Biomedical subjects
Publications and source records attributed to A Smadja.
An unusual case of leiomyosarcoma of the prostate presented as a recurrent pelvic cystic mass. Prostatic sarcoma are rare in adults with a poor prognosis. It is often difficult to determine a definite origin. The authors reviewed the differential diagnosis with pseudosarcoma, inflammatory fibrosarcoma and others rare tumors of the prostate and the seminal vesicle.
There is no current international consensus on the classification of microcarcinomas. There is still controversy over the depth of the stroma invasion and lymph node invasion as well as on confluence of invasive spread. The FIGO classification has been used since 1985 in which microinvasive carcinomas are considered as infraclinical cancers forming a group classed as stage 1a and divided into subgroups: 1a1 = early invasion of the stroma < 1 mm in depth; 1a2 = microinvasive carcinoma with invasion < 5 mm and width < 7 mm. Two important practical points must be added to this classification: demonstration of emboli via lymphatic or blood stream dissemination. Microinvasive carcinoma is demonstrated on conization specimens obtained after guided biopsy revealed intraepithelial neoplasia. Treatment can be standardized on the basis of the pathology report on the conization specimen.
This paper studies gonadal differentiation into the ovary from the earliest interaction between germ cells and somatic cells in the developing urogenital ridge up to the formation of primordial follicles. Granulosa cells appear to be derived from the breaking down of the cordlike arrangement of epithelial cells resulting from proliferation of surface coelomic mesothelium. Thecal cells arise from mesenchymal progenitors cells in the ovarian stroma. Based on the findings of embryology and biology, the authors then propose a classification of ovarian tumors by rearranging the WHO classification.
The authors report a case of recurrent pigmented intraspinal schwannoma with malignant progression. Electron-microscopic study confirmed that melanin pigment was produced by tumor cells and that these cells were derived from the nerve sheath. The histogenesis of pigmented tumors is explained by their neural crest origin and the problem of differential diagnosis of the malignant form with melanoma is discussed.
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Contrary to what is observed in true hermaphroditism and in male pseudo-hermaphroditism, there is no erroneous transmission of the genetic gonadal differentiation programme in female pseudohermaphroditism. All that has happened is virilization of the urogenital sinus and external genitalia in a foetus exposed to exo- or endogenous androgens. In the absence of testis there is no production of anti-mullerian hormone, and for these reasons the uterus, the fallopian tubes and the vagina develop normally, whilst the wollfian ducts are regressed and there is no trace of male deep spermatic pathway. On the basis of recent acquisitions in biochemistry, endocrinology and embryogenesis, the authors compare the various degrees of virilization with the biochemical abnormalities.
From studies on embryogenesis, the authors describe the development, not conditioned by sex steroids, of the upper female genital tract and, in particular, the formation of its cervico-vaginal portion and the shaping of the uterine cervix in about the 16th week of pregnancy. Basing themselves on the physiology of the foeto-placental unit and on the hormonal profile of the foetal ovary, they show that the action of oestrogens on the foetal uterine cervix can be observed only from the 32nd week onward. The action of diethylstilboestrol--a potent oestrogen that is not steroidal and therefore not degraded by foetal metabolism--on the foetal genital tract is explained. An excessive development of the uterine canal caudal part determines structural anomalies of the uterine cervix at birth, the T shape of the uterine cavity and the vaginal diaphragms. The aetiogenesis of clear-cell adenocarcinoma in the cervico-vaginal portion is discussed.
The authors present a histological study of the formation of the corpus luteum after follicular rupture. According to the classical conception, the corpus luteum is derived from luteinisation of the granulosa cells: the theca interna participates in its formation only to a lesser degree. The authors criticize this histogenesis and describe the corpus luteum as being entirely derived from thecal cells. Large and small luteal cells are all derived from mesenchymal elements of the ovarian stroma, which are the precursors of steroid-secreting cells. According to the authors, granulosa cells derived from the primary sex cords of coelomic mesothelial origin only play a support role for the oocyte. After expulsion of the oocyte from the dominant follicle, the granulosa cells which remain in the follicular cavity disappear without a trace.
In the absence of the T.D.F. gene, differentiation of the genital tract follows the female development with Wolffian ducts regression, elaboration of Müllerian ducts, and homologous uro-genital sinus organization. Up to week 32, the fetal ovary secretes no organizing substance and no estrogen. Even if the maternal body is heavily impregnated by estrogens from the fetal-placental unit, the estrogenic and progestogenic activity of any steroid hormones which cross the placental barrier and enter the fetal body is reduced as a result of metabolic degradation within the fetal liver. It is only from week 32 that in normal pregnancies, phenomena of estrogenic action on the uterine cervix of the fetus are seen. This consists of hyperplasia of the endo-cervical epithelium and its emergence towards the exo-cervix. The slightest addition of non-steroid synthetic estrogens administered to the mother may interfere with this hormonal environment of the fetus and result in abnormal development of Müller's tract, particularly in the cervico-vaginal zone.
In the human embryo, sex is all in the genes. Later on, the male and female sexual characters, which are products of the expression of all individual genomes, differentiate men from women. In this paper, the embryogenesis and morphology of true hermaphroditism and male pseudo-hermaphroditism are studied. These are intersexual states determined by errors in genital programme transmission. A relationship is established between the biochemical identification of substances secreted by the testis and the evolution of sexual characters. The genesis of sexual abnormalities according to the stage when the testicular deficit appears is envisaged. The clinical, anatomical, histological and biochemical aspects of these intersexual states are described.
