapy. The Web of Science and Scopus databases were searched to identify the 100 most cited articles on cervical cancer radiotherapy as of September 29, 2019. Articles were ranked based on the total citations received from 2 databases. One hundred articles about radiotherapy for cervical cancer were identified. The following important information was extracted: author, journal, year and month of publication, country or region, and radiotherapy technologies. The 100 most cited articles on cervical cancer radiotherapy were published between 1964 and 2016, and the total citations from 2 databases ranged from 3478 to 211, including a total of 49,262 citations as of September 29, 2019. The index of citations per year ranged from 170.4 to 13.1. These articles were from 16 countries or regions, with most publications being from the United States (n = 38), followed by Austria (n = 15), Canada (n = 8), France (n = 8) and the United Kingdom (n = 7). The International Journal of Radiation Oncology, Biology, Physics produced the most articles (n = 42), followed by Radiotherapy and Oncology (n = 13), Cancer (n = 8) and Journal of Clinical Oncology (n = 7). These articles were categorized as original studies (n = 86), recommendations (n = 5), guidelines (n = 5) and reviews (n = 4). Of the 100 most cited articles, intracavitary brachytherapy (n = 50) and 3-dimensional conformal radiotherapy (n = 34) were the most commonly used treatment techniques. To the best of our knowledge, this is the first report and analysis of the most cited articles on cervical cancer radiotherapy. This bibliographic study presents the history of technological development in external radiation therapy and brachytherapy. Brachytherapy is an indispensable part of radiotherapy for cervical cancer. The International Journal of Radiation Oncology Biology Physics is the journal with the most publications related to cervical cancer radiotherapy.

Triage human papillomavirus testing for cytology-based cervical screening in women of different ages in primary hospitals

Cervical cancer is a serious global health problem. The objective of this study was to provide a suitable cytology-based cervical screening method in women of different ages in primary hospitals.This study was a retrospective cohort study that included 9765 women who underwent primary cytology-based cervical screening and were grouped by age (35-44, 45-54, and 55-64 years old). Patients with abnormal cytology on the primary cervical thin-prep cytologic test (TCT) were advised to undergo triage human papillomavirus (HPV) test. Furthermore, patients with positive outcomes of the 2 indices underwent cervical tissue biopsy. The positive rate of TCT and HPV was compared among the 3 defined age groups. The sensitivity, specificity, and positive predictive value of TCT and HPV were assessed.In total, 2.5% (241/9765) of women had atypical squamous cells of undetermined significance or worse by TCT. High-risk (HR)-HPV infection was found in 70 triage participants. Neoplastic changes were confirmed in 95 patients (95/437, 21.7%) by biopsies. Among the different age groups, the positive rate of abnormal cytology was significantly different (P = .003), and the positive rate of HR-HPV was similar (P = .299). The sensitivity of initial TCT testing to detect intraepithelial neoplasia was higher than that of triage HPV testing, whereas the specificity, the positive predictive value of triage HPV testing was higher than that of TCT. The Youden index of HPV testing was higher than that of TCT detection in the 3 age groups, namely 0.582 versus 0.432, 0.553 versus 0.228, and 0.416 versus 0.332, respectively.The results of this study indicate that TCT testing is suitable as a cervical cancer screening method for women ≥35 years old in primary hospitals. Triage testing for women with HR-HPV has a high negative predictive value, reduces the rate of misdiagnosis, seems to be an excellent triage method for repeat atypical squamous cells of undetermined significance, and reduces the number of referral colposcopies preventing unnecessary overtreatment. The results of this study provide a crucial foundation for a unified guideline cervical cancer screening for primary health care institutions.

Effects of a multidisciplinary team-led school-based human papillomavirus vaccination health-promotion programme on improving vaccine acceptance and uptake among female adolescents

Abstract Introduction: Evidence has consistently shown the high efficacy of human papillomavirus (HPV) vaccines in preventing cervical cancers. However, the HPV vaccine uptake rate in Hong Kong is very low. We will develop and evaluate an innovative, theory-based multidisciplinary team-led school-based HPV vaccination health-promotion program (MDL-SHPVP), engaging female adolescents, parents/guardians, and secondary school personnel in multicomponent educational strategies and interactive discussions. Methods and analysis: A cluster randomized controlled trial is proposed. We will recruit 2520 female adolescents and their parents/guardians from 18 secondary day schools. The MDL-SHPVP is underpinned by the Health Belief Model and Precaution Adoption Process Model. Multicomponent interventions will be offered, including education sessions with small group dialogues with a registered nurse and trained healthcare and lay volunteers, and educational computer games. A team of volunteers will be established to raise HPV, cervical cancer, and HPV vaccine awareness. Outcomes include adolescents’ uptake of the HPV vaccine, adolescents’ intention to receive HPV vaccination, vaccine acceptance among parents/guardians, and parents’/guardians’ and adolescents’ HPV knowledge, attitudes, and beliefs. Data will be collected at baseline, 1 month, and 1 year after intervention. The generalized estimating equations analysis will be used for comparing the outcomes between the 2 groups. Ethics and dissemination: Ethical approval was obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (Ref. no.: 2019.055). We will disseminate the study findings via peer-reviewed publications and presentations at relevant events and international and local conferences. Trial registration number: ClinicalTrials.gov NCT04438291

Perioperative nursing interventions based on the enhanced recovery after surgery concept for patients with gynecological malignancies: A retrospective study

This study aimed to evaluate the effectiveness of nursing interventions based on the enhanced recovery after surgery (ERAS) concept in the perioperative management of patients with gynecological malignancies. A retrospective analysis was performed on 101 patients who underwent surgery for gynecological malignancies at our hospital from January 2023 to June 2024. Propensity score matching was used to balance baseline characteristics, resulting in 41 patients in the ERAS intervention group and 41 patients in the conventional care group. Logistic regression analysis was applied to significant variables to control for confounders. After propensity score matching, the ERAS group (59.3 ± 9.1 years) and the conventional care group (60.5 ± 8.6 years) had no significant differences in baseline age (P = .45). The ERAS group demonstrated significantly better outcomes compared to the conventional care group. The ERAS group had a higher proportion of patients who resumed oral intake (95.1% vs 65.0%, P &lt; .01) and ambulated within 24 hours (92.7% vs 58.3%, P &lt; .001). The length of hospital stay was shorter in the ERAS group (5.3 ± 1.2 days vs 6.8 ± 1.5 days, P &lt; .001), and the overall complication rate was lower (12.2% vs 28.3%, P &lt; .05). Pulmonary infection and deep vein thrombosis occurred less frequently in the ERAS group (4.9% vs 12.5%, P &lt; .05 and 2.4% vs 8.3%, P &lt; .05, respectively). On postoperative day 7, psychological health scores were significantly better in the ERAS group (10.2 ± 3.1 vs 14.5 ± 4.2, P &lt; .001). ERAS-based nursing interventions significantly improve postoperative recovery, reduce complications, shorten hospital stays, and enhance psychological well-being in patients with gynecological malignancies. Further research is needed to validate long-term outcomes.

A case report of a patient with bulky uterine cervical neoplasm who achieved complete response with “intentional internal high-dose policy” high-dose-rate interstitial brachytherapy

Abstract Rationale Gynecological high-dose-rate (HDR) brachytherapy has progressed for years, but it remains difficult for bulky tumors to be controlled locally. Dose limitations to organs at risk (OARs) are invariably obstacles in increasing the prescription dose. Additionally, it is controversial that the excessive hyperdose sleeve, the volume receiving a dose equal to or greater than twice the reference dose, should be eliminated in gynecological HDR brachytherapy. On the other hand, the technique of simultaneous integrated protection was reported for large hepatocellular carcinoma treatment, and similarly, internal high-dose brachytherapy could be used for treating bulky cervical carcinoma. Patient Concerns A 54-year-old female had irregular genital bleeding and lost 13 kg in one year. Diagnosis She was diagnosed with T3bN1M0 cervical cancer in another hospital. The transverse diameter of the primary tumor was 10.5 cm. Interventions The whole pelvis and para-aortic lymph node were irradiated with a total of 50 Gy in 25 fractions, but the size of the tumor showed only a slight decrease to 8.9 cm. After external beam radiotherapy, first-time high-dose-rate interstitial brachytherapy (HDR-ISBT) was administered without “intentional internal high-dose (IIHD) policy,” the technique of high-dose administration to only the inside of the tumor. Considering the rectum dose limitation, in the additional 2 times of brachytherapy, “IIHD policy” HDR-ISBT was applied. In the second and third HDR-ISBT, the percentage of the volume exposed to 200% of the prescribed dose for high-risk clinical target volume increased by 241% and 204% compared with the first HDR-ISBT, while the doses to OARs were not significantly higher than those of the first-time HDR-ISBT. Outcomes Complete response was obtained, and no recurrence findings and side effects caused by HDR-ISBT have been detected for 2 years and 9 months. Lessons To our knowledge, this is the first report of IIHD HDR-ISBT for bulky cervical cancer. This technique can be the solution for treating bulky cervical cancer.

Skeletal muscle metastasis as a first site of recurrence of cervical cancer

Abstract Rationale: Cervical cancer primarily spreads through direct invasion or via local lymphatics, and hematogenous metastasis is infrequent. Previous reports have shown that lung, liver, and bone are the organs most frequently affected by hematogenous metastasis of cervical cancer, while skeletal muscle is very rarely involved. Patient concerns: A 75-year-old Japanese woman presented with a painful muscular mass in her right lower abdomen. Five years ago, she was treated for her International Federation of Gynecology and Obstetrics stage IB2 cervical adenocarcinoma with radical surgery plus adjuvant chemotherapy. Diagnoses: The patient was diagnosed with isolated oblique muscle metastasis from cervical adenocarcinoma as a first site of recurrence. Interventions: The patient was treated with salvage surgery consisting of partial resection of the oblique muscle and ilium. The tumor was completely excised with an adequate surgical margin by a partial resection of the oblique muscle and ilium Outcomes: The patient is currently free of disease at 10 months after the development of recurrent disease. Lessons: We describe a rare case of isolated oblique muscle metastasis as a first site of recurrence of the International Federation of Gynecology and Obstetrics stage IB2 cervical adenocarcinoma, which was successfully treated with surgery. Although skeletal muscle metastasis is rare, this condition should be considered during the follow-up period, especially when patients complain of muscular pain with insidious progression. The present case and our literature review highlighted the possibility that loco-regional treatment may be curative for selected recurrent cervical cancer developed in skeletal muscles.

Age, absolute CD4 count, and CD4 percentage in relation to HPV infection and the stage of cervical disease in HIV-1-positive women

AbstractA subgroup of women who are co-infected with human immunodeficiency virus type 1 (HIV-1) and human papillomavirus (HPV), progress rapidly to cervical disease. We characterized HPV genotypes within cervical tumor biopsies, assessed the relationships of cervical disease stage with age, HIV-1 status, absolute CD4 count, and CD4 percentage, and identified the predictive power of these variables for cervical disease stage in a cohort of South African women.We recruited 181 women who were histologically diagnosed with cervical disease; 87 were HIV-1-positive and 94 were HIV-1-seronegative. Colposcopy-directed tumor biopsies were confirmed by histology and used for genomic DNA extraction. The Roche Linear Array HPV genotyping test was used for HPV genotyping. Peripheral whole blood was used for HIV-1 rapid testing. Fully automated FC500MPL/CellMek with PanLeucogate (PLG) was used to determine absolute CD4 count, CD4 percentage, and CD45 count. Chi-squared test, a logistic regression model, parametric Pearson correlation, and ROC curves were used for statistical analyses. We used the Benjamini-Horchberg test to control for false discovery rate (FDR, q-value). All tests were significant when bothPand q were &lt;.05.Age was a significant predictor for invasive cervical cancer (ICC) in both HIV-1-seronegative (P &lt; .0001, q &lt; 0.0001) and HIV-1-positive women (P= .0003, q = 0.0003). Sixty eight percent (59/87) of HIV-1-positive women with different stages of cervical disease presented with a CD4 percentage equal or less than 28%, and a median absolute CD4 count of 400 cells/μl (IQR 300–500 cells/μl). Of the HIV-1-positive women, 75% (30/40) with ICC, possessed ≤28% CD4 cells vs 25% (10/40) who possessed &gt;28% CD4 cells (bothP &lt; .001, q &lt; 0.001). Furthermore, 70% (28/40) of women with ICC possessed CD4 count &gt;350 compared to 30% (12/40) who possessed CD4 count ≤ 350 (bothP &lt; .001, q &lt; 0.001).Age is an independent predictor for ICC. In turn, development of ICC in HIV-1-positive women is independent of the host CD4 cells and associates with low CD4 percentage regardless of absolute CD4 count that falls within the normal range. Thus, using CD4 percentage may add a better prognostic indicator of cervical disease stage than absolute CD4 count alone.

