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Feghaly I, Kourie H, Moubarak M, Chouery E, Mehawej C, Jalkh N, Atallah D. Genetic profile of borderline ovarian tumors in the Lebanese population by whole-exome sequencing. Int J Gynaecol Obstet 2023; 162:1027-1032. [PMID: 37185951 DOI: 10.1002/ijgo.14805] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 03/23/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To assess the molecular profile of borderline ovarian tumors (BOT) in the Lebanese population by whole-exome sequencing and to correlate the results with the patients' clinical profiles. METHODS We included in this retrospective study 33 tumors belonging to 32 Lebanese women presenting with BOT, diagnosed at Hôtel Dieu de France. A total of 234 genes involved in different germinal and somatic types of cancer were analyzed using next-generation sequencing. RESULTS Molecular analysis of these tumors allowed us to detect mutations in genes involved in the mitogen-activated protein kinase cascade in 57.58% of BOT and to identify variants affecting the DNA repair mechanism in 63.89% of samples. Furthermore, our initial analysis revealed an association between defects in DNA double-strand break repair and the occurrence of mucinous BOT, in 75% of the cases. CONCLUSION This study reports the molecular profiles of BOT in the Lebanese population and compares them to the literature. This is the first study associating the DNA repair pathway to BOT.
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Affiliation(s)
- Iman Feghaly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Hampig Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Malak Moubarak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Gynecology and Gynecological Oncology, Kliniken Essen Mitte, Essen, Germany
| | - Eliane Chouery
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Cybel Mehawej
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Nadine Jalkh
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - David Atallah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
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2
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Heinze K, Cairns ES, Thornton S, Harris B, Milne K, Grube M, Meyer C, Karnezis AN, Fereday S, Garsed DW, Leung SC, Chiu DS, Moubarak M, Harter P, Heitz F, McAlpine JN, DeFazio A, Bowtell DD, Goode EL, Pike M, Ramus SJ, Pearce CL, Staebler A, Köbel M, Kommoss S, Talhouk A, Nelson BH, Anglesio MS. The Prognostic Effect of Immune Cell Infiltration Depends on Molecular Subtype in Endometrioid Ovarian Carcinomas. Clin Cancer Res 2023; 29:3471-3483. [PMID: 37339172 PMCID: PMC10472107 DOI: 10.1158/1078-0432.ccr-22-3815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/14/2023] [Accepted: 06/14/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Endometrioid ovarian carcinoma (ENOC) is the second most-common type of ovarian carcinoma, comprising 10%-20% of cases. Recently, the study of ENOC has benefitted from comparisons to endometrial carcinomas including defining ENOC with four prognostic molecular subtypes. Each subtype suggests differential mechanisms of progression, although tumor-initiating events remain elusive. There is evidence that the ovarian microenvironment may be critical to early lesion establishment and progression. However, while immune infiltrates have been well studied in high-grade serous ovarian carcinoma, studies in ENOC are limited. EXPERIMENTAL DESIGN We report on 210 ENOC, with clinical follow-up and molecular subtype annotation. Using multiplex IHC and immunofluorescence, we examine the prevalence of T-cell lineage, B-cell lineage, macrophages, and populations with programmed cell death protein 1 or programmed death-ligand 1 across subtypes of ENOC. RESULTS Immune cell infiltrates in tumor epithelium and stroma showed higher densities in ENOC subtypes with known high mutation burden (POLEmut and MMRd). While molecular subtypes were prognostically significant, immune infiltrates were not (overall survival P > 0.2). Analysis by molecular subtype revealed that immune cell density was prognostically significant in only the no specific molecular profile (NSMP) subtype, where immune infiltrates lacking B cells (TILB minus) had inferior outcome (disease-specific survival: HR, 4.0; 95% confidence interval, 1.1-14.7; P < 0.05). Similar to endometrial carcinomas, molecular subtype stratification was generally superior to immune response in predicting outcomes. CONCLUSIONS Subtype stratification is critical for better understanding of ENOC, in particular the distribution and prognostic significance of immune cell infiltrates. The role of B cells in the immune response within NSMP tumors warrants further study.
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Affiliation(s)
- Karolin Heinze
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan S. Cairns
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Shelby Thornton
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
- Molecular and Cellular Immunology Core (MCIC), Deeley Research Centre, BC Cancer, Victoria, Canada
| | - Bronwyn Harris
- Molecular and Cellular Immunology Core (MCIC), Deeley Research Centre, BC Cancer, Victoria, Canada
| | - Katy Milne
- Molecular and Cellular Immunology Core (MCIC), Deeley Research Centre, BC Cancer, Victoria, Canada
| | - Marcel Grube
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | - Charlotte Meyer
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | - Anthony N. Karnezis
- Department of Pathology and Laboratory, UC Davis Medical Center, Sacramento, California
| | - Sian Fereday
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Dale W. Garsed
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Samuel C.Y. Leung
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek S. Chiu
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Malak Moubarak
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
| | - Philipp Harter
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
| | - Florian Heitz
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jessica N. McAlpine
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna DeFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - David D.L. Bowtell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Ellen L. Goode
- Mayo Clinic, Department of Health Science Research, Division of Epidemiology, Rochester, Minnesota
| | - Malcolm Pike
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan J. Ramus
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales Sydney, Sydney, Australia
- Multidisciplinary Ovarian Cancer Outcomes Group (Consortium)
| | - C. Leigh Pearce
- Multidisciplinary Ovarian Cancer Outcomes Group (Consortium)
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Annette Staebler
- Institute of Pathology, University Hospital of Tübingen, Tübingen, Germany
| | - Martin Köbel
- Department of Pathology, University of Calgary, Calgary, Alberta, Canada
| | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | - Aline Talhouk
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Brad H. Nelson
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
- Molecular and Cellular Immunology Core (MCIC), Deeley Research Centre, BC Cancer, Victoria, Canada
- Multidisciplinary Ovarian Cancer Outcomes Group (Consortium)
| | - Michael S. Anglesio
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
- OVCARE - British Columbia's Gynecological Cancer Research Program, BC Cancer, Vancouver General Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada
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3
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Imterat M, Harter P, Rhiem K, Heitz F, Schneider S, Concin N, Moubarak M, Welz J, Vrentas V, Traut A, Hahnen E, Schmutzler R, du Bois A, Ataseven B. Incidence and Prognostic Impact of Deleterious Germline Mutations in Primary Advanced Ovarian Carcinoma Patients. Cancers (Basel) 2023; 15:cancers15092534. [PMID: 37174000 PMCID: PMC10177155 DOI: 10.3390/cancers15092534] [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: 03/28/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Data on deleterious variants in genes other than BRCA1/2 remain limited. A retrospective cohort study was performed, including primary OC cases with TruRisk® germline gene panel testing between 2011 and 2020. Patients with testing after relapse were excluded. The cohort was divided into three groups: (A) no mutations, (B) deleterious BRCA1/2 mutations, and (C) deleterious mutations in other genes. A total of 702 patients met the inclusion criteria. Of these 17.4% (n = 122) showed BRCA1/2 mutations and a further 6.0% (n = 42) in other genes. Three-year overall survival (OS) of the entire cohort was significantly longer in patients with germline mutations (85%/82.8% for cohort B/C vs. 70.2% for cohort A, p < 0.001) and 3-year progression-free survival (PFS) only for cohort B (58.1% vs. 36.9%/41.6% in cohort A/C, p = 0.002). In multivariate analysis for the subgroup of advanced-stages of high-grade serous OC, both cohorts B/C were found to be independent factors for significantly better outcome, cohort C for OS (HR 0.46; 95% CI 0.25-0.84), and cohort B for both OS and PFS (HR 0.40; 95% CI 0.27-0.61 and HR 0.49; 95% CI 0.37-0.66, respectively). Germline mutations were detected in a quarter of OC patients, and a quarter of those in genes other than BRCA1/2. Germline mutations demonstrate in our cohort a prognostic factor and predict better prognosis for OC patients.
