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Sumanatilleke M, de Silva NL, Ranaweera G, Appuhamy C, Karunaratne K, de Silva MVC. Postmenopausal hyperandrogenism due to an ovarian sex cord-stromal tumour causing elevated dehydroepiandrosterone sulphate: a case report. BMC Womens Health 2022; 22:297. [PMID: 35843927 PMCID: PMC9288717 DOI: 10.1186/s12905-022-01879-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background The source of excess androgen can be obscure in postmenopausal women with new-onset hyperandrogenism. If serum dehydroepiandrosterone sulphate (DHEAS) is raised, it is presumed to be of adrenal origin because DHEAS is exclusively produced from adrenal cortical cells. This reports an elderly female presenting with new-onset hyperandrogenism due to an ovarian sex cord-stromal tumour, associated with increased serum DHEAS levels. Case description A 76-year-old female with long-standing diabetes and hypertension presented with hirsutism and male type alopecia for six months. She had menopause at 55 years of age. There was a pelvic mass on examination. Total testosterone was 6.106 ng/ml (0.124–0.357) and DHEAS was > 1000 µg/dL (35–430). Contrast-enhanced computed tomography of the abdomen and pelvis showed a heterogeneously enhancing complex mass measuring 11 × 8 cm in the left adnexal region. Adrenal glands were normal. She underwent total abdominal hysterectomy, bilateral salphingo-oophorectomy, and omentectomy. Both testosterone and DHEAS normalised following surgery. Histology revealed a sex cord-stromal tumour, likely a steroid cell tumour with malignant potential. Fluorodeoxyglucose-Positron emission tomography did not show any additional lesions. Conclusions Due to the lack of sulfotransferase in ovarian tissue, markedly elevated DHEAS originating from an ovarian neoplasm is unusual. This phenomenon has not been described except in a patient with a steroid cell tumour causing Cushing syndrome and hyperandrogenism. The mechanism of this rare occurrence remains elusive. Knowledge of this unusual presentation would enable the clinicians to be cautious in localising the androgen source in women with hyperandrogenism.
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Abstract
People who value social hierarchy may resist giving intergroup apologies because such apologies may attenuate the very hierarchies that these people value. We tested this claim across four studies (total N = 541) by examining associations between social dominance orientation (SDO)—a measure of preference for social hierarchy—and support for intergroup apologies. We found that higher SDO scores, and specifically the antiegalitarianism subdimension (social dominance orientation–egalitarianism [SDO-E]), predicted less apology support among U.S. residents in both domestic (Study 1) and international (Study 2) contexts. In Study 3, we found that the effect generalizes to an Australian cultural context. In Study 4, we demonstrated that the negative effect of SDO-E can extend to third-party contexts and is only observed when apologizing would be hierarchy attenuating. These studies show that the desire to maintain social hierarchies is an important driver of opposition to hierarchy-attenuating intergroup apologies.
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Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, Kehoe ST, Konishi I, Olawaiye AB, Prat J, Sankaranarayanan R, Brierley J, Mutch D, Querleu D, Cibula D, Quinn M, Botha H, Sigurd L, Rice L, Ryu HS, Ngan H, Mäenpää J, Andrijono A, Purwoto G, Maheshwari A, Bafna UD, Plante M, Natarajan J. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019; 145:129-135. [PMID: 30656645 DOI: 10.1002/ijgo.12749] [Citation(s) in RCA: 505] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/05/2018] [Accepted: 12/20/2018] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent. METHODS Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations. RESULTS In stage I, revision of the definition of microinvasion and lesion size as follows. Stage IA: lateral extension measurement is removed; stage IB has three subgroups-stage IB1: invasive carcinomas ≥5 mm and <2 cm in greatest diameter; stage IB2: tumors 2-4 cm; stage IB3: tumors ≥4 cm. Imaging or pathology findings may be used to assess retroperitoneal lymph nodes; if metastatic, the case is assigned stage IIIC; if only pelvic lymph nodes, the case is assigned stage IIIC1; if para-aortic nodes are involved, the case is assigned stage IIIC2. Notations 'r' and 'p' will indicate the method used to derive the stage-i.e., imaging or pathology, respectively-and should be recorded. Routine investigations and other methods (e.g., examination under anesthesia, cystoscopy, proctoscopy, etc.) are not mandatory and are to be recommended based on clinical findings and standard of care. CONCLUSION The revised cervical cancer staging is applicable to all resource levels. Data collection and publication will inform future revisions.
