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Saraei P, Heshmati A, Hosseini S. Small-cell neuroendocrine carcinoma of the female genital tract: A comprehensive overview. J Neuroendocrinol 2024; 36:e13394. [PMID: 38626758 DOI: 10.1111/jne.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
Small-cell neuroendocrine carcinomas (SCNECs) of the female genital tract are rare and aggressive tumors that are characterized by a high rate of recurrence and poor prognosis. They can arise from various sites within the female genital tract, including the cervix, endometrium, ovary, fallopian tube, vagina, and vulva. They are composed of cells with neuroendocrine features, such as the ability to produce and secrete hormones and peptides, and a high mitotic rate. Immunohistochemical staining for neuroendocrine markers, such as chromogranin A, synaptophysin, and CD56, can aid in the diagnosis of these tumors. This article provides an overview of the epidemiology, etiology, and risk factors associated with these tumors, as well as their clinical presentation, cellular characteristics, diagnosis, and finally the current treatment options for SCNECs, including surgery, chemotherapy, and radiation therapy, alone or in combination.
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MESH Headings
- Humans
- Female
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Small Cell/therapy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/epidemiology
- Carcinoma, Small Cell/pathology
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/epidemiology
- Risk Factors
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Affiliation(s)
- Pouya Saraei
- Department of Medical Physics, Medicine School, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Heshmati
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Sirák I, Laco J, Vošmiková H, Mell LK, Herrera FG, Šenkeříková M, Vošmik M. SMARCA4-Deficient Carcinoma of Uterine Cervix Resembling SCCOHT-Case Report. Pathol Oncol Res 2022; 27:1610003. [PMID: 34970085 PMCID: PMC8712336 DOI: 10.3389/pore.2021.1610003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Small cell carcinoma of hypercalcemic type (SCCOHT) is a rare gynaecological neoplasm, originating mostly in the ovaries. Cervical origin of this very aggressive malignancy with unknown histogenesis is an extremely rare condition, without published management recommendations. Alterations in SMARCA4 gene are supposed to play the major role in SCCOHT oncogenesis and their identification is crucial for the diagnosis. Adequate genetic counselling of the patients and their families seems to be of great importance. Optimal management and treatment approaches are not known yet but may extremely influence the prognosis of young female patients that suffer from this very resistant disease. Nowadays, a translational research seems to be the key for the further diagnostic and treatment strategies of SCCOHT. The purpose of the case report is to provide practical information and useful recommendations on the diagnosis, management, and treatment of SMARCA4-deficient carcinoma of the uterine cervix resembling SCCOHT.
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Affiliation(s)
- Igor Sirák
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Jan Laco
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Hana Vošmiková
- The Fingerland Department of Pathology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Fernanda G Herrera
- Ludwig Institute for Cancer Research, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mária Šenkeříková
- Department of Medical Genetics, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
| | - Milan Vošmik
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czechia
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Pastorczak A, Krajewska K, Urbanska Z, Szmyd B, Salacinska-Los E, Kobos J, Mlynarski W, Trelinska J. Ovarian carcinoma in children with constitutional mutation of SMARCA4: single-family report and literature review. Fam Cancer 2021; 20:355-362. [PMID: 33907931 PMCID: PMC8484133 DOI: 10.1007/s10689-021-00258-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023]
Abstract
Ovarian carcinoma is an extremely rare malignancy in children, often developing on the underlying inherited background. Female carriers of pathogenic germline mutations of SMARCA4 are at risk of an aggressive type of undifferentiated ovarian cancer called small cell carcinoma of the ovary, hypercalcemic type (SCCOHT). Regardless of age of the patient, stage of the disease, and oncological treatment, the prognosis for SCCOHT is poor. Therefore, early intervention with risk-reducing surgeries is recommended for these patients. In this study, we report genetic testing of a family with two children carrying pathogenic germline mutations of SMARCA4 and summarize the course of SCCOHT in all pediatric patients reported in the literature with constitutional defects identified within the SMARCA4 locus.
