Clinical Profile and Survival Outcome of Endometrial Cancer with p53 Mutation.

Clinicopathologic classification of endometrial cancer imperfectly reflects the tumor biology. Pathologic categorization - especially in high-grade tumors - results in an imprecise estimation of the risk of disease, recurrence, and death. Molecular subtyping is emerging as the standard of care in diagnosis and treatment of endometrial cancers. Molecular markers are important prognostic factors in tumor dissemination and early recurrence of endometrial cancers. TP53 mutation is an important prognostic factor for both serous and endometrioid cancers. The study aims to compare the clinical profile and overall survival of endometrial cancers with and without p53 mutation. Sixty-three patients who underwent surgical staging for carcinoma endometrium were included in the study.TP53 mutation status was determined based on p53 expression by immunohistochemistry (IHC) as a p53 wild or p53 mutant type. Data were analyzed for the clinical profile, p53 mutation status on IHC, histological pattern, tumor grade, stage of the disease, lymph node spread, recurrence pattern, treatment received, 2-year disease-free survival, and overall survival. Recurrence was noted in 12.7% patients after 2-year follow-up, of which 75% patients had p53 mutation. Significant association was seen between p53 expression and high-grade tumors, stage, cervical involvement, and adnexal involvement. The 2-year overall survival of the p53 wild type was 97.2% and the p53 mutant type was 91.7%. The 2-year disease-free survival for the p53 wild type was 94.3% and the disease-free survival of the p53 mutant variety was 83.5%. The 2-year disease-free survival for endometrioid carcinoma with p53 wild type was 100% and p53 mutant variety was 86.2% (p value 0.033). About 15.9% (10) patients were reassigned to the high-risk group needing chemotherapy and radiation according to the ESGO ESTRO 2021 consensus classification, due to their p53 mutation status. IHC to assess somatic p53 mutation may be done in endometrial biopsies irrespective of their histology. This may help to identify that the aggressive tumors thereby help in tailoring surgery, planning adjuvant treatment, and follow-up.

Epithelial ovarian cancer: Review article.

Epithelial ovarian cancer is the second commonest cause of death amongst all gynaecological cancers. Treatment is challenging because almost 75% of cases are diagnosed in advanced stages. Front line treatment with aggressive cytoreduction and adjuvant treatment decides the outcome. Despite the complete response to primary treatment majority will relapse with disease. Treatment options of recurrent disease depends on platinum free interval. Systemic therapy is the mainstay of treatment and secondary cytoreduction may be beneficial in selected patients Newer therapeutic agents are being added in the front line and recurrent setting to improve outcome.

Erratum to: Prognostic Factors for Survival in Patients with Carcinoma Endometrium.

[This corrects the article DOI: 10.1055/s-0041-1735563.].

Prognostic Factors for Survival in Patients with Carcinoma Endometrium.

Francis. V. JamesObjective The study aimed to see the clinical outcome and to identify prognostic factors for survival in patients with carcinoma endometrium. Methods Patients registered at Regional Cancer Centre, Thiruvananthapuram, Kerala, India, with carcinoma endometrium from January 2009 to December 2013 were identified from hospital registry. Data regarding patient demographics, tumor characteristics, treatment schedules, and follow-up were collected using a structured proforma. Survival estimates were generated using the Kaplan-Meier method. Univariate analysis was done using chi-square and Fisher's exact tests. Multivariate analysis using the Cox regression model was performed to determine the impact of prognostic factors on outcome. The statistical analysis was done using SPSS software version 11. Results The median follow-up of the 686 patients was 95 months (range 3-178 months).There were 432 stage 1 (63%), 100 stage II (14.6%), 108 stage III (15.7%), and 46 stage IV patients (6.7%). The 5-year overall survival was 89.2%. Prognostic factors for survival on univariate analysis were age 60 years or older, nonendometrioid histology, high-grade tumor, cervical stromal involvement, para-aortic node involvement, negative progesterone receptor expression, deep myometrial invasion advanced stage, surgery versus no surgery, serosal involvement, and ovarian and fallopian tube involvement. However, on multivariate analysis, age over 60 years, higher histological grade, advanced stage, and deep myometrial and parametrial invasion were associated with significantly poorer survival. Conclusion We found that age over 60 years at presentation, higher grade, advanced stage, deep myometrial invasion, and parametrial invasion were associated with poorer survival.

Adenoid Cystic Carcinoma of Vulva-11 Years' Single-Institution Experience.

