Carcinosarcoma of the ovary: a case-control study

INTRODUCTION

Carcinosarcoma of the ovary is a rare tumor with a grim prognosis. Chemotherapy for these tumors is chosen according to guidelines established for epithelial ovarian cancer (EOC). The purpose of this study is to compare response to chemotherapy and survival in patients with advanced stage carcinosarcoma of the ovary.

METHODS

We identified women with advanced carcinosarcoma of the ovary who underwent first-line platinum and taxane-based chemotherapy. Each case was matched to two women with serous EOC. Cases and controls were matched by age, stage, and year of diagnosis. The Kaplan-Meier method was used to generate overall survival (OS) data. Factors predictive of outcome were compared using the log-rank test and Cox proportional hazards model.

RESULTS

Fifty women treated with first line platinum and taxane-based chemotherapy had advanced carcinosarcoma of the ovary and were selected as cases. The response rates to chemotherapy for cases and controls were 62% and 83% (P=0.03), respectively. Median progression-free survival was 11 months (95% CI, 8 to 14 months) versus 16 months (95% CI, 12 to 21 months; P=0.02) and median overall survival was 24 months (95% CI, 18 to 29 months) versus 41 months (95% CI, 33 to 49 months; P=0.002) for cases and controls, respectively.

CONCLUSION

Patients with advanced carcinosarcoma of the ovary have a poorer response to platinum and taxane-based first-line chemotherapy and worse survival, compared to patients with serous EOC. Aggressive surgical treatment may play an important role. However, other alternative systemic therapeutic approaches should be sought for patients with carcinosarcoma of the ovary.

Relationship among maximal grip, throwing velocity and anthropometric parameters in elite water polo players

AIM

As independent aspects, body size, body composition, and physiological performance of elite athletes have aroused the interest of sports scientists but, unfortunately, studies that combine these aspects are scarcely avalaible in water polo. The aim of the present study was to: 1) to develop an anthropometric profile of highly skilled male Water Polo players, and 2) to identify significant relationships between these features and overhead throwing velocity in highly skilled male water polo players.

METHODS

Thirteen male water polo players, with a mean age of 26.10±4.82, were recruited from the Spanish Water Polo team and an anthropometric assessment on all of them was carried out. Throwing velocity was evaluated in three different situations from the 5 m-penalty line on the center of the water polo goal: A) throwing without a defender nor a goalkeeper; B) throwing with a goalkeeper only, and C) 3) armfuls running shot with goalkeeper. Maximal handgrip was also tested.

RESULTS

Biacromial breadth shows a significative correlation with hand grip in water polo players (r=0.792; P=0.001) and also correlates with Throwing velocity (r=0.716; P<0.001). Biepicondylar femur breadth correlates significatively with hand grip (r=0.727; P<0.05) and also with throwing velocity in "throwing with goalkeeper" situation (r=0.664; P<0.05). Hand grip shows a significant correlation with throwing velocity in "throwing with goalkeeper" situation (r=0.603; P<0.05).

CONCLUSION

In conclusion, body mass aspects are not related with throwing velocity in highly skilled Water Polo players. Maximal hand grip is related with throwing velocity in "throwing with goalkeeper" situation. More investigations about water polo are necessary.

Age related cellular immune response against complete molar pregnancy

OBJECTIVE

Advanced maternal age may result in a weaker immune response against complete molar pregnancy, therefore increasing the risk of gestational trophoblastic neoplasia due to ineffective elimination of the trophoblastic cells after evacuation. The present study was undertaken to investigate the cellular immune response against complete molar pregnancy at the implantation site in younger and older patients.

STUDY DESIGN

Immunolocalization of CD8, granzyme B (GrB), FoxP3 and CD56 was performed on histologic tissue sections prepared from 18 patients aged < or = 40 years and 10 patients aged > 40 years to characterize effector (GrB+CD8+) cytotoxic T cells, GrB positive and negative natural killer cells (CD56) and regulatory T cells (FoxP3+) at the implantation site in complete molar pregnancies.

RESULTS

The number of the different immune cell types did not show significant differences in the implantation sites of complete molar pregnancies between the 2 age groups or between persistent and nonpersistent cases.

CONCLUSION

Immunosenescence of the natural killer and T cells most likely does not play a role in the increased incidence of gestational trophoblastic neoplasia in older patients with complete moles.

Abstract 4789: Functional characterization and clinical correlation of the tumor antigen casein kinase 1-epsilon in ovarian cancer

OBJECTIVES: Prior studies have identified antibodies to casein kinase I epsilon (CKI-ε) in the serum of patients with ovarian cancer. We investigated the expression pattern, functional roles, and clinical correlation of CKI-ε in ovarian cancer.

