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The monomorphic basal cell adenoma of parotid gland is a rare tumor of salivary glands. Its diagnosis is difficult with adenoid cystic carcinoma. In the case reported here, a peculiar type named membranous adenoma, the thickness of basement membranes, their penetration inside the epithelial lobules, form true cylinders as in adenoid cystic carcinoma. The histoenzymology and the electron microscopy provide important diagnostic arguments: activity of alkaline phosphatases lower than in cystic adenoid carcinoma; cells of adenoma more differentiated (epidermoid or secretory cells) than those of cystic adenoid carcinoma. The prognosis of the tumor is good, though recurrences may occur.

An immunohistochemical study was performed on 9 gingival biopsy specimens from patients suffering of a periodontal disease comparatively to 7 control specimens from patients with inflammatory gingival hyperplasia of various causes and from healthy gums. We used mono or polyclonal antibodies as markers of the different types of inflammatory cells (T-1 lymphocytes and their subsets, B-lymphocytes, macrophages, plasma cells). In patients with periodontal disease, the high percentage of transformed T-lymphocytes with a majority of helpers was obvious. In controls, the inflammatory cells were principally B-lymphocytes, macrophages and plasma cells. The characterization of different types of collagen produced by periodontal fibroblasts was performed by specific antibodies (anti I, III, V collagen sera). The respective ratio and the topographic distribution of those collagen substances were different in patients with periodontal disease and controls. In the first eventuality, one could find quite exclusively type I collagen. In the other group, type I collagen was associated with type III sub epithelial and type IV perivasor ar collagen. By means of these findings, the pathogenesis of the periodontal disease was discussed and its immune mechanism was suggested.

The 4 cases of malignant xanthogranuloma reported here are peculiar because of their unusual localization in the cervico-facial area and of their good outcome (3 patients are alive without recurrence more than 6 years after chemotherapy and radiotherapy). Besides the histological study, the 4 cases were examined by immunohistochemical methods : vimentin was positive in 20 to 40% of cells and lysozyme in 5 to 15% of cells. In addition, one case was studied by electron microscope which showed the polymorphism of tumoral cells.

A calcifying epithelial odontogenic tumor, simultaneously located in the two jaws (maxilla and mandible) was examined by histochemical and electron microscopic methods. Squamous tumor cells without secretory polarity were different from those of common ameloblastoma. High activities of alkaline phosphatase and ATPases were demonstrated by light and electron microscopy on the cytoplasmic membrane, findings similar to those in the stratum intermedium cells of the normal dental germ from which these tumor cells seem to arise. The tumor cells, like preameloblasts of the dental germ, also produce a granulo-filamentous material in intracytoplasmic vesicles and discharge it into the stroma. This "pseudo-amyloid" substance represents an abnormal protein of the enamel matrix and calcification, mainly occurring in that substance, might be an attempt at mineralization.

Five of the 12 cardiac sarcomas reviewed in this study were recruited from 7,200 autopsy studies, including 2,980 performed on patients dying from malignant disease (overall incidence of 0.07 p. 100; 0.16 p. 100 in the group with malignant disease). These tumours are fifty times less common than cardiac metastases which were observed in 12.5 p. 100 of patients in the group with malignant disease. The other 7 cases of cardiac sarcoma were recovered from our surgical pathology archives over a 16 years period. The sarcomas were of the following histological types: angiosarcoma (6 cases), rhabdomyosarcoma (3 cases), fibrosarcoma (2 cases) and mesothelioma (1 case). The clinical presentation was very variable. The diagnosis was often made only at surgery or autopsy. The prognosis was very poor, the majority of patients dying of cardiac constriction or visceral metastases, within one year of diagnosis.

The term of "lethal midline granuloma" has been used to apply to a number of diseases. In this paper, it is argued that this term should be only a clinical description of a relentlessly progressive destructive lesion of the nose and face. A list of all the possible causes is presented. There is a group of patients who do not correspond to any specific etiology. Reviewing the observations in the literature and our own, we think that such cases are best classified according to their histological appearance. Those without atypical cells (20% of cases) are always localized to the upper respiratory tract, while those with atypical cells (histiocytes?), 80% of cases, may become generalized and/or may evolve to a malignant lymphoma. When localized, both forms (with and without atypical cells) respond very well to high-dose radiation therapy (40 to 60 Gy). In disseminated forms or relapses following radiotherapy treatment, chemotherapy, the only available alternative treatment, has met with little success. We present the clinical and pathological features of six such patients, of whom one had no atypical cells. Radiotherapy produced a clinical remission in five of five cases, but of shorter duration than that reported in the literature. No treatment other than radiotherapy has yet proven to be regularly efficient in this rare and mutilating disease.

