Tumors In Young Women Research Articles

SMARCA4-deficient uterine tumors in young women: response to immune checkpoint inhibitors.

The online version contains supplementary material available at 10.1007/s13691-024-00721-2.

Radiation-Induced Breast Angiosarcoma Associated with Homolateral Axillary Recurrence: A Case Report

Breast angiosarcoma is a rare aggressive tumor that develops from connective tissue of vascular origin with a tendency towards rapid recurrence and the appearance of visceral metastases. It occurs either as a primary tumor in young women or as a secondary tumor following breast irradiation. We report a case of breast angiosarcoma associated with homolateral axillary recurrence in a 45-year-old woman treated for bilateral breast cancer.

Black adenoma a rare tumor of the adrenal glands: case report and systematic review

Introduction: black adrenal adenomas (ASNs) are tumors of the adrenal cortex with black or dark brown pigment. They are made of lipofuscin, it is a rare tumor and there are only case series and reports in the literature. Material and methods: a detailed systematic review was carried out following the PRISMA guide, of a total of 231 articles submitted to screening, 38 patients can be included. Results: the mean age of presentation was 46.47 years, with a predominance of females in 76.3% of the patients, with no predilection for laterality of the affected adrenal, with a mean size of 2.9cm, 89.5% were hypersecretors, the Cushing's disease occurred in 76.5% of patients, 7.9% of patients had a pheochromocytoma, and 13.2% of patients had primary hyperaldosteronism. Discussion: ASN is a rare tumor that presents clinically as a hormone-producing tumor in young women, or in other cases, in a tomography as an incidentaloma, with tomographic characteristics that suspect malignant pathology, for which surgical treatment is granted.

Breast cancer recurrence rate after mastectomy in young females.

e12591 Background: Breast cancer is the most commonly diagnosed female cancer worldwide and the most common cause of cancer mortality in women. Surgical treatment of early breast cancer includes lumpectomy or mastectomy with or without reconstruction. Despite the surgeon’s best effort to perform a radical resection of the breast tissue during mastectomy to achieve locoregional control, residual fibroglandular tissue was found in 20% of breasts on postoperative breast MRI, which carries a risk of recurrence. Younger women with breast cancer have inferior survival rates despite receiving more aggressive therapy. Tumors in young women are more likely to be poorly differentiated, hormone receptor-negative, have a high proliferation index, and more lymphovascular invasion, which is partially explained by patients’ genetic profile. Another factor that could contribute to poor outcomes is the advanced stage at the time of diagnosis, including larger tumor size and higher rates of axillary lymph node positivity. This knowledge has motivated us to conduct this study that is dedicated to looking at the recurrence rate in young females following mastectomy. Methods: This is a retrospective study that collected data from young female patients who were diagnosed with breast cancer between January 2010 and August 2018, had an age at diagnosis of 18-45 years old, and underwent unilateral or bilateral mastectomy with or without reconstruction. The study also looked at the patient’s risk factors and genetic profile. Results: A total of 115 patients were diagnosed with early-stage breast cancer between January 2010 and August 2018 and underwent mastectomy. 81.74% were Caucasian females, and 8.7% were African American females. The mean age of diagnosis was 36.9 years. The mean BMI was 30.5 kg/m2. 59.13% of patients had a family history of breast cancer. The most common genetic mutations were BRCA1 at 7.83% and BRCA2 at 8.7%. 71% of patients underwent a bilateral mastectomy. 76% of patients had reconstruction. 77% of tumors were ER-positive, 68% PR-positive, and 26% HER2-positive. 49.4% of tumors were Nottingham grade 3. 52% of patients had no nodal involvement, while 35% had N1 disease. 34.6% had lymphovascular invasion. We found that 18/115 patients had recurrence of breast cancer following mastectomy. 5/17 patients had locoregional recurrence, while 12/17 patients had a distant recurrence; 1 patient’s recurrence data was unavailable. The median time to recurrence was 1147.5 days (335 to 3107). The 5-year recurrence free survival rate is 86% ± 3%. Conclusions: Our study found that 15.65% of young females had recurrence after mastectomy. To our knowledge, this is the first dedicated study to look at the recurrence rate after mastectomy in this young, high-risk patient population. Our study aims to encourage larger studies in young females with breast cancer to help tailor the treatment plan in this population.

