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D F Roses

Publications and source records attributed to D F Roses.

At least 55 records · Page 3Linked to original sources
PubMed1991

Volume of malignant melanoma is superior to thickness as a prognostic indicator. Preliminary observation.

There are many clinical and histologic factors that are known to be valuable in predicting survival rates for patients with cutaneous malignant melanomas. Breslow thickness is considered to be the most reliable prognostic factor; however, thickness is a unidimensional measurement. A more accurate mensuration to predict biologic behavior might be one that takes into account the three-dimensional volume of the neoplasm. In a study of 35 primary malignant melanomas, the volumes of the dermal components of the tumors were calculated. Those patients with tumor volumes of 200 mm3 or less had a 91.4% 5-year disease-free survival rate, compared with survival rate of only 16.7% for those patients whose lesions had tumor volumes exceeding 200 mm3. On multivariate analysis, tumor volume exceeded thickness as a prognostic indicator. Thus, measurement of tumor volume proved to be of greater significance than thickness in predicting the outcome for patients with malignant melanomas.

Humans↗
PubMed1991

Survival with regional and distant metastases from cutaneous malignant melanoma.

The clinical course of 312 consecutive patients after initial presentation with metastatic melanoma, 165 of whom presented with regional metastases at cutaneous or subcutaneous, or both, nodal sites and 147 with metastases at distant sites, was reviewed. The five year survival rate for regional metastases was 43.4 per cent compared with a five year survival rate for distant metastases of 4.9 per cent (p less than 0.0001). Favorable prognostic variables for survival from first regional metastases included primary melanoma sites on the extremities compared with the head, neck and trunk (p = 0.043) and a disease-free interval of more than one year from primary surgical treatment to regional metastases (p = 0.0058). Favorable prognostic variables for survival from the first distant metastasis included a disease-free interval of more than one year from primary surgical treatment to distant metastases (p = 0.0092), the type of resection of metastatic disease (p = 0.00027) and the addition of systemic immunotherapy (p = 0.0011). Forty-nine patients with totally resectable distant metastases had a five year survival rate from the treatment of the initial metastasis of 13.1 per cent, whereas 33 patients having palliative resections had a five year survival rate of 7.5 per cent. All 165 patients who did not have resection for distant metastases died within five years. The results of our experience support therapeutic efforts to ablate both regional and distant metastases of malignant melanoma when feasible.

Adult↗
PubMed1991

Flow cytometric analysis of DNA ploidy and S-phase fraction in breast cancer using cells obtained by ex vivo fine-needle aspiration: an optimal method for sample collection.

A total of 203 primary invasive breast cancers were sampled by ex vivo fine-needle aspiration (FNA), directly yielding adequate single cell suspensions for flow cytometric DNA analysis in 194 (96%). Labor-intensive and time-consuming steps of mechanical and enzymatic cellular disaggregation required by the use of fresh, frozen, or paraffin-embedded tissue were avoided, thereby minimizing preparation time. Conservation of tumor tissue allowed for the sampling of very small breast cancers. DNA ploidy and S-phase fraction data were comparable to flow cytometric data reported in other breast cancer studies using various sampling methods. Ex vivo FNA is the easiest and fastest method for sampling breast cancers for flow cytometric DNA analysis.

Biopsy, Needle↗
PubMed1990

Invasive papillary carcinoma of the breast: mammographic appearance.

The mammographic findings in 18 patients with invasive papillary carcinoma were studied retrospectively. The mammograms of 10 patients showed a multinodular pattern, and seven patients had solitary nodules. One patient had an irregular, ill-defined mass in the retroareolar region. Two patients were found to have carcinoma in the contralateral breast, and two patients had intraductal carcinoma adjacent to the invasive papillary carcinoma. The varied mammographic features that may occur with this rare breast malignancy are discussed.

Aged↗
PubMed1990

Thoracotomy for metastatic malignant melanoma of the lung.

