1
|
Asmundo L, Ambrosini V, Anderson MA, Fanti S, Bradley WR, Campana D, Mojtahed A, Chung R, Mcdermott S, Digumarthy S, Ursprung S, Nikolau K, Fintelmann FJ, Blake M, Fernandez-Del Castillo C, Qadan M, Pandey A, Clark JW, Catalano OA. Clinical Intricacies and Advances in Neuroendocrine Tumors: An Organ-Based Multidisciplinary Approach. J Comput Assist Tomogr 2024; 48:614-627. [PMID: 38626756 DOI: 10.1097/rct.0000000000001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) are rare neoplasms originating from neuroendocrine cells, with increasing incidence due to enhanced detection methods. These tumors display considerable heterogeneity, necessitating diverse management strategies based on factors like organ of origin and tumor size. This article provides a comprehensive overview of therapeutic approaches for NENs, emphasizing the role of imaging in treatment decisions. It categorizes tumors based on their locations: gastric, duodenal, pancreatic, small bowel, colonic, rectal, appendiceal, gallbladder, prostate, lung, gynecological, and others. The piece also elucidates the challenges in managing metastatic disease and controversies surrounding MEN1-neuroendocrine tumor management. The article underscores the significance of individualized treatment plans, underscoring the need for a multidisciplinary approach to ensure optimal patient outcomes.
Collapse
Affiliation(s)
| | | | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - William R Bradley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Davide Campana
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ryan Chung
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shaunagh Mcdermott
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Subba Digumarthy
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Stephan Ursprung
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolau
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Blake
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ankur Pandey
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey W Clark
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Saraei P, Heshmati A, Hosseini S. Small-cell neuroendocrine carcinoma of the female genital tract: A comprehensive overview. J Neuroendocrinol 2024; 36:e13394. [PMID: 38626758 DOI: 10.1111/jne.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
Small-cell neuroendocrine carcinomas (SCNECs) of the female genital tract are rare and aggressive tumors that are characterized by a high rate of recurrence and poor prognosis. They can arise from various sites within the female genital tract, including the cervix, endometrium, ovary, fallopian tube, vagina, and vulva. They are composed of cells with neuroendocrine features, such as the ability to produce and secrete hormones and peptides, and a high mitotic rate. Immunohistochemical staining for neuroendocrine markers, such as chromogranin A, synaptophysin, and CD56, can aid in the diagnosis of these tumors. This article provides an overview of the epidemiology, etiology, and risk factors associated with these tumors, as well as their clinical presentation, cellular characteristics, diagnosis, and finally the current treatment options for SCNECs, including surgery, chemotherapy, and radiation therapy, alone or in combination.
Collapse
MESH Headings
- Humans
- Female
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Small Cell/therapy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/epidemiology
- Carcinoma, Small Cell/pathology
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/epidemiology
- Risk Factors
Collapse
Affiliation(s)
- Pouya Saraei
- Department of Medical Physics, Medicine School, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Heshmati
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
3
|
Veneziani AC, Gonzalez-Ochoa E, Alqaisi H, Madariaga A, Bhat G, Rouzbahman M, Sneha S, Oza AM. Heterogeneity and treatment landscape of ovarian carcinoma. Nat Rev Clin Oncol 2023; 20:820-842. [PMID: 37783747 DOI: 10.1038/s41571-023-00819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/04/2023]
Abstract
Ovarian carcinoma is characterized by heterogeneity at the molecular, cellular and anatomical levels, both spatially and temporally. This heterogeneity affects response to surgery and/or systemic therapy, and also facilitates inherent and acquired drug resistance. As a consequence, this tumour type is often aggressive and frequently lethal. Ovarian carcinoma is not a single disease entity and comprises various subtypes, each with distinct complex molecular landscapes that change during progression and therapy. The interactions of cancer and stromal cells within the tumour microenvironment further affects disease evolution and response to therapy. In past decades, researchers have characterized the cellular, molecular, microenvironmental and immunological heterogeneity of ovarian carcinoma. Traditional treatment approaches have considered ovarian carcinoma as a single entity. This landscape is slowly changing with the increasing appreciation of heterogeneity and the recognition that delivering ineffective therapies can delay the development of effective personalized approaches as well as potentially change the molecular and cellular characteristics of the tumour, which might lead to additional resistance to subsequent therapy. In this Review we discuss the heterogeneity of ovarian carcinoma, outline the current treatment landscape for this malignancy and highlight potentially effective therapeutic strategies in development.
Collapse
Affiliation(s)
- Ana C Veneziani
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Eduardo Gonzalez-Ochoa
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Husam Alqaisi
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ainhoa Madariaga
- Medical Oncology Department, 12 De Octubre University Hospital, Madrid, Spain
| | - Gita Bhat
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marjan Rouzbahman
- Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Suku Sneha
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
4
|
Coşkun Ç, Kurucu N, Usubutun A, Soyer T, Ozcan HN, Çelik Ertaş NB, Kutluk T. Small Cell Carcinoma of Ovary, Hypercalcemic Type: A Rare Case Report. J Pediatr Adolesc Gynecol 2023; 36:112-115. [PMID: 36243275 DOI: 10.1016/j.jpag.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/03/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare neoplasm that occurs mostly in women younger than 40 years of age. The unknown histogenesis makes the diagnosis of SCCOHT difficult. SCCOHT was recently shown to be associated with SMARCA4 gene mutation. Serum calcium levels can be used as a marker of treatment response and relapse in SCCOHT. CASE REPORT Here we report on a 16-year-old girl who presented with pelvic mass and hypercalcemia. SCCOHT was diagnosed histopathologically. However, loss of neither BRG1 nor INI1 expression was detected. SUMMARY AND CONCLUSION The diagnosis of SCCOHT should be among the differential diagnoses in adolescents presenting with pelvic mass and hypercalcemia. We would like to share our experience with this rare case, discuss recent management, and emphasize the importance of a multidisciplinary approach. Although it is known that almost all cases have a loss of BRG1 expression and a small group exhibit loss of INI1, our patient indicates that there could be exceptional cases with hitherto undescribed genetic abnormalities.
Collapse
Affiliation(s)
- Çağrı Coşkun
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Nilgun Kurucu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alp Usubutun
- Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H Nursun Ozcan
- Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nur Berna Çelik Ertaş
- Department of Pediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
5
|
Li G, Jiang Y. Case Report: A Durable Response to Camrelizumab and Apatinib Combination Therapy in a Heavily Treated Small Cell Carcinoma of the Ovary, Hypercalcemic Type. Front Oncol 2022; 12:916790. [PMID: 35903699 PMCID: PMC9315103 DOI: 10.3389/fonc.2022.916790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/20/2022] [Indexed: 12/31/2022] Open
Abstract
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare and highly aggressive malignancy with a poor prognosis. Most patients experience recurrence even after surgery and chemotherapy, and there are no standard treatment options for recurrent disease. Here, we report the case of a 36-year-old woman with SCCOHT who underwent primary cytoreductive surgery without adjuvant chemotherapy and remained disease-free for 9 months. She then developed retroperitoneal lymph node metastasis and was treated with two cycles of bleomycin/etoposide/cisplatin chemotherapy. However, the disease progressed and the patient received four cycles of liposomal doxorubicin/ifosfamide chemotherapy, followed by local radiation to the enlarged retroperitoneal lymph nodes. She achieved partial remission for 13 months, after which the disease progressed again. Tumor tissues and blood samples were sent for next-generation sequencing. The results indicated a somatic SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4) mutation, microsatellite stability, and a tumor mutation burden of 1.0 muts/Mb without any germline mutations. An anti-PD-1 antibody, camrelizumab, and an antiangiogenic agent, apatinib, were administered, and the patient achieved partial remission for 28 months. Our study provides the first clinical evidence that the combination therapy of camrelizumab and apatinib could be an effective treatment for recurrent SCCOHT.
Collapse
|
6
|
Simões MFE, da Costa AABA, Silva TN, Fernandes L, Bovolim G, Torrezan GT, Carraro DM, Baiocchi G, Menezes ANO, Santana Dos Santos E, De Brot L. Case Report of Small Cell Carcinoma of the Ovary, Hypercalcemic Type (Ovarian Rhabdoid Tumor) with SMARCB1 Mutation: A Literature Review of a Rare and Aggressive Condition. Curr Oncol 2022; 29:411-422. [PMID: 35200537 PMCID: PMC8870484 DOI: 10.3390/curroncol29020037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/09/2023] Open
Abstract
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare and aggressive condition that is associated with the SMARCA4 mutation and has a dismal prognosis. It is generally diagnosed in young women. Here, we report a case of a young woman with SCCOHT harboring a rare molecular finding with a highly aggressive biological behavior. The patient had a somatic SMARCB1 mutation instead of an expected SMARCA4 alteration. Even though the patient was treated with high-dose chemotherapy followed by stem cell transplantation, she evolved with disease progression and died 11 months after her first symptoms appeared. We present a literature review of this rare disease and discuss the findings in the present patient in comparison to expected molecular alterations and options for SCCOHT treatment.
