Ovarian serous borderline tumors with recurrent or extraovarian lesions: a Japanese, retrospective, multi-institutional, population-based study

BACKGROUND

Ovarian serous borderline tumors (SBT) are typically unilateral and are primarily treated using hysterectomy and bilateral salpingooophorectomy (SO). However, most young patients prefer fertility-sparing surgeries (FSS) with tumorectomy or unilateral SO. Micropapillary morphology and invasive implants have been designated as histopathological risk indicators for recurrence or metastasis, but their clinical impact remains controversial because of limitations like diagnostic inconsistency and incomplete surgical staging.

METHODS

A nationwide multi-institutional population-based retrospective surveillance was conducted with a thorough central pathology review to reveal the clinical features of SBT. Of 313 SBT patients enrolled in the Japanese Society of Clinical Oncology's Surveillance of Gynecologic Rare Tumors, 289 patient records were reviewed for clinical outcomes. The glass slides of patients at stage II-IV or with recurrence or death were re-evaluated by three gynecological pathologists.

RESULT

The 10-year overall and progression-free survival (PFS) rates were 98.6% and 92.3%. The median recurrence period was 40 months and 77.0% was observed in the contralateral ovary within 60 months. Patients aged ≤ 35 years underwent FSS more frequently and relapsed more (p < .001). A clinic-pathological analysis revealed diagnosis during pregnancy, FSS, and treatment at non-university institutes as well as advanced stage and large diameter were independent risk factors of recurrence. Among patients having pathologically confirmed SBTs, PFS was not influenced by the presence of micropapillary pattern or invasive implants.

CONCLUSION

The recurrence rate was lower in this cohort than previous reports, but the clinical impacts of incomplete resection and misclassification of the tumor were still significant on the treatment of SBT.

A Histogram Analysis of the Pixel Grayscale (Luminous Intensity) of B-Mode Ultrasound Images of the Subcutaneous Layer Predicts the Grade of Leg Edema in Pregnant Women

The technique most widely used to quantitatively measure leg edema is only a pitting edema method. It has recently become possible to digitize B-mode ultrasound images and accurately quantify their brightness using an image-analysis software program. The purpose of this study was to find new indices of the grade of leg skin, to study whether or not analyses of the subcutaneous layer of leg skin on ultrasound images using image-editing software program can be used to evaluate it and to digitize it. Images of 282 subcutaneous layers of leg skin in 141 pregnant women were obtained using a B-scan portable ultrasound device. Rectangular photographs (vertical: skin thickness; horizontal: width of probe) were obtained using an image-editing program, and the luminous intensity (pixel grayscale: 0-255) and thickness of the skin were calculated using a histogram. We investigated the correlation between these parameters and the grade of pitting edema (0-3). There was a significant positive correlation between the grade of pitting edema and the average luminous intensity value, its standard deviation, and the skin thickness (ρ = 0.36, ρ = 0.22, ρ = 0.51, p < 0.0001, respectively). In particular, there was strong positive correlation between the grade of pitting edema and both the total number of pixels in a rectangle × (multiplied by) the average luminous intensity value and the total number of pixels in a rectangle × the standard deviation of the average luminous intensity value (ρ = 0.58 and ρ = 0.59, p < 0.0001, respectively). We could quantitatively evaluate the grade of leg edema by analyzing ultrasound photographs of the subcutaneous layer of the leg skin using an image-editing software program and found new indices to digitize it.

Measurement of Skin Thickness Using Ultrasonography to Test the Usefulness of Elastic Compression Stockings for Leg Edema in Pregnant Women

Background: One of the most common treatments for leg edema during pregnancy is the use of compression stockings. The purpose of this study was to evaluate the objective effectiveness in pregnant women, by measuring the changes of skin thickness using ultrasonography. Methods: Pregnant women were diagnosed with leg edema using the pitting edema method at 36 weeks of gestation. Twenty-four pregnant women (48 legs) with leg edema spent time without wearing elastic stockings at 36−37 weeks of gestation. Then, they wore elastic stockings for one week at 37−38 weeks of gestation. We measured the grade of edema (from 0 to 3) and the skin thickness of the lower leg by portable ultrasonography at 36, 37, and 38 weeks of gestation (a before-and-after study). Results: In 24 pregnant women, thigh edema was not detected in any of the 48 legs before or after the use of elastic stockings. All 48 legs in 24 pregnant women had physiological lower leg edema, but not thigh edema. The average grade of pitting edema in each lower leg significantly decreased after using the stockings (36 weeks, 1.77 ± 0.85; 37 weeks, 1.79 ± 0.77; 38 weeks, 1.04 ± 0.74, p < 0.0001). In addition, the skin thickness of the lower legs was significantly decreased after the use of elastic stockings (36 weeks, 7.47 ± 2.45 mm; 37 weeks, 7.93 ± 2.83 mm; 38 weeks, 7.15 ± 2.35 mm, p < 0.0001). Conclusions: The wearing of elastic compression stockings on the lower legs is objectively effective for improving leg edema in pregnant women.

Trend in the prevalence of atrial fibrillation 7 years after the Great East Japan Earthquake

Background

The age-adjusted prevalence rate of atrial fibrillation (AF) had kept increasing until 2-year after the Great East Japan Earthquake (reported in ESC2017). Whether the elevated prevalence was tentative or not has not been sufficiently elucidated yet.

Methods

Community dwellers aged 40 to 74 years living in Iwate Prefecture who underwent annual health checkups (2010 (n=17490), 2011 (n=174236), 2012 (n=183612), 2013 (n=188429), 2014 (n=188424), 2015 (n=193610), 2016 (n=194882), 2017 (n=195428) account for approximately 30% of total population) were enrolled. Participants were divided into two age categories (40–64, 65–74 years). Direct age-adjusted prevalence rate of AF in each year was estimated using the 2010 population as the reference.

Result

Data are shown in the figure.

Conclusion

Prevalence rates of AF increased only in elderly people for up to 3 years after the disaster. This indicated that accelerated development of AF in elderly people due to stressful life after the disaster would not end within a short term and lasted at least 3 years after the disaster.

Figure 1

Funding Acknowledgement

Type of funding source: None

Anti-VEGF therapy resistance in ovarian cancer is caused by GM-CSF-induced myeloid-derived suppressor cell recruitment

BACKGROUND

The mechanism of resistance development to anti-VEGF therapy in ovarian cancer is unclear. We focused on the changes in tumour immunity post anti-VEGF therapy.

METHODS

The frequencies of immune cell populations and hypoxic conditions in the resistant murine tumours and clinical samples were examined. The expression profiles of both the proteins and genes in the resistant tumours were analysed. The impact of granulocyte-monocyte colony-stimulating factor (GM-CSF) expression on myeloid-derived suppressor cell (MDSC) function in the resistant tumours was evaluated.

