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J Tennvall

Publications and source records attributed to J Tennvall.

At least 55 records · Page 3Linked to original sources
PubMed1992

Thallium-technetium subtraction scintigraphy of enlarged parathyroid glands after calcitonin stimulation of parathyroid hormone secretion.

To improve the sensitivity of thallium-technetium subtraction scintigraphy for preoperative localization procedure of enlarged parathyroid glands in primary hyperparathyroidism, we administered calcitonin intramuscularly 4 hours before the scintigraphy in 14 consecutive patients. Injection of calcitonin reduced plasma levels of ionized calcium from 1.47 +/- 0.10 mmol/l to 1.41 +/- 0.09 mmol/l (p less than 0.01). Concomitantly, serum levels of intact parathyroid hormone increased from 6.4 +/- 2.5 pmol/l to 7.9 +/- 2.6 pmol/l (p less than 0.001). The scintigram after calcitonin injection visualized 11 adenomas (sensitivity 78%) compared to only 9 (sensitivity 64%) in conventional scintigrams. In addition, 5 of the adenomas were more distinctly imaged in the scintigram after calcitonin injection, whereas in only one patient was the conventional scintigram better. Thus, the calcitonin injection improved the scintigram in 7 cases and was inferior in only one case (p = 0.031). We conclude that stimulation of parathyroid hormone secretion with calcitonin results in a better preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism.

Adenoma↗
PubMed1992

Moderately differentiated neuroendocrine carcinoma (atypical carcinoid) of the supraglottic larynx. A report of two cases including immunohistochemistry and aspiration cytology.

Moderately differentiated neuroendocrine carcinoma of the larynx is morphologically distinct from the classic carcinoid and small-cell carcinoma. It is composed of medium to large polyhedral cells with an insular, trabecular, or acinar growth pattern, variable pleomorphism, and a tendency to metastasize to skin and bone. We describe the clinicopathological features of the tumor in two patients in whom tumor dissemination resulted in death 13 and 33 months after diagnosis. Both tumors occurred above the glottis and metastasized to bone but not to regional tissues. In one case, the diagnosis was confirmed when the aspiration cytological specimen from a rib lesion suggested a neuroendocrine carcinoma resembling medullary thyroid cancer (triangular cytoplasm, double nuclei, and fine red cytoplasmic granules on May-Grünwald-Giemsa staining). Both tumors were originally misdiagnosed as squamous cell carcinoma, as acinic cell cancer, or as suggesting metastasis of melanoma. Immunohistochemistry gave strong reactivity in both for chromogranin A and calcitonin, although the serum level of calcitonin, determined in one case, was normal.

Aged↗
PubMed1991

Cancer risks in thyroid cancer patients.

Cancer risks were studied in 834 thyroid cancer patients given 131I (4,551 MBq, average) and in 1,121 patients treated by other means in Sweden between 1950 and 1975. Record-linkage with the Swedish Cancer Register identified 99 new cancers more than 2 years after 131I therapy [standardised incidence ratio (SIR) = 1.43; 95% confidence interval (CI) 1.17-1.75] vs 122 (SIR = 1.19; 95% CI 0.88-1.42) in patients not receiving 131I. In females treated with 131I overall SIR was 1.45 (95% CI 1.14-1.83) and significantly elevated were noted for tumours of the salivary glands, genital organs, kidney and adrenal gland. No elevated risk of a subsequent breast cancer or leukaemia was noted. SIR did not change over time, arguing against a strong radiation effect of 131I. Organs that were estimated to have received more than 1.0 Gy had together a significantly increased risk of a subsequent cancer following 131I treatment (SIR = 2.59; n = 18). A significant trend was seen for increasing activities of 131I with highest risk for patients exposed to greater than or equal to 3,664 MBq (SIR = 1.80; 95% CI 1.20-2.58). No specific cancer or group of cancers could be convincingly linked to high-dose 131I exposures since SIR did not increase after 10 years of observation. However, upper confidence intervals could not exclude levels of risk that would be predicted based on data from the study of atomic bomb survivors. We conclude that the current practice of extrapolating the effects of high-dose exposures to lower-dose situations is unlikely to seriously underestimate radiation hazards for low LET radiation.

Female↗
PubMed1991

Induction chemotherapy (cisplatin + 5-fluorouracil) and radiotherapy in advanced squamous cell carcinoma of the head and neck.

