Germ cell neoplasms arising in gonadoblastomas.

Gonadoblastomas have a propensity to give rise to germ cell neoplasms. This study analyzes the clinicopathologic findings in six phenotypic females with features of 46,XY pure gonadal dysgenesis who developed germinomas and other germ cell tumors in gonadoblastomas. All stages in the evolution of germinoma from the germ cells of gonadoblastoma were observed, including in situ, incipient, microinvasive, and metastatic varieties. Admixtures with teratoma and endodermal sinus tumor occurred in two patients. Germ cell tumors which originate in gonadoblastomas appear to have the same clinical behavior and response to therapy as those that arise de novo in the ovary, testis or extragonadal sites. Although it is debatable whether gonadoblastomas are true neoplasms or blastomatoid dysgenetic malformations, their potential for giving rise to fully malignant germ cell neoplasms must be recognized.

Ovarian germinomas (dysgerminomas).

The clinicopathologic findings of 13 patients with ovarian pure germinomas (dysgerminomas) were studied to assess modes of therapy. The patients' ages ranged from 12 to 40 years. Ten patients had unilateral tumors clinically confined to the ovary (Stage I), including 1 patient who had an unsuspected microscopic germinoma in a normal-appearing ovary. Of those with Stage I tumors, only 1 patient developed metastases and died; however, the presence of other elements in the mestases suggested that her primary ovarian neoplasm actually may have been a malignant mixed germ cell tumor. The other 9 patients are alive without tumor after postoperative intervals of 0.3 to 29 years. Three patients had more advanced lesions (Stages II-IV) and 2 died of metastases following orthovoltage irradiation. The results of this study support the concept of individualized therapy for patients with ovarian germinomas.

Obstetrician-gynecologists are primary physicians to women.

Our studies of the practice patterns of Michigan obstetrician-gynecologists indicate that they serve in a dual capacity: that of primary physicians to women and that of specialist obstetrician-gynecologists. They provide a considerable amount of general medical care for their own patients in the former role, and traditional specialist services for their own patients and for those referred by other physicians in the latter. The objectives and educational content of most house officer training programs do not reflect these changes. Training is directed almost exclusively toward preparing residents for specialty practice and often does not offer them basic experience and permit them to develop basic skills in other disciplines, notably internal medicine nad psychiatry, which they will need to practice as parimary physicians to women. An educational program designed to prepare residents more broadly for what they will actually be doing in practice without compromising their training as specialists is described.

PIP: 2 studies conducted in Michigan indicate obstetrician-gynecologists (OBs) function as primary physicians to women. 44 percent of a sample of 1008 patients had no physician other than their OB while 86 percent see only their OB for periodic medical examination. Data from 420 active practitioners showed 87-93 percent (depending upon year of graduation from medical school) treated cancer of the ovary, an equally large number cancer of endometrium with decreasing numbers treating other gynecologic conditions, down to 16 percent of those graduating before 1939 treating genetic problems. (41 percent of those graduating 1959-1969.) The larger percentages of younger doctors treating a wider variety of specialized problems, such as complicated infertility and end ocrine problems, reflects the wider exposure to these matters in recent education. However, almost all the doctors asked said training had not prepared them to handle sexual and marital counseling while 60 percent said they had not enough training in infertility and 30-40 percent wished they had more training in urology. A broader residency program is detailed to give students more experience in primary care. It is also suggested that community hospital programs do not do as good a job of preparing obstetrician-gynecologists. Marginal programs should be closed and training concentrated and broadened to meet the needs of contemporary practice. Discussion by others follows.

Obstetrician-gynecologists are primary physicians to women. I. Practice patterns of Michigan obstetrician-gynecologists.

Michigan obstetrician-gynecologists were asked to complete questionnaires designed to determine what kinds of medical services they provide their patients. The questionnaires completed by 369 doctors, who had graduated from medical school between 1930 and 1964 and who are in active practice, form the basis of this report. More than 50% treat common non-obstetric-gynecologic disorders in their own patients and smaller numbers treat more serious medical conditions. This study confirms a previous one, derived from information obtained from patients, that obstetricians-gynecologists serve as primary physicians to women, not exclusively as specialist-consultants.

The addition of mammography to breast carcinoma screening in a general gynecology practice. One year's experience.

Obstetrician-gynecologists must be in the vanguard of the effort to reduce the death rate from breast carcinoma for it is they who regularly examine a large number of American women. Routine mammography was incorporated into a general gynecologic practice and was recommended for all women over 30. Of 750 women clinically examined, 524 had mammography, and there were 8 carcinomas detected in this group. Six of these were detected by mammography, 5 by mammography alone. Four of these 5 were in situ lesions. In 2 cases the clinical examination was suspicious and the mammography negative. Only 2 of the 8 patients with cancer fell into the commonly cited "high-risk" groups. Based on this experience, suggestions are made for incorporation of mammography into the routine gynecologic examination.

Is the obstetrician-gynecologist a specialist or primary physician to women?

In an attempt to answer the question, "Is the practicing obstetrician-gynecologist a specialist or a primary physician to women?" 1,008 patients of 51 Michigan obstetrician-gynecologists were asked a series of questions concerning their health care. Forty-four per cent have no primary-care physician and 86 per cent see only their obstetrician-gynecologists for regular periodic examinations. Forty-one per cent reported that their obstetrician-gynecologists either had treated them for nongynecologic conditions or had decided that no treatment was necessary. The training and practice of obstetrician-gynecologists must be altered in view of the role they are assuming--that of primary physician to women.