A study detection of the ROS1 gene fusion by FISH and ROS1 protein expression by IHC methods in patients with ovarian malignant or borderline serous tumors

OBJECTIVE

ROS1 is an orphan receptor protein tyrosine kinase which is supposed to undergo genetic rearrangement in carcinogenesis. In the current study, we aimed to investigate the frequency and clinicopathologic features associated with ROS1 gene fusion and ROS1 protein expression in patients with ovarian serous carcinoma or serous borderline tumors.

MATERIALS AND METHODS

Tissue samples of 102 patients with high or low grade serous carcinoma and borderline serous tumors were selected randomly from the archives of Department of Gyneco-pathology, and analyzed for ROS1 gene expression. (Fluorescence in situ hybridization (FISH) method was used to assess ROS1 gene rearrangement, while ROS1 protein expression was analyzed using immunohistochemistry.

RESULTS

The study consisted of 94 cases of high-grade serous carcinoma (92.1%), 2 cases of low-grade serous carcinoma (%2) and 6 cases of serous borderline tumor (5.9%). ROS1 gene rearrangement analysis revealed that 4 patients (3.9%) were FISH-positive; whereas the immunohistochemical analysis yielded only 1 patient (0.9%) exhibiting faint positive expression of ROS1 protein. Given the low incidences of ROS1 gene rearrangement and protein expression, their relationships with clinicopathologic parameters could not be statistically analyzed.

CONCLUSION

Although rare, patients with ovarian serous carcinoma or serous borderline tumor may exhibit ROS1 gene rearrangement and ROS1 protein expression. Further large-scale studies are necessary to explore the clinicopathologic significance of ROS1 gene expression in ovarian serous carcinoma.

The clinical impact of serous tubal intraepithelial carcinoma on outcomes of patients with high-grade serous carcinoma of the ovary, fallopian tube, and peritoneum

Aims

To investigate whether the presence of serous tubal intraepithelial carcinoma (STIC) is associated with clinical outcomes in a nonselected (unknown BRCA status) cohort of patients with a high-grade serous carcinoma (HGSC) of the ovary, fallopian tube, and peritoneum.

Settings and Design

A prospective case-series with planned data collection.

Subjects and Methods

The study was conducted in a total of 131 patients, who underwent primary cytoreductive surgery between 2007 and 2012. Histological examination of the fallopian tubes included the "sectioning and extensively examining the fimbriated end" protocol. The diagnosis of STIC was based on the combination of morphology and immunohistochemistry. The patients were divided into two groups according to the absence or presence of STIC and compared clinicopathologically.

Statistical Analysis Used

Analyses were performed using PASW 18 (SPSS/IBM, Chicago, IL, USA) software. The primary outcome was progression-free survival (PFS), and the secondary outcome was overall survival (OS).

Results

STIC was identified in 20.6% of patients. Median follow-up time was 49.5 months for the STIC-positive group and 38.0 months for the STIC-negative group. Study groups were comparable in terms of clinicopathological characteristics with the exception that patients with STIC had less lymph node involvement (55.0% vs. 65.4%, P = 0.001), and more diagnosis of primary tubal carcinoma (29.6% vs. 3.8%, P = 0.001) compared to those without STIC. No statistically significant differences in terms of PFS (P = 0.462) and OS (P = 0.501) were observed between the groups.

Conclusions

The absolute identification of the origin of tumor cell does not seem to significantly affect the clinical course of the patients with HGSC.

Abstract 3166: Clinopathologic correlation with the LCM based instability profiles for the mitochondrial microsatellite regions in the benign to metastatic transitions of surface epithelium ovarian tumor subtypes

Background: Up to date, genomic and microgenomic changes have been identified in nuclear genome whereas, there is no available data about the mitochondrial genome alterations in paired ovarian tumors. Additionally, genomic factors that involve in the progression to advanced stages of ovarian malignancy is still largely unknown. Current work suggest that the mitochondrial alterations have importance in the progress of carcinogenesis in spesific cell populations at clinical, pathological and molecular pathological levels.

