Butler, Kristina

Background: Catamenial epilepsy refers to cyclic seizure exacerbation in relation to the menstrual cycle. Three distinct patterns have been described: C1-perimenstrual, C2-periovulatory, and C3-inadequate luteal. There is experimental and clinical evidence that gonadal steroid hormones affect neuronal excitability with estrogens being mainly proconvulsant and progesterone anticonvulsant. If reproductive steroids have a role in seizure occurrence, they may also have a role in treatment. Objective: The objective of this study was to critically assess current evidence regarding the efficacy of progesterone as adjunctive therapy in women with intractable catamenial epilepsy. Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, medical librarian, and content experts in the fields of epilepsy and gynecology. Results: A randomized, placebo-controlled clinical trial was selected for critical appraisal. This trial compared the efficacy of adjunctive cyclic natural progesterone therapy versus placebo for seizures in women with intractable partial epilepsy, stratified by catamenial and noncatamenial status. There was no significant difference in proportions of responders between progesterone and placebo in the catamenial and noncatamenial strata. Prespecified secondary analysis showed that the level of perimenstrual seizure exacerbation is a significant predictor of the responder rate for progesterone therapy. Conclusions: Cyclic natural progesterone is not superior to placebo in reducing seizure frequency in women with intractable partial epilepsy. Posthoc findings suggest that progesterone may benefit a subset of women with perimenstrually exacerbated seizures.

Serous borderline tumor (SBT) involving a cervical lymph node is extremely rare. In addition, fine needle aspiration (FNA) cytology of the involved cervical lymph node shares tremendous morphologic similarity with other low-grade papillary carcinomas. Thus, it can be easily misdiagnosed as metastatic carcinoma. A 42-year-old female had a history of bilateral SBT and postbilateral salpingo-oophorectomy. She presented with left cervical lymphadenopathy 6 months later. FNA cytology showed a low-grade papillary neoplasm with psammoma bodies. Needle core biopsy along with immunostains was diagnostic of cervical lymph node involvement (LNI) of SBT. although extremely rare, cervical LNI can be found in patients with SBTs. FNA cytology, sometimes, is indistinguishable from metastatic papillary adenocarcinoma. Cell block or needle core biopsy is essential to make the correct diagnosis.

BACKGROUNDPatients with myeloproliferative neoplasms (MPNs) including polycythemia vera, essential thrombocythemia, and myelofibrosis, are faced with oppressive symptom profiles that compromise daily functioning and quality of life. Among these symptoms, sexuality‐related symptoms have emerged as particularly prominent and largely unaddressed. In the current study, the authors evaluated how sexuality symptoms from MPN relate to other patient characteristics, disease features, treatments, and symptoms.METHODSA total of 1971 patients with MPN (827 with essential thrombocythemia, 682 with polycythemia vera, 456 with myelofibrosis, and 6 classified as other) were prospectively evaluated and patient responses to the Myeloproliferative Neoplasm Symptom Assessment Form (MPN‐SAF) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC‐QLQ C30) were collected, along with information regarding individual disease characteristics and laboratory data. Sexuality scores were compared with an age‐matched, healthy control population.RESULTSOverall, patients with MPN were found to have greater sexual dysfunction compared with the healthy population (MPN‐SAF score of 3.6 vs 2.0; P<.001), with 64% of patients with MPN describing some degree of sexual dysfunction and 43% experiencing severe symptoms. The presence of sexual symptoms correlated closely with all domains of patient functionality (physical, social, cognitive, emotional, and role functioning) and were associated with a reduced quality of life. Sexual problems also were found to be associated with other MPN symptoms, particularly depression and nocturnal and microvascular‐related symptoms. Sexual dysfunction was more severe in patients aged >65 years and in those with cytopenias and transfusion requirements, and those receiving certain therapies such as immunomodulators or steroids.ConclusionsThe results of the current study identify the topic of sexuality as a prominent issue for the MPN population, and this area would appear to benefit from additional investigation and management. Cancer 2016;122:1888–96. © 2016 American Cancer Society.

