<div><h3>Background</h3><div>Lobular endocervical glandular hyperplasia (LEGH) is a benign cervical condition that has been proposed as a precursor lesion to minimal deviation adenocarcinoma (MDA), a rare but highly aggressive subtype of well-differentiated gastric-type endocervical adenocarcinoma (GAS). MDA is more frequently observed in patients with Peutz–Jeghers syndrome (PJS) and is strongly associated with mutations in the STK11 gene. While LEGH is not inherently linked to PJS, its potential progression to MDA warrants vigilance, particularly in patients with PJS due to their heightened risk of gynecologic malignancies. Here, we report a case of LEGH diagnosed during surveillance for PJS, analyzed via whole genome sequencing. LEGH is a benign cervical condition, considered a precursor lesion to minimal deviation adenocarcinoma, often observed in patients with Peutz–Jeghers syndrome (PJS) and potentially linked to mutations in the <em>STK11</em> gene.</div></div><div><h3>Case</h3><div>A 23-year-old woman, diagnosed with PJS at age 11, was referred to a gynecologist after a cystic lesion was detected in the cervix during a follow-up computed tomography scan. Initial examinations, including imaging and colposcopy, did not indicate LEGH or a malignant tumor. Imaging alone is insufficient to exclude premalignant or malignant conditions, as abnormal cervical lesions often require biopsy for a definitive diagnosis. However, cervical cytology showed nuclear atypia was minimal, but some clusters exhibited disordered alignment, and the cytoplasm contained yellowish mucus suggestive of LEGH. Based on these findings, cytology follow-up was planned. However, the patient did not return for further follow-up. After one year and five months, the patient presented with increased mucous vaginal discharge. Cervical cytology indicated atypical glandular cells, and magnetic resonance imaging with contrast enhancement revealed an enlarged cervical lesion, suggesting minimal deviation adenocarcinoma. We performed cervical conization, and a histopathological examination helped confirm LEGH. High-throughput next-generation sequencing of the excised cervical tissue revealed a missense mutation in the serine/threonine kinase 11 (<em>STK11</em>) gene on chromosome 19 (c.1062C > G) and three missense mutations in STK11 interacting protein (<em>STK11IP</em>) on chromosome 2 (c.2G > T, c.1687G > A, c.2255C > T). Mutations in STK11, particularly those affecting its regulatory domains, may significantly increase cancer risk in patients with PJS, and that STK11IP plays a crucial role in modulating STK11 activity. The patient, seeking to preserve fertility, has been monitored for five years post-surgery without evidence of malignant transformation. Continuous monitoring with periodic imaging and cytological assessments has shown no evidence of malignant transformation. The absence of elevated tumor markers further supports the conservative approach. While there a
{"title":"Lobular endocervical glandular hyperplasia diagnosed during surveillance for Peutz–Jeghers Syndrome: A case report","authors":"Takayuki Ichinose , Kazuki Takasaki , Yuko Takahashi , Mana Hirano , Haruka Nishida , Haruko Hiraike , Yuko Sasajima , Kazunori Nagasaka","doi":"10.1016/j.gore.2024.101673","DOIUrl":"10.1016/j.gore.2024.101673","url":null,"abstract":"<div><h3>Background</h3><div>Lobular endocervical glandular hyperplasia (LEGH) is a benign cervical condition that has been proposed as a precursor lesion to minimal deviation adenocarcinoma (MDA), a rare but highly aggressive subtype of well-differentiated gastric-type endocervical adenocarcinoma (GAS). MDA is more frequently observed in patients with Peutz–Jeghers syndrome (PJS) and is strongly associated with mutations in the STK11 gene. While LEGH is not inherently linked to PJS, its potential progression to MDA warrants vigilance, particularly in patients with PJS due to their heightened risk of gynecologic malignancies. Here, we report a case of LEGH diagnosed during surveillance for PJS, analyzed via whole genome sequencing. LEGH is a benign cervical condition, considered a precursor lesion to minimal deviation adenocarcinoma, often observed in patients with Peutz–Jeghers syndrome (PJS) and potentially linked to mutations in the <em>STK11</em> gene.</div></div><div><h3>Case</h3><div>A 23-year-old woman, diagnosed with PJS at age 11, was referred to a gynecologist after a cystic lesion was detected in the cervix during a follow-up computed tomography scan. Initial examinations, including imaging and colposcopy, did not indicate LEGH or a malignant tumor. Imaging alone is insufficient to exclude premalignant or malignant conditions, as abnormal cervical lesions often require biopsy for a definitive diagnosis. However, cervical cytology showed nuclear atypia was minimal, but some clusters exhibited disordered alignment, and the cytoplasm contained yellowish mucus suggestive of LEGH. Based on these findings, cytology follow-up was planned. However, the patient did not return for further follow-up. After one year and five months, the patient presented with increased mucous vaginal discharge. Cervical cytology indicated atypical glandular cells, and magnetic resonance imaging with contrast enhancement revealed an enlarged cervical lesion, suggesting minimal deviation adenocarcinoma. We performed cervical conization, and a histopathological examination helped confirm LEGH. High-throughput next-generation sequencing of the excised cervical tissue revealed a missense mutation