Ege HV, et al. J Gynecol Oncol. 2024 Sep;36:e32. https://doi.org/10.3802/jgo.2025.36.e32

Next-generation human papillomavirus (HPV) vaccines encompass newly licensed and emerging formulations that employ alternative production platforms, expanded valency, or novel antigenic targets beyond conventional L1-based vaccines. These vaccines aim to address affordability challenges, supply limitations, and suboptimal vaccination coverage, particularly in low- and middle-income countries. This review aggregates current clinical, immunological, and programme-related evidence on newly licensed vaccines, including the World Health Organization (WHO)-prequalified bivalent formulations (Cecolin^® and Walrinvax^®), the quadrivalent Cervavac^®, and the Escherichia coli-derived nonavalent Cecolin 9^®, which received national licensure in 2025. Additionally, emerging high-valency candidates in Phase I–III trials—9-valent, 11-valent, and 14-valent formulations—are critically assessed. Clinical trials demonstrate that next-generation HPV vaccines provide robust protection; for example, Cecolin^® showed 100% efficacy against HPV-16/18-associated high-grade squamous intraepithelial lesions (HSIL) and up to 97.8% efficacy against persistent HPV infection, while Walrinvax^® demonstrated 78.6% protection against CIN2+ lesions. Cervavac^® showed non-inferior immunogenicity compared with established vaccines. While comparative analyses of efficacy, immunogenicity, and safety indicate that these vaccines are strong alternatives to established products, robust long-term effectiveness and real-world impact data remain essential before full clinical equivalence can be definitively established. Advances in L2-based platforms further aim to broaden cross-type protection, simplify manufacturing, and enable thermostable formulations, thereby enhancing applicability in resource-limited settings. Economic evaluations demonstrating favorable cost-effectiveness emphasize the essential role of next-generation vaccines in improving access and reducing inequity. Overall, innovations in valency, technology, and delivery strategies have the potential to significantly expand global HPV prevention coverage and accelerate progress toward cervical cancer elimination.

Background/objectives: The study aimed to present cases of malignant struma ovarii from seven centers in Türkiye and evaluate them within the context of the existing literature. Methods: We retrospectively analyzed clinical data from 17 patients treated at seven centers, focusing on clinical features, surgical management, pathology, thyroid function, adjuvant treatment, and outcomes. Additionally, a literature review including eight studies with 178 patients was conducted. Results: The mean age of patients was 44.7 years, with a mean tumor size of 9.2 cm. Elevated Ca 125 was found in 33.3% of patients, while thyroid function abnormalities and hyperthyroidism signs were rare. Pelvic pain and menstrual irregularities were common presenting symptoms. A total of 16 patients (94.1%) had unilateral tumors. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and unilateral salpingo-oophorectomy were the most frequent surgical approaches. Histopathology predominantly showed classical papillary thyroid carcinoma (13 patients, 76%). All patients were FIGO stage I, with no metastasis. Thyroidectomy was performed in seven patients, identifying two concurrent thyroid cancers. Four patients received adjuvant radioactive iodine therapy. During a median follow-up of 43 months, no deaths and one recurrence were observed. The literature review showed a diagnosis age ranging 43–53 years and papillary thyroid carcinoma as the most common subtype. Thyroidectomy and RAI treatment were selectively applied. Among the reported studies, recurrence occurred in 7 of 76 patients (9.2%), while 5-year disease-free and overall survival rates exceeded 94% and 100%, respectively. BRAF mutations were uncommon. Conclusions: Malignant struma ovarii is a rare tumor with a favorable prognosis when diagnosed early and managed appropriately.

Purpose: To evaluate the association between ultrasonographically measured umbilical coiling index (UCI) at 18–24 weeks of gestation and adverse perinatal outcomes in primigravid pregnancies. Methods: This prospective study included 461 primigravid women with singleton pregnancies. UCI was measured at 3 cord segments and classified as hypocoiled (< 0.20), normocoiled (0.20–0.40), or hypercoiled (> 0.40) using percentile distribution and ROC-derived thresholds. Maternal characteristics, delivery outcomes, fetal well-being, placental measurements, cord blood gas values, and neonatal outcomes were compared using Kruskal–Wallis, Mann–Whitney U, and chi-square tests (p < 0.05 was significant). Results: Of the 461 patients, 72 (15.6%) were hypocoiled, 244 (52.9%) normocoiled, and 145 (31.5%) hypercoiled. No significant differences were found in maternal age, BMI, gestational age at delivery, hypertension, diabetes, or placental abruption. Birth weight was lowest in the hypocoiled group (p < 0.001). Umbilical artery pH was significantly lower in the hypercoiled group (p < 0.001). Both hypo and hypercoiled groups showed significantly reduced placental weight/thickness (p < 0.001) and higher rates of non-reassuring non-stress tests (34.7 and 28.3% vs. 9.0%, p < 0.001). Meconium-stained amniotic fluid (p = 0.003), oligohydramnios (p < 0.001), and intrauterine growth restriction (p < 0.001) were more common in abnormal coiling groups. Five-minute Apgar scores were significantly lower in both abnormal groups (p < 0.001). No association was found with fetal death (p = 0.575). Conclusion: Both decreased and excessive umbilical cord coiling in the second trimester are associated with impaired fetal growth and adverse perinatal outcomes. Routine second-trimester UCI assessment may help identify high-risk pregnancies.