Structure and composition of microcalcifications in benign and malignant lesions of the breast: study by light microscopy, transmission and scanning electron microscopy, microprobe analysis, and X-ray diffraction.

Microcalcifications previously located by radiography were extracted from 25 fresh specimens obtained from patients who had undergone tumorectomy or systematized mammary exeresis. Two principal types of microcalcifications were distinguished: Type I microcalcifications were amber in color and generally crystalline on scanning electron microscopy, with only one calcium peak on microprobe analysis; x-ray diffraction revealed that weddellite was involved. Type II microcalcifications were whitish, nonbirefringent under polarized light, and generally ovoid or fusiform, with two peaks, one calcium and the other phosphorus, on microprobe analysis; these microcalcifications were composed of calcium phosphate, the most characteristic form of which is hydroxyapatite, in the form of needles arranged in rosettes on transmission electron microscopy. Type I microcalcifications were observed in four of eight benign breast lesions, in two of three in situ lobular carcinomas, and in no intraductal adenocarcinomas or infiltrating carcinomas. Type II microcalcifications were present in all infiltrating carcinomas and intraductal adenocarcinomas; they were also found in benign lesions (four of eight) and even associated with type I microcalcifications in one in situ lobular carcinoma. There are, therefore, no "benign" or "malignant" microcalcifications; however, the presence of weddellite is a strong indication that a lesion is benign or, at most, an in situ lobular carcinoma.

[Ovarian cancer: anatomo-clinical classifications]. / Cancers de l'ovaire: les classifications anatomo cliniques.

There are important barriers in the correct evaluation of the anatomic involvement of malignant ovarian tumors. Nevertheless, it seems advisable to rationalise the criteria of involvement. The authors relate the past classifications of Heyman, Helsel, Munnel, Davis, Gellé, Rutledge and Burns. The most widely accepted present-day classifications are the TNM system of the UICC and above all that of the FIGO. It seems that an attempt at unification between the two systems is recommendable. However, all classifications are arbitrary in nature because of the very diversity of carcinoma of the ovary.

[Extrauterine pregnancy and its obstetrical prognosis (apropos of 135 cases)]. / La grossesse extra-utérine et son pronostic obstétrical a propos de 135 cas)

The authors have studied 135 case histories of extra-uterine pregnancies which were operated on and followed up the years 1965-1973. They draw attention to: 1. At the clinical level atypical symptoms are found in 29% of cases, which means that the diagnosis is made late in many cases (36% of ruptured tubes) in spite of modern methods of diagnosis. 2. As far as the woman's obstetrical future is concerned they note the low level of further conceptions (51%), the rarity of pregnancies that go to term (24%), and the importance of complication (15%). Fertility after extra-uterine pregnancy is higher when the woman has already had children (43%) as against those women whose extra-uterine pregnancy is in their first pregnancy (25%). They suggest that these results can be improved if on top of surgical treatment further medical supportive treatment is given such as antibiotics, steroids and postoperative hydrotubation.

[Cancer and nipple discharge]. / Cancer et écoulement par le mamelon.

The authors, in a retrospective study, have looked at the clinical and paraclinical parameters that suggest that a cancer may be present when there is a nipple discharge. By using logistic regression on these criteria a model has been able to be constructed with four variables (bloody discharge, and associated palpable tumour, a suspicious mammographic appearance and atypical or proliferating cells in cytology). The probability of a cancer being present varies between three per thousand when none of the four variables are present to 99.1% when all four are present. A first outline of the therapy that can be used is suggested.

[Absence of peritonization after pelvic cancer surgery. Results in 157 cases]. / Absence de péritonisation après la chirurgie pelvienne carcinologique. Intérêt à propos de 157 cas.

Pelvic lymphadenectomy for genital cancer can lead to complications: particularly lymphoceles, post-operative fever, thromboembolism and lymphoedema. We compared two groups in a series of 157 patients treated by extended lymphadeno-colpo-hysterectomy for cancer of the uterine cervix, of the endometrium, of the ovary, of the vagina: Group I: 108/157 patients: visceral peritonization: lymphoceles: 23.1%, post-operative fever: 35.2%. Group II: 49/157 patients: visceral non-peritonization, lymphoceles: 6.1%, post-operative fever: 16.3%.

[Cervical cancer before 35 years of age: epidemiological and prognostic aspects. Retrospective study of 46 cases of cervical cancer before 35 years of age in a series of 449 cases in stages IA2 and IV]. / Le cancer du col utérin avant 35 ans: aspects épidémiologiques et pronostiques. Etude rétrospective de 46 cas de cancers du col utérin avant 35 ans, à partir d'une série de 449 cas de stades IA2 et IV.