Collapse
|
7
|
Sirák I, Laco J, Vošmiková H, Mell LK, Herrera FG, Šenkeříková M, Vošmik M. SMARCA4-Deficient Carcinoma of Uterine Cervix Resembling SCCOHT-Case Report. Pathol Oncol Res 2022; 27:1610003. [PMID: 34970085 PMCID: PMC8712336 DOI: 10.3389/pore.2021.1610003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Small cell carcinoma of hypercalcemic type (SCCOHT) is a rare gynaecological neoplasm, originating mostly in the ovaries. Cervical origin of this very aggressive malignancy with unknown histogenesis is an extremely rare condition, without published management recommendations. Alterations in SMARCA4 gene are supposed to play the major role in SCCOHT oncogenesis and their identification is crucial for the diagnosis. Adequate genetic counselling of the patients and their families seems to be of great importance. Optimal management and treatment approaches are not known yet but may extremely influence the prognosis of young female patients that suffer from this very resistant disease. Nowadays, a translational research seems to be the key for the further diagnostic and treatment strategies of SCCOHT. The purpose of the case report is to provide practical information and useful recommendations on the diagnosis, management, and treatment of SMARCA4-deficient carcinoma of the uterine cervix resembling SCCOHT.
Collapse
Affiliation(s)
- Igor Sirák
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Jan Laco
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Hana Vošmiková
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Fernanda G Herrera
- Ludwig Institute for Cancer Research, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mária Šenkeříková
- Department of Medical Genetics, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Milan Vošmik
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| |
Collapse
|
8
|
Montebello A, Gruppetta M. Hypercalcaemia due to ovarian small cell carcinoma of the hypercalcaemic type. BMJ Case Rep 2021; 14:14/7/e243571. [PMID: 34330726 PMCID: PMC8327804 DOI: 10.1136/bcr-2021-243571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 37-year-old woman presented with a few days' history of lower abdominal pain and an incidental finding of hypercalcaemia. A thorough workup ensued, and the cause was found to be an exceptionally rare ovarian tumour-ovarian small cell carcinoma of the hypercalcaemic type. Acute treatment of hypercalcaemia consisted of aggressive intravenous fluids and bisphosphonates. She underwent surgery to remove the tumour and is currently receiving systemic platinum/etoposide chemotherapy combination to be followed by pelvic radiotherapy. This case highlights the wide range of differential diagnosis for hypercalcaemia and the importance of a stepwise and thorough approach during investigations. We discuss the pathophysiology of malignancy-related hypercalcaemia, focusing especially on parathyroid hormone-related peptide-associated hypercalcaemia.
Collapse
Affiliation(s)
- Annalisa Montebello
- Department of Diabetes and Endocrinology, Mater Dei Hospital, L-Imsida, Malta
| | - Mark Gruppetta
- Department of Diabetes and Endocrinology, Mater Dei Hospital, L-Imsida, Malta
| |
Collapse
|
9
|
Hyperkalzämisches Ovarialkarzinom bei einem 12-jährigen Mädchen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Vivod G, Merlo S, Kovačević N. Hypercalcemia and Unilateral Ovarian Mass in a Young Adult: A Case Report of Small Cell Ovarian Carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928959. [PMID: 33495434 PMCID: PMC7849373 DOI: 10.12659/ajcr.928959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Female, 31-year-old Final Diagnosis: Small cell ovarian cancer • hypercalcemic type Symptoms: Abdominal pain • bloating Medication: — Clinical Procedure: Surgery • adjuvant chemotherapy • adjuvant radiotherapy Specialty: Oncology
Collapse
Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Department of Gynecology and Obstetrics, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Nina Kovačević
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Department of Gynecology and Obstetrics, Medical Faculty Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
11
|
Conley BA, Staudt L, Takebe N, Wheeler DA, Wang L, Cardenas MF, Korchina V, Zenklusen JC, McShane LM, Tricoli JV, Williams PM, Lubensky I, O’Sullivan-Coyne G, Kohn E, Little RF, White J, Malik S, Harris LN, Mann B, Weil C, Tarnuzzer R, Karlovich C, Rodgers B, Shankar L, Jacobs PM, Nolan T, Berryman SM, Gastier-Foster J, Bowen J, Leraas K, Shen H, Laird PW, Esteller M, Miller V, Johnson A, Edmondson EF, Giordano TJ, Kim B, Ivy SP. The Exceptional Responders Initiative: Feasibility of a National Cancer Institute Pilot Study. J Natl Cancer Inst 2021; 113:27-37. [PMID: 32339229 PMCID: PMC7781457 DOI: 10.1093/jnci/djaa061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 02/27/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Tumor molecular profiling from patients experiencing exceptional responses to systemic therapy may provide insights into cancer biology and improve treatment tailoring. This pilot study evaluates the feasibility of identifying exceptional responders retrospectively, obtaining pre-exceptional response treatment tumor tissues, and analyzing them with state-of-the-art molecular analysis tools to identify potential molecular explanations for responses. METHODS Exceptional response was defined as partial (PR) or complete (CR) response to a systemic treatment with population PR or CR rate less than 10% or an unusually long response (eg, duration >3 times published median). Cases proposed by patients' clinicians were reviewed by clinical and translational experts. Tumor and normal tissue (if possible) were profiled with whole exome sequencing and, if possible, targeted deep sequencing, RNA sequencing, methylation arrays, and immunohistochemistry. Potential germline mutations were tracked for relevance to disease. RESULTS Cases reflected a variety of tumors and standard and investigational treatments. Of 520 cases, 476 (91.5%) were accepted for further review, and 222 of 476 (46.6%) proposed cases met requirements as exceptional responders. Clinical data were obtained from 168 of 222 cases (75.7%). Tumor was provided from 130 of 168 cases (77.4%). Of 117 of the 130 (90.0%) cases with sufficient nucleic acids, 109 (93.2%) were successfully analyzed; 6 patients had potentially actionable germline mutations. CONCLUSION Exceptional responses occur with standard and investigational treatment. Retrospective identification of exceptional responders, accessioning, and sequencing of pretreatment archived tissue is feasible. Data from molecular analyses of tumors, particularly when combining results from patients who received similar treatments, may elucidate molecular bases for exceptional responses.
Collapse
Affiliation(s)
- Barbara A Conley
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Lou Staudt
- Center for Cancer Genomics, National Cancer Institute, Bethesda, MD, USA
| | - Naoko Takebe
- Developmental Therapeutics Clinic, National Cancer Institute, Bethesda, MD, USA
| | - David A Wheeler
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Linghua Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria F Cardenas
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Viktoriya Korchina
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Lisa M McShane
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Paul M Williams
- Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Irina Lubensky
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | | | - Elise Kohn
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Jeffrey White
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Shakun Malik
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Lyndsay N Harris
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Bhupinder Mann
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Carol Weil
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Roy Tarnuzzer
- Center for Cancer Genomics, National Cancer Institute, Bethesda, MD, USA
| | - Chris Karlovich
- Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Brian Rodgers
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Paula M Jacobs
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Tracy Nolan
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sean M Berryman
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Julie Gastier-Foster
- Nationwide Children’s Hospital, Columbus, OH, USA; Van Andel Research Institute, Grand Rapids, MI, USA
| | - Jay Bowen
- Nationwide Children’s Hospital, Columbus, OH, USA; Van Andel Research Institute, Grand Rapids, MI, USA
| | - Kristen Leraas
- Nationwide Children’s Hospital, Columbus, OH, USA; Van Andel Research Institute, Grand Rapids, MI, USA
| | - Hui Shen
- Van Andel Research Institute, Grand Rapids, MI, USA
| | | | - Manel Esteller
- Josep Carreras Leukaemia Research Institute, Badalona, Barcelona, Catalonia, Spain
| | | | | | - Elijah F Edmondson
- Pathology and Histology Laboratory, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | - Benjamin Kim
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - S Percy Ivy
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
12
|
Blanc-Durand F, Lefeuvre-Plesse C, Ray-Coquard I, Chaltiel D, Floquet A, Meriaux É, Berton D, Bello-Roufai D, Guillemet C, Dupre PF, Faller É, Alexandre J, Hardy-Bressard AC, Collard O, Fabbro M, Provansal M, Kalbacher E, Genestie C, Pautier P. Dose-intensive regimen treatment for small-cell carcinoma of the ovary of hypercalcemic type (SCCOHT). Gynecol Oncol 2020; 159:129-135. [PMID: 32723678 DOI: 10.1016/j.ygyno.2020.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/11/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Small cell carcinoma of the ovary of hypercalcemic type (SCCOHT) is a rare and rapidly lethal disease affecting young women. Cytoreductive surgery associated with chemotherapy followed by a high dose chemotherapy regimen (HDC) demonstrated improved outcomes in a unique prospective and several retrospective studies, and this report aimed to confirm these results in an independent and larger cohort. METHODS Between 2006 and 2018, we conducted a multicentric prospective study on 44 women diagnosed with SCCOHT. Patients were treated homogeneously with optimal cytoreductive surgery and chemotherapy protocol for four to six cycles (PAVEP). In case of complete response, patients received HDC with stem-cell support, followed by pelvic radiotherapy. The primary endpoint was the event-free survival (EFS) in the per-protocol cohort. Secondary analysis explored the effect of HDC with outcomes. RESULTS Mean age at diagnosis was 33 years old (range 13.8-75.8). 14 patients presented with stage FIGO I, 21 with stage III and 9 with stage IV. Median follow-up was 53.4 months. 38 patients underwent optimal surgery with up to 6 cycles of PAVEP. 30 received HDC, and 21 pelvic radiotherapy. 21 relapses were reported leading to death for 18 patients. Median EFS in the per-protocol cohort was 18.2 months, and 2-year EFS rate was 40%. HDC was significantly associated with better overall survival (p < .001). Grades 3/4 adverse events were frequent but, in most cases, manageable, although one grade-5 adverse-event occurred during HDC. CONCLUSION Intensive regimen containing multidrug chemotherapy, HDC and pelvic radiotherapy, for the management of SCCOHT, demonstrated encouraging survival and should be proposed for all patients. However, the significant toxicity cost associated is of concern and it should be restricted to expert centers.
