► Apparent symptomatic leiomyoma in a young woman. ► Leiomyoma with a gross appearance somewhat different than usual. ► Malignant solitary fibrous tumor of the uterus.

We report a case of a 33 year-old pregnant woman who was diagnosed at the time of the first trimester ultrasound with a multilocular solid arising form the right ovary. An abdominal MRI was performed afterwards and it revealed a pelvic mass, developing from the right ovary, with a liquid component but with a major solid area. CA 125 was within the normal range values. A laparotomy followed by right salpingo-oophorectomy was performed at 14 weeks of gestation and both the frozen section and the definitive histology revealed a borderline mucinous ovarian tumor. Ovarian tumors of low malignant potential comprise 10%–20% of all ovarian malignancies. They carry an excellent prognosis with 95%–99% long-term survival. Whereas in the past, radical surgery (hysterectomy and bilateral salpingo-oophorectomy with peritoneal staging) was standard regardless of the age of the patient, unilateral salpingo-oophorectomy with or without staging has become the recommended management for women who desire childbearing. In the absence of large prospective randomized trials it is difficult to know which are the best management practices and especially to determine the right moment during pregnancy to perform surgery in these patients.

Endometrial cancer of no specific molecular profile (NSMP) represents the most prevalent molecular subtype of endometrial cancer, comprising over 50 % of all diagnoses. Although studies have explored the prevalence of the NSMP subtype, to our knowledge, no systematic review or meta-analysis has specifically targeted grade 3 (G3, high-grade) tumors. We aimed to determine the prevalence of G3 endometrioid endometrial cancer of NSMP and assess regional variations in this prevalence. We also sought to synthesize available data concerning oncologic outcomes, including overall survival, progression-free survival, and disease-specific survival. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No: CRD42024544247). We searched the electronic databases: PubMed/Medline, Scopus, Web of Science, Cochrane Library, and EMBASE. To estimate the overall prevalence of the NSMP subtype, we performed a meta-analysis using the proportions method with the Freeman-Tukey (arcsine) transformation. For estimating oncologic outcomes, we conducted a meta-analysis using hazard ratios (HRs) when available. In the absence of HRs, we utilized Kaplan-Meier curves. All pooled estimates and their corresponding 95% confidence intervals (CIs) were calculated using a random-effects model with the inverse variance method and restricted maximum likelihood estimator. We analyzed 31 studies, encompassing 2,660 patients. The pooled prevalence of NSMP within G3 endometrioid endometrial cancer was 0.29 (95 %CI: 0.23-0.34, I² = 80.8 %). This prevalence was highest in North America (0.43, 95 %CI: 0.17-0.71) and lowest in Europe (0.23, 95 %CI: 0.19-0.28). The random-effects pooled estimate indicated that the NSMP subtype was associated with intermediate oncologic outcomes compared to other molecular subtypes. The pooled prevalence of G3 endometrioid endometrial cancer of NSMP is 29 %. The oncologic outcomes for this molecular subtype seem intermediate, though further refinement and research are needed for a more precise understanding.

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare and highly aggressive ovarian neoplasm, predominantly affecting young women, often in their second or third decade of life. Despite its distinctive clinical and pathological features, diagnosis is frequently delayed due to overlapping characteristics with other small round blue cell tumors. A hallmark of SCCOHT is the biallelic inactivation of the SMARCA4 gene, which leads to loss of BRG1 protein expression and disrupts epigenetic regulation via the SWI/SNF chromatin-remodeling complex. Unlike many other malignancies, SCCOHT exhibits low mutational burden and diploid karyotype, suggesting that epigenetic dysregulation, rather than genomic instability, is the underlying oncogenic mechanism. Clinically, SCCOHT often presents with nonspecific abdominal or pelvic symptoms and is uniquely associated with paraneoplastic hypercalcemia in up to two-thirds of cases. Diagnosis requires a combination of imaging, laboratory evaluation, histopathology, and immunohistochemistry. Treatment is not standardized but typically involves a multimodal approach, including radical surgery and platinum-based chemotherapy, often with multi-agent regimens. The role of radiotherapy is less well defined but may be considered for local control or palliation. Prognosis remains poor, with high recurrence rates and limited response to salvage therapy. Emerging molecular insights have prompted investigations into targeted therapies and immunotherapy, though clinical data are limited. Given the frequent presence of germline SMARCA4 mutations, genetic counseling is strongly recommended, and ongoing research is essential to improve diagnostic accuracy, personalize treatment, and enhance outcomes for this devastating malignancy.

Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare, highly aggressive malignancy that predominantly affects young women. We report a 32-year-old pregnant woman diagnosed with SCCOHT during the first trimester of pregnancy. At 24 weeks, imaging revealed extensive peritoneal carcinomatosis. Following multidisciplinary evaluation, neoadjuvant chemotherapy was initiated, but the disease progressed. At 34 weeks, the patient underwent cesarean delivery followed by cytoreductive surgery. Despite achieving an initial complete resection, the disease recurred rapidly. The patient died shortly after completing adjuvant chemotherapy and initiating immunotherapy. This case highlights the diagnostic and therapeutic challenges of managing SCCOHT during pregnancy and the complex balance of maternal and fetal outcomes. Early diagnosis, coordinated multidisciplinary care, and timely intervention are critical, although the prognosis remains poor despite aggressive multimodal treatment.

Background: Lipoleiomyomas are infrequent but presumably benign tumors. Imaging modalities may help in establishing a diagnosis. Case: A 41-year-old multiparous woman presented with anemia, dysmenorrhea, menorrhagia, and abdominal discomfort. Transvaginal ultrasound and abdominopelvic computed tomography were performed and both suggested a uterine leiomyoma with unusual features. Laparoscopic myomectomy was carried out. Results: Final histology reported findings compatible with lipoleiomyoma of the uterus. Three (3) months after the surgery, this patient recovered well and her abnormal uterine bleeding resolved. Conclusions: When symptomatic, uterine lipoleiomyomas can mimic leiomyomas. The hyperechoic appearance in the ultrasound and the fat-like density in the computed tomography scan are imaging features that can help to establish the diagnosis. (J GYNECOL SURG 29:76)