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Kim M, Hayek J, Acker C, An A, Zhang P, Gorelick C, Kanis MJ. No Racial Disparities Observed Using Point-of-Care Genetic Counseling and Testing for Endometrial and Ovarian Cancer in a Diverse Patient Population: A Retrospective Cohort Study. Cancers (Basel) 2024; 16:1598. [PMID: 38672679 PMCID: PMC11049633 DOI: 10.3390/cancers16081598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 04/28/2024] Open
Abstract
We investigated genetic counseling and testing rates for patients with gynecologic malignancy at a tertiary care center with a large minority population. Our retrospective cohort included newly diagnosed epithelial ovarian, fallopian tube, peritoneal, or endometrial cancer patients between January 2014 and June 2022. For endometrial cancer, 373 patients were identified. A total of 207 (55%) patients were screened using mismatch repair immunohistochemistry (MMR IHC). A total of 82 (40%) had MMR deficiencies on IHC. Of these, 63 (77%) received genetic counseling. A total of 62 (98%) underwent genetic testing, and ultimately, 7 (11%) were diagnosed with Lynch syndrome (LS). The overall rate of LS was 1.9%. MMR IHC testing increased steadily, reaching 100% in 2022. For ovarian cancer, 144 patients were identified. A total of 104 (72%) patients received genetic counseling, and 99 (95%) underwent genetic testing. Rates were not influenced by race, ethnicity, insurance type, or family history of cancer. They were significantly different by cancer stage (p < 0.01). The proportion of patients who received genetic counseling increased from 47% in 2015 to 100% in 2022 (p < 0.01). Most counseling was performed by a gynecologic oncologist (93%) as opposed to a genetic counselor (6.7%). Overall, 12 (8.3%) patients were BRCA+. High rates of counseling and testing were observed with few disparities.
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Affiliation(s)
- Michael Kim
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Judy Hayek
- Division of Gynecologic Oncology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
| | | | - Anjile An
- Weill Cornell Medicine, New York, NY 10065, USA
| | - Peilin Zhang
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | | | - Margaux J. Kanis
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
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McEachron J, Chen YJ, Zhou N, Kao J, Gorelick C, Kanis MJ, Lee YC. Improved survival with combination chemotherapy and external beam radiation therapy in uterine carcinosarcoma. Int J Gynecol Cancer 2022; 32:1402-1409. [DOI: 10.1136/ijgc-2022-003717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesTo evaluate differences in survival and recurrence patterns in stage I–IV uterine carcinosarcoma patients treated with surgery followed by adjuvant chemotherapy alone, radiation alone, or a combination of both chemotherapy and radiation therapy.MethodsA multicenter retrospective analysis of patients with surgically staged carcinosarcoma receiving adjuvant therapy from January 2000 to December 2019 was conducted. Inclusion criteria were patients with carcinosarcoma who had received primary surgical treatment, followed by adjuvant therapy with chemotherapy alone, radiation therapy alone, or a combination of chemoradiation. Patients were excluded for incomplete surgical staging data, adjuvant brachytherapy alone, adjuvant chemotherapy and brachytherapy without external beam radiation therapy, receipt of neoadjuvant chemotherapy and/or pre-operative pelvic radiation, and death due to non-cancer causes. Sites of recurrence were analyzed by adjuvant treatment modality using Pearson’s χ2 test. Progression-free and overall survival were calculated using Kaplan-Meier estimates. Multivariate analysis was performed using Cox proportional hazards model.ResultsOf 176 evaluable patients, 27% (n=47) had stage I, 14% (n=24) stage II, 37% (n=66) stage III, and 22% (n=39) stage IV disease. Among them, 33% (n=59) received chemotherapy alone, 17% (n=29) received radiation therapy alone, and 50% (n=88) received chemoradiation. Patients with stage I disease recurred less frequently (64%) versus stage II (83%), stage III (85%), and stage IV (90%) (p<0.001). Stage I disease demonstrated improved progression-free and overall survival relative to all other stages (p<0.01). Across all stages, patients receiving chemoradiation experienced superior progression-free (p=0.01) and overall survival (p=0.05) versus single modality therapy. However, when analyzed in a stage-specific manor, stage III disease derived the greatest survival benefit from chemoradiation versus all other stages (p<0.01). On multivariant analysis, only stage and receipt of chemoradiation were independent predictors of survival.ConclusionStage I disease demonstrated improved survival compared with other stages regardless of adjuvant treatment modality. Chemoradiation was associated with improved survival and better distant and local disease control for all stages of disease. Patients with stage III disease derived the most benefit from chemoradiation.