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Affiliation(s)
- Majdi Imterat
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
- Department of Gynaecologic Oncology, Hadassah Medical Centers, Faculty of Medicine, Hebrew University of Jerusalem, Kalman Ya'Akov Man St., Jerusalem 91905, Israel
| | - Philipp Harter
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50931 Cologne, Germany
| | - Florian Heitz
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Stephanie Schneider
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Nicole Concin
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Malak Moubarak
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Julia Welz
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Vasileios Vrentas
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Alexander Traut
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50931 Cologne, Germany
| | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50931 Cologne, Germany
| | - Andreas du Bois
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Beyhan Ataseven
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
- Academic Department of Gynecology, Gynecologic Oncology and Obstetrics, Klinikum Lippe, Medical School, University Medical Center East Westphalia-Lippe, Bielefeld University, 33615 Bielefeld, Germany
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4
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Gauduchon T, Kfoury M, Lorusso D, Floquet A, Ventriglia J, Salaun H, Moubarak M, Rivoirard R, Polastro L, Favier L, You B, Berton D, de la Motte Rouge T, Mansi L, Abdeddaim C, Prulhiere K, Lancry Lecomte L, Provansal M, Dalban C, Ray-Coquard I. PARP inhibitors (PARPi) prolongation after local therapy for oligo-metastatic progression in relapsed ovarian cancer patients. Gynecol Oncol 2023; 173:98-105. [PMID: 37105063 DOI: 10.1016/j.ygyno.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/26/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND PARP inhibitors (PARPi) have revolutionized the management of high-grade epithelial ovarian cancer (HGOC) treatment. However, a significant number of patients relapse or progress under PARPi, leading to the introduction of a new line of systemic therapy such as chemotherapy. In patients with a limited number of metastatic sites at progression, -referred to as an oligometastatic progression- a potential indication for local therapy followed by re-introduction or continuation of PARPi treatment rather than initiating a new line of chemotherapy could be proposed. However, the impact of such strategies on progression free survival (PFS) in these patients remains unknown. METHODS This international multicenter retrospective study evaluated the efficacy of PARPi continuation or re-introduction in patients with HGOC after local treatment for oligometastatic progression. The main objective was to assess PFS under PARPi after local therapy (PFS post-LT). Secondary objectives included safety and overall survival (OS). RESULTS 74 patients were identified in 20 centers between April 2020 and November 2021. 65% of patients were BRCA mutated and 92% had received ≥2 lines of prior systemic chemotherapy before the initial introduction of PARPi. Main progression sites were lymph nodes (42%), peritoneum (27%), liver (16%), other visceral (16%) and abdominal wall (4%). Local therapies included radiotherapy (45%), surgery (43%), both (7%), percutaneous thermal ablation (4%) or chemoembolization (1%). Median PFS post-LT was 11.5 months [95% CI 7.4; 17.2]. After a median follow up of 14.8 months, 6 patients (8.1%) discontinued PARPi due to toxicity. The 1-year overall survival rate was 90.7% [95% CI 79.1; 96.0]. CONCLUSIONS With close to one year without progression or introduction of a new line of systemic therapy, this study reports the feasibility and potential benefit of this original strategy in patients with oligometastatic progression under PARPi.
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Affiliation(s)
| | - Maria Kfoury
- Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Domenica Lorusso
- Gynecologic Oncology, Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Anne Floquet
- Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Jole Ventriglia
- Medical Oncology, IRCCS National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | | | - Malak Moubarak
- Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Romain Rivoirard
- Medical Oncology, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Laura Polastro
- Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Laure Favier
- Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Benoit You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Groupement Hospitalier Sud, GINECO, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France
| | - Dominique Berton
- Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | - Laura Mansi
- Medical Oncology, Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Besançon, France
| | | | | | | | | | - Cécile Dalban
- Department of Biostatistics, Direction de Recherche Clinique et de l'innovation du Centre Léon Bérard, Lyon 69008, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est Inserm, Lyon 69008, France.
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5
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Fezza M, Hilal G, Tahtouh R, Moubarak M, Atallah D. HSP27 modulates tumoural immune evasion by enhancing STAT3-mediated upregulation of PD-L1 and NLRC5 in ovarian cancer. Ecancermedicalscience 2023; 17:1526. [PMID: 37113720 PMCID: PMC10129406 DOI: 10.3332/ecancer.2023.1526] [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] [Received: 11/08/2022] [Indexed: 04/03/2023] Open
Abstract
Multiple preclinical studies have demonstrated that the addition of hyperthermia (HT) to immunotherapy could enhance tumour immunogenicity and stimulate an antitumour immune response, primarily via heat shock proteins (HSPs). However, antitumour immune responses are often impeded by immune evasion mechanisms, such as the overexpression of programmed death-ligand1 (PD-L1) and the loss of major histocompatibility complex class 1 (MHC-1) expression. In this context, we sought to investigate the effect of HT on PD-L1 and NOD-like receptor family CARD domain containing 5 (NLRC5) identified as the key transcriptional activator of MHC-1 genes, and their interaction in ovarian cancer. A coculture of ovarian cancer cell lines (IGROV1 and SKOV3) with peripheral blood mononuclear cells was set up. Then, culture media conditioned with IGROV1 or SKOV3 subjected to HT was tested on untreated cell cultures. Knocking down heat shock protein B1 (HSPB1 or HSP27), heat shock protein A1 (HSPA1 or HSP70), and pharmacological inhibition of STAT3 phosphorylation were performed. Subsequently, we measured expression levels of PD-L1, NLRC5, and proinflammatory cytokines. The correlation between PD-L1 and NLRC5 expression in ovarian cancer was evaluated using the Cancer Genome Atlas database. We found that HT produces a concomitant decrease in PD-L1 and NLRC5 expression in coculture. Notably, however, the conditioned media by heat-shocked cells increases their expression. HSP27 knockdown can reverse this increase. Adding STAT3 phosphorylation inhibitor significantly enhanced the expression inhibition of PD-L1 and NLRC5 induced by HSP27 silencing. Correlation analysis showed a positive correlation in ovarian cancer between NLRC5 and PD-L1. These findings demonstrate that HSP27 modulates PD-L1 and NLRC5 expression through the activation of a common regulator 'STAT3'. Moreover, the positive correlation between PD-L1 and NLRC5 led us to conclude that the upregulation of PD-L1 and the downregulation of MHC class I are two mutually exclusive mechanisms of immune evasion in ovarian cancer.
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Affiliation(s)
- Maha Fezza
- Cancer and Metabolism Laboratory, Faculty of Medicine, Saint-Joseph University, B.P. 17-5208 - Mar Mikhael, Beirut 1104 2020, Lebanon
| | - George Hilal
- Cancer and Metabolism Laboratory, Faculty of Medicine, Saint-Joseph University, B.P. 17-5208 - Mar Mikhael, Beirut 1104 2020, Lebanon
| | - Roula Tahtouh
- Cancer and Metabolism Laboratory, Faculty of Medicine, Saint-Joseph University, B.P. 17-5208 - Mar Mikhael, Beirut 1104 2020, Lebanon
| | - Malak Moubarak
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Achrafieh Area, Beirut 166830, Lebanon
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen Mitte, Henricistraße 92, Essen 45136, Germany
| | - David Atallah
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Achrafieh Area, Beirut 166830, Lebanon
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6
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Khalil N, Moubarak M, Alkassis M, Kassis N, Moukarzel M, Atallah D. Long term follow-up after minimally invasive sacrocolpopexy. Int Urogynecol J 2022:10.1007/s00192-022-05430-z. [PMID: 36576540 DOI: 10.1007/s00192-022-05430-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a benign condition that can adversely affect women's quality of life. Minimally invasive mesh sacrocolpopexy is an effective surgical treatment for POP. This study aims to assess the perioperative, postoperative, and long term (10 years) outcome of a single institution cohort undergoing minimally invasive sacrocolpopexy. METHODS This retrospective study included all cases of laparoscopic sacrocolpopexy performed between 2003 and 2016. Patients were contacted by phone in 2022 for long term follow-up. Data on operative time, length of hospital stay, conversion rate, perioperative injuries, early and late postoperative complications and subjective success rates were collected. RESULTS Ninety-five patients were included aged 60±12 years. Most patients (72%) presented grade 3 POP. Grade of prolapse (3±0.4 vs 3±0.5, p<0.01) and hospital stay (3±1.1 vs 3.1±1.7; p<0.01) were significantly higher in patients who developed early postoperative complications (1st year). At long term follow-up (12±3 years), 48 patients responded. Nine subjects (19%) presented a subjective recurrence with bulge symptoms. Surgery satisfaction was of 79%. The most frequent de novo reported symptom was urge urinary incontinence followed by stress urinary incontinence. Three cases (3%) of mesh erosion were described, all occurred after the 5th postoperative year. CONCLUSIONS Laparoscopic mesh sacrocolpopexy is a safe surgical technique that shows satisfying and consistent long-term results despite the occasional onset of new urinary symptoms.
