Highlights Delayed treatment & diagnosis of ovarian torsion may cause pregnancy termination. Optimal management for these patients remains unstandardized. No consensus exists regarding the appropriate surgical approach. A 40-year-old pregnant female presented to us with ovarian torsion and OHSS. She was successfully treated with laparoscopic detorsion.

Background Serous endometrial intraepithelial carcinoma (SEIC) is now considered to represent an early stage of uterine serous carcinoma (USC). It is an intraepithelial lesion but has been reported to cause extrauterine metastases. We report a case of SEIC with serous ovarian carcinoma and lymph node metastasis. Case presentation A 57-year-old post-menopausal woman (gravida 3, para 2, SA1) was referred to our hospital with lower abdominal pain. An ultrasound and MRI showed that the ovary had swollen to 8 cm in size and had a solid lesion. The uterus was normal. The patient underwent exploratory laparoscopy on the suspicion of torsion of the ovarian tumor. Intraoperative findings showed a right ovarian tumor, but no ovarian tumor torsion was observed. A small amount of bloody ascites was found in the Douglas fossa, and bleeding was observed from the tumor itself. A right salpingo-oophorectomy was then performed. Histopathological results revealed a high-grade serous carcinoma. Forty days after the first surgery, we performed a staging laparotomy: a total abdominal hysterectomy, left salpingo-oophorectomy, systematic pelvic and paraaortic lymphadenectomy, and a partial omentectomy. A complete cytoreduction was achieved. In the pathological examination, the invasion of the serous carcinoma was observed in the left ovarian ligament, and lymph node metastasis was found in the paraaortic lymph nodes. Atypical columnar cells formed irregular papillary lesions which had proliferated in the endometrium, and this was diagnosed as SEIC. The final diagnosis was serous ovarian cancer, FIGO stage IIIA1(ii), pT2bN1M0, with SEIC. Conclusion We report a case of SEIC with synchronous serous carcinoma of the adnexa uteri. Both were serous carcinomas and, thus, it was difficult to identify the primary lesion. The distinction between metastatic cancer and two independent primary tumors is important for an accurate diagnosis and tumor staging. Histological diagnostic criteria remain controversial, and further development of a method for differentiating between both diseases is required.

Approximately 1,700 cases of renal transplantation are performed annually, and various diseases may occur due to longterm internal use of postoperative immunosuppressants. We experienced a case of cervical cancer, which is thought to be human papillomavirus (HPV)-related after a living kidney transplantation, underwent laparoscopic radical hysterectomy.A 42-year-old woman underwent living kidney transplantation at the age of 30 years. An increase of CA19-9 was recognized during the follow-up after transplantation. Cervical cytology detected squamous cell carcinoma (SCC); therefore the case was referred to our department. A diagnostic cone resection was performed, and a laparoscopic radical hysterectomy under the diagnosis of cervical cancer stage IB1, was performed. Luminescent ureter catheters were placed on both sides of the ureter, and a DJ stent was placed in the transplant ureter. The right post-peritoneal cavity was difficult to develop due to adhesion. On the left side, radical hysterectomy and pelvic lymph node dissection were performed (pT1bN0M0). Vulvar intra-epithelial neoplasia 3 (VIN3) developed 12 months after the operation and was removed.Following a renal transplantation procedure, close monitoring of the transplanted kidney and transplant ureter is required. Laparoscopic surgery and navigation with a luminescent ureteral catheter are useful methods for avoiding perioperative complications. In addition, in HPV-related cervical cancer, which is considered to be the effect of immunosuppressants, attention should be paid to other new lesions, and careful follow-up is important.

BackgroundSerous endometrial intraepithelial carcinoma (SEIC) is now considered to represent an early stage of uterine serous carcinoma (USC). It is an intraepithelial lesion but has been reported to cause extrauterine metastases. We report a case of SEIC with serous ovarian carcinoma and lymph node metastasis.Case presentationA 57-year-old post-menopausal woman (gravida 3, para 2, SA1) was referred to our hospital with lower abdominal pain. An ultrasound and MRI showed that the ovary had swollen to 8 cm in size and had a solid lesion. The uterus was normal. The patient underwent exploratory laparoscopy on the suspicion of torsion of the ovarian tumor. Intraoperative findings showed a right ovarian tumor, but no ovarian tumor torsion was observed. A small amount of bloody ascites was found in the Douglas fossa, and bleeding was observed from the tumor itself. A right salpingo-oophorectomy was then performed. Histopathological results revealed a high-grade serous carcinoma. Forty days after the first surgery, we performed a staging laparotomy: a total abdominal hysterectomy, left salpingo-oophorectomy, systematic pelvic and paraaortic lymphadenectomy, and a partial omentectomy. A complete cytoreduction was achieved. In the pathological examination, the invasion of the serous carcinoma was observed in the left ovarian ligament, and lymph node metastasis was found in the paraaortic lymph nodes. Atypical columnar cells formed irregular papillary lesions which had proliferated in the endometrium, and this was diagnosed as SEIC. The final diagnosis was serous ovarian cancer, FIGO stage ⅢA1(ⅱ), pT2bN1M0, with SEIC. ConclusionWe report a case of SEIC with synchronous serous carcinoma of the adnexa uteri. Both were serous carcinomas and, thus, it was difficult to identify the primary lesion. The distinction between metastatic cancer and two independent primary tumors is important for an accurate diagnosis and tumor staging. Histological diagnostic criteria remain controversial, and further development of a method for differentiating between both diseases is required.