RESULTS

We found a marked increase and reduction in the number of Gr-1 + MDSCs and CD8 + lymphocytes in the resistant tumour, and the MDSCs preferentially infiltrated the hypoxic region. Protein array analysis showed upregulation of GM-CSF post anti-VEGF therapy. GM-CSF promoted migration and differentiation of MDSCs, which inhibited the CD8 + lymphocyte proliferation. Anti-GM-CSF therapy improved the anti-VEGF therapy efficacy, which reduced the infiltrating MDSCs and increased CD8 + lymphocytes. In immunohistochemical analysis of clinical samples, GM-CSF expression and MDSC infiltration was enhanced in the bevacizumab-resistant case.

CONCLUSIONS

The anti-VEGF therapy induces tumour hypoxia and GM-CSF expression, which recruits MDSCs and inhibits tumour immunity. Targeting the GM-CSF could help overcome the anti-VEGF therapy resistance in ovarian cancers.

P3772Risk factors for future development of atrial fibrillation are not evident among apparently healthy individuals with paroxysmal atrial fibrillation

Background

Atrial fibrillation (AF) is one of the important factors of cardiovascular morbidity and mortality and to find not only patients with persistent AF but also individuals with paroxysmal AF among apparently healthy people is a crucial strategy for decreasing number of patients with serious cardio-embolic stroke. However, screening ability using previously known risk factors for future development of AF has not been examined in individuals with paroxysmal AF.

Methods

A total of 59730 male individuals, aged 40 years or older who underwent multiple comprehensive physical check-ups including 12 lead electrocardiogram (ECG) from 2012 to 2015 were enrolled. Persistent AF was defined a case that consecutively manifested AF till the last checkup. Paroxysmal AF was defined as a case who transiently manifested AF in each of the checkup and subsequently manifested sinus rhythm at the last checkup. Non-AF was defined as a case that never manifested AF in any of checkup. Age-adjusted prevalence rates and their 95% confidence intervals of known-risk factors in the first survey were estimated by logistic regression analysis separately by the three groups (non-AF (n=58602), paroxysmal AF (n=392) and persistent AF (736)).

Results

Age-adjusted prevalence rates (95% confidence interval) of risks factors for AF are shown in the table. Already known risk factors were evidently manifested in persistent AF group, however, prevalence rates of these factors in paroxysmal AF group were not different from the rates in non-AF group.

Conclusion

The repeated measurements of ECG study indicated that individuals who would develop paroxysmal AF in the near future did not have typical risk factors for AF and a screening test using risk factors for AF have no chance to find a high-risk individual for paroxysmal AF.

Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers

Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed diagnostic procedures and treatments for secondary leg lymphedema, and discuss how to better manage leg lymphedema. Among the currently available diagnostic tools, indocyanine green lymphography (ICG-LG) can detect dermal lymph backflow in asymptomatic legs at stage 0. Therefore, ICG-LG is considered the most sensitive and useful tool. At symptomatic stage ≥1, ultrasonography, magnetic resonance imaging-lymphography/computed tomography-lymphography (MRI-LG/CT-LG) and lymphosintiography are also useful. For the treatment of lymphedema, complex decongestive physiotherapy (CDP) including manual lymphatic drainage (MLD), compression therapy, exercise and skin care, is generally performed. In recent years, CDP has often required effective multi-layer lymph edema bandaging (MLLB) or advanced pneumatic compression devices (APCDs). If CDP is not effective, microsurgical procedures can be performed. At stage 1–2, when lymphaticovenous anastomosis (LVA) is performed, lymphaticovenous side-to-side anastomosis (LVSEA) is principally recommended. At stage 2–3, vascularized lymph node transfer (VLNT) is useful. These ingenious procedures can help maintain the patient’s quality of life (QOL) but unfortunately cannot cure lymphedema. The most important concern is the prevention of secondary lymphedema, which is achieved through approaches such as skin care, weight control, gentle limb exercises, avoiding sun and heat, and elevation of the affected leg.

The Effects of the Dietary and Nutrient Intake on Gynecologic Cancers

The contribution of diet to cancer risk has been considered to be higher in advanced countries than in developing countries. In this paper, I review the current issues (a review of the relevant literature), and the effects of the dietary and nutrient intake on three types of gynecologic cancer (cervical, endometrial and ovarian cancers). In cervical cancer, the most important roles of diet/nutrition in relation to cancer are prophylaxis and countermeasures against human papillomavirus (HPV) infection. The main preventive and reductive factors of cervical cancer are antioxidants, such as vitamin A, C, D and E, carotenoids, vegetables and fruits. These antioxidants may have different abilities to intervene in the natural history of diseases associated with HPV infection. For endometrial cancer, the increase in peripheral estrogens as a result of the aromatization of androgens to estrogens in adipose tissue in obese women and insulin resistance are risk factors. Thus, we must mainly take care to avoid the continuous intake of fat energy and sugar. In ovarian cancer, the etiology has not been fully understood. To the best of our knowledge, the long-term consumption of pro-inflammatory foods, including saturated fat, carbohydrates and animal proteins is a risk factor. The intake of acrylamide is also a risk factor for both endometrial and ovarian cancer. Most papers have been epidemiological studies. Thus, further research using in vitro and in vivo approaches is needed to clarify the effects of the dietary and nutrient intake in detail.

A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

BACKGROUND This study aimed to use a portable ultrasound method to quantitatively measure skin thickness and to compare leg edema in obese and non-obese pregnant women. MATERIAL AND METHODS Thirty-six pregnant women (17 primiparas and 19 multiparas) at 27/28 and 37/38 weeks of pregnancy, with and without leg edema, had their lower leg skin thickness measured using a B-scan portable ultrasonography device (72 legs and maximum of 98 measurements). Measurements were compared between women who were obese prior to pregnancy, with a body mass index (BMI) ≥25 kg/m² and non-obese with a BMI <25 kg/m². RESULTS Skin thickness of the legs in pregnant women with edema was significantly increased compared with that in pregnant women without edema (6.4±0.3 mm vs. 4.6±0.4 mm) (p=0.0001). There was a significant correlation between the degree of pitting edema and skin thickness in all edematous legs (r=0.56; n=98; p<0.0001). The cutoff level of edema measured by portable ultrasound in non-obese pregnant women was 4.7 mm (sensitivity 83.9%, specificity 66.7%) and was 7.5 mm in obese pregnant women. Obese pregnant women with edema had a significantly increased leg skin thickness compared with non-obese pregnant women with edema (11.3±1.3 mm vs. 5.7±0.2 mm) (p<0.0001). CONCLUSIONS Portable ultrasonography is a reliable method of quantitatively measuring skin thickness of the lower leg in edema associated with pregnancy. The thickness of the skin in obese pregnant women with edema can be expected to be significantly increased compared with non-obese pregnant women with edema.