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McEachron J, Zhou N, Hastings V, Bennett M, Gorelick C, Kanis MJ, Lee YC. Optimal cytoreduction followed by chemoradiation in stage IVB uterine serous carcinoma. Cancer Treat Res Commun 2022; 33:100631. [PMID: 36096033 DOI: 10.1016/j.ctarc.2022.100631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The prognosis of patients presenting with stage IVB uterine serous carcinoma (USC) remains extremely poor, with a reported 5-year survival of <20%. Here were evaluate the survival impact of cytoreductive surgery and identify other prognostic factors in stage IVB USC. METHODS A multicenter retrospective analysis of patients with stage IVB USC was conducted from 2000 to 2018. Inclusion criteria were patients who had undergone comprehensive surgical staging/tumor debulking; followed by adjuvant chemotherapy+/-external beam radiation therapy (EBRT). Optimal cytoreduction (R1) was defined as residual disease ≤1 cm at completion of surgery, and suboptimal cytoreduction (R2) was defined as >1 cm. Progression free survival (PFS) and overall survival (OS) analysis was performed using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model. RESULTS Final analysis included 68 patients. There was no difference in the frequency of treatment delays between regimens (p = 0.832). 96% of patients received platinum-based chemotherapy. There was no difference in the age (p = 0.227), race (p = 0.936), type of radiotherapy (p = 0.852) or chemotherapy regimen received (p = 0.996) between R1 and R2 cohorts. The median PFS for all patients was 8 months and the median OS was 13 months. Cytoreduction to R1 was associated with a median PFS of 9 months, compared to R2 with a median PFS of 4 months (p < 0.001, HR 0.32, 95% CI 7.4-14.1). Median OS was also improved with R1 vs. R2 cytoreduction (17 months vs. 7 months, respectively) (p < 0.001, HR 0.21, 95% CI 13.7-26.4). Compared to R1, cytoreduction to R0 was not associated with a survival benefit. The R0 median OS was 17 months versus 18 months in R1 (p = 0.67). The combination of adjuvant chemoradiation was associated with improved PFS (11 months vs. 7 months) (p = 0.024, HR 0.41, 95% CI 6.5-9.4) and OS (22 months vs 13 months) (p = 0.65, HR 0.25, 95% CI 10.5-15.4) compared to chemotherapy-alone, respectively. On MVA, only the amount of residual disease (p = 0.003, HR 0.39, 95% CI 0.2-0.7) and receipt of adjuvant chemoradiation (p = 0.010, HR 0.09, 95% CI 0.01-0.58) were independent predictors of survival. CONCLUSIONS In stage IVB USC, optimal cytoreduction should be the goal at the time of primary surgery. The combination of chemoradiation was associated with superior survival compared to chemotherapy alone and should be further investigated in this patient population.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center - Catholic Health, Long Island, NY, United States.
| | - Nancy Zhou
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Victoria Hastings
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Michelle Bennett
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center - Catholic Health, Long Island, NY, United States
| | - Constantine Gorelick
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Margaux J Kanis
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center - Catholic Health, Long Island, NY, United States
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McEachron J, Zhou N, Bennett M, Hastings V, Kanis M, Gorelick C, Lee YC. Optimal adjuvant therapy and outcomes for early-stage uterine serous and clear cell carcinoma. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chen YS, Zhou ZN, Glynn SM, Frey MK, Balogun OD, Kanis M, Holcomb K, Gorelick C, Thomas C, Christos PJ, Chapman‐Davis E. Financial toxicity, mental health, and gynecologic cancer treatment: The effect of the COVID-19 pandemic among low-income women in New York City. Cancer 2021; 127:2399-2408. [PMID: 33899220 PMCID: PMC8239639 DOI: 10.1002/cncr.33537] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND New York City (NYC) emerged as an epicenter of the COVID-19 pandemic, and marginalized populations were affected at disproportionate rates. The authors sought to determine the impact of COVID-19 on cancer treatment, anxiety, and financial distress among low-income patients with gynecologic cancer during the peak of the NYC pandemic. METHODS Medicaid-insured women who were receiving gynecologic oncology care at 2 affiliated centers were contacted by telephone interviews between March 15 and April 15, 2020. Demographics and clinical characteristics were obtained through self-report and retrospective chart review. Financial toxicity, anxiety, and cancer worry were assessed using modified, validated surveys. RESULTS In total, 100 patients completed the telephone interview. The median age was 60 years (range, 19-86 years), and 71% had an annual income <$40,000. A change in employment status and early stage cancer (stage I and II) were associated with an increase in financial distress (P < .001 and P = .008, respectively). Early stage cancer and telehealth participation were significantly associated with increased worry about future finances (P = .017 and P = .04, respectively). Lower annual income (<$40,000) was associated with increased cancer worry and anxiety compared with higher annual income (>$40,000; P = .036 and P = .017, respectively). When controlling for telehealth participation, income, primary language, and residence in a high COVID-19 prevalence area, a delay in medical care resulted in a 4-fold increased rate of anxiety (P = .023, 95% CI, 1.278-14.50). Race was not significantly associated with increased financial distress, cancer worry, or anxiety. CONCLUSIONS Low socioeconomic status was the most common risk factor for increased financial distress, cancer worry, and anxiety. Interventions aimed at improving access to timely oncology care should be implemented during this ongoing pandemic.
