Gynecologic Oncology Reports最新文献

{"title":"Exploring T-cell bispecific antibodies in gynecologic malignancy","authors":"Emily O’Brien,&nbsp;Christopher M. Mayer,&nbsp;Rebecca C Arend","doi":"10.1016/j.gore.2025.101772","DOIUrl":"10.1016/j.gore.2025.101772","url":null,"abstract":"<div><div>Gynecologic cancers present a significant challenge to women’s health, necessitating innovative therapeutic strategies due to high relapse rates despite conventional treatments. Immunotherapy, particularly T-cell bispecific antibodies (TCBs), offers a promising approach by redirecting the immune system to target and eliminate tumor cells. TCBs bind simultaneously to tumor-associated antigens and T cells, inducing T-cell activation and tumor cell lysis. While CAR T-cell therapies have shown success in hematologic malignancies, TCBs offer advantages such as being “off-the-shelf” products with lower rates of severe toxicities. This review provides an overview of TCBs in gynecologic malignancies, focusing on their mechanisms of action, preclinical and clinical data, and safety profiles, while also addressing the challenges and future directions. Preclinical data highlight TCBs targeting AXL, MUC1, LYPD1, and MUC16 in ovarian cancer, demonstrating potent antitumor activity. Clinical trials evaluating MUC16-targeted TCBs in ovarian and endometrial cancers are ongoing. The safety profile of TCBs includes risks such as cytokine release syndrome and on-target off-tumor toxicity, which require careful management. TCBs represent a promising immunotherapeutic approach for gynecologic cancers, warranting further investigation to optimize their efficacy and safety.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101772"},"PeriodicalIF":1.2,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated low-grade serous carcinoma arising in inguinal lymph nodes in the setting of endosalpingiosis: A case report","authors":"Samantha A. Solaru ,&nbsp;Marisa C. Liu ,&nbsp;Vincent Lee ,&nbsp;Robert E. Bristow","doi":"10.1016/j.gore.2025.101769","DOIUrl":"10.1016/j.gore.2025.101769","url":null,"abstract":"<div><h3>Introduction</h3><div>Low-grade serous carcinoma (LGSC) is a rare, indolent subtype of epithelial ovarian cancer that often arises from precursor lesions in the ovary or peritoneum and is associated with MAPK pathway mutations. Unlike high-grade serous carcinoma (HGSC), which typically originates from cells in the fallopian tube, LGSC shows limited response to chemotherapy. An isolated presentation in an extraperitoneal site, such as an inguinal lymph node, is exceedingly rare. We present a case of primary nodal LGSC arising in the setting of endosalpingiosis.</div></div><div><h3>Case</h3><div>An 80-year-old woman presented with a two-year history of left lower quadrant pain and a newly enlarging left groin mass. Imaging identified a vascular left inguinal mass, and initial biopsy favored HGSC. Staging procedures including hysteroscopy, dilation and curettage, and diagnostic laparoscopy with bilateral salpingo-oophorectomy showed normal pelvic organs with no evidence of malignancy. Chemotherapy was initiated but resulted in only a modest response. Surgical resection of the mass itself revealed LGSC with adjacent endosalpingiosis. With no evidence of primary disease elsewhere, a diagnosis of primary inguinal node LGSC arising from endosalpingiosis was made.</div></div><div><h3>Conclusion</h3><div>This case highlights the diagnostic challenges of isolated LGSC without a detectable primary site. Initial misclassification can lead to suboptimal management. Accurate diagnosis requires thorough surgical and pathological evaluation to ensure appropriate treatment in these rare and atypical presentations.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101769"},"PeriodicalIF":1.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pemphigoid gestationis associated with gestational trophoblastic neoplasia: A case report","authors":"Jasmine H. Wong ,&nbsp;Udele Tagoe ,&nbsp;Hatice B. Zengin ,&nbsp;Bijal Amin ,&nbsp;Beth N. McLellan ,&nbsp;Matthew Cowan","doi":"10.1016/j.gore.2025.101771","DOIUrl":"10.1016/j.gore.2025.101771","url":null,"abstract":"<div><div>Pemphigoid gestationis (PG) is well described in pregnancy, classically presenting as a pruritic, periumbilical rash in multiparous women in the second or third trimester.