Female Genital Research Articles

Prognostic significance of CNNM4 in ovarian cancer: a comprehensive bioinformatics analysis

BackgroundOvarian cancer (OV) is a common malignancy in the female reproductive system, characterized by poor prognosis and high recurrence rates. The discovery of dependable molecular markers is crucial for improving the timeliness of detection, diagnosis, and treatment, ultimately aiming to lower fatality rates. CNNM4 (cyclin and CBS domain divalent metal cation transport mediator 4), a member of the CNNM (Cyclin M) family, binds to PRL (prolactin) to regulate magnesium homeostasis and influence tumor cell proliferation. Although CNNM4 is implicated in various cancers, its role in OV remains unclear.MethodsIn vitro experiments assessed CNNM4 expression and its impact on the proliferation and migration of OV cells. Comparisons of TCGA and GTEx data were used to identify correlations between clinical features and outcomes. The role of CNNM4 in OV was further explored through comprehensive bioinformatics analyses.ResultsElevated levels of CNNM4 expression were observed in OV cells and tissues, and were linked to a poor prognosis. CNNM4 could modulate the proliferation and migration of various OV cell lines, including IOSE-80, SKOV-3, and A2780. Through involvement in multiple signaling pathways, evidenced by GSVA and GSEA, CNNM4 was implicated in OV progression. CNNM4 positively regulated the infiltration level of Macrophages M2, T cells CD4 memory resting and NK cells resting, and had a negative regulation effect on NK cells activated and T cells gamma delta. Moreover, CNNM4 is related to drug sensitivity of OV. A prediction model based on CNNM4 expression and clinical symptoms was constructed to predict OV prognosis.ConclusionCNNM4 may affect the progression of OV and is associated with a poor prognosis. It has potential as a biomarker for predicting survival and as a target for therapeutic interventions in OV patients.

Vaginal Ecological Profile and Characteristic of Vaginal Infection of the Genital Tract of Pregnant Women followed at the Laboratory of the Inter-Army Medical Center Senegal

Introduction: Female genital tract infections are a public health problem. Initial treatment of vaginal infections is most often probabilistic. The benignity of the condition and the safety of topical medications allow for immediate management, even empirical. Hence this study, which aims to evaluate the vaginal microecological profile and vaginal infections in pregnant women followed at the laboratory of the Inter Army Medical Center. Methodology: We carried out a descriptive retrospective study over a period of 8 years, from 2012 to 2020, conducted by the laboratory of the Inter Army Medical Center., on pregnant women. After the collection of sociodemographic data, each woman was subjected to a vaginal swab in accordance with good laboratory practices. A macroscopic and microscopic examination and culture were carried out on each sample. Results: During the study period, 3221 pregnant women were included with an average age of 29.91years. 59.05% of these had normal vaginal cleanliness. 1634 women had type IV flora. The direct examination showed that 210 pregnant women were carriers of Gardnerella vaginalis. The prevalence of Candida albicans and Trichomonas vaginalis infections was 10.90% and 1.06%. There was statistically significant difference of the type of flora, bacterial vaginosis in pregnant women of different age groups. Conclusion: The microecological state of the pregnant women was mostly normal. Low rates of vaginal trichomoniasis infections were found in our study. There was a significant difference between the type of flora and the incidence of bacterial vaginosis in pregnant women of different age groups.

Studies on the Effect of Musa paradisiaca on the Morphology and Microanatomy of Some Female Reproductive Organs of Animal Model

Studies on the Effect of Musa paradisiaca on the Morphology and Microanatomy of Some Female Reproductive Organs of Animal Model

Partially inverted and degloved penile skin mimicking the appearance of female genitalia in cases of deaths caused by trains.

Death by collision with an incoming train is common in countries where a railroad network exists. In such cases, when there is severe pelvic trauma, the penis may be partially degloved and turned inside out. The inverted penile skin may then resemble a vulva and the scrotum may mimic labia majora, causing the injured male genitalia to strongly resemble female genitalia. Forensic pathologists should be aware of this possibility when they are called to such a scene of death and are asked by the police to immediately determine the sex of the victim. In the challenging circumstances of a chaotic on-site railway death investigation, an inexperienced doctor might easily mistake male genitals for female genitals and thus delay correct identification of the victim by the police.

Beyond tumor‑associated macrophages involved in spheroid formation and dissemination: Novel insights for ovarian cancer therapy (Review).

