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}
Pub Date : 2025-12-01DOI: 10.1016/j.gore.2025.101996
Bahareh Hamedi , Shilpa Mokshagundam , Antonio Lembo , S John Weroha , Michaela E. McGree , Amanda L. Tapia , Carrie L. Langstraat
Background
Mucinous epithelial ovarian (mEO) tumors are rare entities. In this study, we describe the management and outcomes of patients treated for mucinous borderline tumor and mucinous adenocarcinoma of the ovary.
Methods
This was a retrospective review of patients with mEO tumors from 1988 − 2021 from a single institution database. Primary outcomes were disease recurrence and death within five years post-surgery, evaluated using Cox proportional hazards and Kaplan-Meier survival analysis.
Results
We identified 262 patients with mEO tumors with a mean age of 54.9 years. One-hundred and forty-three patients (55 %) had borderline tumors and 119 (45 %) adenocarcinoma. Most patients underwent complete surgical resection (95 %).
Those with mucinous borderline tumors had favorable prognosis, with 5-year progression-free survival (PFS) and overall survival (OS) of 97%. Among patients with mucinous adenocarcinoma, 5-year PFS was 78% and 5-year OS was 80%. Fifty-seven patients with adenocarcinoma (48%) received adjuvant chemotherapy.
In univariate analysis, adenocarcinoma histology, residual disease, advanced FIGO stage (II-IV), and receipt of adjuvant chemotherapy were associated with recurrence and death within five years of surgery. While a considerable proportion of patients in both cohorts underwent gastrointestinal (GI) endoscopy, all findings were negative/benign.
Conclusions
Mucinous tumors of the ovary have overall favorable survival outcomes. In this cohort, residual disease, histopathology, and receipt of adjuvant chemotherapy were associated with disease recurrence. In addition, GI workup was of limited utility. Further study is needed to clarify ideal adjuvant treatment and GI workup.
{"title":"Mucinous ovarian neoplasm – outcomes of a rare tumor","authors":"Bahareh Hamedi , Shilpa Mokshagundam , Antonio Lembo , S John Weroha , Michaela E. McGree , Amanda L. Tapia , Carrie L. Langstraat","doi":"10.1016/j.gore.2025.101996","DOIUrl":"10.1016/j.gore.2025.101996","url":null,"abstract":"<div><h3>Background</h3><div>Mucinous epithelial ovarian (mEO) tumors are rare entities. In this study, we describe the management and outcomes of patients treated for mucinous borderline tumor and mucinous adenocarcinoma of the ovary.</div></div><div><h3>Methods</h3><div>This was a retrospective review of patients with mEO tumors from 1988 − 2021 from a single institution database. Primary outcomes were disease recurrence and death within five years post-surgery, evaluated using Cox proportional hazards and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>We identified 262 patients with mEO tumors with a mean age of 54.9 years. One-hundred and forty-three patients (55 %) had borderline tumors and 119 (45 %) adenocarcinoma. Most patients underwent complete surgical resection (95 %).</div><div>Those with mucinous borderline tumors had favorable prognosis, with 5-year progression-free survival (PFS) and overall survival (OS) of 97%. Among patients with mucinous adenocarcinoma, 5-year PFS was 78% and 5-year OS was 80%. Fifty-seven patients with adenocarcinoma (48%) received adjuvant chemotherapy.</div><div>In univariate analysis, adenocarcinoma histology, residual disease, advanced FIGO stage (II-IV), and receipt of adjuvant chemotherapy were associated with recurrence and death within five years of surgery. While a considerable proportion of patients in both cohorts underwent gastrointestinal (GI) endoscopy, all findings were negative/benign.</div></div><div><h3>Conclusions</h3><div>Mucinous tumors of the ovary have overall favorable survival outcomes. In this cohort, residual disease, histopathology, and receipt of adjuvant chemotherapy were associated with disease recurrence. In addition, GI workup was of limited utility. Further study is needed to clarify ideal adjuvant treatment and GI workup.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101996"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620312","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 : 2025-12-01DOI: 10.1016/j.gore.2025.101997
Minyoung Jang , Lakeisha Mulugeta-Gordon , Joseph Carver , Natalie Tupper , Julie Barbera , Lauren Schwartz , Nawar Latif
Background
Primary ovarian carcinoid tumors are rare neuroendocrine neoplasms comprising <0.1% of ovarian tumors and 1% of all carcinoid tumors. Up to 30% present with carcinoid syndrome, and approximately one-quarter of these develop carcinoid heart syndrome. Unlike gastrointestinal carcinoid tumors, ovarian lesions can cause carcinoid syndrome without hepatic metastases due to direct venous drainage into the systemic circulation.
