Borderline ovarian tumors account for approximately 20% of epithelial ovarian tumors and are frequently diagnosed in women of reproductive age. Therefore, fertility preservation during treatment of these tumors is of particular importance. Organ-preserving surgeries are the preferred treatment method; however, they are associated with an increased risk of disease recurrence. The aim of this study was to present a clinical case of managing a patient with recurrent borderline ovarian tumor and to assess the possibilities of preserving reproductive function using organ-preserving approaches. We report the clinical case of a 36-year-old patient with recurrent serous borderline cystadenoma of the ovary. In 2018, laparoscopic resection of the left ovary was performed, followed by left-sided adnexectomy. Recurrences occurred in 2022 and 2024, requiring repeated surgical interventions. Menstrual function and the possibility of pregnancy planning using assisted reproductive technology were evaluated during follow-up. Organ-preserving surgeries allowed preservation of the patient’s menstrual function and fertility potential despite multiple tumor recurrences. Timely surgical treatment and careful dynamic monitoring contributed to the absence of severe complications and maintenance of reproductive health. Organ-preserving treatment methods for borderline ovarian tumors represent an effective approach to fertility preservation in women of reproductive age. Nevertheless, they require individualized treatment strategies and continuous monitoring, taking into account the patient’s reproductive plans and risk of recurrence.

Цель исследования: Анализ публикаций о существующих методах сохранения фертильности у пациентов репродуктивного возраста, перед проведением гонадотоксичной противоопухолевой терапии.Материал и методы: Обзор статей, опубликованных в зарубежной и отечественной литературе за последние 10 лет.Результаты: Проблема сохранения фертильности становится более актуальной с каждым годом. На сегодняшний день все чаще поднимается вопрос не только о проведении наиболее эффективного лечения онкологических заболеваний, но и о последующем качестве жизни таких пациентов. Возрастает необходимость развития методов преодоления бесплодия и их интеграцию в оказание помощи онкологическим пациентам. В данном обзоре освещены основные методы сохранения фертильности, их преимущества и недостатки, а также их место в клинической практике.Заключение: Совершенствование вспомогательных репродуктивных технологий, информирование пациентов репродуктивного возраста врачом-онкологом о возможности сохранения биологического материала перед началом противоопухолевой терапии, разработка эффективных стратегий сохранения фертильности являются ключевыми звеньями в комплексном лечении онкологических больных.

Aim . To assess the efficacy and safety of lenvatinib and pembrolizumab for the treatment of mismatch repair-proficient endometrial cancer (EC) in routine clinical practice in Russia. Materials and methods . This multicenter, retrospective, cohort study included patients with recurrent and metastatic EC from 37 cancer centers in Russia treated between May 2020 and April 2023. Patients with histologically verified EC without microsatellite instability who received ≥1 course of pembrolizumab/lenvatinib therapy were included in the study. The primary endpoint was progression-free survival; the clinical characteristics of the patients were additionally analyzed, the objective response rate and the toxicity profile of therapy were assessed. Results . The study included 100 patients. Median age was 65 (30–83) years. The most common histologic tumor subtype was endometrioid adenocarcinoma (68 %); serous adenocarcinoma was diagnosed in 22 % of cases, other types of tumor – 10 % of cases. All patients had pMMR/microsatellite-stable tumors. The median progression-free survival was 7.75 months (95 % confidence interval 0.7–33.8), and a partial response to therapy was observed in 24 % of patients. Almost half of the patients (44 %) required dose reduction due to adverse events. The most common adverse events included fatigue (n = 26; 26 %), hypertension (n = 20; 20 %), and hypothyroidism (n = 14; 14 %). Conclusion . This study confirms the clinical efficacy of lenvatinib and pembrolizumab in patients with recurrent and metastatic EC without mismatch repair system deficiency (pMMR-tumors) in routine clinical practice.

In most cases, ovarian cancer is diagnosed at advanced stages, leading to a poor prognosis. Currently, there is no effective screening for ovarian cancer, so detecting it in the early stages is a fairly successful case.

