Chemotherapy-induced severe hyponatremia is a life-threatening condition. Platinum-based agents play a key role in ovarian cancer treatment but are more likely to cause hyponatremia than other anticancer agents. The optimal strategy for treating ovarian cancer in cases of severe platinum agent-induced hyponatremia remains unclear. We encountered 2 patients with ovarian cancer who developed syndrome of inappropriate antidiuretic hormone secretion (SIADH) after chemotherapy with involved carboplatin. Case 1 was a recurrent ovarian clear-cell carcinoma with peritoneal dissemination, and the patient developed severe hyponatremia due to SIADH on day 5 after receiving triweekly docetaxel and carboplatin (DC) therapy. The chemotherapy regimen was changed to weekly DC therapy, and she completed six cycles of regimen without electrolyte disturbance or tumor recurrence. Case 2 was a newly diagnosed advanced high-grade serous ovarian carcinoma, stage IIIC, with a BRCA1 mutation. She developed SIADH on day 8 after receiving triweekly paclitaxel and carboplatin (TC) therapy as adjuvant therapy after primary debulking surgery. The regimen was changed to weekly TC therapy, and she completed the schedule of chemotherapy without electrolyte disturbance and transitioned to maintenance therapy with a PARP inhibitor. In conclusion, weekly carboplatin administration might be a promising alternative to triweekly carboplatin administration after the development of carboplatin-induced SIADH.

Background and Objectives Irinotecan sometimes causes lethal septic shock but the risk factors remain unclear. This retrospective case-control study explored the potential risk factors for septic shock following irinotecan treatment. Methods All women who received irinotecan-containing chemotherapy for gynecologic malignancies at Shizuoka General Hospital from October 2014 to September 2020 were investigated. The clinical backgrounds and blood test results of those who developed septic shock after irinotecan-containing chemotherapy were compared with those who did not. Odds ratios (ORs) for developing septic shock after receiving irinotecan were calculated with 95% confidence intervals (CIs), using univariable logistic regression analysis. Results During the study period, 147 women received irinotecan-containing chemotherapy. Three women developed septic shock due to neutropenic enterocolitis after irinotecan treatment, and 144 did not. The three patients with septic shock had recurrent cervical cancer, heterozygous variants in the uridine diphosphate glucuronosyltransferase 1A1 ( UGT1A1 ) gene (two patients had *1/ *6 , one had *1/*28 variants), a history of concurrent chemoradiation therapy, 50–60 Gy of pelvic irradiation, and platinum-combined chemotherapy. A history of pelvic irradiation was identified as a possible risk factor for developing septic shock after irinotecan-containing chemotherapy (OR 63.0, 95% CI 5.71–8635; p < 0.001). The OR of UGT1A1 polymorphism for septic shock was 9.09 (95% CI 0.86–1233; p = 0.070) in the complete case analysis. Conclusion Medical personnel involved in cancer therapy should consider the possible risk of septic shock developing due to neutropenic enterocolitis when administering irinotecan-containing chemotherapy in patients with a history of pelvic irradiation.

Cushing's syndrome (CS) during pregnancy is a rare metabolic condition associated with hypertension, hyperglycaemia, and foetal growth restriction (FGR). Here, we report two cases of CS during pregnancy with different clinical courses. Caesarean section was performed in Patient 1 at 26 weeks of gestation due to uncontrollable hypertension and severe FGR. She was diagnosed with CS after delivery. Patient 2 exhibited severe hypertension and was diagnosed with CS at 19 weeks of gestation. Surgical treatment significantly decreased her blood pressure, and she delivered a mature baby at 39 weeks of gestation. For Patient 1, microscopic findings of the placenta were compatible with preeclampsia, while the placenta of Patient 2 showed almost normal pathological findings, although the placenta was extremely small. These two cases indicate that, while maternal hypertension might affect placental growth, placental function could be recuperated by appropriate blood pressure control in the early stage of gestation.

Preventing organ injury and dissemination of an occult malignancy and benign gynecologic disease during vaginal morcellation with a large uterus in laparoscopic hysterectomy.

Chemotherapy-induced severe hyponatremia is a lifethreatening condition. Platinum-based agents play a key role in ovarian cancer treatment, but they are more likely to cause hyponatremia than other anti-cancer agents. The optimal strategy for treating ovarian cancer in the case of severe hyponatremia induced by the platinum agent remains unclear. We report the case of 77-year-old women with multiple peritoneal recurrences five years and eight months after surgery for ovarian clear cell carcinoma. She received tri-weekly docetaxel and carboplatin (DC) therapy and bevacizumab, following which she developed severe hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). We were reluctant to change the drugs because they effectively reduced the cancer antigen 125 level. The chemotherapy regimen was changed to weekly administration off a divided dose of DC, and she completed six cycles of weekly DC without electrolyte disturbance, including hyponatremia, or tumor recurrence. Weekly carboplatin administration may be a promising alternative to tri-weekly carboplatin administration after the development of carboplatin-induced SIADH.