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Affiliation(s)
- Agata Pastorczak
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland.
| | - Karolina Krajewska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | - Zuzanna Urbanska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | - Bartosz Szmyd
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | | | - Józef Kobos
- Department of Histology and Embryology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
| | - Joanna Trelinska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, ul. Sporna 36/50, 91-738, Lodz, Poland
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Vivod G, Merlo S, Kovačević N. Hypercalcemia and Unilateral Ovarian Mass in a Young Adult: A Case Report of Small Cell Ovarian Carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928959. [PMID: 33495434 PMCID: PMC7849373 DOI: 10.12659/ajcr.928959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Female, 31-year-old Final Diagnosis: Small cell ovarian cancer • hypercalcemic type Symptoms: Abdominal pain • bloating Medication: — Clinical Procedure: Surgery • adjuvant chemotherapy • adjuvant radiotherapy Specialty: Oncology
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Department of Gynecology and Obstetrics, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Nina Kovačević
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Department of Gynecology and Obstetrics, Medical Faculty Ljubljana, Ljubljana, Slovenia
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5
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Feng M, Yang K, Xu L, Zhang Y, Zou J. Primary ovarian small cell carcinoma of hypercalcemic type in a pregnant woman: A case report. Medicine (Baltimore) 2020; 99:e20387. [PMID: 32791659 PMCID: PMC7387015 DOI: 10.1097/md.0000000000020387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Ovarian small cell carcinoma of hypercalcemic type (OSCCHT) is a relatively rare and highly fatal gynecological malignancy of unknown histogenesis, affecting mainly girls and young women. OSCCHT occurring during pregnancy is an uncommon event, and preoperative diagnosis of this malignancy is much more difficult in pregnant than non-pregnant women. The aim of this study was to describe a rare case of primary OSCCHT in a pregnant woman and to review the current literature. PATIENT CONCERNS Here we present a case of OSCCHT in a 21-year-old patient in the 32nd week of gestation, who had abdominal pain and irregular vaginal bleeding for 5 hours. Because placental abruption, stillbirth, and hemorrhagic shock were suspected, she subsequently underwent diagnostic laparotomy. During the hysterotomy delivery and exploratory laparotomy, we found a dead fetus in the uterus and a large tumor mass arising from her left ovary. Plasma-based detection showed that the patient had a slightly elevated parathyroid hormone (PTH) level and normal serum calcium. After surgery, her serum PTH levels returned to normal. DIAGNOSIS AND INTERVENTIONS The patient was initially treated with surgery. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as the following additional procedures: appendectomy, sigmoidectomy, debulking of extra-ovarian tumor, lymph node dissection, and peritoneal biopsies. The patient, who was in the third trimester of pregnancy, was diagnosed with OSCCHT that was confirmed to be Stage III. She was recommended chemotherapy after surgery, but she declined chemotherapy. OUTCOMES Unfortunately, the patient died 5 months after surgery. LESSONS OSCCHT is a very rare and highly aggressive tumor type. The clinical symptoms of this tumor are nonspecific, and pathological examination remains the gold standard for diagnosis. Most patients are diagnosed with advanced stage disease and do not respond to chemotherapy. The prognosis of OSCCHT is generally poor, and no treatment guidelines are available as yet. For pregnant woman, OSCCHT is especially harmful to the mother and may indirectly lead to the death of the fetus.
