Detection and correlation of pre-operative, frozen section, and final pathology in high-risk endometrial cancer.

PURPOSE: To evaluate sensitivity and specificity of pre-operative and frozen section pathologic evaluation (FSA) in predicting high-risk (HR) histology endometrial cancer. MATERIALS AND METHODS: A retrospective analysis was performed on all patients diagnosed with endometrial cancer at a single institution. Medical records were abstracted for baseline characteristics, surgical reports for staging, and final histology was confirmed by a gynecologic pathologist. RESULTS: 868 patients were identified. Of these, 118 had Grade 3 endometrioid, 36 clear cell carcinoma (CCC), 47 carcinosarcoma (CS), and 84 uterine papillary serous carcinoma (UPSC) histology. Endometrial biopsy (EMB) had an overall sensitivity of 90%, 77% for low grade, 78% for HR, with a specificity of 0%. For dilation and curettage (D&C), overall sensitivity was 85%, 69% for low grade, and 77% for HR. Specificity was 33%. Sensitivities for combined pre-operative testing for G3 endometrioid, CCC, CS, and UPSC were: 56%, 28%, 72%, and 60%, respectively. For frozen section analysis (FSA), overall sensitivity was 77%, and 67% for low and high grade. For G3 endometrioid, CCC, CS, and UPSC, sensitivities were 57%, 20%, 74%, 32%, respectively. Specificity was 95%. FSA identified an additional six patients (8%) with UPSC, CCC or CS that were pre-operatively low risk, providing an 8% improvement in sensitivity but decreased specificity. CONCLUSIONS: Pre-operative EMB and D&C are overall very sensitive for detecting endometrial cancer; however, sensitivity decreases with HR histology. Pre-op testing will miss 28% of HR diagnoses and FSA provides an opportunity to identify some patients with UPSC, CCC, and CS. If pre-operative results suggest HR cancer, the surgeon should proceed with comprehensive surgical staging without an FSA.

Carcinosarcoma of the ovary: a single institution experience and review of the literature.

PURPOSE: To evaluate the management and outcome in patients with advanced stage primary carcinosarcoma (CS) of the ovary in a single institution. MATERIALS AND METHODS: The authors performed a retrospective analysis of all patients treated for CS of the ovary between 1994 and 2011. The medical records, operative reports and pathology records were abstracted for baseline characteristics, surgical staging, degree of cytoreduction and chemotherapy regimens used. Standard statistical methods for analysis of the data were used. RESULTS: A total of 33 patients with ovarian CS were identified. Of these, 28 records were available for analysis. One patient was Stage I (3.5%), two were Stage II (11.1%), 20 were Stage III (71.4%), and five (17.9%) were Stage IV. The early stage (Stage I and II) patients were excluded from analysis. Of the 25 advanced stage (III and IV) patients, 21 (84.0%) were optimally cytoreduced to a residual disease of < one cm and four (16.0%) were suboptimally cytoreduced. The median progression free survival (PFS) and overall survival (OS) were ten and 21 months, respectively, for advanced stages. Twenty-one (75%) patients received adjuvant chemotherapy and 62% (13 of 21) of treated patients received paclitaxel/carboplatin (T/C) as first-line chemotherapy. The median PFS and OS were 15.6 and 31.7 months, respectively, for those treated with T/C. There was no.difference in PFS (p = 0.42) and OS (p = 0.91) between the patients who received T/C vs. other chemotherapy regimens as a first-line adjuvant chemotherapy. Patients with optimal cytoreduction had an improved PFS compared to those with suboptimal cytoreduction (ten vs. four monthsp = 0.015); however, there was no difference in OS (21 vs. 13 p = 0.117). The two-year OS was 48.0%. In the preset study, PFS was improved in patients who were optimally cytoreduced at the time of diagnosis. CONCLUSION: T/C is an active regimen in the treatment of ovarian CS and has the potential to be the backbone for addition of biologic targeted therapies in the future. For advanced ovarian CS the authors recommend optimal cytoreductive surgery followed by T/C chemotherapy.

Evaluation of the outcome benefit conferred by intensive surveillance strategies in women with early-stage endometrial cancer.

