Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important.

Increased life expectancy and cancer prevalence rates expose patients to a higher risk of developing other comorbidities such as stroke. This study aimed to evaluate the risk factors for and prognosis of stroke in patients with gynecological cancers. A single-center retrospective cohort study was conducted on patients with cervical, endometrial, and epithelial ovarian cancers. Patients were classified into three groups based on the period of stroke onset: at least one year before cancer diagnosis, within one year before cancer diagnosis to six months after the last treatment date, and six months after the last treatment date. Among the 644 patients, stroke occurred in 54 (8.4%). In univariate analysis, stroke was significantly associated with overall survival. In contrast, in multivariate analysis, stroke was significantly associated with age and hypertension, but not with overall survival. Age, pulmonary thromboembolism/deep vein thrombosis, histological grade, and tumor stage were significantly associated with overall survival. Therefore, it is important to establish an appropriate examination and treatment plan for patients with gynecologic cancers using a multidisciplinary approach that incorporates the patient’s age, medical condition, and tumor characteristics rather than excessively considering the adverse effects of stroke on cancer prognosis.

To evaluate the clinical impact of suspicious extra-abdominal lymph nodes (EALNs) identified preoperatively on CT and/or PET/CT images in advanced ovarian cancer. A retrospective study was conducted with 122 patients diagnosed with stage III or IV ovarian cancer with preoperative CT and/or PET/CT images from 2006 to 2022. Imaging studies were evaluated for the presence, size and location of suspicious EALNs. Suspicious lymph node enlargement was defined by a cut-off ≥5mm short-axis dimension on CT and/or lesions with maximum standardized uptake values of ≥2.5 on PET/CT. This study only included patients who did not have their EALNs surgically removed. A total 109 patients met the inclusion criteria; 36 (33%) had suspicious EALNs and were categorized as “node-positive”. The median overall survival (OS) was 45.73 months for the “node-positive” and 46.50 months for the “node-negative” patients (HR 1.17, 95% CI 0.68–2.00, p = 0.579). In multivariate analysis, after adjusting for other variables selected by process of backward elimination using a significance level of p<0.20, suspicious EALNs still showed no clinical significance on OS (aHR 1.20, 95% CI 0.67–2.13, p = 0.537) as well as progression-free survival (aHR 1.43, 95% CI 0.85–2.41, p = 0.174). Old age (aHR 2.23, 95% CI 1.28–3.89, p = 0.005) and platinum resistance (aHR 1.92, 95% CI 1.10–3.36, p = 0.023) affects adversely on OS. Suspicious EALNs did not worsen the prognosis of patients with advanced ovarian cancer. However, its impact on survival is not yet clarified. Further investigation is required to assess the clinical significance of suspicious EALNs on preoperative imaging studies.

"CLO23-052: Risk Factors and Prognosis of Stroke in Gynecologic Cancer" published on 31 Mar 2023 by National Comprehensive Cancer Network.

Purpose: Adenomyosis, a common gynecologic condition of the uterus, affects women with diverse symptoms including pain. Traditionally evaluated pathologically, advanced imaging modality has led to more diagnoses including asymptomatic women. This noninvasive diagnosis has raised questions about disease progression and symptom development. This study aimed to investigate the cellular and molecular patterns associated with adenomyosis and adenomyosis-related pain, focusing on inflammatory processes. We employed an integrative, retrospective bioinformatic design combining publicly available bulk RNA-sequencing data from adenomyotic and control endometrium and myometrium with single-cell RNA-sequencing data from adenomyosis patients stratified by the presence of pain. Patients and Methods: We performed enrichment analysis, gene expression profile analysis with core inflammatory genes, protein–protein network analysis, and cell–cell communication analysis. Results: Activation levels of core inflammation-associated modules revealed elevated inflammatory activity in endometrial tissues compared to myometrial tissues in adenomyosis. Single-cell RNA-seq identified significant upregulation of inflammation modules in cell types such as endothelial, mesenchymal, and NK/T cells, particularly in patients experiencing pain. NK/T cells disclosed co-upregulation in non-canonical inflammatory pathways, implicating them in pain-associated immunity. Also, combinatorial analyses through enrichment analysis and core inflammatory-associated gene expression pattern analysis emphasized key inflammatory genes, including CGAS, TNF, and IL1B, along with pain-specific alterations in DNAJB9, GSTA1, CXCL8, and CXCL3 across cell subpopulations. Additionally, protein–protein interaction (PPI) network analysis identified multipotent stem cells and NK/T cells as key drivers of nociceptive processes, mediated by chemokines such as CCL11 and CXCL13. Moreover, cell–cell communication analysis exhibited pain-associated disruptions in IL-1, estradiol, and 2-AG pathways. Conclusion: These findings underscore the significance of inflammation, mitochondrial immunity, and specific chemokine pathways in the pathophysiology of adenomyosis and its pain. Because the single-cell analyses were based on a small cohort (n = 2 per group), these results should be regarded as hypothesis-generating and require validation in larger, well-characterized cohorts. Understanding these mechanisms could nonetheless help guide the development of targeted therapies to alleviate symptoms and enhance outcomes.