Background. Endometrial cancer (EC) treatment outcomes need to be improved. Immunotargeted therapy lead to long-term and delayed effects compared to chemotherapy. Estimation of long-term efficacy and quality of life are crucial when we are talking about efficacy in whole.Aim. To evaluate the long-term clinical efficacy of lenvatinib plus pembrolizumab therapy in patients with EC.Materials and methods. The study included 43 patients with stages I-IV EC with mismatch repair-proficient tumors and treatment duration of more than 9 months. We evaluated median progression-free survival, objective response, duration of treatment depending on the line of therapy, prevalence and type of adverse events, and correction regimens. Results. Lenvatinib plus pembrolizumab treatment was safe and efficacious in recurrent EC. Median of progression-free survival (patients with response or stabilization more than 9 months) is 10.2 months (95 % confidence interval 9.1-13.0), median of follow up is 9.7 (1.4-33.8) months. There were no complete responses, partial response was in 12 (28 %) patients, disease stabilization was in 31 (72 %) patients. Regarding safety, the overall rate of any-grade adverse events was 56.3 %. The most common treatment-related adverse events were fatigue (32.6 %), hypertension (23.3 %), and hypothyroidism (18.6 %). Dose reduction was performed in 22 (51.2 %) patients.Conclusion. The combination of lenvatinib plus pembrolizumab has long-term efficacy and manageable profile of safety. The presence of a significant pool of patients with durable response allows improving the survival rate of such patients in Russia.

Background. Endometrial cancer (EC) dominates in the structure of gynecological cancer morbidity. There has been an increase in this nosology in women of reproductive age. The morphological precancerous form of endometrioid adenocarcinoma is endometrial intraepithelial neoplasia (EIN), or atypical endometrial hyperplasia (AEH), that is difficult to diagnose: there is a high percentage of underdiagnosis resulting in a wrong treatment strategy. To improve the accuracy of diagnosis, additional immunohistochemical markers are being studied that are not part of the physician»s routine practice. Extremely promising for the prognosis of endometrial malignancy is the assessment of the functioning of the genes of the DNA mismatched nucleotide repair system (DNA mismatch repair system, MMR).Aim. To assess the diagnostic value of (microsatellite instability, MSI) in patients with AEH to rule out coexisting endometrial cancer.Materials and methods. The study includes 72 histological samples: 36 cases of EIN and 36 cases of EC, 14 of which were combined with EIN. To assess the microsatellite status, immunohistochemical staining of specimens was done with the identification of 4 markers, i. e. MLH1, PMS2, MSH2, MSH6. Results. It was found that out of 36 cases of EIN, only one sample showed loss of the PMS2 and MLH1 genes, which amounted to 3 %; the remaining EIN samples showed microsatellite stability. In 5 (36 %) out of 14 cases of combined EC and EIN pathology, MSI/dMMR was identified. Eight (36 %) out of 22 EC samples were found to have MMR deficiency. Loss of PMS2 increases the likelihood of being classified as EC 9-fold (odds ratio 9.1). With that, the presence of foci of adenocarcinoma in the case of AEH if MSI is confirmed can be asserted with a probability of 93 %. The detection of MSI in a histological sample is more often associated with the presence of EC, while the loss of the PMS2 and/or MLH1 genes increases the likelihood of a cancer diagnosis. If during additional immunohistochemical analysis a loss of these genes is observed, then EC can be diagnosed, even with an ambiguous histological pattern.Conclusion. Detection of MSI/dMMR in AEH indicates the presence of foci of coexisting endometrioid adenocarcinoma with an extremely high degree of probability. Detection of MSI/dMMR in the treatment of EC is advisable at the stage of diagnosis.

The All-Russian Expert Concilium about the influence of combined oral contraceptives on breast tissue took place in the 18th of April 2024 in Moscow. It is necessary to study how to manage controlled risk factors of malign breast tumours. The influence of combined oral contraceptives on female breast tissue is widely discussed due to enlargement of possible estrogen components list. It is also actual to study if the combines oral contraceptives may act as potential enhancer/silencer for benign mammary dysplasia and breast cancer risk. The present article demonstrates. Consensus statement of the Russian society of obstetricians and gynecologists and the Russian association of mammologists on the effect of combined oral contraceptives on breast tissue.

This article describes a clinical case of pregnancy management in a patient after surgical treatment of low-grade squamous intraepithelial lesions (LSIL) of the cervix and endometrial cancer. In the structure of female oncological morbidity, precancerous conditions and malignant diseases of the female genital organs occupy leading positions and require the most sparing treatment in women who have not realized reproductive function. The frequency of miscarriage in early pregnancy associated with a history of endometrial cancer, requiring repeated invasive manipulations to assess the effectiveness of treatment, reaches 36–40%, depending on the age of the woman. After surgical interventions on the cervix, regardless of the method of exposure, the frequency of miscarriage significantly increases due to the formation of an organic form of isthmic-cervical insufficiency, which dictates the need for preventive cervical circumcision in a regulated time. In addition, the results of numerous studies also indicate an infectious cause as the main etiological factor in the development and progression of isthmic-cervical insufficiency. Management tactics, obstetric risks, as well as the possibilities of choosing a treatment method are discussed on the basis of the presented clinical case.

