Robot-assisted inguinal sentinel lymph node biopsy in primary yolk sac tumor of the vulva.

BACKGROUND: Primary yolk sac tumor (YST) of the vulva is extremely rare and only introduced in case reports [1]. For those, routine inguinal lymph node dissection (LND) in absence of palpable inguinal lymph node is questionable. To avoid complications of inguinal LND, such as lymphedema, inguinal sentinel lymph node biopsy (SLNB) can be considered [2,3]. Since recent studies reported feasibility of robot-assisted inguinal lymphadenectomy [4], we showed the surgical procedures of robot-assisted inguinal SLNB. VIDEO: A 33-year-old woman with vulvar YST was referred. Two 2 cm sized masses were founded in right vulvar area, and lymph node enlargement was detected in only right external iliac area on imaging studies. Thus, we planned robot-assisted surgical treatment including inguinal SLNB using the fluorescent dye indocyanine green (ICG) during surgery for the vulvar YST. First, we performed intradermal and peri-tumoral injection of 1 ml solution including 1.25 mg of ICG at each 2, 5, 7, and 10 o'clock position for the two tumors. Fifteen minutes later, three-arm robotic surgical system was installed on right thigh. Dissecting the subcutaneous space under the Scarpa's fascia towards the inguinal ligament, one fluorescent inguinal sentinel lymph node was identified and excised, which showed no tumor on pathologic examination (Fig. 1). RESULTS: The procedure time was 70 minutes, and she underwent subsequent robot-assisted pelvic and para-aortic lymphadenectomy and wide local excision of the vulva. CONCLUSION: Robot-assisted inguinal SLNB is feasible. It may be an alternative to inguinal LND for avoiding relevant complications in patients with vulvar malignancy.

Super-radical hysterectomy for recurrent cervical cancer.

BACKGROUND: Recurrent cervical cancer with the pelvic side wall invasion has a deleterious effect on prognosis if there is no alternative method to achieve local tumor control [1, 2]. For the surgical treatment, super-radical hysterectomy has been introduced by Ryukichi Mibayashi in 1941 [3, 4]. However, its feasibility and safety is still on debate because of a lack of reproducibility and high level of surgical techniques. Thus, we showed the surgical procedure of super-radical hysterectomy for recurrent cervical cancer. VIDEO: A 40 year-old woman visited after diagnosis of the pelvic recurrence, who received concurrent chemoradiation before 13 months due to stage IIB cervical cancer. Preoperative examination showed tumor invasion to upper third of the vagina, the right distal ureter and urethra, the posterior bladder wall and the right pelvic wall. Thus, we performed anterior pelvic exenteration with super-radical hysterectomy for removing the right pelvic side wall tumors. First, we ligated the right superior gluteal vessels, and then ligated the right internal iliac vessels. Second, we ligated the right inferior gluteal vessels, and subsequently the right internal pudendal vessels. Third, we resected her genitourinary tract with the right internal iliac vessels around the pelvic floor completely. RESULTS: The procedure time was 160 minutes, and she underwent subsequent procedures including ileal conduit and omental J flap. She was discharged after 2 weeks without complications. CONCLUSION: Super-radical hysterectomy can be considered to be feasible and safe through the step-wise ligation of the internal iliac vessels for recurrent cervical cancer with the pelvic side wall invasion.

Analysis of falsely elevated risk of ovarian malignancy algorithm in women with ovarian endometrioma.

OBJECTIVE: To estimate the incidence of falsely elevated risk of ovarian malignancy algorithm (ROMA) in a group of women with pathologically confirmed endometrioma and to investigate the associated factors. METHODS: One hundred premenopausal women surgically diagnosed with ovarian endometrioma were selected. Preoperative clinical, laboratory, and surgical characteristics were compared between the elevated-risk group (ROMA-premenopausal value, ≥7.4%) and normal-risk group (ROMA-premenopausal value, <7.4%). RESULTS: Elevated ROMA was observed in 15 women (false positive rate, 15%). Excluding one woman with known chronic renal failure, we compared the characteristics of 99 women between the elevated-risk group (n=14) and the normalrisk group (n=85). None of the clinical and surgical variables distinguished the two groups. Serum level of CA 125 >82.3 U/mL and serum level of human epididymis protein 4 (HE4) >46 pmol/L could predict an elevated ROMA test with a statistical significance. When serum level of HE4 ≤46 pmol/L, none of the women showed an elevated ROMA test, regardless of serum level of CA 125; however, 55.6% of the women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 ≤82.3 U/mL and all women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL. CONCLUSION: The incidence of falsely elevated ROMA was 15% in the group of women with pathologically confirmed endometrioma. Interpretation of the ROMA results should be cautious when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL in women with suspicious ovarian endometrioma.

