Paget's disease of the vulva: A review of 89 cases

The purpose of this study was to retrospectively review the clinical characteristics and outcomes of a series of women with Paget's disease of the vulva. A retrospective review was performed of 89 women with Paget's disease of the vulva evaluated at a single institution between 1966 and 2010. Medical records were reviewed for demographic information, clinical data, pathologic findings, treatment modalities and outcomes. We found that the primary treatment was surgery for 74 (83.1%) patients, with positive margins noted in 70.1% of cases. Five patients (5.6%) underwent topical treatment with imiquimod and/or 5-fluorouracil, one patient (1.1%) underwent laser ablation and treatment was unknown in 9 patients (10.1%). The majority of patients had multiple recurrences, with 18% having four or more recurrences. There were no significant differences in recurrence rates between patients who underwent surgery and those who did not. Furthermore, there was no association between positive margins following primary surgery and recurrence. Forty-one patients (46.1%) were diagnosed with 53 synchronous or metachronous cancers. Seven patients (7.9%) were found to have invasive vulvar cancer with 1 mm or more depth of invasion, but none of the patients died of Paget's disease or associated vulvar/vaginal cancer. Our findings suggest that the majority of patients with Paget's disease of the vulva develop multiple recurrences regardless of treatment modality or margin status. Alternatives to surgery are needed to better care for women with this disease

Mucinous differentiation is predictive of improved outcomes in low-grade endometrioid carcinoma.

Objective: Endometrial carcinoma (EC) is the most common gynecological malignancy. Endometrioid carcinoma (EEC), the most common subtype, accounts for 75% of the cases and is often associated with squamous or mucinous differentiation. While the prognosis of pure mucinous carcinoma has been previously studied, the significance of mucinous differentiation in EEC is yet to be determined. The aim of this study was to correlate the presence of mucinous differentiation with clinicopathological features of a large multiinstitutional cohort of low-grade EEC (LGEEC) and to evaluate its impact on clinical outcomes. Method: A retrospective review of LGEEC (FIGO grades 1 or 2) (n = 593) diagnosed at 9 institutions between 1991 and 2011 was conducted to evaluate clinicopathological parameters including age, tumor size, stage, grade, depth and pattern of myometrial invasion (MI), necrosis, papillary architecture, squamous and mucinous differentiation, lymphovascular invasion (LVI), lymph node and cervical involvement, and clinical outcomes. Mucinous differentiation was defined as the presence of =10% cells with intracellular mucin. Data were analyzed using appropriate statistical analysis. Results: Patient median age was 61 years (22-91). Mucinous differentiation was identified in 38% (227/593) of the cases. Even though patients with mucinous differentiation were significantly older (N60 years) and their tumors showed more papillary architecture and MELF pattern of MI, they had a significantly lower recurrence rate (16% vs 23%, P = 0.044) (Table 1). While tumors with only papillary architecture showed poor prognosticators including larger tumor size (N6 cm), advanced stage, deep MI, necrosis, MELF pattern, cervical involvement, and LVI (P = 0.003, P = 0.001, P = 0.05, P = 0.001, P = 0.001, P = 0.05, and P = 0.001, respectively), combining both mucinous and papillary features showed significantly lower recurrence rate (14% vs 23%, P = 0.009). No difference in 5-year OS was detected in either group. Although not significant, the presence of MELF pattern in a separate analysis of patients with absence of mucinous differentiation showed worse outcome (mean DFI 122 vs 138 months). Conclusion: In this large series of LGEEC, the presence of mucinous differentiation was associated with better outcomes despite the presence of poor prognostic factors including old age, papillary architecture, and MELF pattern

Radiotherapy for recurrent small cell carcinoma of the ovary: A case report and review of the literature

• Small cell carcinoma of the ovary is a rare and aggressive malignant tumor. • No effective treatment for recurrent disease has yet been described. • Patients with recurrent disease may respond to salvage surgery, chemotherapy, radiotherapy or a combination of these modalities

Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT): A review of 47 cases*

Objective. Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT) is a rare disease with a poor prognosis. SCCOHT has recently been shown to be associated with SMARCA4 gene mutations as well as molecular and genetic similarities to malignant rhabdoid tumors (MRT). The objective of our study is to describe the clinical characteristics, treatment modalities and outcomes of 47 patients with SCCOHT. Methods. We performed a retrospective analysis of 47 patients with SCCOHT evaluated at MD Anderson Cancer Center between 1990 and 2014. Medical records were reviewed for demographic information, pathologic findings, treatment regimens and outcomes. Results. Median age at diagnosis was 30 years (range 5-46). All patients underwent surgery with unilateral salpingo-oophorectomy (USO) performed in 26 patients (55%), and hysterectomy with bilateral salping000phorectomy (BSO) in 21 patients (45%). Sixteen patients (34.0%) had stage I disease, six (12.8%) stage II, 23 (48.9%) stage III, and two patients (4.3%) had stage IV disease. Information on adjuvant treatment was available for 43 patients: 83.3% received chemotherapy alone, 9.5% chemotherapy followed by radiotherapy, 2.4% chemoradiation, and 4.8% did not receive any adjuvant therapy. Median follow-up was 13.2 months (range, 0.1 to 210.7) with a median overall survival of 14.9 months. Multi-agent chemotherapy and radiotherapy were associated with a better prognosis. Conclusion. Our findings suggest that aggressive therapy including multi-agent chemotherapy and possibly radiotherapy may extend survival. Further study is needed to improve outcomes in these patients including the adoption of systemic therapies used in MRT as well as the development of novel agents targeting specific mutations. (c) 2015 Elsevier Inc. All rights reserved.National Institutes of Health through MD Anderson's Cancer Center Support Grant [CA016672]Hosp Israelita Albert Einstein, Dept Med Oncol, Sao Paulo, BrazilUniv Texas MD Anderson Canc Ctr, Dept Gynecol Oncol & Reprod Med, Houston, TX 77030 USAUniv Texas MD Anderson Canc Ctr, Dept Biostat, Houston, TX 77030 USAUniv Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USAUniv Texas MD Anderson Canc Ctr, Dept Pathol, Houston, TX 77030 USAUniv Fed Sao Paulo, Div Gynecol Oncol, Sao Paulo, BrazilDivision of Gynecologic Oncology, Universidade Federal de São Paulo, São Paulo, BrazilNational Institutes of Health through MD Anderson's Cancer Center Support Grant CA016672.Web of Scienc

John Mercer FRS, FCS, MPhS, JP: The Father of Textile Chemistry

John Mercer (1791–1866) was a pioneering textile and colour chemist with a legacy of achievements. His invention of mercerising that bears his name, treating cellulosics with sodium hydroxide to bring about advantageous changes in fibre and fabric properties, will stand for all time as one of the most important textile chemical treatments ever developed. However, Mercer's contributions to the textiles and coloration industries went far beyond mercerisation. A self‐taught chemical experimentalist par excellence, his keen observations and interest in calico printing led to many novel developments, such as his work on Chrome Yellow and other ‘mineral colours’. Mercer developed new methods for fixing Prussian Blue on calico and wool, developed new mordants for dyeing, improved the extraction of carminic acid from cochineal, and improved the oiling process in Turkey Red dyeing. He saved lives with his research into early antimicrobials, preventing the spread of cholera in textile villages in Lancashire. Mercer was an unsung hero of early photography, and developed light‐sensitive imaging materials and made some of the earliest recorded monochromatic colour photographs. His forward‐looking views on technical education, that workers in the industry should be fully instructed in the nature of the various substances used in their arts, later came to fruition in the establishment of the textile departments in Manchester, Leeds and Glasgow. To this day, Mercer remains the only textile chemist who has ever been elected as a Fellow of the Royal Society since 1852. He is thus quite rightly considered as the Father of Textile Chemistry