Mucinous Neoplasm Research Articles

Prognostic factors of stage I endometrioid or clear cell or mucinous ovarian cancer: Analysis based on surveillance, epidemiology, and end result program, 2000-2016.

e17589 Background: Endometrioid (EEOC), clear cell (OCCC) or mucinous ovarian cancer (MOC) had the highest incidence of Less Common Ovarian Cancers (LCOC). The benefit of adjuvant chemotherapy, lymphadenectomy or fertility-sparing surgery (FSS) for Stage I of these rare cancers remains unclear. Methods: We conducted a retrospective case-controlled study examining the Surveillance, Epidemiology, and End Result (SEER) database between 2000 and 2016. Propensity score matching is used to avoid the selection bias caused by the heterogeneity of demographic and clinical characteristics. Adjuvant chemotherapy or lymphadenectomy or fertility-sparing surgery on overall survival (OS) was compared with log-rank tests. A univariate and multivariate Cox analysis was performed to control for confounders. A nomogram was developed and the discriminatory ability of the model was analyzed. Results: The study identified 4,681 patients with FIGO stage I EEOC, 2,450 with stage I OCCC, and 2,839 with stage I MOC. After the propensity score matching, there was an equally comparable number of patients with or without adjuvant chemotherapy. The results showed that adjuvant chemotherapy could not prolong the 5-year OS of patients with stage I OCCC (86.7% vs. 85.9%, p = 0.732) and MOC (87.6% vs. 88.2%, p = 0.843). Adjuvant chemotherapy was associated with a 5-year OS benefit only in the subgroup of patients with substage IC, grade 3 EEOC (85.2% vs. 67.7%, p = 0.008). We also found that lymphadenectomy improved the 5-year OS of stage I EEOC (93.5% vs. 86.3%, P = 0.000), OCCC (87.8% vs. 82.8%, P = 0.040) and MOC patients (91.8% vs. 84.2%, P = 0.000). Furthermore, we observed that the 5-year OS raised in stage I EEOC (91.9%vs. 87.7%, P = 0.029) and OCCC (87.6% vs. 81.3%, P = 0.051) patients when conducted the non-fertility-sparing surgery (non-FSS) rather than the FSS. However, FSS did not significantly impact the 5-year OS of MOC patients (91.3% vs. 88.8%, P = 0.181). The nomogram survival prediction model showed that the area under the receiver operating characteristic (ROC) curve (AUC) was 0.650, 0.640 and 0.710 in EEOC, OCCC and MOC, respectively. The C-indexes for the OS were 0.666 (95%CI:0.638-0.694), 0.613 (95% CI:0.575-0.650) and 0.677 (95% CI:0.637-0.716), respectively. Conclusions: Adjuvant chemotherapy was associated with a 5-year OS benefit for patients with stage IC, grade 3 EEOC, but it was unnecessary for patients with stage I OCCC and MOC. Lymphadenectomy was associated with a survival benefit for these early cancer patients. FSS is appropriate for stage I MOC but needs to be discussed for stage I EEOC and OCCC. We constructed predictive nomograms to evaluate the OS of patients with stage I EEOC, OCCC or MOC, and it will provide an individualized evaluation of OS for suitable treatments.

BRCA1/2 genes mutations frequency in patients with various histological types of ovarian cancer (data for South of Russia).

