Biotin-rich pseudoherpetic nuclear inclusions may be observed in endometrial epithelial cells during pregnancy, post-partum or in association with choriocarcinoma. They may be observed in tumor cells in a few papillary carcinomas of the thyroid gland in young women. These inclusions may be responsible for false diagnoses of herpesvirus infection at morphological and immunocytochemical examination. They may be responsible for false positives in immunocytochemistry and in situ hybridization.
To further characterize central neurocytoma, a rare intraventricular tumour described in 1982, we analyzed six tumours by immunohistochemistry for MIB1, p53 and bcl-2. bcl-2, an inhibitor of p53-mediated apoptosis is frequently expressed in gliomas, especially in tumors with wild-type p53. Its expression in peripheral neuroblastomas suggests a down-regulation during final terminal differentiation. Six tumors from five patients (one female/four males, age ranged from 18 to 63 years) were examined. All patients were alive from 2 to 88 months after initial surgical resection. On histological sections, tumours demonstrated a typical pattern. Synaptophysin staining was seen in all cases. Proliferation index was low (< 4.5%). bcl-2 was never expressed. p53 expression varied but within low values (< 10% of cells). These latter antibodies were rarely analyzed until now in this usually benign neoplasm which represents a well differentiated variant of neuron derived tumors.
56 cases of granular cell tumour and 2 cases of granular cell congenital epulis have been studied morphologically, histochemically and immunohistochemically. The subject of this study is to evaluate the diagnosis interest of the PAS stain, determine the positivity of 4 antibodies (vimentin, NSE, PS100, NK1/C3) and confirm or not the neuroectodermic origin. The study showed that the microscopic findings are often sufficient. When the diagnosis is less evident, the PAS stain is not discriminant, but we can use the immunohistochemistry study: we confirmed the positivity of the 4 antibodies, but PS100 and NK1/C3 are the most constant. Only the 2 cases of granular cell congenital epulis always show negative immunoreactivity with S100 protein. About the histogenesis, our study confirm the neurogenic origin, but the hypothesis of a non neoplastic nature is raised.
The authors report a case of pseudomyxoma peritonei associated with an appendicular and ovarian mucinous tumor. They emphasize the rarity of bilateral ovarian and appendicular involvement and they discuss the problem of the origin of the primary tumor and evaluation of the prognosis.
263 cases of granular cell tumour had collected [thanks to the collaboration of pathologists Septentrional Association of North, Pas-de-Calais and Aisne departments (A.S.A.P.)]. We studied the age, sex, localisations and the particularity of these tumours. These results had compared to other large series of the literature. Our study showed a majority of men (68%), twenty to sixty year old. The preferential sites are skin (38.57%), oesophagus (19.64%) and tongue (10%). The granular cell tumour is multiple in fifteen cases and associated to neoplastic tumour in twelve cases. Only one case recurred after incomplete excision. There were none malignant tumour.
After a period during which cardiac papillary fibroelastomas were considered incidental autopsy findings cerebral and coronary arteries embolism proved their aggressiveness. Echocardiography is now able to identify them and surgical resection is rapidly required. Sea anemone like macroscopic pattern is characteristic with finely villous masses, each frond being at microscopical examination formed by a central fibroelastic core surrounded by a myxomatous layer overlied by endothelial cells. Histogenesis remains elusive and we tried to clarify it by immunohistochemical analysis of 8 of the 20 cases studied (10 autopsies, 10 surgical resections). Morphological and immunohistochemical data show that endothelial cells play the most important part in abnormal formations.
Primary gastric MALT non-Hodgkin's lymphoma is rare in immunocompetent children. To our knowledge, only two cases have been previously described. We report two cases of gastric MALT lymphoma associated with Helicobacter pylori. Clinico-pathological features are similar to those observed in adults. The relationship between the microbial infection and non-Hodgkin's lymphoma development is discussed.
Forty five Cameroonian patients in West Africa who were diagnosed as having membranous glomerulonephritis (MGN) were studied and followed up over a five year period. The mean age of these patients was 32.3 years with a female to male ratio of 5/4. Proteinuria (93.3%) and nephrotic syndrome (89%) were the two most important clinical manifestations at the time of diagnosis. Seventeen cases (37.8%) of the MGN were considered idiopathic while 62.2% were associated with known aetiological factors. Histologically, the majority of patients were at stage I (35.55%) or stage II (37.8%) of the World Health Organisation (WHO) classification. Except of the patients in stage I, most patients in stage II and all those in stages III and IV, showed associated important, tubular interstitial and vascular lesions. Immunofluorescence studies showed deposits to be mainly IgG (80%) and C3 (71.1%) while electron microscopy showed varied dense deposits in all cases. Seventeen patients with idiopathic MGN and 10 MGN patients whose only associates aetiological factor was a positive hepatis B antigen were followed up over 5 years. During this period, eight patients (29.6%) had a complete clinical remission, eleven patients (40.7%) improved their renal function and decreased their 24 hour proteinuria, while eight (29.6%) patients deteriorated into end stage renal failure and had to be commenced on dialysis; three of them died during this procedure.
