Comparison of In Vivo Study of Co-Polarized and Cross-Polarized Fluorescence Spectroscopy to Co-Minus Cross-Polarized Fluorescence Spectroscopy to Diagnose Precancerous Cervical Lesions by Handheld Probe.

Background: In 2020, the number of new cases of cervix uteri was 604,127, i.e., 3.1% of all cancers, and the number of deaths was 341,831 (3.3%) among both sexes. In vivo fluorescence spectroscopy is an emerging optical technology that offers promise for the diagnosis of disease & has the capability to quickly, noninvasively and quantitatively probe the biochemical and morphological changes that occur as tissue becomes dysplastic. Materials and Method: A cross-sectional observational study was conducted from December 2019 to September 2021 in the OBGY Department, UISEMH, in collaboration with optical imaging laboratory, BIOPHOTONICS, IIT Kanpur. A fabricated in-house fluorescence spectroscope consisting of a laser diode (405 nm) as light source and a miniature spectrometer is used to detect fluorescence signal from the sample. Patient's cervix was examined in the OPD, using an optical handheld probe, which functions on the principle of polarized fluorescence spectroscopy. The tissues were examined and classified on the basis of varying patterns of polarized spectroscopy (co-polarized, cross-polarized and co-minus cross-polarized light). The results were compared with that of cytological, colposcopy and histopathological findings and on various demographic variables. Results and Conclusion: In vivo handheld probe based on polarized fluorescence spectroscopy is an excellent screening technique. Co- and cross- polarized light has shown enhanced accuracy. Accuracy of co-minus cross-polarized light is poor. It is fast, noninvasive and quantitative and, with further developments, has the potential to become a regular screening tool in future.

Staging of Cervical Cancer: What has Changed?

In India, cervical cancer is the second most common cause of cancer-related fatalities and the fourth most common malignancy worldwide affecting women. India accounts for 25% of all cervical cancer-related deaths worldwide each year. The main drawbacks of clinical staging were the imprecise estimation of tumor size and the challenge of determining the involvement of pelvic and para-aortic lymph nodes with the few studies that FIGO allowed to be done for staging of cancer cervix. The use of 2009 staging approach showed that when many cases were operated based only on clinical findings, they subsequently required adjuvant therapy; hence, treatment-related morbidity was negatively impacted by these errors. Changes have been made to the staging of cervical cancer according to the 2018 revised International Federation of Gynecology and Obstetrics (FIGO) guidelines. Correction to cancer of the cervix staging was published recently in 2024. The horizontal extent (lateral extent) of the disease is not taken into consideration for staging in cases of microinvasive disease. Three subgroups have been identified based on the stratification of tumor size: IB1 ≤ 2 cm, IB2 > 2- ≤ 4 cm, and IB3 > 4 cm. Pathology and imaging modalities are added to clinical diagnosis for staging of cancer cervix. The involvement of lymph nodes (LNs) is now classified based on pathology (p) or imaging (r) which specifies that lymph node involvement is diagnosed using pathology (p) or imaging (r). Stage IIIC has been added [IIIC1 (involvement of pelvic nodes) and IIIC2 (involvement of para-aortic nodes)] is assigned to the case in the event of lymph node positive status. Pathological assessment takes precedence over radiological and clinical findings. The involvement of vascular/lymphatic spaces should not change the staging. The lower staging should be assigned when there is doubt about stage. Overall, the revised FIGO staging of cancer cervix (2024) has a number of advantages, including the inclusion of imaging and pathology, tumor size and LN-based categorization. More studies on staging of cancer cervix in different populations using revised staging of cancer cervix will help to prognosticate use of this staging.

"Modernizing Cervical Cytology Screening with Liquid-Based Methods at Community-Level Hospitals: A Much-Needed Breakthrough for India".