The effect of the type of dietary protein on the development of ovarian cancer

We evaluated whether different dietary protein qualities (isocaloric diets involving animal (casein) or plant protein (soy protein) could inhibit the ovarian cancer growth in mice and improve their prognosis and whether chemotherapy had different tumor reducing effects on these mice. In the mice of the 20% plant protein group, the ovarian cancer growth at 5 weeks after tumor implantation was clearly reduced in comparison to the mice in the 20% animal protein group (p< 0.001). The serum levels of insulin and IGF-1 levels were both lower in the mice of the 20% plant protein group than in the mice of the 20% animal protein group (p<0.001 and p<0.01, respectively). Immunohistochemistry revealed that the level of eukaryotic initiation factor 4E-binding protein 1 (p-4EBP1) activity―one of the major downstream effectors of the mTOR pathway ―of the plant protein group was significantly weaker than that of the animal protein group (p<0.001). The prognosis of the 20% plant protein group was better than that of the 20% animal protein group (log-rank test, p=0.0062). The ovarian cancer growth in the 20% plant protein plus cisplatin treatment group was not significantly reduced in comparison to the 20% animal protein plus cisplatin treatment group. Our findings suggest that a diet high in plant protein reduces the growth of human ovarian cancer cells in mice compared to a diet high in animal protein, ―possibly through the lack of activation of the IGF/Akt/mTOR pathway, and leads to a better prognosis with or without cisplatin treatment.

Subtypes of Ovarian Cancer and Ovarian Cancer Screening

Ovarian cancer is the foremost cause of gynecological cancer death in the developed world, as it is usually diagnosed at an advanced stage. In this paper we discuss current issues, the efficacy and problems associated with ovarian cancer screening, and compare the characteristics of ovarian cancer subtypes. There are two types of ovarian cancer: Type I carcinomas, which are slow-growing, indolent neoplasms thought to arise from a precursor lesion, which are relatively common in Asia; and Type II carcinomas, which are clinically aggressive neoplasms that can develop de novo from serous tubal intraepithelial carcinomas (STIC) and/or ovarian surface epithelium and are common in Europe and the USA. One of the most famous studies on the subject reported that annual screening using CA125/transvaginal sonography (TVS) did not reduce the ovarian cancer mortality rate in the USA. In contrast, a recent study in the UK showed an overall average mortality reduction of 20% in the screening group. Another two studies further reported that the screening was associated with decreased stage at detection. Theoretically, annual screening using CA125/TVS could easily detect precursor lesions and could be more effective in Asia than in Europe and the USA. The detection of Type II ovarian carcinoma at an early stage remains an unresolved issue. The resolving power of CA125 or TVS screening alone is unlikely to be successful at resolving STICs. Biomarkers for the early detection of Type II carcinomas such as STICs need to be developed.

Combination of Aprepitant, Azasetron, and Dexamethasone as Antiemetic Prophylaxis in Women with Gynecologic Cancers Receiving Paclitaxel/Carboplatin Therapy

Background

Material/Methods

Results

Conclusions

Groin lymph node detection and sentinel lymph node biopsy in vulvar cancer

OBJECTIVE

To identify suitable diagnostic tools and evaluate the efficacy of sentinel lymph node (SLN) biopsy for inguinal lymph node metastasis in vulvar cancer.

METHODS

Data from 41 patients with vulvar cancer were evaluated retrospectively, including magnetic resonance imaging (MRI) measurements, SLN biopsy status, groin lymph node metastasis, and prognosis.

RESULTS

SLN biopsy was conducted in 12 patients who had stage I to III disease. Groin lymphadenectomy was omitted in five of the nine patients with negative SLNs. All SLN-negative patients who did not undergo groin lymphadenectomy showed no evidence of disease after treatment. On MRI, the long and short diameters of the inguinal node were significantly longer in metastasis-positive cases, compared with negative cases, in 25 patients whose nodes were evaluated pathologically (long diameter, 12.8 mm vs. 8.8 mm, p=0.025; short diameter, 9.2 mm vs. 6.7 mm, p=0.041). The threshold of >10.0 mm for the long axis gave a sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 70.6%, 58.3%, and 92.3%, respectively, using a binary classification test. Decision tree analysis revealed a sensitivity, specificity, and accuracy of 87.5%, 70.6%, and 76.0%, respectively, with the threshold of >10.0 mm for the long axis on MRI. The criteria of >10.0 mm for the long axis on MRI predicted an advanced stage and poorer prognosis using a validation set of 15 cases (p=0.028).

CONCLUSION

Minimally invasive surgery after preoperative evaluation on MRI and SLN biopsy is a feasible strategy for patients with vulvar cancer.

Clinical Efficacy of Ovarian Cancer Screening

Various trials of ovarian cancer screening programs have been reported worldwide. In 2011, one of the most famous papers indicated that annual screening using CA125/transvaginal sonography (TVS) did not reduce ovarian cancer mortality in the United States of America (USA). To investigate the validity of ovarian cancer screening, we verified the analyses of previous reports. At first, we obtained the USA datasets that were used for the analyses and identified many patients in whom cancers were accidentally detected several years after the screening period. We thus performed a new prognostic comparison between the screening group (cancers that were detected through screening or within one year after screening) and the control group (cancers that were found more than one year after screening, without screening, or in the original control group). The results showed that the prognoses of the screening group were significantly better than those of the control group (p=0.0017). In addition, the screening group contained significantly fewer stage IV cases than the control group (p=0.005). In another screening in the United Kingdom, ovarian cancer was detected at a relatively earlier stage (stage I/II: 44%), while the rate of stage IV detection was low (4%). Very recently, this team showed significant difference in the rates with and without screening (p=0.021) when prevalent cases were excluded and indicated the delayed effect of screening. These results contrasted with the USA data. In other studies in the USA and Japan, annual screening was also associated with a decreased stage at detection. New histopathological, molecular and genetic studies have recently provided two categories of ovarian carcinogenesis. Type I carcinomas are slow-growing neoplasms that often develop from benign ovarian cysts. Type II carcinomas are high-grade clinically aggressive neoplasms. The rate of type II carcinomas is significantly higher in Europe and the USA than in Asia (p<0.001). Conversely, type I carcinomas are relatively common in Asia. These data theoretically imply that annual screening would be more effective in Asia.

Magnetic resonance imaging findings and prognosis of gastric-type mucinous adenocarcinoma (minimal deviation adenocarcinoma or adenoma malignum) of the uterine corpus: Two case reports

Our group previously documented the first, very rare case of primary gastric-type mucinous adenocarcinoma of the uterine corpus. Although this type of endometrial cancer appears to be similar to the gastric-type adenocarcinoma of the uterine cervix, its main symptoms, appearance on magnetic resonance imaging (MRI) and prognosis have not been fully elucidated due to its rarity. We herein describe an additional case of gastric-type mucinous adenocarcinoma of the endometrium and review the relevant literature. The two cases at our institution (Kyoto University Hospital, Kyoto, Japan) involved postmenopausal women with a primary complaint of abnormal genital bleeding. Microscopic examination of the hysterectomy specimens indicated a highly differentiated mucinous adenocarcinoma with a desmoplastic stromal reaction. Immunohistochemistry for HIK1083 and/or MUC6 was positive in both cases, suggesting a gastric phenotype. Both patients were diagnosed at an advanced stage, they relapsed or recurred immediately after adjuvant chemotherapy, and eventually succumbed to the disease. The main symptom of gastric-type mucinous adenocarcinoma of the uterine cervix is watery discharge, whereas abnormal genital bleeding in addition to watery discharge is mainly observed in the mucinous type of endometrial adenocarcinoma. Cystic cavities in the tumor are present on MRI in cases of endometrial origin, and prognosis is very poor due to resistance to chemotherapy. Thus, gastric-type mucinous adenocarcinoma of the uterine endometrium exhibits a clinical behavior that is similar to tumors originating from the uterine cervix, but is associated with distinguishing clinical symptoms. The incidence of gastric-type endometrial adenocarcinoma may be higher than expected.

