[Natural history of precursor lesions of cervical cancer]. / Histoire naturelle des lésions précurseurs du cancer du col utérin.

Precursor lesions of invasive cancer of uterine cervix begin at the squamocolumnar junction. On this zone in permanent transformation, human papillomavirus (HPV) gives condylomatous lesions, pure or associated with neoplasic transformation of the epithelium. For 50 years, various histological classifications have been proposed. First, four groups have been designed: light, moderate, severe dysplasia and in situ carcinoma. Secondly, Richart proposed the cervix intraepithelial neoplasia classification (CIN) with three grades (1 to 3) according to their severity. Progression from CIN 1 to CIN 3 and invasive carcinoma is admitted and is consistent with the concept of lesional continuum. However, because of the elevated rate of spontaneous regression of CIN 1, it is probably a lesion of very low potential aggressivity and its role as a precursor is uncertain. Now two groups of different evolutivity are currently considered: low grade and high grade lesions. The last one's, at the opposite of the first, are monoclonal, have major epithelial abnormalities with sometimes abnormal mitoses and are frequently aneuploid. Aggressivity depends on the persistence of HR HPV more than on progressive morphologic transformation. By integrating in-host genoma, it induces modifications on cellular cycle proteins. Revelation by immunohistochemistry brings help to diagnosis of high grade lesions when traditional morphology is ambiguous.

[Endometrial choriocarcinoma in peri-menopausal women]. / Choriocarcinome utérin en péri-ménopause.

We report a case of a primary uterine choriocarcinoma associated with adenocarcinoma occurring during peri-menopausal age, and review the literature. The clinical course and the histopathology of the case were reviewed and a Medline literature search for other cases was performed. BHCG and analysis of uterine curettage provided the diagnosis of choriocarcinoma. Polychemotherapy, started immediately after the patient's clinical condition deteriorated, was successful. Colpohysterectomy and pelvic lymphadenectomy were performed 5 months later. Treatment was completed by vaginal curietherapy. Histopathologic examination of the surgical specimen revealed only adenocarcinoma. The patient was followed for 18 months without evidence of recurrence. The literature search revealed that primary forms are exceptional; the etiology is unknown. Treatment is based on polychemotherapy. Primary choriocarcinomas are rare tumours, associated with other histopathological forms. We document a case occurring during the peri-menopausal period and review the literature on this pathology. The very poor prognosis in the past has changed with early polychemotherapy.

Systemic polyarteritis nodosa diagnosed at hysterectomy.

A 61-year-woman was referred because of declining general health. A diagnosis of uterine malignancy was suspected on the basis of uterine enlargement and an elevated erythrocyte sedimentation rate. Hysterectomy was performed, and histologic examination revealed necrotizing vasculitis affecting the ovaries, fallopian tube, and uterus. Muscle biopsy showed typical periarteritis nodosa lesions. Despite the scarcity of such cases, the incidental finding of necrotizing arteritis in a surgical uterine specimen warrants further investigation to determine if the vasculitic process is localized.

Stromal changes in early invasive breast carcinoma. An immunohistochemical, histoenzymological and ultrastructural study.

The purpose of this work was to detect in periductal connective tissue of breast carcinoma in situ changes induced by intraductal tumor cells before any dehiscence in basement membrane. Histological, electron microscopic, immunohistochemical and histoenzymological methods were used in 3 carcinomas in situ, 4 microinvasive carcinomas and 13 control invasive carcinomas. We could demonstrate a high functional activity of fibroblasts with secretion of mucopolysaccharides and type III collagen around intraductal carcinomas. These changes occurred simultaneously to those of the basement membrane which was either thinning or thickening. Any dehiscence in basement membrane secondarily induced in this periductal stroma the usual changes seen in invasive stroma, peculiarly numerous vascular pedicles, myofibroblasts, elastic material. These periductal stromal changes are interpreted according to recent concepts about the possible influence of tumor cells upon their environment: stimulation of mitotic and metabolic activity of fibroblasts: stimulation of angiogenesis by means of an angiogenic factor.

Effects of estradiol and promegestone on human breast cell cultures. An ultrastructural study.

