Clinical significance of the pattern-based classification in endocervical adenocarcinoma, usual and variants.

BACKGROUND: The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC. METHODS: We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on "pattern of invasion" as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification. RESULTS: A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors. CONCLUSION: Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.

Mature Cystic Teratoma of the Ovary Transforms into Squamous Cell Carcinoma: A Case Report.

Mature cystic teratomas (MCTs) are benign ovarian tumors known to undergo malignant transformation in 1%-2% of cases. Most of these cases lead to squamous cell carcinomas (SCC), and the prognosis is often poor, particularly in advanced-stage disease. A 50-year-old postmenopausal woman presented with a large pelvic mass. The patient initially underwent suboptimal primary surgery and was later diagnosed with stage IIIA SCC arising from MCT. Following the first cycle of chemotherapy with carboplatin and paclitaxel, a computed tomography scan showed a rapidly growing large mass in the pelvic cavity after 4 weeks of primary surgery, leading to a second debulking surgery. However, the patient underwent only one cycle of chemotherapy after secondary debulking surgery because of her poor performance status. Subsequently, after 4 months of secondary debulking surgery, the patient developed rapidly progressive disease, leading to her death approximately after 8 months of diagnosis. While an appropriate multimodal treatment strategy has yet to be established, optimal cytoreductive surgery and adjuvant chemotherapy should be considered for treatment of advanced-stage diseases to improve survival outcomes.

The clinical significance of HERV-H LTR -associating 2 expression in cervical adenocarcinoma.

ABSTRACT: HERV-H LTR -associating 2 (HHLA2) is a recently discovered member of the B7-family of immune checkpoint molecules that is overexpressed in several types of cancer. The aim of the present study was to investigate the expression of HHLA2 in cervical adenocarcinoma (AC) and the relationship between its expression and clinicopathological factors to assess its use as a potential marker for AC prognosis.This study included 76 patients diagnosed with cervical AC. Their resected specimens were obtained and a tissue microarray was constructed. Expression of HHLA2 was detected by the immunohistochemistry. Based on the follow-up data, correlation of HHLA2 expression and clinicopathological features, including overall survival (OS) and disease-free survival, was evaluated. Furthermore, we investigated the correlation between the expression of HHLA2 and programmed death ligand 1 (PD-L1).A total of 76 cases of invasive cervical AC were evaluated. High HHLA2 expression was detected in 62 cases (81.6%) and low HHLA2 expression was presented in 14 cases (18.4%). HHLA2 expression showed a significant negative correlation with lymph node metastasis (P = .011). Disease free survival was 75.0% and 49.0% in high-expression and the low expression group, respectively (P = .057). Although there was no statistical significance, an improved OS was observed in the high expression group (83.1% vs 64.9%, P = .479). Further, the expression of HHLA2 and PD-L1 correlated positively (P = .005). Thus, an improved OS was observed in the PD-L1 expression group (90.7% vs 66.2%, P = .037).High expression of HHLA2 is related to tumor progression and prognosis in patients with cervical AC. Therefore, HHLA2 may be a potential biomarker for predicting prognosis of cervical AC.

The first case of Anti-N-methyl-d-aspartate receptor encephalitis (Anti-NMDAR encephalitis) associated with ovarian mucinous cystadenoma: A case report.

OBJECTIVE: Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune and paraneoplastic encephalitis caused by the N-methyl-d-aspartate receptor antibody which is related to tumors, such as teratomas of the ovaries. To our knowledge, this is the first reported case of Anti-NMDAR encephalitis associated with ovarian mucinous cystadenoma. CASE REPORT: A 23-year-old woman with a flu-like illness, confused mental status, and behavioral changes presented to the hospital. A right-sided ovarian tumor was detected during the work-up and was suspected to be a teratoma that might have caused the encephalitis. A laparoscopic right salpingo-oophorectomy (RSO) was performed. Histopathological examination revealed a mucinous cystadenoma. She recovered gradually and had complete resolution of symptoms after surgical removal of the mucinous cystadenoma and immunotherapy. CONCLUSION: Even though anti-NMDAR encephalitis is caused by ovarian teratoma because it contains various types of tissues, ovarian tumors in anti-NMDAR encephalitis may not be limited to ovarian teratomas.

Laparoscopic total extraperitoneal hernia repair of fallopian tube indirect inguinal hernia in reproductive aged woman: a case report.

An indirect inguinal hernia containing the fallopian tube alone is extremely rare in reproductive-aged women without any genital tract anomalies. Despite this rarity, early diagnosis and adequate management is important to prevent strangulation and recurrence. We present a case of an indirect inguinal hernia containing only the fallopian tube in the hernia sac, which was successfully reduced by using a laparoscopic total extraperitoneal approach and repaired with a polypropylene mesh.

Benign Mature Teratoma in Anterior Mediastinum.

Teratoma of mediastinum is rare germ cell tumor. Anterior mediastinum is the most common extragonadal site. Benign mediastinal teratoma accounts for 60% of all mediastinal germ cell tumors. Benign mature teratoma has excellent prognosis after surgical excision. We present a case of 20-year-old woman diagnosed as benign mature teratoma which compressed main pulmonary trunk. The patient underwent surgical excision.

Ventral hernia with uterine rupture after vaginal delivery.

OBJECTIVE: Ventral hernia is uncommon during pregnancy and is extremely rare in postpartum women. It leads to a life-threatening emergency. CASE REPORT: A 33-year-old woman, gravida 2 para 1, was admitted to our institute with severe abdominal pain and overdistended abdomen immediately after a full-term vaginal delivery. She had a normal prenatal course and denied having any medical and surgical history. The primipara woman with no history of abdominal surgery was diagnosed with a ventral hernia with uterine rupture after vaginal delivery. We performed an emergency laparotomy and primary repair of the uterine rupture and abdominal wall defect. An abdominal binder was provided for the postoperative period. The patient's postoperative period was uncomplicated. She was discharged from the hospital after 12 days. CONCLUSION: If a patient has hernia-related symptoms or complications, the diagnosis and management of the hernia should be performed as soon as possible, regardless of the onset, to decrease maternal and fetal mortality.