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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).

Methods for sampling of the placenta for the purpose of microscopic examination are described, taking into account functional topography and changes significantly linked to foeto-placental pathology. A table shows the chief histological changes seen in the placenta, together with a list of the chief diagnoses in placental pathology.

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.

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.

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.

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.

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.

A cortical adrenal carcinoma arising during the neonatal period and associated with virilization recurred after an initial excision and is in complete remission after a follow-up period of 10 years. The authors have performed a review of the medical literature which has yielded 56 neonatal carcinomas including this one. More than half of these cases concerned the thyroid gland (15 cases) and the adrenal cortex (14 cases). These were followed by malignant melanomas (12 cases), carcinomas of the parotid gland (6 cases), oropharyngeal region (3 cases), adrenal medulla (2 cases) and stomach, liver, breast and cutaneous sweat gland (one case each). Six tumors were associated with congenital malformations which included Beckwith-Wiedeman's syndrome; 4 tumors arose from preexisting tissue lesions; in one case, oral contraceptives were taken during pregnancy. The main treatment of neonatal carcinomas is surgery. Local recurrences (7 cases) do not markedly affect the outcome, whereas metastases (12 cases) have a very unfavorable prognosis. Superficial tumors are diagnosed earlier and more frequently cured. Out of 44 cases for which the outcome is known, only 18 children survived.

Chorionic villus biopsies made during the first trimester of pregnancy offer the advantage of earlier antenatal diagnoses than usual methods. This technic was introduced about 15 years ago but recently improved thanks to innovations in equipment and the contribution of echography. 75 biopsies were made using aspiration technic by echographic-guided catheter. These biopsies were carried out before elective abortion, 18 in an ambulatory setting one to three weeks before the abortion in order to test the social acceptability and tolerance of this method, as well as the inherent risks involved. The biopsy technic is described as well as preliminary results of chromosomic analyses of biopsied chorionic tissues. Drawing from a perspicacious review of the literature, the respective advantages of various biopsy technics and their uses (i.e. sex determination and chromosome analyses by culture and especially direct methods, study of fetal DNA, and enzyme assay) are examined. Finally, the risks of biopsy technic in the immediate and near future are discussed, and the indications today for this new technic are described.

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 pathological study of all placentas from women smoking at least five cigarettes daily during pregnancy (248 cases) and of those placentas from a corresponding control group randomised among all the non-smokers (196 cases) has been set up at the maternity hospital of Haguenau (France) since 1974. The systematic histological examination has shown among smokers a higher frequency of abonormal trophoblast and especially of nuclear clumps in the syncytiotrophoblast. On the other hand, according to a standard protocol, the grouping of various abnormalities has shown, among smokers, a higher frequency of "signs of hypoxia". The lack of relationship between these "signs of hypoxia" and the well-known decreased birthweight among smokers suggests that smoking during pregnancy could always go with a decreased birthweight without a corresponding decreased placental weight, and seldom with an intra-uterine hypoxia. These two effects are independent.The pathological study of all placentas from women smoking at least 5 cigarettes daily during pregnancy (248 cases) and of those placentas from a corresponding control group randomized among all the nonsmokers (196 cases) has been set up at the maternity hospital of Hahuenau (France) since 1974. The systematic histological examination has shown a higher frequency of abnormal trophoblast and especially of nuclear clumps in the syncytiotrophoblast among smokers. On the other hand, according to a standard protocol, the grouping of various abnormalities has shown a higher frequency of signs of hypoxia among smokers. The lack of relationship between these signs of hypoxia and the well-known decreased birthweight among smokers suggests that smoking during pregnancy could always correspond with a decreased birthweight without a corresponding decreased placental weight, and seldom with intrauterine hypoxia. These 2 effects are independent. (author's modified)

Methods of removal, histological analysis, and interpretation of products of abortion are described. Gross pathological examination should include a search for the egg or site of nidation in the decidua, and for embryoplacental lesions in the egg. Histological changes related to the topography, development stage, duration of intrauterine retention, and primary lesions of the villosities are outlined. Apart from incomplete products or those with prolonged intra-utérine retention, it is proposed that ovular pathology be classified in four main syndromes: endometrial changes with a subnormal egg; embryonic alterations with a subnormal placenta; overall hypoplasia of the embryo and placenta; trophoblastic diseases.

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.

