Sendai virus-mediated expression of reprogramming factors promotes plasticity of human neuroblastoma cells

Neuroblastoma (NB) is the most common extracranial solid tumor that originates from multipotent neural crest cells. NB cell populations that express embryonic stem cell-associated genes have been identified and shown to retain a multipotent phenotype. However, whether somatic reprogramming of NB cells can produce similar stem-cell like populations is unknown. Here, we sought to reprogram NB cell lines using an integration-free Sendai virus vector system. Of four NB cell lines examined, only SH-IN cells formed induced pluripotent stem cell-like colonies (SH-IN 4F colonies) at approximately 6 weeks following transduction. These SH-IN 4F colonies were alkaline phosphatase-positive. Array comparative genomic hybridization analysis indicated identical genomic aberrations in the SH-IN 4F cells as in the parental cells. SH-IN 4F cells had the ability to differentiate into the three embryonic germ layers in vitro, but rather formed NBs in vivo. Furthermore, SH-IN 4F cells exhibited resistance to cisplatin treatment and differentiated into endothelial-like cells expressing CD31 in the presence of vascular endothelial growth factor. These results suggest that SH-IN 4F cells are partially reprogrammed NB cells, and could be a suitable model for investigating the plasticity of aggressive tumors.

Abstract P2-04-08: Accuracy of estrogen receptor, progesterone receptor, HER2 Status and Ki67 labeling index between core needle and surgical excisional tumour in 910 patients with breast cancer

Purpose

Accurate determination of ER, PgR, HER2 status and Ki67 labeling index was very important in making decision for adjuvant and neoadjuvant treatment for patients with breast cancer. However discordance of ER, PgR, HER2 status and Ki67 labeling index (Ki67-LI) between core needle biopsy (CNB) and surgical specimens (SSp) varied among reported studies.

The aim of the present study was to compare the accuracy of CNB with that of SSp for ER, PgR,HER-2 status, Ki67-LI detection in breast cancer.

Patients and methods

All patients diagnosed with an early breast cancer in our Cancer Center Hospital between January 2005 and May 2014 was included but exclusion criteria of patients with large tumour requiring neoadjuvant chemotherapy. All CNB were performed under ultrasound guidance, with at least four 14-gauce core biopsies being obtained for pathological examination. ER, PgR, HER-2 status and Ki67-LI were assessed in CNB and in SSp. ER and PgR were determined by

Immunohistochemistry (IHC). The cut points for ER and PgR positive was10%. The cut point for Ki67-LI high expression was 20%. HER2 was determined by IHC and scored from 0 to 3+. FISH analysis was carried out in HER2 2+ cases and in discordant cases.

Results

A total of 910 patients were assessed. CNB can be used with confidence for ER and HER2 determination. Rates for sensitivity, specificity, negative predictive value and positive predictive value for CNB compared with SSp are 99.3%,95.6%,97.2%,98.5% for ER, 94.5%,81.8%,88.2%,90.7% for PgR ,93.0%,99.1%,99.6%,93.9% for HER2, and 87.7%,69.8%,81.1%,79.4% for Ki67-LI, respectively. Specially, the most impact factor of discordance for Ki67-LI and HER2 is Tumour size and that for ER and PgR is lobular carcinoma.

Conclusion

CNB can be used with confidence for ER and HER2 determination. For PgR and Ki67-LI due to substantial discordance results from CNB should be used with caution.

Citation Format: Rikiya Nakamura, Naohito Yamamoto, Yoshiyuki Itookubo, Ayako Nakagawa, Makiko Itami. Accuracy of estrogen receptor, progesterone receptor, HER2 Status and Ki67 labeling index between core needle and surgical excisional tumour in 910 patients with breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-04-08.

Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma

Pericardial mesothelioma is a very rare pericardial tumor. Diagnosing pericardial disease can be challenging, and obtaining an antemortem diagnosis of pericardial mesothelioma is particularly difficult. We herein report the case of a 60-year-old man with pericardial mesothelioma diagnosed on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Chest computed tomography showed a mass surrounding the pericardium, and EBUS-TBNA of the right inferior paratracheal and subcarinal stations was consequently performed. No uptake was noted on (18)F-fluorodeoxy glucose positron emission tomography, other than in the pericardial mass. The results of histological and immunohistochemical examinations indicated the features of malignant mesothelioma. We therefore diagnosed the patient with pericardial mesothelioma, which was subsequently confirmed at autopsy.

Signet ring cell carcinoma of the extrahepatic bile duct diagnosed by preoperative biopsy: a case report

A 73-year-old woman was admitted because of obstructive jaundice. Computed tomography revealed a stricture in the lower bile duct with enhanced bile duct wall. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a tapering stenosis at the lower bile duct. Transpapillary histological biopsy using biopsy forceps through ERCP was performed; the diagnosis of signet ring cell carcinoma (SRCC) of the bile duct was established. Regional lymph node enlargement and distant metastases were not detected on diagnostic imaging. Pancreaticoduodenectomy with pylorus preservation was performed. Histological examination of the resected specimen confirmed SRCC of the extrahepatic bile duct coexisting with adenocarcinoma (ADC) of the extrahepatic bile duct with negative resection margins. However, tumor cells directly invaded the pancreatic parenchyma and the muscle layer of the duodenum, prompting us to administer adjuvant chemotherapy to the patient, with no sign of tumor recurrence at 1-year follow-up. Almost all tumors originating from the extrahepatic bile duct are ADC and other histological variants are rare. Of these, SRCC is extremely rare and only four cases have been reported. Furthermore, to the best of our knowledge, this is the first case report regarding the preoperative diagnosis of SRCC of the bile duct. Current reports indicate that younger age and Asian ethnicity are the clinical features of SRCC of the extrahepatic bile duct. Immunohistochemical staining of CK7, CK20 and MUC2 may be useful for predicting prognosis. Chemotherapy has not resulted in increased survival rates and only surgical resection currently serves as a curative treatment.

The effect of molecular subtype and body mass index on neo-adjuvant chemotherapy in breast cancer patients

The aim of the present study was to analyze the effect of subtype and body mass index (BMI) on neo-adjuvant chemotherapy (NAC) and postoperative prognosis. Two-hundred and forty nine patients who underwent surgery after NAC were included. A multivariate analysis and survival analysis were used to clarify the relationship between BMI, subtype, and NAC. In the logistic regression model, the pCR rate had a significant relationship with the subtype and tumor stage. In the non-pCR group, more overweight patients had significantly a worse disease-free survival (DFS) compared to normal range patients (Log lank test, p < 0.05). In the Cox proportional hazards model, subtype and tumor stage were significantly associated with decreased DFS. In conclusion, patients with the ER (+), HER (-) type and a high BMI had a high risk for recurrence when they achieved non-pCR after NAC.

NCYM, a Cis-antisense gene of MYCN, encodes a de novo evolved protein that inhibits GSK3β resulting in the stabilization of MYCN in human neuroblastomas

The rearrangement of pre-existing genes has long been thought of as the major mode of new gene generation. Recently, de novo gene birth from non-genic DNA was found to be an alternative mechanism to generate novel protein-coding genes. However, its functional role in human disease remains largely unknown. Here we show that NCYM, a cis-antisense gene of the MYCN oncogene, initially thought to be a large non-coding RNA, encodes a de novo evolved protein regulating the pathogenesis of human cancers, particularly neuroblastoma. The NCYM gene is evolutionally conserved only in the taxonomic group containing humans and chimpanzees. In primary human neuroblastomas, NCYM is 100% co-amplified and co-expressed with MYCN, and NCYM mRNA expression is associated with poor clinical outcome. MYCN directly transactivates both NCYM and MYCN mRNA, whereas NCYM stabilizes MYCN protein by inhibiting the activity of GSK3β, a kinase that promotes MYCN degradation. In contrast to MYCN transgenic mice, neuroblastomas in MYCN/NCYM double transgenic mice were frequently accompanied by distant metastases, behavior reminiscent of human neuroblastomas with MYCN amplification. The NCYM protein also interacts with GSK3β, thereby stabilizing the MYCN protein in the tumors of the MYCN/NCYM double transgenic mice. Thus, these results suggest that GSK3β inhibition by NCYM stabilizes the MYCN protein both in vitro and in vivo. Furthermore, the survival of MYCN transgenic mice bearing neuroblastoma was improved by treatment with NVP-BEZ235, a dual PI3K/mTOR inhibitor shown to destabilize MYCN via GSK3β activation. In contrast, tumors caused in MYCN/NCYM double transgenic mice showed chemo-resistance to the drug. Collectively, our results show that NCYM is the first de novo evolved protein known to act as an oncopromoting factor in human cancer, and suggest that de novo evolved proteins may functionally characterize human disease.