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Affiliation(s)
- Nour Khalil
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon.
| | - Malak Moubarak
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon.,Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen Mitte, Essen, Germany
| | - Marwan Alkassis
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon
| | - Nadine Kassis
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon
| | - Maroun Moukarzel
- Department of Urology, Hotel Dieu de France hospital, Beirut, Lebanon
| | - David Atallah
- Department of Gynecology and Obstetrics, Hotel Dieu de France hospital, Beirut, Lebanon
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7
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Thibault G, Kfoury M, Lorusso D, Floquet A, Ventriglia J, Salaun H, Moubarak M, Rivoirard R, Polastro L, Favier L, You B, Berton-Rigaud D, De La Motte Rouge T, Mansi L, Abdeddaim C, Prulhiere K, Lancry Lecomte L, Provansal Gross M, Dalban C, Ray-Coquard I. 528MO Is re-introduction or continuation of PARP inhibitors after local therapy for oligo-metastatic progression in patients with relapsed ovarian cancer relevant? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.656] [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] Open
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8
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Holly J, Harter P, Ataseven B, Moubarak M, Schwameis R, Heikaus S, Concin N, Rhiem K, Denkert C, Heitz F. HRD-Testung und BRCA1/2-Keimbahntestung in der
klinischen Routine bei Patientinnen mit primärem
Ovarialkarzinom. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1746158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- J Holly
- Evangelische Kliniken Essen Mitte, Klinik für
Gynäkologie und Gynäkologische Onkologie, Essen,
Deutschland
| | - P Harter
- Evangelische Kliniken Essen Mitte, Klinik für
Gynäkologie und Gynäkologische Onkologie, Essen,
Deutschland
| | - B Ataseven
- Evangelische Kliniken Essen Mitte, Klinik für
Gynäkologie und Gynäkologische Onkologie, Essen,
Deutschland
- Abteilung für Geburtshilfe und Gynäkologie,
Universitätsklinikum, LMU München, Deutschland
| | - M Moubarak
- Evangelische Kliniken Essen Mitte, Klinik für
Gynäkologie und Gynäkologische Onkologie, Essen,
Deutschland
| | - R Schwameis
- Evangelische Kliniken Essen Mitte, Klinik für
Gynäkologie und Gynäkologische Onkologie, Essen,
Deutschland
- Abteilung für allgemeine Gynäkologie und
gynäkologische Onkologie, Universitätsklinik für
Frauenheilkunde, MedUni Wien, Österreich
| | - S Heikaus
- Evangelische Kliniken Essen Mitte, Zentrum für Pathologie,
Essen, Deutschland
| | - N Concin
- Evangelische Kliniken Essen Mitte, Klinik für
Gynäkologie und Gynäkologische Onkologie, Essen,
Deutschland
- Universitätsklinik für Frauenheilkunde, MedUni
Innsbruck, Österreich
| | - K Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs der
Universitätsklinik Köln, Deutschland
| | - C Denkert
- Institut für Pathologie, Philipps-Universität Marburg
und Universitätsklinik Marburg (UK-GM) Deutschland)
| | - F Heitz
- Evangelische Kliniken Essen Mitte, Klinik für
Gynäkologie und Gynäkologische Onkologie, Essen,
Deutschland
- Klinik für Gynäkologie mit dem Center für
Onkologische Operative Therapie, Charité Campus, Virchowklinikum,
Charité- Universitätsmedizin Berlin, Freie Universität
Berlin, Humboldt Universität zu Berlin, Berlin Institut of Health,
Deutschland
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9
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Moubarak M, Harter P, Ataseven B, Traut A, Welz J, Baert T, Heitz F. Re-treatment with PARPi in patients with recurrent epithelial ovarian cancer: A single institutional experience. Gynecol Oncol Rep 2022; 40:100939. [PMID: 35169607 PMCID: PMC8829558 DOI: 10.1016/j.gore.2022.100939] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Real-life data support prospective evidence that 2nd PARPi therapy can be beneficial. Patients who do not meet OREO criteria might also benefit from a PARPi rechallenge. Patients should be well informed about the limitations and risks of this option. Further trials are needed to understand the mechanisms of PARP resistance.
Introduction We aimed to evaluate real-life experiences with the re-challenge of poly(ADP-Ribose)Polymerase (PARP) inhibitors (PARPi) after a prior PARPi therapy in patients with recurrent EOC. Methods A retrospective descriptive study was conducted at a tertiary care center of excellence for ovarian cancer. Demographic, pathological, and therapeutic data were collected for patients with recurrent epithelial ovarian cancer who were re-treated with PARPi in their therapy course. Results Twenty-nine patients were included in the study. Twenty-six patients received the second PARPi as maintenance therapy after two different lines of therapy and three patients received the second PARPi as upfront therapy after progression. Most of the patients (57.7%) were exposed to first PARPi after a second-line therapy. The median progression-free survival under the first and second PARPi therapy was estimated at 15 and 7 months respectively. PFS under the second PARPi after platinum-based chemotherapy was better after a complete remission with a median PFS of 8.5 months, compared to patients with partial remission (5.5 months). A better PFS was noted in case of negative BRCA status under the second PARPi therapy (median PFS of 7.4 vs. 4.5 months, p = 0.11). The second PARPi therapy was mainly discontinued due to disease progression (84.6% of the cases). Discontinuation of treatment with the second PARP due to toxicity was needed in one case who developed a myelodysplastic syndrome. Conclusion Real-life data support prospective evidence that patients with recurrent EOC may derive benefit of the re-treatment with PARPi in case of clear response to the last platinum-based therapy.
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Affiliation(s)
- Malak Moubarak
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Traut
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Julia Welz
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Thais Baert
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - Florian Heitz
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Corresponding author at: Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte; Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
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10
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Atallah D, El Feghaly C, El Feghaly M, Arab W, Khaddage A, Akiki M, El Kassis N, Chakra RA, Chahine G, Moubarak M. Does Social and Religious Background Matter? A Study of the Psychosocial Impact of Human Papillomavirus on Lebanese Women. J Low Genit Tract Dis 2022; 26:8-12. [PMID: 34928248 DOI: 10.1097/lgt.0000000000000639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The human papillomavirus (HPV) has been associated with an important psychosocial impact. This impact has been poorly evaluated in developing countries, mostly because of the lack of instruments to quantify it. The HIP questionnaire aims to measure HPV-associated affective burden. Our team has previously translated this questionnaire to Arabic and used it to assess the impact of HPV on Lebanese women. MATERIALS AND METHODS While the HIP is a specific tool to evaluate the emotional impact of HPV, the Hospital Anxiety and Depression Scale questionnaire consists of 2 scales, anxiety and depression, and assess the psychological distress in nonpsychiatric patients. The HPV impact profile and Hospital Anxiety and Depression Scale questionnaires were administered to 118 Lebanese women with an HPV-related presentation, aiming to determine which aspect of these women's lives was mostly affected. The association with different sociodemographic factors was also assessed. RESULTS Feelings of "concerns and worries" were mostly strongly felt in our population except for women with genital warts who were more concerned with the risk of transmission and the impact on their partners. All women had predominant feelings of anxiety.Religion was a statistically significant influencing factor and employment a protective factor. Muslim women demonstrated significant adverse affects on HPV impact profile domains that included: "sexual impact," "self-image," "interaction with doctors," and "health control/life impact." CONCLUSIONS Different women perceive the diagnosis of HPV and HPV-related lesions differently. In this study, employment was found to play a protective role, but the biggest influencers were social and religious beliefs.
