508

Communications

in brief

jaws of the forceps, making possible through the second puncture site.

its removal

REFERENCE

1. Yoon, I. B., and King, T. M.: A preliminary and inter* mediate report on a new faparoscopic tubal ring procedure, J. Reprod. Med. 15: 54, 1975.

Cytqpetic studies in gonadal dysgenesis with dysgerminoma ANTONIOS PSAROUDAKIS. MO6HE OETTINGER, M.D.* J. ROGERS BYRD, PH.D. ROBERT B, GREENBLATT, Medtial

College

of Georgia,

Augusta,

M.D.*

M.D.

Gemgia

GONA DAL dysgenesis with femaie phenotype and rnaie 46,XY karyotype is associated with a high incidence of gonadal tumors,’ A classification of these gonadal neoplasms, based on the term “gonocytoma,“ was proposed by Teter in 1960. According to this classification, tumors containing germ cells are assigned to one of four groups, depending on the number of cell types and the endocrine properties of these cell types. Gonocytoma 1 is a homogenous type of tumor which is formed solely of germ cells, i.e., gonocytes, separated by a variable amount of co@agenous tissue, and is synonymous with dysgerminoma-a name given by R. Meyer. This rare ovarian tumor is identical to seminoma found in the testicle. Modern methods of cytogenetics have furnished more detailed information about these patients. Teter and Boczkowskiz observed that whenever a germ cell tumor is found in a dysgenetic gonad, a Y chromosome is present. The aim of the present communication is to report the cases of two patients, both suffering from gonocytoma I-dysgerminoma, in whom a cytogenetk workup proved of great importance in diagnosis and management.

A 1%year-old girl presented with typical features of Turner’s syndrome. Buccal smear was negative for Barr’s sex chromatin. Cytogenetic studies on peripheral blood leukocytes revealed mosaicism with 96 per cent of cells 45,X (Fig. I) and 4 per cent of cells 46,XY (Fig. 2). Fifty cells were counted, out of which 48 contained 45 chromosomes and two cells contained 46 chromosomes. C-banding revealed a Y chromosomes

in those

cells with

46 chromosomes.

At laparotomy

an

Reprint requests: Robert B, Greenblatt, M.D., Department of’ Endocrinology, Medical College of Georgia, Augusta, Georgia 30902. *Research Fellows, Department of Endocrinology.

Fig. 1. Patient No. I. Karyotype showing 45,X. C-handed

Fig. 2. Patient No. 1. Karyotype

showing 46,XY. C-banded.

infantile uterus was found. The left gonad was rePlaced by a large tumor mass, 7 by 5 by 2% cm., firm in consistency, and covered by a gray, glistening, smooth capsule. There were a few nodules in some areas of the tumor, measuring approximately 1.5 cm. in largest diameter. The right gonad was small, somewhat thicker than the usual rudimentary streak. Both adnexd were surgically removed.

Communications

Fig. 3. Patient giant ceil.

No. 2. Photomicrograph

Fig.

4. Patient

of histoIogic

No.

section

2. Karyotype

The microscopic pathology was as follows: the right gonad lacked ovarian differentiation. Its stroma was composed of compact cells resembling fibroblasts. A prominent feature was muItipIe foci of cakifications deep m the stroma, some of them surrounded by cells resembling theta cells. In these areas there were also

of dvsgerminoma

showing

of left ovary

in brief

509

showinK

46,XY.

structures having resemblance to follicles with theta and gt-anulosa cells. These structures suggested an attempt at follicle formation with degenerative changes in which calcification occurred. tumor revealed a dysgerminoma

round

ovoid

tumor

Section

of

the

left

with typical groups of ceils separated by delicate fibro-

510

Communications

lymphoid found.

stroma.

in brief

In

these

cells,

focal

necrosis

was

A 19-year-old white female patient presented with primary amenorrhea. The breasts were underdeveloped and the pubic and axillary hair was very scant. Examination revealed a normal clitoris with slightly underdeveloped labia; a small uterus was felt on pelvic examination but the bvaries were not palpable. The vaginal smear was of the castrate type. FSH and LH radioimmunoassay determinations for 3 consecutive days gave values of 50 m1.U. per milliliter for FSH, and 9.9, 11.9 m1.U. per milliliter for LH. Buccal epithelial cells were negative for Barr’s sex chromatin mass. A diagnosis of gonadal dysgenesis was made and an exploratory laparotomy was performed. Bilateral streak gonads were found, the left one thicker than the right one, On the left gonad there was a small 2 by 1 by 2 cm., irregular, firm nodule which was excised and biopsies were obtained from both streak gonads. The follows:

description sections

of the

microscopic

pathology

was

as

from the left gonadal nodule revealed a dysgerminoma; the histology was quite typical, consisting of large primitive germ cell types and small mature lymphocytes. In some areas of the tumor there was a definite epithelioid reaction with the formation of giant cells (Fig. 3). The specimen from the left gonad showed dysgenesis. In this gonad there were several collections of cells in the hilum which probably originated from the dysgerminoma. They were large cIear celIs and in one area there was a tuberculoid reaction. The specimen from the right gonad showed dysgenesis. No ova were found. Following the exploratory laparotomy, cytogenetic studies on peripheral leukocytes showed the patient’s karyotype to be 46,XY, not different from that of a normal male (Fig. 4). Thirty-nine cells were counted. Three cells contained 45 chromosomes and 36 cells had 46 chromosomes. Ten cells were karyotyped, seven of which were 46,XY. The other three cells with 45 chromosomes had dissimilar chromosomes missing, indicating artifactual random loss rather than chromosome mosaicism. Subsequent to the histologic findings, panhysterectomy was undertaken. We conclude that: (1) there is an association between male karyotype and gonocytoma 1-dysgerminoma; (2) it is possible to find dysgerminoma in mosaics with 45,X chromosomal pattern and minimal occurrence of XY, hence the importance of counting large numbers of

cells

in

cytogenetic

studies;

(3)

all

amenorrheic

patients with an XY karyotype-pure or in mosaic form-should be explored for the existence of germ cell tumors in the gonads. In all XY cases it is recommended that the gonads be extirpated. REFERENCES

1. Collins, J. C., and Schoenenberger, A. P.: J. Urol. 87: 710, 1962. 2. Teter, J., and Bocskowski, K.: Cancer 20: 1301, 1967.

Gonococcal sepsis secondary to fetal monitoring HARAGOPAL

THADEPALLI,

M.D.

KAMALAKAR

RAMBHATLA,

M.D.

JACK

E.

MAIDMAN,

JUAN

J,

,4RCE,

EZRA

C.

DAVIDSON,

M.D. M.D. JR.,

M.D.

Divisions of Infectious Disease5 and Perin&ology, Department5 of Internal Medicine and Obstetrics and Gyrwcology, Martin Luther King, Jr. Gerwal Hospital, Charles R. Dreuj Postgradu&e Medkal School, and Unixersity of Southern Calijornia School of Medicine, Lo~q Ang&.s, Cakyornia INTRAPARTUM fetal monitoring is generally considered to be safe. However, the microbiologic safety of this procedure has not been evaluated. Cultures of amniotic fluid obtained through this catheter device at random revealed potentially pathogenic bacteria in 15 of the 30 women monitored during labor.’ During this study, we encountered one case of gonococcal amnionitis later followed by neonatal sepsis.

A 14-year-old primipara was admitted on September 4, 1974, 3 hours after the rupture of membranes. Her last menstrual period was on November 11, 1973. During the first trimester, she was examined for sore throat when a routine sputum culture was positive for L%‘eisseria gonorrhoeae. At term the blood pressure was 160/114 mm. Hg; pulse, 100 b.p.m.; respirations, 20 per minute; oral temperature, 98.e F. There was pedal edema but no proteinuria. The uterus was 34 weeks’ size, with 5 cm. cervical dilatation; the presenting part was at station zero. Routine urinalysis, blood cell counts, chest x-rays, and x-ray pelvimetry were unremarkable. The heart and lungs were clear. Laboratory &dta were as follows: glucose, 123 mg. per 100 ml.; blood urea, 4 mg. per 100 ml.; chloride, 105 mEq. per liter; bicarbonate, 22 mEq. per liter: sodium, 139 mEq. per liter; potassium, 3.3 mEq. per liter; lactic dehydrogenase, 214 mu. per milliliter; serum glutamic: oxalacetic transaminase. 12 mu. per milliliter: alkaline phosphatase, 119 mu. per milliliter; total bilirubin, 1.0 mg. per 100 ml.; direct bilirubin, 0.2 mg. per 100 ml.; total protein, 6.5 Gm. per 100 ml.; albuminglobulin ratio, 3.6/2.9. The blood pressure was regulated by appropriate measures. The labor was monitored with an intrauterine catheter* and fetal scalp electrodes.? A live female child was delivered by forceps application 12 hours and 44 minutes after admission. During labor, cultures were obtained from the cervix and amniotic fluid was collected through the intrauterine catheter. The Supported by Henry J. Kaiser Family Foundation Grant 1477-51224-XxX. Reprint requests: Haragopal Thadepalli, M.D., Martin Luther King, Jr. General Hospital, 12021 S. Wilmington Ave., Los Angeles, California 90059. *Transcervical intrauterine kit (B2069), Corometrics Medical Systems, Inc., Wallingford, Connecticut. tSpira1 electrode (B2462), Corometrics Medical Systems, Inc.. Wallingford, Connecticut. No.

Cytogenetic studies in gonadal dysgenesis with dysgerminoma.

508 Communications in brief jaws of the forceps, making possible through the second puncture site. its removal REFERENCE 1. Yoon, I. B., and Kin...
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