OBJECTIVE: To investigate the diagnosis and prognosis aspects of carcinoma of the cervix in a group of young patients less 35 years old, not very clear in literature. STUDY: Retrospective and comparative diagnostic and prognostic study. This study is related to the epidemiology and prognosis of such cervical cancer in young women. SUBJECTS: Of 449 new patients with carcinoma of cervix FIGO stages IA2-IV treated between 1972-1990 inclusive, 46 patients were aged less than 35 years old. RESULTS: The frequency is about 10.2%; during the last 20-year period, there was a gradual rise in the proportion of young women with invasive carcinoma of the cervix (7.6% between January 1972 and June 1981, 13.9% between July 1981 and December 1990). There is more frequent incidence of adenocarcinoma in the young women group (19.6% adenocarcinoma < 35 years, 8.2% > 35 years). The overall 5-year survival all stages together is better before 35 years (71% < 35 years, 50% > 35 years), because in women aged less than 35 years, early stages disease (IA2, IB), predominated. Stage for stage, the 5-year survival is a little lower for stage I (78.6% < 35 years, 88.5% > 35 years) and much lower for stage II (45.5% < 35 years, 71% > 35 years). The young age is an independent prognosis factor, predicting early recurrences within 20 months: the relative risk is 3.7. CONCLUSION: The young age (less than 35 years), is a worse prognosis factor of carcinoma of the cervix; the treatment is very difficult: heavy (radiotherapy, neoadjuvant chemotherapy), efficient, problem of femininity.

[Prolapse after hysterectomy. A study of 45 cases (author's transl)]. / Les prolapsus aprés hystérectomie. A propos d'une série de 45 observations.

The authors report 45 cases of prolapse occurring after hysterectomy (26 after subtotal hysterectomy, 9 after total abdominal hysterectomy and 10 after total vaginal hysterectomy). These prolapses are rare and their incidence does not seem to vary with the type of hysterectomy that preceded them. although in some cases hysterectomy could be incriminated as the cause of the prolapse, in the majority of cases the reason was a prolapse that had been neglected when the hysterectomy had been carried out, or a prolapse that appeared a long time after hysterectomy because of the inevitable ageing of the supporting tissues of the pelvis. From the anatomical point of view it is important to distinguish those prolapses where the vaginal vault does not descend and those where there is total descent including the vault of the vagina. The prolapses give rise to difficult problems of therapy. The choice of operation has to take into account anatomical components of the prolapse, the functional repercussions, the urinary symptoms and whether the patient wishes to does not wish to continue sexual activity. If it is not necessary to keep the vagina open an operation that involves colpectomy or colpocervicectomy can give rise to very good anatomical and urinary results. When it is necessary to keep the vagina functioning as a vagina in the case of prolapse after subtotal hysterectomy, it is important to treat the case as though on was dealing with an ordinary prolapse. All the same, when dealing with procidentia it may be wiser to add a colpopexy procedure by the abdominal route. When dealing with a prolapse after total hysterectomy when the vaginal vault is in place, it is sufficient to carry out the usual form of perineal plastic operation general;y to obtain a good result, but when the vaginal vault has come down it is as well to carry out a colpopexy procedure by the abdominal route.

[The obstetrical future of women who have been operated on for uterine synechiae. 107 cases operated on (author's transl)]. / Le devenir obstétrical de femmes opérées de synéchies utérines. 107 cas opérés.

The authors undertake to show that the obstetric future of women who have been operated on for uterine synechiae is not as poor as would appear from previous publications. 59 p. 100 of 75 women who wanted to become pregnant did so and 46 p. 100 went on to have at least one living child. If one only takes into account those women who were able to be followed up, 71 p. 100 became pregnant and 55 p. 100 had pregnancies with a viable child. When women with only uterine synechiae and without an associated lesion were considered, 81 p. 100 of them became pregnant and 67 p. 100 had a viable child. From this it is important to screen for an associated lesion by laparoscopy. The authors also write about the value of hysteroscopy carried out to find synechiae more easily and to control the treatment.

[Tumours of the ovary in young women. The way they arise and the limits of conservative treatment (author's transl)]. / Les tumeurs de l'ovaire de la femme jeune. Modalités et limites du traitement conservateur.

Although tumours of the ovary are rare in woman under the age of 35 they are not exceptional and they form 15 p. 100 of the cases (17 patients) out of a series of 112 tumours of the ovary which were collected in 7 years. 11 of these patients had only one ovary affected and were able to be treated conservatively. In this way 5 of them were able to carry one or more pregnancies to term and another patient who was lost from observation for two years had to have a second operation to deal with a recurrence in the opposite ovary. Conservative treatment is only permissible if one is absolutely sure that the contro-lateral ovary is normal, and if there is the slightest doubt ovariotomy should be carried out to perform a biopsy. Furthermore the authors suggest that in view of the difficulties of strict supervision for a long term the opposite ovary and tube should be removed and hysterectomy carried out once the patient has had one or two children or when they have reached the age of 40.

