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H Beerman

Publications and source records attributed to H Beerman.

At least 19 recordsLinked to original sources
PubMed1997

Accuracy of the Jamshidi trocar biopsy in the diagnosis of bone tumors.

Obtaining a histologic diagnosis is crucial in patients presenting with a tumor or a tumorous condition of the bone. The incisional surgical and the closed trocar biopsy are the most frequently used techniques for obtaining a representative tissue sample for histologic evaluation. This study reports on the reliability of 270 Jamshidi trocar biopsies performed on 258 patients with osseous tumors and tumorlike lesions. All patients were evaluated clinically and radiographically by a team consisting of an orthopaedic surgeon, a radiologist, and a surgical pathologist. In nearly all cases the biopsy and the resection were performed by the same orthopaedic surgeon. The biopsy site was determined in accordance with the planned subsequent resection surgery. Overall, an accurate diagnosis could be reached in 90.7% of the total number of 270 Jamshidi biopsies and in 95% of the 258 patients. The failure rate of the 270 biopsies was 9.3%. No specific contraindications with regard to the kind of lesion were found. Except for the pelvis, the localization of the lesion did not influence the rate of success. The high accuracy of the trocar biopsy, combined with the advantages of this technique over the incisional surgical biopsy, makes it a safe, fast, and adequate technique for obtaining a histologic sample of a bone tumor.

Adolescent↗
PubMed1996

[Follow-up not according to guidelines after an abnormal cervix smear].

OBJECTIVE: To investigate whether the recommendations for the follow-up after a positive cervical smear test, made within the Dutch national screening programme on cervical cancer, are followed in practice. DESIGN: Descriptive. SETTING: The Rotterdam Municipal Health Services Area. METHOD: All cytological and clinical-histological findings on women who had a Pap smear of at least Pap class IIIA in the period 1989-1991, were collected from the Pathological Anatomical National Automised Archives (PALGA). Per smear test result, the cervix-cytological and histological examinations that took place after the screening programme were arranged in order of occurrence. RESULTS: 61% of the women with Pap class IIIA had been followed according to the recommendations, in 12% no follow-up had been done. Repeat cytology was often done much later than after three months as recommended. After Pap class IIIB, IV or V smear test outcome the recommendations were followed in respectively over half, about three-quarters, and all cases. In 9% of women with Pap class IIIB or IV, no follow-up was recorded in the PALGA data base. CONCLUSION: Often, the recommendations for follow-up after a positive smear were followed poorly. Further research into the problems in the follow-up route is necessary.

Continuity of Patient Care↗
PubMed1996

Isolated liver perfusion with mitomycin C in the treatment of colorectal cancer metastases confined to the liver.

We evaluated the technical feasibility of isolated liver perfusion (ILP) in the treatment of patients with colorectal cancer metastases confined to the liver, and investigated whether ILP allows exposure of the tumor to high concentrations of mitomycin C (MMC). Furthermore, survival time and tumor response were studied. Nine patients were treated with 30 mg/m2 MMC recirculated for one hour in the isolated circuit. The MMC concentration in the perfusate and plasma was measured using a high-performance liquid chromatography assay. All complications directly related to the surgical procedure were treated effectively (no mortality). The peak concentration of MMC in the perfusate was 5 to 11 times higher than that measured in the plasma of patients treated with 20 to 60 mg/m2 MMC i.v., and the concentration remained significantly higher during the whole perfusion period. In contrast, the peak concentration of MMC in plasma was approximately two thirds of the lowest peak plasma level measured after i.v. administration of 10 mg/m2 MMC. No systemic toxicity was observed in any of our patients. However, four patients developed veno-occlusive disease of the liver which was mild in three but lethal in one. One of the eight evaluable patients had an objective complete response (25 months), one an objective partial response and five others a clear reduction in tumor size (25-50%). The median survival time was 17 months. This study demonstrates that ILP is technically feasible in patients, and in comparison with systemic therapy allows exposure of hepatic metastases to much higher concentrations of MMC, while systemic toxicity is absent. Remarkably, this single exposure to a high concentration of MMC resulted in a complete response and a median survival time comparable to that in recently published hepatic artery infusion studies with floxuridine and leucovorin. However, due to the hepatotoxicity we are continuing our studies with melphalan to further exploit the possible therapeutic benefit of ILP.

Adult↗
PubMed1994

Results of curettage for postmenopausal vaginal bleeding in women treated with tamoxifen and megestrol acetate for progressive metastatic breast carcinoma.