Collapse
Affiliation(s)
- Félix Blanc-Durand
- Gynecology Unit, Institut Gustave-Roussy, 114 rue Édouard-Vaillant, 94800 Villejuif, France
| | | | | | - Dan Chaltiel
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Anne Floquet
- Institut Bergonié, 229 cours de l'Argonne, 33000 Bordeaux, France
| | - Émeline Meriaux
- Centre François-Baclesse, 3 avenue du Général-Harris, 14000 Caen, France
| | - Dominique Berton
- Institut de Cancérologie de l'Ouest - René-Gauducheau, Boulevard Pr Jacques-Monod, 44800 Saint-Herblain, France
| | - Diana Bello-Roufai
- Institut Curie - Centre René-Huguenin, 35 rue Dailly, 92210 Saint-Cloud, France
| | | | - Pierre-François Dupre
- Centre hospitalier régional universitaire Morvan de Brest, 2 Avenue Foch, 29200 Brest, France
| | - Émilie Faller
- Hôpital de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
| | - Jérôme Alexandre
- Hôpital Cochin-Port Royal, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | | | - Olivier Collard
- Institut de Cancérologie de la Loire - Lucien-Neuwirth, 108 bis avenue Albert-Raimond, 42270 SaintPriest-en-Jarez, France
| | - Michel Fabbro
- Institut du Cancer de Montpellier, 208 rue des Apothicaires, 34298 Montpellier, France
| | - Magali Provansal
- Institut Paoli-Calmettes, 232 boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Elsa Kalbacher
- CHRU Jean-Minjoz, 3 boulevard Alexander-Fleming, 25030 Besançon, France
| | - Catherine Genestie
- Pathology Unit, Institut Gustave-Roussy, 114 rue Édouard-Vaillant, 94800 Villejuif, France
| | - Patricia Pautier
- Gynecology Unit, Institut Gustave-Roussy, 114 rue Édouard-Vaillant, 94800 Villejuif, France.
| |
Collapse
|
13
|
Sessa C, Schneider DT, Planchamp F, Baust K, Braicu EI, Concin N, Godzinski J, McCluggage WG, Orbach D, Pautier P, Peccatori FA, Morice P, Calaminus G. ESGO-SIOPE guidelines for the management of adolescents and young adults with non-epithelial ovarian cancers. Lancet Oncol 2020; 21:e360-e368. [PMID: 32615119 DOI: 10.1016/s1470-2045(20)30091-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/15/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
The European Society of Gynaecological Oncology and the European Society for Paediatric Oncology jointly developed clinically relevant and evidence-based guidelines for the management of adolescents and young adults aged 15 to 25 years with non-epithelial ovarian cancers, including malignant ovarian germ cell tumours, sex cord-stromal tumours, and small cell carcinoma of the ovary of hypercalcaemic type. The developmental process of these guidelines is based on a systematic literature review and critical appraisal process involving an international multidisciplinary developmental group consisting of experts from relevant disciplines (paediatric oncology, paediatric surgery, medical oncology, pathology, psycho-oncology, gynaecological oncology, and reproductive endocrinology). Given the specific and often complex issues involved in treating this group of patients, fertility sparing surgery and decrease of acute and long-term toxicities from treatment were important criteria for guidelines definition. Prior to publication, the guidelines were reviewed by 54 independent international practitioners in cancer care delivery.
Collapse
Affiliation(s)
- Cristiana Sessa
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | | | | | - Katja Baust
- Paediatric Oncology, University Hospital Bonn, Bonn, Germany
| | - Elena Ioana Braicu
- Gynaecologic Oncology, Charité-Universitätsmedizin Berlin, Humboldt-Universitätzu Berlin, Berlin Institute of Health, Institute of Gynecology, Berlin, Germany
| | - Nicole Concin
- Gynaecologic Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan Godzinski
- Paediatric Surgery, Marciniak Hospital, Medical University, Wroclaw, Poland
| | | | | | | | - Fedro A Peccatori
- Gynaecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Philippe Morice
- Gynaecologic Oncology, Institut Gustave Roussy, Villejuif, France
| | | |
Collapse
|
14
|
Pressey JG, Dandoy CE, Pater LE, Sroga Rios J, Sisson R, Dasgupta R, Szabo S. Small cell carcinoma of the ovary hypercalcemic type (SCCOHT): Comprehensive management of a newly diagnosed young adult. Gynecol Oncol 2020; 158:538-546. [PMID: 32654763 DOI: 10.1016/j.ygyno.2020.06.160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SCCOHT is an aggressive malignancy linked to alterations of SMARCA4. We describe the diagnosis and therapy of a 32 year old who received multi-agent chemotherapy and underwent a second look operation with HIPEC followed by high-dose chemotherapy with stem cell transplant. Supportive care, oncofertility, and genetic counseling are described.
Collapse
Affiliation(s)
- Joseph G Pressey
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Oncology, Cincinnati Children's Hospital Medical Center, United States of America.
| | - Christopher E Dandoy
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, United States of America
| | - Luke E Pater
- Department of Radiation Oncology, University of Cincinnati College of Medicine, United States of America
| | - Julie Sroga Rios
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, United States of America
| | - Rebecca Sisson
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, United States of America
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, United States of America
| | - Sara Szabo
- Department of Pathology, University of Cincinnati College of Medicine, United States of America; Division of Pathology, Cincinnati Children's Hospital Medical Center, United States of America
| |
Collapse
|
15
|
Lee EK, Esselen KM, Kolin DL, Lee LJ, Matulonis UA, Konstantinopoulos PA. Combined CDK4/6 and PD-1 Inhibition in Refractory SMARCA4-Deficient Small-Cell Carcinoma of the Ovary, Hypercalcemic Type. JCO Precis Oncol 2020; 4:736-742. [PMID: 32704608 PMCID: PMC7377332 DOI: 10.1200/po.20.00063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Elizabeth K Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Katharine M Esselen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - David L Kolin
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA
| | - Larissa J Lee
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Boston, MA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | |
Collapse
|
16
|
Auguste A, Blanc-Durand F, Deloger M, Le Formal A, Bareja R, Wilkes DC, Richon C, Brunn B, Caron O, Devouassoux-Shisheboran M, Gouy S, Morice P, Bentivegna E, Sboner A, Elemento O, Rubin MA, Pautier P, Genestie C, Cyrta J, Leary A. Small Cell Carcinoma of the Ovary, Hypercalcemic Type (SCCOHT) beyond SMARCA4 Mutations: A Comprehensive Genomic Analysis. Cells 2020; 9:cells9061496. [PMID: 32575483 PMCID: PMC7349095 DOI: 10.3390/cells9061496] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/30/2022] Open
Abstract
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is an aggressive malignancy that occurs in young women, is characterized by recurrent loss-of-function mutations in the SMARCA4 gene, and for which effective treatments options are lacking. The aim of this study was to broaden the knowledge on this rare malignancy by reporting a comprehensive molecular analysis of an independent cohort of SCCOHT cases. We conducted Whole Exome Sequencing in six SCCOHT, and RNA-sequencing and array comparative genomic hybridization in eight SCCOHT. Additional immunohistochemical, Sanger sequencing and functional data are also provided. SCCOHTs showed remarkable genomic stability, with diploid profiles and low mutation load (mean, 5.43 mutations/Mb), including in the three chemotherapy-exposed tumors. All but one SCCOHT cases exhibited 19p13.2-3 copy-neutral LOH. SMARCA4 deleterious mutations were recurrent and accompanied by loss of expression of the SMARCA2 paralog. Variants in a few other genes located in 19p13.2-3 (e.g., PLK5) were detected. Putative therapeutic targets, including MAGEA4, AURKB and CLDN6, were found to be overexpressed in SCCOHT by RNA-seq as compared to benign ovarian tissue. Lastly, we provide additional evidence for sensitivity of SCCOHT to HDAC, DNMT and EZH2 inhibitors. Despite their aggressive clinical course, SCCOHT show remarkable inter-tumor homogeneity and display genomic stability, low mutation burden and few somatic copy number alterations. These findings and preliminary functional data support further exploration of epigenetic therapies in this lethal disease.
Collapse
Affiliation(s)
- Aurélie Auguste
- Medical Oncologist, Gynecology Unit, Lead Translational Research Team, INSERM U981, Gustave Roussy, 94805 Villejuif, France; (A.A.); (A.L.F.)
| | - Félix Blanc-Durand
- Gynecological Unit, Department of Medicine, Gustave Roussy, 94805 Villejuif, France; (F.B.-D.); (B.B.); (S.G.); (P.M.); (E.B.); (P.P.)
| | - Marc Deloger
- Bioinformatics Core Facility, Gustave Roussy Cancer Center, UMS CNRS 3655/INSERM 23 AMMICA, 94805 Villejuif, France;
| | - Audrey Le Formal
- Medical Oncologist, Gynecology Unit, Lead Translational Research Team, INSERM U981, Gustave Roussy, 94805 Villejuif, France; (A.A.); (A.L.F.)
| | - Rohan Bareja
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10001, USA; (R.B.); (D.C.W.); (A.S.); (O.E.); (J.C.)