Effects of estradiol (E2) and promegestone (R 5020) were tested on primary cultures of epithelial human breast cells prepared from surgical specimens of reduction mammoplasty. Comparative morphological studies were performed by means of transmission and scanning electron microscopy in cells without any hormonal adjunction and in those previously treated with E2 or E2 + R 5020. The results were as follows: In basal medium used as control the majority of epithelial cells, although well-differentiated, remained flat with few microvilli, well-developed Golgi apparatus and rough endoplasmic reticulum, was obvious. R 5020 added with E2 increased differentiation of epithelial cells covered with scarce long and branched microvilli, but reduced the turn-over of young cells. E2 seemed to generate more active proliferation of cells. R 5020 inhibited this effect and induced a higher differentiation of mammary epithelial cells.

[Small cell carcinoma. Incidence, histopathology and anatomical features. Analysis of 465 autopsied bronchopulmonary carcinomas (author's transl)]. / Le cancer bronchique à petites cllules: fréquence, histopathologie et évolution anatomique; analyse d'un recrutement nécropsique de 465 cancers bronchopulmonaires.

465 patients with broncho-pulmonary malignant tumors have been autopsied. Small cell carcinoma was diagnosed in 22.5 per cent of these patients. The histo-cytological variants of these tumors (lymphocytoid, polygonal, fusiform and polymorphic) had the same general characteristics (age, sex, survival) and a similar clinical course. Grossly and histologically, the bronchial tumor, always located in proximal bronchial tree, largely involved the mediastinum. Metastases were peculiarly frequent to the liver (69%), to bone (64.2%) and to the central nervous system (36.2%). Three Schwartz-Bartter syndromes and two Denny Brown sensitive neuropathies were noted in this statistical study.

[Pathology of degenerative aortic valve insufficiency]. / Anatomie pathologique des insuffisances aortiques dégénératives.

The authors studies 154 cases of degenerative aortic regurgitation which presented macroscopically with atrophic changes of the valve and sometimes with hypertrophy and calcification. Histologically, the essential abnormality was the finding of mucopolysaccharide deposits dissociating the corpus spongiosa from the corpus fibrosa. Depending on the importance of these lesions, three degrees of severity can be defined, the most extensive (84% of our patient population) appearing to be typical of the disease. In addition, mild mitral valve prolapse (5%) and medial necrosis of the aortic wall (80% of patients undergoing aortic biopsy) were observed. These morphological features are on the whole quite different to those of other aortic valve pathologies (rheumatic, endocarditis). However, the border line with other pathologies with a similar anatomopathological substratum is less clearly defined: genetic abnormalities (Marfan's syndrome, Lobstein's disease, etc...) or age-related degenerative disease. The pathogenesis is not clearly understood but could be related to regional disturbances in collagen metabolism with collagenolysis predominating.

[Cells of the conduction pathways of the human bundles of His. Histoenzymologic and ultrastructural study]. / Les cellules des voies de conduction dans le faisceau de His humain. Etude histoenzymologique et ultrastructurale.

A human His bundle was studied two hours after death by histoenzymological techniques and electron microscopy. The pathway had a much higher cholinesterase activity than the working myocardium, due to its richness in nerve endings: this was confirmed by electron microscopy which also distinguished "common" contractile cells (working cells) from P type and "intermediary" cells; those were by far the most common, presenting an ultrastructure identical to that of the Purkinje cells, classically described in the bundle branches alone. These findings and the unique longitudinal architectural organisation of the His bundle, confirm the studies of JAMES and may explain the rapidity of conduction in this structure.

[Metaplasia and high grade CIN. Diagnostic difficulties]. / Métaplasie et CIN de haut grade. Difficultés diagnostiques.

Squamous metaplasia of cervix represents the physiologic process of transformation of eversed glandular tissue at external orifice by a malpighian tissue. Primarily undifferentiated and immature, the epithelium progressively becomes differentiated and takes glycogen. In a high grade CIN the normal squamous epithelium is replaced by an undifferentiated tissue comporting basal cells with nuclear atypias. When cellular abnormalities are not marked, differential diagnosis exists with immature metaplasia. Cytology with suspicion of squamous intraepithelial lesion is sometimes followed by a diagnosis of high grade CIN on biopsy, but conisation reveals a metaplasia.

[In situ adenocarcinoma of the uterus cervix: difficulties of its cytohistological diagnosis]. / Adénocarcinome in situ de l'endocol: difficultés du diagnostic cyto-histologique.

