Vaginal stump cytology is a test to detect recurrence in postoperative follow-up management for malignant uterine tumors. We investigated the role of vaginal stump cytology after endometrial cancer surgery. We examined 5,053 vaginal stump cytology tests performed after hysterectomy for 399 endometrial cancers at our center during the ten years from 2011 to 2020, including 344 Stage I, 14 Stage II, 28 Stage III, and 13 Stage IV cancers. The average age of the patients was 60.6 years, and the average observation period was 40 months. Recurrence occurred in 24 cases. The tests that detected recurrence were vaginal stump cytology in 2 patients with Stage III and IV cancers, serum CA125 in 7 patients, and computed tomography (CT) in 15 cases. The efficacy rate of vaginal stump cytology was 8.3%in the relapsed cases. In 399 cases, the cost of detecting recurrence every case was 7,579,500 yen for vaginal stump cytology, 1,001,400 yen for serum CA125, and 1,230,593 yen for CT. The cost of vaginal stump cytology limited to Stage III and IV was 916,500 yen. We concluded that vaginal stump cytology was appropriate for Stage III and IV cases as a screening test after endometrial cancer surgery.

Objective: We investigated the importance of routine cardiac function assessments in patients with doxorubicin-induced cardiotoxicity.

Methods: We studied patients who received doxorubicin plus cisplatin therapy as postoperative adjuvant therapy for endometrial cancer. Echocardiography was performed for routine assessment of cardiac function before initiation of doxorubicin + cisplatin therapy, after 3 cycles, after all cycles, and 6 months after the end of treatment. We retrospectively compared the triggers for diagnosis of cardiotoxicity and ejection fraction changes in patients diagnosed with cardiotoxicity before and after introduction of routine assessments.

Results: Cardiotoxicity was diagnosed in 7/144 (4.9%) of the pre-introduction group and 8/57 (14.0%) of the post-introduction group. The number of asymptomatic cardiotoxicity cases diagnosed from decreased ejection fraction by echocardiography was 2/7 (28.6%) in the pre-introduction group, significantly lower than 7/8 (87.5%) in the post-introduction group (p=0.041). Median ejection fractions after treatment for cardiotoxicity were 38%in the pre-introduction group and 54%in the post-induction group, being significantly higher in the post-induction group (p=0.028).

Conclusions: Our findings suggest that introduction of routine assessments may reduce the number of severe cardiac dysfunction cases due to an increase in asymptomatic diagnosed cases.

The use of immunosuppressive drugs after organ transplantation has increased the incidence of malignant tumors because these drugs can induce carcinogenesis. We report a case of uterine cervical small cell neuroendocrine tumor 2 years after living-donor kidney transplantation. The patient developed multiple distant metastases at places, including liver and pleura, and was diagnosed with stage IVB cervical cancer. Her blood examination revealed severe hyponatremia, indicating neoplastic syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Then, she was immediately treated for SIADH before using chemotherapy. But she died due to kidney failure after rapid progression of cancer before chemotherapy. We also report a relationship between immunosuppressive drugs after organ transplantation and malignant tumors and the importance of human papilloma virus vaccine and examination with a review of literature.

YSTs rarely occur in postmenopausal women, and they often coexist with epithelial ovarian tumor. We report a case of postmenopausal YST, which was difficult to make a histological diagnosis. A 67 years old woman had acute abdominal pain, and she was diagnosed with a ovarian tumor rupture. We performed emergency surgery, and the tumor was pathologically diagnosed as YST stage IC2. We started chemotherapy of the BEP regimen immediately, and the AFP level decreased into normal range by the end of the first cycle. In consideration of her age and the possibility of epithelial tumor origin, we performed detailed immunohistochemistry. The mucinous component which consists of major part of the tumor, was intestinal-type and positive for CDX2, p53. A small solid component where YST was suspected, AFP, SALL4, CDX2 and p53 were positive. She experienced severe bone marrow suppression after 1^st cycle, so we changed the regimen to Paclitaxel and Carboplatin from 2^nd cycle. She had been relapse-free at 17 months postoperatively.

Recently, YSTs in postmenopausal women considered to be somatic YST which is derived from epithelial neoplasm. In postmenopausal YST, we should consider somatic YST in making a diagnosis and choosing a chemotherapy regimen.