Case
A 46-year-old woman presented with abdominal discomfort, new onset hypertension, and lower extremity edema. Imaging revealed a 16.8 cm right adnexal mass with mixed solid and cystic components. Echocardiography demonstrated torrential tricuspid regurgitation related to thickened, immobile leaflets, consistent with carcinoid heart syndrome. Serum serotonin and chromogranin A were markedly elevated. She underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, right pelvic and para-aortic lymphadenectomy, and omental biopsy. Pathology showed a carcinoid tumor arising in a mature cystic teratoma, confined to the right ovary (FIGO stage IA). Immunohistochemistry confirmed neuroendocrine differentiation (synaptophysin, chromogranin positive). Postoperatively, chromogranin A normalized, serotonin decreased, and proBNP improved. Three months later, she underwent successful bioprosthetic tricuspid valve replacement with ongoing Cardiology follow up.
Discussion
This case illustrates that ovarian carcinoid tumors may present with minimal symptoms despite significant cardiac involvement. Early cardiac evaluation is warranted in suspected carcinoid tumors to identify carcinoid heart syndrome. Overall survival is generally favorable for early stage ovarian carcinoid tumors. Long-term cardiac prognosis is determined by right ventricular function and presence of residual tumor after resection. Management requires individualized and multidisciplinary surgical planning, balancing tumor resection with timely cardiac intervention.
{"title":"Ovarian carcinoid tumor with carcinoid heart syndrome: A case report and literature review","authors":"Minyoung Jang , Lakeisha Mulugeta-Gordon , Joseph Carver , Natalie Tupper , Julie Barbera , Lauren Schwartz , Nawar Latif","doi":"10.1016/j.gore.2025.101997","DOIUrl":"10.1016/j.gore.2025.101997","url":null,"abstract":"<div><h3>Background</h3><div>Primary ovarian carcinoid tumors are rare neuroendocrine neoplasms comprising <0.1% of ovarian tumors and 1% of all carcinoid tumors. Up to 30% present with carcinoid syndrome, and approximately one-quarter of these develop carcinoid heart syndrome. Unlike gastrointestinal carcinoid tumors, ovarian lesions can cause carcinoid syndrome without hepatic metastases due to direct venous drainage into the systemic circulation.</div></div><div><h3>Case</h3><div>A 46-year-old woman presented with abdominal discomfort, new onset hypertension, and lower extremity edema. Imaging revealed a 16.8 cm right adnexal mass with mixed solid and cystic components. Echocardiography demonstrated torrential tricuspid regurgitation related to thickened, immobile leaflets, consistent with carcinoid heart syndrome. Serum serotonin and chromogranin A were markedly elevated. She underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, right pelvic and para-aortic lymphadenectomy, and omental biopsy. Pathology showed a carcinoid tumor arising in a mature cystic teratoma, confined to the right ovary (FIGO stage IA). Immunohistochemistry confirmed neuroendocrine differentiation (synaptophysin, chromogranin positive). Postoperatively, chromogranin A normalized, serotonin decreased, and proBNP improved. Three months later, she underwent successful bioprosthetic tricuspid valve replacement with ongoing Cardiology follow up.</div></div><div><h3>Discussion</h3><div>This case illustrates that ovarian carcinoid tumors may present with minimal symptoms despite significant cardiac involvement. Early cardiac evaluation is warranted in suspected carcinoid tumors to identify carcinoid heart syndrome. Overall survival is generally favorable for early stage ovarian carcinoid tumors. Long-term cardiac prognosis is determined by right ventricular function and presence of residual tumor after resection. Management requires individualized and multidisciplinary surgical planning, balancing tumor resection with timely cardiac intervention.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101997"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620214","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 : 2025-12-01DOI: 10.1016/j.gore.2025.101998
