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Uterine metastases from extragenital sites are rare. We present a case of a woman who had undergone surgery for small intestinal cancer and subsequently developed metastases in her left ovary and uterus. A nulliparous woman in her 50s underwent laparoscopic partial small bowel resection with lymph node dissection for small intestinal cancer. Five months later, computed tomography (CT) revealed a left ovarian tumor and ascites. She underwent bilateral adnexectomy and adjuvant chemotherapy, and the ovarian tumor was diagnosed as a small intestinal cancer metastasis. Two years after the small intestinal cancer surgery, a positron emission tomography (PET)-CT scan revealed a uterine accumulation. Cervical cytology was negative for intraepithelial lesion or malignancy. Endometrial histology showed an adenocarcinoma of the uterus. The patient underwent total abdominal hysterectomy followed by adjuvant chemotherapy. Histopathology and immunohistochemistry of the uterine tumor revealed that it was a metastasis of small intestinal cancer (Cytokeratin 7 [CK7] [−], Cytokeratin 20 [CK20] [+], Special AT-Rich Sequence-Binding Protein 2 [SATB2] [+], Paired Box Gene 2 [PAX2] [−], and estrogen receptor [ER] [−]). In patients with cancer, histopathology and immunohistochemistry are important for distinguishing between primary and metastatic tumors and for guiding the choice of treatment.

Objective To show how endoCUT mode can be safely managed with cervical conization. Methods Demonstration of the technique and explanation of endoCUT and soft coagulation mode with narrated video footage. Cervical conization is a therapeutic and diagnostic procedure performed for the diagnosis of cervical intraepithelial lesions and cervical cancer. Specific methods include cold scalpel, ultrasonically activated device and laser, and loop electrosurgical excision procedure (LEEP), which involves transpiration and partial excision. The endoCUT mode and soft coagulation in VIO3® (ERBE, Tübingen, Germany) were used to perform cervical conical resection safely and at low cost. The endoCUT mode was originally developed for polypectomy in gastrointestinal endoscopy, where no counter traction can be applied. Results The endoCUT mode approach to cervical conization with several key strategies to minimize blood loss and ensure safety: 1) incisions can be made in close contact; 2) resection can be performed with minimal contact with the lesion; 3) control of bleeding from the resected transection by soft coagulation; and 4) low running cost of endoCUT mode. Conclusion Conventionally, cervical conical resection has been performed by using a device capable of making a close incision (cold scalpel, ultrasonically activated device and laser, and LEEP etc.), but there have been issues with bleeding control and cost. Here, we present a new technique using the endoCUT mode and several strategies for safe and effective resection.

Abstract Background One cause of the increase in cervical cancer rates in Japan is the long-term stagnation in the cervical cancer screening consultation rate. Therefore, improving the screening consultation rate is of urgent concern to reduce cervical cancer incidence. Self-collected human papilloma virus (HPV) tests have been successfully adopted in several countries, such as the Netherlands and Australia, as a measure of individuals who have not undergone cervical cancer screening in national programs. This study aimed to verify whether self-collected HPV tests presented an effective countermeasure for individuals who had not undergone the recommended cervical cancer screenings. Methods This study was conducted from December 2020 to September 2022 in Muroran City, Japan. The primary evaluated endpoint was the percentage of citizens who underwent cervical cancer screening at a hospital with positive self-collected HPV test results. The secondary endpoint was the percentage of included participants who were diagnosed with cervical intraepithelial neoplasia (CIN) or higher among those who visited a hospital and underwent cervical cancer screening. Results The included study participants were 7,653 individuals aged 20–50 years with no record of previous cervical cancer examination in the past 5 years. We mailed these participants information on self-administered HPV tests as an alternative screening procedure and sent the kit to 1,674 women who requested the test. Among them, 953 returned the kit. Among the 89 HPV-positive individuals (positive rate, 9.3%), 71 (79.8%) visited the designated hospital for an examination. A closer examination revealed that 13 women (18.3% of hospital visits) had a CIN finding of CIN2 or higher, among whom one each had cervical cancer and vulvar cancer, eight presented with CIN3, and three presented with CIN2; two cases of invasive gynecologic cancer were also identified. Conclusions We conclude that the self-collected HPV tests showed a certain efficacy as a measure of individuals who had not undergone the recommended cervical cancer screening. We devised ways to have the unexamined patients undergo HPV testing and ensure that HPV-positive individuals visited the hospital. Despite a few limitations, our findings suggest the effectiveness of this public health intervention.

