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OBJECTIVE: To investigate the diagnosis and prognosis aspects of carcinoma of the cervix in a group of young patients less 35 years old, not very clear in literature. STUDY: Retrospective and comparative diagnostic and prognostic study. This study is related to the epidemiology and prognosis of such cervical cancer in young women. SUBJECTS: Of 449 new patients with carcinoma of cervix FIGO stages IA2-IV treated between 1972-1990 inclusive, 46 patients were aged less than 35 years old. RESULTS: The frequency is about 10.2%; during the last 20-year period, there was a gradual rise in the proportion of young women with invasive carcinoma of the cervix (7.6% between January 1972 and June 1981, 13.9% between July 1981 and December 1990). There is more frequent incidence of adenocarcinoma in the young women group (19.6% adenocarcinoma < 35 years, 8.2% > 35 years). The overall 5-year survival all stages together is better before 35 years (71% < 35 years, 50% > 35 years), because in women aged less than 35 years, early stages disease (IA2, IB), predominated. Stage for stage, the 5-year survival is a little lower for stage I (78.6% < 35 years, 88.5% > 35 years) and much lower for stage II (45.5% < 35 years, 71% > 35 years). The young age is an independent prognosis factor, predicting early recurrences within 20 months: the relative risk is 3.7. CONCLUSION: The young age (less than 35 years), is a worse prognosis factor of carcinoma of the cervix; the treatment is very difficult: heavy (radiotherapy, neoadjuvant chemotherapy), efficient, problem of femininity.

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The results of IVF in cases of tubal sterility are compared with those of surgery (macro- or micro-surgery, coelio-surgery). This analysis includes a continuous series of 1051 attempted pregnancies in 640 women (with or mixed tubal sterility with or without endometriosis). After an average 1.64 attempts per patient, 220 women had achieved 241 pregnancies (pregnancy rate: 22.9% per puncture, 34.3% per woman). Of these 241 pregnancies, there were 172 (71.8%) which continued to term, 57 (23.6%) miscarriages and 11 (4.6%) ectopic pregnancies. The pregnancies carried to term were single pregnancies in 129 cases (74.6%), twin pregnancies in 37 cases (21.4%) and triple pregnancies in 7 cases (4%). The indication of coelio-surgery (or microsurgery) is justified in young women with no history of genital tuberculosis, tubal plasty or ectopic pregnancy and presenting with purely tubal sterility with a good prognosis. Restoration of patency after tubal sterilization remains a good indication for microsurgery in young women. In all other cases, indication is for IVF from the outset.

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According to the most recent studies reported in the literature, and those carried out in a trial carried out in Grenoble and Lyon (France) involving 210 in situ cancers of the breast, the respective indications for conservative and radical treatment are proposed for in situ duct cancers. The preferred orientation towards the most conservative treatment possible can be decided only after the prospective studies which are currently being evaluated in both the USA and in Europe.

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Pelvic lymphadenectomy for genital cancer can lead to complications: particularly lymphoceles, post-operative fever, thromboembolism and lymphoedema. We compared two groups in a series of 157 patients treated by extended lymphadeno-colpo-hysterectomy for cancer of the uterine cervix, of the endometrium, of the ovary, of the vagina: Group I: 108/157 patients: visceral peritonization: lymphoceles: 23.1%, post-operative fever: 35.2%. Group II: 49/157 patients: visceral non-peritonization, lymphoceles: 6.1%, post-operative fever: 16.3%.

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The authors, in a retrospective study, have looked at the clinical and paraclinical parameters that suggest that a cancer may be present when there is a nipple discharge. By using logistic regression on these criteria a model has been able to be constructed with four variables (bloody discharge, and associated palpable tumour, a suspicious mammographic appearance and atypical or proliferating cells in cytology). The probability of a cancer being present varies between three per thousand when none of the four variables are present to 99.1% when all four are present. A first outline of the therapy that can be used is suggested.

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Hysteroplasty described by Bret in 1959 represents the procedure of choice in cases of bifid uterus with infertility secondary to repeated interruptions of pregnancy or complicated deliveries. This technique, of which we will remind the main steps, gives excellent results as demonstrated in a joint series from the Gynecological and Obstetrical Clinics of Hopital Edouard Herriot. In view of these good results, it seems that the indications of hysteroplasty should be broader than before in order to prevent the risks inherent in repeated interruptions of pregnancy and complicated deliveries.

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Some of the malformations affecting the female genital system are discovered too late and these may have serious repercussions on the subsequent genital activity of the adult woman. These abnormalities include partial aplasia and, in particular, total or unilateral menstrual retention. Obstructive malformations of this type (diaphragms, segmental atresia, unilateral menstrual retention or retention affecting both sides of the uterus, aplasia, isolated vagina etc...) deserve priority investigation because early correction is the only way of preventing the serious complications to which they may give rise (menstrual reflux, infection, sterility, pelvic endometriosis etc...). Other malformations, less obvious and less "urgent", are also described, but these require treatment only at a later stage.

