Endometroid Carcinoma Research Articles

Idiopathic retroperitoneal fibrosis with endometrial cancer: a case report and literature review

BackgroundRetroperitoneal fibrosis is a rare disease characterized by chronic nonspecific inflammation, which leads to clinical compression manifestations of retroperitoneal organs especially ureter. Approximately 70 percent of retroperitoneal fibrosis cases are idiopathic which has no clear etiology. This study reported a rare case of a 48-year-old woman presented with idiopathic retroperitoneal fibrosis and endometrial cancer.Case presentationA 48-year-old woman presented with irregular vaginal bleeding without abdominal pain, bloating or discomfort. The patient was diagnosed iRPF after splenectomy 13 years ago. Then she took prednisone for 2 years and took tamoxifen for about 11 years. She stopped taking the medication from October 2019 to May 2020 and then started taking tamoxifen again until November 2020. Two weeks after she stopped taking tamoxifen, she presented with irregular vaginal bleeding. Gynecological ultrasound revealed a thick endometrium with uneven echo enhancement and blood flow signals. Then diagnostic curettage was performed with pathological examination showed endometroid carcinoma. Later, the patient was admitted to Peking University Third Hospital for surgery. Preoperative imaging examinations, including CT, MRI, and PET/CT, all showed pelvic enlarged lymph nodes and they were highly suspected to have lymph node metastasis. The patient underwent laparoscopic surgical staging and enlarged lymph nodes in the pelvic and aortic regions were removed. Finally, the pathology confirmed that endometrioid adenocarcinoma and fibrosis, but there was no tumor infiltration in these enlarged lymph nodes. The patient is now in good condition.ConclusionThis case report stressed the difficulty to distinguish between lymph node metastasis and inflammatory hyperplasia by common imaging methods. Due to increased surgical difficulty among retroperitoneal patients, lymphadenectomy should be carefully evaluated to avoid additional surgical complications and over-treatment.

Prise en charge d’une tumeur maligne de l’endomètre chez un sujet de plus de 80 ans : A propos d’un cas à l’Hôpital Régional de Fatick

INTRODUCTION: The gynecological tumors of the patient aged over 70 constitute heterogeneous entities by their oncological and geriatric clinical presentations, which frequently expose to the proposal of “non-standard”, “adapted” or “exceptional” therapies. In Sub-Saharan Africa, cancer is a scourge whose characteristics remain to be clarified, marked by very limited means, and especially by the context of practice in rural areas. We describe in this clinical case the particularity of the management in a rural context of a case of endometrial tumor in an 83-year-old patient at stage IB. OBSERVATION: This is Mrs. M.G., aged 83 4G 4P 4 children, postmenopausal for 30 years who consults for postmenopausal metrorrhagia evolving for 3 months. A diagnostic hysteroscopy was performed showing an ulcerated mass of the uterine cavity bleeding on contact, a biopsy was performed, the result of which was a low-grade endometrial stromal sarcoma. The abdominopelvic CT scan, which demonstrates thickening of the endometrium without damage to surrounding structures, classified as stage IB endometrial tumor. The patient underwent a total hysterectomy with bilateral pelvic dissection. The postoperative course was simple. The patient was discharged on the 7th postoperative day. The result of the histological report: well-differentiated and infiltrating endometroid carcinoma invading the isthmus and the cervix. Parameters and the 4 right and left lymph nodes are unharmed. The histo-prognostic stage was pT2N0Mx. CONCLUSION: The management of endometrial cancer is possible in the rural context in elderly patients. The prognosis is good if the diagnosis is made at an early stage. Surgery could still be offered even for subjects over 80 with less comorbidity. KEYWORDS: Endometrial tumors; Elderly patient; Senegal.