A case report of pelviscopic resection of lipoleiomyoma originating from the uterine cervix in a postmenopausal woman

Rationale: Lipoleiomyoma is a rare neoplasm of the uterus. It is considered a variant of uterine myomas. Its reported incidence varies from 0.03% to 0.2%. Lipoleiomyoma consists of variable proportions of mature lipocytes and smooth muscle cells. These tumors generally occur in asymptomatic obese perimenopausal or postmenopausal women. About 90.7% of lipoleiomyomas arise from the uterine corpus, with only 6.5% arising from the cervix. When it occurs in the cervix, it is difficult to diagnose and treat it. We report an uncommon case of pelviscopic resection of uterine cervical lipoleiomyoma showing continuous growth after menopause. Patient concerns: A 55-year-old postmenopausal woman was diagnosed with 40 mm-sized uterine myoma 4 years ago. The size of the mass increased to 58 mm in the last year. Diagnoses: An ultrasound scan revealed a 58 × 34-mm-sized round hyperechogenic and barely vascularity mass that appeared to have originated on the left side of the uterine cervix. Final pathologic findings showed lipoleiomyoma. Interventions: After admission to the hospital, we performed pelviscopic removal of uterine lipoleiomyoma and both tubes. Microscopic examination revealed a significant amount of fat cells between muscle cells. Outcomes: Surgeries were successful. The patient had been followed up regularly for three years after surgery. She did not experience any complications. She remained disease-free. Lessons: Although lipoleiomyomas mainly occur in postmenopausal women, they can also occur in the uterine cervix. They can increase in size after menopause. They can be removed laparoscopically. If a hyperechoic mass occurred in the uterus after menopause that keeps growing without symptoms, a differential diagnosis of lipoleiomyomas must be performed.

The prognostic and therapeutic potential of Claudin-6 and Trop-2 expression as targeted biomarkers in serous ovarian cancer: An observational study

This study aimed to evaluate the prognostic and predictive significance of Claudin-6 and trophoblast cell surface antigen-2 (Trop-2) expression in serous ovarian carcinoma, assessing their influence on treatment efficacy and clinical outcomes. A retrospective cohort of 73 patients diagnosed with serous ovarian carcinoma was analyzed. All patients underwent standard cytoreductive surgery, with or without neoadjuvant or adjuvant chemotherapy. Immunohistochemistry was used to assess the expression levels of Claudin-6 and Trop-2. Survival outcomes were evaluated using Kaplan–Meier and Cox proportional hazards models, with overall survival (OS) as the primary endpoint. High Trop-2 expression was observed in 67.1% of the patients, while 46.6% exhibited high Claudin-6 expression. Both markers were more common in older, postmenopausal patients, those with larger tumors, and those with distant metastasis. However, no significant associations were found with clinical factors (P &gt; .05). Survival analysis demonstrated that high Trop-2 and Claudin-6 expression were associated with shorter OS and progression-free survival (PFS). Patients with high Trop-2 expression exhibited a median OS of 38 months and PFS of 32 months, whereas those with low Trop-2 expression had a median OS of 62 months and PFS of 60 months (OS: P = .039, PFS: P = .020). Similarly, high Claudin-6 expression was associated with a median OS of 32 months and PFS of 21 months, compared to an OS of 60 months and PFS of 56 months in patients with low Claudin-6 expression (OS: P = .005, PFS: P = .003). Both univariate and multivariate analyses confirmed that advanced age, and high Trop-2, and high Claudin-6 expression were significant predictors of poor OS and PFS (P &lt; .05). These findings underscore the prognostic significance of Claudin-6 and Trop-2 in ovarian cancer, with elevated expression correlating with poorer survival outcomes. These markers may serve as independent prognostic factors, and their targeting through antibody–drug conjugates offers a potential therapeutic strategy to improve survival outcomes and overcome treatment resistance.

A case of misdiagnosed leiomyoma of the vulva: A case report

Rationale: Leiomyoma of the vulva is a rare, benign mass that is present on the vulva. Most commonly, they are described as painless, well-circumscribed, solitary tumors that are misdiagnosed as Bartholin cysts before surgery. Patient concerns: A 45-year-old woman presented with a case of vulvar leiomyoma misdiagnosed as Bartholin cyst preoperatively. A solitary swelling mass measuring 3 cm × 2 cm was found in the left labia majora at the Bartholin gland site on physical examination. Diagnoses: A vulvar mass extent and vascularity may be determined by imaging. A color doppler flow imaging of the posterior vaginal wall revealed abundant blood flow. Intervention: To confirm vulvar leiomyoma, surgery and histopathology were performed. Outcome: After 2 months of follow-up, there were no signs of recurrence in the patient. Lessons: Rare vulvar leiomyomas are often mistaken for Bartholin’s cysts. It is also difficult to distinguish benign from malignant forms, making vulvar leiomyoma a difficult diagnosis. As there are a few techniques used to differentiate between the nature of the tumor, excisional biopsy seems to be the best current procedure employed in addition to being the treatment of choice for such tumors.

Successful treatment of metastatic vulvar malignant melanoma with toripalimab: A rare case report and review of the literature

Rationale: Vulvar melanoma is a rare and aggressive tumor with a high risk of local recurrence and distant metastasis. The prognosis is poor with a 5-year overall survival rate of only 46.6%. Management of vulvar melanoma remains a clinical challenge. Recent evidences have shown that immune checkpoint inhibitors are effective in the treatment of vulvar melanoma. Patient concerns and diagnoses: A 63-year-old woman with vulvar malignant melanoma suffered inguinal lymph node metastasis after vulvectomy and chemotherapy. She underwent inguinal lymph node dissection and inguinal radiotherapy. The tumor progressed again and she received immunotherapy. Interventions: The tumor progressed again, and she was admitted to our hospital and received toripalimab combined with apatinib and abraxane. Outcomes: After 6 cycles of immunotherapy, the efficacy achieved partial remission. And with toripalimab as maintenance therapy, the patient achieved durable antitumor efficacy and good safety. Lessons: In this rare case, the patient with metastatic vulvar malignant melanoma had durable antitumor efficacy and good safety when receiving toripalimab.

Closing the diagnostic gap: Liquid biopsy potential to transform ovarian cancer outcomes in sub-Saharan Africa

Ovarian cancer presents a significant health challenge in sub-Saharan Africa (SSA), where late-stage diagnosis contributes to high mortality rates. This diagnostic gap arises from limited resources, poor healthcare infrastructure, and a lack of awareness about the disease. However, a potential game-changer is emerging in the form of liquid biopsy (LB), a minimally invasive diagnostic method. This paper analyses the current diagnostic gap in ovarian cancer in SSA, highlighting the socio-economic, cultural, and infrastructural factors that hinder early diagnosis and treatment. It discusses the challenges and potential of LB in the context of SSA, emphasizing its cost-effectiveness and adaptability to resource-limited settings. The transformative potential of LB in SSA is promising, offering a safer, more accessible, and cost-effective approach to ovarian cancer diagnosis. This paper provides recommendations for future directions, emphasizing the need for research, infrastructure development, stakeholder engagement, and international collaboration. By recognizing the transformative potential of LB and addressing the diagnostic gap, we can pave the way for early detection, improved treatment, and better outcomes for ovarian cancer patients in SSA. This paper sheds light on a path toward better healthcare access and equity in the region.

Gastric-type endocervical adenocarcinoma with mucoepithelial metaplasia combined with a serous borderline tumor

Abstract Rationale: Gastric-type endocervical adenocarcinoma (GAS) is a rare type of cervical adenocarcinoma that is a mucinous adenocarcinoma with a variety of gastral patterns. To date, there are no systematic clinical diagnosis and treatment guidelines. Patient concerns: In our case, a 49-year-old woman underwent pelvic magnetic resonance imaging (MRI) due to a pelvic mass, and cervical lesions were unexpectedly found. After receiving relevant surgical treatment, the pathological results showed the particularity of the tumor type—cervical gastric adenocarcinoma with a borderline serous tumor of both appendages and the right ovary. Diagnoses: Postoperative routine pathological examination showed mucoepithelial metaplasia accompanied by a borderline serous tumor. Interventions: After gynecological/urinary ultrasound, blood tests, MRI, cervical biopsy, and uterine curettage, “robot-assisted laparoscopic radical hysterectomy + bilateral salpingectomy-ovariectomy + pelvic lymph node dissection + pelvic adhesiolysis” were performed. After the surgery, the patient was treated with radiotherapy and concurrent chemotherapy. Outcomes: After the operation, radiotherapy, and chemotherapy, the patient had no tumor recurrence and is still in good condition. Lessons: The diagnosis of GAS is relatively difficult, its clinical manifestations lack specificity, and the pathogenesis has nothing to do with human papillomavirus infection. The patient was misdiagnosed with vaginitis at a local hospital. However, we found that MRI and pathological examination were helpful for the diagnosis of the disease. Although there are no relevant guidelines to explain the treatment principles of GAS, we believe that early surgery is conducive to the prognosis of the disease because GAS has a certain tolerance to radiotherapy and chemotherapy.

Prognostic value of lymph node ratio in cervical cancer: A meta-analysis

Background: The role of the lymph node ratio (LNR) in the existing tumor node metastasis classification system should be verified as one of the prognosis prediction factors. This work evaluated LNR’s performance in predicting cervical cancer (CC) prognosis through a meta-analysis. Method: Related studies were retrieved from the Cochrane Library, EMBASE, and PubMed databases. The language was restricted to English. The combined hazard ratios (HRs) were utilized to analyze the prognostic value of LNR. Results. Our study included 8 articles with 3325 subjects published after 2015. Based on our analysis, high LNR was the adverse prognostic factor for overall survival (OS, HR = 1.45; 95% CI = 1.23–1.73; P = .238) and disease-free survival (DFS, HR = 2.69; 95% CI = 1.98–3.66; P = .597) among the CC cases. Furthermore, as revealed by subgroup analysis, in CC patients, median LNR of about 0.0625 and 0.066 served as the prominent risk factor for DFS and OS. Conclusions: The current work illustrates that elevated LNR is related to the dismal prognosis of CC. More well-designed clinical studies are warranted for assessing whether LNR is a factor independently predicting the prognosis of CC.

Efficacy and safety of Buzhong Yiqi Decoction in improving cancer-related fatigue and immunity of cervical carcinoma patients

Abstract Background: Cancer-related fatigue (CRF) is essentially universal in cervical carcinoma patients. It develops rapidly, with physical and mental manifestations including generalized weakness, diminished concentration or attention, and it has a negative impact in overall quality of life. Buzhong Yiqi Decoction (BYD), a classical Chinese medical prescription, could be used for allergic rhinitis, gut microbiota disorders, and chronic obstructive pulmonary disease. We preliminarily found that BYD could relieve CRF in cervical carcinoma patients. However, there are few trials on whether BYD could relieve CRF and improve immunity in cervical carcinoma patients. Methods: This is a double-blinded, randomized, controlled clinical trial. From December 1, 2021 to May 31, 2022, cervical carcinoma patients with CRF will be assessed for randomization into treatment group (BYD) and control group (BYD simulation) in a 1:1 ratio. The outcomes are cancer fatigue scale, self-rating anxiety scales, self-rating depression scales, Pittsburgh sleep quality index, and immunity index (CD3+, CD4+, and CD8+) before and after the treatment. Statistical analysis will be performed using SPSS v22.0 software. Results and conclusions: The study will clarify the efficacy and safety of BYD in improving CRF and immunity in cervical carcinoma patients. Trial registration: OSF Registration number: DOI 10.17605/OSF.IO/QFNMD.

