Racial and Ethnic Disparities in Gynecologic Carcinosarcoma: A Single-Institution Experience.

We aimed to determine the incidence, treatment regimen, and treatment outcomes (including progression-free survival and overall survival) of gynecologic carcinosarcoma, a rare, aggressive, and understudied gynecologic malignancy. This retrospective review included all patients with gynecologic cancers diagnosed and treated at a single tertiary care comprehensive cancer center between January 2012 and May 2021. A total of 2116 patients were eligible for review, of which 84 cases were identified as carcinosarcoma: 66 were uterine (5.2% of uterine cancers), 17 were ovarian (3.6% of ovarian cancers), 1 was cervical (0.28% of cervical cancers), and 1 was untyped. Of the patients, 76.2% presented advanced-stage disease (stage III/IV) at the time of diagnosis. Minority patients were more likely to present with stage III/IV (p < 0.0001). The majority of patients underwent surgical resection followed by systemic chemotherapy with carboplatin and paclitaxel. The median PFS was 7.5 months. Of the patients, 55% were alive 1 year after diagnosis, and 45% were alive at 5 years. In the studied population, minorities were more likely to present with more advanced disease. The rate of gynecologic carcinosarcomas was consistent with historical reports.

Searching for the source: Extraovarian primary peritoneal carcinoma presenting as chest wall masses.

Background: Extraovarian primary peritoneal carcinoma (EOPPC) is a rare form of epithelial adenocarcinoma arising from the peritoneal lining with little to no ovarian involvement. To date, very few cases of EOPPC with primary tumors outside of the peritoneum have been described, the majority of which present with a primary tumor in the retroperitoneum. No cases have been reported with primary presentation as a chest wall mass. Case report: This case describes a 64-year-old woman referred for the evaluation of PAX8 positive chest wall masses. Biopsies of these masses demonstrated tumor architecture that was predominantly micropapillary with rare psammomatous calcifications. Immunohistochemically, the tumor was PAX8, CK7, ER, MOC31, and BerEP4 positive, with a mutational pattern of p53. This was consistent with Mullerian adenocarcinoma markers and suggestive of high-grade serous carcinoma. The patient was diagnosed with a unique presentation of EOPPC and is currently alive at 36 months post initial diagnosis. She has been treated with a combination of diagnostic surgery, chemotherapy and radiation therapy. Conclusion: To the best of our knowledge, this is the first documented case of EOPPC presenting with a primary tumor of the chest wall. This case highlights the importance of pathology, immunohistology, and interdisciplinary collaboration in diagnosing and treating rare malignancies.

A case of niraparib PARP-Inhibitor induced Sweet Syndrome in gynecologic cancer.

Sweet Syndrome, or acute febrile neutrophilic dermatosis, is a rare inflammatory dermatologic disorder that can be spontaneous, associated with malignancy, or drug-induced. Reports of Sweet Syndrome in gynecologic oncology patients are sparse, and the majority are thought to be malignancy-associated. The case presented here represents the third case of drug-induced Sweet Syndrome in a gynecologic oncology patient. To the best of our knowledge, this is the first report of Sweet Syndrome after initiation of a poly (ADP-ribose) polymerase inhibitor (PARPi) for maintenance therapy in the treatment of high grade serous ovarian carcinoma (HGSOC). This represents one of the most severe dermatologic adverse effects of treatment with PARPi reported to date, requiring treatment discontinuation.

What happens in the long term: Uptake of cancer surveillance and prevention strategies among at-risk relatives with pathogenic variants detected via cascade testing.

