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J P Koulos

Publications and source records attributed to J P Koulos.

15 recordsLinked to original sources
PubMed1997

Adenocarcinoma of the cervix. Expression and clinical significance of estrogen and progesterone receptors.

BACKGROUND: Although hormone receptor status is an important prognostic indicator in adenocarcinoma of the breast and the endometrium, few studies have investigated the expression and clinical significance of estrogen receptor (ER) and progesterone receptor (PgR) in adenocarcinoma of the cervix. METHODS: ER and PgR expression were determined using an immunohistochemical method in 84 cervical adenocarcinomas. Clinical features and outcome were determined by chart review. RESULTS: ER was identified in 17 of the 84 cases (20%). ER positivity was most frequently detected in mucinous adenocarcinoma of the endocervical type (in 11 of 48 cases) and endometrioid adenocarcinoma (in 4 of 10 cases). PgR was identified in 23 of the 84 cases (27%). PgR positivity was also most frequently detected in mucinous adenocarcinoma of the endocervical type (in 15 of 48 cases) and endometrioid adenocarcinoma (in 6 of 10 cases). Mucinous adenocarcinoma of the intestinal type (five cases), glassy cell carcinoma (two cases), and clear cell adenocarcinoma (two cases) were uniformly negative for both ER and PgR. No association was detected between International Federation of Gynecology and Obstetrics stage and receptor status, but there was a somewhat lower frequency of ER positivity in poorly differentiated tumors (P = 0.07). No association was detected between PgR status and disease free survival. Similarly, no association between ER status and overall survival was observed. Although ER positive tumors may be associated with longer disease free survival than ER negative tumors, this difference did not reach statistical significance in this study (P = 0.06). CONCLUSIONS: ER and PgR positivity were found in 20% and 27%, respectively, of primary cervical adenocarcinomas. However, receptor status was not significantly associated with either overall survival or disease free survival.

Adenocarcinoma↗
PubMed1997

Measuring cervical ectopy: direct visual assessment versus computerized planimetry.

OBJECTIVE: Cervical ectopy has been identified as a possible risk factor for heterosexual transmission of human immunodeficiency virus. To accurately assess the importance of cervical ectopy, methods for measuring ectopy with precision need to be developed. The objective of this study was to evaluate the reliability of two methods of measuring cervical ectopy: direct visual assessment and computerized planimetry. STUDY DESIGN: Cervical photographs of 85 women without cervical disease were assessed for cervical ectopy by three raters using direct visual assessment and a computer planimetry method. Agreement between the two methods, among the three raters, and among measurements by each rater over time was calculated with use of intraclass correlation coefficients, where 1.0 represents perfect agreement and 0 represents no agreement except by chance. RESULTS: The intraclass correlation coefficient among the three raters (interrater agreement) was 0.58 for direct visual assessment without application of acetic acid to the cervix compared with 0.72 for direct visual assessment with acetic acid and 0.82 for computerized planimetry with acetic acid. The intraclass correlation coefficient among measurements by each rater over time (intrarater agreement) was 0.66 for direct visual assessment without acetic acid compared with 0.77 for direct visual assessment and 0.83 for computerized planimetry after application of acetic acid. When acetic acid was used, the intraclass correlation coefficient between the two methods was 0.69. CONCLUSIONS: Computerized planimetry of cervical photographs may provide the most consistent estimate of the percent of ectopy. However, if time and resources make the use of computer planimetry difficult, direct visual assessment after application of 5% acetic acid appears to provide comparable estimates.

Cervix Uteri↗
PubMed1996

Invasive vulvar carcinoma in two women infected with human immunodeficiency virus.