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Affiliation(s)
- Yiting Stefanie Chen
- Department of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Zhen Ni Zhou
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | | | - Melissa K. Frey
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Onyinye D. Balogun
- Department of Radiation OncologyWeill Cornell Medical College and New York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Margaux Kanis
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyNew York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Kevin Holcomb
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Constantine Gorelick
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyNew York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Charlene Thomas
- Clinical and Translational Science CenterDepartment of Biostatistics and EpidemiologyWeill Cornell Medical CollegeNew YorkNew York
| | - Paul J. Christos
- Clinical and Translational Science CenterDepartment of Biostatistics and EpidemiologyWeill Cornell Medical CollegeNew YorkNew York
| | - Eloise Chapman‐Davis
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
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Frey MK, Fowlkes RK, Badiner NM, Fishman D, Kanis M, Thomas C, Christos PJ, Martin P, Gamble C, Balogun OD, Cardenes H, Gorelick C, Pua T, Nguyen L, Holcomb K, Chapman-Davis E. Gynecologic oncology care during the COVID-19 pandemic at three affiliated New York City hospitals. Gynecol Oncol 2020; 159:470-475. [PMID: 32981694 PMCID: PMC7516937 DOI: 10.1016/j.ygyno.2020.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023]
Abstract
Background New York City was among the epicenters during the COVID-19 pandemic. Oncologists must balance plausible risks of COVID-19 infection with the recognized consequences of delaying cancer treatment, keeping in mind the capacity of the health care system. We sought to investigate treatment patterns in gynecologic cancer care during the first two months of the COVID-19 pandemic at three affiliated New York City hospitals located in Brooklyn, Manhattan and Queens. Methods A prospective registry of patients with active or presumed gynecologic cancers receiving inpatient and/or outpatient care at three affiliated New York City hospitals was maintained between March 1 and April 30, 2020. Clinical and demographic data were abstracted from the electronic medical record with a focus on oncologic treatment. Multivariable logistic regression analysis was explored to evaluate the independent effect of hospital location, race, age, medical comorbidities, cancer status and COVID-19 status on treatment modifications. Results Among 302 patients with gynecologic cancer, 117 (38.7%) experienced a COVID-19-related treatment modification (delay, change or cancellation) during the first two months of the pandemic in New York. Sixty-four patients (67.4% of those scheduled for surgery) had a COVID-19-related modification in their surgical plan, 45 (21.5% of those scheduled for systemic treatment) a modification in systemic treatment and 12 (18.8% of those scheduled for radiation) a modification in radiation. Nineteen patients (6.3%) had positive COVID-19 testing. On univariate analysis, hospital location in Queens or Brooklyn, age ≤65 years, treatment for a new cancer diagnosis versus recurrence and COVID-19 positivity were associated with treatment modifications. On multivariable logistic regression analysis, hospital location in Queens and COVID-19 positive testing were independently associated with treatment modifications. Conclusions More than one third of patients with gynecologic cancer at three affiliated New York City hospitals experienced a treatment delay, change or cancellation during the first two months of the COVID-19 pandemic. Among the three New York City boroughs represented in this study, likelihood of gynecologic oncology treatment modifications correlated with the case burden of COVID-19.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter Martin
- NewYork-Presbyterian Weill Cornell Medicine, USA
| | | | | | | | | | - Tara Pua
- NewYork-Presbyterian Queens, USA
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McEachron J, Heyman T, Shanahan L, Tran V, Friedman M, Gorelick C, Economos K, Singhal PK, Lee YC, Kanis MJ. Multimodality adjuvant therapy and survival outcomes in stage I–IV uterine carcinosarcoma. Int J Gynecol Cancer 2020; 30:1012-1017. [DOI: 10.1136/ijgc-2020-001315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022] Open
Abstract
ObjectivesUterine carcinosarcoma is a rare, aggressive form of uterine cancer with a high recurrence rate and poor survival at all stages. We sought to evaluate the outcomes of patients treated with chemotherapy versus a combination of chemotherapy and radiation (chemoradiation) to determine survival.MethodsA multicenter retrospective analysis of patients with stage I–IV carcinosarcoma was conducted from January 2000 to December 2017. Inclusion criteria were primary surgical management, defined as hysterectomy ± salpingo-oophorectomy, comprehensive surgical staging and/or tumor debulking, followed by adjuvant chemotherapy or chemoradiation. Differences in the frequencies of stage, cytoreduction status, treatment delays and sites of disease recurrence were identified using Pearson’s χ2 test. Progression-free and overall survival rates were calculated using Kaplan-Meier estimates.ResultsFinal analysis included 148 patients; 40.5% (n=60) chemotherapy and 59.5% (n=88) chemoradiation. The mean age was 67 years (range 39–89). Stage distribution included 24.3% stage I, 12.2% stage II, 37.2% stage III, and 26.3% stage IV. There was no difference in the frequency of stage (p=0.81), cytoreduction status (p=0.61), treatment delays (p=0.57), or location of recurrence (p=0.97) between cohorts. The most frequent location of recurrence was the abdomen (50.0%). The median progression-free survival favored chemoradiation over chemotherapy (15 vs 11 months, respectively), as did the median overall survival (26 vs 20 months, respectively). Chemoradiation was associated with a statistically significant improvement in 2 year progression-free survival (22.5% vs 13.6%; p=0.006) and 2 year overall survival (50.0% vs 35.6%; p=0.018) compared with chemotherapy alone. On subanalysis of patients receiving chemoradiation, ‘sandwich sequencing’ (chemotherapy–radiation–chemotherapy) was associated with superior overall survival compared with alternate therapy sequences (chemotherapy–radiation and radiation–chemotherapy) (34 months vs 14 months and 14 months, respectively) (p=0.038).ConclusionsChemoradiation was associated with improvement in both progression-free and overall survival for all stages of carcinosarcoma compared with chemotherapy alone.
