Metastatic endometrial carcinoma presenting as a scapular mass: A case report and literature review.

Bone metastases of endometrial cancers are quite rare, especially in the scapula. Only two previous reports of such cases were found in the literature, and in each case a different approach to diagnosis was used. There are no established recommendations for screening for bone metastases at diagnosis or after initial treatment of endometrial cancers. In the present case, a 55-year-old woman with progressive abdominal distension was diagnosed with a cystic mass. Histopathological analysis revealed grade II synchronous endometrioid carcinoma in both the endometrium and the ovaries. The patient received three cycles of combined paclitaxel and carboplatin chemotherapy. Seven months after the last chemotherapy cycle, a palpable lump was found in the right shoulder, suggesting a lesion in the right scapula. A bone scan revealed heightened radioactivity uptake, highlighting the unpredictable nature of the disease progression. The choice of diagnostic imaging modality remains challenging. This case emphasises the need for ongoing investigation of the mechanisms of distant metastasis and for the development of standardised diagnostic and therapeutic strategies.

The challenging journey of cervical cancer diagnosis and treatment at the second largest hospital in Indonesia.

Objectives: Cervical cancer is a major health concern in developing countries. Access to preventive measures is limited in low- and middle-income countries, and cervical cancer is often identified at an advanced stage of the disease. In this study, we aimed to investigate when patients were first diagnosed and received treatment at a large hospital in Indonesia. Methods: Data were collected using a questionnaire from outpatient visits and descriptively analyzed. Totally, 215 cervical cancer patients being treated at the Dr. Soetomo Academic Hospital's gynecological oncology outpatient clinic in Indonesia between August and October 2022 were included. Results: Most patients were 51-60 years old (36.3 %), housewives (87 %), and had an elementary school education level (50 %). Most (88.4 %) admitted they were unaware about cervical cancer prevention, and 85.6 % never underwent screening. Most cervical biopsies were performed at primary hospitals (42.3 %). Fear of cancer treatment was the most frequent reason for patients arriving late at tertiary hospitals (50 %). Treatment delays occurred because patients had to visit two healthcare facilities before visiting a tertiary hospital (47.4 %). Most patients were diagnosed with stage III cancer (38.1 %), and chemotherapy was administered as the first-line therapy (96.3 %). Most patients (51.2 %) received their first therapy >12 months after initial symptom onset. Conclusions: Most cervical cancer patients were diagnosed at a late stage owing to a lack of information regarding early symptoms and irregular screenings. Treatment was delayed owing to social barriers. Therefore, the government should have more strict policies to implement cervical cancer detection and prevention.

Successful Cesarean Myomectomies of Large Uterine Fibroids: Two Cases and a Literature Review.

BACKGROUND No standard guidelines have been specified for a cesarean myomectomy, and several centers remain divided on the justification to perform this procedure, especially for large fibroids. Only a few case reports have been published of cesarean myomectomy for large fibroids. Here, we report 2 cases of successful cesarean myomectomies for large fibroids (>15 cm) during the 38th week of pregnancy. CASE REPORT We encountered 2 primigravida patients, aged 34 and 36 years, respectively, with large fibroids >15 cm in diameter. Using the Pfannenstiel incision, we performed cesarean myomectomies in both patients at term pregnancy. The surgeries were performed by a gynecologic oncologist in a tertiary hospital. Both patients experienced a postoperative decrease in hemoglobin but neither required a blood transfusion. Three days after the operation, the patients were discharged from the hospital in good condition. One year later, the patients and their babies continued to be in good health. The patients did not experience chronic pelvic pain or menstrual abnormalities. Neither patient is currently planning another pregnancy. CONCLUSIONS Based on our report, it may be assumed that cesarean myomectomy for a large fibroid (even for fibroids >15 cm in diameter) is safe if performed by experts in a tertiary hospital. Further larger studies of cesarean myomectomy of large fibroids are required to confirm the safety of this procedure.

WITHDRAWN: The Effect of Electroacupuncture Therapy on Pain, Plasma ß-Endorphin, and Quality of Life of Stage III Cervical Cancer Patients: A Randomized Control Trial.

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The Effect of Electroacupuncture Therapy on Pain, Plasma ß-Endorphin, and Quality of Life of Stage III Cervical Cancer Patients: A Randomized Control Trial.

