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Biomedical subjects

A Sedlis

Publications and source records attributed to A Sedlis.

At least 37 records · Page 2Linked to original sources
PubMed1987

Positive groin lymph nodes in superficial squamous cell vulvar cancer. A Gynecologic Oncology Group Study.

The term microinvasive carcinoma is inappropriate when applied to all vulvar cancers less than or equal to 5 mm thick because approximately 50% of vulvar carcinomas are no thicker than 5 mm and 20% of those superficial tumors metastasize to the lymph nodes. The significant predictors of groin node metastases in patients with superficial vulvar cancer are tumor thickness, histologic grade (proportion of undifferentiated tumor pattern), capillary-like space involvement with the tumor, clitoral or perineal location, and clinically suspicious nodes, according to the linear logistic model analysis of clinicopathologic data in 272 women. No lymph node metastases occurred in approximately one fourth of patients with a combination of low-risk factors: no clinically suspicious nodes, negative capillary-like space, and nonmidline vulvar cancers that were either grade 1 and 1 to 5 mm thick or grade 2 and 1 to 2 mm thick. In contrast, all 10 patients with clinically suspicious nodes and grade 4 tumors had positive groin nodes. The risk of lymph node metastases is best determined by simultaneous evaluation of all risk factors rather than a single factor such as tumor thickness.

Carcinoma, Squamous Cell↗
PubMed1987

Anogenital papillomavirus infection and neoplasia in immunodeficient women.

People with deficient cell-mediated immunity have an increased susceptibility to viral infections and certain cancers, particularly large cell lymphomas and cancers of the skin and anogenital region. All are linked to viral origins. Neoplasms in the immunodeficient patient often occur at a relatively young age, involve multifocal locations, tend to persist, recur, and progress rapidly. Anogenital neoplasms show a strong association with HPV infection and also persist, extend, and progress, in spite of standard therapy. Since standard therapy of anogenital HPV infection and neoplasia is often not effective in immunodeficient patients (and others with an anogenital neoplastic syndrome), special treatment is required. 5-Fluorouracil chemosurgery, followed by maintenance 5-fluorouracil therapy, is effective and provides field suppression against recurrent HPV infection and neoplasia, with minimal damage to affected organs. After removal of all detectable HPV infection or neoplastic lesions, immunodeficient patients require close surveillance of the entire anogenital tract. Immunodeficient patients are an in-vivo human laboratory in which to study the natural history of HPV and its oncogenic effects on the anogenital tract. The theory of HPV oncogenesis is supported by the evidence gathered from these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Human papillomavirus and lower genital neoplasia in renal transplant patients.

Lower genital cytopathology was evaluated in 105 immunosuppressed renal transplant recipients. Evidence of human papillomavirus infection was found in 17.5% and of lower genital neoplasia in 9.5%. The rate of the virus infection in the immunosuppressed was nine times greater than in a general population and 17 times greater than in a matched immunocompetent population. The rate of cervical neoplasia was 16 times greater than in a general population and nine times greater than in a matched immunocompetent population. In one-third of patients with human papillomavirus lesions and one-half of patients with neoplastic lesions, multiple lower genital sites were also involved. Of risk factors evaluated, only the number of sexual partners was associated with the development of human papillomavirus/lower genital neoplasia.

Adult↗
PubMed1986

Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes.

From 1977 to 1984, 114 eligible patients with invasive squamous cell carcinoma of the vulva and positive groin nodes after radical vulvectomy and bilateral groin lymphadenectomy were randomized to receive either radiation therapy or pelvic node resection. Fifty-three of the 59 patients randomized to radiation therapy received a 4500- to 5000-rad tumor dose in five to 6.5 weeks bilaterally to the groins and to the midplane of the pelvis even if only unilateral positive groin nodes had been detected; no radiation was given to the central vulvar area. Fifty-three of the 55 patients randomized to further surgery had pelvic node resection performed on the side containing positive groin nodes either unilaterally or bilaterally. Acute and chronic morbidity was similar for both regimens. The two major poor prognostic factors were clinically suspicious or fixed ulcerated groin nodes and two or more positive groin nodes. The difference in survival for the 114 evaluable patients was significant, favoring the adjunctive radiation therapy group (P = .03). The estimated two-year survival rates were 68% for the radiation therapy group and 54% for pelvic node resection group. The most dramatic survival advantage for radiation therapy was in patients who had either of the two major poor prognostic factors present; at this time, the benefit of radiation therapy for the remaining patients is uncertain. In this randomized prospective study, the addition of adjunctive groin and pelvic irradiation therapy after radical vulvectomy and inguinal lymphadenectomy proved superior to pelvic node resection.