In situ adenocarcinoma is regarded as the precursor of invasive adenocarcinoma. It is asymptomatic and early diagnosis relies solely on cytopathologist. It is usually discovered on a cone for squamous CIN. When diagnosis is made by biopsy, conisation is required to exclude invasive adenocarcinoma. Lesion is histologically characterised by epitheliomatous transformation of endocervical glands without invasion of the chorion. By the appearance of glandular cells, different histological varieties are described. They have no influence on the prognosis. Several benign lesions may mimic adenocarcinoma: tubal metaplasia, glandular atypia due to inflammation or irradiation, mesonephric remnants and microglandular hyperplasia. Precursor lesions (atypical hyperplasia, glandular dysplasia, CIGNI and II) are badly morphologically defined. Preferential location of in situ adenocarcinoma is the transformation zone. Because of this topography, if the surgical margins are disease free, conisation alone may be adequate therapy. HPV infection (mainly HPV 18) are incriminated in its pathogenesis.

[Desmoid fibroma of bone. An histoenzymological and ultrastructural study of the mandible in one case (author's transl)]. / Fibrome desmoïde osseux. Etude histoenzymologique et ultrastructurale d'un cas de siège mandibulaire.

A case of post-traumatic desmoid tumor of the mandible is reported in a 4-year old girl. This tumor was considered typical clinically and by light microscopy. Four years later, the patient was symptomless, without evidence of recurrence. Histoenzymology showed a high level of leucine aminopeptidase activity. On electron microscopy, a part from a few primitive mesenchymal cells, abnormal fibroblasts represented the principal cellular component. These cells showed evidence of intracytoplasmic collagen fibers synthesis and of myoid differentiation (numerous filaments and endocytosis vacuoles). Myofibroblasts, with a microfibrillary network showing areas of dense osmiophilic condensation in the vicinity of cell membrane were also present. This atypical ultrastructural feature suggests, in this case, the non-neoplastic nature of this lesion. It seems to reflect an abnormal reaction to a traumatic aggression, characterized by proliferation of myofibroblasts (which normally disappear in the late stages of healing) and to have, thus, the signification of pathologic scar.

[Angiosarcoma of the breast associated with contralateral carcinoma. Apropos of a case report]. / Angiosarcome mammaire associé à un carcinome controlatéral. A propos d'un cas.

One case of angiosarcoma of the right breast and concomitant controlateral carcinoma in a fifty nine year old woman is described. Clinical and pathological particularities of this case are shortly discussed. In spite of very poor reputation associated with angiosarcoma, size of the two lesions (less than 2 cm) and their good differentiation suggests a favourable prognosis.

[Sarcoma phyllodes of the breast. Apropos of a case withan ultrastructural and histoenzymological study]. / Sarcome phyllode mammaire. A propos d'un cas avec étude ultrastructurale et histo enzymologique.

One case of cystosarcoma phyllodes is reported. Histologically, the neoplasm was composed of two elements: benign epithelial cells and malignant stromal cells. The stromal cells, spindle shaped, grow in solid sheets or in sparcely cellular, myxomatous and alcianophilic areas. Scanning electron microscopy demonstrates a mucous secretion, showing porelike openings and mucous droplets on the surface of tumoral cells.By transmission electron microscopy, sarcomatous cells look like very polymorphous. Secretory cells (showing dilated granular endoplasmic reticulum and abundant lysosomes) are mixed with primitive mesenchymal cells and with intermediate, myoepithelial cells. The myoid origin of these cells is demonstrated by the bundless of myofilaments terminated in marginal plaques on the plasma membrane, the numerous pinocytic vesicles and basal lamina investing irregularly the cells. Histoenzymology corroborates these findings, disclosing a high activity of alkaline phosphatase. Discovery of ambiguous myoepithelial cells associated with undifferentiated cells, likewise reported in epitheliomas, is of a great histogenetic interest. It suggests development of mammary neoplasm from stem cells coming under local of general influences, unknown today, but perhaps responsible of epithelial or conjunctive differentiation. The presence of a contralateral carcinoma in our case is consistent with this hypothesis.

[Genital actinomycosis. Diagnostic and therapeutic difficulties. Report of three cases]. / Actinomycose génitale. Difficultés diagnostiques et thérapeutiques. A propos de trois cas.

