Purpose: Serous adenocarcinoma is a rare, aggressive histologic subtype of endometrial cancer with a high rate of recurrence and a poor prognosis. The optimal adjuvant treatment for early-stage patients is unclear. Our objective was to evaluate the outcomes of stage IA serous endometrial cancers only treated at a single institution and determine whether our current approach of chemotherapy plus vaginal brachytherapy (VBT) is sufficient.Methods: A retrospective chart review of our institution's pathology database, including all cases of stage IA serous endometrial carcinoma from 2000-2014 was completed. Kaplan-Meier estimates were calculated for Overall and Recurrence-Free Survival (OS and RFS); hazard ratios were calculated using Cox proportional hazards modeling for independent prognostic factors.Results: There were 63 patients with stage IA serous endometrial cancer of whom 79.4% were surgically staged. Percent RFS was 76.5% at five years while OS was 84.7% for the whole cohort. One of the 23 patients receiving VBT and chemotherapy recurred at the vagina versus four of 32 patients who were observed. Two patients in the observation group recurred in the pelvis while there were no first pelvic recurrences in the VBT and chemotherapy group (non- significant). Overall survival was 95% in the brachytherapy and chemotherapy group versus 79.6% in the observation group (non-significant). Post-operative management included observation (n=33), combination VBT and chemotherapy (n=21), or chemotherapy with or without external beam radiation therapy (EBRT) (n=9).Discussion: We report one of the largest cohorts of serous endometrial cancer stage IA patients. Our results emphasize the inferior RFS and OS of stage IA serous versus endometrioid endometrial cancer patients. While some centers continue to use EBRT for these patients, our results demonstrate low pelvic recurrence rates with radiotherapy limited to VBT, as well as the high systemic risk regardless of treatment. We advocate for combination chemotherapy and brachytherapy given the poor outcomes in these patients.

Epidermal cysts are a common benign skin abnormality, comprising 85-90% of all excised skin cysts. The term epidermal inclusion cyst refers specifically when the cyst resulted from the implantation of epidermal elements in the dermis. Squamous cell carcinomas (SCCs) are common skin lesions; however, a malignant transformation of an epidermal cyst is very rare with incidence of 0.011-0.045%. Few cases of malignant transformation of an epidermal cyst have been reported in the literature so far. This paper presents a case of squamous cell carcinoma arising from a scrotal epidermal cyst.

The aim of this study was to evaluate the early outcomes and dose-volume parameters of a computed tomography (CT)based image-guided brachytherapy (IGBT) technique for radical treatment of uterine cervical cancer. Materials/Methods: We retrospectively reviewed the medical records of 64 patients with stage IB1-IVA cervical cancer who underwent external beam radiation therapy (EBRT) and CT-based IGBT between February 2012 and March 2014. EBRT was delivered with three-dimensional conformal radiation therapy. The initial 30-40 Gy was delivered to the whole-pelvis and then pelvic irradiation with central shielding. Total pelvis side wall dose was 50 Gy in 25 fractions. Platinum-based chemotherapy was administered concurrently to 48 patients (75%). High-dose-rate IGBT was performed in 3-4 fractions during course of the EBRT with central shielding. A planning CT scan was obtained before the delivery of each brachytherapy fraction. The high-risk clinical target volume (HR-CTV) and organs at risk (rectum and bladder) were contoured on the planning CT. The basis for the treatment plan was the initial prescription to point A. After standard loading of the source, dwell times were modified manually to maximize coverage of the HR-CTV while reducing the dose to the organs at risk. The dose constraints were D90 of the HR-CTV > 6 Gy, D2cc of the rectum < 7 Gy and D2cc of the bladder < 7 Gy. To determine the dose from the combined EBRT (whole pelvic irradiation dose excluding the fractions with central shielding) and brachytherapy, the total dose was calculated as the biologically equivalent dose expressed in 2-Gy fractions (EQD2). The relationships between the EQD2 and local control or complications were analyzed. Results: The median follow-up period was 24 months (range: 14-47 months). The median EQD2 to D90 of HR-CTV and D2cc of the rectum were 72.4 Gy (range: 56.4-100.5 Gy) and 60.9 Gy (range: 41.5-83.3 Gy), respectively. The 2-year overall survival rate, local control rate and progression-free survival rate were 97%, 89%, and 82%, respectively. Five patients (8%) experienced local recurrence and 11 patients (17%) experienced grade 1 rectal bleeding. No other grade 2 complications were observed. The incidence of local recurrence was significantly lower in patients with D90 of the HR-CTV 65 Gy vs. < 65 Gy. The incidence of grade 1 rectal bleeding was significantly higher in patients with D2cc of rectum 55 Gy vs. < 55 Gy. Conclusion: CT-based IGBT for cervical cancer achieved higher rates of local control with lower grade of complications. Dose-volume parameters exhibited significant relationships with early outcomes in CT-based IGBT.

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