METHODS: The expression of CKI-ε in 8 healthy ovaries and 68 ovarian tumor samples was determined by IHC and scored on intensity of antibody expression (scale 0-3) and the percentage of the area stained (scale 0-3). The average from both scores was assigned to each patient. Clinical characteristics for each patient were retrieved from electronic medical records. Statistical significance was determined using the Fisher exact test. Univariate analysis was performed by constructing probability curves according to the Kaplan-Meier method. Immortalized normal human ovarian surface epithelial (HOSE) cell lines with ectopic expression of CKI-ε were established by transfection with a CKI-ε expression construct. CKI-ε-targeting shRNAs were used to generate ovarian cancer cell lines that have stably suppressed CKI-ε expression. Protein expression was determined by Western blot. Growth rate was determined by cell counting. Three-dimensional spheroid culture was performed on Matrigel. The growth of ovarian cancer cell lines harboring either a control shRNA or a CKI-ε-shRNA was evaluated in a mouse xenograft model. The effects of IC261, an inhibitor of CKI-ε, on ovarian cancer cells were evaluated by MTT assay.

RESULTS: CKI-ε was overexpressed in 67% of invasive ovarian tumors (P-value=0.001) and in 14 of 17 ovarian cancer cell lines. Normal HOSE cells that have ectopic expression of CKI-ε have accelerated growth rate and formed spheroids in Matrigel that were two to four times larger than those formed by control HOSE. In contrast, cancer cell lines harboring specific CKI-ε shRNA had reduced growth rate and 6-fold reduced tumor weight in the xenograft model (P-value=0.007). The cancer cell lines also showed CKI-ε-dependent sensitivity to IC261. The median CKI-ε expression level among the ovarian cancer tissue samples was 3. For patients whose score was ≤ 3 and &gt; 3, the mean overall survival was 91 months and 48 months, respectively. Similarly, the mean disease free survival interval was 43 months and 22 months for patients whose score was ≤ 3 and &gt; 3, respectively. Patients who scored &gt; 3 tended to have late stage disease (61%) compared to patients who scored ≤ 3 (39%), (p=0.06).

CONCLUSIONS: CKI-ε is highly expressed in ovarian tumors and cancer cell lines. Studies of cell lines with alterations in CKI-ε expression showed that this signaling protein regulates cell growth and survival.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4789.

Autoantibody profiling to identify biomarkers of key pathogenic pathways in mucinous ovarian cancer

Mucinous epithelial ovarian cancers are clinically and morphologically distinct from the other histopathologic subtypes of ovarian cancer. Unlike other ovarian subtypes, epidemiologic studies have indicated that tobacco exposure is a significant risk factor for developing mucinous ovarian cancer. Detection of autoantibody reactivity is useful in biomarker discovery and for explaining the role of important pathophysiologic pathways in disease. In order to study if there are specific antibody biomarkers in the plasma samples of mucinous ovarian cancer patients, we have initiated a screen by employing a 'reverse capture antibody microarray' platform that uses native host antigens derived from mucinous ovarian tissues as 'baits' for the capture of differentially labelled patient and control autoantibodies. Thirty-five autoantibodies that were significantly elevated in the cancer plasma samples compared with healthy controls, and six autoantibodies that segregated smoking and non-smoking patients were identified. Functional annotation of the antibody targets has identified nine target antigens involved in integrin and Wnt signalling pathways. Immunohistochemistry of archived ovarian specimens showed significant overexpression of eight of the nine target antigens in mucinous ovarian tumour tissues, suggesting that plasma autoantibodies from mucinous ovarian cancer patients might have heightened reactivities with epitopes presented by these overexpressed antigens. Autoantibody profiling may have an unexpected utility in uncovering key signalling pathways that are dysregulated in the system of interest.

[Primary lung paraganglioma. A case report]

Primary lung paragangliomas are rare. They are 1-2% of the paragangliomas, and most of them occur in patients of 43-61 years. They clinically appear as solitary tumors and are in general asymptomatic. These tumors show a nesting pattern (Zellballen) of chief polygonal cells locked by fibrovascular trabeculae with subtenticular cells. The main cells have uniform nuclei with granular eosinophilic cytoplasm, and they are positive for neuroendocrinal markers (Neuron Specific Enolase, sinaptofisine and cromogranine A). Sustentacular cells are positive for protein S-100 and neurofibrilar protein. A differential diagnosis with the carcinoid tumor can be very difficult. The surgical treatment is mandatory , specially high blood pressure and the chances of malignization.

