Pub Date : 2025-10-13DOI: 10.1016/j.gore.2025.101973
Maria Selloua , Giulio Ricotta , Pierre Cougoul , Laurence Gladieff , Gwenaël Ferron
Background
Non–islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome caused by excessive secretion of incompletely processed insulin–like growth factor–2 (IGF–2) from tumor cells. This leads to severe, refractory hypoglycemia.
Case Presentation
A 67–year–old woman presented with stage IIIC high-grade ovarian carcinoma associated with severe hypoglycemia at diagnosis, and at recurrence. Laboratory tests showed suppressed insulin and C–peptide levels, with an elevated IGF–2/IGF–1 ratio, consistent with NICTH. The patient underwent primary surgery followed by adjuvant platinum-based chemotherapy and maintenance therapy with bevacizumab and olaparib. This comprehensive treatment approach led to remission of both the carcinoma and the associated severe paraneoplastic hypoglycemia. The relapse of the disease was accompanied by a recurrence of hypoglycemia, refractory to medical treatement, which ultimately led to the patient’s death.
Conclusion
This represents the first reported case of HGSOC with NICTH, emphasizing the complexity of ovarian cancer presentations and the importance of early diagnosis and comprehensive management in rare paraneoplastic conditions.
{"title":"Non-islet cell tumor hypoglycemia (NICTH) as a rare paraneoplastic syndrome in high-grade serous ovarian carcinoma: A case report and review of the literature","authors":"Maria Selloua , Giulio Ricotta , Pierre Cougoul , Laurence Gladieff , Gwenaël Ferron","doi":"10.1016/j.gore.2025.101973","DOIUrl":"10.1016/j.gore.2025.101973","url":null,"abstract":"<div><h3>Background</h3><div>Non–islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome caused by excessive secretion of incompletely processed insulin–like growth factor–2 (IGF–2) from tumor cells. This leads to severe, refractory hypoglycemia.</div></div><div><h3>Case Presentation</h3><div>A 67–year–old woman presented with stage IIIC high-grade ovarian carcinoma associated with severe hypoglycemia at diagnosis, and at recurrence. Laboratory tests showed suppressed insulin and C–peptide levels, with an elevated IGF–2/IGF–1 ratio, consistent with NICTH. The patient underwent primary surgery followed by adjuvant platinum-based chemotherapy and maintenance therapy with bevacizumab and olaparib. This comprehensive treatment approach led to remission of both the carcinoma and the associated severe paraneoplastic hypoglycemia. The relapse of the disease was accompanied by a recurrence of hypoglycemia, refractory to medical treatement, which ultimately led to the patient’s death.</div></div><div><h3>Conclusion</h3><div>This represents the first reported case of HGSOC with NICTH, emphasizing the complexity of ovarian cancer presentations and the importance of early diagnosis and comprehensive management in rare paraneoplastic conditions.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101973"},"PeriodicalIF":1.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334326","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}
This study aims to describe the incidence, mortality, and survival trends of vulvar and vaginal cancers in a population-based cohort from Northern Italy, with a particular focus on the development of second primary malignancies.
Methods
Data were retrieved from the Cancer Registry of Reggio Emilia, covering the period 1996–2021. Vulvar and vaginal cancers were classified according to ICD-O-3 topography codes C51 and C52, respectively. Age-standardized incidence and mortality rates were calculated using the European Standard Population. Relative survival estimates were computed using the Pohar Perme method. Time trends were analyzed using Joinpoint Regression, and the occurrence of second primary malignancies was assessed based on medical records.
Results
A total of 328 cases were identified: 264 vulvar (80.5 %) and 64 vaginal cancers (19.5 %). The median age at diagnosis was 76.1 years for vulvar cancer and 70.2 years for vaginal cancer. Squamous cell carcinoma was the predominant histological subtype (78 % vulvar, 57.8 % vaginal). The incidence of vulvar cancer showed a significant annual decrease (APC −2.3 %, 95 %CI −3.5; −1.0), while mortality remained stable. Vaginal cancer also exhibited a decreasing incidence trend (APC −3.3 %, 95 %CI −9.1; 2.9), though not statistically significant. The five-year survival rate was 63 % for vulvar cancer and 44 % for vaginal cancer, with a significant improvement for vaginal cancer in the years (1996–2006: 33 %; 2007–2018: 61 %). Second primary malignancies were observed in 30 patients (27 with vulvar and 3 with vaginal cancer).
