[On the problem of ovarian mesonephroma].
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A case of mesonephric adenocarcinoma of the uterine cervix arising in florid mesonephric hyperplasia is reported. The reviewed literature contained many cases of cervical "mesonephroma" but only a few of these were considered to be demonstrably of mesonephric origin. These tumors were usually associated with proliferating mesonephric remnants in the cervix. Similar tubuloglandular mesonephric proliferations without formation of a frankly malignant tumor have also been described in the cervix, most recently as florid mesonephric hyperplasia. This latter entity appears to be benign. Carcinoembryonic antigen (CEA) was focally positive in this cervical adenocarcinoma, suggesting that CEA may not be useful in distinguishing this variant from the more common mullerian adenocarcinoma of the cervix.
Three cases of Endodermal Sinus Tumor are presented and its difference from tumors of the mesonephroma type and associations with the embryoma are pointed out. The three cases were "pure" types and the patients died within 5 months in spite of surgical treatment and chemotherapy. Autopsy showed extensive involvement of peritoneum, diaphragm and pleura.
The fine structure of an ovarian clear cell carcinoma in a 65 year old woman was analysed. The tumor cells were of both clear and "hobnail" types. Both were characterized by the presence of short microvilli, abundant glycogen granules, a well-developed granular endoplasmic reticulum and Golgi apparatus, scanty lysosomes and very few lipid bodies. The tubules and gland-like spaces were always separated from the stroma by a basement membrane. At ultrastructural level the tumor cells do not resemble at all those of cleaar cell renal carcinomas. On the other hand, their submicroscopic features are strongly similar to those of the clear cell tumors found elsewhere in the female genital tract, emphasizing therewith their very probable müllerian origin. It is recommended to eliminate the term "mesonephroma ovarii" to designate the clear cell carcinomas of the ovary.
A 49-year-old black woman developed a urethral glycogen-rich clear cell carcinoma. She was treated with anterior pelvic exenteration. The resected lymph nodes, vagina, uterine cervix, endometrium, ovaries, and urinary bladder were free of neoplasm. Histologically the neoplasm consisted of clear cells growing in sheets and occasional papillary structures. In some areas, hobnail cells were present. Ultrastructurally, the cells had apical caps, short microvilli, and complex cell bases, and contained abundant glycogen. These features were identified in one, but not the other of two previously reported cases. Because glycogen-rich clear cell carcinomas of the lower urinary tract do not resemble ultrastructurally mesonephric remnants or carcinomas known to arise from them, these glycogen-rich clear cell carcinomas should not be called "mesonephromas" as has been the practice.
A 17-year-old female with severe pain of the midabdomen was found to have a retroperitoneal cystic tumor, an ectopic ovary and a fallopian tube without fimbriated end. An attempt is made to determine whether these early embryonic malformations could be traced to a common origin. This is possible provided that the tumor is regarded as a mesonephroma. A histological study of the normal development of the Mullerian duct was performed utilizing human embryonic series. Previous development theories and more recent investigations are discussed. Malformations of the tube described in the literature and possible etiologies are summarized.
Thirty-five women were examined with female pelvic magnetic resonance imaging (MRI). 5 cases demonstrated normal pelvis structures, 3 had physiological atrophic changes, and one had an underdeveloped uterus. The other 26 cases consisted of 8 leiomyoma of uterus, 11 ovarian benign tumor, 3 ovarian cancer, 2 cervical and 2 endometrial carcinoma. Images of normal uterus as well as those pathological conditions mentioned above were depicted, and compared with the operative findings. By means of MRI, we were able to demonstrate the origin of most of the pelvic masses, number, size and location of leiomyoma, myometrial penetration, parametrial extension and lymph node metastasis of endometrial carcinoma. Cervical malignancy could be accurately staged, and serous cyst was possibly distinguished from hemorrhagic cyst. However, one case of mucinous cystadenoma was misdiagnosed as dermoid cyst; one myoma, 1 cm in diameter, in same density as the uterine muscle was overlooked and one mesonephroma of 0.3 cm in diameter situated deep in the cervical fibrous tissue was not detected.
Two cases of paraneoplastic hypercalcemia secondary to ovarian tumors are presented. Both cases were secondary to ectopic parathormone (PTH) production. Other mediators postulated to cause this syndrome are prostaglandins, vitamin D-like sterols, non-vitamin D sterols, vitamin A, cortisol, and "osteoclast-activating factor.' The key treatment modalities for acute hypercalcemia are hydration and diuresis with furosemide; phosphates, steroids, antiprostaglandins, and hemodialysis may also be of value. Calcitonin is theoretically the most attractive treatment modality, but the rapid development of resistance limits its use to acute management. Mithramycin is most effective for long-term palliation of hypercalcemia if tumor-directed therapy is unsuccessful. Review of the literature confirms the previously made observation that mesonephromas are disproportionaately represented in association with this syndrome.
This is a report on 5 cases of mediastinal germ cell tumours. Of three mature teratomas seen in a 48-year old male and a 21-year old and 19-year old female, one was asymptomatic, another one associated with streptococcal pneumonia and the third associated with progressive cough irritation. In addition, a seminoma was seen in a male of 58 years of age and a yolk sac tumour (mesonephroma type 2) in a male of 23 years. Whereas in mature teratomas surgical resection can be considered sufficient, resection combined with chemotherapy should be performed in patients suffering from malignant germ cell tumours, and in addition also radiotherapy in case of seminoma. This approach may result in a significant improvement of the prognosis in malignant mediastinal germ cell tumours.