Cervical Involvement Research Articles

Primary Non-Hodgkin lymphoma of the tongue with cervical lymph node involvement: A rare presentation masquerading squamous cell carcinoma

Primary non-Hodgkin lymphoma (NHL) of the tongue is extremely rare. We present here a case of primary diffuse large B cell NHL, non-germinal center type in a 60-year-old female, who presented with a mass in the base of the tongue and vallecula with cervical lymphadenopathy. Clinically, a diagnosis of squamous cell carcinoma was kept. Fine-needle aspiration cytology was useful in the early diagnosis of the intraoral NHL involving a cervical lymph node.

Does Sequencing of Adjuvant Therapy Influence Outcome for Stage IIIC Endometrial Carcinoma? A Multi-institutional Analysis

In GOG-258, patients who received upfront chemoradiotherapy had more distant relapses compared to those treated with systemic chemotherapy alone, although vaginal and nodal recurrence rates were lower with the addition of adjuvant radiotherapy (RT). Given the importance of both systemic and local therapies, this study evaluates clinical outcomes by the sequence and type of adjuvant therapy for patients with stage IIIC endometrial cancer (EC). In a multi-institutional retrospective cohort study, clinical and treatment data from 12 academic centers were collected for patients with stage IIIC EC treated with curative intent. All patients had surgical staging and received chemotherapy and radiation. Adjuvant treatment (AT) regimens were classified as: adjuvant chemotherapy followed by sequential radiation (ACTRT), concurrent chemoradiation followed by chemotherapy (CCTRT), systemic chemotherapy before and after RT (Sandwich), adjuvant RT followed by chemotherapy (ARTCT) or chemotherapy concurrent with vaginal cuff brachytherapy alone (CCTBT). Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by Kaplan-Meier method and covariates were compared by log-rank test. Chi-square tests were used to compare categorical variables. A total of 670 eligible patients were included (Table) with a median follow-up of 44.1 months. The estimated 5-year OS and RFS rates were 71.5% and 65.5%, respectively. On univariate analysis (UVA) for OS, older age, non-white race, non-endometrioid histology, grade 3 tumor, 2 or more positive nodes, adnexal involvement, cervical involvement, stage IIIC2 vs. IIIC1, and in-field recurrence were associated with worse OS (all p<0.02). On UVA for RFS, older age, non-endometrioid histology, grade 3 tumor, lymphovascular invasion, adnexal involvement, cervical involvement and stage IIIC2 were associated with recurrence. The sequence and type of adjuvant therapy was not correlated with OS or RFS (p = 0.08 and 0.8, respectively). The most common pattern of recurrence was distant metastasis only (66%). Site of first recurrence was significantly different by adjuvant treatment regimen (p = 0.02): ACTRT, CCTRT and Sandwich had a higher proportion of distant metastasis whereas ARTCT and CCTBT had more para-aortic nodal recurrences. Pelvic control was highest for ACTRT. The sequence and type of adjuvant therapy did not impact OS or RFS rates, which were comparable to those of the prospective GOG 258 and PORTEC-3 studies. Adjuvant radiotherapy resulted in excellent pelvic control. Most recurrences were distant despite upfront systemic chemotherapy given in most patients, highlighting the need for novel regimens.Abstract 102; TableFactornAge, Median62Race Caucasian African-American Other480 83 47Stage IIIC1 IIIC2430 240Histology Endometrioid Non-endometrioid441 229Grade 1-2 3320 346RT EBRT BT Both176 94 400Adjuvant therapy ACTRT CCTRT Sandwich ARTCT CCTBT290 112 165 26 77 Open table in a new tab

Extranodal Expansion Of The Lymph Nodes Is An Effective Predictor Of Distant Metastasis Of Nasopharyngeal Carcinoma After Radical Radiotherapy And Chemotherapy

