Recurrent benign mixed tumor of the vagina.

Recurrence of benign mixed tumors has not previously been reported. The case presented here describes this phenomenon 8 years after the original diagnosis was reported in this journal [D. W. Buntine, P. R. Henderson, and J. S. G. Riggs, Gynecol. Oncol. 8, 21-26 (1979)]. There has been no further recurrence in the 3 years since the recurrent tumor was removed. Careful follow-up of large primary benign mixed tumors of the vagina is recommended.

Male partners of women with genital human papillomavirus infection. An assessment of colposcopic abnormalities by histological examination and human papillomavirus hybridization.

Men whose female sexual partners showed histological evidence of human papillomavirus infection were examined. Human papillomavirus DNA was identified in 29 of 35 biopsy samples of colposcopically-identified penile lesions. Human papillomavirus strains that were related to human papillomavirus genotypes 6/11 were observed most commonly (seven of eight patients) in the partners of patients with warty atypia or condylomata, while human papillomavirus strains that were related to human papillomavirus genotypes 16/18 were most-commonly (eight of 15 patients) observed in tissue from the partners of patients with cervical intraepithelial neoplasia. Measurement of human papillomavirus DNA in lesions by the filter in-situ hybridization technique more-frequently indicated human papillomavirus infection (29 of 35 lesions) than did conventional histopathological assessment (21 of 35 lesions) in this "high-risk" group. We conclude that colposcopically-identifiable lesions in male sexual partners are likely to contain human papillomavirus DNA, even if is no definite histological evidence of human papillomavirus infection is present, and that such lesions frequently contain strains of human papillomavirus that have been associated with the development of anogenital carcinoma.

Human papillomavirus--a study of male sexual partners.

Male sexual partners of a cohort of women with genital-tract abnormalities which were associated with human papillomavirus infection were examined for evidence of infection with human papillomavirus. Of the 214 male partners who were examined, 93.5% had visible genital lesions. Of the 196 lesions that were biopsied, 72.5% showed histological evidence of infection with human papillomavirus, and only 20.4% of subjects with histological evidence of human papillomavirus were aware of a lesion. An unexpectedly high proportion (6.1%) of lesions on which a biopsy was performed, particularly those with flat, red, indurated morphology, also showed histological evidence of penile intraepithelial neoplasia. This was not significantly more common among the partners of the women with cervical intraepithelial neoplasia than it was among the partners of the women with other evidence of genital human papillomavirus infection. Penile intraepithelial neoplasia was significantly (P less than 0.001) more common among subjects with no history of non-genital warts. We conclude that the male partners of women with human papillomavirus-associated lesions are very likely to be infected with human papillomavirus, and thus may act as a significant reservoir for the reinfection of their female partners. As the awareness of human papillomavirus-associated lesions was low among the male partners, colposcopic examination and treatment of their male partners, and/or barrier contraception, may be a necessary part of the management of women who are undergoing treatment for human papillomavirus-associated genital disease.

Invasive carcinoma of the cervix in young women.

The cases of 194 women aged 40 years of age or less who had been diagnosed as having invasive cervical cancer in Queensland during 1972-1981 were reviewed retrospectively. Medical records contained a previous cervical cytological report for 89 women, with 18 of these having had a negative result of a smear test within two years of the diagnosis of invasive cancer. Cytological review of five of the 18 cases revealed neoplastic cells in three cases, and possible sampling inadequacies in the other two. Gynaecological symptoms had been present in seven of the 18 patients at the time of the negative result of cytological examination, and these persisted until the diagnosis was eventually made. A high index of suspicion is required when symptoms persist in spite of negative results of cytological examination and we recommend a review of the smear, a repeat smear examination with adequate sampling and referral for colposcopic examination in these circumstances.

Endodermal sinus tumour of the ovary: the place of alphafetoprotein detection, surgery and chemotherapy.

New developments in the management of the rare endodermal sinus tumour of the ovary, together with the reporting of 2 additional patients, are presented. There is a need for accurate clinical and pathological evaluation of the disease. As shown in the present study, histochemical staining for alphafetoprotein (AFP) provides an additional factor in diagnosis, and monitoring of AFP levels in serum is a useful guide to treatment. The prognosis, previously uniformly poor, appears to be improved with the use of multidrug chemotherapy. In a collated series of 98 patients, the 24-month survival rate was 65% in Stage I disease and 67% in Stage II disease. However, the choice of effective drugs remains uncertain. The improved survival of young patients with aggressive chemotherapy has now raised the question of preservation of fertility at the time of surgery. In a small collated series of 26 patients with Stage I disease, survival to 36 months was not jeopardized by the conservative removal of one tube and ovary.