Clinical efficacy of neoadjuvant chemotherapy with irinotecan (CPT-11) and nedaplatin followed by radical hysterectomy for locally advanced cervical cancer

OBJECTIVE

To investigate the clinical efficacy of neoadjuvant chemotherapy (NAC) with irinotecan (CPT-11) and nedaplatin (NED) followed by radical hysterectomy.

METHODS

Patients with locally advanced cervical cancer (stage Ib2-IIb) were treated with NAC followed by surgery, primary surgery or primary radiotherapy. NAC was usually performed using transuterine arterial chemotherapy (TUAC) or intravenous CPT-11/NED. Survival rates were analysed in the three treatment groups; response rates and adverse events associated with NAC, TUAC and CPT-11/NED were compared, along with previously reported adverse events of chemoradiotherapy.

RESULTS

A total of 165 patients with cervical cancer were recruited. Of these, 70 were treated with NAC followed by surgery (48 with CPT-11/NED, 18 with TUAC and four with other types of chemotherapy), 73 were treated with primary surgery and 22 with primary radiotherapy (including chemoradiotherapy). There were no significant differences in progression-free survival or overall survival rates between the three treatment groups. The response rates for the NAC regimen of CPT-11/NED and TUAC were high (75% and 78%, respectively). The frequency of severe thrombocytopenia was lower in patients receiving CPT-11/NED compared with TUAC, and the incidence of severe anaemia, vomiting and cystitis was lower in patients receiving CPT-11/NED compared with chemoradiotherapy.

CONCLUSIONS

The use of CPT-11/NED as a NAC regimen shows favourable activity, with lower toxicity compared with NAC using TUAC or chemoradiotherapy, for the treatment of locally advanced cervical cancer.

Establishment of a Novel Histopathological Classification of High-Grade Serous Ovarian Carcinoma Correlated with Prognostically Distinct Gene Expression Subtypes

Recently, The Cancer Genome Atlas data revealed four molecular subtypes of high-grade serous ovarian carcinoma (HGSOC) exhibiting distinct prognoses. We developed four novel HGSOC histopathological subtypes by focusing on tumor microenvironment: mesenchymal transition, defined by a remarkable desmoplastic reaction; immune reactive by lymphocytes infiltrating the tumor; solid and proliferative by a solid growth pattern; and papilloglandular by a papillary architecture. Unsupervised hierarchical clustering revealed four clusters correlated with histopathological subtypes in both Kyoto and Niigata HGSOC transcriptome data sets (P < 0.001). Gene set enrichment analysis revealed pathways enriched in our histopathological classification significantly overlapped with the four molecular subtypes: mesenchymal, immunoreactive, proliferative, and differentiated (P < 0.0001, respectively). In 132 HGSOC cases, progression-free survival and overall survival were best in the immune reactive, whereas overall survival was worst in the mesenchymal transition (P < 0.001, respectively), findings reproduced in 89 validation cases (P < 0.05, respectively). The CLOVAR_MES_UP single-sample gene set enrichment analysis scores representing the mesenchymal molecular subtype were higher in paclitaxel responders than nonresponders (P = 0.002) in the GSE15622 data set. Taxane-containing regimens improved survival of cases with high MES_UP scores compared with nontaxane regimens (P < 0.001) in the GSE9891 data set. Our novel histopathological classification of HGSOC correlates with distinct prognostic transcriptome subtypes. The mesenchymal transition subtype might be particularly sensitive to taxane.

Abstract A38: Identification through functional genomics screening of factors whose downregulation enhances the side population in ovarian cancer

Cancer stem cells (CSC) play a role in chemoresistance and cancer relapse. CSCs are enriched for a side population (SP) of cells as detected by efflux of hoechst dye. In this research, we performed a functional genomics screen to identify genes whose downregulation generates a SP of serous ovarian cancer cells.

We transfected a library of 81,000 shRNA lentiviral plasmids (Cellecta) targeting 15,000 genes into two serous ovarian cancer cell lines, CH1 and SKOV3, which harbor minimal SP fractions (less than 0.1%). Following transfection, we sorted cells to obtain the SP fraction, expanded these from independently plated single SP cells and extracted DNA. We amplified the transduced shRNAs by PCR and reconstructed shRNA-lentiviral plasmids, followed by transfection into CH1 or SKOV3 to determine reproducibility. Furthermore, we transfected different sequences of shRNAs targeting the identified genes and confirmed the consequent increase in the SP fraction. As a result, suppression of GeneA, GeneB and GeneC markedly increased the SP in CH1 cells (control; 0.08% vs GeneA; 1.1%, GeneB; 1.0%, GeneC; 2.0%). Suppression of GeneD, GeneE and GeneF markedly increased the SP of SKOV3 cells (control; 0.07% vs GeneD; 1.4%, GeneE; 1.1%, GeneF; 1.0%). Moreover, we overexpressed five genes (GeneA, GeneC, GeneD, GeneE and GeneF) in two serous ovarian cancer cell lines, A2780 and IGROV1, which contain more abundant SP fractions and found a marked decrease of the SP fraction (IGROV1: control, 6.8% vs 0.65%, 2.1%, 4.2%, 0.34%, 0.35%, p&lt;0.001, respectively, A2780: control, 3.48% vs 0.01%, 0.15%, 0.22%, 0.08%, 0.21%, p&lt;0.001, respectively).

We next analyzed phenotypic characteristics of CH1 cells in which GeneA, GeneB or GeneC is suppressed. In clonogenicity assays of single cells, we found that the SP had higher clonogenicity than the main population (MP) and control cells (control shRNA; 1%, sh-GeneA-SP vs. MP; 10.7% vs. 5.5%, sh-GeneB-SP vs MP; 8.5% vs. 2.2%, sh-GeneC-SP 3.0% vs. 1.0%, p&lt;0.05, respectively). The CH1 SP had higher tumorigenicity than the MP following subcutaneous injection of 1,000 cells into NOD/SCID mice (control shRNA, 1/4; sh-GeneA-SP vs. MP, 2/4 vs. 1/4; sh-GeneB-SP vs MP, 4/4 vs. 1/4; sh-GeneC-SP vs MP, 4/4 vs. 0/4, respectively). Suppression of these genes significantly elevated cisplatin IC50 values of CH1 cells as compared to the control-control, 40.9nM; sh-GeneA, 110nM; sh-GeneB, 102.3nM; sh-GeneC, 120.3nM; p&lt;0.05, respectively. In addition, suppression of GeneB contributed to paclitaxel resistance while suppression of GeneC enhanced resistance to gemcitabine and paclitaxel. (p&lt;0.05).