Abstract 1861: Trophoblast cell surface antigen 2 (TROP2) expression in human tumors: A tissue microarray study on 18,563 tumors

Abstract Trophoblast cell surface antigen 2 (TROP2) is the target of sacituzumab govitecan (SG), an antibody-drug conjugate that was recently approved for previously treated triple negative breast cancer and urothelial carcinomas. To comprehensively determine TROP2 expression in normal and neoplastic tissues, a tissue microarray containing 18,563 samples from 150 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. TROP2 positivity was found in most normal epithelial cell types and in 109 of 150 tumor categories, including 92 of 95 epithelial tumor categories. Particularly high rates of TROP2 positivity and highest expression levels were seen in squamous cell carcinomas of various origins and various categories of urothelial, breast, prostate, pancreatic, and ovarian cancers (>95% positive). High TROP2 expression was linked to advanced stage (p=0.0069) and nodal metastasis (p<0.0001) in colorectal cancer as well as to nodal metastasis in gastric adenocarcinoma (p=0.0246) and papillary thyroid cancer (p=0.0013). Low TROP2 expression was linked to advanced stage in urothelial carcinoma (p<0.0001), high pT (p=0.0024) and high grade (p<0.0001) in breast cancer, as well as with high grade (p=0.0005) and pT stage (p=0.0009) in papillary renal cell carcinomas. Associations between TROP2 expression and clinicopathological features were not found in clear cell renal cell carcinomas, high grade serous ovarian carcinomas, pancreatic adenocarcinomas and in endometroid endometrium carcinomas. In summary, TROP2 is abundantly expressed in a broad range of epithelial neoplasms. Both TROP2 upregulation and downregulation can be associated with cancer progression in a tumor type dependent manner. As anti-TROP2 cancer drugs have demonstrated efficiency and induce tolerable side effects they may be applicable to a broad range of tumor entities in the future. Citation Format: David Dum, Claudia Hube-Magg, Ronald Simon, Elena Bady, Tim Mandelkow, Niclas C. Blessin, Maximilian Lennartz, Guido Sauter, Sarah Minner, Andreas M. Luebke. Trophoblast cell surface antigen 2 (TROP2) expression in human tumors: A tissue microarray study on 18,563 tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1861.

Detection of early-stage ovarian cancer using a liquid biopsy test based on extracellular vesicle proteins.

e17558 Background: We have recently conducted a study to evaluate the predictive value of proteins associated with extracellular vesicles (EVs) isolated using an alternating current electrokinetic (ACE) system, for the detection of early stage (I & II) ovarian cancer cases. Ovarian cancer patients, typically, have few symptoms in stages I & II; the disease is often undetected until it is advanced. Currently, only 15% of cases are detected at early stages when clinical treatment outcomes are improved. Methods: We tested the feasibility of detecting the presence of early stage (I-II) ovarian cancer using protein biomarkers carried by EVs in patient blood. Using an ACE microelectrode array, EVs were purified from ovarian cancer patient plasma (N = 70; Stage I = 51, Stage II = 19) and female non-cancer donors (N = 290) and tested for the presence of cancer biomarker proteins with multiple bead-based multiplex immunoassay kits. An adaptive boosted trees machine learning algorithm with 100x cross-validation was developed to identify the most important features for differentiation between cases and controls. Results: The machine learning algorithm identified relevant biomarkers for the detection of ovarian cancer with a receiver-operator characteristic area under the curve (AUC) of 0.952 (95% CI: 0.918 – 0.985). Overall sensitivity was 72.9% at 99% specificity, rising to 84.3% at 95% specificity. When further stratified, Stage I sensitivity was 70.6% and stage II sensitivity was 78.9% at the 99% specificity level, as expected. We also separated the cases into endometroid carcinoma (N = 24) and serous carcinoma (N = 36). At the 99% specificity level, the sensitivity was 87.5% and 63.9%, respectively. Conclusions: These results suggest that it is possible to detect early-stage ovarian cancer by analyzing the EV-bound proteins isolated with the ACE technology. EVs may carry the earliest signals of cancer development and a blood-based EV-protein biomarker test can yield high sensitivity and specificity. Stable biomarker detection with small input volumes may be possible. These results require further investigation in larger datasets to validate the current observations with the potential application for general, routine screening, as well as for populations at elevated disease risk.