Krukenberg Tumors in Young Women: Computed Tomography and Magnetic Resonance Imaging Diagnosis.

The purpose of this report was to present the computed tomography (CT) and magnetic resonance imaging (MRI) features of Krukenberg tumors and to review the pertinent clinical data about the rising incidence of this malignancy among young women. This series included 8 women who ranged in age from 24 to 44 years (mean, 36.3 years). They were diagnosed to have Krukenberg tumors during a 5-year period (2011-2016). All patients were evaluated by abdominal CT and pelvic or transvaginal sonography. Five of them also had MRI of the abdomen, and 3 had positron emission tomography scans. The primary cancer was located in the stomach of 7 patients and in the colon in 1. The initial presentation was due to large pelvic mass and abdominal distention by ascites in 3 patients, gastrointestinal symptoms in 4, and small bowel obstruction by carcinoma of the ascending colon in 1 woman. Ovarian metastases were demonstrated on the initial imaging examination of 5 patients and developed as metachronous lesion during follow-up in 3 cases. Six women died 3 to 23 months (mean, 11 months) after the diagnosis. One has survived for 6 years after extensive surgery, and 1 was lost to follow-up. Krukenberg tumors are being diagnosed with an increasing frequency because of well-documented rising incidence of gastric and colorectal carcinomas among young women. Therefore, those presenting with gastrointestinal cancer should have careful imaging of their ovaries for possible metastases, and conversely, the clinical or sonographic detection of bilateral ovarian masses would require evaluation by CT or MRI of the abdomen in search for a potential primary gastrointestinal cancer. This report highlights the CT and MRI features of this neoplastic process and reviews the current concepts about its development and management.

Estrogen receptor-positive breast cancer and adverse outcome in BRCA2 mutation carriers and young non-carrier patients

Estrogen receptor-positive (ER+) breast cancer generally confers a more favorable prognosis than ER-negative cancer, however, a different picture is emerging for BRCA2 mutation carriers and young patients. We used nationwide data from population-based registries to study prognostic effects in those two groups. Of all 2817 eligible women diagnosed with breast cancer in Iceland during 1980–2004, 85% had been tested for the Icelandic 999del5 BRCA2 (c.771_775delTCAAA) founder pathogenic variant. We compared breast cancer-specific survival, effects of ER status, other clinical parameters, and treatment, between three mutually exclusive groups: BRCA2-carriers, non-carriers diagnosed 40 years or younger, and older non-carriers. Prevalence of the BRCA2 mutation among tested patients <=40 years of age was 21.0%, but it was 5.4% among women diagnosed >40 years of age. For ER+ cancer, breast cancer-specific 15-year survival was 49.7%, 55.2%, and 74.7%, among BRCA2-carriers, young and older non-carriers, respectively, whereas for ER-negative cancer, survival was similar (64.0–69.3%) for all three groups. Neither BRCA2 carriers nor young non-carriers did tumor grade 3 predict worse survival than did tumor grade 1. The adverse outcome for the young cases cannot be explained by BRCA2 mutations, as carriers were excluded from the group. Those two clinically important patient groups need special attention with respect to treatment choices, in particular, if diagnosed with ER+ tumors. It is thus advisable to have knowledge of BRCA2 status when treatment decisions are made. Finally, it is important to understand the biological basis for the specific nature of ER+ tumors in young women and BRCA2 carriers.

