Growing teratoma syndrome is a rare condition occurring in patients previously treated for malignant ovarian germ cell tumours. It is characterised by progressive enlargement of mature teratoma implants during or after chemotherapy despite normal tumour markers and the absence of immature or malignant components. It has been reported in up to 12–40 percent of patients with malignant ovarian germ cell tumours and requires complete surgical excision, as it is unresponsive to chemotherapy or radiotherapy. Incomplete resection is associated with recurrence and severe complications, including bowel obstruction and vascular compromise. In women of reproductive age, surgical management must balance oncologic radicality with fertility preservation when feasible.We report the case of a young woman initially managed at another institution for adnexal torsion with ovarian cystectomy, which revealed a mixed malignant ovarian germ cell tumour. Restaging laparoscopy demonstrated diffuse peritoneal carcinomatosis. After three cycles of platinum-based chemotherapy, tumour markers normalised; however, imaging showed progressive enlargement of multiple peritoneal lesions, raising suspicion of growing teratoma syndrome. She was referred to our centre for surgical management.Surgical exploration confirmed diffuse but resectable peritoneal disease, prompting conversion to midline laparotomy. Complete macroscopic cytoreduction was achieved through diaphragmatic, paracolic, and pelvic peritonectomies; infragastric omentectomy; resection and ablation of mesenteric and epiploic implants; and en bloc rectosigmoid resection. Uterine preservation was maintained. Multiple subcentimetric implants involving the right ovary precluded oncologically safe conservation, leading to right adnexectomy with ovarian cortical tissue sampling for cryopreservation.Final histopathological examination demonstrated mature teratoma only with extensive post-chemotherapy fibrosis, confirming the diagnosis. The postoperative course was uneventful, and the patient remains in sustained complete remission nearly four years after surgery.This case highlights the importance of recognising growing teratoma syndrome in patients with enlarging lesions despite normal tumour markers and demonstrates that complete cytoreduction with fertility-sparing intent is feasible.

Le traitement de première ligne du cancer du col utérin au stade avancé a longtemps reposé uniquement sur une chimiothérapie à base de sels de platine, associée au bévacizumab lorsque cela était possible. Depuis 2022, l’immunothérapie fait partie de la stratégie thérapeutique avec, d’une part, le pembrolizumab associé à la chimiothérapie et au bévacizumab chez les patientes qui ont une tumeur exprimant PD-L1 (CPS≥1), et d’autre part, le cémiplimab en récidive au-delà de la première ligne, quelle que soit l’expression de PD-L1 chez des patientes qui n’ont pas reçu d’immunothérapie auparavant. Le bilan préthérapeutique comporte une imagerie adaptée avec scanner thoraco-abdomino-pelvien et/ou un TEP-scanner au 18F-FDG et une IRM pelvienne en cas de rechute, ainsi qu’une évaluation du statut PD-L1 sur les cellules tumorales et sur les cellules immunitaires afin de définir le score CPS qui déterminera l’éligibilité au traitement par pembrolizumab en première ligne (CPS≥1). Lorsque cela est possible, un screening moléculaire et la détermination du statut HER2 peuvent permettre d’orienter les patientes vers des essais thérapeutiques, option qui doit être systématiquement envisagée. Les soins de support précoces sont toujours recommandés.

BACKGROUND:Bilateral salpingo-oophorectomy is the gold-standard risk-reducing surgery for women at high risk of tubo-ovarian or primary peritoneal cancer. Fimbriectomy with delayed oophorectomy has emerged as a promising alternative, potentially reducing tubo-ovarian cancer risk while minimizing the adverse effects of premature menopause. Larger cohorts and longer follow-up are required to confirm these findings. PRIMARY OBJECTIVES:To evaluate the effectiveness of the chosen care pathway in controlling the risk of advanced-stage tubo-ovarian carcinoma, and more specifically to determine whether prophylactic fimbriectomy with delayed oophorectomy is non-inferior to standard bilateral salpingo-oophorectomy in women at high risk and with germline mutations. STUDY HYPOTHESIS:Fimbriectomy with delayed oophorectomy is non-inferior to bilateral salpingo-oophorectomy in preventing oncological risk and reduces menopause-related health disorders. TRIAL DESIGN:This multi-center, non-randomized, pragmatic, preference-based controlled trial allows participants to choose their preventive surgical strategy between standard bilateral salpingo-oophorectomy (according to national guidelines) and fimbriectomy (considered from the age of 35, once childbearing is completed), followed by delayed oophorectomy at age 50 or at clinical menopause. Participants will undergo annual long-term follow-up until age 70. The association between the chosen care pathway and outcomes will be estimated using an inverse probability-weighted, cause-specific Cox model, with age as the time scale. MAJOR INCLUSION/EXCLUSION CRITERIA:This study will be proposed during oncogenetic counseling to pre-menopausal women aged 30 to 50 years with a documented pathogenic germline mutation (BRCA1, BRCA2, RAD51C, RAD51D, or PALB2). Exclusion criteria include prior bilateral oophorectomy or salpingectomy and a personal history of tubo-ovarian cancer. PRIMARY ENDPOINT:Advanced-stage tubo-ovarian or primary peritoneal carcinoma. SAMPLE SIZE:A total of 1100 patients is planned. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS:Recruitment will last 5 years (2026-2031). The first interim analysis is planned 6 to 8 years after study initiation (2032-2034). Final analysis is planned when all patients reach age 70 (around 2071). TRIAL REGISTRATION NUMBER:NCT06726330.