The MYCN oncogene has a central role in the genesis and progression of neuroblastomas, and its amplification is associated with an unfavorable prognosis. We have found that NCYM, a MYCN cis-antisense RNA, is translated in humans to a de novo evolved protein. NCYM inhibits GSK3β to stabilize MYCN, whereas MYCN induces NCYM transcription. The positive feedback regulation formed in the MYCN/NCYM-amplified tumors promotes the aggressive nature of human neuroblastoma. MYCN transgenic mice, which express human MYCN in sympathoadrenal tissues, spontaneously develop neuroblastomas. However, unlike human neuroblastoma, distant metastasis is infrequent. We established MYCN/NCYM double transgenic mice as a new animal model for studying neuroblastoma pathogenesis. We found that NCYM expression promoted both the metastasis and chemo-resistance of the neuroblastomas formed in the double transgenic mice. These results demonstrate that NCYM may be a potential target for developing novel therapeutic tools against high-risk neuroblastomas in humans, and that the MYCN/NCYM double transgenic mouse may be a suitable model for the screening of these new drugs.

Abstract P2-02-09: Accuracy of MRI for estimating residual tumor size after neoadjuvant endocrine therapy in early stage breast cancer with ER positive and HER2 negative

Back ground

Neoadjuvant endocrine therapy (NET) is increasingly being used in the management of breast cancer patients with ER positive and HER2 negative. A major clinical benefit is that patients with large operable tumors may be offered breast-conserving surgery (BCS). Therefore, success of BCS following NAT depends on accurate assessment of the residual tumor extent after NAT. The correlation between the extent of the tumor at pathology and preoperative assessments of the size obtained by physical examination and conventional imaging is impaired by hormonal therapy-induced necrosis and fibrosis. However, the most superior method to assess the extent of residual disease after NAT was unknown. The aim of this study was to evaluate the relative accuracies of mammography(MMG), ultrasound(US), specimen mammography(SMMG) and MRI in predicting residual tumor size and pathological response after neoadjuvant endocrine therapy (NET) in patients with ER positive and HER2 negative. Each prediction method (EPM) was compared with the gold standard of surgical pathology.

Patients and methods

From April 2010 to December 2012, 50 post menopausal patients with breast cancer at clinical stages T1c-T2N0 were prospectively enrolled in this study on NET. Fifty patients (age range, 52-75 years; mean age, 64.1 years) who received NET with 24 weeks of letrozole were evaluated with EPM before and after NET.

We compared the predicted residual tumor size and the predicted response on imaging with residual tumor size and response on the pathologically determined size. We defined the tumor sizes measured by EPM and pathology as in agreement when the greatest tumor dimension measured by EPM was within 70_120% of the measurement determined by microscopic pathology. The EPM assessment was categorized as an underestimation when the longest diameter on imaging was &lt;70% that at pathology and as an overestimation when the longest diameter on imaging was&gt;120% that at pathology. Statistical analysis was performed using logistic regression analysis.

Results

The correlation coefficient between the residual tumor sizes determined by pathology and the predicted tumor size was 0.721(p = 0.651) for MMG, -0.111(p = 0.642) for US, 0.723(P = 0.001) for SMMG and 0.714 (p&lt;0.000001) for MRI.

