Gloria Vasquez

Peritoneal endometriosis: scanning electron microscopy and histology of minimal pelvic endometriotic lesions

In 36 patients with laparoscopically diagnosed endometriosis, biopsies were taken from different areas of the pelvic peritoneum bearing foci of endometriosis. The biopsies were studied by scanning electron microscopy and by light microscopy. Combined use of these techniques resulted in the differentiation of three topographically and morphologically different types of endometriotic lesions: intraperitoneal endometriotic polyps with no glandular openings but associated with deeper endometriotic glands and stroma; intraperitoneal endometriotic foci with surface epithelium, glands, and stroma; and retroperitoneal small lesions with few glands and scant stroma. The morphologic features of endometriotic foci indicate that they do not follow the typical cyclic changes described for the uterine endometrium. Our microanatomic characterization of endometriosis is discussed in relation to the conflicting data concerning peritoneal fluid constituents and infertility in patients with minimal endometriotic lesions.

Tubal lesions subsequent to sterilization and their relation to fertility after attempts at reversal

Tubal biopsy specimens were obtained at the time of tubal anastomosis in 26 previously sterilized women. Scanning electron microscopy showed that half the patients had abnormalities of tubal mucosa, including loss of mucosal folds, deciliation, and polyposis. These pathologic conditions, the morphologic features of which we describe, significantly increase in incidence the longer the time after sterilization. Our evidence suggests that the sooner reversal is performed after sterilization the greater the change of a successful intrauterine pregnancy.

Salpingoscopy: a new pre‐operative diagnostic tool in tubal infertility

Summary. Endoscopy of the fallopian tube allows examination of the tubal mucosa in subfertile patients. Clinical and morphological studies have shown a high correlation between the appearance of the tubal mucosa and the ultimate outcome in terms of pregnancies. Salpingoscopy was originally performed during laparotomy for reconstructive tubal surgery. The present study describes the use of a rigid 3 mm telescope passed along the channel of the operating laparoscope to assess the mucosa of the infundibulum and ampullary segment. Lesions of the infundibulum and ampullary segment have been detected in patients with apparently normal tubes on the hysterosalpingogram and at laparoscopy. The extent of the mucosal lesions can be assessed preoperatively in patients with tubal adhesions, tubo‐cornual or isthmic lesions and hydrosalpinges.

Tubal mucosa and ectopic pregnancy

Summary. Fallopian tubes containing a gestation are frequently normal on macroscopical and gross histological examination. Scanning electron microscopy and light microscopy studies of tubal biopsies taken from five groups of women showed marked differences in the ciliated surface which was measured planimetrically on photographs. The proportion of ciliated cells was significantly lower in biopsies taken from 25 women with tubal pregnancies compared with that in biopsies from seven women with intrauterine pregnancies at the same gestation. Marked deciliation was also seen in eight women biopsied during tubal surgery sometime subsequent to an ectopic pregnancy and in four women biopsied during tubal surgery who subsequently had a tubal pregnancy when compared with a group of women biopsied during tubal sterilization.

The epithelium of human hydrosalpinges: a light optical and scanning electron microscopic study

Summary. Multiple tubal biopsies from 21 patients with thin‐walled dilated hydrosalpinges and from 12 patients with thick‐walled fibrous hydrosalpinges were studied. All the biopsies were examined by light microscopy and scanning electron microscopy and the ciliated surface area at multiple locations measured by planimetry. These biopsies were compared with control biopsies taken from 13 normal women at varying stages of the menstrual cycle.

No correlation between peritubal and mucosal adhesions in hydrosalpinges

OBJECTIVE To correlate the presence and extent of peritubal and mucosal adhesions in hydrosalpinges. DESIGN Comparative study. SETTING Tertiary centers with experience in tubal microsurgery. PATIENTS Infertile women with complete distal tubal block. INTERVENTION Salpingoneostomy. MAIN OUTCOME MEASURE Presence and extent of adhesions. RESULTS Peritubal adhesions occur more frequently than mucosal adhesions in hydrosalpinges. Of 7 hydrosalpinges without peritubal adhesions, 1 showed mucosal adhesions but of 83 hydrosalpinges with peritubal adhesions, 31 (37%) showed no mucosal adhesions. CONCLUSION Accurate endoscopic assessment of the ampullary mucosa is recommended in hydrosalpinx to select the appropriate patient for surgery.