e17548 Background: About 10-15% of malignant ovarian tumors (OC) are associated with hereditary diseases, and about 65-85% of hereditary OC have a mutation in BRCA1/2 genes. The aim of the study was to analyze BRCA1/2 genes hereditary mutation spectrum in patients in the South of Russia diagnosed with OC. Methods: We used EDTA venous blood and FFPE-blocks of 324 patients with histologically verified epithelial OC (T1-3cNx-1Mx-1, stage I-IV). BRCA1 gene mutations (185delAG, 300T > C, 2080delA, 4153delA, 5382insC, 3819delGTAAA, 3875delGTCT) and BRCA2 gene mutations (6174delT) were determined by real-time PCR. Results: The most common types of OC were poorly differentiated serous carcinoma (high degree of malignancy) - 75.6%, well-differentiated serous carcinoma (low degree of malignancy) - 13%, mucinous tumors - 2.8%, endometrioid tumors - 4.3%, clear cell adenocarcinomas - 4.3%. BRCA1/2 genes mutations were found in 52 (16%) patients with OC. The frequency of detected BRCA1/2 genes mutations was: 5382insC - 53.8%, 4153 delA - 9.6%, 300T > G - 21.2%, 2080delA - 7.7%, 185delAG - 3.8%, 6174delT - 3.8%. 3819delGTAAA and 3875delGTCT mutations were not found in the BRCA1 gene. All carriers were confirmed to have the same mutations in the tumor. There were no cases of sporadic changes in BRCA1/2. BRCA1 mutation carriers prevailed in the group of high-grade serous carcinoma patients (11.1%), where all cases of BRCA2 gene mutations were identified. In the group of low-grade serous carcinoma patients, the mutation rate was 1.5%, in the endometrioid adenocarcinomas group - 0.6%, in the mixed epithelial tumors group - 2.8%. In the group of patients with mucinous tumors, mutations were not detected. Conclusions: Thus, frequency of BRCA1/2 gene mutations in OC patients living in the South of Russia was 16.0%. Distribution of mutation types in the BRCA1 gene, with a predominance of 5382insC (53.8%) and 300T > G (21.2%), corresponded to their occurrence ratio in the European populations. BRCA1/2 gene mutations were registered more often in the group of high-grade serous carcinoma patients.

Patient-derived explant model of appendiceal cancer.

4160 Background: Appendiceal cancers (AC) are rare with 5-year survival of 15% for high grade (HG) adenocarcinomas and 75% for low grade (LG) mucinous neoplasms. There is limited literature on the AC tumour microenvironment (TME) in disease progression and drug resistance. Ex vivo cultures, such as patient derived explants (PDEs), have been used for other solid tumours to test anticancer agents, explore the TME, and are being developed as personalised models. The aim of our study was to develop a PDE model of AC, preserve the TME, study the biological profile of AC and test novel therapies. Methods: Fresh tissue was collected during cytoreductive surgery (CRS) from consenting patients with AC with peritoneal disease, Jul 2020-Mar 2021. Tissues from 10 patients were dissected and cultured as PDEs under varying conditions of tissue size, media, matrix support and duration (Table). Uncultured Day 0 tissues and PDEs were fixed in formalin prior to paraffin embedding (FFPE). Immunohistochemical staining was performed on sections of FFPE tissue to assess viability with antibodies against the tumour marker, Cytokeratin-20 (CK20), and cell death marker, cleaved caspase 3 (CC3). Tissue architecture was rated on a 4-point scale (MS, J-SS). Cancer cells were counted in 6 Day 0 samples and PDEs from 3 patients using QuPath v0.3.2. Apoptotic index (AI) was calculated as the proportion of cells positive for CC3 divided by the number of total CK20 positive cells. Results: The mean proportion of tumour and mucin in the tissues was 3% (0-60%) and 39% (0-95%) respectively. Day 0 samples were viable with mean AI of cancer cells 7% (0-4%). Tissue architecture was maintained, as compared to Day 0 control, for varying sizes of PDE and culture durations up to 4d. More small or medium-sized PDEs had improved architecture compared to large sized PDEs (Table). PDEs at 4d had poorer architecture compared to at 1-3d. There was improved architecture in PDEs using enriched media with support factors compared to base media, and in specimens with matrix support compared to none. The mean AI of PDE cancer cells was 21% (0-92%) and 51% of PDEs had no cancer cell death. Conclusions: This is the first study demonstrating that AC tissue is amenable to ex vivo culture as PDEs. The optimal PDE model was <10mm tissue placed on a gelatine sponge in enriched media for 1-3d. PDEs had preserved tissue architecture and viability compared to uncultured tissue. Protein expression was in keeping with the original tumour. We plan to use this model to test anticancer agents and explore the TME of AC.[Table: see text]

Utilization of nano-hmC-seal technology to detect epigenetic signatures of peritoneal metastasis in cell-free DNA (cfDNA) in patients with colorectal and high-grade appendiceal cancer.