Fertility Preservation in the Female Tumor Patients

As we all know, the prevalence of tumors is increasing, and with the development of medical examination and treatment methods, the detection rate and cure rate of tumors in young women are gradually increasing, and many patients still want to realize their dream of parenthood after realizing the basic survival need of "saving life". However, the progression of the disease itself and treatment methods such as radiotherapy and chemotherapy will cause irreversible damage to the fertility of patients, so it is particularly important for these patients to preserve fertility as soon as possible. Fertility preservation is in the ascendant in China, and tumor patients are one of its main indications. In recent years, the technology has made significant progress, the current mature technology includes ovarian tissue cryopreservation and transfer, egg and embryo freezing, etc., due to the lack of understanding and application of specific programs by doctors, many patients miss the opportunity of fertility preservation, in order to provide patients with more scientific fertility preservation programs, this paper combines the fertility preservation related research of female tumor patients at home and abroad in recent years, and reviews the current fertility preservation programs and progress of female tumor patients.

Mature Cystic Teratoma: An Integrated Review.

Ovarian dermoid cysts, also called mature cystic teratomas (MCTs), account for 69% of ovarian germ cell tumors in young women. The tumors are formed by tissues derived from three germ layers, and sebaceous materials are most commonly seen. The origin of MCTs is widely considered to be the germ cell origin, which completes meiosis I. The clinical symptoms vary widely, but 20% of tumors could be asymptomatic. The diagnosis of MCTs is usually made without difficulty by ultrasound and confirmed by histopathology post-operatively. The imaging findings have a high diagnostic value. The typical characteristics present in the sonographic images, including a dermoid plug or Rokitansky nodule, are considered strong evidence for a teratoma. Although the malignant transformation of MCTs is rare, it can occur in some cases, especially in women of advanced age. The treatment of MCTs depends on the risk of malignancy, the age of the patient, and the patient's fertility reserve requirement. In this article, we review the epidemiology, clinical symptoms, diagnosis criteria, cellular origin, and treatment of mature cystic teratomas.

Immunohistochemical profiling of the tumour microenvironment in borderline and malignant ovarian tumours in young women.

Ovarian cancer is a major cause of cancer-related deaths in women. Our previous study highlighted the interaction between cancer cells and the host immune response in solid cancers. The present study aimed to analyse the proportion, density and distribution of T and B lymphocytes within the tumour and surrounding stroma, and their prognostic significance in young women with borderline and malignant ovarian surface epithelial tumours. Full clinicopathological and outcome data were collected for 57 women aged <50 years diagnosed between January 2010 and December 2015. Representative tumour sections were stained for CD3 (T cells) and CD20 (B cells) and tumour-infiltrating lymphocytes (TILs) were scored following the TILs Working Group Recommendations and described as stromal, intra-tumoural, lymphoid aggregates and touching lymphocytes. Data were statistically analysed and the association with clinicopathological variables was assessed. The median age was 41 years and the most common histological type was serous carcinoma (n=21). The risk of malignancy index was a significant predictor of ovarian cancer diagnosis (P<0.05). A total of 15 out of 34 patients with cancer died. There was significantly greater stromal infiltration of CD3 and CD20 TILs (P=0.01 and P=0.03, respectively) and higher intratumoral CD20 expression in ovarian epithelial cancers compared with borderline tumours. The highest CD3 stroma count and density were observed in serous carcinoma, which also exhibited the highest numbers of CD3 and CD20 aggregates. There was no statistically significant difference between touching lymphocytes and tumour histological subtype. There was no significant association between TIL expression and patient survival. The count, distribution and density of T and B lymphocytes in ovarian tumours varied depending on tumour type and invasiveness. Their topographic distribution within the tumour and surrounding stroma did not impact prognosis in young women with ovarian cancer. TIL analysis in an older age group of women with ovarian tumours is ongoing to determine its potential prognostic significance.

