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In this case, a 66‐year‐old female patient presented with the chief complaint of abdominal distention. Computed tomography and magnetic resonance imaging revealed no enlarged ovaries or obvious primary lesions; however, massive ascites and peritoneal disseminated nodules were observed. Ascites cytology revealed adenocarcinoma and immunohistochemical findings suggested serous carcinoma. The patient then underwent tumor reduction surgery after preoperative chemotherapy for suspected Stage IIIC primary peritoneal carcinoma. Postoperative histopathology revealed carcinoma consisting mainly of high‐grade serous carcinoma (HGSC) and sarcoma. In addition, serous intraepithelial carcinoma (STIC) of the fallopian tube was observed in the fimbriae of the left fallopian tube. Recently, it has been noted in the literature that most cases of peritoneal carcinoma are metastases or dissemination of carcinoma originating from the fimbriae of the fallopian tube. This is a rare case of peritoneal carcinosarcoma with STIC, and its report leads to a better understanding of the disease's features and possible therapeutic approaches. [ABSTRACT FROM AUTHOR]

Aim: Ovarian cancer is a gynecological malignancy with a poor prognosis. For platinum‐sensitive relapsed ovarian cancer, maintenance therapy with poly‐ADP ribose polymerase (PARP) inhibitors after chemotherapy is considered; however, olaparib treatment does not always lead to sufficient progression‐free survival (PFS). This study aimed to identify factors that predict the efficacy of maintenance therapy using olaparib in platinum‐sensitive relapsed ovarian cancer. Methods: Twenty‐seven patients with platinum‐sensitive relapsed ovarian cancer, who received initial treatment and showed complete or partial response to prior chemotherapy at our hospital, were included. The primary outcome was the time from the end of previous platinum‐based chemotherapy to disease progression (PFS). The Kaplan–Meier method was used to generate time‐to‐event curves for PFS; multivariate analysis was performed using the Cox proportional hazards regression model. Results: The median PFS was 12 months (95% confidence interval [CI]: 8.3–15.8). Before olaparib administration, the median PFS was 12 months in the <4.1 neutrophil‐to‐lymphocyte ratio group and 4 months in the ≥4.1 group, with PFS being significantly better in the <4.1 group (log‐rank: p = 0.023). When comparing serum cancer antigen 125 (CA125) levels, the median PFS was 13 months in the <18 U/mL group and 6 months in the >18 U/mL group (log‐rank: p = 0.022). Multivariate Cox regression analysis revealed that CA125 was the factor affecting PFS (hazard ratio: 4.85; 95% CI: 1.53–15.38). Conclusions: Serum CA125 levels at olaparib initiation in patients with platinum‐sensitive relapsed ovarian cancer may predict PFS as an effect of maintenance therapy using olaparib to treat recurrent disease. [ABSTRACT FROM AUTHOR]

Metastatic uterine tumors originating from extragenital cancers are a rare clinical occurrence. We report a case of metastatic uterine cancer derived from small-cell lung cancer (SCLC) that necessitated surgical treatment. The patient was a 59 y/o female who had undergone chemotherapy for stage IIIB SCLC. A 15 cm uterine tumor lesion was initially detected on CT scans. The patient had previously been diagnosed with uterine fibroids, but compared to the most recent CT scans taken one and a half months earlier, imaging diagnosis revealed a sudden increase in the size of the tumor when compared to the 8 cm myoma fibroid noted previously. Additional work-up with MRI scans revealed T2-enhanced images of a tumor that had almost completely invaded the myometrium; the tumor presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. A differential diagnosis of uterine sarcoma was considered, but due to the lack of focal hemorrhage or necrosis findings on MRI imaging, the possibility of differential diagnosis of metastatic SCLC was also noted. As the patient was experiencing abdominal symptoms including abdominal distension and tenderness due the tumor, a simple hysterectomy and bilateral salpingo-oophorectomy were performed to palliate the symptoms. During the surgical procedures, intra-abdominal findings noted peritoneal dissemination while intraoperative cell cytology diagnosis of ascites revealed small-cell cancer. The final histopathological diagnosis likewise revealed metastatic small-cell cancer from the primary lung cancer. The clinical status of the lung cancer was evaluated as progressive disease (PD), and a change in chemotherapy regimen was necessitated. Further disease progression was noted on CT scans at 2 and a half months after surgery, and with gradual systemic disease progression, the patient died of disease at 3 months postsurgery. Initial evaluation of rapidly enlarging uterine tumors should include a differential diagnosis of uterine sarcoma; additionally, it is necessary to also consider the rare possibility of metastatic disease as in the present case with a clinical history of extragenital malignancy. [ABSTRACT FROM AUTHOR]

