Pub Date : 2025-12-19DOI: 10.1016/j.gore.2025.102012
Luigi Della Corte , Mario Palumbo , Dominga Boccia , Antonisia Pollio , Daniela Terracciano , Giuseppe Bifulco
Objective
To explore the relationship between hematologic inflammatory indices, serum squamous cell carcinoma antigen (SCC-Ag), and clinicopathological features in vulvar squamous cell carcinoma (VSCC).
Methods
Twenty-seven women with primary VSCC were prospectively analyzed. Peripheral leukocyte subsets and derived ratios, including neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and eosinophil-to-lymphocyte ratio (ELR), were assessed preoperatively. SCC-Ag was measured in 16 patients and analyzed using a 1.9 ng/mL cut-off. Associations with tumor grade, recurrence, and mortality were investigated through non-parametric tests and ROC analysis.
Results
Patients with SCC-Ag ≥ 1.9 ng/mL showed significantly lower lymphocyte counts (1.66 vs. 2.41 × 103/µL, p = 0.021) and higher tumor grade (median G3 vs. G2, p = 0.035), along with trends toward higher NLR and lower LMR. No significant differences emerged for other leukocyte subsets or ratios. Exploratory analyses suggested that both SCC-Ag and NLR were associated with recurrence and mortality at 12 months. Their combination improved prognostic discrimination, suggesting a potential role for integrated inflammatory markers in risk stratification.
Conclusions
Elevated SCC-Ag levels in VSCC are associated with lymphopenia and poor tumor differentiation, reflecting an unfavorable systemic immune profile. The combination of SCC-Ag and inflammatory indices, particularly NLR, may offer a simple and cost-effective tool for postoperative prognostic assessment and surveillance planning.
目的探讨外阴鳞状细胞癌（VSCC）血液学炎症指标、血清鳞状细胞癌抗原（SCC-Ag）与临床病理特征的关系。方法对27例原发性VSCC患者进行前瞻性分析。术前评估外周血白细胞亚群和衍生比率，包括中性粒细胞与淋巴细胞（NLR）、淋巴细胞与单核细胞（LMR）和嗜酸性粒细胞与淋巴细胞比率（ELR）。在16例患者中测量SCC-Ag，并使用1.9 ng/mL的截止值进行分析。通过非参数检验和ROC分析研究与肿瘤分级、复发和死亡率的关系。结果SCC-Ag≥1.9 ng/mL的患者淋巴细胞计数明显降低（1.66 vs. 2.41 × 103/µL, p = 0.021），肿瘤分级明显升高（中位G3 vs. G2, p = 0.035）， NLR升高，LMR降低。其他白细胞亚群或比率无显著差异。探索性分析表明，SCC-Ag和NLR在12个月时均与复发和死亡率相关。它们的结合改善了预后的辨别，提示综合炎症标志物在风险分层中的潜在作用。结论VSCC - ag水平升高与淋巴细胞减少和肿瘤分化不良有关，反映了不利的全身免疫状况。SCC-Ag和炎症指标，特别是NLR的结合，可能为术后预后评估和监测计划提供一种简单而经济的工具。
{"title":"Systemic inflammation indices and serum squamous cell carcinoma (SCC) antigen: an exploratory analysis on prognosis of patients with vulvar squamous cell carcinoma","authors":"Luigi Della Corte , Mario Palumbo , Dominga Boccia , Antonisia Pollio , Daniela Terracciano , Giuseppe Bifulco","doi":"10.1016/j.gore.2025.102012","DOIUrl":"10.1016/j.gore.2025.102012","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the relationship between hematologic inflammatory indices, serum squamous cell carcinoma antigen (SCC-Ag), and clinicopathological features in vulvar squamous cell carcinoma (VSCC).</div></div><div><h3>Methods</h3><div>Twenty-seven women with primary VSCC were prospectively analyzed. Peripheral leukocyte subsets and derived ratios, including neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and eosinophil-to-lymphocyte ratio (ELR), were assessed preoperatively. SCC-Ag was measured in 16 patients and analyzed using a 1.9 ng/mL cut-off. Associations with tumor grade, recurrence, and mortality were investigated through non-parametric tests and ROC analysis.</div></div><div><h3>Results</h3><div>Patients with SCC-Ag ≥ 1.9 ng/mL showed significantly lower lymphocyte counts (1.66 vs. 2.41 × 10<sup>3</sup>/µL, p = 0.021) and higher tumor grade (median G3 vs. G2, p = 0.035), along with trends toward higher NLR and lower LMR. No significant differences emerged for other leukocyte subsets or ratios. Exploratory analyses suggested that both SCC-Ag and NLR were associated with recurrence and mortality at 12 months. Their combination improved prognostic discrimination, suggesting a potential role for integrated inflammatory markers in risk stratification.</div></div><div><h3>Conclusions</h3><div>Elevated SCC-Ag levels in VSCC are associated with lymphopenia and poor tumor differentiation, reflecting an unfavorable systemic immune profile. The combination of SCC-Ag and inflammatory indices, particularly NLR, may offer a simple and cost-effective tool for postoperative prognostic assessment and surveillance planning.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102012"},"PeriodicalIF":1.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.gore.2025.102009
Yuta Endo , Yoshiaki Takagawa , Yuki Yoshimoto , Koki Ando , Rei Nishikawa , Masanori Machida , Yuntao Dai , Ichiro Seto , Motohisa Suzuki , Takahiro Kato , Shigenori Furukawa , Shu Soeda , Keiya Fujimori , Masao Murakami
Objective
To evaluate the efficacy and safety of proton beam therapy (PBT) for recurrent endometrial cancer (REC) and to identify predictors of local control (LC).
