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Chen YJA, Oo M, Xu Y. Case report: Isolated axillary lymph node metastasis in high-risk endometrial cancer. Front Oncol 2024; 13:1271821. [PMID: 38562421 PMCID: PMC10982341 DOI: 10.3389/fonc.2023.1271821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/31/2023] [Indexed: 04/04/2024] Open
Abstract
Introduction There are risks of developing distant metastases over time for both early- and advanced-stage endometrial cancer. Axillary lymph node metastasis as the first site of recurrence, whether isolated or non-isolated, is uncommon, and there are currently no established treatment guidelines for such cases. This study highlights four cases of recurrent endometrial cancer that manifested axillary lymph node metastasis, providing a comprehensive review of their distinctive clinical behavior and the treatment strategies employed. Methods We reviewed and compared four cases of recurrent endometrial cancer that developed axillary lymph node metastasis following adjuvant treatment. Patients' perspectives were also discussed. Results All four patients had aggressive endometrial histology, including high-grade serous carcinoma and carcinosarcoma. The stages at presentation were stages I and III, with laparotomy or laparoscopy used as the initial surgical approach. Axillary lymph node metastasis was the primary site of recurrence in three cases. Of the three patients with isolated axillary lymph node metastasis, two had long-term survival after aggressive locoregional treatment comprising surgery and radiation. Conclusion Axillary lymph node metastasis as the first site of recurrence is rare, even in high-risk endometrial cancer. In addition to systemic chemotherapy, aggressive locoregional treatment can potentially maximize the chance of long-term disease control.
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Affiliation(s)
- Yi-Ju Amy Chen
- Division of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Myoe Oo
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Yiqing Xu
- Department of Hematologic Oncology, Maimonides Medical Center, Brooklyn, NY, United States
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Robinson A, Futterman ID, Atallah F, Weedon J, Chen YJA, Apostol R, Minkoff H. Removal of pregnancy categories and likelihood of prescribing: a randomized trial. J Perinat Med 2022; 51:546-549. [PMID: 36420538 DOI: 10.1515/jpm-2022-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the degree to which removal of FDA' Pregnancy Categories (PC) of medications (A, B, C, and D) from labeling, affects the likelihood that providers will prescribe those medications. METHODS Over a one-year period a convenience sample of providers was recruited into a randomized, survey-based, study. Two versions of the survey were randomly distributed; version 1 presented clinical vignettes, drug information, and PC, while version 2, presented the identical information without the PC. Respondents were asked to estimate their likelihood of prescribing the drug. A mixed linear model was constructed, with likelihood of prescription as the dependent variable, treated as interval-scaled. RESULTS Out of 169 surveys given out, 162 (96%) were returned. Simple effects analysis showed that the presence of PC letter significantly affected the decision to prescribe category B (p<0.001) and C drugs (p=0.008) but not the A or D. Participants were significantly less likely to prescribe class B and C drugs when the letters were not available for review. These findings remained significant even when controlling for covariates (p=0.001). CONCLUSIONS When a PC letter is absent on labeling, physicians were less likely to use category B and C drugs, the most common medications prescribed in pregnancy.