Tamoxifen and megestrol acetate are used as a hormonal treatment for metastatic breast carcinoma. It is suggested that the use of tamoxifen may induce endometrial cancer. In this article we describe nine patients under hormonal treatment for metastatic breast cancer with, firstly, tamoxifen and, later, megestrol acetate. These nine patients all had symptoms of postmenopausal vaginal blood loss during therapy with megestrol acetate, an indication to perform a diagnostic dilatation and curettage. By histopathological examination the curettings showed a decidualized stroma with an infiltration of lymphocytes, some plasma cells and many eosinophils. In none of the patients was atypical hyperplasia or malignancy found. The dilatation and curettage had also a therapeutic effect, since only one of the patients still had complaints, while the other eight did not complain of postmenopausal bleeding again. We review the literature and discuss the value of a diagnostic dilatation and curettage.

Adult↗
PubMed1993

High levels of DNA index heterogeneity in advanced breast carcinomas. Evidence for DNA ploidy differences between lymphatic and hematogenous metastases.

BACKGROUND: The aim of this study was to investigate DNA ploidy status and DNA index heterogeneity of lymphatic and hematogenous metastases of advanced breast carcinomas and the relations among the various tumor sites. METHODS: DNA ploidy status was analyzed by flow cytometry on frozen and paraffin-embedded tissue blocks taken from primary and metastatic tumor sites in 18 patients with advanced breast cancer. RESULTS: Presumably because of the extensive sampling, high percentages of DNA aneuploidy, DNA multiploidy, and DNA index heterogeneity were found in primary breast carcinomas as well as in lymph node and distant metastases. DNA aneuploid tumor stemlines were frequently accompanied by DNA diploid tumor stemlines. Most of the DNA tumor stemlines found in the primary tumors recurred in lymph node (55%) and distant (59%) metastases, even after 17 years of relapse-free survival. DNA tumor stemlines found in distant metastases, however, often differed from those in lymph node metastases (61%). CONCLUSIONS: A marked DNA index heterogeneity can be found in primary and metastatic tumor sites when appropriate sampling is applied. There were no DNA ploidy subclasses, notably absent in either type of metastasis, indicating similar metastatic capacities of both DNA aneuploid and DNA diploid tumor stemlines in advanced breast carcinomas. The difference in DNA ploidy status between lymphatic and hematogenous metastases suggest that these metastases can be generated independently.

Adult↗
PubMed1991

Flow cytometric analysis of DNA stemline heterogeneity in primary and metastatic breast cancer.

Flow cytometric DNA-ploidy analysis was used to investigate intratumor DNA stemline heterogeneity in primary breast carcinomas and lymph node metastases (LNM). The study was done in tumor specimens from 44 patients 35 of whom had LNM. In all, measurements were done in 214 different samples of primary tumors and 211 lymph nodes. Sixty-one percent (27/44) of the primary tumors were found to have multiple DNA aneuploid stemlines when the data of the separate samples per tumor (mean 4.9) were compared. Only five of 44 (11%) primary tumors were DNA diploid; two of these had DNA aneuploid metastases. Statistical analysis of these results indicated that, on average, four samples are needed for reliable determination of the DNA ploidy status of primary tumors by flow cytometry. In the majority of the cases (26/35), distinct tumor DNA stemlines found in LNM were also present in the primary tumor, which suggests that the generation of DNA ploidy diversity may have taken place prior to metastasis. Multiploidy was not related to tumor size but, particularly for LNM, was significantly correlated with age (r = 0.40, P = 0.02). The results of this study support the view that breast cancer is an extremely heterogeneous disease and that underestimation of this factor might account for the disagreement in literature about the prognostic value of DNA ploidy determinations.

Adenocarcinoma, Mucinous↗
PubMed1991

DNA ploidy of primary breast cancer and local recurrence after breast-conserving therapy.

The value of DNA-flow cytometry and clinico-pathological prognostic factors for the prediction of local recurrences after breast-conserving therapy (BCT) were evaluated in a retrospective study. Thirty-one patients with a local recurrence were compared with 31 matched patients without a local recurrence. Morphology and DNA-indices of the local recurrences and their corresponding primary tumours were compared. Ductal carcinoma in situ was present significantly more often in the group with a primary recurring tumour, than in the matched group (P less than 0.001), and the same holds for lobular carcinoma (n = 5). Half of the tumours that recurred had macroscopically positive surgical margins compared to about one-fourth of the matched group. Fifty-six per cent of the DNA-aneuploid stemlines in cases with local recurrence were present in the corresponding primary tumour as well (confidence limits 45%-75%), an indication that the majority of local recurrences are true recurrences and not independently developed tumours. The lack of similarity of DNA stemlines between some primary DNA-aneuploid tumours and their local recurrences indicates that these tumours had developed independently. The percentage of DNA-aneuploid cases in the group with local recurrence (89%) did not differ significantly from that in the matched group (70%). However, the findings suggest a selective recurrence of DNA-diploid stemlines. This might indicate increased resistance of DNA-diploid tumour cells to radiotherapy as compared with the resistance level in DNA-aneuploid cells.

