BACKGROUND

Primary invasive mucinous epithelial ovarian carcinoma (MOC) is a rare subtype of epithelial ovarian carcinoma (EOC). According to the 2020 World Health Organization (WHO) classification, the invasive patterns of MOC are classified into two categories: Infiltrative and expansile invasion. Studies examining the relationship between expansile and infiltrative primary MOCs are limited. In our local setting, there are no published studies to determine the impact of classifying primary MOCs between the two subtypes to treatment outcomes. This study, therefore, aims to determine the prevalence of primary MOC subtypes, their clinical and demographic characteristics, and clinical outcomes.

This is a retrospective study of patients diagnosed with MOCs for a 5-year period from January 2013 to December 2017 in a public end-referral tertiary hospital. A pathological review was conducted using the 2020 WHO classification to determine the pattern of invasion. Demographic data were obtained and the treatment outcome of infiltrative invasion and expansile invasion of ovarian mucinous carcinoma were compared. Log–rank test was used to determine the overall survival (OS) with the specific type of MOCs.

A total of 29 cases were included in this study wherein 79.3% were expansile MOC type and 20.7% were infiltrative. Most of the patients had International Federation of Gynecology and Obstetrics Stage IA (27.6%). All patients had laparotomy and half of the patients received adjuvant therapy, 47.8% and 50% in expansile and infiltrative type, respectively. The factors associated with overall mortality were MOC type: expansile, hazard ratio (HR) = 0.3, 95% confidence interval (CI) = 0.07–0.91, P = 0.047, and infiltrative, HR = 3.3, 95% CI = 1.1–13.5, P = 0.047. Median OS was significantly higher in patients with expansile compared to infiltrative type (42 vs. 25 months, P = 0.039).

Infiltrative invasion was observed to be a prognostic factor showing worse outcomes for ovarian mucinous carcinoma compared to expansile invasion.

OBJECTIVES

This study aims to determine the prevalence and clinicopathologic characteristics of patients with endometrial serous and clear cell carcinoma in a tertiary referral center in the Philippines. It will identify and review patients’ clinical profiles, tumor characteristics, management approaches, and determine their associations with treatment outcomes.

This 5-year retrospective cross-sectional study reviewed all women diagnosed with serous and clear cell endometrial carcinoma in a tertiary cancer referral center in the Philippines from January 2018 to December 2022. Statistical analysis with univariate and multivariate analysis was done to determine association of clinical and tumor characteristics with treatment outcomes. Odds ratios and f-test were used to determine significant relationships among variables.

One thousand new endometrial cancer cases were identified during the study. Prevalence for serous carcinoma was 6.8% and 3.5% for clear cell carcinoma. Both were commonly encountered in the postmenopausal age, with a mean age of presentation of 62 years. Surgery was performed through open surgery for all cases, and included lymphadenectomy and omentectomy. Adjuvant systemic chemotherapy alone was given for 48.5% of serous cases, and in combination with radiotherapy in 42.86% of clear cell cases. Lymphovascular space invasion was significantly associated with treatment outcome for serous carcinoma while depth of invasion was significant for clear cell carcinoma. Among the cases, 41.8 % of serous and 28.57% of clear cell had extrapelvic metastasis, with omentum and lymph nodes as the the more common sites. Adjuvant chemotherapy and multimodal approach of radiation with external pelvic radiotherapy and vaginal brachytherapy impacted treatment outcome.

High-grade endometrial histologies are less common and tend to have more aggressive and less predictable behavior. Surgery is the mainstay of treatment followed by combination adjuvant therapy. Our study shows that the omentum is a common site of extrapelvic metastasis. This supports the need for omentectomy for both serous and clear cell cases, even in early stages. Prognosis tends to be less favorable and recurrences and distant metastasis may occur even for earlier stages. Thus, it is important to identify any clinical factors that may aid in better counseling and giving tailored management for these patients.

BACKGROUND OF THE STUDY

The treatment for cervical cancer among young women can result in adverse effects that contribute to a negative quality of life (QOL). The literature shows varied studies on the QOL of cervical cancer patients, but evidence on the local context is limited, particularly in young patients.

This study aimed to determine the QOL of young women with cervical cancer treated with concurrent chemoradiation.

A prospective cross-sectional research design was employed. A total of 72 cervical cancer patients who were 40 years old and younger and treated with chemoradiation were recruited using complete enumeration. The study locale was in a tertiary government hospital, which is a training center for gynecologic oncology in the Philippines. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and EORTC QLQ of women with Cervical Cancer (CX24) served as data collection instruments. Descriptive statistics were utilized to describe and synthesize the data.

Seventy-two young women with cervical cancer treated with concurrent chemoradiation reported a mean global health status score of 4.75, indicating a moderate QOL. However, functional domains were generally low, with the lowest scores in cognitive (1.71), social (1.64), and physical interference with social activities (1.96). The average symptom score was 2.10, reflecting moderate symptomatology. On the EORTC QLQ-CX24, most QOL aspects were rated low, except for body image (2.01), menopausal symptoms (2.31), and sexual worry (2.79). Sexual enjoyment scored the lowest at 1.16, with an overall average of 1.71.

The study highlights low-to-moderate QoL among young cervical cancer patients post-chemoradiation, underscoring the need for improved supportive care addressing physical, psychological, and social challenges caused by the disease and treatment modality.

BACKGROUND

Cervical cancer is a common malignancy among Filipino women, treated through surgery, chemotherapy, or radiation. To improve outcomes and reduce costs, the European Society of Gynaecological Oncology (ESGO) established 15 quality indicators for its surgical management. The aim of the study was to evaluate the quality of cervical cancer surgeries at a tertiary government hospital in the Philippines, using ESGO quality indicators.