Methods and Findings: We analyzed subtypes of 41 ovarian carcinoma samples including normal and tumor (benign, borderline and malignant) using laser captured microdissection technology. Out of 41 ovarian cases, 19 serous papillary carcinoma, 6 mucinous adenomcarcinoma, 9 endometrioid adenocarcinoma, 5 mixed type ovarian carcinoma, 1 undifferentiated carcinoma and 1 clear cell adenocarcinoma were included in the study. All samples were screened for 5.5kb (MT-D-Loop, MT-CytB, MT-ATPaz6-8, MT-12SrRNA, MT-16SrRNA) of mitochondrial genome by PCR-based sequencing analysis. A total of 91 variations were found. Sixty six percent (60/91) of these variations is shown in MITOMAP and 34% (31/91) is observed as novel variations. Overall, we did not find any correlation in D-Loop variations between pathological prognostic and molecular pathological prognostic factors (CD34,ER,PR,c-erbB-2,p53,MDR1,MDR3). However, the expression of a key component of drug resistance, protein GST (gluthatione S transferase), was detected as 270 in samples with instability; and 165 (median 25-75 percentile) in samples with stability in D-Loop position at 309 for C7TC6 repeats, (p<0.05). Additionally, there was a significant difference in the mitotic index of Ki-67 expression in the samples whom had no changes in CA5 repeats as 37.2+20.00 and 54.3+17.0 in samples with CA5 repeat variations at position 514 (p<0.05).

Conclusion: Our results suggest that our findings will add clinical value for the spesific/novel genetic variations detected in 34% of ovarian tumors. The results of microsatellite analysis in ovarian tumors showed changes of 26% for D310 (C)7-9, 37% for position 16184 (C)8-14. Our data supports the idea that, the variations spesifically in MT-D Loop and MT-CytB gene regions would reflect the preliminary transitional changes in progression of tumorigenesis. The functional use of LCM system and the microgenomic profiles will be definetely helpful for prognostic and therapeutic approaches in the field of mitochondrial oncology .

Citation Format: Ozgul Alper, Gulgun Erdogan, Elif Pestereli, Tayup Simsek, Mualla O. Caliskan, Hakan Gulkesen, Durkadin Demir, Gökhan Görgişen, Seyda Karaveli, Güven Lüleci. Clinopathologic correlation with the LCM based instability profiles for the mitochondrial microsatellite regions in the benign to metastatic transitions of surface epithelium ovarian tumor subtypes. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3166. doi:10.1158/1538-7445.AM2013-3166

Preliminary results of the first human uterus transplantation from a multiorgan donor

OBJECTIVE

To describe the first-year results of the first human uterus transplantation case from a multiorgan donor.

DESIGN

Case study.

SETTING

University hospital.

PATIENT(S)

A 21-year-old woman with complete müllerian agenesis who had been previously operated on for vaginal reconstruction.

INTERVENTION(S)

Uterus transplantation procedure consisting of orthotopic replacement and fixation of the retrieved uterus, revascularization, end to site anastomoses of bilateral hypogastric arteries and veins to bilateral external iliac arteries and veins was performed.

MAIN OUTCOME MEASURE(S)

Resumption of menstrual cycles.

RESULT(S)

The patient had menarche 20 days after transplant surgery. She has had 12 menstrual cycles since the operation.

CONCLUSION(S)

We have described the longest-lived transplanted human uterus to date with acquirement of menstrual cycles.

Laparoscopic surgery compared to traditional abdominal surgery in the management of early stage cervical cancer

The purpose of the study was to compare laparoscopic total radical hysterectomy with classic radical hysterectomy regarding parametrial, and vaginal resection, and lymphadenectomy.

METHODS

Laparoscopic or laparotomic total radical hysterectomy with advantages and disadvantages was offered to the patients diagnosed as having operable cervical cancer between 2007 and 2010. Lymph node status, resection of the parametria and vagina, and margin positivity were recorded for both groups. Data were collected prospectively. Statistical analysis was performed with the SPSS statistical software program.

RESULTS

Totally, 53 cases had classical abdominal radical hysterectomy and 35 laparoscopic radical hysterectomy, respectively. Parametrial involvement was detected in four (11.4%) cases in laparoscopic radical surgery versus nine (16.9%) in laparatomic surgery. All the cases with parametrial involvement had free surgical margins of tumor. Also there were no significant statistical differences in lymph node number and metastasis between the two groups.

CONCLUSION

There is no difference in anatomical considerations between laparoscopic and laparatomic radical surgery in the surgical management of cervical cancer.

