Nuclear expression of survivin is associated with improved survival in metastatic ovarian carcinoma

BACKGROUND: Inhibitor of apoptosis proteins (IAPs) mediate cancer cell survival and chemoresistance. The expression of XIAP, Survivin, and Livin in ovarian carcinoma was analyzed. METHODS: Effusions (106) were analyzed for XIAP, Survivin, and Livin expression using immunoblotting. Effusions (220), corresponding primary tumors (60), and solid metastases (103) were further immunohistochemically analyzed for XIAP and Survivin expression. The results were analyzed for association with anatomic site, clinicopathologic parameters, and survival. RESULTS: Immunoblotting showed frequent expression of XIAP and Survivin, and no expression of Livin. Immunohistochemistry showed cytoplasmic XIAP expression in 208 of 220 (94%) effusions, 50 of 60 (83%) primary tumors, and 87 of 103 (84%) solid metastases, with a significantly higher staining extent in effusions (P < .001). Cytoplasmic Survivin was found in 194 of 220 (88%) effusions, 55 of 60 (92%) primary tumors, and 102 of 103 (99%) solid metastases, with a significantly higher cytoplasmic staining extent in solid metastases (P = .018 and P = .006 compared with primary tumors and effusions, respectively). Nuclear Survivin was expressed in 159 of 220 (72%) effusions, 54 of 60 (90%) primary carcinomas, and 96 of 103 (93%) solid metastases (P > .05). For patients with prechemotherapy effusions, higher nuclear Survivin expression correlated with better progression-free (P = .0003) and overall (P = .002) survival in univariate survival analysis. Nuclear Survivin expression was found to be an independent predictor of progression-free survival (P = .004). CONCLUSIONS: XIAP and Survivin, but not Livin, are frequently expressed in ovarian carcinoma. XIAP and cytoplasmic Survivin are up-regulated in effusions and solid metastases, respectively, possibly mediating survival at these sites. Nuclear Survivin expression predicts better outcome in prechemotherapy patients.     

Optos Optomap Panoramic 200MA™ Imaging of a Serous Choroidal Detachment Responsive to Furosemide

Purpose: To describe a case of a serous choroidal detachment which resulted after discontinuation of furosemide and illustrate the utility of ultrawide-angle fundus imaging in documenting this lesion in the retinal periphery. Design: Observational case report. Method: An 85 year old female presented with symptoms of a “brown curtain” descending over the left eye which was temporally related to recent discontinuation of oral furosemide. Ultrawide-field photography allowed for accurate documentaton of the choroidal detachments. Result: After resuming furosemide, the serous choroidal detachments resolved. Conclusion: We hypothesize a shift of free water following discontinuation of furosemide as a novel etiology for the development of serous chordoidal detachments. Ultrawide-field fundus photography was useful to document this lesion.     

Intravitreal Bevacizumab and Ranibizumab in the Treatment of Acute Central Serous Chorioretihopathy: A Single Center Retrospective Study

Objectives: To evaluate and compare the anatomical and functional outcomes of patients with acute central serous chorioretinopathy (CSC) who did not receive any intervention or treatment with intravitreal bevacizumab or ranibizumab. Methods: A single-center retrospective comparative study. Seventy eyes of 70 patients were recruited for the study; 27 patients were only observed without any medication or intervention (observation group), 23 were treated with intravitreal bevacizumab (IVB group), and the remaining 20 were treated with intavitreal ranibizumab (IVR group). The best-corrected visual acuity (BCVA) and central macular thickness (CMT) obtained by spectral-domain optical coherence tomography were compared between the groups. Results: There were no significant differences between the groups with regard to age, sex, and follow-up periods (p>0.05). The mean time from baseline to initial complete resolution of subretinal fluid was 3.52±1.64 months in the observation group, 1.19±0.60 months in the IVB group, and 1.11±0.47 months in the IVR group; the resolution time was significantly longer in the observation group (p<0.001). While the CMT was significantly thicker in the observation group when compared to the IVB and IVR groups in the first month (p=0.001), it was similar between the groups in the third, sixth, and twelfth months (p>0.05). Additionally, pairwise comparisons of the IVB and IVR groups revealed that there were no significant differences between these groups regarding CMT at any follow-up time (p>0.05). Conclusions: Compared with observation alone, neither IVB nor IVR had a positive effect in terms of anatomical and functional outcomes for acute CSC. Although the resolution time of SRF is shorter by using ranibizumab, both the ranibizumab and bevacizumab could be effective in achieving rapid resolution of serous detachment in patients with acute CSC.     

