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Gestational trophoblastic diseases amalgamate several entities with a common denominator which is a hypersecretion of hCG: complete mole, invasive or not, partial mole or triploid syndrome, gestational trophoblastic carcinoma and trophoblastic carcinoma from the implantation site. These entities differ by their origins, their morphology, their evolution and their treatments. Complete moles are diploid and in 80% of cases, chromosomes are only from paternal origin (diandry or dispermy). Their evolution is unpredictable whatever the molecular biology or cytogenetical methods are. Partial moles, generally triploid, are much more frequent (10-20% of miscarriages) than the number of cases diagnosed during the pregnancy. In 85% of cases, two sets of chromosomes are of paternal origin. The gestational trophoblastic carcinoma is diploid and its genetic material comes from both parents. This probably excludes a direct filiation between complete mole and gestational trophoblastic carcinoma. The trophoblastic tumor from the implantation site comes from the trophoblast of the implantation site which explain why its evolution and its prognosis are totally distinct from the previous one. In this report, we successively discuss the natural history of gestational trophoblastic diseases, their epidemiology and the genetic data explaining their origins.

Objective: To assess the frequency and the consequences of cervical stenosis in patients treated by laser conization or loop electrosurgical excision procedure (LEEP) and to analyse the results of cervical enlargement plastic surgery or neostomia., Methods: Two hundred and fifty-five women treated by laser conization and 277 by LEEP were regularly followed by postoperative colposcopy, for a mean period of 38 and 16 months, respectively. Stenosis was defined as cervical narrowing which could not admit a 2.5 mm-diameter Hegar's dilator., Results: Stenosis complicated 10.2% of the laser conizations and 4.3% of the LEEP. Thus, 38 cases of cervical stenosis of which 7 were complete were diagnosed 2 to 40 months after treatment. Among the 34 non-menopaused women who developed a stenosis, 5 had a secondary amenorrhea, 6 a severe dysmenorrhea and one an infertility related to oligoamucorrhea. In the patients with stenosis, endocervical cell retrieval was possible in 21 (55%) cases and in none the squamocolumnar junction was visible at colposcopy. Seven patients underwent an enlargement plastic surgery of the cervical canal for incomplete stenosis and two a neostomia for complete stenosis. Cervical restenosis has been observed in 7 of 9 cases in a mean delay of 12 months (3 to 48 months). Nevertheless, the endocervical cell retrieval remained possible in 8 of 9 cases and after a mean follow-up of 26 months no menstrual troubles recurred., Conclusion: LEEP provides fewer cervical stenosis than laser conization. The enlargement plastic surgery allows to correct durably the menstrual troubles in spite of the very frequent restenosis.

Objectives: Evaluation of the value of colposcopy and directed biopsy in the follow-up of pregnant women presenting with abnormal cervical smear., Material and Methods: Retrospective study of 146 patients examined by colposcopy during pregnancy between January 1985 and December 1994., Results: Colposcopy was satisfactory in 86% of patients. Colposcopic impression was concordant with the final diagnosis, overestimated and underestimated in 69%, 18% and 13% of the cases, respectively. Directed biopsies were performed in 115 patients. In one case, bleeding necessitated vaginal packing for 24 hours. Directed biopsy correlated well with the final diagnosis in 87% of low grade CIN and in 90% of high grade CIN. In 4 patients, conisation was performed between 10 and 16 weeks of gestation without subsequent obstetrical complications., Conclusion: Colposcopy with directed biopsy is a reliable tool to evaluate abnormal smear during pregnancy.

Objective: Evaluate the diagnosis of cancer of the ovary over time and histological type as a function of outcome., Methods: Primary neoplasms of the ovary diagnosed at the Pathology Institute of Strasbourg between 1975 and 1984 were reassessed to determine the outcome as recorded in the Bas-Rhin Cancer Register., Results: Among the 845 primary neoplasms diagnosed, 318 were carcinomas. More than half of the cases (n = 162) were serous carcinomas followed by mucinous carcinoma (n = 60), endometrioid carcinoma (n = 53), clear-cell carcinoma (n = 13), and poorly differentiated carcinoma (n = 30). Diagnosis was consistent with time and independent of the pathologist. The patients were divided into three groups on the basis of survival. Longest survival was observed in patients with mucinous and endometrioid carcinoma, intermediary survival in those with serous and clear-cell carcinoma, and shortest survival in those with poorly differentiated carcinoma., Conclusion: The histological type of ovary carcinoma, independent of the stage of invasion, is a reliable predictive factor.