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Affiliation(s)
| | - Charbel El Feghaly
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Murielle El Feghaly
- Surgery Department, Saint George Hospital University Medical Center, Beirut, Lebanon
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11
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Atallah D, El Feghaly C, El Feghaly M, Arab W, Khaddage A, Akiki M, El Kassis N, Abboud S, Chahine G, Moubarak M. Validation of the Human Papillomavirus Impact Profile in Lebanese Women With Human Papillomavirus or Associated Lesions. J Low Genit Tract Dis 2022; 26:2-7. [PMID: 34928247 DOI: 10.1097/lgt.0000000000000640] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Human papillomavirus (HPV) is responsible for a multitude of lesions with high psychosocial burden. The "HPV Impact Profile" (HIP) questionnaire is one of the first and most specific tools evaluating the emotional impact of HPV. This study aimed to translate this questionnaire into Arabic and to validate it, in a sample of Lebanese female patients. MATERIALS AND METHODS The HIP questionnaire was translated to Arabic. It was then administered to 118 Lebanese women infected with HPV or screened for HPV-associated lesions, in parallel with the Hospital Anxiety and Depression Scale questionnaire. The psychometric properties of the questionnaire were studied in our sample population. RESULTS The internal consistency of the HIP questionnaire was weak as Cronbach α coefficients of most of the domains were low. The study of the composite matrix resulted in the improvement of the internal consistency after the elimination of some items. Moreover, the "adapted domains" were created by reverse-scoring items with positive implications.The composite reliability and the average variance extracted of all the domains were analyzed. Analysis of discriminate validity through heterotrait-monotrait ratio of correlation ratio analyses of corresponding Hospital Anxiety and Depression Scale domains was also performed along with reliability analysis. There results were satisfying for the adapted domains. CONCLUSIONS The adapted domains of the 27 items questionnaire with reverse scoring of 8 items presented with good psychometric properties, allowing their use in clinical trials and in clinical practice.
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Affiliation(s)
| | - Charbel El Feghaly
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Murielle El Feghaly
- Surgery Department, Saint George Hospital University Medical Center, Beirut, Lebanon
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12
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Atallah D, Arab W, Dagher B, Khalil N, El Rawadi E, Atallah B, Ghaname W, El Kassis N, Chahine G, Moubarak M. Predictive factors of lymph node metastasis and pattern of repartition in patients with epithelial ovarian cancer. Future Oncol 2021; 17:5093-5101. [PMID: 34821515 DOI: 10.2217/fon-2021-0419] [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] [Indexed: 12/24/2022] Open
Abstract
Aim: To determine the rate, repartition and risk factors of lymph node (LN) metastasis in patients with epithelial ovarian cancer. Methods: We reviewed retrospectively the pathological and clinical data of 184 patients with epithelial ovarian cancer at a tertiary care center in Beirut, Lebanon. Results: 88% of patients received a pelvic and para-aortic lymphadenectomy. 70% of patients presented LN metastases at both pelvic and para-aortic levels, while isolated pelvic or para-aortic LN metastases were seen in 16 and 14% of cases, respectively. In a univariate analysis, the rate of positive LNs was higher in patients with serous histology (65 vs 33%; p < 0.001), high-grade tumors (68 vs 26%; p < 0.001), bilateral adnexal involvement (74 vs 27%; p < 0.001), advanced clinical stage (p < 0.001), interval debulking surgery (63.2 vs 36.8%; p = 0.003) and positive peritoneal cytology (79 vs 26%; p < 0.001). In a multivariate analysis, the rate of LN involvement was significantly higher in patients with higher grade, advanced clinical stage and positive peritoneal cytology. Conclusion: Serous histology, grade 3 tumors, positive peritoneal cytology, advanced clinical stage, interval surgery and bilateral adnexal involvement can predict LN metastasis in patients with epithelial ovarian cancer.
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Affiliation(s)
- David Atallah
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Wissam Arab
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bruno Dagher
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nour Khalil
- Department of Urology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Elsa El Rawadi
- Department of Medical Oncology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bachir Atallah
- Department of Statistics, Clinical Research Center, Saint Joseph University, Beirut, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics & Gynecology, Notre Dame de Secours Hospital, Lebanese American University, Jbeil, Lebanon
| | - Nadine El Kassis
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Georges Chahine
- Department of Medical Oncology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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13
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Atallah D, Arab W, Kassis NE, Cortbaoui E, El Khoury C, Chahine G, Moubarak M. Oncoplastic breast-conservative surgery for breast cancers: a uni-institutional case-control study. Future Oncol 2021; 17:3843-3852. [PMID: 34269066 DOI: 10.2217/fon-2021-0280] [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] [Indexed: 11/21/2022] Open
Abstract
The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and conventional breast-conserving surgery (BCS). Data collected retrospectively from two groups of patients diagnosed with breast cancer, cases group (OBCS) and control group (BCS), were analyzed. A total of 277 women were included in the analysis: 193 (69.7%) in the cases group and 84 (30.3%) in the control group. Resected volume was larger in the OBCS group (438.05 ± 302.26 cm3 vs 223.34 ± 161.75 cm3; p < 0.001). Re-excision was required for 7.1% of patients receiving BCS versus 4.7% in the OBCS group (p = 0.402). After long-term follow up, no local recurrences occurred in the OBCS group, while 2.4% of patients receiving BCS had local relapse (p = 0.045). Compared with BCS, OBCS increases oncological safety in terms of re-excision rate and local recurrence.
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Affiliation(s)
- David Atallah
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Wissam Arab
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadine El Kassis
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Emilia Cortbaoui
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Clement El Khoury
- Department of Oncologic Radiology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Georges Chahine
- Department of Medical Oncology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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14
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Abou Chakra R, Najib B, Abdallah W, Akiki M, El Khoury L, Atoui A, Moubarak M, Atallah D. B-Cell Lymphoblastic Lymphoma in Relapse Presenting as a Uterine Mass: A Case Report and Review of Literature. Case Rep Oncol 2021; 14:868-873. [PMID: 34248553 PMCID: PMC8255752 DOI: 10.1159/000515196] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/03/2022] Open
Abstract
B-cell lymphoblastic lymphoma (LBL) is a highly aggressive malignant proliferation of lymphoblasts of B-origin grouped with acute lymphoblastic leukemia. Multiple studies demonstrated the various sites of involvement in adult LBL. The involvement of the uterus as a site of relapse for such disease is rare. We herein report the case of relapsed B-cell LBL mimicking endometrial sarcoma. The patient is a 56-year-old female patient known to have B-cell LBL on chemotherapy. She presented with abdominal pain and fever. Positron emission tomodensitometry-computed tomography showed the presence of a uterine mass with bilateral iliac lymph node involvement. She underwent surgery with mass removal and pathology showed relapsed B-cell LBL.