Breast involvement in visceral leishmaniasis

Visceral leishmaniasis usually involves the bone marrow, lymph nodes, liver and spleen. Involvement of the eye or respiratory or gastrointestinal systems is very rare and usually occurs in immunodepressed patients. Only one case of breast involvement by protozoa has been reported in the literature. We report a case of a visceral leishmaniasis with a solid breast mass caused by leishmania and diagnosed by sonography-guided core biopsy.

COX-2 expression and clinical outcome in early-stage breast cancer patients treated with adjuvant chemotherapy: A prospective study

e22165

Background: To evaluate the association of cox-2 expression with the outcome after adjuvant chemotherapy in patients with early breast cancer. Methods: This was planned as a prospective study recruiting consecutive patients receiving adjuvant anthracycline based chemotherapy and with available tissue blocks permitting all immunohistochemical analyses. Cox-2 expression, in addition to other classical biological factors, was evaluated with immunohistochemistry. Disease and patient related, and biological predictors of both overall survival (OAS) and relapse free survival (RFS) were analyzed by Cox regression analysis. Median and mean survival times were calculated according to the Kaplan Meier method. Results: A total of 88 patients were recruited over a period of 24 months. Median age was 45 (29 to 70), and 60% of subjects were premenapausal. Median tumour diameter and number of axillary lymph nodes involved were 2 cm (1 to 6 cm), and 2 (0 to 15), respectively. Median follow up is 74.2 months. Univariate analysis revealed menopausal status and estrogen receptor expression as predictors of OAS, and menopausal status as the correlate of RFS. Multivariate analysis confirmed the independent predictive value of both menopausal status and estrogen receptor expression for OAS (P=0.009, HR=4.18, and P=0.014, HR=0.20, respectively). No multivariate analysis could be performed for RFS. Cox-2 expression was not associated with OAS or RFS (P=0.208, HR=1.92, and P=0.132, HR=1.89, respectively). Interestingly, Cox-2 expression was correlated with Estrogen receptor (ER) and Progesteron receptor (PR) expression (P=0.006, R=-0.303, and P=0.004, R=-0.312, respectively). Conclusions: Cox-2 expression fails to predict clinical outcome of early breast cancer patients treated with adjuvant chemotherapy. However, Cox-2 expression seems to negatively correlate with ER and PR expression. It should be tested in this patient population whether Cox-2 may play a part in hormonal resistance.

No significant financial relationships to disclose.

Heterotopic triplet pregnancy (twin tubal) in a natural cycle with tubal rupture: case report and review of the literature

The incidence of heterotopic/ectopic pregnancy has risen in recent years, largely due to more frequent use of ovulatory medicine and increased incidence of pelvic inflammatory disease. In a natural cycle, it is a very rare event. Most heterotopic/ectopic pregnancies are localized in the uterine tube and, usually, it is diagnosed when symptoms develop. We report the case of a 37 year-old, gravida 2, para 0, abortion 1 woman with no known risk factors for heterotopic pregnancy. The patient attended the emergency department because of acute abdominal pain. She was evaluated in our department and a heterotopic twin pregnancy in the tube was diagnosed by transvaginal sonography. Intrauterine pregnancy with positive fetal cardiac activity at 9 weeks of gestation according to crown-rump length measurement was detected. Laparotomy was carried out because of acute abdominal syndrome. Right ruptured tubal ectopic/heterotopic pregnancy and hemoperitoneum were diagnosed. Right salpingectomy was carried out. Pathology revealed monochorionic twin tubal pregnancy. In a review of the literature, this is first case of twin tubal pregnancy in one uterine tube. In conclusion, heterotopic pregnancy in twin form in the uterine tube is possible in natural cycles. Intrauterine pregnancy does not exclude extrauterine pregnancy in natural cycles.

Neoangiogenesis and expression of hypoxia-inducible factor 1alpha, vascular endothelial growth factor, and glucose transporter-1 in endometrioid type endometrium adenocarcinomas

OBJECTIVE

Hypoxia Inducible Factor-1alpha (HIF-1alpha) is a transcriptional factor that activates multiple genes including Vascular Endothelial Growth Factor (VEGF) and glucose transporter-1 (GLUT-1) in response to hypoxia and promotes neoangiogenesis.

METHODS

Expression of HIF-1alpha VEGF, and GLUT-1 were analyzed by immunohistochemistry and microvessel density (MVD) was determined by CD 34 immunostaining in 100 endometrioid type endometrial adenocarcinoma, FIGO Stages I-IV.