Light cytology, enzymology, immunofluorescence and scanning electron microscopy have been performed on 49 bronchoalveolar fluids recovered by bronchoscopic lavage. The patients had the following lung diseases: infectious pneumonitis (19 cases), pulmonary fibrosis (13 cases) including 5 sarcoïdosis, 3 idiopathic pulmonary fibrosis and 5 silicosis, hypersensitivity pneumonitis (5 cases) and miscellaneous lung tumors (12 cases). Cytologic studies in comparison with clinical aspects show 4 groups: Group I (chronic bronchopneumopathy and inactive fibrosis) presents numerous cells but few lymphocytes (less than 5%); in Group II (evolutive fibrosis) have an increase percentage of lymphocytes (20%); in Group III (hypersensitivity pneumonitis) is observed a very high percentage of lymphocytes (45%); and in Group IV (cancerous lung diseases) values are not far from normal percentage except for lymphomas. Small macrophages (diameter: 10 microns) with a central monocytoïde nucleus and few cytoplasma, are abundant in groups II and III where lymphocytosis is higher. Scanning electron microscopy shows irregular and rough surface, and numerous spontaneous adherences with erythrocytes, lymphocytes, or bacterias. Enzymatic activity (acid hydrolase, esterase, oxydase) increases in these cells. Lymphocytes have a smooth surface ovocative of T origin which is confirmed by granular acid phosphatase positivity and rosette forming test. Immunofluorescence shows positive granules with IgG, C1Q and C3 in macrophages only for Groups II and III while free immunoglobulins were present in the recovered lavage fluid.

The effect of soft-laser upon cicatrization of the gum was studied in 14 patients. After the initial biopsy, control biopsies were performed on the same patients in non-irradiated gums. In the absence of inflammation, cicatrization took place in a similar manner in the irradiated and control tissues. After an early vascular growth, connective cylinders occurred, accompanied by an increase of enzymatic activity) (oxidative enzymes, leucine aminopeptidase, alkaline phosphatase). Then, the scar was formed of longitudinal bundles. The laser induced an earlier cicatrization (14th day) than in the controls (21st day). The presence of inflammation in the gum delayed cicatrization and often promoted cheloid scars with abnormal anastomosing connective bundles. In this case also, irradiation by soft-laser was followed by a quicker and better cicatrization.

A 5.1/2-year-old girl presented with an isolated diffuse gingival hypertrophy and an abnormal mobility of teeth (alveolysis on roentgenograms). The diagnosis of a plasmacytoma was suspected after pathological and immunohistological examinations of a gingival biopsy. Plasma cells were secreting monoclonal immunoglobulins (heavy chain IgA and light chain lambda), quite different from polyclonal secretions of a reactive plasmacytosis. The electron microscopic study demonstrated polymorphic plasma cells (well-differentiated, dysplastic or undifferentiated cells). The isolated nature of this tumor was confirmed by biological tests and radiological investigations. The extremely rare diffuse gingival locations of extraosseous solitary plasmacytomas was proved by a review of the published litterature. The evolution of such gingival tumors is unknown. It seems to be variable, and, perhaps, diffuse myelomas may develop later on (as in other sites of extra-osseous solitary plasmacytoma).

In this preliminary report, we studied human periodontal normal fibroblasts cultured on a fibrillary tridimensional net of collagen (lattice). As demonstrated by scanning and transmission electron microscope, cells were closely binded to this fibrillar net. They kept their functional activities (oxidatives enzymes, leucine aminopeptidase). As seen in monolayer cultures by immunocytochemical methods, the majority of these cells secreted type I collagen (70 to 80% of them: 15 to 25% secreting type III collagen). Besides, the capacity of retraction of collagen lattices, quite similar to that of skin lattices, was expressed by a decreasing curve up to the 8th day. In order to study the possible role of fibroblastic biological changes in periodontal disease, later on we shall compare the characteristics of normal fibroblast to those of fibroblast taken in periodontal disease.

The case of Shulman's syndrome reported in this article is unusual, because of the topography of the lesions and the lethal course. The perivertebral fasciitis, which was pseudotumoral in appearance, induced a myelomalacia by compression of the cervical spinal cord. In addition, the autopsy revealed severe tissue eosinophilia, cutaneous sclerodermiform sclerosis and pharyngoesophageal lesions unusual in this disease. The pathogenesis of the syndrome is discussed.

