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Resume Les schwannomes coliques sont des tumeurs rares. La plupart sont a cellules fusiformes. La variante epithelioide est exceptionnelle avec seulement 10 observations rapportees dans la litterature. Nous en decrivons deux cas de decouverte fortuite chez des femmes de 37 et 42 ans. Les lesions etaient localisees dans le sigmoide et le colon droit. Elles mesuraient 2,5 et 3 cm de diametre. Toutes deux etaient constituees de nappes de cellules epithelioides monomorphes, sans atypie ni mitose. L’une des tumeurs etait entouree par des nodules lymphoides. A l’etude immunohistochimique, les cellules tumorales exprimaient la proteine S100 et certaines la GFAP. Quelques cellules d’allure fibroblastique, positives pour le CD34 etaient identifiees dans les deux tumeurs. Il n’y avait pas de recidive apres un suivi de 6 et 24 mois. Le schwannome epithelioide colique est une tumeur benigne, d’histogenese incertaine, qui peut preter a confusion avec d’autres tumeurs plus agressives.

Schwannomas of the colon are rare tumors. Most of them are spindle cell tumors. The epithelioid variant is exceedingly rare with only 10 cases reported in the literature. We report two fortuitously discovered cases in 37 and 42-year-old women. The masses were located in the sigmoid and the right colon. They measured 2,5 and 3 cm in diameter. On microscopic examination, they were composed of sheets of uniform epithelioid cells without atypia or mitosis. One of them had a cuff of benign lymphoid hyperplasia. Immunohistochemical study showed positive staining of the tumor cells for S100 protein and some of them for glial fibrillary acidic protein. Some CD34-positive fibroblast-like cells were identified in the two tumors. There was no recurrence with a follow-up ranging from 6 to 24 months. Epithelioid schwannoma of the colon is a benign tumor of uncertain histogenesis which may be confused with more aggressive neoplasms.

The pancreas is an uncommon site of metastasis for renal cell carcinoma. We report 2 cases of patients who underwent total and subtotal pancreatectomy 13 and 10 years after resection of the primary tumor. One of the patients already had liver and cerebellum metastasis, the second one had a solitary metastasis to the pancreas. In both cases, tumoral proliferation invaded the lumen of the Wirsung, and in one case was prominent through the papillae.

Stromal tumors of the digestive tract are undifferentiated connective tissue tumors which are difficult to characterize even with immunohistochemistry.A stromal tumor of the duodenum (the most frequently encountered location) was resected entirely. Histochemistry was unable to provide a precise identification of the histological nature. The tumor was considered to be low grade due to the low mitosis index despite its large size and the presence of necrosis. Careful surveillance was indicated.The risk of these tumors is uncertain and may be assessed on the basis of histological prognosis factors such as tumor size, mitosis index and ploidy. Echoendoscopy can be particularly useful for diagnostic purposes providing information on location in the duodenal musculosa.

Antral gastritis is frequent in alcoholics. The role of H. pylori in the pathogenesis of gastritis in these patients is not well known. The aim of our study was to study the role of H. pylori and cirrhosis in the pathogenesis of antral gastritis in alcoholic patients.Seventy-nine patients were included in the study. All underwent upper gastrointestinal tract endoscopy with antral biopsies, independently of the presence of abdominal pain, and had serological examination for H. pylori antibodies.Cirrhosis and gastritis were present in 50 and 40 patients respectively, H. pylori serological assay and histological identification of the bacterium were positive in 35 (44%) and 19 (24%) patients respectively. Discrepancy between the 2 tests were observed more frequently in cirrhotic patients. A positive serology with a negative histologic examination for H. pylori was present for 18 cirrhotic and 4 noncirrhotic patients (p0.05). A gastritis without evidence of H. pylori was more frequent in cirrhotic than in noncirrhotic patients. H. pylori was histologically present in 11 of 29 cirrhotic patients and in 8 of the 11 noncirrhotic patients with a gastritis (p0.05).Discrepancies between histological examination and H. pylori serology in patients with cirrhosis might be due to the inhospitable environment for H. pylori in case of portal hypertension; the positive serology could be in relation with a past infection.

Laser recanalization of occluded femoral or popliteal arteries was performed in 12 patients using a continuous wave neodymium yttrium aluminum garnet (Nd-YAG) laser. The histologic findings of the laser-irradiated arterial segments in two of these patients are reported. The specimens were obtained 2 and 4 weeks after the laser procedure. The laser-irradiated vessel in Patient 1 had been partially recanalized with reduction of the atherosclerotic occlusion from 3 to 1 cm. The lased arterial lumen manifested thermal injury to the inner quarter of the arterial wall with vacuolization and a rim of carbonization occupying 10% of the width of the arterial wall, but without thrombus formation. Histologic examination in Patient 2 revealed no fibrin deposits, atherosclerotic debris or thrombi at the intimai arterial edge. At the crater site, thermal injury was apparent with vacuolization of the intimai fibrous tissue. The histologic sections obtained 4 weeks after the procedure revealed new fibrous intimai tissue without en-dothelialization in some of the heavily calcified tissue sections. Where the plaques were noncalcified, reen-dothelialization was noted with only minimal damage to the surrounding tissue. No medial or elastic fiber disruption was seen, and no aneurysmal dilation had occurred. Intimai splitting with a cleft betwen the tunica media and the intima was noted at the site of previous balloon angioplasty. In conclusion, the follow-up histologic findings 2 and 4 weeks after laser angioplasty in two patients using a specially designed catheter delivery system and cooling blood perfusate revealed thermal injury to the inner quarter of the arterial vessel wall and no evidence of thrombus formation.