Conclusion
Although vulvar and vaginal cancers remain rare, their burden is significant, particularly in older women. The declining incidence may be attributed to the effects of HPV vaccination and improved screening practices. However, the stable mortality rates underscore the need for optimized treatment strategies. Given the association with second malignancies, long-term surveillance is essential to improving patient outcomes.
Policy Summary
Vulvar and vaginal cancers are rare but require careful and continuous monitoring. Knowledge of the incidence curves and survival of these tumors should encourage stakeholders to invest both in terms of primary prevention (smoking cessation and sex education) but also secondary prevention by implementing screening campaigns without neglecting the importance of HPV vaccination and access to care for all, without regional disparities.
本研究旨在描述意大利北部人群为基础的外阴和阴道癌的发病率、死亡率和生存趋势，特别关注第二原发恶性肿瘤的发展。方法数据从Reggio Emilia癌症登记处检索，涵盖1996-2021年。外阴癌和阴道癌分别按照ICD-O-3地形编码C51和C52进行分类。使用欧洲标准人口计算年龄标准化发病率和死亡率。使用Pohar Perme方法计算相对生存估计。使用关节点回归分析时间趋势，并根据医疗记录评估第二原发恶性肿瘤的发生情况。结果共检出328例，其中外阴癌264例（80.5%），阴道癌64例（19.5%）。外阴癌的中位诊断年龄为76.1岁，阴道癌的中位诊断年龄为70.2岁。鳞状细胞癌是主要的组织学亚型（78%外阴，57.8%阴道）。外阴癌的发病率每年显著下降（APC - 2.3%, 95% CI - 3.5; - 1.0），而死亡率保持稳定。阴道癌的发病率也呈下降趋势（APC - 3.3%, 95% CI - 9.1; 2.9），但无统计学意义。外阴癌的5年生存率为63%，阴道癌的5年生存率为44%，阴道癌的5年生存率显著提高（1996-2006年：33%；2007-2018年：61%）。第二原发恶性肿瘤30例（27例外阴癌，3例阴道癌）。结论虽然外阴和阴道癌仍然很少见，但其负担很大，特别是在老年妇女中。发病率的下降可能归因于HPV疫苗接种的效果和改进的筛查做法。然而，稳定的死亡率强调了优化治疗策略的必要性。鉴于与第二恶性肿瘤的关联，长期监测对改善患者预后至关重要。外阴和阴道癌是罕见的，但需要仔细和持续的监测。了解这些肿瘤的发病率曲线和生存率应鼓励利益攸关方在一级预防（戒烟和性教育）和二级预防方面进行投资，通过实施筛查运动，而不忽视HPV疫苗接种的重要性和所有人获得护理的重要性，而不存在地区差异。
{"title":"Incidence and survival of vulvar and vaginal cancers in a province of Northern Italy: a population-based study","authors":"Isabella Bisceglia , Francesco Marinelli , Vincenzo Dario Mandato , Debora Pirillo , Fortunato Morabito , Antonino Neri , Lucia Mangone","doi":"10.1016/j.gore.2025.101968","DOIUrl":"10.1016/j.gore.2025.101968","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to describe the incidence, mortality, and survival trends of vulvar and vaginal cancers in a population-based cohort from Northern Italy, with a particular focus on the development of second primary malignancies.</div></div><div><h3>Methods</h3><div>Data were retrieved from the Cancer Registry of Reggio Emilia, covering the period 1996–2021. Vulvar and vaginal cancers were classified according to ICD-O-3 topography codes C51 and C52, respectively. Age-standardized incidence and mortality rates were calculated using the European Standard Population. Relative survival estimates were computed using the Pohar Perme method. Time trends were analyzed using Joinpoint Regression, and the occurrence of second primary malignancies was assessed based on medical records.</div></div><div><h3>Results</h3><div>A total of 328 cases were identified: 264 vulvar (80.5 %) and 64 vaginal cancers (19.5 %). The median age at diagnosis was 76.1 years for vulvar cancer and 70.2 years for vaginal cancer. Squamous cell carcinoma was the predominant histological subtype (78 % vulvar, 57.8 % vaginal). The incidence of vulvar cancer showed a significant annual decrease (APC −2.3 %, 95 %CI −3.5; −1.0), while mortality remained stable. Vaginal cancer also exhibited a decreasing incidence trend (APC −3.3 %, 95 %CI −9.1; 2.9), though not statistically significant. The five-year survival rate was 63 % for vulvar cancer and 44 % for vaginal cancer, with a significant improvement for vaginal cancer in the years (1996–2006: 33 %; 2007–2018: 61 %). Second primary malignancies were observed in 30 patients (27 with vulvar and 3 with vaginal cancer).