Background: Endometrial cancer (EC) staging is essential for effective treatment. Recent developments in molecular profiling have improved the management of EC through the identification of molecular subtypes that influence prognosis and the requirement for adjuvant therapies. This study aimed to evaluate clinical and diagnostic data together with immunohistochemical biomarker study related to molecular classification in patients with EC and to explore factors independently associated with the administration of adjuvant therapy. Methods: This retrospective study included 100 patients diagnosed with EC who underwent surgical intervention between October 2020 and October 2022. Data were obtained from clinical records and pathology reports. Patients were categorized based on whether they received adjuvant therapy. Multivariable logistic regression was used to identify independent factors associated with adjuvant therapy use. Results: Patients who received adjuvant therapy were older, had larger tumors, higher abnormal p53 staining (consistent with Tumor Protein 53 (TP53) mutation), and greater lymph node involvement. Independent predictors of adjuvant therapy included Stage IB (odds ratio (OR): 68.571, 95%confidence interval (CI): 10.540–446.114, p < 0.001), Stage II–IV (OR: 153.412, 95%CI: 15.048–1564.055, p < 0.001), and abnormal p53 stainings (OR: 8.572, 95% CI: 1.304–56.341, p = 0.025). Endometrioid carcinoma was negatively associated with adjuvant therapy (OR: 0.104, 95% CI: 0.012–0.911, p = 0.041). Conclusions: The results of this study indicate that abnormal p53 stainings, clinical staging, and the presence of endometrioid tumors are significant determinants for the administration of adjuvant therapy. Integration of clinical staging and exact diagnoses in addition to molecular profiling may improve treatment decisions.
Background: This study systematically reviewed nursing interventions for women with gynaecological cancers to provide empirical evidence for developing evidence-based, patient-centered nursing care. Methods: A comprehensive literature search was conducted across both domestic and international databases, including PubMed, Embase, CINAHL Database, Cochrane, ProQuest, DBpia, the Korean Studies Information Service System (KISS), and the Research Information Sharing Service (RISS). The search covered studies published from January 2015 to February 2024 and utilized MeSH (Medical Subject Headings) terms, such as “gynaecological cancer” and “nursing intervention”. Seven randomized controlled trials and clinical trials with control groups were selected. The types, components, outcome measures, and study designs of the nursing interventions were analyzed using the Population, Intervention, Comparison, and Outcome (PICO) framework. Results: Identified nursing interventions included exercise therapy, cognitive behavioral therapy, mindfulness, telemedicine, sexual health programs, and reflexology. Common outcome measures were anxiety, depression, fatigue, pain, sexual dysfunction, self-efficacy, and quality of life. Nurse-led interventions, particularly those focusing on sexual rehabilitation and psychosocial support, demonstrated significant improvements in patient outcomes. Conclusions: Nursing interventions have proven effective in improving symptom management, psychological well-being, sexual health, and quality of life in women with gynaecological cancer. Future research should focus on standardizing intervention protocols, conducting multicenter clinical trials, and integrating qualitative research to enhance the evidence base. The PROSPERO Registration: CRD420251148600.