e15510 Background: Peritoneal metastases from lower GI tumors are common and cause significant morbidity. Assays of circulating-tumor DNA (ctDNA) to identify peritoneal recurrence after curative-surgical intent are limited due to the low abundance of DNA shed by these tumors, especially mucinous tumors. We demonstrate for the first time an ultra-sensitive test to detect biomarkers modified by the epigenetic mark 5-hydroxymethylcytosine (5hmC) in human cfDNA utilizing nano-hmC seal technology to identify patients with peritoneal metastases (PM) after curative-intent resection. Methods: Patients treated with curative intent resection of colorectal (CRC) and high-grade appendiceal (HGA) cancers underwent prospective plasma collection. Peritoneal disease was documented by direct visual inspection (laparoscopy/laparotomy). Plasma samples were analysed using nano-hmC-seal technique to obtain 5hmC signatures. Genome-wide differential analysis was used to identify significant 5hmC- differentially modified gene body regions (p-value < 0.01 and log-fold change > 10%). Functional annotation analysis was performed to further characterize differentially 5hmC -modified genes noted on multivariate logistic models. Results: Of 64 patients included in the study (CRC = 26; HGA = 38), 47 (73%) were PM+. The median DNA extracted per sample was 23.5 ng (IQR: 15.8-38.3), and no sample failed sequencing criteria. After genome-wide analysis, 39 gene body regions were identified as differentially 5hmC-modified, and 14 genes remained significant after multivariate adjustment. The signatures for PM+ patients were distinguishable from PM- patients using hierarchical clustering and principal component analyses. Functional annotation analysis based on the 14 genes point to alterations in immune and microbiome-related pathways in PM+ group (Table). Conclusions: We report for the first time the detection of peritoneal metastasis in cfDNA from human lower GI cancers using nano-5hmC seal epigenomic technology. This technology could be exploited to detect recurrences in tumors that shed very low levels of cfDNA. This signature is being validated in a prospective clinical trial (NCT 04157322).[Table: see text]

Initial clinical results of the first commercial clinical blood test dedicated to the early detection of pancreatic ductal adenocarcinoma (PDAC).

e16258 Background: The IMMray® PanCan-d blood test for early detection of PDAC has been commercially available in 45 U.S. states since the laboratory’s licensure in August 2021. This is the first clinically-available blood test dedicated to the early detection of PDAC, combining an 8-plex biomarker signature with CA19-9 in a proprietary algorithm. Here we report the initial results of this assay. Methods: All orders received and results reported were reviewed for the IMMray PanCan-d test between August 4, 2021 and February 11, 2022. Serum specimens were processed at the Immunovia, Inc. laboratory in Marlborough, Massachusetts. Demographic information of individuals undergoing testing is based on the completed test requisition submitted by their health care providers. All information was de-identified prior to this analysis. Results: The median age of those tested was 59 years and 46% were male. 76% of patients were referred because of a history of familial pancreatic cancer. Germline mutation prevalence is reported in the table below. 12% of patients had IPMNs or mucinous cystic neoplasms, 2% had chronic pancreatitis and 3% had new onset Diabetes Mellitus. Table. Demographics of Individuals Tested with the IMMray PanCan-d test 80.5% of IMMray PanCan-d results were negative, 1.1% were high-risk signature present, and 11.5% were borderline. These results are fully consistent with validation studies for this assay in high-risk surveillance populations (Brand RE et al Clin Transl Gastroenterol, doi: 10.14309/ctg.0000000000000468). 6.9% of individuals tested had a CA19-9 value of less than 2.5 U/ml, which we identify as presumptively Lewis null (le/le) and CA19-9 non-secretors. Given that CA19-9 contributes significantly to calculated decision values for the IMMray PanCan-d test, individuals with a CA19-9 less than 2.5 U/ml receive a result of test not performed. Conclusions: The commercial availability of a biomarker assay for the early detection of PDAC resulted in a testing population with demographics and referral criteria similar to that of PDAC high-risk surveillance programs in the U.S. IMMray PanCan-d test results were as expected based on prior validation studies.[Table: see text]

Pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous tumor: Different prognostic factors for different overall survival.