Methods
We retrospectively reviewed REC patients treated with PBT at our institution between 2008 and 2021. LC, progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan–Meier method, and prognostic factors were analyzed. Toxicities were graded according to CTCAE v5.0.
Results
Nine patients with a total of 14 lesions were included (median follow-up, 36.4 months). The 1- and 2-year LC rates were 80.2 % and 68.8 %, respectively. Median PFS and OS were 13.6 and 36.4 months, respectively. Tumor size significantly influenced LC, with lesions < 22.5 mm showing superior outcomes. No grade ≥ 3 toxicities attributable to PBT were observed.
Conclusions
These findings suggest that PBT may be a safe and effective salvage treatment for REC, particularly in patients with smaller tumors.
{"title":"Proton beam therapy as an effective treatment option for recurrent endometrial cancer","authors":"Yuta Endo , Yoshiaki Takagawa , Yuki Yoshimoto , Koki Ando , Rei Nishikawa , Masanori Machida , Yuntao Dai , Ichiro Seto , Motohisa Suzuki , Takahiro Kato , Shigenori Furukawa , Shu Soeda , Keiya Fujimori , Masao Murakami","doi":"10.1016/j.gore.2025.102009","DOIUrl":"10.1016/j.gore.2025.102009","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy and safety of proton beam therapy (PBT) for recurrent endometrial cancer (REC) and to identify predictors of local control (LC).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed REC patients treated with PBT at our institution between 2008 and 2021. LC, progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan–Meier method, and prognostic factors were analyzed. Toxicities were graded according to CTCAE v5.0.</div></div><div><h3>Results</h3><div>Nine patients with a total of 14 lesions were included (median follow-up, 36.4 months). The 1- and 2-year LC rates were 80.2 % and 68.8 %, respectively. Median PFS and OS were 13.6 and 36.4 months, respectively. Tumor size significantly influenced LC, with lesions < 22.5 mm showing superior outcomes. No grade ≥ 3 toxicities attributable to PBT were observed.</div></div><div><h3>Conclusions</h3><div>These findings suggest that PBT may be a safe and effective salvage treatment for REC, particularly in patients with smaller tumors.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102009"},"PeriodicalIF":1.3,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recurrence of endometrial carcinoma typically occurs in the pelvic region, with the lungs and lymph nodes being common sites for distant metastasis. However, recurrence involving the head and neck region is exceedingly rare.
Case presentation
We report a case of solitary mandibular recurrence of endometrial carcinoma successfully treated with lenvatinib and pembrolizumab. A 56-year-old woman was diagnosed with stage II clear cell carcinoma of the uterus. She underwent total abdominal hysterectomy, bilateral adnexectomy, partial omentectomy, appendectomy, pelvic and para-aortic lymphadenectomy. Postoperative adjuvant chemotherapy with six cycles of paclitaxel and carboplatin was administered, followed by observation. Two months after the completing of treatment, the patient developed trismus and pain in the left mandible. Imaging studies revealed a 4 cm mass in the left mandible. Needle biopsy confirmed a solitary recurrence of endometrial carcinoma. After the administration of pembrolizumab and lenvatinib therapy, the tumor was no longer detectable, which has been maintained.
Conclusion
Mandibular metastasis from endometrial carcinoma is extremely rare and may mimic primary jaw tumors. Treatment options include surgical resection, radiotherapy, and systemic therapy. A comprehensive evaluation of the primary tumor status, presence of other metastases, and the patient’s functional condition is essential for determining the optimal therapeutic strategy.
