Nordic symposium on gynecological oncology, Svalbard, Norway 1990. Consensus statements.
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Biomedical subjects
Publications and source records attributed to E Simonsen.
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A semi-automatic program, designed for non-computer scientists, was developed for quantification of RNA levels detected by in situ hybridization in heterogeneous tissues. A video camera was used to acquire microscopic images of autoradiographed tissue sections which are then digitized on a video monitor for semi-automated quantification of silver grains. We describe a data entry and analysis procedure for systematic quantification of RNA levels in which about 300 cells per tissue sample can be analysed within 10 min. When compared with visual counting, computer-aided quantification was found to be more objective and reliable, with the highest variation coefficient between individuals being 7.5% using computer-aided quantification, compared to 24% with manual counting of the same section areas. A comparative study of c-myc oncogene expression in 11 mammary adenocarcinomas from 3 independent experiments showed the good reproducibility of results using the computer-aided method, with an 18% maximum variation between experiments. The program, with its simple user-interface, reliability and rapidity, is convenient for measuring specific genetic expression levels in clinical studies requiring large numbers of specimens.
A case is presented of extragenital abdominal choriocarcinoma without uterine lesion in a postmenopausal woman. Nineteen years after her antecedent pregnancy, a legal abortion, and thirteen years after her menopause, the patient was admitted to the hospital because of intermittent abdominal pain. Explorative laparotomy revealed a large tumour mass in the greater omentum, mesosigmoideum, peritoneal implants and metastatic growth to the serosal lining of the uterus and the wall of the stomach. Cytoreductive surgery was performed. The histopathological report showed an extrauterine, nongonadal pure choriocarcinoma. Immunoperoxidase stain was strongly positive for hCG and a raised serum beta-hCG level preoperatively confirmed the diagnosis. A polychemotherapy regimen was administered. However, after six months the beta-hCG levels increased rapidly. Liver, lung and mediastinal metastases were diagnosed. The patient's condition rapidly deteriorated and she expired one month later. The post mortem examination showed a far advanced extragonadal pure choriocarcinoma without any obvious primary origin. The implications for a possible origin of extragonadal nongestational choriocarcinoma are briefly discussed.
Early stage poor-risk ovarian cancer patients are at considerable risk for recurrent disease. Adjuvant radio- or chemotherapy has been found to improve disease-free and overall survival. Carboplatin, a second generation platinum, is documented comparable in efficacy to cisplatin in patients with advanced ovarian cancer. The toxicity profile is different from that of cisplatin. Dose-limiting toxicity is myelosuppression. The incidence and grade of renal and neurological toxicity is much lower compared with cisplatin, as is nausea and vomiting. Carboplatin given intraperitoneally (ip) is shown to have a favorable theoretical therapeutic advantage compared with iv administration since the peak peritoneal cavity/peak plasma concentration ratio is 18. Patients with early stage ovarian cancer seem suitable for carboplatin ip treatment. The study was designed to find the maximal tolerated dose (MTD). Three new patients were given two courses at each dose level. The MTD found was confirmed with further patients. Carboplatin was given in 2 liters of glucose via a subcutaneous implantable port without removal of fluid from the cavity. The starting dose was 300 mg/m2. Dose-limiting toxicity was thrombocytopenia and leukopenia. Leukocyte and platelet counts were reconstituted within 28 days in all cases. One case of severe but transient nephrotoxicity was observed. MTD was determined to 500 mg/m2.
A translation of the MCMI-I has been in use in Denmark for some years. An untested assumption in the interpretation of the pattern of test results is that the psychometric characteristics of the Danish and American versions are similar. The purpose of this study was to evaluate the psychometric properties of the questionnaire by using traditional psychometric analysis techniques on the results of a sample consisting of 423 patients and 179 normal controls. Coefficient alpha was calculated for the 20 clinical subscales of the test and the Danish results were strikingly similar to the original coefficients reported by Millon. Furthermore, factor analysis of the subscales showed a factor structure very similar to American findings, and it is concluded that the psychometric properties of the Danish MCMI are not significantly different from the original.
Choriocarcinoma is a rare malignancy in Scandinavia. We present a case of a young primigravida who experienced an uneventful pregnancy and gave birth to a healthy baby. Six days after delivery she underwent neurosurgery for intracranial hemorrhage. Pathological examination of the evacuated hematoma revealed metastatic choriocarcinoma. Further work-up exposed additional metastases in the lungs and liver. The initial serum level of human chorionic gonadotropin (beta-HCG) was 350,000 IU/I. Chemotherapy was given both intravenously and intrathecally. At 10 weeks, beta-HCG had returned to normal. Treatment was continued for another 10 weeks. Two years after cessation of therapy the patient is still in complete remission. In the discussion we review a scoring system to be used in selecting the mode of treatment, and briefly mention diagnosis and prognosis.
We present a 16-year-old girl with vulvar squamous cell carcinoma. The patient initially received a radical treatment because of lymph-node dissemination. However, recurrent disease erupted a little more than one year after the initial treatment, with metastases in the right lung and multiple osteolytic skeletal metastases. Despite aggressive treatments with chemotherapy the patient died about 2 years after the initial diagnosis. An aggressive radical treatment must be chosen for cases of invasive vulvar carcinoma, irrespective of the patient's age.