in the serine/threonine kinase 11 (<em>STK11</em>) gene on chromosome 19 (c.1062C > G) and three missense mutations in STK11 interacting protein (<em>STK11IP</em>) on chromosome 2 (c.2G > T, c.1687G > A, c.2255C > T). Mutations in STK11, particularly those affecting its regulatory domains, may significantly increase cancer risk in patients with PJS, and that STK11IP plays a crucial role in modulating STK11 activity. The patient, seeking to preserve fertility, has been monitored for five years post-surgery without evidence of malignant transformation. Continuous monitoring with periodic imaging and cytological assessments has shown no evidence of malignant transformation. The absence of elevated tumor markers further supports the conservative approach. While there a","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101673"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2025.101682
Stefania Bellone , Eric R. Siegel , Alessandro D. Santin
Objectives
A subset of COVID-infected cancer patients may develop post-acute sequelae of COVID-19 (PASC), also known as Long COVID (LC). While LC is considered multifactorial in its pathogenesis, growing evidence suggests that persistent microvascular inflammation (ie, spike-induced endotheliosis) causing chronically elevated levels of clotting factors including von Willebrand factor (vWF), clumping/clotting of red blood cells and platelets, and thrombotic complications may be at the root of PASC/LC symptoms. N-Acetylcysteine (NAC), a precursor of glutathione, is an inexpensive FDA-approved drug/supplement endowed with mucolytic, antioxidant, anti-inflammatory and thrombolytic properties. Multiple reports have recently demonstrated the potential clinical activity of NAC in COVID-19 patients. We retrospectively evaluated responses to NAC supplementation in a total of 9 PASC/LC patients, 3 of which reporting regular use of NAC, followed in our Gynecologic Oncology clinic.
Methods
Gynecologic patients using NAC supplement (3 patients) vs controls (6 patients) with persistent LC/PASC symptoms and with elevated plasmatic vWF levels were identified in our Gynecologic Oncology clinic database and evaluated for improvement/normalization in LC/PASC symptoms and vWF levels.
Results
Subjective improvement in shortness of breath, brain fog and fatigue with normalization of vWF levels were noted in 3 out of 3 PASC/LC patients using oral NAC (600–1200 mg BID) vs none of the randomly selected cancer control patients with PASC/LC (Fisher’s exact P = 0.0119).
Conclusions
These preliminary results suggest that NAC may represent an inexpensive, safe and potentially effective supplement to improve many PASC/LC-related symptoms. Prospective randomized studies with NAC in PASC/LC patients are needed to confirm these findings.
{"title":"N-acetylcysteine (NAC) supplementation improves dyspnea and may normalize von Willebrand plasma levels in gynecologic patients with Post-Acute-COVID-Sequela (PASC)/Long COVID","authors":"Stefania Bellone , Eric R. Siegel , Alessandro D. Santin","doi":"10.1016/j.gore.2025.101682","DOIUrl":"10.1016/j.gore.2025.101682","url":null,"abstract":"<div><h3>Objectives</h3><div>A subset of COVID-infected cancer patients may develop post-acute sequelae of COVID-19 (PASC), also known as Long COVID (LC). While LC is considered multifactorial in its pathogenesis, growing evidence suggests that persistent microvascular inflammation (ie, spike-induced endotheliosis) causing chronically elevated levels of clotting factors including von Willebrand factor (vWF), clumping/clotting of red blood cells and platelets, and thrombotic complications may be at the root of PASC/LC symptoms. N-Acetylcysteine (NAC), a precursor of glutathione, is an inexpensive FDA-approved drug/supplement endowed with mucolytic, antioxidant, anti-inflammatory and thrombolytic properties. Multiple reports have recently demonstrated the potential clinical activity of NAC in COVID-19 patients. We retrospectively evaluated responses to NAC supplementation in a total of 9 PASC/LC patients, 3 of which reporting regular use of NAC, followed in our Gynecologic Oncology clinic.</div></div><div><h3>Methods</h3><div>Gynecologic patients using NAC supplement (3 patients) vs controls (6 patients) with persistent LC/PASC symptoms and with elevated plasmatic vWF levels were identified in our Gynecologic Oncology clinic database and evaluated for improvement/normalization in LC/PASC symptoms and vWF levels.</div></div><div><h3>Results</h3><div>Subjective improvement in shortness of breath, brain fog and fatigue with normalization of vWF levels were noted in 3 out of 3 PASC/LC patients using oral NAC (600–1200 mg BID) vs none of the randomly selected cancer control patients with PASC/LC (Fisher’s exact P = 0.0119).</div></div><div><h3>Conclusions</h3><div>These preliminary results suggest that NAC may represent an inexpensive, safe and potentially effective supplement to improve many PASC/LC-related symptoms. Prospective randomized studies with NAC in PASC/LC patients are needed to confirm these findings.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101682"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2025.101678
Grace Pipes , Bahaaeldin Youssef , Mariam Torossian , Kenneth H. Kim , Margaret I. Liang
Introduction
Pseudo-Meigs’ syndrome is a rare condition described as the presentation of a pleural effusion and ascites in the setting of a malignant pelvic mass that is not included in the definition of Meigs’ syndrome, and which resolves with resection of the mass.
