Ovarian malignant germ cell tumors (MOGCTs) represent approximately 5% of all ovarian malignancies. However, in women aged 10 to 30, they account for up to 70% of ovarian neoplasms and may occasionally occur bilaterally. Roughly one-third of MOGCTs are dysgerminomas. These tumors may also be hormonally active. Gestational trophoblastic neoplasia (GTN) is a spectrum of rare tumors arising from abnormal trophoblast proliferation, involving invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) - characterized by elevated levels of human chorionic gonadotropin (hCG). This case report presents a young patient with a hormonally active dysgerminoma initially misdiagnosed as a GTN due to elevated and progressively rising hCG levels, along with clinical symptoms. After the misdiagnosis, the patient was initially treated with monochemotherapy and after the completion of the therapy, hCG levels did not reach negativity. The patient presented with recurrence of hCG levels elevation, and for suspected GTN the chemotherapy was further escalated. The correct diagnosis was only established after thoracotomy excision of the pulmonary lesion, which turned out to be a pulmonary metastasis of dysgerminoma. Thereafter, the patient was promptly treated according to the recommended guidelines and is currently in remission. It is necessary to maintain a broad differential diagnosis in patients with low but persistent hCG levels. GTN is often the first suspected entity, but we must consider the possibility of hormone-producing ovarian tumors, including dysgerminomas.

The Czech Republic is one of the countries with the highest incidence of endometrial cancer in the world. In June 2023, the Women's Cancer Committee of the International Federation of Gynaecology and Obstetrics (FIGO) introduced a new staging system for endometrial cancer, FIGO 2023, which replaced the 2009 version. The FIGO 2023 staging system differs significantly from the previous version by incorporating the result of molecular classification of the tumour and some histopathological parameters - histological type of tumour, tumour grade and presence of substantial lymphovascular invasion - into the definitions of stage I and stage II. For stage I and II tumours, specific separate stages are reserved when the molecular profile of POLEmut or TP53mut is detected. Stages III and IV have also been modified, but the result of the molecular classification of the tumour and other histopathological parameters do not influence the staging. However, the molecular classification result should be reported for all stages. These changes have further strengthened the role of the pathologist in staging. The changes, which are partly based on the recommendations of the three European professional societies ESGO/ESTRO/ESP for the diagnosis and treatment of endometrial cancer, better reflect the biological behaviour of the tumour and significantly refine the prognosis of the patient at a given stage. On the other hand, the FIGO 2023 staging system is quite complex and requires expensive tests, which may pose a problem for its routine use in a global context. The implementation of the FIGO 2023 endometrial cancer staging system in daily practice requires the full involvement of all stakeholders.

OBJECTIVE:To analyze the incidence and mortality of cervical cancer in individual age cohorts in the Czech Republic using nationwide data and data from the largest national gynecological oncology center. MATERIALS AND METHODS:Analysis of a single-institution cohort of newly treated cervical cancer cases from 2022-2024, and analysis of incidence and mortality trends in individual age groups using data from the Czech National Cancer Registry (ÚZIS - Institute of Health Information and Statistics) from 2000-2023. RESULTS:The incidence and mortality of cervical cancer in the Czech Republic have declined significantly over the last 20 years. The decline correlates well with measures that have led to better organization and implementation of changes within the screening program. Analysis in individual age cohorts shows that the largest decline in incidence and mortality occurred in the cohort up to 34 years of age, yet in more than 50% of women with carcinomas in this cohort, cytological screening and subsequent management failed. The upward trend in incidence in the 35-44 and 45-54 age cohorts raises questions about the causes. The high percentage of invasive carcinomas in women examined by a gynecologist in the last three years requires an analysis of the quality of cytology laboratories and management by registering gynecologists. The introduction of high-risk human papillomavirus (HR HPV) testing and referral to expert colposcopy for discrepant findings is one way to improve the situation. Furthermore, audits of diagnosed carcinomas in women who have undergone screening should be introduced. The biggest challenge will be to activate the resistant population of women who underestimate the importance of regular screening examinations. CONCLUSION:Even though we can see an overall decline in incidence and mortality, when individual age cohorts are analyzed, it shows us ways for improvement in each specific age group of women individually.

Cervical cancer remains a major global health challenge, despite the availability of effective preventive measures such as human papillomavirus (HPV) vaccination, earlydetection and treatment of precancerous lesions, and timely management of early-stage disease. In recent years, several European countries have introduced substantial changes to their screening strategies-shifting from conventional cytology to primary HPV testing.This shift, supported by the World Health Organization and International Agency for Research on Cancer recommendations, is underpinned by numerous clinical studies demonstrating the superior sensitivity of HPV testing for detecting high-grade cervical lesions. This article provides an up-to-date overview of cervical cancer screening across Europe, with a focus on screening methods, testing intervals, program organization, and the emerging role of self-sampling.