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Affiliation(s)
- Neerja Bhatla
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Mauricio Cuello Fredes
- Division Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lynette A Denny
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Seija Grenman
- University of Turku and Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
| | - Kanishka Karunaratne
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sean T Kehoe
- University of Birmingham and St. Peters College, Oxford, UK
| | - Ikuo Konishi
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jaime Prat
- Autonomous University of Barcelona, Barcelona, Spain
| | - Rengaswamy Sankaranarayanan
- International Agency for Research on Cancer (WHO-IARC), Lyon, France
- RTI International India, New Delhi, India
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Abstract
The incidence of cancer in pregnancy is increasing. The most frequent malignancies include breast and cervical cancers. Diagnosis may be complicated by late presentation. Imaging during pregnancy should consider risks to the fetus. Diagnostic work-up, including tumor markers, can be influenced by the physiology of pregnancy. Treatment of cancer can often be safely administered with good maternal and fetal outcomes. Chemotherapy, radiotherapy, and surgery must be adapted to the pregnancy state. Counselling and emotional support are an essential part of management.
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Affiliation(s)
- Matthys H Botha
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, Stellenbosch, South Africa
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Karunaratne K, Premaratne S, Hapuachchige C, Ihalagama H. Counselling pregnant women with cancer. Best Pract Res Clin Obstet Gynaecol 2016; 33:117-23. [DOI: 10.1016/j.bpobgyn.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
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Affiliation(s)
- Kanishka Karunaratne
- Sri Lanka College of Obstetricians and Gynaecologists, Sri Lanka; National Cancer Institute, Maharagama, Colombo, Sri Lanka.
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Kularatna S, Wijesinghe P, Abeysinghe M, Karunaratne K, Ekanayake L. Burden of invasive pneumococcal disease (IPD) in Sri-Lanka: Deriving a reasonable measure for vaccine introduction decision making. Vaccine 2015; 33:3122-8. [DOI: 10.1016/j.vaccine.2015.04.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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Karunaratne K, Ihalagama H, Rohitha S, Molijn A, Gopala K, Schmidt JE, Chen J, Datta S, Mehta S. Human papillomavirus prevalence and type-distribution in women with cervical lesions: a cross-sectional study in Sri Lanka. BMC Cancer 2014; 14:116. [PMID: 24558979 PMCID: PMC3936905 DOI: 10.1186/1471-2407-14-116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/12/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cervical cancer ranks second among all cancers reported in Sri Lankan women. This study assessed the prevalence and type-distribution of human papillomavirus (HPV) among Sri Lankan women with invasive cervical cancer (ICC) and pre-cancerous lesions. METHODS 114 women aged 21 years and above, hospitalized in the National Cancer Institute, Sri Lanka with a diagnosis of ICC or cervical intraepithelial neoplasia (CIN) 2/3 were prospectively enrolled between October 2009 and September 2010 (110430/NCT01221987). The cervical biopsy or excision specimens collected during routine clinical procedures were subjected to histopathological review. DNA was extracted from samples with a confirmed histological diagnosis and was amplified using polymerase chain reaction and HPV DNA was detected using Enzyme Immuno Assay. HPV positive samples were typed using reverse hybridization Line Probe Assay. RESULTS Of the cervical samples collected, 93.0% (106/114) had a histologically confirmed diagnosis of either ICC (98/106) or CIN 2/3 (8/106). Among all ICC cases, squamous cell carcinoma was diagnosed in the majority of women (81.6% [80/98]). HPV prevalence among ICC cases was 84.7% (83/98). The HPV types most commonly detected in ICC cases with single HPV infection (98.8% [82/83]) were HPV-16 (67.3%) and HPV-18 (9.2%). Infection with multiple HPV types was recorded in a single case (co-infection of HPV-16 and HPV-59). CONCLUSIONS HPV was prevalent in most women with ICC in Sri Lanka; HPV-16 and HPV-18 were the predominantly detected HPV types. An effective prophylactic vaccine against the most prevalent HPV types may help to reduce the burden of ICC disease.
