Synopsis: ［OBJECTIVES］We aimed to investigate the therapeutic benefit of lymphadenectomy［LA］for advanced ovarian clear cell carcinoma［OCCC］with no preoperative and/or intraoperative lymph node enlargement.Key words: Ovarian Neoplasms/surgery, retrospective study, Lymph Node Excision

［METHODS］From 2002 to 2021, we selected patients with newly diagnosed advanced OCCC with no preoperative and/or intraoperative lymph node enlargement. Patients who did not undergo primary surgery, had severe comorbidities, had residual disease after primary surgery, or did not receive postoperative adjuvant chemotherapy were excluded. Overall survival［OS］and recurrence-free survival［RFS］were compared between LA group and no-LA group.

［RESULTS］Sixteen patients met the eligibility criteria for this study. Pelvic and para-aortic LA in 9 cases, and LA was not performed in 7 cases. There were no significant differences in characteristics of the patients between the two groups. The 3-year RFS rate was 55.6% (95%CI 20.4-80.5) in LA group and 57.1% (95%CI 17.2-83.7) in no-LA group (p＝0.78). The 3-year OS rate was 77.8% (95%CI 36.5-93.9) in LA group and 66.7% (95%CI 19.5-90.4) in no-LA group (p＝0.29).

［CONCLUSIONS］LA for patients with advanced OCCC with no preoperative and/or intraoperative lymph node enlargement may not be associated with OS/RFS.

Synopsis: It has been reported that gynecologic organ metastasis from breast cancer is comparatively rare. We report a case in which multiple pelvic metastases of breast cancer occurred simultaneously with endometrial cancer. The 47-year-old woman was referred to our department after initial treatment for invasive lobular carcinoma of the breast. An examination 15 months after starting tamoxifen revealed endometrial thickening on ultrasound, and adenocarcinoma on endometrial cytology. Histological examination by endometrial curettage identified endometrioid carcinoma, however, CT, MRI, and PET-CT led to no findings suggestive of malignancy. We performed total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection for endometrial cancer. Pathological examination showed no cancer in the endometrium, but the metastasis of breast cancer to the uterine serosa, bilateral ovaries, and lymph nodes was noted. She was diagnosed with stage IA endometrial cancer and recurrent breast cancer. Invasive lobular carcinoma often metastasizes to the gynecologic organs and peritoneum, so we should pay close attention to the presence of peritoneal metastasis or metastasis to the uterus or ovaries during gynecological surgery in patients with a history of invasive lobular carcinoma, and if seeding or metastasis is suspected, changing the plan to biopsy or minimally invasive surgery to identify the primary tumor may be an option.Key words: endometrial cancer, metastatic breast cancer, invasive lobular carcinoma, tamoxifen

Synopsis: Peritoneal mesothelioma accounts for approximately 15%of all mesotheliomas and has a poor prognosis with a 5-year survival rate of approximately 20%. Confirming the diagnosis takes time because of clinical symptom nonspecificity and disease rarity. Herein, we reported a case of peritoneal mesothelioma diagnosed after laparoscopic surgery for suspected peritoneal cancer. A 65-year-old female patient with no menstrual expectancies had previously undergone surgery for lung adenocarcinoma. Two years postoperatively, computed tomography revealed ascites effusion and suspected peritoneal seeding, and the patient was referred to our department. The uterus and bilateral adnexa were normal in size, and tumor markers were negative. Fluorodeoxyglucose-positron emission tomography revealed no accumulation, and laparoscopic surgery was performed for diagnosis. The intraoperative results demonstrated a large intraabdominal meshwork mass and numerous nodules in the peritoneum, and rapid intraoperative diagnosis indicated mesothelial hyperplasia. Permanent histopathology revealed epithelial-type peritoneal mesothelioma. The patient was scheduled to be transferred to the oncology department of another hospital to start chemotherapy but is currently under observation at her request. Tissue diagnosis is crucial for the diagnosis of peritoneal mesothelioma, but we confirmed the diagnosis by performing laparoscopic surgery.Key words: peritoneum, laparoscopic surgery, peritoneal mesothelioma

Synopsis: Vaginal cancer is rare and accounts for 1%–2%of all gynecologic malignancies. Here, we report a case of vaginal cancer associated with complete uterine prolapse that was treated with radiation therapy. The patient was aged 81 years, had four pregnancies and two deliveries, and was on dialysis for autosomal dominant polycystic kidney disease.Key words: Pelvic organ prolapse, vaginal cancer, radiation therapy, electron beam

She underwent pessary insertion therapy for uterine prolapse, which was quickly dropped and followed up; 17 months later, a 3 cm and 1 cm tumor was found in the middle and lower third of the vagina and diagnosed as squamous cell carcinoma, primary vaginal cancer stage I (T1N0M0).

Radiotherapy was chosen instead of surgery because of the high risk of damage to other organs caused by renal cysts filling the pelvis and uterine prolapse. A sheet called a "bolus," which has the same properties as human tissue, was placed on the surface of the vaginal wall as a radiation aid to shift the maximum radiation intensity closer to the epidermis, thereby maximizing the radiotherapy effect.

A total of 50 Gy of external radiation was delivered using 9 MeV electron beams, as used for shallow tumors. Treatment was completed without serious complications.