At relapse, expression of tumor target proteins was evaluated on tissue specimens ob tained both at diagnosis and at recurrence. Immunohisto chemistry showed the tumor cells constantly negative for epidermal growth factor receptor. By contrast, there was some optimistic staining with platelet derived growth element receptor in the major specimen, having a couple of cellular clusters displaying cytoplasmic positivity, while at recurrence a clear diffuse cytoplasmatic positivity for PDGFR reaching virtually 100% on the cells was ob served. ADAR2 was absent in each principal and recurrent tumors, ADAR1 was expressed in the nucleus and cytoplasm, both at diag nosis and at recurrence. Figure five shows the EGFR, PDGFR, ADAR 1 and ADAR2 expression in tumor speci guys at diagnosis and at recurrence.
Based on the target protein expression, the patient started sorafenib 200 mg after each day orally, plus temozolomide one hundred mg m2 day orally for five consecutive days and irino tecan 10 mg m2 day orally for 14 consecutive days, the course was repeated each 28 days. Treatment was nicely tolerated, only generalized selleck inhibitor skin rash associated with grade I dry skin not requiring treat ment discontinuation was recorded. A progression totally free survival was achieved for 5 months when peritoneal carcinomatosis with an important neoplastic peritoneal effusion appeared. The patient died for progressive dis ease a few weeks later. Discussion PME is actually a extremely rare neoplasm and only few reports describe this entity. Equivalent to classical ME, surgery in PME, with or with out systemic chemotherapy and or regional radiotherapy, repre sents a therapeutic selection.
Total surgery seems to become related with much better outcome. All reported PME had been positioned in selleck chemical Neratinib the pelvic cavity. Some authors hypothesized that these tumors originated from undifferentiated cells in the pre sacral remnant. Four patients with ovarian ME had a good prognosis soon after surgery either alone or linked with adjuvant chemo therapy and or radiotherapy. In a case of congenital pelvic ME, prolonged illness no cost survival was accomplished after partial surgical removal and chemotherapy. Inside a equivalent case, pelvic ME was resistant to chemotherapy and also the patient died of metastatic pulmonary progres sion. Analyzing the reported instances, it seems that some PME with favorable prognosis had been sensitive to chemotherapy, although, for chemo resistant tumors, the only curative treat ment was represented by radical surgery.
In our case, we decided to treat the patient with an aggressive initially line therapy. The patient accomplished comprehensive remission but she relapsed only six months just after the finish of treatment. At re lapse we evaluated the expression of tumor target proteins focusing on the protein expression profile usually involved in brain cancers with probable therapeutic implications, which include PDGFR and EGFR.