This report presents two HIV-infected women who developed invasive squamous cell carcinoma of the vulva. One patient was diagnosed with Stage II vulvar cancer 4 years after surgical excision of VIN. This patient underwent a hemivulvectomy and external-beam radiation therapy, but has subsequently developed recurrent vulvar cancer. The other patient was diagnosed with stage IV invasive vulvar cancer 1 year after the diagnosis of VIN and died of invasive vulvar cancer 11 months later. VIN should be considered a serious condition in HIV-infected women and clinicians should be careful to examine the vulva and perianal region in all HIV-infected women.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Evaluation of the Hybrid Capture human papillomavirus deoxyribonucleic acid detection test.

OBJECTIVE: Our purpose was to evaluate the sensitivity and accuracy of a new, nonradioactive human papillomavirus deoxyribonucleic acid detection method. STUDY DESIGN: Cervical samples from 520 women were assayed for human papillomavirus deoxyribonucleic acid with both the Hybrid Capture test and polymerase chain reaction. RESULTS: Human papillomavirus deoxyribonucleic acid was detected with Hybrid Capture in 106 (42%) of 254 samples from women with no evidence of cervical intraepithelial neoplasia and 211 (79%) of 266 with cervical intraepithelial lesions or cervical cancer. There was a good correlation between Hybrid Capture and polymerase chain reaction. Hybrid Capture correctly identified 92% of samples found to contain a human papillomavirus type with a high or intermediate oncogenic risk with polymerase chain reaction. Although Hybrid Capture can quantify the amount of human papillomavirus deoxyribonucleic acid present in a sample, no correlation was observed between the relative amount of human papillomavirus deoxyribonucleic acid detected with Hybrid Capture and the grade of cervical lesion. CONCLUSION: The Hybrid Capture test is a sensitive and accurate method for identifying human papillomavirus types of high and intermediate oncogenic risk in clinical specimens.

Cervix Uteri↗
PubMed1993

Relationships between c-Ki-ras mutations, HPV types, and prognostic indicators in invasive endocervical adenocarcinomas.

OBJECTIVE: Ras gene mutations have been identified in squamous cell carcinomas of the cervix and are associated with advanced-stage tumors. The current study was designed to determine the prevalence of c-Ki-ras mutations in invasive endocervical adenocarcinomas and associations between mutations, HPV status, and known prognostic indicators. METHODS: Paraffin-embedded tissue samples from 32 cases of invasive adenocarcinoma of the endocervix were analyzed for the presence of c-Ki-ras mutations by amplification of DNA extracted from paraffin blocks using the polymerase chain reaction (PCR) and subsequent restriction enzyme digestion of the amplimers. This method allows detection of aspartic acid mutations of the c-Ki-ras gene at codons 12 and 13. Samples were also analyzed for the presence of HPV DNA using PCR and either "consensus sequence" primers or "type-specific" primers for HPVs 16 and 18. Patients' charts were reviewed for clinical information and correlations between clinical outcome and known prognostic indicators and the presence of c-Ki-ras mutations was assessed. RESULTS: c-Ki-ras codon 12 mutations were detected in only 4 of the 32 cases (12.5%) of invasive endocervical adenocarcinomas examined. No codon 13 mutations were detected. Fifty-nine percent of the cases were HPV 16 or HPV 18 DNA positive and only 1 of the 4 cases with a codon 12 mutation was associated with HPV 16 or HPV 18. There were no significant associations between stage or grade of tumor or outcome and the presence of codon 12 mutations. However, using the observed survival as computed by the Berkson Gage Method at 12 months, the estimated median survival for patients with c-Ki-ras codon 12 mutations is 29 months compared to 68 months for patients lacking codon 12 mutations. CONCLUSIONS: These results indicate that c-Ki-ras codons 12 and 13 mutations are uncommon in invasive endocervical adenocarcinomas.

Adenocarcinoma↗
PubMed1992

Localization of cellular retinoid-binding proteins in human cervical intraepithelial neoplasia and invasive carcinoma.