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McEachron J, Chatterton C, Hastings V, Gorelick C, Economos K, Lee YC, Kanis MJ. A clinicopathologic study of endometrial cancer metastatic to bone: Identification of microsatellite instability improves treatment strategies. Gynecol Oncol Rep 2020; 32:100549. [PMID: 32099892 PMCID: PMC7031305 DOI: 10.1016/j.gore.2020.100549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/28/2022] Open
Abstract
Metastasis of endometrial cancer (EC) to bone is rare, occurring in <1.0% of cases. The most common sites of bone metastasis in EC are the spine and hip. Diagnosis of bone metastasis is associated with widely metastatic disease and poor prognosis. The median overall survival following a diagnosis of bone metastasis was 11 months in our series. 87.5% of patients with bone metastasis were found to have microsatellite instability.
Metastasis to bone (BM) is an uncommon manifestation of advanced endometrial cancer (EC). The present study will review the clinicopathologic features of a cohort of patients with EC and BM. We conducted a multi-center retrospective review of patients with EC and BM. Demographic and clinical information was extracted from the medical records. Survival outcomes were determined using Kaplan-Meier Curves. Final analysis included 10 patients. The median age was 65 years (range 31–71). 80% had FIGO stage III/IV disease. The most common site of BM was the spine (66%). All patients presented with extraosseous dissemination at the time of diagnosis of BM and 70% were found to have multiple sites of BM. 80% of patients were diagnosed with BM in the recurrent setting. The median time to diagnosis of bone recurrence was 14 months (range: 0–44). Median survival after diagnosis of BM was 11 months (range: 1–22 months). Patients with endometrioid histology and single site of bone metastasis experienced improved survival (p = 0.04 and p = 0.05, respectively). Eight patients had immunohistochemistry or molecular tumor profiles available for review. Seven of these patients (87.5%) were found to have microsatellite instability (MSI). The most common mutation was hypermethylation of MLH-1 (43%). To our knowledge, this is the first report demonstrating a correlation between MSI and metastasis to bone. The identification of BM in EC is uncommon, but will alter treatment strategies and dramatically impact prognosis. Molecular tumor profiling should be performed to identify targeted therapy options and optimize adjuvant treatment strategies.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Carolyn Chatterton
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center, West Islip, NY, United States
| | - Victoria Hastings
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Constantine Gorelick
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Katherine Economos
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Marguax J Kanis
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
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Alagkiozidis I, Gorelick C, Shah T, Chen YJA, Gupta V, Stefanov D, Amarnani A, Lee YC, Abulafia O, Sarafraz-Yazdi E, Michl J. Synergy between Paclitaxel and Anti-Cancer Peptide PNC-27 in the Treatment of Ovarian Cancer. Ann Clin Lab Sci 2017; 47:271-281. [PMID: 28667027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Paclitaxel is widely used in the treatment of gynecologic malignancies. It targets tumor cells in the M phase of the cell cycle. Cells in other phases survive the insult and repopulate the tumor. PNC-27 is a peptide synthesized of amino acids of the p53-MDM-2 binding domain. It kills various cancer cell lines in a dose-dependent manner. The goal of this study is to assess ovarian cancer cells' sensitivity to PNC-27 after surviving exposure to paclitaxel and to investigate the potential for synergy between PNC-27 and paclitaxel in the treatment of ovarian cancer. METHODS The impact of exposure to paclitaxel on the surface expression of MDM-2 was assessed with the use of flow cytometry. For measurement of cytotoxicity in vitro, ID8 cells were exposed to paclitaxel for 12 hours in various concentrations. At 12 hours, the drug containing media was removed and the cells were cultured in media containing various concentrations of PNC-27 for 24 hours. Viability was assessed with the use of an MTT assay. Survival fractions were plotted against drug concentrations and the data were fit to logistic dose-response curves. Isoeffective combinations were used to create isobolograms. The combined treatment with weekly paclitaxel and PNC-27 was tested in an intraperitoneal mouse model of ovarian cancer (ID8). RESULTS Exposure to paclitaxel rendered incomplete time-dependent killing, while PNC-27 mediated comprehensive, dose-dependent killing of ID8 cells. The cytotoxic effect of PNC-27 was dependent on its binding to MDM-2. Blocking MDM-2 inhibited the killing by PNC-27. ID8 cells surviving paclitaxel demonstrated increased expression of MDM-2 and increased susceptibility to PNC-27. Isobologram for dose combinations that were isoeffective indicates synergistic effect between the 2 agents (Combination index <1). In an in vivo model of ovarian cancer (ID8), the addition of PNC-27 to weekly paclitaxel administration significantly reduces tumor growth. CONCLUSIONS These data demonstrate synergism between PNC-27 and paclitaxel. PNC-27 could target cells surviving paclitaxel and improve its antitumor effect.