The rate of agreement between the final response predictions and the responses measured by pathology were 50% for MMG, 40% for US, 35% for SMMG and 78% for MRI. The MMG,US, SMMG and MRI measurement disagreed with the pathologically determined size in 50%,60%,65%,22%, overestimating the size in 0%,12%, 11%,2% and underestimating the size in 50%, 48%,53%,20% respectively.

Conclusions

Predictions of response and residual tumor size made on MRI were best correlated with the assessments of response and residual tumor size made on pathology than were predictions made on the basis of clinical examination, mammography or ultrasound. MRI is one of the most accurate methods for predicting the extent of residual tumor after NET.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-09.

Pulmonary artery sarcoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

Pulmonary artery sarcoma (PAS) is a rare tumor that is often detected at an advanced stage, when disease is so widespread that a radical surgical procedure is no longer indicated. Therefore, less invasive biopsy techniques are required to establish a definitive preoperative diagnosis. Endobronchial ultrasound (EBUS) is useful for producing real-time images of both lymph nodes and the interior of pulmonary arteries adjacent to the bronchi. We report a case with masslike lesions in the pulmonary artery that were observed by EBUS and from which tissue was obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to establish a diagnosis of PAS.

Carcinomatous pericarditis in 3 breast cancer patients with long-term survival

With advances in drug treatment of breast cancer, the number of patients experiencing cardiac toxicity or carcinomatous pericarditis is expected to increase. These conditions can cause cardiac tamponade, which is a potentially fatal condition requiring prompt diagnosis and treatment. We experienced 3 breast cancer patients with cardiac tamponade due to carcinomatous pericarditis who survived for prolonged periods after treatment with pericardiocentesis and intrapericardial instillation. The 3 women were 68, 46 and 46 years old, respectively, and receiving treatment for recurrent breast cancer after surgery. They developed dyspnea and cough and were diagnosed with cardiac tamponade by echocardiography. Pericardiocentesis was performed, and cytology of the effusion confirmed the diagnosis of carcinomatous pericarditis. Intrapericardial instillation of cisplatin reduced the cardiac effusion, ameliorating symptoms. The patients died 13, 31 and 14 months later, respectively. In our clinical review of 13 other cases of cardiac tamponade due to breast cancer, 85% achieved local control after the aforementioned local treatments, which were considered to be effective. Although the overall prognosis was poor with a median survival time of only 4 months, some patients were able to survive more than 1 year after local treatment with subsequent systemic therapy.

Abstract 4592: Sox8 as a molecular marker of oligodendroglial tumors

Backgournd: The precise diagnosis of oligodendroglial tumors from astrocytic tumors is required because the sensitivity to treatments and outcome of patients are different between these two types of gliomas. However, morphological diagnosis of these tumors is not always easy and sometimes different among pathologists. The aim of this study is to clarify the clinical significance of Sox8 as a molecular marker of oligodendroglial tumors. Materials and Methods: The expression level of Sox8 was evaluated by real-time PCR in 74 gliomas (OII: 7, OIII: 15, AIII: 5, GBM: 47), and was compared with morphological diagnosis and other molecular markers as follows: 1p/19q co-deletion evaluated by array CGH, methylation of MGMT gene promoter by methylation-specific PCR, and IDH-1 mutation by immunohistochemistry. For the evaluation of diagnostic value of Sox8-expression, tumors were divided into two groups owing to the expression level of Sox8 (threshold: 2000), and the clinical outcome of patients were compared between these two groups. Furthermore, these diagnostic significances of Sox8 were compared with those of Olig-1 and Olig-2. Results: The expression level of Sox8 was significantly higher in oligodendroglial tumors (p&lt;0.0001), 1p/19q co-deleted tumors (p&lt;0.0001) and tumors with mutant IDH-1 protein (p&lt;0.0001). The frequency of MGMT methylation was higher in tumors with high Sox8-expression, although statistical significance was not proven. In oligodendroglial tumors, the survival of patients with tumors exhibiting high Sox8-expression was significantly better than those with low SOX8-expression (hazard ratio: 6.2, p=0.031). High-expression of Olig-2 (hazard ratio: 4.5, p=0.026) and 1p/19q co-deletion (hazard ratio: 5.1, p=0.020) were also correlated with favorable outcome of patients, but no significant correlation between the expression of Olig-1 and patients’ outcome was observed. Conclusions: Sox8 was highly expressed in 1p/19q co-deleted oligodendroglial tumors. In oligodendroglial tumors, the expression of Sox8 was the significant prognostic factor of patients’ survival.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4592. doi:1538-7445.AM2012-4592

