Background: Endometrial cancer is the most common gynecological malignancy in high-income countries, with recurrence occurring in approximately 8.3% of endometrioid endometrial carcinoma cases. Recurrence in elderly patients is associated with significantly worse outcomes, compounded by comorbidity burden, atypical clinical presentations, and the technical demands of salvage surgery. The co-occurrence of recurrent endometrioid endometrial carcinoma and acute salpingitis in an elderly patient represents a clinically complex and poorly characterized entity, with no systematic documentation in the current literature. Case Presentation: We report the case of a 78-year-old female patient who underwent open supracervical hysterectomy with bilateral adnexectomy for a large pelvic mass. Histopathological analysis confirmed locally advanced infiltrative endometrioid endometrial carcinoma, FIGO stage IIIA (pT3aNxMx), with concurrent acute purulent salpingitis and parasalpingeal abscesses of the left adnexa. An aggressive tumor progression of residual disease was identified at five months postoperatively, with CT imaging revealing a persistent uterine mass in direct contact with the bladder and a congenitally duplicated left ureter. Following multidisciplinary preoperative planning and Double-J catheter insertion, salvage completion surgery was successfully performed, including radical excision of the cervical stump and concurrent surgical reconstruction of the involved duplicated left ureters via direct bladder reimplantation and end-to-end anastomosis. The second histopathological examination confirmed recurrent locally advanced endometrioid endometrial carcinoma. Conclusions: Incomplete index resection with involved margins in advanced-stage (FIGO IIIA) high-risk endometrioid endometrial carcinoma can permit persistent residual tumor to progress aggressively. Salvage completion surgery in elderly patients with concurrent comorbidities and anatomical variants is highly complex and should be centralized in specialized units with integrated oncological, urological, and perioperative expertise.

Dedifferentiated liposarcoma (DDLPS) of the spermatic cord is an exceptionally rare and aggressive malignancy for which diagnostic and therapeutic guidelines remain limited. We report the case of a 73-year-old man who presented with a rapidly enlarging left inguinal/paratesticular mass. Initial ultrasonography showed a 4.3 × 3.0 × 3.7 cm hypoechoic lesion interpreted as suggestive of leiomyoma. Pelvic magnetic resonance imaging subsequently demonstrated a 10 × 5 × 5 cm neoplastic mass arising from the spermatic cord. The patient underwent radical left orchiectomy. Histopathological examination revealed a high-grade spindle-cell neoplasm with marked pleomorphism and up to 30 mitoses per 10 high-power fields. Immunohistochemistry showed positivity for p16, MDM2, and CDK4, with a Ki-67 proliferative index of 95%, supporting the diagnosis of high-grade DDLPS. Although surgical margins were negative, the disease progressed rapidly. Nineteen days after surgery, the patient developed bilateral pleural effusion, pleural infiltration, pulmonary metastases, and a probable pathological T11 fracture. Because of extensive metastatic disease and clinical deterioration, systemic antineoplastic therapy was not initiated in this advanced setting. The patient died 27 days after hospitalization due to progressive metastatic disease. This case highlights the diagnostic difficulty, aggressive biological behavior, and need for early multidisciplinary management of spermatic cord DDLPS.

Background/Objectives: Backpacks are widely used for carrying loads; however, posteriorly positioned loads can shift the body's center of mass, promote forward trunk and head compensation, and increase neck and shoulder muscle loading. This study examined the effects of a detachable lumbar support cushion at loads equivalent to 10%, 15%, and 20% of the body weight. Methods: Twenty-eight healthy adult men completed repeated-measures trials of backpacks without or with lumbar support cushions. The craniovertebral angle (CVA), forward trunk lean (FTL), pelvic tilt angle (PTA), upper trapezius, sternocleidomastoid (SCM) tone, and stiffness were assessed. The trial registration was completed by the Clinical Research Information Service of the Republic of Korea (KCT0012211). Results: Most variables changed significantly as the load increased, with the largest changes occurring up to 15% and limited additional changes between 15% and 20%. The cushion did not significantly affect CVA or FTL but increased PTA and reduced SCM tone. Conclusions: A detachable lumbar support cushion may modify the PTA and was associated with lower SCM tone during backpack carriage.