Breast Tumors in Young Women in Cotonou: Diagnosis, Treatment and Prognosis

Introduction: The high frequency of benign breast tumors in young women and the rarity of cancers but poor prognosis in a context of diagnostic and therapeutic difficulties deserve special attention. Objective: To study the clinical, therapeutic and prognostic aspects of breast tumors treated in Cotonou between 2015 and 2019. Method: This is a cross-sectional study with retrospective data collection on breast tumors treated between 2015 and 2019 in two reference hospitals in Cotonou. All patients aged under 40 treated for breast tumors were studied. The clinical, therapeutic and evolutionary characteristics of breast tumors were analyzed. Results: Breast cancer rate was 5.2% (n=12) versus 94.8% (n=219) for benign tumors. Self-examination was the circumstance of discovery in 81% (n=187) and average medical examination time was 6.4 months. The clinical characteristics in favor of malignancy were: hard consistency in 4.7% (n=16) of cases, irregularity in 25.6% (n=88) of cases, adhesion in 11.3% (n=39) and axillary adenopathy in 10.4% (n=36) of cases. The probability of confirmation of the nature of suspicious tumor on the clinico-radiological level was 3/10. Therapeutic decisions were mostly taken on clinical and radiological arguments. Histology was not systematic. The prognosis was good for benign tumors and bad for breast cancer with a cure rate of 25%. Conclusion: Diagnosis of breast tumors in young women is much more clinical. The absence of a radiotherapy department limits treatment and worsens the prognosis.

Evaluation of Clinicopathologic Factors and Surgery Management on Borderline Ovarian Tumor Outcomes

Background: Borderline ovarian tumor (BOT) is a tumor most prevalent in young woman with desire to fertility. There are some controversies on the patient characteristic besides to the factors affecting the recurrence rate among different races. Objectives: The aim of this study is to evaluate clinicopathologic features of the tumor to discover the controversies on the topic. Methods: Medical data of the all referred patients to Motahari clinic from January 2010 till October 2020 were recorded. Patient clinicopathologic characteristics affecting on outcome were evaluated. By using SPSS software, data were tested by chi-square and fish exact test. Also, log rank test was used for survival analysis Results: Totally 145 patients were enrolled. 61.4% versus 38.6% of the patients underwent fertility sparing surgery and radical surgery respectively with common characteristics of mostly belong to stage 1A disease (61.8% vs. 66.1%), unilateral (93.3% vs. 89.3%), serous histology (51.7% vs. 66.1%). The characteristics were different in the aspects of age and tumor size. In the aspect of recurrence rate, higher FIGO stage, younger age, tumor size less than 10cm, performing laparoscopy and fertility sparing surgery were with higher rate of recurrence (P-value &lt; 0.05) while histology type of the tumor, lateralization, micropapillary, microinvasion, noninvasive peritoneal implants, receiving adjuvant chemotherapy and performing lymphadenectomy were not statistically significant for recurrence (P-value &gt; 0.05). Two patients had malignant transformation. Conclusions: Fertility sparing surgery was with more recurrence rate in borderline ovarian tumor patients. However, micropapillary, microinvasion were not significantly with higher recurrence rate in our study but they are challenging issues in border line ovarian tumors among different studies. Due to most prevalence of border line ovarian tumors in young women and desire of fertility preservation, we should notice more to clinicopathologic and surgery types affecting on recurrence of BOTs.

Li-Fraumeni Syndrome: Mutation of TP53 Is a Biomarker of Hereditary Predisposition to Tumor: New Insights and Advances in the Treatment.

Simple SummaryLi–Fraumeni Syndrome (LFS) is a rare tumor predisposition syndrome in which the tumor suppressor TP53 gene is mutated in the germ cell population. LFS patients develop a broad spectrum of cancers in their lifetime. The risk to develop these tumors is not decreased by any type of treatment and if the analysis of the TP53 mutational status in the family members was not possible, tumors are often diagnosed in already advanced stages. This review aims to report the evidence for novel mechanisms of tumor onset related to germline TP53 mutations and possible treatments.Li–Fraumeni syndrome (LFS) is a rare familial tumor predisposition syndrome with autosomal dominant inheritance, involving germline mutations of the TP53 tumor suppressor gene. The most frequent tumors that arise in patients under the age of 45 are osteosarcomas, soft-tissue sarcomas, breast tumors in young women, leukemias/lymphomas, brain tumors, and tumors of the adrenal cortex. To date, no other gene mutations have been associated with LFS. The diagnosis is usually confirmed by genetic testing for the identification of TP53 mutations; therefore, these mutations are considered the biomarkers associated with the tumor spectrum of LFS. Here, we aim to review novel molecular mechanisms involved in the oncogenic functions of mutant p53 in LFS and to discuss recent new diagnostic and therapeutic approaches exploiting TP53 mutations as biomarkers and druggable targets.

