Biomedical subjects
Publications and source records attributed to M Lancet.
Vaginal adenosis was diagnosed in a 48-year-old woman who had been on estradiol therapy in the past. The possible role of hormonal factors in the development of vaginal adenosis in older women is discussed.
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The gonads of an elderly patient with a typical testicular feminisation syndrome are described. The unusual histological features consisted of total absence of testicular tubular structures or remnants thereof and distinct proliferation of smooth muscle bundles. In addition, there was fibrous proliferation, areas of ovarian stroma, and rare Reinke crystalloids within Leydig cells. The complete tubular absence may have been the result of fibrous replacement related to patient's advanced age, while the muscular proliferation may have been of hamartomatous nature. Thus, it seems that in elderly patients with testicular feminisation syndrome, the histological appearance of the gonads may vary considerably from that in younger individuals, and in such cases the correct diagnosis should be based mainly on clinical and cytogenetic findings.
Two cases of interstitial and one of angular pregnancy have been presented. Angular pregnancy occurs in the angle of the uterine cavity, while interstitial pregnancy is a true ectopic pregnancy. The outcome may therefore be different: the first may develop or abort into the cavity, while the second will almost always rupture. Because of the rich vascularization of this area, hemorrhage is usually profuse and may be catastrophic. Preoperative diagnosis is rare, but the triad of bleeding in pregnancy, no fetal remnants on dialation and curettage and an asymmetric uterus suggest angular or interstitial pregnancy. More liberal use of laparoscopy may increase the number of cases diagnosed before severe bleeding occurs.
The prevalence of cervicitis, reserve cell hyperplasia, squamous metaplasia, and dysplasia was studied in Jewish women and compared to that reported elsewhere in non-Jewish populations. The study was based on a histologic review of 250 women whose cervices were clinically either normal or presented with minor changes, and of 50 cases of squamous cell carcinoma. The findings indicate that the prevalence of the above-mentioned histologic features in the 2 groups of Jewish women is similar to that observed in comparable groups of non-Jews. It thus appears that in a majority of Jewish women the histologic spectrum leading to cervical cancer unexplicably stops at the dysplastic stage. On the other hand, the results of this study may possibly cast doubt on the well-documented evidence establishing dysplasia as a pre-cancerous lesion. For further elucidation of these problems cytologic studies in matched Jewish and non-Jewish populations will be carried out.
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Endometrial biopsies were performed in asymptomatic IUD wearers on specific days of the menstrual cycle, and the histologic features were compared to those expected for the day of the cycle. Normal women who had endometrial biopsies performed as part of a sterility workup were used as controls. Endometrial asynchronism (defined as histologic delay or advance of 3 days or more) was observed in 33.5% of 113 biopsies performed on 79 women with IUD'S; 30% showed a delay in endometrial development during the secretory phase. Our findings give further support to those who claim that contraception with the IUD is not achieved through one single process but that a number of mechanisms are possible. Endometrial asynchronism may constitute one of such modes of action.
During the 14-year period from 1959 to 1973, 60 primary cervical carcinomas were diagnosed at the Kaplan Hospital; 53 were squamous cell carcinomas and seven, adenocarcinomas. The ages of the patients with cervical adenocarcinoma ranged from 22 to 70 years, with a mean of 51.2 years. Postmenopausal bleeding was the most common symptom. One patient was in clinical stage 0, three were in stage I and three in stage II. All patients were treated by irradiation, and four underwent total hysterectomy in addition. Two patients died of cervical adenocarcinoma 16 and 24 months after establishment of the diagnosis, four are alive one to two years after diagnosis, and one has been lost to follow-up. Histologic examination revealed one in situ adenocarcinoma, four papillary and two nonpapillary tumors. Cervical adenocarcinoma in Jewish women presents clinicopathologic features similar to those described in non-Jewish populations. The only significant difference between the two populations appears to be that adenocarcinomas account for a higher proportion of all cervical carcinomas in Jewish than in non-Jewish women.
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