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Novel use of adjuvant proton beam therapy in patient with pelvic renal transplant diagnosed with stage IB3 cervical adenocarcinoma 质子束辅助疗法在确诊为 IB3 期宫颈腺癌的盆腔肾移植患者中的新应用
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-29 DOI: 10.1016/j.gore.2024.101520
Pedro Versuti Del Cioppo Vasques , Jamie N. Bakkum-Gamez , Patrick G. Dean , Jeremy F. Molligan , Allison E. Garda
Cervical adenocarcinoma is the second most common histology of cervical cancer and treatment can involve surgery, radiotherapy, systemic therapy, and any combination of the three. Photon external beam radiation therapy and brachytherapy have been the mainstay of radiation treatment options for cervical cancer. Here, we report a case of a 41-year-old patient who had a prior renal transplant and was diagnosed with early-stage, intermediate-risk adenocarcinoma treated with modified radical hysterectomy plus adjuvant proton-beam therapy and vaginal brachytherapy. Treatment was well tolerated with a disease-free interval of 14-months and preserved renal function.
宫颈腺癌是宫颈癌中第二常见的组织类型,治疗方法包括手术、放射治疗、全身治疗以及三者的任意组合。光子体外放射治疗和近距离放射治疗一直是宫颈癌放射治疗的主要方法。在此,我们报告了一例 41 岁患者的病例,该患者曾接受过肾移植手术,被诊断为早期中危腺癌,采用改良根治性子宫切除术加质子束辅助治疗和阴道近距离放射治疗。患者对治疗的耐受性良好,无病间隔期为 14 个月,肾功能得以保留。
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引用次数: 0
Invasive acantholytic anaplastic extramammary Paget disease: A previously unreported neoplasm in the vulva and review of the literature 侵袭性棘皮溶解性无性乳腺外Paget病:一种以前从未报道过的外阴肿瘤及文献综述
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-24 DOI: 10.1016/j.gore.2024.101514
Flora Mae G. Sta. Ines , Julia R. Salinaro , Mary Marchese , Cara A. Mathews , M. Ruhul Quddus
This report describes the first documented invasive acantholytic anaplastic extramammary Paget disease (AAEMPD) of the vulva. An 87-year-old female presented with a recurrent vulvar lesion refractory to topical imiquimod and treated with multiple wide local excisions (WLE). Microscopic examination of the final WLE specimen revealed unique histologic features, primarily supra-basal intraepidermal acantholysis with epidermal papillomatosis and hyperkeratosis. The epidermis, composed of two distinct cell populations, exhibited full-thickness atypia. Paget cells with high mitotic activity were present in the basal and parabasal layers surrounding benign squamous cells in the mid-squamous mucosa. The histologic features were suspicious of the EMPD involving a warty lesion and/or invasive squamous cell carcinoma. In addition to the intraepidermal component, dermal invasion was also present with lymphovascular space invasion. Immunohistochemical studies (KRT7, HER2, and GATA3 reactivity in Paget cells, p63 negativity, and rare mucin in Paget cells) supported the diagnosis of acantholytic anaplastic EMPD. AAEMPD, a rare variant of EMPD, shares similar prognosis and behavior with the classic Paget disease. Recognition and accurate diagnosis of this subtype is crucial for optimal patient management, given distinct treatment strategies compared with other entities in the differential diagnosis.
本报告描述了首例有记录的外阴侵袭性棘皮溶解性无弹性乳腺外Paget病(AAEMPD)。一位87岁的女性因外阴复发性病变而就诊,外用咪喹莫特(imiquimod)治疗无效,她接受了多次大范围局部切除(WLE)治疗。对最终的 WLE 标本进行显微镜检查后发现了独特的组织学特征,主要是基底层表皮内棘层溶解,伴有表皮乳头状瘤病和角化过度。表皮由两个不同的细胞群组成,呈现全厚不典型性。基底层和副基底层出现了有丝分裂活性很高的 Paget 细胞,围绕着鳞状粘膜中层的良性鳞状细胞。组织学特征显示,EMPD疑似疣状病变和/或浸润性鳞状细胞癌。除表皮内成分外,真皮层也有淋巴管间隙侵犯。免疫组化研究(Paget 细胞中的 KRT7、HER2 和 GATA3 反应性、p63 阴性和 Paget 细胞中罕见的粘蛋白)支持棘溶性无性 EMPD 的诊断。AAEMPD是EMPD的一种罕见变异型,其预后和行为与典型的Paget病相似。与鉴别诊断中的其他实体相比,该亚型的治疗策略有所不同,因此识别和准确诊断该亚型对于优化患者管理至关重要。
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引用次数: 0