Background: Pain is a major complaint in cancer patients and a global problem that requires medical attention, including pain in cervical cancer. Although pharmacotherapy has been used for the treatment of cancer pain, there are still around 40% cannot be treated only with pharmacotherapy. Objectives: To determine the effects of electroacupuncture (EA) on pain in stage III cervical cancer patients. Methods: Twenty-eight stage III cervical cancer patients were divided into two groups (14 treatments and 14 controls) with randomized control trial design. The treatment group received EA with a frequency of 2/20-25 Hz at points of ST36, SP6, LI4 and LR3 for 30 minutes, while the control group did not receive EA. Both groups were given paracetamol and codeine at the same dose. Assessment was carried out by measuring pain scale (VAS), plasma ß-endorphin levels, and quality of life/QoL (EORTC QLQ-C30) before and after therapy. Results: The average reduction in VAS in the treatment group (2.71 ± 1.14) compared to the control group (0.71 ± 1.33; p < 0.001), average increase in plasma ß-endorphin levels in the treatment group (88.57 ± 52.46 pg/ml) compared to the control group (12.86 ± 56.76 pg/ml; p = 0.001), and in QoL, there were significant differences in symptom improvement between the treatment and control groups in the domain of fatigue, pain, insomnia and overall QoL (p < 0.05). Conclusion: Medical therapy combined with EA decreased pain scale, increased plasma ß-endorphin levels, and improved the QoL for stage III cervical cancer patients.

Electroacupuncture Versus Analgesics for Patients with Stage IIIB Cervical Cancer Post Cisplatin Chemotherapy.

Background: The prevalence of pain at advanced cervical cancer stages is increasing. Existing World Health Organization recommendations for management comprises a 3-step ladder of analgesic therapy but this still cannot address this pain optimally. An alternative therapy used to reduce pain, acupuncture, is almost without side-effects, is safe, and is easy to implement. This study compared electroacupuncture (EA) versus paracetamol 500 mg +10-mg codeine therapy for patients with stage-IIIB cervical cancer post cisplatin chemotherapy. Materials and Methods: Participants were divided into 2 groups (treatment and control groups). A quasiexperimental study was conducted using a nonequivalent control group pretest-post-test design. Participants in the treatment group were given EA for 30 minutes 10 times over 3 weeks, while participants in the control group were given paracetamol 3 × 500 mg and codeine 3 × 10 mg orally every day for 3 weeks. Statistical analysis used paired t-tests, a Wilcoxon test, an independent t-test, or a Mann-Whitney-U test with P < 0.05. Results: Pretest and post-test pain-scale levels were 5.39 ± 0.62 and 4.57 ± 0.88, respectively (P < 0.001). Average endorphin-ß levels at pretest and post-test were 571.80 ± 281.13 and 491.14 ± 272.14, respectively (P = 0.818). Median values of quality of life at pretest and post-test were 681.75 (range: 503.80-915.20) and 635.25 (range: 538.20-781.20; P = 0.383), respectively. Conclusions: Pain-control therapy using drugs or EA produces similar results. However, EA, subjectively, produces improved pain-scale results better than pharmaceuticals.

Effect of Electroacupuncture on Natural-Killer Cells and Tumor Size in Patients with Cervical Squamous-Cell Carcinoma: A Randomized Controlled Trial.

Background: A natural-killer (NK) cell is a cytotoxic lymphocyte that responds to tumor formation. Electroacupuncture (EA) in patients with cancer, who had chemotherapy, enabled them to maintain their T-cell counts (CD3+, CD4+, and CD8+) and NK-cell activity. Objective: To evaluate NK-cell levels and tumor sizes in patients with cervical squamous-cell carcinoma (SCC) after EA on ST 36 (Zusanli). Design: This study was a randomized, experimental clinical study with a pre-post-test, control group design. Setting The study was performed in the obstetrics and gynecology department, Gynecology Oncology Division of the Rumah Sakit Dokter Soetomo General Hospital, in Surabaya, Jawa Timur, Indonesia, conducted from February 2016 until May 2016. Subjects: Patients with cervical SCC, stages IIb-IIIb (locally advanced)-determined clinically and histopathologically-all of whom had 50 mg/m2/week of cisplatin chemotherapy. The patients were divided, consecutively, into 2 groups by simple random sampling. Intervention: The controls received only received the chemotherapy, while treatment-group patients also had EA 1 day on bilateral ST 36 after each chemotherapy cycle. Outcome Measures: Primary outcomes were percent of NK cells and tumor size. Before the first treatment and after the fourth one, all patients underwent peripheral blood examinations (complete blood counts, serum creatinine and blood-urea-nitrogen levels, and flow-cytometry) to determine percentages of NK cells, and pelvic magnetic resonance imaging to measure cervical tumor sizes. Secondary outcomes were pain, nausea, vomiting, and appetite. Results: There was a significant increase in number of NK cells (P = 0.00) and a significant decrease in tumor sizes (P = 0.03) in the treatment group, compared to the control group. There was a significant increase in appetite (P = 0.00) in the treatment group, compared to baseline, but there were no significant differences in pain (P = 0.061), nausea (P = 0.399), and vomiting (P = 0.854). Conclusions: Patients with cervical SCC at stages IIb-IIIb, who received 4 cycles of chemotherapy using 50 mg/m2/week of cisplatin and EA at ST 36, had increased NK-cell percentages in their peripheral blood and had reductions in their cervical tumors.