Case presentation
We report a 37-year-old patient with a twenty-centimeter pelvic mass assumed to be at least a stage IVA ovarian carcinoma due to the presence of a pleural effusion and ascites. She underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy with a final pathology of a stage IA mucinous cancer of the ovary. Her pleural effusion and ascites resolved within weeks after operative management. She did not receive adjuvant chemotherapy, and she remains without evidence of disease for over a year.
Discussion
This case demonstrates the diagnostic complexity of advanced ovarian carcinomas which may have diverse initial presentations. Patients who present with signs of advanced ovarian cancer, such as pleural effusion, may even undergo neoadjuvant chemotherapy before surgical debulking. Our case emphasizes the importance of tissue diagnosis prior to treatment decisions.
{"title":"Pseudo-Meigs’ syndrome in mucinous ovarian carcinoma: A case report","authors":"Grace Pipes , Bahaaeldin Youssef , Mariam Torossian , Kenneth H. Kim , Margaret I. Liang","doi":"10.1016/j.gore.2025.101678","DOIUrl":"10.1016/j.gore.2025.101678","url":null,"abstract":"<div><h3>Introduction</h3><div>Pseudo-Meigs’ syndrome is a rare condition described as the presentation of a pleural effusion and ascites in the setting of a malignant pelvic mass that is not included in the definition of Meigs’ syndrome, and which resolves with resection of the mass.</div></div><div><h3>Case presentation</h3><div>We report a 37-year-old patient with a twenty-centimeter pelvic mass assumed to be at least a stage IVA ovarian carcinoma due to the presence of a pleural effusion and ascites. She underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy with a final pathology of a stage IA mucinous cancer of the ovary. Her pleural effusion and ascites resolved within weeks after operative management. She did not receive adjuvant chemotherapy, and she remains without evidence of disease for over a year.</div></div><div><h3>Discussion</h3><div>This case demonstrates the diagnostic complexity of advanced ovarian carcinomas which may have diverse initial presentations. Patients who present with signs of advanced ovarian cancer, such as pleural effusion, may even undergo neoadjuvant chemotherapy before surgical debulking. Our case emphasizes the importance of tissue diagnosis prior to treatment decisions.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101678"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2025.101677
A. Rafael Guijarro-Campillo , Pablo Padilla-Iserte , Víctor Lago , Raquel Quintana-Bertó , Marta Arnáez-De La Cruz , Aníbal Nieto , Santiago Domingo Del Pozo
Vulvar cancer guidelines recommend inguinal sentinel lymph node (SLN) biopsy as the standard of care for patients with unifocal squamous cell carcinoma tumors less than 4 cm and clinically non-suspicious nodes in the groin [1]. The use of radioactive tracer is mandatory, while the application of blue dye is optional [2]. Combination detection techniques have been established as the most accurate for early vulvar cancer, with increasing evidence supporting indocyanine green (ICG) as an alternative to blue dye [3], [4]. However, protocols for ICG use remain heterogeneous, and the optimal protocol is yet to be defined [5], [6].
This video article presents a stepwise demonstration of the SLN mapping technique using a combination of radioactive 99 m-Tc and ICG with endoscopic near-infrared (NIR) cameras in two cases. A 52-year-old woman diagnosed with T1 vulvar cancer, with no extravulvar disease, was scheduled for wide local tumor excision and bilateral inguinal SLN biopsy. The procedure began with 99 m-Tc detection, followed by ICG identification. A 25 mg vial of ICG was dissolved in 10 mL of sterile water, with 2 mL injected into four intradermal quadrants around the tumor. Ten minutes post-injection, a small incision in the groin was made, assisted by lymphoscintigraphy fluorescence imaging using the NIR/ICG-IMAGE1S™ system. Images of another IB FIGO stage vulvar cancer patient undergoing SLN inguinal procedure with the NIR Da Vinci Xi camera were also included. The sentinel nodes were accurately detected in both patients, with no involvement after histological study. The informed consent for this video was obtained from both patients.