Background: Cervical cancer remains a major cause of morbidity and mortality world-wide, particularly in low- and middle-income countries. Intracavitary brachytherapy is integral to definitive treatment but exposes adjacent organs at risk (OARs) to potentially harmful radiation doses. The influence of bladder volume on dosimetry remains controversial. Methods: This retrospective study included 90 patients with Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB3–IVA cervical carcinoma, treated at Ahsania Mission Cancer and General Hospital, Dhaka (2019–2020). Patients were stratified into three groups based on bladder volume: Group A (0–40 cc), Group B (41–80 cc), and Group C (81–120 cc). All received standard chemoradiation followed by High-Dose-Rate (HDR) intracavitary brachytherapy. Dosimetric parameters (D2cc Equivalent Dose in 2 Gy fractions (EQD2) for bladder, rectum, and sigmoid) and High-Risk Clinical Target Volume (HR-CTV) D90 coverage were analyzed. Early response at 6–8 weeks was also assessed. Results: Mean bladder D2cc was 85.6 Gy (Group A), 73.2 Gy (Group B), and 78.9 Gy (Group C), with Group B significantly lower (p = 0.002). Rectal D2cc followed a similar trend (70.2 Gy, 64.5 Gy, and 72.4 Gy; p = 0.01). Sigmoid D2cc showed no significant variation (p = 0.41). HR-CTV D90 remained comparable across groups (82.8–84.2 Gy; p = 0.48). Complete response was achieved in 73.3% of patients, with no significant difference between groups (p = 0.57). Conclusions: A moderately filled bladder (∼60 cc) provides the most favorable dosimetric profile, significantly reducing bladder and rectal doses while maintaining adequate tumor coverage. Standardizing bladder filling protocols may enhance treatment safety and consistency in HDR brachytherapy for cervical cancer.
Background: The study aimed to evaluate the clinical characteristics, management strategies, and surgical outcomes of vesicovaginal fistulae following gynecologic oncology procedures, and to provide evidence-based recommendations for optimal patient care based on contemporary literature. Methods: Medical records of 10 patients diagnosed with post-surgical vesicovaginal fistulae following gynecologic oncology procedures were retrospectively analyzed. Clinical findings, contributing factors, diagnostic methods, treatment approaches, and postoperative outcomes were evaluated. Conservative management with continuous Foley catheterization was initially attempted, followed by surgical repair using abdominal, vaginal, or laparoscopic techniques when conservative treatment failed. Outcomes were assessed using standardized criteria, including anatomical success, functional outcomes, and complication rates. Results: The study cohort included 10 patients with a mean age of 51.2 years (range 42–66 years). Primary surgical procedures included radical hysterectomy for cervical cancer (n = 6), primary cytoreductive surgery for advanced ovarian cancer (n = 3), and total laparoscopic hysterectomy for benign conditions (n = 1). Initial conservative management with continuous Foley catheterization for 6–8 weeks achieved success in only 2 patients. The remaining 8 patients required surgical intervention, with successful repair achieved in all cases using various approaches: abdominal repair (n = 5), vaginal repair using the Latzko procedure (n = 2), and laparoscopic repair (n = 1). The overall surgical success rate was high with minimal complications. The mean time from primary surgery to fistula diagnosis was 16.8 days. The postoperative hospital stay averaged 6.8 days, with a catheterization duration of 14 days. Conclusions: This study demonstrates that vesicovaginal fistulae following gynecologic oncology procedures can be successfully managed with excellent outcomes by experienced specialists. Conservative management shows limited success, while surgical repair achieves high success with minimal morbidity. Standardized classification and individualized surgical approach selection are essential. These findings support centralization of complex cases to specialized centers and emphasize evidence-based management for optimal outcomes.
Background: This study aimed to evaluate the significance of the systemic immune-inflammation index (SII) and age in patients with vulvar squamous cell carcinoma (VSCC). Methods: We conducted a retrospective analysis of 79 VSCC patients treated at a tertiary cancer center between 1998–2021. SII was calculated as (neutrophil × platelet)/lymphocyte count. Optimal cutoff values were determined by receiver operating characteristic (ROC) curve analysis. Survival outcomes were analyzed using Kaplan-Meier and Cox regression methods. Results: Patients with high SII (≥497.975) had significantly higher rates of lymph node metastasis (p = 0.036, independent t-test with Welch’s correction). Age >65 years was associated with worse 5-year overall survival (OS) (70.7% vs. 83.5%, p = 0.003) and increased nodal involvement (p = 0.02). Multivariate analysis identified age >70 years (hazard ratio (HR) = 2.41, 95% confidence interval (CI): 1.32–4.39) and advanced International Federation of Gynecology and Obstetrics (FIGO) stage (HR = 3.02, 95% CI: 1.85–4.93) as independent prognostic factors. Conclusions: SII shows promise as a predictor of nodal metastasis in VSCC, while advanced age significantly impacts survival outcomes. These findings may help guide risk stratification and treatment decisions for this rare malignancy.