Introduction: Cervical cancer still ranks highest causing cancer-related morbidity and mortality in women in India. It is prudent to emphasise and implement cervical cancer screening strategies in the population efficiently and with regular intervals. Conventionally, PAP smear cytology is obtained by wooden spatula-Ayre's spatula. To improve sensitivity and specificity of the procedure and detection rate, better techniques of cells retrieval are available mainly liquid-based cytology (LBC), with help of cyto-brush. Literature has consistently proven efficiency of the technique and also reduced the proportion of inadequate sampling. We conduct this study to compare both the techniques and efficiency in a community hospital from data over 6 years, to asses its role and benefits among Indian women. Aims and Objectives: To compare conventional PAP smear and liquid-based cytology techniques analysing detection rates of positive lesions (CIN and also includes ASCUS and malignant), incidence of inadequate sampling, efficiency and cost-effectiveness. Methods: This is retrospective study at tertiary care obstetric hospital affiliated to government-run medical college in a metropolitan city of Mumbai. Data are retrieved from the Pathology Department, Medical Records Department, laboratory books and OPD registers. Pap's smear sampling was done mainly from OPD with all indications including routine tests as a part of gynaecological evaluation and screening, as well as for suspicious lesions on inspection. Group A consists women who had conventional PAP smear test for 3 years (Dec 2015-Nov 2018) and Group B had women who benefited by LBC method for 3 years (Dec 2018-Nov 2021). COVID-19 pandemic majorly affected the routine gynaecological OPD practice during 2021 as hospital was COVID facility hospital. Results: Demographic parameters and presentations were comparable and similar. LBC methods have higher detection rate for positive reports, including ASCUS. But results were comparable in both groups and not statistically different. Importantly, incidences of inadequate sampling are reduced significantly with the LBC method. Unsatisfactory smears war high in Group A (7.752%) compared to Group B (3.712%) p-value 0.005, stating the increased rate of requirement of sending repeat smears, which involves higher engagement of time, resources and active participation from healthcare personnel. Conclusion: Good detection rates and significantly low rates of unsatisfactory smears make LBC rational and cost-effective. These are the times to switch to liquid-based cytology techniques, especially at the community level hospitals; in order to detect more women with cervical premalignant as well as malignant neoplastic lesions and to save lives. This can be made possible by emphasising the policy makers to incorporate these services through quality resources.

Observations on the reproductive morphology of the female short-beaked echidna, Tachyglossus aculeatus.

Although monotremes diverged from the therian mammal lineage approximately 187 million years ago, they retain various plesiomorphic and/or reptilian-like anatomical and physiological characteristics. This study examined the morphology of juvenile and adult female reproductive tracts across various stages of the presumptive oestrous cycle, collected opportunistically from cadaver specimens submitted to wildlife hospitals during the breeding season. In adult females, ovaries had a convoluted cortex with follicles protruding from the ovarian surface. While protruding antral follicles were absent from the ovaries of juvenile echidnas, histological analysis identified early developing primordial and primary follicles embedded into the ovarian cortex. The infundibulum epithelial cells of the oviducts were secretory during the follicular phase but not at other stages, the ampulla region was secretory at all stages and is likely responsible for the mucoid layer deposited around the zona pellucida, and the isthmus region of the oviduct appeared to be responsible for initial deposition of the shell coat, as in marsupials. Female echidnas have two separate uteri, which never merge and enter separately into the urogenital sinus (UGS). This study confirmed that both uteri are functional and increase in glandular activity during the luteal phase. In the juvenile uteri, the endometrium was immature with minimal, small uterine glands. A muscular cervical region at the caudal extremity of each uterus, just before the cranial region of the UGS was defined by the absence of glandular tissue in all female echidnas, including the juveniles. There was no evidence of a definitive vaginal region. A clitoris was also detected that possessed a less developed but similar structural (homologous) anatomy to the male penis; urethral ducts while present did not appear to be patent.

Self-Screening for Cervical Cancer Offered through a Digital Platform in a Region of British Columbia with Lower Screening Rates.

