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Zannini G, Facchini G, De Sio M, De Vita F, Ronchi A, Orditura M, Vietri MT, Ciardiello F, Franco R, Accardo M, Zito Marino F. Implementation of BRCA mutations testing in formalin-fixed paraffin-embedded (FFPE) samples of different cancer types. Pathol Res Pract 2023; 243:154336. [PMID: 36736144 DOI: 10.1016/j.prp.2023.154336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023]
Abstract
BRCA1 and BRCA2 are onco-suppressor genes involved in the DNA repair mechanism. The presence of BRCA1/2 mutations confers a higher risk of developing several cancer types. To date, the FDA approved various PARP inhibitors to treat selected BRCA1/2 mutated oncologic patients. At first, PARP inhibitors were approved for patients with ovarian and breast cancers, and subsequently for metastatic pancreatic adenocarcinoma and metastatic castration-resistant prostate cancer after the treatment with chemotherapy. The current guidelines for BRCA testing are very heterogeneous between the different types of tumors regarding the diagnostic algorithm and the type of sample to analyze, such as the blood for the germline mutations and the tumoral tissue for the somatic mutations. Few data have currently been described regarding the detection of BRCA1/2 somatic mutations in formalin-fixed paraffin-embedded (FFPE) samples. In this review, we propose an overview of the BRCA mutations in FFPE samples of several cancers, including breast, ovarian, fallopian tube, primary peritoneal, prostate, and pancreatic cancer. We summarize the types and the frequency of BRCA mutations, the guidelines approved for the test, the molecular assays used for the detection and the PARP inhibitors approved for each tumor type.
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Affiliation(s)
- Giuseppa Zannini
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via L. Armanni 5, Naples 80138, Italy.
| | - Gaetano Facchini
- Medical Oncology Unit, SM delle Grazie Hospital, Via Domitiana, Pozzuoli 80078, Italy.
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via S. Pansini 5, Naples 80131, Italy.
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Via S. Pansini 5, Naples 80131, Italy.
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via L. Armanni 5, Naples 80138, Italy.
| | - Michele Orditura
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Via S. Pansini 5, Naples 80131, Italy.
| | - Maria Teresa Vietri
- U.O.C. Clinical and Molecular Pathology, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, Naples 80138, Italy.
| | - Fortunato Ciardiello
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Via S. Pansini 5, Naples 80131, Italy.
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via L. Armanni 5, Naples 80138, Italy.
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via L. Armanni 5, Naples 80138, Italy.
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via L. Armanni 5, Naples 80138, Italy.
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Rassy E, Assi T, Boussios S, Kattan J, Smith-Gagen J, Pavlidis N. Narrative review on serous primary peritoneal carcinoma of unknown primary site: four questions to be answered. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1709. [PMID: 33490221 PMCID: PMC7812188 DOI: 10.21037/atm-20-941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Serous peritoneal papillary carcinoma (SPPC) represents a particular cancer of unknown primary (CUP) entity that arises in the peritoneal surface lining the abdomen and pelvis without a discriminative primary tumor site. In this review, we discuss the validity of SPPC as a distinct entity. Clinically, patients with SPPC are older, have higher parity and later menarche, are more often obese and probably have poorer survival compared to those with primary ovarian cancer. Pathologically, SPPC is more anaplastic and multifocal, unlike primary ovarian cancer which is commonly unifocal. Biologically, it presents a higher expression of proliferative signals and similar cell cycle and DNA repair protein expression. These differences hint towards SPPC and primary ovarian cancer being as a spectrum of disease. Patients with SPPC are traditionally managed similarly to stage III–IV ovarian cancer. The recommended approach integrates aggressive cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and systemic chemotherapy to remove the macroscopic tumor, eradicate the microscopic residual disease, and control the microscopic metastasis. However, the available evidence lacks proper randomized or prospective studies on SPPC and is limited to retrospective series. The diligent identification of SPPC is warranted to design specific clinical trials that eventually evaluate the impact of the new therapeutics on this distinct entity.
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Affiliation(s)
- Elie Rassy
- Department of Cancer Medicine, Gustave Roussy Institut, Villejuif, France.,Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Stergios Boussios
- Medway NHS Foundation Trust, Gillingham, Kent, UK.,AELIA Organization, 9th Km Thessaloniki-Thermi, Thessaloniki, Greece
| | - Joseph Kattan
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Julie Smith-Gagen
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
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Blontzos N, Vafias E, Vorgias G, Kalinoglou N, Iavazzo C. Primary peritoneal serous papillary carcinoma: a case series. Arch Gynecol Obstet 2019; 300:1023-1028. [PMID: 31486887 DOI: 10.1007/s00404-019-05280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/22/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To present the clinical and laboratory characteristics, as well as the management, of patients with primary peritoneal serous papillary carcinoma (PPSPC). METHODS This is a retrospective study of 19 patients with PPSPC who underwent debulking surgery followed by first line chemotherapy and were managed in Metaxa Memorial Cancer Hospital between January 2002 and December 2017. RESULTS The median age of the patients was found to be 66 years (range 44-76 years). Clinical presentation of PPSPC included abdominal distention and pain, constipation, as well as loss of appetite and weight gain. Two of the patients did not mention any symptomatology and the disease was suspected by an abnormal cervical smear and elevated CA125 levels respectively. Biomarkers measurement during the initial management of the patients revealed abnormal values of CA125 for all the participants (median value 565 U/ml). Human epididymis secretory protein 4 (HE4) and ratios of blood count were also measured. Perioperative Peritoneal Cancer Index ranged from 6 to 20. Optimal debulking was achieved in 5 cases. All patients were staged as IIIC and IVA PPSPC and received standard chemotherapy with paclitaxel and carboplatin, whereas bevacizumab was added in the 5 most recent cases. Median overall survival was 29 months. CONCLUSION PPSPC is a rare malignancy, the management of which should take place in tertiary oncology centers.
