［Objective］Recently, there are several analyses of safety in patients who received short-hydration cisplatin-based chemotherapy. But there are few same analyses in gynecologic cancer. We evaluate safety of short-hydration cisplatin-based chemotherapy in our hospital.

［Methods］Among cases of endometrial cancer in which cisplatin and doxorubicin therapy was performed between January 2017 to December 2020, we compared safety between the short-hydration regimen (SH group) and the usual regimen (non-SH group). Total volume was about 1,500 mL and total hydration time was about 4 hours in SH group. In non-SH group, volume was about 8,000 mL and time was about 20 hours.

［Results］There was no significance between the group in age, serum creatinine, creatinine clearance, regimen dose before treatment. There was no significance in rise of serum creatinine, decline of creatinine clearance, and there were no adverse events over grade 2 in renal and digestive function. 3 cases in SH group received treatment in an outpatient setting.

［Conclusions］Short-hydration cisplatin-based chemotherapy seems to be safety in gynecologic cancer, and it seems to be able to reduce the burden for patients and medical workers because of the shorten of hydration.

Objective: To evaluate the usefulness of geriatric assessment (GA) for elderly gynecological cancer patients. Subjects/methods: The subjects were 148 gynecological cancer patients aged 65 years or older who were scheduled for cancer treatment between July 2020 and June 2021 at the Hokkaido Cancer Center and who gave consent for this study. Before treatment, GA was performed using two tools, Geriatric8 (G8) and mini-COG, and scores were calculated. The primary endpoint was the number of cycles of chemotherapy administered without reducing the standard dose, and the relationship between this and the score was examined. The GA was also performed on subjects who had undergone surgery or radiotherapy, and the characteristics of these patients were also examined. Results］ The G8 scores were 17-14.5 in 62 subjects (41.9%), 11-14 in 59 subjects (39.9%), and 3-10 in 27 subjects (18.3%). The most common mini-COG score was 5 (55.4%), but 23 (15.5%) of the patients had a score of 2 or less, which is considered suspicious for dementia. With regard to the primary endpoint, the success rate of G8 was significantly higher (77.5%, 59.5%, and 25.0%), in descending order from the group with the highest score to the group with the lowest score. The lower score group had a significantly lower success rate than the higher or intermediate group (P＝0.002, P＝0.038). On the other hand, there was no significant difference in the success rate for mini-COG scores. Conclusion: The results suggest that the GA is useful as an indicator of the degree of completion of pharmacotherapy for elderly patients with gynecological cancer.

There have been no reports on the diagnosis and treatment of recurrent small intestinal metastases from malignant melanomas that have transformed from mature cystic teratomas in the ovary. We report a case of partial small intestinal resection and postoperative adjuvant chemotherapy for this disease. The patient was 44 years old and had not yet given birth. She underwent a left adnexectomy for an ovarian tumor and was diagnosed with malignant melanoma upon histopathological examination. Fifteen months after surgery, persistent anemia and a dilated small intestine, as identified on the CT scan, were suspected to indicate a recurrence of small intestinal metastasis; thus, partial resection of the small intestine was performed. A postoperative histopathological examination confirmed the diagnosis of small intestinal metastasis from malignant melanoma. Post-operation, nivolumab was administered for one year, and the patient has been free of recurrence since. The patient was treated in the same way as indicated for cutaneous malignant melanomas, but further studies are needed to confirm the efficacy of this treatment.

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a condition in which excessive antidiuretic hormone secretion accelerates water reabsorption and causes hyponatremia. Possible causes of SIADH include central nervous system disorders, pulmonary disorders, ectopic ADH-producing tumors, and medication. SIADH cases with malignant tumors account for 27.7%of all SIADH cases. We encountered a case of SIADH that developed during chemotherapy for stage IVB cervical cancer where the concomitant use of tolvaptan, a vasopressin V2-receptor antagonist, allowed us to continue chemotherapy, resulting in a partial response. The patient was a 48-year-old woman with a history of two pregnancies and two deliveries. She visited her previous doctor with a chief complaint of irregular genital bleeding and was referred to us with a suspicion of cervical cancer. Cervical histology revealed a diagnosis of endocervical adenocarcinoma, usual type with high-grade neuroendocrine carcinoma. Imaging studies revealed metastases from the pelvis to the para-aortic and mediastinal lymph nodes, liver, lungs, and the fourth cervical vertebra. After starting chemotherapy (Paclitaxel, Cisplatin, and Bevacizumab), hyponatremia with impaired consciousness was observed, and a diagnosis of SIADH was made. Because tolvaptan administration improved hyponatremia, chemotherapy could be continued, and a partial response was obtained. Tolvaptan was effective in treating SIADH that developed during chemotherapy for cervical cancer.

Pembrolizumab for patients with advanced or recurrent solid tumors with high frequency microsatellite instability (MSI-High) that has worsened after cancer chemotherapy has been covered by health insurance since December 2018 in Japan. In this study, 9 of 13 patients with uterine endometrial cancer treated with pembrolizumab achieved a response, and they all maintained a long response of more than 6 months. Five of the nine responders had immune-related adverse events (irAEs). Two patients had serious irAEs that required pembrolizumab discontinuation, but both were appropriately treated, and the patients survived without recurrence for a long period after discontinuation. In addition, three patients with Grade 1 or 2 irAEs resumed treatment and have maintained long-term recurrence-free responses since then. Pembrolizumab tends to have a high response rate and a relatively long period of response, and is considered a useful treatment that can be continued while maintaining the patient's quality of life (QOL). However, severe irAE can significantly impair the quality of life, thus the careful observation of clinical symptoms and laboratory data during treatment and the establishment of a system that allows simple cooperation with specialist departments in the event of an irAE are essential.

Introduction: While nontuberculous mycobacterial (NTM) infection primarily originates in the lungs, gynecologic organ infections are rare. We report an NTM infection in the uterus mimicking cervical cancer with vaginal invasion.

Case: The patient was a 78-year-old woman with previously abnormal genital bleeding was diagnosed with atrophic vaginitis after examinations. The symptoms improved with a low dose of transvaginal estrogen treatment. However, she presented to our hospital five months after the initial diagnosis with recurrent abnormal bleeding, including retention of bloody light discharge. Vaginal examination revealed rigid and painful vaginal tissue and easily bleeding vaginal walls. Therefore, magnetic resonance imaging was performed, and the results revealed a cervical mass with circumferential thickening of the vaginal wall. Cervical cancer with vaginal invasion was suspected. Moreover, subsequent biopsy did not yield a diagnosis of malignancy. Hence, she was diagnosed with uterine NTM infection after NTM culture and DNA-polymerase chain reaction test using vaginal biopsy tissue. She was treated with levofloxacin, rifampicin, and kanamycin, which improved her symptoms.

Conclusions: NTM infection of uterine cervix should be considered in cases where confirmatory tissue diagnosis is not achieved, especially have a NTM history.