This study aimed to evaluate the effectiveness of different tracers´ application techniques for sentinel lymph node (SLN) detection in women with endometrial cancer undergoing laparotomy. Additionally, potential risk factors for SLN detection failure were assessed. We retrospectively analyzed data from 248 endometrial cancer patients who underwent abdominal surgery with SLN mapping between January 2020 and March 2024. Statistical analyses were conducted using the Wilcoxon rank sum test for continuous variables and either Pearson’s chi-square test or Fisher’s exact test for categorical variables, with a significance level set at p < 0.05. Group I + S consisted of 147 women with intracervical and subserosal tracers´application and group I + I included 101 women with intracervical and intrafundal application. Successful detection of SLN on both sides was achieved in 39.9

Introduction The substantial improvement in early-stage cervical cancer survival rates has given rise to the significance of subsequent quality of life. This study aims to assess the quality of life in patients subjected to radical and conservative surgeries for cervical cancer. Materials and methods One hundred patients diagnosed with early-stage cervical cancer (stages IA2-IIA1) undergoing surgical treatment were enrolled in our study between 2007 and 2011. Patients completed quality of life questionnaires EORTC QLQ-C30 and QLQ-CX24, distributed before the surgery, 6, 12, and 120 months after the procedure. At the final 120-month follow-up, 54 patients remained eligible for inclusion. 23 patients (“CONS group”) underwent laparoscopic lymphadenectomy combined with hysterectomy or simple trachelectomy. The remaining 31 patients (“RAD group”) underwent abdominal radical hysterectomy type C1. Results At the 6-month post-surgery assessment, the RAD group reported a significantly higher incidence of menopausal symptoms, decline in physical functioning and concern regarding their sexual well-being. CONS group patients reported notable exacerbation of lymphedema and neuropathy-related symptoms but only a slight decline in physical functioning. Additionally, their role functioning, emotional well-being, and social functioning significantly improved compared to their preoperative baseline. At the 120-month postoperative assessment the RAD group showed a significant decline in several parameters, including lymphedema, peripheral neuropathy, postmenopausal symptoms, fatigue, pain, and physical functioning. Conclusions Cervical cancer treatment is invariably associated with a negative long-term impact on quality of life, RAD group demonstrated poorer outcomes than the CONS group across multiple parameters but even the CONS group exhibited long-term effects of the surgery.

The incidence of cancer during pregnancy is steadily rising because of the postponement of plans for childbearing. One of the most common cancers diagnosed during pregnancy is cervical cancer. Diagnosis of most cases usually occurs in the early stages, but there are still cases of tumors staged IB2 and higher. In these cases, the treatment strategy entails administration of neoadjuvant chemotherapy. However, a universally recognized standardized regimen for neoadjuvant chemotherapy treatment of cervical cancer during pregnancy has yet to be established. The chemotherapy agents used during treatment are known for their fetal adverse effects. The aim of the therapy is to attain full-term pregnancy while minimizing fetal toxicity and decreasing tumor size. In this case report, we present a first-time sequential chemotherapy administration to minimize the cumulative toxicity of individual regimens and demonstrate the benefits for the patient and fetus.

The International Federation of Gynaecology and Obstetrics (FIGO) introduced a new staging system for endometrial carcinoma FIGO 2023 in June 2023. The new staging system differs significantly from previous versions by incorporating other non-anatomical parameters (histological type of tumour, tumour grade and the presence of massive lymphovascular space involvement as well as the molecular classification of the tumour). The FIGO 2023 staging system enhances the accuracy of prognostic assessments for patients at a specific stage with better options for targeted treatment. Another objective was to synchronise staging as much as possible with the European oncogynaecological ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma established in 2021. However, several changes are controversial. Routine molecular classification of endometrial carcinomas is not yet commonly available in most countries of the world. Another limitation of the FIGO 2023 staging system of endometrial cancer is the inclusion of variables whose definitions are still evolving, as well as variables that are subject to considerable interobserver variability in their assessment. Advantages, controversies, and limitations for clinical practice of the new FIGO 2023 endometrial cancer staging system are discussed.

Objective: The aim of this study was to determine how often changes the stage of the tumour in definitive histology against preoperative clinical stage in patient cohort with dia gnosed endometrial cancer. Methods: We evaluated prospectively a cohort of 166 patients with endometrial cancer. They all underwent abdominal hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node bio psy. Patients with high-risk tumours also pelvic lymfadenectomy. We collected data of preoperative dia gnostic bio psy and postoperative definitive histology. The data were statistically processed. Results: Detection of sentinel lymph node was successful in 71.1%, bilateral successful detection was in 40.6%. Discrepancy of tumour grade between preoperative bio psy and definitive histology was generally 31.4%. Upgrading of the tumour was in 22 (14.4%) cases, downgrading in 26 (17%) cases. Upgrade from low-risk to high-risk group of tumours was noticed in eight cases. Histopathological tumour type changed in 6.6%, 4.6% moved to histopathologic high-risk group. The tumour stage changed in definite histology in 57.3%, in 19.2% of cases moved from stage low/ intermediate-risk group to intermediate-high/ high-risk disease group. Conclusion: Correct assessment of preoperative clinical stage and histological grade of endometrial cancer is burdened with a high inaccuracy rate. A lot of cases is up-staged after surgical staging and moved to intermediate-high/ high-risk disease group. Results confirm the importance of oncogynaecologic centre II. evaluation of histopathology findings from dia gnostic bio psies made in referring hospitals. Sentinel lymph node bio psy should be performed even in clinically low/ intermediate-risk disease group.