Aneuploidy↗
PubMed1991

Flow cytometric and histomorphometric analysis of limitations of clinical breast cytomorphometry.

The clinical value and limitations of a previously described cytomorphometric method, based on nuclear size and anisonucleosis, for evaluation of routine fine-needle aspiration of the breast were assessed in a series of 313 histologically investigated primary breast lesions. Limitations were analyzed by histomorphometry and DNA flow cytometry in 116 consecutive cases of histologically confirmed breast carcinoma. Eighty per cent of histologically proven malignant tumours were classified cytomorphometrically as malignant and no false-positive results were encountered. For benign lesions a benign cytomorphometric classification was reached in 66% of the cases. Histomorphometry showed that on the whole the assignment of histologically malignant tumours to a non-malignant cytomorphometric classification was determined by smaller nuclei and not by sampling error. Tumours assigned to a malignant cytomorphometric classification had on average significantly higher DNA indices than did tumours not assigned to a malignant cytomorphometric classification (P less than 0.001). The mean-nuclear areas in cytomorphometry and histomorphometry were strongly correlated with DNA indices indicated by DNA flow cytometry (P less than 0.001 for both). The present findings show that this cytomorphometric method is appropriate for routine quality control of a cytological diagnosis of malignancy in FNA of the breast. However, an inconclusive result in 15-25% of the tumours is inevitable.

Aneuploidy↗
PubMed1991

Cytomorphometry as quality control for fine needle aspiration. A study in 321 breast lesions.

Material collected by fine needle aspiration (FNA) in 321 histologically examined primary breast lesions of previously untreated patients was analyzed by morphometry. The mean nuclear area (MNA) and its standard deviation (SD) were calculated for 50 cells in each case. Four subclasses were defined on the basis of the MNA and SD: benign (less than 10% probability of malignancy), doubtful benign (10% to 49%), doubtful malignant (50% to 90%) and malignant (greater than 90% probability of malignancy). FNA samples showing signs of acute inflammation or only apocrine metaplastic cells were not suitable for analysis by this morphometric method and were excluded. In 274 (85.4%) of the cases, the measurements allowed a definite morphometric conclusion, with predictive values of 99.5% and 100% for the histologically malignant and benign aspirates, respectively. The probability of malignancy in the doubtful malignant group was almost 86%. The morphometric method described is quick, easy to perform and well suited for use in routine daily practice; furthermore, it does not require expensive equipment. The ease of the technique and its high predictive value make this method appropriate for use as a quality control procedure in FNA cytology.

Biopsy, Needle↗
PubMed1990

Prognostic significance of DNA-ploidy in a series of 690 primary breast cancer patients.

Flow cytometric DNA-ploidy measurements were performed on paraffin-embedded and fresh tumor specimens from 690 patients with Stage I-III breast cancer. The conventional classification of DNA-ploidy (diploid versus aneuploid) was compared with a division of tumor ploidy into 5 classes based on DNA index (DI) range. The DI-classification showed a better correlation with tumor size and TNM stage than the conventional classification. Aneuploidy was associated with an impaired survival and distant relapse-free survival (p = 0.02) but the DI-classification improved the discrimination between different prognostic groups of patients. In general, this indicated a more aggressive phenotype for tumors evolved via polyploidization. Hyper-tetraploidy (DI greater than 2.10) indicated a very poor prognosis in pre-menopausal patients. No prognostic effect of aneuploidy and DI-class was found in node-negative and TI patients. Cox multivariate regression analysis showed that aneuploidy was an additional prognostic factor to nodal status (I less than or equal to N less than or equal to 3, N greater than 3 vs. N = 0) and tumor size (T2-4 vs. TI) for overall and distant relapse-free survival. Subdivision according to DI-class did not improve the prognostic power of DNA-ploidy due to stronger correlations with established prognostic factors.

Aged↗
PubMed1988

Intrathecal morphine and clonidine for control of intractable cancer pain. A case report.

The use of intrathecal clonidine, in combination with intrathecal morphine, for the treatment of a patient with intractable cancer pain is reported. The addition of clonidine overcame the problem of tolerance to the analgesic effects of morphine alone. The patient was maintained pain free for three months, without complications, until his death. At autopsy, no evidence of neurotoxicity associated with the prolonged intrathecal administration of clonidine and morphine was found.

Carcinoma, Renal Cell↗
PubMed1984

Malignant pilomatricoma.

An 86-year-old man had a tumor in the right posterior cervical region. The lesion showed histopathologic features of pilomatricoma but differed from that lesion by the presence of cytologically atypical cells and focal squamoid differentiation. The term "malignant pilomatricoma" is suggested for this tumor.

Aged↗