Localized or locally advanced cervical cancer is treated with a curative intent. Its management requires multidisciplinary expertise and a rigorously structured approach to optimize the probability of success. Initial workup (clinical examination, imaging, pathology) allows precise characterization of the tumour and staging according to TNM and FIGO classifications. Surgical management of early stage cancers, ranging from conization for small tumour to hysterectomy, sometimes including sentinel lymph node biopsy, is based on therapeutic algorithms that take into account stage, pathological criteria (invasion, margins, node involvement) and risk category. Postoperative treatment, when required, includes radiochemotherapy, that can be followed by brachytherapy. In locally advanced cancers, treatment consists of radiochemotherapy followed by uterovaginal brachytherapy and immunotherapy that has recently demonstrated its benefits. Since cervical cancer often develops in young women, its management raises important questions related to fertility and sometimes, to the management of cancer during pregnancy. Finally, although it is not the topic of these recommendations, it is important to highlight the major role of vaccination to avoid the vast majority of these cancers.

INTRODUCTION:Benefits on survival of retroperitoneal lymph node (LN) dissection during cytoreductive surgery (CRS) for epithelial ovarian cancer are debated. However, LN involvement may be a prognostic factor especially in case of high-grade serous ovarian cancer (HGSOC). MATERIALS AND METHODS:In the French Epidemiological Strategy and Medical Economics - Ovarian Cancer (ESME-OC) database, we identified patients treated for advanced-stage (FIGO III-IV) HGSOC with chemotherapy and intensive CRS including retroperitoneal LN dissection. Our first objective was to identify prognostic factors in case of maximalist treatment. RESULTS:Of 13032 patients included, 485 with advanced HGSOC diagnosed between May 29, 2006 and December 16, 2019 were analyzed. Primary CRS was performed on 279 patients (57.5%). Of them, 70.3% had LN involvement. Surgery was performed after neo-adjuvant chemotherapy (NAC) in 206 patients (42.5%). Of them, 61.2% had LN involvement. LN involvement was considered major with a Lymph Node Ratio (LNR) ≥25% for 21.1% of patients who underwent primary CRS and 15.0% after NAC. In primary CRS, when adjusted to FIGO stage and BRCA1/2 deleterious mutation, LNR ≥25% vs none indicated a poorer prognosis for both overall survival (OS) (HR = 2.46 [1.25; 4.84], p = 0.009) and progression-free survival (PFS) (HR = 2.23 [1.40; 3.57], p < 0.001). After NAC, LNR ≥25% vs none was a negative prognostic factor with a stronger negative impact on PFS (HR = 2.00 [1.12; 3.57]; p = 0.018). CONCLUSION:LN involvement is a negative prognostic factor in advanced-stage HGSOC especially in case of primary CRS. LN involvement could be a target for developing new therapies.

Minimally invasive surgery now plays a central role in the management of gynecologic cancers, particularly endometrial and cervical cancers. Among these approaches, robot-assisted surgery has progressively developed due to its potential technical advantages, including improved ergonomics, three-dimensional visualization, and greater precision of surgical maneuvers. Despite the increasing adoption of this technology, its true role compared with conventional laparoscopy remains debated, particularly following concerns raised regarding the oncologic safety of minimally invasive surgery in early-stage cervical cancer. This narrative review analyzes the currently available evidence comparing robot-assisted surgery with conventional laparoscopy in endometrial and cervical cancers. Priority is given to studies with a high level of evidence, particularly randomized controlled trials, while also discussing the methodological limitations of the existing literature, which is characterized by heterogeneity in the studied populations, biases related to historical cohorts, and the major impact of the learning curve. Through the evaluation of perioperative, functional, and oncologic outcomes, this review provides a critical synthesis of the current literature and discusses the main challenges associated with the integration of robot-assisted surgery in gynecologic oncology. Particular attention is paid to the influence of surgical expertise, healthcare organization, and adherence to oncologic principles on the observed outcomes. Ongoing prospective trials are expected to provide additional data to better define the role of robot-assisted surgery in gynecologic oncology.

