Elizabeth Vallikad

Significance of preoperative thrombocytosis in epithelial ovarian cancer.

BACKGROUND Reactive thrombocytosis is reported in a variety of solid tumors. A few studies have documented preoperative thrombocytosis in ovarian cancer and identified it as a marker of aggressive tumor biology. AIM To study the incidence of preoperative thrombocytosis (platelets greater than 400x10) in epithelial ovarian cancer and its association with other clinicopathologic factors. MATERIALS AND METHODS Sixty-five patients with invasive ovarian epithelial cancer were retrospectively reviewed and analyzed for the association preoperative thrombocytosis with other clinical and histopathological prognostic factors. Means were analyzed by Students t test; proportions were determined by Chi-square analysis. RESULTS Twenty of 65 (37.5%) patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis were found to have lower hemoglobin (P < 0.0002), more advanced stage disease (P < 0.05) and higher grade tumors (P < 0.02). Patients with thrombocytosis had greater likelihood of subpotimal cytoreduction. CONCLUSIONS Preoperative thrombocytosis is a frequent finding in ovarian carcinomas and their association with advanced stage disease and higher grade denotes that platelets play a role in the tumor growth and progression.

Ovarian serous carcinoma: relationship of p53 and bcl-2 with tumor angiogenesis and VEGF expression.

The aim of the study was to assess the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression in ovarian serous carcinoma and to examine their relation with apoptosis.Paraffin-embedded specimens of 41 cases of ovarian serous carcinomas were evaluated by immunohistochemistry for VEGF, p53, and bcl-2 expression. MVD was assessed with CD31 staining. We investigated the association of tumor angiogenesis (MVD and VEGF) with clinicopathologic factors, p53 overexpression, and bcl-2 expression.There was a significant correlation between high MVD and suboptimal debulking and advanced stage disease. A significant negative correlation was expressed between bcl-2 and VEGF expression. In univariate analysis, only stage had a significant impact on disease-free survival.The results of this study suggest that higher degree of angiogenesis is associated with suboptimal debulking and advanced-stage disease. Expression of VEGF had negative association with VEGF expression.

“The Jelly Belly”: Diagnostic Dilemmas and Current Concepts

BackgroundPseudomyxoma peritonei (PMP) is a rare and poorly understood clinicopathological entity characterized by gelatinous ascites with neoplastic or non-neoplastic mucinous implants in the peritoneum. Although its origin was debated, current evidence in literature favours the appendix as the origin of the disease, over the ovaries. The changing terminologies in the classification of this entity pose diagnostic and management challenges.Case ReportsHerein, we report three cases of PMP in postmenopausal women, their clinical presentation, pathological staging based on the peritoneal tumor deposits and the treatment administered. Two patients recovered uneventfully, while one had recurrence of adenocarcinoma.ConclusionThe rarity of this disease and the diagnostic challenges associated with it are discussed with an emphasis on the current concepts in its origin and management. Appropriate classification and complete removal of the tumor is mandated to prevent disease-related mortality.

Expression of adhesion molecule epithelial cadherin and matrix metalloproteinase-9 in squamous neoplasia of the uterine cervix

Background: The objective of the study was to evaluate the expression of cell adhesion molecules [epithelial cadherin (E-cadherin)] and extracellular matrix protease [matrix metalloproteinase (MMP)-9] in preinvasive and invasive lesions of squamous neoplasia of the uterine cervix. Method: The study included 14 cases of cervical intraepithelial neoplasia (CIN) and 43 cases of squamous cell carcinoma (SCC). Immunohistochemistry (IHC) testing was performed for E-cadherin and MMP-9 using the polymer technique. The pathological prognostic parameters, like tumour grade, stage, lymphovascular space invasion and mitosis were compared with the expression of these markers. Results: The mean age of the patients with CIN was 40.1 years, and 50.9 years for those with SCC. Complete uniform membranous expression of E-caherin was demonstrated in the normal epithelium and most CIN (79%). MMP-9 was not expressed in the normal epithelium, whereas 43% of CIN (of which 67% were CIN grade III) were positive. Loss of membranous E-cadherin was shown in 88% of SCC, and MMP-9 with variable intensities expressed in 74%. A statistically significant association was established between the expression of these immune markers in preinvasive and invasive lesions, although there was no significant association with the prognostic parameters. In addition, the loss of E-cadherin was evident in patients with recurrence, while the expression of MMP-9 was demonstrated in 60%. Conclusion: The loss of membranous E-cadherin and the gain of cytoplasmic MMP-9 are markers of neoplastic transformation in squamous neoplasia of the uterine cervix. However, the expression of these immune markers in our study did not relate to the prognostic parameters, indicating the importance of these markers in early neoplastic transformation.