The outcome of 29 patients who underwent lung resection for treatment of metastatic malignant melanoma from January 1976 to November 1988 was studied. Twenty-two patients underwent total resection for cure of all apparent metastatic disease, whereas seven patients did not undergo total resection. Of the 22 patients who underwent curative resection, the median survival was 11 months, with a 2-year survival of 13.6% and a 5-year survival of 4.5%. Four patients who underwent curative resection are currently alive and free of disease, with one patient surviving more than 10 years. The patients who underwent palliative resection had a median survival of 5 months, only one patient living longer than 10 months. The difference in survival of the patients who underwent curative resection compared with palliative resection was statistically significant. The thickness of the primary cutaneous malignant melanoma, the presence of regional lymph node metastases, the disease-free interval from primary diagnosis to metastatic pulmonary disease, and whether one or two metastatic nodules were removed during curative lung resection were not statistically significant in altering survival. These results demonstrate that although prolonged survival for metastatic melanoma is rare, lung resection in selected patients may be associated with long-term survival.

Adult↗
PubMed1990

Calcifications of the breast after reduction mammoplasty.

Mammograms of 152 patients after mammoplasty were studied and 37 patients were noted to have calcifications. The pattern of these calcifications was studied to determine if specific characteristics could be identified. The calcifications were found to occur within the skin of the breast, mainly at a periareolar location. The ability to identify these benign calcifications further aids in reliably monitoring patients by mammography after reduction mammoplasty.

Adult↗
PubMed1989

Primary hyperparathyroidism associated with two enlarged parathyroid glands.

An increasingly recognized although small percentage of patients with primary hyperparathyroidism have enlargement of two parathyroid glands. We have treated nine patients with primary hyperparathyroidism associated with such double parathyroid gland enlargement. In four of these patients, marked asymmetry of the two enlarged glands was noted and the failure to recognize and excise a second enlarged parathyroid gland resulted in persistent or recurrent hyperparathyroidism. In one of these patients, the second enlargement was present in a super-numerary mediastinal gland. The subsequent excision of the second enlarged parathyroid gland resulted in normocalcemia in each instance. This contrasts with five patients in whom initial excision of two enlarged glands resulted in normocalcemia with no recurrence of hypercalcemia. Only three patients fulfilled the histologic criteria of true double adenomas. The remainder showed multiglandular hypercellularity. This experience supports identifying all parathyroid glands and recognizing that even minimal enlargement of a gland may be important pathophysiologically, regardless of its histopathologic classification. Excision of both enlarged glands, even if asymmetric, is appropriate.

Adult↗
PubMed1989

Circumscribed intraductal carcinoma of the breast.

In a retrospective evaluation of 350 cases of proved intraductal carcinoma detected over a 3-year period, 13 had mammographic features similar to those of benign tumors. The carcinomas were sharply circumscribed, round or oval lesions that contained microcalcifications. These calcifications were smaller and more likely to be asymmetrically located within the nodule than those of the fibroadenomas that they mimicked. While the carcinomas appeared circumscribed on mammograms, microinvasion of surrounding tissue was proved histologically in five of 13 cases, and in another case biopsy revealed metastasis to an axillary lymph node. Although these carcinomas are relatively rare, mammographic detection is important as none were palpable at the time of diagnosis.

Breast Neoplasms↗
PubMed1989

Differentiation of radial scar from scirrhous carcinoma of the breast: mammographic-pathologic correlation.

Radial scar, a sclerosing ductal breast lesion characterized by an irregular stellate pattern of epithelial proliferation around a central fibroelastic core, may be confused histologically with scirrhous carcinoma of the breast. Mammographic features used to distinguish these two entities were found unreliable in a retrospective review of 255 consecutive stellate lesions. Of 73 nonpalpable carcinomas, fourteen (19%) had radiographic features of radial scar. Only the presence of microcalcifications in 11 of those patients helped the authors distinguish carcinoma from radial scars. Four of nine biopsy-proved radial scars had a dense central region, simulating the appearance of scirrhous carcinoma. Stellate lesions with radiolucent centers should be considered suggestive of carcinoma, particularly if associated with microcalcifications.