Ovarian cancer (OC) is the most common and deadly malignant tumor of the female reproductive system. When OC cells detach from the primary tumor and enter the ascitic microenvironment, they are present as individual cells or multicellular spheroids in ascites. These spheroids, composed of cancer and non‑malignant cells, are metastatic units and play a crucial role in the progression of OC. However, little is known about the mechanism of spheroid formation and dissemination. Tumor‑associated macrophages (TAMs) in the center of spheroids are key in spheroid formation and metastasis and provide a potential target for OC therapy. The present review summarizes the key biological features of spheroids, focusing on the role of TAMs in spheroid formation, survival and peritoneal metastasis, and the strategies targeting TAMs to provide new insights in treating OC.

Mechanism of Endometrial Receptivity Affected by Fibroids.

Fibroids are the most common benign tumors of the female reproductive system. Most patients with fibroids are asymptomatic, but the presence of fibroids can still cause some abnormal clinical symptoms, such as increased menstrual volume, abnormal uterine bleeding, pelvic pain, urinary tract and gastrointestinal tract compression symptoms, etc. The impact of fibroids on pregnancy is worth discussing. At present, it is believed that submucosal myoma and intramural myoma affecting uterine cavity shape affect the pregnancy outcome of patients, while the impact of type III intramural myoma on pregnancy is still controversial. A number of studies have found that in addition to direct contact with the endometrial compression, uterine myoma also affects the endometrial flexibility through other ways. In this review, we summarized the effects of fibroids on endometrial receptivity and discussed in depth the mechanisms of such effects, including secretion of cytokines, changes in endometrial blood flow and angiogenesis, effects on endometrial peristalsis and mechanical stress conduction, changes in uterine microecological environment, and abnormal signal transduction pathways. Understanding the mechanism of endometrial receptivity affected by fibroids is significant for exploring the treatment of fibroids, improving the pregnancy outcome of patients with fibroids and increasing the clinical pregnancy rate.

GHRH and reproductive systems: Mechanisms, functions, and clinical implications.

Growth hormone-releasing hormone (GHRH) has classically been considered a regulatory neuropeptide of the hypothalamic-pituitary system, which mediates its anabolic effects through hepatic GH/IGF-I axis. However, during the last decades it has been demonstrated that this key regulatory hormone may be produced in numerous peripheral tissues outside the central nervous system, participating in fundamental physiological functions through a complex balance between its purely endocrine action, and the recently local (autocrine/paracrine) discovered role. Among peripheral sites, its presence in the male and female reproductive systems stands out. In this review, we will first explore the role of the GHRH/GHRH-R hormone axis as a central player in the gonadal function; then, we will discuss available information regarding the presence of GHRH/GHRH-R and the potential physiological roles in reproductive systems of various species; and finally, we will address how reproductive system-related disorders-such as infertility problems, endometriosis, or tumor pathologies (including prostate, or ovarian cancer)-could benefit from hormonal interventions related to the manipulation of the GHRH axis.

Health utilities used in oncology cost-utility analyses: a registry-based analysis.

Health utility is a key input used to perform cost-utility analysis (CUA), which is increasingly used to inform resource allocation decisions. To identify the sources and elicitation methods of health utilities used in CUAs in oncology. We used the Tufts Cost-Effectiveness Analysis registry to identify oncology CUAs published in Medline between 1976 and 2021. Eligible CUAs had to include an oncology population (based on ICD-10 codes), report health utilities, and be published in English. The references of cited health utilities were traced to identify the original health utility study and the method of utility elicitation. Characteristic of included CUAs were summarized and the methods to derive health utilities were compared. A total of 1512 CUAs in oncology were identified. The majority of CUAs (n = 1428, 94.4%) were model-based. Malignant neoplasm of breast and female genital organs was the most common population considered (n = 424, 28.0%). Among these CUAs, 8714 health utilities were identified. Upon review, the sources of 2096 (24.1%) health utilities could not be traced. Of the remaining 6618 health utilities, 1718 (26.0%) were obtained from original health utility study embedded in CUA in which expert opinion (n = 547, 31.8%) or EQ-5D (n = 479, 27.9%) was most frequently used. The 4900 health utilities (74.0%) that were cited from external studies were most often derived using the standard gamble (n = 1258, 25.7%) or EQ-5D (n = 1190, 24.3%). Published health utilities are widely used in oncology CUAs, especially for model-based analyses. However, the identification, selection, and use of health utilities is suboptimal.