Epidermal growth factor: a critical factor in fetal maturation?

Epidermal growth factor (EGF) infused over 3-14 days into fetal sheep of 110-125 days gestation resulted in a number of morphological and endocrine changes. Striking hypertrophy of the skin, wool follicles and their accessory structures was seen, together with a reduction in the ratio of secondary to primary follicles and degenerative changes in wool fibres associated with shedding of fibres. Adrenal, thyroid, liver and kidney weights were increased while thymus weight was decreased. The increase in adrenal size resulted from cortical hypertrophy and was associated with increased cortisol secretion. Thyroid hypertrophy was accompanied by an increase in colloid stores, decreased plasma thyroxine and reverse triiodothyronine (T3) concentrations, unchanged plasma T3 and thyroid-binding globulin and raised thyrotropin (TSH) levels. Thyrotropin receptor affinity and content per gram of tissue were unchanged. Fetal and maternal plasma prolactin and growth hormone levels, and fetal plasma placental lactogen levels, were unchanged, although there was a significant rise in maternal plasma placental lactogen concentrations with high doses of EGF. Other maturational parameters such as switching from fetal to adult haemoglobin and liver glycogen content were unaffected.

Ectopic vaginal trophoblast in association with a partial mole.

A case of ectopic vaginal trophoblast in association with a blighted ovum showing hydropic degeneration is presented. This combination satisfied the histological criteria of Szulman and Surti for inclusion as a partial mole. Subsequent follow-up revealed non-progression of the condition. The problems of obtaining a satisfactory classification for proliferative trophoblastic lesions are outlined.

Malignant stromal tumour of the ovary with virilizing effects in an XXX female with streak ovaries. Clinical and pathological studies.

In gonadal dysgenesis, the presence of the Y sex chromosome appears to have a strong influence on the development of germ cell tumours. The risk of malignancy associated with other sex chromosomal abnormalities is much lower. In the present report, the clinical manifestations--including primary amenorrhoea, tall stature, infertility and poor development of the genitalia and breasts--associated with a predominantly 47, XXX karyotype are described. Malignant change of the streak ovary to an unusual gonadal stromal tumour with lipid-containing cells occurred at a late stage in her life, and this was associated with progressive virilization and production of androgenic and oestrogenic steroids. In view of the risk of malignancy as well as the abnormal endocrine effects, especially in the presence of a Y chromosome, there is a place for the prophylactic removal of these dysgenetic gonads.

Adenocarcinoma of the uterine cervix of probable Wolffian origin.

An unusual type of adenocarcinoma involving the endocervix and the lower segment of the uterus resulting in a vaginal vault recurrence 7 years after hysterectomy is discussed. Features of the tumour which suggest a probable Wolffian duct (or mesonephric) origin are outlined.

Benign rhabdomyoma of the submandibular region.

A case of benign rhabdomyoma is presented, and the pathology is discussed with reference to its differential diagnosis. The literature is reviewed and the common features of the tumor are described.

Parotid gland tumors. Clinicopathologic study.

The clinical findings and histologic features of 154 parotid gland tumors treated at the Health Sciences Centre, Winnipeg, Canada, from 1957 to 1970 were reviewed. The study illustrates a wide variation in the natural history and degree of malignancy of parotid tumors. Approximately 80 per cent were benign; among these, mixed tumors were by far the commonest. For most benign tumors, the recommended surgical treatment is wide local excision with an adequate margin of normal glandular tissue, except when subtotal or conservative total parotidectomy is required because of the size or location of the tumor. The facial nerve should be visualized and preserved. This approach prevents recurrences and minimizes facial nerve injury, since risk of neural injury increases with the extent of the surgical procedure. Total removal of the gland on the basis of the multicentricity or malignant transformation of these tumors is not supported by the findings of this study. For malignant tumors a more radical procedure, that is, subtotal or total parotidectomy with or without node dissection, with sacrifice of the facial nerve if necessary is advisable, depending on the type and anatomic location of the tumor.