Adenocarcinoma, Scirrhous↗
PubMed1989

Mammographic detection of carcinoma of the breast in patients with augmentation prostheses.

Evaluation of 85 patients who had augmentation mammaplasty with low-dose mammography detected microcalcifications in two patients. Both patients had biopsies that confirmed a diagnosis of intraductal carcinoma. A third patient with microcalcifications and a positive family history for carcinoma of the breast was found to have sclerosing adenosis. A fibroadenoma was visualized by mammography in a group of ten patients who were referred for the presence of palpable nodules of the breast. The remainder of the nodules were found to be related to the augmentation procedure.

Adult↗
PubMed1989

The use of preoperative localization of adenomas of the parathyroid glands by thallium-technetium subtraction scintigraphy, high-resolution ultrasonography and computed tomography.

Thirty-six patients with primary hyperparathyroidism were studied preoperatively by thallium-201 and technetium-99m pertechnetate subtraction (Tl-201/Tc-99m) scintigraphy, high-resolution real time ultrasonography and computed tomographic (CT) scanning. None of the patients had had previous surgical treatment of the parathyroid or thyroid glands. All of the patients underwent systematic bilateral exploration of the neck. All of the patients were successfully explored and 41 abnormal parathyroid glands were identified. Five patients had two adenomas. In six instances, adenomas were identified in ectopic anatomic sites. The sensitivity of correctly localizing the abnormal glands with these techniques was 49 per cent for the Tl-201/Tc-99m scintigraphy, 34 per cent for ultrasonography and 41 per cent for CT scanning. The Tl-201/Tc-99m scintigrams detected two of the six ectopically located adenomas, CT detected one, while ultrasound detected none. The five patients with multiple adenomas were not accurately identified as having multiple gland enlargement by any of these studies. Therefore, preoperative localization studies with these three techniques did not provide reliable information for initial bilateral exploration of the neck.

Adenoma↗
PubMed1988

Immunogenicity of a polyvalent melanoma antigen vaccine in humans.

Fifty-five patients with Stage II (36 patients) or Stage III (19 patients) malignant melanoma confirmed histologically received adjuvant immunotherapy with a polyvalent melanoma antigen vaccine to evaluate toxicity and immunogenicity. There was no toxicity. Antibody and/or cellular immune responses to melanoma were induced more frequently in Stage II (36 patients [69%]) than Stage III (19 patients [53%]) disease. The ability of different immunization schedules, alum, or pretreatment with low-dose cyclophosphamide to potentiate immunogenicity was compared after 2 months of immunization. Immunization biweekly with a fixed intermediate dose of vaccine was more immunogenic than immunization weekly with escalating vaccine doses. Alum increased the intensity of cellular responses slightly, whereas pretreatment with cyclophosphamide augmented both the incidence and intensity of cellular immune responses slightly. However, these changes did not reach statistical significance. There was a reciprocal relationship between the induction of humoral and cellular immune responses. These results show that (1) active immunotherapy with a polyvalent melanoma vaccine is safe in patients with minimal disease, (2) the vaccine augments immunity to melanoma in many, but not all, patients, and (3) several immunization strategies failed to potentiate immunogenicity significantly.

Adult↗
PubMed1988

Differentiation of postsurgical changes from carcinoma of the breast.

Evaluation of 486 consecutive mammograms with biopsy and excision scars revealed 25 with spiculated radiodensities on mammography. Of these 25 patients, 17 were diagnosed as having benign scars, based upon the appearance of a central lucency, representing fat in the central portion of the spiculated radiodensity. Seven patients were diagnosed as having carcinoma by the absence of lucency in the radiodensity at a biopsy or excision site.