Abstract Bowel obstruction is common sequelae of advanced ovarian cancer. Reports suggest that from 5.5 percent to 51 percent of ovarian cancer patients with Stage III or Stage IV disease develop a malignant bowel obstruction. During the course of the disease, one-third of all ovarian cancer patients also will develop pleural effusions, and three-quarters of these contain malignant cells. Such complications adversely affect both survival and quality of life. Our murine primary patient ovarian cancer intraperitoneal tumorgrafts (Avatars) maintain high fidelity of genetic aberrations from the original patient tumor, thus representing a clinically relevant model system. Expression microarray data of Avatars with preferential metastasis to the bowel has revealed upregulation of IGF2. To determine if IGF2 overexpression was sufficient for metastasis, four patient Avatars were transfected with IGF2/Gluc. In order to minimize the potential for genetic drift sometimes seen with in vitro culture, pre-transplantation tumors were minced and incubated with lentiviruses (Control vector or IGF-2/Gluc expression vector) ex-in vivo for a short time (2 hours), then directly transplanted intraperitoneally into immunodeficient mice (five or six mice in each Avatar model). Total 32 animals were used in this study. Stable transfection and overexpression of human IGF-2 was achieved and maintained after three passages as determined by ELISA on tumor tissue lysates. Only one out of 32 mice did not engraft tumor after three months, and tumor taking rate was 96.875%, similar to our previous passage successful rate at 98% and indicate that our ex-in vivo transfection method and overexpression of human IGF-2 did not substantially affect the tumor taking rate. By using Xenogen IVIS200 imaging system (Xenogen Corp.), pleural fluid was observed in all the Avatar mice with tumors overexpressing IGF-2 or not, and the retrieved pleural fluids were positive for malignant cells. However higher pleural nodules forming rate was more common in mice with IGF-2 overexpressing tumors 77% (n=9) vs 40% (n=6). In model PH003/IGF-2, the tumor had 100% bowel metastasis (n=9) compare to 60% in the control group (n=6). Taken together, our Avatar models not only effectively recapitulate ovarian cancer abdominal peritoneum metastasis, but also can mimic advanced ovarian cancer with malignant pleural fluid. The IGF-2 overexpression enhanced metastatic potential relative to control tumor. These results also indicate that the ex-in vivo transfection method developed in this study may be a viable approach for biological research and therapies. This work is funded by the Mayo Ovarian SPORE (CA136393). Citation Format: Xiaonan Hou, Marc A Becker, Saravut J Weroha, Kristina A Butler, Suzanne M Greiner, Paul Haluksa. Overexpression of IGF-2 in primary patient ovarian cancer tumorgrafts increases bowel and thoracic metastasis. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1196. doi:10.1158/1538-7445.AM2014-1196

Abstract Purpose: Ovarian cancer has a high recurrence and mortality rate. A barrier to improved outcomes includes a lack of accurate models for preclinical testing of novel therapeutics. Experimental Design: Clinically relevant, patient-derived tumorgraft models were generated from sequential patients and the first 168 engrafted models are described. Fresh ovarian, primary peritoneal, and fallopian tube carcinomas were collected at the time of debulking surgery and injected intraperitoneally into severe combined immunodeficient mice. Results: Tumorgrafts demonstrated a 74% engraftment rate with microscopic fidelity of primary tumor characteristics. Low-passage tumorgrafts also showed comparable genomic aberrations with the corresponding primary tumor and exhibit gene set enrichment of multiple ovarian cancer molecular subtypes, similar to patient tumors. Importantly, each of these tumorgraft models is annotated with clinical data and for those that have been tested, response to platinum chemotherapy correlates with the source patient. Conclusions: Presented herein is the largest known living tumor bank of patient-derived, ovarian tumorgraft models that can be applied to the development of personalized cancer treatment. Clin Cancer Res; 20(5); 1288–97. ©2014 AACR.