Synchronous occurrence of HPV-associated cervical squamous cell carcinoma (FIGO IIA) in prolapsed uterus and adenocarcinoma of the anal canal cT1N0M0

Abstract Rationale: Guidelines of rare synchronous tumours treatment are often unavailable due to lack of wide prospective studies. Additionally, their management is not just a simple sum of coexisting tumours management and has to regard many circumstances like symptoms, age, comorbidities, advancement. Patient concerns: Herein, we report a case of an 81-year-old woman who presented with bleeding from the prolapsed uterus. Diagnoses: Based on physical examination, that is, speculum examination, bimanual, and per rectum, followed by rectoscopy and histopathology, the diagnosis of cervical squamous cell carcinoma FIGO IIA2 in prolapsed uterus with anal canal adenocarcinoma cT1N0M0 was made. Interventions: Dominating complaint of bleeding from prolapsed cervix was managed with radical vaginal hysterectomy in conjunction with wide colpectomy preceded by laparoscopic pelvic and paraaortic lymphadenectomy. Due to the lack of consent for removal of the anus, only radiotherapy was applied instead. Outcomes: The patient underwent magnetic resonance image follow-up. No recurrence was found at 18 months. Lessons: Imaging is useful method of synchronous cancers diagnostics. These cancers may vary in aetiology and stage. Cervical cancer may be co-existing with another anogenital cancer. Therapy of synchronous cancers should be individualized taking into account patient's consent, age, physical condition, and comorbidities.

A rare case of nevus sebaceous of the bilateral labia minora

Abstract Rationale: Nevus sebaceous (NS) is a lesion caused by congenital hyperplastic disorder of the sebaceous glands. It commonly noted in the scalp and face and rarely in the trunk, neck, or oral mucosa. We present a rare case of a lesion arising in the genital region. Patient concerns: A 47-year-old woman complained of a gradual increase in the size of her bilateral labia minora over 2 years, which affected her sexual life and caused walking difficulty. She was admitted to the Department of Obstetrics and Gynecology. On physical examination, no ulcer, discharge, and vulval or vaginal bleeding were found. The bilateral inguinal lymph nodes were not palpable, bilateral labia minora were asymmetric, and the right side was evidently bigger than the left. The labia minora had serrated edges and numerous papillae with a maximum diameter of 0.5 cm. The vagina, cervix, and uterus with its attachments were normal. Blood samples tested negative for human immunodeficiency virus, human papilloma virus, hepatitis B virus, and hepatitis C virus. Diagnosis: A diagnosis of NS of the bilateral labia minora was made following histopathological examination of the resected specimen. Intervention: The bilateral labia minora lesions were resected general anesthesia on August 29, 2016. The operation was successful, and intraoperative blood loss was about 10 ml. Outcomes: After 40 months of postoperative follow-up, no recurrence or appearance of other tumors were noted. Lessons: We recommend surgical removal of lesions in the genital area during adolescence or before adulthood. Adolescence may be the best period for surgical intervention owing to a greater risk of malignant change in adulthood. On the other hand, surgical risk should be avoided in children considering the low incidence of malignant transformation.

Expression of lipoma preferred partner in mammary and extramammary Paget disease

Abstract Backgound: This study aims to identify the expression of lipoma preferred partner (LPP) in Paget disease (PD) and to further understand the pathogenesis of PD. Methods: Tissue microarray was used to evaluate the expression of LPP by immunohistochemistry in 40 PD patients. The results of LPP expression were combined with clinical and histopathological characteristics. Patient files were analyzed retrospectively. Results: Twenty-one cases were mammary Paget disease (MPD) and 19 extramammary Paget disease (EMPD) involving the vulva, scrotum, and penis. LPP was expressed in PD and this expression was significantly greater in MPD versus EMPD (P = .031). The expression of LPP in MPD was significantly related with age (P = .009) and expression of Ki-67 (P = .011). No statistically significant differences were observed in LPP expression as related to sex, body location, and time of PD diagnosis. Conclusions: While LPP is expressed in both MPD and EMPD, the intensity of this expression is greater in MPD. LPP expression is positively correlated with Ki-67 and is more prevalent in middle-aged versus senior MPD patients. Further research is needed to determine its potential role in tumorigenesis and distribution.

An online survey on emotions, impact on everyday life, and educational needs of women with HPV positivity or abnormal Pap smear result

Abstract This study aimed to evaluate the emotional path, impact on everyday life, and adequacy of patient education throughout the diagnostic and therapeutic journey of women who received a positive human papillomavirus (HPV) test or Pap smear result. An online survey was designed to determine the demographic characteristics, dominant feelings throughout the diagnostic and therapeutic procedures, major lifestyle changes, impact on social life, and perceived adequacy of patient information in Italian women with a positive HPV test or abnormal cervical cytology result. In this study, the phases of the “patient's journey” included the initial test, waiting for colposcopy or biopsy, waiting for surgery, and follow-up. Anxiety, worry, and fear were the most frequently cited emotions during the initial tests and intervals between procedures. Anxiety and fear gradually decreased during the journey until surgery, and higher levels of optimism were observed postsurgery. The most frequently reported lifestyle changes were attempts to boost the immune system, increased precautions in sexual practices, and dietary changes. Social life is affected by changes in sexual and intimate relationships with partners. Women reported receiving insufficient patient education on the diagnosis and its implications, progression, management, personal care, and resolution. Significant attention should be given to the psychosocial aspects of the entire patient journey after receiving a positive HPV test or an abnormal Pap smear result. It is essential to establish a good rapport between patients and healthcare professionals, and to educate women regarding the condition by minimizing the gap between the perceived and desired adequacy of information.

Long-term oncological outcome in patients with cervical cancer after 3 trimodality treatment (radiotherapy, platinum-based chemotherapy, and robotic surgery)

Abstract Cervical cancer represents a general health issue spread all over the globe, which prompts the surge of scientific survey toward the rise of survival and condition of life of these patients. American and European guidelines suggest the open surgery, laparoscopic, and robotic surgery are the main therapeutic approaches for radical hysterectomy for patients with cervical cancer. This is the first survey to analyze the long-term oncological outcome of an extensive series of subjects cared for with multimodality treatment, here comprising robotic surgery. This study intents to evaluate the long-term oncological result in patients diagnosed with cervical cancer treated with radiotherapy (±chemotherapy) and robotic surgery compared with open surgery. Medical files of 56 patients diagnosed with cervical cancer who underwent a robotic hysterectomy and radiotherapy ± chemotherapy were retrospectively analyzed. The median age at diagnosis was 50.5 (range: 23–70). Eleven patients (19.6%) presented in an early stage (IB–IIA) and 80.4% advanced stage (IIB–IVA). Overall response rate after radiotherapy and chemoradiotherapy was 96.2%. Pathologic complete response was obtained in 64% of patients. After a median follow-up of 60 months (range: 6–105 months), 8 patients (14.2%) presented local recurrence or distant metastases. Disease-free survival (DFS) was 92% at 2 years and 84% at 3 and 5 years. Overall survival (OS) rates at 2, 3, and 5 years for patients with robotic surgery were 91%, 78%, and 73%, median OS not reached. OS was lower in the arm of open surgery (2, 3, and 5 years 87%, 71%, and 61%, respectively; median OS was 72 months P = .054). The multivariate analysis regarding the outcome of patients revealed an advantage for complete versus partial response (P &lt; .002), for early versus advanced stages (P = .014) and a 10% gained in DFS at 3 years for patients in whom chemoradiotherapy was administered (DFS at 3 years 75% vs 85%) in patients with advanced stages. Robotic surgery has a favorable oncological outcome when associated with multimodal therapy.

The profile analysis of circular RNAs in cervical cancer

Abstract Cervical cancer (CC) is the third most common cancer among women and has a high mortality rate at the advanced stage. The mechanisms underlying the development and progression of CC are still elusive. Circular RNAs (circRNAs) play an important role in various physiological and pathological processes. The aim of this study was to identify the circRNAs significantly associated with cervical squamous cell carcinoma (CSCC), in order to discover novel diagnostic markers and elucidate their mechanistic basis. The circRNA expression profiles of CSCC and paired para-cancerous cervical tissues was downloaded from the Gene Expression Omnibus. Bioinformatics analysis were used to screen for the differentially expressed circRNAs (DECRs). The expression levels of hsa_circ_0000745, hsa_circ_0084927, hsa_circ_0002762, hsa_circ_0075341, hsa_circ_0007905, hsa_circ_0031027, hsa_circ_0065898, hsa_circ_0070190, and hsa_circ_0078383 were verified in CC and normal cervical tissues by quantitative real-time PCR. A total of 197 DECRs were identified between the CSCC and normal tissues, including 87 upregulated and 110 downregulated circRNAs. In addition, 37 miRNAs were predicted for the upregulated circRNAs and 39 for the downregulated circRNAs. Functional analysis showed that the DECRs were associated with positive regulation of substrate adhesion-dependent cell spreading, metabolism, positive regulation of GTPase activity, protein regulation, and intercellular adhesion. The MAPK signaling pathway that plays a significant role in the progression of CC, was also enriched. Consistent with the in-silico analysis, hsa_circ_0000745, hsa_circ_0084927, hsa_circ_0002762, hsa_circ_0007905 were upregulated and hsa_circ_0078383 was downregulated in CC tissues (P &lt; .001), whereas hsa_circ_0075341 (P &lt; .001) and hsa_circ_0031027 (P = .001) showed opposite trends. We identified novel diagnostic and therapeutic biomarkers of CSCC along with the mechanistic basis.

HIV prevalence in patients with cervical carcinoma

Abstract The Human Immunodeficiency Virus (HIV) seropositive prevalence among women with cervical cancer varies in different parts of the world and even within a country. This study aimed to document the prevalence of HIV infection in women with newly diagnosed cervical cancer at a secondary hospital in South Africa. This study is a retrospective review of records of 89 women who were newly diagnosed with cervical cancer between 01 June 2010 and 31 May 2013 at Pelonomi Hospital, Mangaung, South Africa. Data such as age, parity, gravidity, marital status, occupation, HIV status, CD4 count, on anti-retroviral treatment, clinical stage of disease were retrieved from the case files, the Meditech-patient record and Disa laboratory system. Data analysis was done using the SAS statistical package. HIV-seropositive prevalence was 52.4%, with the highest prevalence (91.3%) in the age group 40 years and younger. In HIV-positive women, the mean CD4 cell count was 280 cell/mm3 and 43% of them were not on anti-retroviral treatment. The majority (86%) of all patients presented with late stage disease (International Federation of Gynecology and Obstetrics Stage III and IV) when newly diagnosed with cervical cancer. This study highlights high HIV-seropositive prevalence; severe immunosuppression and late presentation of the disease in women newly diagnosed with cervical cancer. Cervical cancer screening programs need to be fully reinforced into existing HIV health care services to allow for ideal prevention and early detection of the disease. Anti-retroviral treatment needs to be prioritized for HIV-positive women.

Neoadjuvant chemotherapy with paclitaxel plus cisplatin before radical surgery for locally advanced cervical cancer during pregnancy

Abstract Rationale: Despite the development of human papillomavirus vaccines and significant improvement in cervical cancer screening over the past few years, cervical cancer remains the fourth most common cancer in women of childbearing age after breast cancer, melanoma, and thyroid cancer. Patient concerns: In this case report, the patients are all cervical cancer with stage IB2 and IB3 during pregnancy, the management constitutes a major medical challenge related to the impact of treatment on both maternal and fetal outcomes. Neoadjuvant chemotherapy (NACT) is an innovative option for cervical cancer patients with stage IB2 and IB3 before cesarean delivery and radical hysterectomy, and many chemotherapeutic agents are available, cisplatin plus paclitaxel yielded good maternal and fetal outcomes to the authors’ knowledge. Diagnoses: Masses were discovered in the cervix of 4 pregnant women with a history of vaginal bleeding. Biopsy examination of the masses revealed cervical carcinoma, which was staged in accordance with the International Federation of Gynecology and Obstetrics (i.e., FIGO) system. Interventions: The patients were treated with paclitaxel plus cisplatin, followed by cesarean delivery and radical hysterectomy. Outcomes: The 4 patients were treated successfully, with no recurrence during follow-up periods of 14 to 56 months, and all of the children were doing well with no anomalies. Lessons: Although further data are required, in pregnant women with invasive cervical cancer, NACT with cisplatin plus paclitaxel followed by cesarean delivery and radical hysterectomy was a practical treatment option.

