Biomedical subjects
Publications and source records attributed to J Hustin.
Fine needle aspiration cytology of major salivary glands is easy to perform at a low cost. Its predictive value is 100% for malignancy. Its main indications are: the diagnosis of inflammatory lesions, of malignant growths (either epithelial or lymphoma or metastases) and the follow-up of benign lesions which are not immediately amenable to surgery.
Fifty cases of placental lesions detected by sonography during the second half of pregnancy were pathologically investigated. Sonographic evaluation included the size of the lesion, its echogenicity on subsequent examinations and location in relation to the placental margin and umbilical cord insertions. Classical pathologic examination was performed after delivery to confirm the ultrasonographic findings. The echogenic pattern of these lesions was distinct from that of the rest of the placenta and the lesions were classified in two categories. The parenchymal lesions including 19 intervillous thrombosis, 14 caverns, 3 cases of hydatidiform changes, 2 infarcts, 1 septal cyst and one case of fibrin deposition and, the chorionic lesions including 5 subchorionic thrombosis, 3 cases of extrachorial placentas and 2 amniotic cysts. Therefore diagnostic ultrasound gives the clinician a unique opportunity to perform detailed examination of the placenta in vivo and can be an effective and non-invasive way to diagnose different types of lesions that are usually described in the post-partum by the pathologist.
Electron microscopy of spermatozoa is required in cases of important and persistent disorders of motility. Within the frame of fertility investigations, it can also prove useful in cases of in vitro fertilisation failures where structural defects of acrosome may be detected. Lastly subclinical seminal infections are diagnosed in more than 20% and account for a substantial number of acquired head anomalies and necrospermia.
Percutaneous umbilical blood sampling (cordocentesis) appears to be a valuable new procedure for prenatal diagnosis. In order to evaluate whether focal injury of the umbilical vessels caused by the needle puncture is potentially harmful, we completely examined 50 umbilical cords collected between 1 hour and 20 weeks after cordocentesis. Macroscopic evidence of the needle entry was found in 37 cases, including one giant hematoma of the cord. Within 48 hours after the procedure, microscopic examination of transverse sections taken at the puncture site revealed distinct perforation of the vessel wall, associated in four cases with a small hematoma encircling the vessel. One week after cordocentesis, the vessel wall was partially reformed. There were no histologic differences between needle entry in a vein or in an artery. No thromboses of the umbilical vessels were found.
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The pathologic findings in placentas from ten multiple gestations complicated by the so-called vanishing twin phenomenon were studied to confirm the ultrasonographic evidence. Five pregnancies resulted from in vitro fertilization and embryo transfer, and five conceptions were spontaneous. The pregnancies were studied by repeat ultrasound examinations between five and 12 weeks' gestation. First-trimester bleeding was the only clinical sign of this phenomenon. Postpartum evidence of the vanishing twin phenomenon was found in five cases. Morphologically, the lesions were characterized by well-delineated plaques of perivillous fibrin deposition, associated in one case with embryonic remnants. This focal degenerative change of the placental mass, which also exists in about 25% of placentas from uncomplicated term pregnancies, may be the only clue to the disappearance of one conceptus.
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The prenatal diagnosis of dup(3p) was made in a female conceptus, the father being a known carrier of a balanced translocation t(3;10)(p21;q26). Interruption of pregnancy at 19 weeks showed a fetus with a holoprosencephaly field defect. Two other cases of dup(3p) have been observed in the same family. The malformations were different in each of the 3 patients, suggesting a considerable degree of variability of dup(3p).
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The initiation of uteroplacental circulation was investigated in early pregnancy with the following material: contact ultrasonography, 250 cases; direct-vision chorionic biopsy, 10 cases; products from voluntary interruption of pregnancy, 60 cases; and hysterectomy with the pregnancy in situ, three cases. Using all of these techniques, we were unable to demonstrate a true intervillous blood flow during the first 12 weeks. We suggest that during this period the intervillous space is bathed by an acellular fluid that could be plasma filtered by the trophoblastic shell and its endovascular cone. If this is the case, the physiology of early pregnancy must be reconsidered.
Immunohistochemical localization of placental alkaline phosphatase (PlAP) has been performed on eighty-two samples of normal (embryonic, fetal, infantile or adult), cryptorchid or tumorous testicular tissue. The isoenzyme could be demonstrated at the cell membrane of primitive, embryonic germ cells but not in other normal tissues. In-situ carcinomas and seminomas were positively stained in 93% and 94% of cases respectively. The percentage of positivity decreased with tumour differentiation. It is suggested that PlAP is a marker of primitive germ cells and that it reappears in germ cell neoplasms by gene derepression.
The changes in blood levels of prolactin, total and free cortisol, and cortisone were studied and compared in 51 mother-infant pairs, 30 with eutocic delivery and 21 with dystocic delivery. Regardless of the type of delivery, the newborn at term showed significantly higher prolactin and cortisone serum levels than their mothers, and significantly lower levels of free and total cortisol. In fetal distress of short duration, free cortisol levels were significantly raised in both the mother and the child, while prolactin and cortisone levels were significantly higher only in the child. In contrast to these observations, serum prolactin and cortisone levels in the mother were not altered by the occurrence of fetal distress. In the newborn at delivery there was a negative correlation between serum prolactin and the Apgar score at 1 min applied to the part of the graph between 8 and 2 Apgar scores. This study illustrates the utility of fetal prolactin measurements in evaluating the stress to which the fetus is subjected.
The effect of chronic hyperestrogenism on gonadal function was studied in three men who had estrogen-secreting Leydig cell tumors before unilateral orchidectomy and for 11-43 months after surgery. All three men had low plasma gonadotropin and testosterone levels and increased estradiol levels. Impairment of testicular steroidogenesis was also suggested by increased progesterone to 17-hydroxyprogesterone and 17-hydroxyprogesterone to androstenedione ratios in both spermatic venous plasma and the medium of Leydig tumor cells from one patient incubated in vitro. Before surgery, spermatogenesis was abnormal in two men. Testicular endocrine function and spermatogenesis did not return to normal after surgery. During the follow-up period, plasma gonadotropin levels were high in all three men, and testosterone was low normal. Estradiol levels decreased to normal immediately after surgery and then returned to the upper normal limit. The response to hCG stimulation in one man was subnormal. We conclude that chronic hyperestrogenism produced hypothalamo-pituitary inhibition as well as direct steroidogenic blockade at the testicular level. Long term impairment of both endocrine and exocrine testicular functions may be secondary to slowly reversible (or irreversible) estrogen-induced damage to tubular and Leydig cells.
Native hCG and its alpha and beta subunits have been localized by immunocytochemistry in 45 testicular germ cell tumours of the testis. Positivity was found for the three molecules in areas with trophoblastic differentiation or in syncytial-like giant cells present in some seminomas. Isolated positivity of hCG alpha was demonstrated in isolated cells usually found in areas of entodermal differentiation of immature malignant teratomas, and probably of neuro-endocrine function. This finding points to genomic derepression in tumour cells and probably also indicates a variability in subunit synthesis and a defect in subunit recombination.
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The case report is that of patient who underwent tumorectomy plus X-ray therapy for mammary invasive ductal carcinoma. Eight years later a large cystosarcoma phyllodes, developed and quickly recurred after conservative surgery. Reviewing previous mammograms, the authors discovered that at the time of irradiation, there was a small lump which had the appearance of fibroadenoma. It may be that heavy X-ray therapy on a benign epithelial and stromal tumour of the breast, played a major role in the later development of cystosarcoma phyllodes.