Pathogenesis of haemophilic synovitis: experimental studies on blood-induced joint damage

Hemarthrosis is a common manifestation of haemophilia, and joint arthropathy remains a frequent complication. Even though the exact mechanisms related to blood-induced joint disease have not yet been fully elucidated, it is likely that iron deposition in the synovium induces an inflammatory response that causes not only immune system activation but also stimulates angiogenesis. This process ultimately results in cartilage and bone destruction. Investigating the processes that occur in the early stages of blood-induced joint disease in humans has been very limited. Therefore, the use of haemophilic animal models is critical to augment the understanding of this phenomenon. This article discusses three cellular regulators (p53, p21 and TRAIL) induced in synovial tissue that are important for iron metabolism. A cartilage remodelling programme induced by the release of cytokines and growth factors that result in articular damage is also discussed. Full elucidation of the pathogenesis of haemophilic joint disease is required to identify new avenues for prevention and therapy.

[Small intestinal plasmacytoid lymphoma. Clinical presentation with acute abdominal pain]

Primary tumors of the small intestine are rare; 15-20% of the cases are extranodal lymphomas from B or T cells. Higher Incidence occurs in patients between 21 and 50 years. The clinical symptoms are pain, intestinal obstruction, diarrhea, bleeding or perforated peritonitis. In high-grade lymphomas, the cells are large and pleomorphic, with immunoblastic and plasmacytoid features, and immunopositive for alpha chain immunoglobulins. We reported the case of a 56-year-old patient presented with abdominal pain associated with intestinal perforation. Resections of a 9-centimetres-long segment in the small intestine was performed, which was covered by purulent plaques, with a perforation of 5 mm, surrounded by a greyish-white thick intestinal wall. It can be observed in the microscopy a proliferation of neoplastic cells arranged diffusely and with frequent mitosis. Large areas of immunoblastic and plasmacytoid configuration were evident. The immunomarcation was consistent with a lymphoma of large cells, immunophenotype B, with plasmacytoid development. We highlighted the clinical presentation like acute abdominal pain and its clinical and pathological characteristics, especially in the plasmacytoid development that should differ of the true plasmocytoma.

Pathogenesis of haemophilic synovitis: clinical aspects

Arthropathy remains a major cause of morbidity in patients with haemophilia. Frequent bleeding into the joints leads to joint damage with resultant contractures, joint deformities and arthritis. This in turn leads to muscle atrophy, limited physical activity, osteoporosis and disability. Even though several studies of prophylactic factor replacement for persons with severe haemophilia demonstrate improved joint function, this therapy is still not readily available to most people with haemophilia around the world and a universal treatment protocol has not been used. In this article, we discuss key issues in the treatment of severe haemophilia: the optimal timing of initiation and termination of therapy, dosing options and goals of therapy. The options for countries where prophylaxis is not readily available are also discussed. Most studies are small and not randomized making consensus treatment recommendations difficult to formulate. Randomized, clinical trials are needed to provide the answers regarding the optimal treatment of patients with severe haemophilia.

Prevalence of Osteoporosis, Osteopenia, and Vertebral Fractures in Long-Term Renal Transplant Recipients

BACKGROUND

Osteopenia and osteoporosis are frequent complications early after transplantation. Their long-term prevalences and associations with the risk of fractures are not well known. The objective of the present work was to determine the incidence of osteopenia and osteoporosis versus vertebral fractures in renal transplant recipients with stable graft function and with a follow-up of at least 10 years.

PATIENTS AND METHODS

Forty renal transplant recipients, 24 men and 16 women, were included in the study. The mean age was 41.8 years and the follow-up was 130 +/- 14 months. Initial immunosuppression consisted of cyclosporine with or without an antiproliferative agent. Measurements of bone mass density (BMD) were performed by dual-energy X-ray absorptiometry (DEXA). The assessment of vertebral fracture using conventional radiography was evaluated by semiquantitative criteria.

RESULTS

Eleven patients (27.5%) displayed lumbar spine osteoporosis (T-score < -2.5); 21 (52.5%), osteopenia (T-score > -2.5 and < -1) and 8 (20.0%), normal BMD. However, BMD was better preserved at the femoral neck: 14 patients (35.0%) had normal BMD; 20 (50.0%) osteopenia, and 6 (15.0%), osteoporosis. When analyzed together, patients with osteoporosis or osteopenia showed worse graft function at 1 and 8 years compared with normal BMD patients (1.75 +/- 0.634 vs 1.32 +/- 0.33 mg/dL at 1 year; P < .014) and (1.7 +/- 0.4 vs 1.2 +/- 0.2 mg/dL at 5 years; P < .01) and a greater number were prescribed vitamin D (50% vs 23%). Mild vertebral fractures were observed in 60.0% patients with osteoporosis; 70% with osteopenia; and 43% with normal lumbar BMD. Peripheral fractures were more common in patients with osteoporosis (P = .053).

