Benign Endocervical Polyp with Heterologous Elements in a 42-year-old Female: Report of a Case

A 42-year-old female with unremarkable medical history presented for a routine cervical screening upon which an endocervical polyp was identified and submitted entirely for histopathologic evaluation. Microscopic examination showed multiple well-circumscribed nodular fragments of polyp with superficial erosion and focal acute inflammation. Benign endocervical glands were seen within a fibrotic stroma with a prominent smooth muscle component. Intermixed mature adipose tissue and large thick-walled vessels were also identified. Stromal and epithelial atypia were absent; similarly, stromal cellularity, mitoses, and condensation were not identified. Additional deeper levels did not reveal other heterologous elements. The diagnosis of a benign choristomatous endocervical polyp was rendered. As anticipated, the patient recovered completely. A review of the English literature demonstrates rare, namely two other reports of hamartomatous tissue in an endocervical polyp. To the best of our knowledge, we report the third such case.

Analysis of Prediagnostic Metabolic Profiles of Endometrial Carcinoma Patients in the Obese Population

Endometrial carcinoma has been traditionally divided into type 1 and type 2 carcinomas. Excess estrogen is believed to be the pathologic mechanism of type 1 carcinoma. The WHO Classification of Tumors of Female Reproductive Organs lists obesity as a risk factor for type 1 endometrial carcinoma. On the contrary, type 2 carcinoma is generally not associated with estrogen or obesity. Endometrial endometrioid carcinoma is the most common type 1 carcinoma. Endometrial serous carcinoma is a typical type 2 carcinoma. In our community, with a high prevalence of obesity, we investigated whether serous carcinoma, a type 2 carcinoma, could also occur in the obese population, and whether there are identifiable metabolic differences between endometrioid carcinoma patients and serous carcinoma patients in the obese population prior to cancer diagnosis, which might provide clues to the different pathogenesis of the two types of carcinoma. Two cohorts of postmenopausal patients with serous carcinoma or endometrioid carcinoma between 2006 and 2016 were established. Then each cohort was subdivided into four categories based on patients’ average BMI (within 5 years before cancer diagnosis): nonobese (<30), moderately obese (30-35), severely obese (35-40), and morbidly obese (>40). Patients’ average triglycerides, HDL, blood pressures, and HbA1c levels (within 5 years before cancer diagnosis) were obtained. In total, 304 patients were in the endometrioid carcinoma cohort, while 135 patients were in the serous carcinoma cohort. In the morbidly obese category (BMI >40), serous carcinoma patients had significantly lower triglycerides and HbA1c levels than endometrioid carcinoma patients while their BMIs were comparable. For HDL and systolic and diastolic blood pressures, no significant difference was observed between the two groups. In each of the other BMI categories, serous carcinoma patients also had lower triglycerides and HbA1c levels than endometrioid carcinoma patients. In the serous carcinoma patient cohort, there was a moderately negative correlation between average BMI and triglycerides/HbA1c levels, with a Pearson’s correlation coefficient of –0.25 for triglycerides level and –0.19 for HbA1c level. On the contrary, there was no correlation between average BMI and triglycerides/HbA1c levels in the endometrioid carcinoma patient cohort (Pearson’s coefficient close to 0). In summary, the serous carcinoma patients in the obese population lacked the metabolic profiles generally associated with high BMI. These findings show that there are identifiable prediagnostic metabolic differences between endometrioid carcinoma patients and serous carcinoma patients. The metabolic differences between the two groups in each BMI category suggest that BMI should be combined with metabolic markers, rather than used alone, in the evaluation of risk factors for endometrial carcinoma. Future epidemiologic and experimental studies focusing on the association between metabolic syndrome and endometrial carcinoma should separate different histologic subtypes of endometrial carcinoma in the study design due to their distinct metabolic profiles.

Cisplatin and radiation therapy in HIV-positive women with locally advanced cervical cancer in sub-Saharan Africa: A phase II study of the AIDS malignancy consortium

PURPOSE

To determine the feasibility, safety, and tolerability of concomitant chemoradiotherapy administered at standard doses in HIV-infected women with locally-advanced cervical cancer (LACC) receiving antiretroviral therapy (ART).

