High prevalence of cervical intra-epithelial neoplasia in women treated for pelvic inflammatory disease.

Because human papillomavirus (HPV) is sexually transmitted, as are pelvic inflammatory disease (PID) agents, the authors investigated whether cervical intra-epithelial neoplasia (CIN) are more frequent in women under treatment for PID. The study involved 298 patients hospitalized for PID, in whom CIN were investigated by smears and colposcopy. CIN were diagnosed in 42 patients, i.e. in 14% of patients: 21 low-grade CIN and 21 high-grade CIN, including one case of early-stage microinvasion. These figures are to be compared to the 0.5-4% of pre-cancerous lesions found in the general population. Screening smears are frequently inaccurate and direct colposcopy appeared preferable. No clinical study of this type has been published before, but certain authors have mentioned a high CIN incidence in patients with PID histories or followed up in sexually transmitted disease centers. These results show that CIN are more frequent in patients treated for PID; CIN should be investigated systematically in this population.

Malignant cystosarcomas phyllodes of the breast in adolescent females.

The authors report a case of cystosarcoma phyllodes occurring in an adolescent female, thus raising to 19 the number of reported cases. The prognosis of those composite fibro-epithelial tumours is ruled by the malignancy of the connective component: the diagnosis shows no distinctive feature compared with what can be observed in adults. The prognosis (classically better) appears in fact totally similar, justifying the same therapeutic rigour, particularly in the surgical field. A multidisciplinary approach should ensure complete recovery while limiting the harmful effects of the therapy in very young women.

[Dynamics of the prolonged and persistent estrogenic endometrium]. / La dynamique de l'endomètre oestrogénique prolongé et persistant.

Prolonged oestrogenic endometrium and persistent oestrogenic endometrium are frequent pathological states which have in common a variable degree delay or an absence of apparition of histological signs of luteal impregnation. In fact these two main states include several kinds of lesion; in our experience this point of view, which is an artificial division, is a too static one. We have to consider all the possible states to see the evolution of the whole. In this work, we have performed a cautious mounting of the different phases to get a dynamic view of these lesion; with this view one can see with a different lighting luteal insufficiency of the endometrium. In that way numerous secretory dystrophic aspects considered like secretory abnormal endometrium have to be related to prolonged or persistent oestrogenic states of which they are an evolutive variant. This dynamic approach allows to establish clinico-pathological correlations and leads to a best knowledge of hyperplasic endometrium and of treatment and prevention of endometrial hyperplasia.

[Value of screening for cervical intraepithelial neoplasia in women treated for adnexitis]. / Intérêt de la recherche des néoplasies intra-épithéliales du col utérin chez les femmes traitées pour annexite.

OBJECTIVE: To demonstrate that women treated for PID constitute a population with a specially high incidence of cervical intraepithelial neoplasia (CIN) and who should be screened for CIN. POPULATIONS AND METHODS: Retrospective, non-comparative study of 260 patients treated for PID in the Gynecology-Obstetrics Department of Hôtel-Dieu hospital in Rennes (France) from December 1st, 1989 to May 31st, 1996. CIN screening was performed by smear tests and colposcopy. RESULTS: Cervical lesions were detected in 39 patients (15%): five CIN 3 (including one early-stage microinvasion), twelve CIN 2 and 22 CIN 1 and/or condylomas, i.e., 6.5% high grade and 8.5% low grade lesions. Colposcopy in this case proved to be more effective than smears for screening. DISCUSSION: According to epidemiological studies, sexual behavior is a major risk factor of CIN, due to the role played by sexually transmissible human papillomavirus in their pathogenesis. Because the main risk factor of PID is sexual activity, it is likely that CIN are more frequent in women with PID. Our study clearly established that fact because the prevalence of CIN in the general population is only 0.5 to 4% according to literature reports. CONCLUSION: We are in favor of CIN screening in women treated for PID, and in our view colposcopy is the preferred method.

[Injection of placental blood vessels: technique and the preliminary results (author's transl)]. / Injection des vaisseaux placentaires: technique et premiers résultats.

The authors describe a technique for injecting the placenta, using an iodine contrast solution which allows a radiographic picture to be obtained. The vascular supply of the placenta can be shown up by this method accurately and cotyledons can be identified so that their number and their surface can be measured. The preliminary results show that there is a significant difference between the placentas of normal infants and of those with growth retardation. This should give rise to a new approach of the syndrome of intra-uterine growth retardation.

[The placenta of premature births (author's transl)]. / Le placenta de l'accouchement prématuré.