Aims: Study of influence of different sequences of oral micronized progesterone (Pg) on endometrial morphology and the incidence of bleeding., Design: Prospective comparative multicentric study conducted in 101 post-menopausal patients., Patients and Methods: 98 patients who did not wish any regular withdrawal bleeding were given percutaneous oestradiol 17-beta (E2) (1.5 mg/d) associated with micronized Pg (100 mg/d) at bedtime during either 21 out of 28 days (group I), or 25 days per calendar month (group III), during a minimum of 6 months. For those wishing withdrawal bleeding (n = 3), E2 (3 mg/d) during 25 days was associated with Pg (300 mg/d) from the 16th to the 25th day of the month (group III). Endometrial biopsies were performed after 6 months of the same treatment and blindly analysed; transvaginal ultrasonography (measurement of endometrial mucosa thickness) was done in case of insufficient amount of tissue., Results: Groups I and II: 61% of the endometrium were quiescent without mitosis, 23% were slightly active with rare mitoses, 8% partly secretory and 4% subatrophic. Sampling was inadequate in the remaining 4%. Mitotic activity of glands was low on the overall samplings (average < 0.53/1,000 cells). The average mucosa thickness was at 3.9 mm. No bleeding (spotting or withdrawal bleeding) occurred in 73.3% and 82.1% of cycles at the 3rd and 6th months of administration, respectively. Group III: endometrium were quiescent or slightly active and combined with frequent withdrawal bleeding., Conclusions: A relatively low dose of oral progesterone (100 mg/d) combined with E2 during 21d/28d or 25 d/month efficiently controls proliferation, induces a very low endometrial cyclic activity--while reducing spottings--and maintains an amenorrhea in the majority of women. This simple treatment is likely to improve compliance.

The relationship between adenofibroma and cystadenofibroma and the frequency and features of carcinomas developed on these benign tumours are little known. Eight-hundred and forty-five epithelial tumours of the ovary diagnosed over a 10-year period have been re-examined. One-hundred and eighteen adenofibromas and cystadenofibromas were recorded. One-hundred were benign and formed an architectural spectrum from which emerged: (1) surface papillary adenofibroma accounting for 5% of the cases and appearing at a mean age of 27 years; (2) cystadenofibroma in 77.5% of the cases at a mean age of 53 years; (3) adenofibroma in 17.5% of the cases at a mean age of 64 years. Adenofibroma was bilateral in 18 cases. Among the other cases were an endometrioid cyst and two simple serous cysts. The cells were serous in 110 cases, mucinous in 6 cases and weakly acidophilic to clear in 2 cases. Eighteen of these tumours were malignant: 13 were associated with epithelial hyperplasia and 5 with a carcinoma. The 13 adenofibromas with atypical epithelial hyperplasia (at a mean age of 60 years) were all made of serous cells; 6 of them were low-grade and 7 high-grade tumours with 3 microinvasions. One patient died at the age of 78, of an unknown cause; the others are still alive after a mean follow-up of 11.3 years. The 5 invasive carcinomas appeared on an adenofibroma at the mean age of 70 years; 3 patients died (2 of metastases), one is alive after 9 years and one was loss sight of.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: to estimate the frequency, the age, the size, the bilaterality and the prognosis for "borderline" tumours according to the type of cell found. MATERIAL STUDIED: 132 low grade malignant tumours found in 845 primary ovarian carcinomas diagnosed between 1975 and 1984 in the Institute of Pathology in Strasbourg., Results: borderline serous carcinomas (63 cases) were 16.9% of cases were serous neoplasias. The mean age at which the diagnosis was made was 50.3 years of age, and the tumour measured 10 cm. They were bilateral in 20% of the cases and the mean age of survival was 134.7 months. The borderline mucinous carcinomas (68 cases) were 18.2% of mucinous neoplasias. The intestinal sub-variety was found at the mean age of 50 years and was 15.3 cm in diameter. It was rarely bilateral and in some cases was accompanied by peritoneal pseudomyxomatosis. The endocervical sub-variety (18 cases) was diagnosed at a mean age of 41.5 years with a mean size of 13.5 cm. It was rarely bilateral. The two varieties of borderline mucinous carcinomas had a mean survival rate of 154 months. Only one borderline endometrioid carcinoma was found among the 54 endometrioid carcinomas, and none had clear cells, Brenner cells or mixed cells., Conclusion: under the heading of "borderline" carcinoma are different types of tumour with different prognoses. Only serous mucinous varieties which are more frequent, have a low potential for becoming malignant. Endometrioid types and clear cell or Brenner types which have a similar architecture are usually found out to be benign.