Complete cytoreductive surgery remains one of the strongest determinants of outcome in ovarian cancer, yet surgeons still lack rapid tissue-assessment tools that can be repeated throughout an operation. Here we evaluated whether SpiderMass ambient mass spectrometry, combined with machine-learning models, could support ex vivo ovarian tissue typing and exploratory immune microenvironment mapping. A total of 128 ovarian specimens, from 119 patients, were analyzed to train subtype-classification models from fresh-frozen and formalin-fixed paraffin-embedded (FFPE) material, and 24 independent tissues (from 16 patients) were reserved for blinded region-level testing. Initial PCA-LDA models were improved by screening 24 classifiers; Ridge models reached up to 97% 5-fold cross-validation accuracy on the combined cohort. In blinded analyses, the mixed Ridge model produced the fewest errors, although misclassification remained concentrated in underrepresented endometrioid regions. A dual-input network combining SpiderMass spectra with digitized histology improved internal performance to 99% in 5-fold cross-validation and 100% on a small, blinded image-spectrum set, outperforming the molecular-only branch. Model explanation followed by MALDI-MSI cross-checking identified 26 subtype-associated lipids. We then trained a LightGBM cell-state model from immune and epithelial cell spectra and applied it to SpiderMass imaging data. Spatial predictions were broadly concordant with multiplex MALDI-IHC and highlighted subtype-specific differences in immune-cell distribution. In an exploratory analysis of eight high-grade serous carcinoma samples obtained before chemotherapy, longer survivalappeared to be associated with higher lymphocyte scores, higher M1-like macrophage scores and a higher M1/M2 ratio, whereas shorter survival appeared to be associated with higher cancer-cell scores. These data support SpiderMass as a promising ex vivo platform for ovarian cancer typing and hypothesis-generating immunoscoring, while underscoring the need for prospective intraoperative studies, orthogonal biomarker validation, validation in larger cohorts for exploratory immunoscoring and multicenter patient-level external validation before clinical implementation.

La chirurgie mini-invasive occupe aujourd’hui une place centrale dans la prise en charge des cancers gynécologiques, notamment dans les cancers de l’endomètre et du col utérin. Parmi ces approches, la chirurgie robot-assistée s’est progressivement développée grâce à ses avantages techniques potentiels, tels qu’une meilleure ergonomie, une vision tridimensionnelle et une précision accrue des gestes chirurgicaux. Malgré une diffusion croissante de cette technologie, sa réelle place par rapport à la laparoscopie conventionnelle demeure débattue, en particulier depuis les interrogations soulevées concernant la sécurité oncologique de la chirurgie mini-invasive dans le cancer du col utérin précoce. Cette revue narrative analyse les données actuellement disponibles comparant la chirurgie robot-assistée à la laparoscopie conventionnelle dans les cancers de l’endomètre et du col utérin. L’analyse privilégie les études à haut niveau de preuve, notamment les essais randomisés, tout en discutant les limites méthodologiques de la littérature existante, marquée par l’hétérogénéité des populations étudiées, les biais liés aux cohortes historiques et l’impact majeur de la courbe d’apprentissage. À travers l’évaluation des résultats périopératoires, fonctionnels et oncologiques, cette revue propose une synthèse critique de la littérature actuelle et discute les principaux enjeux associés à l’intégration de la chirurgie robot-assistée en oncologie gynécologique. Une attention particulière est portée à l’influence de l’expertise chirurgicale, de l’organisation des soins et du respect des principes oncologiques sur les résultats observés. Des essais prospectifs en cours devraient permettre d’apporter des données complémentaires afin de mieux définir la place de la chirurgie robot-assistée en oncologie gynécologique.

OBJECTIVE:To identify clinicobiological factors associated with receipt of surgery in patients with International Federation of Gynecology and Obstetrics 2014 stage IV high-grade serous ovarian carcinoma and to determine prognostic factors for overall survival and progression-free survival among those undergoing cytoreductive surgery. METHODS:This retrospective study used the nationwide French Epidemiological Strategy and Medical Economics ovarian cancer database. Patients with de novo International Federation of Gynecology and Obstetrics stage IVa to IVb high-grade serous ovarian carcinoma who received at least 1 systemic treatment were included. Patients were grouped according to receipt of cytoreductive surgery (primary or interval) or systemic therapy alone. Clinicobiological characteristics were compared using univariate analyses. Survival was estimated with the Kaplan-Meier method, and hazard ratios were derived from Cox models. Multi-variable analyses identified predictors of surgical management and prognostic factors in operated patients. RESULTS:Among 13,032 patients, 729 had de novo stage IV high-grade serous ovarian carcinoma. Cytoreductive surgery was performed in 478 patients (65.6%), predominantly as interval surgery after neoadjuvant chemotherapy (81.8%). Patients who underwent surgery were younger, had better Eastern Cooperative Oncology Group performance status, more frequent BRCA mutations, and fewer metastatic sites. Complete macroscopic resection was achieved in 83.1%. After a median follow-up of 52.2 months, median overall survival was 49.8 months with surgery versus 25.2 months without, and median progression-free survival was 19.2 versus 10.1 months. Among patients who underwent surgery, Eastern Cooperative Oncology Group >1 (hazard ratio 1.70), multiple metastatic sites (hazard ratio 1.48), and incomplete cytoreduction (hazard ratio 1.96) were independently associated with worse overall survival. Surgical timing had no significant impact on overall survival or progression-free survival. CONCLUSIONS:Cytoreductive surgery was associated with longer survival in selected stage IV high-grade serous ovarian carcinoma patients, though baseline differences between patients who underwent surgery and those who did not preclude causal interpretation. Complete resection is the key determinant of benefit, while timing of surgery is not. Careful multi-disciplinary selection remains essential.

