MOLECULAR CHARACTERISTICS AND PROGNOSTIC MARKERS IN ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA (CRITICAL REVIEW)

Endometrial carcinoma represents the most common gynaecologic malignancy, which frequently arises from malignant progression of endometrial intraepithelial neoplasia (EIN). Nowadays, there are no defined prognostic markers for the prognosis of the malignant progression of EIN and it still represents the subject of various investigations. Different studies indicate, that sex hormone receptors, DNA damage and apoptosis proteins, as well as epithelial-mesenchymal transformation markers play an important role in the progression of EIN. However, most of the published studies are full of contradictory results, which indicates that additional studies are necessary. In current review, we will discuss the current knowledge about the mentioned markers in terms of the prognosis of EIN.

Programmed Death Ligand 1: A Poor Prognostic Marker in Endometrial Carcinoma

Endometrial carcinoma is the only gynaecologic malignancy with a raising incidence and mortality, posing a major health concern worldwide. The upregulation of programmed death ligand 1 (PD-L1) on tumour cells causes T-cell suppression, which impedes antitumour immunity, promotes immune cell evasion and enhances tumour survival. The aim of this study was to evaluate PD-L1 expression in endometrial carcinoma and to correlate it with survival rate. A total of 59 cases of endometrial carcinoma were evaluated. Thirty-two cases of non-neoplastic endometrial tissue were included as control. PD-L1 immunohistochemistry was performed on all cases. PD-L1 expression was evaluated on tumour cells and immune cells. PD-L1 was positive in 62.7% (37/59) and 28.8% (17/59) of immune cells and tumour cells, respectively. PD-L1 expression in immune cells was significantly higher in endometrial carcinoma than in non-neoplastic endometrium (p < 0.001). Among the patients with endometrial carcinoma, PD-L1 expression in tumour cells was significantly higher in patients who died (10/15, 66.7%) compared to those who survived (7/44, 15.9%) (p < 0.001). It is noteworthy to point out that the expression of PD-L1 in tumour cells was significantly associated with a poor survival. This suggests that immunomodulation using PD-L1 inhibitors may be useful in advanced endometrial carcinoma.

Kallistatin inhibits tumour progression and platinum resistance in high-grade serous ovarian cancer

Ovarian cancer is the most lethal gynaecologic malignancy. Although there are various subtypes of ovarian cancer, high-grade serous ovarian cancer (HGSOC) accounts for 70% of ovarian cancer deaths. Chemoresistance is the primary reason for the unfavourable prognosis of HGSOC. Kallistatin (KAL), also known as SERPINA4, is part of the serpin family. Kallistatin has been discovered to exert multiple effects on angiogenesis, inflammation and tumour progression. However, the roles and clinical significance of kallistatin in HGSOC remain unclear. Here, we showed that kallistatin was significantly downregulated in HGSOC compared to normal fallopian tube (FT) tissues. Low expression of kallistatin was associated with unfavourable prognosis and platinum resistance in HGSOC. Overexpression of kallistatin significantly inhibited proliferation and metastasis, and enhanced platinum sensitivity and apoptosis in ovarian cancer cells. Collectively, these findings demonstrate that kallistatin serves as a prognostic predictor and provide a potential therapeutic target for HGSOC.

Pathology perspective on gynaecologic malignancy screening questions in electronic consultation

Introduction The electronic consultation service, eConsult, is an asynchronous web-based platform for provider-to-provider consultation with specialists. This study described the utilization of eConsult by primary care providers to obtain specialist opinion in gynaecologic malignancy screening, with a specific focus on pathology-related inquiries. Methods This is a cross-sectional retrospective review of eConsults submitted to obstetrics/gynaecology between September 2011 and December 2016. All questions pertaining to gynaecologic cancer screening and their pathologies were included. Each question was classified based on a pre-determined taxonomy. The mandatory primary care providers’ exit surveys were analysed to determine eConsult's influence on patient care, primary care providers’ referral patterns, primary care providers’ satisfaction and educational value. Results In total, 1,357 electronic consultations were submitted to the obstetrics and gynaecology service during the study period, of which 329 met inclusion criteria. Indications for a screening test based on patient risk factors made up 36% of consults pertaining to gynaecologic malignancy screening and 17% were inquiries about test intervals based on previous results. Primary care providers pointed out gaps in current screening guidelines. In total, 38% of primary care providers reported the eConsult service helped avoid a specialist referral, whereas 47% of primary care providers received new or additional courses of action. Pathology report interpretation accounted for 5% of eConsults and 6% of primary care providers wished for clarification of incidental pathology findings. Conclusion This study uncovered areas of uncertainty among primary care providers regarding gynaecologic cancer screening and gaps in current clinical guidelines. Furthermore, the role of pathology consultants in an eConsult platform is explored and may be extrapolated into practice.