Cell-Free Supernatant of Vaginal Viridans Streptococcus Induces Membrane Permeabilization and Transcriptional Regulation in Methicillin-Resistant Staphylococcus aureus.

The genus Streptococcus is a heterogenous group of commensal and pathogenic bacteria that are normal inhabitants of the human body, including the female genital tract (FGT). In the FGT microbiome, streptococci represent two major groups: the pathogenic group B Streptococci (GBS) and the commensal viridans group streptococci (VGS). Though members of the VGS are frequently detected from the FGT, their role in the FGT microbiome remains underexplored. Here, we report the characterization of Streptococcus sp. K0074, isolated from the vaginal swab of an endometrial cancer patient admitted to the hospital, with no evidence of bacterial vaginosis. Phylogenetic analysis revealed that the strain is a member of the commensal VGS and possibly represents a novel species in the mitis subgroup. The strain demonstrated the production of low molecular weight bacteriocin-like substance with narrow-spectrum antagonistic activity, affecting the growth, biofilm formation, and colonization of aerobic vaginitis (AV)-causing bacterium methicillin-resistant Staphylococcus aureus (MRSA). The putative bacteriocin exhibited cell membrane-permeabilizing activity and exerted negative regulatory effect on the accessory gene regulator and SaeRS two-component systems of MRSA. Collectively, our results suggest that the isolate may modulate the FGT microbiome by inhibiting or displacing specific pathogen. Furthermore, the results presented here highlight new perspectives regarding the existence of VGS in the FGT microbiome and in particular pinpoint the potential clinical significance of the isolated VGS strain Streptococcus sp. K0074 for the treatment of AV caused by MRSA.

Bushen Jianpi Tiaoxue Decoction (BJTD) ameliorates oxidative stress and apoptosis induced by uterus ageing through activation of the SIRT1/NRF2 pathway

BackgroundUterus ageing is a crucial factor contributing to decreased fertility in older women and is also implicated in menstrual disorders, endometritis, and adenomyosis. Bushen Jianpi Tiaoxue Decoction (BJTD) is a traditional Chinese medicine formulation used to ameliorate endocrine disorders in the female reproductive system and finds extensive application in ageing-related endometrial diseases. However, the mechanisms underlying its improvement of uterus ageing have not been thoroughly investigated. PurposeTo explore the potential components and mechanisms of BJTD in ameliorating uterus ageing through network pharmacology, in vivo, and in vitro experiments. MethodsMorphological changes were observed using hematoxylin and eosin staining, collagen deposition was assessed using Masson staining, and apoptotic-related molecules were detected using Western blot. After determining the modeling doses, BJTD intervention was administered at two doses, and the expression of oxidative stress and apoptosis-related genes and proteins was measured. The levels of cellular apoptosis were evaluated using the TUNEL assay kit and Annexin V/FITC-PI assay kit. The main components of BJTD were determined by UPLC-MS, and the potential targets and mechanisms of BJTD action were explored using network pharmacology and molecular docking. BJTD-Containing Serum (BJTD-S) was extracted and applied in vitro experiments using human endometrial stroma cells (hESC) to preliminarily identify the pathways affected. ResultsWe demonstrated that modeling with 600 mg/kg/day D-Gal for 5 weeks significantly increased collagen deposition in uterine tissues, particularly in the glands and stroma. Additionally, it significantly elevated the levels of TNF-α and IL-1β and increased the expression of p53 and BAX while decreasing BCL-2 expression. BJTD significantly reduced the increased levels of TNF-α and IL-1β induced by D-Gal, and modulated oxidative stress markers such as SOD, MDA, GSH-Px, and T-AOC. BJTD also inhibited the cascade activation of apoptosis induced by D-Gal, suppressing the expression of cleaved-Caspase 8, cleaved-Caspase 3, and BAX. SIRT1 is a potential target of BJTD action. In vitro experiments showed that BJTD-S significantly improved D-Gal-induced apoptosis in hESC cells, and the expression levels of SIRT1, NRF2, and HO-1 were significantly decreased in D-Gal-induced hESC, and BJTD-S significantly increased their expression. ConclusionBJTD can ameliorate oxidative stress and cell apoptosis levels in D-Gal-induced uterine aging, and its active ingredients can activate the SIRT1/NRF2 pathway to exert its effects. Importantly, our study provides novel insights into the molecular mechanisms by which traditional Chinese medicine influence uterus ageing. By specifically targeting the SIRT1/NRF2 pathway, BJTD presents a unique therapeutic approach that has not been extensively explored in previous studies, marking a significant advancement in the treatment of uterus ageing.

