Faculty Bibliography

BACKGROUND/UNASSIGNED:The increasing number of organ transplant recipients has led to a rise in cancer diagnoses in this population. Kidney transplant recipients, in particular, have a two-to-four-fold higher risk of developing cancer due to immunosuppressive therapy. The management of gynecologic cancers in this subset of patients presents unique challenges due to anatomical considerations, immunosuppression, and the nephrotoxicity of oncologic treatments.Case Presentation.A 44-year-old woman with a history of polycystic kidney disease underwent a bilateral nephrectomy followed by a living-related intraperitoneal renal transplant. She presented with pelvic pain and was found to have high-grade ovarian adenocarcinoma, possibly arising from endometriosis. Surgical staging included total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and right pelvic lymph node dissection. The patient underwent six cycles of carboplatin and paclitaxel chemotherapy while maintaining stable renal function with close monitoring of immunosuppressive drug levels. Surveillance imaging detected recurrence in the right pelvic lymph nodes, leading to secondary tumor debulking and whole pelvic radiation therapy. Despite a slight increase in creatinine, kidney function remained stable, and the patient has remained disease-free on subsequent follow-ups. CONCLUSION/UNASSIGNED:The management of ovarian cancer in kidney transplant recipients requires a multidisciplinary approach to balance oncologic control with graft preservation. Close monitoring of renal function, careful surgical planning, and tailored chemotherapy and radiation strategies are critical. More research is needed to establish standardized guidelines for managing gynecologic malignancies in transplant patients.

Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detailed patient history, physical examination, and imaging techniques like transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), which aid in preoperative planning. Management options range from hormonal therapies for symptom relief to minimally invasive surgical techniques. Surgical interventions, categorized as shaving excision, disc excision, or segmental resection, depend on factors such as lesion size, location, and depth. Shaving excision is preferred for its minimal invasiveness and lower complication rates, while segmental resection is reserved for severe cases. This review also explores nerve-sparing strategies to reduce surgical morbidity, particularly for deep infiltrative cases close to the rectal bulb, anal verge, and rectosigmoid colon. A structured, evidence-based approach is recommended, prioritizing conservative surgery to avoid complications and preserve fertility as much as possible. Comprehensive management of bowel endometriosis requires expertise from both gynecologic and gastrointestinal specialists, aiming to improve patient outcomes while minimizing long-term morbidity.

OBJECTIVE/UNASSIGNED:To assess the impact of laparoscopic treatment of endometriosis on pregnancy outcomes in women with infertility, performed either before or after failed fertility enhancement technology (FET). Secondary aims included evaluating the influence of age, body mass index (BMI), prior pregnancies, endometriosis stage, and the presence of endometriomas on reproductive outcomes. DESIGN/UNASSIGNED:Retrospective cohort study of 95 women aged 18-45 with primary or secondary infertility who underwent treatment of endometriosis laparoscopically with or without robotic assistance between January 2015 and January 2023. All surgeries were performed by a single gynecologic surgeon. Patients were grouped based on whether they had prior FET failure or no prior FET. Comparisons were made between pregnant and nonpregnant patients across both groups. MAIN OUTCOME MEASURES/UNASSIGNED:Postsurgical pregnancy rates (spontaneous vs assisted reproductive technology [ART]) and factors associated with pregnancy outcomes, including age, BMI, endometriosis stage, and presence of endometriomas. RESULTS/UNASSIGNED:= .011). Endometriosis stage did not significantly influence outcomes. Patients with endometriomas were more likely to be referred for surgery before FET. CONCLUSIONS/UNASSIGNED:Laparoscopic surgery for endometriosis is associated with high pregnancy rates, regardless of prior FET status. These findings support the role of surgery as a key component in fertility management for women with endometriosis, especially prior to initiating FET.

