[Clinico-morphological characteristics of retrocervical endometriosis]. / Kliniko-morfologicheskaia kharakteristika retrotservikal'nogo éndometrioza.

Clinico-morphologic parameters are described in 18 patients of reproductive age before and after hormonal treatment. There was no clear-cut correlation between morphofunctional endometrial state and endometrioid heterotopies. It did not seem possible to identify the phase of the cycle on the basis of the structural pattern of retrocervical endometriosis. Electron microscopic findings in endometriosis sites were suggestive of considerable variability of epithelial cell activity in different glands as well as within the same gland. Post-treatment structural pattern of retrocervical endometriosis does not exclude the possibility that steroids only block cyclic changes in the functional glandular epithelium, having no effect on nonactive cell elements. In spite of dystrophic changes, present in many retrocervical endometriosis sites, hormonal treatment did not eliminate endometrioid heterotopies, but only relieved pain.

The cytokeratin profiles of ovarian common "epithelial" tumors.

An improved immunohistochemical determination of the cytokeratin profiles of epithelia and their neoplasms is possible using monoclonal antibodies that will either identify all 19 cytokeratins (AE1/3) or delineate specific subsets (35 beta H11, 34 beta E12, 34 beta B4 and Cam 5.2). Ovarian common "epithelial" tumors (CET) contain cytokeratin filaments. To determine the nature and differences in the cytokeratin profiles of ovarian CET, eight benign Brenner tumors, four serous cystadenofibromas, 28 mucinous tumors, 27 serous tumors and six endometrioid, five clear cell and five undifferentiated carcinomas, as well as nine normal ovaries were immunostained with the above five antibodies. AE1/3 staining was predominant, while Cam 5.2 and 35 beta H11 displayed the most frequent staining thereafter. Statistically significant staining differences were found between a number of tumor groups using the antibodies 35 beta H11, 34 beta E12 and Cam 5.2. In this study, all ovarian CET, except the benign Brenner tumors, displayed a predominantly low molecular weight cytokeratin profile. The same profile in the normal surface epithelium lends credence to the belief that these tumors are derived from this epithelium. A significant staining difference between some of the tumor types using some of the antibodies suggests a possible ancillary, diagnostic role of cytokeratin profiling in situations where exact tumor typing is difficult.

Prostatic duct adenocarcinoma with endometrioid features: immunohistochemical and electron microscopic study.

Despite earlier arguments that the so-called "endometrioid carcinoma" is of Müllerian remnant origin, our clinicopathologic study of 35 cases indicated that it is actually an adenocarcinoma of prostatic duct origin. With respect to histology, it has two growth patterns; type A, an exuberant papillary endometrioid pattern with a focal intraductal component, and type B, less papillary-endometrioid growth and more intraductal components. Immunoperoxidase study showed immunoreactivity for prostatic-specific antigen and prostatic acid phosphatase in all 20 cases tested. Ultrastructural study identified prostatic epithelial cells rather than ciliated endometrial features. In 18 of 35 cases, we identified microacinar carcinoma of the prostate, MDAH grade I, Gleason's combined score 2, 3, or 4. Twenty-two treated patients presented with obstruction, hematuria, or both; 20 had stage C or D disease, suggesting that this tumor is more aggressive than was originally assumed.

Normal human peritoneal macrophages are unable to cap and internalize class II antigens.

Normal human peritoneal macrophages show a restricted capacity to differentiate into inflammatory macrophages in vivo. We now report that these cells are unable to cap and internalize HLA-DR, as compared to endometriosis, and other macrophages. Immunoelectron microscopy indicated that lack of modulation was not due to the presence of preclustered antigenic sites. Northern blot analysis demonstrated transcripts for HLA.DR, c-fms, and c-fos, indicating that the surface defects were not likely to be associated with a general depression of transcriptional activity. There was no correlation between the mobility of class II molecules and the ability to present antigen as determined by autologous lymphocyte responses to tetanus toxoid. The inability of normal peritoneal macrophages to modulate class II antigens may represent a normal and more general environmental alteration required to permit peritoneal cells a scavenging function without developing the deleterious effects leading to a peritoneal inflammatory response.

Biopsy in laparoscopically diagnosed endometriosis.

A series of 273 consecutive patients with the primary complaint of pelvic pain were laparoscopically diagnosed as having endometriosis. Peritoneal and/or ovarian biopsy was performed at the endometriosis site or sites in 115 patients. Histologic confirmation of endometriosis was established in 64% of those patients. The severity of the disease did not correlate with positive or negative biopsy results. Thus, the diagnosis of endometriosis may not be histologically confirmed, even in the presence of grossly visible disease. Therefore, diagnosis and treatment of the disease should not depend upon histologic confirmation.

Histology and ultrastructure of human endometriotic tissues treated with dydrogesterone (Duphaston).