The genome of the simultaneously hermaphroditic snail Lymnaea stagnalis reveals an evolutionary expansion of FMRFamide-like receptors

The great pond snail Lymnaea stagnalis has served as a model organism for over a century in diverse disciplines such as neurophysiology, evolution, ecotoxicology and developmental biology. To support both established uses and newly emerging research interests we have performed whole genome sequencing (avg.176 × depth), assembly and annotation of a single individual derived from an inbred line. These efforts resulted in a final assembly of 943 Mb (L50 = 257; N50 = 957,215) with a total of 22,499 predicted gene models. The mitogenome was found to be 13,834 bp long and similarly organized as in other lymnaeid species, with minor differences in location of tRNA genes. As a first step towards understanding the hermaphroditic reproductive biology of L. stagnalis, we identified molecular receptors, specifically nuclear receptors (including newly discovered 2xDNA binding domain-NRs), G protein-coupled receptors, and receptor tyrosine kinases, that may be involved in the cellular specification and maintenance of simultaneously active male and female reproductive systems. A phylogenetic analysis of one particular family of GPCRs (Rhodopsin neuropeptide FMRFamide-receptor-like genes) shows a remarkable expansion that coincides with the occurrence of simultaneous hermaphroditism in the Euthyneura gastropods. As some GPCRs and NRs also showed qualitative differences in expression in female (albumen gland) and male (prostate gland) organs, it is possible that separate regulation of male and female reproductive processes may in part have been enabled by an increased abundance of receptors in the transition from a separate-sexed state to a hermaphroditic condition. These findings will support efforts to pair receptors with their activating ligands, and more generally stimulate deeper insight into the mechanisms that underlie the modes of action of compounds involved in neuroendocrine regulation of reproduction, induced toxicity, and development in L. stagnalis, and molluscs in general.

Pharmacoproteomics reveals energy metabolism pathways as therapeutic targets of ivermectin in ovarian cancer toward 3P medical approaches.

Ovarian cancer is the malignant tumor with the highest mortality rate in the female reproductive system, enormous socio-economic burden, and limited effective drug therapy. There is an urgent need to find novel effective drugs for ovarian cancer therapy. Our previous in vitro studies demonstrate that ivermectin effectively inhibits ovarian cancer cells and affects energy metabolism pathways. This study aims to clarify in vivo mechanisms and therapeutic targets of ivermectin in the treatment of ovarian cancer to establish predictive biomarkers, guide personalized treatments, and improve preventive strategies in the framework of 3P medicine. A TOV-21G tumor-bearing mouse model was constructed based on histopathological data and biochemical parameters. TMT-based proteomic analysis was performed on tumor tissues from the different treatment groups. All significantly differentially abundant proteins were characterized by hierarchical clustering, Gene Ontology (GO) enrichment analyses, and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. In addition, the data were integrated and analyzed with the proteomic data of clinical ovarian cancer tissues from our previous study and the proteomic data of ivermectin intervention in ovarian cancer cells to identify key regulators of ivermectin. Ivermectin (10mg/kg) had a significant anti-ovarian cancer effect in mice, with a tumor inhibitory rate of 61.5%. Molecular changes in tumor tissue of ivermectin-treated mice were established, and protein-protein interaction (PPI) analysis showed that the main differential pathway networks included the TCA cycle, propanoate metabolism, 2-0xocarboxyacid metabolism, and other pathways. Integrating our previous clinical ovarian cancer tissue and cell experimental data, this study found that ivermectin significantly interfered with the energy metabolic pathways of ovarian cancer, including glycolysis, TCA cycle, oxidative phosphorylation, and other related pathways. This study evaluated the anti-ovarian cancer effect in vitro and in vivo, and its specific regulatory effect on energy metabolism. The expressions of drug target molecules in the energy metabolism pathway of ovarian cancer will be used to guide the diagnosis and prevention of ovarian cancer. The significant efficacy of ivermectin will be applied to the treatment of ovarian cancer and personalized medication. This has guiding significance for the clinical diagnosis, treatment, personalized medication, and prognosis evaluation of ovarian cancer. The online version contains supplementary material available at 10.1007/s13167-024-00385-1.