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Affiliation(s)
- Min Feng
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Renmin NanLu Chengdu, Sichuan, P.R. China
| | - Kaixuan Yang
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Renmin NanLu Chengdu, Sichuan, P.R. China
| | - Lian Xu
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Renmin NanLu Chengdu, Sichuan, P.R. China
| | - Yan Zhang
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Renmin NanLu Chengdu, Sichuan, P.R. China
| | - Juan Zou
- Department of Pathology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Renmin NanLu Chengdu, Sichuan, P.R. China
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Lee EK, Esselen KM, Kolin DL, Lee LJ, Matulonis UA, Konstantinopoulos PA. Combined CDK4/6 and PD-1 Inhibition in Refractory SMARCA4-Deficient Small-Cell Carcinoma of the Ovary, Hypercalcemic Type. JCO Precis Oncol 2020; 4:736-742. [PMID: 32704608 PMCID: PMC7377332 DOI: 10.1200/po.20.00063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Elizabeth K Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Katharine M Esselen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - David L Kolin
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA
| | - Larissa J Lee
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Boston, MA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Mathey MP, de Jolinière JB, Major A, Conrad B, Khomsi F, Betticher D, Devouassoux M, Feki A. Rare case of remission of a patient with small cell carcinoma of the ovary, hypercalcaemic type (SCCOHT) stage IV: Case report. Int J Surg Case Rep 2019; 66:398-403. [PMID: 31978720 PMCID: PMC6976912 DOI: 10.1016/j.ijscr.2019.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/18/2019] [Accepted: 11/24/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Small cell carcinoma of the ovary (SCC) is a very rare (less than 1 % of ovarien neoplasia), highly undifferentiated, aggressive malignancy affecting young women and linked to a poor prognosis. Overall survive rate is very low (about 16 %). SCCOHT has recently been shown to be associated with SMARCA4 gene mutations and shows some genetic similarities to malignant rhabdoid tumors (MRT). PRESENTATION OF CASE After a reminder of the clinical, histological description of the SCCOHT and concensus about the medical management, we describe the rare case of a 22 years old patient with complete remission after diagnosis of un undifferentiated SCCOHT stage IV treated by conservative surgery and high-doses chemotherapy, 30 months after diagnosis. DISCUSSION Thus far, no standard therapy exists for SCCOHT. Treatment modalities are surgery, chemotherapy, radiotherapy and autologous stem cell transplant after high-dose chemotherapy. Research for new treatments includes target therapy. CONCLUSION Autologous stem cell transplant after high-dose adjuvant chemotherapy seems to lead to the best survival rates. Invasiveness of the treatment depends on the stage of the disease, age of the patient and her fertility-sparing desire. An international collaboration will be needed to standardise practices due of the small number of patients.
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Affiliation(s)
- M P Mathey
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland.
| | - J Bouquet de Jolinière
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland.
| | - A Major
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - B Conrad
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - F Khomsi
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - D Betticher
- Département d'Oncologie médicale, Pr Dr Med D. Betticher MHA, HFR, hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - M Devouassoux
- Institut de pathologie Multi-Sites des HCL, Groupements hospitaliers Sud et nord, Pr M. Devouassoux MD, PhD, Centre de biologie et pathologie sud, Bat 3D 69495 Pierre Bénite Cedex, France; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
| | - A Feki
- Département de chirurgie gynécologique et oncologique, Pr Dr Med A. Feki MD, PhD, HFR, Hôpital Cantonal, 6 chemin des pensionnats, Fribourg 1708, Switzerland; Institut fur med, OnKologie, Inselspital, 3010 Berne, Switzerland
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Abstract
OBJECTIVE The aim of this study was to investigate the demographic and clinicopathological characteristics and prognosis of women diagnosed with small cell carcinoma of the ovary. METHODS The National Cancer Data Base was accessed, and women diagnosed with small cell carcinoma of the ovary, between 2004 and 2014 were identified. Median and 3- and 5-year overall survival (OS) rates were calculated following generation of Kaplan-Meir curves and compared with the log-rank test. A Cox multivariate model was constructed to identify variables associated with mortality. RESULTS A total 469 women were identified with a median age of 39 years; 81.7% of tumors were unilateral, whereas median size was 13 cm. Only 20.1% of patients had stage I disease. Women who underwent cancer-directed surgery had a 5-year OS rate of 24.1%. Five-year OS rates were 48.6%, 30.7%, 18%, and 12.3% for those with stages I, II, III, and IV disease, respectively, P < 0.001. Younger age (P = 0.013) and the combination of surgery with chemotherapy (CT) (P < 0.001) were associated with superior OS. By multivariate analysis, earlier disease stage and use of CT, but not patient age or performance of lymphadenectomy, were associated with lower mortality. CONCLUSIONS Small cell carcinomas of the ovary are unilateral tumors primarily arising in premenopausal women. Multimodal treatment with cancer-directed surgery and CT results in a modest increase of a generally poor survival.