Gestational trophoblastic disease (GTD) encompasses a group of rare disorders ranging from pre-malignant to malignant conditions. Today, the management of GTD in Europe has evolved into a centralized approach which is crucial for the best outcomes. To investigate the centralized approach, we conducted a literature search on the PubMed/MEDLINE database and others such as SCOPUS, Google Scholar, Cochrane Library, January 2025. Additionally, we searched the official websites of European countries and the EU for information about European Reference Networks (ERNs) and national centers for GTD. We identified three phases in the centralization process of GTD management in Europe. The initial phase involved local hospitals and the development of the concept of centralized and specialized treatment for GTD. In the second phase, national centers for GTD were established. Finally, the creation of ERNs brought these national centers together. ERNs use advanced and multi-level tools of health communication. As conclusion, the current approach to managing GTD in Europe emphasizes the centralization of treatment and follow-up, with national centers and ERNs serving as the core components of this strategy. This approach may be an example of the best management of GTD for the world.
Background: Pelvic exenteration provides a valuable curative treatment option for recurrent or persistent gynaecological malignancies. This case series describes the surgical outcomes and complications of pelvic exenteration surgery in patients with recurrent or persistent gynaecological cancer over a 10-year period at a tertiary university teaching hospital. Methods: Data were collected from the electronic medical record system (Epic Systems) at Cambridge University Hospital between October 2014 and 15 September 2023. The study was conducted as part of a service evaluation. Data were collected and analyzed for patient characteristics, pre-exenteration primary treatment profiles, perioperative complications, survival profiles and follow-up duration. Results: Out of 136 pelvic exenterations performed during the study period, 16 were undertaken for gynaecological cancer. The median age at the time of exenteration was 59.5 years (interquartile range (IQR), 55–66 years). Cervical cancer was the most common primary tumor (5/16, 31.3%). Three patients had vulvar cancer (18.8%), two had vaginal cancer (12.5%), and three had uterine cancer (18.8%). We observed severe (III/IV) complications in 3 out of 16 patients within 30 days of postoperative period. There were no postoperative deaths within 30 days. The median follow-up period was 37.1 months (95% confidence interval (CI): 26.4–47.7). No mortality occurred within 90 days, and the 5-year survival rate was 43.8% (7/16). Conclusions: With a carefully selected patient group, pelvic exenteration represents a safe and curative approach for recurrent or persistent gynaecological cancers.
Background: Real-world data regarding the use of poly (ADP (adenosine phosphate)-ribose) polymerase inhibitors (PARPi) or bevacizumab as maintenance treatment in patients with ovarian cancer (OVCA) is critical in everyday therapeutic decision-making. Our aim was to assess clinical outcomes and adverse events of different maintenance regimens after first-and second-line in patients with OVCA. Methods: This was a retrospective-prospective multi-center observational study including patients recorded in the Hellenic Cooperative Oncology Group (HeCOG) electronic database. Patients were diagnosed with advanced stage, high grade ovarian, primary peritoneal and fallopian tube cancer. Patient demographics, tumor clinicopathologic, germline and tumor molecular data, clinical outcome and toxicity data were recorded. The primary endpoint was progression-free survival (PFS1) from the initiation from first-line treatment. Results: From 11 January 2019 to 09 March 2023, 185 patients with advanced OVCA were identified; median age 56.4. Overall, 120 (64.9%) patients received maintenance treatment after first-line (55.0% received bevacizumab and 37.5% PARPi, predominantly olaparib), while 96 (51.9%) after second-line treatment (mostly olaparib, 78.1%). Notably, 87 (47%) patients received maintenance therapy following both lines of treatment. Germline alterations were identified in 53.7% of patients. Maintenance therapy with either PARPi or bevacizumab significantly improved PFS in both first-line (p < 0.001) and second-line (p <0.001) treatment compared to no maintenance. No difference in overall survival was observed between patients receiving maintenance treatment vs. those who did not (p = 0.590). Most common adverse events with olaparib were anaemia (41%), leukopenia (22.2%), fatigue (17.1%) and thrombocytopenia (13.7%). No differences were found in the rate of adverse events between patients >65 years of age and younger patients. Conclusions: Real-world evidence supports the efficacy of PARPi in improving PFS in advanced OVCA, aligning with clinical trial findings. Early molecular and genetic testing is critical for optimal treatment selection. Further studies evaluating the optimal sequencing and long-term outcomes of maintenance therapies are warranted.