Mesenchymal stem cells and mesenchymal stem cell-derived exosomes: attractive therapeutic approaches for female reproductive dysfunction.

Infertility is a reproductive health problem in the male or female reproductive system. Traditional assisted reproductive technology (ART) has been unable to solve various cases of infertility for years. Clinical researchers have sought to treat infertility using new methods that are more effective and noninvasive than the old methods. Recently, Mesenchymal stem cells (MSCs) and MSCs-derived Exosomes (MSC-Exos) via paracrine activity play an important role in treating various causes of infertility and improving pregnancy outcomes. In this review, we focus on the roles of MSCs and MSC-Exos cell therapy in female infertility in the different types of female reproductive disorders.

MRI-Enhanced metastatic ovarian tumour detection: leveraging enhanced 3D CNN and Data augmentation for exceptional accuracy

ABSTRACT Metastatic Ovarian Tumour remains a challenging medical condition that occurs in the ovaries of female reproductive organs. This severe disease may reduce the life span of the affected person by causing serious effects like imbalanced hormones, improper digestive system, pelvic pain and fertility issues leading to depression. The proposed model employs a 3D CNN architecture, proven effective in image classification tasks, to analyse MRI scans. A few existing approaches have used 2D CNN to detect the tumour, but it is lacking in capturing spatial and temporal features of MRI, which leads to information loss. The MRI-based model achieved an impressive accuracy of 98.6%, showcasing its potential as a valuable tool for early diagnosis. This level of accuracy holds promise for clinical applications, allowing for timely interventions and improved patient life span in cases of ovarian cancer.

The impact of COVID-19 on women's reproductive system.

The coronavirus disease 2019 (COVID-19) pandemic has been a major global focus since 2019. However, drug development and vaccination have been unable to stop the rise in the number of COVID-19 infections. As a result, almost everyone has been infected with COVID-19. As the COVID-19 pandemic nears its end, it is important to explore whether contracting COVID-19 has any irreversible effects on the female reproductive system. This article aims to review the effects of COVID-19 on the female ovary and reproductive system and examine whether these effects are permanent. In conclusion, we can state that COVID-19 has not caused any long-lasting effects on the reproductive health of most women, with the exception of a few cases where premature ovarian failure has been observed. These temporary effects, such as menstrual disturbances and temporary fertility loss, tend to diminish and eventually disappear over time.

Comparative study of the three-dimensional genomes of granulosa cells in germinal vesicle and metaphase II follicles.

Follicle development is a critical process in the female reproductive system, with significant implications for fertility and reproductive health. Germinal vesicle (GV) oocytes are primary oocytes that are arrested in the dictyate stage, also known as the diplotene stage of meiotic prophase I. Metaphase II (MII) is the stage at which the oocyte is typically retrieved for assisted reproductive technologies such as in vitro fertilization (IVF). The granulosa cells play a pivotal role in follicle development processes. 3D chromatin organization is a fundamental aspect of cellular biology that has significant implications for gene regulation and cellular function. In this study, we investigated 3D chromatin organization in granulosacells from GV and MII follicles, which is essential for understanding the regulatory mechanisms governing oocyte development. The results revealed distinct compartmentalization patterns,including stable genomic regions and transitions during oocyte maturation. Notably, there was a significant shift in functional gene activation, particularly in processes related to hormone metabolic pathways. Furthermore, alterations in topologically associating domains (TADs) were observed, with differential expression observed in genes that are involved in crucial biological processes. The analysis also identified a subset of genes with altered promoter-enhancer interactions (PEIs), reflecting a regulatory shift in gene expression related to reproductive processes. These findings provide valuable insights into 3D genome organization in granulosa cells with implications for reproductive health and the development of assisted reproductive technologies. Understanding spatial genome organization at different stages of follicular development may help realize novel strategies for enhancing success rates in assisted reproductive technologies.

Magnetic resonance imaging in the diagnosis of serous adenocarcinoma of fallopian tubes - description of a clinical observation.