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Affiliation(s)
- Rim Abou Chakra
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Bernard Najib
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Wael Abdallah
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Mira Akiki
- Department of Pathology, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Lea El Khoury
- Department of Pathology, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ali Atoui
- Hematology-Oncology Division, Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - David Atallah
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
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15
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Atallah D, El Kassis N, Safi J, El Hachem H, Chahine G, Moubarak M. The use of hysteroscopic endometrectomy in the conservative treatment of early endometrial cancer and atypical hyperplasia in fertile women. Arch Gynecol Obstet 2021; 304:1299-1305. [PMID: 33830345 DOI: 10.1007/s00404-021-06048-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/11/2020] [Accepted: 03/26/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To illustrate the effectiveness of hysteroscopic endometrial resection in conservative treatment of early endometrial cancer/atypical hyperplasia in women of reproductive age. METHODS Review of outcomes of women of reproductive age who underwent fertility sparing treatment (hysteroscopic superficial endometrectomy followed by progestin therapy) in early endometrial cancer. RESULTS Eight women with Stage I endometrial cancer and three with atypical endometrial hyperplasia underwent hysteroscopic superficial endometrial resection, followed by 1-year treatment with oral megestrol acetate. One patient had a synchronous endometrioid ovarian carcinoma. One patient with Grade 2 carcinoma opted for conservative treatment and had hysterectomy 3 months later for persisting disease. Ten patients showed no evidence of residual disease during a 12-month follow-up period with regular hysteroscopy. Five patients had seven pregnancies without assisted reproductive technology. One patient got pregnant after one attempt of in-vitro fertilization and oocyte donation. Pregnancy rate was 54.5%; two patients had two successful pregnancies and deliveries. Average time to pregnancy was 16 months from the end of treatment. All babies were delivered vaginally. CONCLUSION Total superficial endometrial resection followed by progestin can be considered in patients with early endometrial cancer/atypical hyperplasia who still want to conceive. It does not seem to impair fertility nor pregnancy outcomes in women of reproductive age.
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Affiliation(s)
- David Atallah
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. .,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon.
| | - Nadine El Kassis
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
| | - Joelle Safi
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
| | - Hady El Hachem
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
| | - Georges Chahine
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Malak Moubarak
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon
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16
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Arab W, Moubarak M, Fattah S, Khazen J, Khaddage A, El Kassis N, Atallah D. Periductal stromal tumor of the breast in a young lady: A case report. Breast J 2021; 27:380-383. [PMID: 33474791 DOI: 10.1111/tbj.14158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
We present the case of a 30-year-old lady who underwent a core needle biopsy for a BIRADS 4 lesion of her left breast and was diagnosed as having a cellular fibroadenoma. The final diagnosis after excision returned to be a periductal stromal tumor (PST). An extremely rare entity, the PST is actually classified as a subtype of phyllodes tumor, with specific criteria that are only found upon histological examination of the specimen. Care should be taken when considering the diagnosis of fibroadenoma based only on clinical, radiological, and biopsy findings. Any nonclassical, clinical, or radiological findings should prompt a wide excision. Prognosis is generally good when clear margins are obtained and in the absence of malignant heterologous elements.
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Affiliation(s)
- Wissam Arab
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Samah Fattah
- Department of Pediatrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Joseph Khazen
- Department of Pathology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Abir Khaddage
- Department of Pathology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadine El Kassis
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - David Atallah
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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17
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Atallah D, Arab W, El Kassis N, Nasser Ayoub E, Chahine G, Salem C, Moubarak M. Breast and tumor volumes on 3D-MRI and their impact on the performance of a breast conservative surgery (BCS). Breast J 2020; 27:252-255. [PMID: 33336469 DOI: 10.1111/tbj.14137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/26/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/11/2023]
Abstract
Breast conservation rate is being increasingly used nowadays as a marker of breast cancer care among hospitals. Searching for the ideal technique to predict the feasibility of BCS is ongoing. For this matter, the preoperative MRIs of 169 patients operated with radical or conservative surgery were reviewed. We estimated the tumor volume (TV) and breast volume (BV) on enhanced 3D-MRI and compared the tumor-to-breast volume ratio (TV/BV) in both groups. The mean ratio was 9.5% in the mastectomy group and 1.7% in the BCS group. A tumor-to-breast volume ratio less than 4% seemed to favor the adoption of a conservative option. Our data suggest that preoperative 3D-MRI can orient the surgical approach by assessing the TV/BV ratio, increasing lumpectomy rates with clear margins and good cosmetic outcome.
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Affiliation(s)
- David Atallah
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Wissam Arab
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Nadine El Kassis
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Eliane Nasser Ayoub
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Anesthesiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Georges Chahine
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Christine Salem
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Radiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Malak Moubarak
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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Salem C, Hajj MA, Kourié H, Haddad A, Khaddage A, Ayoub EN, Jabbour K, Moubarak M, Atallah D. Radiology management of a 'breast unit' during COVID-19 pandemic: a single institution experience. Future Oncol 2020; 16:2917-2922. [PMID: 33350878 PMCID: PMC7714046 DOI: 10.2217/fon-2020-0585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: To describe the activity in the ‘breast unit’ at the department of radiology during the coronavirus disease 19 lockdown in a university hospital treating coronovirus disease 19 patients in a Middle-Eastern developing country. Materials: This was a retrospective study conducted from March 9 until 11 May 2020, in the breast unit at the department of radiology of a central university hospital in a Middle-Eastern developing country. Data were collected from 205 patients visiting the breast unit during the lockdown period and compared with the activity in the same period in the previous year. Results: Reduction of the breast unit activity was estimated at 73%. In addition, 153 mammograms, 205 ultrasounds, and 16 breast MRIs were done. Indications for mammogram were screening (41.5%), follow-up (22%), clinical symptoms (20%) and breast cancer surveillance (16.5%). MRI was performed mostly for preoperative surgical management. The rate of positive biopsies was 41%. All staff members and patients have accommodated to new adjustments. Conclusion: Activity in the breast unit dropped during the lockdown period. Staff should continue to seek their own and their patient’s safety without diminishing the quality of healthcare.
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Affiliation(s)
- Christine Salem
- Department of Radiology, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - Marie-Ange Hajj
- Department of Radiology, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - Hampig Kourié
- Department of Oncology, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - Antoine Haddad
- Department of Radiology, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - Abir Khaddage
- Department of Pathology, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - Eliane Nasser Ayoub
- Department of Anesthesiology, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - Khalil Jabbour
- Department of Anesthesiology, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecology & Obstetrics, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
| | - David Atallah
- Department of Gynecology & Obstetrics, Faculty of Medicine, Saint Joseph University of Beirut, 116-5137, Beirut, Lebanon
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Atallah D, Moubarak M, Arab W, El Kassis N, Chahine G, Salem C. MRI‐based predictive factors of axillary lymph node status in breast cancer. Breast J 2020; 26:2177-2182. [DOI: 10.1111/tbj.14089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022]
Affiliation(s)
- David Atallah
- Faculty of Medicine Saint Joseph University Achrafieh Lebanon
- Department of Gynecology and Obstetrics Hôtel‐Dieu de France University Hospital Achrafieh Lebanon
| | - Malak Moubarak
- Faculty of Medicine Saint Joseph University Achrafieh Lebanon
- Department of Gynecology and Obstetrics Hôtel‐Dieu de France University Hospital Achrafieh Lebanon
| | - Wissam Arab
- Faculty of Medicine Saint Joseph University Achrafieh Lebanon
- Department of Gynecology and Obstetrics Hôtel‐Dieu de France University Hospital Achrafieh Lebanon
| | - Nadine El Kassis
- Faculty of Medicine Saint Joseph University Achrafieh Lebanon
- Department of Gynecology and Obstetrics Hôtel‐Dieu de France University Hospital Achrafieh Lebanon
| | - Georges Chahine
- Faculty of Medicine Saint Joseph University Achrafieh Lebanon
- Department of Oncology Hôtel‐Dieu de France University Hospital Achrafieh Lebanon
| | - Christine Salem
- Faculty of Medicine Saint Joseph University Achrafieh Lebanon
- Department of Radiology Hôtel‐Dieu de France University Hospital Achrafieh Lebanon
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Eid R, Kourie H, Khaddage A, Moubarak M, Atallah D. Characteristics of ovarian tumors in Lebanon: Twenty years of experience in a Lebanese tertiary center. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.181] [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: 10/23/2022]
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Atallah D, Moubarak M, Dagher B, El Hajj H, El Kassis N. Lebanese experience with cytoreductive surgery in ovarian cancer: A single institution series. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.183] [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: 10/23/2022]
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Atallah D, Moubarak M. Predictive factors of postoperative complications after cytoreductive surgery for ovarian cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.208] [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: 10/23/2022]
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Eid R, Kourie H, Khaddage A, Moubarak M, Atallah D. Ovarian metastases from breast cancer: Series over a 20-year period at a Lebanese tertiary care center. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.232] [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: 10/23/2022]
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Atallah D, Abou Zeid H, Moubarak M, Moussa M, Nassif N, Jebara V. "You only live twice": multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report. BMC Pregnancy Childbirth 2020; 20:135. [PMID: 32111175 PMCID: PMC7048027 DOI: 10.1186/s12884-020-2817-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/18/2020] [Indexed: 01/12/2023] Open
Abstract
Background Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient’s death. Conclusion This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.