Extranodal extension (ENE) of the lymph nodes is a criterion for advanced nodal staging of oropharyngeal and hypopharyngeal carcinoma. The purpose is to investigate whether ENE is a factor affecting distant metastasis of nasopharyngeal carcinoma after radical radiotherapy and chemotherapy. From January 2009 to December 2014, 318 patients of NPC after radical radiotherapy and chemotherapy were enrolled. All patients received radical intensity-modulated radiotherapy. Concurrent chemotherapy was cisplatin intravenous drip every 3 weeks for 4-6cycles.MRI was retrospectively reviewed in all patients and the ENE of the lymph nodes was evaluated in patients with metastatic lymph nodes. According to the tendency of disease metastasis, patients were divided into ascending and descending types. Ascending type (Type A,T3-4N0-1) was defined as advanced local disease and early-stage cervical lymph-node involvement; advanced lymph-node metastases but early -stage local disease was classified as descending type (Type D,T1-2N2-3). Kaplan-Meier methods and Cox proportional hazard models were used to evaluate the impact of different types on distant metastasis free survival. The 5-year distant metastasis-free survival (DMFS) rate of all patients was 85%. There were 143 patients with type A and 175 patients with type D. Compared with type A, type D had worse 5-year DMFS (95% vs 78%; P < 0.05). For type A, univariate analysis and multivariate analysis suggested that ENE was closely related to distant metastasis (P < 0.05). Compared with negative ENE, ENE positive had a higher probability of metastasis within 5 years (DMFS: 99% vs 66.7%; P < 0.05). The independent prognostic factors of type D distant metastasis are ENE and the number of positive lymph nodes. ENEpositive is more likely to have distant metastasis than ENEnegative (DMFS: 84% vs 62.7%). Compared with patients with more than 4 positive lymph nodes, patients with less than 4 positive lymph nodes have significantly better DMFS (83.7% vs 90.9%; P < 0.05 for all). Patients with type D was more likely to metastasize than type A, but no matter how it was typed, ENE was an independent factor affecting distant metastasis and could be considered as a new standard for NPC lymph node staging.

Adjuvant radiotherapy for endometrial cancer with cervical stromal involvement: A patterns of practice survey in Australia and New Zealand.

The purpose of this study is to describe the patterns of practice in Australia and New Zealand for post-operative radiotherapy in endometrial cancer with cervical stromal involvement. A ten-item survey including five clinical case scenarios in endometrial cancer with cervical stromal invasion was emailed to Royal Australian and New Zealand College of Radiologists (RANZCR) radiation oncologists in 2018. Responses were analysed to determine relative frequency distributions and preferred adjuvant treatment modalities for the clinical case scenarios. A total of 65 respondents initiated the survey with 27 respondents treating more than 11 endometrial cancer cases annually. Only 31 respondents answered all five clinical case scenarios. Preferred adjuvant radiotherapy modalities varied for the Stage II cases between vault brachytherapy (VB), pelvic external beam radiotherapy (EBRT) or a combination. For the stage IIIA and IIIC1 cases, the majority recommended pelvic EBRT with or without VB boost (79% and 77%), and of these, most combined with chemotherapy (61% and 88%). For 4 of the 5 case scenarios, when pelvic EBRT was offered, most recommended a VB boost. This patterns of practice survey suggests variability in adjuvant radiotherapy recommendations in endometrial cancer with cervical involvement, particularly in cases where there is lack of randomised data and discrepancies in consensus guidelines.

Cervical spine manifestations of rheumatoid arthritis: a review.

Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.

Utility of sonography for identifying metastatic cervical adenopathy in children with differentiated thyroid carcinoma at presentation.