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10001, USA
| | - David C. Wilkes
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10001, USA; (R.B.); (D.C.W.); (A.S.); (O.E.); (J.C.)
| | - Catherine Richon
- Genomic Platform Gustave Roussy Cancer Institute, 94805 Villejuif, France; (C.R.); (O.C.)
| | - Béatrice Brunn
- Gynecological Unit, Department of Medicine, Gustave Roussy, 94805 Villejuif, France; (F.B.-D.); (B.B.); (S.G.); (P.M.); (E.B.); (P.P.)
| | - Olivier Caron
- Genomic Platform Gustave Roussy Cancer Institute, 94805 Villejuif, France; (C.R.); (O.C.)
| | | | - Sébastien Gouy
- Gynecological Unit, Department of Medicine, Gustave Roussy, 94805 Villejuif, France; (F.B.-D.); (B.B.); (S.G.); (P.M.); (E.B.); (P.P.)
| | - Philippe Morice
- Gynecological Unit, Department of Medicine, Gustave Roussy, 94805 Villejuif, France; (F.B.-D.); (B.B.); (S.G.); (P.M.); (E.B.); (P.P.)
| | - Enrica Bentivegna
- Gynecological Unit, Department of Medicine, Gustave Roussy, 94805 Villejuif, France; (F.B.-D.); (B.B.); (S.G.); (P.M.); (E.B.); (P.P.)
| | - Andrea Sboner
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10001, USA; (R.B.); (D.C.W.); (A.S.); (O.E.); (J.C.)
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10001, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10001, USA
| | - Olivier Elemento
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10001, USA; (R.B.); (D.C.W.); (A.S.); (O.E.); (J.C.)
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10001, USA
| | - Mark A. Rubin
- Department for BioMedical Research, University of Bern, 3001 Bern, Switzerland;
| | - Patricia Pautier
- Gynecological Unit, Department of Medicine, Gustave Roussy, 94805 Villejuif, France; (F.B.-D.); (B.B.); (S.G.); (P.M.); (E.B.); (P.P.)
| | | | - Joanna Cyrta
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10001, USA; (R.B.); (D.C.W.); (A.S.); (O.E.); (J.C.)
- Department for BioMedical Research, University of Bern, 3001 Bern, Switzerland;
- Department of Pathology, Institut Curie, Universite Paris Sciences et Lettres, 6 rue d’Ulm, 75005 Paris, France
| | - Alexandra Leary
- Medical Oncologist, Gynecology Unit, Lead Translational Research Team, INSERM U981, Gustave Roussy, 94805 Villejuif, France; (A.A.); (A.L.F.)
- Gynecological Unit, Department of Medicine, Gustave Roussy, 94805 Villejuif, France; (F.B.-D.); (B.B.); (S.G.); (P.M.); (E.B.); (P.P.)
- Correspondence: ; Tel.: +33-1-42-11-45-71; Fax: +33-1-42-11-52-14
| |
Collapse
|
17
|
Debuquoy C, Romeo C, Vanacker H, Ray-Coquard I. Rare ovarian tumors: an update on diagnosis and treatment. Int J Gynecol Cancer 2020; 30:879-887. [PMID: 32461259 DOI: 10.1136/ijgc-2020-001235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 01/17/2023] Open
Abstract
Rare ovarian cancers occur frequently. Almost half of ovarian malignancies relate to several different 'rare' histotypes, according to the World Health Organization. The most common tumors are epithelial tumors, including high grade serous carcinomas, the presumed 'frequent ovarian cancers', together with low grade serous, mucinous, endometrioid, clear cell, and carcinosarcomas. Sex cord stromal tumors and germ cell carcinomas define two other groups of different subtypes, and small cell carcinomas are an independent high grade subtype closely related to the family of rhabdoid tumors. All of these cancers are primary ovarian cancers, classified by the International Federation of Gynecology and Obstetrics. However, the tumor subtypes display various epidemiologic, clinical, pathological, prognostic, and therapeutic characteristics. Because of the scarcity of data, current understanding of each subtype is limited and treatment has generally been derived from the more common tumor types. The aim of this article is to review the current literature on rare ovarian malignancies.
Collapse
Affiliation(s)
- Charlotte Debuquoy
- Gynecology Surgical Department, Centre Leon Berard, Lyon, Rhône-Alpes, France
| | - Clemence Romeo
- Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France
| | - Helene Vanacker
- Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France
| | - Isabelle Ray-Coquard
- Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France .,University Claude Bernard, Laboratoire HESPER, Lyon, France
| |
Collapse
|
18
|
Tischkowitz M, Huang S, Banerjee S, Hague J, Hendricks WPD, Huntsman DG, Lang JD, Orlando KA, Oza AM, Pautier P, Ray-Coquard I, Trent JM, Witcher M, Witkowski L, McCluggage WG, Levine DA, Foulkes WD, Weissman BE. Small-Cell Carcinoma of the Ovary, Hypercalcemic Type-Genetics, New Treatment Targets, and Current Management Guidelines. Clin Cancer Res 2020; 26:3908-3917. [PMID: 32156746 DOI: 10.1158/1078-0432.ccr-19-3797] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/04/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022]
Abstract
Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare and highly aggressive ovarian malignancy. In almost all cases, it is associated with somatic and often germline pathogenic variants in SMARCA4, which encodes for the SMARCA4 protein (BRG1), a subunit of the SWI/SNF chromatin remodeling complex. Approximately 20% of human cancers possess pathogenic variants in at least one SWI/SNF subunit. Because of their role in regulating many important cellular processes including transcriptional control, DNA repair, differentiation, cell division, and DNA replication, SWI/SNF complexes with mutant subunits are thought to contribute to cancer initiation and progression. Fewer than 500 cases of SCCOHT have been reported in the literature and approximately 60% are associated with hypercalcemia. SCCOHT primarily affects females under 40 years of age who usually present with symptoms related to a pelvic mass. SCCOHT is an aggressive cancer, with long-term survival rates of 30% in early-stage cases. Although various treatment approaches have been proposed, there is no consensus on surveillance and therapeutic strategy. An international group of multidisciplinary clinicians and researchers recently formed the International SCCOHT Consortium to evaluate current knowledge and propose consensus surveillance and therapeutic recommendations, with the aim of improving outcomes. Here, we present an overview of the genetics of this cancer, provide updates on new treatment targets, and propose management guidelines for this challenging cancer.
Collapse
Affiliation(s)
- Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom. .,East Anglian Medical Genetics Unit, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Sidong Huang
- Department of Biochemistry, McGill University, Montreal, Quebec, Canada.,The Rosalind & Morris Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
| | - Susana Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Jennifer Hague
- East Anglian Medical Genetics Unit, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - William P D Hendricks
- Translational Genomics Research Institute, Division of Integrated Cancer Genomics, Phoenix, Arizona
| | | | - Jessica D Lang
- Translational Genomics Research Institute, Division of Integrated Cancer Genomics, Phoenix, Arizona
| | - Krystal A Orlando
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Amit M Oza
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Isabelle Ray-Coquard
- Centre Anti cancereux Léon Bérard, & University Claude Bernard Lyon, GINECO Group, Lyon, France
| | - Jeffrey M Trent
- Translational Genomics Research Institute, Division of Integrated Cancer Genomics, Phoenix, Arizona
| | - Michael Witcher
- The Lady Davis Institute of the Jewish General Hospital, Department of Oncology, McGill University, Montreal, Canada
| | - Leora Witkowski
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Douglas A Levine
- Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - William D Foulkes
- The Lady Davis Institute of the Jewish General Hospital, Department of Oncology, McGill University, Montreal, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Medical Genetics, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Medical Genetics and Cancer Research Program, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Bernard E Weissman
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina. .,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
19
|
Connor YD, Miao D, Lin DI, Hayne C, Howitt BE, Dalrymple JL, DeLeonardis KR, Hacker MR, Esselen KM, Shea M. Germline mutations of SMARCA4 in small cell carcinoma of the ovary, hypercalcemic type and in SMARCA4-deficient undifferentiated uterine sarcoma: Clinical features of a single family and comparison of large cohorts. Gynecol Oncol 2020; 157:106-114. [PMID: 31954538 DOI: 10.1016/j.ygyno.2019.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) and SMARCA4-deficient undifferentiated uterine sarcoma (SMARCA4-DUS) are rare and aggressive tumors, primarily affecting pre- and perimenopausal women. Inactivating SMARCA4 mutations are thought to be the driving molecular events in the majority of these tumors. Here, we report the clinical course of a family with germline SMARCA4 mutation and compare large cohorts of these rare tumor types. METHODS We extracted clinico-pathological medical record data for the family with germline SMARCA4 mutation. Clinico-genomic data from SCCOHT and SMARCA4-DUS cohorts were retrospectively extracted from the archives of a large CLIA-certified reference molecular laboratory. RESULTS We identified a single family with an inherited germline SMARCA4 mutation, in which two different family members developed either SCCOHT or SMARCA4-DUS, both of whom died within one year of diagnosis, despite aggressive surgical, chemotherapy and immunotherapy treatment. Retrospective comparative analysis of large SCCOHT (n = 48) and SMARCA4-DUS (n = 17) cohorts revealed that SCCOHT patients were younger (median age: 28.5 vs. 49.0) and more likely to have germline SMARCA4 alterations (37.5% vs. 11.8%) than SMARCA4-DUS patients. CONCLUSIONS Growing understanding of the role SMARCA4 plays in the pathogenesis of these rare cancers may inform recommended genetic testing and counseling in families with these tumor types.