Adult↗
PubMed1987

Prognostic index for malignant melanoma.

This report verifies the ability of a Prognostic Index (PI) to accurately predict 5-year survival rates for 879 Stage I cutaneous malignant melanoma (MM) patients seen at New York University Medical Center. The PI used in this study was first reported from Munich, West Germany, and is calculated from standard histologic sections by multiplying the MM thickness in millimeters (Breslow method) by the number of MM mitoses per square millimeter. A PI value of less than 19 versus greater than or equal to 19 was found to be a significant and independent prognostic variable for Stage I MM when compared with seven other predictive variables (including Breslow thickness). These PI intervals identified a subgroup of patients with MM of intermediate thicknesses (1.50-3.49 mm) whose significantly worse survival would not have been anticipated if prognosis were determined by Breslow thickness alone. For example, patients with MM 1.50 to 2.49 mm thick have a 5-year survival rate of 84.1% determined by Breslow thickness alone; however, among these patients exists a subgroup with PI greater than or equal to 19 whose survival rate is only 57.6%. This study verifies the additive usefulness of the PI in predicting survival rates of patients with Stage I cutaneous MM.

Age Factors↗
PubMed1986

Familial malignant melanoma.

Characteristics associated with familial compared with nonfamilial malignant melanoma were assessed. These data were obtained from consecutive prospectively completed questionnaires on 1169 cases of cutaneous malignant melanoma. Of these, 69 patients indicated a positive family history for this cancer. Among the various clinical and histological variables compared, those that significantly correlated with the familial occurrence of malignant melanoma include younger age at first diagnosis, smaller diameter of the lesion, lower Clark level, decreased frequency of nonmelanoma skin cancer, and reduced prevalence of noncutaneous cancer. Increased awareness of malignant melanoma among family members could account for some of these observations. Identification of the familial variety of malignant melanoma has practical implications concerning early detection and prompt intervention.

Age Factors↗
PubMed1986

Influence of anatomic location on prognosis of malignant melanoma: attempt to verify the BANS model.

Stage I cutaneous malignant melanomas between 0.76 and 1.69 mm thick (Breslow measurement) in BANS (upper part of the back, posterior aspects of the arms, posterior and lateral aspects of the neck, posterior aspect of the scalp) areas have been reported to portend a relatively poor prognosis compared to non-BANS sites. We were unable to confirm the 15% poorer survival for BANS area lesions (84% BANS, 99% non-BANS) originally reported. In this report of 211 patients, malignant melanomas in BANS sites had a 4.6% poorer 5-year cumulative survival rate (88.9% BANS, 93.5% non-BANS; p = 0.35). Although many more patients need to be studied, we believe this small difference in survival is insufficient to influence therapeutic management strategies.

Adult↗
PubMed1986

Surgical treatment of dermatofibrosarcoma protuberans.

The clinical course and histopathologic factors of 50 consecutive patients treated for dermatofibrosarcoma protuberans were reviewed. Forty-eight patients were observed until the present time or death. No patient had distant metastases develop, although 16 patients had 18 recurrences of the dermatofibrosarcoma protuberans at the site of initial therapy. There was no correlation between the diameter of the primary lesion and the incidence of recurrence. There was no correlation between the histologic pattern of invasion and recurrence. However, a trend toward decreasing recurrence was noted with increasing minimal margins of resections (41 per cent less than 2 centimeters versus 24 per cent greater than or equal to 2 centimeters). The lowest incidence of recurrence (20 per cent) was noted with minimal margins of resection greater than or equal to 3 centimeters. Five year recurrence free survival rates increased with increasing margins of resection--59 per cent less than 1 centimeter; 66 per cent greater than or equal to 1 centimeter; 70 per cent greater than or equal to 2 centimeters, and 80 per cent greater than or equal to 3 centimeters. No patient had distant metastases and no change in histologic pattern was noted with progressive local recurrence.

Adolescent↗