ABSTRACT
OBJECTIVES: We sought to confirm utility of our institution's modified Proactive Molecular Risk Classifier for Endometrial Cancer protocol in our daily practice, which includes mismatch repair (MMR), p53, and L1 cell adhesion molecule (L1CAM) immunohistochemistry with in-house next-generation sequencing for POLE, TP53, and CTNNB1. METHODS: We conducted a retrospective review of all patients in our institution who underwent primary endometrial carcinoma resection from the year prior to protocol implementation (PRE; October 1, 2020, to September 30, 2021) through first year of implementation (POST; October 1, 2021, to September 30, 2022) to compare the distribution of molecular and traditional staging factors using GOG-249 criteria to assign clinical risk. RESULTS: In total, 136 of 260 PRE patients were classified as clinically low risk (LR), of whom 31 were MMR deficient. Of the 157 LR POST patients with endometrioid-type carcinoma, 45 were MMR deficient, 5 were POLE mutant, 5 were TP53 mutant, 56 were of no specific molecular profile (NSMP), and 46 did not receive full protocol testing. Of all 79 POST NSMP endometrioid-type cases, 18 were CTNNB1 mutated and 8 showed L1CAM expression. CONCLUSIONS: Our protocol identified 22 (14%) of 157 LR tumors that harbored incipient intermediate- to high-risk molecular aberrations in TP53, CTNNB1, or L1CAM. Moving forward, results of ongoing trials assessing adjuvant therapy decisions based on molecular classification are necessary to confirm protocol utility and identify appropriate modifications.
Subject(s)
Endometrial Neoplasms , Tumor Suppressor Protein p53 , Humans , Female , Endometrial Neoplasms/genetics , Endometrial Neoplasms/pathology , Retrospective Studies , Middle Aged , Aged , Tumor Suppressor Protein p53/genetics , Biomarkers, Tumor/genetics , DNA Mismatch Repair/genetics , beta Catenin/genetics , Immunohistochemistry , Adult , High-Throughput Nucleotide Sequencing , Aged, 80 and over , Neural Cell Adhesion Molecule L1/genetics , Carcinoma, Endometrioid/genetics , Carcinoma, Endometrioid/pathologyABSTRACT
BACKGROUND: Transvaginal bowel evisceration is an exceptionally rare event. Most reported cases are of small bowel evisceration in postmenopausal women who have undergone hysterectomy. CASE: Here, we report an isolated case of complete procidentia and spontaneous sigmoid colon evisceration leading to sepsis in an 89-year-old woman with no surgical history. CONCLUSIONS: We highlight the risk factors, clinical presentation, and treatment options for this unique multidisciplinary emergency.