Ovotesticular Disorders of sexual development (DSD): A rare case of peritoneal carcinomatosis in an elderly DSD male patient 卵巢性发育障碍(DSD):性发育障碍老年男性患者腹膜癌变的罕见病例
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-24 DOI: 10.1016/j.gore.2024.101515
Anastasia Navitski , Sakshi Sehgal , Kalyani Ballur , Lawrence C. Layman , Robert V. Higgins
Disorders of sexual development (DSDs) represent a spectrum of conditions characterized by atypical gonadal and/or genital development. The incidence is 1 in 5,000 live births. Patients with DSD may be at increased risk for developing gonadal and reproductive tract tumors. This report summarizes the current knowledge on the risks of gonadal tumors in patients with DSD. Specifically, we focus on ovotesticular DSD (OT-DSD), which accounts for 5% of DSD cases and is defined by the presence of both ovarian and testicular tissues in the same individual. We present a rare case of a phenotypically male XY patient with OT-DSD who was diagnosed with aggressive peritoneal cancer at the age of 71.
性发育障碍(DSDs)是以性腺和/或生殖器发育不典型为特征的一系列疾病。其发病率为每 5,000 名活产婴儿中就有 1 例。DSD患者罹患性腺和生殖道肿瘤的风险可能会增加。本报告总结了目前有关 DSD 患者性腺肿瘤风险的知识。具体而言,我们将重点关注卵睾DSD(OT-DSD),它占DSD病例的5%,其定义是在同一个人身上同时存在卵巢和睾丸组织。我们介绍了一例罕见的表型为男性 XY 的 OT-DSD 患者,他在 71 岁时被诊断出患有侵袭性腹膜癌。
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引用次数: 0
Exploring social determinants of health on chemotherapy-induced peripheral neuropathy severity in ovarian cancer: An integrative review 探讨健康的社会决定因素对卵巢癌化疗所致周围神经病变严重程度的影响:综合综述
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-21 DOI: 10.1016/j.gore.2024.101509
Chisom O. Odii, David E. Vance, Fiona B. A. T. Agbor, Amanda Jenkins, Ellen M. Lavoie Smith
Ovarian cancer remains a significant public health concern for women despite advancements in cancer management. Despite comprising only 2.5 % of cancers in women, ovarian cancer ranks as the fifth leading cause of cancer-related deaths among women, with patients frequently receiving late diagnoses. Chemotherapy, a primary treatment, frequently causes chemotherapy-induced peripheral neuropathy (CIPN), affecting over 60 % of patients and leading to severe sensory, motor, and autonomic nerve impairments. This often necessitates dosage reduction or discontinuation of treatment, thereby increasing mortality. While CIPN’s impact on patients is well-documented, there is a paucity of knowledge of how structural and intermediary social determinants of health factors (SDOH), such as socioeconomic and political context, material circumstances such as living and walking conditions, area deprivation, and food availability, affect CIPN severity. The aim of this article was to explore the association between various SDOH and CIPN severity in ovarian cancer, identifying potential research gaps and future research directions. This article seeks to inform targeted interventions to mitigate CIPN’s impact by elucidating these associations.
尽管在癌症治疗方面取得了进步,但卵巢癌仍然是妇女的一个重大公共健康问题。尽管卵巢癌只占女性癌症的 2.5%,但它却是导致女性癌症相关死亡的第五大原因,而且患者经常被晚期诊断。化疗作为一种主要治疗方法,经常会引起化疗诱发的周围神经病变(CIPN),影响超过 60% 的患者,导致严重的感觉、运动和自主神经损伤。这往往需要减少剂量或中断治疗,从而增加死亡率。虽然 CIPN 对患者的影响已得到充分证实,但对于结构性和中间性健康社会决定因素 (SDOH) 如社会经济和政治环境、物质条件(如居住和行走条件)、地区贫困和食物供应等如何影响 CIPN 的严重程度却知之甚少。本文旨在探讨各种 SDOH 与卵巢癌 CIPN 严重程度之间的关联,找出潜在的研究空白和未来的研究方向。本文旨在通过阐明这些关联,为有针对性的干预措施提供信息,以减轻 CIPN 的影响。
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引用次数: 0
Early-career and fellow gynecologic oncologists perceive underpreparedness for the business of medicine: A Society of gynecologic oncology survey study 初入职场的妇科肿瘤学家和同行认为自己对医学事业准备不足:妇科肿瘤学会调查研究
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-21 DOI: 10.1016/j.gore.2024.101501
Jhalak Dholakia , Leslie R. Boyd , Rinki Agarwal , Haley Moss , Emily M. Ko , Emeline Aviki , Margaret I. Liang