It is unclear whether invasive intraductal papillary mucinous neoplasm (IPMN) has different clinical and prognostic characteristics, beyond histological factors, when compared to pancreatic ductal adenocarcinoma (PDAC). compare prognostic features of resected PDAC and invasive IPMN METHODS: A retrospective study of patients resected for PDAC or invasive IPMN realized at Humanitas Cancer Center's Pancreatic Surgery Unit, Milan, Italy, between 2010 and 2016. Data recorded included patient demographics, onset symptoms, preoperative health status, tumor features, histology and surgical characteristics. Overall survival was estimated using Kaplan-Meier and prognostic factors for survival were assessed by multivariate Cox regression. A total of 332 patients were included (PDAC, n=289; invasive IPMN, n=43). Patients with invasive IPMN had better overall survival than PDAC patients (median: 76.6 versus 25.6 months; 5-year OS rate: 65.4% vs. 14.2%; p<0.001). PDAC histology was associated with a significantly higher risk of death than IPMN (hazard ratio 1.815, 95% CI: 1.02, 3.24; p=0.044). Survival was also worse with PDAC in early-stage disease (IA-IB-IIA, N0). In multivariate analysis, independent predictors of worse survival included perineural invasion, preoperative ASA physical status ≥3 and pain at diagnosis. Patients with IPMN had a better prognosis than PDAC patients, regardless of disease stage.

P-269 Malignant tumors of the appendix: A retrospective study

Malignant tumors of the appendix are a rare group of tumors often found fortuitously during surgical removal of the appendix, representing approximately 2% of appendectomy specimens. Our objective was to describe the clinico-pathological characteristics of appendicular tumors, the therapeutic modalities proposed and patient’s evolution after treatment. We conducted a retrospective review of 52 patients diagnosed with malignant tumors in the Medical Oncology department at Mohamed VI University Hospital, Marrakech, Morocco between 2012 and 2021. The clinical, biological, radiological, therapeutic and evolution data were collected. The median age was 50 years. The sex ratio was 0.7. Right lower quadrant pain was a constant complaint, followed by constipation, abdominal bloating and/or distension and vomiting. The diagnostic was based on ultrasound and/or abdominal scan. A complementary colonoscopy was proposed for 4 patients. An appendicectomy for performed on all patients after suspecting an acute appendicitis, an appendicular mucocele or for a diagnostic exploration. 42% (22 cases) were found to have a low-grade appendicular mucinous tumor, 34% a mucinous adenocarcinoma (including 5 patients with pseudomyxoma peritonei) and 24% (12 cases) an neuroendocrine tumor. 36% had localized only in the appendix while 64% were already metastatic. The therapeutic management was based on an additional surgical revision by right hemi-colectomy with ileocecal resection and lymph node dissection in 32% (17 cases), while 3% (2 cases) had undergone cytoreductive surgery with intravenous chemotherapy-peritoneal. Adjuvant chemotherapy was indicated to patients with a localized tumor with R0 and positive lymph node dissection which is the case in 7 patients. Palliative chemotherapy was proposed for metastatic patients with an unresectable tumor 26% (14 cases). 55% were under medical surveillance and screening, and 24% of patients relapsed. 21% (11 cases) were lost to follow-up. Appendicular malignant tumors represent a wide histological spectrum with various clinical subtypes, early diagnosis conditioning its management. Multidisciplinary molecular tumor boards are recommended.

Profile of ovarian tumor in anatomical pathology laboratory of Dr. Soetomo General Academic Hospital Surabaya period 1 January 2016 - 31 December 2020

Ovarian malignant tumors are the fifth leading cause of death from malignant tumors and have the highest mortality rate among uterine malignant tumors in the United States. Factors associated with an increased risk of ovarian cancer include age, nulliparity, and a family history of cancer. The aim of this study was to determine the profile ovarian tumor in anatomical pathological Dr. Soetomo General Academic Hospital during 1 January 2016 – 31 December 2020. This study used a descriptive observational study with a retrospective approach. The data were presented in tables of the distribution of the number of cases, age and histopathological diagnosis. The data was obtained from the electronic medic record (EMR) of Dr. Soetomo General Academic Hospital. There were 1107 cases, the most age was 41-50 years, namely 285 cases (25.75%), mucinous carcinoma was the most histopathological of malignant tumor, namely 145 cases (24.75%), mucinous borderline tumour was the most histopathological of borderline tumor, namely 34 cases (85%) and endometriosis was the most histopathological of benign tumor.