Background: To observe dynamic changes of rectal injury in patients with locally advanced cervical cancer during curative pelvic radiotherapy using magnetic resonance imaging (MRI), and to explore non-invasive radiological methods for assessing radiation-induced rectal injury (RRI). Methods: A retrospective analysis was conducted on pelvic MRI images from 56 patients with locally advanced cervical cancer who underwent radical radiotherapy. MRI scans were conducted at four key stages: before radiotherapy, two weeks after starting external irradiation, upon completing external irradiation, and at the conclusion of brachytherapy. Thickness of the intestinal wall from the anorectal region to the sigmoid take-off at each scanning level was measured by RadiAnt DICOM Viewer software, and the average rectal wall thickness was calculated. Statistical analysis was performed using SPSS 26. Results: Out of the 56 patients undergoing pelvic radiation therapy, 30 (53.6%) reported symptoms of rectal injury, including diarrhea, increased frequency of stools, loose stools, abdominal pain, tenesmus, and difficulty in defecation, typically appearing during the 3rd to 5th week of treatment. Medication-preserved enemas were administered in the 5th week of radiotherapy and at the beginning of brachytherapy. In symptomatic patients, rectal wall thickness at two weeks of radiotherapy (7.76 f 0.96 mm) was significantly greater than that before radiotherapy (6.98 f 0.77 mm) (p < 0.01). Thickness continued to increase during external irradiation, reaching its peak at the end of external irradiation (7.99 f 0.83 mm), followed by a decrease at the end of brachytherapy (7.31 f 0.81 mm), which was significantly reduced compared with end-of-external-irradiation values (p < 0.01). Conclusions: Patients with locally advanced cervical cancer undergoing pelvic radiotherapy exhibit significant early and time-dependent rectal imaging changes prior to the onset of evident clinical symptoms of RRI. MRI may serve as a sensitive diagnostic tool for the early detection and prediction of radiation-induced rectal injury.
Background: The study aimed to explore the predictive value of transvaginal color Doppler ultrasound parameters combined with the systemic immune-inflammation index (SII) in assessing the risk of lymph node metastasis in cervical cancer. Methods: A total of 172 patients diagnosed with cervical cancer from January 2016 to January 2024 were enrolled, and divided into a lymph node metastasis group (56 cases) and a non-lymph node metastasis group (116 cases) based on biopsy results as the gold standard. Clinical data, transvaginal color Doppler ultrasound parameters, and SII were compared between the two groups. Variables showing significantly different values were selected to construct a logistic model, and the diagnostic performance was analyzed using the receiver operating characteristic (ROC) curve. Results: Logistic regression analysis identified Lymph Node Short-axis Diameter (SAD), tumor length-to-shortaxis diameter ratio (LS) <2, peak systolic velocity (PSV), and SII as the independent risk factors for lymph node metastasis in cervical cancer patients. The transvaginal ultrasound pulsatility index (PI) and resistance index (RI) were protective factors. The predictive model incorporating SAD, LS, PSV, PI, RI, and SII achieved an area under the ROC curve (AUC) of 0.946, with a Youden index of 0.762, and sensitivity and specificity of 85.70% and 95.00%, respectively. Conclusions: The risk prediction model integrating transvaginal color Doppler ultrasound parameters and SII demonstrates high predictive value for cervical cancer lymph node metastasis, suggesting a valuable clinical application potential.