RESULTS

High expression of HIF-1alpha, VEGF and GLUT-1 were significantly more prevalent in advanced stages than early stages (p<0.001). High expression of HIF-1alpha was found in 100% of Stage III-IV patients, whereas 50% of Stage II and 9% of Stage I patients had high HIF-1alpha expression. Similarly, high VEGF expression was determined in 4% of Stage I and 30% of Stage II patients, however 90% of Stage III-IV patients had high expression of VEGF. Comparing the GLUT-1 scores, it was found that increasing stages correlated with high GLUT-1 expression. Additionally, a statistically significant difference was also noted in MVD between stages (p<0.001). The average MVD of Stage I patients was 31.87+/-7.73. It was found 49.24+/-7.60 in Stage II, and 78.74+/-14.48 in Stage III-IV patients. On analyzing expression of HIF-1alpha, VEGF and GLUT-1 and MVD in pairs, statistically significant correlations were found between each other (p<0.001).

CONCLUSION

HIF-1alpha was increasingly expressed from early stages through advance stages of endometrioid adenocarcinoma, paralleled by activation of its downstream genes such as GLUT-1, VEGF and increased angiogenesis. These results highlight the importance of hypoxia and related pathways in progression of endometrial carcinoma.

Small cell carcinoma of the cervix: a case report

Small cell carcinoma of the uterine cervix accounts for 1-3% of all cervix cancers. It is an aggressive disease with a poor prognosis. To date, no effective treatment protocol has been determined. Surgery, radiotherapy, and chemotherapy have been used either alone or in combination. Recent data suggests that survival in patients with early staged small cell carcinoma of the cervix is better with surgery combined with chemo-radiotherapy. Here, we presented two patients with stage IB1 small cell carcinoma of the uterine cervix. For both patients, definitive surgery was performed with pelvic and para-aortic lymphadenectomy. Subsequently, they were treated with pelvic external radiotherapy and high-dose-rate intracavitary brachytherapy with concurrent cisplatin based chemotherapy. They were alive with no evidence of disease at 91 and 65 months, respectively.

TRAIL death receptor-4 expression positively correlates with the tumor grade in breast cancer patients with invasive ductal carcinoma

PURPOSE

Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) selectively induces apoptosis in cancer cells but not in normal cells, and a number of clinical trials have recently been initiated to test the safety and antitumoral potential of TRAIL in cancer patients. Four different receptors have been identified to interact with TRAIL: two are death-inducing receptors (TRAIL-R1 [DR4] and TRAIL-R2 [DR5]), whereas the other two (TRAIL-R3 [DcR1] and TRAIL-R4 [DcR2]) do not induce death upon ligation and are believed to counteract TRAIL-induced cytotoxicity. Because high levels of DcR2 expression have recently been correlated with carcinogenesis in the prostate and lung, this study investigated the importance of TRAIL and TRAIL receptor expression in breast cancer patients with invasive ductal carcinoma, taking various prognostic markers into consideration.

METHODS AND MATERIALS

Immunohistochemical analyses were performed on 90 breast cancer patients with invasive ductal carcinoma using TRAIL and TRAIL receptor-specific antibodies. Age, menopausal status, tumor size, lymph node status, tumor grade, lymphovascular invasion, perineural invasion, extracapsular tumor extension, presence of an extensive intraductal component, multicentricity, estrogen and progesterone receptor status, and CerbB2 expression levels were analyzed with respect to TRAIL/TRAIL receptor expression patterns.

RESULTS

The highest TRAIL receptor expressed in patients with invasive ductal carcinoma was DR4. Although progesterone receptor-positive patients exhibited lower DR5 expression, CerbB2-positive tissues displayed higher levels of both DR5 and TRAIL expressions.

CONCLUSIONS

DR4 expression positively correlates with the tumor grade in breast cancer patients with invasive ductal carcinoma.