A-77-years old woman had a solitary ulcerated tumor on her vulva present for one year. It proved, on histologic examination, to be a sebaceous epithelioma of 1.5 cm wide because of a peripheral area with less differentiated cells, excess of mitoses and slight invasiveness. To the authors' knowledge this is the first sebaceous epithelioma documented in this region. Previously have been described one sebaceous hyperplasia and two sebaceous carcinomas, one of them eight years after hemicolectomy for adenocarcinoma of the colon (Torre-Muir syndrome).

A detailed colposcopy study of the cervix, vagina and vulva was conducted in 365 women referred for genital human papillomavirus (HPV) lesions, abnormal cervico-vaginal smear or cervical intraepithelial neoplasia (CIN). Valvuloscopic abnormalities, all biopsied, were found in 144 women, i.e. 40% of the population studied. Five types of vulvoscopic abnormalities are described: diffuse acidophilia (55% of abnormalities), acidophilic maculae (17%), micropapillae (20%), papulae (4%) and leucoparakeratosis (4%). Histological examination of the biopsy specimens obtained from 144 women with abnormal vulvoscopy showed 55 typical flat condylomas (38%), 50 probable flat condylomas (35%) and no signs of condyloma in 38 cases (27%). It also revealed the presence of four vulvar intraepithelial neoplasias (VIN) stages 2-3, all of them associated with typical or probable condyloma. Comparison between the 144 abnormal vulvoscopies and a series of 14 normal vulvoscopies made it possible to establish a significant correlation between the presence of valvuloscopic abnormalities and the finding of histological signs of typical or probable flat condyloma. The vulvoscopic images of subclinical vulvar HPV infection, but apart from papulae and, to a lesser extent, leucoparakeratosis, correlations between vulvoscopic and histological images were imprecise.

This is a case of a 38 year old woman in whom a small basophil cell tumour occurred with inguinal and iliac lymph node metastases followed by pulmonary metastases and extension of the tumour into the vagina and the bladder. The patient died eight months after having started multiple chemotherapy and radiotherapy with telecobalt. Extra studies were carried out ten years later on the cells. This made it possible to diagnose the condition as a neuro-endocrine carcinoma rich in serotonin.

Diffuse placental metastases brought about an early onset of labour and neo-natal death of the infant without cancer being found at autopsy. They were evidence of the generalised blood spread of the immature epidermoid cancer which was responsible for the death of the mother six months after delivery.

The best results in screening for subclinical cancer of the cervix are given by cytological studies. The authors in reviewing their experience in this method of screening studied the result of 15,000 smears which gave a diagnosis of 37 cases of intra-epithelial carcinoma of the cervix, which means 1 case of carcinoma in situ diagnosed in every 400 smears. Although the technique is very simple it has to be carried out according to strict criteria at the time of taking the smear, of fixing it immediately and of staining it. There is a group of patients who are at high risk about the age of forty, when there is a marked influence due to parity. But only a systematic policy will bring about diagnosis of pre-invasive carcinoma in cases where the cervix is clinically healthy. The cytology is usually characteristic, though the diagnosis may be difficult during pregnancy, or when hormone contraception is being used or when there is a trichomonas infection present. This explains why we find false positives in 0.03 per cent of cases in this study and false negatives in 0.03 per cent of cases. Their rarity means that the method is 99.94 per cent reliable. Finally, the cervical smear gives an opportunity for studying the vaginal microbial flora as well as the cyto-hormonal state.