Risk Prediction of Second Primary Malignancies in Primary Early-Stage Ovarian Cancer Survivors: A SEER-Based National Population-Based Cohort Study.

PurposeThis study aimed to characterize the clinical features of early-stage ovarian cancer (OC) survivors with second primary malignancies (SPMs) and provided a prediction tool for individualized risk of developing SPMs.MethodsData were obtained from the Surveillance, Epidemiology and End Results (SEER) database during 1998–2013. Considering non-SPM death as a competing event, the Fine and Gray model and the corresponding nomogram were used to identify the risk factors for SPMs and predict the SPM probabilities after the initial OC diagnosis. The decision curve analysis (DCA) was performed to evaluate the clinical utility of our proposed model.ResultsA total of 14,314 qualified patients were enrolled. The diagnosis rate and the cumulative incidence of SPMs were 7.9% and 13.6% [95% confidence interval (CI) = 13.5% to 13.6%], respectively, during the median follow-up of 8.6 years. The multivariable competing risk analysis suggested that older age at initial cancer diagnosis, white race, epithelial histologic subtypes of OC (serous, endometrioid, mucinous, and Brenner tumor), number of lymph nodes examined (<12), and radiotherapy were significantly associated with an elevated SPM risk. The DCA revealed that the net benefit obtained by our proposed model was higher than the all-screening or no-screening scenarios within a wide range of risk thresholds (1% to 23%).ConclusionThe competing risk nomogram can be potentially helpful for assisting physicians in identifying patients with different risks of SPMs and scheduling risk-adapted clinical management. More comprehensive data on treatment regimens and patient characteristics may help improve the predictability of the risk model for SPMs.

Correlation of Preoperative Level of Serum Ca125 with Surgical Staging of Ovarian Cancer

Background: Ovarian cancer is one of the leading cause of mortality and morbidity of gynaecological malignancies. Lack of early demonstration of symptoms and lack of effective screening tests, ovarian tumours are usually diagnosed at an advanced stage. Different studies shows the association of pre-operative serum CA125 level with the surgical staging of ovarian cancer. Objective: To find out the correlation of pre-operative level of serum CA 125 with the surgical staging (FIGO-2014) of ovarian cancer. Methodology: This cross sectional study was carried out among 81 subjects in the department of gynaecological oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from August 2018 to September 2019. Sampling technique was purposive. All consecutive patients admitted at department of gynaecological oncology, BSMMU with diagnosed ovarian cancer were included in this study. Data were collected and documented on a preformed and pretested structured questionnaire. Clinical examinations and relevant investigations were done and recorded accordingly. Result: Mean age of the study subjects was 45.7 ± 15.2 years with a range of 13-75 years. Mean BMI was 23.3 ± 3.0 kg/m2 and mean age of marriage was 16.1 ± 2.8 years. Maximum study subjects had stage III (44.4%) followed by stage II (23.5%), stage I (21.0%) and stage IV (11.1%). Preoperative CA-125 was &gt;35 U/ml in 90.1% cases. Serum CA-125 was elevated at the advanced stage of ovarian cancer. Maximum study subjects had serous tumors (70.4%) followed by mucinous tumors (11.5%), endometrioid adenocarcinoma (7.4%), malignant teratoma (4.9%) and clear cell tumors (3.7%). Serum CA-125 had significant positive correlation with surgical stages of ovarian epithelial cancer. Conclusion: Surgical stage of epithelial ovarian cancer significantly correlates with CA-125. Bangladesh Med Res Counc Bull 2021; 47(2): 110-117

The cytokeratin 17 expression in primary ovarian tumors has diagnostic but not prognostic significance.

