1. World journal of oncology 2011; 2: 83-84
Cervical metastasis from colorectal cancer- Case Report

Elisabeth Chereau, Marcos Ballester, Julie Gonin, Benedicte Lasieur, Emil Darai
Department of Obstetrics & Gynaecology and Pathology, Cancer Est university pierre et marie curie Paris, France.

Introduction: Common metastatic sites of colorectal cancer are liver, lungs, lymph nodes and peritoneum, but metastasis to cervix is rare.

Case Report: 62 yrs old with history of postmenopausal bleeding was evaluated. She underwent laparotomy for colorectal cancer with lymph node metastasis 3yrs back and received chemotherapy .On examination she had cervical lesion and MRI confirmed cervical cancer FIGO stage 2A1.She underwent radical hysterectomy with bilateral salpingo-ophorectomy and pelvic lymphadenectomy. Histopathology report showed poorly differentiated adenocarcinoma of cervix but IHC profile(cytokeratin 20 and CDx2 positive but cytokeratin 7 negative)revealed colonic cancer metastasis. Following this additional CT chest &Abdomino –pelvis colonoscopy, petFDG was done which showed no evidence of colorectal cancer recurrence or metastasis.

Discussion : The pathological mechanism involved in occurrence of cervical metastasis in absence of metastasis elsewhere suggest that cervix was involved via dissemination in peritoneal pouch of Douglas through posterior vaginal cuff subsequent to first laparotomy .Preoperative diagnosis of extragenital origin of cervical metastasis could lead to different therapeutic strategy including initial chemotherapy specific to colonic cancer and then pelvic radiotherapy.

Conclusion : In event of adenocarcinoma of cervix in a patient with history of colorectalcancer, the possibility of an extragenital origin should be ruled out.Thus the risk of radical surgery can be avoided.


2. AJOG2011; 204:357.e-12
Molecular biomarkers in endometrial hyperplasia can predict cancer progression
S. Anita, G. Einar, S. Ivar, M. Anais et al.
Department of pathology and Gynecology, Stavanger University hospital, Gede institute, University of Bergen, Norway;
Department of pathology and gynecologic oncology, University of Texas, Anderson centre.

Objective: To assess the value of 2003 WHO and endometrial intraepithelial neoplasia (EIS)classifications, D-score and molecular biomarker in endometrial hyperplasia (EH)for cancer progression.

Design: Retrospective study

Setting : Stavanger University, University of Bergen, University of Texas, Anderson Cancer Center, Fudan University.

Population : Of all 931 consecutive cases that routinely were diagnosed as EH, from 1980 to2004, only152 cases were available for further analysis.

Method: Quantitative analysis of immunohistochemical expression was done on curettage samples and percentage of positive cells and nuclei, was evaluated. COX2stains were evaluated as positive or negative. Computerized morphometric analysis technique for D-score was performed; a D–score of <1 represented high risk EIN lesion; a D-score of≥1.0 represented low risk EIN lesions.

Result : The WHO and EIN classifications correlated weakly with CK5/6 and p16. D-score >1 had lowest false negative progression rate and COX2 negativity was independent multivariate caner progression predictor, but only in cases with D-score <1. 61% with a combined D-score of <1 and negative COX2 progressed, which contrasted with 2.8% (P<0.0001;hazard ratio,53.0).

Conclusion : Combined D-score <1 and COX2 negativity strongly predict cancer progression in endometrial hyperplasias.


3. Obstet Gynecol 2011; 118:537-47
Thirty day mortality after primary cytoreductive surgery for advanced ovarian cancer in the elderly
T. M. Melissa, G. A. Barbara, G. S. Rebecca, F. R. David, G. J. Heidi
Department of Obstetrics and Gynecology and Surgery, University of Washington School of Medicine, Washington.


Objective: To identify factors associated with increased 30-day mortality after advanced ovarian cancer debulking among elderly women.

Design: Database analysis

Setting : University of Washington.

Population : A total of 5475 women were included, who were identified older than age 65 years in the SEER (Surveillance Epidemiology and End Results). Medicare database with ovarian cancer diagnosed from January 1995 to December 2005.

Method: A database linking medicare records with surveillance, epidemiology and end result (SEER) were used to identify a cohort of 5475women aged 65 years and older who had primary debulking surgery for stage 3 or 4 epithelial ovarian cancer. Women were excluded if the diagnosis was based on autopsy or death certificate only, non-invasive pathology, disease that was not pathologically confirmed, non-epithelial malignancies or second primary malignancy diagnosed any time in six months before or after the date of ovarian cancer diagnosis. Multivariable analysis was performed to identify patients-related and treatment-related variable associated with 30 day mortality.

Result : Five thousand four hundred seventy five women had surgery for advanced ovarian cancer and the overall 30-day mortality was 8.2%. Women admitted electively had a 30-day mortality of 5.6% and those admitted emergently had a 30-day mortality of 20.1%. Advancing age, increasing stage and increasing co-morbidity score were all associated with an increase in 30-day mortality among elective admissions. A group of women at high risk admitted electively included those aged 75 or older with stage IV disease and women aged 75 or older with stage III disease and a co-morbidity score of 1 or more. This group had an observed 30-day mortality of 12.7%.

Conclusion : Age, cancer stage, and co-morbidity scores may be helpful to stratify electively admitted patients based on predicted postoperative mortality. If validated in a prospective cohort, then these factors may help identify women who may benefit from alternative treatment strategies.