Predictive value of preoperative serum squamous cell carcinoma antigen level for lymph node metastasis in early-stage cervical squamous cell carcinoma

Abstract To explore the predictive value of preoperative serum squamous cell carcinoma antigen (SCC-Ag) level for lymph node metastasis (LNM), particularly, in patients surgically treated for early-stage cervical squamous cell carcinoma. We enrolled 162 patients with cervical squamous cell carcinoma stages IB to IIA following the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification. The patients had previously undergone radical surgery. Correlation of the SCC-Ag level with clinicopathological features and the predictive value of SCC-Ag for LNM were analyzed. High preoperative SCC-Ag level was correlated with FIGO stage (P = .001), tumor diameter &gt;4 cm (P &lt; .001), stromal infiltration (P &lt; .001), LNM (P &lt; .001) and lymphovascular space invasion (LVSI), (P = .045). However, it was not correlated with age, histological differentiation, parametrial involvement, and positive vaginal margin (P &gt; .05). Univariate analysis revealed that FIGO stage (P = .015), tumor diameter (P = .044), stromal infiltration (χ2 = 10.436, P = .005), SCC-Ag ≧ 2.75 ng/mL (χ2 = 14.339, P &lt; .001), LVSI (χ2 = 12.866, P  &lt; .001), parametrial involvement (χ2 = 13.784, P &lt; .001) were correlated with LNM, but not with age, histological differentiation, and positive vaginal margin. Moreover, multivariate analysis demonstrated that SCC-Ag ≧2.75 ng/mL (P = .011, OR = 3.287) and LVSI (P = .009, OR = 7.559) were independent factors affecting LNM. The area under the receiver operator characteristic curve of SCC-Ag was 0.703 (P &lt; .001), while 2.75 ng/mL was the best cutoff value for predicting LNM. The sensitivity and specificity of diagnosis were 69.4% and 65.9%, respectively. High SCC-Ag level was revealed to be an independent risk factor for the prognosis of squamous carcinoma of the cervix before an operation. Besides, SCC-Ag (2.75 ng/mL) can be utilized as a potential marker to predict LNM in early stage cervical cancer before an operation.

Primary signet ring cell carcinoma of the uterine cervix

Abstract Rationale: Primary signet ring cell carcinoma of the uterine cervix is extremely rare and the clinical characteristics and prognosis are not well known and there are no specific guidelines for treatment. Patient concerns: A 43-year-old woman was referred to our hospital for abnormal uterine bleeding lasting 1 month. Diagnoses: Histological examination revealed a signet ring cell carcinoma of the uterine cervix. After evaluation of extragenital origin, the patient was diagnosed International Federation of Gynecology and Obstetrics stage IIIC1 primary signet ring cell carcinoma or the uterine cervix. Intervention: The patient was prescribed concomitant chemo-radiation followed by intracavitary brachytherapy. Outcomes: She showed no evidence of disease after treatment but, it recurred after 7 months of last treatment. Lessons: Different approaches to diagnosis and treatment of this rare disease are needed and molecular pathological studies related to the onset of the disease are required.

The significance of m6A RNA methylation modification in prognosis and tumor microenvironment immune infiltration of cervical cancer

Recent studies have highlighted that N6-methyladenosine (m6A) plays a significant role in tumorigenicity and progression. However, the mechanism of m6A modifications in the tumor microenvironment (TME) immune cell infiltration in cervical cancer (CC) remains unclear. Clinical and RNA sequencing data of 25 m6A RNA methylation regulators were acquired from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database. LASSO Cox regression analysis was used to generate a prognostic risk signature. m6A modification patterns were identified based on the expression of 25 m6A regulators, and their correlation with TME immune cell-infiltrating characterization was analyzed. Principal component analysis was used to construct an m6A-scoring signature (m6A score) to evaluate the m6A modification patterns of individual CC samples and guide the selection of more effective immunotherapeutic strategies. Genetic and expression alterations of 25 m6A regulators were highly heterogeneous between CC and normal tissues. METTL14 and IGF2BP1 were selected to conduct the prognostic risk signature. Three m6A modification patterns were identified in 659 CC samples, which were associated with distinct clinical outcomes and biological pathways. The TME immune cell-infiltrating characterization of the three m6A modification patterns was highly consistent with 3 tumor immune phenotypes, including immune-excluded, immune-inflamed, and immune-desert phenotypes. Due to the heterogeneity of m6A modification patterns, an m6A scoring signature was established to evaluate the m6A modification patterns of individual CC samples. Univariate and multivariate Cox regression analyses revealed that the m6A score is a robust and independent prognostic biomarker for assessing the prognosis of CC patients. A low m6A score, characterized by higher somatic mutation and higher expression of proliferation-related and DNA repair-related genes, indicated poor overall survival. Activation of immune infiltration was exhibited by the high m6A score, which was likely to have a good response and clinical benefits to antiPD-1/L1 immunotherapy. This study highlights the prognostic value of 25 m6A regulators in CC. The m6A modification is related to immune regulation and the formation of TME heterogeneity and complexity. An m6A scoring signature to clarify the individual m6A modification pattern could enhance our understanding of TME immune cell-infiltrating characterization and guide immunotherapy strategies.

The prevalence and genotype distribution of human papilloma virus in cervical squamous intraepithelial lesion and squamous cell carcinoma in Taizhou, China

Abstract Human papillomavirus (HPV) infection is a common sexually transmitted disease worldwide and the leading cause of cervical cancer. Current vaccines do not cover all HPV genotypes whereas the distribution of HPV genotypes varies in different geographic regions. The study aimed to investigate the distribution of HPV genotypes in patients with cervical squamous intraepithelial lesion (SIL) and cervical squamous cell carcinoma (SCC) in Taizhou City of Jiangsu Province, China. A total of 940 patients including 489 cases with cervical low-grade squamous intraepithelial lesions (LSIL), 356 cases with cervical high-grade squamous intraepithelial lesions (HSIL), and 95 cases with cervical SCC, underwent a biopsy or surgery in Taizhou People's Hospital between January 2019 and December 2019. The HPV testing results were retrospectively analyzed. The overall prevalence of any, high-risk, and low-risk HPV was 83.83%, 81.91%, and 12.13%, respectively. The 5 most common HPV genotypes were HPV16 (35.64%), HPV52 (16.91%), HPV58 (13.94%), HPV33 (8.94%), and HPV18 (7.98%). The prevalence of any and HR-HPV in SCC was significantly higher than those in LSIL and HSIL, while the prevalence of LR-HPV in SCC was significantly lower than those in LSIL and HSIL (P &lt; .01). Single and dual HPV infections were prevalent in SCC, LSIL, and HSIL. Furthermore, the prevalence of dual HPV infection in SCC was significantly higher than those in LSIL and HSIL (P = .002). The HPV prevalence varied by age, being highest among women with SCC, LSIL, and HSIL aged 40 to 49 years, 40 to 49 years, and 50 to 59 years, respectively. In conclusion, the findings revealed a very high prevalence of HPV in women with cervical lesions in Taizhou. Routine HPV tests must cover all common HPV genotypes in clinical practice.

Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization

Abstract This study was to identify the predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN) after cervical conization. Totally 415 patients with CIN ≥ II who underwent loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) were included in this retrospective study. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between postoperative recurrence and clinicopathological data. After the mean follow-up of (21.48 ± 5.82) months, 90 (21.69%) out of 415 cases were subjected to recurrence after cervical conization. The influencing factors for postoperative recurrence included times of full-term birth, history of preterm birth, history of abortion, positive margin, cone length, width, depth, smoking, and history of complicating diseases (P &lt; .05). Multivariate Cox model indicated the positive margin (HR = 2.144, 95% CI: 1.317–3.492, P &lt; .05), history of preterm birth (HR = 4.515, 95% CI: 1.598–12.754, P &lt; .05), history of complicating diseases (HR = 3.552, 95% CI: 1.952–6.462, P &lt; .05) were independent risk factors for recurrence after cervical conization. The restricted cubic diagram showed that the cone depth &gt;0.5 cm was a protective factor for postoperative recurrence. For the patients with high-grade CIN after cervical conization, positive margins, histories of preterm birth, and complicating diseases were associated with increased risk of recurrence, but cone depth (&gt;0.5 cm) with lower risk of recurrence.

The association between rs1800872 polymorphism in interleukin-10 and risk of cervical cancer

Abstract Background: In recent years, several reports have tried to prove this connection between rs1800872 polymorphism in interleukin-10 and cervical cancer among different populations, but the results are debatable. Thus, we collected all the published literature and conducted an integrated meta-analysis, which provided better evidence-based medicine for the relationship between rs1800872 polymorphism in interleukin-10 and risk of cervical cancer. Methods: We systematically performed our search on PubMed, EMBASE, Web of Science, WanFang database, and CNKI for all papers related to this research, published up to August 1, 2020. Summary odds ratios (OR) with 95% confidence interval (95% CI) were calculated in allelic, homozygous, heterozygous, dominant, and recessive model to appraise the association. Results: The meta-analysis included 8 studies containing 1393 cervical cancer cases and 1307 controls. The aggregate data under heterozygous model and dominant inheritance model (OR = 0.66, 95% CI: 0.55--0.80) indicated a significant association between rs1800872 and the low risk of cervical cancer in the entire population. And the aggregated data under the dominant inheritance model shows that rs1800872 is significantly associated with the reduction in the risk of cervical tumors in the entire population. Conclusion: Our conclusion is that the AC/AA + AC variant of Rs1800872 indicates a protective effect in the development of cervical cancer.

A fertility-sparing surgery in lymphoepithelioma-like carcinomas of the uterine cervix: A case report

Introduction: A poorly differentiated lymphoepithelioma-like carcinoma (LELC) of the cervix is an extremely rare presentation. We herein present an unusual case of LELC of the cervix, which was treated with radical trachelectomy for fertility preservation. Patient concerns: A 28-year-old female patient presented with a 1-month-history of post-coital vaginal bleeding, and a 2 cm tumor was found on gynecological sonography and magnetic resonance imaging. Diagnosis: The final pathological examination established a conclusive diagnosis of LELC of the cervix. After surgery, the patient was finally diagnosed as The International Federation of Gynecology and Obstetrics (FIGO) stage IB1 with no vaginal wall or parametrium infiltration. Interventions: Subsequently, a surgery was scheduled, and intraoperatively, we performed resection twice because of a frozen biopsy result that was resection margin-positive initially. As a result, further resection was performed, which was a 5mm thickness for each. Cisplatin adjuvant chemotherapy was administered 3 weeks after the operation to prevent recurrence. Outcomes: The patient has been followed for 1 year postoperatively, with an adjuvant treatment, with no evidence of tumor recurrence or metastasis. Conclusion: Based on this case, we highly recommend that operators should consider a deeper resection margin range than that visible on magnetic resonance imaging. More attention is needed to better understand the treatment method for LELC of the cervix. We also plan to closely monitor the patient’s prognosis and fertility, and to conduct additional studies.

Hydronephrosis in patients with cervical cancer is an indicator of poor outcome

Abstract Cervical cancer is a common malignancy in women. The presence of hydronephrosis in patients with cervical cancer can be a challenging clinical problem. The appropriate management of these patients and the prediction of their outcomes are concerns among gynecologists, urologists, medical oncologists, radiation oncologists, and nephrologists. We enrolled a total of 2225 patients with cervical cancer over a 12-year period from the nationwide database of Taiwan's National Health Insurance Bureau. Among them, 445 patients had concomitant hydronephrosis. The remaining 1780 patients without hydronephrosis were randomly enrolled as a control group for the analysis of associated factors. The results indicated that the proportions of patients with hypertension, chronic kidney disease, and diabetes were significantly higher in the hydronephrosis group. The hydronephrosis group showed a higher all-cause mortality than the non-hydronephrosis group (adjusted hazard ratio 3.05, 95% confidence interval 2.24–4.15, P &lt; .001). The rates of nephrectomy and stone disease were also significantly higher in the hydronephrosis group. A higher percentage of other cancers was also observed in the hydronephrosis group than in the non-hydronephrosis group (12.36% vs 8.99%, respectively). This study shows that cervical cancer with hydronephrosis may have a higher morbidity and mortality than cervical cancer without hydronephrosis. Other factors such as human papilloma virus vaccination, smoking, and cancer staging need to be further studied.

Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors

Abstract This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life. Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at P &lt; .05. The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12 months of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12 months. Starting VD therapy ≤3 months after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12 months of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12 months of dilation. Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3 months after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12 months. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.

Condyloma acuminatum mimicking cervical cancer in a pregnant woman and treatment with cryotherapy: A case report

Rationale: Condyloma acuminata and anogenital warts are protruding papillomatous lesions caused by human papillomavirus. In pregnant women, condyloma acuminata over the cervical region may grow rapidly, mimicking cervical cancer. Patient concerns: A pregnant woman at 14 weeks of gestation with condyloma acuminatum mimicking cervical cancer was referred to our hospital for further management. Diagnosis: Condyloma acuminata. Interventions: Tumor biopsy was performed twice, and the pathology confirmed condyloma acuminatum. Immunohistochemistry revealed focal positivity for p16 and Ki-67. Cryotherapy was performed and regular follow-up was performed at 2-week intervals. A small residual condyloma acuminata was found and treated with cryotherapy. Outcome: During the follow-up period, no recurrence of condyloma acuminata was noted. She delivered a baby at 37 weeks of gestation via cesarean section, without complications. Lessons: Condyloma acuminata of the cervix may grow faster during pregnancy, mimicking cervical cancer. Multiple factors must be considered when treating condyloma acuminata during pregnancy. Cryotherapy is proposed as a 1st-line treatment in all trimesters because of its safety, convenience, and cost-effectiveness. Serial follow-up at 2-week intervals to observe post-cryotherapy conditions is recommended.

A retrospective study of immunotherapy using the cell wall skeleton of Mycobacterium bovis Bacillus Calmette-Guérin (BCG-CWS) for cervical cancer

Mycobacterium bovis Bacillus Calmette-Guérin (BCG) has the potential to promote adaptive immunity. We sought to examine the synergistic effect of BCG-CWS vaccination on cervical cancer patients undergoing standard treatments including surgery, chemotherapy, and/or radiation. We retrospectively analyzed 103 patients (13 cases administered with BCG-CWS vaccine and 90 controls without BCG-CWS) who underwent a standard treatment for cervical cancer from 2005 to 2021. The BCG-CWS group underwent repeated intradermal injections of the BCG-CWS vaccine before or immediately after the standard therapy start from 2011 to 2018. The vaccination was repeated weekly for 1 month, and then every 4 weeks thereafter. The effectiveness of the BCG-CWS vaccination on cervical cancer treatment was evaluated by determining the hazard ratios of overall survival between the BCG-CWS group and the control group with multivariate analysis using the Cox model. Hazard ratios between 2 groups were determined after adjustment by clinical parameters including surgery, chemotherapy, radiation, age, clinical stage, presence of human papillomavirus, and pathology. Long-term follow-up revealed a significantly better prognosis (hazard ratio: 0.2108, P = .008 by the Cox model) for patients with cervical cancer in the BCG-CWS group compared to patients in the control group. Among patients with advanced cancer worse than stage IB2, some completely cleared the disease, whereas the others showed long-term survival with recurrence. BCG-CWS therapy appears to be an effective immune adjuvant therapy for cervical cancer, although randomized control studies are needed to confirm this. We also need to clarify the underlying mechanisms slowing the progression of cervical cancer in those receiving this vaccination. This study sheds light on the potential of immunostimulatory drugs such as BCG-CWS and suggests the important role of immunity for cancer elimination in combination therapy.

Construction of prognosis model of pyroptosis gene and characterization of tumor microenvironment infiltration in cervical cancer

Pyroptosis has been demonstrated in recent years to be an inflammatory form of programmed cell death. However, the prognostic evaluation of cervical cancer (CESC) to pyroptosis is insufficient and their correlations with prognosis remain unclear. In this study, we identified 15 differentially expressed pyroptosis-related genes between tumor samples and normal samples. By using Cox regression analysis, a 3-gene risk signature was built and classified all CESC patients in the cancer genome atlas cohort into a low-risk or high-risk group. CESC patients in the low-risk group showed significantly higher survival probabilities than those in the high-risk group (P &lt; .05). And the risk score was found to be an independent factor for predicting the overall survival of CESC patients. Besides, based on 33 pyroptosis-related genes, all CESC cases could be divided into 3 clusters with consensus clustering analysis. We characterized and analyzed the characteristics of tumor microenvironment infiltration in different clusters. Our findings provide a foundation for future research targeting pyroptosis and its immune microenvironment to improve prognosis in CESC patients.

A study of different minimum segment area parameters on automatic IMRT plans for cervical cancer using Pinnacle3 9.10 TPS [RETRACTED]

Based on Pinnacle39.10 treatment planning system (TPS) automatic planning module, we investigated the effect of minimum segmentation area (MSA) parameters on Auto-Plan Intensity Modulated Radiotherapy (AP-IMRT) without affecting the dose distribution of the target and the Organ at Risk (OAR). The results provided the basis for the ideal MSA parameters in the design of AP-IMRT plan. Ten patients with cervical cancer in our hospital were selected randomly for AP-IMRT design. Each patient was devised with 10 AP-IMRT plans. The prescription dose of PTV was 50 Gy/25 fractions. The radiotherapy plans of all patients were adopted with 7 field-averaged fixed fields. The MSA was set to 4 cm2, 9 cm2, 14 cm2, 20 cm2, 25 cm2, 40 cm2, 50 cm2, 60 cm2, 80 cm2, and 100 cm2. Plan quality and delivery efficiency were evaluated based on dose-volume histograms (DVHs), control points, monitor units (MUs), dosimetric measurement verification results, and plan delivery time. Except for the small difference in monitor units, the number of segmentations and target dose coverage, there were no statistically significant differences between the other dosimetric parameters in the planning target volumes. With the increase of MSA, the total number of MUs in AP-IMRT decreased from (649 ± 32) MUs to (312 ± 26) MUs, and the total number of segmentations decreased from (69 ± 1) to (28 ± 3). There was no statistical significance in the dose distribution of AP-IMRT target area with the MSA of 4-50 cm2 (P > .05). There was no significant difference in OAR dose between AP-IMRT plans with different MSA (P > .05). The calculated gamma indices using the 3% /3 mm and 2%/2 mm criteria. Both of the gamma pass rate and DTA pass rate all ≥95% under the condition of MSA are greater than 4 cm2, and the difference was no statistically significant (P > .05). The plan delivery times decreased with increasing MSA (P < .05). When using Pinnacle3 9.10 TPS to design AP-IMRT plan for cervical cancer, the parameter of MSA can be increased appropriately. Increasing the MSA allows for improved plan delivery accuracy and efficiency without significantly affecting the AP-IMRT plan quality. The MSA in the range of 14 to 50 cm2 can obtain a more reasonable dose distribution in the target area while the dose of target area and OAR had no significant changes. It is important to improve the plan quality, delivery accuracy, and efficiency for cervical AP-IMRT radiation therapy.

Identification and verification of a 4-gene signature predicting the overall survival of cervical cancer

Cervical cancer (CC) is one of the most common gynecological malignancies, ranking fourth in both incidence and mortality in women worldwide. Early screening and treatment are of great significance in reducing the incidence and mortality of CC. Due to the complex molecular mechanisms of tumor progression, the predictive power of traditional clinical information is limited. In this study, an effective molecular model is established to assess prognosis of patients with CC and guide clinical treatment so as to improve their survival rate. Three high quality datasets (GSE138080, GSE52904, GSE67522) of expression profiling were obtained from gene expression omnibus (GEO) database. Another mRNA expression and clinicopathological data of CC were obtained from The Cancer Genome Atlas (TCGA) dataset. The bioinformatic analyses such as univariate analysis, multivariate Cox proportional-hazards model (Cox) analysis and lasso regression analysis were conducted to select survival-related differentially expressed genes (DEGs) and further establish a prognostic gene signature. Moreover, the performance of prognostic gene signature was evaluated based on Kaplan–Meier curve and receiver operating characteristic (ROC) curve. Gene set enrichment analysis (GSEA) and tumor immunity analysis were carried out to elucidate the molecular mechanisms and immune relevance. A 4-gene signature comprising procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2 (PLOD2), spondin1 (SPON1), secreted phosphoprotein 1 (SPP1), ribonuclease H2 subunit A (RNASEH2A) was established to predict overall survival (OS) of CC. The ROC curve indicated good performance of the 4-gene signature in predicting OS of CC based on the TCGA dataset. The 4-gene signature classified the patients into high-risk and low-risk groups with distinct OS rates of CC. Univariate analysis and multivariate Cox regression analysis revealed that the 4-gene signature was an independent factor affecting the prognosis of patients with CC. Our study developed a 4-gene signature capable of predicting the OS of CC. The findings may be beneficial to individualized clinical treatment and timely follow-up for patients with CC.

Perception of human papilloma virus (HPV) vaccination during the COVID-19 pandemic

The COVID 19 pandemic is far from over, and vaccines remain important tool for fighting the disease. As the preventive effects of the COVID-19 vaccine emerges, it is likely that the perception of importance and safety of vaccines have a positive effect on the acceptance of other vaccines. However, it is still unclear how COVID-19 pandemic has affected the general vaccination perception and acceptance. Therefore, the objective of this study was to investigate the impact of the COVID-19 pandemic on the perception of HPV vaccination. This study involved an offline survey of 161 women aged between 20 and 49 years who visited the gynecologic clinic at Chung-nam National University Sejong Hospital from January 2021 to June 2021. The questionnaire consists of items related to experience and knowledge of COVID-19 and HPV viruses, as well as attitudes toward HPV vaccination. Knowledge about COVID-19 virus and HPV correlated positively with their experiences (P = .011 and P = .045, respectively). Positive attitude was increased, and negative attitude was reduced toward HPV vaccination in the COVID-19 pandemic era. Participants stated that accurate information and cost reduction about HPV vaccine was needed to increase the HPV vaccination rate. During the COVID-19 pandemic era, positive attitudes towards HPV vaccination have tended to increase. To increase the HPV vaccination rate, public efforts are needed for further information and cost reduction.

High expression of PYK2 is associated with poor prognosis and cancer progression in early-stage cervical carcinoma

Proline-rich tyrosine kinase-2 (PYK2), also known as calcium dependent tyrosine kinase, regulates different signal transduction cascades that control cell proliferation, migration, and invasion. However, the role of PYK2 in cervical cancer remains to be elucidated. The current study retrospectively included 134 patients with cervical cancer from December 2007 to September 2014. PYK2 expression was detected in tissue microarray and cervical cancer cell lines. Statistical analysis was performed to evaluate its clinicopathological significance. Small interfering RNA (siRNA) was employed to suppress endogenous PYK2 expression in cervical cancer cells to observe the biological function. PYK2 expression was up-regulated in cervical cancer specimens compared with paired adjacent normal cervical tissue samples. Statistical analyses indicated that PYK2 expression might be an independent prognostic indicator for patients with early-stage cervical cancer. A nomogram model was constructed based on PYK2 expression and other clinicopathological risk factors, and it performed well in predicting patients survival. In cellular studies, down-regulation of PYK2 remarkably inhibited cellular proliferation, migration and invasion. PYK2 expression possessed the potential to serve as a novel prognostic marker in cervical cancer patients.

Myeloid sarcoma arising at the uterine cervix in a patient with intestinal Behçet’s disease and concurrent myelodysplastic syndrome: A case report

Introduction: Myeloid sarcoma (MS) is an extramedullary tumor that consists of myeloblasts and rarely involves the female reproductive organs. Intestinal Behçet’s disease (BD) is a chronic, inflammatory illness that is often associated with myelodysplastic syndrome (MDS). When MDS is diagnosed, some patients with intestinal BD experience synchronous gastrointestinal flares. Case presentation: We report the case of a 49-year-old woman who presented with vaginal bleeding and an incidentally identified MS in the uterine cervix. Subsequent bone marrow biopsy showed simultaneous MDS without chromosomal abnormalities. This is the first reported case of concomitant MS, myelodysplastic disease, and intestinal BD. Conclusions: The accurate diagnosis of MSs that develop at non-predominant sites is crucial for a positive patient prognosis. MDS should be suspected in patients with a history of intestinal BD diagnosed with MS.