Carcinoma, Squamous Cell↗
PubMed1985

Prognostic factors in carcinoma of the vulva.

The clinical and pathologic characteristics of epidermoid carcinoma of the vulva in 84 women treated by vulvectomy were evaluated in relation to inguinal node status and survival. Tumor diameter, depth of invasion, clinical node status, vascular invasion, and pattern of invasion were all individually correlated with the pathologic status of the inguinal nodes. However, when evaluated in combination, only the clinical status of the inguinal nodes, the depth of invasion, and the pattern of invasion (in this order of significance) were predictive of pathologic inguinal node status. Tumor diameter, inguinal node status, depth of invasion, pattern of invasion, and vascular invasion were individually correlated with survival. When evaluated in combination, the clinical diameter of the lesion was the most important predictor of survival; depth of invasion and vascular invasion contributed additional information.

Carcinoma, Squamous Cell↗
PubMed1984

The relationship between human papillomavirus and lower genital intraepithelial neoplasia in immunosuppressed women.

In a group of 20 immunosuppressed women with lower genital neoplasia, evidence of associated human papillomaviral infection was found in all patients on the basis of the histologic identification of koilocytes in the upper strata of areas of mild or moderate dysplasia. Immunohistochemical study of similar areas disclosed human papilloma structural antigens in the lesions in 60%, while 50% had lesions in which human papilloma virions were detected by the electron microscope. An abnormal immunologic status, indicated by an altered T-helper/T-suppressor ratio, a deficient response to mitogenic stimulation, or both, was confirmed in 80% of the patients studied. Twelve of the 20 patients had unusually persistent and recurrent intraepithelial neoplasia, and in one the disorder progressed to invasive epidermoid carcinoma. The progressive behavior of human papillomavirus-associated neoplasia in these immunosuppressed patients might represent an accelerated version of the long-term course of such lesions in immunocompetent hosts.

Adolescent↗
PubMed1983

Multimodality treatment of adenocarcinoma of the vagina Stage IV: potential for cure.

A 26-year-old nulligravida presented with a Stage IV adenocarcinoma of the vagina with a frozen pelvis and positive lymph nodes in the right external iliac and inguinal regions. Following transposition of the ovaries laterally, a successful treatment program of cyclic radiotherapy and 5-fluorouracil was undertaken. Patient is now alive 3 years posttherapy with a functional vagina, return of menses, and without evidence of tumor. She experienced a small-bowel stricture 5 months posttherapy which required small-bowel resection. This case suggests that an integrated multimodality program is feasible and that 5-fluorouracil may be synergistic with radiation.

Adenocarcinoma, Mucinous↗
PubMed1983

Association of human papillomavirus infection with cervical intraepithelial neoplasia.

Human papillomavirus infections of the cervix were assessed in patients attending a colposcopy clinic. Of 348 patients with cervical biopsies, 134 (38.5%) had human papillomavirus infections, and of 251 patients with cervical intraepithelial neoplasia (CIN) 112 (44.6%) had human papillomavirus. The majority of patients with human papillomavirus had concurrent CIN (83.6%; 112/134). Patients with human papillomavirus were significantly younger than patients without human papillomavirus (24.4 versus 29.9 years mean age; P less than .001), had significantly milder degrees of CIN (84% versus 43% mild/moderate dysplasia; P less than .001), and had a significantly lower mean number of pregnancies (2.16 versus 3.05; P less than .001). A matched pairs analysis of 69 pairs showed the same distribution of CIN in both human papillomavirus and nonhuman papillomavirus patients. Electron microscopy of human papillomavirus--specific koilocytes confirmed the presence of human papillomavirus particles in the nuclei.

Adult↗
PubMed1982

Adenomatoid tumor of the uterus simulating interstitial pregnancy.

A case of an adenomatoid tumor of the uterus is presented. The 22-year-old patient was admitted with classic signs and symptoms of an interstitial pregnancy. However, emergency surgery confirmed the diagnosis of an adenomatoid tumor of the uterus concomitant with an intrauterine pregnancy. Although rare, adenomatoid tumors of the uterus may present as a uterine abnormality, possibly causing problems in the differential diagnosis of it and an interstitial pregnancy.

Adult↗
PubMed1980

Massive ovarian edema: review of world literature and report of two cases.

The subject of massive edema of the ovary is reviewed in detail. Two new cases are reported. One is the first case of massive ovarian edema to occur during pregnancy. In addition, all cases from the world literature since the original description in 1969 are reviewed. Background information, clinical signs and symptoms, laparotomy findings, and pathology from all 22 cases are reviewed. Etiology and management are discussed.

Adolescent↗