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Affiliation(s)
- David Atallah
- Saint Joseph University, Beirut, Lebanon. .,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, P.O. Box: 116-5137, Beirut, Lebanon.
| | - Hicham Abou Zeid
- Saint Joseph University, Beirut, Lebanon.,Department of Anesthesiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Malak Moubarak
- Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, P.O. Box: 116-5137, Beirut, Lebanon
| | - Maya Moussa
- Saint Joseph University, Beirut, Lebanon.,Department of Anesthesiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Nadine Nassif
- Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, P.O. Box: 116-5137, Beirut, Lebanon
| | - Victor Jebara
- Saint Joseph University, Beirut, Lebanon.,Department of Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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Antoun S, Atallah D, Tahtouh R, Assaf MD, Moubarak M, Ayoub EN, Chahine G, Hilal G. Glucose restriction combined with chemotherapy decreases telomere length and cancer antigen-125 secretion in ovarian carcinoma. Oncol Lett 2019; 19:1338-1350. [PMID: 31966066 PMCID: PMC6956372 DOI: 10.3892/ol.2019.11233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
Although chemotherapy is the standard treatment for ovarian cancer (OC), recent studies have focused on its coupling with hypoglycemic drugs to decrease glucose availability. Similarly to cancer antigen 125 (Ca-125), telomerase, the key protein for telomere lengthening, is overexpressed in 90% of OC cases. The aim of the present study was to investigate the effect of the combination of glucose restriction and chemotherapy on telomere length and Ca-125 secretion in OC cells. SKOV-3, OVCAR-3 and Igrov-1 cells were treated with 20 µM cisplatin and 100 nM paclitaxel for 48 h in three different glucose concentrations: i) 4.5 g/l, ii) 1 g/l and iii) 0.5 g/l. The same treatment was repeated once per week for 6 consecutive weeks. The surviving cells were considered platinum-taxane escape (PTES) cells. The expression levels of telomerase and Ca-125 in treated and PTES cells were quantified by qPCR, and Ca-125 secretion by ELISA. Telomere length was evaluated by qPCR according to the Cawthon method. The modulation of Ca-125 by telomerase was assessed using inhibitors, small interfering RNA and transfection with human telomerase reverse transcriptase (hTERT) vectors. The implication of phosphatidylinositol-4,5-bisphosphate 3-kinase/protein kinase B/mechanistic target of rapamycin (PI3K/Akt/mTOR) in Ca-125 modulation was investigated using specific inhibitors. An increase in hTERT and Ca-125 expression levels (range, 1.5-3 fold) was observed in short-term treated cells. However, an opposite effect was detected in PTES cells, where the rate of decrease in the expression levels of hTERT and Ca-125 reached 60% after treatment in 0.5 g/l glucose. Moreover, telomere length was decreased by 30% in cells treated with 0.5 g/l glucose. Inhibition of hTERT expression significantly decreased Ca-125 secretion, suggesting a potential modulation of Ca-125 by hTERT. The inhibition of the PI3K/Akt/mTOR pathway also decreased Ca-125 secretion; however, the effect of this treatment was not enhanced when coupled with telomerase inhibitors. In conclusion, the combination of chemotherapy and glucose restriction was observed to decrease Ca-125 secretion and telomerase expression leading to shortening in telomere length. Thus, decreasing glucose availability for OC cells during treatment may lead to a better clinical outcome and potentially improve the prognosis of patients with OC.
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Affiliation(s)
- Stephanie Antoun
- Cancer and Metabolism Laboratory, Faculty of Medicine, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - David Atallah
- Department of Obstetrics and Gynecology, Hotel-Dieu De France Hospital, Beirut 16-6830, Lebanon
| | - Roula Tahtouh
- Cancer and Metabolism Laboratory, Faculty of Medicine, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - Mona Diab Assaf
- Pharmacology and Cancerology Laboratory, Faculty of Sciences, Lebanese University, Beirut 6573/14, Lebanon
| | - Malak Moubarak
- Department of Obstetrics and Gynecology, Hotel-Dieu De France Hospital, Beirut 16-6830, Lebanon
| | - Eliane Nasser Ayoub
- Department of Anesthesiology, Hotel-Dieu De France Hospital, Beirut 16-6830, Lebanon
| | - Georges Chahine
- Department of Oncology, Hotel-Dieu De France Hospital, Beirut 16-6830, Lebanon
| | - George Hilal
- Cancer and Metabolism Laboratory, Faculty of Medicine, Saint Joseph University, Beirut 1107 2180, Lebanon
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Atallah DM, Antoun S, Moubarak M, EL Kassis N, Chahine GY, Hilal G. Telomere length and its implication as prognostic marker in ovarian cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17055] [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: 11/20/2022] Open
Abstract
e17055 Background: Telomeres are DNA structures protecting the linear ends of eukaryotic chromosomes against degradation and fusion, thereby maintaining genome stability. Telomerase is an enzyme that stabilizes the length of linear chromosomes by de novo synthesizing telomeric repeats during incomplete DNA replication, thus ensuring immortalization. This enzyme is expressed in 80% of cancers, including ovarian carcinoma. The human telomerase reverse transcriptase has been investigated as a detection marker for cancers in early stages, and a prognosis marker in late stages disease. The aim of this study is to investigate telomere length as a marker for survival and recurrence in ovarian carcinoma. Methods: 37 ovarian cancer biopsies have been isolated from Lebanese patients. The biopsies were subjected to DNA extraction, and then telomere length was assayed in cancer cells following the method elaborated by R. Cawthon (2002). The results obtained were expressed as ratios (36B4 is a single copy gene) Ct Telomere/Ct 36B4. Clinical data of each patient have been retrieved, including survival, recurrence, lymph node ratio, age, weight. Results: The results obtained revealed a direct relation between telomere length and survival. In fact, patients with shorter survival rates (less than 1 year) exhibited 30% longer telomeres compared with patients with longer survival rates (3 to 5 years). Moreover, recurrence rates increased with longer telomeres. Higher ratios (35%) were detected in patients with early recurrence (less than 1 year) compared to patients with late or absent recurrence. However, no direct effect between telomere length and the other parameters was spotted. Conclusions: telomere length could be used as a prognostic marker in patients with ovarian cancer by predicting better survival and lower recurrence in case of shorter telomeres. This will be of a great value when making therapeutic decisions in a heterogeneous and aggressive disease as ovarian cancer.