Also we investigated characteristics of SKOV3 cells in which GeneD, GeneE or GeneF was suppressed. In clonogenicity assays of single cells, we found that SP cells had higher clonogenicity than MP and control cells (p&lt;0.05, respectively). Suppression of these three genes significantly increased the IC50 values of SKOV3 for liposomal doxorubicin, gemcitabine and paclitaxel (p&lt;0.05, respectively). Suppression of GeneD significantly increased cisplatin IC50 values compared to control cells (p&lt;0.05).

In conclusion, we identified six genes, whose down-regulation contributed to an increase in the SP of serous ovarian cancer, through functional genomics screening. Moreover, suppression of these genes was associated with CSC phenotypes, including clonogenicity, chemoresistance and in vivo tumorigenicity. These results are important with regard to revealing the molecular mechanisms of tumor recurrence.

(Gene names are masked owing to potential conflict with a patent.)

Citation Format: Noriomi Matsumura, Koji Yamanoi, Susan K. Murphy, Junzo Hamanishi, Kaoru Abiko, Ken Yamaguchi, Tsukasa Baba, Masafumi Koshiyama, Ikuo Konishi. Identification through functional genomics screening of factors whose downregulation enhances the side population in ovarian cancer. [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 A38.

Genomic profile predicts the efficacy of neoadjuvant chemotherapy for cervical cancer patients

BACKGROUND

Neoadjuvant chemotherapy (NAC) using platinum and irinotecan (CPT-11) followed by radical excision has been shown to be a valid treatment for locally advanced squamous cervical cancer (SCC) patients. However, in NAC-resistant or NAC-toxic cases, surgical treatment or radiotherapy might be delayed and the prognosis may be adversely affected. Therefore, it is important to establish a method to predict the efficacy of NAC.

METHODS

Gene expression microarrays of SCC tissue samples (n = 12) and UGT1A1 genotyping of blood samples (n = 23) were investigated in terms of their association with NAC sensitivity. Gene expression and drug sensitivity of SCC cell lines were analyzed for validation.

RESULTS

Microarray analysis revealed that the glutathione metabolic pathway (GMP) was significantly up-regulated in NAC-resistant patients (p < 0.01), and there was a positive correlation between 50 % growth inhibitory concentrations of CPT-11 and predictive scores of GMP activation in SCC cells (r = 0.32, p < 0.05). The intracellular glutathione (GSH) concentration showed a highly positive correlation with GMP scores among 4 SCC cell lines (r = 0.72). UGT1A1 genotyping revealed that patients with UGT1A1 polymorphisms exhibited significantly higher response rates to NAC than those with the wild-type (79.5 vs. 49.5 %, respectively, p < 0.05).

CONCLUSIONS

These results indicate that GMP scores of cancerous tissue combined with UGT1A1 genotyping of blood samples may serve as highly potent markers for predicting the efficacy of NAC for individual SCC patients.

Invasion of uterine cervical squamous cell carcinoma cells is facilitated by locoregional interaction with cancer-associated fibroblasts via activating transforming growth factor-beta

OBJECTIVE

Local invasion is a common pattern of spread in uterine cervical squamous cell carcinoma (CSCC). Although transforming growth factor-beta (TGF-β) facilitates invasion of various types of cancer cells, the role of the TGF-β pathway in CSCC is unclear. In this study, we analyzed the role of TGF-β signaling in the progression of CSCC.

METHODS

Immunohistochemistry was used to examine the expression of TGF-β pathway molecules in 67 CSCC samples with clinicopathological data. Activation of the TGF-β pathway was investigated following co-culture of CSCC cells and cervical cancer-associated fibroblasts (CCAFs).

RESULTS

Clinicopathological analysis of CSCC samples revealed that prominent expression of TGF-β receptor-2 was more frequent in CSCC with lymphovascular space invasion (LVSI) than without LVSI (p < 0.01). Lymph node metastasis was more frequent in cases in which phosphorylated SMAD3 (pSMAD3) was localized exclusively at the boundary of tumor clusters (n = 9, p < 0.05). Recombinant TGF-β1 increased pSMAD3 expression and enhanced cellular invasion (p < 0.005) in CSCC cells, which was attenuated by an inhibitor of the TGF-β receptor (p < 0.005). Enhanced pSMAD3 expression and invasion was also observed when conditioned media from CSCC cells co-cultured with CCAFs were administered. Luciferase assays showed that this medium contained a large amount of active TGF-β. Along with TGF-β activation, thrombospondin-1 was upregulated in both CSCC cells and CCAFs, while thrombospondin-1 silencing in either CSCC cells or CCAFs repressed the activity of TGF-β. Thrombospondin-1 was prominently expressed in cases with pSMAD3 boundary staining (p < 0.05).

CONCLUSIONS

These results suggest that interaction between CSCC cells and surrounding CCAFs activates TGF-β via thrombospondin-1 secretion to facilitate CSCC invasion.

Two cases of recurrent ovarian clear cell carcinoma treated with sorafenib

Sorafenib is an oral multikinase inhibitor targeting Raf and other kinases. The anti-tumor effect of sorafenib is thought to be mediated through its inhibition of the RAS-Raf-Erk pathway, as well as its inhibition of VEGFR and PDGFR. Sorafenib has been effective at treating patients with renal cell carcinoma (RCC). Ovarian clear cell carcinoma (OCCC) is a chemoresistant subtype of ovarian cancer. OCCC is represented by cells with clear cytoplasm that resemble those observed in RCC. Using a microarray database, the gene expression profile of OCCC was similar to that of RCC. The effects of sorafenib against human OCCC are unknown. Therefore, we used sorafenib to treat two patients with recurrent chemoresistant OCCC, and observed good effect in both of them without severe side effects. We believe that sorafenib is an effective agent against OCCC. Given the chemoresistant nature of this tumor, this drug appears to be very valuable.

Exchange of intraoperative balloon occlusion of the internal iliac artery for the common iliac artery during cesarean hysterectomy in a patient with placenta percreta

Patient: Female, 36

Final Diagnosis: Pregnancy – placenta increta

Symptoms: —

Medication: —

Clinical Procedure: Cesarean hysterectomy

Specialty: Obstetrics and Gynecology

Advanced papillary serous carcinoma of the uterine cervix: a case with a remarkable response to paclitaxel and carboplatin combination chemotherapy

Papillary serous carcinoma of the uterine cervix (PSCC) is a very rare, recently described variant of cervical adenocarcinoma. This review, describes a case of stage IV PSCC whose main tumor existed in the uterine cervix and invaded one third of the inferior part of the anterior and posterior vaginal walls. Furthermore, it had metastasized from the para-aortic lymph nodes to bilateral neck lymph nodes. Immnoreactivity for CA125 was positive, whereas the staining for p53 and WT-1 were negative in both the original tumor and the metastatic lymph nodes. Six cycles of paclitaxel and carboplatin combination chemotherapy were administered and the PSCC dramatically decreased in size. The main tumor of the uterine cervix showed a complete response by magnetic resonance imaging (MRI), and on rebiopsy, more than 95% of the tumor cells in the cervix had microscopically disapperared. This is the first report of PSCC in which combination chemotherapy was used and showed a remarkable response.