CONCLUSIONS

Osteoporosis and osteopenia are common among long-term renal transplant recipients are associated with poorer graft function. Lumbar spine BMD osteoporosis is associated with peripheral fractures. However, mild vertebral deformities are not associated with the presence of osteopenia or osteoporosis.

High Body Mass Index and Posttransplant Weight Gain Are Not Risk Factors for Kidney Graft and Patient Outcome

BACKGROUND

High body mass constitutes a significant risk factor for morbidity and mortality in the general population, but it has been associated with an increased survival among dialysis patients. Its effects on renal transplant outcomes are controversial. The aim of our present work was to investigate the impact of high body mass and posttransplant weight gain on patient and graft outcomes.

PATIENTS AND METHODS

One thousand consecutive renal transplant recipients (631 men and 369 women) were included in the study. Their mean age was 42.9 years and the follow-up was at least 2 years. Basal immunosuppression was azathioprine (Aza) and steroids in 196 patients, cyclosporine (CsA) without or with antiproliferative agent in 557, and 239 were presented tacrolimus (Tac).

RESULTS

At the time of transplantation the body mass index (BMI) was 23.7 +/- 3.9 kg/m2, namely, <18.5 kg/m2 in 6.3%; 18.5 to 25 in 61.7%; 25 to 30 in 25.4%; and >30 in 6.5%. Pretransplant obesity was associated with old age and female gender. Obese patients experienced a greater risk of delayed graft function (P < .01) and surgical wound complications (P < .01). After 1 year, 299 patients (29.9%) displayed weight gain >10% (mean 8.6% +/- 10.4% or 5.0 +/- 6.1 kg). Patients on Aza showed increased body weight by 11.9% +/- 10.9%; CsA patients by 9.5% +/- 10.3%, and Tac patients by 4.9% +/- 9.1% (P < .001). Univariate and multivariate analysis showed that pretransplant BMI had no effect on graft or patient survival either in the whole group or in the patients treated with CsA or TAC. Posttransplant weight gain above 5% or 10% did not influence graft or patient outcomes.

CONCLUSIONS

The new immunosuppressive regimes reduce posttransplant weight gain. Pretransplant high body mass and 1-year posttransplant weight gain were not risk factors for graft or patient survival in our experience.

Cost structure of a postcombustion CO2 capture system using CaO

This paper presents the basic economics of an emerging concept for CO2 capture from flue gases in power plants. The complete system includes three key cost components: a full combustion power plant, a second power plant working as an oxy-fired fluidized bed calciner, and a fluidized bed carbonator interconnected with the calciner and capturing CO2 from the combustion power plant. The simplicity in the economic analysis is possible because the key cost data for the two major first components are well established in the open literature. It is shown that there is clear scope for a breakthrough in capture cost to around 15 $/t of CO2 avoided with this system. This is mainly because the capture system is generating additional power (from the additional coal fed to the calciner) and because the avoided CO2 comes from the capture of the CO2 generated by the coal fed to the calciner and the CO2 captured (as CaCO3) from the flue gases of the existing power plant, that is also released in the calciner.

Correlation between the EGFR intron 1 CA dinucleotide repeat and skin toxicity in lung cancer patients treated with erlotinib

14001

Background: Acneiform rash is the main toxicity of erlotinib, an epidermal growth factor receptor (EGFR) inhibitor. The length of the CA dinucleotide repeat in EGFR intron 1 has been suggested to predict the biological effects of tyrosin kinase inhibitors. Thus, we compared this polymorphism with the rash severity in non-small cell lung cancer (NSCLC) patients treated with erlotinib. Methods: Toxicity was evaluated in 18 metastatic or locally advanced unresectable NSCLC patients treated orally with 150 mg/d of erlotinib: 7 retrospectively and 11 prospectively. Rash was graded according to a modified scale based on the Common Toxicity Criteria v.3.0, which subclassified grade II rash into IIA (topic intervention indicated) and IIB (oral intervention indicated). Genomic DNA was isolated from each patient; the length of the EGFR intron 1 CA dinucleotide repeat was measured by PCR amplification and analyzed on a capillary sequencer. Results: The most common EGFR genotypes were: 16, 20, 17 and 18 CA repeats (with 50, 25, 8 and 8% frequency, respectively). 33% of the subjects with a total amount of CA repeats <34 had grade IIB-III rash vs 11% of the subjects with =34 CA repeats. In addition, all patients with 0 grade toxicity belonged to the =34 CA group. When the only patient with a previous dermatological disease (psoriasis) was excluded from the analysis, the difference between both groups increased, reaching statistical significance (p=0.047). Conclusions: This data suggests that NSCLC patients with long EGFR intron 1 CA alleles present lower grades of skin toxicity when treated with erlotinib than patients with short CA alleles. Further studies are required to confirm this data.

[Table: see text]

No significant financial relationships to disclose.