A phase II study was made of 58 consecutive patients with previously untreated locally advanced squamous cell carcinomas of the head and neck. The induction chemotherapy consisted of 3 courses of cisplatin (100 mg/m2) and a subsequent 120-h infusion of 5-fluorouracil (1,000 mg/m2/24 h) repeated every 3 weeks. It was followed by radiotherapy to a median target dose of 66 Gy and surgery for residual tumour. A total of 91 per cent received all 3 courses of chemotherapy, which was well tolerated. Complete response (CR) was obtained in 20 patients (35%) after chemotherapy and in 40 patients (69%) after subsequent radiotherapy. The median observation time was 28 months (range 15-57). The actuarial survival at 2 years for complete responders to chemotherapy was 83 per cent, implying a prolonged survival (p = 0.002) compared to those with less than CR. Complete responders after chemotherapy had also a significantly longer recurrence-free survival, though 19 out of 20 did not undergo surgery. Complete response after this induction therapy is thus an important prognostic predictor.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Cisplatin and 5-FU combined with radiotherapy and surgery in the treatment of squamous cell carcinoma of the esophagus. Palliative effects and tumor response.

The combination of cisplatin (90-120 mg/m2) and 5-fluorouracil (5-FU) (1,000 mg/m2/day in continuous infusion for five days) was given for 2-3 cycles, prior to combined radiotherapy and surgery, to 73 patients with esophageal squamous cell carcinoma, 60 with limited disease (LD), and 13 with extensive disease (ED) (i.e. with metastasis) of whom 3 had recurrent disease. Before preoperative radiotherapy among 60 LD patients, 12 (20%) had complete response, 21 (35%) partial response, 25 (42%) had stable disease, and 2 (3%) progressive disease. Swallowing was improved in 35/73 (48%) of the cases. In the resected specimens, no tumor was found in 8/53 (15%) of the cases, microscopic tumor in 18/53 (34%) and macroscopic tumor in 27/53 (51%). In the ED group, complete response of distant metastases was obtained in 6/13 (48%) of the patients, one of whom is still alive with no evidence of disease 62 months after the start of treatment.

Aged↗
PubMed1990

Immunohistochemical examination of 25 cases of Merkel cell carcinoma: a comparison with small cell carcinoma of the lung and oesophagus, and a review of the literature.

Merkel cell carcinomas (MCC) were compared to small cell carcinomas of the lung (SCCL) and oesophagus (SCCO). Most MCC were of the intermediate cell type while SCCL and SCCO were usually of the small cell type. Only MCC of trabecular type could be separated from SCCL and SCCO by means of histopathological examination alone. All MCC (25) stained with cytokeratin CAM 5.2, 20 of which in a "paranuclear globular" or combined "paranuclear globular"/diffuse pattern while 17 MCC stained with cytokeratin AE1/AE3. Cytokeratin CAM 5.2 reacted with 60 percent of the SCCL and 86 percent of the SCCO, and cytokeratin AE1/AE3 with 33 and 28 percent respectively. Neurofilament stained 17 MCC in a "paranuclear globular" pattern but none of the SCCL and SCCO. All MCC with a diffuse staining pattern for cytokeratin CAM 5.2 were negative for neurofilament. The results of this study and review of the literature indicate that in most instances Merkel cell carcinoma can be separated from other SCC, pulmonary as well as extrapulmonary, by means of histopathological and, above all, immunohistochemical examinations.

Antigens, CD↗
PubMed1990

Anaplastic thyroid carcinoma. Doxorubicin, hyperfractionated radiotherapy and surgery.

Sixteen consecutive patients with anaplastic carcinoma of the thyroid were prospectively treated according to a combined regimen consisting of hyperfractionated radiotherapy, doxorubicin and debulking surgery. The radiotherapy was preoperatively administered to a target dose of 30 Gy in 3 weeks, and postoperatively to an additional dose of 16 Gy in 1.5 weeks. Radiotherapy was administered twice daily, 5 days a week, with a target dose of 1 Gy per fraction and with a minimum interval of 6 hours. A dose of 20 mg doxorubicin was administered intravenously 1 to 2 hours before the first radiotherapy session every week. Debulking surgery was feasible in 9 patients. Local complete remission was achieved in 5 patients and 3 of these are still alive disease-free at 10, 30, and 30 months respectively after diagnosis. Only 6 patients succumbed to a local failure. This combination regimen was well tolerated despite the patients' high age and advanced disease.

Aged↗
PubMed1990

Small cell carcinoma of the oesophagus: a clinical and immunohistopathological review.