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Affiliation(s)
- Nikolaos Blontzos
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece.
| | - Evangelos Vafias
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
| | - George Vorgias
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
| | - Nikolaos Kalinoglou
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
| | - Christos Iavazzo
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
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Yuan J, He L, Han B, Li Y. Long-term survival of high-grade primary peritoneal papillary serous adenocarcinoma: a case report and literature review. World J Surg Oncol 2017; 15:76. [PMID: 28399919 PMCID: PMC5387239 DOI: 10.1186/s12957-017-1134-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/22/2017] [Indexed: 01/05/2023] Open
Abstract
Background Primary peritoneal papillary serous carcinoma (PPPSC) is an uncommon disease which has a high malignancy and a poor prognosis. Case presentation We report here a long-term survival case of PPPSC with postoperative lung metastasis. A 62-year-old female patient with PPPSC was administered two cycles of neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and six cycles of platinum-based (docetaxel + carboplatin) intraperitoneal chemotherapy postoperatively. The patient reached a complete remission at the completion of primary treatment. Malignant thoracic effusion and lung metastasis developed 5 months after the treatment. The patient underwent video-assisted thoracoscopic surgery plus hyperthermic intrapleural chemotherapy. Conclusions Up to present, the patient has been survived with tumor for over 86 months with a good performance status, with only encapsulated effusion found at the latest follow-up. As a relatively new regime, the application of CRS + HIPEC in our patient has been proved example for MPE management, although more large-scale studies are needed to substantiate its efficiency and safety.
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Affiliation(s)
- Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Liang He
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital Affiliated to the Capital Medical University, Beijing, 100038, People's Republic of China
| | - Bing Han
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital Affiliated to the Capital Medical University, Beijing, 100038, People's Republic of China.
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Iavazzo C, Gkegkes ID, Vrachnis N. Primary peritoneal cancer in BRCA carriers after prophylactic bilateral salpingo-oophorectomy. J Turk Ger Gynecol Assoc 2016; 17:73-6. [PMID: 27403072 DOI: 10.5152/jtgga.2016.15223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/05/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The presence of deleterious mutations in breast cancer (BRCA)-1 or BRCA-2 gene has a decisive influence on the development of various types of neoplasms, such as breast, ovarian, tubal, and peritoneal cancers. Primary peritoneal cancer is an aggressive malignancy which, due to the absence of a specific screening test, cannot be diagnosed in its early stages. As a risk-reducing option, prophylactic bilateral salpingo-oophorectomy and mastectomy are often proposed in BRCA gene carriers. The effectiveness of a preventive surgical treatment is, however, unclear in the development of peritoneal cancer. MATERIAL AND METHODS An extensive electronic search was performed in PubMed, Scopus, and Cochrane databases. RESULTS The total number of patients who underwent prophylactic bilateral salpingo-oophorectomy was 1,830, of whom 28 presented with peritoneal cancer (1.53%). The age of the included patients ranged from 48 to 61 years. BRCA-1 was present in 9 out of 28 patients and BRCA-2 in 2 patients, while the type of BRCA was unclear in 17 patients. Salpingo-oophorectomy was performed in 23 out of 28 patients, while oophorectomy was carried out in 5 patients. The interval from initial risk-reducing surgical treatment to the presentation of peritoneal cancer ranged from 12 to 84 months. CONCLUSION Modification of the follow-up guidelines and increase in healthcare providers' awareness may reduce the risk of peritoneal cancer.
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Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, United Kingdom
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
| | - Nikolaos Vrachnis
- Second Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece
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Concurrent primary peritoneal low-grade serous carcinoma and endometrial high-grade serous carcinoma. Int J Gynecol Pathol 2015; 34:288-92. [PMID: 25760900 PMCID: PMC4423656 DOI: 10.1097/pgp.0000000000000133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 64-yr-old postmenopausal woman with high-grade squamous intraepithelial lesion and atypical glandular cell of undetermined significance on her Pap test was found to have endometrial serous carcinoma (high grade) involving a polyp in a subsequent endometrial biopsy. She underwent hysterectomy and bilateral salpingo-oophorectomy with multiple biopsies of the peritoneum. Microscopic examination of the entirely submitted uterus showed no residual serous carcinoma. Multiple foci of low-grade serous tumor with extensive calcifications and psammoma bodies were identified on the surfaces of the left fallopian tube, ovaries, and biopsies of the peritoneum, consistent with peritoneal primary low-grade serous carcinoma. To our knowledge, this is the first reported case of low-grade serous carcinoma of the peritoneum with a concurrent (high-grade) serous carcinoma of the endometrium arising from an endometrial polyp.