Distinguishing primary from secondary mucinous ovarian tumors: an algorithm using the novel marker DPEP1

Distinguishing primary mucinous ovarian cancers from ovarian metastases of digestive organ cancers is often challenging. Dipeptidase 1 was selected as the candidate novel marker of colorectal cancer based on an analysis of a gene expression microarray. Immunohistochemical analysis indicated that 13/16 ovarian metastases of colorectal cancers, but only 1/58 primary mucinous ovarian cancers, were dipeptidase 1-positive (threshold; ≧25% expression, P<0.0001). Next, five immunohistochemical markers (dipeptidase 1, estrogen receptor-α, cytokeratin 7, cytokeratin 20, and caudal type homeobox 2) were analyzed in combination. In a hierarchical clustering analysis, the mutually exclusive expression of cytokeratin 7 and dipeptidase 1 specifically identified the ovarian metastases of colorectal cancers (P<0.0001). In a decision tree analysis, cytokeratin 7, caudal type homeobox 2, and dipeptidase 1 classified primary mucinous ovarian cancers and ovarian metastases of digestive organ cancers with 90% accuracy. Finally, the five immunohistochemical markers were combined with six preoperative factors (patient's age, tumor size, laterality, serum CEA, CA19-9, and CA125) and combinations were analyzed. Of the 11 factors, 4 (dipeptidase 1, cytokeratin 7, caudal type homeobox 2, and tumor size) were used to generate a decision tree to classify primary mucinous ovarian cancers and metastases of digestive organ cancers with 93% accuracy. In conclusion, we identified a novel immunohistochemical marker, dipeptidase 1, to distinguish primary mucinous ovarian cancers from ovarian metastasis of colorectal cancers. The algorithm using immunohistochemical and clinical factors to distinguish metastases of digestive organ cancers from primary mucinous ovarian cancers will be useful to establish a protocol for the diagnosis of ovarian metastasis.

Retroperitoneal lipoma arising from the urinary bladder

Retroperitoneal benign lipomas are extremely rare and represent about 2.9% of all primary retroperitoneal tumors. About 80% of the tumors in the retroperitoneal cavities are malignant neoplasms. We experienced a case of a retroperitoneal lipoma simulating an ovarian mature cystic teratoma. A diagnosis was correctly made by magnetic resonance imaging (MRI) prior to surgery, and a total tumorectomy was performed. The retroperitoneal lipoma was recognized to have arisen from the urinary bladder. Histological sections revealed a tumor consisting of typical adipose cells without atypia. These types of lipomas should be carefully followed-up because they often recur and undergo malignant transformations.

Chemosensitivity testing of paclitaxel versus docetaxel in human gynecological carcinomas: a comparison with carboplatin

BACKGROUND

The tetrazolium dye (MTT) assay is useful in predicting chemosensitivity.

MATERIALS AND METHODS

Using the MTT assay, an in vitro chemosensitivity test was designed for paclitaxel and docetaxel. The results were then compared with the sensitivity to carboplatin in 60 resected gynecological carcinomas.

RESULTS

The mean tumor inhibition rates [I.R.s; %] for paclitaxel, docetaxel and carboplatin were all higher in ovarian carcinomas than in endometrial carcinomas [74.3% vs. 47.3% (p < 0.01), 57.2% vs. 21.9% (p < 0.001), 71.3% vs. 50.1% (p < 0.01), respectively]. In 28 ovarian carcinomas, the I.R.s for paclitaxel and carboplatin were higher than docetaxel [74.3% and 71.3% vs. 57.2%, respectively (p < 0.05)]. In particular, the I.R. for paclitaxel was significantly higher than docetaxel [83.0% vs. 62.9% (p < 0.05)] in serous adenocarcinomas. In clear cell adenocarcinomas, however, both the I.R.s for paclitaxel and docetaxel were significantly lower than carboplatin [27.8% and 23.3% vs. 58.5%, respectively (p < 0.01)]. In 10 cervical carcinomas, the I.R. for docetaxel was significantly lower than paclitaxel and carboplatin [39.5% vs. 64.1% and 60.5%, respectively (p < 0.05)]. In 22 endometrial carcinomas, the I.R. for docetaxel was also lower than paclitaxel and carboplatin [21.9% vs. 47.4% and 50.1% (p < 0.01, p < 0.001, respectively)]. Furthermore, the I.R. for docetaxel was significantly lower in G2 and G3 adenocarcinomas [16.9% vs. 45.8% and 52.8% (p < 0.05, p < 0.01, respectively)] [16.5% vs. 46.2% and 53.2% (p < 0.01, p < 0.001, respectively)].

CONCLUSION

The antitumor activity of both paclitaxel and docetaxel was higher in ovarian carcinomas than in endometrial carcinomas. In ovarian carcinomas, however, paclitaxel and carboplatin were superior to docetaxel. In cervical and endometrial carcinomas, docetaxel was significantly worse than paclitaxel and carboplatin.

Chemosensitivity testing of a novel platinum analog, nedaplatin (254-S), in human gynecological carcinomas: a comparison with cisplatin

BACKGROUND

The tetrazolium dye (MTT) assay is useful for predicting chemosensitivity.

MATERIALS AND METHODS

Using the MTT assay, an in vitro chemosensitivity test was designed for nedaplatin (cis-diammine glycolato platinum; 254-S) and the results were compared with the sensitivity to cisplatin in 137 resected gynecological carcinomas.

RESULTS

The mean tumor inhibition rate [I.R.; %] for nedaplatin was equal or superior to cisplatin in 15 cervical [70.7% vs. 63.9%], 65 ovarian [61.7% vs. 54.8%] and 57 endometrial carcinomas [52.1% vs. 47.7%]. In ovarian carcinomas, the I.R.s for nedaplatin were significantly higher than cisplatin in poorly-differentiated, serous and endometrioid adenocarcinomas 180.7% vs. 56.4% (p < 0.05), 77.0% vs. 64.9% (p < 0.01), and 68.2% vs. 54.6% (p < 0.05), respectively].

CONCLUSION

Our data suggest that nedaplatin has equivalent or superior antitumor activity to cisplatin in cervical, ovarian and endometrial carcinomas. In particular, nedaplatin showed a significantly better antitumor activity among the histological subtypes of ovarian carcinomas.

[Bilateral massive ovarian edema: a case report including MR findings and etiology]

A 42-year-old woman with bilateral massive ovarian edema (MOE) is presented. MOE is usually seen in women 6 to 33 years of age. Therefore, accurate re-operative assessment of MOE is important to avoid unnecessary oophorectomy procedures. MR findings of MOE are characteristic and reflect very well the diffuse stromal edema noted on microscopy. The etiology and MR findings of MOE are discussed.

