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Saturday, December 17, 2016

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OVARIAN CANCER and US




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OVARIAN CANCER and US
An ovarian cancer blog which includes quality resource materials: education, research, social networking, genetics and (some) healthcare politics.


    “Not everything that can be counted counts and not everything that counts can be counted.”
Albert Einstein
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OA: Upper Tract Urothelial Carcinoma in the Genetically Predisposed Patient (Lynch Syndrome)
Saturday, December 17, 2016 3:48 AM
open access (partial):
Upper Tract Urothelial Carcinoma in the Genetically Predisposed Patient: Role of Urinary Markers in Predicting Recurrence

Abstract

Background: Upper tract urothelial carcinoma (UTUC) is an uncommon disease that is diagnosed clinically by the selective use of urine cytology, urine biomarkers, and imaging of the upper tract. We present a case of a patient with Lynch syndrome and high-grade UTUC that was diagnosed by an abnormal Cxbladder assay, prompting further endoscopic examination.
Case Presentation: A 59-year-old Caucasian female with a history of endometrial cancer and bladder cancer with Lynch syndrome presented for evaluation of recurrent urothelial carcinoma. Her previous bladder tumors have been T1 high grade and Ta high grade and have been treated with resection and multiple cycles of intravesical Bacillus Calmette–Guerin (BCG) therapy. She had also undergone a robotic left distal ureterectomy and psoas hitch for a high-grade distal ureteral tumor. Surveillance cystoscopy 7 months after revealed a biopsy-confirmed bladder tumor, which was resected, and she was started on maintenance BCG therapy. At presentation, follow-up urine cytology and UroVysion studies were negative. Cxbladder test was also initially negative. However, during close clinical monitoring, the Cxbladder test became positive. Cystoscopy was once more performed, which was unremarkable. Bilateral ureteroscopy was performed, revealing high-grade upper tract renal papillary carcinoma (UTUC) in the left renal pelvis. The patient declined a nephroureterectomy. She was treated with two sessions of holmium laser ablation of the left renal pelvis tumor and underwent 6 weekly courses of BCG + interferon instilled into her left renal pelvis using a 5F open-ended catheter. Repeat urine cytology, UroVysion, and Cxbladder tests were negative after completion of upper tract BCG therapy.
Conclusion: Cxbladder test may be useful and an adjunct to urine cytology and the UroVysion FISH assay to evaluate patients at high risk for recurrent UTUC.
Introduction
Upper tract urothelial carcinoma (UTUC) is a rare diagnosis that only accounts for 5% of urothelial carcinoma (UC).1 UTUC carries a poor prognosis and can have aggressive characteristics.1 The clinical diagnosis of UTUC is typically with the selective use of urinary cytology, urinary biomarkers, and imaging of the upper tract with particular focus on the collecting system.....

    FIG. 1.  MRI of the abdomen showing normal appearance of the left renal pelvis in which high-grade transitional cell tumor was discovered on ureteroscopy.

 Conclusion
Cxbladder test may be useful and an adjunct to urine cytology and the UroVysion FISH assay to evaluate patients at high risk for recurrent UTUC. This case report adds to the emerging evidence that Cxbladder is a useful tool for monitoring the recurrence of UTUC.
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Childhood neuroendocrine tumours: a descriptive study revealing clues for genetic predisposition
Saturday, December 17, 2016 3:30 AM
 Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. They most commonly occur in the intestine, where they are often called carcinoid tumors, but they are also found in the pancreas, lung and the rest of the body.
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abstract:
Childhood neuroendocrine tumours: a descriptive study revealing clues for genetic predisposition : British Journal of Cancer


Neuroendocrine tumours (NETs) are rare in children and limited data are available. We aimed to specify tumour and patient characteristics and to investigate the role of genetic predisposition in the aetiology of paediatric NETs.

Methods:
Using the Dutch Pathology Registry PALGA, we collected patient- and tumour data of paediatric NETs in the Netherlands between 1991 and 2013 (N=483).
Results:
The incidence of paediatric NETs in the Netherlands is 5.40 per one million per year. The majority of NETs were appendiceal tumours (N=441;91.3%). Additional surgery in appendiceal NETs was indicated in 89 patients, but performed in only 27 of these patients. Four out of five patients with pancreatic NETs were diagnosed with Von Hippel–Lindau disease (N=2) and Multiple Endocrine Neoplasia type 1 (N=2). In one patient with an appendiceal NET Familial Adenomatous Polyposis was diagnosed. On the basis of second primary tumours or other additional diagnoses, involvement of genetic predisposition was suggestive in several others.
Conclusions:
We identified a significant number of patients with a confirmed or suspected tumour predisposition syndrome and show that paediatric pancreatic NETs in particular are associated with genetic syndromes. In addition, we conclude that treatment guidelines for appendiceal paediatric NETs need revision and improved implementation.
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OA: High-grade serous ovarian cancer 3 years after bilateral salpingectomy (stage 1V)
Saturday, December 17, 2016 3:23 AM
abstract
 High-grade serous ovarian cancer 3 years after bilateral salpingectomy: A case report
 View Abstract      (open access) Download PDF

Although epithelial ovarian cancer commonly originates from the ovarian surface epithelium and/or ovarian inclusion cysts, it was recently proposed that high‑grade serous ovarian cancer (HGSC) develops from the fallopian tubes. In our department, we encountered a case of HGSC that contradicts the hypothesis of a tubal origin for HGSC. A 51-year-old postmenopausal woman had undergone hysterectomy, left oophorectomy and bilateral salpingectomy for uterine myoma. Three years later, the patient was diagnosed with stage IV ovarian cancer and underwent primary debulking surgery. The pathological examination revealed HGSC, although there was no evidence of serous tubal intraepithelial carcinoma or any other type of cancer in the previously resected left ovary and bilateral fallopian tubes. Moreover, p53 overexpression was not detected in the right ovarian cancer specimen, while paired box gene 8, a marker of fallopian tube epithelium, was highly expressed. Therefore, HGSC may develop from an inclusion cyst with metaplasia of from the ovarian surface epithelium.

     In conclusion, we herein report a case of HGSC that
    developed 3 years after BS, contradicting the hypothesis of a
    tubal origin. There was also no region of STIC or p53 expression
    detected in the present case. Based on these findings, we
    consider that other mechanisms must be responsible for carcinogenesis
    in HGSC in patients without p53 mutations.


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Care Delivery Patterns, Processes, and Outcomes for Primary Ovarian Cancer Surgery SOGC
Saturday, December 17, 2016 3:15 AM
abstract:
 The Society of Obstetricians and Gynaecologists of Canada
Care Delivery Patterns, Processes, and Outcomes for Primary Ovarian Cancer Surgery: A Population-Based Review Using a National Administrative Database

Objectives
In this pan-Canadian study, we sought to elucidate the current state of surgical care for primary ovarian cancers and factors influencing selected short-term outcomes; these were in-hospital mortality (IHM), major complications (MCs), failure-to-rescue (FTR), and hospital length of stay (LOS).ry it:

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