Cellular retinoic acid-binding protein (CRABP) and cellular retinol-binding protein (CRBP) were localized in biopsies of normal squamous epithelium, cervical intraepithelial neoplasia (CIN), and invasive squamous cell cancer of the cervix uteri by immunohistochemistry. In both the normal stratified squamous epithelium of the exocervix and low-grade CIN, CRABP I was present predominantly in the basal layer of the epithelium. The more superficial, differentiated cell layers lacked immunoreactive protein. In high-grade CIN (CIN2-3), the distribution of CRABP I was altered. Immunoreactive CRABP I was detected in all layers of high-grade CIN. In squamous cell carcinoma of the cervix, CRABP I was detected in cells throughout the tumor but was minimal in cells demonstrating squamous differentiation. In contrast to CRABP I, CRBP was diffusely present throughout the cervical epithelium irrespective of the state of differentiation or the presence of disease.

Adolescent↗
PubMed1989

Immature teratoma of the ovary.

Twenty-five cases of patients with pure immature teratoma of the ovary, accrued from the Connecticut Tumor Registry from 1969 to 1984, were reviewed. Two patients had grade 1 tumors, twelve had grade 2 tumors, and eleven had grade 3 tumors. The majority of patients (23) were stage I at the time of initial surgery. Twenty-one of the twenty-three patients were treated with some form of unilateral adnexal surgery with or without adjuvant combination chemotherapy (VAC). Two of the twenty-three patients were treated with total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) with the addition of either VAC chemotherapy or radiation therapy. Recurrence occurred in two patients, both of whom had grade 3 tumors and were subsequently treated with surgical resection plus VAC chemotherapy. One patient, who recurred after initial therapy with unilateral salpingo-oophorectomy (USO) plus VAC chemotherapy, was successfully treated with surgical resection and further chemotherapy. Two patients were stage III at the time of initial surgery, one of whom was treated with USO plus adjuvant combination chemotherapy and radio-therapy. The other patient was treated with TAH/BSO plus VAC chemotherapy. In our series, no patient died from immature teratoma (one patient died from advanced breast carcinoma). It is reasonable to withhold chemotherapy from patients with stage I, grade 1 and 2, immature teratoma which may be treated initially with conservative surgery. The risk of recurrence in patients with grade 3 tumors warrants the addition of further chemotherapy.

Adolescent↗
PubMed1989

Molar pregnancy coexisting with a normal fetus: a case report.

Molar pregnancy with a coexisting live fetus is a rare occurrence. We present morphologic and cytogenetic analysis of a recent case. Cytogenetic studies revealed a 46, XX karyotype for the fetus, the normal placenta, and the abnormal placenta. Chromosome banding studies confirmed the presence of maternal and paternal chromosomes in all three tissues. These studies favored the possibility that both tumor and fetus arose from a single gestation. Subsequently, the patient required chemotherapy for low-risk, metastatic trophoblastic disease.

Adult↗
PubMed1989

Dysgerminoma: a study of 13 cases from the Connecticut Tumor Registry.

Thirteen cases of patients with dysgerminoma of the ovary, accrued from the Connecticut Tumor Registry from 1974-84, were reviewed. Seven of the 13 patients were stage I at the time of initial surgery. Two of these patients had a diagnosis of dysgerminoma arising within a gonadoblastoma. Five of the seven patients were treated with some form of adnexal surgery; one patient received adjuvant combination chemotherapy consisting of vincristine, dactinomycin, and cyclophosphamide (VAC) and another received radiation therapy. Two of the seven patients were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) plus radiation therapy. One patient, whose tumor recurred after initial therapy with unilateral oophorectomy, was successfully treated with radiation therapy. Six patients had advanced disease at the time of initial surgery. One patient with stage II disease and three patients with stage III disease were treated with TAH/BSO plus radiation therapy. One patient with stage III disease was treated with unilateral adnexectomy plus combination chemotherapy consisting of vinblastine, bleomycin, dactinomycin, cyclophosphamide, and cisplatin (VAB-VI). One patient with stage IV disease was treated with decompressive laminectomy with tumor resection, removal of left pelvic mass, radiation therapy and adjuvant combination chemotherapy (VAC). In our series, no patient died from dysgerminoma (one patient died of an apparently unrelated cause). The role of radiation therapy in the treatment of advanced and recurrent dysgerminoma has been demonstrated. However, the use of combination chemotherapy has been playing an increasingly important role in patients treated with conservative surgery in which preservation of fertility is a concern.

