Andrew Tiltman

Placental bed spiral arteries in the hypertensive disorders of pregnancy

Objective— The investigation of the histology of the placental bed spiral arteries in normal pregnancy and in pregnancies complicated by hypertension, with or without proteinura.

Placental bed biopsies in placental abruption

Objective To investigate structural changes in the uteroplacental blood vessels in association with placental abruption.

Anatomical variation of the oestrogen receptor in the non-neoplastic myometrium of fibromyomatous uteri

Myometrial tissues from a total of 30 normal and 30 fibromyomatous uteri were compared in order to assess whether the oestrogen receptor distribution is similar for both types. All patients concerned were premenopausal with no history of exogenous hormone usage. Material taken from the subserosal, midmyometrial and subendometrial regions of both the fundus and the lower segment was stained by immunocytochemistry for the oestrogen receptor. No significant difference in the oestrogen receptor content was noted between the fundus and the lower segment in either the normal or the fibromyomatous myometria. Similarly, the phase of the menstrual cycle did not affect the total receptor content of either group of tissue. The oestrogen receptor content in the non-neoplastic portion of the fibromyomatous myometria was highest in the subendometrial and lowest in the subserosal region. The differences in receptor content between normal and fibromyomatous myometria were minimal in the subendometrial region but marked in the subserosal region. The myometrium of fibromyomatous uteri thus expresses significantly increased levels of oestrogen receptor, and the pathogenesis of fibromyomata may be related to an inherent abnormality in the myometrium.

Anatomical variation of the oestrogen receptor in normal myometrium.

Tissue from 20 surgically resected uteri was examined in order to test the hypothesis that the oestrogen receptor content of the myometrium may not be uniform throughout the uterus. All patients were premenopausal, had no history of any exogenous steroid hormone use and were in the proliferative phase of the menstrual cycle. Material was taken from the subserosal, midmyometrical and subendometrial regions of both the fundal and lower uterine segments. Care was taken to remove all endometrium. Suitable samples were analysed by radioimmunoassay (RIA) for oestrogen receptors. An adjacent block from each area was fixed in formalin and stained immunocytochemically for oestrogen receptors. The results of the RIA show a significantly higher receptor content in the subendometrial region than in either the midmyometrial or the subserosal region. No significant difference was demonstrated between the numbers of receptors in the fundus and in the lower uterine segments. The differences were also well demonstrated by immunocytochemistry, according to which 83% of all cells counted in the subendometrial region were positive, while only 61% of cells in the middle and 47% of those in the subserosal region were positive.

Peutz‐Jeghers syndrome in association with adenoma malignum (minimal deviation adenocarcinoma) of the cervix. Case report

A 44-year-old woman was admitted to the Gynaecological Oncology and Radiotherapy unit of the Groote Schuur Hospital in Cape Town for persistent dysuria and a vaginal tumour. At the age of 16 the diagnosis of PeutzJeghers syndrome (PJS) had been made after she had presented with rectal bleeding and was found to have melanin pigmentation around the mouth and on her fingers. At the time she underwent surgery twice to relicvc intestinal obstruction due to duodenal intussusception. Two ycars later she had a bowel resection at which time duodenal hamartomatous polyps were found confirming the diagnosis of PJS. At the agc of 19 several anal polyps were removed. At the age of 40 she underwent a total abdominal. hysterectomy with bilateral salpingooophorectomy for menorrhagia. Histological examination of the cervix was thought to show adenosis. Three years later she presented to her gynaecologist with persistent dysuria, when the

The distribution of fibronectin in the placental bed in normotensive and hypertensive human pregnancies

Summary Endovascular trophoblast invasion into the spiral arteries of the placental bed is restricted to the decidual segments in pregnancy-associated hypertension (pre-eclampsia). Little is known about mechanisms that control trophoblast invasion. Extracellular matrix proteins such as fibronectin could be involved, as they are in other invasive processes. The observation of increased plasma fibronectin levels in patients that will develop pre-eclampsia (Ballegeer et al., 1989) prompted us to study the distribution of this glycoprotein in the placental bed of normotensive and hypertensive pregnant patients. Paraffin embedded sections were stained for fibronectin using the indirect peroxidase labeled antibody technique. Spiral arteries undergoing physiological changes stained virtually negative. In vessels with subintimal thickening an occasional fibronectin positive lining of endothelium and positive areas in the fibrous subintimal cushions could be found. The most intensive staining for fibronectin however was found in the arteries with acute atherosis, i.e., the vascular lesion that is thought to be associated with pre-eclampsia.

IMMUNOCYTOCHEMICAL LOCALIZATION OF ADENYLYL CYCLASE IN HUMAN MYOMETRIUM

The enzyme adenylyl cyclase (AC) plays a pivotal role in smooth muscle relaxation. Biochemical evidence suggests that AC is predominantly located in the outer layers of the myometrium; however, neither immunocytochemical nor histochemical studies have been undertaken to demonstrate the specific cellular distribution of the enzyme in this tissue. As part of an ongoing study of the human myometrium, a polyclonal antibody against types V and VI AC was used to detect the presence of these isoforms in sections of formalin‐fixed, wax‐embedded myometrial tissue. A positive reaction was seen in the cytoplasm of the smooth muscle cells with the midmyometrial area having the greatest number of positive cells, when compared to the subserosal and subendometrial areas. It is hypothesized that AC isoform type VI is the predominant isoform present in the myometrium and that the percentage distribution of positive cells reflects the area of highest myometrial activity during parturition. Microsc. Res. Tech. 40:488–491, 1998.

A clinical appraisal of stage 1 mucinous carcinoma of the ovary

Thirty patients with stage I mucinous carcinoma of the ovary are reviewed with special reference to possible prognostic factors. The role of adjuvant therapy is discussed. Adjuvant therapy is recommended only for patients with poorly differentiated tumours and with stage Ic disease.