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Biomedical subjects

G G Kenter

Publications and source records attributed to G G Kenter.

52 records · Page 3Linked to original sources
PubMed1994

Unique combination of an ovarian gonadoblastoma, dysgerminoma, and mucinous cystadenoma in a patient with Turner's syndrome: a cytogenetic and molecular analysis.

Phenotypically female patients with a (mosaic) XY karyotype are at high risk to develop gonadoblastoma with potential progression to dysgerminoma. We studied a Turner's syndrome patient with a composite ovarian neoplasm of a gonadoblastoma, a dysgerminoma, and a mucinous cystadenoma. Nonradioactive in situ hybridization showed that the patient had a XO/XY genotype with deletion of part of Yq. Molecular analysis located the chromosomal breakpoint in deletion interval 6, indicating that potential genes responsible for the development of gonadoblastoma may be located on the short arm of the Y chromosome or on the long arm, centromeric of deletion interval 6. Moreover, using the XO/XY mosaicism as a clonal marker, the dysgerminoma and the mucinous cystadenoma were shown to be of independent origin. Therefore, in this case, we find support for the hypothesis that mucinous cysts with gastrointestinal epithelium can be of ovarian surface epithelial cell origin. This case also demonstrated that the occurrence of a composite tumor does not unequivocally imply that both components are of the same origin. Clonal analysis is required to determine the relation of the tumor constituents.

Adult↗
PubMed1993

Human papillomavirus type 16 in tumor tissue of low-stage squamous carcinoma of the uterine cervix in relation to ploidy grade and prognosis.

BACKGROUND: The relationship among the presence of human papillomavirus (HPV) in tumor cells, DNA ploidy, and the prognosis of squamous cell carcinoma of the uterine cervix was studied. METHODS: HPV 16 was detected using the polymerase chain reaction on paraffin-embedded material from 69 patients with Stage IB and IIA carcinoma of the uterine cervix. The presence or absence of HPV was related to age, survival, and ploidy status as measured by DNA flow cytometry. All patients were treated by radical surgery. RESULTS: Thirty-four patients had HPV 16, and 35 did not. The mean age of the patients differed statistically significantly between the HPV-positive group (51.1 years) and the HPV-negative group (45.1 years, P = 0.015). No difference was found in the mean DNA index (1.21 versus 1.22, P = 0.85) or 5-year survival rate (85% versus 86%, P = 0.87) between the two groups. CONCLUSIONS: The high prevalence of HPV 16 in cervical cancer, which appeared to be correlated with age (in combination with its presence in diploid and aneuploid tumors), indicated the important role of HPV 16 in the evolution of cervical cancer. However, using stepwise Cox regression analysis, the presence of HPV 16 had no additional prognostic value over lymph node metastases findings.

Adult↗
PubMed1992

[Morbidity and results of 100 radical hysterectomies performed in an oncology center].

One hundred consecutive radical hysterectomies performed in a Dutch oncology centre during a five and a half year period between 1984 and 1990, were analysed. The operations were performed in a uniform manner by the same three surgeons. Surgical mortality was nil. Mean operating time was 4 hours and mean blood loss amounted to 1200 ml. One patient developed a vesicovaginal fistula. Long lasting urinary symptoms occurred in 32% of patients, sex problems in 13%. The latter situation was encountered significantly more frequently when surgery was combined with radiotherapy. Eighty-two of the 100 patients had a primary cervical carcinoma and were analysed further. Distribution according to stage was as follows: stage IA: 3, IB: 64, IIA: 13, IIB: 2. Postoperative external and intracavitary pelvic radiation was given in 34 patients (41%). Three-year survival of these patients amounted to 86%. One-third of patients had a large primary tumour (diameter greater than 4 cm). Three-year survival rate in this subgroup of patients was 78%. Lymph node metastases were found in 14 patients (17%). Three-year survival rates for patients with and without lymph node metastases were 64% and 94%, respectively (p less than 0.0001). Results and complications of this series were compared with the current literature data and found to be comparable and sometimes even better than recent literature data. These findings may serve to advocate further centralisation of this kind of surgery in oncological centres in the Netherlands.

Adolescent↗
PubMed1990

DNA ploidy level as prognostic factor in low stage carcinoma of the uterine cervix.

