Prevention of Recurrent Mucinous Borderline Ovarian Tumor with Aromatase Inhibitor.

BACKGROUND: Aromatase inhibitors (AIs) are used for estrogen-modulated conditions. Some borderline ovarian tumors (BOT) express estrogen receptors. We present 2 cases of progression from mucinous cystadenoma to mucinous BOT (mBOT) after prior cystectomies in whom an AI was used with recurrence prevention. CASES: Two patients underwent laparoscopic ovarian cystectomy for mucinous cystadenoma. Serial imaging demonstrated recurrent ovarian cysts for which both underwent fertility sparing surgery (FSS) with ovarian cystectomy for mBOT. Both patients were initiated on an AI and have been without recurrence. SUMMARY AND CONCLUSION: BOT predominantly occur in reproductive aged females. FSS with cystectomy is an option, but recurrence occurs in 12-36% of cases. The use of AI in prevention of recurrent BOT shows promise, and more studies are needed to explore this treatment.

Distinct methylation profile of mucinous ovarian carcinoma reveals susceptibility to proteasome inhibitors.

Mucinous type of epithelial ovarian cancer (MuOC) is a unique subtype with a poor survival outcome in recurrent and advanced stages. The role of type-specific epigenomics and its clinical significance remains uncertain. We analyzed the methylomic profiles of 6 benign mucinous adenomas, 24 MuOCs, 103 serous type of epithelial ovarian cancers (SeOCs) and 337 nonepithelial ovarian cancers. MuOC and SeOC exhibited distinct DNA methylation profiles comprising 101 genes, 81 of which exhibited low methylation in MuOC and were associated with the response to glucocorticoid, ATP hydrolysis-coupled proton transport, proteolysis involved in the cellular protein catabolic process and ion transmembrane transport. Hierarchical clustering analysis showed that the profiles of MuOC were similar to colorectal adenocarcinoma and stomach adenocarcinoma. Genetic interaction network analysis of differentially methylated genes in MuOC showed a dominant network module is the proteasome subunit beta (PSMB) family. Combined functional module and methylation analysis identified PSMB8 as a candidate marker for MuOC. Immunohistochemical staining of PSMB8 used to validate in 94 samples of ovarian tumors (mucinous adenoma, MuOC or SeOC) and 62 samples of gastrointestinal cancer. PSMB8 was commonly expressed in MuOC and gastrointestinal cancer samples, predominantly as strong cytoplasmic and occasionally weak nuclei staining, but was not expressed in SeOC samples. Carfilzomib, a second-generation proteasome inhibitor, suppressed MuOC cell growth in vitro. This study unveiled a mucinous-type-specific methylation profile and suggests the potential use of a proteasome inhibitor to treat MuOC.

Ovarian Mucinous Cystadenoma After Ovarian Graft.

BACKGROUND: Freezing strips of ovarian cortex before chemotherapy followed by transplantation is an experimental method to preserve fertility for reproductive-aged women with cancer. We report a case of a cancer patient who developed a mucinous cystadenoma in a grafted piece of ovarian cortex. CASE: A 32-year-old woman with a Ewing sarcoma had ovarian cryopreservation using cortical strip freezing before receiving chemotherapy. Five years later she had no ovarian function, and the strips were thawed and grafted back onto the ovary. She spontaneously became pregnant 1 year after this procedure and delivered a healthy neonate near term. During the cesarean delivery, a 5×3-cm cyst was removed from the graft. On pathologic evaluation, it was determined to be a mucinous cystadenoma. CONCLUSION: Ovarian pathology can develop in previously frozen ovarian cortex tissue after transplantation back onto the ovary. This suggests that routine gynecologic surveillance remains important for these women.

[Therapeutic effect of docetaxel combined with oxaliplatin for treatment of recurrent epithelial ovarian cancer].

OBJECTIVE: To evaluate the efficacy and safety of docetaxel (Taxotere) (DTX) and oxaliplatin (OXA) for treatment of recurrent epithelial ovarian cancer. METHODS: Thirty-six patients with histologically confirmed recurrent epithelial ovarian cancer received chemotherapy with DTX and OXA. DTX at the dose of 75 mg/m(2) was administered on day 1 by intravenous infusion in 60 min, followed by OXA at 100 mg/m(2) given by a 2 h infusion. The chemotherapy cycles were repeated every 21 days, and the patients received at least 2 cycles. RESULTS: All the patients were available for response evaluation, among whom 3 (8.3%) showed complete responses and 17 (47.2%) showed partial responses, with an overall response rate of 55.6%. The main adverse effects included hematological toxicities and peripheral neuropathy. CONCLUSION: Combination of DTX and OXA produces good therapeutic effect with tolerable toxicity profile for treatment of recurrent epithelial ovarian cancer.