1,000 endomyocardial biopsies performed in 110 patients treated by cardiac graft were reviewed. These biopsies permitted early detection of acute rejection after cyclosporin treatment and a good appreciation of its intensity. By this method, almost all rejection episodes were resolved after adequate treatment. Chronic rejection was diagnosed by arteriography used in vivo or in cardiac transplants removed by surgery or necropsy. Rejection provoked an obliterative fibrous endarteritis often complicated by atherosclerosis and its ischaemic consequences. 34 autopsies were performed in patients dead at a variable time after cardiac or cardio-pulmonary transplantation. In early death (14 cases), graft failure and systemic disorders were observed. Acute and chronic rejection was noted less frequently (9 cases). Systemic infections (10 cases) occurred either early (post-surgical complications) or late (bacterial, fungal and parasitic lesions). In one case, death was due to a contemporaneous bladder carcinoma. The complications of cyclosporin treatment are briefly discussed.

We report two cases of mechanical limitation of buccal opening. CT scanning of bone anomalies diagnosed on standard radiography allowed to define malformation of the coronoid piston on the one hand, and the temporo-malar groove on the other: a combination of Langenbeck's and Jacob's disease in one case and Langenbeck's disease in the other. Coronoidectomy, systematically bilateral, demonstrated these morphological anomalies together with formation of coronoido-malar neo-arthrosis.

Pathological examinations during autopsy of 1457 cases of cancer demonstrated the presence of metastatic pulmonary emboli in 10 p. cent (148 cases). The were divided, as a function of their site and histological type of the primary neoplasm, as follows: hepatoma 33 p. cent, chorioepithelioma 25 p. cent, endocrine glands 19 p. cent, biliary tract 17.6 p. cent, hypernephroma 15.6 p. cent, sarcoma 13 p. cent, and various other tumors such as cancer of the pancreas, and breast. Two anatomical types of these emboli can be distinguished: one mixed type associated with a pulmonary cancerous lymphangitis (90 cases), and observed at a later stage in the disease. This may be latent or cause a subacute cor pulmonale. The other type is not associated with lymphangitis (58 cases), results from hematogenic cancers (hepatoma, hypernephroma, etc...), is often seen at an early stage, and causes sudden death. Histological examination enabled the consequences of any infarct developing as a result of the emboli to be demonstrated, and the origin of the emboli from neoplasmatic thromboses in the primary cancer drainage routes or from metastases in the liver to be determined.

The myxoma of the jaws represent 8% of the odontogenic tumours in our series (324 cases). The 5 cases described here were studied by histoenzymological and electron microscopic methods. The first method demonstrated in the majority of tumoral cells a high level of activity of alkaline phosphatases and ATPases similar to that noted in odontoblasts of the dental pulp. In addition, an acid phosphatase activity was also present in numerous cells but usually at a low intensity. Ultrastructurally, the tumour was composed of 3 main cellular types: young round cells with numerous ribosomes; stellate secretory cells with well-developed granular ergastoplasma and Golgi apparatus; fusiform cells with characteristics of fibroblasts. Some macrophages and myofibroblasts were also present. The intercellular substance was granulofilamentous and in one of our cases calcifications were obvious upon some collagen fibers. All these results seem to corroborate the hypothesis of odontogenic nature of the tumour. Early odontogenic induction induces the transformation of fibroblasts into cells with enzymatic activities similar to those of odontoblasts and the calcification of collagen fibers seen in one of our cases would express an early mineralization.

One case of myoepithelioma of the submandibular gland is reported. The tumor was composed of mixed spindle-shaped and plasmacytoid cells. The electron microscopy showed intracytoplasmic myofilaments, with variations in number and in repartition from one cell to another. Histoenzymologically, ATPasic and alkaline phosphatase activities could not be demonstrated in these poor differentiated myoid cells. Usually, the tumor has a good behavior. It represents a rare tumor (7 cases - 0,8% - in a retrospective study of 850 salivary gland tumors). Without demonstration of myofilaments by ultrastructural analysis, the diagnosis of such a tumor is very difficult. Taking into consideration new concepts about the myoepithelial cell, the histogenesis of this neoplasm is discussed.