A descriptive retrospective review was conducted on medical records of early-stage cervical cancer patients who underwent radical surgery from January 1, 2019, to December 31, 2021. Data were collected using ESGO’s 15 quality indicators. Incomplete records were excluded from the study. Descriptive statistics and Kaplan–Meier analysis were used.

Fifty-four patients underwent surgery, averaging 18 cases per year. Most surgeries (75.93%) were supervised by certified gynecologic oncologists, and 85.2% were discussed in multidisciplinary conferences. All patients had appropriate preoperative assessments and metastatic imaging. Pathology reports met the required standards, and lymph node staging was achieved in all cases. Adequate lymph node harvest was 68.18% (pelvic) and 65.91% (paraaortic). Fertility counseling was provided, although none pursued fertility-sparing treatment. Surgical complications included two vesicovaginal fistulas (3.7%). Clear margins were achieved in 92.59%, with 24.30% upstaged postoperatively. Adjuvant chemoradiotherapy rates were highest in 2019 (93.33%). No recurrences were noted for stage IB1 after a median 34-month follow-up.

The surgeries met ESGO quality standards, demonstrating that these indicators can be adapted locally, ensuring quality assurance in care.

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a mesenchymal tumor which lies along the spectrum of smooth muscle neoplasm of the uterus. This type of neoplasm has morphologic features intermediate between the benign leiomyoma and the malignant leiomyosarcoma but is characterized by distinct pathologic findings. STUMPs are rare and standardized treatment for these neoplasms remains to be controversial as its behavior and clinical course is unpredictable and response to various treatments remains to be challenging up to this time. Due to the rarity of these cases, consensus on the standardized treatment on the best surgical approach and adjuvant therapy has not been reached. This study presents a 40-year-old nulligravida who had initial surgical resection of uterine mass but had recurrence of a suprapubic mass with complete treatment of eight cycles of doxorubicin and now presenting with stable disease.

Nongestational ovarian choriocarcinoma (NGOC) is a sporadic and aggressive malignant germ cell tumor, with fewer than 100 cases reported in the literature. We present the case of a 28-year-old woman diagnosed with NGOC, who underwent fertility-sparing surgery and adjuvant bleomycin, etoposide, and cisplatin chemotherapy, followed by a recurrence managed with the second-line chemotherapy and radiotherapy. This report highlights the diagnostic challenges, unique β-human chorionic gonadotropin profile, disease course, and treatment response.

Although commonly seen in the ovary, fallopian tube, peritoneum, and endometrium, the serous carcinoma histology is considered a rare subtype when seen in the cervix. The prevalence of cervical adenocarcinoma, including serous carcinoma, varies between 5% and 15% of all cervical malignancies. A thorough literature study revealed only 113 cases of serous carcinoma of the cervix, highlighting its infrequency relative to other cervical cancer variants. As a subtype of adenocarcinoma, serous carcinoma of the cervix has aggressive characteristics and usually unfavorable prognosis, more so its clinicopathological characteristics are relatively unclear because of its rarity and limited number of cases and reviews seen in literature. This is a case of a 44-year-old G3P3 with a primary complaint of heavy vaginal bleeding. The diagnosis of serous carcinoma of the cervix was made by histopathological evaluation, confirmed by immunostaining. With physical examination and diagnostic imaging confirming an early stage disease, the patient successfully underwent primary surgical management.

Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive soft-tissue sarcoma that commonly presents late in the disease due to its nonspecific symptoms. Due to its rarity, there is still no standardized treatment regimen. A multimodal approach remains to be the cornerstone of treatment-complete cytoreductive surgery, chemotherapy, and radiotherapy. Despite advances in treatment, use of targeted and immunotherapy, an improved survival rate remains to be elusive. This paper presents a case of DSRCT in a 21-year-old Filipino patient as well as a review of the related literature of reported DSRCT cases in females and the emerging therapies for the disease.

Herlyn–Werner–Wunderlich Syndrome (HWWS) is a rare congenital Mullerian duct anomaly, characterized by the presence of an obstructed hemivagina with uterus didelphys and an ipsilateral renal anomaly (OHVIRA). Ovarian serous adenocarcinoma is a type of epithelial ovarian cancer and accounts for about 90% of all ovarian cancers. The incidence of Müllerian duct anomalies associated with ovarian cancer is unknown. Due to its rarity of these conditions, diagnosis and management are challenging. In this paper, we present a case of a 53-year-old, nulligravid woman who presented with an acute abdomen. A transrectal and transabdominal sonography showed an ovarian mass with malignant features. Immediate surgical intervention was performed, and removal of the ovarian mass was done. Intraoperatively, findings of obstructed hemivagina, uterine didelphys, and the absence of one kidney were noted, suggestive of HWWS. Biopsy of the mass revealed borderline serous cystadenocarcinoma of the right ovary.

Embryonal rhabdomyosarcoma of the uterus is a rare condition with only a few cases documented. Exceedingly rare, however, is its concomitant incidence with uterine inversion. The infrequency with which genital tract sarcoma with uterine inversion is encountered makes the diagnosis and management a formidable challenge. The present case reports a 12-year-old nulligravida who complained of a rapidly growing introital mass of 3-month duration. Suspicion of nonpuerperal uterine inversion was confirmed by imaging, and malignancy was proven through adequate tissue sampling. While there is no unified protocol in the management of prolapsed genital tract sarcomas, the complete inversion of the corpus necessitated surgery. In the case presented, exploratory laparotomy and total hysterectomy through a double setup, abdomino-vaginal approach was done. The case illustrates the diagnostic, therapeutic, and ethical dilemmas in handling an aggressive tumor in an adolescent. Early recognition and a multidisciplinary approach are extremely crucial in ensuring improved prognosis and holistic treatment.