Ploidy and chromatin pattern analysis as an aid for cervical smear diagnosis.

In the present study we used computer-assisted microscopy to analyze the morphology of Feulgen-stained cell nuclei in cell populations obtained at the same time as routinely performed cervical smears and in the same way. We investigated in a series of 110 cases whether the quantitative morphonuclear description of cytological cervical samples is able to aid pathologists to distinguish between benign and more suspect premalignant lesions. For this task nuclear DNA content, nuclear morphometry (size and anisonucleosis level) and chromatin pattern-related parameters were compiled for each specimen enrolled in the database. A set of 32 normal and 17 high-grade squamous intraepithelial lesion (HSIL) specimens (with diagnostic confirmations) were selected as references and used to establish a discriminant model on the basis of cytometry-generated variables. This model was then used to score the remaining 61 cases in our series (including cases exhibiting benign cellular changes, squamous cells of undetermined significance, low-grade SIL and cancers). The results show that a model discriminating efficiently between normal and HSIL groups can be obtained by combining 5 quantitative features (1 DNA ploidy-related, 2 morphometrical and 2 chromatin texture features). A 97% specificity and an 88% sensitivity characterized the boundary so established. When applied to new cases, the model was in fact able to correct diagnoses for cases which had been down- or up-graded on the basis of the Bethesda system, and provided scores in accordance with histological control.

[Cancer of the cervix, papillomavirus, contraception and tobacco]. / Cancer du col utérin, virus du papillome, contraception et tabac.

This survey started in May 1989 and deals with 2,436 patients treated by 10 gynecologists from the Brussels region. In addition to routine cytological analysis in cervical smears, an additional test for Human Papilloma Virus (HPV 16, 18 and 33) was advised for these women. Gynecologists filled in a questionnaire about these patients. In cases with benign cytology, virus prevalence was 2 times greater in woman who took contraceptive pills, over at least 6 months, than in each of the other groups using either diaphragm or male condoms or no contraception, or at menopausal age. It was strange to find that viral prevalence varied according to the pill trade mark, but not according to the pill hormonal content. No confounding factor in population recruitment could be detected. In contrast to viral infection, prevalence of cancer lesions was not increased in the oral contraception group. Squamous intraepithelial lesions of Low Grade and High Grade (SIL LG and HG) were on the contrary 2 times less frequent in women taking the pill, with or without HPV infection. During follow-up of 223 women, the same HPV genotype persisted in SIL lesions but it disappeared within 4 to 8 weeks in 68% of normal cervical smears. However, beyond this period, the proportion of women with persisting virus remained nearly constant, indicating that a subgroup may be less able to mount a defence against the infection. Risk factor of cigarette smoking for SIL LG or HG was 1.6 in women with HPV and 4.0 in those with no virus. This factor was 3.3 in women with oral contraception and 4.5 in the other group.

[Role of hormones in the genesis of breast cancer]. / Le rôle des hormones dans la genèse des cancers du sein

The author makes a general review of the influence of hormones on carcinogenesis of the breast. He explains the efforts wich have been made these last years in order to formulate a pronostic which could predict the efficacy of a treatment. He finally discuss the possible part hormones could play and among them principally oestrogens and prolactin in the breast cancer.

[The enigmatic Stein-Leventhal syndrome]. / L'énigmatique syndrome de Stein-Leventhal.

The individual features of the Stein-Leventhal syndrome has been submitted to a step-by-step review by the author. After a critical study of its clinical manifestations, the author insisted on the variously hypothetized pathways of biosynthesis of ovarian steroids, commenting each one of them and drawing diagrams of special clarity. The alterations that can possibly occur in Stein-Leventhal syndrome: aromatization deficiency, partial enzymatic inhibition due to 3 beta ol dehydrogenase deficiency, have been investigated. To follow, the author discussed: the mechanism of adrenocortical interference, the part played by the pituitary gland and hypothalamus. In the author's opinion, four etiological types of the "micropolycystic ovarian syndrome" can be distinguished, according as the hypothalamic origin is a primary one or secondary to hereditary hypercorticism, and according as the biosynthesis inhibition takes place at the aromatization level or at the levels at which 3 beta ol dehydrogenase activity exerts itself. Interesting therapeutical and prognostic conclusions can be drawn from these suggestions.