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Lu B, Shi H. An In-Depth Look at Small Cell Carcinoma of the Ovary, Hypercalcemic Type (SCCOHT): Clinical Implications from Recent Molecular Findings. J Cancer 2019; 10:223-237. [PMID: 30662543 PMCID: PMC6329856 DOI: 10.7150/jca.26978] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/21/2018] [Indexed: 12/27/2022] Open
Abstract
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a highly aggressive cancer in young women. The histogenesis remains unclear although a potential origin of germ cells has been suggested recently. The high throughput next generation sequencing techniques have facilitated the identification of inactivating SMARCA4 mutations as the driver of SCCOHT. These findings may greatly impact on the prevention, diagnosis, molecular classification and treatment of SCCOHTs. The SMARCA4 mutations, typically associated with dual loss of BRG1 and BRM expression, are highly sensitive and specific for the diagnosis of SCCOHT. Germline mutations of SMARCA4 support familial SCCOHT with a critical requirement of genetic counseling and possible prophylactic surgery for carriers. SCCOHT, malignant atypical teratoid/rhabdoid tumors, thoracic sarcomas and some undifferentiated carcinomas harbor rhabdoid morphology and mutations in the SMARC genes, generating an emerging molecular classification of SMARC-mutated tumors. A multi-modality treatment approach consisting of surgery and high dose multi-agent chemotherapy in atypical teratoid/rhabdoid tumors may have potential benefits for SCCOHT patients. Preliminary studies have implicated that the inhibitors targeting EZH2 and the receptor tyrosine kinase, and anti-PD-L1 immunotherapy might be potentially effective for SCCOHT patients. These recent advances on molecular genetics, diagnosis and treatment of SCCOHT address the necessity of multiple institutional collaboration work among oncologist, pathologist, genomic scientist, geneticist, molecular biologist, and pharmacologist.
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Affiliation(s)
- Bingjian Lu
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.,Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Haiyan Shi
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
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Auron A, Alon US. Hypercalcemia: a consultant's approach. Pediatr Nephrol 2018; 33:1475-1488. [PMID: 28879535 DOI: 10.1007/s00467-017-3788-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/24/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022]
Abstract
Due to their daily involvement in mineral metabolism, nephrologists are often asked to consult on children with hypercalcemia. This might become even more pertinent when the hypercalcemia is associated with acute kidney injury and/or hypercalciuria and renal calcifications. The best way to assess the severity of hypercalcemia is by measurement of plasma ionized calcium, and if not available by adjusting serum total calcium to albumin concentration. The differential diagnosis of the possible etiologies of the disturbance in the mineral homeostasis starts with the assessment of serum parathyroid hormone concentration, followed by that of vitamin D metabolites in search of both genetic and acquired etiologies. Several tools are available to acutely treat hypercalcemia with the current main components being fluids, loop diuretics, and antiresorptive agents. This review will address the pathophysiologic mechanisms, clinical manifestations, and treatment modalities involved in hypercalcemia.
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Affiliation(s)
- Ari Auron
- Bone and Mineral Disorders Clinic, Division of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Uri S Alon
- Bone and Mineral Disorders Clinic, Division of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Yoshida Y, Kaneki E, Kijima M, Kodama K, Yamaguchi S, Yagi H, Yasunaga M, Ohgami T, Onoyama I, Okugawa K, Yahata H, Sonoda K, Kato K. Two types of small cell carcinoma of the ovary: Two typical case reports. Gynecol Oncol Rep 2018; 25:125-130. [PMID: 30094313 PMCID: PMC6072903 DOI: 10.1016/j.gore.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022] Open
Abstract
•This report shows very rare cases of small cell carcinoma of the ovary, hypercalcemic type and pulmonary type.•Their chemo sensitivity is quite different. These two cases followed opposite clinical courses.•The first case (SCOHT) progressed rapidly, and showed resistance to chemotherapy and radiotherapy.•The second case (SCOPT) showed sensitivity to chemotherapy and radiotherapy although recurrence was repeated.
