Founder BRCA1 and BRCA2 mutations in French Canadian breast and ovarian cancer families

We have identified four mutations in each of the breast cancer-susceptibility genes, BRCA1 and BRCA2, in French Canadian breast cancer and breast/ovarian cancer families from Quebec. To identify founder effects, we examined independently ascertained French Canadian cancer families for the distribution of these eight mutations. Mutations were found in 41 of 97 families. Six of eight mutations were observed at least twice. The BRCA1 C4446T mutation was the most common mutation found, followed by the BRCA2 8765delAG mutation. Together, these mutations were found in 28 of 41 families identified to have a mutation. The odds of detection of any of the four BRCA1 mutations was 18.7x greater if one or more cases of ovarian cancer were also present in the family. The odds of detection of any of the four BRCA2 mutations was 5.3x greater if there were at least five cases of breast cancer in the family. Interestingly, the presence of a breast cancer case <36 years of age was strongly predictive of the presence of any of the eight mutations screened. Carriers of the same mutation, from different families, shared similar haplotypes, indicating that the mutant alleles were likely to be identical by descent for a mutation in the founder population. The identification of common BRCA1 and BRCA2 mutations will facilitate carrier detection in French Canadian breast cancer and breast/ovarian cancer families.

Oral contraceptives and the risk of hereditary ovarian cancer. Hereditary Ovarian Cancer Clinical Study Group

BACKGROUND

Women with mutations in either the BRCA1 or the BRCA2 gene have a high lifetime risk of ovarian cancer. Oral contraceptives protect against ovarian cancer in general, but it is not known whether they also protect against hereditary forms of ovarian cancer.

METHODS

We enrolled 207 women with hereditary ovarian cancer and 161 of their sisters as controls in a case-control study. All the patients carried a pathogenic mutation in either BRCA1 (179 women) or BRCA2 (28 women). The control women were enrolled regardless of whether or not they had either mutation. Lifetime histories of oral-contraceptive use were obtained by interview or by written questionnaire and were compared between patients and control women, after adjustment for year of birth and parity.

RESULTS

The adjusted odds ratio for ovarian cancer associated with any past use of oral contraceptives was 0.5 (95 percent confidence interval, 0.3 to 0.8). The risk decreased with increasing duration of use (P for trend, <0.001); use for six or more years was associated with a 60 percent reduction in risk. Oral-contraceptive use protected against ovarian cancer both for carriers of the BRCA1 mutation (odds ratio, 0.5; 95 percent confidence interval, 0.3 to 0.9) and for carriers of the BRCA2 mutation (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 1.1).

CONCLUSIONS

Oral-contraceptive use may reduce the risk of ovarian cancer in women with pathogenic mutations in the BRCA1 or BRCA2 gene.

Risk factors for familial and sporadic ovarian cancer among French Canadians: a case-control study

OBJECTIVE

The objective was to compare risk factors between familial and sporadic ovarian cancer by means of a case-control approach.

STUDY DESIGN

We conducted a case-control study among French Canadian women in Montreal during 1995-1996. One hundred seventy women 20 to 84 years old with histologically confirmed diagnoses of primary ovarian carcinomas or borderline tumors were interviewed concerning their reproductive, family, and medical histories. During the same period 170 randomly selected population control subjects, frequency-matched to the case patients according to age and ethnic group, were also interviewed. Unconditional logistic regression methods were used for data analysis.

RESULTS

The major factors influencing the risk of development of ovarian cancer were as follows: (1) family history of breast or ovarian cancer, (2) a late age at use of oral contraceptives (a protective effect), and (3) a late age at last childbirth (a protective effect for familial case patients only).

CONCLUSION

These factors had equally great impacts in familial and sporadic cases, implying that the underlying mechanisms of carcinogenesis in sporadic and familial ovarian cancer may be similar and that hereditary ovarian cancer may be preventable.

The future of HPV testing in clinical laboratories and applied virology research

BACKGROUND

Human papillomaviruses (HPV) are now considered etiologic agents of cancer of the uterine cervix. Adjunctive diagnostic procedures for the detection of HPV infection could increase the sensitivity of primary and secondary screening of cervical cancer. HPV testing could also improve the specificity of screening programs resulting in avoidance of overtreatment and saving of costs for confirmatory procedures.

OBJECTIVES

To review the rationale of HPV testing in genital diseases and the potential applications of HPV DNA detection methods for clinical and epidemiological purposes.

RESULTS

Progression of HPV infection is associated with the persistence of HPV infection, involvement of high-risk HPV types, high HPV viral load in specimens, integration of viral DNA and possibly the presence of cofactors. The design of HPV diagnostic tests will need to take into account these parameters of disease progression. HPV DNA detection techniques based on signal-amplification are standardized, commercially available and detect several high-risk HPV types. They increase the sensitivity of screening for high-grade and low-grade lesions. Although they may yield false-negative results in the presence of significant HPV-related disease, new test formats could resolve this weakness. Amplification techniques are ideal instruments for epidemiologic purposes since they minimize misclassification of HPV infection status and allow for the detection of low viral burden infections. They are currently not readily applicable to diagnostic laboratories.

CONCLUSIONS

Before recommending HPV testing, prospective trials of untreated LSIL with HPV testing as well as the determination of the efficacy and cost-effectiveness of novel HPV tests, need to be completed.

Laparoscopic staging of early ovarian cancer

The relevance of staging in early ovarian carcinoma is reviewed in light of the advances in surgical laparoscopy. Data from the literature suggest that a lymphadenectomy should be performed instead of a sampling. We have realized the former through laparoscopy. In this paper we propose a detailed surgical technique, similar to the laparotomy approach, that ensures an adequate nodal evaluation. Ten patients underwent a completion of staging by laparoscopy, including peritoneal washings for cytology, peritoneal and ovarian biopsies, an infracolic omentectomy, and a lymph node dissection. The use of laparoscopy for staging of early ovarian carcinoma appears to be a valuable alternative to traditional surgical staging.

