Significance of ovarian histology in the management of patients presenting a premature ovarian failure.

BACKGROUND: Premature ovarian failure (POF) is a heterogeneous syndrome, possibly due to mutations of genes involved in the normal development of the ovary and/or follicles. Based essentially on animal models, these mutations are associated with various ovarian phenotypes, from a complete absence of follicles to a partial follicular maturation. The aim of the present study was to determine whether ovarian histology, compared to pelvic ultrasonography, would be helpful in identifying which patients display an impaired follicular reserve and/or growth, and in orientating the search for POF aetiology. METHODS AND RESULTS: We studied a cohort of 61 patients suffering from POF with a normal karyotype. Their median age (range) at diagnosis was 26 years (15-39). The FSH plasma level was high, 67.0 IU/l (13-155). Estradiol and inhibin B plasma levels were low: 18.5 pmol/l (18.5-555) and 5 pg/ml (5-105) respectively. Both pelvic ultrasonography and ovarian biopsies were performed in each patient. The presence of follicles suggested at ultrasonography was confirmed at histology in 56% of the patients. Ovarian histology led to the distinction of two phenotypes: (i) small-sized ovaries, deprived of follicles; and (ii) normal-sized ovaries with partial follicular maturation. To confirm the value of ovarian biopsies, samples from 20 normal women were studied. These demonstrated that ovarian biopsy at random enables reliable assessment of follicular presence, especially when their size is <2 mm. CONCLUSION: Ovarian histology appears to be a reliable tool in evaluating the follicular reserve, and helpful and complementary to clinical and hormonal phenotyping in orienting the search for the various genetic causes of POF syndrome.

[Verrucous carcinoma of the vulva: a tailored treatment]. / Carcinomes verruqueux vulvaires: un traitement sur mesure.

OBJECTIVE: Verrucous carcinoma is a rare form of vulvar squamous carcinoma, with particular clinical presentation and histological description. We analyze the specificity of the treatment of this form. MATERIALS AND METHODS: We analyzed the records of 8 patients treated in our hospital between 1995 and 2001. In the absence of an associated lesion, the treatment was partial vulvectomy without lymph node dissection. A close follow-up was then organized. RESULTS: Mean age was 76 years (range 54 to 92). In 7 out of the 8 cases we found an associated lesion: invasive squamous carcinoma, VIN III or lichen. Two patients later developed a squamous carcinoma. Two others died because of intercurrent diseases. The last four patients are doing well. CONCLUSION: We confirm the efficacy of the treatment generally proposed: partial vulvectomy, without lymph node dissection and without complementary treatment but with a close follow-up. The coexistence of other vulvar lesions such as lichen is remarkable in our series.

Three-dimensional imaging of solid breast tumors with ultrasound: preliminary data and analysis of its possible contribution to the understanding of the standard two-dimensional sonographic images.

Reconstructed three-dimensional sonographic images are presented from patients having different histological types of breast tumors. Scanning is manual and performed using two-dimensional annular array, sector transducers fitted on a mechanical arm, to provide spatial location. The three-dimensional data are displayed using two different modalities. Planar reformatted sections allow the visualization of planes reconstructed along any direction chosen by the operator. Of particular interest are the reconstructions obtained along equatorial planes of the tumors, i.e. planes parallel to the chest wall and, consequently, to the fibroglandular layer of the breast. Volume rendering is obtained using the shaded-surface visualization technique.Three-dimensional imaging provides new information and allows a better interpretation of the standard two-dimensional images. Planar reformatted sections confirm that ductal carcinomas present margin jagging on all views, including the equatorial section planes. Using the shaded-surface visualization technique, these tumors appear with a spiked outer surface. Thus, the most specific sonographic finding associated with ductal carcinomas may be that margin jagging extends over the entire periphery of the mass. On planar reformatted sections, benign tumors are surrounded by a continuous hyperechogenic rim, i.e. the rim is present irrespective of the section plane orientation. Medullary carcinomas are also surrounded by a hyperechogenic rim. However, a clearly distinctive feature of these lesions is found on planar reformatted sections: the rim is discontinuous on certain section planes. A mass can be considered benign only if its rim is continuous, i.e. if it is present all around the tumor.