BACKGROUND: Cascade genetic testing for hereditary cancer syndromes offers affected relatives the opportunity to pursue cancer screening and risk-reducing surgery and thus reduces morbidity and mortality. The purpose of this study was to measure the long-term utilization of targeted cancer prevention and quality of life among at-risk relatives offered clinician-facilitated cascade genetic testing. METHODS: In a pilot study, at-risk relatives of patients with a hereditary cancer syndrome were contacted directly by the clinical team and offered telephone genetic counseling and genetic testing via an at-home, mailed saliva kit. Two-year follow-up results evaluating the use of targeted cancer prevention strategies and the quality of life for enrolled relatives were reported. Quality-of-life was measured with validated surveys, and scores were compared to the time of initial contact by the Wilcoxon signed-rank test. RESULTS: Ninety-five at-risk relatives were enrolled in the initial pilot study, and 72 (76%) participated in the 2-year follow-up; 57 of these (79%) had completed genetic testing. Twenty-five of those 57 relatives (44%) were found to harbor an inherited pathogenic variant. Guideline-based cancer surveillance was recommended to 18 relatives; 13 (72%) completed at least one recommended screening, and six (33%) completed all recommended screenings. Risk-reducing surgery was recommended to 10 relatives; four (40%) completed a total of eight procedures. Quality-of-life surveys demonstrated low levels of anxiety, depression, distress, and uncertainty. CONCLUSIONS: The 2-year follow-up of the original pilot study revealed that clinician-facilitated cascade testing resulted in genetically targeted cancer screening and prevention with preserved quality of life. These results, to be confirmed by larger randomized controlled trials, suggest that medical systems should consider supporting clinician-facilitated cascade testing programs.

Incarcerated ventral wall hernia after robotic urogynecologic surgery: A case report.

Trocar site hernia is a rare complication of minimally invasive surgery, with incidence estimates varying widely. Studies have demonstrated rates of up to 1.2% in patients undergoing gynecologic surgery. Yet, little is known about hernia risk in the urogynecologic patient population who undergo robotic reconstructive surgery. Risk factors for the development of trocar site hernia include both incisional risk factors (trocar placement location, trocar diameter, intraoperative trocar manipulation) and patient risk factors (obesity, pelvic organ prolapse or other hernia). This report presents a case of large incarcerated small bowel hernia at a trocar site following robotic urogynecologic surgery and the resulting interventions, including repeat surgery, to reduce the hernia. This case should prompt urogynecologic surgeons to check port sites after extensive dissections to assess if large peritoneal or fascial defects need additional closure.

Leveraging Health Information Technology to Collect Family Cancer History: A Systematic Review and Meta-Analysis.

PURPOSE: Collection of family cancer histories (FCHs) can identify individuals at risk for familial cancer syndromes. The aim of this study is to evaluate the literature on existing strategies whereby providers use information technology to assemble FCH. METHODS: A systematic search of online databases (Ovid MEDLINE, Cochrane, and Embase) between 1980 and 2020 was performed. Statistical heterogeneity was assessed through the chi-square test (ie, Cochrane Q test) and the inconsistency statistic (I2). A random-effects analysis was used to calculate the pooled proportions and means. RESULTS: The comprehensive search produced 4,005 publications. Twenty-eight studies met inclusion criteria. Twenty-seven information technology tools were evaluated. Eighteen out of 28 studies were electronic surveys administered before visits (18, 64.3%). Five studies administered tablet surveys in offices (5, 17.8%). Four studies collected electronic survey via kiosk before visits (4, 14.3%), and one study used animated virtual counselor during visits (1, 3.6%). Among the studies that use an FCH tool, the pooled estimate of the overall completion rate was 86% (CI, 72% to 96%), 84% (CI, 65% to 97%) for electronic surveys before visits, 89% (CI, 0.74 to 0.98) for tablet surveys, and 85% (CI, 0.66 to 0.98) for surveys via kiosk. Mean time required for completion was 31.0 minutes (CI, 26.1 to 35.9), and the pooled estimate of proportions of participants referred to genetic testing was 12% (CI, 4% to 23%). CONCLUSION: Our review found that electronic FCH collection can be completed successfully by patients in a time-efficient manner with high rates of satisfaction.

Ovarian cancer arising from the proximal fallopian tube in a patient with a BRCA2 mutation.

Patients with BRCA mutations are at high risk of high grade serous ovarian cancer. A paradigm shift has resulted in the current understanding that many cases of ovarian cancer actually arise from the fimbriated fallopian tube. The case presented here involves fallopian tube carcinoma arising from the cornua of the uterus in a BRCA2 carrier. This case suggests that pathologic analysis of risk-reducing bilateral salpingo-oophorectomy (RRBSO) specimens via serial sectioning and extensively examining the fimbriated end (SEE-FIM) may be insufficient to diagnose all occult lesions of interest. This case also provides a new consideration in the ongoing debate over the role of concurrent hysterectomy at time of RRBSO in BRCA carriers.