Kaposi's sarcoma is a multiform mesenchymal neoplasm of uncertain histogenesis but of possible viral origin. Several anatomo-clinical forms have been described the cutaneous nodular lesion being the most common and at highest frequency in equatorial Africa. Eighteen of such typical lesions were reported; their morphology was uniform and associated: 1) spindle cells, 2) an excess of vascular spaces composed of intratumoral intercellular slits and of intra and peritumoral well structured vessels, 3) a lymphoplasmocytic inflammatory infiltration. The lesions of the other and less common forms of Kaposi's sarcoma associated the same histological features in variable combination. At one end of the histological spectrum the lesions are essentially composed of irregular capillaries with few spindle cells, at the other end the tumor is a highly cellular neoplasm with few or no angiogenic features. The vascular structure of the typical lesions appeared clearly at the ultrastructural level. Most tumor cells were of endothelial type and formed cylinders with virtual or large central lumina, reminiscing of vascular sprouts. Pericyte-like cells were also present. In one the three ultrastructurally investigated cases, a tumor cell of the endothelial type contained intranuclear herpes virus like inclusions, group to which belongs the cytomegalovirus (CMV), a possible promoter of Kaposi's sarcoma.

The expression of calbindin (28,000 mol. wt Vitamin D-dependent calcium binding protein) was studied in sensory neurons of the chick dorsal root ganglion by combining immunocytochemical and ultrastructural features. In the chick embryo at E10, about 20% of the neuroblasts were immunostained with antibodies raised to calbindin. After hatching, two subpopulations of primary sensory neurons were labeled with calbindin-antibodies and could be identified: the large Al cell bodies (6%) mainly characterized by huge blocks of rough endoplasmic reticulum and the small Bl cell bodies (14%) which contain parallel cisternae of rough endoplasmic reticulum. The other neuronal cell types A2 and B2 were devoid of any immunostaining. Thus, calbindin is an early and reliable marker of two subclasses of primary sensory neurons in the chick dorsal root ganglion.

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.

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.

Three cases of central giant cell reparative granulomas of the mandible are reported. The first shows classic manifestations. The second illustrates the role of traumatism in the genesis of these lesions. The third highlights the effect of pregnancy in their growth. The bilateral character of the lesions in this last patient led us to evoke the diagnosis of hyperparathyroidism and cherubism. They were ultimately discarded. A diagnostic approach is proposed which takes into account the location of the lesion and the medical history of the patient. Both experimental data concerning the potential of the cells found in the ramus of the mandible in laboratory animals and notions which apply to the periodontal bone remodelling enable one to better understand and differentiate between the central giant cell reparative granuloma and the genuine cell tumor of the mandible.

The mechanism instigating triploidy is linked to placental aspects. When 2 of 3 gametes are paternal in origin, molar pregnancy results, while if 2 of 3 gametes are of maternal origin the placenta is normal (15% of cases). Hydatidiform mole and chorioadenoma destruens or invasive mole are indistinguishable one from the other in terms of clinical appearance, histology and course of disease, and are always benign. Their karyotype is 46,XX (except for 3% which are 46,XY) completely paternal in origin and usually homozygotes. Trophoblastic carcinoma however is aneuploid and heterozygotic which emphasizes its allograft nature i.e. with no apparent relationship to hydatidiform mole.

Comparing the cytogenetic and morphological data on cases of hyperplasia and neoplasia of the trophoblast allows some conditions to be better defined and separated. The term partial mole or embryonic mole should be replaced by the term triploid syndrome because of the especially strong correlation between the triploid caryotype and the special aspect of the placenta. Triploidy is usually the result of fecundation of a haploid ovule by two spermatozoids, probably due to the similarity of the haploids of the two parents, as is suggested by the study of HLA antigens. Classical hydatidiform mole, or perivillous trophoblastic hyperplasia, is usually discovered earlier, during an ultrasound examination or abortion and its histological diagnosis is easy. The caryotype of complete hydatidiform mole is diploid, nearly always XX, with the two sex chromosomes coming from the father (the maternal sex chromosome being eliminated). The caryotype of vesicular dystrophia without trophoblastic hyperplasia is, on the other hand, normal. Trophoblastic microcarcinomas have a better known presentation. And trophoblastic carcinomas are distinct from non-trophoblastic neoplasms which secrete HCG and from benign trophoblastic pseudo-tumors which are often non-secretory.

About 7 cases the author describes a uterine tumor made up of serous cysts with endotheliform covering and small areas of immature leio-myocytes.

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.

Malarial placenta is characterized by the presence of parasites in maternal erythroblasts, by an excess of intervillous macrophages and by an excess of perivillous fibrin deposits stained with malaric pigment. The high frequency of prematures, hypotrophic neonates and still-births in the malarial population is explained by the intervillous macrophages, which decrease the maternal blood output and the perivillous excess of fibrin which reduces the materno-fetal exchanges.