[Malignant mixed mesodermal tumor detected by uterine inversion. Apropos of a case. Review of the literature]. / Tumeur mésodermique mixte maligne révélée par une inversion utérine. A propos d'un cas. Revue de la littérature.

The authors report the anatomoclinical observation of an 82-year old patient presenting a mixed malignant mesodermal tumour (MMMT) revealed by a uterine inversion. The histological examination revealed sarcomatous and carcinomatous lesions with zones of chondroid metaplasia infiltrating largely the myometrium. A total vaginal hysterectomy, accompanied by radiotherapy, got the better of an early local relapse. The histogenetic hypotheses of MMMTs, the particular circumstances of the tumour revelation, as well as the methods of treatment are reviewed.

Mass screening for breast cancer with sonomammography: a prospective study.

A prospective study was performed to assess the reliability of sonographic mammography in mass screening for breast lesions and diagnosis of small, presumably early, breast cancers. 1350 women underwent a sonomammographic examination of the breasts. Sonomammographic images were described in terms of their elementary constituents. Final diagnosis was obtained through cytological, and, when indicated, histological analysis. This ultimately led to the diagnosis of 13 breast cancers. Statistical analysis of the elementary sonomammographic image data using a logistic regression found two criteria to be highly associated with cancer. These were: (1) jagged aspect of the margins extending to the anterior or posterior walls; (2) major axis of the lesion not parallel to the skin surface. When combined, these two criteria have a 100% sensitivity and 99.6% specificity. The conclusions of the present study were validated for the screening of young women and may be applied to the screening of small lesions. However, these conclusions should be restricted to tumors 5 mm or more in diameter and of the common histological type, i.e. the infiltrating ductal carcinomas. Within these limitations, sonographic mammography can be considered a reliable technique for mass screening for breast cancer.

[Primary solid tumors of the epididymis. Apropos of 4 cases of benign tumor and one case of malignant mesothelioma]. / Les tumeurs solides primitives de l'épididyme. A propos de quatre cas de tumeurs bénignes et d'un cas de mésothéliome malin.

Based on a series of 5 tumours of the epididymis, the authors recall the relative frequency of primary solid tumours of the epididymis. They present 2 benign mesotheliomas and discuss the various histogenetic theories for their development, one fibroma, one haemangio-fibro-leiomyoma and one malignant mesothelioma of the cord, invading the epididymis. These are rare tumours (Broth's review of the literature revealed 278 cases in the world, consisting of 209 benign tumours (75%) and 69 malignant tumours (25%). The most frequent benign tumour is the mesothelioma (75% of the benign tumours), formerly referred to as an "adenomatoid tumour". Its histogenesis is still controversial (epithelial or mesothelial origin). The mesothelial theory is the more widely accepted. According to the majority of authors, malignant mesothelioma of the epididymis does not exist, but our case of malignant tumour questions this concept. The other tumours consist of benign and malignant mesenchymal, epithelial or dysembryoplastic tumours. The borderline with spermatic cord tumours is not always easy to define. The authors recall the value of comparative scrotal ultrasonography for the topographical diagnosis of tumours of the epididymis and testicular tumours and the differential diagnosis with certain epididymal cysts.

[Ultrasonography of subclinical primary testicular tumors. Apropos of a Sertoli cell tumor]. / Echographie des tumeurs testiculaires primitives infracliniques. A propos d'une tumeur à cellules de Sertoli.

The authors report an original case of an adult presenting with a bilateral Sertoli cell testicular tumour in whom one of the impalpable lesions was detected by routine ultrasonography. This appears to be the first reported description of the ultrasonographic appearance of such a subclinical tumour. The review of 20 published cases reporting the appearance of impalpable primary tumours reveals that in the great majority of cases the echostructure is hypoechoic and therefore does not present any histological specificity, and that these tumours tend to be essentially seminomas or Leydig cell tumours. The indications for scrotal ultrasonography in the detection and follow-up of scrotal tumours are discussed.