Immunotherapies based on PD-1/PD-L1 pathway inhibitors in ovarian cancer treatment.

Immunotherapies based on anti-programmed death 1/programmed death ligand 1 (PD-1/PD-L1) pathway inhibitors may turn out effective in ovarian cancer (OC) treatment. They can be used in combination with standard therapy and are especially promising in recurrent and platinum-resistant OC. There is growing evidence that the mechanism of the PD-1/PD-L1 pathway can be specific for a particular histological cancer type. Interestingly, the data have shown that the PD-1/PD-L1 pathway blockade may be effective, especially in the endometrioid type of OC. It is important to identify the cause of anti-tumor immune response suppression and exclude its other mechanisms in OC patients. It is also necessary to conduct subsequent studies to confirm in which OC cases the treatment is effective and how to select patients and combine drugs to improve patient survival.

Amniotic band syndrome in dichorionic diamniotic twin pregnancy.

BACKGROUND: Amniotic band syndrome (ABS) is a rare disorder which leads to a number of deformities of the fetus body. The treatment depends on the severity of the defect and the extent of the deformity. CASE REPORT: A 36-year-old primigravida with a dichorionic diamniotic (DCDA) twin pregnancy was diagnosed during the first-trimester ultrasonography with fetal lower part edema of one twin caused by amniotic bands. A selective termination of the affected fetus was performed. The remainder part of the pregnancy was normal. A healthy newborn was delivered at term. After delivering the placenta, the presence of fetus papyraceus was detected. The amniotic bands were unidentifiable in the pathologist's examination. A reliable ultrasonographic diagnosis enables the detecting ABS in early pregnancy. CONCLUSION: In the case of ABS in DCDA twin pregnancy, conducting a selective termination of the affected fetus creates the opportunity for the proper development of the healthy fetus as well as reaching its full maturity. HIPPOKRATIA 2017, 21(1): 46-48.

Macrophage-derived chemokine CCL22 and regulatory T cells in ovarian cancer patients.

The study was undertaken to evaluate macrophage-derived chemokine (CCL22) levels in the peritoneal fluid (PF) and plasma of patients with ovarian cancer (n = 93) in relation to regulatory T cells (Tregs; n = 75). The peritoneal fluid CCL22 concentrations were significantly higher in epithelial ovarian cancer (EOC) patients than in patients with benign tumors-serous cystadenoma (n = 32). There was no difference in plasma levels of CCL22 in EOC patients compared with the non-cancer and healthy volunteers (n = 10). There were no significant differences in the plasma and PF CCL22 levels based on tumor grade. However, women with stage IV FIGO (International Federation of Gynecologists and Obstetricians) had significantly higher plasma CCL22 levels than patients with stages I and III. Women with stage I FIGO had significantly higher PF CCL22 levels than patients with stages II and III. Women with endometrioid cystadenocarcinoma had higher PF CCL22 levels than women with undifferentiated carcinoma. The percentage of tumor-infiltrating Tregs (11.06 %) was significantly higher compared to PF (3.05 %) and peripheral blood (PB) (2.01 %). Moreover, the percentage of Tregs was higher in the PF than in the PB of EOC patients. There were no significant differences in the PB, PF, and tumor-infiltrating Tregs percentage based on tumor stage, grade, or histology. Elevated levels of CCL22 found in the ascites could create a chemokine gradient aiding in Treg cells migration. Increased Tregs percentage in the local microenvironment of ovarian cancer might be an important mechanism of immunosuppression.

Pelvic pain, free fluid in pelvis, and human chorionic gonadotropin serum elevation: recurrence of malignant ovarian germ-cell tumor or early pregnancy?

Conservative treatment of metastatic germ-cell tumor of the ovary does not exclude the possibility of pregnancy in the future. Serum beta-human chorionic gonadotropin (beta-hCG) serves as pregnancy test, and has also been proven to be a useful marker for ovarian germ-cell tumors. This paper is a case report of a 19-year-old patient who was admitted to a district hospital in emergency due to pelvic pain, amenorrhoea, and free fluid in the pelvis. Laboratory tests demonstrated slight increase in beta-hCG serum concentration and transvaginal ultrasound (TVUS) showed no evidence of gestational sac in the uterus. At the age of 14, the patient was diagnosed with malignant germ-cell tumor of the left ovary in FIGO Stage IV and was treated with four courses of chemotherapy according to TGM-95 protocol with etoposide, ifosfamide, and cisplatin, followed by conservative surgery and adjuvant two courses of cytostatics. The initial diagnosis was recurrence of ovarian malignancy and the patient was referred to an oncology center. Wait-and-see approach and repeated ultrasound examination confirmed a normal intrauterine pregnancy which concluded with the delivery of a healthy newborn through cesarean section.

Dendritic cell subsets in the peritoneal fluid and peripheral blood of women suffering from ovarian cancer.

BACKGROUND: Evaluation of immature myeloid and lymphoid dendritic cells (DCs) in the peritoneal fluid (PF) and peripheral blood (PB) mononuclears of women with ovarian carcinoma (n = 47) and benign ovarian tumors (n = 37). METHODS: Mononuclear cells were isolated from PF and PB, stained with monoclonal antibodies (mAbs) against DC antigens (anti-BDCA-1, anti-BDCA-2), and estimated using flow cytometry. RESULTS: The percentage of PF myeloid DC (MDC) in mononuclears was significantly lower in patients with ovarian cancer in comparison to the group of nonmalignant ovarian tumors (0.65% and 6.95%). The percentage of PF lymphoid DCs (LDCs) was higher in patients with ovarian cancer than in the reference group (0.64% and 0.09%). The percentage of PB MDCs and LDCs did not differ significantly between studied groups. In women suffering from ovarian cancer the percentage of both MDCs and LDCs was higher in the PF than in the PB. In the reference group the percentage of MDCs was higher but that of LDCs was lower in the PF than in the PB. In women with ovarian cancer, PF MDCs/LDCs ratio was lower in comparison to patients with serous cystadenoma. In PB the ratio of MDCs to LDCs did not differ significantly between studied groups. CONCLUSIONS: We concluded that MDCs population may be affected by the presence of malignant disease. LDC subsets may have influence on the local immune response in the PF of women with malignant tumors of the ovary. (c) 2008 Clinical Cytometry Society.

Myeloid and lymphoid dendritic cells in the peritoneal fluid of women with ovarian cancer.

PURPOSE: The aim of the study was to estimate the myeloid and lymphoid subpopulation of dendritic cells (DCs) in the peritoneal fluid (PF) of women with ovarian tumors. MATERIAL AND METHODS: We studied 34 patients with serous cystadenocarcinoma and 29 women with serous cystadenoma. Dendritic cells were isolated from peritoneal fluid, stained with monoclonal antibodies anti-BDCA-1 and anti-BDCA-2 and estimated using flow cytometry. RESULTS: Peritoneal fluid myeloid DCs constituted 0.59% of mononuclear cells in patients with ovarian cancer and 7.2% in women with serous cystadenoma. Lymphoid DCs constituted 0.39% of PF mononuclears in women with ovarian cancer and 0.07% in patients with serous cystadenoma. The percentage of lymphoid DCs was higher in patients with ovarian cancer than in women with serous cystadenoma. The BDCA-1/BDCA-2 DCs ratio in peritoneal fluid of patients with serous cystadenoma was significantly higher in comparison to ovarian cancer. CONCLUSIONS: Decreased BDCA-1/BDCA-2 DCs ratio in patients with ovarian cancer may favour Th2 lymphocyte differentiation and/or induction of immunological tolerance.