Background: This study aimed to assess the diagnostic value of a deep learning (DL)-based multimodal approach that combines ultrasound (US) and magnetic resonance imaging (MRI) features in differentiating benign and malignant ovarian tumors, and to develop an intelligent auxiliary diagnostic tool. Methods: A total of 887 patients (665 benign, 222 malignant) with pathologically confirmed ovarian tumors from 2022 to 2024 were retrospectively enrolled. All patients underwent preoperative US and MRI within one week. A dual-channel DL model was constructed: the US branch (ResNet50) extracted 2D features from grayscale color Doppler flow imaging, while the MRI branch (3D ResNeXt101) extracted 3D features from T2-weighted imaging (T2WI), dynamic contrast-enhanced (DCE)-MRI, and apparent diffusion coefficient (ADC) maps. The extracted features were integrated using an attention-based fusion mechanism. With pathology as the gold standard, the diagnostic performance of the proposed model was compared with US alone, MRI alone, and the Assessment of Different NEoplasias in the adneXa (ADNEX) model. Results: In the test cohort (n = 266), the DL model showed a sensitivity of 92.73%, specificity of 98.58%, accuracy of 97.37%, and an area under the curve (AUC) of 0.957, which were significantly higher than those of US (AUC = 0.792, z = 3.92, p < 0.001), MRI (AUC = 0.844, z = 2.76, p = 0.006), and ADNEX (AUC = 0.885, z = 2.07, p = 0.022). Conclusions: The DL-based US-MRI multimodal fusion model significantly enhances the diagnostic accuracy for differentiating benign and malignant ovarian tumors, providing a promising intelligent auxiliary tool for early and precise diagnosis.
Background: This study evaluated the efficacy of concurrent chemoradiotherapy (CCRT) combined with pelvic high-frequency focused hyperthermia (HFH) in stage IIB-IVA cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) classification) and assessed the incidence of acute radiation proctitis (ARP). Methods: Patients with locally advanced cervical cancer (LACC) were assigned to control (standard CCRT: volumetric modulated arc therapy, brachytherapy, and weekly cisplatin) or experimental groups (CCRT plus pelvic HFH). Primary endpoints included ARP incidence, clinical response, progression-free survival (PFS), and overall survival (OS). Results: Among the 70 enrolled patients (36 experimental, 34 control), the experimental group showed significantly lower symptomatic ARP incidence (19.44% vs. 44.12%; p = 0.026) and reduced severity. The objective response rate was higher (86.11% vs. 70.59%) but not statistically significant (p = 0.114). The experimental group had superior 2-year PFS (44.44% vs. 26.47%; p = 0.003) and 3-year OS (61.11% vs. 47.06%; p = 0.006), with prolonged median PFS (18 vs. 11 months) and OS (29 vs. 18 months). Cox regression indicated a significantly reduced risk of progression (Hazard Ratio (HR) = 0.3574, p = 0.002) and death (HR = 0.4627, p = 0.034) in the experimental group. Conclusions: Adding pelvic HFH to CCRT reduced ARP incidence and improved survival outcomes in LACC, suggesting its potential as a beneficial adjunct therapy.