No study has evaluated the diagnostic accuracy of sonography for the depiction of metastatic cervical adenopathy in children with differentiated thyroid carcinoma at presentation or determined which sonographic features are most useful. To evaluate the diagnostic accuracy of sonography for identifying metastatic cervical adenopathy in children with differentiated thyroid carcinoma at presentation and to determine the most useful sonographic features. We evaluated cervical lymph node sonography and histology in children with proven thyroid carcinoma in a 10-year period. We excluded children in whom a preoperative sonogram was not available and those who did not have surgical resection of lymph nodes. We used histology as the gold standard. On sonography, we analyzed the size, shape, echotexture and vascularity of the lymph nodes and correlated these findings with the histology. We reviewed sonograms and histology of resected lymph nodes in 52 children and adolescents with proven differentiated thyroid carcinoma (33 females; ages 5-18years, mean 13.2years). Metastatic cervical lymph node disease was proved on histology in 33/52 (64%) of our patients at presentation. Sonographic findings correctly predicted whether the nodes were histologically involved with metastatic disease in 42/52 (81%). Sensitivity of sonography was 79%, specificity 84%, positive predictive value (PPV) 90%, negative predictive value (NPV) 70% and accuracy 81%. A significant association was seen between round shape (P=0.0002), abnormal echotexture (P≤0.0001) and vascularity (P≤0.0001), and abnormal lymph node histology. Importantly, in 11/26 (47%) patients with sonographic and histologically proven abnormal nodes, the nodes were normal in size and shape and the presence of metastatic involvement was recognized sonographically only on the basis of abnormal echogenicity and vascularity. Sonography has a high accuracy, specificity and PPV for identifying metastatic cervical lymph node involvement in children with differentiated thyroid carcinoma at presentation. Most of the abnormal lymph nodes were round in shape and had abnormal echogenicity and vascularity. Importantly, this paper emphasizes that in children, nodes with histologically proven metastases from differentiated thyroid carcinoma can be normal in size and shape. In these patients the presence of metastatic involvement might be recognized sonographically only on the basis of abnormal echogenicity and vascularity.

Preoperative and intraoperative assesment of myometrial invasion and histological grade section

Objective: The role of systematic lymphadenectomy in clinically early-stage endometrial cancer is controversial. A number of factors can predict lymph node metastasis including myometrial invasion, tumor grade in endometrial cancers. The purpose of the present study is to evaluate the accuracy of preoperative MRI and intraoperative frozen section in determining the depth of myometrial invasion, cervical involvement, tumor size, and lymph nodal status. We also studied the accuracy of preoperative endometrial biopsy and intraoperative frozen section in determining the grade of the tumor.

Necessity of radical hysterectomy for endometrial cancer patients with cervical involvement

Necessity of radical hysterectomy for endometrial cancer patients with cervical involvement

S1902 Video Swallow Study and Neck CT Reveals the Rare Association of Diffuse Idiopathic Skeletal Hyperostosis With Oropharyngeal Dysphagia

INTRODUCTION: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by non-inflammatory ossification of ligamentous tissue. While the disease is not uncommon, cervical involvement is rare, and oropharyngeal obstruction as a presenting symptom is even more infrequent. An existing diagnosis of DISH or previous radiographic evidence of the process should be high on the differential when evaluating for new or progressive dysphagia. CASE DESCRIPTION/METHODS: An 82-year-old male with a history of cervicalgia was evaluated for six months of solid food dysphagia. During this period he endorsed an unintentional 15 lb weight loss. Outside of his cervicalgia, a full review of systems was negative other than a mild benign tremor. Initial evaluation of dysphagia by endoscopy was unremarkable. A head/neck CT was obtained, with referral to speech pathology for a video-fluoroscopic swallow study which revealed osteophytes at C3-C4 and C5-C6, with impaired bolus transfer. Both ENT and neurosurgery were consulted. Given his dysphagia he underwent surgery for C3 through C7 osteophyte resection. At a 6-month follow-up, he endorsed a near complete resolution of cervicalgia and dysphagia. DISCUSSION: Cervical osteophytes are a known cause of oropharyngeal dysphagia, causing obstruction via anterior displacement of the hypopharynx. Odynophagia due to pressure ulcerations is often a presenting symptom. However, it is atypical for DISH, or Forestier Disease, to present as such. DISH is a disorder of abnormal ossification with a pathogenesis that is not fully understood. While the disease lacks consistent laboratory abnormalities or associated genetic markers, radiologic findings are well established and include ossification of the anterior paravertebral ligaments and peripheral enthuses. The relative risk of dysphagia in DISH is not well established. Typically, a consult to surgery for resection in cases of dysphagia is recommended; but due to the rarity of this presentation, there is limited data on optimal management. As DISH associated musculoskeletal symptoms are typically conservatively managed similarly to mild chronic lower back pain, there is potential for overlooking the disease during evaluation of dysphagia. In patients with cervicalgia or lower back pain, review of previous imaging studies to rule out DISH may be warranted.Figure 1.: Video Fluoroscopic Swallow Study showing impaired transfer corresponding to visible cervical osteophytes, in particular at C3-C6.Figure 2.: Head/Neck CT, Sagittal View Prior to surgical intervention with osteophyte resection.Figure 3.: Head/Neck CT, Sagittal view following C3 through C7 anterior cervical disc osteophyte resection.