Synchronous bilateral primary ovarian cancer with right endometroid carcinoma and left high-grade serous carcinoma: a case report and literature review

BackgroundEpithelial ovarian cancer is the most frequent gynecologic malignancy; it has a poor prognosis and often occurs bilaterally. Most cases of synchronous bilateral ovarian cancer (SBOC) are metastases from the other ovary, while bilateral primary ovarian cancer is rare.Case presentationThe patient was a 47-year-old Japanese woman with a complaint of abdominal pain for 1 month. Imaging results revealed bilateral ovarian tumors with suspicion of malignancy. The patient underwent a laparotomy with total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, and resection of suspected dissemination in the peritoneum. Histopathological and immunohistochemical studies showed that the right ovarian tumor was an endometrioid carcinoma (G2) and had no association with endometriotic lesions. However, the left ovarian tumor was a high-grade serous carcinoma (HGSC). The final staging was stage 1 right endometrioid carcinoma and stage IIb left HGSC. Six courses of adjuvant chemotherapy with paclitaxel, docetaxel, and carboplatin were administered. The patient showed no signs of recurrence 24 months postoperatively.ConclusionsTo the best of our knowledge, the combination of histological types in this case may be the first report of primary bilateral ovarian cancer. In SBOC, it is important to differentiate the subtypes of histology using immunostaining, in addition to morphopathology.

Pelvic Carcinosarcoma Showing a Diverse Histology and Hierarchical Gene Mutation with a Common POLE Mutation to Endometrial Endometroid Carcinoma: A Case Report

POLE mutation-type endometrial cancer is characterized by an extremely high tumor mutation burden. Most POLE mutation-type endometrial cancers are histologically endometrioid carcinomas, and POLE mutation-type carcinosarcomas are rare among endometrial cancers. We report a case of endometrial and pelvic cancer in a 53-year-old woman who was analyzed using next-generating sequencing. The endometrial lesion harbored a p.T457del POLE mutation with an elevated tumor mutation burden and low microsatellite instability. The pelvic lesion showed divergent histological features, consisting of high-grade endometrioid carcinoma, neuroendocrine carcinoma, and chondrosarcoma. In addition to the common POLE mutation detected in the endometrial lesion, the pelvic lesion in each element showed additional gene mutations in a hierarchical manner. Therefore, it is indicated that the p.T457del POLE mutation is a pathogenic mutation and may be related to POLE mutation-induced carcinogenesis and divergent morphogenesis in endometrial cancer.

446 Endometriosis as a facilitating factor for the invasion of the endometrial cancer? A case report

Endometriosis affects approximately 10% of women in reproductive age. It can be distinguished into endometriosis: externa, interna/adenomyosis und extragenitalis. Its association with endometrial cancer is currently a point of discussion. We present an atypical case of an advanced endometrial endometroid carcinoma developed on the ground of endometriotic changes. The 50 years old woman, G6/P2, BMI of 28 m2/kg, was admitted to our tertiary emergency department with an abdominal pain. Echographic examination revealed a cystic-solid tumor of 8 cm on the right adnexa and normal endometrium of 5 mm.

Snail Immunoexpression in Endometrioid Endometrial Carcinomas.

Endometrial carcinoma is one of the most prevalent cancers affecting women with epidemiological placing it as the sixth most common cancer in women. One of the factors implicated in EMT (epithelial-mesenchymal transition), Snail is regarded as having a pivotal role. We selected a number of 30 endometrial carcinomas, in a 2-year period (2020-2022). Snail immunoexpression was identified in the tumor cells for 70% of the endometroid carcinoma cases studied. Tumor cells showed both nuclear and cytoplasmic expression but only nuclear signals were quantified. The average percent of marked tumor cells was 38.6±24.9, corresponding to well differentiated carcinomas. Our analysis also showed a significant association between higher tumor grade and snail expression (p=0.000). Alteration of the epithelial-mesenchymal phenotype in endometrial carcinomas by Snail overexpression in high-grade and advanced-stage lesions constitutes mechanisms involved in the process of tumor progression.