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Affiliation(s)
| | | | - Malak Moubarak
- Hôtel Dieu de France University Hospital, Beirut, Lebanon
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Atallah D, Moubarak M, Saliba S, Nassar M, Abboud S, Kesrouani A, Ghossain M, Elkassis N. Placental Malformation: Accreta and Beyond. Placenta 2018. [DOI: 10.5772/intechopen.80588] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Antoun S, Atallah D, Tahtouh R, Moubarak M, Alaeddine N, Hilal G. Abstract 2413: TP53 gene mutations differently regulate ovarian cancer metabolism: Ex vivo and in vitro studies. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2413] [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
Background: Even in the presence of oxygen, cancer cells tend to metabolize glucose into lactate instead of undergoing oxidative phosphorylation. Knowing that glucose is crucial for tumor's proliferation, new patient's treatment strategies tend to combine chemotherapy to hypoglycemic drugs. p53 is a tumor suppressor and key regulator of glycolysis in cancer cells, however highly mutated in tumors. In ovarian cancer, the majority of studies concerning p53 mutations focus on the DNA binding domain since the majority of hotspot mutations affects this region of the gene. However, mutations affecting other regions such as the proline rich domain linked directly to apoptosis may also affect the protein's expression and activity. The aim of this study is to investigate the effect of various positions of mutations in TP53 gene on glycolysis, apoptosis and transcription of p53 target genes.
Material and Methods: this study was divided into two parts. The in vitro study was done using 3 ovarian cancer cell lines SKOV-3 (p53 null), Igrov-1 (WT p53) and Ovcar-3 (DNA domain mutant p53), along with the transfection of SKOV-3 cells by three different vectors: WTp53, P72R p53 and R249S p53. The ex vivo part was performed on 30 ovarian cancer biopsies. The biopsies were subjected to Tp53 immunohistochemistry and sequencing to study the mutations and their effect on p53 expression. The effect of Tp53 mutations on glucose metabolism was assayed by glucose consumption measurements, lactate production and mRNA expression of various glycolytic enzymes. To study the effect of mutations on the transcriptional activity of p53, p21 and MDM2 expression was quantified in these cells. Annexin V assay was performed on transfected SKOV-3 to study the apoptotic activity of WT and mutant p53.
Results: DNA binding domain mutant cells (Ovcar-3 and R249S SKOV-3) presented a 30% increase in glucose consumption and lactate production when compared to IGROV-1 and WT SKOV-3. P72R SKOV-3 exhibited the same pattern as WTp53 cells. The increase in the mRNA expression of glucose transporters GLUT-1 and 3 and of the glycolytic enzymes PK, PFK, G6PDH and aldolase in cells with DNA binding domain mutations varied from 20 to 30%, whereas the levels of PDHa and TIGAR decreased significantly (40%). The transcriptional activity of DNA binding domain mutant cells showed a 50% decrease in comparison to WT and P72R mutant cells. The apoptotic activity of p53 was unaltered in P72R transfected SKOV-3 cells. The ex vivo results revealed a high frequency of the P72R variant in the ovarian biopsies (69%), associated with an overexpression of the p53 protein. The glycolytic and transcriptional patterns of cells extracted from these biopsies were similar to those obtained in transfected cells.
Conclusion: Though both DNA-binding and proline-rich domains mutations lead to p53 overexpression, only the first type promotes Warburg effect and could have the worst patient's prognosis.
Citation Format: Stephanie Antoun, David Atallah, Roula Tahtouh, Malak Moubarak, Nada Alaeddine, George Hilal. TP53 gene mutations differently regulate ovarian cancer metabolism: Ex vivo and in vitro studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2413.
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Atallah D, Antoun S, Moubarak M, El Kassis N, Chahine G, Hilal G. TP53 domains’ mutations alter glycolysis in epithelial ovarian carcinoma: Ex vivo and in vitro study. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.132] [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: 11/30/2022]
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Antoun S, Atallah D, Tahtouh R, Alaaeddine N, Moubarak M, Khaddage A, Ayoub EN, Chahine G, Hilal G. Different TP53 mutants in p53 overexpressed epithelial ovarian carcinoma can be associated both with altered and unaltered glycolytic and apoptotic profiles. Cancer Cell Int 2018; 18:14. [PMID: 29422776 PMCID: PMC5791177 DOI: 10.1186/s12935-018-0514-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/23/2018] [Indexed: 01/09/2023] Open
Abstract
Background p53 is a tumor suppressor and key regulator of glycolysis in cancer cells, however highly mutated in tumors. In ovarian cancer, studies concerning p53 mutations focus on the DNA binding domain since the majority of hotspot mutations affects this region. Yet, mutations in other regions such as the proline rich domain may also affect the protein’s expression and activity. The aim of this study is to investigate the effect of various positions of mutations in TP53 gene on glycolysis, apoptosis and transcription of p53 target genes. Methods Mutations frequency and their effect on p53 expression were assessed by PCR-SSCP, sequencing and immunohistochemistry on 30 ovarian cancer biopsies. Six tumors were cultured, as well as SK-OV-3, OVCAR-3 and Igrov-1. SK-OV-3 cells were transfected with 2 TP53 mutants. p53 transcriptional activity was assayed by qPCR, apoptosis by flow cytometry and glycolysis by glucose and lactate measurements, with quantification of glycolytic enzymes expression. Results Our results showed a high frequency of the P72R mutant, associated with p53 overexpression in the ovarian biopsies. However, P72R mutant cells showed similar apoptosis and glycolysis as WT cells. DNA binding domain mutations decreased the transcriptional activity of the protein and increased glucose consumption and lactate production. Conclusion Despite the overexpression of the P72R mutated protein in the biopsies, it showed a similar apoptotic activity and glucose regulation ability as WT p53. Knowing that p53 expression status is used for chemotherapeutic approaches and prognosis in ovarian cancer, the results obtained highlight the importance of locating TP53 mutations. Electronic supplementary material The online version of this article (10.1186/s12935-018-0514-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Antoun
- 1Cancer and Metabolism Laboratory, Faculty of Medicine, Saint Joseph University, Damascus Road, Riad el Solh, Beirut, 1107 2180 Lebanon
| | - David Atallah
- 2Obstetrics and Gynecology Department, Hotel-Dieu De France Hospital, Beirut, Lebanon
| | - Roula Tahtouh
- 1Cancer and Metabolism Laboratory, Faculty of Medicine, Saint Joseph University, Damascus Road, Riad el Solh, Beirut, 1107 2180 Lebanon
| | - Nada Alaaeddine
- 3Regenerative Medicine and Inflammation Laboratory, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Malak Moubarak
- 2Obstetrics and Gynecology Department, Hotel-Dieu De France Hospital, Beirut, Lebanon
| | - Abir Khaddage
- 4Anatomy and Pathology Department, Hotel-Dieu De France Hospital, Beirut, Lebanon
| | - Eliane Nasr Ayoub
- 5Anesthesiology Department, Hotel-Dieu De France Hospital, Beirut, Lebanon
| | - George Chahine
- 6Oncology Department, Hotel-Dieu De France Hospital, Beirut, Lebanon
| | - George Hilal
- 1Cancer and Metabolism Laboratory, Faculty of Medicine, Saint Joseph University, Damascus Road, Riad el Solh, Beirut, 1107 2180 Lebanon
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Atallah D, Moubarak M, El Kassis N, Abboud S. Clinical research ethics review process in Lebanon: efficiency and functions of research ethics committees - results from a descriptive questionnaire-based study. Trials 2018; 19:27. [PMID: 29325585 PMCID: PMC5765668 DOI: 10.1186/s13063-017-2397-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Clinical trials conducted in Lebanon are increasing. However, little is known about the performance of research ethics committees (RECs) in charge of reviewing the research protocols. This study aimed to assess the level of adherence to the ethics surrounding the conduct of clinical trials and perceptions of team members regarding roles of the RECs during the conduct of clinical trials in Lebanon. The research question was: Are RECs adherent to the ethics surrounding the conduct of clinical trials (chapters II and IV in ‘Standards and Operational Guidance for Ethics Review of Health-related Research with Human Participants’ in Lebanon?’ Methods This was a quantitative and descriptive questionnaire-based study conducted among RECs of university hospitals in Lebanon. The questionnaire had to be completed online and included general questions in addition to items reflecting the different aspects of a REC performance and effectiveness. All the questionnaire was assigned a total score of 175 points. General information and questions assigned point values/scores were analysed using descriptive statistics: frequency and percentage, mean score ± standard deviation. Results Ten RECs participated in the study (52 persons: four chairs, one vice-president, 47 ordinary members). Forty-seven (90.4%) had previous experience with clinical research and 30 (57.7%) had a diploma or had done a training in research ethics. Forty-one percent confirmed that they were required to have a training in research ethics. All RECs had a policy for disclosing and managing potential conflicts of interest for its members, but 71.8% of participants reported the existence of such a policy for researchers. Thirty-three point three percent reported that the RECs had an anti-bribery policy. The questionnaire mean score was 129.6 ± 22.3/175 points reflecting thus an excellent adherence to international standards. Conclusion Inadequate training of REC members and the lack of anti-bribery policies should be resolved to improve their performance. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2397-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Atallah
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Beirut, Lebanon. .,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. .,Health Department, University of Liverpool, Liverpool, UK.