Prognostic factors for squamous cervical carcinoma identified by competing-risks analysis: A study based on the SEER database

Cervical cancer has a high incidence of malignant tumors and a high mortality rate, with squamous cervical carcinoma (SCC) accounting for 80% of cases. A competing-risks model is recommended as being more feasible for evaluating the prognosis and guiding clinical practice in the future compared to Cox regression. Data originating from the Surveillance, epidemiology, and end results (SEER) database during 2004 to 2013 were analyzed. Univariate analysis with the cumulative incidence function was performed to assess the potential risk of each covariate. Significant covariates (P &lt; .05) were extracted for inclusion in a Cox regression analysis and a competing-risks model that included a cause-specific (CS) hazard function model and a sub-distribution (SD) hazard function model. A total of 5591 SCC patients met the inclusion criteria. The three methods (Cox regression analysis, CS analysis, and SD analysis) showed that age, metastasis, American Joint Committee on Cancer stage, surgery, chemotherapy, radiation sequence with surgery, lymph node dissection, tumor size, and tumor grade were prognostic factors affecting survival in patients with SCC. In contrast, race and radiation status were prognostic factors affecting survival in the Cox regression and CS analysis, but the results were different in the SD analysis. Being separated, divorced, or widowed was an independent prognostic factor in the Cox regression analysis, but the results were different in the CS and SD analyses. A competing-risks model was used as a new statistical method to more accurately identify prognostic factors than conventional Cox regression analysis leading to bias in the results. This study found that the SD model may be better suited to estimate the clinical prognosis of a patient, and that the results of an SD model analysis were close to those of a CS analysis.

Blood glucose levels and the risk of HPV multiple infections in high-grade squamous intraepithelial lesions: A retrospective cross-sectional study of Chinese patients

Besides the controversy of the association of high glycemic index and glycemic load with precancerous cervical lesions, only a few studies have examined the impact of fasting blood glucose levels on human papillomavirus (HPV) multiple infections. In the present study, we appraised the relationship between blood glucose levels and multiple HPV infections in a population of HPV-positive women with cervical high-grade squamous intraepithelial lesions (HSIL). The present study was designed as a cross-sectional correlative analysis. A total of 560 participants with a pathologically confirmed HSIL with HPV infection were included from a hospital in China during January 1, 2018, and December 31, 2019. The target variables and the outcome variables were the glucose levels at the baseline and HPV multiplicity, respectively. The odds ratio and 95% confidence intervals were calculated to estimate the risk of multiple infections via logistic regression analysis. The average age of the 560 participants was 44.63 ± 10.61 years; the nonlinear relationship was detected between the glucose levels and multiplicity of HPV, with an inflection point at 5.4. After adjusting for the full range of variables, the effect sizes and confidence intervals for the left and right sides of the inflection points were found to be 0.379 (0.196–0.732) and 5.083 (1.592–16.229), respectively. In this cross-sectional study, both high and low blood glucose levels increased the risk of multiple HPV infections, demonstrating a U-shaped relationship between the blood glucose levels and multiple HPV infections.

Efficacy and safety of endostar combined with chemoradiotherapy versus chemoradiotherapy alone in locally advanced cervical cancer: A PRISMA-compliant systematic review and meta-analysis

Background: To evaluate the role and safety of endostar in cervical cancer by comparing the efficacy and adverse reactions of endostar combined with concurrent chemoradiotherapy in patients with locally advanced cervical carcinoma. Methods: The quality of the included literature was evaluated by searching the database for the comparison of endostar combined with concurrent radiotherapy and chemotherapy in cervical cancer patients; objective response rate (ORR) and disease control rate (DCR) were used as the main outcome indicators, and statistical analysis was performed using RevMan5.3 and State15.3 software. Results: A total of 13 studies were included in this study, including 1057 patients with locally advanced cervical cancer, suggesting that endostar combined with chemoradiotherapy can significantly improve the objective response rate (ORR: odds ratio 3.88, 95% confidence interval 2.77–5.45, P &lt; .00001) and disease control rate (DCR: odds ratio 4.43, 95% confidence interval 2.78–7.04; P &lt; .00001), and there was no significant increase in treatment-related adverse reactions. Conclusions: In this meta-analysis, endostar combined with concurrent chemoradiotherapy significantly improved ORR and DCR in patients with locally advanced cervical cancer without increasing toxicity. However, this study only analyzed the short-term efficacy of endostar, and its influence on overall survival and progression-free survival needs to be further verified in large randomized controlled trials with long-term follow-up.

Association of human papillomavirus vaccination with cervical cancer screening: A systematic review and meta-analysis

Introduction: Prophylactic vaccination and routine screening are effective at preventing most cases of cervical cancer. Globally, cervical cancer is the fourth most frequently diagnosed cancer among women. The aim of this study was to investigate the association between human papillomavirus virus (HPV) vaccination (1, 2, or 3 doses) and cervical cancer screening. Methods: PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library electronic databases were systematically searched from July 1, 2006, up to September 30, 2021. We pooled estimates using random-effects models. Heterogeneity between studies was quantified using Cochran Q test and I2 statistics. In total, 12 studies involving 2.4 million individuals were included in the meta-analysis. Results: In the adjusted estimates, uptake of HPV vaccination was associated with increased cervical cancer screening (pooled relative risk [RR]: 1.35; 95% confidence interval [CI]: 1.21, 1.50; n = 12). Between-study heterogeneity was large (I2 = 99%). Compared to unvaccinated, those who received 3 doses of HPV vaccine had the highest uptake of cervical cancer screening (RR: 1.85; 95% CI: 1.58, 2.17), followed by those who received 2 doses (RR: 1.34; 95% CI: 1.21, 1.47). No statistically significant association with screening was found for those who received a single dose of the HPV vaccine. Conclusion: In this meta-analysis, uptake of HPV vaccination was associated with higher cervical cancer screening. It is plausible that vaccinated individuals are more likely to engage in preventive health behaviors. Healthcare providers should remind patients to continue with routine screening for cervical cancer regardless of their HPV vaccine status since vaccination does not protect against all HPV types.

Health economic evaluation of an mRNA high-risk human papillomavirus (HR-HPV) assay versus a DNA HR-HPV assay for the proposed French cervical screening programme

Objective: Population screening programmes must make good use of resources for the health system and users. To evaluate impacts of the type of diagnostic test in the new French cervical screening programme, an messenger ribonucleic acid (mRNA) high-risk human papillomavirus assay was compared to a deoxyribonucleic acid (DNA) high-risk human papillomavirus assay for a hypothetical cohort of women aged 25 to 65 years. Perspective: This evaluation takes the perspective of the French healthcare system. Setting: France Methods: A decision tree model reflecting the French cervical screening algorithms was parametrised using French cost and population data and the Danish Horizon study. The outcomes were total costs, and number of colposcopies, HPV tests and cytology tests for the cohort. One-way and probabilistic sensitivity analyses and scenarios analyses were conducted to test the robustness of results to parameter and structural uncertainty. Results: Adopting an mRNA versus DNA assay as part of national cervical screening in France is estimated to save €6.5 million (95% credibility intervals €-1.3 - €13.5 million) and prevent 47,795 (95% credibility intervals 35,309 - 60,139) unnecessary colposcopies, 38,666 unnecessary HPV tests and 121,670 cytology tests over two years for a cohort of 2,168,806 million women aged 25 to 65 years. Sensitivity analyses indicated robust results across a range of inputs. Conclusion: The choice of high-risk human papillomavirus assay makes a significant difference to resource use and costs and is important to consider when implementing cervical screening in France. Using an mRNA versus DNA assay can result in cost savings and reductions in unnecessary testing and procedures, which in turn benefits women and the health care system.

The diagnostic accuracy of macrophage colony-stimulating factor for cervical cancer: A systematic review and meta-analysis

Background: Macrophage colony-stimulating factor (M-CSF) overexpression in plasma levels serves as a useful predictor of carcinogenesis and poor prognosis. Thus, we aimed to investigate the diagnostic performance of M-CSF for cervical cancer. Methods: A comprehensive search of eligible studies was performed in PubMed/MEDLINE, Cochrane Library, Google Scholar, Scopus, Web of Science, and EMBASE published until October 2021. For statistical analysis, Meta-disc software is used. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, 95% confidence interval (CI), and the area under the curve were estimated. A P value &lt;.05 was considered statistically significant. Results: A total of 5 studies were included in this systematic review and meta-analysis. The result showed that the pooled sensitivity and specificity of M-CSF to diagnose cervical cancer were 70% (95% CI: 66%–74%) and 84% (95% CI: 80%–88%), respectively. The summary positive likelihood ratio and negative likelihood ratio were 4.41 (95% CI: 2.86–6.82) and 0.36 (95% CI: 0.29–0.45), respectively. The area under the curve of the summary receiver operating characteristic curve was 0.86 (95% CI: 0.83–0.88), indicating the excellent diagnostic performance of M-CSF for cervical cancer. Conclusions: The results of this study showed that M-CSF has diagnostic value for the early detection of cervical cancer. As a result, M-CSF can be utilized in conjunction with existing test platforms to diagnose cervical cancer.

Use of ginger to control nausea and vomiting caused by chemotherapy in patients with cervical cancer undergoing treatment

Abstract Introduction: Uterine cervix tumors have an invasive nature, with the capacity to proliferate to surrounding organs such as the vagina, bladder, and rectum, as well as the capacity for dissemination and involvement of structures distant from its place of origin. According to the International Federation of Gynecology and Obstetrics, patients with stages IB I, IB I microscopic (small dimension &lt;4 cm) are indicated for radiotherapy or adjuvant chemoradiotherapy with cisplatin (40 mg/m2). However, cisplatin has side effects such as hematological implications (anemia, neutropenia, and thrombocytopenia), gastrointestinal disorders (nausea, vomiting, diarrhea, constipation), and fatigue. Zingiber officinale contains bioactive compounds that act on pregnancy and postoperative nausea, chemotherapy-induced nausea and vomiting, and also in the management of fatigue, myalgia, and insomnia. This study aimed to evaluate the effects of ginger on chemotherapy-induced nausea and vomiting in patients with cervical cancer undergoing treatment with cisplatin and radiotherapy. Methods and analyses: A randomized intervention clinical and controlled trial with a triple-blind design is described, comparing the effects of institutional antiemetic therapy alone, as well as in combination with 2 different ginger concentrations. Ethics and dissemination: Due to the nature of the study, we obtained approval from the Division Ethics Committee of Liga Contra o Câncer. All participants signed an informed consent form prior to randomization. The results of this study will be published in peer-reviewed journals. The data collected will also be available in a public repository of data. Trial registration number: This study is registered in the Brazilian Registry of Clinical Trials under number RBR-47yx6p9. This study was approved by the Division Ethics Committee of Liga Contra o Câncer under CAAE 40602320.0.0000.5293.

Laparotomic radical hysterectomy versus minimally invasive radical hysterectomy using vaginal colpotomy for the management of stage IB1 to IIA2 cervical cancer

Abstract This study compared survival outcomes for patients with stage IB1 to IIA2 (International Federation of Gynecology and Obstetrics stage 2009) cervical cancer who underwent open radical hysterectomy (ORH) versus those who underwent minimally invasive radical hysterectomy (MIRH) using vaginal colpotomy (VC). Data for 550 patients who were diagnosed with cervical cancer at our institution during the period August 2005 to September 2018 was retrospectively reviewed. Of these, 116 patients who underwent radical hysterectomy (RH) were selected after applying the exclusion criteria. All MIRH patients underwent VC. Clinicopathological characteristics and survival outcomes between the ORH and MIRH groups were compared using appropriate statistical testing. Ninety one patients were treated with ORH and 25 with MIRH during the study period. Among the MIRH patients, 18 underwent laparoscopy-assisted radical vaginal hysterectomy and 7 underwent laparoscopic RH. Preoperative conization was performed more frequently in MIRH patients than in ORH patients (44% vs 22%, respectively, P = .028). The incidence of lymph node invasion was higher in the ORH group than in MIRH group (37.4% vs 12.0% respectively; P = .016). Following RH, ORH patients underwent adjuvant treatment more frequently than MIRH patients (71.4% vs 56.0%, respectively, P = .002). There were no significant differences between ORH and MIRH patients for either progression-free survival (PFS) (91.3% vs 78.7%, respectively; P = .220) or 5-year overall survival (OS) (96.6% vs 94.7%, respectively, P = .929). In univariate analysis, lympho-vascular space invasion was the only clinicopathological feature associated with decreased PFS. No other clinicopathological factors was significantly associated with PFS or OS in univariate and multivariate analyses. Despite a higher incidence of unfavorable prognostic factors in ORH patients, their survival outcomes were not different to those of MIRH patients with VC.

