Late rupture of external iliac artery pseudo-aneurysm is an uncommon complication in patients who undergo extensive gynecologic radical surgeries. A 28-year-old woman with stage IB cervical cancer underwent pelvic lymphadenectomy and extrafascial trachelectomy. Two months after surgery, massive bleeding from ruptured pseudo-aneurysm of the external iliac artery occurred. Endovascular management with covered stent placement was feasible and safe to stop bleeding.

Intraoperative injury of the obturator nerve has rarely been reported in patients with gynecological malignancies undergoing extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end-to-end anastomosis or grafting when achieving tension-free anastomosis is not possible.

Uterine sarcomas are rare, accounting for 3-7% of uterine malignancies. This review aims to summarize advancements in diagnostics and treatment over the last decade, focusing on innovative imaging techniques, molecular diagnostics, and treatment modalities. Recent diagnostic advancements include enhanced imaging techniques such as MRI and AI-driven algorithms, improving accuracy in differentiating between benign and malignant uterine tumors. Biomarkers like lactate dehydrogenase (LDH) and microRNAs have shown potential in preoperative identification. Treatment strategies continue to evolve, with surgical resection being the cornerstone. The role of lymphadenectomy and adnexectomy varies by histopathological subtype, emphasizing personalized approaches. Adjuvant therapies remain controversial, tailored to patient risk factors and tumor characteristics. Fertility-sparing options are viable for selected patients, though not recommended for high-grade tumors. Significant progress in diagnostic techniques and personalized treatment approaches has improved the management of uterine sarcomas. Future guidelines from major oncology groups are expected to standardize care. Continued research is essential for refining treatment protocols and enhancing patient outcomes.

Purpose: The learning curve cumulative summation (LC-CUSUM) test is commonly used as a quantitative assessment of the individual learning process. This study aimed to evaluate the skill acquisition process for performing ultrasound staging of endometrial cancer using the LC-CUSUM test.Methods: Sixty-seven ultrasound examinations performed by two operators were evaluated using the LC-CUSUM test according to their rate of success or failure to correctly stage myometrial invasion, serosa involvement, and pelvic and para-aortic lymph node involvement. The reference standard was the pathologic result. After the learning phase, the cumulative summation (CUSUM) test was applied to assess performance maintenance.Results: The processes achieved satisfactory performance in the majority of the cases according to the established definitions. Operator 1 reached adequate performance within the 30th procedure for all the locations considered, while operator 2 performed fewer than 30 ultrasound examinations by the audit time. The CUSUM test confirmed that the target quality was preserved after the learning phase. Moreover, the ultrasound staging for endometrial cancer was highly accurate.Conclusion: Using the LC-CUSUM test made it possible to monitor the achievement and maintenance of a satisfactory performance quantitatively. The LC-CUSUM test could be a valuable instrument to survey diagnostic pathways in gynecological ultrasonography quantitatively.

Determination of the tumor marker concentration in peritoneal fluid (PF) may help to assess its potential to detect small concentration changes between benign ovarian pathology and early stage ovarian cancer. Peritoneal washing, which can also be obtained when PF is absent, is already included in the International Federation of Gynecology and Obstetrics (FIGO) staging classification for ovarian cancer but sampling has not yet been standardized. Since our aim was to evaluate the relationship between marker concentration in PF and washing, standardization of the sampling protocol was a prerequisite to ensure reliable results. Thirty-three women with non-malignant pathology of the reproductive organs were included in the study. We used three promising tumor markers for evaluation of the marker concentration in local fluid: osteopontin (sOPN), splice variant 6 of sCD44 (sCD44-v6) and vascular cell adhesion molecule-1 (sVCAM-1). After aspiration of PF, washing of the uterus, ovaries and pelvic peritoneum was performed with saline solution. Patients were divided into two groups based on the solution volume: A-20 ml and B-50 ml. To determine the efficiency of washing in relation to solution volume, washing was repeated three times. Concentrations of markers in samples were determined using flow cytometry. Mean concentrations of markers were significantly higher (P <0.001) in PF than in the first washing. We demonstrated a significant positive correlation between marker concentrations in PF and first washing (sOPN: r = 0.447, P = 0.048; sCD44-v6: r = 0.660, P = 0.002; sVCAM-1: r = 0.526, P = 0.017). When using a smaller solution volume for washing, significantly higher (sVCAM-1: 2.5-fold, P = 0.021; sOPN: 3-fold, P = 0.024) or equal (sCD44-v6) mean concentrations of tumor markers were obtained. Our work demonstrates for the first time that concentrations of sOPN, sCD44-v6 and sVCAM-1 in PF correlate with peritoneal washing in women with non-malignant pathology of the reproductive organs. This indicates that, for selected tumor markers, washing can replace PF when PF is absent. A standardized protocol for sampling PF and performing washing during laparoscopy was established.