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Affiliation(s)
- Ioannis Alagkiozidis
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Constantine Gorelick
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Tana Shah
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Yi-Ju Amy Chen
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Vinita Gupta
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Dimitre Stefanov
- Department of Epidemiology and Biostatistics, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Abhi Amarnani
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Yi-Chun Lee
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Ovadia Abulafia
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Ehsan Sarafraz-Yazdi
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
| | - Josef Michl
- Department of Gynecologic Oncology, SUNY-Downstate Medical Center, Brooklyn, NY, USA
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Sarafraz-Yazdi E, Gorelick C, Wagreich AR, Salame G, Angert M, Gartman CH, Gupta V, Bowne WB, Lee YC, Abulafia O, Pincus MR, Michl J. Ex vivo Efficacy of Anti-Cancer Drug PNC-27 in the Treatment of Patient-Derived Epithelial Ovarian Cancer. Ann Clin Lab Sci 2015; 45:650-658. [PMID: 26663795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Despite an 80% response rate to chemotherapy, epithelial ovarian cancer has the highest case fatality rate of all gynecologic malignancies. Several studies have shown the efficiency of anticancer peptides PNC-27 and PNC-28 in killing a variety of cancer cells selectively in vitro and in vivo. The purpose of this study was to evaluate the efficacy of PNC-27 against human primary epithelial ovarian cancer. METHODS We established primary cultures of freshly isolated epithelial ovarian cancer cells from patients with newly diagnosed ovarian cystadenocarcinomas. Two cell lines were obtained, one from mucinous cystadenocarcinoma, and the other from high-grade papillary serous carcinoma. The cancerous properties of these cells were characterized in vitro morphologically, by their growth requirements and serum independence. Treatment effects with PNC-27 were followed qualitatively by light microscopy, and quantitatively by measuring inhibition of cell growth using the MTT cell proliferation assay and direct cytotoxicity by measuring lactate dehydrogenase (LDH). RESULTS PNC-27 inhibits in a dose-dependent manner the growth of and is cytotoxic to human primary cancer cells that had been freshly isolated from two ovarian epithelial cancers. The results further show that the control peptide PNC-29 has no effect on the primary cancer cells. Our results also show that PNC-27 is cytotoxic to cells from long-established and chemotherapy-resistant human ovarian cancer cell lines. CONCLUSION These findings show, for the first time, the efficacy of PNC-27 on freshly isolated, primary human cancer cells. Our results indicate the potential of PNC-27 peptide as an efficient alternative treatment of previously untreated ovarian cancer as well as for ovarian cancers that have become resistant to present chemotherapies.
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Affiliation(s)
- Ehsan Sarafraz-Yazdi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Constantine Gorelick
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA Division of Gynecologic Oncology, Methodist Hospital, Brooklyn, NY, USA
| | - Allison R Wagreich
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA Department of Obstetrics and Gynecology, The Cancer Institute of New Jersey, UMDNJ, NJ, USA
| | - Ghadir Salame
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Mallorie Angert
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Charles H Gartman
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Vinita Gupta
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Wilbur B Bowne
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Ovadia Abulafia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Matthew R Pincus
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA Department of Pathology, New York Harbor VA Medical Center, Brooklyn, NY, USA
| | - Josef Michl
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA Department of Cell Biology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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11
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Abstract
BACKGROUND AND OBJECTIVES Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists. METHODS A retrospective chart review of patients who presented for robotic hysterectomy from 2009-2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and χ2 tests. RESULTS We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P<.001), less blood loss (P=.013), and a longer mean operative time were observed (P<.0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P=.007) and more patients underwent hysterectomy for ovarian cancer (P=.0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse-related procedures. The minimum follow-up period was 30 days in both groups. CONCLUSION Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury.
