J. Dietl

Comparative analysis of the immunophenotypes of decidual and peripheral blood large granular lymphocytes and T cells during early human pregnancy.

PROBLEM: The functional role of the leukocytes in the decidua is not clear. They may regulate the maternal immune response to the fetal allograft. However, the factors controlling maternal and fetal communication have not yet been identified.

Expression of the p53 tumour suppressor gene in human placenta: An immunohistochemical study

Since human trophoblast undergoes extensive proliferation and exhibits invasive growth comparable to that of a malignant tumour, human placenta at various different stages of gestation was investigated immunohistochemically with the monoclonal antibody Ab-6 for expression of the p53 tumour suppressor gene. p53 protein was detected in the nuclei of a few trophoblastic cells, almost all belonging to the cytotrophoblast and only very few to the syncytiotrophoblast, in nearly all specimens investigated (first trimester 10/10, second trimester 5/5, third trimester 4/5). First trimester trophoblast exhibited increased expression of p53 protein in the juxtastromal areas of cytotrophoblast cell islands and columns, that is, in areas where high proliferative activity and increased expression of the epidermal growth factor receptor have been described in the literature. Staining was also occasionally seen in trophoblast invading the myometrium. It is most likely that immunohistochemically detectable expression of p53 protein in the trophoblast is due not to mutation of the gene, as in malignant tumours, but rather to up-regulation of the p53 tumour suppressor gene, which could be a mechanism for controlling trophoblast proliferation.

Intradecidual T Lymphocytes Lack Immunohistochemically Detectable T-Cell Receptors

ABSTRACT: The decidua apparently plays a major role in immune tolerance to the semiallogeneic embryo. In the present study we applied the immunohistochemical ABC method to investigate the expression of CD3, TCR α/β and TCR γ/δ molecules on intradecidual T cells with a panel of mAbs. Whereas intradecidual T cells expressed readily detectable amounts of CD3, they lacked immunohistochemically detectable amounts of either α/β or γ/δ TCR heterodimers on their cell surface. Peripheral blood smears of the same patients showed normal expression of α/β and gM/δ TCR on CD3 + T cells. The specific absence of (α/β or γ/δ) TCR molecules on the surface of intradecidual T cells could be one of the decisive factors in tolerance of the maternal immune system towards the fetus.

The Distribution of tissue inhibitor of metalloproteinases-2 (TIMP-2) in the human placenta

Matrix metalloproteinases (MMPs) secreted by human cytotrophoblasts are crucial for the invasion of the placental bed by these cells. The invasive growth of the trophoblast is similar to that of malignant tumours in many respects, but, unlike the latter, it is strictly controlled. Tissue inhibitors of metalloproteinases (TIMPs) have been postulated to play a role in the control of trophoblast invasion. In this immunohistochemical study, the distribution of TIMP-2 in the human placenta was investigated. In first trimester placenta, the cytotrophoblasts in columns exhibited strong cytoplasmic staining for TIMP-2. Villous cytotrophoblasts exhibited staining of moderate intensity with accentuation at the cell membrane, especially at the interfaces with the syncytiotrophoblast and the villous stroma. Staining of the cytoplasm and apical border of the syncytiotrophoblast was weak and focal. In term placenta, the few cytotrophoblasts present exhibited a staining pattern similar to that of the cytotrophoblasts in first trimester placenta, and there was marked linear staining of the syncytiotrophoblast at the interface with the stroma. Because it is the first trimester cytotrophoblast columns that invade the placental bed, the results demonstrate that the strongest immunoreactivity for TIMP-2 in the trophoblast is found in cells that are known to produce MMPs and exhibit an invasive growth pattern. These findings indicate that TIMP-2 may be involved in autoregulation of the invasive growth of the trophoblast.

Ovarian surface epithelium and human ovarian cancer.

Approximately 80-90% of adult ovarian cancers are assumed to originate from ovarian surface cells. The morphology of the ovarian surface epithelium changes constantly, exhibiting features such as crypts, inclusion cysts, villous processes and different forms of müllerian epithelium. The unique nature of ovarian surface features and their absence in the immediately adjacent peritoneal mesothelium suggest that local factors may play an important part in modifying the growth and morphology of the ovarian surface epithelium. Recent studies tend to emphasize oncogene activation, along with concomitant cytogenetic changes, in the development of ovarian cancer. This review focuses on the roles of exogenous and endogenous factors and ovulation in the pathogenesis of ovarian cancer.