{"title":"Solitary mandibular recurrence of uterine endometrial carcinoma successfully treated with chemotherapy alone: A case report","authors":"Takato Ishida, Shoji Maenohara, Hiroshi Yagi, Hideaki Yahata, Kiyoko Kato","doi":"10.1016/j.gore.2025.102013","DOIUrl":"10.1016/j.gore.2025.102013","url":null,"abstract":"<div><h3>Background</h3><div>Recurrence of endometrial carcinoma typically occurs in the pelvic region, with the lungs and lymph nodes being common sites for distant metastasis. However, recurrence involving the head and neck region is exceedingly rare.</div></div><div><h3>Case presentation</h3><div>We report a case of solitary mandibular recurrence of endometrial carcinoma successfully treated with lenvatinib and pembrolizumab. A 56-year-old woman was diagnosed with stage II clear cell carcinoma of the uterus. She underwent total abdominal hysterectomy, bilateral adnexectomy, partial omentectomy, appendectomy, pelvic and <em>para</em>-aortic lymphadenectomy. Postoperative adjuvant chemotherapy with six cycles of paclitaxel and carboplatin was administered, followed by observation. Two months after the completing of treatment, the patient developed trismus and pain in the left mandible. Imaging studies revealed a 4 cm mass in the left mandible. Needle biopsy confirmed a solitary recurrence of endometrial carcinoma. After the administration of pembrolizumab and lenvatinib therapy, the tumor was no longer detectable, which has been maintained.</div></div><div><h3>Conclusion</h3><div>Mandibular metastasis from endometrial carcinoma is extremely rare and may mimic primary jaw tumors. Treatment options include surgical resection, radiotherapy, and systemic therapy. A comprehensive evaluation of the primary tumor status, presence of other metastases, and the patient’s functional condition is essential for determining the optimal therapeutic strategy.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102013"},"PeriodicalIF":1.3,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1016/j.gore.2025.102011
Victoria M. Ettorre , Luca Palmieri , Sarah Ottum , Michelle Greenman , Alessandro D. Santin
Background
Treatment of recurrent chemotherapy, aromatase (AI) and MEK Inhibitor (MEKi) resistant low grade serous ovarian cancer (LGSOC) remains a challenge. Novel treatment options for KRAS mutated MEKi resistant LGSOC are warranted.
Case
A 73-year-old with recurrent, metastatic, platinum-resistant LGSOC harboring a KRAS mutation experienced a prolonged response to the combination of Avutometinib and Defactinib after failing multiple lines of chemotherapy, aromatase inhibitor (AI), and targeted therapy with the MEK inhibitor Binimetinib (MEK-162). Following Avutometinib and Defactinib treatment, she experienced a confirmed and long-lasting (4 years) partial response as well as a return of CA-125 to baseline. The oral drug combination was well tolerated with no dose-limiting toxicity or need for dose reduction over the 4 year period.
Conclusion
The Avutometinib and Defactinib combination may represent a new standard treatment option for platinum-resistant and AI-resistant/recurrent LGSOC who have failed other MEKi.
{"title":"Long lasting response to the combination of Avutometinib and Defactinib after progression on Binimetinib in a patient with recurrent low grade serous ovarian carcinoma − A case report","authors":"Victoria M. Ettorre , Luca Palmieri , Sarah Ottum , Michelle Greenman , Alessandro D. Santin","doi":"10.1016/j.gore.2025.102011","DOIUrl":"10.1016/j.gore.2025.102011","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of recurrent chemotherapy, aromatase (AI) and MEK Inhibitor (MEKi) resistant low grade serous ovarian cancer (LGSOC) remains a challenge. Novel treatment options for KRAS mutated MEKi resistant LGSOC are warranted.</div></div><div><h3>Case</h3><div>A 73-year-old with recurrent, metastatic, platinum-resistant LGSOC harboring a KRAS mutation experienced a prolonged response to the combination of Avutometinib and Defactinib after failing multiple lines of chemotherapy, aromatase inhibitor (AI), and targeted therapy with the MEK inhibitor Binimetinib (MEK-162). Following Avutometinib and Defactinib treatment, she experienced a confirmed and long-lasting (4 years) partial response as well as a return of CA-125 to baseline. The oral drug combination was well tolerated with no dose-limiting toxicity or need for dose reduction over the 4 year period.</div></div><div><h3>Conclusion</h3><div>The Avutometinib and Defactinib combination may represent a new standard treatment option for platinum-resistant and AI-resistant/recurrent LGSOC who have failed other MEKi.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102011"},"PeriodicalIF":1.3,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1016/j.gore.2025.102010
Maria Fazal , Serena Mao , Deborah Armstrong , Akila N. Viswanathan
{"title":"Pembrolizumab and SBRT for vaginal cuff recurrence of endometrial carcinoma with regression beyond the radiation field","authors":"Maria Fazal , Serena Mao , Deborah Armstrong , Akila N. Viswanathan","doi":"10.1016/j.gore.2025.102010","DOIUrl":"10.1016/j.gore.2025.102010","url":null,"abstract":"","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102010"},"PeriodicalIF":1.3,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1016/j.gore.2025.102008
Minyoung Jang, Stefan Gysler, Nawar A. Latif, Emily M. Ko, Robert L. Giuntoli II, Sarah H. Kim, Fiona Simpkins, Dimitrios Nasioudis
Objective
Mucinous ovarian carcinoma (MOC) is a rare histologic subtype of ovarian cancer. While prognosis of early stage disease is excellent, novel treatment options are needed for advanced stage and recurrent MOC, which are associated with poor oncologic outcomes. In this context, we aimed to investigate the genomic profile of MOC and characterize the prevalence of actionable genomic alterations.
