Synopsis: We retrospectively investigated lymphocele appeared after the surgery including lymphadenectomy for gynecologic cancers in Toyama University hospital between January 2012 and February 2021. In 115 patients, 20 (17.4%) cases had lymphoceles. The incidence rate of lymphocele was 12.8%, 22.9%, and 18.9% (cervical cancer, endometrial cancer, and ovarian cancer). Though there was no difference among the cancer types, there was a significant correlation between the incidence of lymphocele and the number of dissected paraaortic lymph nodes, but not other site lymph nodes. Four lymphocele cases (3.5%) needed therapeutic intervention. Two cases with local infection could be cured with antibacterial drug and drainage; meanwhile, lymphoceles in the other 2 cases were improved after lymphoscintigraphy. Case 1 was stage IIIC ovarian cancer, that appeared lymphocele postoperative day 38. Lymphoscintigraphy was performed postoperative day 87, and the lymphoceles were disappeared postoperative day 137. Case 2 was stage II endometrial cancer, that appeared lymphocele postoperative day 14. Lymphoscintigraphy was done postoperative day 35, and the lymphoceles disappeared after two weeks. These suggest that lymphoscintigraphy improves lymphocele induced by lymphadenectomy in gynecologic cancers.

Synopsis: A low-dose regimen of Etoposide and Cisplatin (EP) has been established as an induction chemotherapeutic strategy to reduce the mortality risk of chemotherapy-related mortality in patients with choriocarcinoma or germ cell tumors, especially those in poor general status. An 80-year-old patient consulted her family physician with a complaint of abnormal uterine bleeding. She was referred to the gynecology department at the secondary hospital. With a preoperative diagnosis of uterine sarcoma, she underwent an abdominal hysterectomy and bilateral adnexectomy. Pathological examination revealed ovarian choriocarcinoma, and she was referred to our institution. The residual tumors were rapidly growing. Diagnostic imaging identified a 16 cm tumor with pulmonary and hepatic metastases. Serum hCG levels were high at 502,241 mIU/mL. After twenty-two cycles of low-dose EP, the pelvic mass was surgically removed. The patient has been free from recurrence for two years. Although comprehensive chemotherapy for choriocarcinoma often results in considerable side effects, it remains efficacious for many healthy patients under age 50. The patient was 80 years old and considered to be at high risk for conventional regimens. The continuation of low-dose EP was successful. Therefore, continuing low-dose EP therapy is an alternative for older patients, striking a balance between effectiveness and tolerability.

Synopsis: Undescended ovary (UO) is an uncommon congenital condition. We present a case of ovarian endometrioid carcinoma thought to have developed in an UO. A 49-year-old female underwent surgery for a suspected appendiceal tumor 9 years ago. Intraoperative findings revealed an ovarian tumor in the retroperitoneal cavity, but the surgery was terminated without tumor removal because of the suspicion of anaphylactic shock. Subsequently, MRI suspected an ovarian chocolate cyst, and the patient was followed up for 9 years with dienogest medication. The patient visited our hospital with right lower abdominal pain and fever complaints, and CT scan revealed a mass in the right retroperitoneal cavity. It was diagnosed as ovarian cancer developed within the chocolate cyst, based on the CT and MRI images and elevated tumor marker levels. Because complications of appendicitis were suspected on the basis of CT images, antibiotic therapy was initiated and surgery was performed. The area around the ileum was abscessed and adhered to the tumor. A right hemicolectomy was performed and the region was resected as a lump, considering the tumor invasion. The postoperative pathological diagnosis was stage IA ovarian endometrioid carcinoma. Malignancy in UO is so uncommon that further accumulation of similar cases is desired.

Synopsis: A 67-year-old woman diagnosed with endometrial cancer (pT3aN0M0) was treated with surgery and adjuvant chemotherapy (paclitaxel plus carboplatin). Four years and two months later, computed tomography (CT) scans revealed bone and lung metastases, leading to a new course of chemotherapy (paclitaxel plus carboplatin). Bone recurrence was identified 5 years and 1 month after surgery. A genetic examination revealed a tumor status with high microsatellite instability. A complete response was achieved with pembrolizumab treatment. Twenty-five months later, a blood test revealed elevated levels of cancer antigen 19-9 (CA19-9) and glycated hemoglobin, while CT demonstrated an enlarged pancreas. Despite having imaging and pathologic results that were indicative of autoimmune pancreatitis, gastroenterologists ultimately diagnosed her with pancreatitis induced by pembrolizumab. After she discontinued pembrolizumab, serum CA19-9 levels normalized and subsequent CT scans displayed a reduction in pancreas size. No recurrence of pancreatitis and adverse event was observed 3 years and 4 months after pembrolizumab treatment. This case suggests that pancreatitis, which resembles autoimmune pancreatitis was induced by pembrolizumab treatment, necessitating collaborative management by all departments. Attention should be paid to immune-related adverse events following long-term treatment with pembrolizumab.

Synopsis: The medical insurance coverage in Japan for radiofrequency ablation (RFA) has been extended since September 2022. We are reporting a case of long-term survival following surgery and RFA for oligometastatic lung tumor originating from uterine cancer.Key words: body of the uterus, radiofrequency ablation, endometrial cancer, clear cell carcinoma, oligometastatic lung tumor

The patient was a 64-year-old woman who underwent hysterectomy, adnexectomy, and lymph node dissection. The postoperative diagnosis revealed clear cell carcinoma at stage IIIC1. Following postoperative chemotherapy, multiple recurrent tumors were detected in the lungs, and the patient underwent surgery and RFA. Subsequently, a metastasis in the S6 segment of the right lung appeared, leading to another RFA procedure. As the hilar and mediastinal lymph nodes enlarged, the patient underwent a S6 segmentectomy, superior mediastinal lymph node dissection, and right hilar lymphadenectomy, including the area that had previously undergone RFA. Histopathological examination confirmed lymph node metastasis, but RFA showed the complete disappearance of the S6 tumor. Since then, the patient has survived for approximately 10 years since the initial diagnosis.

RFA, as a local therapy, is considered to yield excellent results in the treatment of metastatic lung tumors, making it a promising new treatment option.