A scanning electron microscopic study of 40 oral mucosal smears from healthy controls or patients with cancer of the mouth has enabled a comparison of the "external" characteristics of normal, malignant and dysplastic (post-radiotherapeutic) cells. Normal cells, particularly the cells of the superficial epithelial layers, were characterized by well-defined polarized external protrusions with ridges on the upper surface and microvilli on the under surface. In cancer cells, both the shape and arrangement of these formations were profoundly altered. Dysplastic cells presented an intermediate appearance which was sufficiently characteristic to allow them to be distinguished from neoplastic cells.

One case of Merkel cell carcinoma is reported in a 71 years-old woman. Lately treated by surgical excision (14 years after the occurrence of the tumour), this tumour was already associated with inguinal lymph node metastases. Its evolution was lethal within 3 months after local recurrence, cutaneous and visceral (lung, liver) metastases. This tumour, characteristic histologically and ultrastructurally (secretory granules), was accompanied by an infiltrative epidermoid carcinoma. This association and the presence of cytokeratin in tumoral Merkel cells are arguments for the common origin of keratinocytes and neuroendocrine Merkel cells from a common young epithelial cell.

61 cases of histiocytosis X of jaws were reported here. They occurred more often in man (72% of men) than in woman, with an average age of 27 years. The mandible was affected more frequently than the maxilla. Clinically, dental expulsion, gingival swelling, fractures or pain were the usual symptoms. Roentgenographic examination showed either central or peripheral (alveolar bone) osteolytic areas. The histologic diagnosis was easy when eosinophilic polymorphous leukocytes or histiocytes were preponderant. In the other cases, immunohistochemistry (positivity of S-100 protein) and electron microscopy (presence of Birbeck granules about paraffin embedded specimens) were of a great usefulness. The prognosis of the disease was mainly related to the diffusion of lesions to other skeletal portions or extraskeletal localizations (37% of our cases). It has been improved by combination of chemotherapy to surgery (despite of frequent recurrences), 40 upon 45 patients are well after a follow-up of 2 to 10 years after the last localization.

On the basis of 324 cases of maxillary tumours, the authors review the classification of these neoplasms. The most frequent tumours are benign epithelial odontogenic tumours, which represent 55% of all tumours. The most common of these tumours is the ameloblastoma, followed by the odontomas. Most of the tumours of non-dental origin are benign (72% of this group). Amongst the malignant tumours, osteosarcomas are much more common than chondrosarcomas. The authors also discuss the various types of cyst and their respective relative frequency.

A case of sialadenosis was studied by means of several morphological methods (light microscopy with micrometric measurement, transmission and scanning electron microscopy, immunopathology, histoenzymology). In that disease, these investigations seem to corroborate the hypothesis of a dyscrinism, true perturbation of the salivary excretion with storage of secretory granules in the cells and consecutive hypertrophy. This dyscrinism should result from a deterioration of branches of autonomic nervous system. In the case reported here, no etiology was proved but the hypothetic part of a recent antiulcerous treatment by Tagamet was suggested.

Prognosis in 11 cases of hemangiopericytoma of the orofacial region (9 buccal and 2 parotid tumors) was, as with these lesions in other zones, an uncertain entity: 4 local recurrences within 8 months to 7 years; one fatal outcome after 3 years from pulmonary micrometastases. Histologic classification of these tumors into 3 cytologic groups of increasing malignancy (I to III) is a function of the number of their cytologic anomalies. They are also divided according to their overall morphology into poorly differentiated, differentiated and sclerous types. Positive correlations between structure and cytologic criteria of malignancy and structure and clinical course have been demonstrated. Ultrastructural examination in 2 cases showed polymorphic endothelial, fibroblastic and smooth muscle cells in contact with adult tumoral pericytes. This suggests the origin of the tumor from young cells of multiple potency rather than from adult pericytes.

From amongst a series of eight cardiac myxomas, two were studied by electron microscopy, which enabled us to identify, amongst varous cell types, two main ones. One of these was a secretory cell with Golgi apparatus and secretory vacuoles, and the other was of the expected type, with microfilaments showing signs of progressive differentiation towards either muscle or epithelial structure. A morphological picture of this sort tends to lend support to the concept of a dysgenetic origin for these tumours, arising from pluripotent embryonic cells sequestrated in the region of the fossa ovalis.