Uterine leiomyosarcoma (LMS) is a gynecological malignancy with an extremely poor prognosis. Multiple new therapeutic agents, including pazopanib, trabectedin, and eribulin, have been clinically applied to treat uterine LMS, and their therapeutic effects are expected. We encountered one patient with advanced recurrent uterine LMS who achieved a partial response to a four-year treatment with eribulin. A 31-year-old woman was diagnosed with stage 2B LMS. After the first recurrence, Gemcitabine, Docetaxel (GD) therapy was administered, and complete response (CR) was achieved. However, 2 years and 10 months later, recurrence occurred at the vaginal cuff, and GD therapy and doxorubicin hydrochloride were administered, resulting in CR. Five months later, she experienced another recurrence at the same location and was treated with eribulin. To date, 53 courses of eribulin have been administered and are currently ongoing. Maintaining low neutrophil-to-lymphocyte ratio and low platelet-to lymphocyte ratio in this manner is considered to be one of the reasons why eribulin continues to be effective. We encountered a rare case in which eribulin was administered for the longest period of time, and produced an observable effect in uterine LMS.

Abstract Background Peritoneal carcinoma is a rare disease that is diagnosed and treated in a manner similar to ovarian cancer. In most cases, the histological type is serous carcinoma, and chemotherapy is effective. However, there are a few case reports of mucinous peritoneal carcinoma. We inferred the histological type before surgery using an ascites cell block sample, which was useful for determining the treatment plan. Case presentation Our patient was a 60-year-old Japanese woman. She presented with a feeling of fullness in the abdomen. A computed tomographic scan showed a large quantity of ascitic fluid and thickening of the greater omentum, as well as thickening of the peritoneum at the pouch of Douglas and diaphragm. Hence, peritoneal carcinoma was suspected. The tumor markers carcinoembryonic antigen, cancer antigen 19-9, and cancer antigen 125 were all increased, and no malignant findings were observed in the uterus or ovaries. Cells suggestive of carcinoma were found in the ascitic fluid, and immunostaining by the cell block method suggested the possibility of mucinous carcinoma. The preoperative chemotherapy strategy was changed to short courses, and tumor reduction surgery was planned. Similar to the suspicion before surgery, the pathology results indicated mucinous carcinoma, and the therapeutic effect of chemotherapy was grade 0. Conclusions Determining whether peritoneal carcinoma is serous carcinoma is important for therapy and prognostic prediction. In this case, we encountered a patient for whom surgery was chosen because of drug therapy resistance inferred through histological type estimation using the cell block method. Inferring the histological type by cell block preparation is useful for diagnosis and treatment selection.

Recently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.

Objective: Complete resection is the curative treatment choice for recurrent gynecological malignancies. Laterally extended endopelvic resection (LEER) is an effective surgical salvage therapy for lateral recurrence. However, when a recurrent tumor occupies the ischial spine and sacrum, LEER is not indicated, and surgical salvage therapy is abandoned. Theoretically, complete resection of such a tumor is possible by additional pelvic bone resection along with the standard LEER. Nevertheless, owing to the anatomical complexities of the beyond-LEER procedure, 2 major issues should be solved: sciatic nerve injury and tumor disruption during pelvic bone amputation. To overcome these technical challenges, we applied a multidirectional beyond-LEER approach, a novel salvage surgical procedure, with an aim of demonstrating its technical feasibility. Methods: We created a simulation model of a laterally recurrent tumor that occupied the right ischial spine and sacrum in a Thiel-embalmed cadaver. Results: Multidirectional approaches, including laparoscopic, perineal, and dorsal phases, were safely applied. We laparoscopically marked the L4-L5-S1 complex and S2 nerve with different colored tapes, and by pulling them out into a dorsal surgical field, the sciatic nerve was safely preserved. The dissection lines of the multidirectional approaches were aligned using tapes as landmarks, and complete tumor clearance without tumor disruption was accomplished. By following the cadaveric training, the first laparoscopic-assisted beyond- LEER procedure was successfully performed in a patient with recurrent ovarian cancer. Conclusion: Using a Thiel-embalmed cadaver, we demonstrated the technical feasibility of a sciatic nerve-preserved beyond-LEER procedure, which was successfully performed in a patient with recurrent ovarian cancer. [ABSTRACT FROM AUTHOR]