Objective

There is a research gap on the impact of payment, reimbursement, and academic productivity in career decision-making for early-career (EC) attendings in gynecologic oncology. We sought to assess gynecologic oncology fellows and EC attendings on their knowledge and perceptions regarding the business of medicine.

Methods

An anonymous survey was electronically disseminated to fellow and EC SGO members. Key themes were the business of medicine, productivity, and compensation/negotiation. A 5-point Likert scale was utilized; descriptive statistics were calculated using SPSS.

Results

There was a 29 % response rate: 82 fellows and 102 EC attendings. Most were white (n = 143, 78 %) and female (n = 138, 75 %.) Most fellows (n = 67, 82 %) were interested in, and most EC (n = 82, 82 %) were employed in, academic/non-private practice. Fellows and EC attendings reported insufficient education on RVUs (relative value units) and reimbursement (80 %, n = 66; 81 %, n = 83) and did not feel prepared for the business aspect of practice (80 %, n = 66; 73 %, n = 75). Over 40 % of fellows did not understand how RVUs relate to practice. Thirty-three percent of EC attendings did not understand RVU assignments; 29 % were satisfied with methods used to determine productivity, and 17 % did not understand their compensation. Over 60 % of fellows felt unprepared to negotiate clinical productivity expectations. For EC attendings, 47 % were uncomfortable negotiating clinical expectations, 32 % negotiating academic expectations, and 52 % negotiating compensation changes. Female EC felt less prepared than male EC regarding the business of medicine (p = 0.02), RVU assignments (p < 0.01), and compensation negotiations (p < 0.01).

Conclusion

Most gynecologic oncology fellows and early-career attendings do not feel prepared for the business of medicine. Women were less comfortable with these concepts than men. Formal education should be incorporated into career development curricula.
目的在妇科肿瘤学早期职业(EC)主治医师的职业决策中,关于薪酬、报销和学术生产力的影响还存在研究空白。我们试图评估妇科肿瘤学研究员和妇科肿瘤学早期职业主治医师对医疗业务的了解和看法。方法通过电子方式向研究员和妇科肿瘤学早期职业主治医师SGO成员发布匿名调查。关键主题是医疗业务、生产力和薪酬/谈判。采用 5 点李克特量表;使用 SPSS 计算描述性统计:回复率为 29%:82 名研究员和 102 名 EC 主治医师。大多数研究员(n = 67,82%)对学术/非私人实践感兴趣,大多数急诊主治医师(n = 82,82%)受雇于学术/非私人实践。研究员和执业医师报告称,RVUs(相对价值单位)和报销方面的教育不足(80%,n = 66;81%,n = 83),并且感觉没有为业务方面做好准备(80%,n = 66;73%,n = 75)。超过 40% 的研究员不了解 RVU 与实践的关系。33%的急诊科主治医师不了解 RVU 的分配;29%的主治医师对确定生产率的方法感到满意,17%的主治医师不了解自己的报酬。超过 60% 的研究员认为自己没有做好协商临床生产率预期的准备。就执委会主治医师而言,47%的人在协商临床期望值时感到不自在,32%的人在协商学术期望值时感到不自在,52%的人在协商薪酬变化时感到不自在。在医疗业务(p = 0.02)、RVU 分配(p < 0.01)和薪酬谈判(p < 0.01)方面,女性执委的准备程度低于男性执委。与男性相比,女性对这些概念不太适应。正式教育应纳入职业发展课程。
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引用次数: 0
Treatment of recurrent ovarian germ cell tumours: Is there a role for immune checkpoint inhibitors? 复发性卵巢生殖细胞瘤的治疗:免疫检查点抑制剂能发挥作用吗?
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-19 DOI: 10.1016/j.gore.2024.101502
Laurence Bernard
Ovarian germ cell tumours predominantly affect young women and have an excellent prognosis. While most contemporary papers concentrate on reducing treatment morbidity and preserving fertility, some women still succumb to refractory or recurrent OGCTs. Despite the significant impact of immune checkpoint inhibitors (ICIs) on many tumors, no case of a chemo-resistant ovarian germ cell tumour successfully treated with immunotherapy has been reported. In testicular cancer, only a few cases of partial response or stable disease to ICIs have been described. PD-L1 expression does not predict response, but microsatellite instability status may serve as a potential biomarker. MSI testing should be performed on a recurrent tumour sample as MSI status may evolve during treatment.
卵巢生殖细胞瘤主要影响年轻女性,预后良好。虽然大多数当代论文都集中在降低治疗发病率和保留生育能力方面,但仍有一些女性死于难治性或复发性卵巢生殖细胞瘤。尽管免疫检查点抑制剂(ICIs)对许多肿瘤产生了重大影响,但目前还没有化疗耐药卵巢生殖细胞瘤成功接受免疫疗法治疗的病例报道。在睾丸癌方面,只有少数病例描述了对 ICIs 的部分反应或病情稳定。PD-L1的表达不能预测反应,但微卫星不稳定性状态可作为潜在的生物标志物。由于 MSI 状态可能会在治疗过程中发生变化,因此应在复发肿瘤样本上进行 MSI 检测。
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引用次数: 0
Racial disparities in receipt of radiation and brachytherapy in cervical cancer patients: Do they exist in a SEER-Medicare population? 宫颈癌患者接受放射治疗和近距离放疗的种族差异:SEER-Medicare 群体中是否存在这种差异?
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-19 DOI: 10.1016/j.gore.2024.101505
Emily G. Gleason , Daniel H. Saris , Elizabeth A. Tubridy , Colleen M. Brensinger , Emily M. Ko

