Mucinous ovarian carcinoma (MOC) is a unique subtype of ovarian cancer with an uncertain etiology, including whether it genuinely arises at the ovary or is metastatic disease from other organs. In addition, the molecular drivers of invasive progression, high-grade and metastatic disease are poorly defined. We perform genetic analysis of MOC across all histological grades, including benign and borderline mucinous ovarian tumors, and compare these to tumors from other potential extra-ovarian sites of origin. Here we show that MOC is distinct from tumors from other sites and supports a progressive model of evolution from borderline precursors to high-grade invasive MOC. Key drivers of progression identified are TP53 mutation and copy number aberrations, including a notable amplicon on 9p13. High copy number aberration burden is associated with worse prognosis in MOC. Our data conclusively demonstrate that MOC arise from benign and borderline precursors at the ovary and are not extra-ovarian metastases.

Objective. Mucinous ovarian carcinoma (MOC) is an uncommon ovarian cancer histotype that responds poorly to conventional chemotherapy regimens. Although long overall survival outcomes can occur with early detection and optimal surgical resection, recurrent and advanced disease are associated with extremely poor survival. There are no current guidelines specifically for the systemic management of recurrent MOC. We analyzed data from a large cohort of women with MOC to evaluate the potential for clinical utility from a range of systemic agents.

Background The role of different subtypes of tumour infiltrating lymphocytes (TILs) in breast ductal carcinoma in situ (DCIS) is still poorly defined. This study aimed to assess the prognostic significance of B and T lymphocytes and immune checkpoint proteins expression in DCIS. Methods A well characterised DCIS cohort ( n = 700) with long-term follow-up comprising pure DCIS ( n = 508) and DCIS mixed with invasive carcinoma (IBC; n = 192) were stained immunohistochemically for CD20, CD3, CD4, CD8, FOXP3, PD1 and PDL1. Copy number variation and TP53 mutation status were assessed in a subset of cases ( n = 58). Results CD3+ lymphocytes were the predominant cell subtype in the pure DCIS cohort, while FOXP3 showed the lowest levels. PDL1 expression was mainly seen in the stromal TILs. Higher abundance of TILs subtypes was associated with higher tumour grade, hormone receptor negativity and HER2 positivity. Mutant TP53 variants were associated with higher levels of stromal CD3+, CD4+ and FOXP3+ cells. DCIS coexisting with invasive carcinoma harboured denser stromal infiltrates of all immune cells and checkpoint proteins apart from CD4+ cells. Stromal PD1 was the most differentially expressed protein between DCIS and invasive carcinoma ( Z = 5.8, p < 0.0001). Dense TILs, stromal FOXP3 and PDL1 were poor prognostic factors for DCIS recurrence, while dense TILs were independently associated with poor outcome for all recurrences (HR = 7.0; p = 0.024), and invasive recurrence (HR = 2.1; p = 0.029). Conclusions Immunosuppressive proteins are potential markers for high risk DCIS and disease progression. Different stromal and intratumoural lymphocyte composition between pure DCIS, DCIS associated with IBC and invasive carcinoma play a potential role in their prognostic significance and related to the underlying genomic instability. Assessment of overall TILs provides a promising tool for evaluation of the DCIS immune microenvironment.

INTRODUCTION: SOURCES AND BIOAVAILABILITY OF ALUMINIUM Aluminium is the most abundant metal and constitutes 8% of the earth's crust. It is a normal constituent of vegetable and animal tissues and is present in raw untreated water. In domestic tap-water supplies, aluminium may be present in high concentrations either from its presence in raw water or, more commonly, as a result of its use during the water-purification process. Aluminium in the metallic form is widely used for both industrial and domestic purposes, and a variety of aluminium salts are used in foods, fluids, cosmetics and medications. The toxicity of aluminium in patients with renal failure is now well documented, and dialysis encephalopathy, osteomalacia and anaemia are recognized hazards in such patients if aluminium is not excluded from dialysis fluids and medications. The safe levels of aluminium in food, water, medications and infusion fluids for subjects with normal renal function are unknown, but aluminium has been implicated as causative agent in a number of dementia diseases, including Alzheimer's disease.

1. Plasma and urinary aluminium levels, and renal function, were investigated in a control group of rats (n = 5) and in two groups that received an intravenous bolus dose of aluminium chloride (either 25 micrograms or 800 micrograms of aluminium, n = 7 and 5, respectively). 2. In the control group (plasma aluminium concentration 76.8 +/- 14.2 ng/ml), 59.4 +/- 3.5% of the plasma aluminium was ultrafilterable. The percentage ultrafilterable after the administration of 25 micrograms of aluminium was 41.9 +/- 7.8 (plasma concentration 154.3 +/- 18.6 ng/ml). However, after administration of 800 micrograms of aluminium, to give a plasma concentration of 19,800 +/- 2956 ng/ml, only 1.06 +/- 0.13% was ultrafilterable. 3. Such results have generally been interpreted as indicating an increase in protein-binding of aluminium with increasing aluminium concentration. In buffered aqueous solutions of aluminium chloride at pH 7.4, with an aluminium concentration of 189 +/- 6 ng/ml, 96.12 +/- 0.02% was ultrafilterable (n = 6). This concentration is comparable with that attained in the low-dose (25 micrograms) aluminium group of animals and suggests that the difference between the ultrafilterable percentage of aluminium in plasma compared with that in aqueous solution is indeed due to the binding of aluminium to high Mr material (proteins). In contrast, however, in an aqueous buffered (pH 7.4) solution containing 28,200 ng of aluminium/ml, only 1.05 +/- 0.09% was ultrafilterable. This indicates insolubility (i.e. colloid formation) of the aluminium at this high concentration. The same percentage (1.06 +/- 0.13) was ultrafilterable from plasma from the high-dose (800 micrograms) aluminium group with a plasma aluminium concentration of 19,800 +/- 2956 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)