Clinicopathological features, prognosis, and fertility outcomes in Chinese Han women treated for ovarian yolk sac tumor: A retrospective case series study from two tertiary-care academic medical centers.

Objective:Ovarian yolk sac tumor (YST) is a very rare malignant tumor in young women. This study aimed to explore the clinicopathological prognostic characteristics and reproductive outcomes of Chinese Han patients.Methods:To describe a case series study, we reviewed the clinicopathological data of 50 YST patients treated from 2 tertiary medical academic medical centers from January 2009 to December 2019. The Akaike information criterion was used to select variables. The influence of relevant characteristics on prognosis factors was analyzed by the Cox proportional hazard model.Results:The median follow-up time was 64.5 months (range from 3 to 124 months). The median age was 22.7 years (3 to 34 years). Abdominal pain (54.0%) or mass (42.0%) were the most common clinical symptoms in the early stage of diagnosis. The tumors were located bilaterally in 4 cases. 27 patients, 7 patients, 13 patients, and 3 patients were in stage I, II, III, and IV, respectively. Twenty-one stage I patients and 12 stage II to IV patients underwent fertility-preserving surgery. Of the 50 patients who received postoperative chemotherapy, 49 received the BEP regimen. At the last follow-up, 92% of the patients were still alive. The overall survival rate and disease-free survival rate were 91.6% and 90.6%, respectively. Recurrence occurred in 7 (14%) patients with a median survival time of 16.7 months (range from 3 to 50 months). Six patients had recurrence in the abdominal space. The percentage of Ki67 (P = .01) and tumor size (P = .03) were 2 important prognostic factors in multivariate analysis. In terms of survival outcomes, fertility-preserving surgery can be equivalent to radical surgery. Sixteen patients tried to conceive, and 6 patients with advanced-stage succeeded in 10 pregnancies. Of these, 6 patients successfully gave birth to 6 healthy babies.Conclusions:The diagnosis of YST of childbearing age is very rare. Because the failure of primary treatment is related to the residual disease after salvage surgery, the fertility and survival results of patients undergoing fertility-preserving surgery are promising.

Ovarian dysgerminoma in a 14-year-old presenting with an adnexal mass and elevated beta-human chorionic gonadotropin (beta-hCG)

Introduction: Ovarian germ cell tumors most commonly affect young women in the second and third decades of life. Dysgerminomas account for 30–50% of malignant ovarian germ cell tumors and are classically associated with elevated lactate dehydrogenase (LDH). Elevated human chorionic gonadotropin (hCG) in the setting of an adnexal mass in this age group may raise concern for ectopic pregnancy. It is critical to maintain a high index of suspicion for possible germ cell tumor in young women with adnexal masses to avoid unnecessary surgical spillage that might upstage a malignancy. We present a case of a 14-year-old female with adnexal mass and elevated hCG who was ultimately diagnosed with ovarian dysgerminoma. Case Report: A 14-year-old female presented to the emergency room with vaginal bleeding and altered mental status and was found to have a markedly elevated beta-hCG, normal LDH, and an 8 cm complex adnexal mass. She underwent minimally invasive surgery and was ultimately diagnosed with stage 1A dysgerminoma with abundant synctiotrophoblast giant cells. Patient remained in remission for four years until she began experiencing new irregular periods. This time she was found to have an elevated LDH, normal B-hCG, and a 10 cm pelvic mass. She underwent exploratory laparotomy, removal of pelvic mass, right salpingo-oophorectomy, pelvic lymph node debulking, and adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (BEP). Conclusion: Dysgerminoma, the most common malignant ovarian germ cell tumor, may present with the uncommon profile of markedly elevated hCG and otherwise normal tumor markers. While ectopic pregnancy must be considered in this scenario, keeping dysgerminoma in the differential diagnosis of a young woman with a solid adnexal mass and elevated hCG may allow for intact removal of the mass, possibly helping to avoid adjuvant chemotherapy.