Cervical cancer is highly preventable through vaccination, early detection, and treatment, yet is the fourth most common cancer globally. HPV testing is superior to cytology for the detection of cervical pre-cancer, and jurisdictions around the world are implementing HPV primary screening, which offers the opportunity for self-screening, an important self-care intervention. Digital health solutions are also increasingly important components of self-care. In this study, we assessed the acceptability and completion of self-screening for cervical cancer offered through a digital platform within a low screening uptake region of British Columbia. The primary objective of this study was to evaluate the acceptability of self-screening for cervical cancer offered through a digital platform as measured by return rates of self-screening kits. Patients due or overdue for cervix screening were invited to participate. Eligible participants registered online to receive a self-screening kit, which included a device for vaginal self-screening, instructions, and a return envelope, sent to their home. After self-screening using the vaginal device, HPV testing was conducted. HPV-negative participants were returned to routine screening, and HPV-positive participants were recommended for cytology or colposcopy. Attendance rates at follow-up were evaluated. Participants were invited to complete an acceptability survey. From April 2019 to December 2023, 283 participants were sent kits, with 207 kits returned for a completion rate of 73%. Of valid samples (n = 202), 15 were HPV positive, and 93% attended follow-up care. Most respondents found the CervixCheck website easy to use, informative, and secure and were satisfied with receiving their results online. CervixCheck had a high completion rate among participants who were sent a self-screening kit. High compliance with recommended follow-up and high acceptability of self-screening for cervical cancer was observed. Most participants indicated they would self-screen again in the future. Innovative approaches to cervical screening, including self-screening and the use of digital health interventions, are ways to enhance equity and improve uptake of cervical screening.

The evolving landscape of immunohistochemistry in cervical and uterine carcinoma in gynecologic oncology: current status and future directions.

Immunohistochemistry (IHC) has become an indispensable tool in routine gynecological pathology, particularly with the advancements in molecular understanding and histological classification of gynecological cancers. This evolution has led to new immunostainings for diagnostic and classification purposes. This review describes the diagnostic utility of IHC in gynecological neoplasms, drawing insights from literature reviews, personal experiences, and research findings. It delves into the application of IHC in resolving morphologically equivocal cases, emphasizing its role in achieving an accurate diagnosis. The selection of appropriate immunomarkers for common scenarios encountered in gynecological pathology aids pathologists in navigating complex cases. Specifically, we focus on cervical and endometrial malignancies, elucidating the molecular rationale behind the use of specific immunohistochemical markers. An updated overview of essential immunohistochemical markers provides knowledge for precise diagnosis and classification of gynecological cancers. This review serves as a valuable resource for clinicians and researchers involved in the management and study of gynecological malignancies, facilitating improved patient care and outcomes.

Primary cervical signet ring cell carcinoma: A rare case report and literature review.

Introduction: Signet-ring cell carcinoma of the uterine cervix commonly occurs owing to metastasis. Today, the rarity of primary cervical origin is still making it a diagnostic challenge. This review aims to raise awareness to maintain early diagnosis and appropriate management. Case Presentation: A 37-year-old patient presented with postcoital vaginal bleeding with a history revealing a negative Papanicolaou smear 2 years prior. Pelvic examination revealed a cervical mass and the biopsy was interpreted as a signet ring cell pattern. Detailed extrapelvic evaluation was made to rule out a possible extragenital primary tumor. The patient underwent a type-2 radical hysterectomy, pelvic and paraaortic lymphadenectomy. Following the histopatologic evaluation, the case was diagnosed and managed as primary cervical signet ring cell carcinoma (PCSRCC) with International Federation of Gynecology and Obstetrics 2018 stage IIIC. The patient received adjuvant chemoradiotherapy and is currently disease-free 24 months following surgery. Discussion: The small number of cases causes difficulty with an accurate diagnosis. Imaging and immunohistochemical (IHC) studies should be performed to distinguish possible primary sites. IHC studies are not yet close to refusing or confirming the diagnosis. Due to the lack of data, there is no consensus on the proper therapeutic strategy. Prognosis and survival appear to depend upon the stage of disease at diagnosis. Therefore, the awareness of such a histopathological kind of cervical cancer is crucial.