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A large number of studies have drawn attention to the multiplication of the number of endometrial cancers in women under oestrogens. All these retrospective studies are concordant, but the majority can be the object of criticisms and do not necessarily carry conviction. Oestroprogestational associations seem, on the contrary, to protect, in a certain measure, against the appearance of carcinoma of the endometrium. The author concludes that, in the uncertainty, it is indubitably necessary not to establish as a principle that the menopause should be treated with oestrogens, but to give under surveillance the necessary oestrogen treatment to women who need them. One should take care to choose an oestrogen as natural as possible, and it is desirable to associate it with progesterone.

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The authors report five observations of endometrial stromal nodules. These nodules are composed of cells identical to those of the endometrial stroma. They constitute the benign form of endometrial stromal tumors. From the macroscopic point of view, they present as nodular formations, most often single, well defined, non-fasciculated, whitish or yellowish sometimes cystisized. From the microscopic point of view, these nodules contain areas of plexiform or glandular arrangement with, occasionally, pseudo-rosettes. Small collagenous zones can often be observed. E.S.N. should be distinguished on the one hand from endolymphatic stromal myosis, and on the other hand from sarcoma of the endometrial stroma. Histogenesis of the lesion is also discussed.

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The authors present a series of 45 plastic operations for bicornuate uterus. Three women were operated on for functional symptoms, eight for sterility of which seven were primary, and thirty four for infertility. They are sorry that three women were lost to follow up. They used the Bret-Palmer technique with modifications that they themselves describe. They justify this choice as against other techniques of metroplasty. The anatomical results are, in the main, good when controlled by hysterosalpingography 3 to 6 months after the operation. The functional results, by which is meant the pregnancies that have been obtained, are medium as far as sterility is concerned. Four out of the eight women who were operated on became pregnant. But they are very good in cases of infertility, because thirty out of the thirty four cases that were operated on had one or two pregnancies. The authors justify their indications for metroplasty after a first spontaneous abortion by the good results they have had, and because bicornuate uteri give rise to many obstetrical complications. Furthermore in unoperated cases there is often difficulty in attempting a new pregnancy, and quite often spontaneous late abortions or premature labours. In certain cases they carried out the operation after first spontaneous abortions, but they are more conservative in operating in cases of primary sterility. The authors do not think it is necessary always to carry out a cerclage procedure nor a caesarean operation automatically in cases that have become pregnant after metroplasty.

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Microcalcifications previously located by radiography were extracted from 25 fresh specimens obtained from patients who had undergone tumorectomy or systematized mammary exeresis. Two principal types of microcalcifications were distinguished: Type I microcalcifications were amber in color and generally crystalline on scanning electron microscopy, with only one calcium peak on microprobe analysis; x-ray diffraction revealed that weddellite was involved. Type II microcalcifications were whitish, nonbirefringent under polarized light, and generally ovoid or fusiform, with two peaks, one calcium and the other phosphorus, on microprobe analysis; these microcalcifications were composed of calcium phosphate, the most characteristic form of which is hydroxyapatite, in the form of needles arranged in rosettes on transmission electron microscopy. Type I microcalcifications were observed in four of eight benign breast lesions, in two of three in situ lobular carcinomas, and in no intraductal adenocarcinomas or infiltrating carcinomas. Type II microcalcifications were present in all infiltrating carcinomas and intraductal adenocarcinomas; they were also found in benign lesions (four of eight) and even associated with type I microcalcifications in one in situ lobular carcinoma. There are, therefore, no "benign" or "malignant" microcalcifications; however, the presence of weddellite is a strong indication that a lesion is benign or, at most, an in situ lobular carcinoma.

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After recalling the possible risks of conservation of adnexae, the authors stress the advantages of such an approach. Taking into account the patient's age, ovarian disease, certain hormonal conditions and the risks of cancer, the authors generally tend to conserve ovarian function, unless there are absolute or relative contra-indications, such as those discussed by the authors.

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Thirteen ovarian tumours were the subject of a histochemical and immunohistochemical study using antibodies to collagen IV, III, I, and to laminin. Our study shows that it is not possible to assess the integrity of the basement membrane using simple histochemical methods (P.A.S., Gordon Sweets staining). In contrast, in benign epithelial tumours, a continuous basement membrane may be visualized beneath the epithelium of the cysts using antibodies to collagen IV and to laminin, collagen IV and laminin being two of the constituents of basement membranes. In malignant epithelial tumours, the immunoreactive material of collagen IV type or of laminin type, is arranged in a distinctly discontinuous manner, and is of unequal thickness around the edge of the cysts or of the neoplastic clusters. In three cases of borderline epithelial tumours, the discontinuity of the immunoreactive material (collagen IV or laminin) lying beneath the epithelium of the cysts, is not so pronounced. In comparison with studies carried out on the cervix uteri, this latter type of tumor, because of the constitution of its basement membranes, would appear to occur at a particular moment in their evolution, i.e. when they pass from the intra-epithelial stage and become infiltrative.

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The value of "differential cytology" in the diagnosis of preclinical carcinoma of the cervix uteri was assessed from serial sections of operative specimens in a series of 452 patients. Although not absolute, this value was found to be considerable. Used to supplement colposcopy-guided biopsy, it makes it possible to decide on the therapeutic approach (notably simple destruction by laser) without having recourse to conization. However, the results are only valid for the team which presents them, and before deciding to treat intra-epithelial carcinomas by laser destruction, each team must perform the same "quality control".

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