PATIENTS AND METHODS

Eligible participants had HIV infection and untreated, histologically-confirmed, invasive carcinoma of the uterine cervix, FIGO stages IB2, IIA (if tumor >4 cm), IIB, IIIA, IIIB, or IVA and met standard eligibility criteria. Subjects were prescribed 41.4-45 Gy external beam radiation therapy followed by high dose rate brachytherapy concomitant with up to six weekly doses of cisplatin 40 mg/m2 and were followed for 12 months.

RESULTS

Sixty-four women were screened at two sites in sub-Saharan Africa, of whom 40 eligible participants were enrolled, for a screening ratio of 1.60. Of the 38 eligible participants who initiated study treatment, 31 (82%) completed treatment. By the 12-month follow-up visit, 7 women had died of disease and 29 of 31 (94%) returned for follow-up. One-year progression-free survival was 76.3% (95% CI, 59.4-86.9%), and did not significantly differ according to stage at entry (p = 0.581). Participant-reported adherence to ART was high; by 12 months, 93% of participants had an undetectable viral load. The most common grade 3 or 4 adverse event was decreased lymphocyte count that affected all treated participants. Non-hematologic serious adverse events were similar to those observed in women with LACC without HIV infection.

CONCLUSIONS

The majority of HIV-infected women with LACC can complete concomitant chemoradiotherapy with the same cisplatin dose used in HIV-uninfected women with comparable tolerability and high ART adherence while on treatment.

An institutional pilot study to investigate physical activity patterns in boys with haemophilia

INTRODUCTION

Haemophilia is a bleeding disorder characterized by musculoskeletal bleeding. Trauma-induced bleeding into joints and muscles may be associated with participation in physical activities. Recognizing this, persons with haemophilia may limit physical activities to avoid bleeding. The characterization of physical activity profiles (type, intensity, frequency and duration) in children with differing severities of haemophilia has not been well documented. This is required to better understand the relationship between physical activity and bleeding in children with haemophilia.

AIM

This study was a prospective, cross-sectional, observational study to compare the quantity, type and intensity of physical activity as measured by accelerometry in boys with different haemophilia severities.

METHODS

Subjects wore an accelerometer daily for 1 week and completed validated self-report PedHAL and 3DPAR questionnaires. Accelerometer activity levels were classified as sedentary, light, moderate or vigorous.

RESULTS

A total of 66 males were enrolled, 24 had mild/moderate and 42 had severe haemophilia. Subjects average age was 11.52 years (±3.99) and their average BMI was 20.74 kg m(2) (±5.68). Boys with severe haemophilia reported significantly more time per day spent in sedentary activities compared to those with mild/moderate haemophilia. Furthermore, the amount of time engaged in sedentary activities increased with age in those boys with severe haemophilia, whereas the opposite was true in those with mild/moderate haemophilia.

CONCLUSION

We speculate that prophylaxis in children with severe haemophilia permitted them to engage in similar amounts of moderate to vigorous physical activity (MVPA) as children with mild/moderate haemophilia. Increasing sedentary time in the severe cohort with age may be attributed to increasing arthropathy among other psychosocial factors.

A clinical and pathologic comparison between stage-matched endometrial intraepithelial carcinoma and uterine serous carcinoma: is there a difference?

Endometrial intraepithelial carcinoma (EIC) is a rare pathologic variant of uterine serous carcinoma (USC). Our aim is to distinguish patterns of clinic-pathologic outcomes in patients with EIC and USC for disease limited to the endometrium (stage 1A) as well as with distant metastasis (stage 4B). Surgically staged patients were retrospectively identified and relevant variables were extracted and compared. Kaplan-Meier was used to generate the survival data. More USC (n = 29) exhibited lymphovascular invasion (stage 4, P = .01) and expressed higher levels of estrogen receptor-α than EIC (P = .0009 and .063 for stages 1 and 4, respectively). The survival is comparable, with 1 recurrence in each group for stage 1A disease. For stage 4 EIC and USC, the progression-free survival (14 vs10 months) and overall survival (19 vs 20 months) are similar to what is previously published. In conclusion, EIC, whether limited to the endometrium, or widely metastatic, imparts similar outcomes and should be treated comparably with stage-matched USC.