Phenotypic heterogeneity in Chinese dystonia patients with KMT2B variants

Background: KMT2B-related dystonia is a recently discovered childhood onset movement disorder. It usually progresses to generalized dystonia with cervical, cranial, pharynx and larynx involvement. Our study is to summarize genotype-phenotype features with KMT2B-related dystonia in China.

Locally advanced nasal pyramid squamous cell carcinoma: our 15 years’ experience in a series of 35 total rhinectomies

Locally advanced nasal pyramid squamous cell carcinoma (LA-NPSCC) are rare malignancies. Their specific outcomes are unclear. Their management remains challenging with several controversies, in particular regarding the realization of total rhinectomy and the role of elective neck node treatment (1). Between 2005 and 2019 in our department (Gustave Roussy Cancer Campus), n=35 patients with LA-NPSCC were treated with at least total rhinectomy (Supplementary data 1). The typical presentations were males (63%), with a median age of 61 years, smokers (78%), presenting stage IVa LA-NPSCC (AJCC 8th), originated from the nasal mucosa, especially the anterior nasal septum (Supplementary data 2). Thirteen patients (37%) presented with clinical and/or radiological cervical lymph node involvement at diagnosis (cN+).

Comparative analysis of the efficacy of definitive chemoradiation therapy and surgery followed by adjuvant radiation therapy in advanced-stage oral tongue cancer.

It is a retrospective analysis of the treatment outcomes of 211patients with stage III-IVA-B resectable OTSCC. The patients were divided into two groups depending on the treatment modality: 114patients received surgery followed by adjuvant RT or CRT (S-RT/CRT) group; the definitive CRT group consisted of 97patients. The five-year overall survival (OS) was 57.0% in S-RT/CRT group vs 20.4% in CRT group; the five-year disease-free survival (DFS) in S-RT/CRT group was 56.5% vs 15.5%, in the CRT group. Comparison of survival curves revealed statistically significant higher OS and DFS rates in patients of S-RT/CRT group as compared with those in CRT patients (hazard ratio= 0.33 (95% confidence interval 0.23-0.47), p< 0.001vs hazard ratio= 0.25 (95% confidence interval 0.17-0.37), p< 0.001). A multivariate analysis showed a statistically significant prognostic effect of the primary tumor extension cT4 (p= 0.004), cervical lymph node involvement cN2 (p< 0.001), cN3 (p= 0.04) and treatment modality (p< 0.001) on OS. There was also found a statistically significant prognostic effect of the primary tumor extension cT4 (p= 0.02), cervical lymph node involvement cN2 (p< 0.001) and treatment modality (p< 0.001) on DFS. 18 (15.8%) patients of S-RT/CRT group and 13 (13.4%) patients (p= 0.77) of CRT group developed mandibular osteoradionecrosis. Primary surgery with adjuvant RT or CRT in advanced-stage resectable OTSCC significantly increases five-year OS and DFS rates as compared to those after definitive CRT.

Clinical, Genomic, and Pharmacological Study of MYCN-Amplified RB1 Wild-Type Metastatic Retinoblastoma.