Background: Ovarian cancer represents a leading cause of global morbidity and mortality among gynecological malignancies. Kirsten rat sarcoma (KRAS) gene mutations, particularly in Exon 2, play a significant role in the development of mucinous ovarian carcinoma (MOC); however, studies investigating this mutation in specific populations remain limited. This exploratory study aimed to investigate the prevalence of KRAS Exon 2 mutations and their clinicopathological correlates in MOC patients from Azerbaijan. Methods: This cross-sectional exploratory study involved 25 patients with mucinous ovarian carcinoma who had available paraffin blocks and met the inclusion criteria. KRAS mutations were detected using polymerase chain reaction (PCR) and sequencing techniques. Comprehensive clinicopathological data, including bilaterality, age, cancer stage, histological grading, growth pattern, and tumor markers, were systematically analyzed using the Chi-square test and Fisher's exact test for categorical variables, and t-tests or nonparametric equivalents for continuous variables. Results: A total of 25 participants met the inclusion criteria. KRAS Exon 2 mutations were detected in 12% of patients. Power analysis revealed that the current sample size could detect large effect sizes (Cohen's w >= 0.55) with 80% power. No significant associations were found between bilaterality (p = 0.565), age (p = 0.089), cancer stage (p = 0.518), and KRAS mutations. However, a statistically significant association was observed between histological grading and KRAS mutations (p = 0.038), specifically with Grade 3 tumors showing a higher mutation frequency. Mutations were more frequent in patients with an expansile growth pattern (67% vs. 33%) and elevated tumor markers, though these associations did not reach statistical significance. Conclusions: This exploratory study demonstrates that KRAS Exon 2 mutations are significantly associated with a higher histological grade in MOC, suggesting their potential role as prognostic biomarkers and therapeutic targets. The 12% mutation rate is lower than global averages, indicating possible population-specific genetic variations. Larger multicenter studies are needed to validate these findings.
Background: The desire to ensure prolonged survival for patients with advanced gynaecological cancer is a key concern for every doctor. This study presents an analysis of outcomes from an Estonian regional cancer center, evaluating prognostic factors associated with locally advanced gynecological cancer and the potential for long-term survival following pelvic exenteration. Methods: The study included patients with resistant or recurrent gynecological cancer. The analysis present data on all 34 cases in which pelvic exenteration was performed at the Tartu University Hospital. The majority of patients (88.2%) had tumour recurrence. Thirteen patients (38%) had previously undergone surgery for gynaecological cancer. Results: Of the 34 patients, 21(62%) underwent total pelvic exenteration and 13 (38%) exenterations with vulvectomy. The median age of the study cohort was 59 years (range, 34-80). The median duration of surgery was 4.4 hours (range, 121-530 minutes). The median blood loss was 707 mL (range 100-2500 mL). The median tumor diameter was 7 cm (range 2-25 cm). The mean follow-up was 52 months. The overall postoperative complication rate was 41%. One patient died postoperatively (2.9%). Median survival for ovarian cancer was 48.3 months, cervical cancer 31.6 months, vaginal or urethral cancer 29.2 months and for endometrial cancer 7.7 months. Overall survival rates were 62% at 1 year, 44% at 3 years, 28% at 5 years, and 15% at 15 years. Multivariable analysis showed that distant metastasis (p = 0.0002), endometrial cancer (p = 0.0096), resection line (p = 0.017) were the most important factors affecting long-term survival. Conclusions: In the present study, we found that patients with relapsed or persistent locally advanced cervical, vaginal, or ovarian cancer who underwent pelvic exenteration demonstrated substantially better survival outcomes than patients with endometrial cancer, particularly those with aggressive histologic subtypes and multiple unfavorable prognostic markers.
Background: Uterine smooth muscle tumors of uncertain malignant potential (STUMPs) represent a heterogeneous group of tumors with varying histological and biological characteristics. Tumors featuring a dominant myxoid stroma are uncommon in the uterus. This case emphasizes the importance of recognizing the myxoid pattern in smooth muscle tumors, especially within the STUMP category. Case: In this study, we present a 39-year-old woman with a large transmural intrauterine nodule. The findings indicated smooth muscle tumor tissue with a fascicular pattern, without significant ischemic necrosis or cytological pleomorphism. The mitotic count was 1/10 High Power Field (HPF). The tumor exhibited more than 50% myxoid histomorphology, indicative of a rare and specific type of smooth muscle differentiation. Immunohistochemical analysis showed positive reactions for smooth muscle differentiation, retained progesterone receptor expression, and no aberrant tumor protein p53 (p53) or cyclin-dependent kinase inhibitor 2A (p16) expressions. The marker of proliferation Ki-67 was low. Considering all the characteristics, this myxoid smooth muscle tumor was diagnosed as a STUMP myxoid neoplasm. The patient underwent a hysterectomy with bilateral salpingectomy and bilateral ovarian conservation. The patient is currently under follow-up and has not experienced any complications. Conclusions: This case illustrates an extremely rare instance of STUMP, which continues to pose challenges in both diagnosis and treatment. Myxoid patterns are exceptionally uncommon and often hard to detect, making them surprising in smooth muscle tumors. Recognizing this distinct differentiation is crucial, as accurate diagnostic criteria must be applied during the histopathological evaluation of these tumors. The presence of a myxoid pattern suggests a worse prognosis, highlighting the need for more vigilant follow-up in these patients.