INTRODUCTION: Adenoid cystic carcinoma of vulva (ACC-vulva) is an extremely rare entity with <100 cases reported in the literature so far. OBJECTIVE: To study the clinical profile and outcome of ACC-vulva treated at a tertiary cancer care centre in South India. METHODS: This is a retrospective, record-based study of histopathologically confirmed cases of ACC-vulva treated at our centre from January 2005 to March 2016. RESULTS: Only four patients were diagnosed with ACC-vulva during the 11-year period under study. The longest duration of follow-up was 129 months. The age at diagnosis ranged from 32 to 43 years, with a median of 40 years. All patients were married, parous and premenopausal and presented with a painless unilateral vulval swelling. All patients had involvement of the Bartholin's gland site with normal overlying skin. In all patients, wide excision was performed. Unilateral inguinal node dissection was done in one case. Perineural infiltration was documented in two cases, while positive excision margins were present in three cases. None of the patients had any lymph node involvement at diagnosis or during follow-up. Two patients had recurrence of disease. The disease-free interval was 23 months for one patient and 118 months for the other. In both, local (vulval) and distant (multiple lung) metastases were detected simultaneously. CONCLUSION: Adenoid cystic carcinoma of vulva is an extremely rare, slowly progressing neoplasm mostly involving the Bartholin's gland. The usual treatment includes wide excision and adjuvant radiotherapy (if required). There may be late local and distant recurrence.

Role of laparoscopy in predicting surgical outcomes in patients undergoing interval cytoreduction surgery for advanced ovarian carcinoma: A prospective validation study.

OBJECTIVE: The objective of this study was to evaluate the safety and efficacy of laparoscopy in detecting inoperable disease in patients undergoing interval cytoreduction (ICR) for advanced ovarian carcinoma (AOC). The primary outcome measured was the performance of laparoscopy-based predictive index value (PIV) score developed by Fagotti et al. The secondary outcomes measured were performance of individual parameters included in PIV score and optimal cytoreduction (OCR) rates in our population. PATIENTS AND METHODS: This is a single-arm, prospective validation trial. Patients undergoing ICR for AOC in our institution were evaluated prospectively with laparoscopy before planned attempt at debulking surgery. Seven laparoscopic parameters included in laparoscopic PIV score were evaluated. Laparoscopic findings were compared with the final outcomes of definitive surgery. OCR was defined as residual disease <1 cm. The efficiency of the individual laparoscopy score was analyzed using receiver operating characteristic (ROC) curves. RESULTS: A total of 73 patients planned for ICR for AEOC were included in the study. Laparoscopic PIV score could successfully predict inoperability in 12 (16.4% of total study population) out of 14 inoperable patients in the total population and thus could avoid 85% of unsuccessful surgeries at a PIV score cutoff of ≥8. Performance of individual parameters included in PIV score was also evaluated. Two parameters out of seven, that is, mesenteric retraction and stomach infiltration had poor performance on ROC curve. Modified PIV score was calculated for each patient after excluding these two parameters. Modified PIV score had similar performance as Fagotti's PIV score at cutoff ≥6 (P = 0.728, for difference in area under the curve). No staging laparoscopy-related serious adverse events were noted in any of the patients. CONCLUSIONS: Laparoscopy is a safe, effective, and accurate method for predicting inoperability in patients undergoing ICR for AEOC.

Extra Mammary Paget's Disease of Vulva-a Case Report.

Extra mammary Paget's disease (EMPD) is a rare condition involving the vulva, anogenital region, and axilla. Vulvar disease usually presents as a slow growing well-defined itchy plaque with crustations or ulcerations over the affected area in postmenopausal women. Well-established guidelines for diagnosis and management are not available for this rare condition. Our patient is a 64-year-old postmenopausal woman with a history of similar complaints of 2 years duration, not responding to multiple topical treatments. She was diagnosed with EMPD on incisional biopsy and treated with surgery at our centre.

Role of frozen section in intraoperative assessment of ovarian masses: a tertiary oncology center experience.

Surgical management of ovarian lesions vary considerably depending on the nature of the lesion. As the preoperative imaging and serum tumor marker levels are of limited value in the proper categorization of ovarian lesions, intraoperative pathological assessment is commonly requested for a primary diagnosis. Aim of the study is to assess the accuracy of the frozen section in the diagnosis of ovarian masses in our center and to analyze the causes of diagnostic discrepancies. In this retrospective study, frozen section diagnosis of 233 cases of ovarian masses was compared with the permanent section diagnosis. The overall accuracy of frozen section was 91.85 %. The sensitivity of frozen section diagnosis for benign, borderline and malignant tumors was 99.2, 88.46 and 82.95 % respectively. The corresponding specificity was 96.5, 93.23 and 99.3 %. There were 19 discordant cases including 18 false negative cases and one false positive case. Frozen section is an important diagnostic tool to determine the nature of ovarian masses. Careful macroscopic examination, evaluation of multiple sections along with clinical and radiological findings helps to reduce false positive and false negative results. Frozen section examination has limitations especially in cases of borderline tumors. This modality is most effective when the pathologist and surgeon are aware of the advantages and limitations.