Neuroendocrine Tumor of the Gynecological Tract: A Case Report of High-Grade Neuroendocrine Carcinoma of the Endometrium

Neuroendocrine tumors (NETs) of the gynecological tract are rare and aggressive tumors with no standardized management protocol. This group can be classified based on location of origin, morphologic features, and prognosis. In addition, NETs of the endometrium can co-occur with non-NET endometrial carcinoma. Our case concerns a 71-year-old female who was diagnosed with high-grade neuroendocrine carcinoma arising in conjunction with endometroid carcinoma with focal sarcomatoid features. We provide a succinct review of the literature in order to emphasize the development, diagnosis, management, and prognosis of NET of the endometrium.

Villin expression in human tumours: a tissue microarray study on 12,429 tumours

Villin protein is part of the brush border of the apical membrane of epithelial cells. Villin is used as an immunohistochemical marker for colorectal and gastrointestinal neoplasms although other tumour entities can also express villin. To comprehensively determine villin expression in normal and neoplastic tissues, a tissue microarray containing >14,000 samples from 118 different tumour types and subtypes as well as 608 samples of 76 different normal tissue types was analysed. Villin positivity was found in 54 of tumour categories and was most commonly seen in adenocarcinomas and neuroendocrine tumours of the colorectum (60–100%), upper gastrointestinal tract (61–100%), bilio-pancreatic system (25–86%), yolk sack tumours (76%), and in mucinous carcinomas of the ovary (67%). Villin was also common in various categories of extra-gastrointestinal neuroendocrine neoplasms (22–41%), kidney tumours (up to 18%), hepatocellular carcinoma (25%), endometroid carcinoma of the ovary (20%) and of the endometrium (12%) as well as in adenocarcinomas of the lung (12%). These data demonstrate that villin is frequently expressed in gastrointestinal, biliopancreatic, and neuroendocrine neoplasms, but at least weak villin positivity occurred in 54 different tumour categories. Villin immunohistochemistry should, thus, be applied as a part of a panel for the distinction of tumours.

MUC5AC expression is linked to mucinous/endometroid subtype, absence of nodal metastasis and mismatch repair deficiency in ovarian cancer

Mucin 5AC (MUC5AC) is a secreted gel-forming mucin which is expressed by mucus producing cells of several organs but can also be found in cancer cells of the ovary, pancreas, and gastrointestinal tract. This study aimed to characterize the expression of MUC5AC and its potential prognostic implications in different ovarian cancer subtypes. MUC5AC expression was analyzed by immunohistochemistry on a tissue microarray containing 603 ovarian cancers. MUC5AC was commonly expressed in mucinous (27/36; 75%) and endometrioid (12/39; 31%) carcinomas, whereas malignant mixed Mullerian tumors (2/27; 7%), high-grade serous (20/373; 5%) and clear cell carcinomas (1/28; 4%) were only rarely MUC5AC positive and also showed lower expression levels. MUC5AC positive endometroid carcinomas and high-grade serous carcinomas lacked lymph node metastases (p = 0.0495 and p = 0.0216) suggesting a more favorable prognosis. Deficient mismatch repair (dMMR), associated with a favorable prognosis in different cancer types, was found in 4/39 (10%) MUC5AC positive cancers but in only 5/375 (1%) of MUC5AC negative cancers (p = 0.0052). In subgroup analyses MUC5AC positive endometroid carcinomas more frequently showed dMMR (4/10; 40%) as opposed to MUC5AC negative endometroid carcinomas (3/23; 13%; p = 0.0932). In summary, the results of our study show that MUC5AC expression is associated with mucinous and endometrioid ovarian carcinomas, lack of nodal metastases and dMMR. MUC5AC expressing ovarian cancers should be evaluated for dMMR.