Flow cytometry was used to measure DNA content of tumor cells in paraffin-embedded archival material from 89 patients with squamous cell carcinoma of the cervix uteri stages IB and IIA. Patients were all treated with radical hysterectomy and transperitoneal lymphadenectomy. Twenty-four percent received radiotherapy postoperatively because of tumor spread into parametria or positive lymph nodes. Ploidy grade was compared to other prognostic factors. DNA-aneuploidy was seen in 44 (49%), DNA-diploidy in 16 (18%) and 29 (33%) of the tumors were DNA-periploid. Sixty-nine (78%) patients were in FIGO stage IB, 20 (22%) in IIA. In 19 (21%) lymph node metastases were found, vasoinvasion in 25 (28%). Overall disease-specific 5-year survival was 80%. There was a significant effect of positive lymph nodes (90% vs 47%) and vasoinvasion (87% vs 64%) on the 5-year survival (resp. P less than 0.01 and P = 0.02). No correlation was found between stage (81% for IB vs 80% for IIA) or DNA-ploidy grade (81% for aneuploidy, 82% for periploidy, 79% for diploidy) and survival (resp. P = 0.9 and P = 0.8). Ploidy grade was equally divided over other prognostic factors. In stepwise Cox regression analysis DNA-ploidy grade showed no independent effect on survival. We conclude that DNA flow cytometry in this material was of no additional prognostic value.

DNA, Neoplasm↗
PubMed1989

Carcinoma of the uterine cervix stage I and IIA: results of surgical treatment: complications, recurrence and survival.

Between 1967 and 1981, 213 patients with carcinoma of the uterine cervix Stage I and IIA underwent an abdominovaginal radical hysterectomy with transperitoneal lymphadenectomy. In 1987 the overall 5-year survival rate was 87.5% and the 10-year survival 85%. Recurrences were seen in 29 patients (13.7%). Lymph node metastases occurred in 39 patients (18%). Five-year survival decreased from 94% without positive nodes to 65% with positive nodes. The median blood loss was 2100 cc. Fistulas were seen in 6.7% of the patients. Long-term voiding problems were encountered in 40.8%. In 25% of the women intercourse was impeded postoperatively because of shortening of the vagina. The results obtained with this type of radical surgery in cervical cancer Stages I-IIA are good and do not differ from other methods reported in the literature. However this also means that this more difficult and time-consuming approach does not improve survival rates. For this reason there are no reasons to change from the Wertheim operation to this combined approach.

Adult↗
PubMed1988

Low stage invasive carcinoma of the uterine cervix stage I-IIA morphological prognostic factors.

Histological material was reviewed from the 213 patients who had undergone radical surgery for carcinoma of the uterine cervix stage I and IIA between 1967 and 1981. Squamous carcinoma was found in 179 patients (84.7%). In 39 patients (18%) there were lymph node metastases and in nine (4.2%) tumor spread into the parametrium. Vaso-invasion was present in 49 patients (22%). Prognostic factors were studied by Cox's regression analysis. Lymph node metastases and vaso-invasion were both found to be significantly related to survival rate (P = 0.0001 and P = 0.0008). Stage, cell type, differentiation and invasion depth were of no prognostic importance.

Adenocarcinoma↗
PubMedDate not supplied

A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.

Surgical damage to the pelvic autonomic nerves during radical hysterectomy is thought to be responsible for considerable morbidity, i.e., impaired bladder function, defecation problems, and sexual dysfunction. Previous anatomical studies and detailed study of surgical techniques in various Japanese oncology centers demonstrated that the anatomy of the pelvic autonomic nerve plexus permits a systematic surgical approach to preserve these nerves during radical hysterectomy without compromising radicality. We introduced elements of the Japanese nerve-preserving techniques and carried out a feasibility study in ten consecutive Dutch patients. The technique involved three steps: first, the identification and preservation of the hypogastric nerve in a loose tissue sheath underneath the ureter and lateral to the sacro-uterine ligaments; second, the inferior hypogastric plexus in the parametrium is lateralized and avoided during parametrial transsection; third, the most distal part of the inferior hypogastric plexus is preserved during the dissection of the posterior part of the vesico-uterine ligament. The clinical study showed that the procedure is feasible and safe, except possibly when used with very obese patients and patients with broad, bulky tumors. Surgical preservation of the pelvic autonomic nerves in radical hysterectomy deserves consideration in the quest to improve both cure and quality of life in cervical cancer patients.

