Biomedical subjects

B Lindahl

Publications and source records attributed to B Lindahl.

118 records · Page 7Linked to original sources

PubMedDate not supplied

Spontaneous endometrial hyperplasia. A prospective, 5 year follow-up of 246 patients after abrasio only, including 380 patients followed-up for 2 years.

The treatment of patients with endometrial hyperplasia differs widely, ranging from immediate hysterectomy to no treatment or follow-up at all. This is due to the fact that a vital question has not been answered, namely: is endometrial hyperplasia a predecessor to carcinoma or not? In order to investigate whether endometrial hyperplasia is a premalignant state we have followed up 246 patients with abrasio only for 5 years. We found that there was no higher risk of CGH and adenomatous hyperplasia developing into a carcinomatous state than in normal cases. We found it possible to follow up these patients with abrasio only as scheduled. The very few patients developing carcinoma did so already at the first control after 3 months. Among atypical endometrial hyperplasias there was an increased risk of developing endometrial carcinoma. We could divide these patients into two groups: one with very severe atypia so close to carcinoma that an immediate hysterectomy was recommended. Nine out of 12 had already developed carcinoma at the time of the operation. In another group of 21 patients followed with abrasio only, 2 had developed carcinoma at the first control. This means that among 368 patients with endometrial hyperplasia followed-up with abrasio for 2 years, 13 were found to have carcinoma. Twelve patients with very severe atypia were recommended to have an operation and 9 were found to have cancer. Among the other 356 patients, 4 were found to have cancer at the first control (2 with an initial diagnosis of CGH and 2 with atypical hyperplasia).

Adenoma↗

PubMedDate not supplied

Spontaneous endometrial hyperplasia. A 5 year follow-up of 82 patients after high-dose gestagen treatment.

Endometrial hyperplasia was proposed as a predecessor to endometrial carcinoma already at the end of the 19th century. However, there have been different opinions regarding this view. The treatment also varies, but generally cyclic progesterone at a dose of 10 mg a day is used. In order to investigate whether endometrial hyperplasia is a premalignant state and also whether a high-dose gestagen treatment would cure a high proportion of these patients, a prospective randomised study was started in 1982. We now present the 5 year follow-up consisting of 82 patients treated with high-dose gestagen. In this study 19 out of 82 patients had hysterectomies (2 due to hyperplasia and 11 due to bleeding), almost the same frequency as in a previous report with patients followed-up with abrasio only, but now mainly due to bleeding problems. In summary, no carcinoma developed and the hyperplasia was cured with 500 mg MPA i.m. twice weekly for three months. However, the bleeding problems, though almost always only spotting, remained, leading to a frequency of hysterectomy that was still too high. We find latter clinical problem an enigma. Further studies are therefore in progress in our group which try to identify other treatment modalities for those patients with bleeding problems or who redeveloped hyperplasia after abrasio, in order to avoid hysterectomies.

Atrophy↗

PubMedDate not supplied

Flow cytometrical considerations. The results of three different ways of nuclear preparation and two ways of calculating upon DNA index, number of populations and S-phase rate in endometrial tissue.

Histopathologically normal endometrial tissues were used to compare the preparation methods of Tribukait, Thornthwaite and Vindelöv. Three hundred and forty-one preparations were analyzed giving as a result significant differences regarding the DNA-indices, number of DNA-populations and percentage of cells in S-phase fraction. We also compared a manual way of calculation to a semi-automatic method (RFIT). No difference was found between the manual way and RFIT provided that the same internal standard was used. However, the two different internal standards gave different results within the same method of preparation.

Cell Nucleus↗

PubMedDate not supplied

Flow cytometrical comparison of different nuclear preparation methods upon number of DNA-populations and S-phase fraction using fresh and formalin-treated normal endometrial tissue.

In order to compare the flow cytometrically estimated DNA-parameters, histopathologically normal uterine mucosa from 250 patients was used. We compared the method of Schütte combined with those of Vindelöv or Thorntwaite in 250 and 139 cases respectively. We also compared the concomitant results when using fresh or formalin fixated material. Regarding Shütte-Thorntwaite there was no significant difference in number of DNA-populations of fresh or formalin-treated samples. However, significant differences were found regarding the number of DNA-populations when comparing Vindelöv with Schütte-Vindelöv and also between the two methods (Shütte-Thorntwaite and Schütte-Vindelöv) regarding all parameters investigated. Thus we strongly recommend that laboratories test out relevant parameters on histopathologically normal material from the organ from which later tumor material will be retrieved.

Cell Count↗

PubMedDate not supplied

Flow cytometrical comparison of different semi-automatic ways of measuring S-phase fractions using fresh and formalin-treated normal endometrial tissue.

Histopathologically normal endometrial tissue from 250 patients was prepared for DNA measurements according to the technique of Schütte, combined with the techniques of Vindelöv and Thorntwaite for formalin-fixed material; the latter methods were used alone for fresh material. To estimate the influence of different analysis methods we used two semi-automatic methods (Cellfit, MacCycle) and a manual method. Differencies between these methods were found regarding CV (the width of the peak), and S-phase fractions [S%, (S + G2)%]. We therefore conclude that histopathologically normal tissue must first be evaluated by these methods to establish the range of normal values for a certain organ/tissue, before a certain set of values are applied in the clinical situation.

Automation↗

PubMedDate not supplied

Endometrial carcinoma: results of primary surgery on FIGO stages Ia-Ic and predictive value of histopathological parameters.