Efficacy of PD-1/PD-L1 blockade immunotherapy in recurrent/metastatic high-grade neuroendocrine carcinoma of the cervix: A retrospective study.

Although high-grade neuroendocrine carcinoma of the cervix (HGNECC) accounts for less than 1 % of all cervical cancers, it exhibits marked aggressiveness and resistance to radiation and chemotherapy. We retrospectively investigated the efficacy of immunotherapy for recurrent/metastatic HGNECC in a real-world setting. From September 2016 to December 2022, a total of 29 patients with HGNECC accepted PD-1/PD-L1 inhibitors; of these, six cases (20.7 %) were PD-L1 positive (combined positive score ≥1). According to their primary treatment, the patients were assigned to either a surgery group (n = 14) or a non-surgery group (n = 15). In the surgery group, four patients received anti-PD-1 therapy immediately after surgery, while six, two, one, and one patients started immunotherapy after the first, second, third, and forth recurrence, respectively. In the non-surgery group, seven patients started immunotherapy as part of their primary treatment, while the other four, two, and two patients received anti-PD-1 drugs as the second, third, and forth lines of treatment, respectively. The seven-patient group showed longer progression-free survival after immunotherapy (PFSi) and overall survival than those of their counterparts (P = 0.085 and 0.08, respectively), while this benefit was not observed in other subgroups. No significant correlation was observed between PD-L1 and PFSi expression. Interestingly, one patient with a high tumor mutation burden (TMB-H) had a long PFSi of 26 months and experienced no recurrence until the last follow-up. Based on these findings, we propose that PD-1/PD-L1 inhibitors may prolong the survival of patients with HGNECC who start immunotherapy as the first-line of treatment. This indicates that early immunotherapy may be a better choice for this challenging malignancy. Moreover, the predictive role of TMB-H in immunotherapeutic outcomes requires further investigation.

Predictive value of short cervix in early third trimester for preterm birth in women with normal mid-trimester cervical length.

BACKGROUND: Short cervical length in the mid-trimester is a powerful predictor of preterm birth. However, clinical significance of cervical length in the third trimester for predicting preterm birth has not been established yet. OBJECTIVE: To examine the predictive role of a shortened cervix in the third trimester for preterm birth in women who had a normal cervical length in the second trimester STUDY DESIGN: : This retrospective cohort study included women who underwent cervical length measured at least once in both the second trimester (16+0 weeks to 27+6weeks) and the early third trimester (28+0 weeks to 33+6weeks). Women with short cervical length in the second trimester, those with multiple pregnancies, those who underwent cerclage operation, and those who had iatrogenic preterm birth were excluded. The study population were divided into two groups based on cervical length in the third trimester: a short cervix (≤ 25 mm) group and a control group (> 25 mm). Rates of preterm birth (< 37 weeks) were compared between two groups. Predictive performances of cervical length in the third trimester for preterm birth were assessed. RESULTS: Women with a short cervical length at 28+0 to 33+6 weeks accounted for 12.6% (n = 717) of the total study population (n = 5,682). Preterm birth rate was 9.5% in the short cervix group, which was significantly higher than that (3.2%) in the control group (p < 0.001). The adjusted odds ratio for short cervical length on preterm birth was 2.73 (95% CI: 1.96-3.79). A short cervix in the third trimester had a sensitivity of 30.1%, a specificity of 88.1%, a positive predictive value of 9.5%, and a negative predictive value of 96.8% in predicting preterm birth. The addition of third-trimester cervical length to the predictive model significantly increased the area under the curve from 0.64 (95% CI: 0.60-0.68) to 0.67 (95% CI: 0.63-0.71) (p = 0.002), demonstrating improved predictive performance. CONCLUSIONS: Approximately 13% of women with normal cervical length in the mid-trimester had a short cervical length after 28 weeks, which increased the risk of preterm birth. The high specificity and negative predictive value of third-trimester cervical length measurements underscore their critical utility in identifying women at low risk for preterm delivery.

