The latest advances in the pharmacological management of endometriosis.

INTRODUCTION: Endometriosis is a benign disease, characterized by a wide range of symptoms and different degrees of severity, which is why therapy should be individually adapted to the patient's needs. Over the years, a lot of research has gone into finding new therapeutic approaches for this enigmatic disease. AREAS COVERED: This review presents the latest advances in pharmacological management of endometriosis and is solely focused on studies published from 2010 to 2021. EXPERT OPINION: Clinicians and researchers are constantly searching for new therapeutic strategies for endometriosis patients. As there are well-established treatments, however, any new medication should fulfill at least one of the three criteria: increased efficacy, comparable efficacy but a better safety profile, or treatments that have a lack of accompanying contraceptive effects that are seen in most endometriosis treatments. While some new substances show promising results, further studies are needed to demonstrate the fulfillment of one of the above-mentioned criteria.

Development of a tool for prediction of ovarian cancer in patients with adnexal masses: Value of plasma fibrinogen.

OBJECTIVE: To develop a tool for individualized risk estimation of presence of cancer in women with adnexal masses, and to assess the added value of plasma fibrinogen. STUDY DESIGN: We performed a retrospective analysis of a prospectively maintained database of 906 patients with adnexal masses who underwent cystectomy or oophorectomy. Uni- and multivariate logistic regression analyses including pre-operative plasma fibrinogen levels and established predictors were performed. A nomogram was generated to predict the probability of ovarian cancer. Internal validation with split-sample analysis was performed. Decision curve analysis (DCA) was then used to evaluate the clinical net benefit of the prediction model. RESULTS: Ovarian cancer including borderline tumours was found in 241 (26.6%) patients. In multivariate analysis, elevated plasma fibrinogen, elevated CA-125, suspicion for malignancy on ultrasound, and postmenopausal status were associated with ovarian cancer and formed the basis for the nomogram. The overall predictive accuracy of the model, as measured by AUC, was 0.91 (95% CI 0.87-0.94). DCA revealed a net benefit for using this model for predicting ovarian cancer presence compared to a strategy of treat all or treat none. CONCLUSION: We confirmed the value of plasma fibrinogen as a strong predictor for ovarian cancer in a large cohort of patients with adnexal masses. We developed a highly accurate multivariable model to help in the clinical decision-making regarding the presence of ovarian cancer. This model provided net benefit for a wide range of threshold probabilities. External validation is needed before a recommendation for its use in routine practice can be given.

Therapy of a clear cell adenocarcinoma of unknown primary arising in the abdominal wall after cesarean section and after hysterectomy.

Clear cell carcinoma arising in a cesarean section scar is extremely rare. Due to the rarity of the tumor, treatment strategies still need to be further elucidated. We report a case of a woman with a clear cell carcinoma of 10 cm outside the abdominal cavity in her cesarean section scar. Staging surgery revealed two lymph nodes with metastatic dissemination of a clear cell adenocarcinoma. After staging surgery, six cycles of adjuvant chemotherapy with carboplatin/paclitaxel were performed. The patient was disease-free 10 months after completion of chemotherapy. Comprehensive treatment consisting of radical surgery combined with adjuvant chemotherapy can be considered for this uncommon tumor entity.