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Faour O, Gilloteaux J. Calcitonin: Survey of new anatomy data to pathology and therapeutic aspects. TRANSLATIONAL RESEARCH IN ANATOMY 2017. [DOI: 10.1016/j.tria.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Fahiminiya S, Witkowski L, Nadaf J, Carrot-Zhang J, Goudie C, Hasselblatt M, Johann P, Kool M, Lee RS, Gayden T, Roberts CWM, Biegel JA, Jabado N, Majewski J, Foulkes WD. Molecular analyses reveal close similarities between small cell carcinoma of the ovary, hypercalcemic type and atypical teratoid/rhabdoid tumor. Oncotarget 2016; 7:1732-40. [PMID: 26646792 PMCID: PMC4811493 DOI: 10.18632/oncotarget.6459] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/16/2015] [Indexed: 01/04/2023] Open
Abstract
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is the most common undifferentiated ovarian malignancy diagnosed in women under age 40. We and others recently determined that germline and/or somatic deleterious mutations in SMARCA4 characterize SCCOHT. Alterations in this gene, or the related SWI/SNF chromatin remodeling gene SMARCB1, have been previously reported in atypical teratoid/rhabdoid tumors (ATRTs) and malignant rhabdoid tumors (MRTs). To further describe the somatic landscape of SCCOHT, we performed whole exome sequencing on 14 tumors and their matched normal tissues and compared their genomic alterations with those in ATRT and ovarian high grade serous carcinoma (HGSC). We confirmed that SMARCA4 is the only recurrently mutated gene in SCCOHT, and show that recurrent allelic imbalance is observed exclusively on chromosome 19p, where SMARCA4 resides. By comparing genomic alterations between SCCOHT, ATRT and HGSC, we demonstrate that SCCOHTs, like ATRTs, have a remarkably simple genome and harbor significantly fewer somatic protein-coding mutations and chromosomal alterations than HGSC. Furthermore, a comparison of global DNA methylation profiles of 45 SCCOHTs, 65 ATRTs, and 92 HGSCs demonstrates a strong epigenetic correlation between SCCOHT and ATRT. Our results further confirm that the genomic and epigenomic signatures of SCCOHT are more similar to those of ATRT than HGSC, supporting our previous hypothesis that SCCOHT is a rhabdoid tumor and should be renamed MRT of the ovary. Furthermore, we conclude that SMARCA4 inactivation is the main cause of SCCOHT, and that new distinct therapeutic approaches should be developed to specifically target this devastating tumor.
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Affiliation(s)
- Somayyeh Fahiminiya
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Leora Witkowski
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Javad Nadaf
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Jian Carrot-Zhang
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Catherine Goudie
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Pascal Johann
- Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcel Kool
- Division of Pediatric Neuro-Oncology, German Cancer Research Center DKFZ, Heidelberg, Germany.,German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
| | - Ryan S Lee
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tenzin Gayden
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Charles W M Roberts
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Current affiliation: Comprehensive Cancer Center and Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jaclyn A Biegel
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Nada Jabado
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Medical Genetics, Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Medical Genetics, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
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15
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Stewart L, Garg R, Garcia R, Swisher E. Small cell ovarian carcinoma: Long term survival in juvenile case with poor prognostic features. Gynecol Oncol Rep 2016; 18:45-48. [PMID: 27896308 PMCID: PMC5121138 DOI: 10.1016/j.gore.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022] Open
Abstract
Background Ovarian small cell carcinoma is a rare, aggressive neoplasm that occurs in young women and has a poor long-term prognosis. Treatment involves surgical resection and chemotherapy. The required radicality of surgery is uncertain, balancing cytoreduction with fertility preservation. Various chemotherapy regimens are utilized due to confusion regarding the neoplasm's lineage. Case We describe an adolescent with small cell carcinoma, hypercalcemic type, stage IA. Surgery included left salpingo-oopherectomy, left pelvic/paraaortic lymphadenectomy, omentectomy and peritoneal biopsies. She received four cycles of bleomycin, etoposide and cisplatin, similar to high-risk germ cell cancers. She has received no further therapy and is eleven years from diagnosis without evidence of disease. Conclusion This is the first long-term juvenile survivor managed with both fertility-sparing surgery and BEP (bleomycin, etoposide, cisplatin). SCCO can be treated with less-toxic chemotherapy directed at germ cell tumors. Fertility-sparing surgery should be considered in adolescents with early stage SCCO. Long term survival in adolescents with SCCO is possible.
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Affiliation(s)
- Lauren Stewart
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
| | - Ruchi Garg
- Mid Atlantic Gynecology Oncology and Pelvic Surgery Associates, Annandale, VA, USA
| | - Rochelle Garcia
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA; Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
| | - Elizabeth Swisher
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
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16
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Witkowski L, Goudie C, Foulkes WD, McCluggage WG. Small-Cell Carcinoma of the Ovary of Hypercalcemic Type (Malignant Rhabdoid Tumor of the Ovary): A Review with Recent Developments on Pathogenesis. Surg Pathol Clin 2016; 9:215-226. [PMID: 27241105 DOI: 10.1016/j.path.2016.01.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Small-cell carcinoma of the ovary of hypercalcemic type (SCCOHT) is a highly malignant and aggressive tumor and is the most common undifferentiated ovarian malignancy to occur in women younger than 40. SCCOHT is characterized by deleterious germline or somatic mutations in SMARCA4. Given the striking morphologic and molecular similarities between SCCOHT and atypical teratoid/malignant rhabdoid tumor, we propose this should be reflected in a nomenclature change and that SCCOHT be renamed malignant rhabdoid tumor of the ovary. SMARCA4 (BRG1) immunohistochemistry is useful in diagnosis because there is loss of nuclear immunoreactivity in SCCOHT but retention of staining in mimics.