Simple SummaryWe present two cases of a subtype of retinoblastoma, a rare ocular tumor in children, presenting without the typical mutation in the RB1 gene but showing amplification of the transcription factor MYCN frequently reported in pediatric malignancies. Even though previous reports suggested that this tumor sybtype could present metastases, patients with metastatic disease were not reported. Our cases had metastasis to the orbit and lymph nodes and poor sensitivity to standard chemotherapy but no dissemination to the central nervous system, as described for patients with mutations in the RB1. We were able to grow the cells of one of our patients in vitro, perform comprehensive genomic analysis that showed previously not reported mutations and other chromosomal alterations. In an animal model, we could reproduce the clinical dissemination and we identified an innovative active drug combination that could help for the treatment of these children with poor prognosis.An uncommon subgroup of unilateral retinoblastomas with highly aggressive histological features, lacking aberrations in RB1 gene with high-level amplification of MYCN (MCYNRB1) has only been described as intra-ocular cases treated with initial enucleation. Here, we present a comprehensive clinical, genomic, and pharmacological analysis of two cases of MCYNRB1 with orbital and cervical lymph node involvement, but no central nervous system spread, rapidly progressing to fatal disease due to chemoresistance. Both patients showed in common MYCN high amplification and chromosome 16q and 17p loss. A somatic mutation in TP53, in homozygosis by LOH, and high chromosomal instability leading to aneuploidy was identified in the primary ocular tumor and sites of dissemination of one patient. High-throughput pharmacological screening was performed in a primary cell line derived from the lymph node dissemination of one case. This cell line showed resistance to broad spectrum chemotherapy consistent with the patient’s poor response but sensitivity to the synergistic effects of panobinostat–bortezomib and carboplatin–panobinostat associations. From these cells we established a cell line derived xenograft model that closely recapitulated the tumor dissemination pattern of the patient and served to evaluate whether triple chemotherapy significantly prolonged survival of the animals. We report novel genomic alterations in two cases of metastatic MCYNRB1 that may be associated with chemotherapy resistance and in vitro/in vivo models that serve as basis for tailoring therapy in these cases.

Loss-of-Function Variants in HOPS Complex Genes VPS16 and VPS41 Cause Early Onset Dystonia Associated with Lysosomal Abnormalities.

The majority of people with suspected genetic dystonia remain undiagnosed after maximal investigation, implying that a number of causative genes have not yet been recognized. We aimed to investigate this paucity of diagnoses. We undertook weighted burden analysis of whole-exome sequencing (WES) data from 138 individuals with unresolved generalized dystonia of suspected genetic etiology, followed by additional case-finding from international databases, first for the gene implicated by the burden analysis (VPS16), and then for other functionally related genes. Electron microscopy was performed on patient-derived cells. Analysis revealed a significant burden for VPS16 (Fisher's exact test p value, 6.9 × 109 ). VPS16 encodes a subunit of the homotypic fusion and vacuole protein sorting (HOPS) complex, which plays a key role in autophagosome-lysosome fusion. A total of 18 individuals harboring heterozygous loss-of-function VPS16 variants, and one with a microdeletion, were identified. These individuals experienced early onset progressive dystonia with predominant cervical, bulbar, orofacial, and upper limb involvement. Some patients had a more complex phenotype with additional neuropsychiatric and/or developmental comorbidities. We also identified biallelic loss-of-function variants in VPS41, another HOPS-complex encoding gene, in an individual with infantile-onset generalized dystonia. Electron microscopy of patient-derived lymphocytes and fibroblasts from both patients with VPS16 and VPS41 showed vacuolar abnormalities suggestive of impaired lysosomal function. Our study strongly supports a role for HOPS complex dysfunction in the pathogenesis of dystonia, although variants in different subunits display different phenotypic and inheritance characteristics. ANN NEUROL 2020;88:867-877.

How useful are cervical Pap smears in detecting endometrial carcinomas? A tertiary cancer center experience.

