Objective: To report a case of myomatous erythrocytosis syndrome (MES) with an extra-uterine manifestation.Case report: A 43-year-old woman presented with progressive abdominal distension and rapid enlargement of a pelvic mass. Upon survey, a high-level of hemoglobin (19.0 g/dl) was documented. The initial impression was an ovarian malignancy, but uterine sarcoma could not be ruled out because of its rapid growth. However, during exploratory laparotomy, the pelvic mass was found to be a 31 cm broad ligament leiomyoma; which is extremely rare for its size and location. The specimen was further studied immunohistochemically, which revealed excessive expressions of erythropoietin and erythropoietin receptors in addition to the diffusely matured blood vessels in the myoma tissue. The patient’s hemoglobin level resumed to normal three months post-surgery. The diagnosis of MES was confirmed both clinically and histologically.Conclusion: A correct preoperative diagnosis is challenging when MES manifests as an extrauterine mass. The coexistence of MES should be considered in the management of all leiomyoma with polycythemia, regardless of locations.

Background: Placenta mesenchymal dysplasia (PMD) is a rare placental anomaly associated with various fetal and maternal complications. Whether close ultrasound surveillance can prevent intrauterine fetal demise (IUFD) in patients with PMD is still under investigation. Amniotic fluid embolism (AFE) is a rare, lethal, and unpredictable maternal complication that has never been described in association with PMD. Here, we report a case of PMD, in which the fetus eventually demised in utero despite weekly color Doppler monitoring, and the mother subsequently encountered AFE during delivery. Case presentation: A 43-year-old woman who had received three frozen embryo transfer, was found to have a singleton pregnancy with an enlarged multi-cystic placenta at 8 weeks’ gestation. Fetal growth restriction (FGR) was noted since the 21^stweek. The fetus eventually demised in-utero at 25 weeks despite weekly color Doppler surveillance. Cesarean section was performed under general anesthesia due to placenta previa totalis and antepartum hemorrhage. During surgery, the patient experienced a sudden blood pressure drop and desaturation followed by profound coagulopathy. AFE was suspected. After administration of inotropic agents and massive blood transfusion, the patient eventually survived AFE. PMD was confirmed after pathological examination of the placenta. Conclusions: While FGR can be monitored by color Doppler, our case echoed previous reports that IUFD may be unpreventable even under intensive surveillance in PMD cases. Although AFE is usually considered unpredictable, PMD can result in cumulative risk factors contributing to AFE. Whether a specific link exists between the pathophysiology of PMD and AFE requires further investigation.

Background: The treatment-free interval is a significant predictor of worse prognosis and poor response rates of the second-line treatment in patients with carboplatin and paclitaxel (PT)-pretreated, advanced, or recurrent endometrial cancer (EC). Whether lenvatinib plus pembrolizumab still confers a survival benefit compared with doxorubicin in patients with platinum-free intervals of <6 months remains unclear. Methods: This multi-institutional retrospective analysis was performed using de-identified electronic health records from the TriNetX Research Network. Patients with advanced or recurrent ECs who received lenvatinib plus pembrolizumab or doxorubicin within six months of first-line PT were identified. A 1:1 propensity score matching (PSM) was conducted to control for potential confounding variables. Overall survival (OS) and adverse event profile were the primary and secondary outcomes. Results: Between January 2018 and February 2024, 130 patients with PT-treated, advanced, or recurrent ECs who received lenvatinib plus pembrolizumab and 122 patients who received doxorubicin at a platinum-free interval of <6 months were identified across 31 healthcare organizations. In the balanced cohort following PSM with 117 patients in each group, treatment with lenvatinib plus pembrolizumab was associated with improved OS compared with treatment with doxorubicin (12.8 vs. 8.2 months, p = 0.012, hazard ratio: 0.65, 95% confidence interval: 0.46–0.91). Regarding adverse event analysis, a higher incidence of hypothyroidism and proteinuria was observed with lenvatinib plus pembrolizumab, and more hematological toxicities were observed with doxorubicin. Conclusions: in patients with treatment-free intervals of <6 months, lenvatinib plus pembrolizumab still confers improved survival compared with doxorubicin in PT-treated, advanced, or recurrent ECs.