We assessed the value of cytokeratin 17 (CK17) expression for the differential diagnosis between primary ovarian mucinous tumors and metastases from the gastrointestinal tract (GIT) and the significance of CK17 expression in a broad spectrum of primary ovarian tumors with respect to their prognosis. The sample set consisted of 554 primary ovarian tumors and 255 GIT tumors. In the primary ovarian tumors, a higher CK17 expression (in > 10% of tumors cells) was present only in 0-11.4% of all tumors (including mucinous tumors, micropapillary serous borderline tumors, clear cell, endometrioid, and high-grade serous carcinomas). The only exception was low-grade serous carcinoma, where higher CK17 expression was present in 24% of cases. Concerning GIT tumors, the higher levels of CK 17 expression (in > 10% of tumor cells) were observed in the upper GIT tumors (68.5% of pancreatic ductal adenocarcinoma, 61.6% of gallbladder adenocarcinoma, and 46% of gastric adenocarcinoma), which differs substantially not only from most of the primary ovarian tumors, but also from colorectal carcinoma (3.7%; p < 0.001). The results of our study suggest that expression of CK17 can potentially be used as an adjunct marker in differential diagnosis between primary ovarian mucinous tumors and metastases from the upper GIT, but not from colorectal carcinoma. However, in GIT tumors, CK17 can be used in the differential diagnosis between adenocarcinomas of the upper and lower GIT. Statistical analysis did not reveal strong association of CK17 expression with clinicopathological variables or patient outcomes in any primary ovarian tumors.

A Novel Case of Recurrent Mucinous Borderline Ovarian Tumor: Early Relapse and Fatal Outcome

Unlike ovarian carcinomas, borderline ovarian tumors (BOTs) are associated with a favorable prognosis: their recurrence rate is around 5–7%, and the survival rate is more than 97% when diagnosed early. There are only a few reports of recurrence and fatal outcomes. Herein, we report a novel case of recurrent mucinous BOT, with a literature review. A 63-year-old woman presented to a local doctor with abdominal fullness. She was diagnosed as having a polycystic tumor. The lesion was suspected to be a mucinous BOT (M-BOT) on magnetic resonance imaging. Upper and lower gastrointestinal endoscopy revealed no digestive cancerous lesions, and surgery was performed. Intra-operative diagnosis confirmed the diagnosis, and total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy were performed. The final pathological diagnosis was non-invasive M-BOT (stage I c1 (T1c1N0M0)). The result of immunohistochemical staining supported the diagnosis of primary ovarian mucinous tumor.Four months after surgery, relapse occurred. Blood tests revealed an elevated carbohydrate antigen 19-9 level, and computed tomography revealed multiple liver metastases, peritoneal dissemination, left ureter infiltration, and carcinomatous peritonitis. Although the patient underwent chemotherapy, she died. This case of a very short progression-free and overall survival in stage I M-BOT indicates that some M-BOTs could result in fatal clinical outcomes despite diagnosis at an early stage. Frequent follow-up appointments after surgery could help detect relapse and increase survival in such cases.

Unusual site of pseudomyxoma peritonei recurrence after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a case report of intraluminal disease manifestation in the small bowel

BackgroundPseudomyxoma peritonei (PMP) is an uncommon clinical condition characterized by the presence of mucinous ascites, mainly induced by perforated appendiceal mucinous neoplasms (AMN). The peritoneal surface of the small bowel is usually spared from disease manifestation due to peristaltic movements. Mucinous tumours can disseminate as PMP on the entire peritoneum, but are rarely intraluminal. For the first time in literature, we report a case of intraluminal PMP involving the ileum.Case presentationA 75-year-old male was treated for perforated AMN and disseminated PMP with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. During follow-up, the patient developed intraperitoneal recurrence together with intraluminal depositions in the ileum, both disease manifestations with identical KRAS and SMAD4 mutations. Hereafter, the patient was treated with palliative care.ConclusionThis case illustrates the variation in the biological and clinical behaviour of this rare disease. Clinicians should be aware of unusual tumour distribution patterns of PMP, including the presence of mucinous tumour within the small bowel.