Collapse
Affiliation(s)
- Yamicia D Connor
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Diana Miao
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Cynthia Hayne
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brooke E Howitt
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - John L Dalrymple
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kimberly R DeLeonardis
- Department of Internal Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Katharine M Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Meghan Shea
- Department of Internal Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
20
|
Mathey MP, de Jolinière JB, Major A, Conrad B, Khomsi F, Betticher D, Devouassoux M, Feki A. Rare case of remission of a patient with small cell carcinoma of the ovary, hypercalcaemic type (SCCOHT) stage IV: Case report. Int J Surg Case Rep 2019; 66:398-403. [PMID: 31978720 PMCID: PMC6976912 DOI: 10.1016/j.ijscr.2019.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/18/2019] [Accepted: 11/24/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Small cell carcinoma of the ovary (SCC) is a very rare (less than 1 % of ovarien neoplasia), highly undifferentiated, aggressive malignancy affecting young women and linked to a poor prognosis. Overall survive rate is very low (about 16 %). SCCOHT has recently been shown to be associated with SMARCA4 gene mutations and shows some genetic similarities to malignant rhabdoid tumors (MRT). PRESENTATION OF CASE After a reminder of the clinical, histological description of the SCCOHT and concensus about the medical management, we describe the rare case of a 22 years old patient with complete remission after diagnosis of un undifferentiated SCCOHT stage IV treated by conservative surgery and high-doses chemotherapy, 30 months after diagnosis. DISCUSSION Thus far, no standard therapy exists for SCCOHT. Treatment modalities are surgery, chemotherapy, radiotherapy and autologous stem cell transplant after high-dose chemotherapy. Research for new treatments includes target therapy. CONCLUSION Autologous stem cell transplant after high-dose adjuvant chemotherapy seems to lead to the best survival rates. Invasiveness of the treatment depends on the stage of the disease, age of the patient and her fertility-sparing desire. An international collaboration will be needed to standardise practices due of the small number of patients.
Collapse
Affiliation(s)
- M P Mathey
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland.
| | - J Bouquet de Jolinière
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland.
| | - A Major
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - B Conrad
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - F Khomsi
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - D Betticher
- Département d'Oncologie médicale, Pr Dr Med D. Betticher MHA, HFR, hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - M Devouassoux
- Institut de pathologie Multi-Sites des HCL, Groupements hospitaliers Sud et nord, Pr M. Devouassoux MD, PhD, Centre de biologie et pathologie sud, Bat 3D 69495 Pierre Bénite Cedex, France; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - A Feki
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| |
Collapse
|
21
|
Abstract
OBJECTIVE The aim of this study was to investigate the demographic and clinicopathological characteristics and prognosis of women diagnosed with small cell carcinoma of the ovary. METHODS The National Cancer Data Base was accessed, and women diagnosed with small cell carcinoma of the ovary, between 2004 and 2014 were identified. Median and 3- and 5-year overall survival (OS) rates were calculated following generation of Kaplan-Meir curves and compared with the log-rank test. A Cox multivariate model was constructed to identify variables associated with mortality. RESULTS A total 469 women were identified with a median age of 39 years; 81.7% of tumors were unilateral, whereas median size was 13 cm. Only 20.1% of patients had stage I disease. Women who underwent cancer-directed surgery had a 5-year OS rate of 24.1%. Five-year OS rates were 48.6%, 30.7%, 18%, and 12.3% for those with stages I, II, III, and IV disease, respectively, P < 0.001. Younger age (P = 0.013) and the combination of surgery with chemotherapy (CT) (P < 0.001) were associated with superior OS. By multivariate analysis, earlier disease stage and use of CT, but not patient age or performance of lymphadenectomy, were associated with lower mortality. CONCLUSIONS Small cell carcinomas of the ovary are unilateral tumors primarily arising in premenopausal women. Multimodal treatment with cancer-directed surgery and CT results in a modest increase of a generally poor survival.
Collapse
|
22
|
Abstract
Traditionally, the management of epithelial ovarian cancer has been approached using a one-size-fits-all mentality. This strategy does not acknowledge the differences in epidemiology and clinical behavior of many of the histologic and molecular subgroups of ovarian cancer, specifically the rare histologies. While cytoreductive surgery followed by adjuvant platinum and taxane-based chemotherapy is the mainstay of primary treatment of epithelial ovarian cancer as a group, further investigation of novel therapeutics is critical for improving outcomes of these rare histologies. This article focuses on the management of non-high grade serous histologies of ovarian cancer.
Collapse
|
23
|
Ray-Coquard I, Morice P, Lorusso D, Prat J, Oaknin A, Pautier P, Colombo N. Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv1-iv18. [PMID: 29697741 DOI: 10.1093/annonc/mdy001] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- I Ray-Coquard
- Centre Leon Bérard, University Claude Bernard Lyon & GINECO group, Lyon
| | - P Morice
- Gustave Roussy & GINECO group, Villejuif, France
| | - D Lorusso
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - J Prat
- Hospital de Sant Pau, Autonomous University of Barcelona
| | - A Oaknin
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Pautier
- Gustave Roussy & GINECO group, Villejuif, France
| | - N Colombo
- University of Milan-Bicocca and European Institute of Oncology, Milan, Italy
| |
Collapse
|
24
|
Yin L, Li J, Wei Y, Ma D, Sun Y, Sun Y. Primary ovarian small cell carcinoma of pulmonary type with coexisting endometrial carcinoma in a breast cancer patient receiving tamoxifen: A case report and literature review. Medicine (Baltimore) 2018; 97:e10900. [PMID: 29879027 PMCID: PMC5999514 DOI: 10.1097/md.0000000000010900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Small cell carcinoma of the ovary (SCCO) is a rare and aggressive extra-pulmonary variant of small cell tumors of uncertain histogenesis. The pathogenesis and optimal treatment of SCCO is unclear. We present a very rare case of a synchronous primary ovarian small cell carcinoma and endometrioid adenocarcinoma of the uterus in a patient after 2 years of tamoxifen treatment for breast cancer. This is the first such report in the English literature. PATIENT CONCERNS A 46-year-old woman had a history of left breast cancer that was treated with a simple mastectomy and sentinel lymph node biopsy in 2013. The post-operative pathology was invasive ductal carcinoma of the left breast. she had been taking tamoxifen for 2 years. The patient underwent an exploratory laparotomy to reduce the tumor burden, improve bowel compression symptoms, and promote defecation in 2015. The post-operative pathology revealed a rare, simultaneous occurrence of two tumors (endometrial adenocarcinoma and SCCO [pulmonary type]). DIAGNOSES Primary ovarian small cell carcinoma of pulmonary type with coexisting endometrial carcinoma in a breast cancer patient. INTERVENTIONS The patient received 3 courses of chemotherapy after operation. The effect was not apparent and the general health status was poor. OUTCOMES The patient died of progressive disease 7 months post-operatively. LESSONS The present case suggests that tamoxifen use might be among many etiologic factors in SCCO development. Despite its rarity, SCCO requires a high degree of attention in clinical work because it is an aggressive tumor that has a poor prognosis.
Collapse
Affiliation(s)
- Lei Yin
- Department of General Surgery, Huzhou Central Hospital, Huzhou
| | - Jianning Li
- The Central Sterile Supply Department, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Yunhai Wei
- Department of General Surgery, Huzhou Central Hospital, Huzhou
| | - Dejian Ma
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
- The Fourth Surgical Department, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan
| | - Yamei Sun
- Department of Clinical Laboratory, Zhucheng People's Hospital of Shandong Province, Zhucheng, China
| | - Yanlai Sun
- The Fourth Surgical Department, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan
| |
Collapse
|
25
|
Qin Q, Ajewole VB, Sheu TG, Donohue R, Singh M. Successful treatment of a stage IIIC small-cell carcinoma of the ovary hypercalcemic subtype using multi-modality therapeutic approach. Ecancermedicalscience 2018; 12:832. [PMID: 29910829 PMCID: PMC5985749 DOI: 10.3332/ecancer.2018.832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Indexed: 12/22/2022] Open
Abstract
Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare but highly undifferentiated, aggressive malignancy that primarily affects young women. Due to its early onset, unclear familial history and vague presenting symptoms, most SCCOHT patients present late with advanced disease. The prognosis is extremely poor, with <10% disease-free survival for advanced stages. Although several therapeutic regimens have been proposed, to date there is no consensus on the optimal strategy. Here, we describe a successful case of advanced-stage SCCOHT of the left ovary treated with cytoreductive surgery, semi-intense chemotherapy, high-dose consolidative chemotherapy, autologous hematopoietic stem cell transplantation and pelvic radiation with long-term survival. Given the almost universal mortality of advanced SCCOHT in long-term follow-up, we believe this case highlights the importance of prompt diagnosis when a young patient presents with abdominal swelling and hypercalcemia as well as early, aggressive, combined modality treatment. This case is also especially remarkable given the patient underwent fertility preservation surgery, which is not recommended by most of the current literature. However, as therapies improve and more young patients may survive SCCOHT, the question of fertility will increase in relevance. We believe the pros and cons of conservation should be discussed in detail with the patient.