Abstract P5-07-05: Deciphering the inferior prognosis of young women with estrogen receptor-positive early-stage breast cancer through full transcriptome analysis: A FLEX database sub-study

Abstract Introduction: Young women with estrogen receptor (ER)-positive early-stage breast cancer (EBC) frequently present with larger, higher-grade, more aggressive tumors, with lower ER expression than older women. Post-hoc analyses within the MINDACT and TAILORx cohorts reported that women aged 40-50 with ER+ EBC exhibited a chemotherapy benefit independent of genomic risk compared to women aged &amp;gt; 50, possibly due to chemotherapy-induced ovarian suppression (CIOS). However, women &amp;lt; 40 years, who seldom develop CIOS, are under-represented in clinical trials. Therefore, it is important to distinguish the tumor biological profile within this younger age group. To understand the biological basis underlying why younger women have poorer outcomes than older women, this study aimed to identify genes that distinguish tumors in younger women from older women. Methods: EBC patients enrolled in the FLEX study (NCT03053193) undergo standard of care MammaPrint (MP) and BluePrint (BP) tests, and consent to clinically annotated whole transcriptome data collection. MP categorizes tumors as High Risk (HR) or Low Risk (LR) of recurrence. Together, MP and BP classify molecular subtype as Luminal A, Luminal B, HER2, or Basal. Whole transcriptome gene expression differences were compared among ER+ tumor specimens from three age groups: &amp;lt; 40 years old (n=283), 40-54 years old (n=1535), and ≥ 55 years old (n=4355). Differentially expressed genes (DEGs) were identified from 100 randomized iterations for each comparison; an equal number of LR and HR samples were analyzed in each group. DEGs found in &amp;gt; 20 iterations indicated gene stability within the age group. DEGs were also identified within each age group after correcting for BP subtype, and between pre-menopausal (n=1314) and post-menopausal (n=4859) women. Gene expression data were quantile normalized using R package ‘limma’. DEGs with an adjusted p&amp;lt;0.05 and fold change ≥ 2 were considered significant. Results: Overall, 76.0% of women &amp;lt; 40 years, 53.6% of women aged 40-54, and 48.5% of women ≥ 55 years had MP HR tumors. In addition, women &amp;lt; 40 years had higher frequencies of BP Basal and HER2 tumors (20.5% and 9.2%, respectively) compared with women ≥ 55 years (8.0% and 2.4%, respectively; p&amp;lt;0.0001). In line with unsupervised hierarchical clustering and previous studies, tumors from patients aged 40-54 exhibited limited DEGs in comparison to women ≥ 55 years. In contrast, most gene expression differences were primarily observed between women &amp;lt; 40 and ≥ 55 years (11 DEGs; 10 downregulated and 1 upregulated). We identified limited DEGs within BP Luminal A (n=23), Luminal B (n=10), and Basal (n=7) tumors from women aged &amp;lt; 40 relative to women ≥ 55 years. No DEGs were found in HER2-type tumors. Within Luminal A and Basal tumors, upregulated genes in women &amp;lt; 40 years are important for proliferation and immune responses. Luminal B tumors in women aged &amp;lt; 40 have increased DEGs involved in ER and HER2 signaling. Within all subtypes, DEGs supporting metabolic functions were downregulated in tumors of women &amp;lt; 40 years compared with women ≥ 55 years. Few DEGs were observed between pre-menopausal women and post-menopausal women, though none with &amp;gt; 2-fold change. Conclusion: Tumors from women aged 40-54 had few DEGs, suggesting observed chemotherapy benefit represents differences in host biology rather than intrinsic tumor biology as compared with tumors from women &amp;lt; 40 or ≥ 55, where detected DEGs are associated with proliferation, receptor signaling, and metabolism. Fewer DEGs were observed by menopausal status than age, indicating age is a more relevant cutoff. Future studies will aim to further characterize this high risk young patient population. Citation Format: Shubhada Dhage, Mina Gendy, Nina D'Abreo, Ruth Oratz, Sami G. Diab, VK Gadi, Cathy Graham, Midas Kuilman, Shiyu Wang, Patricia Dauer, Andrea Menicucci, William Audeh, Douglas K. Marks. Deciphering the inferior prognosis of young women with estrogen receptor-positive early-stage breast cancer through full transcriptome analysis: A FLEX database sub-study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-07-05.