[High-grade lesions probability in ASCUS HPV positive patient according to HPV type]. / Probabilité diagnostique d'une lésion de haut grade chez les patientes ASCUS HPV positif en fonction du typage HPV.

OBJECTIVES: The aim of our study was to assess the proportion of high-grade histological lesions, according to HPV type, in patients referred for colposcopy involving a positive HPV-HR test and ASC-US cytology. METHODS: This is a retrospective descriptive study of asymptomatic patients aged 25 to 65 with a positive HPV-HR test and ASC-US cytology. Data were collected at the Nord-Franche-Comté Hospital from September 2019 to February 2022. The primary outcome was the proportion of high-grade histological lesions in patients with ASC-US cytology combined to HPV 16 or 18 (associated or not with other HPV type), compared with HPV no 16 no 18. RESULTS: Among the 298 patients included, 67% were HPV no 16 no 18, 22% HPV 16 associated or not with others and 11% HPV 18 associated or not with others. We found significantly fewer high-grade lesions in patients with ASC-US cytology and HPV no 16 no 18 than in patients with HPV 16 or 18 (8.5% versus 22.7%, p<0.01). In patients presenting an ASC-US cytology with HPV no 16, no 18: 53% of the biopsies found no histological lesion compared with 30% for the other HPVs (p<0.01). CONCLUSIONS: We've highlighted the reality of colposcopists: a high ratio of normal coloscopy associated with normal or low-grade biopsies, in patients with a positive HPV-HR test no 16, no 18 and ASC-US cytology.

Barriers and facilitators of retention in care after cervical cancer screening: patients' and healthcare providers' perspectives.

BACKGROUND: Cervical cancer continues to threaten women's health, especially in low-resource settings. Regular follow-up after screening and treatment is an effective strategy for monitoring treatment outcomes. Consequently, understanding the factors contributing to patient non-attendance of scheduled follow-up visits is vital to providing high-quality care, reducing morbidity and mortality, and unnecessary healthcare costs in low-resource settings. METHODS: A descriptive qualitative study was done among healthcare providers and patients who attended the cervical cancer screening clinic at Mbarara Regional Referral Hospital in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analysed in line with the social-ecological model to identify barriers and facilitators. RESULTS: We conducted 23 in-depth interviews with 5 healthcare providers and 18 patients. Health system barriers included long waiting time at the facility, long turnaround time for laboratory results, congestion and lack of privacy affecting counselling, and healthcare provider training gaps. The most important interpersonal barrier among married women was lacking support from male partners. Individual-level barriers were lack of money for transport, fear of painful procedures, emotional distress, and illiteracy. Inadequate and inaccurate information was a cross-cutting barrier across the individual, interpersonal, and community levels of the socio-ecological model. The facilitators were social support, positive self-perception, and patient counselling. CONCLUSIONS: Our study revealed barriers to retention in care after cervical cancer screening, including lack of partner support, financial and educational constraints, and inadequate information. It also found facilitators that included social support, positive self-perception, and effective counselling.

Small-cell neuroendocrine carcinoma of the cervix with leptomeningeal spread: A rare coincidence report and literature review.

Background: Metastasis from cancers of the cervix to the central nervous system is relatively uncommon. Small-cell neuroendocrine cancer of the cervix is a very rare tumor with a high tendency to spread early. Case Description: A 33-year-old-woman was diagnosed with a small-cell neuroendocrine cancer of the cervix after complaining about a long time of post-coital bleeding. The patient was treated with eight cycles of chemotherapy and whole pelvis consolidation radiotherapy. One year later, the patient experienced local recurrence with metastases to the liver, left adrenal, and brain. Brain metastases were treated with radiosurgery. The patient started immunotherapy. Two months later, the patient was presented to the emergency department with urinary incontinence, neck pain, and difficulty walking. She was then diagnosed with craniospinal leptomeningeal disease (LMD). The patient received craniospinal palliative radiation therapy. The disease activity was severely progressive, and the patient passed out within 10 days after being diagnosed with cranial LMD. Conclusion: A high index of suspicion for LMD is essential in patients diagnosed with cervix cancer who present with unexplained neurologic symptoms, especially with the high-grade neuroendocrine cancer type. Implementing robust research to uncover the biology of these aggressive tumors is important due to the rarity of this pathology.

