Background:Endometriosis is a common gynecological condition that often presents with pelvic pain and infertility, but in rare cases may masquerade as a gastrointestinal or gynecologic malignancy. Case:A 49-year-old G0 presented with abdominal pain, fevers, elevated tumor markers, and a large adnexal mass concerning for malignancy. Intra-operatively, mucinous lesions diffusely involved abdominopelvic structures. Intra-operative frozen section (IOFS) revealed invasive cancer and full cytoreductive surgery was completed. Final pathology was downgraded to atypical cystic endometriosis with mucinous metaplasia. Conclusion:Endometriosis, a nonmalignant condition, can present as pelvic masses associated with elevated tumor markers. The case presented here depicts a confounding preoperative and intraoperative picture where endometriosis was falsely identified as malignancy. Endometriosis should always remain a part of the differential diagnosis in a premenopausal patient with presumed gastrointestinal or gynecologic malignancies.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality that aims to target the main site of tumor dissemination in ovarian cancer, the peritoneum, by combining the benefits of intraperitoneal chemotherapy with the synergistic effects of hyperthermia all during a single administration at the time of cytoreductive surgery. High-quality evidence currently only supports the use of HIPEC with cisplatin at the time of interval cytoreduction after neoadjuvant chemotherapy for stage III epithelial ovarian cancer. Many questions remain, including HIPEC's role at other timepoints in ovarian cancer treatment, who are optimal candidates, and specifics of HIPEC protocols. This article reviews the history of normothermic and hyperthermic intraperitoneal chemotherapy in ovarian cancer and evidence regarding HIPEC implementation and patient outcomes. Additionally, this review explores details of HIPEC technique and perioperative care, cost considerations, complication and quality of life data, disparities in HIPEC use, and unresolved issues.

The epithelial mesenchymal transition (EMT) is the process by which cancer cells of epithelial origin, including endometrial cancer, acquire a mesenchymal phenotype with enhanced migratory and invasive capacity, to facilitate metastasis. The regulation of EMT is tissue-specific, and in endometrial cancer, endocrine signaling pathways serve as critical regulators of EMT. The intersections of endocrine signaling and EMT highlight potential avenues for therapeutic intervention to target cancer metastasis with the aim of reduced mortality.

Objectives: We sought to evaluate the perioperative outcomes of patients undergoing single-stage breast and gynecologic surgery for either breast cancer or a hereditary breast and ovarian cancer syndrome (HBOC). Methods: All patients with documented genetic testing undergoing single-stage breast and gynecologic extirpative surgery for breast cancer or an HBOC syndrome with or without immediate breast reconstruction were included. Perioperative outcomes including intraoperative, <30-day, and 30-90-day postoperative complications were analyzed with descriptive statistics. Results: Forty-three patients underwent single-stage surgery between September 2015 and July 2020 at a single academic tertiary referral hospital. Most patients underwent combined surgery for breast cancer (81.3%) and concurrent gynecologic prophylaxis (97.7%). Median patient age was 48 years and median BMI was 26.8 kg/m2. There were 33 patients (76.7%) with a pathogenic genetic mutation, the most common of which was BRCA1 (41.9%). All breast surgeries were mastectomies, 90.7% of which were bilateral; 48.8% included axillary lymph node dissection. The majority (88.4%) of breast extirpative procedures were followed by immediate reconstruction. The gynecological procedures were most commonly performed via conventional laparoscopy (55.8%): Fifty-eight percent of patients underwent total hysterectomy and bilateral salpingo-oophorectomy (BSO) and 37.5% underwent BSO alone. Median total operative time was 459.5 minutes (74-818 min). Median length of hospital stay was four days (1-14 d), and median estimated blood loss was 25cc (25-200 cc). The only intraoperative complication was a breast reconstructive flap failure that required vascular reanastomosis. Overall, 34.8% of patients had a complication. Complications during the first 30 post-operative days included four readmissions for reoperation, one venous thromboembolism (VTE), two transfusions, and nine complications of breast surgery (three hematomas, three wound dehiscences, and three surgical site infections). Six of these patients required reoperation <30 days after their original surgery. Complications between 30-90 days following surgery included three readmissions for reoperation, three non-infectious breast reconstructive complications, one VTE, and one transfusion. One patient required debridement of her mastectomy site and one underwent laparoscopic repair of vaginal cuff dehiscence (Table 1). Conclusions: Single-stage breast and risk-reducing gynecologic surgeries are associated with similar complication rates to multi-stage surgeries with the benefit of providing the patient with a single recovery period. Further studies are encouraged to motivate multi-disciplinary collaboration with the ultimate goal of shorter overall recovery time for patients with breast cancer or an HBOC syndrome. We sought to evaluate the perioperative outcomes of patients undergoing single-stage breast and gynecologic surgery for either breast cancer or a hereditary breast and ovarian cancer syndrome (HBOC). All patients with documented genetic testing undergoing single-stage breast and gynecologic extirpative surgery for breast cancer or an HBOC syndrome with or without immediate breast reconstruction were included. Perioperative outcomes including intraoperative, <30-day, and 30-90-day postoperative complications were analyzed with descriptive statistics. Forty-three patients underwent single-stage surgery between September 2015 and July 2020 at a single academic tertiary referral hospital. Most patients underwent combined surgery for breast cancer (81.3%) and concurrent gynecologic prophylaxis (97.7%). Median patient age was 48 years and median BMI was 26.8 kg/m2. There were 33 patients (76.7%) with a pathogenic genetic mutation, the most common of which was BRCA1 (41.9%). All breast surgeries were mastectomies, 90.7% of which were bilateral; 48.8% included axillary lymph node dissection. The majority (88.4%) of breast extirpative procedures were followed by immediate reconstruction. The gynecological procedures were most commonly performed via conventional laparoscopy (55.8%): Fifty-eight percent of patients underwent total hysterectomy and bilateral salpingo-oophorectomy (BSO) and 37.5% underwent BSO alone. Median total operative time was 459.5 minutes (74-818 min). Median length of hospital stay was four days (1-14 d), and median estimated blood loss was 25cc (25-200 cc). The only intraoperative complication was a breast reconstructive flap failure that required vascular reanastomosis. Overall, 34.8% of patients had a complication. Complications during the first 30 post-operative days included four readmissions for reoperation, one venous thromboembolism (VTE), two transfusions, and nine complications of breast surgery (three hematomas, three wound dehiscences, and three surgical site infections). Six of these patients required reoperation <30 days after their original surgery. Complications between 30-90 days following surgery included three readmissions for reoperation, three non-infectious breast reconstructive complications, one VTE, and one transfusion. One patient required debridement of her mastectomy site and one underwent laparoscopic repair of vaginal cuff dehiscence (Table 1). Single-stage breast and risk-reducing gynecologic surgeries are associated with similar complication rates to multi-stage surgeries with the benefit of providing the patient with a single recovery period. Further studies are encouraged to motivate multi-disciplinary collaboration with the ultimate goal of shorter overall recovery time for patients with breast cancer or an HBOC syndrome.