PubMed Health⌕ Search

Biomedical subjects

J R Karlen

Publications and source records attributed to J R Karlen.

10 recordsLinked to original sources
PubMed1996

Dermatofibrosarcoma protuberans of the vulva. A case report.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a cutaneous malignancy that is uncommon anywhere on the body but is especially uncommon on the vulva. This cancer rarely metastasizes but has a high incidence of local recurrence because of its tendency to grow in fingerlike projections away from the primary tumor. CASE: A 36-year-old, black woman was the 10th and youngest patient with DFSP of the vulva to be reported. Treatment of the 5-cm, mobile, well-circumscribed lesion consisted of local excision. Several adjacent microscopic lesions showing DFSP were found in the pathologic specimen, however, so an even wider excision was performed. Twenty-seven months following removal, there was no evidence of recurrence. CONCLUSION: Survival rates for DFSP of the skin range from 91% to 100% in reported series, but local recurrence rates of 20-49% have also been noted. The reported deaths from the disease have resulted from extensive local spread due to inadequate excision and, only rarely, metastases. Because DFSP tends to spread to microscopic projections away from the visible lesions, very wide local excision is required for tumor control.

Adult↗
PubMed1995

Carcinoma of the endometrium.

Carcinoma of the endometrium is the most common gynecologic malignancy. The majority of women present with stage I disease, and the most common presenting symptom is postmenopausal bleeding. Early detection of endometrial cancer is important, because up to 90 percent of patients with stage I disease can be successfully treated. Certain risk factors, such as obesity, hypertension and diabetes mellitus, are associated with the development of this malignancy. Office endometrial sampling has a sensitivity of up to 97 percent for diagnosing carcinoma of the endometrium and can often eliminate the need for dilatation and curettage. Endometrial cancer is treated by total abdominal hysterectomy, bilateral salpingo-oophorectomy and, in many cases, postoperative radiation therapy.

Endometrial Neoplasms↗
PubMed1983

The multidisciplinary team approach to exenteration of the pelvis.

The experience of a newly formed, multidisciplinary, pelvic exenteration team is presented which consists of a gynecologic oncologist, a general surgeon and a urologist. The first 20 exenterations performed by this team are reviewed. Nine patients had no postoperative problems, and of the 11 patients who did have complications, all but two, which resulted in death, were corrected without resultant debilitation. Fourteen of the 18 patients who survived the operation are tumor-free for as long as three years postoperatively. Operative proficiency as well as operative mortality and morbidity have certainly improved quite significantly as the team has gained experience.

Adult↗
PubMed1979

Dysgerminoma associated with pregnancy.

From a review of 26 reported case (our case being the 27th) of dysgerminoma associated with pregnancy, several salient facts are evident. Torsion and incarceration are common among these rapidly enlarging tumors. Obstetrical complications occurred in nearly half and fetal demise in one quarter of the reviewed cases. Our case was typical of patients presenting with this vexed problems: The patient was under 25 (as were 70%); nulliparous (as were 67%); and the tumor appeared confined to one ovary (as in 89%). Authorities are in dispute as to the treatment of stage IA dysgerminomas, and the association of pregnancy complicates this debate even further. The results of conservative treatment in this series were jarring: There were recurrences in 30% of the 23 stage IA tumors, and the recurrences were all following unilateral oophorectomy. In our case, the grossly normal contralateral ovary was infiltrated with dysgerminoma cells. While treatment of a young woman with a dysgerminoma of 1 ovary is a matter of perplexity, we believe that a unilateral operation should be limited to those women who desire above all earthly things to retain their childbearing capacity.

Adult↗
PubMed1976

Treatment, results and prognostic factors in stage I and II sarcomas of the corpus uteri.

One-hundred and four cases of Stage I and II uterine sarcomas treated at Rosewell Park Memorial Institute over a 27 year period are reviewed. Included are 30 cases of mixed mesodermal tumor, 27 cases of carcinosarcoma, 25 cases of endometrial stromal sarcoma, and 22 cases of leiomyosarcoma. Prognostic factors were found to include histologic classification, stage, uterine size, depth of myometrial invasion, and type of treatment. Endometrial stromal sarcomas had the best over-all prognosis. Radiation therapy alone was inadequate treatment, but was of adjunctive value to surgery in terms of increasing survival and decreasing pelvic recurrences in patients with endometrial stromal sarcoma, mixed mesodermal tumor, and carcinosarcoma. Patients with leiomyosarcoma did not benefit from adjunctive radiation therapy.

Adult↗
PubMed1975

Melanoma of the vulva.

Twenty-three cases of malignant melanoma of the vulva recorded at Roswell Park Memorial Institute over a 36-year period have been reviewed. The findings confirm those of earlier series that these lesions tend to occur in postmenopausal Caucasians and most commonly originate on the labia minora and clitoris. Twenty of 23 patients were treated with therapy more conservative than radical vulvectomy and regional node dissection, with a resultant 25% 5-year survival and 10% 10-year survival among eligible patients. The fact that 12 of 14 recurrences surgical removal of these structures; No patient in this series with a lesion greater than 2 cm or with clinically positive groin nodes survived 5 years. According to the literature, very few patients with groin node involvement have survived, even with radical surgical therapy, and a combination of therapeutic modalities in treating these patients is recommended.

Adult↗