Methods
The American Association of Cancer Research Genomics Evidence of Neoplasia Information Exchange was accessed, and patients with mucinous ovarian, appendiceal and colorectal carcinoma were identified. Data from the OncoKB database, as provided by cBioPortal, were utilized to determine the presence of pathogenic gene alterations. When comparing the genomic profile of mucinous ovarian and colorectal or appendiceal carcinoma, to decrease the false discovery rate, a q-value of < 0.05 as derived from the Benjamini-Hochberg FDR correction procedure was deemed statistically significant.
Results
A total of 148 patients with MOC contributing to 157 tumor samples were identified. The most commonly observed genetic alterations were in KRAS (69.4 %), TP53 (64.3 %), CDKN2A (33.3 %), CDKN2B (24 %), ERBB2 (12 %), PIK3CA (9.6 %), and ARID1A (9.0 %). BRCA1 (0 %) and BRCA2 (2.3 %) mutations were rare. Homologous deletion of chromosome 9p21.3 was present in 34.4 % of patients. Compared to mucinous appendiceal carcinoma (n = 268), MOC is characterized by a higher incidence of TP53, CDKN2A, CDKN2B, and ERBB2 and a lower rate of GNAS gene alterations (q < 0.001). Compared to colorectal mucinous adenocarcinoma (n = 358), MOC is characterized by a higher incidence of KRAS, TP53, CDKN2A, CDKN2B, and ERBB2 and a lower rate of PIK3CA, KMT2D, SMAD4, BRAF, and APC gene alterations (q < 0.001).
Conclusions
MOC has a distinct genomic profile with molecular vulnerabilities that can be exploited using novel targeted therapies. Participation of patients with MOC in molecularly driven early phase basket trials should be encouraged.
{"title":"Identifying and capitalizing on unique molecular alterations of mucinous ovarian carcinoma for the development of novel therapeutic strategies","authors":"Minyoung Jang, Stefan Gysler, Nawar A. Latif, Emily M. Ko, Robert L. Giuntoli II, Sarah H. Kim, Fiona Simpkins, Dimitrios Nasioudis","doi":"10.1016/j.gore.2025.102008","DOIUrl":"10.1016/j.gore.2025.102008","url":null,"abstract":"<div><h3>Objective</h3><div>Mucinous ovarian carcinoma (MOC) is a rare histologic subtype of ovarian cancer. While prognosis of early stage disease is excellent, novel treatment options are needed for advanced stage and recurrent MOC, which are associated with poor oncologic outcomes. In this context, we aimed to investigate the genomic profile of MOC and characterize the prevalence of actionable genomic alterations.</div></div><div><h3>Methods</h3><div>The American Association of Cancer Research Genomics Evidence of Neoplasia Information Exchange was accessed, and patients with mucinous ovarian, appendiceal and colorectal carcinoma were identified. Data from the OncoKB database, as provided by cBioPortal, were utilized to determine the presence of pathogenic gene alterations. When comparing the genomic profile of mucinous ovarian and colorectal or appendiceal carcinoma, to decrease the false discovery rate, a q-value of < 0.05 as derived from the Benjamini-Hochberg FDR correction procedure was deemed statistically significant.</div></div><div><h3>Results</h3><div>A total of 148 patients with MOC contributing to 157 tumor samples were identified. The most commonly observed genetic alterations were in <em>KRAS</em> (69.4 %), <em>TP53</em> (64.3 %), <em>CDKN2A</em> (33.3 %), <em>CDKN2B</em> (24 %), <em>ERBB2</em> (12 %), <em>PIK3CA</em> (9.6 %), and <em>ARID1A</em> (9.0 %). <em>BRCA1</em> (0 %) and <em>BRCA2</em> (2.3 %) mutations were rare. Homologous deletion of chromosome 9p21.3 was present in 34.4 % of patients. Compared to mucinous appendiceal carcinoma (n = 268), MOC is characterized by a higher incidence of <em>TP53</em>, <em>CDKN2A</em>, <em>CDKN2B</em>, and <em>ERBB2</em> and a lower rate of <em>GNAS</em> gene alterations (q < 0.001). Compared to colorectal mucinous adenocarcinoma (n = 358), MOC is characterized by a higher incidence of <em>KRAS</em>, <em>TP53</em>, <em>CDKN2A</em>, <em>CDKN2B</em>, and <em>ERBB2</em> and a lower rate of <em>PIK3CA</em>, <em>KMT2D</em>, <em>SMAD4</em>, <em>BRAF</em>, and <em>APC</em> gene alterations (q < 0.001).</div></div><div><h3>Conclusions</h3><div>MOC has a distinct genomic profile with molecular vulnerabilities that can be exploited using novel targeted therapies. Participation of patients with MOC in molecularly driven early phase basket trials should be encouraged.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102008"},"PeriodicalIF":1.3,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paget’s disease (EMPD) of the vulva primarily affects postmenopausal women and can present significant challenges in early clinical detection.