</div><div>We describe a unique case of a woman with gestational trophoblastic neoplasia (GTN) status post dilation and curettage on methotrexate (MTX) who presented with a diffuse, pruritic rash. After the rash persisted and flared despite multiple cycles of MTX, biopsies were obtained supporting a diagnosis of PG.</div><div>It is important to consider PG on the differential in non-pregnant patients with GTN with a persistent pruritic rash, even in the setting of ongoing treatment with MTX.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101771"},"PeriodicalIF":1.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient hybrid intracavitary-interstitial brachytherapy for cervical cancer with minimal sedation in a freestanding setting","authors":"Ngoc-Anh Le ,&nbsp;Shyamal Patel ,&nbsp;Kavin Mutyala ,&nbsp;Ayan Issac ,&nbsp;Bhuvi Mamtani ,&nbsp;Lyndsay Willmott","doi":"10.1016/j.gore.2025.101767","DOIUrl":"10.1016/j.gore.2025.101767","url":null,"abstract":"<div><h3>Background</h3><div>Radiation therapy for locally-advanced cervical cancer consists of external beam radiation therapy and brachytherapy. Image-guided brachytherapy and hybrid intracavitary and interstitial brachytherapy treatments (HBT) can potentially improve outcomes; however, current literature describes the procedure requiring significant resources, limiting widespread use. Here is described a single institutional experience with CT-guided interstitial needle placement in a typical freestanding outpatient setting.</div></div><div><h3>Methods</h3><div>All patients that were treated with HBT from June 2018 to May 2020 were included in this series. All tandem, ovoid and needle insertions and high dose rate (HDR) treatments were performed in a freestanding clinic. The patients were treated using minimal sedation (oral lorazepam and oxycodone/acetaminophen). If any vaginal bleeding occurred, vaginal packing was inserted with pressure held. Time stamps and clinical data was collected during each procedure.</div></div><div><h3>Results</h3><div>Sixty-three (63) patients underwent placement of a total of 244 interstitial implants. Two of sixty-three (2/63, 3.2%) patients were unable to tolerate the procedure under minimal sedation and converted to epidural anesthesia. The median time for the entire procedure, from the time of patient entry into the CT room to exit of the HDR treatment room, was 70.0 min (mean 70.3 mins, range 54–100 mins). The median time after tandem and ovoid insertion to complete interstitial needle insertion was 9.0 mins (mean 9.8 mins, range 4–24 mins). Bleeding occurred in 22.1 % (54/244) of implants, which resolved after median 3 (mean 3.33, range 1–8) minutes of vaginal packing with pressure.</div></div><div><h3>Conclusion</h3><div>High-dose-rate, image-guided adaptive hybrid brachytherapy boost with minimal sedation is feasible in the freestanding clinic setting, with a high percentage of patients completing treatment (96.8 %). Twenty-two percent (22.1 %) of patients had vaginal bleeding, all resolved with vaginal packing and pressure. Combining intracavitary and interstitial implants using a hybrid applicator appears to be feasible, efficient and safe in an outpatient freestanding clinic. Further studies are warranted.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101767"},"PeriodicalIF":1.2,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low mitotic count may affect the prognosis of uterine leiomyosarcoma: A report of two cases","authors":"Christine Cho ,&nbsp;Ciara Marshall ,&nbsp;Erik Washburn ,&nbsp;Edward Podczaski ,&nbsp;Joel Sorosky ,&nbsp;Shaina Bruce","doi":"10.1016/j.gore.2025.101766","DOIUrl":"10.1016/j.gore.2025.101766","url":null,"abstract":"<div><h3>Introduction</h3><div>Uterine leiomyosarcoma (uLMS) is characterized by its aggressive nature, early metastatic potential, and poor clinical outcomes. Diagnosis of uLMS requires two out of the following three diagnostic criteria: marked cytologic atypia, 10 mitoses per 10 high power fields, tumor cell necrosis. This case series presents two cases of uLMS with a low mitotic rate and an indolent disease course, with excellent response to hormone therapies.