Benign, borderline, and malignant endometrioid neoplasia arising in endometriosis in association with tamoxifen therapy.

Tamoxifen therapy may result in a variety of endometrial proliferative lesions, including adenocarcinoma, and as recently suggested, proliferative changes within endometriosis. This report describes an endometrioid adenocarcinoma arising in ovarian endometriosis in a patient taking tamoxifen. There were also foci of benign and borderline endometrioid adenofibroma in the same ovary and a synchronous endometrioid endometrial adenocarcinoma in the uterus. The spectrum of benign, borderline, and malignant endometrioid neoplasia arising within endometriosis suggests that tamoxifen, as a result of its estrogenic effects, may cause proliferative and, in rare instances, malignant changes in endometriosis.

Malignant fibrothecomatous tumour of the ovary: diagnostic value of anti-inhibin immunostaining.

Malignant ovarian tumours of the fibrothecoma group are rare. The clinicopathological features of a case of ovarian malignant fibrothecoma in which there was metastatic disease in the small intestine and peritoneum at presentation are described. A number of differential diagnoses were considered but positive immunohistochemical staining of the resected ovarian and small intestinal neoplasms with anti-inhibin was of value in confirming a sex cord-stromal tumour and in excluding other lesions. The two tumours were also ultrastructurally identical. Classical malignant fibrothecomas are said to show four or more mitotic figures per 10 high power fields (HPF). Although the intestinal secondary was mitotically active, the primary ovarian tumour contained only one to two mitoses per 10 HPF, showing that formal mitotic counts are not an absolute indicator of malignant behaviour in this group of tumours.

Retrograde ejaculation--pregnancy following artificial insemination.

A case of retrograde ejaculation is described where pregnancy was achieved by artificial insemination using sperm recovered from the urinary bladder. The importance of the accurate diagnosis of retrograde ejaculation and its management is discussed.

LHRH analogue therapy in infertile women with luteal phase defects.

Management of patients with unexplained (ovulatory) infertility is a difficult clinical problem. Some of these women exhibit repetitive luteal phase defects which may or may not respond to conventional treatment with anti-oestrogens or progesterone supplementation. Ablation of the defective cycles, by rendering the patients hypogonadotrophic, and then substituting induced cycles using exogenous gonadotrophins, was employed in 10 women who had been inexplicably infertile for up to 14 years. Over a trial period of six cycles good luteal phase progesterone profiles were achieved in all instances, but only two term pregnancies occurred. A further two patients conceived but one aborted and one had a tubal pregnancy. The results are discussed critically, regarding the importance of luteal phase defects in the aetiology of infertility and the conception rates which may occur even if no specific therapy is prescribed.

Counselling patients for artificial insemination and subsequent pregnancy.

Patients contemplating conception by artificial insemination can be assured that their pregnancy will be as normal as that following natural insemination. In particular, there is no evidence of increased rate of abortion or fetal abnormality. In general, the results of AIH are disappointing and patients should be made aware of this before such treatment is advised or undertaken. The indications must be well defined and a realistic prognosis given. Pregnancy rates with AID are good using either fresh or frozen semen. It is the moral and legal implications of this procedure which raise the problems. Therefore it is vital that a couple be allowed to consider these problems fully before proceeding and it is the responsibility of their medical practitioner to ensure that they have the facility to do this.