Adolescent↗
PubMed1987

The role of second-look laparotomy in treatment of epithelial ovarian cancer.

Forty-two patients underwent a second-look laparotomy to assess response to systemic chemotherapy for epithelial ovarian cancer. In 20 cases the operation showed no histologic evidence of disease. None of these cases received additional treatment at the time of negative second-look laparotomy. There has only been one recurrence noted in an average follow-up interval of 38.5 months. The remaining 22 cases did have residual carcinoma and 16 have developed progressive carcinoma despite secondary treatment. We found second-look laparotomy to be a safe and reliable assessment tool. However, we could not demonstrate a medical benefit from the procedure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Clear-cell adenocarcinoma of the lower genital tract: Memorial Hospital 1974-1984.

Seventeen previously unreported cases of clear-cell adenocarcinoma originating in the vagina (13) and cervix (four) are presented. The mean age of the patients was 23.6 years. Four patients with cervical tumors and four patients with vaginal tumors underwent radical hysterectomy, bilateral pelvic lymphadenectomy, and partial vaginectomy. A total vaginectomy, with replacement of the excised vagina with a split-thickness skin graft or a segment of sigmoid colon, was added to the above procedure in five patients with vaginal cancer. In four patients, definitive treatment was radiation. All of the patients in the present series are without evidence of disease, with follow-up ranging from 21 months to more than ten years.

Adenocarcinoma↗
PubMed1985

Cell surface antigens of human trophoblast and choriocarcinoma defined by monoclonal antibodies.

Six distinct cell surface antigens of human trophoblast and choriocarcinoma were defined with MAbs. The distribution of the antigens was determined by MHA assays on 150 tumor cell lines and normal cell cultures and by immunofluorescence tests with a wide range of normal adult and fetal tissues and a tumor panel. Antigen LK26 is expressed on all cultured choriocarcinoma, teratocarcinoma and renal cancer lines but is absent from most cell lines derived from other tumor types and from cultures of normal kidney epithelium and fibroblasts. LK26 expression in normal tissues is restricted to the trophoblast. No other adult or fetal tissue was found to express the antigen, but choriocarcinoma and teratocarcinoma tissues were LK26+. SV19 is expressed on cultured choriocarcinomas and teratocarcinomas and on subsets of breast and colon cancer lines, but not on 120 additional cultures tested. In tissues, SV19 is detected in normal placenta, mammary gland and colon epithelium as well as in tumors of breast, colon and lung. Two antibodies, AbSV63 and AbK8, react with PLAP and AbSV63 also reacts with the intestinal form of the enzyme. AbLK24 defines a heat-stable determinant present on choriocarcinoma and breast cancer cell lines but absent from most other cultured cells. It is expressed on a small range of normal and malignant epithelial tissues, including normal trophoblast, normal breast epithelium and urothelium and tumors derived from these tissues. One antigen, K66, showed a wide distribution on cultured epithelial cells but was not found in any normal or malignant tissue. Finally, S4, a previously described marker of normal and malignant kidney epithelial cells, was also expressed on the choriocarcinoma cell lines. Four of the antigens are glycoproteins that could be immunoprecipitated from radiolabelled extracts of choriocarcinoma cells: LK26 (Mr 35,000), SV19 (Mr 40,000), PLAP (Mr 68,000) and S4 (Mr 160,000). The highly restricted distribution of LK26, SV19, S4, and PLAP in normal tissues and their expression in tumors make these antigens potential diagnostic markers of gestational choriocarcinoma and germ-cell tumors and, possibly, targets for immunotherapy.

Alkaline Phosphatase↗