Intravenous metastasis of unexpected uterine sarcoma in the context of uterine fibroids: case report and literature review.

Objective: Endometrial stromal tumors are rare and complex mesenchymal tumors that often present with clinical symptoms similar to uterine leiomyomas. Due to their atypical nature, they are prone to be misdiagnosed or overlooked by healthcare professionals. This study presents a case report of an incidentally discovered endometrial stromal sarcoma with venous metastasis, which was initially misdiagnosed as a uterine leiomyoma. In addition, this study reviews previously documented cases of similar tumors. Case report: During a routine medical examination in 2016, a 50-year-old woman was diagnosed with uterine fibroids. In June 2020, she began experiencing moderate, irregular vaginal bleeding. Nevertheless, a histopathological examination indicated an endometrial stromal sarcoma with a striking amalgamation of both low-grade and high-grade features. Molecular analysis identified a rare MED12 gene mutation. The patient underwent total hysterectomy, bilateral salpingectomy, and resection of the metastatic lesions. Postoperative management included radiotherapy, chemotherapy, and hormone therapy. After completion of chemotherapy, the patient was followed up for 27 months with no evidence of tumor recurrence. Conclusion: This case report highlights the importance of pathological, immunohistochemical, and molecular aspects of this rare tumor involving the inferior vena cava and showing the presence of atypical gene mutations. The successful treatment outcome further emphasizes the importance of advances in diagnostic modalities for managing rare tumors like this.

Managing Inflammatory Myofibroblastic Tumor of the Uterus: A Case Report and Comprehensive Review of Pathological and Therapeutic Approaches.

BACKGROUND Inflammatory myofibroblastic tumor (IMT) is a rare disease, and uterine IMT is even rarer. IMT is hard to distinguish from endometrial polyp and submucous myoma. The treatment of IMT is still controversial. Here, we report a case of uterine IMT, discussing both pathological and therapeutic aspects. CASE REPORT A 32-year-old woman was admitted to our hospital for a uterine mass, hypermenorrhea, and anemia. She had been suffering from these symptoms for almost a year. Pelvic ultrasound and MRI revealed a mass about 7 cm in diameter at the bottom of the uterus. Serum tumor markers were negative. She was diagnosed with submucous fibroids of the uterus. Then she underwent hysteroscopic mass resection. Histopathological and immunohistochemistry stain analysis revealed IMT of the uterus. Due to the malignant potential of IMT, she was advised to undergo a total hysterectomy, but she refused because she wanted to retain the uterus and fertility. A watch-and-wait strategy without any therapy was chosen, and the patient is currently disease-free after 18-month follow-up. CONCLUSIONS IMT is a disease with malignant potential and may recur at a late stage; hence, a correct diagnosis is essential for patients with IMT. Surgery is the preferred treatment for IMT. For early-stage, young women who want to preserve fertility, conservative surgery is acceptable, but close follow-up is required to avoid recurrence and metastasis. If a patient cannot undergo surgery or the disease has metastasized extensively, targeted therapy for ALK gene, immunotherapy, and other methods can be considered.

Recurrent squamous cell carcinoma arising in ovary mature cystic teratoma: A case report.

RATIONALE: Malignant transformation of mature cystic teratoma is very rare, of which squamous cell carcinoma (SCC) is the most common type. Prognosis of SCC arising in mature cystic teratoma of the ovary is very poor. Our experience may provide new ideas for the treatment of this disease. PATIENT CONCERNS: The patient was a 56-year-old woman and was admitted for a lower abdominal pain. She underwent a laparoscopic surgery with 4 cycles of chemotherapy and had achieved a complete response; 10 months after the completion of initial treatment, her cancer relapsed. She underwent a cytoreductive surgery with concurrent chemoradiotherapy and has achieved a complete response again. DIAGNOSES: This patient was initially diagnosed with ovarian cancer (stage IIIB) arising from malignant transformation of mature teratoma; 10 months after the completion of initial treatment, she was diagnosed with recurrent ovarian cancer. INTERVENTIONS: This patient was initially treated with laparoscopic bilateral salpingo-oophorectomy. After histopathological confirmation that she had ovarian cancer, she underwent laparoscopic total hysterectomy and omentectomy with 4 cycles of chemotherapy. After her ovarian cancer recurred, she underwent open cytoreductive surgery and concurrent chemoradiotherapy. OUTCOMES: The patient achieved complete response after both initial and relapsed treatment. LESSONS: Optimal cytoreduction and concurrent chemoradiotherapy may be an option to improve the prognosis of patients with recurrent SCC arising in ovary mature cystic teratoma.

Association between coffee drinking and endometrial cancer risk: A meta-analysis.

AIM: Coffee drinking is considered as a risk factor of endometrial cancer (EC). Here, we conducted a meta-analysis of observational study to evaluate the relationship between coffee drinking and the risk of EC. METHODS: The MEDLINE and EMBASE databases were searched until July 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: A total of 24 studies (12 case-control and 12 cohort studies) on coffee intake with 9833 incident cases of EC and 699 234 subjects were included in the meta-analysis. The pooled RR of endometrial cancer for the highest versus the lowest categories of coffee intake was 0.71 (95% CI: 0.65-0.77; I2  = 14%, p for heterogeneity = 0.26). By study design, the pooled RRs were 0.68 (95% CI: 0.56-0.83) for case-control studies and 0.70 (95% CI: 0.63-0.77) for cohort studies. For different regions, the pooled RRs were 0.74 (95% CI: 0.62-0.88) in Europe, 0.71 (95% CI: 0.64-0.79) in United States/Canada, and 0.40 (95% CI: 0.28-0.57) in Japan. By additional subgroup analysis, a stronger inverse association was shown in caffeinated coffee drinkers (RR 0.66, 95% CI: 0.52-0.83), individuals with the higher body mass index (BMI) (RR 0.65, 95% CI: 0.54-0.79), never smokers (RR 0.68, 95% CI: 0.56-0.84), ever smokers (RR 0.56, 95% CI: 0.45-0.70), and those who never used hormone replacement therapy (HRT) (RR 0.88, 95% CI: 0.79-0.98). The consumption of filtered or boiled coffee showed no significant association. CONCLUSIONS: Increased coffee intake is associated with a reduced risk of EC.

Biological Characteristics of Cervical Precancerous Cell Proliferation.

High-grade squamous intraepithelial lesions (HSILs) are regarded as precancerous lesions that can progress to cervical carcinoma; however, it is very difficult to effectively differentiate these precancerous cells from cancerous cells based on morphology alone. Additionally, the difference between precancerous cells and cancerous cells in regard to biological behaviour remains unclear. We previously cultured primary normal uterine cervical keratinocytes from human normal cervical tissue and cervical precancerous cells that were naturally infected with human papillomavirus from small-sized neoplastic cervical tissues. Here, we extended our study to further observe the in vitro proliferative characteristics of cervical precancerous cells at the cellular and molecular levels. In this study, we found that the growth rate of precancerous cells was significantly faster than that of normal cervical cells and slower than that of Caski cells. However, the proliferative capacity of such precancerous cells was similar to that of cancerous cells of the cervix at the molecular level. These results suggest that the surrounding environment of the cells may play an important role in the development of cervical cancer, which provides an important basis for the further study of precancerous and cancerous lesions of the cervix.