Giant immature teratoma in a 15 year old causing anti-n-methyl-d-aspartate (anti-nmda) receptor encephalitis-like and Guillain-Barré Syndrome as paraneoplastic manifestations: A case zreport

Germ cell tumor is the most prevalent ovarian tumor in young women between 10 and 30 years of age.[1] However, immature teratomas account for only 20% of the malignant ovarian tumors found in the adolescent age group.[2] More uncommon is the occurrence of immature teratoma causing anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis and Guillain-Barré Syndrome (GBS). This is a case of a 15-year-old female, nulligravid, who initially presented sudden behavioral change and symmetrical weakness of both lower and upper extremities with concomitant seizure episodes and with palpable lower abdominal mass. The patient was diagnosed to have GBS and treated with intravenous immunoglobulin causing resolution of neurologic symptoms months after. During the management of GBS, the patient noted increasing abdominal girth. Tumor markers showed elevated alpha-fetoprotein, CA125, and lactate dehydrogenase. An imaging study revealed predominantly solid ovarian mass hence malignancy was considered. Once the medical condition stabilized, the patient underwent fertility-sparing surgery with the final histopathologic result of immature teratoma. The aim of this report is to present a case of anti-NMDAR encephalitis and GBS as paraneoplastic manifestation of immature teratoma.

Therapeutic approach of uterine leiomyoma; choosing the most appropriate surgical option

The most common benign pelvic tumor in young women is uterine leiomyoma. It is often asymptomatic, but can cause symptoms such as pelvic-abdominal pain, vaginal bleeding, urinary and intestinal transit disorders. If there is a suspicion of malignancy, it is necessary to perform fractional uterine curettage to establish the histopathological diagnosis. The surgical treatment of uterine leiomyoma includes several procedures: myomectomy, subtotal or total hysterectomy. The procedure will be chosen depending on the patient's particularities: BMI, uterine size, leiomyoma location, surgical history or other associated pathologies. Laparoscopic hysterectomy has a 45-minute shorter duration of intervention than vaginal hysterectomy, and the conversion rate to the open procedure is lower. Laparoscopically treated cases have fewer postoperative complications compared to other surgical procedures and have a shorter hospitalization and recovery time. The recurrence rate of uterine leiomyoma is similar for both laparoscopic and open abdominal approach, and the frequency of long-term complications such as adhesion syndrome or pelvic pain is higher after the latter.

A case of repeat hepatectomy for liver metastasis from solid pseudopapillary neoplasm of the pancreas: a case report

BackgroundSolid pseudopapillary neoplasm of the pancreas is a rare tumor in young women, metastasizing in only 5–15% of cases, and most commonly to the liver. Although treatment guidelines have not been established, surgical resection is usually performed. We report a rare case of repeat hepatectomy for liver metastases after distal pancreatectomy with solid pseudopapillary neoplasm.Case presentationThe patient was a 71-year-old woman who underwent distal pancreatectomy for solid pseudopapillary neoplasm, and liver metastasis occurred 4 years after the first surgery. Partial liver resection was performed for four liver metastases, and histopathological examination revealed a diagnosis of liver metastasis from solid pseudopapillary neoplasm. However, 18 months later, liver metastases were detected again; three tumors were identified, and partial resection was performed, which has provided 18 months’ recurrence-free survival.ConclusionsLong-term prognosis can be expected following R0 resection for resectable liver metastasis from solid pseudopapillary neoplasm.

