Synopsis: Ependymomas arise generally from ependymal cells covering the ventricles and central canal of the spinal cord, but rarely occur outside the central nervous system (CNS). In the field of gynecology, ovarian ependymomas are the most commonly reported, while primary cases of the fallopian tube have not been reported. In this report, we describe a case of primary ependymoma of the left fallopian tube that was discovered accidentally during histopathological examination of a specimen obtained after laparoscopic surgery for uterine adenomyosis and endometriotic cyst. A 42-year-old woman underwent laparoscopic total hysterectomy and bilateral adnexectomy. Histopathology revealed a 9 mm diameter neoplastic lesion with perivascular pseudorosette and ependymal rosette in the lumen of the ampulla of the left fallopian tube. Immunohistochemical staining was positive for GFAP, EMA, CK7, PAX-8, WT1, estrogen and progesterone receptors. S-100, CK20, CD10 and p53 were negative. Based on these findings and the absence of other neoplastic lesions on brain MRI and FDG-PET CT, the diagnosis of primary ependymoma of the fallopian tube was made. The patient has remained disease-free for 11 years. If diagnosis of extra-CNS ependymomas is difficult because they show a variety of histologic structures in addition to the rosette structure, GFAP-positive finding is useful.

Synopsis: We encountered a case of LAMN with appendiceal endometriosis requiring differentiation from an ovarian tumor, ultimately diagnosed through postoperative pathology. The patient, a 43-year-old woman (G1P1), initially presented to a local gastroenterology clinic with constipation and lower abdominal pain. When her symptoms persisted, a contrast-enhanced CT scan suggested a ruptured endometriotic cyst in the right ovary. She was referred to our hospital, where pelvic MRI revealed a suspected ruptured right ovarian tumor, with malignancy difficult to exclude. Blood tests showed an elevated inflammatory response. After antimicrobial treatment, elective laparotomy was performed. Intra-abdominal findings included chocolate-like endometriotic material and ocherous jelly-like ascites. Both adnexa appeared normal, but the appendix was perforated, leading to a suspicion of perforated appendicitis. An appendectomy was performed. Postoperative pathology confirmed the presence of LAMN and appendiceal endometriosis. This case highlights the importance of considering appendiceal mucinous tumors or appendiceal endometriosis in the differential diagnosis when a ruptured ovarian tumor with hemorrhage is suspected.

Synopsis: Lenvatinib plus Pembrolizumab combination therapy (LP) is indicated for patients with advanced or recurrent solid tumors that have progressed after prior chemotherapy. However, this treatment is associated with various treatment-emergent adverse events (TEAEs). We report a case of recurrent endometrial cancer that developed severe immune-related TEAEs after initiating LP therapy, which was successfully controlled by re-challenging with LP.

Case: A 70-year-old woman with endometrioid carcinoma, G1, stage IA. She experienced a recurrence at the vaginal stump and retroperitoneum 11 months post-surgery. Despite undergoing TC therapy, the tumors continued growing and LP was initiated. On day 21 of treatment, grade 4 thrombocytopenia developed, prompting the discontinuation of LP. Remission was achieved with prednisolone (PSL) 40 mg/day, platelet transfusion, and high-dose intravenous immunoglobulin therapy. However, tumor growth was observed during PSL tapering. LP therapy was re-initiated with 10 mg/day of PSL, and the patient has continued LP therapy without PSL, maintaining a partial response with no serious TEAE.

Re-challenging with LP after severe immune-related TEAEs may offer a favorable risk-benefit profile compared to cytotoxic chemotherapy. The effectiveness and safety of re-challenging of LP therapy warrant further investigation through additional case studies.

Synopsis: 【Background】Endometriosis metastasis to pelvic lymph nodes is often observed, but malignant transformation of the same site alone is rare.

【Case】In this case, we experienced a case of endometrial carcinoma (Grade 3) with squamous differentiation in the lymph nodes in a solitary setting without cancerous lesions in the uterus and adnexa, despite staging surgery for suspected ovarian cancer.

Endometriosis was detected in the bilateral adnexa, and CIN3 lesions were found in the cervix, but none of the lesions were considered lymph node conflicting. The patient had a history of transvaginal alcohol fixation of bilateral ovarian endometriosis lesions. It was thought that an intra-abdominal endometriosis lesion may have become malignant in the lymph nodes, and squamous cell transformation may have occurred.

【Conclusion】As there were no malignant findings in uterine ovaries, and the endometriotic lesions metastasized only to the lymph nodes and became malignant, completely replacing the endometrioid carcinoma, we report this case with a discussion of the literature.

Synopsis: Among gynecological malignancies, there have been no reports on primary thyroid malignancies of the uterus. In addition, anaplastic thyroid cancer has a very poor prognosis, the median overall survival is 6.8 months, with no standard treatment having been established. We herein report on a case in which the combination of lenvatinib mesylate and pembrolizumab was effective against recurrent lesions due to uterus primary heterotopic anaplastic thyroid cancer. The case was a 72-year-old female. She visited our department with the chief complaints of frequent urination and urinary urgency, and a pelvic tumor was discovered on the dorsal side of her uterus. As a result, a laparotomy was performed. Hysterectomy and bilateral salpingo-oophorectomy were also performed, thus leading to a histopathological diagnosis of uterus primary heterotopic anaplastic thyroid cancer. Multiple recurrences were soon observed following surgery; however, lenvatinib mesylate proved to be an effective treatment. In addition, because her PD-L1 antibody positivity rate was high, we switched to lenvatinib mesylate and pembrolizumab combination therapy, thus resulting in further therapeutic effects. Subsequently, treatment was continued and a partial response was maintained for 30 months following recurrence. Although uterus primary heterotopic anaplastic thyroid cancer is extremely rare, combination therapy with lenvatinib mesylate and pembrolizumab may be an effective treatment strategy.