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Deux outils pedagogiques, un carnet de stage et un questionnaire d’evaluation de la satisfaction, ont ete developpes et mis en place au sein de l’ensemble des services du laboratoire de biologie medicale des Hopitaux universitaires de Strasbourg accueillant des internes inscrits au diplome d’etudes specialisees de biologie medicale. Le questionnaire d’evaluation a permis de dresser dans un premier temps un etat des lieux de la satisfaction des internes concernant l’enseignement dispense pendant les stages semestriels. L’analyse a montre quatre grands axes d’amelioration a developper dans certains services : definir des objectifs pedagogiques, organiser la formation avec un planning predetermine en debut de semestre, revoir certaines modalites d’enseignement et mieux integrer l’interne a l’equipe biologique. Apres cet etat des lieux, nous avons mis en place un carnet de stage pour repondre aux attentes des internes. En effet, ce carnet presente les objectifs pedagogiques du stage, l’organisation de la formation et des enseignements et les modalites de validation des objectifs et du stage. Des mesures d’amelioration ont egalement ete prises dans les services en fonction des resultats des evaluations. L’evaluation a alors de nouveau ete realisee selon la meme methodologie et les resultats montrent une amelioration de la satisfaction des internes sur l’ensemble de leur formation de 74 a 88 %, le niveau retenu de satisfaction minimal a atteindre ayant ete fixe a 80 %. Le questionnaire et le carnet de stage sont presentes dans cet article. L’evaluation incitative pour les enseignants et surtout non penalisante participe avec le carnet de stage a mettre en place un systeme en amelioration continue.

The role of state and trait anxiety on observer ratings of social skill and negatively biased self-perception of social skill was examined. Participants were aged between 7 and 13 years (M = 9.65; SD = 1.77; N = 102), 47 had a current anxiety diagnosis and 55 were non-anxious controls. Participants were randomly allocated to a high or low anxiety condition and asked to complete social tasks. Task instructions were adjusted across conditions to manipulate participants' state anxiety. Observers rated anxious participants as having poorer social skills than non-anxious controls but there was no evidence that anxious participants exhibited a negative self-perception bias, relative to controls. However, as participants' ratings of state anxiety increased, their perception of their performance became more negatively biased. The results suggest that anxious children may exhibit real impairments in social skill and that high levels of state anxiety can lead to biased judgements of social skills in anxious and non-anxious children.

[Figure][1] A 26-year-old man who had a kidney transplant in 2009 as a result of nephropathic cystinosis was examined for bicytopenia (platelet count, 98 × 109/L; hemoglobin, 113 g/L). May-Grunwald-Giemsa staining showed a normocellular bone marrow with numerous megakaryocytes without

Four genetic lymphoma-specific events ( MYC , BCL2 , BCL6 and CCND1 ) identified in a high grade B lymphoma case

The term « double » or « triple hit lymphoma » is commonly used to describe mature B cell neoplasms with either BCL2 and/or MYC and/or BCL6 gene rearrangements. These rare and aggressive lymphomas with high Ki67 expression are categorized as « B-cell lymphomas unclassified, with features intermediate between diffuse B-cell lymphoma and Burkitt lymphoma » category in the WHO 2008 classification. To our knowledge, only 2 cases of lymphoma have been described with four specific genetic events (quadruple hit) involving MYC, BCL2, BCL6 and CCND1 genes (Bacher U. et al., Genes Chromosomes Cancer 2011). We describe here the third observation. A patient, a 79 years old man, suffering from paraesthesias for 4 months, was admitted for polyneuritis in a context of poor general condition. Clinical examination showed the presence of numerous axillary, supraclavicular, mediastinal and inguinal lymphadenopathy, neuro-meningeal invasion and skin infiltration. The biopsy of a skin nodule of left arm revealed an infiltration consisting in large proliferating cells (Ki67 80%) stained by anti-CD20, BCL2 and BCL6 antibodies, but not with CD10 nor CD23, consistent with a diffuse large B-cell lymphoma (DLBCL), NOS diagnosis. Blood cell count showed 8.1 G/L leukocytes, 13.2 g/dL hemoglobin, 166 G/L platelets. LDH and β-2 microglobulin were elevated (989 U/I, and 9.14 mg/L respectively). Blood cell film examination showed the presence of 28% of pathological basophil lymphocytes (medium sized, with slightly clumped chromatin and frequent prominent nucleoli). Flow cytometry revealed that these cells expressed a monotypic lambda immunoglobulin light chain and were CD19, CD20, FMC7, CD22 positive, with a dim CD5 positivity and no CD10 staining. The negativity of CD23 associated to strong CD148 staining (Miguet et al, J Proteome Res2009) were in favour of the diagnosis of variant pleomorphic mantle cell lymphoma (MCL). Cytogenetic study performed in the WBC found a complex hyperdiploid karyotype (47 chromosomes) with a t(3;22) translocation involving BCL6 and IGL genes, structural abnormality of a chromosome 8 resulting in juxtaposition of 5’MYC and BCL2 in FISH (with break of the MYC probe in FISH), a derivative chromosome 18 from a t(14;18) translocation with fusion of 5’IGH and BCL2, and a t(11;14) complex translocation involving IGH and CCND1 (54% of the nuclei). Overexpression of cyclin D1 was detected in the WBC by RQ-PCR, as well as in the skin lesion using immunochemistry. Others numeral (trisomy 12) and structural abnormalities (involving the 1, 7, 14 and 21 chromosomes) were also detected. The patient was treated with a chemotherapy combining rituximab, ifosfamide, cytosine arabinoside and intrathecal methotrexate. He is still alive 5 months after the diagnosis. This third case of quadruple hit lymphoma confirms the complexity of the classification of such aggressive malignancies. Initial rearrangement of the CCND1 gene characterizes MCL that may harbour in very rare cases additional rearrangements of MYC or BCL6. Conversely, cyclin D1 overexpression is considered a rare feature in DLBCL. Recently, Ok CY et al. (Cancer 2014) proposed to reclassify DLBCL with expression of cyclin D1 and CCND1 chromosomal rearrangement and CD5 positivity as aggressive pleomorphic MCL variant. But no case with rearrangement of 2 (or more) genes (BCL2 and/or MYC and/or BCL6) was described in this study. Juskevicius D et al. (Am J Surg Pathol 2014) suggest the existence of a “gray zone” in which morphologic, clinical and genetic features are insufficient to segregate CD5- and SOX11-negative lymphomas with overexpression of cyclin D1/ translocation involving CCND1between blastoid MCL from cyclin D1-positive DLBCL. In our case, immunophenotyping of circulating cells (CD5+, CD148++) as well as genetic and molecular features (translocation involving CCND1 and IGH, and overexpression of cyclin D1) allow us to diagnose a probable genetically unstable aggressive pleomorphic MCL variant with rearrangement of several extra genetic hits. Disclosures No relevant conflicts of interest to declare.