PIP: Out of 112 ovarian tumors observed by the authors during a 7 year period, only 17, or 15%, were on women below 35. In 6 of these 17 cases total hysterectomy was necessary; in the remaining 11 cases only one ovary was affected by the tumor, so that it was possible to treat the disease with unilateral ovariectomy, allowing 5 patients to become pregnant. Conservative treatment by unilateral ovariectomy is advisable only in cases when the controlateral ovary is normal. Postoperatory surveillance of such cases is difficult and must go on for years; in cases where the patient is over 40 and has children the opposite ovary should also be removed.

[Basement membranes of epithelial tumors of the ovary. Histochemical and immunohistochemical study using antibodies to collagen IV, III, I and to laminin]. / Les membranes basales des tumeurs épithéliales de l'ovaire. Etude histochimique et immunohistochimique à l'aide d'anticorps anti-collagène IV, III, I et anti-laminine.

Thirteen ovarian tumours were the subject of a histochemical and immunohistochemical study using antibodies to collagen IV, III, I, and to laminin. Our study shows that it is not possible to assess the integrity of the basement membrane using simple histochemical methods (P.A.S., Gordon Sweets staining). In contrast, in benign epithelial tumours, a continuous basement membrane may be visualized beneath the epithelium of the cysts using antibodies to collagen IV and to laminin, collagen IV and laminin being two of the constituents of basement membranes. In malignant epithelial tumours, the immunoreactive material of collagen IV type or of laminin type, is arranged in a distinctly discontinuous manner, and is of unequal thickness around the edge of the cysts or of the neoplastic clusters. In three cases of borderline epithelial tumours, the discontinuity of the immunoreactive material (collagen IV or laminin) lying beneath the epithelium of the cysts, is not so pronounced. In comparison with studies carried out on the cervix uteri, this latter type of tumor, because of the constitution of its basement membranes, would appear to occur at a particular moment in their evolution, i.e. when they pass from the intra-epithelial stage and become infiltrative.

[Tubal epithelium. Scanning electron microscopy in the menstrual cycle, in pregnancy and in the menopause (author's transl)]. / L'épithélium tubaire. Microscopie électronique à balayage au cours du cycle menstruel, de la grossesse et de la ménopause.

The Fallopian tubes of 18 women who were either in reproductive age or were menopausal were studied by scanning electron microscopy. There were different cells seen in the epithelium. These were ciliated and non-ciliated cells, and cells, with a single cilium which was central and cells with short cilia. These elements undergo cyclical changes: secretory phenomena are at their maximum during the ovulatory phase. There is no sudden desquamation in tubal epithelium, nor is there massive deciliation. All the same, there are images that look like marguerites (described in the text) which are evidence of cellular regeneration. The appearance suggests a state of rest in precocious menopausal women and in pregnancy. The phenomena seen during the secretory phases disappear and the distribution of the cells is modified. Deciliation is found 20 to 30 years after the menopause. The physiological significance of these phenomena is still uncertain and their role in pathology has still to be defined.

[Personal experience with salpingoplasty. Apropos of 285 cases]. / Notre expérience de la salpingoplastie. A propos de 285 cas.

285 cases of salpingoplasty are reported and studied. Only 172 patients could be followed up recently. The percentage of pregnancies was 27-7, 20 per cent were intra-uterine pregnancies. The percentage of successful pregnancies was 45-93 if only those patients who were seen again were reviewed. The results are best when the operation is carried out in the most conservative and most anatomically restorative fashion. This fine surgery, which must be carried out so delicately and with such detail, which will appeal more and more to modern technicians using micro-surgery, should stay in the hands of specialists because there is no doubt that the level of success rises with the experience of the operator.

[Hysteroplasty for hemi-uterus and divided uterus. Apropos of 45 cases]. / Hystéroplasties pour hémi-utérus et utérus cloisonné. A propos de 45 cas.