Summary We report an unusual case of lambda light chain deposits without overt plasma cell dyscrasia. The clinical presentation was hepatomegaly without biochemical sign of renal involvement. Portal hypertension, spontaneous rupture of the spleen and fracture of the 12th thoracic vertebra occurred during the course of the disease. Ultrastructural studies showed that lambda light chain deposits were associated with amyloid-like deposits. This case suggests that light chain deposition disease and amyloidosis could be two expressions of the same disease.

The aim of this study was to specify the signs and course of patients with a dilated common bile duct without obstruction. We included patients with a dilated common bile duct of more than 12 mm on endoscopic retrograde cholangiography, and we excluded patients with stones, tumor or other visible obstruction. Two hundred and seven patients (8.4 p. 100 of endoscopic retrograde cholangiography) were included. One hundred and nineteen (57.5 p. 100) had undergone cholecystectomy. Sixty-five p. 100 of patients had signs suggesting biliary tract disease, and 78 p. 100 had biological signs of cholestasis. The size of the common bile duct was not different whether the patient had been cholecystectomized (16.2 +/- 0.3 mm.M +/- SEM) or not (16.2 +/- 0.4 mm). Forty-one patients in the non cholecystectomized group had gallbladder stones. Thus, 47 of our 207 patients (23 p. 100) had neither gallbladder stones nor previous cholecystectomy. Endoscopic retrograde cholangiography was completed by endoscopic sphincterotomy in 130 patients, either in the intent of not missing obstruction, or for therapeutic purposes. Follow-up more than one month after endoscopic retrograde cholangiography was available for 159 patients (77 p. 100). The median survival was 73 months. One hundred and ten patients (69 p. 100) were asymptomatic, 36 (23 p. 100) had atypical abdominal pain while 13 (8 p. 100) patients had episodes of biliary colic and/or fever and/or jaundice. During follow-up, an initially unrecognized obstacle was discovered in 8 patients: 5 common bile duct stones, 2 ampullary tumors and one pancreatic tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonographic, computed tomographic, and angiographic abnormalities of nodular regenerative hyperplasia have been described in very few cases. We report here the case of a 50-year-old man with round, well-limited hypoechogenic lesions involving the two lobes of the liver, and hypervascular, poorly delineated angiographic lesions. Computed tomography and magnetic resonance of the liver were normal. Histological examination of large liver specimens provided by intraoperative biopsy allowed the diagnosis of nodular regenerative hyperplasia. Such a pseudo-tumoral ultrasonographic and angiographic pattern must be recognized in order to avoid diagnostic and therapeutic mistakes, especially since percutaneous liver biopsy usually fails to diagnose this disease.

A study was performed to compare the lesions induced by argon and neodymium YAG laser beams in the normal fundic wall of the same beagle dogs and to follow their healing over a 21-day period. The total energy per application was 21 joules for the argon laser and 53 joules for the neodymium YAG laser. Both laser beams were emitted from the same distance, directed at right angles to the tissue surface, and with the same flow rate of coaxial gas. Thirty-nine shots were performed with each type of laser. Differences between the two lasers were observed in the appearance of the impacts, the volume of tissue affected, and the rate of healing, but all the lesions healed without any perforation. The differences observed were probably due to differences between the two lasers in the radial distribution of luminous energy and its absorption and transformation within the tissue into heat. It was concluded, however, that under the experimental conditions chosen, both kinds of laser could be used to penetrate the mucosal and submucosal tissue without risk of damage either to the longitudinal or to the serosal layers of the fundic wall.

On the basis of two years' experience, a technique for the use of percutaneous endoluminal continuous emission Nd-YAG laser has been developed for arterial recanalisation. The effectiveness of this type of laser has been demonstrated in a large number of clots and atheromatous plaques, including calcified plaques. A balloon catheter gives a coaxial position of the fiber in center of the artery. Infusion of a blood solution containing 3 g of haemoglobin/100 ml at a rate of 20 ml/minute limits the thermal parietal lesions, improves the conditions of laser treatment and eliminates any risk of arterial perforation. No embolic debris is collected down-stream. Recanalisation of long arterial segments in amputated legs was performed prior to the human application. Ten patients have been treated with no mortality and virtually no morbidity. The narrowness of the reformed arterial lumina resulted in early re-thrombosis in the first 5 cases, requiring balloon modelling to ensure patency with a follow-up of 1 to 3 months in the 5 following patients.

The authors report a case of recurrent haemangiopericytoma of the tongue complicated with a single pulmonary metastasis revealed by a spontaneous pneumothorax.