Papillary fibroelastoma is a seldom reported tumour. It usually occurs in adults and develops on the aortic and mitral valves. It is not different of giant Lambl excrescences and differential diagnostic can be difficult with the myxoma. Its systematic surgical ablation is justified by the important risk of embolic complications. It has rarely been reported in children. We report a case peculiar by fortuitous diagnostic, tricuspid site, large size and occurrence in a 3-year old child.
We report a case of a 29-year-old female patient who suffered from visual disturbance, resulting from a lesion in the sphenoid bone which, histologically, proved to be a giant cell tumour. Reviewing our laboratory practice over a 50 year period, only 7 cases of true giant cell tumour were found and they were in two major locations, i.e. the skull and vertebrae. These few cases led us to focus on the problem raised by the lack of histological patterns of malignancy. In agreement with Mazabraud's theory, it seems that a vertebral location is associated with a good prognosis and that gene mapping of chromosome 17 in relation to p53 mutations could be a valuable tool in the diagnosis of potential malignant behaviour.
The authors report an additional case of lympho-epithelial tumor. First described in 1987 by Santa-Cruz et al., this tumor, also called cutaneous lymphadenoma, is rare. The mean age is 44. The lesion is generally located on the face and the clinical diagnosis of basal cell carcinoma is most often evoked. The tumor has a peculiar histological feature with cyst-like cavities composed by an epithelial proliferation and intraepithelial lympho-histiocytic cells. It is considered as a benign tumor. Its origin is still discussed but a pilosebaceous nature seems to be accepted.
Frozen section examination for intraoperative diagnosis is often difficult in thyroid pathology. Fine-needle aspiration is widely used in the patients selection for surgery. Such a selection is accompanied by an increase in difficult frozen section cases, whose diagnosis is often differed to permanent sections. Thus, frozen section sensitivity is relatively low. In the era of cost containment, an increasing number of authors suggest that frozen section examination is unnecessary, and that surgical planning could rely on preoperative cytology only. Others consider fine-needle aspiration cytological evaluation and frozen section examination as complementary tools and recommend their association. The authors describe the technical aspects and difficulties of frozen section examination in thyroid pathology, and discuss its interest in surgical planning, in the light of preoperative cytology. Each team has to estimate local thyroid cytology development and accuracy, to define new indications for frozen section examination in thyroid pathology, according to local therapeutic choices. Such an approach could consistently reduce the number of intraoperative consultation for thyroid pathology, without prejudice for the patients.
UNLABELLED:Parkinson's disease (PD), a disorder of unknown etiology, is associated with the degeneration of dopaminergic neurons in nigro-striatal pathways. MPTP, a meperidine analog, causes parkinsonism in human and nonhuman primates. MPP+, the active metabolite of MPTP, inhibits the activity of respiratory chain complex I. In patients with PD, a reduced complex I activity was found in substantia nigra, skeletal muscle, and platelets. Because complex I is partially encoded by the mitochondrial genome, several studies have searched for mitochondrial (mt) DNA abnormalities in patients with PD. Our aim was to answer the following questions: (1) are there some abnormalities of mtDNA in PD? (2) if there are some, what are these abnormalities? and (3) what is the pathogenic role of these abnormalities?METHODS:The literature review was performed using Medline [National Library of Medicine, Washington] and Current Contents [Institute for Scientific Information, Philadelphia] databases. Periods screened were 1966-March, 1998 (Medline) and March 17, 1997-March 9, 1998 (Current Contents). Keywords were: "Parkinson" or "Parkinson's", and "mitochondrial DNA" or "mtDNA". We limited our research to articles in English and French.RESULTS:Medline search provided 59 articles. Current Contents search provided 22 articles. Twelve articles were found in both databases. Thirty-eight of the 69 articles were either reviews about mitochondrial diseases (19 articles) or original articles not related to mtDNA (19 articles). Our final selection included the remaining 31 articles.