The authors present a series of 45 plastic operations for bicornuate uterus. Three women were operated on for functional symptoms, eight for sterility of which seven were primary, and thirty four for infertility. They are sorry that three women were lost to follow up. They used the Bret-Palmer technique with modifications that they themselves describe. They justify this choice as against other techniques of metroplasty. The anatomical results are, in the main, good when controlled by hysterosalpingography 3 to 6 months after the operation. The functional results, by which is meant the pregnancies that have been obtained, are medium as far as sterility is concerned. Four out of the eight women who were operated on became pregnant. But they are very good in cases of infertility, because thirty out of the thirty four cases that were operated on had one or two pregnancies. The authors justify their indications for metroplasty after a first spontaneous abortion by the good results they have had, and because bicornuate uteri give rise to many obstetrical complications. Furthermore in unoperated cases there is often difficulty in attempting a new pregnancy, and quite often spontaneous late abortions or premature labours. In certain cases they carried out the operation after first spontaneous abortions, but they are more conservative in operating in cases of primary sterility. The authors do not think it is necessary always to carry out a cerclage procedure nor a caesarean operation automatically in cases that have become pregnant after metroplasty.

[Attempt at a standardized interpretation of testicular histopathology in male sterility]. / Essai d'interprétation standardisée de l'histopathologie testiculaire dans les stérilités masculines

The authors present a standard for interpreting the histopathology of testicular biopsies carried out during the framework of investigation of male sterility. The standard is based on a study of the alterations in the seminiferous tubes (T), the peritubular membranes (M) and the interstitial tissue (I). This method of histological assessment has been used to study 35 subjects on whom bilateral bipolar biopsies were carried out (130 specimens). The statistical study showed: a) the absence of any difference between the pieces taken from the two poles in each testis; b) the level of concentration of spermatozoa could not be tied up with any of the three histological parameters. This applied also for hormone levels with the exception of GUT which seem to correlate directly with M; c) the presence of a varicocoele does not reflect in any way the membrane or the interstitial tissue; d) spermograms carried out after the biopsies showed that testicular biopsy does not cause permanent trauma to the testis. The advantages and disadvantages of this quantitative method are discussed.

[Cytogenic chorionic nodule of the uterus]. / Le nodule du chorion cytogène de l'utérus.

The authors report five observations of endometrial stromal nodules. These nodules are composed of cells identical to those of the endometrial stroma. They constitute the benign form of endometrial stromal tumors. From the macroscopic point of view, they present as nodular formations, most often single, well defined, non-fasciculated, whitish or yellowish sometimes cystisized. From the microscopic point of view, these nodules contain areas of plexiform or glandular arrangement with, occasionally, pseudo-rosettes. Small collagenous zones can often be observed. E.S.N. should be distinguished on the one hand from endolymphatic stromal myosis, and on the other hand from sarcoma of the endometrial stroma. Histogenesis of the lesion is also discussed.

[Gonadic dysgenesis and dicentric chromosome Y. A report of two cases, one of which had a gonadoblastoma (author's transl)]. / Dysgénésie gonadique et chromosome Y dicentrique. Rapport de deux cas dont un avec gonadoblastome.

The authors report two new cases of primary amenorrhoea due to the presence of a dicentric Y with a chromosome formula of 45,X/46,X,dic(Y). These two patients show how variable the clinical manifestations of these gonosome anomalies can be, since one had a Turner's syndrome and the other is a woman who looks completely normal but only has primary amenorrhoea. A review of the literature has brought to light only 45 cases similar to ours and shows the different clinical aspects of these patients who are 45,X/46,Xdic(Y). Finding that one of our patients had a gonadoblastoma has confirmed the need to carry out bilateral castration when there is a dysgenetic gonad with a Y chromosome, in order to treat or prevent a dysgenetic tumour from arising.

[Value of differential cytology in the diagnosis of preclinical forms of cervix uteri cancer]. / Valeur de la cytologie différentielle dans le diagnostic des formes précliniques du cancer cervico-utérin.

The value of "differential cytology" in the diagnosis of preclinical carcinoma of the cervix uteri was assessed from serial sections of operative specimens in a series of 452 patients. Although not absolute, this value was found to be considerable. Used to supplement colposcopy-guided biopsy, it makes it possible to decide on the therapeutic approach (notably simple destruction by laser) without having recourse to conization. However, the results are only valid for the team which presents them, and before deciding to treat intra-epithelial carcinomas by laser destruction, each team must perform the same "quality control".

[Uterine and sigmoid perforations following voluntary interruption of pregnancy by aspiration. A case report (author's transl)]. / Perforation utérine et sigmoïdienne après interruption volontaire de grossesse par aspiration. A propos d'un cas.

A recent case of mixed uterine and colic perforations associated with generalized peritonitis is reported, the lesions developing within the context of the digestive complications of the method known as aspiration for voluntary interruption of pregnancy. The frequency, severity, and treatment of these lesions are described, urgent laparotomy being necessary to correct both abdominal digestive tract and genital lesions. Prevention of these complication technique. Coelioscopy is essential if a perforation is suspected, and must be followed by a laparotomy if its presence is confirmed.