Differential diagnosis of uterine adenosarcoma: identification of JAZF1-BCORL1 rearrangement by comprehensive cancer genomic profiling.

BACKGROUND: Uterine adenosarcoma is a rare malignant tumor that accounts for 8% of all uterine sarcomas, and less than 0.2% of all uterine malignancies. However, it is frequently misdiagnosed in clinical examinations, including pathological diagnosis, and imaging studies owing to its rare and non-specific nature, which is further compounded by the lack of specific diagnostic markers. CASE PRESENTATION: We report a case of uterine adenosarcoma for which a comprehensive genomic profiling (CGP) test provided a chance to reach the proper diagnosis. The patient, a woman in her 60s with a history of uterine leiomyoma was diagnosed with an intra-abdominal mass post presentation with abdominal distention and loss of appetite. She was suspected to have gastrointestinal stromal tumor (GIST); the laparotomically excised mass was found to comprise uniform spindle-shaped cells that grew in bundles with a herringbone architecture, and occasional myxomatous stroma. Immunostaining revealed no specific findings, and the tumor was diagnosed as a spindle cell tumor/suspicious adult fibrosarcoma. The tumor relapsed during postoperative follow-up, and showed size reduction with chemotherapy, prior to regrowth. CGP was performed to identify a possible treatment, which resulted in detection of a JAZF1-BCORL1 rearrangement. Since the rearrangement has been reported in uterine sarcomas, we reevaluated specimens of the preceding uterine leiomyoma, which revealed the presence of adenosarcoma components in the corpus uteri. Furthermore, both the uterine adenosarcoma and intra-abdominal mass were partially positive for CD10 and BCOR staining. CONCLUSION: These results led to the conclusive identification of the abdominal tumor as a metastasis of the uterine adenosarcoma. The JAZF1-BCORL1 rearrangement is predominantly associated with uterine stromal sarcomas; thus far, ours is the second report of the same in an adenosarcoma. Adenosarcomas are rare and difficult to diagnose, especially in atypical cases with scarce glandular epithelial components. Identification of rearrangements involving BCOR or BCORL1, will encourage BCOR staining analysis, thereby potentially resulting in better diagnostic outcomes. Given that platinum-based chemotherapy was proposed as the treatment choice for this patient post diagnosis with adenosarcoma, CGP also indirectly contributed to the designing of the best-suited treatment protocol.

Efficacy of Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Treatment of Recurrent Uterine Sarcoma.

OBJECTIVE: Uterine sarcomas (USs) are characterized by poor response to systemic chemotherapy and high recurrence rates. This study evaluates whether the use of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) confers survival benefit in comparison with conventional treatment modalities in patients with recurrent US. METHODS/MATERIALS: A retrospective analysis of patients with recurrent US at a single institution for an 11-year study period was performed. All women with a pathologic diagnosis of leiomyosarcoma, adenosarcoma, endometrial stromal sarcoma, or undifferentiated US were identified. Overall and disease-free survival was estimated using Kaplan-Meier method. Comparisons between the study groups were performed with the log-rank test and Cox regression. RESULTS: A total of 26 patients were identified. Five patients received chemotherapy and/or radiotherapy without surgical intervention, 14 patients underwent surgery alone or a combination of surgery and adjuvant systemic chemotherapy, and 7 patients received cytoreductive surgery with HIPEC. There was no treatment-related mortality in any group, and only 1 patient had grade III-IV surgical complications. Median disease-free survival was 2.4 months for patients with nonsurgical treatments, 5.3 months for patients treated with conventional surgery, and 11.3 months for patients treated with HIPEC. Median overall survival was 35.9 months for patients treated with conventional surgery and 43.8 months for patients treated with HIPEC. CONCLUSIONS: Our study is the first to compare survival outcomes of HIPEC versus conventional therapies for recurrent US and is suggestive of treatment benefit. Further studies with more patients and longer follow-up to evaluate the role of HIPEC in management of this disease are warranted.

Effect of Nigella sativa (N. sativa L.) and oxidative stress on the survival pattern of MCF-7 breast cancer cells.

N. Sativa L., an oriental spice, has long been used as a natural medicine for treatment of many acute as well as chronic conditions. It has been used in the treatment of diabetes, hypertension, and dermatological conditions. There has been very few studies on the effects of N. Sativa as cancer prevention/therapy. Our objective therefore, was to expose MCF-7 breast cancer cells to aqueous and alcohol extracts and in combination with H2O2 as an oxidative stressor. Measurement of cell survival under various concentrations and combinations was conducted using standard cell culture techniques, exposure protocols in 96 well plates and Fluoro-spectrosphotometry. Following cellular growth to 90% confluency, exposure to water (WE) and ethanol (AE) extracts of N. sativa and H2O2 was performed. Toxicity index (LC50) was calculated from percent survival using regression analysis. Results showed that the alcohol extract and its combinations were able to completely inactivate the MCF-7 cells (LC50 ranged from 377.16-573.79 in descending potency for H2O2 + AE, AE and Mix of WE and AE). H2O2 alone effectively inactivated MCF-7 cells (LC50 = 460.94). The least effective combinations in descending potency were WE + H2O2, WE + AE + H2O2, and WE (LC50 were 725.79, 765.94, and 940.5 respectively. Combinations other than AE + H2O2 showed possible interactions, which lead to reduction in their potency. In conclusion, N. Sativa alone or in combination with oxidative stress were found to be effective in vitro in inactivating MCF-7 breast cancer cells, unveiling opportunities for promising results in the field of prevention and treatment of cancer.

[Endolymphatic polychemotherapy with local ultra high frequency hyperthermia for the combined treatment of invasive rectal cancer]. / Endolimfaticheskaia polikhimioterapiia s lokalnoi SVCh-gipertermiei v komplekse lecheniia rasprostranennykh form raka priamoi kishki.

The results of treatment of diffuse forms of rectal cancer with the use of a preoperative course of endolymphatic polychemotherapy (fluorouracil and platidiam) and local SHF-hyperthermia are presented. The most pronounced effect of treatment was noted in patients with metastases to the regional lymph nodes. The method suggested is effective in treatment of all the types of adenocarcinoma. All the patients survived for 2 years.