</div></div><div><h3>Conclusion</h3><div>Although vulvar and vaginal cancers remain rare, their burden is significant, particularly in older women. The declining incidence may be attributed to the effects of HPV vaccination and improved screening practices. However, the stable mortality rates underscore the need for optimized treatment strategies. Given the association with second malignancies, long-term surveillance is essential to improving patient outcomes.</div></div><div><h3>Policy Summary</h3><div>Vulvar and vaginal cancers are rare but require careful and continuous monitoring. Knowledge of the incidence curves and survival of these tumors should encourage stakeholders to invest both in terms of primary prevention (smoking cessation and sex education) but also secondary prevention by implementing screening campaigns without neglecting the importance of HPV vaccination and access to care for all, without regional disparities.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101968"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289866","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 : 2025-10-08DOI: 10.1016/j.gore.2025.101969
Carlye Goldenberg , Kavita Krell , Edgar Diaz Miranda , Sooah Ko , Maya Demirchian , Grace Anne Dyer , Mark Hunter , Erin Tuller , Amanda Hull , Lei Lei
Objective
This study examined how obesity, smoking, and pregnancy history, characterized as lifestyle factors, are associated with survival of epithelial ovarian cancer; and investigated whether epithelial ovarian cancer presentation, survival, and cancer recurrence are affected by patient home geographic location.
Methods
A retrospective analysis was conducted on all patients with epithelial ovarian cancer treated at the University of Missouri and Ellis Fischel Cancer Center between 2008 and 2023. Patient charts were reviewed for cancer history, lifestyle factors, patient status, laboratory values, and residential zip codes which were categorized using Missouri ZIP Health Rankings. Survival, Cox univariate and multivariate logistic regression, and association analyses were performed.
Results
In this cohort, stage at diagnosis, histologic subtype, age at diagnosis, and initial CA125 level proved to be significant predictors of survival, while lifestyle factors, including BMI, smoking, and pregnancy were not. Notably, patients residing in communities with the lowest zip code health rankings experienced higher rates of cancer recurrence, despite a lower overall number of cases compared to higher-ranked communities.
Conclusion
Although the lifestyle factors investigated in this study were not significantly associated with survival, a geographic disparity in recurrence rates and total cases was clear, suggesting possible underdiagnosis and barriers to accessing care in lower ranked zip codes. These findings emphasize an evident need to further investigate community-specific healthcare access and delivery, as well as other lifestyle factors that may be contributing to these differences.
