Epithelioid sarcoma is a mesenchymal soft tissue sarcoma often arising in the extremities, usually in young adults with a pick of incidence at 35 years of age. Epithelioid sarcoma (ES) is characterized by the loss of SMARCB1/INI1 (integrase interactor 1) or other proteins of the SWI/SNF complex. Two distinct types, proximal and distal, with varying biology and treatment outcomes, are distinguished. ES is known for aggressive behavior, including a high recurrence rate and regional lymph node metastases. An optimal long-term management strategy is still to be defined. The best treatment of localized ES is wide surgical resection. Neo-adjuvant or adjuvant radiotherapy may be recommended, as it reduces the local recurrence rate. Sentinel lymph node biopsy should be considered in ES patients. Patients with metastatic ES have a poor prognosis with an expected median overall survival of about a year. Doxorubicin-based regimens are recommended for advanced ES. Tazemetostat, an EZH2 methyltransferase, has shown promising results in ES patients. Novel therapies, including immunotherapy, are still needed.

Indocyanine green (ICG) is a fluorescent agent which is characterized by a wide range of applications in the proper visualization of the operating field, differentiation of vital structures, and localization of lesions to be excised. An investigation and overview of novel approaches of indocyanine green in modern gynecological oncology was conducted, including ovarian cancer surgery with its compartmental approach and compartmental surgery in endometrial cancer. Ureteral visualization and perfusion, lymphography, lymph node transfers, or the localization of anastomotic leakage in bowel surgery are examples of applications aimed at reducing the risk of surgical complications and improving the patients’ quality of life. The general use of indocyanine green in lymph node detection, subcategorized and analyzed, is constantly improved and reviewed. A therapeutic approach with macromolecules is being tested in preclinical models. Early results could suggest the future application of indocyanine green not only in broad-sense imaging but also as a cytotoxic agent conjugated with macromolecules. Further studies on the application of indocyanine green in laparoscopy, open surgery, and finally as a curative cytotoxic agent are needed.

Indocyanine green (ICG) is widely used in minimally invasive surgery for real-time fluorescence imaging of vascular, biliary, and urological structures. Although its intravenous use has been extensively validated, data on intraureteral administration remain scarce, particularly regarding renal safety. We report the case of a 50-year-old woman undergoing laparoscopic bilateral endometrioma excision with intraureteral ICG instillation for ureteral visualisation. Despite an uneventful surgery, the patient developed anuria and acute kidney injury (AKI) within 24 h, requiring temporary hemodialysis. Imaging demonstrated bilateral renal dysfunction without evidence of ureteral transection. Renal function gradually improved with supportive care, and dialysis was discontinued. This is, to our knowledge, the first reported case of AKI following intraureteral ICG use. Potential mechanisms include dye-induced tubular toxicity, ischemic injury, and multifactorial perioperative stressors. Given the increasing adoption of near-infrared fluorescence in gynecologic and urologic surgery, our case highlights the urgent need for systematic studies on the renal safety of intraureteral ICG administration. Until further evidence emerges, surgeons should use the technique with caution, particularly in patients with preexisting risk factors for AKI.

Ovarian cancer accounts for more deaths than any other malignancy of the female reproductive system. Early diagnosis of this disease is difficult because there are no systematic opportunistic screening methods. At advanced stages, diagnostic laparoscopy is the first step in confirming disease advancement and obtaining samples for genetic and pathologic examination needed to start chemotherapy. Swiftly starting oncological treatment is crucial for increasing the survival rate in these patients. We present the case of a 51-year-old woman with metastatic International Federation of Gynecology and Obstetrics (FIGO) stage IIIC ovarian cancer who had delayed her therapy after initial laparoscopy due to COVID-19 infection and presented with an extreme case of surgical port metastasis.

Endometriosis is defined as the presence of the endometrial tissue, glands, and stroma, outside the endometrium and myometrium and is characterized by chronic pain and subfertility. Recently, clinical interviews and imaging have increasingly supplemented, and in certain contexts replaced, laparoscopy as the main diagnostic method. However, when we suspect cancer, laparoscopic inspection of abdominal and pelvic cavity, with biopsies and histological confirmation remains the gold standard. The most important biomarker used in endometriosis diagnosis remains CA 125, which is a well established marker in ovarian cancer. The sensitivity of CA 125 limits its clinical usefulness in endometriosis diagnosis. In this paper we present the case of the patient with significantly elevated levels of CA 125 and high suspicion of ovarian neoplasm in imaging studies.