Selective gene-expression profiling of migratory tumor cells in vivo predicts clinical outcome in breast cancer patients

Introduction

Metastasis of breast cancer is the main cause of death in patients. Previous genome-wide studies have identified gene-expression patterns correlated with cancer patient outcome. However, these were derived mostly from whole tissue without respect to cell heterogeneity. In reality, only a small subpopulation of invasive cells inside the primary tumor is responsible for escaping and initiating dissemination and metastasis. When whole tissue is used for molecular profiling, the expression pattern of these cells is masked by the majority of the noninvasive tumor cells. Therefore, little information is available about the crucial early steps of the metastatic cascade: migration, invasion, and entry of tumor cells into the systemic circulation.

Methods

In the past, we developed an in vivo invasion assay that can capture specifically the highly motile tumor cells in the act of migrating inside living tumors. Here, we used this assay in orthotopic xenografts of human MDA-MB-231 breast cancer cells to isolate selectively the migratory cell subpopulation of the primary tumor for gene-expression profiling. In this way, we derived a gene signature specific to breast cancer migration and invasion, which we call the Human Invasion Signature (HIS).

Results

Unsupervised analysis of the HIS shows that the most significant upregulated gene networks in the migratory breast tumor cells include genes regulating embryonic and tissue development, cellular movement, and DNA replication and repair. We confirmed that genes involved in these functions are upregulated in the migratory tumor cells with independent biological repeats. We also demonstrate that specific genes are functionally required for in vivo invasion and hematogenous dissemination in MDA-MB-231, as well as in patient-derived breast tumors. Finally, we used statistical analysis to show that the signature can significantly predict risk of breast cancer metastasis in large patient cohorts, independent of well-established prognostic parameters.

Conclusions

Our data provide novel insights into, and reveal previously unknown mediators of, the metastatic steps of invasion and dissemination in human breast tumors in vivo. Because migration and invasion are the early steps of metastatic progression, the novel markers that we identified here might become valuable prognostic tools or therapeutic targets in breast cancer.

Abstract 2978: In vivo profiling of migratory tumor cells identifies novel mediators for invasion and dissemination in human breast cancer

Breast cancer is one of the most frequent malignant neoplasms occurring in women in developed countries and metastasis of breast cancer is the main cause of death in these patients. Molecular profiling has led to the identification of gene sets, or “signatures,” the expression of which in primary tumors is associated with metastatic risk and poor outcome for the patients. Early such signatures were derived from whole pieces of tumor tissue. We now know that tumors are highly heterogeneous, that not all cells within a tumor are migratory and invasive, and that the tumor microenvironment gives spatial-temporal cues to tumor cells for invasion and metastasis. Therefore, despite having prognostic value in patients, early signatures have given little insight on the specific mechanisms of metastasis and especially the crucial early steps of the metastatic cascade: migration, invasion and entry of tumor cells into the systemic circulation. Using an in vivo invasion assay, we isolated the migratory tumor cell subpopulation from MDA-MB-231 derived orthotopic tumors and compared their molecular profile to the average primary tumor cells, thus deriving a gene expression profile specific for invasion and dissemination of breast cancer. Unsupervised bioinformatics analysis of this human invasion signature (HIS) shows that the most significant upregulated gene networks in the migratory breast tumor cells include genes regulating DNA repair, embryonic development and cell movement, with TGFβ acting as a central regulator of the migratory phenotype. Importantly, we developed a panel of patient-derived breast tumor xenografts in mice by orthotopic engraftment of tumor tissue from surgical resections, which we have used to directly validate our findings from the MDA-MB-231 xenografts. Indeed, in both MDA-MB-231 and patient-derived xenografts, we found a significant increase of nuclear γH2AX staining as well as increased nuclear accumulation of phospho-ATM and Smad2/3 in the migratory tumor cells compared to the average primary tumor cells. These findings confirm a novel link between activated DNA repair pathways and tumor cell invasion in vivo, as well as identify specifically the migratory subpopulation of a primary tumor to have a gene pattern similar to embryonic development. In addition, we verified that the function of selected genes from the HIS was required for in vivo invasion and hematogenous dissemination in the MDA-MB-231 and the patient-derived xenografts by use of specific inhibitors. Finally, the HIS significantly predicts risk of metastasis in public breast cancer databases independent of other clinical parameters. Overall, our data suggests a molecular basis for the invasive properties of tumor cells in human breast tumors in vivo and a rationale for new prognostic and therapeutic target design.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2978. doi:1538-7445.AM2012-2978