Collapse
Affiliation(s)
- Qian Qin
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Veronica B Ajewole
- Houston Methodist Cancer Centre, Houston Methodist Hospital, Houston, TX 77030, USA.,Department of Pharmacy Practice, Texas Southern University College of Pharmacy and Health Sciences, Houston, TX 77004, USA
| | - Tiffany G Sheu
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Rachel Donohue
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Monisha Singh
- Houston Methodist Cancer Centre, Houston Methodist Hospital, Houston, TX 77030, USA
| |
Collapse
|
26
|
Khosla D, Gupta N, Koshy A, Dalal A, Pandey AK, Dimri K. Ovarian Small Cell Carcinoma of Hypercalcemic Type in an Adolescent Girl. J Obstet Gynaecol India 2018; 69:60-62. [PMID: 30956495 DOI: 10.1007/s13224-018-1091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022] Open
Abstract
Objective Small cell carcinoma of ovary, hypercalcemic type is a rare malignancy with a dismal prognosis. The diagnosis is often confused with many other tumors. Case Report We describe a rare case of ovarian small cell carcinoma of hypercalcemic type in an adolescent. She presented with abdominal pain, awareness of mass and vomiting. She underwent exploratory laparotomy and right ovarian excision. The detailed histopathological examination including immunohistochemistry was suggestive of ovarian small cell carcinoma of hypercalcemic type. She had progressive disease on chemotherapy and ultimately died within 2 years of diagnosis. Due to rarity of this neoplasm and its aggressive nature, the optimal treatment regimen has not been established. Conclusion We report this case because of its rare occurrence leading to clinical and diagnostic challenges and need to explore effective treatment options to improve survival in these patients.
Collapse
Affiliation(s)
- Divya Khosla
- 1Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Nalini Gupta
- 2Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Abin Koshy
- 1Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Ashwani Dalal
- 1Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| | - A K Pandey
- 3Department of General Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Kislay Dimri
- 1Department of Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
27
|
Ruiz-García G, Torroba-Carón MA, Ferri-Ñíguez B, Lencina-Guardiola M, García-Molina F, Martínez-Barba E. [The value of immunohistochemistry using SMARCA4/BRG1 in the diagnosis of small cell ovarian carcinoma hypercalcemic type. A report of two cases]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 51:61-67. [PMID: 29290327 DOI: 10.1016/j.patol.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/28/2017] [Accepted: 02/12/2017] [Indexed: 10/19/2022]
Abstract
Small cell carcinoma of ovary-hypercalcemic type is an undifferentiated carcinoma. We describe two cases in women aged 32 and 29. Both presented with large masses and complete surgical extirpation was impossible. Histologically, the images were similar, with diffuse cell proliferation, accompanied by the presence of follicle-like spaces. In both cases it was necessary to make a differential diagnosis with entities such as adult or juvenile granulosa cell tumour, small cell carcinoma of pulmonary type, dysgerminoma and even peripheral neuroectodermal tumour. The absence of SMARCA4/BRG1 immunostaining proved very useful in the diagnosis of hypercalcemic small cell ovarian carcinoma.
Collapse
Affiliation(s)
- Gema Ruiz-García
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - M Amparo Torroba-Carón
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Belén Ferri-Ñíguez
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Miriam Lencina-Guardiola
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Francisco García-Molina
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Enrique Martínez-Barba
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| |
Collapse
|
28
|
Fotopoulou C, Hall M, Cruickshank D, Gabra H, Ganesan R, Hughes C, Kehoe S, Ledermann J, Morrison J, Naik R, Rolland P, Sundar S. British Gynaecological Cancer Society (BGCS) epithelial ovarian/fallopian tube/primary peritoneal cancer guidelines: recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2017; 213:123-139. [DOI: 10.1016/j.ejogrb.2017.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
|
29
|
Stewart L, Garg R, Garcia R, Swisher E. Small cell ovarian carcinoma: Long term survival in juvenile case with poor prognostic features. Gynecol Oncol Rep 2016; 18:45-48. [PMID: 27896308 PMCID: PMC5121138 DOI: 10.1016/j.gore.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022] Open
Abstract
Background Ovarian small cell carcinoma is a rare, aggressive neoplasm that occurs in young women and has a poor long-term prognosis. Treatment involves surgical resection and chemotherapy. The required radicality of surgery is uncertain, balancing cytoreduction with fertility preservation. Various chemotherapy regimens are utilized due to confusion regarding the neoplasm's lineage. Case We describe an adolescent with small cell carcinoma, hypercalcemic type, stage IA. Surgery included left salpingo-oopherectomy, left pelvic/paraaortic lymphadenectomy, omentectomy and peritoneal biopsies. She received four cycles of bleomycin, etoposide and cisplatin, similar to high-risk germ cell cancers. She has received no further therapy and is eleven years from diagnosis without evidence of disease. Conclusion This is the first long-term juvenile survivor managed with both fertility-sparing surgery and BEP (bleomycin, etoposide, cisplatin). SCCO can be treated with less-toxic chemotherapy directed at germ cell tumors. Fertility-sparing surgery should be considered in adolescents with early stage SCCO. Long term survival in adolescents with SCCO is possible.
Collapse
Affiliation(s)
- Lauren Stewart
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
| | - Ruchi Garg
- Mid Atlantic Gynecology Oncology and Pelvic Surgery Associates, Annandale, VA, USA
| | - Rochelle Garcia
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA; Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
| | - Elizabeth Swisher
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
| |
Collapse
|
30
|
|
31
|
Kascak P, Zamecnik M, Bystricky B. Small Cell Carcinoma of the Ovary (Hypercalcemic Type): Malignant Rhabdoid Tumor. Case Rep Oncol 2016; 9:305-11. [PMID: 27462229 PMCID: PMC4939673 DOI: 10.1159/000446694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 01/09/2023] Open
Abstract
We present a rare case of malignant rhabdoid tumor (ovarian small cell carcinoma of hypercalcemic type) in a 24-year-old female with fulminant course. Clinically, hypercalcemia was not found at the time of primary diagnosis. However, it appeared later during the course of tumor progression. Histologically, the tumor showed classical features of small cell carcinoma of hypercalcemic type. Therapy included radical surgery with adjuvant chemotherapy. Despite this intensive therapy, the disease recurred and the patient died 10 months after the diagnosis. We discuss the diagnosis and therapy of this tumor, as well as its recent classification as malignant rhabdoid tumor.
Collapse
Affiliation(s)
- Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital, Trenčîn, Slovakia; Faculty of Health, Alexander Dubcek University, Trenčîn, Slovakia
| | - Michal Zamecnik
- Medirex Group Academy n.o., Bratislava, Slovakia; Department of Pathology, Agel Laboratories, Nový Jičîn, Czech Republic
| | | |
Collapse
|
32
|
Witkowski L, Goudie C, Ramos P, Boshari T, Brunet JS, Karnezis AN, Longy M, Knost JA, Saloustros E, McCluggage WG, Stewart CJR, Hendricks WPD, Cunliffe H, Huntsman DG, Pautier P, Levine DA, Trent JM, Berchuck A, Hasselblatt M, Foulkes WD. The influence of clinical and genetic factors on patient outcome in small cell carcinoma of the ovary, hypercalcemic type. Gynecol Oncol 2016; 141:454-460. [PMID: 26975901 DOI: 10.1016/j.ygyno.2016.03.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is an aggressive tumor, with long term survival at ~30% in early stage disease. SCCOHT is caused by germline and somatic SMARCA4 mutations, but the effect of the mutation type on patients remains unknown. Furthermore, the rarity of SCCOHT has resulted in varied treatment, with no standardized protocols. We analyzed 293 cases to determine the effect of treatment modalities and SMARCA4 mutations on patient diagnosis and outcome. METHODS In 293 SCCOHT patients we collected information on age and stage at diagnosis, treatment modality (surgery, chemotherapy, radiotherapy, and/or high-dose chemotherapy with autologous stem cell rescue (HDC-aSCR)), SMARCA4 mutation origin (germline/somatic), and overall survival. Cox analysis and log-rank tests were performed on 257 cases with available survival data. RESULTS The strongest prognostic factors were stage at diagnosis (p=2.72e-15) and treatment modality (p=3.87e-13). For FIGO stages II-IV, 5-year survival was 71% for patients who received HDC-aSCR, compared to 25% in patients who received conventional chemotherapy alone following surgery (p=0.002). Patients aged ≥40 had a worse outcome than younger patients (p=0.04). Twenty-six of 60 tested patients carried a germline SMARCA4 mutation, including all patients diagnosed <15years; carriers presented at a younger age than non-carriers (p=0.02). CONCLUSIONS Stage at diagnosis is the most significant prognostic factor in SCCOHT and consolidation with HDC-aSCR may provide the best opportunity for long-term survival. The large fraction of SMARCA4 germline mutations carriers warrants genetic counseling for all patients.