Aarushi A. Caro , Alícia Gordún Peiró , Eva Hadadi , Yani Berckmans , Yvon Elkrim , Ayla Debraekeleer , Gisèle Mateu Cabrera , Kim De Veirman , An Coosemans , Damya Laoui
Objective
Ovarian cancer (OC) is the deadliest gynecological malignancy, with patients experiencing late diagnosis and high recurrence. AXL is highly expressed in OC and correlates with worse prognosis. We aim to evaluate the use of AXL-targeting nanobodies as a novel therapeutic modality to inhibit the AXL-GAS6 axis in OC.
Methods
ID8-fLuc cells were in vivo passaged three times to obtain the fast-progressing P3 ID8 Thy1.1 cell line. The expression of AXL in ID8 lines was assessed by flow cytometry and immunofluorescence, while serum GAS6 levels in tumor-bearing and naïve mice were measured by ELISA. Using in silico analyses, we correlated AXL and GAS6 expression with OC patient outcomes and assessed AXL expression in different tissues and patient cohorts. Orthotopic ovarian tumors were processed to a single cell suspension and treated in vitro with the nanobody (AXL-Fc), a PARP inhibitor (Olaparib), or controls (PBS or DMSO) for 24 h or 72 h, followed by flow cytometry to assess stages of cell death and cancer cell proliferation.
Results
In vivo passaging of ID8-fLuc cells resulted in a faster-progressing P3 ID8 Thy1.1 cell line that recapitulates stages I-III observed in OC patients. In OC patients, AXL and GAS6 genes are highly expressed in primary and metastatic tumors, and enriched in platinum-resistant patients. AXL-Fc induces necrosis in OC cells from orthotopic ovarian tumors. AXL-Fc synergizes with Olaparib, resulting in decreased OC cell proliferation.
Conclusions
Leveraging the synergistic effects of AXL-Fc with Olaparib, we propose a new AXL-targeting treatment approach for OC that warrants further investigation.
{"title":"A fast-progressing orthotopic ovarian cancer model reveals synergistic antitumor effects of AXL-targeting nanobodies and Olaparib","authors":"Aarushi A. Caro , Alícia Gordún Peiró , Eva Hadadi , Yani Berckmans , Yvon Elkrim , Ayla Debraekeleer , Gisèle Mateu Cabrera , Kim De Veirman , An Coosemans , Damya Laoui","doi":"10.1016/j.gore.2025.101998","DOIUrl":"10.1016/j.gore.2025.101998","url":null,"abstract":"<div><h3>Objective</h3><div>Ovarian cancer (OC) is the deadliest gynecological malignancy, with patients experiencing late diagnosis and high recurrence. AXL is highly expressed in OC and correlates with worse prognosis. We aim to evaluate the use of AXL-targeting nanobodies as a novel therapeutic modality to inhibit the AXL-GAS6 axis in OC.</div></div><div><h3>Methods</h3><div>ID8-fLuc cells were <em>in vivo</em> passaged three times to obtain the fast-progressing P3 ID8 Thy1.1 cell line. The expression of AXL in ID8 lines was assessed by flow cytometry and immunofluorescence, while serum GAS6 levels in tumor-bearing and naïve mice were measured by ELISA. Using <em>in silico</em> analyses, we correlated AXL and GAS6 expression with OC patient outcomes and assessed AXL expression in different tissues and patient cohorts. Orthotopic ovarian tumors were processed to a single cell suspension and treated <em>in vitro</em> with the nanobody (AXL-Fc), a PARP inhibitor (Olaparib), or controls (PBS or DMSO) for 24 h or 72 h, followed by flow cytometry to assess stages of cell death and cancer cell proliferation.</div></div><div><h3>Results</h3><div><em>In vivo</em> passaging of ID8-fLuc cells resulted in a faster-progressing P3 ID8 Thy1.1 cell line that recapitulates stages I-III observed in OC patients. In OC patients, <em>AXL</em> and <em>GAS6</em> genes are highly expressed in primary and metastatic tumors, and enriched in platinum-resistant patients. AXL-Fc induces necrosis in OC cells from orthotopic ovarian tumors. AXL-Fc synergizes with Olaparib, resulting in decreased OC cell proliferation.</div></div><div><h3>Conclusions</h3><div>Leveraging the synergistic effects of AXL-Fc with Olaparib, we propose a new AXL-targeting treatment approach for OC that warrants further investigation.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101998"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620213","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 : 2025-12-01DOI: 10.1016/j.gore.2025.101989
