Noninvasive detection of microsatellite instability in patients with endometrial cancer

The analysis of mismatch repair proteins in solid tissue is the standard of care (SoC) for the microsatellite instability (MSI) characterization in endometrial cancer (EC). Uterine aspirates (UAs) or circulating-DNA (cfDNA) samples capture the intratumor heterogeneity and provide a more comprehensive and dynamic molecular diagnosis. Thus, MSI analysis by droplet-digital PCR (ddPCR) in UAs and cfDNA can provide a reliable tool to characterize and follow-up the disease. The UAs, paraffin-embedded tumor tissue (FFPE) and longitudinal plasma samples from a cohort of 90 EC patients were analyzed using ddPCR panel and compared to the SoC. A high concordance (96.67%) was obtained between the analysis of MSI markers in UAs and the SoC. Three discordant cases were validated as unstable by ddPCR on FFPE samples. Besides, a good overall concordance (70.27%) was obtained when comparing the performance of the ddPCR assay on UAs and cfDNA in high-risk tumors. Importantly, our results also evidenced the value of MSI analysis to monitor the disease evolution. MSI evaluation in minimally invasive samples shows great accuracy and sensitivity and provides a valuable tool for the molecular characterization and follow-up of endometrial tumors, opening new opportunities for personalized management of EC.

Genomic Profiling of Uterine Aspirates and cfDNA as an Integrative Liquid Biopsy Strategy in Endometrial Cancer

The incidence and mortality of endometrial cancer (EC) have risen in recent years, hence more precise management is needed. Therefore, we combined different types of liquid biopsies to better characterize the genetic landscape of EC in a non-invasive and dynamic manner. Uterine aspirates (UAs) from 60 patients with EC were obtained during surgery and analyzed by next-generation sequencing (NGS). Blood samples, collected at surgery, were used for cell-free DNA (cfDNA) and circulating tumor cell (CTC) analyses. Finally, personalized therapies were tested in patient-derived xenografts (PDXs) generated from the UAs. NGS analyses revealed the presence of genetic alterations in 93% of the tumors. Circulating tumor DNA (ctDNA) was present in 41.2% of cases, mainly in patients with high-risk tumors, thus indicating a clear association with a more aggressive disease. Accordingly, the results obtained during the post-surgery follow-up indicated the presence of ctDNA in three patients with progressive disease. Moreover, 38.9% of patients were positive for CTCs at surgery. Finally, the efficacy of targeted therapies based on the UA-specific mutational landscape was demonstrated in PDX models. Our study indicates the potential clinical applicability of a personalized strategy based on a combination of different liquid biopsies to characterize and monitor tumor evolution, and to identify targeted therapies.

High-risk endometrial carcinoma profiling identifies TGF-β1 as a key factor in the initiation of tumor invasion

Endometrial cancer is among the three most common cancers in females in industrialized countries. In the majority of cases, the tumor is confined to the uterus at the time of diagnosis and presents a good prognosis. However, after primary surgery, 15% to 20% of these tumors recur and have limited response to systemic therapy. We carried out gene expression profiling of high-risk recurrence endometrial cancers to identify new therapeutic approaches targeting the molecular pathways involved in the acquisition of an aggressive tumor phenotype. A microarray gene-expression analysis on a total of 51 human endometrial carcinomas revealed 77 genes specifically altered in high-risk recurrence tumors (P < 0.001). The bioinformatics analysis of gene-gene interactions and molecular relationships among these genes pointed to a prominent role for TGF-β1 signaling in the acquisition of an aggressive phenotype. We further showed that TGF-β1 has a principal role at the initiation of endometrial carcinoma invasion through the promotion of the epithelial to mesenchymal transition that leads to the acquisition of an invasive phenotype in HEC-1A and RL95-2 cells. Impairment of this initial step with SB-431542, a specific TGF-β1 inhibitor, precluded further persistent endometrial carcinoma invasion. In conclusion, we showed that the characterization of the molecular changes associated with the acquisition of an aggressive phenotype represents a realistic strategy for the rational identification and characterization of new potential therapeutic targets in an effort to improve the clinical management and the outcome of high-risk endometrial cancer patients.

[Preputial neurilemoma]

OBJECTIVE

To present a case of preputial neurilemoma.

METHODS

A 23-year-old man presented with a small, nodular, preputial mass that he had noted three years earlier.

RESULTS

The tumor was excised under local anesthesia without complications. Currently, no evidence of tumor recurrence has been observed.

CONCLUSIONS

Preputial nuerilemoma is rare. Diagnosis is based on the findings of the pathological study.

Subacute cutaneous lupus erythematosus in a patient with rheumatoid arthritis

A 51-year woman with a seropositive rheumatoid arthritis (RA) developed antiLa/SSB antibodies and erythematosquamous lesions on her upper back. The histological diagnosis was subacute cutaneous lupus erythematosus (SCLE) (papulosquamous form). There was no indication or a drug-induced SCLE. The concurrence of RA and SCLE seems to be rare. We review the clinical, serologic and immunogenetic features in these patients with coexistent RA and SCLE.

[Chronic hepatitis C virus infection associated with anti-LKM 1]

A case of chronic hepatitis in a 20-year-old patient in whom hepatitis C virus infection markers and type 1 liver and kidney antimicrosome antibodies (anti-LKM 1) were detected, thereby allowing diagnosis of autoimmune type 2b hepatitis, is reported. The different types of autoimmune hepatitis (AIH) and the type 2a and 2b AIH are discussed as are the rejection of this terminology by some authors followed by their proposals and the therapeutic strategy to be used in these patients.

[Mucinous adenocarcinoma of the anal region. Study of 4 cases]

OBJECTIVE

We report 4 cases of a special anal tumor featuring a long history of inflammatory signs and fistulas in that area.

DESIGN

A retrospective study from the histologic diagnosis back to the first symptom and up to the last follow-up or death.

PATIENTS

We studied all patients with a histologic diagnosis of mucinous adenocarcinoma of the anus admitted to our hospital.

RESULTS

All of them showed a long history of anal inflammatory signs and/or fistula before diagnosis. In all cases, the tumors were mucinous adenocarcinomas with minimal cytologic atypia. Of the 4 patients, one is dead, and we have lost the follow-up of another one 13 months after surgery when he had no evidence of recurrence.

CONCLUSIONS

In every patient with a long-standing anal fistula or a recurrent anal abscess, a biopsy is mandatory to rule out an underlying low grade mucinous carcinoma and if it shows a low grade mucinous adenocarcinoma, the treatment of choice will be local resection if it is available. If not, an abdominal perineal resection showed be done without hesitation.