[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.

[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.

[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.

Lack of evidence for a role of human papillomaviruses in transitional cell carcinoma of the bladder.

PURPOSE: In view of the conflicting results reported in the literature, we assessed the involvement of human papillomaviruses (HPV) in the development of transitional cell carcinoma of the bladder. MATERIALS AND METHODS: A total of 58 bladder papillomatous proliferations was histologically examined and analyzed for the presence of HPV deoxyribonucleic acid (DNA) sequences by Southern blot hybridization and the polymerase chain reaction (PCR) method. RESULTS: Typical features of condyloma acuminatum were observed in the bladder specimen of a patient with urethral condylomatosis. Of the specimens 57 had histological features of transitional cell carcinoma but no known signs of HPV infection. HPV-6 DNA was detected in the condylomatous tumor. However, no HPV DNA was detected in the 57 bladder cancers by Southern blot hybridization and polymerase chain reaction. CONCLUSIONS: These findings do not support an etiological role of HPV in the development of transitional cell bladder cancer.

[Ultrasound-guided biopsies for breast nodules: value of automatic biopsy needle]. / Biopsies échoguidées des nodules du sein: intérêt du boîtier automatique.

Within 18 month, 83 solid breast nodules were biopsied with a long throw biopsy gun with 18 gauge needle (Monopty, Bard Urological, Covington) and a 13 Mhz real time AU 530 (Easote Biomedica, Italy) for the ultrasound guidance. The biopsy procedure was well tolerated with no serious complications, and with no insufficient material. US guided biopsy detected 9 cancers, 47 specific benign lesions (39 fibroadenomas, 1 lipofibroadenoma, 4 sclerosing adenoses, 1 fibromatosis, 1 cyst, 1 lymphadenopathy) and 27 non specific benign fibrocystic dystrophy. In 14 out of the 15 nodules surgically removed, the histological diagnoses were identical. In the one remaining case a fibroadenomas was assessed. In the 36 other cases no evolution occurred. US guided core biopsy with automatic device is probably a very useful approach of uncertain pathological diagnoses in mastology.

[Treatment of external ano-genital condylomata with 0.5% podophyllotoxin]. / Traitement des condylomes ano-génitaux externes par podophyllotoxine à 0.5%.

There are several possible protocols for the treatment of ano-genital condylomata. In this study, the efficacy of podophyllotoxin (0.5%) was assessed. The authors observed a recovery rate at 1 month of 81% in cases of condylomata of the balano-preputial and vulvar mucous membranes, a rate of 67% in condylomata of the keratinized tissues and 63% in those of the anal margin. Response to treatment is also dependent on the morphology of the lesion; regression was observed in 78% of cases of condylomata acuminata and in 57% of cases of endophytic condylomata. The side effects were local and consisted of erosion in 20% of cases. The efficacy of treatment was, amongst other things, analysed according to the recurrence of the infection at one month, which occurred in 16% of cases affecting mucous membranes. In the therapeutic arsenal for the treatment of condylomata, podophyllotoxin 0.5% is a first line treatment for condylomata acuminata of the genital mucous membranes.

CO2 laser for therapeutic circumcision in adults.

The use of carbon dioxide laser for 38 posthetomies or therapeutic circumcisions in the treatment of phimosis, paraphimosis, balanitis of Zoon or a genital infection by the human papillomaviurs permits clean and hemostatic incisions. The clean and dry wound produced by the carbon dioxide beam offers several advantages. It reduces the surgeon's risk of contamination by the HIV virus and the subsequent sear is regular and without edema. In 57% of primary phimosis cases, the histological analysis showed a lichen sclerosus et atrophicus.

[Outpatient excision of low grade cervical intraepithelial lesions using loop diathermy]. / Exérèse ambulatoire des lésions intra-épithéliales de bas grade du col utérin à l'anse diathermique.

Twenty five years after the introduction of outpatient treatment for cervical precancers, several cases of invasive cancer after laser, cryotherapy or electrocautery have been described. As a consequence, the diathermy loop excision has recently been proposed for the treatment of cervical intraepithelial neoplasia. The new generators seem to assure a high quality of cut and allow the histological analysis of all the lesional tissue excised as deep as the laser vaporisation usually goes (7 mm). We have tested this treatment on a series of CIN I on an outpatient basis and our results confirm that loop excision can replace destructive treatments for CIN I. As for high grade lesions, we still think that laser conisation under general anesthesia remains the best choice.

[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.

[Hydatid cyst of the breast. Case report]. / Kyste hydatique du sein. A propos d'un cas.

The rarity of mammary echinococcosis leads the authors to report the demonstrative case of a 45-year-old woman, para 9, gravida 9, who had always breast fed, undergoing surgery for a cyst of the right breast and which was found histologically to be a hydatid cyst. Progression of the tumour was particularly slow (approximately 10 years). Mammography forms an essential part of pre-treatment evaluation since it enables circumscription of the lesions and study of regional lymph nodes which are normal in all cases. At any event, cystectomy is the only effective method of treatment, recognised by all authors. Clinical and mammographic evaluation after 2 years of our patient was normal.

[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.

[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.

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.

[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.

[Facial circumscribed ossifying myositis. Anatomo-clinical and tomodensitometric study]. / Myosite ossifiante circonscrite faciale. Etude anatomo-clinique et tomodensitométrique.

1 case of circumscribed myositis ossificans of the temporal muscle is reported in a 21 years-old man. The initial complaint was a sudden non traumatic swelling. Roentgenography showed a characteristic feature: peripheral radio-opacity around a non-opacified area. Under microscope, we could find 3 zones: a central fibroblastic area, an intermediate zone with immature osteoid bone, a peripheral zone with mature lamellar bone. In addition, we used histoenzymological and electron microscopical methods. The difficulties of diagnosis, the pathogenesis and the prognosis of this disease were also discussed.

[Intraepithelial neoplasm of the uterine cervix and angiogenesis: morphologic study]. / Néoplasie intra-épithéliale du col utérin et angiogénèse: étude morphologique.

Thirty uterine cervix specimens sampled following conization or total hysterectomy were studied using histology, histoenzymology (vessel phosphatase alkaline activity), and immunohistochemistry (demonstration of laminin and type IV collagen in epithelium and vessel basement membranes). Pathologic conditions included dystrophia, moderate dysplasia, severe dysplasia, and intraepithelial carcinoma. Results were compared to findings in a control group. We found that the severity of vascular abnormalities correlated positively with the severity of histologic epithelial lesions; this finding is consistent with colposcopic results. Anarchic angiogenesis with large, moniliform, tortuous vessels was seen in severe dysplasias and carcinomas. The vascular anomalies seem to precede the development of histologic lesions in some instances. Histogenesis of the abnormal vessels may involve production of an angiogenic factor by the cancerized epithelia.