Ovarian endometrioid adenocarcinoma with yolk sac component has been reported in fewer than twenty cases in the literature. A majority of the diagnoses are described in postmenopausal women without specific reference to germline genetic testing. We describe, to our knowledge, the first case in the English literature of a premenopausal woman that presented with an ovarian endometrioid adenocarcinoma with focal yolk sac component and was subsequently found to have a germline MSH2 mutation confirming a diagnosis of Lynch syndrome. Concurrent diagnosis of ovarian endometrioid adenocarcinoma with yolk sac tumor and Lynch syndrome is an extremely rare finding in a young patient and requires careful follow-up. Genetics evaluation and testing may be reasonable for individuals with this rare or mixed tumor pathology at young age of onset and can have clinical utility in guiding future cancer treatment or surveillance.

No abstract

Objective To examine the cytotoxicity of epigenetic drugs independently and in combination with chemotherapy on ovarian cancer cells Caov‐3, and to investigate their ability to acquire chemoresistance in omental microenvironments and whether epigenetic drugs can counteract this chemoresistance. Methods A pilot study was conducted in Cooper University Hospital, NJ, USA from August 1 to October 31, 2017, among women undergoing surgeries for uterine and ovarian cancer. Cytotoxicity assays using IC50 values of epigenetic drugs and paclitaxel and cisplatin were performed on Caov‐3. Omental adipose‐derived stem cells (OASCs) were isolated from omentum with/without metastases. Caov‐3 was cultured with OASCs’ conditioned medium and subjected to different drugs. Cell viability and secretome was measured using MTT and Elisa, respectively. Results Three women met the eligibility criteria and were included in the study. Epigenetic drugs alone or in combination with chemotherapy showed 85%–94% increased cytotoxicity against Caov‐3 (P≤0.005). Metastatic OASCs conditioned medium showed up to 27‐fold increase in tumorigenic factors and promoted chemoresistance (28%–35%; P < 0.050) against chemotherapy. Epigenetic therapy resulted in up to a 40‐fold reversal in this chemoresistance. Conclusion Epigenetic therapies could have an important role in treating a subgroup of ovarian cancer patients that demonstrate resistance to first‐line chemotherapy.

Choriocarcinomas are rare malignant trophoblastic tumors. There is a strong need for development of guidelines for therapeutic decision making.

Regional lymph node metastasis is a well-established negative predictive prognostic factor in endometrial carcinomas. Recently, our approach to the pathologic evaluation of lymph nodes in endometrial carcinomas has changed, mainly due to the utilization of immunohistochemical stains in the assessment of sentinel lymph nodes, which may result in the identification of previously unrecognized disease [particularly isolated tumor cells (ITCs)] on hematoxylin and eosin stained slides. However, the clinical significance of this finding is not entirely clear. Following the experience in other organs systems such as breast, the Eight Edition of the American Joint Committee on Cancer’s Cancer Staging Manual has recommended utilizing the N0(i+) terminology for this finding, without impact in the final tumor stage. We performed a comparative retrospective multi-institutional survival analysis of 247 patients with endometrial carcinoma with regional lymph node metastasis of various sizes identified in nonsentinel lymphadenectomy, demonstrating that the cumulative survival of patients with isolated tumor cells in regional lymph nodes is not statistically different from patient with negative lymph nodes, and is statistically different from those with lymph nodes showing micrometastasis or larger metastatic deposits. In addition, we evaluated the prognostic implications of the number of involved regional lymph nodes, demonstrating a worsening prognosis as the number of involved lymph nodes increases from none to one, and from one to more than one. Our data suggests that regional lymph nodes with isolated tumor cells in patients with endometrial carcinoma should likely be considered, for staging purposes, as negative lymph nodes, simply indicating their presence with the (i+) terminology.

Conflicting literature on microcytic, elongated, and fragmented patterns of tumor invasion, and mismatch repair protein expression pose a challenge in therapeutic decision making.

BACKGROUND: Challenger® is a commercially available on-line educational package, which offers focused readings on a variety of OB/GYN topics with self-assessments tests. It was utilized during the night float block to comply with duty hour restrictions, while still providing educational enrichment. Each resident completed 2–3 modules weekly, including a pre-test, educational content, and a post-test. The Challenger® program allows supervision and monitoring of resident progress. The total cost of Challenger® was approximately $6,000. METHODS: After one year of usage of Challenger®, residents completed a quality assessment questionnaire which evaluated the reading assignments, test questions, and their perception of its usefulness as a learning tool. RESULTS: Sixteen residents completed the quality assessment questionnaire on Challenger®. One hundred percent of residents found the reading assignments were easy to understand. Seventy-five percent of residents learned “sometimes/rarely” from the modules. Eighty-one percent of residents rated the question quality as “poor/fair.” Seventy-five percent of residents believed it to not be worthwhile. Eighty-one percent did not believe that it helped to prepare for boards exams. Eighty-eight percent were unlikely to endorse continuation or recommend Challenger® to other residency programs. DISCUSSION: Challenger® was not a useful learning tool for OB/GYN resident education. Some readings were outdated. Some questions were of poor quality in assessing knowledge base. As pre- and post-test questions were the same, and residents often finished an entire module's reading section plus the pre- and post-tests within 30 minutes, it is uncertain whether the readings were actually completed.

No abstract