{"title":"Step-by-step combination of 99mTc and ICG with endoscopic near infrared cameras in SLN mapping early-stage vulvar cancer","authors":"A. Rafael Guijarro-Campillo , Pablo Padilla-Iserte , Víctor Lago , Raquel Quintana-Bertó , Marta Arnáez-De La Cruz , Aníbal Nieto , Santiago Domingo Del Pozo","doi":"10.1016/j.gore.2025.101677","DOIUrl":"10.1016/j.gore.2025.101677","url":null,"abstract":"<div><div>Vulvar cancer guidelines recommend inguinal sentinel lymph node (SLN) biopsy as the standard of care for patients with unifocal squamous cell carcinoma tumors less than 4 cm and clinically non-suspicious nodes in the groin <span><span>[1]</span></span>. The use of radioactive tracer is mandatory, while the application of blue dye is optional <span><span>[2]</span></span>. Combination detection techniques have been established as the most accurate for early vulvar cancer, with increasing evidence supporting indocyanine green (ICG) as an alternative to blue dye <span><span>[3]</span></span>, <span><span>[4]</span></span>. However, protocols for ICG use remain heterogeneous, and the optimal protocol is yet to be defined <span><span>[5]</span></span>, <span><span>[6]</span></span>.</div><div>This video article presents a stepwise demonstration of the SLN mapping technique using a combination of radioactive 99 m-Tc and ICG with endoscopic near-infrared (NIR) cameras in two cases. A 52-year-old woman diagnosed with T1 vulvar cancer, with no extravulvar disease, was scheduled for wide local tumor excision and bilateral inguinal SLN biopsy. The procedure began with 99 m-Tc detection, followed by ICG identification. A 25 mg vial of ICG<!--> <!-->was dissolved in 10 mL of sterile water, with 2 mL injected into four intradermal quadrants around the tumor. Ten minutes post-injection, a small incision in the groin was made, assisted by lymphoscintigraphy fluorescence imaging using the NIR/ICG-IMAGE1S™ system. Images of another IB FIGO stage vulvar cancer patient undergoing SLN inguinal procedure with the NIR Da Vinci Xi camera were also included. The sentinel nodes were accurately detected in both patients, with no involvement after histological study. The informed consent for this video was obtained from both patients.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101677"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2024.101549
M. Klein , H. Pirzadah , Y. Magharehabed , A. Chapple , N. Nair , A. Jernigan , T. Castellano
Objective
There is no standard clinical trial screening process in gynecologic oncology. In our low resource, highly diverse gynecologic oncology patient population, we sought to create an equitable, adaptable, manual screening process.
Methods
Our objective is to describe our clinical trial screening process and success in improving trial enrollment. An Institutional Review Board (IRB) approved quality improvement (QI) project was implemented in July 2022 to evaluate trial access. Screenable events were defined. Potential patients were those with a screenable event: new patients or diagnoses, regimen changes, progressions, and recurrences. Events were categorized into screen positive or screened no trial available. Screen positives were further categorized as screen positive, enrollment failure events or enrollments. Data about patients were collected via weekly research team meetings. Monthly meetings occurred to review progress. The data were compared to trials available, number of patients with trail available, and those that enrolled. Reasons for enrollment fails were tracked.
Results
Over time, “screen no trial available” (SNTA) rates stayed stable, but enrollment rates increased. Patient preference accounted for 32.8 % of enrollment failures (n = 42), pre-existing symptoms 23.4 % (n = 30), and location 21.1 % (n = 27). During increased employee turnover, there was a rise in enrollment fails due to staffing (n = 6, 4.7 %). We describe an effective process of clearly defining and tracking our patient population and ‘screenable events’ for which all patients are screened and offered trial participation if eligible.
Conclusions
We show that we improved understanding of the patient population, built a clinical trial portfolio better matched to population served, exceeded national averages for enrolling patients on trials, and are improving number eligible.
{"title":"“Developing a manual clinical trials screening process in a diverse southern gynecologic oncology practice”","authors":"M. Klein , H. Pirzadah , Y. Magharehabed , A. Chapple , N. Nair , A. Jernigan , T. Castellano","doi":"10.1016/j.gore.2024.101549","DOIUrl":"10.1016/j.gore.2024.101549","url":null,"abstract":"<div><h3>Objective</h3><div>There is no standard clinical trial screening process in gynecologic oncology. In our low resource, highly diverse gynecologic oncology patient population, we sought to create an equitable, adaptable, manual screening process.</div></div><div><h3>Methods</h3><div>Our objective is to describe our clinical trial screening process and success in improving trial enrollment. An Institutional Review Board (IRB) approved quality improvement (QI) project was implemented in July 2022 to evaluate trial access. Screenable events were defined. Potential patients were those with a screenable event: new patients or diagnoses, regimen changes, progressions, and recurrences. Events were categorized into screen positive or screened no trial available. Screen positives were further categorized as screen positive, enrollment failure events or enrollments. Data about patients were collected via weekly research team meetings. Monthly meetings occurred to review progress. The data were compared to trials available, number of patients with trail available, and those that enrolled. Reasons for enrollment fails were tracked.</div></div><div><h3>Results</h3><div>Over time, “screen no trial available” (SNTA) rates stayed stable, but enrollment rates increased. Patient preference accounted for 32.8 % of enrollment failures (n = 42), pre-existing symptoms 23.4 % (n = 30), and location 21.1 % (n = 27). During increased employee turnover, there was a rise in enrollment fails due to staffing (n = 6, 4.7 %). We describe an effective process of clearly defining and tracking our patient population and ‘screenable events’ for which all patients are screened and offered trial participation if eligible.</div></div><div><h3>Conclusions</h3><div>We show that we improved understanding of the patient population, built a clinical trial portfolio better matched to population served, exceeded national averages for enrolling patients on trials, and are improving number eligible.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101549"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2024.101661
