Clinicopathological features and programmed death-ligand 1 immunohistochemical expression in a multicenter cohort of uterine and ovarian melanomas: a retrospective study in Japan (KCOG-G1701s).

The objective of this study was to propose prognostic factors and optimal treatment strategies by analyzing the clinicopathological features and programmed death-ligand 1 (PD-L1) expression. We analyzed 31 patients diagnosed with uterine or ovarian melanoma between 1997 and 2017 in the Kansai Clinical Oncology Group/Intergroup. Twenty-four and seven patients with cervical and ovarian melanomas were included, respectively. Immune checkpoint inhibitors were used in seven patients, and the objective response rate was 40%. Notably, two patients with objective responses had a high PD-L1 expression. Ten and four patients with cervical and ovarian melanomas, respectively, had high PD-L1 immunohistochemical expressions. Multivariate analysis revealed that tumor stage was an independent prognostic factor for progression-free survival in patients with cervical melanomas. In patients with ovarian melanomas, the 1-year cumulative progression-free and overall survival rates were 0 and 29%, respectively. Kaplan-Meier analyses revealed that age <60 years was associated with poorer progression-free and overall survivals in patients with ovarian melanomas. In patients with cervical melanomas, the 1-, 3-, and 5-year cumulative overall survival rates were 53, 32, and 16%, respectively. Histological atypia was associated with a poorer progression-free survival, but there was no difference in survival between patients who underwent radical hysterectomy and those who did not. The present study is a large cohort study of uterine and ovarian melanomas, which are aggressive tumors with a significantly poor prognosis, even after standard surgery and adjuvant therapy. The use of immune checkpoint inhibitors is a promising and effective treatment option.

Transvaginal ultrasonography and endometrial cytology as a diagnostic schema for endometrial cancer.

OBJECTIVE: To determine whether the combined use of transvaginal ultrasonography and endometrial cytology is an effective diagnostic schema for endometrial cancer and hyperplasia of the uterus. METHODS: Five hundred fifty-two women were enrolled in this study. For all subjects, endometrial thickness was evaluated by transvaginal ultrasonography. Endometrial cytology was carried out according to the following criteria: all women with atypical uterine bleeding, for asymptomatic postmenopausal women with endometrial thickness >or=5 mm, and for asymptomatic premenopausal women with endometrial thickness >or=20 mm. When the cytological findings were abnormal, we performed a hysteroscopy-guided biopsy within 2 weeks. Women who received transvaginal ultrasonography alone, or those who showed negative cytology, underwent repeated gynecological examination and transvaginal ultrasonography 3, 6, and 12 months after the first examination. RESULTS: Endometrial cytology was done on 129 women (23.4% of all subjects), of whom 14 were diagnosed as 'positive' cytology, 20 as 'suspicious positive', and 95 as 'negative'. A total of 34 women with 'positive' or 'suspicious positive' cytological result underwent hysteroscopy-guided endometrial biopsy. The histological diagnosis of the endometrium included 13 endometrial cancers, 9 endometrial hyperplasias (one atypical hyperplasia and 3 hyperplastic polyps), and 10 normal endometria. As a diagnostic schema for endometrial cancer, this combined method resulted in 100% sensitivity, 99.1% specificity, 92.9% positive predictive value, and 100% negative predictive value. For endometrial hyperplasia, the method resulted in 100% sensitivity, 89.6% specificity, 40.0% positive predictive value, and 100% negative predictive value. CONCLUSION: A combination of transvaginal ultrasonography and endometrial cytology may be an effective diagnostic schema for endometrial cancer and hyperplasia.