</div></div><div><h3>Case 1</h3><div>A 44-year-old female was diagnosed with uLMS following a supracervical hysterectomy in 2006. The primary tumor demonstrated tumor cell necrosis, cytologic atypic, and 6 mitoses per 10 HPF. Her 18-year disease course is notable for four debulking surgeries and multiple courses of hormonal therapy resulting in durable responses.</div></div><div><h3>Case 2</h3><div>A 75-year-old female was diagnosed with smooth muscle tumor of uncertain malignant potential (STUMP) status post debulking surgery which was revised to leiomyosarcoma following lung biopsy confirmation of metastasis. The primary tumor and lung biopsy demonstrated tumor cell necrosis, cytologic atypia and 2 mitosis per 10 HPF. She demonstrated stable disease on letrozole for 11 months.</div></div><div><h3>Discussion</h3><div>These cases demonstrate that uLMS with low mitotic activity may exhibit less aggressive behavior than typical high-grade sarcomas. Recognizing this distinction can guide prognostication and treatment selection.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101766"},"PeriodicalIF":1.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-line pembrolizumab used concurrently with multi-agent chemotherapy and inhaled tranexamic acid (TXA) for management of stage III mixed trophoblastic tumor complicated by pulmonary hemorrhage","authors":"Rose Emlein ,&nbsp;Marguerite Palisoul ,&nbsp;Heather Einstein ,&nbsp;Amy Brown ,&nbsp;Amanda Ramos ,&nbsp;Jonathan A. Cosin ,&nbsp;Clare Zhou","doi":"10.1016/j.gore.2025.101760","DOIUrl":"10.1016/j.gore.2025.101760","url":null,"abstract":"<div><h3>Introduction</h3><div>We report a case of the use of nebulized TXA and first line pembrolizumab with chemotherapy for treatment of Stage III gestational trophoblastic neoplasia (GTN) in the setting of hemodynamic instability secondary to pulmonary hemorrhage.</div></div><div><h3>Case review</h3><div>The patient is a 44 year old G3P2 with newly diagnosed Stage III intermediate trophoblastic tumor (epithelial trophoblastic tumor and placental site trophoblastic tumor) with known pulmonary metastases. She was admitted for anemia secondary to hemoptysis requiring blood transfusion and expedition of chemotherapy. She received induction etoposide &amp; cisplatin (EP) and was initiated on nebulized tranexamic acid. After two cycles of induction chemotherapy with continued increase in β-hcg levels she was started on pembrolizumab in addition to first-line multi agent chemotherapy with etoposide, methotrexate, actinomycin-D (EMA)-EP. She received six cycles of EMA/EP with pembrolizumab, requiring various dose reductions and delays. β-hcg reached a maximum of 72,316 on cycle 1 day 1 of EMA/EP and normalized after cycle 3. She completed 12 months of maintenance pembrolizumab. Β-hcg has remained undetectable and she has recovered to her pre-diagnosis level of functioning.</div></div><div><h3>Conclusion</h3><div>GTN can be highly vascular and pulmonary metastases can cause life-threatening hemorrhage. Nebulized TXA provides a promising method to stabilize pulmonary hemorrhage in GTN. Pembrolizumab has been previously shown to be effective in recurrent or chemo-resistant GTN. Use in combination with first line therapy in GTN provides a promising option for patients with highly morbid disease, requiring aggressive therapy.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101760"},"PeriodicalIF":1.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low density of intratumoral M1-macrophage infiltration may correlate with worse prognosis in low-grade early-stage uterine endometrioid carcinoma","authors":"Michiko Nagamine ,&nbsp;Hiroshi Ogi ,&nbsp;Maki Hirai ,&nbsp;Ikoi Omatsu ,&nbsp;Sanzo Moriwaki ,&nbsp;Saya Shibata ,&nbsp;Satoru Yasukawa ,&nbsp;Kaori Yoriki ,&nbsp;Motohiro Kojima ,&nbsp;Taisuke Mori ,&nbsp;Kyoko Itoh ,&nbsp;Eiichi Konishi","doi":"10.1016/j.gore.2025.101758","DOIUrl":"10.1016/j.gore.2025.101758","url":null,"abstract":"<div><h3>Objective</h3><div>Low-grade type 1 endometrial carcinoma generally has a favorable prognosis if diagnosed in the early stage. However, a small proportion of the patients experience recurrence, which becomes a significant clinical challenge. Our objective was to explore the differences in tumor immune microenvironment (TIME) between recurrent and cured low-grade early-stage endometrioid carcinoma cases.