Highlights Vulvar proximal-type epithelioid sarcoma during pregnancy is extremely rare. Immediate and agressive treatment is essential even in pregnancy, and vulvectomy during pregnancy is considered safe. Further reserch is required to discuss about the effectiveness of adjuvant therapy.

Renal transplantation is a viable treatment option for patients with end-stage kidney disease; however, it requires careful surgical manipulation as the transplanted kidney is placed in the iliac fossa. Herein, we report a case of a 41-year-old female with a history of two renal transplants who presented with hypermenorrhea and dysmenorrhea. Computed tomography revealed transplanted kidneys in the bilateral iliac fossae (right atrophic), and magnetic resonance imaging showed uterine adenomyosis. Three-dimensional computed tomography was performed to determine the relationship between the arteriovenous vessels, iliac vessels, and ureter of the transplanted left kidney. A diamond-shaped trocar was inserted while monitoring the transplanted kidney. Total laparoscopic hysterectomy and bilateral salpingectomy were performed without any perioperative complications. Immunosuppressants were continued postoperatively. Laparoscopic surgery for gynecological diseases can be advantageous and should be considered in patients who underwent renal transplants.

ObjectiveTo compare single‐photon emission computed tomography with computed tomography (SPECT/CT) and lymphoscintigraphy (LSG) for the detection of sentinel lymph nodes (SLNs) in patients with early‐stage cervical cancer.MethodsThis hospital‐based, single‐center, retrospective study included 128 patients with cervical cancer (aged >18 years) treated between 2014 and 2022. Injection of 99 m Technetium‐labeled phytate into the uterine cervix was used to detect pelvic SLNs. SNL identification rates and locations were analyzed for preoperative LSG and SPECT/CT.ResultsMedian age and body mass index of patients were 40 years (range, 20–78 years) and 21.7 kg/m2 (range, 16–40 kg/m2), respectively. There was no significant difference in overall identification rates (identification of at least one SLN) of SLNs between SPECT/CT (91%) and LSG (88%). There was no significant difference in bilateral SLN identification rates between SPECT/CT (66%) and LSG (65%). A total of 219 pelvic SLNs (110 right and 109 left hemipelvis) were identified by SPECT/CT; the most frequent locations were the obturator (122 SLNs, 56%) and external iliac (67 SLNs, 30%).ConclusionSPECT/CT and LSG showed high SLN identification rates in patients with cervical cancer, and there was no significant difference in overall or bilateral SLN identification rates between the two techniques.

We encountered a case of life-threatening pulmonary embolism (PE) after an extensive retroperitoneal tumor (RT) surgery. The patient complained of abdominal distension. Preoperatively, an ovarian tumor and colon adenoma were suspected. Upon laparotomy, tumor resection and partial rectal resection were performed; the tumor had originated from the retroperitoneum. On postoperative day 11, the patient suddenly went into fatal shock complicated by strong back pain and dyspnea after the continuous pressure drain was removed. Thrombolysis, anticoagulation, and percutaneous catheter-directed treatment were attempted for the massive PE; however, these induced copious intra-abdominal bleeding. A substantial blood transfusion was required, which increased her body mass by 40 kg. On day 22, an intra-abdominal embolism was resected, and hemodynamics stabilized. RTs have a potential risk of perioperative thromboembolism; therefore, we suggest that surgery should take place in an academic hospital with an experienced circulatory team. To preserve life after PE, early diagnosis and multidisciplinary treatment are indispensable.

Genital bleeding is the most common and serious complication in gynecologic malignancy. Different techniques are available for the control of severe bleeding, but standard treatment strategies have not been determined. Herein we report on the successful use of the balloon technique in two cases of genital bleeding in uterine neoplasm. The first case was of advanced cervical cancer with massive genital bleeding during radiotherapy. A metreurynter (mini-metro) was inserted into the vagina and hemostasis was indirectly achieved in the vaginal hematoma. The other case was of postoperative recurrent bleeding after cervical conization. A Foley balloon catheter was inserted into the endocervical canal and balloon tamponade directly stopped the bleeding. This technique is safe for massive genital bleeding in some cases of gynecological cancer, and can be conventionally performed regardless of the facility or department. The need for invasive treatment for fatal bleeding in gynecological cancer in which gauze packing is ineffective may be avoided by balloon tamponade without serious complications.