Recurrent giant Gartner's duct cysts. A report of two cases.

BACKGROUND: Gartner's duct cysts are cystically dilated wolffian duct remnants found in the upper anterolateral part of the vagina. Many such giant cysts are diagnosed during childhood and result from ectopic communication with the ureter or cervix. There is a paucity of literature on recurrent and giant cysts presenting among older women. CASES: A 43-year-old woman presented in 1981 with a 7 x 14-cm, left, paravaginal, cystic mass. This was initially drained vaginally, then marsupialized vaginally. Following marsupialization, the patient began to note large gushes of fluid from the vagina. Ultrasound demonstrated a 3-cm cyst thought to arise within the broad ligament. The patient required total abdominal hysterectomy/bilateral salpingo-oophorectomy for endometrial hyperplasia. Exploration revealed neither a broad ligament nor vaginal mass. Postoperatively, vaginal drainage continued. Computed tomography demonstrated a multiloculated, cystic mass left of the vaginal cuff. Exploratory laparotomy revealed the mass to be within the paravaginal space. The cyst was marsupialized into the peritoneal cavity. A 32-year-old woman was diagnosed in 1992 with an 8 x 10-cm right pelvic mass found on examination and confirmed by computed tomography. At exploratory laparotomy the mass was found to be within the paravaginal space and was resected vaginally. In 1999 the patient returned, complaining of rectal pain. Examination and ultrasound revealed a right, multiloculated pelvic mass displacing the rectum, uterus and vagina. Magnetic resonance imaging demonstrated that the mass was entirely inferior to the levator plate. The cyst was resected vaginally. CONCLUSION: Giant Gartner's cysts tend to be misdiagnosed as pelvic masses. Magnetic resonance imaging is the best imaging modality for localizing these cysts. Recurrences of giant cysts tend to be multiloculated. Management strategies for multiloculated recurrences include periodic surveillance, schlerotherapy and marsupialization into the peritoneal cavity.

Development of wound infections among women undergoing cesarean section.

Sixty consecutive wound infections were studied among 1104 women undergoing cesarean section. Wound infections caused by cervical-vaginal flora were associated with prolonged labor, particularly with greater duration of fetal monitoring and number of vaginal examinations, and with organisms isolated from the endometrium at cesarean section. In contrast, women with wound infections caused by Staphylococcus aureus had neither prolonged labor nor S aureus isolated at cesarean section. The 25% of wound infections associated with S aureus represent potentially preventable conditions that presumably arise from exogenous sources.

Murine NK cell heterogeneity: subpopulations of C57BL/6 splenic NK cells detected by NK-1.1 and NK-2.1 antisera.

NK-1.1 antiserum - (BALB/c X C3H)F1 anti-CE - and NK-2.1 antiserum - NZB anti-BALB/c - detect genetically distinct alloantigens on C57BL/6 natural killer (NK) cells. We have analyzed whether these two alloantigens are associated with functional subsets of NK cells. For this study, nylon wool nonadherent C57BL/6 spleen cells (SC) were treated with complement (C) and NK-1.1 or NK-2.1 antisera and then tested for NK activity against a panel of tumor targets in 6- and 19-hour 51Cr release assays. The NK activity against the prototype NK target YAC-1 was reduced equally by both antisera. Similar reductions by both antisera were also observed when SC were tested against another murine lymphoma target, L5178c127v, against the C57BL/6 melanoma B16, and against the human liver cell line Chang. In contrast, NK activity to the lymphoma FBL-3 and the human erythroleukemia K562 was significantly reduced in SC treated with NK-2.1 antiserum and C, whereas SC treated with NK-1.1 antiserum and C showed either less reduction or no reduction in activity against these two cell lines. With two other targets, E male G2 and RBL-5, neither serum produced significant depletion of activity, Analysis of SC indirectly labeled with either NK-1.1 or NK-2.1 antiserum and fluorescein-labeled goat anti-mouse Ig, however, did not detect significant differences between NK-1+ and NK-2+ cell populations.

Analysis and enrichment of murine natural killer cells with the fluorescence-activated cell sorter.

The antiserum anti-NK 1.1 defines an alloantigen specific for natural killer (NK) cells on normal C57BL/6 spleen cells (SC). With complement this antiserum lysed an insignificant percentage of SC, yet could deplete SC suspensions of NK effector cells. The antiserum was also used in this study to indirectly fluorescein label NK cells. The anti-NK 1.1 serum labeled 10 to 15% of nonadherent, nylon column passed SC. The labeled cells were analyzed on the fluorescence-activated cell sorter (FACS), by using flow fluorometry, and were found to be small to medium-sized cells. SC were sorted on the FACS into labeled (NK-1+) and unlabeled (NK-1-) populations, and assayed for NK activity on YAC-1 cells. When compared with control SC, labeled NK-1+ cells were enriched 4- to 13-fold in lytic activity, whereas unlabeled NK-1- cells had little if any NK effector function. Thirty to 60% of the labeled SC adhered to YAC-1 tumor cells in a visual target binding cell assay. The percentage of lymphocytes in the sorted NK-1+ population that bound YAC-1 cells was over 3-fold greater than in unsorted control SC preparations. NK-1- sorted cells did not bind YAC-1 targets. In a preliminary experiment NK-1+ sorted SC inhibited outgrowth of YAC in A/J mice, whereas NK-1- sorted cells did not.

Presence of T cell-associated surface antigens on murine NK cells.

The expression of T cell-associated surface antigens on natural killer (NK) spleen cells of C57BL/6 mice was evaluated by cytotoxic depletion experiments with alloantisera prepared against the Thy 1, Ly 1, Ly 2, Ly 5, Ly 6, and NK 1 antigens. The NK activity of these nonimmunized spleen cells for YAC-1 leukemia cells was dramatically reduced by antisera to the Ly 5 and NK 1 antigens. Variable results were obtained with anti-Ly 6 sera--certain pools of this antiserum decreased the NK activity, whereas other pools showed only negligible effects. The NK activity of the same cell suspensions was not affected by antisera to the Thy 1, Ly 1, and Ly 2 antigens. In parallel tests the T cell-associated cell surface antigens of alloimmune T killer cells were similarly evaluated by cytotoxic depletion experiments. In this case, the activity of these cells was consistently diminished by antisera to the Thy 1, Ly 2, Ly 5, and Ly 6 antigens, but not by antisera to the Ly 1 and NK 1 antigens. On this basis it was concluded that the NK cells expressed a restricted subset of T cell-associated alloantigens and therefore may have been derived from the T cell lineage of lymphocytes.