Potential anatomical determinants of retrograde menstruation: a comprehensive narrative review.

A century ago, Sampson identified three uterine anatomical structures that may determine the amount of retrograde menstruation and the likelihood of the development of endometriosis: the cervix, the intramural portion of the fallopian tubes, and the myometrium. Critical appraisal was undertaken of data published over the last 40 years on the potential effect of the characteristics of these three anatomical variables on the risk of endometriosis. There is some evidence to support the pathogenic role of the diameter of the cervical canal, stenosis of internal or external orifices, and stiffness of cervical tissue. One study showed a significant association between the morphology of the intramural tubal tract and the frequency of endometriosis. A large body of evidence points to abnormalities of the myometrial structure as the anatomical aberration most consistently associated with endometriosis. These abnormalities have largely been interpreted as signs of early-onset adenomyosis, which may precede endometriosis and even lead to its development by increasing the amount of retrograde menstruation. Future research should aim to verify whether a positive relationship exists between the substantially increased number of ovulatory menses occurring in the decade following menarche, the development of anatomical myometrial abnormalities, changes in the amount of retrograde menstruation over time, and the risk of endometriosis.

Recommendations for strain elastography of the uterine cervix.

PURPOSE: Conventional vaginal strain ultrasound elastography, not based on shear-wave elastography imaging, can assess the biomechanical properties of the uterine cervix. This assessment may inform the risks of preterm birth and failed induction of labor. However, there is considerable variation in the approaches to strain elastography, including the placement of the region of interest (ROI). Therefore, our aim was to provide recommendations for cervical elastography. METHODS: We conducted a literature review on (1) elastography principles, and (2) the cervical anatomy. Subsequently, we performed elastography scanning using a Voluson™ E10 Expert scanner with the BT18 software of (3) polyacrylamide hydrogel simulators, and (4) pregnant women. RESULTS: Increasing the distance between the ROI and probe led to a decrease in the obtained strain value; a 53% decrease was observed at 17.5 mm. Similarly, an increased angle between the ROI and probe-centerline resulted in a 59% decrease for 40° angle. Interposition of soft tissue (e.g., cervical canal) between the ROI and the probe induced an artifact with values from the posterior lip being 54% lower than those from the anterior lip, even after adjusting for probe-ROI distance. Equipment and the recording conductance significantly influenced the results. CONCLUSION: Our findings inform recommendations for future studies on strain cervical elastography.

Transcriptional profiling of mucus production in rhesus macaque endocervical cells under hormonal regulation.

OBJECTIVE: Endocervical mucus production is a key regulator of fertility throughout the menstrual cycle. With cycle-dependent variability in mucus quality and quantity, cervical mucus can either facilitate or block sperm ascension into the upper female reproductive tract. This study seeks to identify genes involved in the hormonal regulation of mucus production, modification, and regulation through profiling the transcriptome of endocervical cells from the non-human primate, the rhesus macaque (Macaca mulatta). INTERVENTION: We treated differentiated primary endocervical cultures with estradiol (E2) and progesterone (P4) to mimic peri-ovulatory and luteal-phase hormonal changes. Using RNA-sequencing, we identified differential expression of gene pathways and mucus producing and modifying genes in cells treated with E2 compared to hormone-free conditions and E2 compared to E2-primed cells treated with P4. MAIN OUTCOME MEASURES: We pursued differential gene expression analysis on RNA-sequenced cells. Sequence validation was done using qPCR. RESULTS: Our study identified 158 genes that show significant differential expression in E2-only conditions compared to hormone-free control, and 250 genes that show significant differential expression in P4-treated conditions compared to E2-only conditions. From this list, we found hormone-induced changes in transcriptional profiles for genes across several classes of mucus production, including ion channels and enzymes involved in post-translational mucin modification that have not previously been described as hormonally regulated. CONCLUSION: Our study is the first to use an in vitro culture system to create an epithelial-cell specific transcriptome of the endocervix. As a result, our study identifies new genes and pathways altered by sex-steroids in cervical mucus production.