Primary small cell carcinoma of the oesophagus (SCCO), histologically indistinguishable from its counterpart of the lung, is a rare tumour. Less than 100 cases are reported. A review of 558 consecutive patients with oesophageal carcinomas referred to our department revealed seven cases. These were studied and compared to a survey of 80 cases collected from 24 reports. The present results, as well as the survey, indicate a poor prognosis with rapid and widespread dissemination, and that death is attributed to distant metastases rather than local failure. Freedom from local symptoms was achieved in all seven patients, regardless of therapy modalities employed. A complete response of the primary lesion was observed in three patients after chemo- and subsequent radiotherapy. According to these findings the most suitable treatment approach seems to be the same as for small cell carcinoma of the lung. A detailed immunohistochemical analysis revealed more characteristics similar to small cell carcinoma of the lung than that of the skin, viz 'Merkel cell carcinoma'.

Adult↗
PubMed1990

Chemotherapy and multimodality treatment in thyroid carcinoma.

With the combination of pre- and postoperative chemotherapy and radiotherapy, the majority of patients with anaplastic giant cell thyroid carcinoma will achieve local tumor control. A few patients may even be cured by this treatment. Only few patients with differentiated thyroid carcinoma respond to chemotherapy treatment. However, at present it is not possible to discern these few. Chemotherapy for advanced thyroid carcinoma cannot as yet be routinely recommended. Doxorubicin, cisplatin, and VP16 are the drugs currently considered most effective. Side effects may be severe. Multimodality treatment may be an alternative.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Delaying factors in primary treatment of breast cancer.

An effort has been made to study possible delaying factors in the diagnosis and primary treatment of breast cancer. The data are based on 273 female patients, referred to the Department of Oncology, Lund, constituting 50% of all primary breast carcinomas without a previous malignancy diagnosed in 1986 in a catchment area of 1.2 million. Of these, 68% initially consulted a general or private practitioner, whereas only 21% directly consulted surgical departments. The interval from the initial consultation to operation, analysed multivariately, was correlated to the number of referral-steps (13 vs. 75 days), the category of physician initially consulted (15 vs. 33 days), and the outcome of a combined positive or negative mammography + aspiration cytology (13 vs. 58 days). If one or both of these diagnostic procedures were negative, the delay varied considerably between the four categories of physicians initially consulted. The median time between decision and start of radiotherapy was 38 days, constituting 46% of the time from the initial consultation to start of this treatment modality.

Adult↗
PubMed1989

Merkel cell carcinoma: management of primary, recurrent and metastatic disease. A clinicopathological study of 17 patients.

The clinicopathology of Merkel cell carcinoma (MC) has been evaluated in 17 patients, and its outcome and clinical management in 14 of these. The histopathologic diagnosis was confirmed by electronmicroscopy and/or immunohistopathology. The location of the primary lesions demonstrated a predilection for the skin of the face and the extremities. The primary treatment usually consisted of a wide excision only. Four out of five patients with MC of the face suffered from local and/or nodal relapses, in contrast to only one out of seven patients with primary lesion on the extremities. The three patients treated for local recurrences and/or regional node metastases were alive and disease-free 22-72 months after recurrences. Three patients developed distant metastases. Two of these died within 4 months after initial diagnosis. One patient completely responded to chemotherapy. The high frequency of local recurrences would justify an excision with generous margins, except when the tumour is close to a vital structure. Radiotherapy could in these cases obviate the necessity for extensive operations. If the primary lesion is located on an extremity, regional lymphadenectomy seems only to be necessary whenever nodal involvement is suspected. Node dissection is also recommended for suspected nodes in the face or on the neck, but the guidelines for elective node dissections in these sites are not obvious since the results of salvage therapy were excellent and the location of relapses unpredictable.

Aged↗
PubMed1988

Enhanced therapeutic tumour dose of 131I-MIBG by accelerated diuresis.

Different biokinetics of intravenously (i.v.) administered 131I-MIBG in the same patient, a child with abdominal neuroblastoma, is demonstrated with and without accelerated elimination by means of hyperhydration. By hyperhydration it was possible to increase the estimated tumour dose by a factor of 2.1 without affecting the whole body dose. The present results indicate that, if accelerated diuresis is implemented, higher radioactivity of 131I-MIBG can be administered and thereby an increased therapeutic tumour dose achieved.

3-Iodobenzylguanidine↗
PubMed1988

Palliation of multiple bone metastases from prostatic carcinoma with strontium-89.