The histological criteria for diagnosing micro-invasive carcinoma of the cervix and for deciding the treatment which should theoretically follow these criteria have been reviewed from the literature. To make a diagnosis of micro-invasive carcinoma it is necessary to have an adequate biopsy specimen and at least a cone that has been taken to include healthy material. There is a need to have a classification that can easily be used by pathologists and the following different stages of early epithelioma are therefore proposed: widespread, spreading-incipient, early micro-invasive and an established micro-invasive. The risk of metastasis, although it is slight, should only be considered in the established micro-invasive stage. This may make extended surgical treatment justified.

The two large mature sacro-coccygeal teratomas reported seem to be responsible for the death of fetuses in the fifth and sixth months of pregnancy. A review of the literature shows that teratomas are exceptionally rare during this period. Their outcome depends upon the degree of maturity of the tumor, its size, whether its location is pelvic or not, the presence of any associated malformations and upon prematurity.

The transmission of malaria occurs mainly in and following the rainy season (intermittent transmission) in the Sahelian zone of Africa. On the other hand in rainy Equatorial Africa the transmission of malaria is continuous so that it is stable and can give rise to continuous antigenic stimulation in pregnant women which in turn gives rise to passive early high level immunity in the infant. 150 couples of mother and cord blood and 206 placentae were studied. We found 12.1% of carriers of blood parasites in the blood as compared with 1.6% in the cord bloods (exclusively P. falciparum). Where there were medium quantities of fluorescent antibodies in the mothers 74% could be found in the cord serum. Two methods were used to measure antimalarial antibodies as evidence of infection and also partly protective: the first method was indirect immunofluorescence, and the second was co-electrosyneresis. There was a narrow correlation between the level of precipitant antibodies in the mothers who were infected and in the fetal cord bloods. Anatomo-pathological examination of the placenta showed that 2 out of the 206 had parasites in them, 9 out of the 206 had fibrin deposits around the villi and 6.8% of the placentae showed lesions of malaria. On the other hand, in West Africa there was very little maternal morbidity as evidence by fever and anaemia, or of fetal morbidity. There was no single case of congenital malaria. The levels of the plasma indices in the towns could be explained because of prophylaxis which was both controlled and uncontrolled.

In 115 consecutive placentae from an unselected population living in a high malaria endemic region (Franceville, Haut-Ogooué, Gabon, 40 (35%) have the peculiar lesions of maternal plasmodium infection. The lesions show considerable histological variation but the following features are constant: a) deposits of variable amounts of malarial pigment and b) excess of perivillous fibrinoid. Accumulation of maternal erythrocytes with parasites, concentration of macrophages in intervillous spaces and villities are inconstant. In addition, splitting and segmental thickening of the trophoblast basal membrane with occasional aggregations of dense fibrillary structures are found at ultrastructural level. 56% of the mothers have Plasmodium falciparum (94%) or Plasmodium malariae in their peripheral blood. Placental lesions have been found only in 65% of the cases with peripheral parasitemia. Although Plasmodium are present in 35 (87%) placentae, no parasites have been found in the cord blood. The difference between the mean birth-weight of full-term neonates from mothers with placental lesions (n = 38) or with normal placenta (n = 54) is 220 g. This difference is statistically highly significant (p less than 0,001). It appears that the low mean birth-weight is not related to the high percentage (39%) of primipare in the infected group but, in all probability, to the placental lesions.

The authors re-emphasize that the sure diagnosis of carcinoma of the cervix depends on histology; having considered a series of 15,000 smears in an article on cytological screening for carcinoma of the cervix. They show that the main prop of this histological examination should definitely be conisation. They furthermore prepare an inventory of the different possible methods of treatment of intra-epithelial carcinoma, stating for each method the advantages and disadvantages of the method. Their attitude to treatment is conservative, and they believe that conisation in every case is sufficient when complete removal of the in situ lesion is carried out whatever the age of the patient is. They state the limits of this method and define clearly the contra-indications for such a scheme of treatment, which can only be carried out routinely with the absolutely necessary cooperation of a cytology laboratory and faultless histology.

