D. W. Fortune

NON‐IMMUNOLOGICAL HYDROPS FETALIS

In a consecutive series of 182 cases of hydrops fetalis 33 (17·6 per cent) were due to causes other than blood group incompatibility, the incidence of non‐immunological hydrops fetalis being 1 in 3538 deliveries. Of the 33 cases, 13 were idiopathic, 6 were associated with twin pregnancies, 7 had major malformations and the remaining 7 had a variety of associated diseases.

The ‘simple’ ovarian cyst: aspirate or operate?

Summary. One hundred ultrasound‐guided ovarian cyst punctures were performed in 88 patients. To minimize the risk of unexpected malignancy, only persistent or painful cysts <10 cm in diameter were aspirated, cysts with solid areas or multiple locules were excluded. Cytological diagnosis was not possible in 72 of the 100 fluids; of the others 20 contained cells suggestive of follicular or luteal cysts, four samples suggested endometriosis and four benign tumours of epithelial origin. Oestradiol levels were high in 54 cystic fluids, and a combination of oestradiol estimation and cytology facilitated the identification of a follicular origin. Most such patients would normally have undergone surgery, but this was eventually required in only 10 of 60 in whom the cyst fluid was clear or slightly blood‐stained and in 16 of the 28 with heavily blood‐stained fluid. Ultrasound‐guided ovarian cyst puncture would appear to be a valid alternative to surgery for carefully selected benign ovarian cysts especially when the cyst is considered not to contain blood.

Growth and Malignancy of Ovarian Tumours in Pregnancy

A series of 164 ovarian tumours diagnosed during pregnancy or the puerperium is presented. The commonest were the benign cystic teratoma (45 cases) and the mucinous cystadenoma (40 cases). Rapid growth of the tumour during pregnancy was observed in 5 of the 41 patients (12%) in whom assessment was possible; in none of these was the lesion malignant. The incidence of malignancy was 2.4% (4 of 164 cases) or 10 times less than that of ovarian tumours in non‐pregnant patients. This difference was accounted for by the variation in age distribution in pregnant and non‐pregnant patients with ovarian tumours.

Endometrial carcinoma: Steroid receptors and response to medroxyprogesterone acetate

The steroid receptor content of the primary endometrial cancer of 22 patients who were treated for recurrent or advanced disease has been measured and correlated with response to medroxyprogesterone acetate. No patient with a progesterone receptor (PR)-negative tumor responded and only 2 patients with PR-positive tumors responded, perhaps related to the low levels of PR in the tumors. It waits to be assessed whether receptor status is as good a guide to response to hormone therapy as tumor differentiation, site of recurrence, or disease-free interval.

Survey of congenital tumors in perinatal necropsies

Summary In an audit of 17,417 necropsies from 1939 to 1989 at the Royal Womens Hospital, Melbourne, Victoria, 46 congenital tumors comprising 24 teratomas, 8 vascular tumors, 6 neuroblastomas, three rhabdomyomas, two mesoblastic nephromas, one thyroid adenoma, one hepatic adenoma and one cerebellar medullo‐blastoma were found. The teratomas were generally large tumors and, because of their size and location, incompatible with extrauterine life. Ten teratomas were associated with polyhydramnios, three with obstructed labour, five of the fetuses were hydropic and four had malformations at sites distant to the tumor. Twenty teratomas occurred in stillbirths, half of whom were macerated. The vascular tumors were associated with polyhydramnios in three cases and hydrops fetalis in two. The neuroblastomas were all incidental findings. Four were intra‐adrenal, one was an adrenal tumor which had metastasized to the liver and the remaining case was a small paravertebral lesion. Two of the three rhabdomyomas were multiple and one of these occurred in a case of tuberous sclerosis. One of the mesoblastic nephromas occurred in a hydropic fetus who had the Arnold‐Chiari malformation. The thyroid and hepatic adenomas were small incidental lesions. The cerebellar medulloblastoma had led to marked hydrocephalus. Congenital tumors have different incidence, presentation and behaviour than those in childhood or adult life. The association of congenital tumors with congenital malformations and hydrops fetalis should always be remembered.

Endometrial carcinoma in premenopausal women: a clinicopathological study

A clinicopathological review of 106 cases of premenopausal endometrial carcinoma has confirmed the good prognosis in such patients. Women less than 40 years old were more likely to be nulliparous, over 80 kg in weight, and to present with irregular or heavy and irregular bleeding, than women 40 years or older. Seven patients developed malignancies at other sites. A detailed pathological review of 32 cases revealed poor prognostic features in 30% of patients; corpora lutea were identified in the ovaries of 13 patients. It is suggested that factors other than anovulation are related to the development of endometrial cancer in the over 40 age group.

Endometrial Carcinoma in Young Women

Summary: Endometrial carcinoma in young women is uncommon. The majority of cases occur in women who have been taking oestrogen‐containing oral contraceptives, in those with the Stein‐Leventhal syndrome, or in those with gonadal dysgenesis treated by long‐term oestrogen replacement therapy. We have observed 4 women under 40 years of age with adenocarcinoma of the uterus in whom chromosomal abnormalities associated with Turners syndrome were confirmed only after the diagnosis of carcinoma had been made. None of these had received replacement oestrogen therapy. It is postulated that chromosomal abnormalities in young women with endometrial carcinoma are more common than previously thought. As the disease in this group appears to behave in a benign fashion, a conservative approach to therapy is advocated.

Non‐immune hydrops fetalis: changing contribution to perinatal mortality

Summary. During the decade to 1979, 203 hydropic infants died in the State of Victoria, Australia. Non‐immune hydrops fetalis (NIHF) became more common than immune hydrops fetalis as a cause of fetal hydrops, and its contribution to the total perinatal mortality increased from 0.1% to 3%. The perinatal mortality rate of infants with NIHF was virtually 100%. The most consistent finding at post‐mortem was pulmonary hypoplasia which was probably due to compression from serous cavity effusions. Survival may be improved by early diagnosis and termination of the pregnancy in selected patients with viable infants before the development of gross serous cavity effusions The most constant clinical sign associated with hydrops fetalis was polyhydramnios which is an indication for ultrasonography and cardiotocography to detect cases of NIHF and to select the optimum time for delivery.

Cytoplasmic steroid receptors in ovarian tumours

Summary. Cytoplasmic oestrogen receptors were measured in 40 primary and four secondary ovarian tumours; of these, 43 tumours were also analysed for cytoplasmic progesterone receptors and 34 tumours for cytoplasmic androgen receptors. Serous tumours were significantly more likely to be oestrogen‐receptor positive than mucinous tumours, but the incidence of positive progesterone and androgen receptors was similar in serous, mucinous and endometrioid tumours. The mean oestrogen receptor content of serous tumours was significantly higher than that of endometrioid tumours. Well‐differentiated epithelial tumours were significantly more likely to be oestrogen‐receptor and progesterone‐receptor positive than less differentiated epithelial tumours. Two granulosa cell tumours were oestrogen‐receptor positive and one of these was also progesteronereceptor and androgen‐receptor positive. Four normal óvaries were also analysed for receptor content and two were found to be androgen‐receptor positive. The presence of cytoplasmic receptors in ovarian tumours may explain their reported response to endocrine therapy.

SCLEROSING STROMAL TUMOUR OF THE OVARY CASE REPORT WITH ENDOCRINE STUDIES

The findings in a patient who was found to have a sclerosing stromal tumour of the ovary associated with a tubal pregnancy are described. Measurement of hormones in blood before and after removal of the tumour suggested the tumour was andro‐gen‐secreting.