{"title":"Assessing the socio-geographic and lifestyle factors impacting epithelial ovarian cancer outcomes: a retrospective study based on county health ranking in Missouri","authors":"Carlye Goldenberg , Kavita Krell , Edgar Diaz Miranda , Sooah Ko , Maya Demirchian , Grace Anne Dyer , Mark Hunter , Erin Tuller , Amanda Hull , Lei Lei","doi":"10.1016/j.gore.2025.101969","DOIUrl":"10.1016/j.gore.2025.101969","url":null,"abstract":"<div><h3>Objective</h3><div>This study examined how obesity, smoking, and pregnancy history, characterized as lifestyle factors, are associated with survival of epithelial ovarian cancer; and investigated whether epithelial ovarian cancer presentation, survival, and cancer recurrence are affected by patient home geographic location.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on all patients with epithelial ovarian cancer treated at the University of Missouri and Ellis Fischel Cancer Center between 2008 and 2023. Patient charts were reviewed for cancer history, lifestyle factors, patient status, laboratory values, and residential zip codes which were categorized using Missouri ZIP Health Rankings. Survival, Cox univariate and multivariate logistic regression, and association analyses were performed.</div></div><div><h3>Results</h3><div>In this cohort, stage at diagnosis, histologic subtype, age at diagnosis, and initial CA125 level proved to be significant predictors of survival, while lifestyle factors, including BMI, smoking, and pregnancy were not. Notably, patients residing in communities with the lowest zip code health rankings experienced higher rates of cancer recurrence, despite a lower overall number of cases compared to higher-ranked communities.</div></div><div><h3>Conclusion</h3><div>Although the lifestyle factors investigated in this study were not significantly associated with survival, a geographic disparity in recurrence rates and total cases was clear, suggesting possible underdiagnosis and barriers to accessing care in lower ranked zip codes. These findings emphasize an evident need to further investigate community-specific healthcare access and delivery, as well as other lifestyle factors that may be contributing to these differences.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101969"},"PeriodicalIF":1.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289868","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 : 2025-10-05DOI: 10.1016/j.gore.2025.101963
Sara Perelmuter , Laura Keenahan , Alicia Mecklai , Panagiota Andreopoulou , Sangeeta Kashyap , Jamieson Greenwald , Lisa Mosconi , Michael Battista , Ravi N. Sharaf , Melissa K. Frey
Risk-reducing bilateral salpingo-oophorectomy (rrBSO) is a standard of care for individuals with BRCA1/2 pathogenic variants and other hereditary ovarian cancer syndromes. While the oncologic benefits are clear, the abrupt estrogen deprivation of premature surgical menopause confers increased risks of cardiovascular disease, osteoporosis, and cognitive decline—yet long-term preventive care remains inconsistently provided. This commentary presents a multidisciplinary pilot model developed at a major academic center to bridge this gap.
Eligible patients seen in a gynecologic oncology clinic received an educational flyer summarizing chronic disease risks and evidence-based prevention strategies. Referral algorithms were created to streamline access to cardiology, endocrinology, and neurology.
From December 2023 to October 2024, 49 patients (median age 49 years, range 27–61) engaged with the program. All patients accepted the flyers, and at one-month follow-up (47 reached), 98% reported positive feedback, 94% found the material accessible, and 23% noted increased motivation for preventive care. The most frequent comment was that the flyers were easily understandable (70%). Eight patients were referred to preventive cardiology (6 scheduled), and six to endocrinology for low bone density (5 scheduled).
These preliminary findings suggest that patients with premature surgical menopause are highly motivated to engage in chronic disease prevention when provided with accessible education and a clear pathway to care. Integrating survivorship-focused preventive strategies into routine gynecologic oncology visits is feasible, well-received, and addresses a pressing unmet need. As cancer prevention improves, the next frontier must include structured care for long-term health after premature surgical menopause.