Pregnane X receptor activation induces FGF19-dependent tumor aggressiveness in humans and mice

The nuclear receptor pregnane X receptor (PXR) is activated by a range of xenochemicals, including chemotherapeutic drugs, and has been suggested to play a role in the development of tumor cell resistance to anticancer drugs. PXR also has been implicated as a regulator of the growth and apoptosis of colon tumors. Here, we have used a xenograft model of colon cancer to define a molecular mechanism that might underlie PXR-driven colon tumor growth and malignancy. Activation of PXR was found to be sufficient to enhance the neoplastic characteristics, including cell growth, invasion, and metastasis, of both human colon tumor cell lines and primary human colon cancer tissue xenografted into immunodeficient mice. Furthermore, we were able to show that this PXR-mediated phenotype required FGF19 signaling. PXR bound to the FGF19 promoter in both human colon tumor cells and "normal" intestinal crypt cells. However, while both cell types proliferated in response to PXR ligands, the FGF19 promoter was activated by PXR only in cancer cells. Taken together, these data indicate that colon cancer growth in the presence of a specific PXR ligand results from tumor-specific induction of FGF19. These observations may lead to improved therapeutic regimens for colon carcinomas.

Primary bilateral ovarian and uterine Burkitt's lymphoma following chemotherapy for breast cancer

BACKGROUND

Burkitt's lymphoma is extremely rare in the United States, with reports of approximately 300 new cases each year. A case of Burkitt's lymphoma involving the uterus, cervix, ovaries and appendix 15 years after adjuvant chemotherapy for breast cancer is presented.

CASE REPORT

A 58-year-old woman presented with an abdominal mass. MRI revealed a pelvic mass originating from the uterus. Her past medical history was significant for an infiltrating ductal carcinoma of the left breast with positive lymph nodes and extra nodal invasion diagnosed at age 43. She had a left modified radical mastectomy in 1990 with adjuvant chemotherapy. Histologic sections of the uterus, cervix, ovaries, appendix and external iliac lymph node obtained at laparotomy revealed diffuse neoplastic lymphoid infiltration with necrosis. Light microscopy revealed starry sky patterns and immunohistochemical staining demonstrated atypical lymphocytes which stained for CD20, CD10, bcl-6, and Ki-67. After complete staging, chemotherapy was started and the patient is presently tumor free 41 months after the diagnosis.

CONCLUSION

Burkitt's lymphoma arising from the uterus/cervix is extremely rare and may present as a pelvic mass. Early diagnosis, aggressive chemotherapy, +/-surgical intervention, plays an important role in management and survival of patients with Burkitt's lymphoma.

Expanding the roles for pregnane X receptor in cancer: proliferation and drug resistance in ovarian cancer

PURPOSE

We examined the presence of the pregnane X receptor (PXR) and its effects on ovarian cancer cells after activation by its cognate ligand.

EXPERIMENTAL DESIGN

SKOV-3 and OVCAR-8 ovarian carcinoma cells were analyzed for expression of PXR by quantitative reverse transcription-PCR and Western blot. Human ovarian cancer tissue was also analyzed for PXR expression by immunochemistry. Ligand (agonist)-induced PXR target genes were analyzed in SKOV-3 cells by quantitative reverse transcription-PCR. SKOV-3 cell proliferation was assessed by MTT assay. In vivo confirmation of in vitro effects of PXR ligands were done in NOD.SCID mice carrying SKOV-3 xenografts.

RESULTS

PXR is expressed in ovarian cancer cells. In SKOV-3 cells, PXR is functional and its activation by cognate ligands induces PXR target genes (CYP2B6, CYP3A4, and UGT1A1) but not MDR1 and MRP2. PXR activation in SKOV-3 cells induces cell proliferation and drug resistance. In mice harboring SKOV-3 xenografts, rifampicin (PXR agonist) induces cell proliferation and tumor growth.