18 cases of trisomies 13, 18, or 21 were diagnosed either by examining the caryotype or on clinical criteria. When the placenta was examined in 60% of cases there was a marked retardation of villous maturation with frequent persistence of embryonic forms of villi. The authors suggest that the failure of the villi to mature was often a reflection of pathology in the oocyte which started to show itself at the beginning of the pregnancy.

The purpose of this research was to study the relationship between placental characteristics and the degree of failure of growth between 37 and 41 weeks of pregnancy. The cases of severe small-for-dates (percentiles of 1 to 5) and moderate small-for-dates (percentiles of 6 to 10) were compared with a control series (percentiles of 11 to 90) with an equivalent gestational age. In both groups of small-for-dates babies one could find that the chorionic arteries and their trunks were of a lower diameter than those of the villi that were small and that there were sub- chorial deposits of fibrin in both groups. The greater number of placental abnormalities were found in those babies who were severely small-for-dates at a gestational age of between 37 and 39 weeks. The relationship between acute fetal distress and small for dates was analysed. There was little difference in the likelihood of fetal distress between the two groups of small-for-dates babies, but there were differences between both groups and the control group.

The study was carried out on 42 ova that had developed to the 8th to 17th days stages inclusive and that were removed by chance when endometrial biopsy was carried out. This study shows that there were 12 normal or nearly ova and 30 pathological ones. The pathology consists of an alteration of the embryonic stock without affecting the placenta, of an embryo-placental hypoplasia and of maternal vascular troubles that lead to complete necrosis of the ovum. The risk of a defective egg is raised when the oocyte remains in the follicle for more than 14 days.

494 placentae coming from two different geographical parts of Gabon were studied. They were grouped into control, premature, small-for-dates and stillborn. The urban population gives rise to most mothers of about 26 years of age, who deliver normally at 38 weeks of babies weighing 3,300 g and 50 cm long, with placentae weighing 550 g, as well as premature babies and those in which there is white cell infiltration of the membranes, signs of toxaemia and normal placentae. On the eastern plateaux of Gabon there are more mothers around the age of 23, who deliver normally at 37 weeks of pregnancy of babies weighing 3,100 g and 48 cm long, with placentae weighing 450 g, with small-for-dates babies and inflammation of the placenta. Malaria is the cause of many premature deliveries and of small-for-dates and stillborn, especially in the plateaux.

An oophorectomy specimen in a patient aged 36 showed a dermoid cyst with a struma ovarii and what was considered to be a folliculo-trabecular adenoma. Two osseous metastases appeared 4 and 8 years later respectively. The follow-up so far is 15 years. This is the twentieth reported case of mature cystic teratoma of the ovary containing metastating thyroid carcinoma.

It has been shown by comparative study of prepubertal ovaries both in the normal and ectopic positions that there is obvious follicular development which is quantitatively greater in ectopic ovaries. If the follicles reach the stage of cavitation they generally progress towards atresia. In any case it is possible however for follicular rupture to occur in the true sense with the onset of luteinisation. A perfectly developed corpus luteum has been observed in the ovary of a newborn infant.

Ovarian pregnancies usually are diagnosed by the trophoblast which has gone into the ovarian tissue being found histologically. These pregnancies usually suggest haemorrhage from the corpus luteum or a rupture of ovarian cysts. The average age at which they appear is 29, just as it is the age for tubal pregnancies, but they do differ because there are few signs of infection and of infertility, and there are more multipara and women who are wearing an IUD. Two-thirds of ovarian pregnancies are on the peritoneal surface or in the hilum, away from the corpus luteum, and one-third are situated on the scar of the follicular ostium and have later infiltrated into the follicle. Most of these cases can be explained by reflux of the oocyte into the peritoneum.

The authors report 14 cases of atypical myomata wich might have been mistaken for sarcomata were it not for the fact that they were devoid of mitotic features. Four of the myomata were immature types with small fusiform cells and without connective tissue fibres. Two of the myomata had a plexiform structure several cm. in diameter and appaered to correspond to tissue that was undergoing endothelial and periocytal regeneration round an old focus of necrosis. These features could only be made out precisely under the microscope. The other eight myomata were mature in form and associated with abnormal nuclei (large, hyperchromatic irregular multi-nuclear giant cell clumps) surrounding the periphery of centres of hypoxia, more commonly after pregnancy (3 cases) or treatment with progesterone (2 cases).

