Search

Summary Xanthogranulomatous cholecystitis (XGC) is a rare form of cholecystitis, characterized by the presence of xanthogranuloma, prominent yellow structures within the gallbladder wall that is very often lithiasic. When XGC presents in its pseudo-tumoral form with occasional adjacent organ involvement, it can mimic gallbladder carcinoma (GBC). The etiopathogenesis of XGC is inflammatory destruction of Rokitansky-Aschoff sinuses containing biliary and cholesterol pigments within the gallbladder wall; this leads to a florid granulomatous histiocytic inflammatory reaction. The prevalence ranges from 1.3% to 8.8% of all cholecystectomies and varies from country to country; XGC occurs predominantly in patients over 50 years of age, and is equally distributed between males and females. Its association with GBC remains a topic of debate in the literature (between 0 and 20%). Symptoms are non-specific and generally similar to those of acute or chronic cholecystitis. XGC, when associated with altered health status, leads to the suspicion of GBC. XGC can also come to light due to an acute complication of cholecystolithiasis, in particular, gallstone migration. Imaging by sonography and CT scan is suggestive, but magnetic resonance imaging is more specific. In difficult cases, biopsy may be necessary to eliminate the diagnosis of tumor. In case of pre- or intra-operative diagnostic doubt, the opinion of a hepatobiliary specialty center can be of help. When diagnosis of GBC has been eliminated, laparoscopic cholecystectomy is recommended, although with a high risk of conversion to laparotomy and complications.

Resume La cholecystite xanthogranulomateuse (CXG) est une entite rare de cholecystite, caracterisee par la presence de xanthogranulomes proeminents au sein de la paroi d’une vesicule biliaire tres souvent lithiasique. Sa presentation pseudo-tumorale avec parfois un envahissement des organes de voisinage peut mimer un cholangiocarcinome de la vesicule biliaire (CVB). L’etiopathogenie resulte d’un processus de destruction inflammatoire des sinus de Rokitansky-Aschoff, associe a des depots de pigments biliaires et de cholesterol dans la paroi de la vesicule biliaire, entrainant une reaction histiocytaire granulomateuse floride. Avec une prevalence variant entre 1,3 % et 8,8 % des cholecystectomies selon les pays, la CXG predomine chez les patients de plus de 50 ans, avec un sex-ratio equilibre. Son association a un CVB reste controversee dans la litterature (entre 0 et 20 %). Ses symptomes sont aspecifiques, similaires a ceux d’une cholecystite aigue ou chronique, parfois associes a une alteration de l’etat general, pouvant faire evoquer le diagnostic de CVB. Son mode de revelation peut etre une complication aigue en rapport avec les calculs vesiculaires, notamment leur migration. L’echographie et le scanner peuvent evoquer le diagnostic, mais c’est l’IRM qui est l’examen le plus specifique. Dans les cas difficiles, il est parfois necessaire de recourir a la biopsie pour ecarter une pathologie tumorale. En cas de doute diagnostique pre ou peroperatoire de CXG, un avis doit etre sollicite aupres d’un centre referent en pathologie hepatobiliaire. En l’absence de doute avec un CVB, une cholecystectomie par voie cœlioscopique est recommandee avec un risque eleve de conversion et de complication.

Resume Le syndrome Low-Phospholipid Associated Cholelithiasis (LPAC) est une maladie genetique responsable du developpement d’une lithiase intrahepatique. Elle est en lien avec une mutation du gene ABCB4 codant pour la proteine MDR3, un transporteur biliaire. Cette entite nosologique est definie par la presence de deux criteres sur les trois suivants : apparition des symptomes biliaires avant 40 ans, recidive des symptomes apres cholecystectomie, et existence de foyers hyperechogenes intrahepatiques en echographie. La plupart des formes cliniques sont simples, mais il existe des formes compliquees, avec lithiase intrahepatique etendue et ses consequences : migration lithiasique, angiocholite, abces intrahepatique. L’evolution chronique peut aboutir a une cholangite sclerosante secondaire ou une cirrhose biliaire secondaire. Dans de rares cas, on peut observer une degenerescence en cholangiocarcinome. Le traitement repose sur l’acide ursodesoxycholique qui permet une dissolution des calculs. Des therapeutiques interventionnelles, radiologiques, endoscopiques ou chirurgicales sont justifiees dans les formes compliquees. Cette mise au point illustre et resume l’ensemble de la pathologie, de la lithiase vesiculaire simple au cholangiocarcinome, en passant par la cirrhose biliaire secondaire requerant une transplantation hepatique, a l’aide de cas cliniques et d’iconographies de patients pris en charge au sein de notre service.