Radiotherapy in the treatment of uterine sarcomas : A retrospective analysis of 54 cases

BACKGROUND In the general population, uterine sarcoma (US) is an uncommon tumor, which accounts for approximately 1-3% of all uterine neoplasms. Its biological behavior is characterized by hematogenous metastases and local recurrent growth including the pelvis and peritoneal cavity. In the management of US, surgery is the primary form of treatment. Up to now the role of adjuvant radiotherapy has not been clearly established. PATIENTS AND METHODS We report about 54 patients with US treated from 1954 to 1994 by surgical resection alone (22) or a combination of surgery and irradiation (32) and evaluate the influence of histology, stage and different treatment options on survival. RESULTS AND CONCLUSIONS Our data indicate an increased disease-free survival for patients treated with adjuvant radiotherapy, especially if poor prognostic factors are present (advanced tumor stage, histopathological grade II or III of leiomyosarcoma and mixed mesodermal sarcoma). Postoperative irradiation using doses between 50 and 60 Gy is recommended, in selected cases brachytherapy should be added. Prospective multicentric trials including a statistically evaluable number of patients are necessary to further clarify the role of multimodality treatment programs for US.

Primary Langerhans Cell Histiocytosis of the Vulva

Primary Langerhans cell histiocytosis (LCH) of the female genital tract is very uncommon. Since the natural history of this tumor is unpredictable, with spontaneous remissions and exacerbations, establishment of the diagnosis is often difficult. In the few reported cases of LCH involving the vulva there were systemic manifestations of the disease. We report the clinical and histopathological findings in the case of a 36-year-old woman who presented with a 9-year history of vulvar lesions. The diagnosis of LCH was established by immunohistochemical techniques, which demonstrated sheets of S-100 protein-positive histiocytes in the dermal tumor. The patient received radiotherapy to the vulva and responded with complete remission.

Bilateral tubal pregnancy with intra-uterine gestation after IVF-ET : therapy by bilateral laparoscopic salpingectomy : a case report

A patient with heterotopic (combined) pregnancies after IVF-ET was treated by bilateral laparoscopic salpingectomy. The patient was delivered of a healthy newborn in the 38th week of pregnancy.

High‐dose immunoglobulin in the antenatal treatment of neonatal alloimmune thrombocytopenia: case report and review

GIFT can be easily and economically introduced into hospitals, and has therefore become widely available in Units unable to offer IVF or cryopreservation facilities (Interim Licensing Authority 1991). However, the number of oocytes transferred back to the patient should be limited to a maximum of three (Interim Licensing Authority 1991) to reduce the risk of multiple pregnancy after GIFT. The use of the IVC (intravaginal culture) technique to transfer supernumerary oocytes and sperm to a local IVF unit with the facilities for cryopreservation provides a simple and cost-effective method for maximizing the chance of achieving a pregnancy per surgical procedure. This has important implications in the structuring ofinfertility services, both within the National Health Service and the private sector. The present report describes the first viable pregnancy achieved following the intra-vaginal transport of embryos from a GIFT unit to an IVF unit for cryopreservation. The modified IVC protocol used in the present study in which the transported supernumerary oocytes were examined for evidence of fertilization 20-24 h after insemination, enables screening for polyspermy. In addition, cryopreservation at the 1 cell pronucleate stage offers improved embryo survival rates compared with cryopreservation at early cleavage stages (Troup et al. 1990). This differs from the original method of IVC (Ranoux ct al. 1988) which involved the culture of embryos for 2 days before they were checked. Whilst it is unlikely that every GIFT unit will be able to provide a cryopreservation service, the present report of a viable pregnancy shows it is possible for IVF centres to provide embryo storage facilities for the GIFT units within their region, with the IVC technique providing a convenient method for transport and culture of oocytes between the two units.

Immunohistochemical localization of tissue inhibitor of metalloproteinases-2 (TIMP-2) in first trimester human placental decidua.

BACKGROUND Matrix metalloproteinases have been shown to play an important role both in the invasive growth of malignant tumors and in human placentation. However, unlike tumor cell invasion, cytotrophoblast invasion is strictly controlled in its extent. Tissue inhibitors of metalloproteinases (TIMP) may play an important role in the modulation of cytotrophoblast growth into maternal tissue. STUDY DESIGN We have undertaken an immunohistochemical study of the distribution of TIMP-2 in the decidua of first trimester human pregnancy. RESULTS Moderate to strong staining for TIMP-2 was found in decidual stromal cells and the walls of blood vessels in all cases. No unequivocal staining of decidual leukocytes was seen. CONCLUSION These findings suggest that TIMP-2 secretion in first trimester human decidua is confined to certain cell populations. Decidual stromal cells are probably an important source of TIMP and may contribute to the regulation of human cytotrophoblast invasion in vivo.