PTEN-mediated Akt activation in human neocortex during prenatal development

Akt is a crucial factor for cell survival and migration. Phosphatase and tensin (PTEN) negatively regulates cell growth and survival by inhibiting PI3K-dependent signaling. PTEN also blocks Akt phosphorylation, a main downstream molecule of PI3K cascade. So far, no studies have shown PTEN expression and Akt phosphorylation levels in the developing human neocortex. Our hypothesis is that spatial and temporal expression of PTEN is likely to modulate developing human brain cortical modeling by regulating Akt activation. Therefore, our aim is to analyze the expression pattern of PTEN and phospho-Akt levels using immunohistochemistry, Western blot, and semiquantitative analysis in the developing human neocortex (n=13 fetuses from first, second, and third trimesters). PTEN expression was decreased parallel to development, but some cells revealed strong nuclear immunoreactivity in the developing neocortex while the active Akt level was increased. Double immunohistochemistry was performed for proliferating cell nuclear antigen (PCNA)-Tuj1 (as neuronal marker) and PCNA-GFAP (Glial marker) to the subsequent sections of PTEN and Akt-stained slides. PCNA (+) cells were mostly positive for glial fibrillary acidic protein (GFAP) and correlated with active-Akt immunoreactivity. Our results suggest that Akt-mediated signaling plays an active role in cell migration, survival, and cerebral cortical modeling throughout prenatal life and that PTEN is the most likely protein to regulate this signaling.

Clinical importance of circulating and cellular expression levels of Fas and Fas ligand in pediatric patients with lymphoproliferative malignancies

Objectives of this study were to determine the extend of soluble Fas (sFas) and soluble FasL (sFasL) at the time of diagnosis and to evaluate its prognostic relevance under chemotherapy in childhood lymphoproliferative malignancies. The authors measured the circulating sFas and sFasL by ELISA in 25 children with newly diagnosed either ALL or NHL, as well as their expression of Fas and FasL at the time of diagnosis and remission. They did not observe any statistically significant difference between the patient group and age-matched healthy controls for sFas levels, whereas sFasL concentration in study population at the time of diagnosis was significantly higher than that in control subjects (1.05 +/- 1.46 vs. 0.36 +/- 0.18 ng/mL, p = .024). At remission the authors observed a significant decrease in the sFasL levels of all patients whose sFasL concentrations were above the minimal detectable level at the time of diagnosis (p = .008). sFasL and Fas/FasL immunohistochemical staining did not have an effect on survival. sFasL may be a marker in monitoring complete remission in children with LPM.

Expression of c-erbB-2 and p53 in Breast Carcinoma Patients: Comparison with Traditional Prognostic Factors and Survival

We aimed to determine the correlations between standard clinicopathological factors and expression of c-erbB-2 and p53 proteins, and to investigate the significance of these variables in relapse and disease-free survival (DFS) in breast carcinoma patients. Data from 200 patients who had undergone mastectomy for breast carcinoma were evaluated. Significant correlations were found between c-erbB-2 positivity and high histological grade (grade 3) tumour, p53 positivity and high grade tumour, and age < 60 years and oestrogen receptor negativity. Twenty-six patients (13%) developed a recurrence. Disease relapse was more frequent in patients who had axillary lymph node (ALN) metastasis, high grade tumour, c-erbB-2 positivity and p53 positivity; these variables were also associated with a shorter DFS. The effects of ALN metastasis and p53 positivity were significant. In conclusion, ALN metastasis and p53 positivity were important factors for predicting disease relapse in mastectomy-treated breast carcinoma patients; other clinicopathological criteria and c-erbB-2 positivity were not predictive.

Distribution of N-cadherin in human cerebral cortex during prenatal development

An important subgroup of adhesion molecules is the superfamily of cadherins, which takes part in cell recognition and differentiation during development. To our knowledge only one study describing N-cadherin expression in developing human brain has been performed so far. Our aim is to identify N-cadherin expression to establish a relationship between its expression and function in human cerebral cortex during prenatal development. In the present study, localization and intensity of N-cadherin was investigated in developing cerebral cortex. Fetuses from spontaneous abortions (n=13) were obtained from first, second, and third trimesters. Western blot analysis revealed three bands and the third trimester samples showed the strongest bands for N-cadherin. Cell processes, axon bundles, and some of the developing neurons revealed immunoreactivity for N-cadherin throughout pregnancy. The immunoreactivity increased in the developing neocortex and expanded from the ventricular layer toward the marginal zone as development progressed. Moreover, the immunoreactivity was strong in vascular endothelium during all three trimesters. We conclude that N-cadherin is dynamically related to the organization of cerebral cortex layers during prenatal development. The dynamic expression pattern implicates N-cadherin as a potential regulator of cell migration, axon extension and fasciculation, the establishment of synaptic contacts, and neurovascular angiogenesis in the developing human cerebral cortex.