Investigation of BRCA1 methylation and FAT3 mutation as a potential biomarker in ovarian cancer samples

Ovarian cancer is one of the most dangerous and leading gynecological cancer with significant cancer related mortality among women. As the cancer detection is the key to increased survival, we aimed to test molecular markers in Ovarian Cancer (OC) Figo stage I, II and III tumor samples in order to identify genetic/epigenetic events having biomarker potential. Seven genes (BRCA1, IGFBP-3, DAPK1, RASSF1, CDKN2A, MLH1, and ANO5) were studied for their methylation status and three genes (FAT1, FAT3 and NF1) were tested for their mutation status on 24 ovarian cancer tumor samples and 10 normal ovarian tissue samples. The methylation frequency for BRCA1 and DAPK1 was found to be 83.3% and 8.3% respectively while no hypermethylation was observed for IGFBP-3, RASSF1, CDKN2A, ANO5 and MLH1 genes for selected CpG sites in all samples. BRCA1 hypermethylation was frequently found in serous (88.7%) than mucinous (66.6%) histotype (p < 0.035). Statistically, BRCA1 methylation was found commonly in older females (>45 year) (88%, n = 18), however, data was not significant (p < 0.25). BRCA1 methylation was also found to be associated with Figo stage III (78.5%) patients (p < 0.04), suggesting that this could be a late event in progression of ovarian cancers. Out of 24 OC samples, FAT1 (4.16%), FAT3(16.6%), and NF1 (8.3%) were found to be mutated for selected alleles. FAT3 mutation was recurrent in mucinous histology but did not display any significant correlation with clinic-pathological characteristics of tumor samples. Our study reports, frequent BRCA1 promoter methylation in serous and mucinous OC samples and therefore, it may serve as potential biomarker in therapeutic settings in future. FAT3 is an emerging diagnostic biomarker however, its clinical utility is required to be validated in a large cohort of ovarian cancer samples.

Involvement of tissue changes induced by neoadjuvant treatment in total mesorectal excision (TME): novel suggestions for determining TME quality.

Few studies to date have investigated morphological changes after neoadjuvant treatment (NAT) and their implications in total mesorectal excision (TME). This study was primarily designed to evaluate whether tissue changes associated with NAT affected the quality of TME and additionally to suggest a more objective method evaluating TME quality. This study enrolled 1322 consecutive patients who underwent curative robot-assisted surgery for rectal cancer. Patients who did and did not receive NAT were subjected to propensity-score matching, yielding 402 patients in each group. NAT independently reduced complete achievement of TME [odds ratio (OR) = 2.056, p = 0.017]. Intraoperative evaluation identified seven tissue changes significantly associated with NAT, including tumor perforation, mucin pool, necrosis, fibrosis, fat degeneration, and rectal or perirectal edema NAT (p < 0.001-0.05). Tumor perforation (OR = 5.299, p = 0.001) and mucin pool (OR = 14.053, p = 0.002) were independently associated with inappropriate (near-complete + incomplete) TME. Complete TME resulted in significantly reduced local recurrence (4.3% vs 15.3%, p = 0.003) and increased 5-year DFS rate (80.6% vs 67.6%, p = 0.047) compared with inappropriate one. By contrast, two tiers of complete and near-complete TMEs vs incomplete TME did not. Notably, among patients with complete TME, those who received NAT had a lower 5-year DFS than those who did not (77.8% vs 83.3%, p = 0.048). NAT-associated tissue changes, somewhat interrupting complete TME, may provide unsolved clue to the relative inability of NAT to improve overall survival. The conventional three-tier grading of TME seems to be simplified into two tiers as complete and inappropriate.

Interval Appendectomy Specimens.

Patients with perforated appendicitis are often managed with antibiotic therapy followed by a delayed appendectomy. Histologic features of such specimens have been incompletely described, especially in the recent literature. To describe the histomorphology of interval appendicitis with a focus on features that could mimic important conditions, such as infections, Crohn disease, and mucinous neoplasms. Histologic evaluation of 100 interval appendectomy specimens with clinical and radiologic correlation. A total of 54 of the 100 patients (54%) had radiologic evidence of appendiceal perforation, and 97% were treated with intravenous and/or oral antibiotic therapy prior to appendectomy. Percutaneous drains were placed in 34 cases (34%). Common histologic findings included mural eosinophilic infiltration (54%), periappendiceal fibrosis (54%), and xanthogranulomatous inflammation (31%). Periappendiceal fibrosis was frequent among patients with radiologic evidence of perforation. Nine cases (9%) featured pulse granulomata associated with fecal material. Epithelioid granulomata were detected in 6% of cases and were confined to mucosal lymphoid follicles in all cases. Only 4 of these were accompanied by mural lymphoid aggregates that raised the possibility of Crohn disease. Changes mimicking mucinous neoplasms were more common: 14% of cases (14 of 100) displayed goblet cell hyperplasia, 15% (15 of 100) contained diverticula, and 16% (16 of 100) showed mural or periappendiceal mucin pools. Although interval appendectomy specimens occasionally contain inflammatory infiltrates that mimic infections and/or Crohn disease, changes that can be confused with mucinous neoplasms are more frequently encountered.

