A Rare Presentation of Endometrial Cancer recurrence with Scapular metastasis: A Case Report and Review of the Literature

Bone metastasis from endometrial cancer is rare. Most of the early stage endometrial cancers with endometrioid histology are confined to the uterus at the time of diagnosis and confer a good prognosis. Endometrial metastases to the bone are generally restricted to the axial skeleton, including the pelvis and thoracolumbar vertebrae. Skeletal metastases in the appendicular skeleton such as scapula, clavicle and extremities to tibia, and tarsus are rarely reported. We present the case of a 50-year-old woman with diagnosis of endometrioid adenocarcinoma of the endometrium, FIGO stage IB, grade 2, with lympho-vascular space invasion who developed recurrence within 10 months with bone metastasis to left scapula and extraosseous soft tissue mass over left shoulder. There are very few cases reported in literature of scapular metastases in an early-stage endometrial carcinoma. We discuss evaluation, treatment options, overall survival rates and provide a literature review of prior published reports

Disengagement of impacted fetal head during caesarean section in advanced labour using C-snorkel device versus the conventional method: a randomised control trial.

This pilot study was a randomized control trial conducted in the labour ward and operating theatre of Pusat Perubatan UKM, between May 2013 to September 2013. The trial included 34 women whom were in advance labour during caesarean section. The C-snorkel device was used to disengage an impacted fetal head during caesarean section. Maternal outcomes evaluated were blood loss, blood transfusion, duration of surgery, incidence of extended tears and post operative infection. The fetal outcomes evaluated were APGAR score at 1 and 5 minutes, umbilical cord pH, trauma to the fetus during delivery and admission to the neonatal intensive care unit

Growing Teratoma Syndrome: A Rare Case Report and Review of the Literature

Growing teratoma syndrome is rare and usually it occurs in the younger aged group. The use of chemotherapy following initial surgical resection will yield the diagnosis following tumour enlargement. Complete resection is usually curative and renders better prognosis

Comparing efficacy of octyl-cyanoacrylate dermabond adhesive glue versus vicryl 3/0 suture for closure of caesarean section skin incision in UKMMC- a prospective randomised controlled trial.

This is a prospective randomised controlled trial conducted at a tertiary hospital on 82 women who underwent caesarean section. The study group, 41 women underwent dermabond skin closure whereas the control group, 41 women had subcuticular vicryl skin closure. Anaesthesia, prophylactic antibiotic, operative technique and post-operative oral analgesia was standardised between both groups. Outcomes that were measured at day 2 before discharge and at postoperative day 10-14 were pain score using VAS, duration and total analgesic dose (after day 2), time taken for skin closure and adverse events between both groups in particular inflammation, surgical site infection and allergic reaction (itching)

Investigating the role of immune responses in preventing relapse in women with high-grade serous ovarian cancer (HGSOC)

Development of novel diagnostic and prognostic clinical tests or models is critical to help stratify patients with ovarian cancer for an improved disease outcome, particular for a better survival and quality of life. This data presented herein give evidence that the diagnostic and prognostic prediction model for ovarian cancer patients can be improved by using inflammatory and immunosuppressive parameters, allowing for personalised therapy. We also identified the relationship between these novel biomarkers, which can be used in combination as potential anti-tumour targets in ovarian cancer, adding to the understanding of how these biomarkers co-exist within the tumour microenvironment

Interleukin 6 Present in Inflammatory Ascites from Advanced Epithelial Ovarian Cancer Patients Promotes Tumor Necrosis Factor Receptor 2-Expressing Regulatory T Cells

BackgroundEpithelial ovarian cancer (EOC) remains a highly lethal gynecological malignancy. Ascites, an accumulation of peritoneal fluid present in one-third of patients at presentation, is linked to poor prognosis. High levels of regulatory T cells (Tregs) in ascites are correlated with tumor progression and reduced survival. Malignant ascites harbors high levels of Tregs expressing the tumor necrosis factor receptor 2 (TNFR2), as well as pro-inflammatory factors such as interleukin 6 (IL-6) and tumor necrosis factor (TNF). IL-6 is also associated with poor prognosis. Herein, we study the effect of IL-6 and TNF present in ascites on the modulation of TNFR2 expression on T cells, and specifically Tregs.MethodsAscites and respective peripheral blood sera were collected from 18 patients with advanced EOC and soluble biomarkers, including IL-6, sTNFR2, IL-10, TGF-β, and TNF, were quantified using multiplexed bead-based immunoassay. Peripheral blood mononuclear cells (PBMC) from healthy donors were incubated with cell-free ascites for 48 h (or media as a negative control). In some experiments, IL-6 or TNF within the ascites were neutralized by using monoclonal antibodies. The phenotype of TNFR2+ Tregs and TNFR2− Tregs were characterized post incubation in ascites. In some experiments, cell sorted Tregs were utilized instead of PBMC.ResultsHigh levels of immunosuppressive (sTNFR2, IL-10, and TGF-β) and pro-inflammatory cytokines (IL-6 and TNF) were present in malignant ascites. TNFR2 expression on all T cell subsets was higher in post culture in ascites and highest on CD4+CD25hiFoxP3+ Tregs, resulting in an increased TNFR2+ Treg/effector T cell ratio. Furthermore, TNFR2+ Tregs conditioned in ascites expressed higher levels of the functional immunosuppressive molecules programmed cell death ligand-1, CTLA-4, and GARP. Functionally, TNFR2+ Treg frequency was inversely correlated with interferon-gamma (IFN-γ) production by effector T cells, and was uniquely able to suppress TNFR2+ T effectors. Blockade of IL-6, but not TNF, within ascites decreased TNFR2+ Treg frequency. Results indicating malignant ascites promotes TNFR2 expression, and increased suppressive Treg activity using PBMC were confirmed using purified Treg subsets.ConclusionIL-6 present in malignant ovarian cancer ascites promotes increased TNFR2 expression and frequency of highly suppressive Tregs

New Predictive Biomarkers for Ovarian Cancer

Ovarian cancer is the eighth-most common cause of death among women worldwide. In the absence of distinctive symptoms in the early stages, the majority of women are diagnosed in advanced stages of the disease. Surgical debulking and systemic adjuvant chemotherapy remain the mainstays of treatment, with the development of chemoresistance in up to 75% of patients with subsequent poor treatment response and reduced survival. Therefore, there is a critical need to revisit existing, and identify potential biomarkers that could lead to the development of novel and more effective predictors for ovarian cancer diagnosis and prognosis. The capacity of these biomarkers to predict the existence, stages, and associated therapeutic efficacy of ovarian cancer would enable improvements in the early diagnosis and survival of ovarian cancer patients. This review not only highlights current evidence-based ovarian-cancer-specific prognostic and diagnostic biomarkers but also provides an update on various technologies and methods currently used to identify novel biomarkers of ovarian cancer