Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing the patient’s probability of survival in relation to the underlying disease and the existing comorbidities. Materials and Methods: During 2015–2019, 594 cases hospitalized for vaginal bleeding outside of pregnancy were included in the research. For all cases, the frequency of comorbidities was calculated, applying the Cox proportional hazard model, considering the hospitalizations (from the following year after the first outpatient or hospital assessment) as a dependent variable; age and comorbidities were considered as independent variables. Results: Analysis of variance (ANOVA) for mean age of patients enrolled after diagnosis and multiple comparisons (via the Tukey post-hoc test) indicate significant differences (p < 0.05) between the average age for endometrial cancer (EC) and that for the typical endometrial hyperplasia or other diagnoses. The most common comorbidities were hypertension (62.28%), obesity (35.01%), and diabetes (22.89%), followed by cardiovascular disease. An intensely negative correlation (r = −0.715281634) was obtained between the percentage values of comorbidities present in EC and other endometrial lesions. The lowest chances of survival were calculated for 88 (14.81% of the total) patients over 50 years (the probability of survival in the next 10 years being between 0 and 21%). The chances of survival at 10 years are moderately negatively correlated with age (sample size = 594, r = −0.6706, p < 0.0001, 95% confidence interval (CI) for r having values from −0.7126 to −0.6238) and strongly negatively correlated with the CCI (r = −0.9359, p < 0.0001, 95% CI for r being in the range −0.9452 to −0.9251). Conclusions: Using CCI in endometrial lesions is necessary to compare the estimated risk of EC mortality with other medical conditions.

In the early differential diagnosis of endometrial cancer (EC), decisive and mandatory histological aspects are considered, in addition to obvious clinical manifestations. In addition, sonographic aspects are characteristic in relation to the stage, degree, and histological types of identified cancer. This bi-center retrospective observational study included 594 women with abnormal uterine bleeding outside pregnancy, for which a biopsy was performed in the Obstetrics and Gynecology Departments of the Emergency County Hospitals of Arad and Timis Counties, Romania, between 2015 and 2019. Most of the cases were represented by EC or endometrial hyperplasia (EH). Of the 594 cases, 25.5% (n = 153) were EC at women aged between 41 and 85 years. High International Endometrial Tumor Analysis (IETA) scores (3, 4) were associated with a relative risk of 2.9335 compared with other endometrial lesions (95% CI 2.3046 to 3.734, p < 0.0001, NNT 1.805). Histological aspects and pelvic ultrasound using IETA scores represent valuable noninvasive assets in diagnosing and differentiating endometrial cancer from benign uterine pathology.

Background/Objectives: Sentinel lymph node (SLN) mapping has become a standard approach in the surgical staging of early-stage endometrial cancer, aiming to reduce the morbidity associated with full lymphadenectomy while preserving diagnostic accuracy. Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) represents a novel, minimally invasive approach for SLN mapping that may offer specific benefits in terms of access, cosmetics, and recovery, particularly in select patient populations. Methods: A comprehensive literature search was conducted in the main databases for studies evaluating the use of V-NOTES for sentinel lymph node mapping in patients with endometrial cancer. Results: Of the 12 included studies, three were observational cohort studies, while the remaining were case reports and series. The mean patient age was 59.6 years, with a majority being overweight or obese. V-NOTES was performed using both transperitoneal and retroperitoneal approaches, with indocyanine green (ICG) being the most used tracer. The overall mean SLN detection rate was 98.19%, with a bilateral detection rate of 93.7%. The average operative time was 155 min, the mean blood loss was 72.03 mL, and the average hospital stay was 2.4 days. The complication rate was low (3.9%), with no conversions to laparotomy reported. Conclusions: V-NOTES appears to be a feasible and safe alternative for SLN mapping in early-stage endometrial cancer, with high detection rates and favourable perioperative outcomes. However, due to the limited number of comparative studies and small sample sizes, further prospective research is needed to establish its efficacy relative to traditional minimally invasive techniques and to determine the optimal patient selection criteria.