Ovarian cancer, notable for its severe prognosis among gynecologic cancers, has seen substantial progress in treatment approaches recently. Enhanced protocols in chemotherapy and the introduction of poly (ADP-ribose) polymerase (PARP) inhibitors for maintenance therapy have markedly improved outcomes for patients with specific genetic profiles, such as those positive for BRCA mutations or exhibiting homologous recombination deficiency (HRD). Additionally, the method of intraperitoneal chemotherapy administration has emerged as a valuable alternative to traditional transvenous routes, showing promise for wider clinical adoption. The field of surgery has also evolved, with increasing exploration into the benefits and feasibility of laparoscopic methods over more invasive traditional surgeries, aiming for complete tumor removal but with reduced patient impact. The hereditary nature of ovarian cancer underscores the importance of genetic testing, which has become integral in tailoring treatment strategies, particularly in determining suitability for PARP inhibitors. The formation of the East Asian Gynecologic Oncology Trial Group (EAGOT) aims to optimize treatment across Japan, Korea, China, and Taiwan. The ovarian cancer committee of EAGOT shared the current policies, focusing on 5 topics: 1) strategies for maintenance therapy after initial surgery and chemotherapy, 2) drug regimens for platinum-sensitive and platinum-resistant recurrence, 3) intraperitoneal chemotherapy, 4) laparoscopic surgery as an alternative to laparotomy, and 5) current status of genetic testing (BRCA, HRD, and panel tests) for ovarian cancer and its prospects. EAGOT's multi-national trials aim to harmonize these evolving treatment strategies, ensuring that the latest and most effective protocols are accessible across the region, thereby significantly impacting patient outcomes in East Asia. [ABSTRACT FROM AUTHOR]

Introduction: Placenta percreta is associated with maternal morbidity and mortality. A hysterectomy is often needed to control the bleeding in such cases. However, it has been advocated that placenta percreta be managed conservatively to avoid massive pelvic bleeding and to preserve the patient's fertility. Here, we present a case of placenta percreta diagnosed by magnetic resonance imaging, and treated with systemic administration of methotrexate.Case Presentation: A 27-year-old nulliparous Japanese woman at 39 gestational weeks had an uncomplicated vaginal delivery of a 3244-g infant. However, her placenta was not delivered, and we could not remove it manually. Contrast-enhanced magnetic resonance imaging indicated deep myometrial invasion by placental tissue and the whole placenta was strongly enhanced. Seven days post-partum, her serum human chorionic gonadotropin level was 12,656IU/L. Our patient hoped to preserve her uterus for a future pregnancy. She therefore received 13 courses of methotrexate (50mg/week, intravenous injection). Her serum human chorionic gonadotropin level was undetectable 97 days after the first methotrexate injection. At 117 days post-partum, she had a labor-like pain every three minutes and delivered the placenta. Our patient regained normal menses and at follow-up remained in good health. Two years later, she delivered a healthy daughter.Conclusion: We should try to detect placenta percreta in high-risk patients by any means. For low-risk patients, we should give a diagnosis swiftly and control any intrauterine infection and massive bleeding. [ABSTRACT FROM AUTHOR]