Case Presentation: We report an exceedingly rare case of invasive acantholytic extramammary Paget’s disease in a 78-year-old female patient. After biopsy-proven carcinoma, a radical hemivulvectomy of the left vulva was performed, which revealed an invasive adenocarcinoma, most consistent with primary extramammary Paget’s carcinoma. Histologic examination demonstrated a unique morphology, featuring an in-situ component with suprabasal intraepidermal acantholysis and an invasive component with various morphologies, including basaloid, skin adnexal-like, focal squamoid, and mammary-like differentiation, resembling ductal carcinoma in situ (DCIS) with comedonecrosis and invasive ductal carcinoma. This varied morphology has not been described before. Interestingly, the tumor shows loss of MMR protein (MSH2, MSH6).
Conclusion
In the literature, acantholytic Paget’s disease and acantholytic anaplastic Paget’s disease have been used interchangeably. While anaplastic Paget’s disease has been reported in the mammary and extramammary sites (scrotum, esophagus), involvement of the vulva has been reported only once in the literature. However, the current case is the first documented loss of MMR. Both cases presented with invasive disease ranging in depth from 3-5 mm, and positive lymph nodes emphasizing on the urgent need to further explore prognostic factors of this rare entity and to differentiate it from other acantholytic lesions, such as squamous cell carcinoma in situ and other acantholytic dermatoses.
{"title":"Invasive Acantholytic Extramammary Paget's Disease of the Vulva With Mammary Carcinoma-Like Differentiation and MMR Loss: Report of an Unusual Case and Its Clinical Mimics","authors":"Jessica Claus , Janina Pearce , Areta Bojko , Padmini Manrai , M.Ruhul Quddus , Shivali Marketkar","doi":"10.1016/j.gore.2025.102007","DOIUrl":"10.1016/j.gore.2025.102007","url":null,"abstract":"<div><h3>Background</h3><div>Paget’s disease (EMPD) of the vulva primarily affects postmenopausal women and can present significant challenges in early clinical detection.</div><div><strong>Case Presentation:</strong> We report an exceedingly rare case of invasive acantholytic extramammary Paget’s disease in a 78-year-old female patient. After biopsy-proven carcinoma, a radical hemivulvectomy of the left vulva was performed, which revealed an invasive adenocarcinoma, most consistent with primary extramammary Paget’s carcinoma. Histologic examination demonstrated a unique morphology, featuring an in-situ component with suprabasal intraepidermal acantholysis and an invasive component with various morphologies, including basaloid, skin adnexal-like, focal squamoid, and mammary-like differentiation, resembling ductal carcinoma in situ (DCIS) with comedonecrosis and invasive ductal carcinoma. This varied morphology has not been described before. Interestingly, the tumor shows loss of MMR protein (MSH2, MSH6).</div></div><div><h3>Conclusion</h3><div>In the literature, acantholytic Paget’s disease and acantholytic anaplastic Paget’s disease have been used interchangeably. While anaplastic Paget’s disease has been reported in the mammary and extramammary sites (scrotum, esophagus), involvement of the vulva has been reported only once in the literature. However, the current case is the first documented loss of MMR. Both cases presented with invasive disease ranging in depth from 3-5 mm, and positive lymph nodes emphasizing on the urgent need to further explore prognostic factors of this rare entity and to differentiate it from other acantholytic lesions, such as squamous cell carcinoma in situ and other acantholytic dermatoses.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102007"},"PeriodicalIF":1.3,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.gore.2025.102004
Maya Gross , Joyce Y. Wang , Barbara A. Goff , Ting Martin Ma , Kylie H. Kang , Kemi M. Doll , Soledad Jorge
Objectives
Prolonged chemoradiation (CRT) duration predicts inferior survival in locally advanced cervical cancer (LACC). Pre-treatment delays and causes of prolonged treatment duration are less characterized. We aimed to quantify delays across the care continuum and identify predictors of delayed CRT initiation and treatment prolongation.
Methods
In this retrospective cohort study, we evaluated LACC patients receiving definitive CRT from 2013 to 2024 at an NCI-designated Cancer Center. We assessed care intervals and sociodemographic/clinical variables. Primary outcome was total patient delay (diagnosis to CRT completion), subdivided into delayed treatment initiation (>75th percentile from diagnosis to CRT) and prolonged CRT duration (>56 days). Secondary outcomes included predictors of delay / prolongation (x2 tests, logistic regression), progression free survival (PFS), and overall survival (OS).
