The pathology of endometriosis.
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Biomedical subjects
Publications and source records attributed to H Fox.
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In an immunohistochemical study of the presence of the beta subunit of human chorionic gonadotrophin (hCG) in ovarian neoplasms it was found that hCG was detectable in 42% of ovarian epithelial tumors, an incidence of hCG synthesis which very closely approximates that found in radioimmunoassay studies. There was no relationship between the capacity of an ovarian neoplasm to synthesize hCG and the histologic type of the tumor, the degree of malignancy of the neoplasm, or the prognosis.
A study of the immunoglobulin content of endometria from women with and without endometriosis has shown that, in women with endometriosis, both IgG and IgA are more commonly found in the interstitium of the endometrial stroma than is the case in endometria from women without this disease. It is thought that the increased stromal content of immunoglobulins in endometriosis is simply a passive reflection of elevated serum IgG and IgA levels. Both the incidence and extent of positive endometrial glandular epithelial staining for IgG and IgA are markedly increased in women with endometriosis: the excess of intraepithelial IgA is probably simply a consequence of the excess of stromal IgA, but the increased epithelial staining for IgG lends support to the concept that many women with endometriosis develop autoantibodies directed against an endometrial epithelial antigen. No relationship could be demonstrated, however, between IgG deposition in the endometrium of women with endometriosis and a history of infertility.
A case of primary papillary mesothelioma of the ovary is reported and its microscopic and ultrastructural features described. This tumour was an incidental surgical finding and was accompanied by multiple, partially cystic, peritoneal lesions with similar microscopic features. The histological pattern was predominantly papillary with well-differentiated mesothelial cells and a prominent stromal infiltrate that included large numbers of lymphocytes and lipid-filled macrophages. A comparison is made with adenomatoid tumours and with other tumours of ovarian epithelium and it is suggested that this tumour may represent the benign counterpart of one form of clear cell carcinoma of the ovary. The presence of multiple peritoneal lesions may indicate limited malignant potential comparable to some other papillary epithelial neoplasms of the ovary.
A case is described of a neuroblastoma which appeared to arise in a mature cystic teratoma of the ovary. The literature concerning neural tumours of the ovary is briefly reviewed and the grounds for believing that the development of such neoplasms is an indication of the presence of immature neuroepithelial components in a teratoma, rather than a result of malignant change in a fully mature teratoma, are discussed.
A case of meconium ileus equivalent in a 25-year-old woman with cystic fibrosis is reported and the pathology of this condition is described. On gross examination the lumen of the terminal ileum was completely obstructed by a mass of inspissated faecal material with a putty-like consistency. The principal microscopic findings were plugging of the mucosal crypts with mucoid secretion, distention of goblet cells and the presence of a thick layer of mucus, admixed with faecal material, adherent to the mucosal surface. Mucin histochemistry demonstrated sulphomucin in the terminal ileum, although acidic mucins in the normal small intestine are almost exclusively non-sulphated.
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Chlamydia trachomatis was isolated from the cervix in five out of 294 women at routine cervical cytology screening. Significant sera antibody titres were obtained from six out of 115 isolate-negative women similarly screened. The antibody response increased in proportion to the past frequency and severity of cervical pathology and sexually transmitted disease.It is suggested that the true incidence of chlamydial genital infection in general practice will be five times as high as the current cervical isolation rate.
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CMV was isolated from the cervix of 4.2 per cent of 191 gynaecological patients and from 9.8 per cent of 51 women post-partum; all patients were attending the same general practice clinic. The CMV excretion rate was particularly high in the early post-partum period decreasing to nearly normal levels as menstruation returned. Three of 14 (21.4 per cent) post-partum patients excreted CMV before menses had restarted whereas virus was isolated from only two of 36 (5.6 per cent) women who had returned to a normal menstrual cycle. Although this difference was not statistically significant, the excretion rate early post-partum was significantly higher than in the gynaecological group (p less than 0.05). Five of seven excretors in the gynaecological group were in the first half of a menstrual cycle at the time of virus isolation thus suggesting that hormonal changes may lead to CMV reactivation in the genital tract. Other factors which may influence the presence of CMV in the genital tract of non-pregnant women are discussed. Three of four infant born to women excreting virus on the cervix post-partum became infected with CMV.
A quantitative immunohistochemical study of IgA-containing plasma cells in the human uterine cervix has shown that the number of such cells increases during the late secretory phase of the menstrual cycle but decreases in the early secretory phase of the cycle, in pregnancy, in cystic glandular hyperplasia of the endometrium and after the menopause. These results are interpreted as indicating that progesterone causes an increased plasma cell localisation in the cervix whilst oestrogens cause a decrease: it is suggested that this reflects hormonal control of a receptor mechanism and that this receptor can also be blocked by high levels of LH or hCG. The number of cervical epithelial cells containing secretory component (SC) is increased in the late secretory phase of the menstrual cycle, in users of contraceptive pills and in pregnancy. It is suggested that progesterone acts to increase the intra-epithelial content of SC and that no other hormonal factor need be involved.
The various forms of endometrial hyperplasia are classified and a description given of their pathology and of their inter-relationships. The nosological status of endometrial adenocarcinoma in situ and the histological differentiation between hyperplasia with severe cellular atypia and endometrial adenocarcinoma are discussed. The aetiology and pathogenesis of the various endometrial hyperplasias are considered and grounds are given for the belief that glandular hyperplasia with cellular atypia is a form of intraendometrial neoplasia. A new terminology, based on the biological nature of the various endometrial abnormalities, is proposed and a plea is made for the introduction of the term 'intraendometrial neoplasia' to encompass all forms of endometrial glandular hyperplasia with cellular atypia and intraendometrial adenocarcinoma.
The theoretical and practical reasons for replacing the terms "cervical dysplasia" and "cervical carcinoma in situ" by the single diagnostic entity of "cervical intraepithelial neoplasia" are reviewed and the advantages and drawbacks of this newer terminology discussed. The histological characteristics and cytological features of the various grades of cervical intraepithelial neoplasia are described and the differential diagnosis of this lesion is considered.
The light microscopic, immunohistological and ultrastructural findings in two cases of malignant fibrous histiocytoma arising in salivary glands are presented and the features of seven previously reported cases are reviewed. This neoplasm is extremely rare in this site and may pose problems in diagnosis. It has to be distinguished from other spindled cell tumours, in particular from epithelial tumours of predominantly spindled cell pattern; immunohistological markers for histiocytic cells may be of value. The histogenesis of this neoplasm is controversial but our electron microscopic findings support an origin from mesenchymal cells which differentiate along a broad fibrohistiocytic spectrum.
A study of the nutrition knowledge and attitudes of shoppers in a new kind of cooperative food store indicated shoppers were primarily interested in cooperatives because of the food: its believed superiority in terms of growing conditions, freedom from processing, or nutritional value. Shoppers were skeptical of processed foods and believed organic foods, vitamin supplements, and other special nutrition measures are needed to ensure health. Working members and vegetarians were significantly less orthodox in their nutrition attitudes than nonworking members and nonvegetarians. Seventy-five percent of the sample thought nutrition information and the education function of the cooperative were important. Topics of greatest interest to these food cooperative shoppers were organic gardening, food preservation and preparation, and vegetarianism.
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