Serous adenocarcinoma of the fallopian tubes is an extremely rare and difficult to diagnose form of the female genital tract malignancies. This pathology is often asymptomatic or accompanied by a nonspecific clinical picture, including serosanguineous vaginal discharge, colicky pain in the lower abdomen and pelvis, and adnexal mass. These symptoms are known in the literature as the Lacko triad and are considered pathognomonic for fallopian tube cancer. However, all of these symptoms occur in less than 15% of patients. The low frequency of occurrence and the absence of pathognomonic clinical picture lead to a high number of diagnostic errors, or to the diagnosis of the disease already in a neglected stage, which significantly worsens the prognosis for the patient. The exact diagnosis at the preoperative stage is established in only 4% of cases. This clinical observation describes a case of serous adenocarcinoma of the fallopian tube with all manifestations of the Lacko triad and MR imaging, which allowed us to suspect the presence of serous adenocarcinoma in the patient at the preoperative stage.

The Application of Nano Drug Delivery Systems in Female Upper Genital Tract Disorders.

The prevalence of female reproductive system disorders is increasing, especially among women of reproductive age, significantly impacting their quality of life and overall health. Managing these diseases effectively is challenging due to the complex nature of the female reproductive system, characterized by dynamic physiological environments and intricate anatomical structures. Innovative drug delivery approaches are necessary to facilitate the precise regulation and manipulation of biological tissues. Nanotechnology is increasingly considered to manage reproductive system disorders, for example, nanomaterial imaging allows for early detection and enhances diagnostic precision to determine disease severity and progression. Additionally, nano drug delivery systems are gaining attention for their ability to target the reproductive system successfully, thereby increasing therapeutic efficacy and decreasing side effects. This comprehensive review outlines the anatomy of the female upper genital tract by highlighting the complex mucosal barriers and their impact on systemic and local drug delivery. Advances in nano drug delivery are described for their sustainable therapeutic action and increased biocompatibility to highlight the potential of nano drug delivery strategies in managing female upper genital tract disorders.

Exosomal ncRNAs in reproductive cancers.

Extracellular vesicles, particularly exosomes, play a pivotal role in the cellular mechanisms underlying cancer. This review explores the various functions of exosomes in the progression, growth, and metastasis of cancers affecting the male and female reproductive systems. Exosomes are identified as key mediators in intercellular communication, capable of transferring bioactive molecules such as miRNAs, proteins, and other nucleic acids that influence cancer cell behavior and tumor microenvironment interactions. It has been shown that nc-RNAs transported by exosomes play an important role in tumor growth processes. Significant molecules that may serve as biomarkers in the development and progression of male reproductive cancers include miR-125a-5p, miR-21, miR-375, the miR-371 ~ 373 cluster, and miR-145-5p. For female reproductive cancers, significant miRNAs include miR-26a-5p, miR-148b, miR-205, and miRNA-423-3p. This review highlights the potential of these ncRNAs as biomarkers and prognostics in tumor diagnostics. Understanding the diverse roles of exosomes may hold promise for developing new therapeutic strategies and improving treatment outcomes for cancer patients.

A Rare Collision of Endometrioid Adenocarcinoma and Second Recurrent Low-Grade Endometrial Stromal Sarcoma 8 Years After Hysterectomy: A Case Report and Literature Review

Low grade endometrial stromal sarcoma (LG-ESS) is a rare malignancy of mesenchymal origin in the female reproductive system, which has the characteristic of late recurrence. Endometrial carcinoma is a group of epithelial tumors, and is one of the most common gynecological malignancies among women worldwide. The coexistence of LG-ESS and endometrial carcinoma is extremely rare, and there is no relevant report about the collision of endometrial carcinoma and recurrent LG-ESS currently. In the present study, we report a tumor of recurrent LG-ESS accompanied with endometrioid adenocarcinoma in a young patient 8 years after hysterectomy. She was first diagnosed with LG-ESS at the age of 19 and received fertility-sparing therapy. During the 13-year follow-up period, she successfully delivered and experienced two recurrences of LG-ESS, and an unexpected endometrioid adenocarcinoma component was found in the second recurrent tumor. Adjuvant chemotherapy and endocrine therapy were administrated to the patient after completely removing the tumor, and no sign of disease recurrence or metastasis were found 7 months after the last surgery. This study emphasizes the importance of long-term management of LG-ESS and brings new insights to clinicians and pathologists about collision tumors involving recurrent tumor.