Abstract P3-14-13: Necessity of Confirming the Biological Marker of Distant Metastatic Lesion for Breast Cancer Patients

Background

The systemic management of metastatic breast cancer patients is usually based on biological marker of the primary tumor. However, characteristics of hormone status or HER2 over expression may change with metastatic site due to long term treatment for metastatic cancer with endocrine therapy, chemotherapy or biologic agents. The first purpose of this study was to investigate the concordance in HER2 over expression between primary tumor and distant metastases. The second purpose was to evaluate the efficacy of biologic agents for the patients with positive changes in HER2 status.

Material and methods One hundred forty-one patients had biopsy or operation of their metastatic site from 2000 to December 2009 at the Chiba Cancer Center Hospital. Specimen of operation or biopsies of suspected metastatic site were obtained from breast cancer patients. Specimen were analyzed pathologically to confirm metastatic disease and secondly to evaluate

HER2 by immunohistochemistry or FISH.

Results

Specimen of metastatic site were 67 local lesion (breast or lymph node), 27 brain, 16 liver, 12 bone and 5 others organs (stomach, intestine, ovary or uterus. Negative, positive or no change in HER2 status was observed in 4%, 6%, and 90% respectively. Positive changes of HER2 in metastatic site were 3(4%) local lesion, 3(11%) brain, 1 (7%) lung, 0(0%) liver, 2(17%) bone, and 0(0%) others, respectively. Three patients with positive change in HER2 status of metastatic site were treated to trastuzumab. Two of 3 patients with HER2 positive change were assessed to responded to trastuzumab-based treatment schedules.

Conclusions This study demonstrates the presence of substantial discordance in HER2 overexpression between primary tumor and metastases site.Metastatic tissue confirmation might be considered in patients with suspicious metastatic recurrence or resistance trastuzumab treatment.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-14-13.

Mandibular bone metastasis of rectal cancer: Report of a case

A 56-year-old man was referred with lower rectal cancer showing anal canal invasion and liver metastasis. He underwent an abdominoperineal resection and a partial hepatectomy. Adjuvant therapy with tegafur-uracil and leucovorin was administered postoperatively. Lung metastasis was detected 2 years later and was resected. Right mandibular metastasis was diagnosed 2 months after the resection of the lung metastasis. A partial mandibular resection was performed after chemoradiotherapy, followed by reconstruction with a titanium frame and oral cavity reconstruction with a greater pectoral musculocutaneous flap. The pathological diagnosis was metastatic rectal cancer, and the therapeutic effect chemoradiotherapy was Grade 2. He is presently alive without any evidence of cancer, and has maintained a good quality of life 3 years after the mandibular resection and more than 5 years after his first operation. Mandibular metastasis from rectal cancer is very rare and the prognosis is poor according to the literature, so this case is considered to be very unusual.

EML4-ALK fusion gene assessment using metastatic lymph node samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration

PURPOSE

Anaplastic lymphoma kinase (ALK) fusion genes represent novel oncogenes for non-small cell lung cancers (NSCLC). Several ALK inhibitors have been developed, and are now being evaluated in ALK-positive NSCLC. The feasibility of detecting ALK fusion genes in samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was determined. The clinicopathologic characteristics of ALK-positive lung cancer were also analyzed.

EXPERIMENTAL DESIGN

From April 2008 to July 2009, NSCLC cases with hilar/mediastinal lymph node metastases detected by EBUS-TBNA were enrolled. Positive expression of ALK fusion protein was determined using immunohistochemistry, and ALK gene rearrangements were further examined to verify the translocation between ALK and partner genes using fluorescent in situ hybridization and reverse transcription-PCR. Direct sequencing of PCR products was performed to identify ALK fusion variants.