Background/Objectives: Traditional histopathological classification of endometrial cancer (EC) exhibits limited prognostic precision due to interobserver variability and incomplete reflection of tumor biology. The Cancer Genome Atlas (TCGA) introduced molecular subtypes, with POLE-ultramutated tumors showing superior outcomes. This systematic review and meta-analysis assesses the prognostic impact of pathogenic/likely pathogenic POLE exonuclease-domain mutations (EDM) on survival in EC. Methods: PRISMA 2020-compliant search of PubMed, Embase, and Web of Science (2015–2025) identified 20 studies (n = 7708 EC patients; 159 POLE-mutant, 2.1%). Eligibility: Adult EC patients with POLE EDM vs. non-POLE, reporting OS/PFS/DFS/RFS/CSS hazard ratios (HR). ROBINS-I assessed bias; random-effects meta-analysis pooled multivariable HR. Results: The meta-analysis revealed a significantly reduced risk of death in POLE-mutant endometrial cancer patients, with an OS pooled hazard ratio (HR) of 0.35 (95% CI 0.21–0.58; I² = 17.9%) across eight studies. Disease control endpoints (DFS/PFS/RFS) from 10 studies showed an even more substantial benefit, with a pooled HR of 0.22 (95% CI 0.12–0.41; I² = 0%). Cancer-specific survival HRs ranged from 0.00 to 0.32 across four studies, often with zero events in POLE cohorts. ROBINS-I bias was low to moderate; heterogeneity stemmed from the comparators and stages. Conclusions: POLE-EDM confers a robust, favorable prognosis across EC stages, supporting molecular risk stratification and treatment de-escalation.

Background/Objectives: Sentinel lymph node (SLN) mapping has become a standard approach in the surgical staging of early-stage endometrial cancer, aiming to reduce the morbidity associated with full lymphadenectomy while preserving diagnostic accuracy. Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) represents a novel, minimally invasive approach for SLN mapping that may offer specific benefits in terms of access, cosmetics, and recovery, particularly in select patient populations. Methods: A comprehensive literature search in the main databases was conducted for studies evaluating the use of v-notes for sentinel lymph node mapping in endometrial cancer patients. Results: Of the 12 included studies, three were observational cohort studies, while the remaining were case reports and series. The mean patient age was 59.6 years, with a majority being overweight or obese. V-NOTES was performed using both transperitoneal and retroperitoneal approaches, with indocyanine green (ICG) being the most commonly used tracer. The overall mean SLN detection rate was 98.19%, with a bilateral detection rate of 93.7%. The average operative time was 155 minutes, mean blood loss was 72.03 mL, and average hospital stay was 2.4 days. The complication rate was low (3.9%), with no conversions to laparotomy reported. Conclusions: V-NOTES appears to be a feasible and safe alternative for SLN mapping in early-stage endometrial cancer, with high detection rates and favorable perioperative outcomes. However, due to the limited number of comparative studies and small sample sizes, further prospective research is needed to establish its efficacy relative to traditional minimally invasive techniques and to determine optimal patient selection.

Background: Endometriosis of the cervix is a rare, non-cancerous disease that can look or behave like cancerous cervical tissue, causing challenges regarding diagnosis and management. Discrimination between benign and malignant lesions can be difficult when utilizing cytological, colposcopic, and histopathological data if the findings do not agree with each other. Case Presentation: We report the case of an asymptomatic 45-year-old woman who was initially diagnosed with FIGO stage IA1 microinvasive cervical carcinoma based on cytological, colposcopic, and conization findings. Further evaluation yielded persistent uncertainty in diagnostic imaging and, in addition, a concern for invasive cervical disease. Therefore, the patient underwent a total hysterectomy with bilateral salpingo-oophorectomy, and the result of the postoperative evaluation was cervical endometriosis without evidence of invasive malignancy. This example demonstrates the diagnostic challenges associated with rare benign cervical lesions, which may resemble cervical carcinoma, and emphasizes the high-risk for overtreatment due to the vagueness of these types of cases. Conclusions: When there is a discrepancy among clinical findings, cytology, and histopathology in suspicious cervical lesions, cervical endometriosis must be considered in the differential diagnosis. To increase accuracy in diagnosis and minimize the possibility of unnecessary radical treatment, careful histopathologic reevaluation and multidisciplinary assessment are necessary.