Novel Approaches in Ovarian Cancer Research against Heterogeneity, Late Diagnosis, Drug Resistance, and Transcoelomic Metastases

The development of modern technologies has revolutionised science and has had a huge impact on biomedical studies. This review focuses on possible tools that scientists can use to face the challenges of fighting ovarian cancer. Ovarian cancer is the deadliest gynaecologic malignancy and, even after years of study, the mortality has not decreased significantly. In the era of sequencing and personalised and precision medicine, we are now closer than ever to helping patients and physicians in regard to treatment and diagnosis of this disease. This work summarises the newest findings in the development of ovarian cancer research.

Chemotherapy Resistance in Advanced Ovarian Cancer Patients

Ovarian cancer is the seventh most common gynaecologic malignancy seen in women. Majority of the patients with ovarian cancer are diagnosed at the advanced stage making prognosis poor. The standard management of advanced ovarian cancer includes tumour debulking surgery followed by chemotherapy. Various types of chemotherapeutic regimens have been used to treat advanced ovarian cancer, but the most promising and the currently used standard first-line treatment is carboplatin and paclitaxel. Despite improved clinical response and survival to this combination of chemotherapy, numerous patients either undergo relapse or succumb to the disease as a result of chemotherapy resistance. To understand this phenomenon at a cellular level, various macromolecules such as DNA, messenger RNA and proteins have been developed as biomarkers for chemotherapy response. This review comprehensively summarizes the problem that pertains to chemotherapy resistance in advanced ovarian cancer and provides a good overview of the various biomarkers that have been developed in this field.

Bilateral ovarian serous cystadenocarcinoma metastasizing to cervix: a rare case report

Ovarian carcinoma is the second most common gynaecologic cancer and the leading cause of death from gynaecologic malignancy. Two-third of all malignant epithelial ovarian tumors are constituted by serous ovarian cystadenocarcinomas. It is generally observed that ovarian cancer tends to remain intraabdominal even in advanced cases and that dissemination is usually by invasion of adjacent viscera, diffuse intraperitoneal implantation, and metastatic involvement of aortic and pelvic lymph nodes. Metastasizes to the uterine cervix, vagina, or vulva in ovarian cancer is rare. The reverse i.e. ovarian metastasis from cervical tumor is rather more common. Published literature suggest that, patients with cervical metastases had associated malignant ascites, retroperitoneal lymph node involvement, and significant peritoneal carcinomatosis. Cervical metastasis in ovarian malignancies always indicates the advanced stage of tumor and multi-organ involvement, indirectly stating poor prognosis. The median survival in cases of ovarian cancer metastasizing to cervix is 4.4 months. Authors report a case of bilateral ovarian serous cystadenocarcinoma metastasising to posterior lip of cervix resulted in poor prognosis and proved fatal for the patient with review of published literature.

Role of Imaging in Dilemma of Adnexal Masses in Postmenopausal Women

ABSTRACT Adnexal masses in postmenopausal women represent a spectrum of conditions from gynaecologic and non gynaecologic sources. Post-menopausal women are especially at high risk of gynaecologic malignancy however even in this population majority of adnexal masses are benign. Tumor markers and high frequency transvaginal ultrasonography with doppler studies project high quality images allowing for detailed macroscopic appearances of masses and remain the least expensive modalities available. Adnexal masses that are suspicious for cancer, women should be referred to gynaecologic oncologist for optimal care. How to cite this article Yadav P, Gupta M, Agarwal M, Garg R, Verma U, Gupta S. Role of Imaging in Dilemma of Adnexal Masses in Postmenopausal Women. J South Asian Feder Menopause Soc 2017;5(1):45-50.