Ferroptosis is a novel types of regulated cell death and is widely studied in cancers and many other diseases in recent years. It is characterized by iron accumulation and intense lipid peroxidation that ultimately inducing oxidative damage. So far, signaling pathways related to ferroptosis are involved in all aspects of determining cell fate, including oxidative phosphorylation, metal-ion transport, energy metabolism and cholesterol synthesis progress, et al. Recently, accumulated studies have demonstrated that ferroptosis is associated with gynecological oncology related to steroid hormone signaling. This review trends to summarize the mechanisms and applications of ferroptosis in cancers related to estrogen and progesterone, which is expected to provide a theoretical basis for the prevention and treatment of gynecologic cancers.

Rationale: Endometrial stromal sarcoma (ESS) is a rare disease in patients with uterine malignancies, accounting for <1%. Low-grade endometrial stromal sarcoma (LGESS) accounts merely 0.2% of gynecologic malignant tumor. Primary low-grade extrauterine endometrioid stromal sarcomas (LGEESS) is even more uncommon, with only a few documented case reports. We report a case of primary LGEESS exhibiting widely invasion in multiple organs after hysterectomy, which is the first case reported in Jiangsu Province of China. Patient concerns: A 42-year-old nulliparous female with dysgnosia presented with a moderate amount of irregular vaginal bleeding, abdominal pain and distension, and frequent urination for 2 days. Her surgical history included a total hysterectomy and bilateral salpingectomy for uterine fibroids 6 years ago. Ultrasonography and the abdominal and pelvic computed tomography scan detected some solid polycystic masses in the pelvic and abdominal cavities. Diagnoses: The histopathology of the specimen confirmed the diagnosis of LESS in the absence of florid endometriosis. The patient was diagnosed with primary extrauterine endometrial stromal sarcoma at FIGO stage III. Interventions: Surgery and histopathology were performed. Outcome: After surgery, the patient was maintained on leuprorelin acetate microspheres with sustained release for injection at 3.75 mg once every 4 weeks while refusing further radiotherapy. Lessons: The diagnosis of primary LGEESS is challenging mainly because of their unforeseen location and nongynecologic signs and symptoms. Total hysterectomy and bilateral salpingo-oophorectomy are recommended to LGESS, while additional resection for extrauterine disease depends on disease extent and resectability.

The objective of this study was to identify risk factors for recurrent cervical high-grade squamous intraepithelial lesions (HSIL/CIN2-3) following loop electrosurgical excision procedure (LEEP), with a particular focus on evaluating the protective effect of human papillomavirus (HPV) vaccination, including effective timing of administration, against disease recurrence. This retrospective study analyzed 343 patients with colposcopy-directed biopsy-confirmed cervical HSIL who underwent LEEP, including 127 vaccinated and 216 unvaccinated individuals. Multivariate logistic regression analysis was employed to identify risk factors associated with HSIL recurrence. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff timing of HPV vaccination for preventing post-LEEP HSIL recurrence. Among the 343 patients, the post-LEEP HSIL recurrence rate was 9.0%. Multivariate logistic analysis identified CIN3 (OR = 2.956, 95% CI 1.046–8.352, P = .041), glandular involvement (OR = 3.517, 95% CI 1.165–10.621, P = .026), positive margins (OR = 2.496, 95% CI 1.100–5.667, P = .029), and persistent HPV infection (OR = 6.253, 95% CI 2.043–19.135, P = .001) as independent risk factors for HSIL recurrence. HPV vaccination was associated with a lower risk of HSIL recurrence (OR = 0.249, 95% CI 0.082–0.760, P = .015). ROC analysis indicated that administration of the HPV vaccine within 6 months post-LEEP was the optimal cutoff time for preventing recurrence (AUC = 0.851, P = .017). Vaccination either before LEEP or within this 6-month postoperative period significantly reduced the risk of HSIL recurrence ( P = .034). CIN3, gland involvement, positive margins, and persistent HPV infection increase the risk of cervical HSIL recurrence after LEEP. HPV vaccination, when administered either before or within 6 months after LEEP, is associated with a lower risk of cervical HSIL recurrence.