Genital actinomycosis is a rare bacterial infection affecting women of child-bearing age, which is sometimes related to the use of an IUD or an intra-vaginal pessary. Nevertheless, this relationship is at best tenous and actinomycosis is not the only bacterial infection caused by IUD use. Genital actinomycosis often occurs as a pelvic tumour which is sometimes difficult to correctly diagnose and consequently treat accordingly. Rapid diagnosis is essential in order to avoid any irreparable tissue damage. Treatment of this condition consists of a combination of antibiotics and surgery to achieve complete recovery. Three cases are described.

[Comparison of different types of ovarian wound closure in rats. Role of biological glue]. / Comparaison de différents types de "fermeture" de l'ovaire chez la rate. Place de la colle biologique.

Three techniques for closing the ovary have been compared. The test was carried out on 30 rats' ovaries. After the ovary had been cut with scissors it was closed with rapid acting Tissucol (a biological glue) or closed with interrupted stitches of 10/0 Vicryl, or left to close by itself. Sixty days later the ovaries were looked at macroscopically and histologically. The macroscopic score was established according to the presence of adhesions, the size of the ovary, the presence of cysts; and the histological score was carried out according to the presence of granulomatous macrophage lesions, the degree of fibrosis and the existence of germ cell cysts. The results were identifically the same as far as these five different criteria were concerned. All the same, Tissucol brought about less fibrosis and less atrophy of the ovary. Tissucol, therefore, is a good alternative for suturing the ovary as compared with stitching or no formal closure after the removal of ovarian cysts, particularly laparoscopically.

[Possibilities and limitations of the acetic acid test in the identification of vulvar papillomavirus lesions. A colposcopic, histologic and virologic study]. / Apports et limites du test à l'acide acétique dans l'identification des lésions vulvaires à papillomavirus. Etude colposcopique, histologique et virologique.

42 subclinical HPV related vulvar lesions have been studied by Southern Blot Hybridization and histological samplings. 15 women had normal Pap smears. Cervical intraepithelial neoplasia was present in 24 other women, 15 of them had HPV on Southern Blots. Macular or papular areas on the vulva were strongly correlated with HPV infection, since 6 out 9 of them harboured HPV 16, 42 or X. Histologically, flat condyloma was present in 6 cases. However, 33 nonspecific acetowhite reactions of the vulva were free of HPV. It is therefore important to recognize such aspects on colposcopical examination of the vulva to avoid unnecessary treatment.

[Subclinical vulvar lesions. Vulvoscopic and histologic aspects. Apropos fo 74 cases]. / Lésions infracliniques vulvaires. Aspects vulvoscopiques et histologiques. A propos de 74 cas.

Subclinical vulvar lesions have been studied using the magnifying colposcope after 5% acetic acid application in 65 women with H.P.V. related cervical lesions and/or cervical intraepithelial neoplasms. Different vulvoscopic patterns are described: micropapillae (51%), diffuse acetowhite reaction (18%), papules (13%) and leukoplakia (11%). A normal appearance was found in 7% of the cases. Histological diagnosis is far different: normal histological appearance or minimal histological changes are noted in 57% of the biopsy specimens, flat condylomas of the vulva in 38% and vulvar intraepithelial neoplasms (V.I.N.) in 15%. The most frequent clinical aspects, i.e., acetowhite reaction and micropapillae are seldom related to V.I.N. The significance of these H.P.V. histologically-related vulvar lesions is still difficult to assess. Unlike cervical intraepithelial neoplasms, the malignant potential of V.I.N. remains uncertain. The risk of progression to invasive cancer in young women is low, probably less than 5%. On the other hand, vulvae may harbour H.P.V. able to influence subsequent recurrences of dysplasias of the cervix. Further studies are needed, especially Southern blot hybridization of vulvar biopsy specimens, to determine whether these histological abnormalities definitely harbour viruses and need subsequent treatment.

[Endometrial ossification. Apropos of 5 recent cases]. / Ossification endométriale. A propos de 5 observations récentes.

Five cases of ossification of the endometrium that have been seen in the course of five years are reported. Special attention is paid to a case that occurred in the post-partum period. Several different hypotheses as to the aetiology of the pathology of this condition are discussed yet again; the only one that seems likely to be possible is that these ossifications start as metaplasias. The clinical, paraclinical and therapeutic angles are also dealt with.