Objectives

To evaluate if race is associated with disparities in receipt of radiation (RT) and outcomes for Medicare patients with cervical cancer who are candidates for primary radiation-chemotherapy.

Methods

This SEER-Medicare retrospective study included White and Black patients with stage IB1 through IVA squamous cell carcinoma or adenocarcinoma diagnosed 2000–2017 who were candidates for primary radiation-chemotherapy. Receipt of treatment by race and associated cancer specific (CSS) and overall survival (OS) outcomes were analyzed using frequency distributions, chi squared, log rank, multivariable Cox proportional-hazards models, and multivariable logistic models.

Results

1038 patients (84.9 % White and 15.1 % Black) were included. 825 (79.5 %) received RT, and 601 (57.9 %) received brachytherapy (BT). Blacks were more likely to undergo RT than Whites (86.0 % vs. 78.3 %, p = 0.028) and had similar rates of BT (58.0 % vs. 57.9 %, p = 0.986). Median RT duration was 64.0 days (IQR 52.0, 75.0), and 276 (33.5 %) completed treatment in ≤ 56 days, with no differences by race (p = 0.488, 0.303, respectively). BT was more frequently provided at larger hospitals, National Cancer Institute-designated cancer centers, and teaching hospitals. When adjusted for covariates, no significant differences in RT, BT, or RT duration by race were identified. Median unadjusted OS was 3.58 years (95 % CI 2.92, 4.42) for White patients and 2.50 years (95 % CI 2.0, 5.25) for Black patients, with no differences in OS (HR 0.93, 95 % CI 0.75, 1.13) or CSS (HR 1.13, 95 %CI 0.86, 1.43).