Victoria: A multicentric, randomized, open-label, phase I/II of mTOR inhibitor (VISTUSERTIB) combined with anastrozole in patients with hormone receptor-positive advanced/metastatic endometrial cancer—A CLIPP program INCA in collaboration with GINECO group.

5507 Background: Endometrial carcinoma is generally hormone dependent and aromatase inhibitors are used in routine practice before or after 1st line chemotherapy (CT) for HR positive patients. Deregulation of the Pi3K-Akt-mTOR signaling pathway is observed in many tumor types including endometroid carcinoma driven oncogenesis and hormonal resistance. Vistusertib (V) is a small-molecule ATP competitive inhibitor of both mTORC1 and mTORC2 complexes. Methods: Adult patients (pts) with recurrent oestrogen or progesterone (ER and/or PR) positive advanced/metastatic endometrial carcinoma, one previous line of chemotherapy (CT) allowed, with ECOG PS 0/1, were randomised (2:1, stratification according to prior CT line: 0 vs 1) to receive V (125 mg bid/2 days/week, orally) + Anastrozole (A, 1 mg/d, orally) or A alone. Treatments were given until progression, intolerable toxicity or patient willingness. Following a safety run in phase, a Simon’s 2-stage design was employed to explore the 8-week progression free rate (PFR-8W) according to central review (p1: 60%, p0: 40%, type I error rate of 5%, power of 80%). At the end of Stage II, if ≥24/46 evaluable pts are progression free at 8w in Arm A+V, the combination will be considered of interest for further investigation. Overall response rate (ORR) by RECIST v1.1, safety and progression-free survival (PFS) were key secondary endpoints. Results: Out of 75 patients (pts) enrolled, 73 were randomised and treated (Arm V+A: 49; Arm A: 24; median age: 69.5 y [36.8; 87.8]), BMI ≥30 kg/m²: 45%). PS ECOG was 0 (48%) and 44% of randomised pts were chemotherapy naïve; 12% previously received hormonal therapy. At the end of the safety run-in, no major safety concerns were reported. At the end of Simon’ Stage II, centrally assessed PFR-8W was 67.3% (33/49 [95% CI unilateral: 54.7; -]) for A + V arm and 39.1% (9/23 [[95% CI unilateral: 22.2; -[) for arm A. Median PFS was 5.2 months (95% CI: 3.4-8.9) and 1.9 months (95% CI: 1.6-8.9) for A+V and A arms, respectively. One complete response and 11 partial responses (PR) were observed (ORR: 24.5 % (CI 95% [13.3 – 38/9%]) in the combination arm and 4 PR in arm A (ORR: 17.4% [CI 95%: 5-38.8%]). Fatigue, lymphopenia, hyperglycaemia and diarrhoea were the main (≥10%) Grade ≥2 adverse events related to V. Overall survival and translational research are ongoing. Conclusions: The A+V combination demonstrated clinically and meaningful improvement in 8w-PFR and median PFS with manageable toxicity. PI3K pathway remains a key target for new therapies in endometrial cancer and translational research must help to better select pts benefiting from these targeted therapies. Clinical trial information: NCT02730923.