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Affiliation(s)
- Leora Witkowski
- Department of Human Genetics, McGill University, 3755 Cote Ste Catherine, Montreal, Quebec H3T1E2, Canada
| | - Catherine Goudie
- Department of Pediatric Oncology, McGill University, 3755 Cote Ste Catherine, Montreal, Quebec H3T1E2, Canada
| | - William D Foulkes
- Department of Human Genetics, McGill University, 3755 Cote Ste Catherine, Montreal, Quebec H3T1E2, Canada
| | - W Glenn McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast Health and Social Care Trust, Grosvenor Road, Belfast, Northern Ireland BT12 6BA, UK.
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17
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Witkowski L, Goudie C, Ramos P, Boshari T, Brunet JS, Karnezis AN, Longy M, Knost JA, Saloustros E, McCluggage WG, Stewart CJR, Hendricks WPD, Cunliffe H, Huntsman DG, Pautier P, Levine DA, Trent JM, Berchuck A, Hasselblatt M, Foulkes WD. The influence of clinical and genetic factors on patient outcome in small cell carcinoma of the ovary, hypercalcemic type. Gynecol Oncol 2016; 141:454-460. [PMID: 26975901 DOI: 10.1016/j.ygyno.2016.03.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is an aggressive tumor, with long term survival at ~30% in early stage disease. SCCOHT is caused by germline and somatic SMARCA4 mutations, but the effect of the mutation type on patients remains unknown. Furthermore, the rarity of SCCOHT has resulted in varied treatment, with no standardized protocols. We analyzed 293 cases to determine the effect of treatment modalities and SMARCA4 mutations on patient diagnosis and outcome. METHODS In 293 SCCOHT patients we collected information on age and stage at diagnosis, treatment modality (surgery, chemotherapy, radiotherapy, and/or high-dose chemotherapy with autologous stem cell rescue (HDC-aSCR)), SMARCA4 mutation origin (germline/somatic), and overall survival. Cox analysis and log-rank tests were performed on 257 cases with available survival data. RESULTS The strongest prognostic factors were stage at diagnosis (p=2.72e-15) and treatment modality (p=3.87e-13). For FIGO stages II-IV, 5-year survival was 71% for patients who received HDC-aSCR, compared to 25% in patients who received conventional chemotherapy alone following surgery (p=0.002). Patients aged ≥40 had a worse outcome than younger patients (p=0.04). Twenty-six of 60 tested patients carried a germline SMARCA4 mutation, including all patients diagnosed <15years; carriers presented at a younger age than non-carriers (p=0.02). CONCLUSIONS Stage at diagnosis is the most significant prognostic factor in SCCOHT and consolidation with HDC-aSCR may provide the best opportunity for long-term survival. The large fraction of SMARCA4 germline mutations carriers warrants genetic counseling for all patients.
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Affiliation(s)
- Leora Witkowski
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Catherine Goudie
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Pilar Ramos
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Talia Boshari
- Lady Davis Institute and Segal Cancer Center, Jewish General Hospital, Montreal, QC, Canada
| | | | | | - Michel Longy
- Cancer Genetics Unit & INSERM U916, Institut Bergonié, Université de Bordeaux, Bordeaux, France
| | | | - Emmanouil Saloustros
- Hereditary Cancer Clinic, Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, Australia
| | - William P D Hendricks
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Heather Cunliffe
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Douglas A Levine
- Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, New York, USA
| | - Jeffrey M Trent
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, QC, Canada; Lady Davis Institute and Segal Cancer Center, Jewish General Hospital, Montreal, QC, Canada; Department of Medical Genetics and Cancer Research Program, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
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