Adenocarcinoma↗
PubMedDate not supplied

Surgical treatment of low stage cervical carcinoma: back to the old days?

Radical hysterectomies for the treatment of cervical carcinoma are being performed laparoscopically by some surgeons. Others combine the laparoscopic lymphadenectomy with a radical vaginal hysterectomy or a radical trachelectomy, like in the Schauta procedure. In this way the procedure resembles the AVRUEL-procedure (Abdominal Vaginal Radical Uterus Extirpation with transperitoneal Lymphadenectomy), as developed in 1957 by Sindram who combined the Wertheim and the Schauta procedure together with abdominal lymphadenectomy in one single operation. Because of the high complication rate in the form of voiding problems and sexual impairment caused by the Schauta part, this operation is no longer performed. In order to pay attention to the morbidity associated in the past with the combined abdomino-vaginal approach compared to the single abdominal approach, we reassembled the data of several large Dutch centers where patients were treated either by the AVRUEL or the abdominal radical hysterectomy. A total of 730 patients underwent an AVRUEL procedure, all carried out between 1957 and 1981. Fistulas occurred in 57 patients (7.8%), long-term urologic complications in 233 patients (32%), and sexual dysfunction in 71 (9.7%) were found. A total of 928 patients underwent an abdominal radical hysterectomy, of whom in 511 cases the complication rates have been described. Twelve fistulas occurred (2%), long-term micturition problems in 55 (10%), and sexual problems in 11 (2%). There was no difference in 5-year survival rates in both groups. From the above-mentioned data it is clear, that returning to the old days in terms of a re-introduction of the Schauta procedure is not to be preferred. In order to conclude if the laparoscopically assisted radical vaginal hysterectomy or the trachelectomy are an improvement, they should be carried out according to clearly defined prospective protocols in which data can be compared to those of other techniques with special attention to late complications including micturition and sexual sequelae.

Adult↗
PubMedDate not supplied

Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions.

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified.

Age Distribution↗
PubMedDate not supplied

Detection of T helper responses, but not of human papillomavirus-specific cytotoxic T lymphocyte responses, after peptide vaccination of patients with cervical carcinoma.

Human papillomavirus type 16 (HPV16)-encoded E7 oncoprotein is constitutively expressed in cervical carcinoma cells and is required for cellular transformation to be maintained. The E7 protein, therefore, forms an attractive target for T-cell-mediated immune intervention to prevent or treat HPV16+ tumors. The authors performed a peptide-based phase I/II vaccination trial to induce anti-tumor immune responses in patients with recurrent or residual cervical carcinoma. Fifteen HLA-A*0201+ patients with HPV16+ cervical carcinoma received vaccinations with synthetic peptides representing 2 HPV16 E7-encoded, HLA-A*0201-restricted cytotoxic T lymphocyte epitopes and a pan-HLA-DR-binding T-helper epitope, PADRE, in adjuvant. No signs of toxicity were observed. Two patients had stable disease for more than 1 year after vaccination, 3 patients died of the disease during or shortly after the vaccination period, and 10 patients maintained progressive cervical carcinoma. Specific immune responses directed against the vaccine components were analyzed in peripheral blood samples. No cytotoxic T lymphocyte responses against the HPV16 E7 peptides were detectable. After vaccination, strong PADRE helper peptide-specific proliferation was detected in 4 of 12 patients. In conclusion, peptide vaccination with 2 HPV16 E7 cytotoxic T lymphocyte epitopes and a universal T helper epitope is well tolerated by patients with advanced cervical carcinoma. Despite a reduction of in vitro cytolytic or proliferative recall responses to some, but not all, conventional antigens in this patient group, peptide-specific proliferative responses were induced in 4 patients. Based on the current study, it is now feasible to perform peptide vaccination in earlier stages of HPV16-induced cervical disease.

Adult↗
PubMedDate not supplied

An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer.

The objective of this study was to evaluate the problems with miction, defecation, and sexuality after a radical hysterectomy with or without adjuvant radiotherapy for the treatment of cervical cancer stage I-IIA. This study included an observational longitudinal study of self-reported bladder, defecation, and sexual problems with a baseline score. Ninety-four women were included in the study. An age-matched control group consisted of 224 women. The patients showed significantly more negative effects on sexual function compared with both the controls and their situation before the treatment throughout 24 months of follow-up. The problems included less lubrication, a narrow and short vagina, senseless areas around the labia, dyspareunia, and sexual dissatisfaction. Up to 12 months after the treatment, the patients complained significantly more of little or no urge to urinate and diarrhea as compared with the controls. Adjuvant radiotherapy did not increase the risk of bladder dysfunction, colorectal motility disorders, and sexual functions. We conclude that a radical hysterectomy for the treatment of early-stage cervical carcinoma is associated with adverse effects mainly on sexual functioning.