Analysis of microsatellite instability in endometroid carcinoma with deficient mismatch repair

Objective: To analyze the microsatellite instability (MSI) status in endometrioid endometrial carcinoma (EEC) with deficient mismatch repair (dMMR) and to explore the concordance between MSI next generation sequencing (NGS)/PCR and MMR immunohistochemistry (IHC) results. Methods: Sixty dMMR EEC cases by IHC from November 2017 to February 2019 were selected in the Department of Pathology, Peking Union Medical College Hospital. Two pathologists reviewed the IHC results. The MSI status and the germline/somatic mutational status of MMR genes were analyzed by NGS. MLH1 promoter methylation status was determined by methylation-specific PCR (MSP) in cases with MLH1 protein deficiency. In cases with discrepant results between MMR IHC and MSI NGS, the MSI status was detected again by PCR, and the reasons for the discrepancy were discussed with gene mutation and MLH1 promoter methylation results. Results: Among 60 dMMR EEC specimens, 3 samples were re-assigned as proficient mismatch repair (pMMR) after pathological review, and identified as MSS by NGS. Another 3 dMMR cases showed MSI-uncertainty (MSI-U) by NGS due to insufficient tumor content. In the remaining 54 cases, the concordance between MMR IHC and MSI NGS was 87% (47/54). The seven discrepant cases was further analyzed: in 5 discrepant cases with MLH1/PMS2 protein loss, one case did not have enough samples for detection, one case was MSI-H, and the remaining three cases were MSS by PCR. All these 5 cases with MLH1/PMS2 protein loss showed the MLH1 promoter hypermethylation, two of which also had a somatic mutation in the MSH2 gene. The two discrepant cases with MSH6 protein loss were both MSS by PCR, one of which was considered to have Lynch syndrome with germline mutation in MSH6 gene. Conclusions: Although the overwhelming majority of dMMR EEC cases by IHC shows MSI-H by NGS/PCR, there are uncommon discrepant dMMR EEC cases with MSS. They are mostly found in cases with MLH1/PMS2 protein loss caused by MLH1 promoter hypermethylation and rarely related to Lynch syndrome. Both MMR IHC and MSI NGS/PCR tests have their advantages and disadvantages, complimentary to each other.

Endometrial Cancer Suppresses CD8+ T Cell-Mediated Cytotoxicity in Postmenopausal Women.

Endometrial cancer is the most common gynecological cancer. To investigate how it suppresses host immune function, we isolated CD8+ T cells from endometrial endometroid carcinomas and adjacent non-cancerous endometrium and determined if the tumor environment regulates cytotoxic capacity. Endometrial carcinomas had increased numbers of CD8+ T cells compared to adjacent non-cancerous endometrium. Tumor CD8+ T cells expressed significantly less granzyme A (GZA), B (GZB), and PD-1 than those in adjacent non-cancerous tissues and also had significantly lower cytotoxic killing of allogeneic target cells. CD103-CD8+ T cells, but not CD103+CD8+ T cells, from both adjacent and tumor tissue were primarily responsible for killing of allogeneic target cells. Secretions recovered from endometrial carcinoma tissues suppressed CD8+ cytotoxic killing and lowered perforin, GZB and PD-1 expression relative to non-tumor CD8+ T cells. Furthermore, tumor secretions contained significantly higher levels of immunosuppressive cytokines including TGFβ than non-tumor tissues. Thus, the tumor microenvironment suppresses cytotoxic killing by CD8+ T cells via the secretion of immunosuppressive cytokines leading to decreased expression of intracellular cytolytic molecules. These studies demonstrate the complexity of CD8+ T cell regulation within the endometrial tumor microenvironment and provide a foundation of information essential for the development of therapeutic strategies for gynecological cancers.

Immunologic factors involved in the malignant transformation of endometriosis to endometriosis-associated ovarian carcinoma.