Detection of human papillomavirus DNA in cervical lavage specimens by a nonisotopic consensus PCR assay

A gene amplification method that combines PCR with an enzyme immunoassay (PCR-EIA) for quantitation of amplified DNA was developed for the detection of human papillomavirus (HPV). Samples were amplified with consensus primers MY09 and MY11. Amplified DNA products were reacted in solution with type-specific nested RNA probes labelled with digoxigenin-11-UTP. Hybrids were captured on a microtiter plate coated with an antidigoxigenin antibody. Bound DNA-RNA hybrids were quantitated by the addition of an alkaline phosphatase-labelled monoclonal antibody directed against DNA-RNA hybrids and a fluorogenic substrate. The detection limit of PCR-EIA was six copies of HPV type 18 DNA in the original specimen. The assay was used to assess HPV infection of the uterine cervixes of 65 women referred to a colposcopy clinic. In 66 cervicovaginal lavage specimens, all 23 HPV strains detected by a standard isotopic PCR assay were also detected by the PCR-EIA (sensitivity, 100%; 95% confidence interval, 85.2 to 100%). Forty-two of the 43 samples that did not contain HPV types 6/11, 16, 18, 31, 33, 35, and 45 were also negative by PCR-EIA, for a specificity of 97.7%. Low-level cross-reactivity was encountered between HPV types 18 and 45 as well as between types 33 and 58. PCR-EIA provides a convenient means of objectively measuring PCR-amplified HPV DNA from common genital HPV types.

Absence of human papillomavirus sequences in ovarian pathologies

The role of human papillomaviruses (HPVs) in ovarian epithelium (either normal or neoplastic) remains controversial. We have investigated by PCR the presence of HPV DNA in fresh tissue from ovarian neoplasms and in primary cell cultures established from either normal, benign or malignant ovarian surface epithelia. None of the fresh samples and primary ovarian cultures contained HPV DNA sequences.

Primary cultures of normal and tumoral human ovarian epithelium: a powerful tool for basic molecular studies

To begin delineating the cellular and molecular events that are important in ovarian carcinogenesis, we have developed a simple and rapid method for the establishment of primary cultures derived from benign tumors, malignant tumors, and ascites of the ovary that are representative of the original clinical material from which they are derived. From 23 ovarian epithelial ascites collected, 13 were successfully established in culture and cells survived an average of 7 to 8 passages. From 65 solid epithelial ovarian tumors (benign and malignant) 36 were cultured for an average of 6 passages for cultures derived from benign tumors and 11 or 12 passages in the case of malignant tumors. Cells were scored as epithelial in nature by morphology and histochemical analysis using anti-cytokeratin antibodies. Cultures, especially those derived from solid tumors, sometimes displayed fibroblastic-like contamination which was quickly resolved. We include limited molecular analyses both to characterize the origin of the populations we have established as well as to demonstrate the usefulness of these cultures in molecular studies.

Analysis of antigen expression at multiple tumor sites in epithelial ovarian cancer

The question of whether the antigenic phenotype of human epithelial ovarian cancer varies in a given patient between the primary tumor and metastatic sites or among metastatic sites themselves is an important issue in planning potential therapeutic strategies for ovarian cancer. We have obtained tumor specimens from at least two separate sites during operations on 12 patients with epithelial ovarian cancer, and we have typed these specimens with a group of 18 monoclonal antibodies that react with cell-surface glycoprotein and carbohydrate antigens, including blood group antigens. Antibodies with relative specificity for malignant cells as well as those that detect more widely distributed epithelial antigens were used. A total of 31 specimens from 12 patients with advanced adenocarcinoma (8 serous, 3 undifferentiated, 1 endometrioid) of the ovary were studied, including fresh ascites cells in two patients. Frozen sections of tumor specimens were stained with the antibodies by the indirect immunoperoxidase technique and graded semiquantitatively. Little difference was seen in antigenic expression of tumors that were obtained from various sites in the same patient for either the epithelial cell markers or blood group markers. Intratumoral antigenic heterogeneity was seen, but this was generally quite consistent within a given patient's specimens. As anticipated, variations in antigen expression were seen among specimens from different patients. The antigenic phenotype of the tumor specimens in a given patient, as determined immunohistochemically by our group of antibodies, showed only minor variation among primary and metastatic sites.

Lymphangioma circumscriptum of the vulva: case report and review of the literature

Lymphangioma circumscriptum is a benign disorder of lymphatic channels. The pathology consists of a collection of subcutaneous lymphatic cisterns communicating through dilated channels with superficial clusters of vesicles. The most common symptom is recurrent oozing of clear fluid. Management consists of wide excision, assuring free lateral and deep margins by frozen-section analysis. Involved margins have been shown to increase the recurrence rate. Laser vaporization has been used recently with relatively good results. The etiology of this lesion is unclear; however, lymphatic obstruction has been suggested as a possible cause in occasional cases. Two cases of vulvar lymphangioma circumscriptum have been reported previously in the literature, both arising in elderly women after radiation therapy for squamous cell carcinoma of the cervix. We present the third case, arising in a 42-year-old woman with no previous surgery or radiation.

[Pityrosporum folliculitis (author's transl)]

Pityrosporum folliculitis occurs mainly among adult males on the back and may result from antibiotic and steroid administration. The lipophilic yeasts are numerous in the papulo-pustular lesions and can easily be demonstrated in the perifollicular inflammation on histological slides. 8 new cases with typical clinicopathological features are recorded by the authors. The best results are obtained with topically applied amphotericin B or econazol.