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Affiliation(s)
- My-Linh T Nguyen
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Erin Stevens
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Christopher J LaFargue
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Michael Karsy
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Tarah L Pua
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Constantine Gorelick
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sean S Tedjarati
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
| | - Tana S Pradhan
- Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA
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12
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Alagkiozidis I, Jaffe J, Lozano M, Mize B, Gorelick C, Salame G, Abulafia O, Lee Y. Extent of lymph node dissection and overall survival in patients with uterine carcinosarcoma, papillary serous, and endometrioid adenocarcinoma. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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von Walstrom G, Stevens E, Fatehi M, Salame G, Lee Y, Gorelick C, Economos K. Clinical utility of a chemoresponse assay for gynecologic malignancies. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Nguyen M, LaFargue C, Karsy M, Stevens E, McKernan S, Pua T, Gorelick C, Tedjarati S, Pradhan T. Routine cystoscopy after robotic gynecologic oncology surgery: Are we increasing urinary injury detection or simply achieving medical-legal benefit? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Sarafraz-Yazdi E, Salame G, Gorelick C, Wagreich A, Angert M, Abulafia O, Pincus MR, Michl J. Abstract C44: Ex vivo cytotoxicity of PNC-27 on primary human ovarian and endometrial cancers. Cancer Res 2011. [DOI: 10.1158/1538-7445.fbcr11-c44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
We have developed a series of anti-cancer peptide drugs, PNC-27 and PNC-28 from the MDM2- binding domain of the p53 protein (AA12–26 and 17–26, respectively) and a newly designed membrane residency peptide (MRP) that allows the drug to insert itself into cellular plasma membrane. To date, we have treated in vitro cells from over 20 different human epithelial cancer cell lines, including pancreatic, colon, lung, breast and ovarian cancer with PNC-27 and PNC-28. In all cases both peptides induce tumor cell necrosis within minutes to hours. Recent biophysical and ultrastructural studies have shown that cancer cell necrosis is due to the formation of transmembrane pores by PNC-peptide inducing direct cell lysis. Furthermore, we have found that PNC-28 destroys a highly metatstatic pancreatic cancer (BMRPA1.TUC-3) xenotransplanted into Nu/Nu mice. Remarkably, the PNC-peptides have no effect on the growth or viability of normal cells in culture such as human fibroblasts, keratinocytes and normal pancreatic acinar cells. Most importantly, the PNC-peptides have shown no effect on human umbilical-cord derived human hematopoetic stem cells in vitro to differentiate into mature blood cells and in vivo on blood cell differentials from tumor bearing and PNC-peptide treated animals. These results strongly indicate that PNC-27 and PNC-28 are potent anti-cancer drugs. The results strongly suggest the drugs' considerable potential against different epithelial cancers without exerting the limiting side effects of suppressing a patient's bone marrow, hematopoesis, normal cell growth and differentiation. Clearly, the cytotoxic efficacy of the PNC-peptides against long-established cancer cell lines is not directly transferable to a primary cancer in a future patient. Thus, to study the effect of PNC-peptide on a primary human cancer as close as possible to the in vivo (the tumor) situation, we freshly established in culture, under an IRB-approved protocol, cancer cells from the tissues of two primary human ovarian cancers and human uterine cancers. The cells released from the tumor tissue placed into a tissue culture dish were collected and their derivation as a homogenous cell population and from their respective tumors confirmed by immune-cytopathological comparative analysis. The cells' cancerous properties were confirmed in vitro within the first four passages (p) of the newly established primary cells when the cells' genomic makeup is still virtually identical (>99%) to that present in the tumor tissue per se. Cell growth and cell death in cells from p1–p4 and treated with PNC-27 or a control peptide PNC-29 were measured using MTT cell proliferation and LDH cytotoxicity assays. The results clearly demonstrate that PNC-27 effectively kills these primary human ovarian and uterine cancer cells in a dose-dependant manner with an LD50 of 100 and 150μg/ml, respectively. Throughout these experiments the effect of PNC-27 on the cancer cells' morphology was recorded, demonstrating the cells' complete disruption during the course of the treatment whereas the cancer cells treated with PNC-29 (up to 500μg/ml) remained morphologically indistinguishable from untreated cancer cells. These findings demonstrate for the first time the potentials of PNC-27 anti-cancer peptide as an efficient drug against freshly established and thus primary cells from these rather frequent human gynecological malignancies.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the Second AACR International Conference on Frontiers in Basic Cancer Research; 2011 Sep 14-18; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2011;71(18 Suppl):Abstract nr C44.
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Affiliation(s)
| | | | | | | | | | | | | | - Josef Michl
- 1SUNY Downstate Medical Center, Brooklyn, NY
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16
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Salame G, Pradhan TS, Stevens E, Lee Y, Economos K, Gorelick C, Serur E, Ruffner N, Wilson K, Abulafia O. The validity of the MSKCC nomogram in predicting overall survival of black patients with uterine cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Sherer DM, Salame G, Shah T, Lee YC, Serur E, Economos K, Gorelick C, Abulafia O. Transvaginal sonography of postabortal (Redo) syndrome. J Clin Ultrasound 2011; 39:155-156. [PMID: 21337586 DOI: 10.1002/jcu.20795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 12/16/2010] [Indexed: 05/30/2023]
Abstract
Acute hematometra, also termed the postabortal syndrome or redo syndrome, is a rare immediate complication of suction curettage characterized by severe lower abdominal cramping in association with an enlarged and markedly tender uterus. We describe the transvaginal sonographic features of this syndrome.