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Affiliation(s)
- Angela Robinson
- Department of OBGYN, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Fouad Atallah
- Department of OBGYN, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jeremy Weedon
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Yi-Ju Amy Chen
- Department of OBGYN, Maimonides Medical Center, Brooklyn, NY, USA
| | - Radu Apostol
- Department of OBGYN, Coney Island Hospital, Brooklyn, NY, USA
| | - Howard Minkoff
- Department of OBGYN, Maimonides Medical Center, Brooklyn, NY, USA
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Alagkiozidis I, Gorelick C, Shah T, Chen YJA, Gupta V, Stefanov D, Amarnani A, Lee YC, Abulafia O, Sarafraz-Yazdi E, Michl J. Synergy between Paclitaxel and Anti-Cancer Peptide PNC-27 in the Treatment of Ovarian Cancer. Ann Clin Lab Sci 2017; 47:271-281. [PMID: 28667027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Paclitaxel is widely used in the treatment of gynecologic malignancies. It targets tumor cells in the M phase of the cell cycle. Cells in other phases survive the insult and repopulate the tumor. PNC-27 is a peptide synthesized of amino acids of the p53-MDM-2 binding domain. It kills various cancer cell lines in a dose-dependent manner. The goal of this study is to assess ovarian cancer cells' sensitivity to PNC-27 after surviving exposure to paclitaxel and to investigate the potential for synergy between PNC-27 and paclitaxel in the treatment of ovarian cancer. METHODS The impact of exposure to paclitaxel on the surface expression of MDM-2 was assessed with the use of flow cytometry. For measurement of cytotoxicity in vitro, ID8 cells were exposed to paclitaxel for 12 hours in various concentrations. At 12 hours, the drug containing media was removed and the cells were cultured in media containing various concentrations of PNC-27 for 24 hours. Viability was assessed with the use of an MTT assay. Survival fractions were plotted against drug concentrations and the data were fit to logistic dose-response curves. Isoeffective combinations were used to create isobolograms. The combined treatment with weekly paclitaxel and PNC-27 was tested in an intraperitoneal mouse model of ovarian cancer (ID8). RESULTS Exposure to paclitaxel rendered incomplete time-dependent killing, while PNC-27 mediated comprehensive, dose-dependent killing of ID8 cells. The cytotoxic effect of PNC-27 was dependent on its binding to MDM-2. Blocking MDM-2 inhibited the killing by PNC-27. ID8 cells surviving paclitaxel demonstrated increased expression of MDM-2 and increased susceptibility to PNC-27. Isobologram for dose combinations that were isoeffective indicates synergistic effect between the 2 agents (Combination index <1). In an in vivo model of ovarian cancer (ID8), the addition of PNC-27 to weekly paclitaxel administration significantly reduces tumor growth. CONCLUSIONS These data demonstrate synergism between PNC-27 and paclitaxel. PNC-27 could target cells surviving paclitaxel and improve its antitumor effect.
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Affiliation(s)
- Ioannis Alagkiozidis
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Constantine Gorelick
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Tana Shah
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Yi-Ju Amy Chen
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Vinita Gupta
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Dimitre Stefanov
- Department of Epidemiology and Biostatistics, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Abhi Amarnani
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Yi-Chun Lee
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Ovadia Abulafia
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Ehsan Sarafraz-Yazdi
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Josef Michl
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
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Amy Chen YJ, Lin CY, Feng J, Cogdell D, Zhang W, Liu J, Sneige N, Gong Y, Guo M. Accuracy of EasyChip HPV blot genotyping assay to detect high-risk HPV genotypes in SurePath Papanicolaou specimens. J Am Soc Cytopathol 2016; 5:351-358. [PMID: 31042547 DOI: 10.1016/j.jasc.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION EasyChip HPV blot is a human papillomavirus (HPV) genotyping assay that can be potentially used for HPV assay validation or clinical HPV research. To evaluate its genotyping accuracy, we compared EasyChip HPV blot with quantitative real-time polymerase chain reaction (qRT-PCR)/type-specific PCR assays in the detection of 8 high-risk HPV genotypes. MATERIALS AND METHODS Archival SurePath Papanicolaou specimens with abnormal results and follow-up biopsy (n = 154) were selected retrospectively for HPV genotyping by EasyChip HPV blot. To determine the accuracy of the assay, qRT-PCR and type-specific PCR also were performed and results for 8 high-risk HPV genotypes were compared (HPV16, 18, 31, 33, 35, 45, 52, and 58). RESULTS A total of 95 Papanicolaou specimens were qualified for data analysis. Concordance between EasyChip HPV blot and qRT-PCR/type-specific PCR assays was high, with a very good agreement for the 8 high-risk HPV genotypes (95%; kappa value: 0.894, 95% CI: 0.805-0.984) and for HPV16 and HPV18 (96%; kappa value: 0.899, 95% CI: 0.802-0.996). HPV16 was the most frequent HPV genotype by EasyChip HPV blot. The odds ratio of HPV16/18 for high-grade cervical intraepithelial neoplasia was 11.25 (95% CI: 3.93-32.31). CONCLUSIONS EasyChip HPV blot is a reliable HPV genotyping assay that can be used for HPV assay validation or clinical HPV studies.
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Affiliation(s)
- Yi-Ju Amy Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Obstetrics and Gynecology Department, Bronx Lebanon Hospital Center, Bronx, New York
| | - Ching-Yu Lin
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Jie Feng
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Cogdell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, Comprehensive Cancer Center of Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Jinson Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nour Sneige
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yun Gong
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ming Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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