Exploring the Pathological Journey of Superficial Spreading Squamous Cell Carcinoma of the Cervix Into the Endometrium.

The superficial extension of cervical squamous cell carcinoma (SCC) into the endometrium by replacing the endometrial glands is rare, as it normally spreads by invading the stroma or by lymphatic invasion. We present a case of a postmenopausal female complaining of vaginal discharge followed by vaginal bleeding. Microscopy showed a superficial spreading SCC of the cervix extending superficially into the endometrium with focal myometrial invasion. Carcinoma in situ changes were observed in the vagina. Based on the Fluhmann criteria and ancillary immunohistochemical testing, it was concluded to be an extension of cervical SCC and not primary endometrial carcinoma. The importance of this entity has not been given because of its low incidence.

Cisplatin-induced bone marrow failure in an adult patient with Fanconi anemia.

INTRODUCTION: Fanconi anemia (FA) is a genetic disorder characterized by bone marrow failure typically developing in the first decade of life, congenital abnormalities, and an increased predisposition to malignancy. However, patients with FA can remain undiagnosed until adulthood and present with solid organ malignancies. Due to impaired DNA repair mechanisms, patients with FA are highly susceptible to severe bone marrow toxicity when treated with cisplatin. CASE REPORT: A 38-year-old woman, diagnosed with locally advanced squamous cell carcinoma (SCC) of the uterine cervix, underwent treatment with weekly cisplatin concurrent with radiotherapy. After the second week of cisplatin treatment, she presented with severe pancytopenia. The prolonged and severe pancytopenia following cisplatin and radiation, along with cervical SCC in the absence of risk factors and the presence of parental consanguinity, raised the possibility of FA as the underlying cause. Whole exome sequencing revealed a homozygous FANCI c.668A > C (p.Lys223Thr) missense variant confirming the diagnosis of FA. MANAGEMENT AND OUTCOME: The pancytopenia exhibited a protracted course, necessitating admission and supportive treatment with antibiotics, red blood cell and platelet transfusions, as well as filgrastim and eltrombopag. Eventually, the pancytopenia improved after approximately 40 days of hospitalization. DISCUSSION: SCC of the head and neck or gynecologic organs in a young adult without known risk factors should prompt consideration of FA. Cisplatin should be avoided in patients with FA.

Pseudomyxoma Peritonei in a Case of Carcinoma Cervix: Subtle Finding With Implications on Management and Prognosis.

Pseudomyxoma peritonei (PMP) is a well-known entity in gastrointestinal and ovarian tumors of mucinous histology. It has important implications on prognosis depending on whether seen in conjunction with a benign or a malignant tumor. In the current report, we describe a case of PMP in a case of advanced endocervical adenocarcinoma of the cervix which was managed surgically.

Is Hysteroscopic Metroplasty Advisable for U2bC2V1 Malformation?

A complete uterine septum, with a double cervix and vaginal septum, is a complex and rare congenital genital tract anomaly. The diagnosis is difficult and often challenging, requiring complex imaging investigations and diagnostic hysteroscopy. The benefit of hysteroscopic metroplasty for this uterine malformation is still the subject of dispute. However, the potential benefits of obtaining pregnancies and reducing the rate of abortions make this surgical method a desirable one. We present a series of three cases with U2bC2V1 malformation that were diagnosed via magnetic resonance imaging (MRI), in which hysteroscopic removal of the uterine septum and resection of the longitudinal vaginal septum were performed, with the preservation of the two cervixes. All patients became pregnant after the hysteroscopic intervention and reported an improvement in dyspareunia and dysmenorrhea.