The efficacy of strontium-89 in relieving pain caused by disseminated bone metastases was studied in 11 patients with prostatic carcinoma. The therapy consisted either of 3 i.v. injections of 100 MBq strontium-89 chloride in intervals of 4 weeks in 8 patients or 200 MBq i.v. administered on one occasion in 3 patients. The study suggests that 1-3 i.v. injections of 100 MBq strontium-89 may be a worthwhile and fairly atoxic treatment for palliation of bone pain from metastatic prostatic carcinoma.

Bone Neoplasms↗
PubMed1987

Primary localized non-Hodgkin's lymphoma of the thyroid: a retrospective clinicopathological review.

Primary localized non-Hodgkin's lymphomas (NHL) of the thyroid are rare. The data presented are derived from 819 consecutive patients with NHL and six patients with anaplastic thyroid carcinomas of small cell type investigated and treated at our department between 1970 and 1981. The present analyses are based on the 19 patients, who were found to have localized primary thyroid lymphomas. Four of these patients were initially considered to have undifferentiated small cell carcinomas of the thyroid but revealed to be lymphomas at re-examination supplemented with immunohistopathologic staining. Prognosis has been evaluated with regard to initial stage, histopathology according to the Kiel classification and therapy. Median follow-up was 5 years. The crude survival was 77% 5 years after diagnosis. This was not significantly less (4.2%) than the overall-survival in an age- and sex-matched population, despite the majority of patients having tumours which were locally advanced, often with spread to regional lymph nodes, and in many cases a histology showing a high-grade malignancy according to Kiel classification. The excellent prognosis in the current study compared to other studies is probably mainly attributed to more extensive staging procedures. The biologic behaviour supports the hypothesis that these lymphomas represent lymphomas of mucosa associated lymphoid tissue (MALT). According to present results anaplastic thyroid carcinoma of small cell type must be extremely rare.

Aged↗
PubMed1986

Is the EORTC prognostic index of thyroid cancer valid in differentiated thyroid carcinoma? Retrospective multivariate analysis of differentiated thyroid carcinoma with long follow-up.

The European Organization for Research on Treatment of Cancer (EORTC) Thyroid Cancer Cooperative Group presented a prognostic index in 1979 that included all histologic groups of thyroid carcinomas, and was based on a multivariate analysis of 507 patients with a median follow-up of 40 months. The current report not only uses a multivariate analysis to study the clinical validity and reproducibility of this index on case material consisting of 226 differentiated thyroid carcinomas with a considerably long follow-up (11 years), but also it investigates possible prognostic factors, other than those proposed by the EORTC. Three EORTC variables could be reproduced as important: age at diagnosis, locally advanced disease, and distant metastases. Of the additional histopathologic variables tested, microscopic tumor invasion beyond thyroid capsule (pT4) and marked cellular atypia (MCA) proved to be significant. When the effect of the age-correlated tumor factors pT4 and MCA of differentiated thyroid carcinomas were taken into consideration, age alone lost its prognostic importance as a guide for treatment.

Adult↗
PubMed1984

Kinetics of 201Tl uptake in adenomas and well-differentiated carcinomas of the thyroid. A double isotope investigation with 99Tcm and 201Tl.

A visually increased uptake of 201Tl chloride corresponding to a 'cold' (131I or 99Tcm ) thyroid nodule is mostly seen in well-differentiated carcinomas but also often in follicular adenomas. Since a visually increased uptake of 201Tl can be due to an increased initial uptake and/or a delayed elimination, an extended dynamic investigation was performed in patients with well-differentiated carcinomas or with follicular adenomas. Data were collected in a dynamic simultaneous double isotope ( 99Tcm + 201Tl) study up to 50 min after intravenous administration. Adenomas could be significantly separated from carcinomas by the elimination (p = 0.0001), but not by the initial uptake.

Adenoma↗
PubMed1983

Radiologic evaluation of subdiaphragmatic spread of Hodgkin's disease.

A prospective investigation is presented on the usefulness of lymphography, computed tomography, ultrasound, radionuclide examinations and fine-needle aspiration biopsy of the spleen and the liver in assessing subdiaphragmatic spread of Hodgkin's disease. Initial staging laparotomy is superior to all other diagnostic procedures. If laparotomy cannot be performed, CT and scintigraphy of the spleen are recommended. At restaging CT and lymphography provide equal diagnostic yield; CT is suggested, however, to be used in the first place.

Adolescent↗