{"title":"Unmet needs after prevention: a model for managing premature surgical menopause post-risk-reducing bilateral salpingo-oophorectomy","authors":"Sara Perelmuter , Laura Keenahan , Alicia Mecklai , Panagiota Andreopoulou , Sangeeta Kashyap , Jamieson Greenwald , Lisa Mosconi , Michael Battista , Ravi N. Sharaf , Melissa K. Frey","doi":"10.1016/j.gore.2025.101963","DOIUrl":"10.1016/j.gore.2025.101963","url":null,"abstract":"<div><div>Risk-reducing bilateral salpingo-oophorectomy (rrBSO) is a standard of care for individuals with BRCA1/2 pathogenic variants and other hereditary ovarian cancer syndromes. While the oncologic benefits are clear, the abrupt estrogen deprivation of premature surgical menopause confers increased risks of cardiovascular disease, osteoporosis, and cognitive decline—yet long-term preventive care remains inconsistently provided. This commentary presents a multidisciplinary pilot model developed at a major academic center to bridge this gap.</div><div>Eligible patients seen in a gynecologic oncology clinic received an educational flyer summarizing chronic disease risks and evidence-based prevention strategies. Referral algorithms were created to streamline access to cardiology, endocrinology, and neurology.</div><div>From December 2023 to October 2024, 49 patients (median age 49 years, range 27–61) engaged with the program. All patients accepted the flyers, and at one-month follow-up (47 reached), 98% reported positive feedback, 94% found the material accessible, and 23% noted increased motivation for preventive care. The most frequent comment was that the flyers were easily understandable (70%). Eight patients were referred to preventive cardiology (6 scheduled), and six to endocrinology for low bone density (5 scheduled).</div><div>These preliminary findings suggest that patients with premature surgical menopause are highly motivated to engage in chronic disease prevention when provided with accessible education and a clear pathway to care. Integrating survivorship-focused preventive strategies into routine gynecologic oncology visits is feasible, well-received, and addresses a pressing unmet need. As cancer prevention improves, the next frontier must include structured care for long-term health after premature surgical menopause.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101963"},"PeriodicalIF":1.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334330","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 : 2025-10-01DOI: 10.1016/j.gore.2025.101965
Jennifer McEachron, Jamie N. Bakkum-Gamez
{"title":"Early introduction of trastuzumab deruxtecan (T-DXd) in HER2 expressing rare gynecologic malignancies – How early is too early?","authors":"Jennifer McEachron, Jamie N. Bakkum-Gamez","doi":"10.1016/j.gore.2025.101965","DOIUrl":"10.1016/j.gore.2025.101965","url":null,"abstract":"","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"61 ","pages":"Article 101965"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324245","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 : 2025-10-01DOI: 10.1016/j.gore.2025.101964
Stephany Amezcua , Matthew W. Lee , Laurel S. Aberle , Katelyn B. Furey , Xiaoyue Mona Guo
Objective
To evaluate TikTok videos with the hashtag #PapSmear and analyze their educational quality, themes, tone, creator, and engagement metrics.
Methods
A cross-sectional analysis of the top 150 TikTok videos with #PapSmear was conducted in September 2023. Videos were evaluated by four independent reviewers for engagement metrics, video topic, intent, tone, creator, and themes. The educational quality of videos was assessed using the brief DISCERN tool. Statistical analyses were performed to examine differences and relationships across groups.
Results
Among the 150 videos reviewed, 75.3 % focused on Pap smears, while 24.7 % discussed pelvic exams. Patients created 60.7 % of videos while healthcare providers contributed 39.3 %. Videos created by healthcare providers were more likely to be neutral or positive in tone and focus on educational content. Videos created by patients tended to have a negative tone, often focusing on personal experiences or comedy. Negative tones were significantly associated with higher engagement by “likes” and “shares” compared to neutral and positive tones. DISCERN scores were low across all videos. Healthcare provider videos did not score significantly higher than patient-generated content (p > 0.05). 10 % (n = 15) of videos addressed trauma related to a Pap smear or pelvic exam.
Conclusion
Our analysis of the top 150 TikTok videos with #papsmear shows low educational quality across all creators, highlighting the difficulty of providing accurate health information on social media. To improve the quality and impact of health communication on social media, healthcare professionals might consider integrating relatable storytelling and appropriate humor while still prioritizing medical accuracy and trauma-informed messaging.