Resume Introduction Le traitement chirurgical est le traitement de reference des volumineux carcinomes hepatocellulaires (VCHC) ≥ 5 cm. La fibrose peut constituer une contre-indication a la resection en raison du surrisque d’insuffisance hepatique postoperatoire mais son impact sur les suites postoperatoires et la recidive demeure mal defini. Notre objectif etait donc de comparer les facteurs pronostiques de survie chez les patients cirrhotiques ou non, apres hepatectomie pour VCHC. Methodes Les donnees des patients reseques pour VCHC entre 2012 et 2016 dans deux centres de reference ont ete analysees. Les resultats obtenus chez les patients cirrhotiques (fibrose F4) et non cirrhotiques (F0–F3) ont ete compares. Les patients ayant recu un traitement medical (sorafenib) ou radiologique (chimioembolisation intra-arterielle, radiofrequence) ont ete exclus. Resultats Soixante patients ont ete inclus. Les donnees preoperatoires et peroperatoires etaient identiques entre les deux groupes. Les patients cirrhotiques (n = 15) etaient plus souvent porteurs de nodules satellites a l’anatomopathologie definitive (73 % vs 44 % ; p = 0,073) mais leurs tumeurs etaient mieux differenciees que celles des patients non-cirrhotiques (p = 0,041). La survie mediane des patients cirrhotiques etait de 34 mois vs 29 mois chez les non-cirrhotiques (p = 0,8) et la survie sans recidive etait respectivement de 14 mois vs 18 mois (p = 0,9). Le degre de fibrose n’avait pas d’impact sur la survie globale (p = 0,2) ou la survie sans recidive (p = 0,6). Conclusion Le traitement chirurgical des VCHC chez les patients cirrhotiques permet d’obtenir des resultats oncologiques satisfaisants et comparables a ceux obtenus chez les patients non-cirrhotiques. Le traitement curatif des VCHC doit donc etre envisage, sous reserve d’une fonction hepatique conservee, quel que soit le degre de fibrose.

Low-Phospholipid Associated Cholelithiasis (LPAC) is a genetic disease responsible for the development of intrahepatic lithiasis. It is associated with a mutation of the ABCB4 gene which codes for protein MDR3, a biliary carrier. As a nosological entity, it is defined by presence of two of the three following criteria: age less than 40 years at onset of biliary symptoms, recurrence of biliary symptoms after cholecystectomy, and intrahepatic hyperechogenic foci detected by ultrasound. While the majority of clinical forms are simple, there also exist complicated forms, involving extended intrahepatic lithiasis and its consequences: lithiasis migration, acute cholangitis, intrahepatic abscess. Chronic evolution can lead to secondary sclerosing cholangitis or secondary biliary cirrhosis. In unusual cases, degeneration into cholangiocarcinoma may occur. Treatment is built around ursodeoxycholic acid, which yields dissolution of biliary calculi. Complicated forms may call for interventional, radiological, endoscopic or surgical treatment. This synthetic review illustrates and summarizes the different aspects of this entity, from simple gallbladder lithiasis to cholangiocarcinoma, as well as secondary biliary cirrhosis requiring liver transplant, on the basis of clinical cases and the iconography of patients treated in our ward.

Summary Background Hepatectomy remains the standard treatment for large hepatocellular carcinoma (LHCC) ≥ 5 cm. Fibrosis may constitute a contraindication for resection because of high risk of post-hepatectomy liver failure, but its impact on patient outcome and cancer recurrence remains ill defined. Our aim was to compare predictors of survival in patients with and without cirrhosis following hepatectomy for LHCC. Methods The data on consecutive patients undergoing hepatectomy for LHCC in two tertiary centres between 2012 and 2016 were reviewed. The outcomes of cirrhotic (F4) and non-cirrhotic (F0–F3) patients were compared. Patients with perioperative medical (sorafenib) or radiological (transarterial chemoembolization, radiofrequency) treatments were excluded. Results Sixty patients were included. Preoperative and intraoperative features were identical between both groups. Cirrhotics (n = 15) presented more satellite nodules on specimens (73% vs. 44%; P = 0.073) but better differentiated lesions than non-cirrhotics (P = 0.041). The median overall survival of cirrhotics was 34 vs. 29 months for non-cirrhotics (P = 0.8), and their disease-free survival was 14 versus 18 months (P = 0.9). Fibrosis stage did not impact overall (P = 0.2) nor disease-free survivals (P = 0.6). Conclusion Hepatectomy for LHCC in cirrhotics can achieve acceptable oncological results when compared to non-cirrhotic patients. Curative resection of LHCC should be attempted if liver function is acceptable, whatever the fibrosis stage.