Actualización en el tratamiento de la coriorretinopatía serosa central crónica

Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual acuity in patients younger than 60 years. Its pathophysiology remains partially unknown, although it has been postulated that choroidal hyper-permeability may be involved. This typically produces a neurosensory retinal detachment and/or a detachment of the retinal pigment epithelium in the posterior pole. Although acute CSC generally does not require treatment, when chronic it must be treated to avoid visual impairment. With the development of new imaging techniques, there has been an improvement in diagnosis, and different therapeutic strategies have been proposed. Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity, the resolution of subretinal fluid, and to prevent recurrences. The most commonly used treatments today are photodynamic therapy, micropulse subthreshold laser, mineralocorticoid antagonists, or anti-vascular endothelial growth factor drugs. There are also other proposals and new treatments being developed, with promising results. This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice.     

The Macular Buckling Technique in the Treatment of Optic Disk Pit Maculopathy

In 1988 we introduced the macular buckling procedure for the treatment of optic disk pit maculopathy and we have been applying it since then. The surgery consists of a scleral sponge fixation of 7.5 × 5.5 mm at the posterior pole of the globe corresponding to the macula along the vertical axis of the 12 to 6 o'clock meridian. No additional treatment of any kind (laser, diathermy, or cryotherapy) is used. The correct positioning of the sponge during the surgery is monitored by B-scan ukrasonography. Within the first week after surgery, indocyanine green angiography (ICG) is used to evaluate the choroidal circulation. During the same period, magnetic resonance imaging (MRI) of the orbit is performed to determine the sponge position in relation to the optic nerve. We analyze the results of 23 eyes with optic disk pit maculopathy that underwent surgery with the macular buckling technique between November 1988 and December 1998. In 20 of them the macula and the surrounding area of the retina became completely flat. No recurrence was noted in the successfully treated patients in the follow-up period, which ranged from 9 months to 10 years. Visual acuity was improved by 1 to 7 Snellen lines in 18 of the 23 patients. An improvement in visual field indices was also recorded. The sponge positioning between the temporal part of the optic disk and the macula acts mechanically and seems to provide a barrier that prevents the flow of the fluid from the pit toward the macula     

Psychological factors associated with acute and chronic central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSC) has been associated with several psychological factors. But previous psychological data are limited and mainly restricted to male patients and small sample size. In this study we investigated psychosomatic complaints, personality factors, life events, and stress coping in acute and chronic recurrent CSC patients. Methods: Ninety-five patients (71 men, 24 women) with either acute or chronic CSC were evaluated regarding critical life events before diagnosis, psychosomatic complaints, personality traits and coping style. The characteristics of CSC patients were compared with a control group comprising 75 patients (46 men, 29 women) suffering from acute or chronic ophthalmic disorders other than CSC. Results: Compared with patients of the control group, CSC patients reported more psychosomatic problems, unfavourable stress coping strategies and critical life events as well as elevated tension, aggression, strain, emotional instability and achievement orientation. Except for aggression the observed characteristics were more pronounced in acute than in chronic CSC patients. Conclusions: The appearance of CSC may be associated with an accumulation of stressful life events with an unfavourable coping style and distinctive personality factors. Acute CSC is related to more unfavourable stress coping and more physical complaints compared to its chronic course. Elevated aggression may imply one potential risk factor for CSC manifestation and also may have an adverse effect with its chronification.     

Role of the pathologist in assessing response to treatment of ovarian and endometrial cancers

Standardisation of pathological evaluation of tissue responses to therapy permits robust stratification of patient outcomes for management decisions and allows comparison of results across clinical trials. In gynaecological pathology there are two major areas where pathological assessment of treatment response is currently used to determine ongoing therapy. High-grade serous carcinoma (HGSC) of tubo-ovarian origin frequently presents as high-stage disease and may be managed by neoadjuvant chemotherapy with debulking surgery. The chemotherapy response score (CRS) is a reproducible, validated three-tiered morphological scoring system to assess the response of HGSC to treatment. Interobserver agreement is shown to be substantial following online training, and women with CRS3 have significantly improved progression-free and overall survival. Low-grade endometrioid endometrial cancer and atypical hyperplasia/endometrioid intraepithelial neoplasia may be managed by progestogenic therapy in women who wish to preserve fertility or for whom medical co-morbidities preclude surgical management. The response to treatment is assessed histologically in successive endometrial biopsies. The histological parameters are well described, but the pathological classification of treatment response is still under development. Pathological assessment of the response to treatment is incorporated into clinical guidelines.