P. Tonui , P. Itsura , O. Omenge , N. Faiza , A. Keter , A. Mburu , J. Oguda , Amina R. Hassan , S. Cu-Uvin
<div><h3>Introduction</h3><div>Visual Inspection with Acetic Acid (VIA) has been adopted for cervical cancer screening in Kenya and other Low-Middle Income Countries despite providing suboptimal results among HIV-infected women. It is mostly performed by nurses in health centers. Innovative ways of improving the performance of VIA in HIV-infected women are desired.</div></div><div><h3>Objective</h3><div>To establish the feasibility of screening with VIA and Digital Cervicography with Real-time Consultation (VIA-DCRC), and compare its performance to screening with VIA alone among HIV + women.</div></div><div><h3>Methods</h3><div>This was a cross-sectional analytical study of two hundred HIV + women. There were two groups of women who underwent either VIA or VIA/DCRC cervical cancer screening arms. In the VIA/DCRC arm, a trained nurse did the VIA, captured an image of the cervix, uploaded it, and electronically shared it in real-time with three blinded study consultants (gynecologic oncologists) who separately assessed the digital image and classified it as VIA/DCRC positive or negative. Any two opinions of the gynecologic oncologists that concurred were considered as the final diagnosis.</div><div>All participants who screened positive underwent colposcopy and biopsy prior to treatment. Tissues obtained were subjected to histopathological examination. A fraction (15 %) of those who screened negative for VIA and VIA/ DCRC had random cervical biopsies taken at 12 and 6o’clock positions. We estimated the measures of accuracy using the Bayesian method.</div></div><div><h3>Results</h3><div>The mean age was 39.7 +/- 10.7 years. Average CD4 + count and plasma viral load (log base 10) were 492.2 (SD: 255.3) cells per mm<sup>3</sup>, and 2.6 (SD: 0.7) copies per ml respectively. None of the women was a smoker.</div><div>The median (IQR) time taken for at least one gynecologic oncologist to respond to a digital consultation was 2.0 (IQR 1.0, 4.0) minutes, range: 1.0 – 47.0.</div><div>Overall, 60.5 % were diagnosed with cervical pre-malignancies (VIA: 23.1 % (95 % Credible Bounds (CB): 10.1, 37.5), VIA/DCRC: 37.5 % (95 % CB: 26.6, 50.1)).</div><div>VIA sensitivity, specificity, positive predictive value and negative predictive value were 28.1 % (95 % CB: 11.2, 6.8), 97.8 % (95 % CB: 93.0, 99.7), 79.8 % (95 % CB: 47.3, 96.8), and 80.4 % (95 % CB: 71.0, 87.5) while that of VIA/DCRC was 69.3 % (95 % CB: 47.8, 89.7), 87.9 % (95 % CB: 76.3, 94.4), 77.6 % (95 % CB: 61.9, 89.3), and 80.3 % (95 % CB: 70.2, 88.9) respectively. Compared to the VIA/DCRC group, there was evidence of better sensitivity, comparable negative predictive value, but poor specificity, RR: 2.46 (95 % CB: 1.06, 6.26), RR: 1.65 (95 % CB: 1.00, 3.50), and RR: 0.90 (95 % CB: 0.78, 0.98) respectively.</div></div><div><h3>Conclusions</h3><div>Cervical cancer screening in HIV + women using VIA/DCRC is feasible and it significantly improves the sensitivity, and comparable negative predictive value of V
{"title":"Digital cervicography using mobile phones with real-time consultation (DCRC) to improve performance of Visual Inspection with Acetic Acid (VIA) in cervical cancer screening of HIV-infected women. A cross-sectional study","authors":"P. Tonui , P. Itsura , O. Omenge , N. Faiza , A. Keter , A. Mburu , J. Oguda , Amina R. Hassan , S. Cu-Uvin","doi":"10.1016/j.gore.2024.101661","DOIUrl":"10.1016/j.gore.2024.101661","url":null,"abstract":"<div><h3>Introduction</h3><div>Visual Inspection with Acetic Acid (VIA) has been adopted for cervical cancer screening in Kenya and other Low-Middle Income Countries despite providing suboptimal results among HIV-infected women. It is mostly performed by nurses in health centers. Innovative ways of improving the performance of VIA in HIV-infected women are desired.</div></div><div><h3>Objective</h3><div>To establish the feasibility of screening with VIA and Digital Cervicography with Real-time Consultation (VIA-DCRC), and compare its performance to screening with VIA alone among HIV + women.</div></div><div><h3>Methods</h3><div>This was a cross-sectional analytical study of two hundred HIV + women. There were two groups of women who underwent either VIA or VIA/DCRC cervical cancer screening arms. In the VIA/DCRC arm, a trained nurse did the VIA, captured an image of the cervix, uploaded it, and electronically shared it in real-time with three blinded study consultants (gynecologic oncologists) who separately assessed the digital image and classified it as VIA/DCRC positive or negative. Any two opinions of the gynecologic oncologists that concurred were considered as the final diagnosis.</div><div>All participants who screened positive underwent colposcopy and biopsy prior to treatment. Tissues obtained were subjected to histopathological examination. A fraction (15 %) of those who screened negative for VIA and VIA/ DCRC had random cervical biopsies taken at 12 and 6o’clock positions. We estimated the measures of accuracy using the Bayesian method.</div></div><div><h3>Results</h3><div>The mean age was 39.7 +/- 10.7 years. Average CD4 + count and plasma viral load (log base 10) were 492.2 (SD: 255.3) cells per mm<sup>3</sup>, and 2.6 (SD: 0.7) copies per ml respectively. None of the women was a smoker.