Introduction A glioblastoma arising from an ovarian mature cystic teratoma is extremely rare. Guidelines for treatment of glioblastoma arising in teratoma have not been established because of its rarity. We report a case of glioblastoma arising from an ovarian teratoma diagnosed at Stage IA and we review the literature on glioblastoma arising in an ovary. Patients A 31-year-old woman (gravida 3, para 1) visited a hospital because of abdominal fullness. She had no significant medical or gynecological history. Magnetic resonance imaging revealed a bilateral ovary tumor that suggested mature cystic teratoma. She underwent a total hysterectomy with bilateral salpingo-oophorectomy and partial omentectomy because frozen section diagnosis during surgery was immature teratoma of the left ovary. Based on the morphology and immunohistochemical results, the final diagnosis was a glioblastoma arising from an ovarian teratoma. Additional treatment options were recommended, but she chose close observation. Six months later she relapsed, which was diagnosed by computed tomography (CT) imaging of an enlarged para-aortic lymph node. She underwent systematic para-aortic and pelvic lymphadenectomy. The metastatic lymph node showed pathological features similar to those of the primary tumor. Temozolomide (TMZ) was administered for maintenance therapy followed by TMZ with concomitant radiotherapy. After 6 months, CT indicated ascites and lymph node metastasis. She received a carboplatin+etoposide regimen. Results After 3 cycles of the carboplatin+etoposide regimen, her diseases were remarkably reduced. Conclusion To our knowledge, this is only the fifteenth reported case of glioblastoma occurring in an ovarian mature cystic teratoma. There is no consensus regarding the most appropriate treatment for recurrent glioblastoma arising from the ovary. A regimen of carboplatin+etoposide may be an alternative choice for patients with recurrent highgrade glioma. [ABSTRACT FROM AUTHOR]

Introduction Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare mesenchymal tumors with characteristics between benign leiomyomas and leiomyosarcomas (LMSs). Diagnosis, surgical management, and follow-up of this neoplasm remain controversial due to their unaggressive behavior and prolonged patient survival rate compared to LMSs. However, recurrence is estimated at almost 10% and may include delayed recurrences. When morcellated uterine tumors are unexpectedly found to be LMSs or tumors with atypical features (atypical leiomyoma, smooth muscle tumors of uncertain malignant potential), there may be significant clinical consequences. Methods We report the case of a 49-year-old woman (gravida 2, para 2) who presented with recurrence and transformation into LMS 37 months after the first operation without morcellation for STUMP. Results The patient had undergone a total laparoscopic hysterectomy and bilateral salpingooophorectomy without morcellation for a suspected uterine myoma, which was histologically proven to be STUMP. The patient presented with two months of dull pain on her right back buttock. Computed tomography showed a relapse of STUMP at the right side of the vaginal stump to pelvic wall and right hydronephrosis. The patient underwent a laparotomy for complete removal of the neoplastic recurrence and removal of the right kidney and ureter, which was histologically proven to be recurrence and transformation into LMS. The patient received adjuvant gemcitabine plus docetaxel. To date, the patient is disease-free. Conclusion STUMP needs frequent surveillance for the risk of recurrence and transformation into LMS, even many years after the first diagnosis and even after complete removal without morcellation. [ABSTRACT FROM AUTHOR]

Objectives Leiomyosarcomas in pelvis are mainly derived from uterus, however it is rare tumor and poor prognosis. Recently, several new anticancer compounds against leiomyosarcomas have been averrable. In this presentation we report treatment and prognosis of uterine leiomyosarcomas in last 5 years in our instrument. Methods: We analyzed response rate, prognosis and adverse effects of anticancer compounds for five cases of recurrent uterine leiomyosarcoma. Results Average age was 53.6 yr. Metastatic sites were lung for 3 cases and abdominal cavity for 2 case, which were completely resected surgically. Disease free survival after the resection of metastatic sites were 4 months, 22 months and 52 months for lung metastasis cases who underwent VATS and 41months for colon metastasis case who underwent pelvic exenteration. As third line chemotherapy pazopanib was used for 3 cases, trabectedin for 2 cases and eribulin for 2 cases. In this study, all cases were PD, however severe adverse effect (level 3 and 4) was not observed. Conclusions In this study, only one case showed disease free survival who underwent tumor section surgery recurrent uterine leiomyosarcoma, however severe adverse effects was not found in new anticancer compounds. [ABSTRACT FROM AUTHOR]