Objectives:Endometriotic cyst fluid (ECF) contains a large amount of reactive oxygen species (ROS), and endometriotic cysts are exposed to strong oxidative stress, which may cause malignant transformation. In this study, ROS production by ECF was clinically analysed. Methods:Human immortalized epithelial cells derived from ovarian endometrioma (EMosis-CC/TERT 1) were treated with ECF. In addition, ROS production in EMosis-CC/TERT 1 was measured, and its clinical significance was analysed. Results:A total of 38 ECF samples were obtained from patients diagnosed with endometriotic cysts. In EMosis-CC/TERT1, significantly higher levels of ROS were induced by ECF than by the vehicle control and ferric nitrilotriacetate. There were no significant differences in ROS production by laterality and preoperative serum CA125 values. There were several patients whose cyst sizes were approximately 5 cm and had relatively high ROS production. Production of ROS by ECF was relatively higher in patients older than 40 years of age than in those younger than 40. Discussion:Our study revealed that ROS are highly produced by ECF in EMosis-CC/TERT1 cells; therefore, exposure to ECF induced strong oxidative stress. Development of a therapeutic strategy to reduce ROS production might be useful for preventing malignant transformation of endometriotic cysts. [ABSTRACT FROM AUTHOR]

Aim The maximum standardized uptake value (SUVmax) of primary tumors in positron emission tomography can be used to predict prognosis in various cancers, but its significance in recurrent tumors remains unclear. In the present study, we evaluated the utility of the SUVmax for predicting therapeutic effects in recurrent gynecological malignancies. Methods From February 2012 to July 2014, patients with recurrent gynecological cancer who were treated with chemotherapy or radiotherapy were enrolled in this study. The SUVmax of recurrent lesions before treatment were compared to the therapeutic effects. Results Fifty patients with recurrent gynecological cancer were enrolled. The mean SUVmax was significantly higher in patients with stable disease/progressive disease than in patients who achieved complete remission/partial remission (13.24 ± 9.78 vs 8.61 ± 5.34, P = 0.039). In patients who were administered chemotherapy, the SUVmax was significantly higher in those with stable disease/progressive disease than in those who achieved complete remission/partial remission (13.24 ± 9.78 vs 8.61 ± 5.34, P = 0.0392) as well as those administered radiotherapy or concurrent chemoradiation therapy (18.15 ± 3.25 vs 11.33 ± 3.98, P = 0.0073). In ovarian cancer patients administered chemotherapy, when the cut-off value of the SUVmax was set as 6.94, the sensitivity and specificity of predicting therapeutic effects were 0.75 and 0.846, respectively. Conclusion Although the number of enrolled cases was small, our study revealed that the SUVmax in recurrent gynecological tumors might predict therapeutic effects. If the SUVmax is relatively high, multimodal therapy, including surgical removal, should be considered. [ABSTRACT FROM AUTHOR]

Aim Insulin-like growth factor ( IGF)- I is known to stimulate fetal growth. One of the IGF-binding proteins, IGFBP-1, suppresses IGF- I activity, and thereby inhibits fetal growth. Because hypoxic stress in the uterus is known to cause fetal growth restriction, we examined the effects of hypoxia on IGFBP-1 production and phosphorylation status. Methods Because liver is a main IGFBP-1 production site in the fetus, we used a hepatoma cell line, Hep G2 cells, that secrete a large amount of IGFBP-1, express IGF- I receptors and model fetal liver metabolism in vitro. IGFBP-1 was analyzed by sodium dodecylsulfate polyacrylamide gel electrophoresis ( PAGE) following immunoblotting, and IGFBP-1 phosphorylation status was analyzed by native PAGE following immunoblotting. Results Total concentrations of IGFBP-1 in media were higher and the highly phosphorylated isoforms were dominant in low oxygen conditions. Phosphorylation of IGF- I receptor by IGF- I was attenuated in low oxygen conditions. IGF- I-induced phosphorylation of insulin receptor substrate-1 ( IRS-1) was attenuated in low oxygen conditions as well. However, attenuated phosphorylation of IGF- I receptor and IRS-1 were not observed in low oxygen conditions if the cells were stimulated with LR3IGF- I that has a similar binding affinity to IGF- I receptor but much less binding affinity to IGFBP-1 compared to those of native IGF- I. While IGF- I-induced cell proliferation was also inhibited in low oxygen conditions, LR3IGF- I-stimulated cell proliferation was not inhibited. These findings indicate that low oxygen conditions inhibit IGF- I action by increasing IGFBP-1, especially phosphorylated IGFBP-1, which inhibits IGF- I action. Conclusion This study has indicated that hypoxia-induced IGFBP-1 production in the fetus may be a conserved physiological mechanism for restricting IGF- I-stimulated fetal growth. [ABSTRACT FROM AUTHOR]