The ameloblastic fibrosarcoma is a rare variety of neoplasm. Three new cases reported here occurred within preexistent benign odontogenic tumors (ameloblastic fibroma or fibro-odontoma). These large, osteolytic tumors, spreading to adjacent soft parts, recurred after surgical treatment in two cases. One of them had a lethal course, with pleuro-pulmonary, mediastinal lymph node and hepatic metastases. Histologically, these sarcomas show a malignant mesenchymal component and few benign ameloblastic islands, which often disappear after one or several recurrences. Histoenzymologically, a high level of alkaline phosphatase and ATPase activities is always present, a feature not present in common fibrosarcomas. The ultrastructural study demonstrates, in analogy with odontogenic myxomas, clear cells provided with numerous microfilaments, secretory cells and also some fibroblasts and myofibroblast-like cells. In addition to these pleomorphic cells, a great number of peculiar granular cells with numerous lysosomal bodies were also found. The histogenesis of these tumors in unknown. Perhaps the epithelial component, being unable to assume its functions of organization, may initiate the malignant transformation of its odontogenic mesenchyme.

Sixty-three cell smears from oral mucosa were studied by scanning electron microscopy. Among them, smears from ten healthy controls showed three kinds of cells: flat (superficial) cells with linear anastomosing microridges and microvilli; polygonal (intermediate) cells with well-defined crests between their faces and numerous microvilli; and round (parabasal) cells entirely covered by microvilli. Twenty-five smears from patients with untreated squamous-cell carcinoma showed enlarged polymorphous cells (round, globular, and elongated); microvilli, variable in their dimensions, were irregularly distributed on their surfaces. Eighteen smears from patients with severe epithelial dysplasia showed polymorphous cells with discontinuous but obvious edges separating their faces and with irregular microvilli and ridges. Nine smears were also performed in patients with various other mucosal lesions (lichen planus, leukoplakia, white sponge naevus, pemphigus vulgaris, and herpes). All of these smears were studied comparatively between examination of smears and biopsies by light microscopy. The smears were truly reliable, particularly for distinguishing between dysplastic and tumoral cells.

After a short summary of the bone histophysiology, the general characteristics, the nosology and the differential diagnosis of dystrophic and dysplastic lesions of bone are related. Then, their main varieties are classified in two chapters: osteogenic and osteolytic lesions.

2 cases of pleomorphic adenoma with unusual histological feature are related. In the 1st case, the tumor was mistaken for a schwannoma. The electron microscopic study only permitted the diagnosis; in the 2nd case, the tumor, obviously malignant, was firstly diagnosed as synovial sarcoma; in this case also, ultrastructural study permitted to recognize a malignant mixed tumor with an unusual "sarcomatous" change of its myoepithelial component.

Ear cartilage has been studied by histochemistry, histoenzymology, immunofluorescence and electron microscopy in three cases of relapsing polychondritis. The most significant lesions have been observed at the cellular level, both by enzymology and electron microscopy: chondrocytes of peripheral zones seem to be first hypertrophic and then necrotic; at the opposite, their is no correlation between histochemical and electron microscopic studies about the chondroid intercellular substance whom lesions are probably secondary to the cellular ones. A few chondrocytes are positive with antiimmunoglobulins sera (IgM and IgA); this fact could be a proof of the dysimmune nature of this disease.

The effect of soft-laser upon human gingival fibroblasts was studied after an initial biopsy followed by irradiation and numerous biopsies performed 5 mn, 15 mn, 1 hour and 24 hours after irradiation. In addition, control biopsies were performed in the same way on a non-irradiated gingival area. One hour after irradiation and up to 24 hours later, the enzymatic activities of the fibroblasts were obvious: oxidative enzymes, leucine aminopeptidase, and considerable Brachet's test highly positive (RNA). By transmission electron microscopy were changes were found in these fibroblasts. They were more numerous and their cytoplasmic organelles were increased (mitochondria, rough endoplasmic reticulum). An abundant granular material as well as collagen fibrils were accumulated along their cytoplasmic membrane. On the whole, from the 1st hour on following irradiation by soft-laser a stimulation of metabolic activity of the fibroblasts (oxidative activities, proteic synthesis) was observed with increased production of collagen.

Three cases of mandibular condyle metastasis of particular interest are reported: -- In two out of the three cases they were detected early enough for the primary tumour to be diagnosed; -- they all presented with articular symptoms; -- all three were treated surgically by excision of the condyles. Diagnosis was confirmed by histological examination, a rare event when mandibular metastasis are concerned, these usually being diagnosed after the primary tumour and then irradiated without histological proof. Primary tumours were respectively bronchial, pancreatic, and mammary.