CORRESPONDENCE
Uterine fibrolipoleiomyoma adenomatoid tumor?
or
To the Editors: We read with great interest the article by Honor6 entitled “Uterine fibrolipoleiomyoma: Report of a case with discussion of histogenesis” (AM. J. OBSTET. GYNECOL. 132:635, 1978). From the photomicrographs an alternative diagnosis, that is, adenomatoid tumor, appears possible. The interweaving of wide spaces with bands of smooth muscle in a poorly circumscribed lesion is histologically characteristic of intramyometrial adenomatoid tumors. This diagnosis is also supported by gross location and description.‘, ’ In our experience adenomatoid tumors are more common than tumors of fatty tissue in the uterine wall. Special stains might be useful in separating these two entities: oil red 0 for fat and stains for mucopolysaccharides such as periodic acid-Schiff-alcian blue. The latter would demonstrate mucopolysaccharide in the lining cells of an adenomatoid tumor, which is a lesion related to mesothelium.3 Neutral fat would not be expected in the spaces of such a tumor. It is not clear from Dr. Hono&‘s paper whether these additional stains were performed and what results were obtained. Virginia A. LiVolsi, M.D. Mary Catherine Bibro, M.D. Department of Pathology Yale University School of Medicine New Haven, Connecticut 06510 REFERENCES 1. Young,
L. A.: Am. J. Clin.
Pathol. 1974. GYNECOL.
48:537,
1967.
2. Taxy, J. B.: Cancer 34306, 3. Teel,
P.: AM. J. OBSTET.
75:1347,
1958.
Reply to Drs. LiVolsi and Bibro To the Editors: The points made by Drs. LiVolsi and Bibro are well taken. For the sake of brevity and because I was primarily interested in histogenesis, I kept to a minimum the description of the lesion and omitted discussion of differential diagnosis. I realize now that I should have mentioned that the fat stain (oil red 0) was strongly positive and the periodic acid-Schiff-alcian blue stain was completely negative. The adenomatoid tumor was considered in the differential diagnosis and
excluded on the basis of the histologic and tinctorial characteristics of the tumor. Louis H. Honors’, F.R.C.P.(C) Department of Laboratories Grace General Hospital 241 LeMerchant Road St. Joh?lS, Newfoundland, Canada AlE lP9
Development of small-for-gestational age infants To the Editors: The recent paper by Vohr and associates entitled, “The preterm small-for-gestational age infant: A two-year follow-up study” (Am. J. Obstet. Gynecol. 133:425, 1979) reports generally favorable developmental progress during the first 2 years of life in premature small-for-gestational age @GA) infants. However, I think it is misleading to suggest that obstetric decision-making in cases of intrauterine growth retardation can be based on these findings. The SGA babies in this study were compared to appropriate-for-gestational age (AGA) babies of the same birth weight but not the same gestational age. I believe that the critical comparison is that of the SGA baby with other babies of similar gestational age and no growth retardation. Once the obstetrician ascertains that intrauterine growth retardation is present, there is little value in comparing the likely outcome to what might have occurred if the baby had been delivered before the diagnosis was made. Lawrence Grylack, M.D. Division of Neonatology Columbia Hospital for Women Department of Pediatrics Georgetown Unizlersity School of Medicine 2425 L. Street NW Washington, D. C.
Year of publication of Bard’s Compendium To the Editors: The “Classic Pages” (AM. J. OBSTET. GYNECOL. 132:90 1, 1978) recently displayed a page from Samuel Bard’s work with the identification of publisher “New York, Collins & Perkins, 1808.” Reference was made to editions in 1812, 1815, 1817, and 1819. In Chapters in American Obstetrics, by Herbert Thorns, M.D. (1933). on
273
Uterine fibrolipoleiomyoma adenomatoid tumor?
or
To the Editors: We read with great interest the article by Honor6 entitled “Uterine fibrolipoleiomyoma: Report of a case with discussion of histogenesis” (AM. J. OBSTET. GYNECOL. 132:635, 1978). From the photomicrographs an alternative diagnosis, that is, adenomatoid tumor, appears possible. The interweaving of wide spaces with bands of smooth muscle in a poorly circumscribed lesion is histologically characteristic of intramyometrial adenomatoid tumors. This diagnosis is also supported by gross location and description.‘, ’ In our experience adenomatoid tumors are more common than tumors of fatty tissue in the uterine wall. Special stains might be useful in separating these two entities: oil red 0 for fat and stains for mucopolysaccharides such as periodic acid-Schiff-alcian blue. The latter would demonstrate mucopolysaccharide in the lining cells of an adenomatoid tumor, which is a lesion related to mesothelium.3 Neutral fat would not be expected in the spaces of such a tumor. It is not clear from Dr. Hono&‘s paper whether these additional stains were performed and what results were obtained. Virginia A. LiVolsi, M.D. Mary Catherine Bibro, M.D. Department of Pathology Yale University School of Medicine New Haven, Connecticut 06510 REFERENCES 1. Young,
L. A.: Am. J. Clin.
Pathol. 1974. GYNECOL.
48:537,
1967.
2. Taxy, J. B.: Cancer 34306, 3. Teel,
P.: AM. J. OBSTET.
75:1347,
1958.
Reply to Drs. LiVolsi and Bibro To the Editors: The points made by Drs. LiVolsi and Bibro are well taken. For the sake of brevity and because I was primarily interested in histogenesis, I kept to a minimum the description of the lesion and omitted discussion of differential diagnosis. I realize now that I should have mentioned that the fat stain (oil red 0) was strongly positive and the periodic acid-Schiff-alcian blue stain was completely negative. The adenomatoid tumor was considered in the differential diagnosis and
excluded on the basis of the histologic and tinctorial characteristics of the tumor. Louis H. Honors’, F.R.C.P.(C) Department of Laboratories Grace General Hospital 241 LeMerchant Road St. Joh?lS, Newfoundland, Canada AlE lP9
Development of small-for-gestational age infants To the Editors: The recent paper by Vohr and associates entitled, “The preterm small-for-gestational age infant: A two-year follow-up study” (Am. J. Obstet. Gynecol. 133:425, 1979) reports generally favorable developmental progress during the first 2 years of life in premature small-for-gestational age @GA) infants. However, I think it is misleading to suggest that obstetric decision-making in cases of intrauterine growth retardation can be based on these findings. The SGA babies in this study were compared to appropriate-for-gestational age (AGA) babies of the same birth weight but not the same gestational age. I believe that the critical comparison is that of the SGA baby with other babies of similar gestational age and no growth retardation. Once the obstetrician ascertains that intrauterine growth retardation is present, there is little value in comparing the likely outcome to what might have occurred if the baby had been delivered before the diagnosis was made. Lawrence Grylack, M.D. Division of Neonatology Columbia Hospital for Women Department of Pediatrics Georgetown Unizlersity School of Medicine 2425 L. Street NW Washington, D. C.
Year of publication of Bard’s Compendium To the Editors: The “Classic Pages” (AM. J. OBSTET. GYNECOL. 132:90 1, 1978) recently displayed a page from Samuel Bard’s work with the identification of publisher “New York, Collins & Perkins, 1808.” Reference was made to editions in 1812, 1815, 1817, and 1819. In Chapters in American Obstetrics, by Herbert Thorns, M.D. (1933). on
273