{"title":"Themes, perspectives, and educational quality of content related to #PapSmears on TikTok","authors":"Stephany Amezcua , Matthew W. Lee , Laurel S. Aberle , Katelyn B. Furey , Xiaoyue Mona Guo","doi":"10.1016/j.gore.2025.101964","DOIUrl":"10.1016/j.gore.2025.101964","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate TikTok videos with the hashtag #PapSmear and analyze their educational quality, themes, tone, creator, and engagement metrics.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis of the top 150 TikTok videos with #PapSmear was conducted in September 2023. Videos were evaluated by four independent reviewers for engagement metrics, video topic, intent, tone, creator, and themes. The educational quality of videos was assessed using the brief DISCERN tool. Statistical analyses were performed to examine differences and relationships across groups.</div></div><div><h3>Results</h3><div>Among the 150 videos reviewed, 75.3 % focused on Pap smears, while 24.7 % discussed pelvic exams. Patients created 60.7 % of videos while healthcare providers contributed 39.3 %. Videos created by healthcare providers were more likely to be neutral or positive in tone and focus on educational content. Videos created by patients tended to have a negative tone, often focusing on personal experiences or comedy. Negative tones were significantly associated with higher engagement by “likes” and “shares” compared to neutral and positive tones. DISCERN scores were low across all videos. Healthcare provider videos did not score significantly higher than patient-generated content (p > 0.05). 10 % (n = 15) of videos addressed trauma related to a Pap smear or pelvic exam.</div></div><div><h3>Conclusion</h3><div>Our analysis of the top 150 TikTok videos with #papsmear shows low educational quality across all creators, highlighting the difficulty of providing accurate health information on social media. To improve the quality and impact of health communication on social media, healthcare professionals might consider integrating relatable storytelling and appropriate humor while still prioritizing medical accuracy and trauma-informed messaging.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"61 ","pages":"Article 101964"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145216526","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 : 2025-10-01DOI: 10.1016/j.gore.2025.101966
Ovya Ganesan , Stephanie M. Mueller , Diana Miao , M Aiven Dyer , Natalie Cain , Colleen M. Feltmate , Dennis P. Orgill
Objective
Radiation therapy is essential for treating vaginal and vulvar cancers but can cause chronic pain, sexual dysfunction, infections, and delayed wound healing. These complications profoundly impact survivors’ quality of life and may impede cancer-directed treatment in recurrent disease. We describe a multidisciplinary approach involving Plastic and Reconstructive Surgery, Gynecologic Oncology, and Radiation Oncology for managing complex radiation-induced wounds.
Methods
We retrospectively reviewed two patients with severe vaginal/vulvar radiation wounds treated at a tertiary wound care center.
Results
Case 1: A 71-year-old woman with vulvar squamous cell carcinoma (VSCC) underwent vulvectomy and adjuvant chemoradiation, developing acute radiation dermatitis. Recurrent VSCC required further surgery, and reconstruction was complicated by wound necrosis, which was treated with debridement, quarter-strength sodium hypochlorite and advanced dressings. Following a third vulvectomy for further recurrence, she again demonstrated impaired wound healing. Despite ongoing management, cancer persists.
Case 2: A 73-year-old woman with locally advanced endometrial adenocarcinoma received chemotherapy, external radiation, brachytherapy, hysterectomy with bilateral salpingo-oophorectomy, and stereotactic radiation for bone metastasis. Two years post-radiation, she developed vaginal necrosis, which was managed with hypochlorous acid solution, sharp debridement, and hyperbaric oxygen therapy. She recently enrolled in a clinical trial for persistent cancer.
In both cases, wound complications delayed optimal cancer-directed therapy.
Conclusion
These cases highlight the importance of a multidisciplinary strategy to manage severe radiation-induced vaginal/vulvar wounds. Focused on pain control, odor reduction, and optimizing the wound environment, care is often palliative given disease complexity, underscoring the challenges in balancing wound healing with ongoing cancer treatment.
{"title":"Insights from plastic and reconstructive surgery wound specialists in managing complex vaginal and vulvar toxicities following radiation therapy","authors":"Ovya Ganesan , Stephanie M. Mueller , Diana Miao , M Aiven Dyer , Natalie Cain , Colleen M. Feltmate , Dennis P. Orgill","doi":"10.1016/j.gore.2025.101966","DOIUrl":"10.1016/j.gore.2025.101966","url":null,"abstract":"<div><h3>Objective</h3><div>Radiation therapy is essential for treating vaginal and vulvar cancers but can cause chronic pain, sexual dysfunction, infections, and delayed wound healing. These complications profoundly impact survivors’ quality of life and may impede cancer-directed treatment in recurrent disease. We describe a multidisciplinary approach involving Plastic and Reconstructive Surgery, Gynecologic Oncology, and Radiation Oncology for managing complex radiation-induced wounds.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed two patients with severe vaginal/vulvar radiation wounds treated at a tertiary wound care center.