We have shown for the first time that PLR is a novel independent prognostic marker in patients with ovarian cancer.

TREK-1 and -2 are expressed in normal ovaries and ovarian cancer. TREK-1 modulators have a significant effect on cell proliferation and apoptosis. We propose investigation of the therapeutic potential of TREK-1 blockers is warranted.

Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma that can affect the vulval skin. Surgical excision is the gold-standard treatment, however, recurrence rates are high and extensive excisions can produce long-lasting cosmetic and functional defects. We describe one of the largest case series to-date (n = 6) on the use of topical 5% imiquimod cream as a novel treatment option and discuss our experiences. With the addition of our six cases to the literature, there are now 29 documented cases of vulval EMPD treated with 5% imiquimod cream. Of these, 50% of primary disease cases and 73% of recurrent primary disease cases have achieved clinical resolution with 5% imiquimod therapy alone. These findings suggest that imiquimod provides a viable alternative to surgical excision for vulval EMPD. However, we acknowledge that this is a simple retrospective analysis and that treatment scheduling and follow-up needs investigation in a trial setting.

High-risk HPV platforms and test of cure: should specific HPV platforms more suited to screening in a 'test of cure' scenario be recommended?Objective: When the Sheffield screening laboratory changed the high-risk human papillomavirus (hrHPV) platforms from hybrid capture 2 â (HC2; Digene Ltd) and to cobas 4800 â (Roche) an unexpected and substantial increase in the number of cytology-negative/hrHPV-positive test-of-cure (ToC) samples after large loop excision of the transformation zone (LLETZ) was noted. We explore the potential reasons for these increased rates and discuss the implications this may have on the English NHS cervical screening programme (CSP). Methods: A retrospective cohort study with interval analysis between June 2007 and June 2012.Results: ToC was performed on 1530 women with HC2 and 396 with cobas 4800: 95.1% and 92.4% of women had negative cytology at ToC in the HC2 and cobas4800 testing period, respectively. Of these 13.9% and 27.8% tested positive for hrHPV in the HC2 and cobas 4800 group, respectively (P = <0.0001). No clinically significant increase in the number of cases of cervical intraepithelial neolpasia (CIN) was detected by the cobas4800 test in spite of doubling the number of cytology-negative/hrHPV-positive ToC samples.Conclusions: As far as we are aware, this is the first study reporting potential differences between different HPV platforms currently available in the English programme. The immediate impact of this increase in rates of hrHPV detection with cobas4800 is an increased number of colposcopy referrals to our service. The NHSCSP needs to assess whether this increase is acceptable and, if not, whether specific HPV platforms more suited to screening in a ToC scenario should be recommended.

This case describes the initial presentation of lung cancer as a generalized seizure in a woman at 31 weeks gestation. Histologic examination revealed evidence of placental metastases without evidence of fetal involvement. Case reportA 34-year-old primigravida was admitted as an emergency to the Labour Suite after a generalized self-limiting seizure at 31/40 gestation. On admission she was drowsy, her blood pressure was 116/68 and catheter urine tested positive for protein (1'/). On examination there was epigastric and right upper quadrant tenderness. Lung auscultation revealed left-sided basal crepitations and there were three beats of clonus and a positive Babinski reflex in the left lower limb. Cardiotocograph was normal and there was no significant edema. Blood tests revealed normochromic normocytic anemia (Hb 10.0), mildly elevated liver enzymes (gGT 83, ALT 55) and a CRP of 34. Platelets, white cell count, urate, urea and electrolytes, random glucose and remaining parameters of liver function were normal. Although there were some unusual features, eclampsia was considered to be the most likely diagnosis.Treatment with magnesium sulfate was commenced according to protocol on the high dependency area of the Labor Suite and 16 mg of dexamethasone was given intramuscularly. Six hours after admission the patient underwent a cesarean section under regional anesthesia. A male infant was delivered in good condition (cord gases normal; birth weight 2.01 kg).Postoperatively the patient remained normotensive and aproteinuric. However, the oxygen satura-tion was only 80% on room air and there was extensive left-sided bronchial breathing on auscultation. A portable chest X-ray revealed shadowing over the left mid-zone, and the diagnosis of pneumonia was considered. A departmental chest X-ray on day 2 demonstrated a left-sided pleural effusion. Cytological examination of a pleural aspirate revealed adenocarcinoma cells. A CT brain/thorax/abdomen was arranged. This revealed multiple brain metastases with evidence of raised intracranial pressure and a mid-line shift, a left-sided bronchial mass and multiple liver metastases. At bronchoscopy there was evidence of a large malignant looking bronchial mass and biopsies were obtained. Histology revealed an invasive poorly differentiated adenocarcinoma. Immuno-histochemistry indicated primary lung cancer. The placental histology revealed microscopic metastatic disease on two separate placental blocks prepared for histology.Subsequently the patient received palliative whole brain radiotherapy and chemotherapy, but the tumor did not respond.The baby made good progress and was discharged. Subsequent follow up to this date has shown no evidence of metastatic disease in the baby. Discussion