The significance of vaginal hormonal cytology and the leukocyte adherence inhibition test for the detection of malignancy.

Raised leukocyte adherence inhibition (LAI) test values were found for 25 women with endometrial carcinoma and 12 women with benign hyperplastic endometrium. Of 42 patients with oligomenorrheic and polymenorrheic disturbances of the menstrual cycle and whose hyperestrogenism was assessed by cytologic indices (i.e., eosinophilic and karyopyknotic indices), 38 exhibited positive or borderline LAI test values with either one or both of the antigens used. The LAI test was negative with both antigens in four women with hyperestrogenism associated with a 28-day menstrual cycle. The high correlation between hyperestrogenism and positive LAI test results as well as between the LAI test and the presence of tumors suggests that both hormonal cytology and the LAI test might be useful as screening methods for evaluating risk factors for the development of malignant tumors of the female reproductive tract. Both methods are fairly simple, reproducible and convenient for long-term follow-up.

[Classification of germinal tumors of the testis]. / Klasifikace germinálních nádoru varlete.

Based on the collection of more than 500 personal as well as consiliary cases of TGCT and a thorough review of the existing classifications, the essential synonyms used for designating TGCT entities have been subjected to a critical reappraisal. The tumour entities have been defined exactly to facilitate their coding according to the ICD-O system. The existing classification system have been subjected to a critical reappraisal and compared one to another as well as to our own classification as suggested by ourselves in 1974 and used since then. A detailed discussion and exact coding of well-defined entities is believed to permit an almost complete interconvertibility of the most significant classifications with that of ours and thus to form a reliable basis for amy form of comparison, including the therapeutic results. The bioptic examination of surgical specimens obtained by orchiectomy (other samples are regarded unsuitable) must be carried out in a standardized manner. This should permit not only the usual typing of the respective tumour but also the data necessary for proper tumour staging which today appears to be a natural prerequisite for rational treatment and its monitoring. The main principles of bioptic examination of testicular tumours have been summarized in brief.

["Giant" oncocytic renal adenomas]. / "Obrovské" onkocytární adenomy ledvin.

Postmortem and bioptic material from the 1953-1976 period included 7 cases of oncocytic renal adenoma larger than 5 cm including 3 larger than 10 cm. Macroscopic characteristics included red-brownish coloration and extensive foci of central hyalinosis. Microscopy showed them as being made up of cells resembling oncocytes with relatively active nuclei with solid, occasionally focus-like tubular structure. In spite of the large size and, in some rarer cases, focal nuclear atypia all of the tumours appeared to behave in a benign way. The causes of their increased frequency in the past decade remain to be clarified yet.

[An ovarian tumor with structural gonadoblastoma, dysgerminoma and choriocarcinoma]. / Ovariální nádor se strukturami gonadoblastomu, dysgerminomu a choriokarcinomu.

A 14 1/2-year old girl with menometrorrhagia followed by amenorrhea and abdominal pain had a pelvic resistance with limited mobility. Histology of a left ovarian tumour showed gonadoblastoma turning to dysgerminoma and associated with choriocarcinoma (M-9073/1, M-9060/3, M-90101/3). Genuine ovarian tissue was hypoplastic on both sides. In the right ovary, there were additional thecalutein cysts. The patient's karyotype was 46 XX. She has been without any relapse 2 1/2 years after chemotherapy and actinotherapy.

Carcinoma of the prostate in specimens removed for benign hyperplasia.

Unexpected carcinoma was found in 69 cases (7.7%) our of 891 patients subjected to surgery for clinically benign hyperplasia. The incidence was higher in specimens removed by suprapubic or retropubic approach (10.2%) than by transurethral resections (2.7%). Carcinoma was found most frequently in patients aged 70 to 80 years (50.8%), next being the age group 60 to 70 years. A statistically significant prevalence of carcinoma was in th medium sized prostases (30-40 grams = 12.4%) well compared to smaller or larger prostates. The principles for a systematic topographically oriented microscopic examination are described. Morphological categories of latent carcinoma are defined as microcarcinoma, focal, multifocal or diffuse carcinoma. Adenocarcinoma was the uniform pattern of these latent carcinomas. The therapeutic attitude towards the microscopically diagnosed clinically latent prostatic carcinoma is discussed.

[Juvenile granulosa cell tumor with subsequent occurrence of gastrointestinal polyposis, subcutaneous lipomatosis and nodular goiter]. / Juvenilní nádor z bunek granulózy s následným výskytem polypózy zazívacího traktu, subkutánní lipomatózy a nodózí strumy.

A juvenile tumour from granulosa cells (M-8622/1), 13 x 8 x 6 cm, in the right ovary in a three-month-old girl produced some symptoms of pseudopubertas praecox isosexualis which disappeared after operation. Microscopic examination of the tumour revealed in addition to typical structures a less common differentiation to Sertoli cells. Despite actinotherapy and chemotherapy one and a half years after the onset of the disease X-ray examination revealed metastases in the lungs which were successfully cured by further doses of the above two types of treatment. Between the age of 6 and 15 years the girl developed successively polyposis of the stomach, small and large intestine (M-7564/0), subcutaneous lipomatosis of the trunk and left lower extremity (M-8881/0) and nodular goitre (M-7164/0), predominantly quiescent. In the literature a connection between gonadal stromal ovarian tumours and mesenchymal tumours, intestinal polyposis and disorders of the thyroid gland is described, but in different patients. The authors' observation is unique by the successive incidence of these changes in a single patient surviving 15 years after operation; and thus genetically conditioned associations could be involved.

Ultrastructural changes of the adrenal cortex in Cushing's syndrome treated with aminoglutethimide (Elipten Ciba)

The main ultrastructural feature of human adrenal cortices following administration of aminoglutethimide (Elipten CIBA), a steroid biosynthesis blocking agent, is a striking intracellular accumulation of lipids, also seen in the light microscopy. The lipids accumulate in the adrenocortical cells but are also stored in the cytoplasm of pericapillary histiocytes. The lipids are present in the adrenocortical cells mostly as rounded liposomes of variable size, whereas those in the histiocytes usually show up as an amorphous debris with abundant myelin figures and cholesterol crystals. In some areas of the adrenal cortex activated histiocytes changing into lipophages may become the prevalent cell. They also take the place of destroyed adrenocortical cells and can form compact cell aggregates of variable size or even columnar strands between neighbouring capillaries, thus resembling columns of adrenocortical cells. In some of the adrenocortical cells focal cytoplasmic degradation, turning into coagulation necrosis, was observed. In others initial cytolysis was found. In contrast with earlier findings in experimental animals, mitochondrial changes in humans were not a prominent feature. The only changes occasionally observed were a focal disappearance of the vesicular cristae and a concomitant fibrillary loosening of the mitochondrial matrix.

Effect of 4-cholesten-3-one on steroidogenesis and morphology of rat adrenal cortex.

The production of corticosteroids from endogenous precursors was decreased in adrenal glands of male rats fed a diet containing one per cent of 4-cholesten-3-one for 3 and 7 days. In contrast, the conversion of labelled progesterone into corticosteroids was only slightly affected as shown by the increased aldosterone to 18-hydroxydeoxycorticosterone ratio. Morphological method revealed lipoid adrenal hyperplasia developing progressively during the observation period. In the adrenal gland, the content of 4-cholesten-3-one rose slightly and, as shown in the experiment with labelled 4-cholesten-3-one, it can serve only as a weakly effective precursor of corticosteroid biosynthesis. Cholesterol content in the adrenals decreased and lipoid hyperplasia could not be explained therefore by cholesterol accumulation.