The histological and ultrastructural changes of ectopic endometrium were studied during treatment with dydrogesterone (Duphaston) in eighteen infertile patients with laparoscopically confirmed endometriosis. Three types of response to therapy, i.e. no response, moderate and good, are detailed. First, focal secretory transformation of the endometriotic epithelium with decidualization of the ectopic stroma was seen in four patients (no response to therapy). In all other patients, the endometriotic implants were undifferentiated (moderate response to therapy) or revealed morphologic features of involution (good response to therapy). Proliferation of endometriotic cells was not seen during treatment with Duphaston, while total eradication of microscopic implants was never observed. Endometriotic implants with good response to Duphaston therapy demonstrated an enhanced autophagic activity within many epithelial cells. Only two patients conceived during a one-year post-treatment follow-up. Both patients demonstrated a good response to therapy.

The ultrastructure of selected gynecologic neoplasms.

Several articles have been published recently that discuss the role of electron microscopy in the diagnosis and study of gynecologic neoplasms. It becomes apparent from those works and the review just presented that, although an ultrastructural study is not necessary for reaching a diagnosis of many of these tumors, it may be necessary or supportive in identifying the more poorly differentiated ones. Furthermore, electron microscopy is valuable in providing evidence for the histogenesis of some of these neoplasms. Unfortunately for the pathologist, a certain level of morphologic differentiation (and an absence of metaplasia) in a cell is usually necessary for these goals to be achieved. For example, an adenomatoid tumor (see the article by Dr. Srigley, Mr. Toth, and Mr. Edwards in this issue) of the fallopian tube can readily be accepted as being composed of mesothelial cells, because both the neoplastic cells and normal mesothelial cells have the same highly differentiated features of long, slender microvilli, prominent intercellular junctions, and many microfilaments. On the other hand, there is very little resemblance between the granulosa cells of a granulosa-cell tumor and mature mesothelial cells. Thus, if one of the theories of histogenesis of granulosa cells were correct--namely, that they are derived ultimately from mesothelial lining--the ultrastructural evidence would rest on recognizing a similarity between the two types of cells at an earlier stage of differentiation. The neoplastic granulosa cell has differentiated along a separate, specialized line in which the ultrastructural resemblance to the parent cell is partly, if not completely, lost. Another example of the type of information that electron microscopy can provide is in relation to the common epithelial tumors. There is good evidence that the serous tumors in this group arise from mesothelium, although ultrastructurally their differentiation has veered from a mesothelial direction to one in which the cells have a complement of organelles related to secretory activity. Paradoxically, the mucinous cystic tumors, which have been classified traditionally as tumors of surface epithelial origin, are now thought to be of germ-cell origin in some cases, as examples of monophyletic teratomas. The ultrastructural evidence for this conclusion rests on the presence of anchoring filaments in the microvilli of the neoplastic cells, similar to those of normal intestinal epithelium, and on an admixture of various types of gastrointestinal cells, including those that contain dense-core granules (argentaffin cells).(ABSTRACT TRUNCATED AT 400 WORDS)

Nucleolar canalicular structure in extrauterine endometriosis.

Under the influence of progesterone the unique intranuclear structure known as the nucleolar canalicular structure (NCS) develops in the human endometrium. This organelle was not described previously outside the uterus. In this report the cases of two patients in whom the NCS appeared in extrauterine endometriosis are presented.

Subcutaneous endometriosis diagnosed by fine needle aspiration cytology.

The fine needle aspiration cytology (FNAC) of two patients manifesting cutaneous/subcutaneous endometriosis is presented. Endometrial tissue sampled by the aspiration technique manifested different cytologic characteristics as compared to those of endometrial tissue obtained by standard exfoliative methods. A primary difference was the appearance of the endometrial cells in syncytial clusters in the aspirate, in contrast to the three-dimensional clusters seen in exfoliated material. These cases emphasize the need to include endometriosis in the differential diagnosis of palpable lesions of the abdominal wall, especially in women with healed surgical scars, and the role of FNAC in diagnosing such lesions.

[Ultrastructure of the ectopic endometrial glandular epithelium in five cases of adenomyosis--with particular reference to the normal proliferative endometrium and endometrial adenocarcinoma].

Although we encounter endometriosis not infrequently, the exact nature of this entity has not yet been determined. In order to study the morphogenesis of this disease, we chose the adenomyotic glandular epithelium as distinct ectopic glands and examined them in the electronmicroscope, comparing them with the proliferative phase of the endometrium and the uterine body adenocarcinoma. Five cases were selected from 76 histologically proven cases of adenomyosis at our University. Epon blocks were ultrasectioned with a Porter MT II microtome, stained with uranium acetate and lead, and observed in a JEM 100 C electronmicroscope. The characteristics of adenomyotic glandular epithelium compared to the normal proliferative endometrium were: 1) expanded smooth nuclear membrane with scattered fine chromatin and zero to one irregularly surfaced nucleoli, 2) in cytoplasm, rough ER and free ribosomes are distinct, mitochondria are round to oval in shape with moderate irregularity, and microfibrillar structures and interdigitations are present in moderate amounts. Although there are few similarities to endometrial cancer, these findings would suggest that adenomyosis may be an intermediate between the normal proliferative endometrium and endometrial cancer.

