Clinicopathological and embryological considerations of single ectopic ureters opening into Gartner's duct cyst: a unique subtype of single vaginal ectopia.

We report 6 cases of single ectopic ureters opening into a Gartner's duct cyst. All but 1 patient were children. The presenting symptoms were urinary incontinence, urinary tract infection, a vaginal mass or weight loss. All but 1 patient had a mass protruding into the vagina. In 5 cases nephroureterectomy was performed successfully. The cyst wall was left untouched to allow for its spontaneous collapse. Although 2 cysts were found to communicate with the vagina, 4 presented as a closed space. All resected kidneys were more dysplastic than those with vaginal ectopia without cyst formation. The etiology and pathogenesis of the anomaly are unknown but some speculations are made.

Non-clear-cell adenocarcinoma arising in vaginal adenosis.

We report a case of adenocarcinoma of the vagina occurring in a woman without exposure to diethylstilbestrol. The adenocarcinoma arises in benign adenosis and lacks a clear-cell component. Both the adenosis and adenocarcinoma appear to be of müllerian origin.

Paravaginal wolffian duct (mesonephros) adenocarcinoma: a light and electron microscopic study.

This is a report of an adenocarcinoma of mesonephric origin studied by light microscopy, electron microscopy, and immunocytochemistry. Unlike previous reports, our lesion was located paravaginally and not in the leaves of the broad ligament or in the cervix. The light microscopic features are similar to those of previous cases in the literature. Although not specific, the ultrastructural features of the tumor are similar to those of mesonephric structures and different from those of müllerian structures. The diagnosis always should be considered when a tumor occurs at the site where mesonephric remnants may be found and after exclusion of a carcinoma of other pelvic organs or a metastasis from a primary neoplasm elsewhere.

Intramural papilloma of the vagina: evidence of Müllerian histogenesis.

A papillary tumor occurred in the posterior-superior vaginal wall of a 5-year-old girl who was free of recurrence one year following surgical excision. The light microscopic features included papillae lined by eosinophilic cells with uniform, bland nuclei, solid areas of identical cells, and scattered glandular lumina which contained mucopolysaccharides. Foci of eosinophilic hyaline globules were another distinctive feature. Electron microscopy of the tumor demonstrated features associated with müllerian neoplasms including projecting microvilli, whorls of perinuclear cytoplasmic microfilaments, conspicuous lysosomes, squamous metaplasia, complex cytoplasmic interdigitations, and pseudoinclusions of "cytoplasmic" collagen. Previously described "mesonephric papillomas" of the vagina and cervix are compared with the tumor of the authors' patient. The previously described tumors share some histologic and clinical features, although they were superficial rather than intramural proliferations. The authors conclude that the ultrastructure, location, and documented presence of müllerian structures in the vagina favor a müllerian origin for this vaginal tumor. A number of other vaginal tumors that occur in children and young women show different light microscopic features.

Prenatal diethylstilbestrol exposure and human genital tract abnormalities.

The incidence of clear cell adenocarcinoma of the vagina and cervix associated with intrauterine exposure to DES and similar compounds during the first half of pregnancy has increased. Ninety percent of these cancers have occurred in patients 14 years of age or older. Although these carcinomas are exceedingly rare, nonneoplastic abnormalities including vaginal adenosis, cervical eversion (ectropion), and transverse cervical and vaginal ridges are frequent in the exposed population, particularly if the drug was administered early in pregnancy. Current evidence favors a disturbance in development of the müllerian duct as the explanation of these changes. Whether DES is only a teratogen or also a carcinogen is unknown, as is the possible role of other factors in the development of cancer. An increased incidence of cancer among exposed males has not been documented.

Malignant mixed tumor of the vagina probably arising in mesonephric rests.

An exceedingly rare tumor arising in the upper lateral vagina is described histologically, histochemically, and ultrastructurally. It is compared to the lesion reported by Okagaki et al. which is considered to represent the same type of tumor. Comparison with synovial sarcomas indicates that the lesion is similar, but the reasons why it should not be so classified are discussed. Evidence is presented for the origin of these tumors in mesonephric rests (Gartner's duct).

Comparison of cancer cell surfaces of the lower reproductive tract by scanning electron microscopy.

The squamous cells of the cervix simulate those of the vagina and vulva both histologically and by scanning electron microscopy. However, in areas of the cervix undergoing active metaplasia, there are cells which share some of the characteristics demonstrated by scanning electron microscopy of both squamous and columnar epithelium. In these cells there is a wide range of characteristics of each cell type, suggesting a possible gradual transition from columnar to squamous epithelium. Furthermore, the cells of severe dysplasia and of intraepithelial and invasive squamous cancers of the cervix, though histologically similar to those of vaginal and vulvar cancers, are distinctly different when examined by scanning electron microscopy. These findings suggest that both metaplastic and neoplastic squamous cells are derived from the same progenitor columnar cells of the cervix, by orderly transition in the former and by atypical transformation in the latter. Second, the distinctiveness from the vaginal and vulvar cells indicates different embryonic stem cell lines.

[Clear cell carcinoma of the female genital tract]. / Les carcinomes à cellules claires du tractus génital féminin

Even though the existence of clear cell carcinomata is universally acknowledged at all levels of the female genital tract, the nomenclature and the pathogenesis are still controversial. Following the observation of several examples of these tumours, we have been tempted to define and state the origin of these tumours. In the light of urogenital embryogenesis we think that it is discretion that has led to purely descriptive terms to describe these carcinomata. A critical study of the hypotheses as to the pathogenesis that have been suggested about these tumours in the literature allows the summary of numerous arguments in favour of a müllerian origin or viewed in a broader aspect, coelomic origin for these tumours.