Background/Objectives: Uterine fibroids may contribute to lower urinary tract symptoms (LUTS) through pelvic mass effects, but urinary and sexual outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) and their anatomical correlates remain unclear. We evaluated 6-month urinary and sexual outcomes, described urinary changes by dominant fibroid location, and explored associations between uterine morphology and baseline urinary symptom burden. Methods: This retrospective study included 75 women with paired baseline and 6-month urinary assessments (anterior, n = 45; non-anterior, n = 30). Measures included the Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and Female Sexual Function Index (FSFI; n = 63); pretreatment magnetic resonance imaging (MRI) characterized uterine anatomy. Results: At 6 months, OABSS decreased from 3.51 ± 3.07 to 2.57 ± 2.29 (p = 0.005); UDI-6, IIQ-7, and ICIQ-UI SF also improved (all p ≤ 0.009), and OABSS ≥ 3 prevalence declined from 53.3% to 40.0% (p = 0.002). Mean urinary symptom scores decreased in both location groups. The larger longitudinal-diameter subgroup had higher baseline OABSS (4.20 vs. 2.71; p = 0.034) and OABSS ≥ 3 prevalence (70.0% vs. 34.3%; p = 0.003), whereas the corresponding comparisons for uterine volume and anteroposterior diameter were not significantly associated. The mean FSFI total score increased from 21.6 ± 5.8 to 26.5 ± 6.6 (summary-derived conservative p-value bound, p < 0.005). Conclusions: USgHIFU was associated with improved urinary symptoms, urinary symptom-related quality of life, and sexual function. The exploratory association between the longitudinal-diameter groups and baseline overactive bladder symptom burden warrants confirmation using continuous measurements and adjusted analyses.

Cervical clear cell carcinoma (CCC) is a rare human papillomavirus (HPV)-independent adenocarcinoma. A 73-year-old woman presented with postmenopausal bleeding. Ultrasonography demonstrated a cervical mass and a 5.0 × 5.0 mm right cornual nodule. On 3.0-T magnetic resonance imaging (MRI), the cornual lesion measured 5.2 × 5.3 mm and, like the cervical tumor, showed high signal intensity on diffusion-weighted imaging (b = 1000 s/mm2). 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) demonstrated intense uptake in the cervical mass (30.6 × 29.2 × 41.2 mm; SUVmax 10.4) and in the spatially separate right cornual nodule (5.2 × 5.1 mm; SUVmax 14.6), without FDG-avid nodal or distant metastatic disease. The concordant identification of the cornual lesion by ultrasonography, MRI, and PET/CT prompted multidisciplinary reassessment and radical hysterectomy to obtain definitive pathological characterization of both lesions. Histopathology demonstrated clear cell carcinoma at both sites; however, because molecular, genomic, or clonality analyses were not performed, their biological relationship remains uncertain. All 30 examined lymph nodes and the surgical margins were negative. The cervical primary was staged as pT1b3 pN0 cM0 (FIGO 2018 stage IB3). The patient received four cycles of postoperative chemotherapy with paclitaxel plus cisplatin. At 14 months after surgery, gynecological examination and pelvic MRI showed no evidence of recurrence. This case highlights the complementary roles of ultrasonography, MRI, and 18F-FDG PET/CT in characterizing a minute spatially separate uterine lesion while underscoring the need for cautious interpretation when the relationship between lesions cannot be established.

Ectopic adrenal cortical tissue (EACT) is an uncommon developmental heterotopia and is exceptionally rare in the ovary of adult women. A 52-year-old woman, 6 years after menopause, was evaluated for progressive enlargement of a uterine leiomyoma and postmenopausal spotting. Transvaginal ultrasonography and pelvic magnetic resonance imaging demonstrated multiple uterine leiomyomas but no adnexal mass or endometrioma. During total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, dense adhesions between the sigmoid colon and posterior cul-de-sac were unexpectedly encountered. Histopathologic examination of the adhesion-related tissue revealed neither endometriosis nor significant inflammatory change. Microscopic examination of the ovary identified a 1.9 mm, sharply circumscribed nodule composed of clear, vacuolated zona fasciculata-like cells and compact eosinophilic zona reticularis-like cells. The lesional cells showed diffuse Melan-A immunoreactivity and focal-to-patchy inhibin-α positivity, supporting adrenocortical differentiation. The findings established a diagnosis of ovarian EACT. This case emphasizes that microscopic ovarian adrenal rests may be radiologically occult and should be distinguished from ovarian steroidogenic neoplasms by integrating clinical, morphologic, and immunohistochemical findings.

Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is a rare variant of urothelial carcinoma accounting for less than 1% of all bladder malignancies, characterized by syncytially arranged tumor cells within a dense lymphoplasmacytic stroma and consistent Epstein-Barr virus (EBV) negativity. We report a male patient in his sixth decade presenting with painless gross hematuria. Cystoscopy revealed an endoscopically unresectable lateral wall bladder mass, confirmed on biopsy as muscle-invasive high-grade urothelial carcinoma, LELC variant (cT2N0M0), with moderate (2+) GATA3 positivity and negative EBER-ISH. Following three cycles of neoadjuvant cisplatin-gemcitabine chemotherapy, restaging imaging demonstrated complete clinical response (ycT0N0M0). Radical cystectomy with extended bilateral pelvic lymph node dissection and ileal conduit urinary diversion was performed. Final histopathological examination confirmed complete pathological response (ypT0N0), with fibrosis and inflammatory changes only, negative surgical margins (R0), and 10-15 tumor-free lymph nodes retrieved. This case highlights the exceptional chemosensitivity of bladder LELC to platinum-based neoadjuvant chemotherapy and underscores the necessity of proceeding with radical cystectomy despite radiological complete response.

BackgroundLipedema is a chronic condition that is increasingly being detected and gaining public awareness; however, strongly validated therapeutic options are lacking.ObjectivesGiven need for appropriate lipedema management approaches and demand for new studies and methods, this investigation aimed to compare effects of a combined treatment consisting of extracorporeal shock wave therapy (ESWT), manual lymphatic drainage (MLD), intermittent pneumatic compression (IPC), and lifestyle recommenda-tions to a 5-week pre-treatment period prior to treatment in patients with lipedema.MethodsWe conducted a retrospective evaluation of patients undergoing a 5-week pre-treatment period with lifestyle recommendations followed by a 5-week treatment period (10 sessions) with a standardized protocol including ESWT, MLD and IPC. Circumference measurements at three designated points on the lower extremities were recorded at start and end of pre-treatment period and before and after treatment.ResultsData from 55 female patients (age: 46.9 ± 11.9 years; body mass index: 29.54 ± 7.33 kg/m[2]) who completed both the 5-week pre-treatment lifestyle-only observation period and the subsequent 5-week combined treatment period were analyzed. Comparison of changes in lower extremity circumference measurements between the two periods demonstrated significantly greater reductions during the combined treatment period at five of the six evaluated measurement sites.(p < 0.05).ConclusionIn this retrospective cohort study, combined use of ESWT, MLD, IPC, and lifestyle recommendations was associated with improvements in lower extremity circumference measurements; however, due to its non-randomized design, causal inferences cannot be made. Further randomized controlled trials are needed to clarify individual and combined effects of these treatments.

Castleman disease (CD) is a rare lymphoproliferative disorder with nonspecific clinical and imaging manifestations, making it easily confounded with other pelvic tumours. This article reports the case of a 43-year-old female who presented with a 4-year history of abnormal uterine bleeding starting in 2021. Pelvic ultrasound revealed a solid mass in the left adnexal region. The patient underwent laparoscopic resection of a left pelvic retroperitoneal mass, and postoperative pathological diagnosis confirmed hyaline vascular CD. The patient recovered well after surgery, and no recurrence was observed during follow-up at 1, 2, and 6 months postoperatively. This case suggests that although CD is rare, it should be given due consideration in the differential diagnosis of pelvic masses in female patients. Complete laparoscopic excision not only enables definitive diagnosis but also provides a curative outcome. Enhancing awareness of this disease may help prevent misdiagnosis and missed diagnosis and can serve as a valuable reference for the early identification and optimal surgical management of similar cases.