To determine the role of routine cervical Pap smears in detecting endometrial carcinomas. A retrospective study was carried out from the histopathology archives for cases diagnosed as endometrial carcinomas with Pap smears within 6 months before histological diagnosis. The demographic details, reports of Pap smears and other tumor parameters on histopathology were noted. We identified 380 of 482 cases of endometrial carcinoma with a documented Pap smear within 6 months before histopathogical diagnosis. Out of 380 cases, 187 cases (49.2%) had shown abnormalities on Pap smear of which 80 cases (42%) were diagnosed as atypical glandular cells and 78 cases (41.7%) were diagnosed as adenocarcinoma. The presence of glandular abnormality on Pap smear significantly correlated with the tumor type, myometrial invasion and cervical involvement on histopathology (P < .05). Cases which had higher FIGO staging also had a higher detection rate on Pap smear (P < .05). The Pap smear may help in detection of endometrial carcinoma especially in cases with type 2 endometrial carinomas, tumor with cervical involvement and/or advanced FIGO stage.

EVALUATION OF MYOMETRIAL INVASION AND CERVICAL INVOLVEMENT IN TYPE I ENDOMETRIAL CANCER USING DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING

Objective: Surgical procedure and adjuvant treatment of type I endometrial cancer were affected by some variables assessed preoperatively. Diffusion-weighted magnetic resonance imaging (DWI) is a promising modality in evaluating myometrial invasion and cervical involvement, investigating the diagnostic values of DWI in assessing myometrial invasion and cervical involvement.&#x0D; Methods: A cross-sectional study was conducted. This study involved all type I endometrial cancer patients in Dr. Cipto Mangunkusumo Hospital from April 2016 until April 2019. The depth of myometrial invasion and cervical involvement was examined using 1.5-T MR unit. The result was compared to the surgical pathologic findings as the reference standard.&#x0D; Results: 34 types I endometrial cancer patients were enrolled in this study. The sensitivity of DWI in evaluating myometrial invasion and cervical involvement in type I endometrial cancer was 94.12% and 57.14%, while the specificity was 64.71% and 92.59%, respectively.&#x0D; Conclusion: DWI can provide reliable prognostic variable information about the myometrial invasion and cervical involvement in the preoperative preparation of endometrial cancer patients.

Evaluation of MTAP immunohistochemistry loss of expression in ovarian serous borderline tumors as a potential marker for prognosis and progression

IntroductionSerous borderline tumors (SBT) are the most common subtype of ovarian borderline tumors with excellent clinical course. However, they can recur or progress to low-grade serous carcinoma (LGSC) in a small proportion of the cases. Beside BRAF and KRAS mutations, copy number alterations (CNA), particularly loss of chromosome 9p21 locus which results in deletion of genes CDKN2A and MTAP, have been suggested to be involved in disease progression. MTAP immunohistochemistry recently has been introduced for mesothelioma as a reliable surrogate marker for the homozygous deletion of chromosome 9p21 locus. Therefore, in the current study, we aimed to evaluate the MTAP loss of expression in serous borderline tumors and low-grade serous carcinomas to identify if it can be used as a marker for prognosis and progression. MethodEighty-four total cases of ovarian serous lesions, including 21 cases of serous cystadenomas, 21 cases of serous borderline tumors, 12 cases of low-grade serous carcinomas and 30 cases of high-grade serous carcinomas were selected. MTAP immunohistochemistry was performed on the representative blocks and cytoplasmic staining was used for interpretation. The cases were labeled as positive (retained) if MTAP showed cytoplasmic granular staining and negative (loss of expression) if negative cytoplasmic staining was observed in the presence of positive internal control. ResultTen of 21 cases of serous borderline tumors showed loss of MTAP expression (48%). Among those, 7 cases were bilateral, 2 cases had micropapillary features, one case had supraclavicular and cervical lymph node involvement by serous borderline tumor and 2 cases had progression to low-grade serous carcinoma, including one of micropapillary tumors. Also 8 out of 12 cases of LGSCs showed MTAP loss of expression (66%). Only 4 of 30 cases of high-grade serous carcinomas (13%) and none of the serous cystadenoma cases showed loss of expression of MTAP. ConclusionTo our knowledge, this is the first description of MTAP immunohistochemistry in serous borderline tumors and low-grade serous carcinomas. Our study was limited due to small sample size. However, it showed an association between MTAP loss of expression and adverse clinical behavior in ovarian serous borderline tumors. This supports the role for further investigations in larger series to evaluate the role of MTAP stain as a prognostic marker in these neoplasms.