Effects of Schisandra chinensis Baillon (Schizandraceae) on lipopolysaccharide induced lung inflammation in mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Schisandra chinensis Baillon (Sc), an anti-inflammatory herb that has been used in traditional Chinese medicine for thousands of years, is frequently used to treat upper respiratory tract infections. AIM OF THE STUDY: This study was conducted to evaluate the ability of a water extract of Sc to prevent airway inflammation both in vitro and in vivo. MATERIALS AND METHODS: Human lung alveolar epithelial-derived A549 cells were stimulated with to interleukin-1ß, tumor necrosis factor-α, and interferon-γ (IL-1ß, TNF-α, and INF-γ; cytokine mixture; CM) and treated with Sc extracts. They were then evaluated using nitric oxide (NO), IL-8 and monocyte chemotactic protein-1 (MCP-1) secretions. In the in vivo study, BALB/c mice were challenged with lipopolysaccharide (LPS) to induce acute airway inflammation. After this challenge, the mice were treated with Sc extracts (10, 50 and 100mg/kg) by oral administration, and inflammatory cells in the bronchoalveolar lavage (BAL) fluid were counted. IL-6 and TNF-α secretions were measured using an enzyme-linked immunosorbent assay. Lung tissues of the LPS treated mice were prepared and stained with hematoxylin and eosin (HE) for histological examination. RESULTS: In the A549 cells, Sc extracts dose-dependently and significantly inhibited CM-induced NO production and reduced IL-8 and MCP-1 secretions. Sc extracts efficiently suppressed neutrophil and macrophage infiltrations of lung tissues and increased IL-6 and TNF-α levels in BAL fluid in LPS-instilled BALB/c mice. In addition, Sc extracts treatment inhibited pathologic progress in the lung tissues, as confirmed by H&E staining. These findings indicate that Sc extracts could be potentially useful for the treatment of acute lung inflammation and acute lung injury.

Deficiency of H3K79 histone methyltransferase Dot1-like protein (DOT1L) inhibits cell proliferation.

Dot1-like protein (DOT1L) is an evolutionarily conserved histone methyltransferase that methylates lysine 79 of histone H3 (H3K79). Mammalian DOT1L participates in the regulation of transcription, development, erythropoiesis, differentiation, and proliferation of normal cells. However, the role of DOT1L in cancer cell proliferation has not been fully elucidated. DOT1L siRNA-transfected A549 or NCI-H1299 lung cancer cells displayed a nonproliferating multinucleated phenotype. DOT1L-deficient cells also showed abnormal mitotic spindle formation and centrosome number, suggesting that DOT1L deficiency leads to chromosomal missegregation. This chromosomal instability in DOT1L-deficient cells led to cell cycle arrest at the G(1) phase and induced senescence as determined by enhanced activity of senescence-associated ß-galactosidase activity. Meanwhile, overexpression of a catalytically active DOT1L, not an inactive mutant, restored DOT1L siRNA-induced phenotypes. Overall, these data imply that down-regulation of DOT1L-mediated H3K79 methylation disturbs proliferation of human cells. In addition, although H3K79 methylation is down-regulated in aged tissues, it is up-regulated in lung cancer cell lines and tumor tissues of lung cancer patients. Therefore, H3K79 methylation is a critical histone modification that regulates cell proliferation and would be a novel histone mark for aging and cancer.

Balance between SIRT1 and DBC1 expression is lost in breast cancer.

SIRT1 (silent mating-type information regulation 2 homologue 1)-mediated cellular resistance to various stresses is negatively regulated by deleted in breast cancer 1 (DBC1), which was originally reported to be deleted in breast cancer. However, the suggested functions of SIRT1 as a potential tumor promoter and of DBC1 as a potential tumor suppressor have been challenged by observations of their respective down- and up-regulation in various cancers. The aim of the present study was to simultaneously evaluate the expression levels of SIRT1 and DBC1 in the normal and tumor breast tissues from 28 breast cancer patients and to determine correlations with clinicopathological variables. SIRT1 and DBC1 expression was higher in tumor tissues than in matched normal tissues at the protein level, but not at the transcriptional level. Overexpression of SIRT1 and DBC1 in tumor tissue was correlated with favorable and unfavorable clinicopathological factors, suggesting their pleiotropic functions as a potential tumor promoter and tumor suppressor in tumorigenesis. Interestingly, although the overall expression of SIRT1 and DBC1 increased in tumor breast tissues, the correlation between SIRT1 and DBC1 expression was weaker in tumor tissue than in normal tissue. This suggests that the negative regulation of SIRT1 by DBC1 may retard tumorigenesis in breast tissue. Therefore, the correlation between SIRT1 and DBC1 is a potential prognostic indicator in breast cancer.