BACKGROUND/UNASSIGNED:Number of organ transplant recipients continues to rise worldwide with increasing accessibility and growing advancements in transplant medicine. Transplant patients have at least a two-to-four fold higher risk of developing cancer compared to the general population. As the prevalence of transplant patients increases, a growing number of these patients are expected to present with concurrent conditions such as cancer, requiring more complex and interdisciplinary care. CASE/UNASSIGNED:A 44-year-old patient with an intraperitoneal pelvic renal transplant, found to have high-grade ovarian adenocarcinoma most likely arising from endometriosis, successfully underwent surgical staging, adjuvant chemotherapy, and subsequent pelvic radiation for recurrence. Her kidney function and graft viability were preserved throughout her treatment with careful monitoring. CONCLUSION/UNASSIGNED:Management of reproductive tract cancers in kidney transplant recipients is complex. Current practices largely rely on evidence from observational studies and case reports for these cancers and more research is needed in this area.

OBJECTIVE/UNASSIGNED:The use of energy during minimally invasive surgery is associated with thermal damage that can affect the process of wound healing. METHODS/UNASSIGNED:This was a randomized clinical trial including 78 women who underwent total laparoscopic hysterectomy. Patients were randomized based on the device used for colpotomy, monopolar hook versus harmonic scalpel. The thickness of the cauterized margins in the cervicovaginal tissues of the hysterectomy specimens was measured by the pathologist. RESULTS/UNASSIGNED: = 0.001)). With regard to secondary outcome measures, there was no significant difference between the two groups. CONCLUSION/UNASSIGNED:https://en.irct.ir/trial/33902?revision=61236. IRCT20180130038567N2.

Ovarian endometriomas affect many patients with endometriosis and have significant effects on quality of life, fertility, and risk of malignancy. Endometriomas range from small (1-3 cm), densely fibrotic cysts to large (20 cm or greater) cysts with varying degrees of fibrosis. Endometriomas are hypothesized to form from endometriotic invasion or metaplasia of functional cysts or alternatively from ovarian surface endometriosis that bleeds into the ovarian cortex. Different mechanisms of endometrioma formation may help explain the phenotypic variability observed among endometriomas. Laparoscopic surgery is the preferred first-line modality of diagnosis and treatment of endometriomas. Ovarian cystectomy is preferred over cyst ablation or sclerotherapy for enabling pathologic diagnosis, improving symptoms, preventing recurrence, and optimizing fertility outcomes. Cystectomy for small, densely adherent endometriomas is made challenging by dense fibrosis of the cyst capsule obliterating the plane with normal ovarian cortex, whereas cystectomy for large endometriomas can carry unique challenges as a result of adhesions between the cyst and pelvic structures. Preoperative and postoperative hormonal suppression can improve operative outcomes and decrease the risk of endometrioma recurrence. Whether the optimal management, fertility consequences, and malignant potential of endometriomas vary on the basis of size and phenotype remains to be fully explored.

Endometriosis is a frequent, estrogen-dependent, chronic disease, characterized by the presence of endometrial glands and stroma outside of the uterine cavity. Although it is not considered a precursor of cancer, endometriosis is associated with ovarian cancer. In this review, we summarized the evidence that clear-cell and endometrioid ovarian carcinomas (endometriosis-associated ovarian carcinoma-EAOC) may arise in endometriosis. The most frequent genomic alterations in these carcinomas are mutations in the AT-rich interaction domain containing protein 1A (ARID1A) gene, a subunit of the SWI/SNF chromatin remodeling complex, and alterations in phosphatidylinositol 3-kinase (PI3K) which frequently coexist. Recent studies have also suggested the simultaneous role of the PTEN tumor-suppressor gene in the early malignant transformation of endometriosis and the contribution of deficient MMR (mismatch repair) protein status in the pathogenesis of EAOC. In addition to activating and inactivating mutations in cancer driver genes, the complex pathogenesis of EAOC involves multiple other mechanisms such as the modulation of cancer driver genes via the transcriptional and post-translational (miRNA) modulation of cancer driver genes and the interplay with the inflammatory tissue microenvironment. This knowledge is being translated into the clinical management of endometriosis and EAOC. This includes the identification of the new biomarkers predictive of the risk of endometriosis and cancer, and it will shape the precision oncology treatment of EAOC.