</div><div>The median (IQR) time taken for at least one gynecologic oncologist to respond to a digital consultation was 2.0 (IQR 1.0, 4.0) minutes, range: 1.0 – 47.0.</div><div>Overall, 60.5 % were diagnosed with cervical pre-malignancies (VIA: 23.1 % (95 % Credible Bounds (CB): 10.1, 37.5), VIA/DCRC: 37.5 % (95 % CB: 26.6, 50.1)).</div><div>VIA sensitivity, specificity, positive predictive value and negative predictive value were 28.1 % (95 % CB: 11.2, 6.8), 97.8 % (95 % CB: 93.0, 99.7), 79.8 % (95 % CB: 47.3, 96.8), and 80.4 % (95 % CB: 71.0, 87.5) while that of VIA/DCRC was 69.3 % (95 % CB: 47.8, 89.7), 87.9 % (95 % CB: 76.3, 94.4), 77.6 % (95 % CB: 61.9, 89.3), and 80.3 % (95 % CB: 70.2, 88.9) respectively. Compared to the VIA/DCRC group, there was evidence of better sensitivity, comparable negative predictive value, but poor specificity, RR: 2.46 (95 % CB: 1.06, 6.26), RR: 1.65 (95 % CB: 1.00, 3.50), and RR: 0.90 (95 % CB: 0.78, 0.98) respectively.</div></div><div><h3>Conclusions</h3><div>Cervical cancer screening in HIV + women using VIA/DCRC is feasible and it significantly improves the sensitivity, and comparable negative predictive value of V","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101661"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2024.101672
Abdulkareem Fayoumi
Endometrial stromal tumors (ESTs) are uncommon mesenchymal tumors of the reproductive system associated with heterogeneous histomolecular features. According to the World Health Organization (WHO), ESTs are classified into benign endometrial stromal nodules (BESN) and endometrial stromal sarcomas (ESSs), which are further divided into low-grade and high-grade subtypes. High-grade ESS is frequently associated with YWHAE–NUTM2 gene fusions, while a newly recognized subtype with BCOR rearrangements, including fusions, alterations, and internal tandem duplications (ITDs), has recently been incorporated into the molecular classification of ESS. BCOR, a transcriptional corepressor of BCL-6, contributes to tumor progression through its role in polycomb repressive complex 1 (PRC1), underscoring its importance in oncogenesis and potential as a therapeutic target. Advances in molecular diagnostics, such as next-generation sequencing (NGS) and fluorescence in situ hybridization (FISH), have improved the precision of diagnosing BCOR-altered ESS, enabling better prognostic stratification. These findings also support the development of targeted therapies, including CDK4/6 inhibitors and immunotherapies targeting PD-1 and CTLA-4 pathways. Despite these advancements, barriers such as limited access to molecular diagnostics and the high cost of novel therapies remain significant challenges. This review bridges molecular and clinical insights into ESS, emphasizing the diagnostic, prognostic, and therapeutic implications of BCOR rearrangements. By integrating these advances into clinical practice, it aims to improve outcomes for patients with this rare and aggressive malignancy.
{"title":"BCOR abnormalities in endometrial stromal sarcoma","authors":"Abdulkareem Fayoumi","doi":"10.1016/j.gore.2024.101672","DOIUrl":"10.1016/j.gore.2024.101672","url":null,"abstract":"<div><div>Endometrial stromal tumors (ESTs) are uncommon mesenchymal tumors of the reproductive system associated with heterogeneous histomolecular features. According to the World Health Organization (WHO), ESTs are classified into benign endometrial stromal nodules (BESN) and endometrial stromal sarcomas (ESSs), which are further divided into low-grade and high-grade subtypes. High-grade ESS is frequently associated with YWHAE–NUTM2 gene fusions, while a newly recognized subtype with BCOR rearrangements, including fusions, alterations, and internal tandem duplications (ITDs), has recently been incorporated into the molecular classification of ESS. BCOR, a transcriptional corepressor of BCL-6, contributes to tumor progression through its role in polycomb repressive complex 1 (PRC1), underscoring its importance in oncogenesis and potential as a therapeutic target. Advances in molecular diagnostics, such as next-generation sequencing (NGS) and fluorescence in situ hybridization (FISH), have improved the precision of diagnosing BCOR-altered ESS, enabling better prognostic stratification. These findings also support the development of targeted therapies, including CDK4/6 inhibitors and immunotherapies targeting PD-1 and CTLA-4 pathways. Despite these advancements, barriers such as limited access to molecular diagnostics and the high cost of novel therapies remain significant challenges. This review bridges molecular and clinical insights into ESS, emphasizing the diagnostic, prognostic, and therapeutic implications of BCOR rearrangements. By integrating these advances into clinical practice, it aims to improve outcomes for patients with this rare and aggressive malignancy.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101672"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2024.101669
Xin Zhao , Shi Shen , Cailing Su , Juan Chang , Yunfang Yan , Jianmin Zhao
Cervical cancer is a significant public health issue for women, with human papillomavirus (HPV) infection rates exhibiting regional variations throughout China. This study examined data from a cohort of 24,588 rural women who engaged in cervical cancer screening in Luonan County from 2021 to 2023, utilizing high-risk HPV (hrHPV) testing methodologies. The findings revealed an overall HPV positivity rate of 14.18 %, with hrHPV positivity rates of 13.99 % in 2021, 12.97 % in 2022, and 15.32 % in 2023. Infection rates increased with age, showing significant differences among age groups. Types 52, 16, and 58 were the most prevalent hrHPV types. Single-type infections were more common than multiple infections, with prevalent combinations such as HPV16 + HPV52, HPV52 + HPV58, and HPV51 + HPV16. The results highlight the imperative for improved screening, especially for women aged 60 to 64 residing in rural areas, and emphasize the importance of HPV vaccination and targeted screening for the prevention and eventual eradication of cervical cancer.
