Pipelle endometrial biopsy has been widely performed as an effective and minimally invasive test for endometrial diseases. However, the effectiveness of pretreatment pipelle endometrial biopsy in the ovarian, fallopian tube, and peritoneal cancers remains unexplored. We performed pretreatment pipelle endometrial biopsy for 90 patients with ovarian, fallopian tube, and primary peritoneal cancers from January 2014 to November 2021. We retrospectively analyzed the association between the results of pipelle endometrial biopsy and clinicopathological data. 25/61 (41.0%) cases with clinical stage II or higher were diagnosed with pipelle endometrial biopsy-positive (Pipelle-positive) and Pipelle-positive was not observed in 29 cases with clinical stage I. Pipelle-positive had significantly more high-grade serous carcinomas, positive peritoneal cytology, positive endometrial cytology, and positive cervical cytology than pipelle endometrial biopsy-negative cases. In 23 Pippele-positive, we confirmed surgical pathology, and 17/23 (74.0%) had a completely same diagnosis with pipelle endometrial biopsy. Conversely, 6/23 (26.0%) showed a minor diagnostic discrepancy between pipelle endometrial biopsy and surgical pathology. Companion diagnostic tests were performed using pipelle endometrial biopsy samples in four primarily inoperable patients and all tests were evaluable. Pipelle endometrial biopsy may allow for prompt histological diagnosis and initiation of chemotherapy while collecting tumor tissue for genetic testing in some advanced cases.
Background There have been several reports of ovarian cancer cells being detected on endometrial cytology. Recently, pipelle endometrial biopsy has been widely performed as an effective, minimally invasive, and low-cost test for endometrial diseases. However, the effectiveness of pretreatment pipelle endometrial biopsy in the ovarian, fallopian tube, and peritoneal cancers remains unexplored. Methods We performed pretreatment pipelle endometrial biopsy for 90 patients with ovarian, fallopian tube, and primary peritoneal cancers from January 2014 to November 2021. We retrospectively analyzed the association between the results of pipelle endometrial biopsy and clinicopathological data. Results 25/61 (41.0%) cases with clinical stage II or higher were diagnosed with pipelle endometrial biopsy-positive (Pipelle-positive) and Pipelle-positive was not observed in 29 cases with clinical stage I. Pipelle-positive had significantly more high-grade serous carcinomas (p = 0.005), positive peritoneal cytology (p < 0.001), positive endometrial cytology (p < 0.001), and positive cervical cytology (p < 0.001) than pipelle endometrial biopsy-negative cases. In 23 Pippele-positive patients, we confirmed surgical pathology, and 17/23 (74.0%) had a completely same diagnosis with pipelle endometrial biopsy. Conversely, 6/23 (26.0%) showed a minor diagnostic discrepancy between pipelle endometrial biopsy and surgical pathology. Companion diagnostic tests (myChoice CDx and microsatellite instability test) were performed using pipelle endometrial biopsy samples in four primarily inoperable high-grade serous carcinoma patients and all tests were evaluable. Conclusion Pipelle endometrial biopsy is useful as a minimally invasive tumor sampling method for some advanced ovarian, fallopian tube, and peritoneal cancers. It may allow for prompt histological diagnosis and initiation of chemotherapy while collecting tumor tissue for genetic testing in primarily inoperable patients.
Levonorgestrel is used worldwide as an emergency oral contraceptive. There have been occasional reports of ectopic pregnancy after oral levonorgestrel use. We present a case of ectopic tubal pregnancy after the use of oral levonorgestrel as an emergency contraceptive in a 37-year-old woman with a history of treatment for Chlamydia trachomatis infection. She conceived after sexual intercourse on menstrual day 14 of the first menstrual cycle following a normal delivery. After salpingectomy for this right tubal pregnancy, her following pregnancy was an ectopic pregnancy in the contralateral tube, which was treated with laparoscopic salpingectomy. Histopathological examination revealed endometriosis. We should be aware of ectopic pregnancy even after emergency contraceptive use, especially in patients with risk factors, such as Chlamydia infection and endometriosis. Because the efficacy of levonorgestrel decreases after ovulation, we should check the stage of the cycle before prescription.
BackgroundSquamous cell carcinoma arising from mature cystic teratoma of the ovary (MCT-SCC) has a poor prognosis at advanced stages. Although the relationship between the homologous recombination deficiency (HRD) status and platinum-based chemotherapy sensitivity or poly (ADP ribose) polymerase (PARP) inhibitor efficacy in epithelial ovarian cancer has been demonstrated in clinical trials, the significance of the HRD status in MCT-SCC remains unclear.Case presentationA 73-year-old woman with no remarkable past medical history was referred to our hospital for a huge left ovarian tumor. Laparotomy was urgently performed due to tumor rupture. We performed total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy. The ovarian tumor was strongly adherent to the surrounding pelvic organs and could not be completely resected. The postoperative diagnosis was stage IIIB MCT-SCC (pT3bNXM0) of the left ovary. After surgery, we conducted the myChoice CDx and microsatellite instability (MSI) tests. The genomic instability (GI) score of 87 was remarkably high, and there was no BRCA1/2 pathogenic mutation. In contrast, the MSI test was negative. After six courses of combination therapy with paclitaxel and carboplatin, the residual tumors had shrunk by 73% (target lesions: 85 mm to 23 mm) and SCC-Antigen levels decreased from 12.8 ng/ml postoperatively to 1.6 ng/ml at the end of the initial course of chemotherapy and remained in the normal range thereafter. We considered the complete removal of residual tumors feasible and performed interval debulking surgery (IDS). We performed residual tumor resection and pelvic and para-aortic lymphadenectomy, and the tumors were completely resected. Subsequently, the patient underwent two courses of the combination of paclitaxel, carboplatin, and bevacizumab, followed by maintenance therapy with olaparib and bevacizumab. Five months after IDS, no recurrence has been observed.Conclusion To the best of our knowledge, this is the first reported case of MCT-SCC with HRD-positive status. Although its frequency is unknown, platinum-based chemotherapy followed by maintenance therapy with oraparib and bevacizumab could be one of the promising treatment options for MCT-SCC.
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