Endometriosis is a risk factor for low-grade serous, clear cell, and endometroid ovarian carcinoma. In both endometriosis and ovarian carcinoma, immunological factors are associated with clinical outcome. Chronic inflammation in endometriosis may be linked to tumorigenesis, but exact processes contributing to endometriosis-associated ovarian carcinoma remain unknown. This review aims to describe potential immunological factors involved in the malignant transformation of endometriosis into ovarian carcinoma. PubMed and Embase were searched from inception up to October 2020 for studies comparing immunological processes in endometriosis and endometriosis-associated ovarian carcinoma. Detailed analysis of immune components in the malignant transformation of endometriosis into endometriosis-associated ovarian carcinoma is lacking. Altered levels of chemokines and cytokines as IL-6, IL-8, IL-10, and TNF-α are reported and the function, number and polarization of NK cells, dendritic cells, and monocytes differ between endometriosis and associated ovarian carcinoma compared to healthy tissue. In addition, altered inflammasome and complement systems, indicate a role for the immune system in the carcinogenesis of endometriosis. Chronic inflammation in endometriosis may potentially drive inflammation-induced carcinogenesis in endometriosis-associated ovarian carcinoma. Exact immunological pathways and cellular processes remain unknown and require more thorough investigation.

Role of WT1, B-cell lymphoma 2, Ki-67 (Mib1), and Her2/Neu as diagnostic and prognostic immunomarkers in ovarian serous and endometroid carcinoma.

Ovarian cancer is the fifth common cause of death due to cancer in women. It constitutes 3% of all cancers in females and 15%-20% of genital malignancy. Most of the ovarian cancers are serous type followed by the endometrioid type. Sometimes, glands of these two carcinomas are indistinguishable histologically. It also becomes difficult to differentiate these two types when they are poorly differentiated. The aim of this study was to find differences in immunomarker expressions between serous and endometrioid carcinomas and the association of their staining patterns with other clinicopathological prognostic factors. Immunohistochemical staining for WT1, B-cell lymphoma 2 (Bcl2), Ki67 (MIB1), and Her2/Neu were done in paraffin-embedded tissues of histologically diagnosed 38 cases of ovarian serous and endometrioid carcinomas and staining patterns were correlated with other clinicopathological prognostic factors. Of these 38 cases (21 serous and 17 endometrioid), 24 cases were in Stage I/II and 14 cases Stage III/IV. On the other hand, 16 cases were in low grade, 12 cases intermediate grade, and 10 cases high grade. Twenty of 21 serous carcinomas were strongly positive for WT1, whereas most of the endometrioid carcinomas were negative. Ki67 (MIB1) labeling index and Her2/Neu were higher in both higher grade and stages. On the contrary, the intensity of Bcl2 staining was lower in higher grades and stages lesions. The use of WT1 may be useful in resolving diagnostic dilemma between serous and endometrioid carcinoma, especially in difficult cases. Ki67, Bcl2, and Her2/Neu may be used as prognostic markers.

Synchronous occurrence of two primary gynaecological tumors: A case report

Synchronous occurrence of two primary tumors is rare. Endometrial and ovarian cancers are the most frequently simultaneously occurring primary tumors. Here we are presenting, similar rare presentation of 40 years old lady who has been referred to us with complaint of abnormal uterine bleeding and lump abdomen since one year. Patient underwent total abdominal hysterectomy and bilateral salpingoopherectomy with surgical staging. Histopathological examination showed moderately differentiated endometroid ovarian carcinoma and endometroid adenocarcinoma of uterus with metastasis to cervix. Keywords: Synchronous, Primary tumors, Endometrial cancer, Ovarian cancer.

Genomic Amplification and Functional Dependency of the Gamma Actin Gene ACTG1 in Uterine Cancer.