Vinita Popat , Adam Rucker , Joseph W. Carlson , Aimee Keegan , Lorna Rodriguez-Rodriguez
Background
Somatically derived ovarian yolk sac tumors (SD-YSTs) in postmenopausal women are rare and typically present with advanced-stage disease, often carrying a poor prognosis.
Case
We describe a 74-year-old woman with stage IIIB SD-YST who underwent complete surgical resection followed by cisplatin-etoposide chemotherapy, with bleomycin omitted due to frailty. Chemotherapy scheduling was modified in real time according to alpha-fetoprotein (AFP) kinetics, with treatment intervals shortened from 21 to 14 days after AFP levels rose between early cycles. Despite dose reductions due to thrombocytopenia, AFP levels normalized after cycle 3, and treatment was discontinued after cycle 4.
Outcome
The patient has remained disease-free for over five years with ongoing surveillance.
Conclusion
This case underscores the potential for long-term remission in SD-YST with platinum-based therapy, even when standard regimens require modification for older or frail patients. It highlights the value of biomarker-guided treatment adjustments to optimize chemotherapy timing in rare ovarian malignancies.
{"title":"Somatically derived ovarian yolk sac tumor in a postmenopausal woman: A case report of durable remission with personalized chemotherapy","authors":"Vinita Popat , Adam Rucker , Joseph W. Carlson , Aimee Keegan , Lorna Rodriguez-Rodriguez","doi":"10.1016/j.gore.2025.101989","DOIUrl":"10.1016/j.gore.2025.101989","url":null,"abstract":"<div><h3>Background</h3><div>Somatically derived ovarian yolk sac tumors (SD-YSTs) in postmenopausal women are rare and typically present with advanced-stage disease, often carrying a poor prognosis.</div></div><div><h3>Case</h3><div>We describe a 74-year-old woman with stage IIIB SD-YST who underwent complete surgical resection followed by cisplatin-etoposide chemotherapy, with bleomycin omitted due to frailty. Chemotherapy scheduling was modified in real time according to alpha-fetoprotein (AFP) kinetics, with treatment intervals shortened from 21 to 14 days after AFP levels rose between early cycles. Despite dose reductions due to thrombocytopenia, AFP levels normalized after cycle 3, and treatment was discontinued after cycle 4.</div></div><div><h3>Outcome</h3><div>The patient has remained disease-free for over five years with ongoing surveillance.</div></div><div><h3>Conclusion</h3><div>This case underscores the potential for long-term remission in SD-YST with platinum-based therapy, even when standard regimens require modification for older or frail patients. It highlights the value of biomarker-guided treatment adjustments to optimize chemotherapy timing in rare ovarian malignancies.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101989"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690326","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 : 2025-12-01DOI: 10.1016/j.gore.2025.101999
Luying Zhang, Yuxin Wang, Cang Qiu, Yang Li, Kelei Zhao, Xiaohan Yuan, Yanting Liu, Ping Lu, Min Zhang
Background
Platinum-refractory ovarian cancer (PROC) is extremely malignant and aggressive. Patients typically have a diminished quality of life and limited survival, with an overall survival (OS) of less than one year. Until early 2024, bevacizumab remains the only targeted agent approved in China for the treatment of PROC. The standard regimen for PROC in China is non-platinum single-agent chemotherapy, or chemotherapy combined with bevacizumab. However, these therapies have not achieved satisfactory clinical outcomes.
