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Quality improvement procedures and measuring the satisfaction of nursing home residents is a major priority. A study assessed the differences between the results of a survey conducted by internal staff and of one carried out by an external service provider to evaluate the satisfaction of the residents of a nursing home., (Copyright © 2016. Published by Elsevier Masson SAS.)

Sclerosing epithelioid fibrosarcoma is a rare tumor recently described. The histological presentation can be confused with certain soft tissue benign tumors and certain sarcomas. Metastatic spread is usually late in the natural course of the disease. We report a case of recurrent sclerosing epithelioid fibrosarcoma with pleural metastases which developed ten years after surgical resection of the primary tumor. The tumor was formed by small uniform round epithelioid cells with a clear cytoplasm. The tumor cells were strongly positive for vimentin. This clinical case is discussed in light of other cases reported in the literature.

Arterial endofibrosis is a rare disease usually affecting the external iliac artery in highly trained athletes. We report a case of bilateral external iliac endofibrosis in a 44-year-old cyclist. Microscopic examination of the resection specimen showed an isolated thickening of the arterial intima, and confirmed the diagnosis of this entity of unknown etiology.

A retrospective study is realized including 14 cases of clear cell sarcomas of tendons and aponeuroses, found in the files of Institut Gustave-Roussy (1969-1983). The main microscopic features are emphasized. In comparison with other soft tissue sarcomas, clear cell sarcomas are clinically characterized by a great frequency of local lymph node metastases (4 of 14 cases). The prognosis is usually particularly poor. The exact histogenesis remains obscure, but the results of special stains, support origin from migrated neural crest cells: melanin is visualized in 2 out of 12 tumors in which Fontana-Masson is performed. S 100 protein, a neuroectodermal marker, is positive by immunoperoxidase technique (PAP) in 6 of 10 tested cases. A better diagnostic approach is allowed with the help of ultrastructural study performed in 3 cases. These tumors must be separated from synovialosarcomas. Because the histogenesis is not actually sure, it is preferable to call them "soft tissue clear cell sarcomas".

We report 7 cases of unusual fibroadenomas of the breast. They are characterized by an exuberant cellular proliferation within the ductal lumens. They appear in young women from 20 to 40 years old. These lesions are histologically identical to those described by Azzopardi (1979) under the name of "Argyrophilic cells in fibroadenomas" and by Eusebi and Azzopardi (1980) and by Govoni (1981) and called "Lobular endocrine neoplasia in fibroadenoma of the Breast". An immunohistochemical study reveals a major positivity of these cells, in all cases, with Antikeratin Antibody (anti Kl1) and with Epithelial Membrane Antigen (anti EMA) proving the epithelial origin of these cells. There cells cannot yet be regarded as belonging to the neuro-endocrine group, because of the negativity, in all cases of Grimelius and Bodian stains, and of the very heterogeneous positivity observed with Neuron-Specific Enolase antibody (anti NSE) and with anti Human Natural Killer antibody (anti HNK). These cellular proliferations seem to us, on the microscopical point of view related to the atypical epithelial hyperplasias of the breast, and different from the in situ lobular carcinoma. Thus we propose to call these lesions "variant of the breast fibroadenoma" characterized by an atypical epithelial clear cell hyperplasia. The treatment of these lesions merely consists of a lumpectomy. Only one case is associated with an eleven years free of disease follow-up: a follow-up comprised between on to fifteen months is observed in the others cases. The knowledge of these benign lesions appears to us very important, to avoid improper treatment caused by an erroneous diagnosis of carcinoma developing in a breast fibroadenoma.

This is a clinicopathologic study of 6 cases of alveolar soft-part sarcoma. The patients age ranges from 8 to 47 years. All patients are women. In 5 cases the localization of the primary tumor is the lower extremities. Histologically the tumors have a distinctive organoid pattern outlined by thin-walled capillaries and are composed of nests of large polyhedral cells with abundant finely granular, acidophilic cytoplasm. Two tumors, among the 4 tested cases, have cytoplasmic PAS positive diastase-resistant crystalline structures. Electron microscopic study of one tumor shows intracytoplasmic glycogen, small membrane-bound electron-dense granules, Golgi lamellae and crystalline structures. Immunoperoxidase study performed in one case reveals a positivity with antikeratin and anti-enolase (NSE) antibodies. The prognosis of this tumor is poor. The main metastasis are in the lung and in the brain. Often the patients develop metastasis before detection of the primary tumor. The histogenesis of alveolar soft part sarcoma and the identity of the characteristic crystalloids remain open for discussion.

"Le Centre de Prolifération d'Aschoff" (CPA) has many synonyms: radial scar, benign sclerosing ductal proliferation, non encapsulated sclerosing lesions, fibroelastic center, fibroadenosis with fibroelastic core etc... In a retrospective study from the files of the Gustave-Roussy Institute, 88 cases were found: 18 cases between 1955 and 1959 and 70 cases more recently, between 1976 and 1981. CPA is an unusual lesion, observed in 2% of benign breast lesions, and in less of 1% of malignant breast lesions. Macroscopically, when CPA is not associated to a carcinoma, it has either a pseudotumoral feature (46% of the cases), or only a microscopic appearance (54% of the cases). In these last cases, it is always found by chance at the time of the examination of specimens of fibrocystic disease. When it is associated to a carcinoma, these two features are less well individualized. Mammographically and macroscopically, they are often problematical. They cause considerable diagnostic problems because of their pseudotumoral features, being similar to small stellate carcinomas. Two cases were misinterpreted at the time of the extemporaneous examination for a carcinoma and in 36 other cases, the diagnosis was uncertain and the definitive report was delayed. For the non-pseudotumoral form, a relationship was found in this series between previous cytological aspirations and CPA. The evolution of this lesion was difficult to evaluate because of the great number of the patients lost to follow up in this series. Although a slight trend was observed for patients to subsequently develop a breast carcinoma, no statistically significant difference was observed. From this study, close follow-up of these patients is considered necessary.