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Background Data on platinum sensitivity of low‐grade serous ovarian carcinoma (LGSOC) in the upfront setting is lacking, and there is limited and contradictory information on chemotherapy responses in recurrent disease. Methods Patients with LGSOC seen at a comprehensive cancer center from January 1, 1998 to September 30, 2021 were identified from institutional databases. Response to neoadjuvant chemotherapy (NACT) or adjuvant platinum‐based chemotherapy and to second‐ to fifth‐line regimens was retrospectively characterized by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Wilcoxon rank‐sum and two‐tailed Fisher exact tests were employed. Results Of 50 patients, 12 received platinum doublets for suboptimal residual disease and 11 as NACT. Of 12 patients with suboptimal residual disease, seven (58%) achieved objective responses (five partial responses [PRs] and two complete responses); of the 11 patients who underwent NACT, one (9%) achieved a PR (p = .027). The 15 remaining patients had stable disease on first‐line platinum chemotherapy. Of 44 patients who recurred, 20 had RECIST‐evaluable responses to second‐line and 27 to third‐line chemotherapy. Objective response rates to platinum‐based chemotherapy were 22% (two of nine) in the second line and 10% (one of 10) in the third. In second and third lines, highest response rates were observed with nonplatinum chemotherapy with bevacizumab, at 100% (two of two) and 30% (three of 10), respectively. Conclusions Primary platinum‐based chemotherapy has moderate activity in LGSOC and minimal activity in the recurrent setting, suggesting standard definitions of platinum sensitivity may not apply in LGSOC. In the second and third lines, nonplatinum chemotherapy/bevacizumab elicited the highest response rates.

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INTRODUCTION: Aborting uterine fibroids are common benign tumors of the uterus that may cause abnormal uterine bleeding and/or pelvic discomfort. Commonly these may be removed in the office or ER however, many cite heavy bleeding as a common complication and advocate that these types of myomas be removed in the OR. The purpose of this case series is to determine the demographics of aborting myomas and common complications. METHODS: A retrospective review of all patients from January 2018-June 2019 undergoing vaginal myomectomy at a large suburban hospital was conducted. The size and location of the leiomyomas were noted as well as any operative complications including blood loss. RESULTS: During this time frame, there was a total number 7739 Gyn cases done of all types. A total number of 10 patients had a vaginal myomectomy. The incidence of this type of case is 0.129%. The median blood loss was 25cc. Nine patients had a blood loss of less than 50cc. One patient with an 8cm fibroid had a 1250cc blood loss and required two units of packed red blood cells. The mean duration of the procedure was 35 minutes. The fibroid size measured via largest diameter ranged from 2 to 11 cm with a median of was 5 cm. CONCLUSION: In this case series, vaginal myomectomies appear to be a safe and effective method of uterine fibroid removal resulting in minimal blood loss. However it appears that for larger myomas, there should be a consideration for removal in the operating room.

Introduction: Accessory breast tissue is a rare finding in the general population with an incidence of 1-2%. Ectopic mammary tissue may occur anywhere along the milk line, from the axilla to the groin. Thus, breast cancer present in the vulva may arise as a primary breast adenocarcinoma or distant metastasis. Differentiating the two can be clinically challenging but is critically important as it impacts prognosis and treatment. Using genomic and bioinformatic approaches, we re-evaluated a previously histopathologically diagnosed rare case of metachronous vulvar ectopic breast cancer. Methods: Two biobanked breast tumor samples were obtained from a 43-year-old woman diagnosed with in situ breast cancer 17 months prior to her presentation and diagnosis with vulvar ectopic breast carcinoma. Whole exome (WES) and whole transcriptomic sequencing (RNAseq) were performed on all breast and vulvar tumor samples. Bioinformatics analysis was performed using the QIAGEN software suite (CLC Genomic Workbench, QCI-T) and Ingenuity Pathway Analysis (IPA). Sequence variants with >10 reads and 5% AF were selected for analysis. Results: We performed detailed molecular characterization of breast and vulvar tumor samples. WES profiles revealed, respectively, 4904 and 166 somatic mutations from primary breast and vulva tumor tissues. Among these mutations, 60 mutations were shared between primary breast and vulva tumors. Given the length of the WES target (~54MB). We calculated the probability that the shared mutations could occur by chance alone. To estimate this likelihood, we made the assumption that all positions interrogated by WES could be mutated with equal probability. Under this assumption, it is highly unlikely that the 60 identical mutations identified in multiple samples would occur by chance alone (Fisher exact test - p <10100) Beyond these shared mutations, we identified a number of known breast cancer functional variants including variants in TP53, KMT2D, MET and an additional 32 likely pathogenic genes in the vulvar tumor that were not shared with the patient’s original breast tumor tissues. Similarly, we also identified a pathogenic variant in PRKAR1A and an additional 95 likely pathogenic variants in genes including ATRX, ATXN3, CTBP2, SCN2A only in the breast tumor. Conclusion: This illustrative case provides an interesting resolution to a clinically difficult question: differentiating synchronous or metachronous breast carcinoma in the vulva. While unusual, answering this question correctly significantly impacts staging and treatment for that patient. Citation Format: Sabina Swierczek, Deep Pandya, Jean-Noel Billaud, Boris Reva, Magdalena Swierczek, Matthew Reeves, Sara Farisello, Steven Sieber, Anya Laibangyang, Vaagn Andikyan, John A. Martignetti, Linus Chuang. Metastatic versus primary: Genomic analysis suggests a metastatic origin for breast cancer previously diagnosed as metachronous vulvar ectopic breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 70.

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