Results
Among 92 patients, median time to CRT initiation was 49 days (IQR 40–62) and median treatment duration was 57 days (IQR 52–60). Treatment delay or prolongation was associated with insurance type, external beam radiation therapy (EBRT) at an outside facility, and adenocarcinoma histology (p < 0.05). Time from diagnosis to completion of LACC staging was the interval most predictive of treatment delay (OR 3.7, CI 1.8–7.7). Treatment prolongation was associated with longer intervals between EBRT and brachytherapy (BT) (OR 2.6,CI 1.6–4.2) but not with time to initiate EBRT or EBRT duration. PFS and OS were not associated with primary outcomes.
Conclusions
A quarter of patients waited over 2 months to initiate CRT, and half experienced prolonged treatment duration. Delays in staging and transitions in care, especially between institutions, contributed significantly to total patient delay.
目的探讨局部晚期宫颈癌（LACC）放化疗时间延长的预后。治疗前的延迟和治疗持续时间延长的原因较少被描述。我们的目的是量化整个护理连续体的延迟，并确定延迟CRT开始和治疗延长的预测因素。方法在这项回顾性队列研究中，我们评估了2013年至2024年在nci指定的癌症中心接受最终CRT的LACC患者。我们评估了护理间隔和社会人口统计学/临床变量。主要终点是患者总延迟（诊断到CRT完成），再细分为延迟治疗开始（从诊断到CRT的第75个百分位数）和延长CRT持续时间（56天）。次要结局包括延迟/延长（x2检验，逻辑回归）、无进展生存期（PFS）和总生存期（OS）的预测因子。结果92例患者中位开始CRT的时间为49天（IQR 40-62），中位治疗时间为57天（IQR 52-60）。治疗延迟或延长与保险类型、外部设施外束放射治疗（EBRT）和腺癌组织学相关（p < 0.05）。从诊断到完成LACC分期的时间是最能预测治疗延迟的时间间隔（OR 3.7, CI 1.8-7.7）。治疗延长与EBRT和近距离治疗（BT）之间的间隔时间延长相关（OR 2.6,CI 1.6-4.2），但与开始EBRT的时间或EBRT持续时间无关。PFS和OS与主要结局无关。结论四分之一的患者开始CRT的时间超过2个月，一半的患者治疗时间延长。延迟的分期和过渡的护理，特别是机构之间，贡献了显著的总患者延误。
{"title":"Treatment delay and prolongation in locally advanced cervical cancer","authors":"Maya Gross , Joyce Y. Wang , Barbara A. Goff , Ting Martin Ma , Kylie H. Kang , Kemi M. Doll , Soledad Jorge","doi":"10.1016/j.gore.2025.102004","DOIUrl":"10.1016/j.gore.2025.102004","url":null,"abstract":"<div><h3>Objectives</h3><div>Prolonged chemoradiation (CRT) duration predicts inferior survival in locally advanced cervical cancer (LACC). Pre-treatment delays and causes of prolonged treatment duration are less characterized. We aimed to quantify delays across the care continuum and identify predictors of delayed CRT initiation and treatment prolongation.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we evaluated LACC patients receiving definitive CRT from 2013 to 2024 at an NCI-designated Cancer Center. We assessed care intervals and sociodemographic/clinical variables. Primary outcome was total patient delay (diagnosis to CRT completion), subdivided into delayed treatment initiation (>75th percentile from diagnosis to CRT) and prolonged CRT duration (>56 days). Secondary outcomes included predictors of delay / prolongation (x<strong><sup>2</sup></strong> tests, logistic regression), progression free survival (PFS), and overall survival (OS).</div></div><div><h3>Results</h3><div>Among 92 patients, median time to CRT initiation was 49 days (IQR 40–62) and median treatment duration was 57 days (IQR 52–60). Treatment delay or prolongation was associated with insurance type, external beam radiation therapy (EBRT) at an outside facility, and adenocarcinoma histology (p < 0.05). Time from diagnosis to completion of LACC staging was the interval most predictive of treatment delay (OR 3.7, CI 1.8–7.7). Treatment prolongation was associated with longer intervals between EBRT and brachytherapy (BT) (OR 2.6,CI 1.6–4.2) but not with time to initiate EBRT or EBRT duration. PFS and OS were not associated with primary outcomes.</div></div><div><h3>Conclusions</h3><div>A quarter of patients waited over 2 months to initiate CRT, and half experienced prolonged treatment duration. Delays in staging and transitions in care, especially between institutions, contributed significantly to total patient delay.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102004"},"PeriodicalIF":1.3,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-09DOI: 10.1016/j.gore.2025.102002
Ester P. Olthof , Nicholai A. Oostveen , Maaike A. van der Aa , Ruud L.M. Bekkers , Constantijne H. Mom , Jacobus van der Velden , Joost Nederend , Edith M.G. van Esch
Aim
This study evaluates the prognostic and therapeutic implications of clinical-radiologic discrepancy in parametrial invasion of cervical cancer prior to radical hysterectomy. We compared patients with radiological presence but clinical absence of parametrial invasion (discrepancy group) to those without radiologic and clinical suspicion of parametrial invasion (consensus group).