Adult↗
PubMedDate not supplied

Efficacy of screening women at high risk of hereditary ovarian cancer: results of an 11-year cohort study.

The outcome of screening and prophylactic surgery in 269 women at high risk of hereditary ovarian cancer is reported. Screening was performed using transvaginal ultrasound and serum CA125 testing. Mean follow-up was 26 months (583 person-years). A total of 113 (42%) of 269 women had a pathogenic BRCA1 or BRCA2 mutation, and 127 (47%) of 269 women underwent salpingo-oophorectomy. No occult cancers were found. In eight women having both elevated CA125 levels and abnormal ultrasound findings, a malignancy was found. Four of these cancers (one borderline, one stage Ia, one stage IIIb, and one stage IIIc ovarian or peritoneal cancer) were detected at the first screening visit. One stage IIIb and one stage IIIc cancer were detected at the second screening visit after 12 months, and two interval stage IIIc and IV cancers were detected 8 and 10 months after the first screening visit. No peritoneal carcinoma was found among those 114 women who underwent bilateral salpingo-oophorectomy with normal or benign pathology results, after a mean follow-up of 16 months (152 person-years). We conclude that the efficacy of screening women at high risk of ovarian cancer seems poor because the majority of cancers were detected at an advanced stage.

Adult↗
PubMedDate not supplied

Postoperative radiation therapy improves prognosis in patients with adverse risk factors in localized, early-stage cervical cancer: a retrospective comparative study.

The objective of this study was to assess the role of postoperative radiotherapy (RT) in early-stage cervical carcinoma with risk factors other than positive nodes, parametrial invasion, or positive margins and to compare outcomes using the Leiden University Medical Center (LUMC) modification of the Gynecologic Oncology Group (GOG) system with the GOG prognostic scoring system itself. Between January 1984 and April 2005, 402 patients with early-stage cervical cancer underwent radical hysterectomy. A total of 51 patients (13%) had two of the three risk factors and had pathologic tumor size (> or =40 mm), invasion (> or =15 mm), and capillary lymphatic space involvement, and were identified as the so-called high-risk (HR). We compared 34 patients who received RT based on the LUMC risk profile (67%) with 17 who did not (33%). The GOG score was calculated as well. We compared the GOG scores within the LUMC risk groups: HR+ (two out of three risk factors) and HR- (less than two out of three risk factors). Differences in 5-year cancer-specific survival (CSS) and 5-year disease-free survival (DFS) between the HR group treated with RT (86%, 85%) and without RT (57%; 43%) were statistically significant. The LUMC criteria did not significantly differ from the GOG risk profile, concerning recurrence, CSS, and DFS. HR patients benefit from adjuvant RT. The LUMC modification of the GOG system seems to be simpler and has a slightly higher threshold for the indication for RT but without a difference in outcome.

Adult↗
PubMedDate not supplied

Value of Cyfra 21-1, TPA, and SCC-Ag in predicting extracervical disease and prognosis in cervical cancer.

BACKGROUND: The value of serum Cyfra 21-1 level was compared with tissue polypeptide antigen (TPA), and squamous cell carcinoma antigen (SCC-Ag) in squamous cell cervical cancer. MATERIALS AND METHODS: Pre- and post-treatment serum levels of patients were compared with lymph node status, parametrial involvement, and prognostic data. RESULTS: Pretreatment serum levels of each marker were significantly related to tumor stage, tumor size and the presence of either lymph node metastases or parametrial involvement. The clinical performance of each marker in predicting extracervical disease at initial diagnosis appeared to be similar. None of these tests achieved the conditions of a perfect test. Pretreatment serum levels of each marker showed prognostic value in the univariate analysis. The clinical performance of post-treatment SCC-Ag levels in predicting complete remission versus the presence of tumor during follow-up was better than Cyfra 21-1 or TPA. CONCLUSION: SCC-Ag appears to be more useful than Cyfra 21-1 for monitoring patients with cervical cancer.

Antigens, Neoplasm↗