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Shigeta N, Yoshino K, Matsuzaki S, Morii E, Ueda Y, Kimura T. Clear cell adenocarcinoma of the peritoneum: a case report and literature review. J Ovarian Res 2014; 7:86. [PMID: 25366349 PMCID: PMC4219116 DOI: 10.1186/s13048-014-0086-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/27/2014] [Indexed: 11/30/2022] Open
Abstract
Clear cell adenocarcinoma (CCC) is generally thought to originate from ovarian, endometrial, or renal tissue. A CCC of the peritoneum (CCAP) is an extremely rare medical condition and is associated with a poor prognosis. To date, only 10 cases of CCAP have been reported, of which half resulted in death or recurrence within 6 months after initial treatment because CCAP is commonly resistant to multiple drugs. In this report, we present a case of CCAP of the pouch of Douglas coexisting with an endometriosis and we offer a review of the related literature.
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Affiliation(s)
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Osaka, Japan.
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Primary malignant tumors of peritoneal and retroperitoneal origin: clinical and imaging features. Surg Oncol Clin N Am 2014; 23:821-45. [PMID: 25246051 DOI: 10.1016/j.soc.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peritoneal carcinomatosis and metastatic involvement of the retroperitoneum are manifestations of many organ-based malignancies and lymphoproliferative disorders. Primary malignancies of peritoneal and retroperitoneal origin occur much less frequently, and are difficult to distinguish from metastatic disease on imaging alone. However, the imaging features of these primary tumors, taken in concert with the clinical data, can be helpful in narrowing the scope of the differential diagnosis. This review presents the clinical and imaging features of primary peritoneal and retroperitoneal tumors arising from the various tissue components that comprise the ligaments, mesenteries, and connective tissues of the peritoneal and retroperitoneal spaces.
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Bakrin N, Gilly FN, Baratti D, Bereder JM, Quenet F, Lorimier G, Mohamed F, Elias D, Glehen O. Primary peritoneal serous carcinoma treated by cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. A multi-institutional study of 36 patients. Eur J Surg Oncol 2013; 39:742-7. [PMID: 23510853 DOI: 10.1016/j.ejso.2013.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/12/2013] [Accepted: 02/20/2013] [Indexed: 12/22/2022] Open
Abstract
AIM Primary peritoneal serous carcinoma (PPSC) is a rare condition, histologically identical to ovarian serous carcinoma and often diagnosed at late stage. There is not any standardized treatment for PPSC. A retrospective multicentric study was performed in French speaking centers to evaluate cytoreduction surgery and Hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinomatosis from different origins. The manuscript's aim was to study the particular population with PPSC. METHODS Between September 1997 and July 2007, 36 patients with PPSC from 9 institutions underwent 39 procedures. RESULTS Mortality and morbidity rates were 5.6% and 20.6% respectively. The overall survival at 1, 3 and 5 years are respectively 93.6, 71.5 and 57.4%. The median overall survival was not reached. By univariate analysis, the only factor that had prognostic value was PCI (p = 0.03). CONCLUSIONS The therapeutic approach combining cytoreductive surgery with HIPEC may achieve long-term survival in patients with PPSC.
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Affiliation(s)
- N Bakrin
- Surgical Oncology Department, Lyon Civil Hospices, South Lyon University Hospital Center, 165 chemin du grand Revoyet, 69365 Pierre Bénite, France.
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Photodynamic detection and management of intraperitoneal spreading of primary peritoneal papillary serous carcinoma in a man: report of a case. Surg Today 2013; 44:373-7. [DOI: 10.1007/s00595-013-0500-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
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Hou XQ, Cui HH, Jin X. Coexistence of tuberculous peritonitis and primary papillary serous carcinoma of the peritoneum: A case report and review of the literature. World J Gastroenterol 2009; 15:761-3. [PMID: 19222106 PMCID: PMC2653450 DOI: 10.3748/wjg.15.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A major diagnostic challenge to the evaluation of an incomplete intestinal obstruction is to distinguish between infectious and malignant etiologies. We present a case of an elderly woman complaining of abdominal pain accompanied with nausea and vomiting, and failure to pass gas or stools. Anti-tuberculosis drugs were used to relieve her abdominal pain, and a needle biopsy of the peritoneal cavity showed evidence of primary papillary serous carcinoma of the peritoneum (PSCP). This is a rare description of tuberculosis in the setting of PSCP. This report illustrates the potential complex nature of malignancies, and emphasizes the need to consider coexistence of malignancy and infection in patients, especially in those with risk factors for malignancy who fail with antibiotic therapy.
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