Background. Advances in the treatment of gynecological cancer have led to improvements in survival but also an increase in menopausal symptoms, especially in young women with premature iatrogenic menopause. Methods. A narrative review was performed to clarify the possibility of prescribing hormone replacement therapy (HRT) after hormone-dependent gynecological cancers (ovarian cancer [OC], cervical adenocarcinoma [AC], and endometrial cancer [EC]). Results. HRT can be prescribed to patients with early-stage, grade I–II OC who experience bothersome menopausal symptoms non-responsive to alternative non-hormone therapy after optimal surgery. Caution should be exercised in administering HRT after serous borderline tumors and endometrioid OC, and HRT is not recommended in low-grade serous OC. HRT is not contraindicated in AC survivors. After surgery for EC, HRT can be prescribed in women with early-stage low-grade EC. There is not enough data to give indications to patients with advanced EC. Conclusions. HRT can be discussed with patients, evaluating the risks and benefits of hormone-dependent gynecological cancer. Counseling should be performed by gynecologic oncologists experienced in the management of these patients.

Background: To date, little and discordant data still exists on the management of cervical cancer (CC) during pregnancy. In this paper, we report our experience of the treatment of these patients analyzing the oncologic, obstetric, and neonatal outcomes. Methods: Between January 2010 and December 2021, 13 patients were diagnosed with CC during pregnancy. All patients underwent platinum-based neoadjuvant chemotherapy (NACT) and 11/13 patients underwent a cesarean radical hysterectomy (CRH). Results: All 13 patients were diagnosed with squamous-cell carcinoma, FIGO-2018 stage between IB2-IIIC1. The majority of patients had a partial (61.5%) or complete (15.4%) response to NACT. Most patients had a regular course of pregnancy and the obstetric complications observed were gestational diabetes mellitus in 23.1% and IUGR in 15.4% of cases. CRH was performed in the absence of major complications. Only 2 patients (15.4%) had disease recurrence and only 1 patient (7.7%) died of disease. All children are currently healthy. At birth, we observed mainly prematurity-related complications (38.5% respiratory distress syndrome and 7.7% neonatal jaundice) and only a case of congenital malformation (hypospadias). In our pediatric population, we reported a case of malignancy (acute myeloid leukemia). Conclusion: NACT seems to be safe and efficacious in controlling tumor burden during pregnancy. CRH following NACT appears to be feasible, avoiding repeated surgery and treatment delays. This approach is also reasonably safe from a maternal, obstetric, and neonatal point of view.

Complete uterine septum, cervical septum and longitudinal vaginal septum: a challenging differential diagnosis with double cervix - Facts, Views and Vision in ObGyn

Feasibility of single step hysteroscopic myomectomy: fibroid size is the most significant factor based on data from a single centre and surgeon - Facts, Views and Vision in ObGyn

Background: Complete bicorporeal uterus, double cervix and obstructive longitudinal vaginal septum (classified as U3bC2V2 according to ESHRE/ESGE classification) is a rare congenital anomaly of the genital tract. This condition is typically associated with ipsilateral renal agenesis and is known as Herlyn-Werner-Wunderlich syndrome or OHVIRA (Obstructed HemiVagina and Ipsilateral Renal Anomaly) syndrome. The primary symptoms include dysmenorrhea and pelvic pain, which usually manifest after menarche due to haematocolpos in the obstructed hemivagina. Diagnosis is often challenging and frequently delayed. Early detection and surgical drainage of the haematocolpos are essential for symptom relief and prevention of complications. Various surgical approaches have been described, with vaginoplasty and septal resection being the recommended treatment. Objective: To propose a step-by-step demonstration with narrated video footage of an integrated approach for one-stop diagnosis and ultrasound-guided endoscopic hymen-sparing treatment in a patient with OHVIRA syndrome. Materials and Methods: We present the case of a 17-year-old virgo-intacta female who was referred to our institution due to dysmenorrhea, abnormal uterine bleeding and a right presumed ovarian endometrioma. A preoperative evaluation, including pelvic ultrasound and MRI, suspected a U3bC2V2 malformation, associated to a right haematocolpos and ipsilateral renal agenesis. The patient underwent a complete minimally invasive vaginoscopic resection of the obstructive longitudinal vaginal septum under transabdominal ultrasound guidance, using a 15Fr bipolar mini-resectoscope. The procedure successfully drained the haematocolpos and allowed visualisation of the right cervix, confirming the preoperative diagnosis. Results: The procedure was performed in our Digital Hysteroscopic Clinic (DHC) - CLASS Hysteroscopy -under general anaesthesia (with laryngeal mask), according to an ambulatory model of care. No complications occurred and the patient was discharged three hours after the procedure. Main outcomes: After 40 days, hysteroscopic office control revealed a normal vagina with double cervix and complete bicorporeal uterus (classified as U3bC2V0 according to ESHRE/ESGE classification), and the patient had complete relief of symptoms. Conclusion: The combined approach of one-stop diagnosis and ultrasound-guided minimally invasive vaginoscopic resection of the obstructive longitudinal vaginal septum, using a 15Fr bipolar mini-resectoscope, has proven to be an effective strategy. This approach leads to optimal surgical results without complications.

A total endoscopic levonorgestrel-releasing intrauterine system (LNG-IUS) placement: a novel approach for obese patients with early-stage endometrial cancer - Facts, Views and Vision in ObGyn