The Evolution of Expermentally Induced Hydrosalpinges in Rabbits

Damage to fallopian tubes caused by hydrosalpinges is a major reason for persisting infertility. We describe the mucosal changes that occur following induction of experimentally induced hydrosalpinges in 25 rabbits. Ampullary biopsies obtained at varying intervals were examined with light microscopy and scanning and transmission electron microscopy. Mucosal folds showed progressive atrophy. The epithelium was flattened. The population of ciliated cells decreased and, finally, deciliation became generalized. The morphology of nonciliated cells changed from an initial high content of granules of secretion to a final stage of vacuolated cytoplasm. Cell desquamation was common.

The response of human endometriotic implants to the anti-progesterone steroid R 2323: a histologic and ultrastructural study.

The histology and ultrastructure of small endometriotic lesions were studied in 19 patients before and after hormonal therapy with the anti-progesterone steroid R 2323 (Gestrinone). Histologic results demonstrate that treatment of endometriosis with this steroid does not result in complete elimination of the endometriotic foci, although glandular proliferation and secretion are arrested in most implants. The ultrastructural results indicate that this inhibition of proliferation and secretion is related to an enhanced activity of the lysosomal system in the epithelial cells of some endometriotic foci. In other implants, or even in other cells of the same foci, epithelial cells with only a small amount of supranuclear cytoplasm but lacking lysosomes may be found. The morphologic data demonstrate that the cellular involutionary response to the antiprogesterone drug Gestrinone involves an activation of the lysosomal system, an abortive apocrine secretion of cell remnants and finally, in some implants, an extrusion of individual epithelial cells. Since this involutionary process of endometriotic cells mimics the pre-menstrual lysosomal degradation in the endometrium, it is suggested that the competitive binding of the antiprogesterone Gestrinone to the progesterone receptors of endometriotic epithelium may cause a cellular progesterone withdrawal effect.

An experimental study of tubo-ovarian function following restoration of patency in hydrosalpinges

The recovery of tubal function after restoration of patency in mechanically induced hydrosalpinges was studied in twenty sexually mature rabbits by correlating the morphological lesions of tubal damage and adhesion formation with the ovulatory function, pregnancy rate and nidation index at 2 and 4-8 weeks postoperative intervals. Two weeks after hydrosalpinx correction no implantations occurred although the oviducts had a patency rate of 63% and no or slight adhesions were present. From four weeks after hydrosalpinx correction implantations occurred. Morphological studies showed a partial or complete recovery of mucosal lesions in this group of rabbits. The number of ovulations correlated with the presence or absence of a moderate degree of postoperative adhesion formation.

Ciliogenesis following salpingostomy of rabbit hydrosalpinges

Twenty-five artificially induced hydrosalpinges were studied in New Zealand white rabbits. Hydrosalpinges had been created after 2-16 wk occlusion of both the fimbrial end and the ampullary isthmic junction (A.I.J.), using either Ethilon 8/0 or tantalum clips. Their diameters ranged from 4 to 12 mm, being larger in the clipped oviducts. In hydrosalpinges larger than 6 mm diameter, a salpingostomy was done and ampullary biopsies were taken and prepared for scanning electron microscopy, and 1-micron sections and ultrathin sections for transmission electron microscopy. The changes observed were those found in previous work (Vásquez et al., 1981). Post-salpingostomy biopsies were taken from 10 patent oviducts at different intervals of time, ranging from 2 days to 8 wk. Ciliogenesis was observed between the 2nd and 3rd wk after salpingostomy.