Use of segmental colorectal lavage cytology during surveillance colonoscopy for detecting dysplastic and cancer cells in patients with ulcerative colitis.

PURPOSE: To examine whether segmental colorectal lavage cytology (CRLC) during surveillance colonoscopy was useful for detecting dysplastic and cancer cells in ulcerative colitis (UC) patients. METHODS: We examined whether CRLC can detect dysplastic and cancer cells in total colectomy materials of 39 UC patients. After washing the luminal surface of dissected colorectal tissues with saline, the fluid was collected. We also examined whether segmental CRLC during surveillance colonoscopy can detect dysplastic and cancer cells in 45 UC patients. Fluid was collected after washing segmental colorectum including the suspicious region. Cytological specimens were stained with Papanicolaou and immunocytochemically stained with anti-p53 antibody. RESULTS: Although cancer and dysplastic cells were found by CRLC in 9 and 4 UC patients receiving total colectomy respectively, histology revealed 9 cancer lesions but only 2 dysplastic foci. In segmental CRLC, cancer cells were detected in 2 UC patients and dysplastic cells in 4 UC patients. Biopsy revealed 2 cases with colon cancer lesions but only 2 cases with dysplastic foci. CONCLUSIONS: Segmental CRLC is a less-invasive and effective method in detecting dysplastic and cancer cells in UC patients during surveillance colonoscopy. It could be used as a complementary method for colonoscopy-directed biopsy.

Challenges in Managing Patients with Hereditary Cancer at Gynecological Services.

AIM: To reveal current problems and challenges faced by our gynecologic services department in managing patients with hereditary cancers. METHODS: We collected clinical data of patients with hereditary cancers, identified via genetic testing (or clinically diagnosed in cases of Cowden syndrome or Peutz-Jeghers syndrome), and treated in our gynecological department from 2012 to 2018. RESULTS: Fifteen patients had hereditary breast and ovarian cancer (HBOC), 6 had Lynch syndrome, 2 had Cowden syndrome, and 2 had Peutz-Jeghers syndrome. Five patients diagnosed with HBOC were younger than 40 years at diagnosis. Risk-reducing salpingo-oophorectomy (RRSO) was performed on 1 patient with a BRCA1 mutation at age 38 years. Seven patients overall underwent RRSO, and none had malignancies on pathological examinations. Peritoneal washing cytology (PWC) was suspicious for malignancy in one patient; however, subsequent PWC at 6 months after RRSO was negative. A patient with endometrial cancer and Lynch syndrome and a patient with atypical endometrial hyperplasia (AEH) and Cowden syndrome strongly desired fertility preservation. They achieved remission after medroxyprogesterone acetate treatment and multiple dilations and curettages, respectively. One patient with Lynch syndrome developed AEH after 11 years of surveillance. Laparotomy revealed adjacent low-grade and high-grade serous ovarian cancer with positive ascites cytology. She had no recurrence during 7-year follow-up after laparotomy. CONCLUSION: Managing patients with hereditary cancer, positive or false-positive ascites cytology discovered during RRSO, and desired preservation of fertility is highly challenging.

Expression of p16 in nodular fasciitis: an implication for self-limited and inflammatory nature of the lesion.

Nodular fasciitis (NF) is a self-limited tumorous lesion occurring in the upper as well as lower extremities. NF is composed of a proliferation of "primary culture"-like myofibroblastic cells with nuclear atypia and large nucleoli, thus mimicking sarcoma. NF harbors a promoter-swapping fusion gene containing the entire coding region of USP6 gene. Therefore, NF is a tumor with a fusion oncogene but self-limited. In order to explore why NF is self-limited, we examined whether myofibroblastic cells in NF express p16 protein, a gene product of CDKN2A gene and an inhibitor of cyclin-dependent kinase 4 (CDK4) as well as one of the hallmarks of cellular senescence. We immunohistochemically demonstrated strong and diffuse expression of p16 in myofibroblastic cells in 11 out of 15 cases of NF, and strong but partial expression in the remaining 4 of the cases. We also showed that 15 out of 15 cases of NF were immunohistochemically negative or only showed focal and faint immunopositivity for CDK4, murine double minute 2 (MDM2), and TP53 proteins. Furthermore, there were no significant changes in the copy number of CDKN2A, CDK4 and MDM2 genes, and no significant mutations in TP53, RB1, and CDKN2A genes in 1 case of NF selected. These data suggest a possible involvement in cell cycle arrest and presumed cellular senescence by p16 in myofibroblastic cells in NF. This may explain the self-limited as well as inflammatory nature of NF as a senescence-associated secretory phenotype.

Pazopanib treatment of a platinum-resistant recurrence of a high-grade Sertoli cell tumor and assessment of the treatment response by FDG-PET/CT: A case report.

Ovarian Sertoli cell tumors (SCTs) are rare sex cord tumors (Oliva et al., 2005). The standard treatment for high-grade SCTs is surgery followed by platinum-based chemotherapy. Although platinum-based chemotherapy is also an option for recurrent SCTs (Sigismondi et al., 2012), there is no established chemotherapy regimen for platinum-resistant recurrent SCTs. The effectiveness of pazopanib in treating epithelial ovarian cancer has recently been reported (du Bois et al., 2014; Pignata et al., 2015). In the case described herein, pazopanib was used to treat the platinum-resistant recurrence of a high-grade Sertoli cell tumor, and the response was evaluated by 18F-fluoro-deoxyglucose positron emission tomography (FDG-PET)-computed tomography (CT). Written informed consent to reporting the case was obtained from the patient.