Methods
Women with International Federation of Gynaecology and Obstetrics (2009) stage IA-IIA cervical cancer, diagnosed between 2009 and 2017, who underwent magnetic resonance imaging prior to radical hysterectomy were retrospectively selected from the Netherlands Cancer Registry. Kaplan-Meier estimates and Cox proportional hazards were used for survival and logistic regression for risk of adjuvant therapy and toxicity.
Results
Of 886 patients included, 87 (10%) had clinical-radiologic parametrial invasion discrepancy. Patients with discrepancy were more likely to have poor prognostic factors (i.e., a larger tumor, increased depth of invasion, lymphovascular space invasion, nodal metastases and positive resection margins) than those without. The 5-year disease-free and overall survival rates were lower in the discrepancy (74% and 82%) than in the consensus group (86% and 92%). However, after confounder adjustments, disease-free and overall survival were not affected by clinical-radiologic discrepancy. Patients with discrepancy in parametrial invasion were more likely to receive adjuvant therapy (54% vs 23%) and experience therapy-related toxicity (44% vs 29%).
Conclusion
Clinical-radiologic discrepancy of parametrial invasion occurs in approximately 10% of patients and is associated with poor prognostic factors and increased likelihood of adjuvant therapy and toxicity. This highlights the importance of addressing these factors in treatment counselling for either primary chemoradiotherapy or surgery.
{"title":"Prognostic and therapeutic implications of clinical-radiologic discrepancy in parametrial invasion prior to primary radical hysterectomy in cervical cancer","authors":"Ester P. Olthof , Nicholai A. Oostveen , Maaike A. van der Aa , Ruud L.M. Bekkers , Constantijne H. Mom , Jacobus van der Velden , Joost Nederend , Edith M.G. van Esch","doi":"10.1016/j.gore.2025.102002","DOIUrl":"10.1016/j.gore.2025.102002","url":null,"abstract":"<div><h3>Aim</h3><div>This study evaluates the prognostic and therapeutic implications of clinical-radiologic discrepancy in parametrial invasion of cervical cancer prior to radical hysterectomy. We compared patients with radiological presence but clinical absence of parametrial invasion (discrepancy group) to those without radiologic and clinical suspicion of parametrial invasion (consensus group).</div></div><div><h3>Methods</h3><div>Women with International Federation of Gynaecology and Obstetrics (2009) stage IA-IIA cervical cancer, diagnosed between 2009 and 2017, who underwent magnetic resonance imaging prior to radical hysterectomy were retrospectively selected from the Netherlands Cancer Registry. Kaplan-Meier estimates and Cox proportional hazards were used for survival and logistic regression for risk of adjuvant therapy and toxicity.</div></div><div><h3>Results</h3><div>Of 886 patients included, 87 (10%) had clinical-radiologic parametrial invasion discrepancy. Patients with discrepancy were more likely to have poor prognostic factors (i.e., a larger tumor, increased depth of invasion, lymphovascular space invasion, nodal metastases and positive resection margins) than those without. The 5-year disease-free and overall survival rates were lower in the discrepancy (74% and 82%) than in the consensus group (86% and 92%). However, after confounder adjustments, disease-free and overall survival were not affected by clinical-radiologic discrepancy. Patients with discrepancy in parametrial invasion were more likely to receive adjuvant therapy (54% vs 23%) and experience therapy-related toxicity (44% vs 29%).</div></div><div><h3>Conclusion</h3><div>Clinical-radiologic discrepancy of parametrial invasion occurs in approximately 10% of patients and is associated with poor prognostic factors and increased likelihood of adjuvant therapy and toxicity. This highlights the importance of addressing these factors in treatment counselling for either primary chemoradiotherapy or surgery.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 102002"},"PeriodicalIF":1.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-06DOI: 10.1016/j.gore.2025.101995
Ioana Bondre , H. Meryem Soylu , Francesca Corbetta , Breana Hill , Elise Wilson , Rodney Gabriel , Ramez Eskander , Michael McHale , Cheryl Saenz , Pratibha Binder , Steven Plaxe
Objective
To evaluate the association of abdominal wall blocks at the time of robotic hysterectomy performed for endometrial cancer (EC) with in-hospital post-operative opioids.
Methods
We performed a retrospective cohort study of patients in the Vizient database who had robotic hysterectomy for EC between January 2019 and December 2022. The exposure was any block coded separate from the surgery, and the primary outcomes were any IV/oral opioid. Fentanyl was excluded due to frequent intra-op use. Length of stay (LOS) and direct cost were compared. The association between block and opioid use was assessed via risk ratio. The quantity of each opioid was expressed in standard resource units (SRU) – a metric used to standardize the consumption of medications across facilities.