[Association of EGFR expression with angiogenesis and chemoresistance in ovarian carcinoma].

OBJECTIVE: To clarify the association of EGFR expression with angiogenesis and chemoresistance in ovarian cancer. METHODS: Immunohistochemical PV-6000 staining was used to detect the expression of EGFR, LRP protein and MVD in 102 ovarian tumor specimens. RESULTS: EGFR, LRP positive rates and MVD in borderline and malignant ovarian specimens were significantly higher than those in the normal and benign ones (P < 0.01). EGFR positive expression rate in stage III-IV carcinoma tissues, poor differentiation and with ascites was higher than that in stage I-II carcinomas of well differentiation and without ascites (P < 0.05). MVD was related to histological grade, residual tumor and ascites, LRP positive expression had no correlation with the clinicopathologic parameters (P > 0.05). The effective rate of chemotherapy in patients with EGFR and LRP-positive expression were 57.1% and 53.7%, respectively, significantly lower than that in cases with EGFR and LRP-negative expression (85.0% and 90.9%, P < 0.05). In the 64 cases with complete data, the three-year survival rate was 53.0%. The survival time was shorter in the cases with EGFR and LRP-positive expression, poor differentiation, ascites and chemoresistance (P < 0.01), and only LRP-positive expression and chemotherapeutic effect were independently related to survival time (P < 0.05). There was a correlation between EGFR and MVD (r = 0.548, P < 0.01), EGFR and LRP positive expression (P = 0.020). CONCLUSION: The expression of EGFR in ovarian cancer is related to angiogenesis and chemoresistance. EGFR and LRP-positive expression are related to chemoresistance, and detection of the two proteins may be helpful in guiding chemotherapy choice for ovarian cancer. LRP-positive expression and chemotherapeutic effect may be independent prognostic factors.

[Correlations of EGFR and LRP to chemotherapy resistance and prognosis of ovarian cancer].

BACKGROUND & OBJECTIVE: Abnormal expression and activation of epidermal growth factor receptor (EGFR), which is closely related to the recurrence and poor prognosis of ovarian cancer, can promote chemotherapy resistance of tumor cells. Lung resistance protein (LRP), a multidrug resistance protein causing platinum-resistance, is an independent factor in predicting chemotherapy sensitivity to ovarian cancer. This study was to explore the correlations of EGFR and LRP to chemotherapy resistance and prognosis of ovarian cancer. METHODS: Expressions of EGFR and LRP in 76 specimens of ovarian malignant tumor, nine borderline tumor, 17 benign tumor and 15 normal ovary were studied using immunohistochemistry. Patients with ovarian cancer were followed up. Correlations of EGFR and LRP to chemotherapy efficacy and survival time of patients with ovarian cancer after operation were analyzed. RESULTS: The positive rates of EGFR and LRP in malignant specimens (73.68% and 71.79%) were significantly higher than those in normal and benign ones (P <0.01). EGFR was highly expressed in ovarian cancer patients at late stage (III-IV), with poor differentiation and ascites (P <0.05). The short-term efficacy rates of ovarian cancer were lower in patients with positive expressions of EGFR and LRP (57.14% and 53.70%) than in those with negative expressions (P<0.05). The positive rates of EGFR and LRP were significant higher in patients with chemotherapy resistance (92.86% and 85.71%) than in those sensitive to chemotherapy (P<0.05). The three-year survival rate of ovarian cancer patients was 53.00%. Patients with positive EGFR and LRP and poor short-term efficacy after chemotherapy had short survival time (P<0.01). CONCLUSION: The expression of EGFR and LRP could be used to predict chemotherapy resistance and prognosis of ovarian cancer.

[Remarkable effect of gemcitabine-oxaliplatin (GEMOX) therapy in a patient with advanced metastatic mucinous cystic neoplasm of the pancreas].

Gemcitabine(GEM)is the standard therapy for advanced pancreatic cancer. GEM-oxaliplatin (GEMOX) combination treatment has been reported to be superior to GEM alone in terms of clinical progression-free survival, but it is not the therapy of choice for pancreatic cancer. We report a case of advanced mucinous cystic neoplasm (MCN) of the pancreas with multiple hepatic metastases in a 39-year-old female. She was treated with 16 courses of GEMOX (GEM 1,500 mg/day at a rate of 10 mg/m2/min on the first day and oxaliplatin 150 mg/day at 100 mg/m2 on the second day, every 3 weeks). The pharmacist helped her to avoid severe side effects. When the hepatic metastases disappeared after 13 courses, the primary MCN was removed surgically after 16 courses of GEMOX treatment. No recurrence has been observed 22 months postoperatively. GEMOX might be effective for the treatment of MCN of the pancreas.