From 1958 through 1980, 113 women with invasive squamous cell carcinoma of the vulva were treated with vulvectomy. Post-operative irradiation was given with cobalt-60 beam or 10 MV photons from a linear accelerator from anterior fields including the vulva and groins, with the intention of delivering 40-52 Gy with 2-4 Gy/day at a depth of 0.5 cm or 2 cm. The overall corrected five-year survival rate was 68%. The prognosis was shown to worsen significantly with advancing stages (I/96%, II/75%, III/62% and IV/19%), increasing grades (GI/78%, G2/70% and G3/22%) and increasing size of the tumor (T1/90%, T2/71% and T3/37%), as it also did when there were signs of vascular invasion, multifocal tumors or positive nodes in the inguinal regions. Recurrences were diagnoses in 32% of the patients. With the less aggressive surgical approach used, combined with radiation therapy to eradicate subclinical disease, the morbidity rate was acceptable and the survival rate comparable to that reported after more aggressive surgery.
A case of secondary lymphedema of legs and truncus due to cancer colli uteri and treatment is presented. Differential diagnosis and treatment models are suggested.
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Paraffin-embedded curettage material from 120 patients with stage I and II endometrial cancer were analyzed by flow cytometry. The follow-up time in all cases was at least 5 years or until death. It was possible to determine DNA ploidy in 111 cases and S-phase was also evaluated in 92/111 cases. DNA ploidy and S-phase were then compared with the FIGO grading and clinical outcome. DNA ploidy results showed that 11% of grade 1 tumors were aneuploid, 14% of grade 2, 42% of grade 3, and 85% of the cases of uterine papillary serous carcinoma (UPSC) were aneuploid. Patients with tumors that showed an S-phase fraction below 5% had a cumulative 5-year cancer mortality of 7% whereas 49% of the patients with tumors having S-phase fraction above 10% died of their cancer. The prognostic significance of DNA and S-phase correlated fairly well with the FIGO grading as determined by a pathologist with special interest in gynecologic oncology and the DNA parameters added prognostic information independent of the FIGO grading.
Adenoid cystic carcinoma (ACC) is a slow-growing tumor with a marked tendency for perineural and local invasion. The neoplasm occurs more frequently in the head and neck region and only 39 previously described cases of adenoid cystic carcinoma of Bartholin's gland are found in the world literature. Most authors advocate surgery as the primary treatment. Several cytostatic drugs have been tried but the results have been poor. The benefit of radiotherapy in the treatment of this type of tumor is not yet established. This is a report of five new cases all treated with surgery and postoperative radiotherapy. Three patients had histopathologically proven evidence of residual disease after surgery and were subsequently treated with radiotherapy. They are now living without evidence of disease after 28, 51, and 138 months.
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Bartter's syndrome is characterized by chronic hypokalaemia, activation of the renin-angiotensin system and normal blood pressure. To investigate whether a generalized disturbance of sodium-potassium pump function might be of pathogenetic importance, lymphocytic sodium-potassium homeostasis was examined in 5 patients suffering from Bartter's syndrome. Two of the patients were treated with potassium chloride supplementation, the others were without medical treatment when studied. All were severely hypokalemic (serum potassium 2.8 +/- 0.24 mmol/l, mean +/- SEM). Lymphocyte sodium and potassium concentration (14.4 +/- 0.37 and 94.4 +/- 7.7 mmol/l, respectively), ouabain sensitive 22Na-efflux rate constant (2.68 +/- 0.25 h), and absolute ouabain sensitive efflux rate (38.16 +/- 4.2 mmol l-1 h) did not differ from matched controls. Ouabain binding capacity was 126 900 +/- 23 500 sites/cell in patients vs 50 400 +/- 17 900 in controls (p less than 0.05). In conclusion, patients with Bartter's syndrome may have an intrinsic abnormal pump function, characterized by an increased pump density and a low cation turn-over rate per pump unit.
278 patients with either stage I or II endometrial carcinoma treated between January 1979 and January 1982 were reviewed, particularly as regards certain prognostic factors. Uterine papillary serous carcinoma (UPSC), FIGO grade 3, nuclear grade 3, and age were the major independent prognostic factors. UPSC was diagnosed in 8% of the patients. The cancer mortality in the non-UPSC group was 7%, vs. 41% in the UPSC group. In the latter group all the deaths occurred within 2 1/2 years. Poorly differentiated non-UPSC had the same cancer death rate as UPSC, but usually had a completely different histological pattern. There was no significant difference in survival between stage I and stage II when corrected for FIGO grade and nuclear grade.
Neoplastic lesions of the vagina account for 1% of all gynecologic malignancies. The overall 5-year survival rate for this disease is poor. This study comprised 58 patients with diagnosis of squamous cell carcinoma of the vagina treated between 1960 and 1984. Median age at diagnosis was 70 years. The lesions were staged according to FIGO. The numbers of patients in various stages were: I/13, II/24, III/12 and IV/9 and according to histologic differentiation: low grade/11, medium grade/17 and high grade/25; not recorded, 5. Twenty patients were treated with primary surgery and irradiation, 30 were treated with intracavitary and/or external irradiation only. The 5-year corrected survival rates were: St I/50%, St II/30%, St III/17% and St IV/10%; grade I/57%, grade 2/32% and grade 3/17%, younger than 70 years of age/43% and older than or 70 years of age/21%. The incidence of rectovaginal or vesicovaginal fistulas amounted to 17%. The treatment results of primary carcinoma of the vagina are poor. Prognostic factors for survival should be considered at treatment planning.
Tumor growth in the pelvis with nerve involvement causes severe pain which is notoriously resistant to pharmacological treatment. Chordotomy is a classical method for the relief of pain. This is a retrospective study of 24 chordotomy cases, operated on at the department of Neurosurgery, and independently evaluated at the department of Gynecologic Oncology. Initially 19 patients (79%) were painfree whereas 4 patients (17%) had only moderate or no relief following the operation (one not evaluable). 10 patients remained free of pain until death. There were no serious complications. Possible causes of pain relapse are analysed. We conclude that chordotomy is worth consideration when facing severe pelvic cancer pain.
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