Sarcomere and cytoskeleton genes, or actomyosin genes, regulate cell biology including mechanical stress, cell motility, and cell division. While actomyosin genes are recurrently dysregulated in cancers, their oncogenic roles have not been examined in a lineage-specific fashion. In this report, we investigated dysregulation of nine sarcomeric and cytoskeletal genes across 20 cancer lineages. We found that uterine cancers harbored the highest frequencies of amplification and overexpression of the gamma actin gene, ACTG1. Each of the four subtypes of uterine cancers, mixed endometrial carcinomas, serous carcinomas, endometroid carcinomas, and carcinosarcomas harbored between 5~20% of ACTG1 gene amplification or overexpression. Clinically, patients with ACTG1 gains had a poor prognosis. ACTG1 gains showed transcriptional patterns that reflect activation of oncogenic signals, repressed response to innate immunity, or immunotherapy. Functionally, the CRISPR-CAS9 gene deletion of ACTG1 had the most robust and consistent effects in uterine cancer cells relative to 20 other lineages. Overall, we propose that ACTG1 regulates the fitness of uterine cancer cells by modulating cell-intrinsic properties and the tumor microenvironment. In summary, the ACTG1 functions relative to other actomyosin genes support the notion that it is a potential biomarker and a target gene in uterine cancer precision therapies.

Increasing Yttrium-90 Dose Conformality Using Proximal Radioembolization Enabled by Distal Angiosomal Truncation for the Treatment of Hepatic Malignancy

PurposeTo evaluate safety and feasibility of improving radiation dose conformality via proximal radioembolization enabled by distal angiosomal truncation where selective administration was not practical. Materials and MethodsHepatic malignancies treated via angiosomal truncation between January 2017 and March 2019 were retrospectively evaluated. Thirty-three patients (8 women, 25 men; mean age, 62.2 y; range, 36–78 y) underwent 39 treatments. Of treatments, 74.3% (n = 29) were for hepatocellular carcinomas, 10.2% (n = 4) were for cholangiocarcinomas, and 15.4% (n = 6) were for metastatic tumors (1 colorectal adenocarcinoma, 1 pancreatic adenocarcinoma, 3 melanomas, and 1 endometroid carcinoma). Truncation was achieved using temporary embolic devices including a microvascular plug, detachable coil, gelatin slurry, and balloon microcatheter, after which proximal radioembolization was performed. Range of treatment activity was 0.47–5.75 GBq. Technetium-99m macroaggregated albumin and bremsstrahlung single photon emission computed tomography (CT)/CT threshold analysis was conducted to delineate and compare distribution of activity within the treatment angiosome before and after radioembolization. ResultsDosimetric analysis of 14 patients demonstrated a significant reduction in nontarget liver radiation exposure at 5, 20, and 40% thresholds (P = .002, P = .001, and P = .008, respectively). There were no grade 3 or higher adverse events. There was no significant change in Albumin-Bilirubin grade and Eastern Cooperative Oncology Group Performance Status (P = .09 and P = .74) before and 3 months after the procedure. Truncated arteries were patent on subsequent angiography in 11 cases and on MR angiography or CT angiography in 38 of 39 cases. ConclusionsProximal radioembolization enabled by distal angiosomal truncation is safe and decreases nontarget parenchymal radioembolization dose in cases not amenable to selective administration.

Synchronous Primary Ovarian and Endometrial Carcinomas in a Young PatientCase report and literature review

Synchronous primary ovarian and endometrial carcinomas is a rare condition encountured in clinical practice, especially in young patients with history of endometriosis. The most frequent histopatological subtype is endometrioid carcinoma. We present a case of a 36-years old patient admitted in the Emergency Department for lower abdominal pain and abnormal uterine bleeding. The clinical and ultrasound examination diagnosed bilateral ovarian cystic tumors, a normal uterine structure and no abdominal fluid colection. Serum levels of ROMA score was performed with normal value. The International Ovarian Tumor Analysis (IOTA) criteria used for ovarian tumors scoring diagnosed a 55% probability for malignant tumors. Laparotomy was performed with prelevation of peritoneal fluid for citology. After right anexectomy was performed, the intraoperative histopathological examination diagnosed endometrioid ovarian carcinoma. Left anexectomy and total hysterectomy with omentectomy and multiple peritoneal biopsy was further performed. The final histopathological examination confirmed endometroid carcinoma in both ovaries and endometrial tissue. Keywords: synchronous genital carcinomas, endometrioid subtype, endometriosis