Results
Three hundred and twenty of the 9062 patients (3.5 %) had a block and 8,742 (96.5 %) did not. Blocks were performed at 66 (20.4 %) hospitals. 184 patients (57.5 %) in the block group received an IV opioid vs 5,890 (67.4 %) of the patients without a block (RR 0.85, 95 % CI 0.77–0.94, p < 0.001). Patients who received blocks were less likely to receive IV (52.5 % vs 64.8 %, RR 0.81, 95 % CI 0.73–0.89, p < 0.001) and oral hydromorphone (6.9 % vs 3.9 %, RR 2.53, 95 % CI 1.68–3.81, p < 0.001) and more likely to receive oral hydrocodone/acetaminophen (11.3 % vs 0.88 %, RR 12.77, 95 % CI 8.73–18.67, p < 0.001).
Conclusion
Blocks are infrequently performed and are associated with a modest reduction in the number of patients receiving post-op IV opioids. We found no difference in LOS or cost. Limitations include lack of detail regarding type of block, anesthetic, and phase of care.
目的探讨子宫内膜癌（EC）机器人子宫切除术时腹壁阻滞与院内阿片类药物的关系。方法：我们对Vizient数据库中2019年1月至2022年12月期间因EC接受机器人子宫切除术的患者进行了回顾性队列研究。暴露是与手术分开的，主要结果是静脉/口服阿片类药物。芬太尼因术中频繁使用被排除在外。比较住院时间（LOS）和直接费用。通过风险比评估阻滞和阿片类药物使用之间的关系。每种阿片类药物的数量以标准资源单位（SRU）表示，这是一种用于标准化各设施药物消耗的度量。结果9062例患者中有320例（3.5%）发生阻滞，8742例（96.5%）未发生阻滞。66家（20.4%）医院实施阻滞。阻断组184例患者（57.5%）接受静脉注射阿片类药物，未阻断组5890例患者（67.4%）（RR 0.85, 95% CI 0.77-0.94, p < 0.001）。接受阻断治疗的患者较少接受静脉注射（52.5% vs 64.8%, RR 0.81, 95% CI 0.73-0.89, p < 0.001）和口服氢吗啡酮（6.9% vs 3.9%, RR 2.53, 95% CI 1.68-3.81, p < 0.001），更可能接受口服氢可酮/对乙酰氨基酚（11.3% vs 0.88%, RR 12.77, 95% CI 8.73-18.67, p < 0.001）。结论阻滞很少发生，并且与术后接受静脉注射阿片类药物的患者数量适度减少有关。我们发现LOS和成本没有差异。局限性包括缺乏关于阻滞类型、麻醉和护理阶段的细节。
{"title":"Abdominal wall blocks in robotic hysterectomy for endometrial cancer are associated with a modest reduction in the frequency of patients receiving post-operative intravenous opioids","authors":"Ioana Bondre , H. Meryem Soylu , Francesca Corbetta , Breana Hill , Elise Wilson , Rodney Gabriel , Ramez Eskander , Michael McHale , Cheryl Saenz , Pratibha Binder , Steven Plaxe","doi":"10.1016/j.gore.2025.101995","DOIUrl":"10.1016/j.gore.2025.101995","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association of abdominal wall blocks at the time of robotic hysterectomy performed for endometrial cancer (EC) with in-hospital post-operative opioids.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of patients in the Vizient database<!--> <!-->who had robotic hysterectomy for EC between January 2019 and December 2022. The exposure was any<!--> <!-->block coded separate from the surgery, and the primary outcomes were any IV/oral opioid. Fentanyl was excluded due to frequent intra-op<!--> <!-->use. Length of stay (LOS) and<!--> <!-->direct cost<!--> <!-->were compared. The association between block and opioid use<!--> <!-->was assessed via risk ratio. The quantity of each opioid was expressed in standard resource units (SRU) – a metric<!--> <!-->used to standardize the consumption of medications across facilities.</div></div><div><h3>Results</h3><div>Three hundred and twenty of the 9062 patients (3.5 %) had a block and 8,742 (96.5 %) did not. Blocks were performed at 66 (20.4 %) hospitals.<!--> <!-->184 patients (57.5 %) in the block group received an IV opioid vs 5,890 (67.4 %) of the<!--> <!-->patients without a block (RR 0.85, 95 % CI 0.77–0.94, p < 0.001). Patients who received blocks were less likely to receive IV (52.5 % vs 64.8 %, RR 0.81, 95 % CI 0.73–0.89, p < 0.001)<!--> <!-->and oral hydromorphone (6.9 % vs 3.9 %, RR 2.53, 95 % CI 1.68–3.81, p < 0.001)<!--> <!-->and more likely to receive oral hydrocodone/acetaminophen (11.3 % vs 0.88 %, RR 12.77, 95 % CI 8.73–18.67, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Blocks are infrequently performed and<!--> <!-->are associated with a modest reduction in the number of patients receiving post-op IV opioids.<!--> <!-->We found no difference<!--> <!-->in<!--> <!-->LOS or cost. Limitations include lack of detail regarding type of block, anesthetic, and phase of care.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"63 ","pages":"Article 101995"},"PeriodicalIF":1.3,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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