Case presentation
A 63-year-old woman presented with an incidentally detected left neck mass. Ultrasound-guided biopsy revealed high-grade serous ovarian carcinoma. She received first-line bevacizumab plus platinum-based chemotherapy but showed disease progression after two cycles, consistent with platinum-refractory ovarian cancer. After similarly failing second-line gemcitabine therapy (2 cycles), she achieved complete response (CR) and maintained progression-free survival (PFS) for 23.9 months with third-line etoposide combined with anlotinib and sintilimab.
Conclusion
This case demonstrates that the combination of etoposide, anlotinib, and sintilimab can induce sustained CR in platinum-refractory ovarian cancer, achieving remarkable 23.9-month PFS. The synergistic activity of this regimen successfully reversed multidrug resistance and may redefine third-line therapeutic strategies for this challenging population.
{"title":"Etoposide combined with anlotinib and sintilimab successfully achieved long term progression-free survival in platinum-refractory ovarian cancer: A case report","authors":"Luying Zhang, Yuxin Wang, Cang Qiu, Yang Li, Kelei Zhao, Xiaohan Yuan, Yanting Liu, Ping Lu, Min Zhang","doi":"10.1016/j.gore.2025.101999","DOIUrl":"10.1016/j.gore.2025.101999","url":null,"abstract":"<div><h3>Background</h3><div>Platinum-refractory ovarian cancer (PROC) is extremely malignant and aggressive. Patients typically have a diminished quality of life and limited survival, with an overall survival<!--> <!-->(OS)<!--> <!-->of less than one year. Until early 2024, bevacizumab remains the only targeted agent approved in China for the treatment of PROC. The standard regimen for PROC in China is non-platinum single-agent chemotherapy, or chemotherapy combined with<!--> <!-->bevacizumab. However, these therapies have not achieved<!--> <!-->satisfactory clinical outcomes.</div></div><div><h3>Case presentation</h3><div>A 63-year-old woman presented with an incidentally detected left neck mass. Ultrasound-guided biopsy revealed high-grade serous ovarian carcinoma. She received first-line bevacizumab plus platinum-based chemotherapy but showed disease progression after two cycles, consistent with platinum-refractory ovarian cancer. After similarly failing second-line gemcitabine therapy (2 cycles), she achieved complete response (CR) and maintained progression-free survival (PFS) for 23.9 months with third-line etoposide combined with anlotinib and sintilimab.</div></div><div><h3>Conclusion</h3><div>This case demonstrates that the combination of etoposide, anlotinib, and sintilimab can induce sustained CR in platinum-refractory ovarian cancer, achieving remarkable 23.9-month PFS. The synergistic activity of this regimen successfully reversed multidrug resistance and may redefine third-line therapeutic strategies for this challenging population.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101999"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690324","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 : 2025-12-01DOI: 10.1016/j.gore.2025.102001
Sarah P. Huepenbecker , Katherine C. Fuh
{"title":"Considering homologous recombination deficiency status in HIPEC: could molecular testing someday drive “targeted” surgery?","authors":"Sarah P. Huepenbecker , Katherine C. Fuh","doi":"10.1016/j.gore.2025.102001","DOIUrl":"10.1016/j.gore.2025.102001","url":null,"abstract":"","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 102001"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747276","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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