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Objective Mutations in the MAP kinase pathway (KRAS, NRAS, BRAF) are common in low grade serous ovarian carcinoma (LGSOC). The effect of these and other mutations on RNA transcription in this disease is poorly understood. Our objective was to describe patterns of somatic mutations and gene transcription in a racially diverse population with LGSOC. Methods Utilizing an institutional tumor registry, patients with LGSOC were identified and charts were reviewed. RNA was extracted from available tumor tissue. Commercial tumor profiling results were analyzed with PanCancer pathway nanoString mRNA expression data. Along with nanoString n-Solver software, Chi-squared, Fishers Exact, and Cox proportional hazards models were used for statistical analysis, with significance set at p Results 39 patients were identified—20% Black, 43% Hispanic, and 36% non-Hispanic White. 18 patients had commercial somatic DNA test results, and 23 had available tumor tissue for RNA extraction and nanoString analysis. The most common somatic alterations identified was KRAS (11 patients, 61%), followed by ERCC1 and TUBB3 (9 each, 50%). KRAS mutations were less common in smokers (14.3% vs 90.9%, p = 0.002). RNA expression analysis demonstrated a greater than two-fold decrease in expression of HRAS in tumors from older patients (p = 0.04), and a greater than two-fold decrease in the expression of HRAS in recurrent tumors (p = 0.007). No significant differences were seen in somatic testing results, RNA expression analysis, or progression free survival between different racial and ethnic cohorts. Conclusions Somatic deficiencies in ERCC1, TUBB3, and KRAS are common in LGSOC in a population of minority patients. HRAS demonstrates decreased expression in tumors from older patients and recurrent tumors.

Cystic adenomyosis is a rare form of adenomyosis. Presently, these cysts are generally considered to be of a benign nature and result from cyclical response to menstrual dynamics.A 31-year-old, African-American female presented for a second opinion with a chief complaint of pelvic pain. She had recently undergone an exploratory laparoscopy with findings suggestive of endometriosis. She was never pregnant and had been taking oral contraceptive pills for over 3 months with little relief This patient had no history of uterine surgery. Pelvic ultrasound performed after her surgery revealed a cystic structure, homogeneously echogenic in the anterior corpus of the uterus, measuring 2.7 x 2.4 x 3.5 cm. This structure appeared consistent with an adenomyotic cyst. The patient's symptoms improved after the transvaginal aspiration, and she no longer required narcotics.Of all the possibilities considered, this cyst most closely resembled an adenomyotic cyst in its clinical presentation, location within the myometrium and gross appearance of the chocolate cyst fluid. Imaging is key in distinguishing this process from other congenital and acquired gynecologic entities. Awareness of this condition is important for timely and accurate diagnosis followed by appropriate intervention.

According to the prescribing information, pegfilgrastim should not be administered within 14 days prior to, or within 24 hours after, the administration of cytotoxic chemotherapy. However, few data exist to support this recommendation. A single-institution retrospective review was conducted of all patients with ovarian or primary peritoneal cancer who received prophylactic pegfilgrastim on the same day as myelosuppressive chemotherapy from May 2003 to June 2006. Forty-six patients were treated for the following malignancies: 35 (76%) epithelial ovarian, 6 (13%) primary peritoneal, and 5 (11.0%) ovarian germ cell or stromal cell carcinoma. All patients met the current guidelines of using colony-stimulating factors for prophylaxis against febrile neutropenia. A total of 269 cycles of chemotherapy were administered. All patients received pegfilgrastim within 1 hour of the completion of chemotherapy administration. Grade 1 or 2 neutropenia developed in 10 cycles (3.7%), and the mean absolute neutrophil count was 4926/uL (range, 1,293-24,300). No patients had febrile neutropenic episodes, hospitalizations, or antibiotic use secondary to neutropenia, nor did they have dose reductions or chemotherapy delays due to neutropenia. Administration of pegfilgrastim on the same day as myelosuppressive chemotherapy in patients with ovarian or primary peritoneal cancer may be determined to be a convenient, safe, and effective approach.

Objectives This study was designed to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of weekly docetaxel with concurrent radiotherapy (RT) for the primary treatment of locally advanced squamous cell carcinoma of the cervix. Methods Eligible patients included those with locally advanced squamous cell cervical cancer without para-aortic lymph node involvement. Docetaxel dose levels were 20 mg/m 2 , 30 mg/m 2 and 40 mg/m 2 given intravenously weekly for 6 cycles. Three patients were to be treated at each dose level and 6 to receive the MTD. Results Fifteen patients completed 4–6 cycles of chemotherapy. One of three patients experienced 2 delayed grade 3 severe adverse events (SAE) at the 20 mg/m 2 dose level consisting of colonic and ureteral obstruction. At the 30 mg/m 2 dose level, 1/4 patients had a probable treatment-related celiotomy due to obstipation and a necrotic tumor. Of the 8 patients treated at the 40 mg/m 2 dose level, 1 experienced grade 3 pneumonitis, likely treatment related. Overall, 10/15 (67%) experienced grade 1 or 2 diarrhea, 6 had grade 2 hematologic toxicity, and 2 had grade 2 hypersensitivity. 10 of 16 patients (67%) had no evidence of disease with follow-up ranging from 10–33 months (average 23 months). Conclusions The recommended phase II dose of docetaxel administered weekly with concurrent radiotherapy for locally advanced squamous cell carcinoma of the cervix is 40 mg/m 2 .