</div></div><div><h3>Methods</h3><div>We retrospectively examined the TIME in recurrent (n = 11) and non-recurrent (cured, n = 10) cases of low-grade, early-stage endometrioid carcinoma. Cases treated with preoperative or postoperative chemotherapy or radiotherapy were excluded. Multiplex immunohistochemistry was performed on tissue microarrays constructed from formalin-fixed paraffin-embedded tissue blocks of primary surgical specimens and, when available, recurrent lesions. TIME was evaluated by the densities (cell count/mm²) of CD68-positive macrophages, M1 (CD80- or CD86-positive) and M2 (CD206-positive) macrophages, CD15-positive neutrophils, and CD3-positive lymphocytes. Intraluminal areas were evaluated separately. In addition, clusters of foam cells in the stroma were visually examined.</div></div><div><h3>Results</h3><div>Compared with the cured group, the primary tumor of recurrent group demonstrated significantly lower densities of CD68-positive macrophages and M1 macrophage. Moreover, analysis of matched primary versus recurrent lesions in a subset of recurrent cases revealed similar immune cell infiltration profiles, suggesting temporal stability of TIME of recurrent cases. Notably, although foam cell clusters were present in both groups with similar frequencies, M1 macrophages were detected exclusively in the cured group, whereas a small number of M2 macrophages were occasionally present in the recurrent group.</div></div><div><h3>Conclusions</h3><div>These findings underscore the potential prognostic value of an activated, pro-inflammatory immune response in early-stage endometrial carcinoma and warrant further investigation into the mechanisms underlying tumor recurrence.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101758"},"PeriodicalIF":1.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis","authors":"Nikita Sinha ,&nbsp;Olivia D. Lara ,&nbsp;Kimberly Dessources ,&nbsp;Emily P. Jones ,&nbsp;Leslie H Clark ,&nbsp;Russell Broaddus ,&nbsp;Benjamin B. Albright","doi":"10.1016/j.gore.2025.101764","DOIUrl":"10.1016/j.gore.2025.101764","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to describe the discriminatory ability of the Silva pattern-based classification system for invasive endocervical adenocarcinoma (EAC) in predicting risks of lymph node (LN) metastasis, recurrence, and death.</div></div><div><h3>Method</h3><div>We systematically searched PubMed, Scopus, and Embase through 2024 for manuscripts describing patients with EAC by Silva pattern-based classification. We included studies reporting outcomes of LN metastasis, recurrence, or death by Silva pattern. Random-effects <em>meta</em>-analysis was used to summarize binomial proportions and compare outcomes between groups.</div></div><div><h3>Results</h3><div>We identified 19 studies including 2998 patients (20.8 % pattern A, 23.1 % pattern B, 54.1 % pattern C). Silva pattern A cases showed a significantly lower risk of LN metastasis (3/509; 0.6 %) than pattern B (6.1 %; OR = 0.33, 95 %CI 0.16–0.67) or pattern C (22.0 %; OR = 0.09; 95 %CI 0.05–0.16). Across 5 studies limited to stage I disease, there were no Silva pattern A cases with LN metastasis, recurrence, or death. Among 11 studies reporting on recurrence and death, Silva pattern A cases had distinctly low risk of 0.3 % for both outcomes, including a significantly lower risk of recurrence (OR = 0.15, 95 %CI 0.06–0.34) and death (OR = 0.21, 95 %CI 0.09–0.50) versus patterns B/C. Silva pattern B cases showed significantly lower risk of all outcomes compared with pattern C.</div></div><div><h3>Conclusions</h3><div>We demonstrate that Silva classification is highly predictive of oncologic outcomes for EAC, with patterns A, B, and C showing distinct low, intermediate, and high risk profiles. The low risk profile of pattern A may justify future prospective study of surgical and adjuvant treatment de-escalation from the current standard of care, while pattern C cases may warrant consideration of adjuvant treatment escalation.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101764"},"PeriodicalIF":1.