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Affiliation(s)
| | | | | | - Anco Molijn
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Kusuma Gopala
- GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, India
| | | | - Jing Chen
- GlaxoSmithKline Vaccines, Pte Ltd, Singapore, Singapore
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de Silva R, Karunaratne K, Mendis LN, Ramesh R, Chow VTK. PCR detection and typing of human papilloma virus DNA in squamous carcinoma of the cervix in a cohort of Sri Lankan women. Ceylon Med J 2009; 51:114-7. [PMID: 17315590 DOI: 10.4038/cmj.v51i3.1255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the prevalence of human papilloma virus (HPV) types 16 and 18 in squamous carcinomas of the cervix in Sri Lanka. DESIGN Case control study. SETTING One gynaecological unit at the Cancer Institute, Maharagama, Sri Lanka. PATIENTS 15 patients with squamous carcinoma of the cervix, and 15 age matched controls with histologically normal cervices. MEASUREMENTS DNA was extracted from paraffin embedded cervical biopsies. Polymerase chain reaction was performed on extracted DNA employing primers specific for HPV types 16 and 18. RESULTS HPV 16 DNA was detected in 11 out of 15 cervical cancer biopsies (73.3%), in comparison with 3 out of 15 normal controls (20%). HPV 18 was detected in 3 out of 15 cervical cancer biopsies, but not in a single control biopsy. CONCLUSION Despite the limited number of cases in this cohort, this study supports the strong association between HPV 16 and squamous cancer of the cervix.
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Affiliation(s)
- Rajiva de Silva
- Department of Immunology, Medical Research Institute, Colombo 8.
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Karunaratne K. Prosecution or persecution? West J Med 2002. [DOI: 10.1136/bmj.324.7336.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
A modular system for high-output solid-phase combinatorial synthesis has been designed and developed. The system employs three technological innovations to achieve its high efficiency and reliability: (1) application of microreactors as the reaction units in solid-phase synthesis; (2) use of radiofrequency tagging as the non-chemical tracking method; and (3) development of the directed sorting technology for split & pool synthesis. The system has been successfully applied in the synthesis of compound libraries of several hundred to several thousand compounds in multi-milligrams per compound quantity by many organizations.
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Affiliation(s)
- X Y Xiao
- IRORI, a Discovery Partners International Company, 9640 Towne Centre Drive, San Diego, California 92121, USA
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Karunaratne K. Management of gynecological cancers in developing countries, experience in Sri Lanka. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gunasekera PC, Karunaratne K. Please, no more deaths from neglect. Ceylon Med J 1998; 43:127-33. [PMID: 9813929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Sharma V, Persad E, Mazmanian D, Karunaratne K. Treatment of rapid cycling bipolar disorder with combination therapy of valproate and lithium. Can J Psychiatry 1993; 38:137-9. [PMID: 8467440 DOI: 10.1177/070674379303800213] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Over the past two decades there has been a great deal of interest in the use of anticonvulsants to treat a variety of primary psychiatric disorders. Valproate, one such anticonvulsant, has been found to be effective in the treatment of acute mania, mixed states and rapid cycling disorders. This paper presents the results of an open study with combination therapy of valproate and lithium in a series of nine patients (mean age = 50 years). These patients had previously been treated with various psychotropic agents, including a combination of carbamazepine and lithium. All but one patient showed marked or moderate improvement in their condition. Of particular interest was the observation that in three patients there was evidence of augmentation between valproate and lithium during the depressed phase of their illness. There was significant improvement in their depression within 24 to 48 hours of the addition of lithium to valproate. The combination therapy was very well-tolerated. It is concluded that valproate and lithium combination therapy provides a safe and effective alternative for the treatment of rapid cycling variant of bipolar illness.
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Affiliation(s)
- V Sharma
- Mood Disorders Unit, London Psychiatric Hospital, Ontario
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