[Morphologic and cell kinetic studies of prostate cancers. Contribution to grading]. / Morphologische und zellkinetische Untersuchungen an Prostatakarzinomen. Ein Beitrag zum Grading.

The combined histologic and cytologic grading of carcinomas of the prostate is not only important in evaluation of prognosis but determines the choice of therapy with knowledge of staging. Tissue biopsies of 2,200 prostatic carcinomas were classified and graded histologically and cytologically. Furthermore, autoradiographic studies were performed on 69 needle biopsies with 3H-thymidine. The cytologic parameters were correlated with cell-kinetic parameters in classification. Several subgroups of degrees of malignancy were found. Grade Ia corresponds to highly differentiated glandular carcinomas by histology and cytology. Grade Ib carcinomas were histologically well but cytologically moderately differentiated. Grade IIa carcinomas are histologically moderately to poorly but cytologically moderately differentiated. Grade IIb carcinomas correspond to poorly differentiated tumors by histological and cytological criteria. Grade III carcinomas are in most cases undifferentiated. This differentiated grading is particularly important for therapeutic consequences in incidental carcinomas. The therapeutic consequences of grade Ia carcinomas are frequent controls and a wait-and-see attitude. Grade Ib and IIa carcinomas must be treated according to their clinical stage by total prostatectomy. Grade IIb and III carcinomas need a palliative treatment by hormones, castration, irradiation or cytostatic drugs.

Ultrastructural changes in uterine myometrium of mice with experimentally-induced adenomyosis.

Ectopic pituitary transplantation induced a high incidence of adenomyosis in SHN mice. Early signs of the development of adenomyosis were the penetration of stromal connective tissue into myometrium followed by uterine gland invasion. Associated with these changes, the inner layer of myometrium showed the involution of smooth muscle cells and distended intercellular spaces.

Peritoneal endometriosis: scanning electron microscopy and histology of minimal pelvic endometriotic lesions.

In 36 patients with laparoscopically diagnosed endometriosis, biopsies were taken from different areas of the pelvic peritoneum bearing foci of endometriosis. The biopsies were studied by scanning electron microscopy and by light microscopy. Combined use of these techniques resulted in the differentiation of three topographically and morphologically different types of endometriotic lesions: intraperitoneal endometriotic polyps with no glandular openings but associated with deeper endometriotic glands and stroma; intraperitoneal endometriotic foci with surface epithelium, glands, and stroma; and retroperitoneal small lesions with few glands and scant stroma. The morphologic features of endometriotic foci indicate that they do not follow the typical cyclic changes described for the uterine endometrium. Our microanatomic characterization of endometriosis is discussed in relation to the conflicting data concerning peritoneal fluid constituents and infertility in patients with minimal endometriotic lesions.

Endocrine dependency of endometriosis: an ultrastructural study.

The comparison of the ultrastructural features of endometriotic implants in 96 patients before and after suppressive therapy by danazol showed that the glands of the ectopic endometrium had a wide range of morphologic development. In about one-third of the pretreatment biopsies significantly different ultrastructural patterns were observed in the same specimen, ranging from poorly to highly differentiated endometrial glands. Adequate morphological changes during the menstrual cycle were found in implants only in 14 patients during the proliferative phase, but adequate, homogeneously performed secretory changes were completely missing during the luteal phase. Besides incomplete or delayed secretory changes the majority was proliferative rather than secretory. After 6 months of endocrine suppression laparoscopic biopsies of endometriosis were repeated, and the ultrastructural findings lead to three conclusions. 1. Poorly differentiated endometriotic foci do not respond to danazol. 2. Endometriotic implants consisting of highly differentiated epithelium with adequate cyclic variations respond well to danazol and disappear in nearly 80% of cases. 3. In endometriosis with mixed areas consisting of various degrees of glandular differentiation the hormonal suppression can eliminate endometriotic implants or arrest them at a proliferative stage. If the morphological appearance of the ectopic implants depends not simply upon the endocrine stimulus, but primarily on the degree of differentiation and maturity of the cell, then perhaps cyclic modulation is only a secondary phenomenon, and hormones play only a secondary role in therapy. If this hypothesis is correct, only complete elimination of endocrine influence can cure endometriosis. Transient or incomplete suppression may lead only to partial regression.

Ultrastructural comparison of endometriotic implants and eutopic endometrium.

Ultrastructural features of endometriotic implants suggest an incomplete response to the prevalent hormonal milieu. The cyclic changes, especially in the secretory phase, appear to depend more on the morphologic differentiation of the ectopic implants than on the hormonal stimulus. The endometriotic tissue encompassed a wide range of morphologic development from poorly to highly differentiated glands. Variations occurred from gland to gland and even within the same gland. Complete proliferative development was found only in some of the patients and full secretory transformation was absent in all. The incomplete morphologic response to cyclic hormonal changes may explain the frequent failure of endocrine therapy.