</div></div><div><h3>Results</h3><div>Case 1: A 71-year-old woman with vulvar squamous cell carcinoma (VSCC) underwent vulvectomy and adjuvant chemoradiation, developing acute radiation dermatitis. Recurrent VSCC required further surgery, and reconstruction was complicated by wound necrosis, which was treated with debridement, quarter-strength sodium hypochlorite and advanced dressings. Following a third vulvectomy for further recurrence, she again demonstrated impaired wound healing. Despite ongoing management, cancer persists.</div><div>Case 2: A 73-year-old woman with locally advanced endometrial adenocarcinoma received chemotherapy, external radiation, brachytherapy, hysterectomy with bilateral salpingo-oophorectomy, and stereotactic radiation for bone metastasis. Two years post-radiation, she developed vaginal necrosis, which was managed with hypochlorous acid solution, sharp debridement, and hyperbaric oxygen therapy. She recently enrolled in a clinical trial for persistent cancer.</div><div>In both cases, wound complications delayed optimal cancer-directed therapy.</div></div><div><h3>Conclusion</h3><div>These cases highlight the importance of a multidisciplinary strategy to manage severe radiation-induced vaginal/vulvar wounds. Focused on pain control, odor reduction, and optimizing the wound environment, care is often palliative given disease complexity, underscoring the challenges in balancing wound healing with ongoing cancer treatment.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"61 ","pages":"Article 101966"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145216524","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 : 2025-10-01DOI: 10.1016/j.gore.2025.101957
Lilla Markel , Lidys Rivera , A. Ordobazari , Ardeshir Hakam , Wilfredo Lorenzo , Mitchel S. Hoffman , Robert M. Wenham , Monica Avila
Background
Mammary-like gland adenocarcinoma of the vulva is a rare and aggressive form of vulvar cancer with histopathologic resemblance to breast cancer. This rare type of vulvar cancer develops from primary metaplasia of mammary-like anogenital glands, more recently discovered anatomic components of the anogenital region.
Case presentation
We present a 77-year-old African-American female with a six-month history of painless, left lower vulvar lesion referred to our cancer center following confirmatory biopsy of invasive mammary type adenocarcinoma. Preoperative PET CT demonstrating focal avidity (SUV 7.8) in the vulvar region with no evidence of metastatic disease. She underwent exam under anesthesia, left radical vulvar excision with primary closure, left inguinal sentinel lymph node mapping and biopsy for a TNM stage of T2N0M0 and vulvar FIGO stage IB grade 2. Somatic testing was significant for a BRCA1 mutation (variant p.S770, c.2309C>G).
Conclusion
Mammary-like gland adenocarcinoma of the vulva is a rare but aggressive neoplasm that presents diagnostic challenges due to its resemblance to breast carcinoma. Radical resection and sentinel lymph node assessment is feasible. Melanocytic skin types pose a unique set of differences regarding detection, diagnosis and potential genomic variations such as BRCA1 mutation in our patient. Genetic and genomic assessments should be considered to further guide optimal therapeutic options.
{"title":"Radical resection and sentinel lymph node evaluation of mammary-like adenocarcinoma of the vulva (MLAV) with somatic BRCA1 mutation","authors":"Lilla Markel , Lidys Rivera , A. Ordobazari , Ardeshir Hakam , Wilfredo Lorenzo , Mitchel S. Hoffman , Robert M. Wenham , Monica Avila","doi":"10.1016/j.gore.2025.101957","DOIUrl":"10.1016/j.gore.2025.101957","url":null,"abstract":"<div><h3>Background</h3><div>Mammary-like gland adenocarcinoma of the vulva is a rare and aggressive form of vulvar cancer with histopathologic resemblance to breast cancer. This rare type of vulvar cancer develops from primary metaplasia of mammary-like anogenital glands, more recently discovered anatomic components of the anogenital region.</div></div><div><h3>Case presentation</h3><div>We present a 77-year-old African-American female with a six-month history of painless, left lower vulvar lesion referred to our cancer center following confirmatory biopsy of invasive mammary type adenocarcinoma. Preoperative PET CT demonstrating focal avidity (SUV 7.8) in the vulvar region with no evidence of metastatic disease. She underwent exam under anesthesia, left radical vulvar excision with primary closure, left inguinal sentinel lymph node mapping and biopsy for a TNM stage of T2N0M0 and vulvar FIGO stage IB grade 2. Somatic testing was significant for a BRCA1 mutation (variant p.S770, c.2309C>G).</div></div><div><h3>Conclusion</h3><div>Mammary-like gland adenocarcinoma of the vulva is a rare but aggressive neoplasm that presents diagnostic challenges due to its resemblance to breast carcinoma. Radical resection and sentinel lymph node assessment is feasible. Melanocytic skin types pose a unique set of differences regarding detection, diagnosis and potential genomic variations such as BRCA1 mutation in our patient. Genetic and genomic assessments should be considered to further guide optimal therapeutic options.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"61 ","pages":"Article 101957"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145216521","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 : 2025-10-01DOI: 10.1016/j.gore.2025.101967
Thomas Westerhoff , Nathalie Baudoux , Manuela Undurraga , Patrick Petignat , Intidhar Labidi-Galy , Melpomeni Kountouri
Objectives
The prognosis for metastatic cervical cancer has dramatically improved in the past years with the addition of anti-PD1/PD-L1 immunotherapy to standard platinum-based chemotherapy +/-bevacizumab. Here, we aimed to investigate the benefit from combining chemo-immuno-radiotherapy for metastatic cervical cancer patients who had oligo-metastasis progression under maintenance immunotherapy, while the other metastatic sites are in remission.
