Use of platinum-based chemotherapy and pembrolizumab to treat squamous cell carcinoma arising in a mature teratoma of the ovary in a pre-menopausal woman with negative response: A case report.

Squamous cell carcinoma of the ovary (SCC) is a rare and aggressive disease and optimal treatment is unknown. Here we report the case of a 29- year-old woman who presented with abdominal pain and was ultimately found to have a multi-septate, gas containing pelvic mass with mixed fat, soft tissue, and calcified components concerning for a ruptured teratoma with fistulization to the distal ileum and cecum on imaging. Operative findings included a 20 cm pelvic mass arising from the right ovary with frank invasion into the ileum and cecum and dense adhesion to the anterior abdominal wall on surgical exploration. Pathologic specimens were remarkable for stage IIIC SCC of the ovary arising in a mature teratoma, with a tumor proportion score of 40%. She progressed on first line treatment with cisplatin, paclitaxel and pembrolizumab as well as second line treatment with gemcitabine and vinorelbine. She died nine months after her initial diagnosis.

The use of oocyte cryopreservation for fertility preservation in patients with sex chromosome disorders: a case series describing outcomes.

PURPOSE: Characterize outcomes among adolescents and young adults (AYAs) with sex chromosome disorders (SCDs) after oocyte cryopreservation (OC) consultation. METHODS: Retrospective case series of all AYA (< 25 years) patients with SCDs seen for OC consultation from 2011 to 2019 at a large, urban, academic fertility center. All AYA patients with an SCD seen for OC consult in the study time period were reviewed and included. Data collected included patient age, SCD type, number of patients who attempted OC, number of cycles attempted, and cycle outcomes. RESULTS: Twenty-two patients were included: 9 with Turner syndrome, 12 with mosaic Turner syndrome, and 1 with 47,XXX. Mean age at consult was 14.7 ± 3.5 years. Fourteen patients elected for OC: 5 with Turner syndrome, 8 with mosaic Turner syndrome, and 1 47,XXX who pursued 31 OC cycles total. Of those 14 patients, 10 underwent retrieval, 9 froze oocytes, and 8 froze mature (MII) oocytes. Seven patients underwent > 1 cycle and 7 had ≥ 1 cancelation. 3/3 patients who pursued cycles after 1st cancelation never got to retrieval. Age, SCD type, and baseline FSH did not predict ability to freeze MIIs. One patient returned after OC and attempted 4 ovulation induction cycles and 2 IVF cycles; all were canceled for low response. CONCLUSIONS: AYA patients with SCDs have a high risk of poor response and cycle cancelation but the majority froze MIIs. Thus, setting expectations is important. A larger sample size is needed to evaluate possible clinical predictors of success.

The effect of endometrial thickness on live birth outcomes in women undergoing hormone-replaced frozen embryo transfer.

OBJECTIVE: To determine the impact of endometrial thickness on live birth outcomes and obstetric complication rate after hormone-replaced frozen embryo transfer. DESIGN: Retrospective cohort study. SETTING: Large, urban, academic fertility center. PATIENTS: All patients with a singleton live birth after single euploid embryo transfer (by array comparative genomic hybridization or next-generation sequencing) in a hormone-replaced frozen embryo transfer cycle between January 2017 and December 2018 were reviewed. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The primary outcomes were birth weight and obstetric complication rate. RESULTS: A total of 492 patients were included. The median endometrial thickness was 8.60 mm (range, 6.0-20.0). The median gestational age at live birth was 39.4 weeks with a median birth weight of 3,345.2 g. Endometrial thickness was significantly correlated with birth weight. When patients were dichotomized into groups (those with an endometrial thickness of <7 mm and those with an endometrial thickness of >7 mm), neonates born from endometria with a thickness of <7 mm were born earlier (37.3 vs. 39.4 weeks and born with lower birth weights (2,749.9 vs. 3,345.2 g). It should be noted that only seven patients had an endometrium measuring <7 mm. Moreover, 7.1% (n = 35) of patients had an obstetric complication. Endometrial thickness was not significantly associated with obstetric complications, even with adjustments for age and medical history. CONCLUSIONS: Endometrial thickness may be a valuable predictor of placental health and birth weight. Further study is required to examine the relationship with individual obstetric complications, as our study may not have been powered to observe differences in obstetric complication rate, as well as the relationship between endometrial thickness and outcomes in natural frozen embryo transfer cycles.

Assessment of urogenital schistosomiasis knowledge among primary and junior high school students in the Eastern Region of Ghana: A cross-sectional study.

BACKGROUND: Knowledge of urogenital schistosomiasis can empower individuals to limit surface water contact and participate in mass drug administration campaigns, but nothing is currently known about the schistosomiasis knowledge that schoolchildren have in Ghana. We developed and implemented a survey tool aiming to assess the knowledge of urogenital schistosomiasis (treatment, transmission, prevention, symptoms) among science teaches and primary and junior high school students in the Eastern Region of Ghana. METHODS: We developed a 22-question knowledge survey tool and administered it to 875 primary and 938 junior high school students from 74 schools in 37 communities in the Eastern Region of Ghana. Teachers (n = 57) answered 20 questions matched to student questions. We compared knowledge scores (as percent of correct answers) across topics, gender, and class year and assessed associations with teacher's knowledge scores using t-tests, chi-squared tests, univariate, and multivariate linear regression, respectively. RESULTS: Students performed best when asked about symptoms (mean±SD: 76±21% correct) and prevention (mean±SD: 69±25% correct) compared with transmission (mean±SD: 50±15% correct) and treatment (mean±SD: 44±23% correct) (p<0.0005). Teachers performed best on prevention (mean±SD: 93±12% correct, p<0.0005) and poorest on treatment (mean±SD: 69±16% correct, p<0.001). When listing five facts about urogenital schistosomiasis, teachers averaged 2.9±1.2 correct. Multiple regression models suggest that gender, class year, teacher score, and town of residency explain ~27% of variability in student scores. On average, junior high school students outperformed primary school students by 10.2 percentage points (CI95%: 8.6-11.8); boys outperformed girls by 3.5 percentage points (CI95%: 2.3-4.7). CONCLUSIONS: Our survey parsed four components of student and teacher knowledge. We found strong knowledge in several realms, as well as knowledge gaps, especially on transmission and treatment. Addressing relevant gaps among students and science teachers in UGS-endemic areas may help high-risk groups recognize risky water contact activities, improve participation in mass drug administration, and spark interest in science by making it practical.