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Objective: Ovarian cancer is the deadliest of all gynecologic tumors. Current treatment methods include debulking surgery with chemotherapy, however even with treatment, the five-year survival rate is below 45%. Cancer immunotherapy is an innovative treatment option being highly researched. Interleukins (ILs) are signaling molecules used by the human immune system to assist in detecting and destroying cancer cells. The ability of tumor cells to evade the immune system is a major challenge we face in fighting cancer. Ox40L/Ox40 and 4-1BBL/4-1BB are key immune costimulatory molecules that increase T cell activation to eliminate tumors. Past research has shown that IL9 has unique influences on various types of cancer, however, its role in ovarian cancer has not yet been assessed. In this study, ovarian cancer cells were treated with IL9 and the expression of Ox40L and 4-1BBL were measured. Methods: A2780 ovarian cancer cells were treated with IL9. Proliferation of ovarian cancer cells was measured by a Clonogenic Survival Assay and Quick Proliferation Assay. RT-PCR was conducted to determine whether IL9 upregulated the costimulatory molecules Ox40L and 4-1BBL. IHC was performed to further investigate IL9 upregulation of Ox40L and 4-1BBL. Results: Treatment of A2780 ovarian cancer cells with IL9 resulted in decreased proliferation of the ovarian cancer cells. By using RT-PCR, it was determined that IL9 treated ovarian cancer cells displayed upregulation of the costimulatory molecules Ox40L and 4-1BBL. Upregulation of OX40L and 4-1BBL was further confirmed by IHC. Conclusions: IL9 inhibited growth of ovarian cancer cells, and IL9 upregulated the key immune costimulatory molecules Ox40L and 4-1BBL. This suggests that increased expression of Ox40L and 4-1BBL may be associated with the inhibitory effect of IL9 on proliferation of ovarian cancer. This study warrants further investigation of the role of Ox40L and 4-1BBL in ovarian cancer growth.

e18629 Background: The prevalence of anxiety and depression disorder in patients with cancer is about 10% and 22%, respectively. Cancer patients were seven times more likely to have a psychiatric disorder than the normal population. Prior studies have used multiple questionnaires like GAD7, HADS, PHQ2 and PHQ9 which have been approved by national guidelines to assess severity of anxiety and depression in the cancer population. Patient Health Questionnaire-4 (PHQ4) questionnaire is a validated screening tool for anxiety and depression disorders. This study aimed to implement a concise screening tool, PHQ4, to identify the mental health status of cancer patients early and intervene with counseling, medications, and referral to PCP/Palliative care for symptoms control. Methods: Patients completed the 4-item PHQ4 during their clinic visits at University of Texas Medical Branch between December 1, 2021, and February 1, 2022. The patient was provided with a PHQ4 questionnaire at the beginning of their visit. The PHQ4 implements two screening questions for anxiety and depression each, with the frequency of symptoms determining the score on a scale of 0 (not at all) to 3 (nearly every day) for each item. When the total score was > or = 3, a presumptive diagnosis of anxiety, depression, or both was made. These patients were given information regarding support groups, resources for interventions, and provided with medications/referrals to primary care/palliative care/psychiatry for further management. Demographic factors (i.e., age, sex, race/ethnicity), type of cancer, and stage of cancer were other variables that were collected and analyzed as well. Results: Out of 70 total patients, 12 (17.1%) screened positive for anxiety, 14 (20%) screened positive for depression, and 9 (12.9%) screened positive for both depression and anxiety. 10 (14.3%) patients were diagnosed with mild symptoms (score 3-5), 10 (14.3%) with moderate symptoms (6-8), and 4 (5.7%) with severe symptoms. Median age of study population was 60, median age for positive screening was 54.5 years. While there were 35 males and females included in the study, 10 males (14.3%) and 7 females (10%) screened positive. Caucasian ethnicity (76.5%) and Colorectal cancer (24.3%) had the highest prevalence of patients who screened positive. All patients who screened positive were either stage 3 or 4 cancer patients. All patients (100%) who screened positive, received intervention. Conclusions: Based on our results, PHQ4 almost met the national average for depression screening. It possibly over diagnosed patients with anxiety and depression which may have been also contributed by other social/financial/personal stressors, warranting further attention with social worker support. PHQ4, is a quick, validated, effective screening tool that can regularly monitor cancer patients’ psychological health and enable timely intervention.

Gastric cancer, a leading cause of cancer-related death in the world, may occur with an additional synchronous malignancy in rare cases. Of these rare cases many are colorectal cancer. Microsatellite instability is a phenomenon that may contribute to the pathogenesis of both cancers, as are field cancerization and genetic susceptibility, although none of these explain many concurrent cases. In this case, we described a patient with locally advanced microsatellite instability-high gastric cancer and synchronous microsatellite stable rectal cancer, who received a combination chemo-immunotherapy regimen and achieved complete response. This report reflects on current knowledge surrounding synchronous primary malignancies and achieving complete response.

Primary bone lymphoma (PBL) is a rare extranodal presentation within lymphomas and primary bone malignancies. Pathologic fracture (PF) is a common complication of metastatic bone disease but is, rarely, the presentation of a primary bone tumor. We report a case of an 83-year-old man with a history of untreated prostate cancer, presenting with atraumatic fracture of his left femur after months of intermittent pains and weight loss. Radiographic workup revealed a lytic lesion suspicious for PF secondary to metastatic prostate cancer; however, initial core biopsy results were inconclusive for malignancy. A complete blood count with differential and complete metabolic panel was within normal limits. During surgical fixation and nailing of the femur, a reaming biopsy was performed as a repeat measure and revealed diffuse large B-cell lymphoma. Staging with positron emission tomography and computed tomography found no evidence of lymphatic or visceral involvement and chemotherapy was promptly initiated. This case highlights the diagnostic workup challenges for PF secondary to PBL, especially in the setting of concurrent malignancy. Because of the non-specific presentation of a lytic lesion on imaging associated with atraumatic fracture, we highlight PBL as an important diagnostic consideration.