A prospective comparative study of 300 placentas of premature births and 300 full-term placentas demonstrated that in the former there was a higher frequency of certain types of anomalies: abnormal placental insertion; premature involution of the base plate; signs of fetal hypoxia; placental inflammation. In practice, however, pathological examination of the placenta appears to be of interest only for detecting inflammatory lesions.

[Primary pure carcinoid tumor of the breast: a case report. Review of the literature]. / Tumeur carcinoïde primitive pure du sein: une observation. Revue de la littérature.

The authors present a case of primary pure carcinoid tumour of the breast and point out how rare it is and how they made their diagnosis mainly by histology. A review of the literature makes it possible to assess the prognosis which should be good and they also describe the anatomo-pathological findings in these tumours. Finally these tumours show a strange histogenesis which if it is understood makes it possible to understand certain processes of cellular differentiation in breast tissue.

[Juvenile ovarian granulosa tumor associated with pregnancy. A case report. Review of the literature]. / Tumeur juvénile de la granulosa ovarienne associée à la grossesse. A propos d'une observation. Revue de la littérature.

A case of juvenile tumour of the granulosa occurred in a pregnant woman. Outcome was rapidly fatal. These tumours are classed as mesenchyma tumours of the sexual cords of the ovaries. The juvenile form occurs before the age of 30 years in 97% of the cases and has characteristic endocrine and anatomic features. The tumour remains localized in the ovary for a long period and may be treated with conservative surgery to preserve fertility in these young patients. Follow-up is aimed at detecting relapse which may occur early. Prognosis in such cases is very poor. Pregnancy does not modify the prognosis which is generally good.

[Uterine leiomyosarcoma. Nine case reports, review of the literature]. / Le léiomyosarcome utérin. A propos de 9 observations, revue de la littérature.

OBJECT OF THE STUDY: To evaluate management and outcome of the treatment of uterine leiomyosarcoma. PATIENTS AND METHODS: Retrospective study of a series of 9 patients treated for uterine leiomyosarcoma in this hospital from 1982 to 1994. RESULTS: The condition is rarely suspected preoperatively, diagnosis is usually made on histological examination of the operative specimen. The outcome is related to the mitotic activity of the tumour and to the infiltration of nearly structures. Surgery is the only effective treatment, chemotherapy is ineffective, adjuvant radiotherapy improves local control of the tumour but has no incidence on survival. CONCLUSION: In the absence of an effective adjuvant treatment uterine leiomyosarcoma bears a poor prognosis with the only exception of small non infiltrating tumours with a low mitotic activity.

[Malignant melanoma of the vagina. Two case reports. Review of the literature]. / Mélanome malin du vagin. A propos de deux observations. Revue de la littérature.

OBJECTIVE: Report the diagnosis and therapeutic approach in two cases of primary malignant melanoma of the vagina. RESULTS: Malignant melanoma is rarely localized in the vagina, resulting from the malignant transformation of an ectopic melanocyte during menopause. The clinical diagnosis is often made in an advanced stage with a variable degree of pigmentation, usually on the anterior aspect of the vagina. Surgical exeresis should be extensive with a 1-cm safety margin. Radiotherapy may be effective as a complementary treatment for limited surgery or as first intention therapy aimed as improving local control before surgery. CONCLUSION: Locoregional relapse occurs in 60% of the cases, emphasizing the importance of local treatment. The prognosis is unfavourable with a 23 month mean survival. Total survival at 5 years is only 17%.

[The extemporaneous histological examination of the umbilical cord. A reliable procedure for evaluating the risk of neo-natal infection (author's transl)]. / L'examen histologique extemporané du cordon ombilical. Un procédé fiable pour l'appréciation du risque infectieux néo-natal.

The authors report a study carried out on a consecutive series of 184 placentas of immature or small-for-dates newborn for whom a concomitant examination of the umbilical cord was carried out, with the purpose of finding out whether there was infection of the cord which was defined expressly as a true umbilical blood-vessel infection. The 27 cases of infection which were found were classified using a method with 5 values of 0 to 5 given to two sections of the cord that were sectioned. The one was near the placenta, the other near the fetus. Then the findings were compared with the clinical picture of infection in the infant and with bacteriological tests carried out on the digestive tract and on the meconium. This comparison shows how reliable this examination was in prognosing the risk of neo-natal infection and it would appear in screening out neo-natal infection by adding raised values for infection in the cord.