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Affiliation(s)
- David M Sherer
- The Division of Obstetrical and Gynecological Ultrasound, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
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18
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Gorelick C, Andikyan V, Mack M, Lee YC, Abulafia O. Prognostic Significance of Preoperative Thrombocytosis in Patients With Endometrial Carcinoma in an Inner-City Population. Int J Gynecol Cancer 2009; 19:1384-9. [DOI: 10.1111/igc.0b013e3181a47d47] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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19
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Sherer DM, Gorelick C, Dalloul M, Sokolovski M, Kheyman M, Kakamanu S, Abulafia O. Three-dimensional sonographic findings of a cervical pregnancy. J Ultrasound Med 2008; 27:155-158. [PMID: 18096743 DOI: 10.7863/jum.2008.27.1.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A cervical pregnancy is an uncommon ectopic pregnancy that accounts for less than 1% of such gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. The current diagnostic modality of this potentially life-threatening condition is transvaginal sonography, supported at times by magnetic resonance imaging. The definitive diagnostic imaging feature of a cervical pregnancy is the location of a gestational sac in the cervix in the presence of a closed internal uterine cervical os. We report the 3-dimensional transvaginal sonographic findings of a cervical pregnancy at 6 weeks' gestation.
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Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
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20
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Sherer DM, Cheung W, Gorelick C, Lee YC, Serur E, Zinn HL, Sokolovski M, Abulafia O. Sonographic and magnetic resonance imaging findings of an isolated vaginal leiomyoma. J Ultrasound Med 2007; 26:1453-6. [PMID: 17901151 DOI: 10.7863/jum.2007.26.10.1453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098, USA.
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21
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Sherer DM, Gorelick C, Wagreich A, Lee YC, Serur E, Zigalo A, Abulafia O. Sonographic findings of a large vulvar lipoma. Ultrasound Obstet Gynecol 2007; 30:786-7. [PMID: 17763338 DOI: 10.1002/uog.5130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Lipomas of the vulva are rare benign tumors that consist of mature fat cells often interspersed with strands of fibrous connective tissue. They arise from the vulvar fatty pads and present as soft, multilobulated subcutaneous neoplasms. Histological examination reveals a thin capsule surrounding a lobular proliferation of lipocytes. Liposarcomas of the vulva have been described rarely. We present the sonographic findings of a large lipoma of the vulva, and demonstrate the contribution of topical application of a high-frequency transvaginal transducer in depicting lobular structural features, characteristic of this soft tissue tumor.
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Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, New York, NY, USA
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22
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Sherer DM, Gorelick C, Zigalo A, Sclafani S, Zinn HL, Abulafia O. Placenta previa percreta managed conservatively with methotrexate and multiple bilateral uterine artery embolizations. Ultrasound Obstet Gynecol 2007; 30:227-8. [PMID: 17590876 DOI: 10.1002/uog.4075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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23
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Sherer DM, Gorelick C, Gabbur N, Borowski D, Serur E, Zinn HL, Kheyman M, Abulafia O. Transvaginal sonographic findings of a large intramural uterine hematoma associated with iatrogenic injury sustained at termination of pregnancy. Ultrasound Obstet Gynecol 2007; 30:110-3. [PMID: 17559185 DOI: 10.1002/uog.4059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We report a case in which a patient presented with severe right lower abdominal pain associated with nausea and vomiting 3 days after termination of pregnancy. Transvaginal ultrasonography showed a large intramural mass in the anterior aspect of the lower segment of an acutely retroflexed uterus. Computed tomography and magnetic resonance imaging findings were consistent with an intramural hematoma as a result of iatrogenic injury sustained during the preceding termination of pregnancy. The patient was managed expectantly. Systematic review of the literature confirmed that this is the first report of sonographic findings associated with an intramural uterine hematoma some days after the injury sustained at termination of pregnancy. This case supports utilization of real-time ultrasound guidance during intrauterine surgery of selected cases to decrease procedure-related morbidity.
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Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
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24
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Sherer DM, Dalloul M, Gorelick C, Kheyman M, Abdelmalek E, Zinn HL, Abulafia O. Unusual maternal vasculature in the placental periphery leading to the diagnosis of abdominal pregnancy at 25 weeks' gestation. J Clin Ultrasound 2007; 35:268-73. [PMID: 17436318 DOI: 10.1002/jcu.20375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Abdominal pregnancy is a rare condition in which the fetus and placenta are located within the peritoneal cavity. Sonographic findings include visualization of the fetus separate from the uterus, failure to visualize the uterine wall between the fetus and urinary bladder, close approximation of fetal parts to the maternal abdominal wall, eccentric position or abnormal fetal attitude, and visualization of extrauterine placental tissue. We present an unusual case in which mid-trimester transabdominal color Doppler sonographic findings depicted unusual maternal vasculature in the placental periphery leading to the diagnosis of abdominal pregnancy. Postpartum maternal angiography confirmed these vessels as abnormal maternal arterial perfusion of the extrauterine placenta emanating from the uterine arteries and inferior epigastric arteries. Systematic review of the literature confirms that this is the first report of such sonographic manifestations of an abdominal pregnancy.