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of intrawound vancomycin powder on surgical site infection in inguinal lymph node dissection: a randomized controlled trial pilot study","authors":"Jessica B. DiSilvestro ,&nbsp;Emily Zitek ,&nbsp;Katina Robison ,&nbsp;Jasmine Ebott ,&nbsp;Corinne Jansen ,&nbsp;Katrin Eurich ,&nbsp;Cara Mathews ,&nbsp;Paul DiSilvestro ,&nbsp;Matthew Oliver ,&nbsp;Ashley Stuckey ,&nbsp;Katherine Miller ,&nbsp;Elizabeth Lokich","doi":"10.1016/j.gore.2025.101765","DOIUrl":"10.1016/j.gore.2025.101765","url":null,"abstract":"<div><h3>Background</h3><div>Inguinal lymph node dissections are morbid surgeries with high rates of postoperative wound infections. The primary objective of this pilot study was to assess the feasibility of implementing a randomized controlled trial to assess the impact of intrawound vancomycin powder on postoperative complications after inguinal lymph node dissection in patients with vulvar cancer. Secondary objectives included 1) 30-day composite postoperative complication rate, and 2) adverse effects.</div></div><div><h3>Methods</h3><div>This was a single-site, unblinded randomized controlled trial. Patients with vulvar cancer planning to undergo an inguinal lymph node dissection were randomized 1:1 to receive intrawound vancomycin powder at the time of surgery versus standard of care without vancomycin powder. Descriptive statistics and Chi-square were utilized.</div></div><div><h3>Results</h3><div>Between October 2022 to May 2024, 31 patients met eligibility criteria and 30 patients enrolled (97 % recruitment rate). Three patients did not undergo surgery (90 % retention rate). All patients received their correctly assigned arm and all patients completed the postoperative follow-up (100 % adherence rate).</div><div>One patient in the vancomycin group had a composite postoperative complication (hematoma), while three patients in the control arm had a complication (three inguinal surgical site infections) [8 % vs. 21 %, p = 0.32]. There were no postoperative infections identified in the patients who received intrawound vancomycin powder. No adverse events occurred with the application of vancomycin.</div></div><div><h3>Conclusion</h3><div>This pilot study showed that this was a feasible trial with high recruitment, retention and adherence rates. The data supports proceeding with a larger trial to further elucidate the impact of this low-cost intervention.</div><div>Trial Registration: ClinicalTrials.gov Identifier: NCT05625373.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101765"},"PeriodicalIF":1.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of intravenous leiomyomatosis: a case report illustrating two distinct surgical approaches","authors":"Michal Moshkovich ,&nbsp;Emily Volfson ,&nbsp;Robert J. Cusimano ,&nbsp;Miranda Witheford ,&nbsp;Marcus Q. Bernardini ,&nbsp;Johannes Koen ,&nbsp;Rachel Soyoun Kim","doi":"10.1016/j.gore.2025.101762","DOIUrl":"10.1016/j.gore.2025.101762","url":null,"abstract":"<div><div>Intravenous leiomyomatosis (IVL) is a benign smooth muscle growth originating in the uterus that extends into the lumen of venous or lymphatic vessels beyond the myoma. The tumour may enter the inferior vena cava (IVC) or the heart. For IVL with cardiac involvement, two distinct surgical approaches may be considered. The conventional approach involves concurrent intracardiac tumour resection via sternotomy, and resection of the intrabdominal/pelvic tumour by laparotomy, incision into the IVC, and a hysterectomy. Alternatively, an abdominal-only approach allows complete resection of the cardiac, abdominal, and pelvic portions of the IVL through IVC incision and hysterectomy. Considerations for surgical timing include a single-stage procedure, where all tumour components are addressed in one operation, or two-stage procedures, where cardiac and abdominal/pelvic components are resected in separate operations. Both approaches carry specific risks and benefits for the surgical course and patient recovery. We report two cases of patients presenting with symptomatic IVL. Patient A underwent a single-stage abdominal-only approach, including tumour removal from the IVC and hysterectomy, while Patient B underwent a two-stage surgical course involving initial intracardiac tumour resection via sternotomy, followed by a delayed subsequent abdominal tumour resection. We discuss the clinical decision-making process, benefits, and risks of both approaches, as well as preoperative and postoperative management considerations.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"59 ","pages":"Article 101762"},"PeriodicalIF":1.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}