OBJECTIVE:Approximately 70 % of patients with epithelial ovarian cancer (EOC) will relapse. Beyond the platinum-free interval (PFI), predictive factors for efficacy of subsequent therapies are poorly understood. We evaluated the impact of the PFI on progression-free survival (PFS), overall survival (OS) and the role of therapies used at relapse. METHODS:This retrospective study using the French ESME Ovarian Database included patients with first relapse of EOC after front-line platinum-based chemotherapy (PBCT). The impact of prognostic factors on survival was analyzed using multivariate Cox regression, with results expressed as hazard ratios, adjusted for patient and tumor characteristics, including a subgroup analysis of high-grade serous cancer. RESULTS:5558 patients, treated between 2010 and 2019 were included (median age 65 IQR 57-71). Median second- and third line PFS and OS were proportionally higher with PFI prolongation. Other factors influencing PFS and OS were BRCA mutation, FIGO stage, chemotherapy and maintenance regimens, and PS. PBCT was more effective than single-agent chemotherapy, even with a PFI < 6 months (PFSn2: adjusted HR = 0.48 95 %IC [0.43;0.53], OSn2: HR = 0.51 95 %IC [0.46;0.57]). Use of PARP inhibitors (PARPi) in second line seems to reduce outcomes in the third line. Findings were consistent in the HGSC subgroup. CONCLUSION:PFI remains an important prognostic factor but should no longer be the sole consideration for treatment selection at relapse in EOC, particularly in HGSC. The potential impact of prior PARPi maintenance on subsequent PBCT warrants investigation in prospective trials.

Objective Interest in long-term outcomes of radical hysterectomy for cervical cancer has increased, especially after the LACC trial findings, which showed worse outcomes for minimally invasive surgery. However, limited information is available on 10-year oncological outcomes, particularly, recurrence and survival. The primary objective of this study was to analyze the 10-year oncological outcomes of patients with International Federation of Gynecology and Obstetrics 2009 stage IB1 cervical cancer treated with radical hysterectomy performed via minimally invasive or open approaches. Methods This retrospective, multi-center, observational study updates the data from the SUCCOR cohort. Patients diagnosed between January 2013 and December 2014 with tumors <= 4 cm without extra-cervical metastasis and treated with radical hysterectomy as the primary treatment were included, and a 10-year follow-up after surgery was successfully conducted. Results A total of 556 patients were analyzed. The median age was 46 years (range; 18-82). The most common final International Federation of Gynecology and Obstetrics 2009 stage was IB1, 474 patients (85%), and the most common histology was squamous carcinoma, 376 patients (67.6%). The 5-year disease-free survival was 93%, and the 10-year disease-free survival was 90%. The overall survival was 97% at 5 years and 89% at 10 years. During follow-up, 9% (n = 49) of patients experienced recurrences, 78% (n = 38) within the first 5 years. Comparing surgical approaches, 10-year disease-free survival was 92% for minimally invasive surgery and 88% for open surgery (p = .12). Similarly, 10-year overall survival was 92% for minimally invasive surgery and 88% for open surgery (p = .12). Post-recurrence disease-specific survival was 47% at 60 months and 39% at 96 months. The 2-year survival after recurrence was 80% for late recurrences (>5 years) versus 69% for early recurrences. Conclusions The overall survival after radical hysterectomy at 5-years was 97% in patients with early-stage cervical cancer. The recurrence rate at 10 years was 9%. No differences in 10-year survival were observed between the surgical approaches.

High-grade serous carcinoma is the most lethal gynecological malignancy. Although serous tubal intra-epithelial carcinoma is increasingly recognized as a precursor to high-grade serous carcinoma, its optimal management remains controversial. This review examines the controversies in serous tubal intra-epithelial carcinoma pathogenesis, diagnosis, management, and follow-up, highlighting the need for collaboration, standardized guidelines, and further research to improve patient outcomes.