{"title":"Epidemiological study of HPV infection in 24,588 rural women in Luonan, China","authors":"Xin Zhao , Shi Shen , Cailing Su , Juan Chang , Yunfang Yan , Jianmin Zhao","doi":"10.1016/j.gore.2024.101669","DOIUrl":"10.1016/j.gore.2024.101669","url":null,"abstract":"<div><div>Cervical cancer is a significant public health issue for women, with human papillomavirus (HPV) infection rates exhibiting regional variations throughout China. This study examined data from a cohort of 24,588 rural women who engaged in cervical cancer screening in Luonan County from 2021 to 2023, utilizing high-risk HPV (hrHPV) testing methodologies. The findings revealed an overall HPV positivity rate of 14.18 %, with hrHPV positivity rates of 13.99 % in 2021, 12.97 % in 2022, and 15.32 % in 2023. Infection rates increased with age, showing significant differences among age groups. Types 52, 16, and 58 were the most prevalent hrHPV types. Single-type infections were more common than multiple infections, with prevalent combinations such as HPV16 + HPV52, HPV52 + HPV58, and HPV51 + HPV16. The results highlight the imperative for improved screening, especially for women aged 60 to 64 residing in rural areas, and emphasize the importance of HPV vaccination and targeted screening for the prevention and eventual eradication of cervical cancer.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101669"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2025.101679
Eveline N.B. Pham , Caroline B. van den Berg , Ingrid Boere , Vera de Geus , Juanita A. Haagsma , Marianne Maliepaard , Jan Willem M. Mens , Floris H. Groenendijk , Heleen J. van Beekhuizen
Objective
This study aimed to assess the QoL in patients with uterine carcinosarcoma (UCS) and identify factors influencing survival.
Methods
A prospective cohort study was conducted of patients with UCS who were treated between 2016 and 2022 in a Dutch academic hospital. QoL was evaluated using the EORTC QLQ-C30 and QLQ-EN24 questionnaires at baseline, end of treatment, and at one, two, and five years after treatment. Outcomes were described as mean scores in functioning and symptom domains. The mean scores of the QLQ-C30 were compared to those of a matched group from the general Dutch population. Clinical data were collected. Factors influencing survival were assessed via Cox proportional hazards models.
Results
The study included 64 patients, 56 of them participated in the QoL questionnaires. The median progression-free survival was 13 months, and overall survival was 20 months. QoL was significantly lower in all functional domains at one year after treatment compared to members of the general population. The most affected functioning domains were physical, role, cognitive, and social functioning and symptoms like fatigue, pain, and lymphedema. Long-term QoL remained compromised, with global health and insomnia notably impaired even five years after treatment. Significant prognostic factors for better overall survival included lower FIGO stage, surgery, and chemotherapy.
Conclusions
Patients with UCS experience significant deterioration in QoL. Despite extensive treatment, QoL remains poor, emphasizing the need for integrating QoL considerations into treatment decisions to balance the benefits of treatment with potential QoL impairments.