INTRODUCTION: The optimum follow-up regimen after treatment for early-stage endometrial cancer with curative intent is unknown. The National Comprehensive Cancer Network recommends a physical exam and vaginal cytology every three to six months for two years then at six to 12 month intervals with annual chest X-rays (CXR). However, there is debate as to whether intensive follow-up results in an improvement in outcomes for those with recurrent endometrial cancer. OBJECTIVE: To determine if intensive surveillance for recurrent cancer in women with early-stage endometrial cancer improves their outcomes. MATERIALS AND METHODS: The Roswell Park Cancer Institute tumor registry was used to identify patients with Stage I and II endometrial cancer initially diagnosed and treated over an 18-year period, who subsequently recurred. Clinico-pathological variables were abstracted. Patients were divided into two groups, depending on their mode of diagnosis of recurrent cancer: 1) routine screening, or 2) symptomatic. The outcomes between the two groups were compared. RESULTS: Fifty-two patients met inclusion criteria. Twenty-three patients were diagnosed via routine screening methods and 29 were symptomatic at presentation. Groups were equally represented with respect to age, stage, grade, adjuvant therapy, site of recurrence (local, distant), and time to recurrence (p > 0.05). Median survival time was 79 months for those diagnosed during routine screening and 80 months for symptomatic patients (p > 0.05). CONCLUSION: Pap smear and CXR appear to be of limited utility as the present study has shown that women diagnosed as a result of intensive surveillance did not have a better outcome than those who presented when symptomatic.

Corneal graft rejection complicated by Paracoccus yeei infection in a patient who had undergone a penetrating keratoplasty.

A 68-year-old man who had undergone two penetrating keratoplasties of his left eye was admitted with early corneal graft failure. Culture of the anterior chamber fluid yielded Paracoccus yeei, a nonfermentative gram-negative bacillus which thus far had only been implicated in ocular disease by means of PCR and 16S rRNA gene sequencing directly on patient material.

The use of cod liver oil by patients receiving pegylated liposomal doxorubicin is associated with a lack of severe palmar-plantar erythrodysesthesia.

Pegylated liposomal doxorubicin (PLD) is an effective and tolerable agent in the treatment of recurrent and refractory ovarian carcinoma. One of the most common dose-limiting toxicities of PLD is palmar-plantar erythrodysesthesia (PPE). We report a retrospective review of patients who took cod liver oil (CLO) while being treated with PLD at Roswell Park Cancer Institute. None of the patients required dose reduction, treatment interruption or discontinuation secondary to skin toxicity. No patient experienced grade 2 or greater PPE. The mechanism for the development of PLD-induced PPE is unknown. CLO may possibly mitigate it via decreased extravasation of PLD and/or by a blunting of the local inflammatory response. The effects of CLO should be further evaluated in a prospective, randomized trial, and attempts to elucidate the mechanism by which CLO may exert its effects should be pursued.

[Genetic factors of predisposition to endometriosis and response to its treatment]. / Geneticheskie factory predraspolozhennosti i terapii éndometrioza.

The relative frequencies of the normal (+) and null (0) alleles of the glutathione-S-transferase M1 (GSTM1) gene, as well as those of the rapid (R) and slow (S) forms of N-acetyl transferase 2 (NAT-2), were studied in the Russian and French populations and in endometriosis (EM) patients. In the total Russian and French populations, the proportions of homozygotes for deletion in gene GstM1 (0/0) were 42.2 and 45.8%, respectively, whereas in Russian and French EM patients, these values were 58.6 and 76.9%, respectively. The differences in these proportions between the total population and subjects with EM were significant at the confidence levels of 0.98 (chi 2 = 5.45; P < 0.02) and 0.90 (chi 2 = 3.01; P < 0.1) for the French and Russian populations, respectively. The frequencies of allele S of the Nat-2 gene were also similar in the Russian and French populations (60 and 63.1%, respectively), with these frequencies being somewhat higher in EM patients (71.2 and 77.7%, respectively). In Russians, the proportion of EM patients who were homozygous for the R form of NAT-2 (R/R) was significantly lower (chi 2 = 5.1). Forty-three of the patients with external genital EM received complex treatment with the use of the interferon inducer Cyclopheron. In 17 patients, a pronounced positive dynamics was observed, and 29 patients exhibited an increased resistance to the immunomodulating therapy. These groups comprised 1 and 25 GstM1 0/0 homozygotes, respectively; the number of patients with the slow NAT-2 form was 13 (7 S/S and 6 S/R genotypes) and 29 (20 S/S and 9 S/R genotypes), respectively. The obtained data indicate that the GstM1 and Nat-2 genes are involved in the EM pathogenesis. Therefore, molecular screening for the GstM1 0 and Nat-2 S alleles would be a good prognostic test when prescribing the postoperative treatment for EM and predicting its effectiveness.