When perforation of the uterus occurred while a therapeutic termination of pregnancy was being carried out in a 25-year-old woman it was shown that the monomorphic trophoblastic pseudotumour was invading the myometrium. It was not secreting HCG when it was diagnosed and it had not recurred 19 months after the diagnosis and hysterectomy.

Systematic ultrasound examination made it possible to discover a placental angioma measuring 50 mm in diameter and situated in contact with the feral plaque. This angioma had reached 78 mm in size across its largest diameter by the 23rd week and appeared to become stable thereafter, getting in size towards the 35th week. This state of involution was confirmed when the placenta was examined and it was found there was a second angioma present, and that is was functional, and that there were several microangiomata. The pregnancy, clinically and biologically, was normal throughout and ended with the birth of a healthy girl, who in particular had no enlargement of her heart.

A histochemical, ultrastructural and fluorescent light study in a case of amnion nodosum showed that the matrix of the granulation tissues came from the breakdown of fetal erythrocytes.

25.8% of the 500 fetuses that died in utero after the 20th week of amenorrhoea died between the 28th and 32nd week, which is the 8th lunar month of the pregnancy. Among the factors that could have brought about this result at that time of pregnancy that we examined it was shown that there were important changes in the circulation, the metabolism and the immune system in the mother. In the fetus, autonomic functions started to appear and these were especially liver, hypothalamo-pituitary, and adrenal cortex functions. The placenta itself underwent changes in its quality which were necessary to compensate for fetal growth retardation. Every change that occurred in the placenta, such as immaturity, inflammation and blood flow changes, were shown to be remarkably frequent between the 28th and 32nd week and were contributory to causing fetal death. So it appears that the 8th lunar month is a very important time for the successful development of the fetus and requires more attention if morbidity and perinatal mortality are to be lowered.

The 100 fallopian tubes had been obtained from women whose mean age was 30 and whose mean period of amenorrhea was 38 days. Each fallopian tube gave rise to at least sixteen samples and was sectioned if necessary several times. There had been tubal rupture in 25 cases, and in at least 7 cases the rupture involved the ovum and its implantation site. The location of the implantation site could be determined in only 30 cases: 10 in the mesosalpin; x 10 in the antimesosalpinx; 8 lateral and 2 circumferential. The anatomic site of the implantation was isthmic in 7 cases; ampullary in 85 cases, of which 6 were near to the isthmus; infundibular in 7 cases and fimbrial in 1 case. Tubal lesions were found in 22% of the cases, but associated were also found frequently: tubal adenomyosis (17 cases); adherent tubal fimbriae (14 cases); peritoneal adhesions (11 cases) and decidual changes in 12 cases. The 74 remaining fallopian tubes were considered to have been previously normal and to have been affected only by changes linked to the pregnant state (edema, congestion, lymphocytic infiltration) or to complications or this state (a smoothing out of the tubal mucosa; a peritoneal granuloma surrounding blood products; a localized infarct of the fimbriae or wall; and haemorrhage involved in thromboses, ovum detachment or necrosis). The ovum and implantation appeared to be normal in 26 cases and to have had development prematurely stopped because of extensive haemorrhage in 41 cases. In 22 cases there was hypoplasia, and difficulty in determining the cause in 11 cases. From a morphological point of view preserving at least one third of gravid fallopian tubes is justifiable, because the chronic lesions are often discrete and the changes of pregnancy generally appear to be reversible. The persisting pathogenic factors are not necessarily tubal, as can be seen by the role of delays in transport of the ova.

The abdominal wall of five fetuses suffering from the Prune-Belly syndrome and four others that had abdominal distension without enlargement of the bladder were studied histologically. This showed that there was no specific character to the abdominal wall defect classically described in the Prune-Belly syndrome. All the same, the results emphasize the importance of the teratogenic action of distension on the muscle growth in the abdominal wall as time goes on. This abdominal distension, if it starts early enough, lasts long and is severe can lead to changes that can progress as far as aplasia, or a lesser fault in development so that in some cases there may be no major abnormality in the abdominal wall.