Sanford Kaminester

Embryonal carcinoma of the ovary (disgerminoma)

Abstract Three cases of embryonal carcinoma of the ovary are reported. This neoplasm has its exact prototype in the male gonad. Its origin is from embryonal cells of the genital ridge. Teratoid derivation cannot be excluded. Clinically there are no outstanding characteristics but onset early in puberty is frequent. The gross appearance is similar to other solid carcinomas. The histologic picture, however, is distinctive. Large cells with prominent nuclei, supported by a lymphoid stroma produces a classical picture. Diffuse alveolar forms with scant stroma and no lymphocytes have been confused in the older literature with large round cell sarcoma and endothelioma. The prognosis is grave.

Brenner tumor of the ovary

Abstract A small solid type of Brenner tumor was accidently discovered in the left ovary removed for a chronic inflammation. The clinical benignity is indicated. The gross appearance similar to fibroma is emphasized. The constituents of the tumor are (1) proliferating stroma (2) columns of branching epithelium containing clear cells with well-defined borders. True and pseudogland spaces in the solid columns are frequent.

Innervation to and Within the Uterus.

In the course of certain experiments it became desirable to know the nature of the distribution of nerve paths from the pelvic plexus to their ultimate destinations in the uterus. Accordingly, we have performed a series of experiments in suitable ovariectomized rabbits. In some of these the parametrium was cut through progressively and the uterus left intact. In others, the uterus was cut first and the parametrium left entire. These experiments showed that when some spot in the middle third of the parametrium is cut, the uterus above the level of section fails to respond to lumbar sympathetic stimulation, even though the uterus itself is still intact. With the parametrium uncut, but the uterus severed, the whole organ still responds to pre-sacral nerve stimulation. Experiments on the essentiality of the utero-vaginal junction (containing the uterine cervical ganglia) were performed. This whole region, including cervices, could be excised without modifying the responses of the uterine cornua when the lumbar sympathetic nerves are stimulated. Section of a selected small region of the parametrium at the level of and close to the site of the cervices, promptly abolishes uterine responses to sympathetic nerve stimulation. In other experiments point stimulation of suitable places on the parametrium was made progressively from the tubal end, caudad. It was found in favorable experiments that the uterus contracts more or less locally, directly opposite the site of parametrial stimulation. This local contraction spreads very slowly in both directions, cephalad and caudad. Our results indicate, therefore, that lumbar motor sympathetic fibers pass close to the utero-vaginal junction and then dip more or less deeply into the parametrium as they pass toward the upper end of the uterus. Along their whole course they give off fibers to the uterus, innervating rather restricted regions, and do not contribute to a widespread, diffuse plexus within the uterine walls.

Menstruation-Like Bleeding with Constant Estrogen Dosage in an Ovariectomized Woman.

Corner 1 and Zuckerman 2 have reported recently that daily injection of a small amount of estrogen (ca. 30-60 units) into ovariectomized Macacus rhesus monkeys is associated with periodic menstruation-like bleeding which occurs during the period of treatment. Until then, the view was held generally that such bleeding depended upon estrogen-, or progesterone-withdrawal. There is no mention in the literature, however, of a result obtained in women comparable to that in the work of Corner and Zuckerman. The present note records such an observation. This case is that of a woman, 38 years of age, who underwent bilateral ovariectomy and salpingectomy for cystic ovaries and meno-metrorrhagia. There was no infection, and the uterus was conserved in toto. The operation was performed on December 27, 1939, following a period of amenorrhea lasting for two years. This condition was terminated by persistent and excessive uterine bleeding following a course of injections of estrone and Antuitrin-S, in another clinic. The patient came to the clinic at Greenpoint Hospital on February 21, 1940, for treatment of menopausal flushes. Five milligrams of estradiol-dipropionate (Di-Ovocylin, Ciba) were given twice weekly for 2 weeks, then once a week for 3 weeks. After this, 2 weeks elapsed between injections, and at the end of this time, on April 15, a period of uterine bleeding lasting 4 days took place. Pelvic examination showed the uterus to be normal in size, shape and consistency. At this point, a regular routine and constant dose of estrogen was instituted. It consisted of 2 mg of Di-Ovocylin given subcutaneously at intervals of 2 weeks, supplemented with one tablet (0.5 mg) of estradiol (Ovocylin, Ciba) per day. This routine was maintained without variation until September 14, 1940.

Technique of Preparing Transplanted Uterine Fistulae.

The purpose of the present paper is to describe a surgical preparation for studying the relationship between the extrinsic and intrinsic innervation of the rabbits uterus and the myometrial response to oestrin and progestin. This method consists of transplanting the uterus to the anterior abdominal wall, thus severing all the pathways of the motor sympathetic nerves to this organ. It was necessary to perform the operation in 3 stages. After a brief experience it was found desirable to use animals that had dropped at least one litter. Adequate results can often be obtained in animals made pseudopregnant. First stage. A mature female rabbit weighing approximately 3 1/2 kg. was anesthetized with ether. A longitudinal incision was made to the right of the midline, starting about 3 cm. above the symphysis and extending cephalad a distance of about 6 to 8 cm. The right uterine cornu was brought up into the wound, the tubal end clamped, ligated and incised. Included in this ligature was the ovarian artery and whatever veins accompanied it. The free border of the uterus was then scarified as was an area on the peritoneal surface of the anterior abdominal wall. This area paralleled the original incision and was about 1/2 cm. lateral to it. The scarified area on the uterus was then brought into contact with that on the anterior abdominal wall and fixed there by means of interrupted sutures of plain catgut. These sutures penetrated about half the thickness of the muscle coat. Thus, this stage resulted in a ventro-fixation of the uterus. Second stage. After an interval of from 1 to 3 weeks the second stage was undertaken. The abdomen was again opened, this time in the midline.

Local Uterine Growth in Untreated Ovariectomized Rabbits.

Two principal conditions favor uterine growth, (1) hormonal, such as occurs in the presence of oestrone 1 and progesterone, 2 and (2) local, such as is observed in the gravid horn of a unilateral pregnancy. The growth of such a cornu is much greater than that which takes place in the non-gravid horn exposed to the identical hormonal environment. 3 The difference has been ascribed to the presence of the fetuses. Local uterine growth is also observed when, during pseudopregnancy, a uterine cornu is distended with rolled rubber dam. 4 Thus the 2 growth factors may be said to be essentially hormonal and physical. The present note is concerned with experiments in which an isolation of these factors is achieved, and uterine growth induced by physical factors alone in the absence of ovarian hormonal influence. The procedure is as follows: mature rabbits are ovariectomized at the end of a week of pseudopregnancy, at which time the uteri of the various animals are in comparable structural states. After one week of castration paraffin pellets (m.p. 54°) of 2 sizes (1/8“ and 1/4” diameter, respectively, and 1/2-3/4“ in length) are inserted per vaginam into a uterine horn and anchored there by a loose stitch at each end of the pellet. Control sections of uterine tissue are distended, excised and fixed in formol-acetic fixative solution. In each of 11 experiments it has been found that, in the absence of ovarian hormonal influences, marked uterine enlargement occurs. The muscle cells undergo hypertrophy, connective tissue increases and dilatation of the small vessels takes place. The endometrium, after 2 weeks of chronic distension, is in a state of active proliferation but contains no secreting cells. These changes take place concurrently with some atrophy in non-distended portions of the same uterus.