The effectiveness of mindfulness-based stress reduction intervention on alleviating anxiety and depression in postoperative patients with cervical cancer

Abstract Background: Surgical treatment for cervical cancer, as a stressor, largely leads to strong psychological reactions to stress like anxiety and depression. Whether mindfulness-based stress reduction (MBSR) can alleviate anxiety and depression in patients after cervical cancer surgery is controversial. Therefore, we aim to perform a meta-analysis involving randomized controlled trials analyzing the effect of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery, thus providing evidence-based medical evidences for nonpharmacological interventions. Methods: Randomized controlled trials analyzing the effect of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery will be searched in online databases, including Cochrane Central Register of Controlled Trials Repositories, PubMed, Embase, Web of Science, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan Fang Data. After screening eligible studies, we will perform a meta-analysis on the effect of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery. Results: The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. Conclusion: This study will provide reliable evidence-based evidences for the effects of MBSR on alleviating anxiety and depression in patients after cervical cancer surgery. Ethics and dissemination: Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. OSF Registration number: DOI 10.17605/OSF.IO/EXUM3.

Successful treatment of locally advanced bulky cervical cancer complicated by irreducible complete uterine prolapse

Abstract Rationale: Cervical cancer complicated by irreducible complete uterine prolapse in elderly patients is extremely rare. No standard treatment has been established for these conditions. Patient concerns: A 74-year-old woman with a 30-year history of pelvic organ prolapse presented with irreducible complete uterine prolapse and a large exophytic mass involving the cervix and vaginal wall. Diagnosis: Biopsy of the mass was performed at the referring institution and showed invasive verrucous-type squamous cell carcinoma. Interventions: A prolapsed uterus with a tumor mass could not be manually reduced. After completion of concurrent chemoradiotherapy, the tumor mass in the prolapsed uterus decreased and could be reduced manually. Subsequently, the patient underwent hysterectomy and intra-abdominal uterosacral ligament suspension. Outcomes: At 19 months of postoperative follow-up, the patient remained disease-free and had no evidence of vault prolapse. Lessons: This study has important clinical implications and may provide a therapeutic strategy to address unmet medical needs in combination with locally advanced cervical cancer complicated by irreducible complete uterine prolapse. These conditions were successfully treated using a multidisciplinary approach of chemoradiotherapy followed by radical hysterectomy and uterosacral ligament suspension.

Cathepsins and their role in gynecological cancers: Evidence from two-sample Mendelian randomization analysis

Prior studies have reported connections between cathepsins (CTS) and gynecological cancers; however, the exact causal links are yet to be fully understood. Leveraging publicly accessible genome-wide association study summary datasets, we performed a two-sample bidirectional Mendelian randomization (MR) and multivariate MR (MVMR) analysis, with the inverse variance weighted (IVW) method as the primary approach. MR analysis demonstrated inverse associations between CTSB and cervical cancer (IVW: odds ratio [OR] = 0.9995, 95% confidence interval [CI] = 0.9991–0.9999, P = .0418), CTSE and ovarian cancer (IVW: OR = 0.9197, 95% CI = 0.8505–0.9944, P = .0358), CTSZ and ovarian cancer (IVW: OR = 0.9449, 95% CI = 0.8938–0.9990, P = .0459), CTSE and high grade serous ovarian cancer (IVW: OR = 0.8939, 95% CI = 0.8248–0.9689, P = .0063), and CTSZ and high grade serous ovarian cancer (IVW: OR = 0.9269, 95% CI = 0.8667–0.9913, P = .0268). A positive correlation was identified between CTSH and clear cell ovarian cancer (IVW: OR = 1.1496, 95% CI = 1.0368–1.2745, P = .0081). Nevertheless, subsequent adjustment for the false discovery rate revealed that none of the P-values retained statistical significance (P FDR  &gt; 0.05). MVMR analysis results elucidated that CTSZ was inversely associated with cervical cancer (IVW: OR = 0.9988, 95% CI = 0.9981–0.9996, P = .0022). Moreover, a positive association was noted between CTSF and cervical cancer (IVW: OR = 1.0007, 95% CI = 1.0000–1.0014, P = .0364), and similarly, between CTSS and cervical cancer (IVW: OR = 1.0005, 95% CI = 1.0000–1.0011, P = .0490). CTSO exhibited a positive association with non-endometrioid endometrial cancer (IVW: OR = 1.4405, 95% CI = 1.1864–1.7490, P &lt; .001), and CTSH was positively associated with clear cell ovarian cancer (IVW: OR = 1.1167, 95% CI = 1.0131–1.2310, P = .0263). The MVMR analysis findings reveal that CTSZ emerges as a protective element against cervical cancer, whereas CTSF and CTSS represent risk factors for this disease. CTSO stands out as a risk factor for non-endometrioid endometrial cancer, and CTSH acts as a risk factor for clear cell ovarian cancer. This study elucidates causative connections between CTS and gynecological cancers, providing innovative insights for diagnostic and therapeutic optimization.

Genetic evidence linking anti-polyomavirus 2 IgG seropositivity to ovarian cancer risk

Antibody-related immune phenotypes reflect long-term host–pathogen interactions and immunogenetic regulation, and have been increasingly implicated in cancer susceptibility. In ovarian cancer, observational associations between immune responses and disease risk remain difficult to interpret due to confounding and potential reverse causation. Genetic analyses may help clarify whether specific antibody immune response profiles are linked to ovarian cancer risk. We investigated the associations between 46 genetically predicted antibody immune response phenotypes and ovarian cancer using a 2-sample Mendelian randomization framework. Genetic instruments for antibody traits were obtained from large genome-wide association studies, while ovarian cancer summary statistics were derived independently from the FinnGen R12 and OpenGWAS resources. Causal estimates were derived primarily using inverse-variance weighted models and subsequently synthesized across datasets to improve precision. Multiple testing adjustment was applied, and additional analyses were conducted to assess robustness and causal directionality. Across the evaluated antibody phenotypes, most showed no evidence of a causal association with ovarian cancer risk. After meta-analysis and correction for multiple comparisons, genetically predicted anti-polyomavirus 2 immunoglobulin G (IgG) seropositivity was associated with a modest increase in ovarian cancer risk (odds ratio = 1.062, 95% confidence interval: 1.027–1.099). Sensitivity analyses did not indicate substantial pleiotropic bias, and reverse-direction analyses provided no support for ovarian cancer influencing anti-polyomavirus 2 IgG levels. These findings suggest that genetic liability to anti-polyomavirus 2 IgG seropositivity, as a marker of immune response rather than active infection, is modestly associated with ovarian cancer risk in individuals of European ancestry. Although the effect size is small, the results highlight a potential role for antibody-mediated immune processes in ovarian cancer etiology and warrant further investigation in diverse populations and experimental settings.

Prognostic model based on stem cells and oxidative stress related genes for ovarian cancer

Ovarian cancer (OC) is a common gynecological condition. Cancer stem cells (CSCs) are tumor cells with the potential to differentiate and self-renew. The aim of this study was to identify genes relevant to stem cells and oxidative stress (OS) in OC and to construct corresponding prognostic models. OS-related genes were obtained from GenBank. The mRNAsi-OS differentially expressed genes (DEGs) were filtered by overlapping OS-related genes, DEGs associated with mRNAsi, and DEGs in OC. Then, the Absolute Shrinkage and Selection Operator (LASSO) algorithm and univariate Cox regression were adopted to construct an OS-mRNAsi-related prognostic model. Subsequently, we validated the predictive value of the model using both the training and validation sets. The differences in immune infiltration and immunotherapy between the OS-CSC-related high- and low-risk subgroups were further explored. Finally, we analyzed the drug sensitivity between the 2 subgroups. A total of 5 prognostic genes ( PLK2 , CACNA1C , PENK , NR0B 1, and HNF4A ) related to CSC and OS were screened. The area under the curve (AUC) value of the prognostic model in predicting the 3-, 5-, and 7-year survival rate of patients with OC was &gt;0.6, which revealed that the efficiency of the prognostic model was acceptable. The results of CIBERSORT demonstrated noticeable differences in the tumor microenvironment between the OS-CSC-related high- and low-risk subgroups. In addition, the risk score obtained based on OS and mRNAsi can be used to estimate the effectiveness of immunotherapy in patients with OC. Finally, the sensitivity of 5 common drugs (docetaxel, cisplatin, doxorubicin, mitomycin C, and paclitaxel) was evaluated using an OS-CSC-related prognostic model. In conclusion, an OS-CSC-related prognostic model based on 5 genes ( PLK2 , CACNA1C , PENK , NR0B 1, and HNF4A ) was constructed using bioinformatics analysis, which may provide new insights into the treatment and evaluation of OC.

Occult metastasis of hormone receptor-positive breast cancer to the ovary: A case report and literature review

Rationale: Breast cancer is the most common malignancy among women worldwide. It typically metastasizes to the bone, lungs, and liver, while ovarian involvement is relatively uncommon. This report aims to illustrate the clinical features, diagnostic approach, and treatment strategies for this rare type of metastasis through a case study, thereby enhancing clinicians’ awareness and management capabilities. Patient concerns: A 32-year-old premenopausal woman presented with a palpable nodule in the left breast. Comprehensive diagnostic evaluation, including mammography, ultrasonography, contrast-enhanced computed tomography, and core needle biopsy, confirmed invasive ductal carcinoma, classified as Luminal A subtype (estrogen receptor/progesterone receptor-positive, human epidermal growth factor receptor 2-negative). Diagnoses: Invasive ductal carcinoma of the left breast (pT3N3M1, stage IV) with ovarian metastasis. Interventions: The patient received 6 cycles of docetaxel/doxorubicin/cyclophosphamide chemotherapy (docetaxel, doxorubicin, and cyclophosphamide), followed by left modified radical mastectomy with axillary lymph node dissection, achieving R0 resection. Laparoscopic bilateral adnexectomy was also performed for ovarian ablation. Final pathology confirmed metastatic breast carcinoma in the ovaries. Outcomes: The patient successfully achieved surgical tumor reduction, recovered well postoperatively, and showed no clinical evidence of disease progression. Lessons: This case highlights the distinct characteristics of ovarian metastases in HR+/HER2− breast cancer and their critical importance in differential diagnosis, particularly in distinguishing them from primary gynecologic tumors. For patients with a history of breast cancer, the presence of pelvic lesions should prompt consideration of metastatic potential to guide appropriate comprehensive treatment.