Rapidly growing leiomyoma in a postmenopausal woman

We present here a case of a rapidly growing leiomyoma occurring after menopause. The tumor weighed 4329 g, suggesting the rapid accumulation of 'hyaline fibrosis'. A small amount of proliferative activity was detected as evidenced by Ki-67 antigen immunoreactivity.

Treatment of huge uterine tumors thought to be benign in post-menopausal women

BACKGROUND

When we find a huge uterine myoma-like tumor after menopause, we are hesitant whether to recommend surgery or not.

MATERIAL/METHODS

In order to treat huge uterine tumors after menopause, we surgically removed a total of 25 uterine tumors over 10 cm in diameter from 25 post-menopausal women, and examined these tumors microscopically.

RESULTS

Clinical assessments of the 25 tumors before surgery indicated that 24 were myomas and one was a sarcoma, based on cytology-, sonography- and MR imaging-examinations. However, the postoperative histological results revealed 22 leiomyomas, one leiomyosarcoma, one endometrial stromal sarcoma and one endometrial carcinoma at Ic stage complicated by multiple leiomyomas. Overall, 12% of the tumors were malignant (3/25 cases) and 8.3% were false negative cases (2/24 cases; diagnosed as myoma uteri) among the cases of huge uterine tumors after

CONCLUSIONS

When a huge uterine tumor after menopause is diagnosed clinically as myoma uteri, surgery should be recommended since there ia a significant chance of malignancy.

The relationship between endometrial carcinoma and coexistent adenomyosis uteri, endometriosis externa and myoma uteri

The relationship between endometrial carcinoma and coexistent adenomyosis uteri, endometriosis externa and myoma uteri has been reported in only a few studies. We studied the characteristics of the endometrial carcinomas accompanied by these benign diseases. The total number of endometrial carcinoma cases was 179, consisting of 29 (16%) endometrial carcinomas with adenomyosis uteri, 12 (7%) with endometriosis externa, 51 (28%) with myoma uteri, and 87 controls (49%) without these benign diseases. Seventy-nine, 75, and 65% of the endometrial carcinomas with adenomyosis uteri, endometriosis externa and myoma uteri, respectively, showed a low histologic grade (G1). In particular, the patients with adenomyosis uteri and endometriosis externa were relatively younger than the control patients (54.2, 54.1 years old versus 57.7 years old). Furthermore, these patients were all treated at stage 1 and had a good prognosis. In brief, there are some clinicopathologic differences between the endometrial carcinoma cases with benign hormone-dependent disease and the cases without these disease.

Two kinds of endometrial neoplasia arising from different origins in the uterine corpus: comparison of p53 expression and sex steroid receptor status

This study presents a case of endometrial clear cell adenocarcinoma complicated by complex atypical glandular hyperplasia surrounded by adenomyosis in the uterine myometrium. The former was immuno-negative for estrogen receptor (ER) and positive for p53, whereas both of the latter were immuno-positive for ER and negative for p53. Therefore, there were two kinds of neoplasia arising from different origins in the uterine corpus.

Intermittent, repetitive administrations of irinotecan (CPT-11) reduces its side-effects

To reduce the side-effects of irinotecan (CPT-11) while maintaining its anti-cancer effects against recurrent ovarian carcinomas, we devised a novel administration schedule for CPT-11 single chemotherapy. It consisted of an initial dose of 70 mg/m2, followed by increasing the dose to 100 mg/m2 every 10 days (three times per month) for 9 cycles. Nineteen patients with refractory or recurrent ovarian carcinomas were treated. In comparison with a late phase II study of single CPT-11 chemotherapy in Japan (100 mg/m2 every 7 days; four times per month), the number of patients who suffered from leukocytopenia and diarrhea higher than grade 3 was significantly lower with our new method (36.8 versus 57.1%; P < 0.01 and 0 versus 19.2%; P < 0.001, respectively). The total response rate was 26% (5/19). This rate was almost equal to a late phase II study. We suggest that our new protocol of single CPT-11 administration should be available clinically to all patients for reducing the side-effects while maintaining its anti-cancer effects. CPT-11 is useful in patients with refractory ovarian carcinomas as a second- or third-line chemotherapy.

Adenocarcinomas arising from uterine adenomyosis: a report of four cases

Adenocarcinomas arising from adenomyosis uteri are rare. This study reports four such cases and characterizes them clinically and microscopically. In all four patients, the endometrial cytology was negative, and MR imaging and ultrasound sonography did not detect the tumors preoperatively. The histological subtypes of the four tumors were endometrioid (one grade 1, one grade 3), serous, and clear cell. In three cases, the adenocarcinomas were present exclusively in the myometrium, and a transition between the carcinomas and the adenomyotic glands was observed in all cases. The eutopic endometrium was normal except in one case in which there was a small focus of invasive carcinoma. In two of four cases, pelvic or paraaortic lymph node metastases were present. In the carcinomas, ER immunoreactivity was not found in any tumor and PR positivity was found in only one tumor. In contrast, p53 immunopositivity was found in three of four carcinomas. Adenocarcinomas arising from adenomyosis are difficult to diagnose preoperatively, and their aggressive behavior in some cases seems to be related to the histological subtype.

Cystic Ovarian Lesions in SSFP Diffusion Imaging

PURPOSE

MR assessments of ovarian cystic lesions are usually based on morphological features, signal intensities and enhancement with contrast media. This study was performed to evaluate the usefulness of the steady-state free precession (SSFP) diffusion imaging of cystic ovarian lesions for analyzing cystic contents.

MATERIALS AND METHODS

Sixty-one ovarian cystic lesions in 37 patients were examined. The diffusion-related coefficient (DRC) and the ratio of the relative apparent diffusion coefficient of the lesion to that of subcutaneous fat tissue (rADC(L)/rADC(F)) were calculated from SSFP diffusion images.

RESULTS

The DRCs and the rADC(L)/rADC(F) ratios in endometrial cysts and in the fatty parts of dermoid cysts were significantly lower than in other cystic tumors.

CONCLUSION

SSFP diffusion imaging can be included in clinical practice to analyze ovarian cystic lesions within a short scan time; the DRC and the rADC(L)/rADC(F) ratio are useful for evaluating cystic contents.

Immunohistochemical expression of topoisomerase IIalpha (Topo IIalpha) and multidrug resistance-associated protein (MRP), plus chemosensitivity testing, as chemotherapeutic indices of ovarian and endometrial carcinomas

OBJECTIVE

The purpose of this study was to investigate the chemosensitive and chemoresistant indices of gynecologic malignancies.

METHODS

We studied the expression of topoisomerase II alpha(Topo II alpha) and multidrug resistance-associated protein (MRP), and then correlated them with the in vitro chemosensitivities of gynecologic tumor cells using immunohistochemistry and a tetrazolium dye (MTT) assay.