{"title":"Quality of life and survival in patients with uterine carcinosarcoma: A tertiary center observational study","authors":"Eveline N.B. Pham , Caroline B. van den Berg , Ingrid Boere , Vera de Geus , Juanita A. Haagsma , Marianne Maliepaard , Jan Willem M. Mens , Floris H. Groenendijk , Heleen J. van Beekhuizen","doi":"10.1016/j.gore.2025.101679","DOIUrl":"10.1016/j.gore.2025.101679","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the QoL in patients with uterine carcinosarcoma (UCS) and identify factors influencing survival.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted of patients with UCS who were treated between 2016 and 2022 in a Dutch academic hospital. QoL was evaluated using the EORTC QLQ-C30 and QLQ-EN24 questionnaires at baseline, end of treatment, and at one, two, and five years after treatment. Outcomes were described as mean scores in functioning and symptom domains. The mean scores of the QLQ-C30 were compared to those of a matched group from the general Dutch population. Clinical data were collected. Factors influencing survival were assessed via Cox proportional hazards models.</div></div><div><h3>Results</h3><div>The study included 64 patients, 56 of them participated in the QoL questionnaires. The median progression-free survival was 13 months, and overall survival was 20 months. QoL was significantly lower in all functional domains at one year after treatment compared to members of the general population. The most affected functioning domains were physical, role, cognitive, and social functioning and symptoms like fatigue, pain, and lymphedema. Long-term QoL remained compromised, with global health and insomnia notably impaired even five years after treatment. Significant prognostic factors for better overall survival included lower FIGO stage, surgery, and chemotherapy.</div></div><div><h3>Conclusions</h3><div>Patients with UCS experience significant deterioration in QoL. Despite extensive treatment, QoL remains poor, emphasizing the need for integrating QoL considerations into treatment decisions to balance the benefits of treatment with potential QoL impairments.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101679"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gore.2024.101545
Rebecca B. Perkins , Lindsay Fuzzell , Naomi C. Brownstein , Holly B. Fontenot , Alexandra Michel , Sidika Kajtezovic , Paige Lake , Susan T. Vadaparampil
Background
The 2019 ASCCP Risk-Based Management Consensus Guidelines prefer expedited treatment, defined as proceeding to excisional treatment without first performing colposcopic biopsy, for patients with screening results indicating a high risk of cervical precancer. In this mixed methods study, we explored clinician attitudes toward expedited treatment.
Methods
In 2021, a national sample of 671 clinicians who performed colposcopy completed surveys; a subset (n = 41) of clinicians who performed colposcopy and/or directed patient treatment completed qualitative interviews.
Results
Among 671 colposcopists, 25.7 % were currently performing expedited treatment, 50.8% were not currently using expedited treatment but were willing to adopt this change, and 23.6% were not willing to perform expedited treatment. Binomial regression analyses indicated that internal medicine and family medicine clinicians (compared to Obstetrician-Gynecologists), and those practicing in academic medal centers (compared to private practice) had higher odds of currently performing expedited treatment; internal and family medicine clinicians also reported higher odds of being willing to adopt this change. Qualitative interviews highlighted benefits including improved cancer prevention among older patients, reduced loss to follow-up, reduction of time and expense for patients, and allowing shared decision-making. Concerns expressed related to future pregnancy complications, lack of available excisional treatment services (e.g., LEEP), patient preference, avoiding over- and under-treatment, and using biopsy results to plan excisional procedures.
Conclusions
Approximately 25 % of colposcopists are currently performing expedited treatment, and an additional 50 % would be willing to adopt this practice for high-risk patients. Improving access to expedited treatment for appropriate patients could improve cervical cancer prevention.
{"title":"Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer","authors":"Rebecca B. Perkins , Lindsay Fuzzell , Naomi C. Brownstein , Holly B. Fontenot , Alexandra Michel , Sidika Kajtezovic , Paige Lake , Susan T. Vadaparampil","doi":"10.1016/j.gore.2024.101545","DOIUrl":"10.1016/j.gore.2024.101545","url":null,"abstract":"<div><h3>Background</h3><div>The 2019 ASCCP Risk-Based Management Consensus Guidelines prefer expedited treatment, defined as proceeding to excisional treatment without first performing colposcopic biopsy, for patients with screening results indicating a high risk of cervical precancer. In this mixed methods study, we explored clinician attitudes toward expedited treatment.</div></div><div><h3>Methods</h3><div>In 2021, a national sample of 671 clinicians who performed colposcopy completed surveys; a subset (n = 41) of clinicians who performed colposcopy and/or directed patient treatment completed qualitative interviews.</div></div><div><h3>Results</h3><div>Among 671 colposcopists, 25.7 % were currently performing expedited treatment, 50.8% were not currently using expedited treatment but were willing to adopt this change, and 23.6% were not willing to perform expedited treatment. Binomial regression analyses indicated that internal medicine and family medicine clinicians (compared to Obstetrician-Gynecologists), and those practicing in academic medal centers (compared to private practice) had higher odds of currently performing expedited treatment; internal and family medicine clinicians also reported higher odds of being willing to adopt this change. Qualitative interviews highlighted benefits including improved cancer prevention among older patients, reduced loss to follow-up, reduction of time and expense for patients, and allowing shared decision-making. Concerns expressed related to future pregnancy complications, lack of available excisional treatment services (e.g., LEEP), patient preference, avoiding over- and under-treatment, and using biopsy results to plan excisional procedures.</div></div><div><h3>Conclusions</h3><div>Approximately 25 % of colposcopists are currently performing expedited treatment, and an additional 50 % would be willing to adopt this practice for high-risk patients. Improving access to expedited treatment for appropriate patients could improve cervical cancer prevention.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"57 ","pages":"Article 101545"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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