Collapse
Affiliation(s)
- Leora Witkowski
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Catherine Goudie
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Pilar Ramos
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Talia Boshari
- Lady Davis Institute and Segal Cancer Center, Jewish General Hospital, Montreal, QC, Canada
| | | | | | - Michel Longy
- Cancer Genetics Unit & INSERM U916, Institut Bergonié, Université de Bordeaux, Bordeaux, France
| | | | - Emmanouil Saloustros
- Hereditary Cancer Clinic, Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, Australia
| | - William P D Hendricks
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Heather Cunliffe
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Douglas A Levine
- Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, New York, USA
| | - Jeffrey M Trent
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, QC, Canada; Lady Davis Institute and Segal Cancer Center, Jewish General Hospital, Montreal, QC, Canada; Department of Medical Genetics and Cancer Research Program, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
| |
Collapse
|
33
|
Wang JJ, Liu Q, Wu N, Zhou XD, Wang H, Wang X, Tu P, Zhou XJ, Shi QL. Ovarian small-cell carcinoma hypercalcemic type successfully treated: a case report and literature review. Onco Targets Ther 2016; 9:1409-14. [PMID: 27042109 PMCID: PMC4795582 DOI: 10.2147/ott.s97170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ovarian small-cell carcinoma hypercalcemic type (OSCCHT) is a relatively rare and highly fatal gynecological malignancy. Prognosis is generally poor, and no treatment guidelines are offered. Here, we report a case of OSCCHT successfully treated by complete excision and a postoperative chemotherapy scheme of carboplatin and paclitaxel. A 29-year-old female with with pelvic mass and significantly increased serum calcium (4.90 mmol/L) was referred to our hospital on August 22, 2013. Abdominal ultrasonography and computed tomography revealed a pelvic nonhomogeneous echo of a 113×102 mm mass, possibly coming from the adnexa of the uterus. Preoperative examinations indicated high levels of serum calcium and relevant acute renal dysfunction; hence, continuous renal replacement therapy was performed until all tests reached minimum operation requirements. Interestingly, after excision, serum calcium levels decreased rapidly and therefore, extra calcium had to be taken in order to take the level back up to normal. The patient was diagnosed with OSCCHT based on the clinical data and pathological examinations. After six cycles of chemotherapy, the patient was in a good condition and on follow-up there were no signs of recurrence.
Collapse
Affiliation(s)
- Jian-Jun Wang
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Qi Liu
- Department of Obstetrics and Gynecology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Nan Wu
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Xiao-Die Zhou
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Hai Wang
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Xuan Wang
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Pin Tu
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Xiao-Jun Zhou
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Qun-Li Shi
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| |
Collapse
|
34
|
Callegaro-Filho D, Gershenson DM, Nick AM, Munsell MF, Ramirez PT, Eifel PJ, Euscher ED, Marques RM, Nicolau SM, Schmeler KM. Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT): A review of 47 cases. Gynecol Oncol 2015; 140:53-7. [PMID: 26546963 DOI: 10.1016/j.ygyno.2015.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/22/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT) is a rare disease with a poor prognosis. SCCOHT has recently been shown to be associated with SMARCA4 gene mutations as well as molecular and genetic similarities to malignant rhabdoid tumors (MRT). The objective of our study is to describe the clinical characteristics, treatment modalities and outcomes of 47 patients with SCCOHT. METHODS We performed a retrospective analysis of 47 patients with SCCOHT evaluated at MD Anderson Cancer Center between 1990 and 2014. Medical records were reviewed for demographic information, pathologic findings, treatment regimens and outcomes. RESULTS Median age at diagnosis was 30 years (range 5-46). All patients underwent surgery with unilateral salpingo-oophorectomy (USO) performed in 26 patients (55%), and hysterectomy with bilateral salpingooophorectomy (BSO) in 21 patients (45%). Sixteen patients (34.0%) had stage I disease, six (12.8%) stage II, 23 (48.9%) stage III, and two patients (4.3%) had stage IV disease. Information on adjuvant treatment was available for 43 patients: 83.3% received chemotherapy alone, 9.5% chemotherapy followed by radiotherapy, 2.4% chemoradiation, and 4.8% did not receive any adjuvant therapy. Median follow-up was 13.2 months (range, 0.1 to 210.7) with a median overall survival of 14.9 months. Multi-agent chemotherapy and radiotherapy were associated with a better prognosis. CONCLUSION Our findings suggest that aggressive therapy including multi-agent chemotherapy and possibly radiotherapy may extend survival. Further study is needed to improve outcomes in these patients including the adoption of systemic therapies used in MRT as well as the development of novel agents targeting specific mutations.
Collapse
Affiliation(s)
- D Callegaro-Filho
- Department of Medical Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Division of Gynecologic Oncology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - D M Gershenson
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A M Nick
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E D Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R M Marques
- Division of Gynecologic Oncology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S M Nicolau
- Division of Gynecologic Oncology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - K M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
35
|
Callegaro-Filho D, Burke TW, Eifel PJ, Ramirez PT, Euscher EE, Schmeler KM. Radiotherapy for recurrent small cell carcinoma of the ovary: A case report and review of the literature. Gynecol Oncol Rep 2014; 11:23-5. [PMID: 26076089 PMCID: PMC4434155 DOI: 10.1016/j.gore.2014.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 12/19/2014] [Indexed: 10/26/2022] Open
Abstract
•Small cell carcinoma of the ovary is a rare and aggressive malignant tumor.•No effective treatment for recurrent disease has yet been described.•Patients with recurrent disease may respond to salvage surgery, chemotherapy, radiotherapy or a combination of these modalities.
Collapse
Affiliation(s)
| | - Thomas W Burke
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth E Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
36
|
Gynecologic Cancer InterGroup (GCIG) Consensus Review for Ovarian Small Cell Cancers. Int J Gynecol Cancer 2014; 24:S30-4. [DOI: 10.1097/igc.0000000000000293] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractSmall cell carcinomas of the ovary are uncommon and account for less than 1% of ovarian cancers. They were first recognized in 1979, and a number of reports appeared during the next 2 decades. They are highly aggressive tumors and usually carry a poor prognosis, although this may reflect that most are diagnosed at advanced stage; however, those diagnosed as stage 1A have only 30% to 40% of long-term survivors. More reports followed extending our experience in the diagnosis and management of these rare cancers. The classification is described below and shown in Table 1, but a revision is expected to be published from the World Health Organization in 2014.
Collapse
|
37
|
Bitton RC, Mak MP, Takahashi TK, Aguiar FN, Abdo E, Diz MDPE. Advanced small-cell ovarian carcinoma, hypercalcemic type: a challenging therapeutic entity. AUTOPSY AND CASE REPORTS 2014; 4:47-52. [PMID: 28573118 PMCID: PMC5444398 DOI: 10.4322/acr.2014.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/16/2014] [Indexed: 01/30/2023] Open
Abstract
Small-cell ovarian carcinoma (SCOC) is a rare and aggressive neoplasia, predominantly affecting young women who are frequently first diagnosed with advanced stage disease. Platinum-based chemotherapy (ChT) can provide high response rates and rapidly ameliorate symptoms in this scenario. However, progression after chemotherapy usually occurs quickly, leading to high mortality rates. In addition, ChT complications, such as tumor lysis syndrome (TLS) can also occur, jeopardizing the patient's outcome. We present a case of metastatic SCOC in a 47-year-old patient who achieved tumor response after platinum-based chemotherapy and developed TLS, from which she recovered with supportive treatment. After the second ChT cycle, she developed febrile neutropenia and died 8 weeks after the diagnosis of SCOC. Although SCOC is a chemo-sensitive tumor, short-lived responses and frequent chemotherapy complications lead to a dismal prognosis.
Collapse
Affiliation(s)
- Rafael Caparica Bitton
- Department of Clinical Oncology - Instituto do Câncer do Estado de São Paulo - São Paulo/SP - Brazil
| | - Milena Perez Mak
- Department of Clinical Oncology - Instituto do Câncer do Estado de São Paulo - São Paulo/SP - Brazil
| | - Tiago Kenji Takahashi
- Department of Clinical Oncology - Instituto do Câncer do Estado de São Paulo - São Paulo/SP - Brazil
| | - Fernando Nalesso Aguiar
- Department of Pathology - Instituto do Câncer do Estado de São Paulo - São Paulo/SP - Brazil
| | - Elias Abdo
- Department of Clinical Oncology - Instituto do Câncer do Estado de São Paulo - São Paulo/SP - Brazil
| | | |
Collapse
|
38
|
Bahri M, Lahmar R, Ben Salah H, Kallel N, Ben Amar M, Daoud J. Carcinome à petites cellules de l’ovaire. Cancer Radiother 2014; 18:198-200. [DOI: 10.1016/j.canrad.2014.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
|
39
|
Recurrent SMARCA4 mutations in small cell carcinoma of the ovary. Nat Genet 2014; 46:424-6. [PMID: 24658004 DOI: 10.1038/ng.2922] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/18/2014] [Indexed: 12/30/2022]
Abstract
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare, highly aggressive form of ovarian cancer primarily diagnosed in young women. We identified inactivating biallelic SMARCA4 mutations in 100% of the 12 SCCOHT tumors examined. Protein studies confirmed loss of SMARCA4 expression, suggesting a key role for the SWI/SNF chromatin-remodeling complex in SCCOHT.
Collapse
|
40
|
Abstract
Small cell carcinoma of the ovary, hypercalcemic type is a very rare, highly aggressive tumor associated with a poor prognosis. Diagnosis is typically challenging secondary to undifferentiated cells and the rarity of the tumor. We report our experience with a 5-year-old girl who presented with stage IV disease.