Conclusions

Black Medicare patients with cervical cancer had greater receipt of RT than White patients, similar rates of BT, and no difference in survival.
方法这项 SEER-Medicare 回顾性研究纳入了 2000-2017 年确诊的 IB1 至 IVA 期鳞状细胞癌或腺癌的白人和黑人患者,他们都是原发性放射化疗的候选者。研究使用频率分布、卡方、对数秩、多变量考克斯比例危险模型和多变量逻辑模型分析了不同种族接受治疗的情况以及相关的癌症特异性(CSS)和总生存率(OS)结果。其中 825 人(79.5%)接受了 RT 治疗,601 人(57.9%)接受了近距离放射治疗 (BT)。黑人比白人更有可能接受 RT 治疗(86.0% 对 78.3%,P = 0.028),接受近距离放射治疗的比例相似(58.0% 对 57.9%,P = 0.986)。中位 RT 持续时间为 64.0 天(IQR 52.0,75.0),276 人(33.5%)在 56 天内完成治疗,种族间无差异(p = 0.488,0.303)。大医院、国家癌症研究所指定的癌症中心和教学医院更常提供 BT。经协变量调整后,RT、BT 或 RT 持续时间在种族间无显著差异。白人患者未经调整的中位 OS 为 3.58 年(95 % CI 2.92,4.42),黑人患者为 2.50 年(95 % CI 2.0,5.25),OS(HR 0.93,95 % CI 0.75,1.13)或 CSS(HR 1.13,95 %CI 0.86,1.43)无差异。
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引用次数: 0
Direct oral anticoagulants (DOACs) for postoperative venous thromboembolism prophylaxis in patients with gynecologic malignancies: A quality mini-review 妇科恶性肿瘤患者术后预防静脉血栓栓塞的直接口服抗凝剂 (DOAC):高质量微型综述
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-19 DOI: 10.1016/j.gore.2024.101508
Peter W. Ketch , Sean C. Dowdy , Robert D. McBane II , J. Michael Straughn Jr , Teresa K.L. Boitano
Venous thromboembolism (VTE) is a common cause of morbidity and mortality in gynecologic oncology patients with an increased risk in the postoperative period. Historically, international guidelines have recommended 28 days of low molecular weight heparin (LMWH) or unfractionated heparin (UFH) for extended VTE prophylaxis after major abdominal and pelvic surgery for gynecologic malignancies. Direct oral anticoagulants (DOACs) have emerged as an attractive alternative to injectable anticoagulants. This quality mini-review evaluated the literature around the use of DOACs for postoperative VTE prophylaxis after surgery for gynecologic cancer. Overall, the reviewed literature supports the use of DOACs in select patients within this population which may lead to an improved patient experience, higher rates of treatment compliance, and increased cost savings.
静脉血栓栓塞症(VTE)是妇科肿瘤患者发病和死亡的常见原因,术后风险更高。一直以来,国际指南都建议在妇科恶性肿瘤腹部和盆腔大手术后使用 28 天的低分子量肝素(LMWH)或非分数肝素(UFH)来延长 VTE 预防期。直接口服抗凝剂(DOACs)已成为注射用抗凝剂的一种极具吸引力的替代药物。这篇高质量的微型综述评估了有关妇科癌症手术后使用 DOACs 预防 VTE 的文献。总体而言,所回顾的文献支持在这一人群中的特定患者中使用 DOAC,这可能会改善患者的就医体验、提高治疗依从性并节约更多成本。
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引用次数: 0
The time is now: Concrete actions are needed to improve diversity and representation in clinical trials participation 时不我待:需要采取具体行动,提高临床试验参与的多样性和代表性
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-19 DOI: 10.1016/j.gore.2024.101513
Jhalak Dholakia, Susan C. Modesitt
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引用次数: 0
Androgen receptor expression in recurrent granulosa cell tumor of the ovary: Clinical considerations of treatment and surveillance in a transgender male 复发性卵巢颗粒细胞瘤中雄激素受体的表达:变性男性治疗和监测的临床考虑
IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-18 DOI: 10.1016/j.gore.2024.101504
Jordyn Tumas , Ruben D. Alberto Hiraldo , Tara Berman
Granulosa cell tumors (GCT) represent a rare subtype of ovarian cancers. A majority of these tumors express androgen receptor (AR), making them hormonally sensitive. AR positivity not only suggests a potential role of anti-androgen therapy in treating these tumors but also poses a cause for concern: female to male (FTM) transgender patients undergoing exogenous testosterone therapy may be at risk for recurrence, progression, or even incidence of this type of cancer. Although treatment of GCT in transgender individuals has not been well-described, the impact of exogenous hormone use on cancer physiology and treatment should be considered, while also addressing gender dysphoria throughout treatment and in surveillance. Here, we describe a FTM transgender patient with recurrent AR-positive adult granulosa cell tumor after starting testosterone supplementation, along with a literature review to explore the current knowledge of ovarian changes observed following FTM gender transition and subsequent risk of ovarian cancer.
颗粒细胞瘤(GCT)是一种罕见的卵巢癌亚型。这些肿瘤大多表达雄激素受体(AR),因此对激素敏感。AR阳性不仅表明抗雄激素疗法在治疗这些肿瘤中的潜在作用,同时也引起了人们的关注:接受外源性睾酮治疗的女变男(FTM)变性患者可能面临复发、恶化甚至发生此类癌症的风险。虽然变性人的 GCT 治疗尚未得到很好的描述,但应考虑外源性激素的使用对癌症生理和治疗的影响,同时在整个治疗和监测过程中解决性别失调问题。在此,我们描述了一名开始补充睾酮后复发 AR 阳性成人颗粒细胞瘤的 FTM 变性患者,并通过文献综述探讨了 FTM 性别转换后观察到的卵巢变化以及随后的卵巢癌风险的现有知识。
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引用次数: 0
期刊
Gynecologic Oncology Reports
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