[Ovarian goiter. Apropos of a case]. / Le goitre ovarien. A propos d'un cas.

When the authors had a case of ovarian goitre with the Demons-Meigs syndrome they started to look at the literature for the incidence, the clinical presentation, the prognosis and the ways of treating this anatomopathological entity. Although histological examination can rarely make sure that the lesions are benign they are in most cases, as in the remainder of ovarian tumours, so that the outlook should be good.

[Intraductal carcinomas in situ. Retrospective study of 21 cases and review of the literature]. / Les carcinomes canalaires in situ. Etude rétrospective de 21 dossiers et revue de la littérature.

In situ canalicular carcinomas are defined as malignant, galactophoric epithelial cells, do not invade the basal membrane. The author saw 21 cases of in situ canalicular carcinomas which were treated surgically at the University Hospital of Rennes. It is possible from these cases to include certain themes: there is a pathology of an early carcinoma of the breast which will go on growing. It concerns patients in the menopausal age who 1 in 3 have a family history of neoplasia. Medical examination is important because in 1 out 2 cases leads to complimentary examinations which help to make the diagnosis. Mammography is essential because it leads to the diagnosis of a finding of suspicious microcalcifications as well as arranges an outline. The histology will indicate what the therapy should be. Comedocarcinomas (cellular proliferation with central necrosis) has to be considered as separate from other better differentiated types (solid, cribriform, papillary and clinging carcinomas). In fact comedocarcinomas often have a poor prognosis and the factors are: the size, the mitotic activity, the poor cellular differentiation, perigalactoriphic reaction, and stromal and multi centre micro-invasion. Treatment has to be adapted to features of this pathology. Mastectomy which used to be routine in these cases because of the high incidence of multiple centres, are to be reserved for cases with a poor prognosis. At present conservative treatment is being evaluated, but it seems logical to recommend it in non-invasive cancers with a good prognosis when a large lumpectomy followed up by radiotherapy to the whole breast can be used, particularly because this form of treatment is now given to invasive tumours. It is very important to follow-up these patients regularly and for a long time, clinically and with mammography if conservative treatment is carried out, in any case when the opposite breast is at risk. Conclusion. Now that treatments have become varied the improvement in prognosis will depend on early diagnosis. This means that mammography screening will proceed to an increasing number of non-invasive cancers of the breast that are discovered, and to a need to work out acceptable and effective treatment for these cancers.

[Circumstances in the detection of carcinoma in situ of the breast. Apropos of 12 cases]. / Les circonstances de découverte des carcinomes in situ du sein. A propos de 12 cas.

In France, 7,000 women die yearly of cancer of the breast, and 25,000 new cases are registered. The seriousness of the illness and its frequency show how important it is to diagnose it early at a stage before invasion or in situ (where 95 to 100% can be cured). In 4 years, at the University Hospital of Rennes, 90 out of 446 patients who were operated on for breast lesions had invasive cancer of the breast, i.e. 20%. 12 had a carcinoma in situ of the breast (C.I.S.E.), constituting 2.6%, of which 9 were in situ duct carcinomas and 3 in situ lobular carcinomas. In situ carcinoma of the breast can take almost any clinical form (a nodule, pain in the breast, mastitis, blood stained discharge from the nipple or Paget's disease). This means that lobular carcinoma in situ is always a surprise when diagnosed histologically in a lesion that is clinically benign. Since the anatomo-pathological diagnosis is difficult, a simple examination of the breast is not to be relied on in cases of carcinoma in situ of the breast. Mammography is the only truly valuable investigation in early diagnosis of C.I.S.E.

[Immature teratoma of the ovary. Apropos of 3 cases. Review of the literature and an evaluation]. / Tératome immature de l'ovaire. A propos de trois observations. Revue de la littérature et mise au point.

Immature teratoma of the ovary is a rare tumour (1% of cancer of the ovary) usually seen in adolescents or young women. It is a malignant tumour derived from an abnormal germ-cell which undergoes meiotic division. The diagnosis is based on the pathological examination which reveals immature tissue derived from two or three types of embryonic tissue (endo-, meso- and ectoderm). Intraperitoneal dissemination occurs and immature or mature recurrence is observed. The prognosis was particularly severe before the use of polychemotherapy which has also made conservative surgery possible. At the present time, the consensus is to reduce the duration of the chemotherapy with a regular clinical and laboratory (tumour markers, aFP) monitory. A second look laparotomy verifies successful treatment.

