D'avril 1976 à mars 1987, 300 ponctions-biopsies hépatiques transpariétales à l'aveugle par excision à l'aiguille TRU-CUT ont été effectuées dans un service de Médecine Interne. La ponction-biopsie hépatique est contributive au diagnostic dans 76,2 % des cas. Dans la pathologie liée à l'alcoolisme, du fait de la spécificité des lésions histologiques, la ponction-biopsie hépatique est particulièrement utile au diagnostic des affections débutantes (stéatose et hépatite) et a un intérêt pronostique dans la cirrhose. Au cours des hépatites chroniques, elle affirme le diagnostic et fournit des arguments étiologiques et pronostiques. La découverte histologique d'une hépatite granulomateuse confirme parfois un diagnostic hésitant : sarcoïdose, tuberculose. Le diagnostic d'hépatite médicamenteuse est retenu sur un faisceau d'arguments cliniques, biologiques et histologiques. Dans les hémopathies l'intérêt est triple : recherche d'une participation hépatique, détection d'une complication intercurrente et réalisation du bilan d'extension pré-thérapeutique. Réalisée après une échographie, la ponctionbiopsie hépatique permet de reconnaître les cholestases intra-hépatiques et de suspecter une cholestase extra-hépatique non identifiée par l'échographie. Dans la cirrhose biliaire primitive, elle confirme le diagnostic et précise le degré de gravité et d'évolutivité. Au cours des cancers hépatiques, la ponction-biopsie hépatique est actuellement supplantée par la tomodensitométrie et l'échographie. Dans les maladies de surcharge enfin, la ponction-biopsie hépatique contribue largement au diagnostic et apprécie le retentissement hépatique de l'affection et son évolutivité.

Between April 1976 and March 1987, in an Internal Medicine department some 300 unguided percutaneous liver biopsies were performed, using the Tru-Cut excision needle. The procedure contributed to the diagnosis in 76.2% of the cases. In alcoholism-related pathology with its specific lesions, liver biopsy is particularly useful in diagnosing incipient fatty degeneration and hepatitis and helps in the prognosis of cirrhosis. In chronic hepatitis, it asserts the diagnosis and provides aetiological and prognostic data. The finding of granulomas at histology sometimes clinches a hitherto undecided diagnosis : sarcoidosis or tuberculosis? The diagnosis of drug-induced hepatitis rests on convergent clinical, biochemical and histological elements. In blood diseases, liver biopsy is of interest on three scores: it shows whether or not the liver is involved, detects intercurrent complications and evaluates the extent of the lesions before treatment. When performed after ultrasonography, it enables intrahepatic cholestasis to be recognized and extrahepatic cholestasis, unidentified by ultrasounds, to be suspected. In primary biliary cirrhosis, it confirms the diagnosis and informs on the severity and progressiveness of the disease. In hepatic cancers, liver biopsy has recently been superseded by computerized tomography and ultrasonography. Finally, it largely contributes to the diagnosis of overload disease and evaluates their activity and their impact on the liver.

Le carcinome neuroendocrine cutané (CNEC) est une tumeur rare. Nous rapportons l'observation d'une patiente de 75 ans atteinte d'un CNEC de la joue droite, rapidement évolutif et récidivant malgré une exérèse chirurgicale suivie d'une radiothérapie. L'aspect clinique du CNEC n'est pas spécifique. La tumeur est de siège intradermique; les cellules tumorales ont un aspect monotone. La classification de GOULD a un intérêt pronostique et distingue trois types de car cinomes. L'immunohistochimie est un complément indispensable à l'examen en microscopie optique. Cette tumeur est très difficile à différencier d'une métastase d'un carcinome viscéral à petites cellules qui doit être systématiquement recherché. Le traitement associe la chirurgie et la radiothérapie. La chimiothérapie, très efficace dans notre observation, est à envisager dans le protocole thérapeutique.

Between April 1976 and March 1987, in an Internal Medecine department some 300 unguided percutaneous liver biopsies were performed, using the Tru-Cut excision needle. The procedure contributed to the diagnosis in 76.2 % of the cases. In alcoholism-related pathology with its specific lesions, liver biopsy is particularly useful in diagnosing incipient fatty degeneration and hepatitis and helps in the prognosis of cirrhosis. In chronic hepatitis, it asserts the diagnosis and provides aetiological and prognostic data. The finding of granulomas at histology sometimes clinches a hitherto undecided diagnosis : sarcoidosis or tuberculosis ? The diagnosis of drug-induced hepatitis rests on convergent clinical, biochemical and histological elements. In blood diseases, liver biopsy is of interest on three scores : it shows whether or not the liver is involved, detects intercurrent complications and evaluates the extent of the lesions before treatment. When performed after ultrasonography, it enables intrahepatic cholestasis to be recognized and extrahepatic cholestasis, unidentified by ultrasounds, to be suspected. In primary biliary cirrhosis, it confirms the diagnosis and informs on the severity and progressiveness of the disease. In hepatic cancers, liver biopsy has recently been superseded by computerized tomography and ultrasonography. Finally, it largely contributes to the diagnosis of overload disease and evaluates their activity and their impact on the liver.

Cutaneous neuroendocrine carcinoma (CNEC) is a rare tumour. We report the case of a 75-year old woman affected with a rapidly progressive CNEC of the right cheek which kept recurring despite surgical excision followed by radiotherapy. The clinical features of CNEC are not specific. The tumour is located in the dermis, and the tumoral cells (Merkel cells) have a monotonous appearance. Gould's classification of these carcinomas into three types has a prognostic value. Immunohistochemistry is a mandatory complement to light microscope examination. It is very difficult to distinguish between CNEC and metastasis from a visceral small cell carcinoma. Treatment consists of surgery combined with radiotherapy. Chemotherapy was very successful in our patient and should be considered in other cases.

Cutaneous neuroendocrine carcinoma (CNEC) is a rare tumour. We report the case of a 75-year old woman affected with a rapidly progressive CNEC of the right cheek which kept recurring despite surgical excision followed by radiotherapy. The clinical features of CNEC are not specific. The tumour is located in the dermis, and the tumoral cells (Merkel cells) have a monotonous appearance. Gould's classification of these carcinomas into three types has a prognostic value. Immunohistochemistry is a mandatory complement to light microscope examination. It is very difficult to distinguish between CNEC and metastasis from a visceral small cell carcinoma. Treatment consists of surgery combined with radiotherapy. Chemotherapy was very successful in our patient and should be considered in other cases.