The transverse vaginal septum: a clinicopathologic evaluation.

Twelve cases of transverse vaginal septum were clinically and pathologically evaluated. Seven cases were treated with electrosurgical excision of the septum with encouraging results. Histologic findings in the patients in this study support the view that the epithelium of the vagina and the transverse septum are of mesonephroid origin.

Microinvasive carcinoma of the vulva: a clinicopathologic evaluation.

Two types of neoplasms described as superficially invasive or microinvasive carcinoma of the vulva were identified. One type, which can be treated by conservative surgery, is commonly associated with extensive overlying intraepithelial neoplasia. Usually 1 focus of microinvasion, but occasionally more invades less than 2 mm into the underlying stroma. The infiltrating cells comprise 1 or more isolated cords, and confluency is never present. The second and less common form tends to metastasize early to lymph nodes and should be treated by a radical approach. This type is seldom associated with overlying intraepithelial neoplasia. It tends to be poorly differentiated and is confluent. In this series, 2 of 3 patients with confluent microinvasion had metastases to the lymph nodes, but none of 15 patients with nonconfluent microinvasion developed metastases.

Endometrial carcinoma in women 40 years of age or younger.

Adenocarcinoma of the endometrium in patients 40 years of age or younger is rare and accounts for 2.9% of all endometrial cancers diagnosed in the study community. However, the diagnosis of malignancy was confirmed in only 32 of 54 patients (59.2%) with pathologic material available for review. None of the 32 patients had Stein-Leventhal syndrome or was receiving sequential oral contraceptives. Obesity was found in only 37.5%, nulligravidity in 37.5%, and hypertension in 25%. In 81%, the presenting symptom was abnormal vaginal bleeding, and 6 patients (19%) had coexisting ovarian neoplasms (4 endometrioid carcinomas, 1 mucinous cystadenocarcinoma, and 1 adenocarcinoma arising in a cystic teratoma). Atypical endometrial hyperplasia, previously interpreted as well-differentiated adenocarcinoma, was diagnosed in 11 of 22 patients. The pathologic criteria for establishing a diagnosis of atypical endometrial hyperplasia and distinguishing it from well differentiated adenocarcinoma of the endometrium are emphasized. Thirteen of 32 patients received no radiation therapy and none developed pelvic recurrence or metastatic tumor. The 2 deaths from tumor were in patients with stage 3 ovarian cancer, and no patients died of endometrial carcinoma. The current policy is to treat patients with atypical endometrial hyperplasia and well-differentiated adenocarcinoma (clinical stage I, pathology confirmed) by hysterectomy without irradiation treatment. Because of 6 of the 32 patients (19%) had coexisting ovarian neoplasms, careful examination of the adnexa at the time of clinical staging is emphasized.

The endodermal sinus tumor: special features.

Eight cases of endermal sinus tumor, two extragonadal and six gonadal, seen at the American University of Beirut are reviewed. Three of them present special clinical and pathologic features that further substantiate the extraembryonic origin of this teratoid tumor and its association with dysgenetic gonads. We consider the two histologic types, endodermal sinus pattern and polyvesicular vitelline architecture, to be part of the same tumor. The prognosis in this series was unfavorable.

Electrical breast stimulation. Oxytocin, prolactin and uterine response.

Electrical breast stimulation using a modified electromyograph was performed on 10 pregnant women between 38 and 42 weeks of gestation. An adequate uterine contraction pattern (at least three contractions lasting > or = 30 seconds in a 10-minute interval either recorded by external tochodynamometry, palpated and/or felt by the patient) was obtained in 8 of the 10. Two patients, however, had uterine hyperstimulation (contractions lasting > 90 seconds). In contrast to previous reports, serum oxytocin levels increased significantly in 7 of the 10 patients. Moreover, this increase preceded or was concomitant with the uterine contractions. Serum prolactin varied unpredictably following electrical breast stimulation. The stimulation was well tolerated, without any discomfort, by all the patients. Electrical breast stimulation can thus be used for the stimulation of uterine contractions.

Microinvasive carcinoma of the vulva. A report of two cases with regional lymph node metastasis.

Microinvasive squamous cell carcinoma of the vulva (invasion less than 5 mm) is a controversial concept. While initial observations did not identify regional lymph node metastases in patients with this lesion, 9.4% of all cases summarized from the literature have reported regional metastases. Presented here are two cases of poorly differentiated squamous cell carcinoma of the vulva (invasion of 2.0 and 3.0 mm) with lymph node metastases. Both patients' neoplasms consisted of a single focus of symmetrically expanding ("spray") carcinoma with infiltrating cords and isolated cells. While keratin formation was abundant, cytologic atypia was prominent. It is the authors' opinion that the degree of tumor differentiation, as judged by multiple parameters and pattern of invasion, is far more important than depth of invasion in predicting tumor behavior to determine therapy.

The twisted adnexa: a clinical pathological review.

Fifteen cases of twisted uterine adnexa are reviewed. Laparoscopy is helpful in establishing an early diagnosis. The histologic, as well as the clinical, pictures of the various conditions are presented.

Eosinophilic granuloma with involvement of the female genitalia.

Four cases of eosinophilic granuloma involving the female genital tract are reviewed. The disease may remain localized, but more often involves other organs. Of particular interest was the association of the disease with diabetes insipidus in three patients. One of the patients with diabetes insipidus was successfully treated with radiotherapy to the hypothalamic area as soon as the symptoms of the disease appeared. Genital lesions may respond to radiotherapy. Chemotherapy is to be used for disseminated disease. Treatment of this condition requires studying the extent of the disease and establishing early treatment, as with any malignant lesion.