Collapse
|
41
|
Gamwell LF, Gambaro K, Merziotis M, Crane C, Arcand SL, Bourada V, Davis C, Squire JA, Huntsman DG, Tonin PN, Vanderhyden BC. Small cell ovarian carcinoma: genomic stability and responsiveness to therapeutics. Orphanet J Rare Dis 2013; 8:33. [PMID: 23433318 PMCID: PMC3635907 DOI: 10.1186/1750-1172-8-33] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/14/2013] [Indexed: 12/21/2022] Open
Abstract
Background The biology of small cell ovarian carcinoma of the hypercalcemic type (SCCOHT), which is a rare and aggressive form of ovarian cancer, is poorly understood. Tumourigenicity, in vitro growth characteristics, genetic and genomic anomalies, and sensitivity to standard and novel chemotherapeutic treatments were investigated in the unique SCCOHT cell line, BIN-67, to provide further insight in the biology of this rare type of ovarian cancer. Method The tumourigenic potential of BIN-67 cells was determined and the tumours formed in a xenograft model was compared to human SCCOHT. DNA sequencing, spectral karyotyping and high density SNP array analysis was performed. The sensitivity of the BIN-67 cells to standard chemotherapeutic agents and to vesicular stomatitis virus (VSV) and the JX-594 vaccinia virus was tested. Results BIN-67 cells were capable of forming spheroids in hanging drop cultures. When xenografted into immunodeficient mice, BIN-67 cells developed into tumours that reflected the hypercalcemia and histology of human SCCOHT, notably intense expression of WT-1 and vimentin, and lack of expression of inhibin. Somatic mutations in TP53 and the most common activating mutations in KRAS and BRAF were not found in BIN-67 cells by DNA sequencing. Spectral karyotyping revealed a largely normal diploid karyotype (in greater than 95% of cells) with a visibly shorter chromosome 20 contig. High density SNP array analysis also revealed few genomic anomalies in BIN-67 cells, which included loss of heterozygosity of an estimated 16.7 Mb interval on chromosome 20. SNP array analyses of four SCCOHT samples also indicated a low frequency of genomic anomalies in the majority of cases. Although resistant to platinum chemotherapeutic drugs, BIN-67 cell viability in vitro was reduced by >75% after infection with oncolytic viruses. Conclusions These results show that SCCOHT differs from high-grade serous carcinomas by exhibiting few chromosomal anomalies and lacking TP53 mutations. Although BIN-67 cells are resistant to standard chemotherapeutic agents, their sensitivity to oncolytic viruses suggests that their therapeutic use in SCCOHT should be considered.
Collapse
Affiliation(s)
- Lisa F Gamwell
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Woopen H, Sehouli J, Pietzner K, Darb-Esfahani S, Braicu E, Fotopoulou C. Clinical experience of young patients with small cell ovarian carcinoma of the hypercalcemic type (OSCCHT). Eur J Obstet Gynecol Reprod Biol 2012; 165:313-7. [DOI: 10.1016/j.ejogrb.2012.07.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/28/2012] [Accepted: 07/29/2012] [Indexed: 11/24/2022]
|
43
|
Abstract
PURPOSE OF REVIEW Small-cell carcinomas of the gynecologic tract are aggressive malignancies that can be misdiagnosed or inappropriately managed. This review provides a summary of current literature that will help the clinician to correctly diagnose and treat patients with small-cell carcinomas of the cervix, ovary, uterus, vagina, and vulva. RECENT FINDINGS Small-cell carcinomas of gynecologic sites are rare and carry a poor prognosis. Stage is an important prognostic factor in small-cell carcinoma of the cervix, uterus, and ovary. Early stage disease has varied treatment approaches based on the site of malignancy, but systemic chemotherapy with or without radiation plays a role in the adjuvant setting to mitigate the risk of recurrence. Advanced stage patients require treatment with chemotherapy and possibly radiation, usually in a manner analogous to small-cell lung cancer. The preferred chemotherapy regimen contains a platinum agent and etoposide. For small-cell ovarian carcinomas, it is important to differentiate those of the hypercalcemic type from those of the pulmonary type. The small-cell carcinomas of the vagina and vulva need to be distinguished from Merkel cell cancers. SUMMARY The majority of small-cell tumors of the gynecologic tract will require systemic chemotherapy with a platinum agent and etoposide, both in the setting of early and advanced stage disease. Prospective trials with new chemotherapy or targeted agents are needed to improve the treatment of this aggressive cancer.
Collapse
|
44
|
Penault-Llorca F, Le Breton F. [Gynecopathology. Case 3. Small cell hypercalcemic type ovarian tumor]. Ann Pathol 2012; 32:194-7. [PMID: 22748335 DOI: 10.1016/j.annpat.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Frédérique Penault-Llorca
- Service d'anatomie et cytologie pathologiques, centre Jean-Perrin, 58 rue Montalembert, Clermont-Ferrand cedex 1, France.
| | | |
Collapse
|
45
|
Zagouri F, Thomakos N, Rodolakis A, Bamias A, Chalazonitis A, Sotiropoulou M, Antsaklis A, Dimopoulos MA, Papadimitriou CA. Quiz case: a 19-year-old woman with hypercalcemia and abdominal pain. ONKOLOGIE 2012; 35:126-7. [PMID: 22414978 DOI: 10.1159/000336973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
46
|
Schneider DT, Terenziani M, Cecchetto G, Olson TA. Gonadal and Extragonadal Germ Cell Tumors, Sex Cord Stromal and Rare Gonadal Tumors. RARE TUMORS IN CHILDREN AND ADOLESCENTS 2012. [DOI: 10.1007/978-3-642-04197-6_39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
47
|
Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer 2011; 21:951-63. [PMID: 21697684 DOI: 10.1097/igc.0b013e31821bec6b] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In young patients with borderline ovarian tumor a conservative treatment approach does not seem to have a significant impact on survival, and the outcome regarding fertility is good in general. It can be considered even if noninvasive peritoneal implants are discovered at the time of the initial surgery. In contrast, in patients with epithelial ovarian cancer, conservative surgery should be considered only in adequately staged patients, with a stage IA grade 1 (and probably 2) serous, mucinous or an endometrioid tumor, including a careful follow-up. Such an approach could also probably be discussed in stage IC grade 1 disease.In patients with nonepithelial malignant ovarian tumors, conservative surgery is also feasible, particularly in patients with malignant germ cell tumors because of their high chemosensitivity leading to an excellent prognosis in general.
Collapse
|
48
|
Benito Reyes V, Martínez Lanao D, Lubrano Rosales A, Arencibia Sánchez O, Falcón Vizcaíno O. Ovarian small cell carcinoma of hypercalcaemic-type: history of the disease in a patient who refused treatment. J OBSTET GYNAECOL 2011; 31:354-6. [PMID: 21534770 DOI: 10.3109/01443615.2011.556273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- V Benito Reyes
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain.
| | | | | | | | | |
Collapse
|
49
|
Estel R, Hackethal A, Kalder M, Münstedt K. Small cell carcinoma of the ovary of the hypercalcaemic type: an analysis of clinical and prognostic aspects of a rare disease on the basis of cases published in the literature. Arch Gynecol Obstet 2011; 284:1277-82. [PMID: 21298438 DOI: 10.1007/s00404-011-1846-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 01/20/2011] [Indexed: 10/24/2022]
Abstract
PURPOSE Ovarian small cell carcinoma of the hypercalcaemic type is a very rare and highly aggressive malignant disease, mainly affecting young women. Due to the rarity of this tumour entity, prospective randomised trials are unlikely to be conducted, and the only retrospective analysis based on a large case series is from 1994. Since diagnostic and treatment modalities may have changed, we initiated this analysis. METHODS The aim of our study was to review and analyse cases published since 1975 to validate former findings and to gather more information about therapy options, diagnostic and prognostic factors. A systematic literature search of the PubMed/Medline database was performed assessing all articles until September 2010. All retrieved articles were evaluated and cross-checked for references on the topic. In total, 135 cases were included, selected from 62 case reports and smaller case studies. RESULTS Small cell carcinoma mostly affects women with a mean age of 23.4 years. They present with unspecific symptoms like abdominal pain or palpable mass, sometimes accompanied by an elevated calcium or CA-125 serum concentration. The tumour appears nearly almost unilaterally, mostly affecting the right ovary. Tumour stage is a clearly prognostic factor. Adjuvant chemotherapy consisting of etoposide, cisplatinum/carboplatinum or vinca alkaloids has shown improved survival, whereas radiotherapy has not. CONCLUSIONS In spite of limitations this analysis provides new insights especially with respect to therapeutic aspects. This review underlines the importance of case reports in rare tumour entities in order to answer open questions.
Collapse
Affiliation(s)
- Rebecca Estel
- Departement of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Klinikstr. 32, 35385 Giessen, Germany
| | | | | | | |
Collapse
|
50
|
Montalto SA, Gupta A, Hakmi A, Raju KS. Small cell carcinoma of the ovary: hypercalcaemic type. J OBSTET GYNAECOL 2011; 31:199-200. [PMID: 21281053 DOI: 10.3109/01443615.2010.522269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S A Montalto
- Department of Gynaecology, 1Kent Cancer Centre, Maidstone Hospital, Maidstone, Kent ME16 9QQ, UK.
| | | | | | | |
Collapse
|