| | - Malak Moubarak
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | | | - Sara Abboud
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Atallah D, Moubarak M, Nassar M, Kassab B, Ghossain M, El Kassis N. Case series of outcomes of a standardized surgical approach for placenta percreta for prevention of ureteral lesions. Int J Gynaecol Obstet 2017; 140:352-356. [PMID: 29178185 DOI: 10.1002/ijgo.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/08/2017] [Revised: 11/01/2017] [Accepted: 11/24/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To report the outcomes of women with placenta percreta who were surgically treated by a specialized technique based on gynecologic oncology experience, and to demonstrate its safety in preventing ureteral lesions and reducing blood loss. METHODS In the present retrospective study, data from patients with placenta percreta radically treated at Hôtel-Dieu de France, Beirut, Lebanon, between December 2012 and January 2017 were reviewed. Demographic, pathology, and delivery data, medical history, per-operative and postoperative information, and neonatal data were assessed. Operative and postoperative outcomes were compared between emergency and scheduled cases. RESULTS Data from 35 patients were reviewed. Median gestational age at delivery was 34 weeks. Cesarean hysterectomy was scheduled in 20 (60%) cases. No ureteral lesions were noted. The median estimated blood loss was 1 L and a median of 3 units of red blood cells units was transfused. Emergency and scheduled cases presented comparable estimated blood loss, intra-operative transfusion, bladder injury incidence, and surgery duration (all P>0.05). The mean delivery weight was 2100 g; admission to the neonatal intensive care unit was needed for 30 (86%) neonates. CONCLUSION The surgical technique developed for placenta percreta was found to be effective (operative and postoperative outcomes) and safe (prevention of ureteral lesions).
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Affiliation(s)
- David Atallah
- School of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Malak Moubarak
- School of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Malek Nassar
- School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Bernard Kassab
- School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Michel Ghossain
- School of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Radiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Nadine El Kassis
- School of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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Atallah D, Antoun S, Moubarak M, El Kassis N, Seoud M, Chahine G, Hilal G. Modulation of CA-125 expression by hTERT in ovarian cancer: Possible implication of PI3K/AKT/mTOR signaling pathway. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.186] [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: 11/30/2022]
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Atallah D, Moubarak M, Safi J, El Kassis N. P350 Safety of oncoplastic surgery in early breast cancer: a case–control study. Breast 2015. [DOI: 10.1016/s0960-9776(15)70380-2] [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: 10/23/2022] Open
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Atallah D, Salameh C, Sarkis R, Ghossain M, Safi J, Moubarak M, Ghanameh W, Moukarzel M, El Kassis N. [Laparoscopic treatment of vaginal agenesis: three cases]. J Med Liban 2014; 62:227-231. [PMID: 25807721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Ninety per cent of cases of congenital vaginal agenesis are represented by the Mayer-Rokitansky-Küster-Hauser syndrome, the remaining 10% being represented by the testicular feminization syndrome and vaginal aplasia. Numerous surgical methods for the treatment of vaginal agenesis have been described. Neovagina construction by sigmoid colpoplasty seems to be the best surgical option as regards the anatomical and functional outcome. METHOD We report the case of three patients operated of neovagina construction with a sigmoid graft by a laparoscopic-perineal approach. RESULTS The surgical intervention lasted for 330 minutes, 210 minutes and 150 minutes respectively for the three patients. There were no perioperative complications. The duration of hospitalization was respectively 7, 4 and 6 days. The length of the neovagina was 15, 14 and 18 cm without retraction on the follow-up at 2 and 6 months. The vaginal wall maintained its patency allowing normal intercourse. The patients had normal sexual life after the surgery. CONCLUSION Our results demonstrate the feasibility of laparoscopic-perineal neovagina construction by sigmoid colpoplasty when it is performed by experienced surgeons in gynecology and digestive laparoscopic surgery.
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Zogheib E, Dermigny F, Pessayere J, Moubarak M, Benamar A, Trojette F, Remadi JP, Dupont H. Conséquences médicales et sociales à court et moyen terme de la chirurgie cardiaque chez les octogénaires. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.annfar.2013.07.048] [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: 11/24/2022]
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Bernasinski M, Gette S, Malinovsky JM, Viry Babel F, Charpentier C, Audibert G, Guirlet M, Lorne E, Moubarak M, Zogheib E, Dupont H, Ozier Y, Mertes PM. Les TRALI au CHU de Nancy : une incidence reconsidérée après l’application stricte des critères de Toronto. Transfus Clin Biol 2013; 20:40-5. [DOI: 10.1016/j.tracli.2013.02.028] [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] [Received: 10/20/2012] [Accepted: 02/20/2013] [Indexed: 11/15/2022]
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Montravers P, Villamizar J, Sansom A, Barsam E, Agaesse V, Abourachid H, Moubarak M. Superinfection of Posttraumatic Retroperitoneal Hematoma Secondary to Ascending Urinary Tract Infection. ACTA ACUST UNITED AC 2001; 50:931-3. [PMID: 11371855 DOI: 10.1097/00005373-200105000-00027] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Retroperitoneal hematoma is a common feature after blunt abdominal trauma, but secondary infection of these hematomas is a rare complication and its mechanisms have not been fully elucidated. We report a case of infected retroperitoneal hematoma secondary to renal trauma related to ascending urinary tract infection.
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Affiliation(s)
- P Montravers
- Service d'Anesthésiologie C and the Service d'Urologie, Centre Hospitalier Universitaire d'Amiens, Hôpital Sud, Salouel, 80054 Amiens, France.
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Gamain J, Medelli D, Vanelslander J, Moubarak M. [Measure of cardiac output using a non-invasive method]. Cah Anesthesiol 1988; 36:235-6. [PMID: 3395909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- J Gamain
- Département d'Anesthésie-Réanimation, C.H.U.-Hôpital Sud, Amiens
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Gamain J, Medelli-Gamain D, Vanelslander J, Moubarak M, Pietri J. [Thoracic complications caused by catheterization of the superior vena cava system]. Phlebologie 1985; 38:639-42. [PMID: 3912770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The authors report on 8 observations of respiratory complications, following catheterization of the superior caval system. They mention its clinical features, the seriousness of its development and the diagnostic procedure. The symptomatic treatment is based on the evacuation of the extravasation and the withdrawal of the catheter. Sometimes there has to be recourse to surgery. Finally, the authors emphasize the need for prevention of such typically iatrogenous complications.
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