Resume Objectif de l’etude Decrire l’extension microscopique des carcinomes epidermoides ORL a partir d’une serie de pieces operatoires obtenues prospectivement pour des patients traites avec intention curative pour proposer une definition des volumes cibles en radiotherapie. Materiel et methode Les pieces operatoires ont ete analysees macroscopiquement avant etude microscopique. Le front tumoral macroscopique a ete identifie a l’œil nu puis des implants microscopiques (emboles vasculaires, engainements perinerveux, foyer de carcinome in situ) ont ete recherches au microscope optique dans les tissus sains au-dela de ce front. La distance de l’implant le plus distant a ete relevee et confrontee a la longueur de tissu sain examinable. Resultats Sur les 21 pieces analysees, 12 correspondaient a des tumeurs localement evoluees. Les extensions microscopiques maximales moyenne et mediane etaient respectivement de 2,9 et 1,0 mm (0–15 mm). Le 90 e percentile etait de 5 mm et le 95 e percentile de 11 mm. Le pourcentage de longueur de tissus macroscopiquement sains comprenant des implants tumoraux microscopiques etait de 10 %. Il n’a pas ete retrouve de correlation entre la distance maximale d’essaimage et la taille tumorale ou le degre de differenciation. Conclusions La probabilite de presence de materiel tumoral microscopique au-dela de 5 mm etait tres faible (moins de 5 % des cas) dans cette serie de patients atteints de tumeur majoritairement localement evoluee. La couronne peritumorale definit une zone a haut risque sur les premiers millimetres. L’utilisation d’une terminologie precise doit permettre une analyse pertinente des facteurs de risques locaux, notamment pour l’appreciation de la qualite d’une resection ou la definition des volumes anatomocliniques. Les autres facteurs histocliniques et les particularites de certains sites tumoraux ne sauraient etre omises dans la definition des volumes cibles. Une confirmation sur une serie plus grande et plus homogene est souhaitable.

Idiopathic portal hypertension is a rare clinical syndrome which may be associated with a spectrum of histological lesions, including nodular regenerative hyperplasia and incomplete septal cirrhosis. Here, we report eight adult patients with idiopathic portal hypertension who experienced an unusually severe clinical evolution characterized by the development of progressive hepatic failure requiring orthotopic liver transplantation. Our aims are: (a) to stress the distinctive clinical presentation of these patients, (b) to describe their biological and histopathological features, and (c) to evaluate the results of orthotopic liver transplantation in this rare indication.Complete clinical charts and histological data were available in all patients. All patients were male. Their age at diagnosis ranged from 17 to 59 years. Complications of portal hypertension revealed the disease in all cases. Medical treatment was performed in all patients and portosystemic shunt in three.The development of progressive hepatic failure led to the indication of liver transplantation after a delay ranging from 3 to 10 years. Explanted livers showed pure nodular regenerative hyperplasia in three patients and incomplete septal cirrhosis in five. Recovery was uneventful. All patients are alive, without recurrence of the disease.This report points to the existence of severe cases of idiopathic portal hypertension occurring without underlying or associated systemic disease and characterized by a poor clinical course and requiring liver transplantation.

Resume Nous presentons le cas d’une patiente de 75 ans avec une tumeur vasculaire splenique nodulaire decouverte fortuitement. L’exploration TDM, echographique conventionnelle et avec produit de contraste rejeterent l’angiome splenique typique. La patiente est finalement splenectomisee. L’examen anatomopathologique montre un hemangiome capillaire thrombose. L’arsenal radiologique ne permet pas toujours d’affirmer le diagnostic d’hemangiome splenique, du fait de la localisation splenique, des remaniements tumoraux, et lorsque la taille est importante. L’imagerie ne peut alors exclure une lesion maligne.

To assess microscopic extensions of head and neck squamous cell carcinomas aiming at a proposal for target volumes of radiation therapy.Surgical specimens were prospectively analysed macroscopically and microscopically. Tumour borders were identified per macroscopic visual examination and inked on stained slides. Then microscopic implants (perineural or lymphatic involvement, or in situ carcinomas) were looked for with an optic microscope in the macroscopic healthy tissue surrounding the tumour. The maximal length from tumour border was correlated with the maximal length of macroscopically healthy tissues assessable.Twenty-one specimens were analysed and 12 were locally advanced tumours. Mean and median maximal microscopic extensions were 2.9 and 1.0mm (0-15mm), respectively. The 90th and 95th percentiles were 5 and 11mm, respectively. The ratio between healthy tissue length and maximal microscopic tumour extension was 10%. No correlation was found with tumour grade or volume.The presence of microscopic tumour was unlikely after 5mm from macroscopic tumour (≤5% of patients in this series) but should be assessed along with other histoclinical factors and particularities of tumour behaviour by anatomic site. A rigorous terminology should authorize a relevant appreciation of local risk of recurrence, particularly in adjuvant setting or for clinical target volume definition. Larger and more homogenous confirmatory series are needed.

