Undifferentiated Endometrial Carcinoma, an Immunohistochemical Study Including PD-L1 Testing of a Series of Cases From a Single Cancer Center.

Undifferentiated endometrial carcinoma (UEC) is a rare and poorly recognized entity, associated with a poor outcome. The clinical, pathologic, and immunohistochemical features of 17 cases diagnosed at our center are described. The median age was 60 yr. Postmenopausal bleeding was the most common presenting symptom (76.9%). Most patients presented with advanced stage (64.7%). Total hysterectomy with bilateral salpingo-oophorectomy was the commonly offered surgical treatment (80.0%). Nine (52.9%) patients received adjuvant treatment. The median overall survival was 11 mo. Pure UEC was seen in 8 cases (47.0%), while dedifferentiated carcinoma in 5 cases (29.4%). The epithelial component was part of carcinosarcoma or was mixed with serous carcinoma in 2 cases (11.8%) each. Positivity for one or more of the cytokeratin cocktails, mostly as strong focal staining, was evident in 16 cases (94.1%). PAX-8 was negative in 13 cases (86.7%). BRG-1/SMARCA4 was lost in 3 cases (20.0%). Eleven cases (64.7%) were MLH1/PMS2 deficient. Ten cases (66.7%) were positive for programmed death ligand 1, with positivity in 10%, 20%, and 100% of tumor cells detected in a single case each. Only 2 of 11 (18.2%) referral cases were correctly diagnosed as UEC. UEC is a rare tumor that is frequently misdiagnosed. A panel of immunostains is necessary to make the correct diagnosis. The range of positivity for programmed death ligand 1 testing suggests that immunotherapy might be considered in the adjuvant setting, especially with the poor response of this tumor to traditional therapies.

Prevalence of Abnormal Pap Smears: A Descriptive Study from a Cancer Center in a Low-Prevalence Community

Background and aims: Cervical cancer is the fourth most common cancer in women worldwide and the 13th in Jordan. The cervical smear (Pap smear) is a simple approach to detect pre-cancerous cervical lesions. The aim of this study was to evaluate the prevalence of abnormal cervical smears in women seen at the Early Detection/Community Outreach clinic of King Hussein Cancer Center (KHCC). Materials and Methods: In this retrospective study, reports of routine cervical Pap smears performed in the pathology department at KHCC from January 2007 to December 2016, were reviewed. During this period, a total of 5,529 routine smears were assessed for epithelial abnormalities and histopathological grading. Results: A total of 210 (3.8%) abnormal Pap smears were found, with atypical squamous cell of undetermined significance (ASC-US) reported in 110 (52.4%) cases, atypical glandular cells of undermined significance (AGUS) in 58 (27.6%), low grade squamous intra-epithelial lesion (LSIL) in 27 (12.9%) and high grade intra-epithelial lesion (HSIL) in 13 (6.2%). Only single cases of ASC-H and squamous cell carcinoma were reported. The available biopsies showed benign findings in 70.1% of cases, low grade squamous intraepithelial lesions in 11.5% and high grade squamous intraepithelial lesions in 18.4%. Conclusions: The low epithelial cell abnormality (EPCA) prevalence illustrated in this study argues against introduction of population-based HPV testing and vaccination. It calls for a more cost-effective measures in a country with limited resources, where a more widely available Pap-smear testing might suffice.

Management of cancer during pregnancy: obstetric and neonatal outcomes.

OBJECTIVE: This study aimed to assess the management and the obstetric and neonatal outcomes of pregnancies complicated by cancer. METHODS: A retrospective analysis of patients with cancer during pregnancy who were treated at King Hussein Cancer Center and King Abdullah University Hospital in Jordan between January 2002 and December 2009 was conducted. The medical records of patients with invasive cancer diagnosed during pregnancy and their newborns were reviewed to retrieve information on treatment and obstetric and neonatal outcomes. Numerical data were tested for normal distribution using Kolmogorov-Smirnov. Statistical analyses were conducted using SPSS 18.0. RESULTS: A total of 46 patients with a diagnosis of cancer in pregnancy were treated. The most common tumor types were breast cancer, hematologic malignancies, and gastrointestinal malignancies. In 17 patients, a miscarriage or a termination of pregnancy occurred in the first trimester. In 25 of 46 patients, a single or a combination of treatment modalities was commenced. The distribution of therapies was as follows: chemotherapy alone, n = 5; surgery alone, n = 7; surgery and chemotherapy, n = 6; surgery and radiation therapy, n = 1; surgery with chemotherapy and radiation therapy, n = 3; chemotherapy and radiation therapy, n = 1; interferon, n = 1; and hormonal therapy, n = 1. The mean (SD) gestational age at delivery was 35.7 (2.7) weeks. The mean birth weight was 2580 (870) g. Preterm delivery occurred in 17 patients. There were 4 neonatal deaths, 2 of them delivered at 33 weeks, 1 delivered at 34 weeks, and 1 delivered at 35 weeks gestation. There were no congenital malformations. CONCLUSIONS: The remarkable finding is a high rate of iatrogenic preterm delivery with a high rate of neonatal mortality. Delivery should be postponed preferably until after a gestational age of 35 weeks.