Microsatellite instability, which is caused by a deficiency in the DNA unpaired nucleotide repair system, is an important pathogenetic event for some tumors. In addition, the detection of this molecular feature becomes an independent prognostic factor in the course of the disease and a predictor for the appointment of therapy with immune checkpoint inhibitors. Immunohistochemistry is a reliable and available method for detecting a deficiency in the DNA mismatch repair system, and it has recommended as a screening for hereditary syndromes associated with microsatellite instability. This article discusses the advantages and disadvantages of this research method from the point of view of the practitioner.

В обзоре представлена сравнительная характеристика эндометриоза и злокачественных опухолей с учетом актуализации классификаций опухолей яичников, рассмотрены факторы риска, морфологическая картина, специфические признаки атипичного эндометриоза, особенности этиопатогенеза. Показана ассоциация большинства хронических заболеваний, встречающихся в популяции, и эндометриоза. Приведены клинические случаи редких форм эндометриоз-ассоциированного рака различной локализации. Описаны потенциальные факторы злокачественной трансформации эндометриоза. На основании представлений о некотором сродстве эндометриоза и рака рассмотрена потенциальная возможность использования лекарственных препаратов в лечении онкологических заболеваний.

Background. Endometrial hyperplasia is one of the most common pathologies of the female reproductive system. There is a high risk of transformation of an atypical form of endometrial hyperplasia into endometrial cancer, which takes a leading position in oncogynecological morbidity. Immunohistochemical markers can become predictors of endometrial malignancy, their role is currently being actively studied.Aim. Search for molecular predictors of malignant transformation of endometrial hyperplasia.Materials and methods. Histological and immunohistochemical studies were performed in 107 patients with diagnoses of endometrial hyperplasia without atypia (EH), endometrial atypical hyperplasia (EIN), endometrioid adenocarcinoma (EC). The tumor receptor status, MSI, expression of ARID1A, PTEN, β-catenin, PAX2, proliferation index (Ki-67) were determined by the immunohistochemical method according to the standard protocol.Results. Loss of PAX2 expression was most common in precancerous and malignant endometrial cells. Loss of PAX2 expression was found in 89 % of cases in the EIN samples, in 86 % of cases in the EC samples and only in 2 cases of EH. Loss of PTEN expression was less common: with an equal proportion in 67 % of the samples of EIN and EC, while practically not occurring in women with benign GE. MSI was detected in 36 % of endometrial cancer samples. There was a deficiency in the DNA repair system in 1 case of EIN. Loss of ARID1A expression was detected in endometrial cancer with a frequency of 33 %. This gene functioned normally in all cases of EIN and EH. The expression of β-catenin was more pronounced in EC than in cases of EH. The Ki-67 proliferation index was statistically higher in the EC group than in EH and EIN.Conclusion. Evaluation of morphological data and expression of the panel of markers PAX2, PTEN, ARID1A, β-catenin, Ki-67 index, PMS2 and MLH1 will improve diagnostic search in case of suspected malignancy of endometrial hyperplasia.

AIM: The aim of this study was to define and standardize the clinical and diagnostic criteria for borderline ovarian tumors at the preoperative stage. MATERIALS AND METHODS: A retrospective analysis of 35 clinical case histories of patients with morphologically established borderline ovarian tumors has been conducted. Clinical and morphological data were analyzed: age, anamnesis, examination data, disease stage, histological study results. Laboratory parameters were assessed: CA-125 tumor marker level and ultrasound characteristics using criteria defined by IOTA, ADNEX and O-RADS groups. RESULTS: A single cyst with a solid component was a typical ultrasound type of borderline ovarian tumors (45.71%). The application of the simple IOTA rules in regards to evaluating the formations proved possible in 100% of the cases and the formation was regarded as undefined in 62.86% of the cases. In 51.43% of the cases, the formation belonged to O-RADS 4 (10% to 50% risk of malignancy). The study of CA-125 tumor marker levels showed insufficient sensitivity, only 57.14% of patients having the parameter above the norm. CONCLUSIONS: The application of the IOTA and O-RADS criteria allows for differentiating not only benign and malignant, but also borderline ovarian tumors, thus determining the choice of an organ-preserving treatment for patients of reproductive age.