[Primary seropapillary peritoneal carcinoma. 16 case reports. Review of the literature]. / Carcinome séropapillaire primitif du péritoine. A propos de 16 observations. Revue de la littérature.

OBJECTIVE: Review of primary seropapillary carcinoma of the peritoneum. TYPE OF STUDY: Retrospective. PLACE: Department of Gynaecology and Oncology, University Hospital, Rennes. SUBJECT: 16 patients who underwent chemotherapy and surgery. RESULTS: Mean age at onset was 62 years with a late clinical diagnosis at an advanced stage. Macroscopically, peritoneal miliary was often associated with a predominant tumoural formation on the epiploon. Treatment included surgical exeresis with endoxan-cisplatin chemotherapy. The prognosis was equivalent to ovarian tumours at similar stages. CONCLUSION: Primary seropapillary carcinosis of the peritoneum is a separate group of peritoneal carcinosis distinguishable from peritoneal mesotheliomas and which have a prognosis similar to ovarian tumours. These tumours should be classed as part of the large group of mullerian tumours.

[Trophoblastic tumor at the site of placental implantation. Apropos of a new case]. / La tumeur trophoblastique du site d'implantation placentaire. A propos d'un nouveau cas.

The authors report a case in which a trophoblastic tumour developed at the implantation site in a 34-year-old woman in her second pregnancy. She had previously had trophoblastic disease that had persisted after a molar pregnancy. Using monoclonal anti-beta-hCG antibodies in order to localise the tumour by clinical radio immunodetection made it possible to cure the patient. The tumour was a secretory tumour and hysterectomy was the cure.

[Breast cancer associated with pregnancy. Nine case reports. Review of the literature and current update]. / Cancer du sein associé à la grossesse. A propos de 9 observations. Revue de la littérature et mise au point.

The authors report nine personal cases in a review of the literature concerning cancers of the breast associated with pregnancy and lactation (until a year post-partum). The diagnosis of the illness is reported to be difficult in pregnant women and it is necessary to use fully all the diagnostic procedures available and in particular cytology and histology. Surgery is urgent. It is classical practice to carry out a mastectomy with axillary clearance. Nevertheless more conservative treatments are now being suggested. The principal problem of therapy is linked to the effects of adjuvant therapy on the fetus be they radiotherapy or chemotherapy, particularly because it is very important that treatments should be thorough and start early in the pregnancy. The overall prognosis is bad because pregnancy seems above all to aggravate serious forms of the disease.

[Borderline ovarian tumors. A review and 11 cases]. / Tumeurs borderline de l'ovaire. Mise au point, à propos de 11 cas.

OBJECTIVE: To clarify and classify the still debated diagnostic and prognostic elements of borderline tumours of the ovary and analyze the data obtained in our series. AIM: Develop an adapted management scheme, integrating relatively good prognosis and known or suspected factors of poor prognosis. SIEGE: Department of Gynaecology-Obstetrics, Hôtel-Dieu (CHU) Rennes, France. SUBJECTS: Eleven patients with borderline tumour of the ovary diagnosed and managed over the last 5 years. RESULTS: Current morphology and macroscopy examinations of the tumour do not provide data capable of predicting malignancy. The borderline nature of the tumour is not a histological diagnosis. The problems encountered lead to a search for new techniques such as digitalized nuclear morphology. Some progress has been made in classifying prognosis factors. Other than stage, important factors appear to be age, histological type, mitotic index, atypical cells and invasive peritoneal implants. Management decisions depend on prognosis factors but should especially take into account parity. Methods include cystectomy and total hysterectomy with annexectomy. Evaluation of chemotherapy and radiotherapy is still to preliminary. CONCLUSION: The slow clinical course, allowing good mid-term prognosis, is still the best reason for a moderated therapeutic approach relying on conservative or more aggressive surgery alone.

[A study of the weight of the placenta in normal and pathological pregnancies (author's transl)]. / Etude du poids du placenta dans les grossesses normales et pathologiques.

The authors have studied 826 placentas in premature births, and in growth retardation and normal births. First of all they describe the technique which should be followed. They establish in this way a correlation between the weight of the placenta and the weight of the infant at birth on the one side and the gestational age on the other. On the other hand, they find that there is no correlation between the weight of the placenta and the mother's weight-gain in pregnancy when this is more than 12 kg. The weight of the placenta is shown to decrease after the 41st week of pregnancy and the placental index is at its highest at 38 weeks of pregnancy according to their study. They suggest that a curve of placental weight growth during pregnancy is useful in studying prematurity and growth retardation.