The aim of the present investigation was to see if alternative histopathological parameters could identify a smaller high risk group than commonly seen using routine histopathological parameters. The material consisted of 150 primary resected patients of FIGO Ia-Ic diagnosed as endometrial carcinoma and 12 cases of atypical hyperplasias which were suspected to contain small areas of carcinoma. The patients were treated from December 1979 to April 1993 at the Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden. Those with deep myometrial invasion (> 50%) were given external radiotherapy (20-30 Gy) postoperatively. The follow-up period ranged from 2.5 to 5 years with 116 patients followed-up for more than 5 years. As no therapy was given before surgery we could investigate histopathologic variables such as degree of differentiation and cytology, number of mitoses per high power field (x 40), nuclear polymorphism, mode of invasion, the extension of myometrial invasion, vessel invasion as well as grade of lymphocyte reaction around the tumour cells. We found the degree of differentiation, vessel invasion, number of mitoses, mode of invasion and cytologic abberation to be significant prognostic parameters. The frequency of deep myometrial invasion (> 50%) was extremly high (51/150 = 33%). However, this usually strong parameter was only significant when comparing stage Ia with Ic. Thus the prognostic capacity of myometrial invasion is diminished in primary hysterectomized patients. In the regression analyses only vascular invasion remained significant. By combining vascular invasion with the degree of differentiation we diminished the high-risk group consisting of candidates for further investigation and treatment. Thus a high risk group consisting of poorly differentiated carcinomas with vascular invasion was constructed comprising 24 of 139 patients with a mortality rate of 60%.

Endometrial Neoplasms↗

PubMedDate not supplied

Endometrial thickness and ovarian cysts as measured by ultrasound in asymptomatic postmenopausal breast cancer patients on various adjuvant treatments including tamoxifen.

Endometrial thickness as measured by ultrasound during tamoxifen treatment has previously been reported. However, there has not been any study investigating endometrial thickness before treatment and following it at regular intervals during treatment. 90 patients with breast cancer without any gynecological symptoms were followed (aged more than 50 years at the operation of their breast cancer). They were investigated by vaginal ultrasound and a common clinical investigation at our out-care patient department. Adjuvant breast cancer therapy consisted of tamoxifen, tamoxifen after radiotherapy and/or in a few cases cytostatics, cytostatics with or without the addition of radiotherapy, radiotherapy or no further therapy. Patients with receptor positive tumours were given tamoxifen. Their endometrium was already thicker before the start of adjuvant treatment as measured by ultrasound. After 3 months and 12 months we found the endometrium to be significantly thicker in those treated with tamoxifen compared to other treatment groups. After 12 months of tamoxifen treatment 22/32 women had an endometrial thickness of 5 mm or more. The frequency of ovarian cysts also seemed to be affected by therapy. In patients treated with tamoxifen alone or in combination, the frequency of cysts was 5/35 before treatment, 6/37 after 3 months, and 0/32 after one year. The corresponding frequencies for those not treated with tamoxifen were 2/20, 3/11 and 3/23 respectively.

Antineoplastic Agents, Hormonal↗

PubMedDate not supplied

Histopathologic findings in thickened endometria, as measured by ultrasound in asymptomatic, postmenopausal breast cancer patients on various adjuvant treatment including tamoxifen.

Pallents with breast cancer exhibit an increased risk of developing cancer from other organs, a risk that might increase due to tamoxifen treatment. This drug has been found to cause activation of oestrogen receptors, leading to oestrogenic effects on the postmenopausal endometrium. We report follow-up of 94 patients with breast cancer without initial symptoms aged more than 50 years at the time of operation. They were followed-up with vaginal ultrasound at regular intervals and endometrial sampling was performed according to treatment after surgery: tamoxifen, tamoxifen in combination with other regimes and without tamoxifen treatment. A large proportion were investigated prior to treatment. We identified endometrial carcinoma, metastasis of breast carcinoma and histopathological changes in 17/67 (25%) of the patients treated with tamoxifen compared to 1/32 in those not treated with tamoxifen.

Breast Neoplasms↗

PubMedDate not supplied

Steroid receptor concentrations as a prognostic factor in atypical endometrial hyperplasia.

Patients with atypical adenomatous hyperplasia run the risk of developing endometrial carcinoma in about 30% of cases, but about 60% normalise without any treatment. High-dose gestagen treatment cures almost 100% but as only 40% need treatment a prognostic factor to identify those at risk would be useful. Using material from 52 patients we investigated whether steroid receptor concentrations could be that factor. However, we could not identify any association between histopathology after a short follow-up and steroid receptor concentrations.

Adenocarcinoma↗

PubMedDate not supplied

Flow cytometry as a prognostic method for the identification of adenomatous hyperplasia at risk of developing endometrial carcinoma.

Patients with atypical adenomatous hyperplasia (AAH), run the risk of developing adenocarcinoma at a frequency of about 30%, while around 60% of patients normalise spontaneously. High dose gestagen treatment cures almost 100% of the patients, but as only 40% need this regimen, prognostic factors to identify those in need of treatment would be useful. We studied 50 patients with AAH and investigated if flow cytometric DNA analysis could serve as a discriminating factor. Number of DNA populations and S-phase fractions (SPF) were identified. Among 50 patients 3 were aneuploid, one of these developed carcinoma. Forty-seven patients were diploid, 12 with a SPF above 7.8, and 35 with lesser value. Seven and one carcinoma developed in the groups, respectively. With our DNA method it was thus possible to identify eight out of nine patients developing endometrial carcinoma. The surveillance group could thus be reduced to 30% using this method, patients in need of hormonal treatment or surgery.

Adenoma↗