Methods
We report a case series of two patients diagnosed with multisite metastatic cervical cancer (including peritoneal carcinomatosis) who, after an initial response to pembrolizumab, presented with pelvic progression while maintaining complete regression of extra-pelvic metastases. Both patients underwent radical pelvic external beam radiotherapy (EBRT) and concomitant chemotherapy with weekly cisplatin +/- brachytherapy, while pursuing immunotherapy with pembrolizumab.
Results
The two patients achieved durable complete response after completing this treatment scheme and tolerated it well. Patient 1 is in complete response 30 months after the end of chemo-radiotherapy. Patient 2 is in complete response 24 months after the end of chemo-radiotherapy.
Conclusions
This case series suggests that chemo-immuno-radiotherapy with EBRT may represent a salvage treatment for patients who develop secondary loco-regional resistance to immunotherapy, as long as there is remission of the metastatic sites. Given the low response rate to chemotherapy in metastatic cervical cancer patients resistant to pembrolizumab, chemo-radiotherapy while pursuing immunotherapy should be investigated in highly selected patients with oligo-metastasis progression.
{"title":"Durable complete response with chemo-immuno-radiotherapy for metastatic cervical cancer progressing under immunotherapy: a case series","authors":"Thomas Westerhoff , Nathalie Baudoux , Manuela Undurraga , Patrick Petignat , Intidhar Labidi-Galy , Melpomeni Kountouri","doi":"10.1016/j.gore.2025.101967","DOIUrl":"10.1016/j.gore.2025.101967","url":null,"abstract":"<div><h3>Objectives</h3><div>The prognosis for metastatic cervical cancer has dramatically improved in the past years with the addition of anti-PD1/PD-L1 immunotherapy to standard platinum-based chemotherapy +/-bevacizumab. Here, we aimed to investigate the benefit from combining chemo-immuno-radiotherapy for metastatic cervical cancer patients who had oligo-metastasis progression under maintenance immunotherapy, while the other metastatic sites are in remission.</div></div><div><h3>Methods</h3><div>We report a case series of two patients diagnosed with multisite metastatic cervical cancer (including peritoneal carcinomatosis) who, after an initial response to pembrolizumab, presented with pelvic progression while maintaining complete regression of extra-pelvic metastases. Both patients underwent radical pelvic external beam radiotherapy (EBRT) and concomitant chemotherapy with weekly cisplatin +/- brachytherapy, while pursuing immunotherapy with pembrolizumab.</div></div><div><h3>Results</h3><div>The two patients achieved durable complete response after completing this treatment scheme and tolerated it well. Patient 1 is in complete response 30 months after the end of chemo-radiotherapy. Patient 2 is in complete response 24 months after the end of chemo-radiotherapy.</div></div><div><h3>Conclusions</h3><div>This case series suggests that chemo-immuno-radiotherapy with EBRT may represent a salvage treatment for patients who develop secondary loco-regional resistance to immunotherapy, as long as there is remission of the metastatic sites. Given the low response rate to chemotherapy in metastatic cervical cancer patients resistant to pembrolizumab, chemo-radiotherapy while pursuing immunotherapy should be investigated in highly selected patients with oligo-metastasis progression.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"61 ","pages":"Article 101967"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266215","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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