Operating-room temperature and warming protocols as predictors of postoperative hypothermia in ovarian cancer surgery: A retrospective cohort study

Perioperative hypothermia is a common but preventable complication associated with increased morbidity and delayed recovery in surgical oncology patients. However, limited evidence exists regarding its prevalence, predictors, and consequences in women undergoing cytoreductive surgery for ovarian cancer. This retrospective cohort study included 245 patients who underwent primary or interval cytoreductive surgery for epithelial ovarian cancer at a tertiary care center between 2014 and 2022. Patients were stratified into normothermia (≥36.0°C) and hypothermia (&lt;36.0°C) groups based on core temperature at surgical closure. Intraoperative warming strategies and operating-room temperature were recorded. Multivariate logistic regression was used to identify independent predictors of postoperative hypothermia. Postoperative outcomes were compared between groups. Postoperative hypothermia occurred in 39.6% of patients. Independent risk factors included age ≥ 60 years (odds ratio [OR] 1.89, P  = .025), body mass index &lt; 22 kg/m² (OR 1.96, P  = .022), American Society of Anesthesiologists class III–IV (OR 2.05, P  = .020), ascites volume &gt; 500 mL (OR 1.97, P  = .031), operative time ≥ 240 minutes (OR 2.92, P  = .001), blood loss ≥ 400 mL (OR 2.23, P  = .011), absence of active warming (OR 4.12, P  &lt; .001), and OR temperature &lt; 22°C (OR 2.47, P  = .005). Hypothermia was associated with higher rates of shivering (40.2% vs 12.2%, P  &lt; .001), surgical site infection (16.5% vs 6.8%, P  = .019), longer time to ambulation and gastrointestinal recovery, prolonged hospital stay, and increased 30-day readmission. Postoperative hypothermia is highly prevalent and clinically significant among ovarian cancer patients undergoing cytoreductive surgery. Intraoperative warming strategies and maintaining adequate OR temperatures play critical roles in prevention. These findings highlight the importance of standardized thermal care protocols led by perioperative nursing teams to improve surgical outcomes. These conclusions apply to female patients only, as the cohort exclusively comprised women undergoing ovarian cancer cytoreductive surgery.

Endometrial adenocarcinoma arising from adenomyosis: A case report and literature review

Background: Endometrial carcinoma arising from adenomyosis (EC-AIA) is remarkably uncommon, and its underlying molecular mechanisms are not yet fully elucidated. This knowledge gap is particularly significant given that most reported EC-AIA cases are well-differentiated and hormone receptor-positive, creating a critical need to characterize the rare, aggressive variants and their clinical implications. Objective: This study aims to address this gap by presenting a unique case of poorly differentiated endometrioid adenocarcinoma with adenomyosis, exploring their potential association, and to synthesize current understanding through literature review to inform clinical decision-making. Case presentation: A 45-year-old woman with a history of adenomyotic lesion resection presented with abnormal uterine bleeding. Postoperative pathology confirmed poorly differentiated endometrioid adenocarcinoma (International Federation of Gynecology and Obstetrics IIIC2 stage), with immunohistochemistry showing estrogen receptor/progesterone receptor (PR) negativity, p53 mutation pattern, and nonspecific molecular profile. Concurrent adenomyosis (0.6 cm) was identified, though direct histological transition between adenomyosis and carcinoma was not established. The patient underwent cytoreductive surgery and platinum-based chemotherapy. Discussion: Our analysis reveals that the relationship between adenomyosis and endometrial carcinoma remains debated. This case (characterized by high-grade histology, hormone receptor negativity, and widespread metastases) provides crucial evidence diverging from the classic EC-AIA profile (typically well-differentiated and hormone-sensitive), implying a distinct malignant transformation mechanism. These findings challenge the conventional understanding of EC-AIA and highlight the spectrum of its clinical presentations. Conclusion: This study underscores that the management of suspected malignant transformation of adenomyosis requires multidisciplinary evaluation. More importantly, our findings demonstrate that aggressive treatment should be initiated even without definitive pathological confirmation when clinical suspicion is high. The significance of this work lies in its contribution to recognizing the heterogeneous nature of EC-AIA, urging future research to focus on elucidating molecular mechanisms and developing personalized therapeutic strategies for these aggressive variants.

Is omentectomy mandatory in patients with epithelial ovarian cancer having a macroscopically normal-appearing omentum?: A retrospective study

This study aims to determine the necessity of mandatory omentectomy during staging surgery in patients with epithelial ovarian cancer (EOC) with a normal-appearing omentum. This study analyzed patients with EOC who underwent staging surgery at Korea University Anam Hospital between January 2010 and December 2023, excluding those with incomplete data and those lost to follow-up. The patients were categorized into the omentectomy and non-omentectomy groups. We compared the characteristics, disease-free survival, overall survival, and recurrence risk factors, using statistical tests including the Student t test, chi-square test, Fisher’s exact test, Kaplan–Meier analysis, and Cox regression, conducted with SPSS. Among 222 patients, 166 underwent omentectomy and 56 did not. The median follow-up period for all patients was 43 months, and no significant difference in disease-free survival or overall survival was observed between the groups. Factors associated with increased EOC recurrence included advanced stages (stage III: adjusted hazard ratio [HR], 2.19; P  = .006 and stage IV: adjusted HR, 4.55; P  &lt; .001), elevated cancer antigen 125 level (adjusted HR, 3.37; P  &lt; .001), positive pelvic lymph nodes (adjusted HR, 2.34; P  = .001), more chemotherapy (adjusted HR, 1.05; P  &lt; .001), and positive washing cytology (adjusted HR, 1.77; P  = .014). Omentectomy status in patients with EOC with unsuspected omental metastasis was not associated with survival benefit, suggesting that omentectomy is not mandatory for a normal-appearing omentum and may be considered optional during staging surgery. To reduce the risk of recurrence, close monitoring is crucial for patients with advanced-stage EOC, elevated cancer antigen 125 level, positive pelvic lymph nodes, more chemotherapy, and positive washing cytology.

A rare large cell variant of small-cell carcinoma of the ovary, hypercalcemic type in a postmenopausal woman: Case report

Rationale: Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is an extremely rare and aggressive ovarian malignancy associated with SMARCA4 mutation, accounting for less than 0.01% of ovarian tumors. It predominantly affects young females and is characterized by poor prognosis. Here, we report a unique case of SCCOHT with a special pathological classification of large cell variant type in a 59-year-old postmenopausal woman, an age that is rare for this disease. Patient concerns: A 59-year-old female patient presented with lower abdominal pain. A hard and restricted mass was palpated at the back of the uterus during pelvic physical examination. MRI examination showed a huge solid mixed-signal mass shadow in the right adnexal area, with a size of 10 × 7 × 7 cm. Diagnoses: Postoperative histopathological and immunohistochemical analyses demonstrated abundant large cells under microscopic examination and a loss of BRG1 protein expression, leading to the diagnosis of large cell variant of SCCOHT in right ovary. Genetic testing confirmed a mutation in the SMARCA4 gene (exon 6, c.1103del p.[Q368Rfs*43]). Interventions: The patient underwent pelvic tumor cytoreductive surgery and pelvic adhesion release surgery, and the implanted lesions in the pelvic cavity were resected during the operation. Outcomes: The patient underwent extensive surgical resection and completed 6 cycles of TC chemotherapy (paclitaxel + carboplatin). Despite the postoperative pathological stage reached Stage II, during the 18-month follow-up after the operation, no evidence of tumor progression or recurrence was observed. Lessons: SCCOHT is a highly malignant tumor associated with a generally poor prognosis, particularly for tumors at stage II or higher. Nevertheless, the favorable prognosis observed in this case suggests that the traditional understanding may require reevaluation. Whether there is a correlation between the age of onset of SCCOHT and the prognosis remains to be elucidated through systematic clinical research in the future.

Predictive value of MR imaging IVIM and T2 mapping in malignant transformation of endometriosis

This study aims to explore the value of MRI intravoxel incoherent motion (IVIM) combined with T2 mapping in predicting the malignancy of endometriosis (EM) and construct a noninvasive preoperative risk assessment model. A retrospective analysis was conducted on 156 patients with pathologically confirmed EM or endometriosis - associated ovarian cancer, who were divided into the benign group (102 cases) and the malignant transformation group (54 cases). Two observers independently measured the IVIM parameters (D, D * , f) and T2 values to construct single-parameter and multi-parameter joint models. The receiver operator characteristic curve was used to evaluate the diagnostic efficacy, and logistic regression was used to analyze the independent predictors. The values of D, f, and T2 in the malignant transformation group were significantly lower than those in the benign group (all P  &lt; .05), while there was no statistically significant difference in D * value. The area under curve (AUC) of D, f, T2, and the combined model D + f + T2 were 0.737, 0.701, 0.773, and 0.874, respectively. The optimal cutoff values of D, f, and T2 were 1.10 × 10⁻³ mm 2 /s, 37.30 %, and 119.65 ms, respectively. Values lower than these may indicate a risk of malignant transformation of EM. Logistic regression confirmed that D, D * , and T2 were independent predictors of EM malignancy. IVIM combined with T2 mapping can non-invasively and quantitatively assess the risk of malignant transformation of EM. The combined model of parameters of two sequences has good potential for clinical promotion.

Interaction between ENPP1 and homologous recombination deficiency defines distinct pan-cancer signatures: A retrospective observational study

Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), 1st identified in breast cancer and subsequently in multiple other cancer types, is an innate immune checkpoint regulator that recently emerged as a promising biomarker and therapeutic target. Homologous recombination deficiency (HRD) has gained clinical relevance with therapeutic vulnerability, particularly in breast and ovarian cancers. Despite the increasing significance of ENPP1 and HRD in cancer biology and treatment, their potential relationships have not yet been comprehensively investigated. We analyzed the relationship between ENPP1 expression and HRD score across the Cancer Genome Atlas pan-cancer and individual tumor types using the Pearson and Spearman correlations. To account for heterogeneity, pan-cancer samples were clustered using linear regression into 3 groups based on Bayesian Information Criterion. Differential expression, functional enrichment, and survival analyses were performed for these clusters at both the pan-cancer and representative tumor type levels. Although the pan-cancer relationship between ENPP1 expression and HRD score was heterogeneous, significant correlations were observed in 11 tumor types. Linear regression-based clustering resolved this heterogeneity into 3 functionally and clinically distinct groups: Cluster 1 was characterized by proliferation programs; Cluster 2 by extracellular matrix remodeling, differentiation, and immune response; and Cluster 3, by metabolic reprogramming. Clinically, Cluster 3 was associated with better survival than Clusters 1 and 2 in a pan-cancer analysis ( P  &lt; .0001). At the individual tumor type level, these global cluster features were further modified in tissue-specific contexts, reflecting local microenvironment adaptation. Significant survival differences were observed in patients with adrenocortical carcinoma, chromophobe renal cell carcinoma, low grade glioma, and mesothelioma, further underscoring the tissue-specific modification of global cluster features. Our comprehensive pan-cancer analysis revealed the intrinsic heterogeneity of ENPP1 expression and HRD score, which may arise from complex and dynamic interactions with diverse cancer hallmarks, including proliferation, extracellular matrix remodeling, immune response, and metabolic reprogramming, and can be generalized into 3 clusters with distinct molecular and clinical characteristics. At the individual tumor type level, these global cluster features were further modified to adapt to a tissue-specific microenvironment, manifesting distinct tissue-specific patterns. Collectively, these findings provide a foundation for refining biomarker-driven precision medicine strategies for diverse tumor types.

Effect of exercise intervention on quality of life, sleep quality, and BMI in patients with ovarian cancer: A systematic review and meta-analysis

Background: Ovarian cancer, the most lethal gynecological malignancy, significantly impairs patients’ quality of life (QOL), sleep quality, and body composition. Exercise has shown promise in mitigating these effects in other cancers, but evidence specific to ovarian cancer remains limited and heterogeneous. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases (PubMed, Embase, Web of Science, Cochrane Library) were searched up to April 2025 for randomized controlled trials evaluating exercise interventions in ovarian cancer patients. Outcomes included QOL, sleep quality (assessed via Pittsburgh Sleep Quality Index), BMI, and fatigue. Risk of bias was assessed using Cochrane RoB 2.0. Random-effects models were employed for meta-analysis, with heterogeneity evaluated via I 2 statistics. Results: Nine randomized controlled trials (n = 767) were included. Exercise significantly improved QOL (Standardised mean differences [SMD] 0.59, 95% CI 0.41–0.77; P  &lt; .001) and sleep quality (Pittsburgh Sleep Quality Index: SMD −0.56, 95% CI −0.84 to −0.25; P  &lt; .01), though heterogeneity was high for QOL ( I 2 =98%). No significant effects were observed for BMI (SMD −0.20, 95% CI −0.92 to 0.51; P  &gt; .05) or fatigue (SMD −0.35, 95% CI −0.92 to 0.23; P  &gt; .05). Methodological limitations included bias in randomization and blinding. Conclusion: Exercise interventions may enhance QOL and sleep quality in ovarian cancer patients, but impacts on BMI and fatigue remain inconclusive. Future studies should prioritize rigorous designs and individualized approaches.