Monographs in pathology最新文献

The examination of spontaneous abortion specimens is as important as doing perinatal autopsies or surgicals in today's practice of medicine. The results of the pathologist's examination assist obstetricians in specific follow-up of future pregnancies and geneticists in predicting the chances of specific developmental defects or repeat pregnancy loss. Without the information provided by the pathologist, the other specialists can offer no real assistance. More extensive use of cytogenetic analysis of placentas may help explain intrauterine fetal death in pregnancies with confined placental mosaicism, which complicates one to two percent of pregnancies. A brief review of morphologic and genetic differences between partial and complete moles emphasizes the disparate origins of these distantly related conditions.

In summary, recent light microscopic studies, complemented by immunocytochemical and cytogenetic techniques, have demonstrated profound differences in the etiology, morphology, and clinical behavior of various forms of GTD. In addition, in vitro studies combined with immunohistochemical and ultrastructural analysis of normal trophoblast have provided new insight into the factors that coordinate the interactions of trophoblastic and maternal cells at the implantation site and have elucidated some of the mechanisms that regulate normal trophoblastic invasion. Analysis of the studies of normal and neoplastic trophoblast suggests that each of the specific forms of GTD is related to discrete pathologic aberrations occurring at different stages of gametogenesis and placentation. The results of these studies are examined in light of what is known about the pathobiology of GTD and are correlated with the histologic classification of GTD developed by the International Society of Gynecological Pathologists under the auspices of the World Health Organization.

This article has reviewed the immunologic factors of human infertility and some of the animal models that have provided experimental evidence for the better understanding of these disorders. It is clear that definitive evidence for human autoimmune diseases of the gonads is still lacking. However, recent findings in infertile men represent tangible support for this possibility and should stimulate further studies. Insofar as these diseases are relatively rare, meaningful clinical investigations can best come from a multicenter effort based on patients with well-defined clinical and laboratory profiles. To arrive at a firmer immunologic basis for these human diseases, it will be helpful to extrapolate from experimental studies. For both testicular and ovarian diseases, it will be desirable to refine the methods for quantifying humoral and cellular immune responses to the organ-specific autoantigens in the testis and ovary. Immunohistochemical localization of immune reactants is likely to be successful when performed early in the disease process and on tissue from patients with active disease. The nature of the immune deposits in testes will need to be confirmed by the classic approach of elution of antibody from the tissue with dissociating agents, followed by quantitation. The large quantity of tissue required for study can come from orchiectomy specimens from infertile men with unilateral vasal stenosis. In addition to immunologic reactions that lead to inflammation, future studies should take into consideration the possible existence of autoantibodies that react against hormone receptors or other functional ligands involved in ovarian or testicular physiology. Despite the paucity of evidence for human autoimmune diseases of the gonads, the likelihood of existence of these diseases is also supported by the ease with which experimental autoimmune disease of the gonads can be induced. We have described the experimental models of gonadal autoimmune diseases in detail, since analysis of these diseases has led to some unique contributions to immunopathology research and the physiology of the gonads. It is anticipated that future studies will characterize the target antigens as well as the local and systemic mechanisms that prevent autoimmune disease of the gonads in normal individuals. Moreover, it is anticipated that the model of neonatal thymectomy and oophoritis/orchitis will help to define the intricate interplay among thymic function, tolerance mechanisms, and autoimmunity. It is important to emphasize that research on the maternal-fetal immunologic relationship is a rapidly moving and controversial field. Although we have tried to point out controversial areas, the reader may wish to consult several excellent recent reviews. The anatomy and function of the hemochorial placenta and decidua are extraordinarily complex.(ABSTRACT TRUNCATED AT 400 WORDS)

The various methods currently available to assess the structural and functional fitness of the spermatozoa for the reproductive process have been reviewed. The semen analysis remains the single most important predictor of male fertility potential, even though sperm motility and morphology are inadequately and subjectively evaluated. Of the various tests used to assess sperm penetrating ability, the zona-free hamster oocyte penetration assay probably is the most useful and most widely used, especially to screen the penetrating competence of spermatozoa to be used for extracorporeal insemination procedures. However, several important limitations prevent it from being a definitive method for the assessment of fertility. The electron microscopic examination of the sperm as complementary to semen analysis and the zona-free hamster oocyte penetration assay is an important procedure, in that it permits a detailed assessment of the structural integrity, and hence the functional adequacy, of the various subcellular components that are responsible for cell motility, penetrating competence, and fertilizing ability. Unfortunately, the oocyte escapes analytical methods.

The major problems with the management of dysplasia in the large bowel are few when dealing with adenomas or invasive carcinomas. Many more problems arise in the clinical and pathologic management of dysplasia in inflammatory bowel disease. The interesting question of dysplasia occurring in other polyps remains intriguing, and particularly the notion that hyperplastic and adenomatous polpys tend to occur in the same segment of bowel and therefore may have the same predisposing factor. We hope that by the time the next volume of the monograph is published on gastrointestinal pathology, all of these problems will have been resolved.