Embryonal rhabdomyosarcoma: adjuvant and ex vivo assay-directed chemotherapy.

The aim of this retrospective study was to evaluate differences in treatment of embryonal rhabdomyosarcoma (RMS) of the uterus in 2 premenopausal women. We discuss adjuvant chemotherapy and use of ChemoFx Assay (Precision Therapeutics, Pittsburgh, PA) to guide choice of active chemotherapeutic agents. Two premenopausal patients were identified with a pathologic diagnosis of embryonal RMS of the uterus. Both met inclusion criteria for the study. A 21-year-old woman underwent a staging abdominal hysterectomy for a variant of embryonal RMS. Vincristine, actinomycin D, and cyclophosphamide were given adjunctively for a complete response. A 20-year-old woman underwent a diagnostic dilation and curettage revealing embryonal RMS. Initial treatment included an abdominal hysterectomy and nodal sampling. Presentation to a subsequent gynecologic oncologist 7 months later revealed recurrence. Carboplatin, doxorubicin, and paclitaxel provided a partial response. After a second surgical resection, ChemoFx Assay identified ifosfamide and mitomycin C as active agents and resulted in a complete response. Recommended treatment includes surgery and chemotherapy with possible radiation therapy if deemed necessary. The benefit of adding neoadjuvant or adjuvant chemotherapy and radiation therapy allows for a conservative surgical approach and improved survival. Choosing active chemotherapy agents can be aided by ChemoFx Assay. The chemotherapy most commonly used for treatment of embryonal RMS is a combination of vincristine, actinomycin D, and cyclophosphamide.

Secondary cervical cancer in a patient with chronic lymphocytic leukemia and recurrent chronic lymphocytic leukemia mimicking recurrent cervical dysplasia: a case report.

BACKGROUND: Patients with chronic lymphocytic leukemia (CLL) have up to a 3-fold risk of site-specific secondary cancers. The only exception is a lower incidence of cervical cancer in this population. CASE: A 70-year-old, white woman with stage IV CLL was diagnosed 2 years prior to presentation with stage Ia1 squamous cell carcinoma of the cervix. Following an abnormal Pap smear, a colposcopy and biopsies were performed. Initial pathologic impression of the cervical biopsies was high grade dysplasia. The final review was consistent with CLL without cervical dysplasia. CONCLUSION: Cervical cancer in patients with CLL is a rare occurrence. The pathologic changes on cervical epithelium caused by CLL can mimic dysplastic cellular changes. Expert pathologic review of cervical biopsies is warranted to distinguish between the diagnoses, thus altering management.

Endometrial carcinoma in vitro chemosensitivity testing of single and combination chemotherapy regimens using the novel microculture kinetic apoptosis assay: implications for endometrial cancer treatment.

OBJECTIVE: The in vitro microculture kinetic (MiCK) apoptosis assay has been used to predict single or combination chemotherapy response in leukemia patients. This feasibility study addressed MiCK in endometrial cancer specimens. METHODS: Endometrial cancer specimens from total abdominal hysterectomies were processed at a central laboratory. Single cell suspensions of viable endometrial cancer cells were plated in individual wells. Single and combination regimens were tested: combinations of doxorubicin, cisplatin, and paclitaxel and carboplatin and paclitaxel (Gynecologic Oncology Group [GOG] 209 endometrial cancer phase III trial arms) as well as single agent testing with paclitaxel, carboplatin, doxorubicin, cisplatin, ifosfamide, and vincristine (active agents in GOG trials). Apoptosis was measured continuously over 48 hours. RESULTS: Fifteen of nineteen patients had successful assays. The highest mean chemo sensitivity was noted in the combination of cisplatin, doxorubicin, and paclitaxel with lower mean chemosensitivity for carboplatin and paclitaxel. Combination chemotherapy had higher chemosensitivity than single drug chemotherapy. However, in 25% of patients a single drug had higher chemosensitivity than combination chemotherapy. As single agents, ifosfamide, cisplatin, and paclitaxel had the highest kinetic unit values. CONCLUSION: Using a panel of agents simulating clinical dose regimens, the MiCK assay was feasible in evaluating in vitro chemosensitivity of endometrial cancer. MiCK assay results correlated with GOG clinical trial results. However, 25% of patients might be best treated with single agent chemotherapy selected by MiCK. Ifosfamide, cisplatin, and paclitaxel appear to have high activity as single agents. MiCK may be useful in future new drug testing and individualizing endometrial cancer patient's chemotherapy management.

A rare malignant Brenner tumor of the ovary in a 77-year-old woman: a case report.

BACKGROUND: A malignant Brenner tumor is a rare form of invasive epithelial ovarian cancer and is extremely uncommon in women > 65 years of age. We present a case of an invasive Brenner tumor of the ovary in a woman greater than age 70. CASE: A 77-year-old woman presented with a rare, invasive Brenner tumor of the ovary. She was referred for evaluation of a complex pelvic mass and elevated serum CA-125. Treatment included complete surgical resection and staging procedure. Pathology revealed a malignant Brenner tumor. Immunohistochemical staining with cytokeratin 7 was positive, with cytokeratin 20 was negative, and was positive for uroplakin III and thrombomodulin. CONCLUSION: The histologic appearance of malignant Brenner tumor is similar to that of transitional cell cancer of the ovary and transitional epithelium of the urinary bladder. Immunohistochemical staining of malignant Brenner tumor often demonstrates positivity for uroplakin III, thrombomodulin and cytokeratin 7 and negativity to cytokeratin 20. The mainstay of treatment is surgical resection, but the exact regimen and benefit of adjuvant therapy remain unknown.