Objective: Uterine sarcoma is a rare malignant gynecological tumor with a poor prognosis. Many studies have identified the clinical stage as an important prognostic factor; however, the heterogeneity of patient distribution in the International Federation of Gynecology and Obstetrics (FIGO) stage has reportedly required further revision. Therefore, this study retrospectively investigated the factors related to the prognosis of uterine sarcoma, with particular attention to tumor size, which can be evaluated preoperatively., Methods: Clinical data were extracted from the medical records of patients with uterine sarcoma treated between January 2010 and January 2023. Kaplan-Meier survival curves were plotted according to clinical factors such as histological type, clinical stage, chemotherapy, and tumor size. Factors that were significant in the univariate analysis were subjected to the multivariate analysis using Cox proportional hazards regression., Results: Thirty-four patients with uterine sarcoma, comprising 24 (70.5%), five (14.7%), three (8.8%), and two (5.9%) with leiomyosarcoma, undifferentiated sarcoma, high-grade endometrial stromal sarcoma, and low-grade endometrial stromal sarcoma, respectively, were included. Based on the FIGO stage, 15 (44.1%), six (17.6%), three (8.8%), and 10 patients had stage I, II, III, and IV disease, respectively, at the time of diagnosis. All patients underwent surgery as initial treatment; 15 received postoperative chemotherapy. Among the 32 patients with uterine leiomyosarcoma, undifferentiated sarcoma, or high-grade endometrial stromal sarcoma, overall survival differed significantly in the univariate analysis based on disease stage (I + II vs. III + IV) and tumor size (≤10 vs. >10 cm). However, only tumor size was an independent prognostic factor in the multivariate analysis., Conclusion: Tumor size (≤10 vs. >10 cm) may possibly have a prognostic impact on uterine sarcoma., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of Kyorin University issued approval R04-088. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Asano et al.)

Objective: To assess the efficacy of the FIGO 2018 classification system for nodal-specific classifications for early-stage cervical cancer; specifically, to examine the impact of nodal metastasis on survival and the effect of postoperative treatments, according to histological subtypes., Methods: This society-based retrospective observational study in Japan examined 16,539 women with the 2009 FIGO stage IB1 cervical cancer who underwent primary surgical treatment from 2004 to 2015. Associations of cause-specific survival (CSS) with nodal metastasis and postoperative adjuvant therapy were examined according to histology type (squamous cell carcinoma [SCC], n=10,315; and non-SCC, n=6,224)., Results: The nodal metastasis rate for SCC was higher than that for non-SCC (10.7% vs. 8.3%, p<0.001). In multivariable analysis, the impact of nodal metastasis on CSS was greater for non-SCC tumors (adjusted-hazard ratio [HR], 3.11; 95% confidence interval [CI], 2.40-4.02) than for SCC tumors (adjusted-HR, 2.20; 95% CI, 1.70-2.84; p<0.001). Propensity score matching analysis showed significantly lower CSS rates for women with pelvic nodal metastasis from non-SCC tumors than from SCC tumors (5-year CSS rate, 75.4% vs. 90.3%, p<0.001). The CSS rates for women with nodal metastasis in SCC histology were similar between the postoperative concurrent chemoradiotherapy/radiotherapy and chemotherapy groups (89.2% vs. 86.1%, p=0.42), whereas those in non-SCC histology who received postoperative chemotherapy improved the CSS (74.1% vs. 67.7%, p=0.043)., Conclusion: The node-specific staging system in the 2018 FIGO cervical cancer classification is applicable to both non-SCC tumors and SCC tumors; however, the prognostic significance of nodal metastases and efficacy of postoperative therapies vary according to histology., Competing Interests: Honorarium, Chugai, textbook editorial expense, Springer, and investigator meeting attendance expense, VBL therapeutics (K.M.) and none for others., (Copyright © 2022. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.)