ABSTRACT
AIMS: Adult granulosa cell tumours (AGCTs) are uncommon ovarian sex cord-stromal tumours which recur following surgical removal in up to 50% of patients. Treatment options for recurrent and advanced stage AGCTs are limited, with poor response to chemotherapy and radiotherapy. We aimed to assess epidermal growth factor receptor (EGFR), HER2 and insulin-like growth factor-1 receptor (IGF-1R) status in AGCTs with a view to investigating whether or not these receptors might be potential therapeutic targets in these neoplasms. METHODS AND RESULTS: Immunohistochemical staining for EGFR, HER2 and IGF-1R was undertaken in 31 AGCTs. Tumour DNA was also analysed for mutations in the tyrosine kinase domain of EGFR (exons 18-21) by Cobas mutation RT-PCR. Twenty-three of 31 (74%) AGCTs showed some degree of EGFR expression, generally with cytoplasmic or mixed membranous and cytoplasmic staining of variable intensity. Eleven of 27 (41%) cases exhibited strong membranous and cytoplasmic expression of IGF-1R. HER2 expression was not seen. No mutations were found in exons 18-21 of the EGFR gene in hot-spots of therapeutic relevance. CONCLUSIONS: This study raises the possibility that anti-EGFR and/or anti-IGF-1R therapies may be of potential benefit in ovarian AGCTs, and this requires further study. Lack of known mutations within the tyrosine kinase domain of EGFR suggests that EGFR-related tyrosine kinase inhibitors may not be useful therapeutically.
Subject(s)
ErbB Receptors/metabolism , Granulosa Cell Tumor/metabolism , Ovarian Neoplasms/metabolism , Receptor, ErbB-2/metabolism , Receptor, IGF Type 1/metabolism , Adult , Aged , Aged, 80 and over , DNA Mutational Analysis , ErbB Receptors/chemistry , ErbB Receptors/genetics , Exons , Female , Granulosa Cell Tumor/genetics , Granulosa Cell Tumor/pathology , Humans , Immunohistochemistry , Middle Aged , Ovarian Neoplasms/genetics , Ovarian Neoplasms/pathology , Protein Structure, TertiaryABSTRACT
We report a case in which a vaginal adenocarcinoma was discovered in a 67-year-old woman 16 years after hysterectomy for cervical adenocarcinoma in situ. Both the vaginal and cervical lesions exhibited morphologic and immunohistochemical (CDX2-positive) features of intestinal differentiation. Linear array human papillomavirus genotyping demonstrated the vaginal adenocarcinoma to contain human papillomavirus 45. We believe the vaginal adenocarcinoma to be related to the cervical adenocarcinoma in situ and to represent recurrence of this. This is an extremely rare phenomenon with, as far as we are aware, only one previous report in the literature.
Subject(s)
Adenocarcinoma/pathology , Neoplasm Recurrence, Local/pathology , Uterine Cervical Dysplasia/pathology , Uterine Cervical Neoplasms/pathology , Vaginal Neoplasms/pathology , Adenocarcinoma/metabolism , Adenocarcinoma/virology , Aged , Female , Humans , Hysterectomy , Immunohistochemistry , Neoplasm Recurrence, Local/metabolism , Neoplasm Recurrence, Local/virology , Papillomavirus Infections/complications , Uterine Cervical Neoplasms/metabolism , Uterine Cervical Neoplasms/surgery , Vaginal Neoplasms/metabolism , Vaginal Neoplasms/virology , Uterine Cervical Dysplasia/metabolism , Uterine Cervical Dysplasia/virologyABSTRACT
This study evaluated the clinical and histopathological responses of vulval lichen sclerosus (LS) and squamous hyperplasia (SH) to photodynamic therapy (PDT). A novel bioadhesive patch containing aminolevulinic acid (ALA) at a dose of (38 mg/cm(2)) was used to treat 10 patients before irradiation with light of 630 nm. Clinical, histopathological and pathological responses to treatment were assessed at 6 weeks post-treatment. After 17 cycles of PDT, six patients reported significant symptomatic relief and no cutaneous photosensitivity. Histopathological differences were not demonstrated, but statistically significant induction of apoptosis was seen. It can be concluded that ALA-PDT patch-based formulation is pragmatic and primarily offers symptomatic management of vulval LS and SH.
Subject(s)
Aminolevulinic Acid/administration & dosage , Aminolevulinic Acid/therapeutic use , Photochemotherapy , Photosensitizing Agents/administration & dosage , Photosensitizing Agents/therapeutic use , Vulvar Lichen Sclerosus/therapy , Adhesiveness , Administration, Cutaneous , Aminolevulinic Acid/pharmacology , Female , Humans , Hyperplasia/pathology , Hyperplasia/therapy , Photosensitizing Agents/pharmacology , Vulvar Lichen Sclerosus/pathologyABSTRACT
Advising patients when to drive after surgery is a common practice which gynaecologists need to do on a regular basis as a part of their duty to patients. We carried out a literature search regarding advice given on driving after gynaecological surgical procedures, and found no study or research on this area. We then carried out a questionnaire survey of 99 gynaecologists in Northern Ireland. We have identified wide variation in clinical practice, and advocate a United Kingdom wide survey and further studies to find out optimum time to drive after different gynaecological surgeries. There is a need for national guidelines on driving after surgery, which would be of great benefit to gynaecologists, patients, motor insurers, police and all other interested parties.