CONCLUSION

PXR activation, regardless of the type of ligand agonist present, promotes the "malignant" phenotype of cancer cells. These data serve as the basis for finding novel nontoxic inhibitors of PXR activation as a method to control cell growth and prevent induction of drug resistance.

The one that didn't get away

My part in a lifesaving drama was small... or so I thought.

Consistency of reporting basic characteristics of lung nodules and masses on computed tomography1

RATIONALE AND OBJECTIVES

To assess the consistency of chest computed tomography (CT) reports in describing basic characteristics of lung nodules and masses.

MATERIALS AND METHODS

We retrospectively identified 107 consecutive patients with preoperative chest CT scans before resection of a lung nodule or mass over a 4-year period within a single institution. There were 54 men and 53 women with a mean age of 64 years (range, 37-86) years. The CT scans were reported by a cohort of 20 board-certified radiologists, three of whom reviewed more than 10 CT scans (n = 60 exams). The CT reports were reviewed for lesion characteristics including size, location, and description of margins, presence or absence of calcification, fat and cavitation, and the diagnosis or differential diagnosis. Pathology reports were reviewed for the same characteristics and the final diagnosis. Both CT and pathologic reports of emphysema were noted in lobectomy specimens. The differences between the interpreting radiologists were also sought.

RESULTS

A diagnosis or differential diagnosis was provided in 90% (96/107) of CT reports. The diagnosis of bronchogenic carcinoma was made in 78% (59/76) of those with bronchogenic carcinoma, compared with 65% (20/31) of those with other diagnoses (P = NS). Radiologists described the margins of the nodule or mass in 64% (68/107) of cases, similar in frequency to 66% of pathologists (71/107). Radiologic description of an irregular/spiculated margins predicted bronchogenic carcinoma in 86% of cases (42/49), while a smooth/lobulated margins predicted a diagnosis other than bronchogenic carcinoma in 58% (11/19; P < .05). The presence or absence of calcification was noted in 7% (5/76) of cases of bronchogenic carcinoma and 32% (10/31) of those with other diagnoses (P < .05, chi square). Both radiologists and pathologists consistently reported the size of the lesions with a correlation coefficient between radiology and pathology reports of 0.88. CT reporting of the characteristics of the lesion did not differ among lesions of different sizes. There was no significant difference between major reporters (more than 10 cases) in this study. Emphysema in the surrounding lung was reported in 25% (20/81) of radiology and 38% (31/81) of pathology reports (P = NS).

CONCLUSION

This series demonstrates a lack of consistent reporting of the margins of resected lung nodules both on CT and on pathologic specimens. The presence or absence of calcification was inconsistently reported, although more frequently noted in diagnoses other than bronchogenic carcinoma. As large-scale CT screening for lung cancer becomes more common, radiologists should prioritize developing and adopting standardized reporting criteria for the CT evaluation of lung nodules.

Acute vision loss after general anesthesia in a cat

A 6-year-old, male castrated, domestic shorthair cat presented with a 2-week history of blindness following general anesthesia. Behavioral changes, lethargy, inappetence and neurological deficits were also noted. Ophthalmic evaluation revealed blindness, normal pupillary light response and dazzle response, but no other abnormalities. Serodiagnostic testing for common infectious agents was negative and a cerebrospinal fluid analysis was normal. History and postmortem examination following euthanasia revealed cerebrocortical necrosis most consistent with anesthesia related hypoxia.

Establishing the social impact of individuation

The present research examined relations between individuation, the willingness to publicly differentiate oneself from others, and three dimensions that may lead to high social impact: creativity, leadership, and nonverbal expressiveness. Study 1 describes the development of a Q-sort prototype of the high individuator. In Study 2 the prototype was used to construct a new measure of individuation; individuation showed predicted relations with creativity, leadership, and nonverbal expressiveness. In Study 3 the prototype measure was used to examine the behavioral expression of individuation within the context of a combined managerial and personality assessment center. High individuators engaged in more creativity, leadership, and nonverbal expressiveness; they were more willing to express dissenting opinions; and they contributed more to a group discussion task than did low individuators. The results clarify the link between high individuation and high social impact.