Little is known about the development of the central nervous system (CNS) in humans. Ethical considerations preclude experimental studies in this field, and as a result most available data on human ontogenesis are descriptive. Comparative anatomic and embryologic studies have demonstrated that the main developmental milestones are conserved across species, and their results can be used to suggest a likely scenario for human development. The development of the ventricles, meninges, and choroid plexuses are discussed in this article. The central cavity of the neural tube is formed during neurulation, which occurs during the fourth gestational week. The first milestone is occlusion of the spinal neurocele (the central canal in the neural tube) shortly after neurulation. This prevents free communication between the ventricular system and the amniotic cavity. The second milestone is development of the meninges, which separate the central nervous system from the rest of the body. The embryonic origin of the meninges varies across species. In birds (and probably in mammals), the spinal meninges are derived from the somitic mesoderm, the brainstem meninges from the cephalic mesoderm, and the telencephalic meninges from the neural crest. Differentiation of the meninges, which involves formation of the subarachnoid space, occurs early, before the cerebrospinal fluid (CSF) begins to flow around the CNS. During ontogenesis, the meninges play a key role in regulating the growth of underlying nervous structures. They induce the formation of the superficial glial limiting layer and stimulate the growth of precursors located in the superficial blastemas of the cerebellum and hippocampus. The choroid plexuses are complex specialized structures that produce most of the CSF. Their epithelium derives from the neural tube epithelium and their mesenchyma from the meninges. Of the many enzymes produced in the choroid plexuses, some reflect the pivotal metabolic role of these structures (alkaline and acid phosphatases, magnesium-dependent ATPase, glucose-6-phosphatase, thiamine pyrophosphatase, adenylate cyclase, oxidoreductase, esterases, hydrolases, cathepsin D, and glutathion S-transferase). The two enzymes that are crucial to the production of CSF are Na+/K+ ATPase and carbonic anhydrase. Inactivation of catecholamines is mediated by catechol-O-methyltransferase and by the monoamine oxidases A and B. The morphology and synthesis profile of the choroid plexuses changes during development, although little is known about these changes in humans.
The respective roles of fine-needle cytology and core biopsy for the investigation of breast densities and microcalcifications are discussed. For microcalcifications, the type, number, and conditions of development should be taken into account, and the reliability of investigations are directly related to stereotactic visibility, i.e., to advances in digitization. Fine-needle biopsy has been almost completely discarded as a means for investigating microcalcifications but remains useful when performed under ultrasound or stereotactic guidance to investigate densities presumed to be nonmalignant. Doubtful densities are best investigated by core biopsy.
There have been several reports regarding the accuracy of the PAPNET system applied to the screening for cancerous and precancerous lesions. Based on neuronal networks, this computerized tool was initially trained to select atypical cells. It has been approved in the USA for the re-screening of cervical smears for quality assurance. However, its particular behaviour has not been frequently studied when the system is designed to detect frequent infectious organisms. We report the results of re-screening of 42 inflammatory cervico-uterine smears by the PAPNET system. The computerized images were reviewed by two different pathologists, with complete agreement between the two observers in 39 cases. Infectious organisms were detected in only 66% of cases. Trichomonas, mycoses and Gardnerella were diagnosed in 63%, 56% and 87% of cases respectively. No herpetic lesions were identified. The low accuracy of the PAPNET system in the diagnosis of infectious cervico-uterine smears should be taken into account if this system is developed as an exclusive pre-screening method.
The development of breast cancer screening has radically changed the diagnostic approach to breast lesions. Stereotactic large-core breast biopsy was developed to reduce the number of unnecessary surgical excisional biopsies in the increasing number of patients with doubtful or suspicious mammogram findings. The methods used to evaluate this new technique are discussed, as well as results in terms of efficacy, factors that may influence efficacy, and difficulties in interpreting large-core biopsies. Recommendations regarding the harvesting and interpretation of stereotactic large-core biopsies are made.
Fine-needle cytology and core biopsy of the breast done under mammographic or ultrasonographic guidance can assist in decision-making (monitoring, diagnostic or therapeutic procedures). Cytologic studies and histologic evaluation of core biopsies have their own limitations: the samples are small in size, and the histopathological features of the lesions are often complex. Each step of an image-guided diagnostic procedure contributes to the reliability of the method. The characteristics of the mammogram and/or ultrasonogram image provide initial orientation. Whether they are concordant with the results of the cytologic or histologic study is an important factor. The main limitations of stereotactically-guided biopsies are ballistic with targets that are difficult to circumscribe (fine microcalcifications or ill-defined density). With ultrasonography, verification of the sampling site in the target is essential. The performances of these procedures are closely dependent on the experience of the operators and on the quality of the cooperation between clinicians, radiologists and pathologists.