Human papillomavirus (HPV) is the most common sexually transmitted viral infection worldwide, which may result in the development in benign lesions or malignant tumors. The prevalence of HPV infection is twice as high in pregnancy as in non-pregnant women. Additionally, there is a risk of vertical transmission of HPV from mother to fetus during pregnancy or childbirth. Various studies have reported an increased risk of adverse pregnancy outcomes in HPV-positive women, including miscarriage, preterm birth, premature rupture of membranes, preeclampsia, fetal growth restriction, and fetal death. HPV vaccination is not currently recommended during pregnancy. On the other hand, there is no evidence linking HPV vaccination during pregnancy with adverse pregnancy outcomes and termination of pregnancy is not justified in this case.

Aim: To review the changes in the new version of the FIGO 2023 staging system for endometrial cancer. Methods and results: The new FIGO 2023 endometrial cancer staging system provides key updates for the dia gnosis and treatment of endometrial cancer. An important step in dia gnosis is molecular classification, which allows more accurate risk stratification for recurrence and the identification of targeted therapies. The new staging system, based on the recommendations of the international societies ESGO, ESTRO and ESP, incorporates not only the description of the pathological and anatomical extent of the disease, but also the histopathological characteristics of the tumour, including the histological type and the presence of lymphovascular space invasion. In addition, the staging system uses molecular testing to classify endometrial cancers into four prognostic groups: POLEmut, MMRd, NSMP and p53abn. Each group has its own specific characteristics and prognosis. The most significant changes have occurred in stages I and II, in which the sub-staging better reflects the bio logical behaviour of the tumour. This update increases the accuracy of prognosis and improves individualized treatment options for patients with endometrial cancer. Conclusion: The updated FIGO staging of endometrial cancer for 2023 incorporates different histologic types, tumour features, and molecular classifications to better reflect the current improved understanding of the complex nature of several endometrial cancer types and their underlying bio logic behaviour. The aim of the new endometrial cancer staging system is to better define stages with similar prognosis, allowing for more precise indication of individualised adjuvant radiation or systemic treatment, including the use of immunotherapy.

Endometriosis is a chronic disease characterised by the presence of endometrial tissue outside the uterine cavity, affecting 5- 15% of women, especially those of reproductive age. The disease may manifest itself as dysmenorrhoea, dyspareunia, sterility and chronic pelvic pain, among other symptoms. Although it is not malignant, it shares some characteristics with cancer and can lead to epithelial ovarian carcinoma. The risk of malignant transformation of endometriosis is estimated at 1% in premenopausal women and 1- 2.5% in postmenopausal women. Our case report describes a 46-year-old female patient with long-standing abdominal pain and a history of surgically confirmed endometriosis. Imaging revealed a cystic mass in the left mesogastrium, which was subsequently surgically removed. Histological examination confirmed the presence of a low-grade endometrioid carcinoma arising from an extragenital endometriosis lesion. Following surgical treatment, the patient underwent adjuvant chemotherapy, after which she was in complete remission. The diagnosis of malignant transformation of endometriosis is complex, requiring a combination of thorough clinical examination, imaging, and histopathological verification. Therapy involves radical surgery and possibly adjuvant chemotherapy, similar to ovarian carcinomas. Despite advances in treatment and research, endometriosis remains a complex disease with unclear aetiology, heterogeneous clinical presentation, and risk of malignant transformation.

BACKGROUND:International Federation of Gynaecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique - FIGO) introduced a new staging system for endometrial carcinoma - FIGO 2023 - in June 2023. OBJECTIVE:The new staging system differs significantly from previous versions. The new system represents a significant departure from the traditional staging systems for other gynaecological cancers, as the definition of individual stages includes not only the traditional anatomical extent of the tumour, but also the molecular profile of the tumour and other histopathological parameters - histological type of tumour, tumour grade and the presence of substantial lymphovascular invasion. The new system defines stages I and II in a completely different way and expands the definition of stages III and IV, allowing for different types of tumour spread outside the uterus. The introduction of molecular testing is the main change in the new staging system. When certain molecular markers are detected, stage I or II is completely changed. By including these non-anatomical parameters, the FIGO 2023 staging system improves the accuracy of a patient's prognosis at a specific stage with better options for individualized treatment, including the use of immunotherapy. Another goal was to synchronise staging as much as possible with the recommendations of three professional societies: the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP). The staging system for carcinosarcoma remains identical to the staging system for endometrial cancer. CONCLUSION:This article presents an overview of the new FIGO 2023 endometrial cancer staging system and discusses its advantages and disadvantages for clinical practice.