Epidemiological and Anatomopathological Characteristics of Breast Tumors in Young Women in Cotonou in the Republic of Benin from 2015 to 2019

<i>Objective</i>: Study the epidemiological and anatomopathological characteristics of breast tumors of young woman. <i>Patients and Methods</i>: This was a retrospective and evaluative cross-sectional study of patients treated for a breast tumor between January 1, 2015 and December 31, 2019 in two hospitals in Cotonou. All the complete files of patients under the age of 40 treated for breast tumors of whatever nature were listed. The patients were recalled for clinical and / or radiological evaluation. The epidemiological and histological characteristics of breast tumors were analyzed. <i>Results</i>: The study involved 231 breast tumors including 12 cancers (5.2%) and 219 benign tumors (94.8%). The mean age of the patients was 25.7 years±7.2. Self-examination was the most common discovery (81%). The average consultation time was 6.4 months. The right breast and the upper-external quadrant were the most affected in 53% and 31.1%, respectively. Fibroadenomas (70.7%) and invasive ductal carcinomas (9/12) were the most frequent. Obesity and a family history of breast cancer were associated with the occurrence of breast cancer in young women (p ≤ 5%). The relative risk of developing breast cancer was practically zero before the age of 30. Benign breast tumors spontaneously regressed in part or in whole in 35.3% of cases (n=55), they were stable in 44.8% of cases (n=70) and increased in volume in 19.8% of cases (n=31). The age of diagnosis strongly influenced the evolution of tumors in the young woman in Cotonou (p=0.02). In 56% of cases, breast tumors diagnosed before the age of 20 spontaneously resolved in part and in whole. The breast cancer case fatality in women under 40 was 11.1%. <i>Conclusion</i>: Breast tumors in young women are mostly benign. More than half of these tumors diagnosed before the age of 20 resolve spontaneously. The risk of breast cancer is virtually zero before the age of 30 in our series.

Proton Radiotherapy to Preserve Fertility and Endocrine Function: A Translational Investigation

Photon radiation therapy (x-ray radiation therapy [XRT] and gamma-ray radiation therapy [GRT]) of tumors close to ovaries causes reproductive and endocrine sequelae due to ovarian primordial follicle depletion. Given its finite range, proton radiation therapy (PRT) can preserve ovarian function when ovaries are positioned distal to the spread-out Bragg peak (SOBP) in tumors of the abdominopelvic region. This study compared anti-Müllerian hormone (AMH) levels (a biomarker of ovarian function) and primordial follicle survival after invivo mouse pelvic GRT versus PRT. One hundred twenty-four female prepubertal mice received sham, GRT, or PRT with ovaries positioned at various depth with respect to the proton SOBP, with single doses of 1.8 or 0.2 Gy. AMH was measured at baseline, 1, 3, and 8 weeks after treatment, and the total number of surviving primordial follicles was counted. Multivariable linear mixed-effects modeling was used to assess the relationship between radiation therapy modality and dose on AMH and primordial follicle survival. For ovaries beyond the SOBP, ovarian function (P = .5) and ovarian primordial follicle (OPF; P = 1.0) were spared relative to sham controls. For ovaries in the SOBP plateau, ovarian function and primordial follicle reserve 8 weeks after treatment were reduced for all groups: 1.8 Gy GRT (βAMH = -4.9 ng/mL; βOPF = -728.2/animal), 1.8 Gy (relative biological effectiveness [RBE] = 1.1) PRT (βAMH = -5.1 ng/mL; βOPF = -728.2/animal), 0.2 Gy GRT (βAMH = -2.5 ng/mL; βOPF = -595.1/animal), and 0.2 Gy (RBE = 1.1) PRT (βAMH = -3.0 ng/mL; βOPF = -555.4/animal) relative to sham controls (all differences P < .001). This study uses an animal model to demonstrate the safety of proton therapy in sparing fertility. Ovaries positioned beyond the SOBP during PRT maintain ovarian reserve, suggesting that a proton beam has no energy and exit dose beyond SOBP. This study proposes that proton therapy is much safer than photon radiation therapy to protect ovarian follicles with the same dose, and it supports further testing of proton therapy for abdominopelvic tumors in young women.