Background: Endometrial cancer (EC) incidence is increasing. This study determined prognostic factors for disease-free survival (DFS) and overall survival (OS) in EC patients from a single tertiary center over 22 years. Methods: 1028 patients who underwent surgery for EC between 2000-2022 were evaluated retrospectively using International Federation of Gynecology and Obstetrics (FIGO) 2009 staging. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. Results: 899 (87.7%) patients had endometrioid histology. Grade distribution: 475 (46.2%) grade 1, 371 (36.1%) grade 2, 170 (16.75%) grade 3. FIGO staging: 833 (81.0%) stage I, 71(7%) stage II, 87 (9%) stage III, 31 (3.0%) stage IV. 368 (35.8%) patients had >= 50% myometrial invasion, 130 (12.7%) cervical involvement, 384 (37.4%) lymphovascular space invasion (LVSI), 80 (7.8%) lymph node metastases. Risk classification: 520 (50.6%) low risk, 195 (19.0%) intermediate risk, 121 (11.8%) high-intermediate risk, 190 (18.6%) high risk. Lower OS and DFS rates were significantly associated with non-endometrioid histology, advanced stage, high grade, high risk classification, >= 50% myometrial invasion, cervical involvement, lymph node metastases, and LVSI (all p <0.001). In multivariate analysis, independent DFS prognostic factors were FIGO stage (hazard ratios (HR): 4.37 for stage II, HR: 8.68 for stage III, both p < 0.001) and tumor grade (HR: 2.26 for grade 2, p = 0.039; HR: 4.52 for grade 3, p < 0.001). Independent OS prognostic factors were risk classification (HR: 2.12 for intermediate-high risk, p = 0.031; HR: 2.75 for high risk, p = 0.003) and tumor grade (HR: 1.86 for grade 2, p = 0.024; HR: 2.71 for grade 3, p = 0.002). Median follow-up was 84 months. Conclusions: FIGO staging, tumor involvement, LVSI, and lymph node metastases significantly affected survival outcomes. These findings support comprehensive surgical staging and histopathological assessment for prognostic stratification.
Background: Ovarian sarcomas are uncommon. They often present with non-specific symptoms in advanced stages and carry a poor prognosis. Due to their rarity and heterogeneity, little is known regarding their behaviour and there are no definitive management guidelines. DICER] mutations are an emerging finding in gynaecological sarcomas but have been rarely reported in ovarian adenosarcomas. Case: A 35-yearold woman presented with acute abdominal pain, fevers and abdominal distension. Following initial pursuit of an infectious cause she proceeded to diagnostic surgery and right salpingo-oophorectomy. Histopathology demonstrated a poorly differentiated high grade spindle cell sarcoma of the ovary with heterologous rhabdoid and chondroid differentiation, most in keeping with an adenosarcoma. Molecular testing identified DICER] mutations. Following peritoneal recurrence she received palliative-intent chemotherapy with doxorubicin followed by maintenance cyclophosphamide. This was associated with a complete metabolic and radiologic response that was maintained for 14 months until a rapid, large volume recurrence. Conclusion: This is a unique case offering insight into the behaviour and diagnostic challenge of a rare tumour and its novel molecular finding.
