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Manning-Geist BL, Cowan RA, Schlappe B, Braxton K, Sonoda Y, Long Roche K, Leitao Jr MM, Chi DS, Zivanovic O, Abu-Rustum NR, Mueller JJ. Assessment of wound perfusion with near-infrared angiography: A prospective feasibility study. Gynecol Oncol Rep 2022; 40:100940. [PMID: 35169608 PMCID: PMC8829563 DOI: 10.1016/j.gore.2022.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022] Open
Abstract
There are no validated technologies for skin perfusion assessment at time of laparotomy closure. This prospective non-randomized study failed to demonstrate feasibility of skin perfusion measurement using NIR angiography. Successful subjective perfusion assessment with NIR angiography suggests an ongoing role for investigation of this technology.
Objective To assess the feasibility of quantitatively measuring skin perfusion before and after suture or staple skin closure of vertical laparotomies using indocyanine green (ICG) uptake with near-infrared angiography. Methods This was a prospective, non-randomized feasibility study of patients undergoing surgery with a gynecologic oncology service from 2/2018–8/2019. Feasibility was defined as the ability to quantitatively measure ICG uptake adjacent to the wound at the time of skin closure in ≥ 80% of patients. Patients were assigned suture or staple skin closure in a sequential, non-randomized fashion. Skin perfusion was recorded using a near-infrared imaging system after ICG injection and measured by video analysis at predefined points before and after skin closure. Clinicodemographic, pre- and intraoperative details, and surgical secondary events were recorded. Results Of 20 participants, 10 were assigned staple closure and 10 suture closure. Two patients (10%) achieved objective quantification of ICG fluorescence before and after laparotomy closure, failing the predefined feasibility threshold of ≥ 80%. Reasons for failed quantification included overexposure (12), insufficient ICG signal uptake (6), and insufficient video quality (2). Near-infrared angiography wound perfusion was subjectively appreciated intraoperatively in 85% (17/20) of patients before and after wound closure. Conclusions Objective assessment of laparotomy skin closure with near-infrared angiography–measured perfusion did not meet the pre-specified feasibility threshold. Adjustments to the protocol to minimize overexposure may be warranted. The ability to subjectively appreciate ICG perfusion with near-infrared angiography suggests a possible role for near-infrared angiography in the real-time intraoperative assessment of wound perfusion, particularly in high-risk patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jennifer J. Mueller
- Corresponding author at: Gynecology Service, Department of Surgerym, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Cowan R, Schlappe B, Braxton K, Sonoda Y, Roche KL, Leitao M, Chi D, Zivanovic O, Abu-Rustum N, Mueller J. Feasibility of assessing wound perfusion at the time of laparotomy closure. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schlappe B, Zhou Q, O'Cearbhaill R, Iasonos A, Soslow R, Abu-Rustum N, Mueller J. Comparison of outcomes of primary mucinous ovarian cancer patients receiving either an adjuvant gynecologic or gastrointestinal chemotherapy regimen. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schlappe B, Mueller J, Zivanovic O, Cadoo K, Hensley M, Chiang S, Soslow R, Abu-Rustum N, Leitao M. Outcomes of patients with uterine carcinosarcoma and low-volume lymph node metastases. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schlappe B, Weaver A, Ducie J, Eriksson A, Dowdy S, Cliby B, Glaser G, Abu-Rustum N, Mariani A, Leitao M. Multicenter study comparing survival outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A sentinel lymph node algorithm vs a comprehensive pelvic and paraaortic lymphadenectomy. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schlappe B, O'Cearbhaill R, Zhou Q, Iasonos A, Mueller J, Zivanovic O, Gardner G, Long Roche K, Sonoda Y, Chi D. Comparison of outcomes in optimally-cytoreduced ovarian cancer patients receiving postoperative intraperitoneal chemotherapy vs intravenous dose-dense chemotherapy without bevacizumab. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schlappe B, Weaver A, Ducie J, Eriksson A, Dowdy S, Cliby B, Glaser G, Abu-Rustum N, Mariani A, Leitao M. Multicenter study comparing oncologic outcomes in patients with serous and clear cell endometrial carcinoma between two nodal assessment methods: A sentinel lymph node algorithm vs a comprehensive pelvic and para-aortic lymphadenectomy. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schlappe B, Schiavone M, DeLair D, Ducie J, Eriksson A, Zivanovic O, Makker V, Soslow R, Abu-Rustum N, Leitao M. Clinical behavior of FIGO stage I endometrioid endometrial adenocarcinoma diagnosed as high-grade on preoperative biopsy and low-grade on hysterectomy specimen. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schlappe B, Jordan E, Zhou Q, Iasonos A, Leitao MM, Park KJ, Alektiar KM, Zivanovic O, Sabbatini P, Aghajanian C, O'Cearbhaill RE. Treatment and outcomes of small cell neuroendocrine carcinoma of the cervix (SCCC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5531 Background: Extrapulmonary small cell carcinoma is rare. SCCC represent 2% of cervical cancers and can portend a poor prognosis. Treatment standardization is challenging given its rarity. We describe management of limited stage (LS; disease could be encompassed within one radiation port) at a large tertiary referral center and the characteristics and outcomes in a cohort of patients (pts) with LS and extensive stage (ES) SCCC. Methods: Pts with SCCC diagnosed from 1/1990-1/2016 were identified following IRB approval. Clinicopathologic, treatment, and follow-up data were recorded. Descriptive statistics were provided. Median PFS/OS or PFS/OS rate were estimated using Kaplan-Meier method. Results: 39 pts were identified, 29 with LS. Select characteristics are shown in table. Tumor molecular profiling revealed MYC amplifications, TP53 mutations, PIK3CA mutation among the small subset of pts who had this performed. LS SCCC was treated with whole pelvic radiation therapy (RT) (4500-5040cGy) and concurrent IV cisplatin (60mg/m2) on day 1 and etoposide (120mg/m2) on days 1, 3, and 5 during RT and days 1-3 post RT to complete a total of 4 cycles. 26 pts, all had LS, underwent initial surgical management. No pt had prophylactic cranial RT. 3 pts (8%), all had LS, developed brain metastases. Median follow-up was 59.5 months (1.9-234.1). Median PFS (95%CI) for LS pts was 39.2 months (15.1-not estimable) vs 2.9 months (0.9-4.6) for ES. Median OS(95%CI) was 31.8 months (16.3-56.0) for the whole cohort, 52.8 months (31.8-not estimable) for LS and 5.9 months(1.8-16.3) for ES. Conclusions: In the LS SCCC cohort treated with concurrent cisplatin/etoposide chemo/RT and outback cis/etoposide +/- post initial radical hysterectomy the 5-year PFS (95%CI) was 37.5% (19.2-55.9%). Clinicopathologic characteristics and risk factors for SCCC appear distinct to cervical cancers and lung small cell cancers. Further investigation of molecular alterations and treatment of this rare tumor is needed to improve pt outcomes. [Table: see text]
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Affiliation(s)
| | - Emmet Jordan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Kay J. Park
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Paul Sabbatini
- Memorial Sloan-Kettering Cancer Center and Weil Cornell Medical College, New York, NY
| | - Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center and Weil Cornell Medical College, New York, NY
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Schlappe B, Mueller J, Gardner G, Chi D, Zivanovic O, O'Cearbhaill R. Cited rationale for variance in use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian, fallopian tube, and primary peritoneal carcinoma. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schlappe B, Mueller JJ, Olvera N, Dao F, Kandoth C, Bogomolniy F, Viale A, Huberman K, Nanjangud G, Hussein Y, Taylor B, Soslow R, Levine DA. Abstract B14: Molecular characterization of mucinous ovarian carcinoma. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.ovca15-b14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Mucinous ovarian carcinoma (MOC) is a rare, chemoresistant tumor known to share pathologic features with tumors of the gastrointestinal and pancreaticobiliary tracts. To better understand the genomic and proteomic landscapes of invasive MOCs, we identified somatic mutations and proteins expression in a single institution cohort and compared these results with data from TCGA tumor projects.
Twenty-six tumors consistent with primary invasive MOC after expert pathology review and with available paired tumor and normal tissue were identified from institutional databases between July 2001 and July 2012. DNA extracted from FFPE or fresh frozen samples underwent next generation sequencing with a combination of a candidate gene assay (37 genes), the MSK-IMPACT assay (341 genes), transcriptome sequencing, and whole exome sequencing. Copy number alterations were identified using data from the MSK-IMPACT assay, whole exome sequencing or Affymetrix SNP 6.0 arrays. Immunohistochemistry (IHC) was performed using optimized antibodies for six proteins to confirm the diagnosis of MOC (ER, PR, CK7, CK20, CDX-2, PAX8) and seven proteins to correlate with mutation status and copy number alterations (p53, ARID1A[Baf250a], PTEN, PMS2, MSH6, HER2, p16). Mutation data for other TCGA tumor types was obtained from the cBio Cancer Genomics Portal (cbioportal.org).