. Within current clinical guidelines there is a clear trend towards a decrease in surgical activity in endometriosis due to the possible adverse effect that surgery on the ovaries has on the ovarian reserve and the achievement of pregnancy. In the absence of contraindications preference is given to long-term hormone therapy or the use of assisted reproductive technologies. The aim of the study was to analyse and compare existing scientific studies and clinical guidelines for the treatment of endometriosis and overcoming female infertility in order to develop the most rational approach to surgical interventions for external genital endometriosis (EGE). Methods: The study analysed Russian and international scientific articles on endometriosis and female infertility, clinical guidelines and treatment protocols published in 2013-2020. In the studied sources, special attention was paid to the verification of the diagnosis of EGE, indications for surgical treatment, and currently accepted patient management regimens. Results: The study showed that the main indications for surgery remain the presence of large endometriomas, as well as genital endometriosis associated with pelvic pain or infertility with ineffective hormonal therapy or ART programs. In the presence of infertility and endome- triosis, the patient should be informed about the possible decrease in the ovarian reserve associated with surgical treatment; consultation with a reproductologist is required. Conclusion: Treatment of endometriosis should remain as personalised as possible, with particular attention paid to defining clear indications for surgical treatment. An absence of specific reproductive plans allows for empirical hormone therapy to

Insufficient diagnosis of ovarian tumors during pregnancy and decreased oncological alertness constitute huge problems that can subsequently have an unfavorable outcome for both the pregnant woman and the fetus. The difficulties of diagnosing and treating ovarian cancer during pregnancy were demonstrated on the following clinical case example. In pregnant patient A. at 19-20 weeks of pregnancy, a lesion was found in the area of the right appendages (100.9 55.4 93.4 mm, V = 273 cm3), with many tissue partitions and parietal tissue inclusions. The growth of the neoplasm was noted (CA-125 884 U / ml) and the pain syndrome occurred in the patient at 23-24 weeks of pregnancy. Magnetic resonance imaging revealed a solid-cystic neoplasm of the right ovary (cystadenoma?) and surgery was performed in November 2019. Based on the results of histological examination, a high-grade serous ovarian cancer was diagnosed without signs of microsatellite instability MSI-H/dMMR (in the right ovary, in the biopsy of the left fallopian tube). The patient. received two cycles of polychemotherapy (TC scheme). The treatment was tolerated satisfactorily (CA-125 287.3 U / ml). At a gestational age of 34 6/7 weeks (January 2020), a simultaneous operation was performed, including a lower midline laparotomy, a lower uterine segment caesarean section, extirpation of the uterus with appendages, and an omentectomy. A boy was born (weight 2280 g, height 44 cm) with the Apgar score of 7/7 points, with no complications noticed in the postpartum period. Postoperative histological examination showed metastasis of carcinoma in the left ovary with signs of therapeutic pathomorphosis. The treatment was completed in March 2020 after six cycles of polychemotherapy.

Рак шейки матки (РШМ) занимает четвертое место в структуре онкологической заболеваемости женщин, уступая злокачественным опухолям молочной железы, колоректальному раку и раку легкого. В России наблюдается неуклонный рост показателей заболеваемости инвазивными формами РШМ. За последнюю четверть века смертность больных РШМ репродуктивного возраста выросла в 2 раза. Стандартом лечения прогрессирования опухолевого процесса РШМ признан режим паклитаксел с цисплатином (карбоплатином). Добавление антиангиогенной терапии (бевацизумаб) к стандартному режиму химиотерапии увеличивает общую выживаемость всего на 4%. После проведения терапии комбинацией паклитаксел + карбоплатин + бевацизумаб ответ на другие линии химиотерапии не превышает 10%. Результаты исследования KEYNOTE-158 продемонстрировали объективные ответы у 91% больных РШМ длительностью более 6 мес при использовании пембролизумаба 200 мг каждые 3 нед в случаях экспрессии PD-L1 (CPS≥1) при приемлемой токсичности. Представляемый клинический случай успешного лечения пембролизумабом пациентки с PD-L1-экспрессирующим метастатическим РШМ способствует дальнейшему накоплению опыта и может помочь в выборе правильной тактики лечения с целью повышения эффективности терапии и увеличения показателей выживаемости данной категории пациентов.