RESULTS

In the 19 ovarian carcinomas examined, the mean Topo II alpha index (%) and the tumor cell growth inhibition rate (I.R.: %) for doxorubicin and etoposide in the clear cell adenocarcinomas [15.8, 21.4, 32.3] were all lower than in the endometrioid [33.9; p<0.001, 58.3, 61.9; p<0.05, respectively] and serous adenocarcinomas [43.6; p<0.001, 75.0, 79.8; p<0.01, respectively]. Comparing these markers with the clinical response to chemotherapy, the overall predictive accuracy of the Topo II alpha index and the MTT assay was 87.5% (14/16) and 81.3% (13/16), respectively. In the 24 endometrial carcinomas examined, the mean Topo II a index and the I.R for doxorubicin and etoposide in the G1 carcinomas [22.2, 26.8, 21.5] were significantly lower than in the G2/G3 carcinomas [38.4, 54.0; p<0.001, 40.5; p<0.05]. Furthermore, strong MRP expression (> or = 50%) was detected in 13 (93%) of the 14 G1 carcinomas, but in only 4 (44%) of the 9 G2/G3 carcinomas (p<0.05).

CONCLUSIONS

The Topo II alpha index and the results of in vitro chemosensitivity testing may be of assistance in selecting the appropriate chemotherapeutic drugs against gynecologic malignancies based on their histological type and differentiation, along with MRP expression.

Gynecologic malignancies accompanied by benign hormone-dependent diseases

OBJECTIVE

To investigate the correlation between benign gynecologic diseases and hormone-dependent malignancies such as endometrial carcinoma in postmenopausal women.

DESIGN

We retrospectively analyzed the prevalence of myoma uteri and adenomyosis uteri in 136 cases of endometrial carcinomas. We used 222 uterine prolapse cases as controls.

RESULTS

The results showed that 21.6% and 9.9% of healthy postmenopausal women (control) had myoma uteri and adenomyosis uteri, respectively, after the cessation of menses. However, postmenopausal women with endometrial carcinomas had a 1.5- to 2-fold higher prevalence, respectively, for myoma uteri and adenomyosis uteri as compared with the postmenopausal control women.

CONCLUSION

There was a higher prevalence of myoma uteri and adenomyosis uteri in postmenopausal patients with endometrial carcinomas than in the control population.

Correlation between Topo II alpha expression and chemosensitivity testing for Topo II-targeting drugs in gynaecological carcinomas

BACKGROUND

The purpose of this study was to investigate the correlation between topoisomerase II alpha (Topo II alpha) expression and the chemosensitivity to Topo II-targeting drugs in gynaecological carcinomas.

MATERIALS AND METHODS

We analysed the expression of Topo II alpha, and then correlated this with the in vitro chemosensitivities of 43 gynaecological tumors using immunohistochemistry and a tetrazolium dye (MTT) assay.

RESULTS

There was a significant correlation between the Topo II alpha index (the number of positive cells per 100 cells: %) and the tumor cell growth inhibition rate in culture (I.R.: %) for doxorubicin and etoposide (r = 0.631, p < 0.001 and r = 0.645, p < 0.001, respectively). The I.Rs for doxorubicin and etoposide in endometrial carcinomas were lower than those in ovarian carcinomas [38.2 +/- 22.8 vs 54.6 +/- 29.8, 37.3 +/- 19.8 vs 59.3 +/- 30.6] (p < 0.05, respectively). Furthermore, the number of high Topo II alpha index (over 30%) tumors in the ovarian carcinoma cases was higher than that in the endometrial carcinoma cases (63.1% vs 45.8%, p < 0.05).

CONCLUSIONS

Our data suggest that the Topo II alpha index of a tumor is a reflection of its chemosensitivity to Topo II-targeting drugs. The use of this index may enable prediction of a clinical response to chemotherapy using Topo II-targeting drugs in gynaecological malignancies.

Management of malignant ovarian tumors in young women. 21 nulliparous cases

To evaluate the management of malignant ovarian tumors in young women who wish to maintain fertility, we retrospectively reviewed ovarian malignancies in 21 young women who were both nulliparous and under 40 years of age. With stage 1a disease, all 9 patients were treated with conservative surgical therapies, and all of them are still alive, irrespective of histological type. With stage 1c disease, 5 (83%) of 6 patients were treated with conservative surgical therapies. Among them, 2 patients with epithelial tumors, who were treated with conservative surgical therapies and potent cis-diamminedichloroplatinum (CDDP)-based combined chemotherapies, are still alive. Furthermore, one of them had a successful pregnancy. On the other hand, 3 out of 4 patients with nonepithelial tumors were treated with conservative surgical therapies. However, 2 (67%) out of 3 died; both of them were treated with non-CDDP-based chemotherapy. In 6 patients with disease beyond stage 2, 4 (67%) were treated with radical surgical therapies, but 2 (33%) were treated with conservative surgery and CDDP-based combined chemotherapy, one of which was followed by a successful pregnancy in spite of nonepithelial tumor. As above, we could obtain some successful pregnancies in cases beyond stage 1c after conservative surgery by adding definite CDDP-based combined chemotherapy. However, we must carefully select the patients with nonepithelial tumors for conservative therapy by adding definite CDDP-based combined chemotherapy and inform them of the risks of therapy.

Chemosensitivity testing of irinotecan (CPT-11) in ovarian and endometrial carcinomas: a comparison with cisplatin

BACKGROUND

The tetrazolium dye (MTT) assay is useful in predicting chemosensitivity.

MATERIALS AND METHODS

Using an MTT assay, we designed an in vitro chemosensitivity test for irinotecan (CPT-11) and compared it with sensitivity to cisplatin in gynecologic carcinomas removed from 49 patients.

RESULTS

The mean tumor inhibition rate (I.R.: %) for irinotecan was relatively inferior to the I.R. for cisplatin in both ovarian and endometrial carcinomas [40.2 vs 53.2 and 43.5 vs 58.0] (p < 0.05, respectively). In ovarian carcinomas, 13 (48.1%) of 27 cases were irinotecan-sensitive (I.R. > or = 50%) and 77% of the tumors were judged to be irinotecan and/or cisplatin-sensitive. There was no significant difference in the I.R. for irinotecan among the various histologic subtypes. Comparing in vitro sensitivity to irinotecan with clinical responses in 8 patients who received irinotecan, the overall accuracy of the MTT assay for evaluating clinical effectiveness was 75% (6 out of 8). In endometrial carcinomas, we found 9 (40.9%) out of 22 cases to be irinotecan-sensitive. The I.R. for irinotecan in G1 carcinomas [33.5] was significantly lower than in G2 carcinomas [59.3] (p < 0.05).

CONCLUSION

Our data suggest that irinotecan appears to have moderate antitumor activity in vitro against both ovarian and endometrial carcinomas and that differences in irinotecan sensitivity among the histologic subtypes were evident in the latter but not in the former.

Ovarian actinomycosis complicated by diabetes mellitus simulating an advanced ovarian carcinoma

A patient presented with a pelvic tumor which mimicked an advanced ovarian carcinoma with invasion into urinary bladder, rectum and uterus, as detected by MR imaging. After surgery, however, actinomycosis of the left ovary was diagnosed by pathological examination. Ovarian actinomycosis in this patient was complicated by diabetes mellitus.