The median age of the cohort was 58 years (range 20-86 years). Most (19/26, 73%) of the tumors were stage I. Somatic TP53 and KRAS mutations were the most common seen and were identified in 18 (69%) cases each, with a co-mutation rate of 50% (13/26). Other commonly mutated genes include ARID1A, PTEN, and PIK3CA. Homozygous deletions of CDKN2A were found in 27% (7/26). ERBB2 alterations were identified in 19% (5/26) and consisted of three amplifications and two mutations. Mutations in at least one potentially targetable gene were identified in 42% (11/26) of tumors. IHC was concordant with sequencing results in 154/182 (85%) of stained cases. Pancreatic, colorectal, lung adenocarcinoma, endometrial, and stomach cancers have the highest frequency of KRAS mutations. Co-mutations of KRAS and TP53 occur most commonly in pancreatic (59%) and colorectal (21%) carcinomas. CDKN2A homozygous deletions are also found at a similar frequency in pancreatic adenocarcinomas (28%). When evaluating the mutation rates of the five most commonly mutated genes in our MOC cohort with colorectal, pancreatic, gastric and high-grade serous ovarian carcinomas (HGSOC) in the TCGA datasets, pancreatic adenocarcinoma showed the most similarity. HGSOC showed little similarity to the MOCs.
KRAS and TP53 co-mutation are common in invasive MOCs. Other commonly mutated genes include ARID1A, PTEN, and PIK3CA. Potentially targetable ERBB2 alterations were identified in several cases. Despite anatomic distinctions, the mutational landscape of MOC shares similarities with that of pancreatic adenocarcinoma including frequent CDKN2A deletions and KRAS/TP53 co-mutation. The suggested shared molecular pattern with pancreatic adenocarcinoma offers potential to guide future developmental therapeutics.
Citation Format: Brooke Schlappe, Jennifer J. Mueller, Narciso Olvera, Fanny Dao, Cyriac Kandoth, Faina Bogomolniy, Agnes Viale, Kety Huberman, Gouri Nanjangud, Yaser Hussein, Barry Taylor, Robert Soslow, Douglas A. Levine. Molecular characterization of mucinous ovarian carcinoma. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B14.
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Affiliation(s)
| | | | | | - Fanny Dao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Agnes Viale
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kety Huberman
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yaser Hussein
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Barry Taylor
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY
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Tatsumi K, Schlappe B, Everett EN, Gibson PC, Mount SL. Primary vaginal mucinous adenocarcinoma of intestinal type, associated with intestinal metaplasia of Skene ducts in a diethylstilbestrol-exposed woman. Am J Clin Pathol 2015; 144:790-5. [PMID: 26486744 DOI: 10.1309/ajcpvz0qnluo7ofe] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Primary mucinous vaginal adenocarcinoma of intestinal type is an extremely rare malignancy of uncertain histogenesis, which makes for a diagnostic challenge. We report a case and describe the histopathologic features and the unusual immunoprofile of this rare entity. METHODS We report a case of vaginal mucinous adenocarcinoma of intestinal type in a diethylstilbestrol-exposed woman in which intestinal metaplasia of the Skene duct was found at the time of recurrence. RESULTS As the histogenesis of primary vaginal intestinaltype adenocarcinomas remains uncertain, the finding of Skene duct metaplasia in association with invasive adenocarcinoma lends support to the origin of vaginal mucinous adenocarcinomas of intestinal type to be metaplasia, at least in some cases. Such an origin accounts for the unusual immunohistochemical profile, which raises concern for a metastatic adenocarcinoma of gastrointestinal origin. CONCLUSIONS Recognition of this rare entity is important, particularly to avoid the pitfall of misdiagnosing metastatic disease.
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Broach V, Mueller J, Schlappe B, Bogomolniy F, Bisogna M, Dao F, Jelinic P, Levine D. Tumor-derived serum exosomal microRNA as a novel biomarker for high-grade serous carcinoma. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schwartz A, Schlappe B, Wong C, Luebbers R, Everett E. Abstract number 18: Assessment of primary care providers' current clinical practices in determining a woman's risk for ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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