Synchronous Mucinous Carcinomas of Ovary and Appendix: A Case Report With Diagnostic Pitfalls and Review of Corresponding Literature

Background Diagnosis of the primary ovarian mucinous neoplasms occasionally poses a challenge because historically most tumors diagnosed as primary ovarian were documented as metastases from gastrointestinal and pancreatobiliary tracts. This challenge is attributed to the overlapping histologic features, the gray zone, between primary and metastatic mucinous neoplasms in the ovary. While presentation of both primary and metastatic mucinous tumors manifests by the presence of an ovarian mass, determination of the site of origin is clinically significant, because most treatment guidelines are based on the tissue of origin. Case Presentation We present an unusual case of mucinous adenocarcinoma of the ovary and the appendix with diagnostic pitfalls and challenges of immunohistochemical profile. Conclusion Utilization of molecular analysis in challenging cases of ovarian neoplasms helps to narrow down the gray zone and lessens the misdiagnosis of primary ovarian mucinous tumors.

Reaffirming microcystic ultrasound appearance of borderline ovarian tumors using three-dimensional 'silhouette' rendering.

The data that support the findings of this study are available from the corresponding author upon reasonable request. Figure S1 Borderline tumor in the right ovary. Figure S2 17.4-mm borderline tumor in the left ovary. Figure S3 Borderline tumor in the left ovary. Figure S4 20-mm borderline tumor in the left ovary. Figure S5 Benign, serous, ovarian cystadenofibroma. Figure S6 Benign, serous, ovarian cystadenoma. Figure S7 Mucinous intraepithelial ovarian tumor. Figure S8 Clear cell carcinoma of the ovary. Videoclip Figure 2 Videoclip Figure 3 Videoclip Figure 4 Videoclip Figure S2 Videoclip Figure S3 Videoclip Figure S4 Videoclip Figure S5 Videoclip Figure S7 Videoclip Figure S8 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Risk factors of malignant mucinous cystic neoplasm of pancreas and its prognosis

Risk factors of malignant mucinous cystic neoplasm of pancreas and its prognosis

Mucinous borderline ovarian tumors: pathological and prognostic study at Salah Azaiez Institute.

Introductionovarian Mucinous Borderline Tumors (MBT) are characterized by an epithelial proliferation similar to those of well differentiated adenocarcinomas but are distinguished by the absence of stromal invasion. They are often difficult to diagnose histologically. The aim of the work was to specify the pathological and clinical features and to highlight the prognostic of these tumors.Methodsstudy was retrospective including 49 cases of primary ovarian MBT, diagnosed at the Patholgy Department of Salah Azaiez Institute from 1992 to 2019.Resultsmedian age was 48 years old. Histologically, the cases were divided into 34 cases of pure MBT, 13 cases with intraepithelial carcinoma and 2 cases associating an intraepithelial carcinoma with microinvasion. The majority of our cases were classified FIGO I and only one case FIGO III. Sixteen patients received conservative treatment and 30 received radical treatment. The treatment wasn’t specified in three patients. The prognosis was good in the majority of cases. Only one patient had a contralateral recurrence after a follow-up period of three years. There were no significant differences regarding the risk of recurrence and risk factors such as age, gestation, hormonal status, FIGO stage and conservative treatment. We raised this part.Conclusionthe prognosis of the ovarian MBT is good. However, it is necessary to multiply the samples to avoid missing a carcinomatous focus with an anarchic invasion of the stroma which constitutes a poor prognosis factor. It was changed by these sentences below: the diagnosis of MBT is not easy. Indeed, the distinction of MBT from carcinomas remains the greatest challenge for pathologists. Once this diagnosis is made with certainty, the tumor can be considered to have a good prognosis, especially stage I tumors which are the most common.