RESULTS

One hundred and nine cases were eligible for the analysis using re-sliced samples. Screening of these specimens with immunohistochemistry revealed ALK positivity in seven cases (6.4%), all of which possessed echinoderm microtubule-associated protein-like 4-ALK fusion genes as detected by fluorescent in situ hybridization and reverse transcription-PCR. All ALK-positive cases had an adenocarcinoma histology and possessed no EGFR mutations. Compared with ALK-negative cases, ALK-positive cases were more likely to have smaller primary tumors (P < 0.05), to occur at a younger age (<60 years; P < 0.05), and to occur in never/light smokers (smoking index < 400; P < 0.01). Mucin production was frequently observed in ALK-positive adenocarcinomas (29.4%; P < 0.01).

CONCLUSIONS

EBUS-TBNA is a practical and feasible method for obtaining tissue from mediastinal and hilar lymph nodes that can be subjected to multimodal analysis of ALK fusion genes in NSCLC.

Restaging by endobronchial ultrasound-guided transbronchial needle aspiration in patients with inoperable advanced lung cancer

We present two cases of inoperable advanced lung cancer in which the main lesions were mediastinal lymph nodes detected with positive positron emission tomography (PET). Drug therapy was very effective, and post-treatment PET results were negative. Restaging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed on the mediastinal lymph nodes with a short axis < or = 10 mm measured by computed tomography (CT). Cancer cells were detected, which helped determine the therapeutic strategy. Re-evaluation of mediastinal lymph nodes using EBUS-TBNA appears to be useful, even among patients with inoperable advanced lung cancer.

Pulmonary metastasis with endobronchial spread from sinonasal melanoma during a 9-year follow-up

A 60-year-old woman was diagnosed with pulmonary metastasis with endobronchial spread of sinonasal melanoma 9 years after the initial treatment. She had originally been diagnosed with sinonasal malignant melanoma and received chemotherapy combined with carbon ion radiotherapy. During routine follow-up, chest CT showed a nodular lesion on the left upper lung lobe. Bronchoscopic examination showed diffuse melanosis without intrinsic masses from the left main bronchus to the peripheral bronchial mucosa. Transbronchial biopsy was performed for both the pulmonary lesion and endobronchial melanosis lesions. Melanoma cells were histologically detected in both the mucosal and submucosal layers.

Mediastinal follicular lymphoma diagnosed with multidirectional analysis using tissue samples obtained by EBUS-TBNA

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been developed as a useful tool for the diagnosis of diseases adjacent to the airway to be used in place of open surgery or mediastinoscopy. In this report, we present a 46-year-old man with a solid tumor in the mediastinum. Since no other pathological sites were identified, EBUS-TBNA was employed for tumor sampling. Sufficient tissue specimens were collected and the diagnosis of follicular lymphoma was established based on the combination of immunohistochemistry, flow cytometry and FISH analysis. This report demonstrates the advantage of EBUS-TBNA even for the diagnosis of hematological disease.

Primary hepatoid adenocarcinoma of the uterine cervix

Hepatoid adenocarcinoma is characterized histologically by neoplastic epithelial cells that resemble hepatocellular carcinoma (HCC) and produce alpha-fetoprotein (AFP). We describe a case of hepatoid adenocarcinoma of the uterus that, unlike any other previously reported case, was strictly confined to the cervix. A cervical biopsy demonstrated poorly differentiated adenocarcinoma, and hysterectomy and bilateral salpingo-oophorectomy were subsequently performed. Histologically, the lesion consisted of solid sheets of hepatoid cells accompanied with areas of endometroid adenocarcinoma. The tumor cells showed strong and diffuse cytoplasmic immunoreactivity with AFP in both medullary and adenocarcinoma components. Metastases to bilateral pelvic lymph nodes were detected 12 months after surgery. Since undergoing total pelvic irradiation, the patient has been alive and in full remission for 22 months. To our knowledge, this is the first report of primary hepatoid adenocarcinoma of the uterine cervix.