Nodular salpingitis of the isthmus is a clinicopathological entity related to what is classically referred to as interstitial adenomyosis. These two lesions are due to the same aetiopathogenic process and result from inflammatory proliferation of the tubal epithelium with formation of pseudoglandular ducts. The only difference between the two is that one is ensheathed by a fine network of mesonephric muscle fibres and the other is surrounded by a thick layer of myometrial muscle fibres. These two lesions should be grouped under the same heading: nodular salpingitis. The term adenomyosis is incorrect due to the absence of endometrial glandular ducts and stroma in these lesions. Nodular salpingitis of the isthmus should be distinguished from tubal endometriosis, which is part of the clinical expression of extrauterine endometriosis. In particular, this lesion must be distinguished from interstitial endometriosis which, for some authors, corresponds to colonisation of the tubal mucosa by endometrium and, for others, to metaplasia of the tubal mucosa.
The authors report a case of multiple malignancies (squamous cell carcinoma and carcinoid) arising in a dermoid cyst of the ovary. The tumor being revealed by an umbilical metastasis. They insist on the rarity of this entity and discuss the elements of diagnosis and prognosis through a review of literature.
On the basis of the findings of their investigation of the embryogenesis of the female genital tract, the authors advance a hypothesis concerning the origin of ambiguities between the genetic sex and the gonophoric sex which determine primary sexual characteristics observed in Morris' syndrome and in gonadoblastoma. According to the authors, in gonadoblastoma there is dysgenesis or even agenesis of the gonads, with a total absence of Sertoli cells and, therefore, no secretion of anti-Müller substance and this explains the development of the Müller canals into uterus and Fallopian tubes and the presence of a vagina in an XY subject. In the syndrome of the feminizing testis, XY subjects have testes containing Sertoli cells which have produced anti-Müller substance. However, the initiation of the production of this substance is delayed and it is this delay which has permitted the tendency towards feminization of the uro-genital sinus with the formation of a vagina. The authors thus refute the theory which holds that the Müller cells are involved in the genesis of the vagina.
On the basis of their results of studies of human embryos and foetuses, the authors believe that the myometrium is derived from the primitive mesenchyme, while the endometrium is derived from the coelomic mesothelium. The myometrium is the site of non-specific tumours common to all soft tissues (of other organs): leiomyoma, lipoleiomyoma, leiomyoblastoma, leiomyosarcoma; vascular tumours: angioma, haemangiopericytoma. The endometrium is the site of tumours derived either from the epithelial contingent (of glandular tubules): adenoma, adenocarcinoma; or from the epithelio-connective tissue contingents: mullerian dysplasia, carcinosarcoma (homologous mixed mesodermal tumour). The authors classify heterologous mixed mesodermal tumours in a separate group; they believe that they constitute true mixed mesodermal tumours derived from two cell clones: one of mullerian origin and the other derived from the primitive mesenchyme.
The authors, in this article, have reviewed the different proofs that confirm that Halban's fascia does exist. The authors have been able to find, separate out and use Halban's fascia in a series of 263 vaginal operations for genital prolapse taking the anatomo-surgical approach. From the histological approach, they have shown that Halban's fascia is constituted by fibro-connective tissue strips between which there are large numbers of blood vessels and muscles and nerve endings. From the point of view of embryogenesis, they believe that Halban's fascia comes from the same mesenchyme layer as that which gives rise to the corpus spongiosus of the penis. As far as sexual physiology is concerned, the authors review the various clinical experiments that have been carried out throughout the world medical literature which shows that there is an erogenous zone in the upper anterior part of the vagina and they believe that Halban's facia, which is homologous with the corpus spongiosus, is the site of origin of vaginal orgasm. Finally, as far as physiology and biology of reproduction is concerned, they believe that the vaginal fluid that is secreted by Halban's fascia during intercourse plays an important role for the survival of spermatozoa.
We report a case of pflügerome, a tumor now designated by the term "mixed germ cell sex cord and stroma tumor". This infrequent tumor consists in a proliferation of germ cells surrounded by Sertoli-granulosa-type cells and arises in patients with a feminine phenotype and a 46XY karyotype; it should be differentiated from gonadoblastomas that are seen in patients with a female phenotype and a 46XY or 46XX/46XY mosaic karyotype. Prognosis is good and recovery occurs following exeresis. On the basis of their studies on gonadal differentiation in human embryos, the authors propose the following terms: "tumors of the gonadal anlage with male differenciation" for gonadoblastomas, "tumors of the gonadal anlage with female differentiation" for pflügeromes.
Among 841 autopsies realized between january 1982 and september 1988, by the Pathological the department of Amiens University Hospital the ten patients dead of infectious endocarditis have been autopsied. Macroscopic and microscopic observations have two cases of acute endocarditis and eight of subacute endocarditis. For the two patients dead of acute endocarditis, autopsy affirms the cardiovascular etiology of death. For the eight cases of subacute endocarditis, necropsic findings differs from the germs. In the three cases where the germ is a Staphylococcus aureus, the diagnosis of endocarditis was made before death and the cardiovascular etiology of death was affirmed by autopsy. For the other germs (3 Streptococcus sp, 1 Salmonella typhimurium, and 1 germ unknown), the diagnosis of endocarditis was made by autopsy, but necropsy disclosed the cause of death in only two cases.
In this study including twelve embryos, aged 4 to 8 weeks, and twenty-one fetuses between 9 and 25 weeks, and a group of five still-born fetuses between 25 and 40 weeks, the authors used conventional techniques of histological preparations and immuno-chemistry according to the BSA technique (biotin-streptavidin with peroxidase labelling), in order to demonstrate that the uterus presents a "dual embryogenesis". The endometrium with its stroma and the transition zone endometrium-myometrium have a coelomic origin. The myometrium with the common connective tissue derive from primary mesenchyma. According to the authors, the "dual embryology" of the uterus, would permit simplifying the taxonomy of the histogenesis of uterine tumors.