Gynecologic oncology care during the COVID-19 pandemic at three affiliated New York City hospitals.

BACKGROUND: New York City was among the epicenters during the COVID-19 pandemic. Oncologists must balance plausible risks of COVID-19 infection with the recognized consequences of delaying cancer treatment, keeping in mind the capacity of the health care system. We sought to investigate treatment patterns in gynecologic cancer care during the first two months of the COVID-19 pandemic at three affiliated New York City hospitals located in Brooklyn, Manhattan and Queens. METHODS: A prospective registry of patients with active or presumed gynecologic cancers receiving inpatient and/or outpatient care at three affiliated New York City hospitals was maintained between March 1 and April 30, 2020. Clinical and demographic data were abstracted from the electronic medical record with a focus on oncologic treatment. Multivariable logistic regression analysis was explored to evaluate the independent effect of hospital location, race, age, medical comorbidities, cancer status and COVID-19 status on treatment modifications. RESULTS: Among 302 patients with gynecologic cancer, 117 (38.7%) experienced a COVID-19-related treatment modification (delay, change or cancellation) during the first two months of the pandemic in New York. Sixty-four patients (67.4% of those scheduled for surgery) had a COVID-19-related modification in their surgical plan, 45 (21.5% of those scheduled for systemic treatment) a modification in systemic treatment and 12 (18.8% of those scheduled for radiation) a modification in radiation. Nineteen patients (6.3%) had positive COVID-19 testing. On univariate analysis, hospital location in Queens or Brooklyn, age ≤65 years, treatment for a new cancer diagnosis versus recurrence and COVID-19 positivity were associated with treatment modifications. On multivariable logistic regression analysis, hospital location in Queens and COVID-19 positive testing were independently associated with treatment modifications. CONCLUSIONS: More than one third of patients with gynecologic cancer at three affiliated New York City hospitals experienced a treatment delay, change or cancellation during the first two months of the COVID-19 pandemic. Among the three New York City boroughs represented in this study, likelihood of gynecologic oncology treatment modifications correlated with the case burden of COVID-19.

Latino Parents' Beliefs about Television Viewing by Infants and Toddlers.

OBJECTIVE: To determine Latino parents' beliefs regarding the effects of television viewing on infants and toddlers. METHODS: We conducted interviews with 26 Latino parents of infants and toddlers. We evaluated parents' beliefs about the health effects of television viewing, sources of information on this topic and facilitators and barriers to following the American Academy of Pediatrics (AAP) screen-time guidelines. RESULTS: Parents believed that television viewing was educational for children but were concerned that watching television could worsen children's vision. Parents would be motivated to limit television viewing by children if it were recommended by a health care provider. Most parents were confident that they could limit their children's television viewing, although some perceived logistical challenges to following guidelines. CONCLUSIONS: Parents in our study had limited knowledge of the effects of television. Counseling on television by health care providers for Latino parents may decrease Latino infants and toddlers' television exposure.

Understanding how Latino parents choose beverages to serve to infants and toddlers.

To determine Latino parents' beliefs on the health effects of beverages on infants and toddlers, their sources of information on beverages and perceived barriers to following guidelines for healthy beverage consumption by children. We conducted 29 interviews with parents of Latino children ages 6-36 months. Parents were recruited in three community health centers in Northern California. The interviews were recorded, transcribed and analyzed using standard qualitative methods. The following dominant themes emerged. Parents believed that water and milk were healthy beverages for children and that sugar-sweetened beverages (SSBs) were unhealthy. Views on 100% fruit juice were mixed. Parents distinguished between homemade beverages such as "agua fresca" which they considered healthy, despite containing added sugar, and beverages from stores which were viewed as unhealthy. Participants' main source of information on beverages was the federal nutrition program for Women, Infants, and Children (WIC). Parents were confused, however, as to why WIC provides juice yet counseled parents to avoid giving their children juice. Parents preferred to receive information on beverages from experts. Differing practices among family members regarding which beverages they provide to children was the most important barrier to following beverage guidelines. Our study suggests that Latino parents are receptive to counseling on beverages from expert sources. Such counseling should address both store-bought and homemade beverages. The WIC program is a key source of information on beverages for Latino parents; thus counseling offered by WIC should be evidence-based and avoid mixed messages.