Acceptability of HPV screening among HIV-infected women attending an HIV-dedicated clinic in Abidjan, C\xf4te d\u2019Ivoire

BackgroundCervical cancer incidence is high among women living with HIV due to high-risk HPV persistence in the cervix. In low-income countries, cervical cancer screening is based on visual inspection with acetic acid. Implementing human papilloma virus (HPV) screening through self-sampling could increase women’s participation and screening performance. Our study aims to assess the preintervention acceptability of HPV screening among HIV-infected women in Abidjan, Côte d’Ivoire.MethodsApplying the Health Belief Model theoretical framework, we collected qualitative data through in-depth interviews with 21 HIV-infected women treated in an HIV-dedicated clinic. Maximum variation sampling was used to achieve a diverse sample of women in terms of level of health literacy. Interviews were recorded and transcribed with the participants’ consent. Data analysis was performed using NVivo 12.ResultsScreening acceptability relies on cervical cancer representations among women. Barriers were the fear of diagnosis and the associated stigma disregard for HIV-associated health conditions, poor knowledge of screening and insufficient resources for treatment. Fees removal, higher levels of knowledge about cervical cancer and of the role of HIV status in cancer were found to facilitate screening. Healthcare providers are obstacle removers by their trusting relationship with women and help navigating through the healthcare system. Self-confidence in self-sampling is low.ConclusionsFree access to cervical screening, communication strategies increasing cervical cancer knowledge and healthcare provider involvement will foster HPV screening. Knowledge gathered through this research is crucial for designing adequate HPV-based screening interventions for women living with HIV in this setting.

Adjuvant Treatment Modalities, Prognostic Factors, and Outcome of the Uterine Carcinosarcoma

ObjectiveTo determine the impact of adjuvant therapy and other factors associated with the recurrence and survival of patients with uterine carcinosarcoma (UCS). MethodsA total of 102 patients who underwhent surgery for UCS from 1998 to 2017 were included in the analysis. Data were analyzed using Kaplan–Meier methods and Cox proportional hazards regression. ResultsAt 240 months, the actuarial recurrence rate was 34.3%. Distant recurrence was the most common recurrence pattern. Patients with higher CA 125 levels, sarcoma dominance, cervical involvement, advanced stage, no lymphadenectomy, and residual tumour had a significiantly higher risk of recurrence. Five-year disease-free survival (DFS) and overall survival (OS) were 67% and 77%, respectively. FIGO stage was found to be an independent prognostic factor for DFS and OS. Sarcoma dominance was independently associated with decreased OS. ConclusionSarcoma dominance is associated with poor survival in UCS. Adjuvant treatment was not found to affect recurrence or survival. Given this finding, more effective postoperative strategies are needed.

Occurrence of cervical spine arthritis with prominent bone edema highly responsive to adalimumab in a patient with psoriatic peripheral arthritis and long-standing remission

Cervical spine involvement frequently occurs in patients with psoriatic arthritis (PsA) even in absence of sacroiliitis. Long disease duration, high disease activity in the first five years and presence of peripheral involvement are all predictors of this peculiar articular involvement. We describe the case of a PsA patient, with an initial oligoarthritis pattern of disease highly responsive to etanercept monotherapy and long-standing clinical remission, who developed cervical spine involvement with bone marrow edema of odontoid process and early atlo-axial instability. Notably, he did not exhibit any other clinical symptom or sign of disease activity and was highly responsive to switching to a second anti-TNF drug (adalimumab). The case stresses the importance of strict monitoring PsA patients and considering the possible changing pattern of disease. Early identification of cervical spine involvement requires proper use and interpretation of imaging techniques. Interestingly different articular manifestations of PsA may show different response to therapy even in the same patient.