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Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Road, Box 24, Brooklyn, NY 11203, USA
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25
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Sherer DM, Gorelick C, Gabbur N, Cheung W, Lee YC, Serur E, Zinn HL, Zigalo A, Abulafia O. Color Doppler imaging and 3-dimensional sonographic findings of urinary bladder leiomyoma. J Ultrasound Med 2007; 26:667-70. [PMID: 17460009 DOI: 10.7863/jum.2007.26.5.667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
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26
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Dalloul M, Sherer DM, Gorelick C, Serur E, Zinn H, Sanmugarajah J, Zigalo A, Abulafia O. Transient bilateral ovarian enlargement associated with large retroperitoneal lymphoma. Ultrasound Obstet Gynecol 2007; 29:236-8. [PMID: 17252529 DOI: 10.1002/uog.3920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Bilateral ovarian enlargement may reflect benign or malignant processes of the ovary. Benign causes of ovarian enlargement include luteomas, tumors such as mature cystic teratomas, fibrothecomas, cystadenomas and rare conditions including capillary hemangioma and massive edema of the ovaries. Ovarian malignancies include epithelial, stromal and germ-cell tumors. Primary malignancies that may exhibit metastases to the ovaries include gastrointestinal, breast and soft tissue tumors such as lymphoma. We present an unusual case in which a patient presenting with weakness and mild lower abdominal and pelvic pain was noted at sonography to have bilaterally enlarged ovaries with features similar to those of massive ovarian edema as described previously, which has been associated with venous and lymphatic obstruction. Subsequent computerized tomography (CT) imaging depicted a large retroperitoneal tumor, CT-guided biopsy of which revealed diffuse large B cell lymphoma. The patient responded well to chemotherapy with significant shrinkage of the tumor, and reappearance of normal findings on ovarian sonography. This case demonstrates that bilaterally enlarged ovaries may be the first clinical evidence of a large retroperitoneal tumor and that in such cases CT imaging may be warranted.
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Affiliation(s)
- M Dalloul
- Division of Maternal-Fetal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098, USA
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27
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Sherer DM, Gorelick C, Gupta A, Dalloul M, Sokolovski M, Zinn HL, Abulafia O. Acquired hematometra and hematotrachelos in an adolescent with dysfunctional uterine bleeding. J Ultrasound Med 2006; 25:1599-602. [PMID: 17121957 DOI: 10.7863/jum.2006.25.12.1599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098, USA.
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28
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Sherer DM, Eugene P, Gorelick C, Ramachandran S, Serur E, Kheyman M, Abulafia O. Acute spontaneous hematotrachelos following methotrexate treatment of a suspected tubal pregnancy. J Ultrasound Med 2006; 25:1091-3. [PMID: 16870905 DOI: 10.7863/jum.2006.25.8.1091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
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29
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Sherer DM, Gorelick C, Hellmann M, Lee YC, Angus S, Zinn H, Kheyman M, Abulafia O. Transvaginal sonographic findings of endometrial metastases of mammary ductal carcinoma. J Ultrasound Med 2006; 25:917-20. [PMID: 16798904 DOI: 10.7863/jum.2006.25.7.917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- David M Sherer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, New York 11203-2098, USA.
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30
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Sherer DM, Stimphil R, Hellmann M, Gorelick C, Serur E, Zigalo A, Jain M, Abulafia O. Transvaginal sonographic findings of isolated intramural uterine choriocarcinoma mimicking an interstitial pregnancy. J Ultrasound Med 2006; 25:791-4. [PMID: 16731898 DOI: 10.7863/jum.2006.25.6.791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- David M Sherer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098, USA.
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31
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Sherer DM, Hellmann M, Gorelick C, Lee YC, Abdelmalek E, Sokolovski M, Abulafia O. Transvaginal sonographic findings associated with emphysematous vaginitis at 32 weeks' gestation. J Ultrasound Med 2006; 25:515-7. [PMID: 16567441 DOI: 10.7863/jum.2006.25.4.515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- David M Sherer
- Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn 11203-2098, USA.
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Abstract
OBJECTIVE Coenzyme Q10 is an antioxidant that may have a therapeutic role in cervical cancer. STUDY DESIGN We investigated the cellular and molecular effects of 30 micromol/L Coenzyme Q10 in HeLa cells. Cell growth assays, fluorescence-activated cell sorting analyses, and Oil Red O staining were performed. Microarray experiments were performed in duplicate and analyzed on the basis of 2-fold changes in levels of gene expression. RESULTS Coenzyme Q10 inhibited cell growth and led to apoptosis. Microarray analysis showed that 264 sequences were altered over time, with enrichment in lipid-related genes. Enhanced lipid accumulation was confirmed with Oil Red O staining. CONCLUSION A lipid response to Coenzyme Q10 may affect mechanisms of growth inhibition in HeLa cells.
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Affiliation(s)
- Constantine Gorelick
- Albert Einstein College of Medicine, Albert Einstein Cancer Center and Montefiore Medical Center Bronx, NY 10467, USA
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