Objective: To analyze and compare outcomes of adjuvant chemoradiotherapy in patients with International Federation of Gynecology and Obstetrics (FIGO) stage III endometrial cancer (EC) patients using the “Sandwich” sequence and chemotherapy (CT) alone.Methods: From, 2005 to, 2019, we retrospectively reviewed 80 patients with FIGO stage III EC who received treatment at our institute. We analyzed 66 patients who had undergone complete surgical staging followed by adjuvant treatment with sandwich chemoradiotherapy (39 patients) and CT alone (27 patients). The 5-year overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS) were calculated using the Kaplan–Meier method. Additional prognostic factors were analyzed using Cox proportional hazards regression.Results: Herein, the analysis was conducted using 66 patients with a median follow-up period of 50 and 85 months in the sandwich and CT-alone arms. Comparing the sandwich sequence and CT-alone groups, the 5-year OS and PFS were 87% vs. 70% (p = 0.097) and 77% vs. 65% (p = 0.209), respectively. The sandwich therapy conferred an improved 5-year DSS (92% vs. 70%, p = 0.041) and a lower local recurrence rate (0% vs. 11%, p = 0.031). In multivariable analyses, grade 3 histology and deep myometrial invasion were independent risk factors for 5-year OS and DSS. The sandwich sequence was a positive predictor for 5-year DSS (hazard ratio [HR] = 0.23, p = 0.029). The sandwich arm demonstrated higher acute hematologic toxicity than the CT-alone arm. CT dose delay/reduction and treatment completion rates were similar in both groups.Conclusion: For patients with stage III EC, postoperative sandwich chemoradiotherapy appears to offer a superior 5-year DSS and local control with tolerable toxicity when compared with CT alone.

Background: The influence of hormone replacement therapy on the probability of developing diabetes mellitus in individuals with prediabetes remains uncertain. Methods: Leveraging data from 106 healthcare organizations across 15 countries and involving over 114 million participants, the study established cohorts, applied propensity score matching, and examined outcomes related to diabetes mellitus. Specifically targeting individuals aged 46-60 with prediabetes before menopause, the study categorized them into HRT and non-HRT groups. Subsequent stratified analyses, incorporating factors such as age and race, were conducted to comprehensively explore potential variations in the outcomes. Results: The study involved 6566 individuals (HRT and non-HRT), with propensity score matching ensuring balanced cohorts. Over a 20-year follow-up, the HRT group demonstrated a lower incidence of diabetes mellitus compared to the non-HRT group, with a Hazard Ratio of 0.693 (95% CI: 0.577, 0.832). Stratified analyses revealed age-specific nuances, with significant protective effects in individuals aged 46-50 and 55-60. Additionally, ethnicity played a role, with HRT demonstrating significant benefits in White individuals but not in the Black or Asian populations. BMI analysis indicated a significant risk reduction with HRT in individuals with BMI less than or equal to 24.9 and 25-29.9 kg/m 2, but not in those with BMI greater than or equal to 30 kg/m2. Conclusion: In our study, we demonstrate a sustained 20-year decrease in the risk of diabetes among premenopausal individuals with prediabetes who undergo Hormone Replacement Therapy. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors Declaration of Interest: We declare no competing interests. Ethical Approval: Due to the anonymous nature of the data, the requirement for informed consent was waived. It is important to highlight that TriNetX strictly adheres to the guidelines outlined by the Health Insurance Portability & Accountability Act and the General Data Protection Regulation. Additionally, the Western Institutional Review Board has granted TriNetX an informed consent waiver, as the platform exclusively aggregates counts and statistical summaries of de-identified information. Furthermore, our specific utilization of TriNetX for this study has received approval from the Institutional Review Board (IRB) committee of Taichung Veterans General Hospital (approval number: CE24061A, TCVGH).

Background/Objectives: The treatment-free interval (TFI) predicts benefit from platinum rechallenge in gynecological cancers, but its prognostic value in patients receiving second-line pembrolizumab plus lenvatinib for recurrent endometrial cancer (EC) is unknown. We evaluated whether the TFI is associated with survival and toxicity in this setting. Methods: Using the TriNetX Research Network (122 healthcare organizations, United States and Europe), we identified adults aged 18–90 years with advanced or recurrent EC between January 2018 and June 2026 who received three to six cycles of first-line carboplatin plus paclitaxel, progressed, and then received pembrolizumab plus lenvatinib. Patients were stratified by TFI (<6 months, Cohort 1; ≥6 months, Cohort 2) and matched 1:1 by propensity score. The primary outcome was overall survival (OS), compared using Kaplan–Meier and Cox proportional-hazards methods; adverse-event risks were exploratory outcomes compared using z-tests for the risk difference, without adjustment for multiple comparisons. Results: Of 420 eligible patients, 119 remained in each cohort after matching, with balanced baseline characteristics. Median OS was 10.0 months in Cohort 1 versus 23.6 months in Cohort 2 (hazard ratio 1.60, 95% confidence interval 1.12–2.29; p = 0.009), and 3-year OS was 32.5% versus 40.5%. Grade 3 anemia occurred earlier and more often in Cohort 1 (hazard ratio 1.74, 95% confidence interval 1.10–2.76; p = 0.017), whereas hypothyroidism was less frequent (31.9% versus 47.1%; p = 0.017); the remaining adverse events did not differ significantly between cohorts. Conclusions: A TFI ≥ 6 months is associated with significantly longer OS and a largely similar toxicity profile. The TFI is a readily available, real-world evidence-based reference for the prognosis and for the comparative adverse-event profile of the two TFI groups in this setting.