Resume Kes greffons arteriels cryopreserves sont-ils viables ? Le but de ce travail est d'etudier leur devenir immunologique en clinique. Nous avons realise 20 greffes arterielles pour sauvetage de membre iteratif. La greffe a toujours ete ABO compatible. Un bilan immunologique comportant : anticorps (AC) irreguliers, allo et auto AC HLA, AC anti-tissus, cultures cellulaires allogeniques ; a ete realise systematiquement a J0, J21, J51 et J180. Vingt-cinq biopsies ont ete realisees chez 18 patients entre le 3e et 10e mois. Les populations cellulaires ont ete controlees sur 10 biopsies en polymerase chaine reaction (PCR). Neuf des 18 patients ont presente une elevation des AC HLA de classe I ou II, le reste du bilan est reste normal. En PCR, seules les cellules du receveur sont presentes au troisieme mois. L'etude histologique a montre l'absence de rejet chronique. Cette bonne tol?ance immunologique va de paire avec une tres bonne permeabilite secondaire de 72 % a 24 mois.

Purpose To assess the usefulness of a labial salivary gland biopsy (LSGB) in subsets of patients with uveitis. Methods A retrospective study of 116 consecutive patients with uveitis for whom a LSGB had been done because of suspected ocular sarcoidosis (n=87) or unexplained uveitis (n=29). Eighty six patients had a suspicion of ocular sarcoidosis because of ocular features (n=67), an elevated angiotensin converting enzyme (ACE) (n=30) or because of CT findings (n=33) suggestive of sarcoidosis. The biopsy results were analyzed together with their ophthalmological features and the results of other relevant examinations, such as the serum levels of ACE and a chest radiography or a CT scan. Results Six of the 116 patients (5.2%) with uveitis had sarcoid granulomas on the LSGB. At the end of the study, 32 patients had proven sarcoidois while 23 patients were considered as having either indeterminate or presumed sarcoidosis, according to the criteria of Abad et al. A raised ACE (p=0.033) and a compatible radiology (p=0.019) were related to a positive LSGB test but not to the features of uveitis. Granulomas were only found in the LSGB of the patients with an elevated ACE or compatible CT scans. Conclusion In this study, the LSGB sensitivity (18.75%) in the patients with proven sarcoidosis appears to be lower than in other reports. Our results suggest that this investigation should be limited to the patients with a raised ACE and/or CT scans pattern compatible with sarcoidosis and should not be performed in patients with unexplained uveitis or because of ophthalmological features.

Hepatocellular carcinoma and other tumours of the liver are extremely rare in Wilson's disease. We report a patient who presented with a cholangiocarcinoma associated with Wilson's disease. The literature review underlines that patients with Wilson's disease should be considered at risk of hepatocellular carcinoma, cholangiocarcinoma and undifferentiated carcinoma in the liver. Risk factors seem to be long disease duration and probably a poor observance to therapy. A liver imaging should be included in the follow-up of patients with Wilson's disease.

We report a case of splenic vascular neoplasm in a 75 year old asymptomatic woman. CT and enhanced sonography were not consistent with a typical hemangioma. Splenectomy was finally realised and pathologic exam showed a capillary hemangioma with thrombosis. The imaging appearance of splenic hemangiomas may be complex because of splenic topography, size and complicating features. The differentiation of these lesions from malignant disease may not be possible.

We report a new case of aggressive juvenile fibromatosis (FJA) in a 20 months old girl. It was initially treated by hemimandibulectomy. A secondary reconstruction was performed with a fibular flap at the age of 9 years. FJA is a locally aggressive lesion which does not metastasize. It occurs chiefly in girls during childhood. Radiographs are non-specific (extensive osteolytic lesion). The clinicopathologic diagnosis is discussed with the other mandibular fibrous tumors in children.

Inflammatory bowel disease (IBD) encompasses two forms of intestinal inflammation: ulcerative colitis and Crohn's disease. Besides abnormalities of immunoglobulins production and complement activation, T lymphocytes play an important role in pathogeny of these diseases. Although T-cells number is increased in intestinal mucosa of such patients, CD4/CD8 ratio of T lymphocytes subsets is normal in mucosa. Activated T-cells expressing interleukin-2 receptors (CD25) are increased in lamina propria from patients with IBD. Cytokines induce abnormal expression of class II antigens of major histocompatibility complex by epithelial cells which may act as antigen presenting cells to CD4 T-cells. Better understanding of pathogenic mechanisms in IBD might justify new immunosuppressive therapeutics to treat these patients.

Thirteen months after a bilateral nephrectomy for a synchronous bilateral renal cell carcinoma involving both adrenal glands, a 46 years-old man underwent a simultaneous adrenal and kidney allotransplantation. The left renal allograft was harvested together with a ipsilateral adrenal gland using a common aortic patch. Maintenance immunosuppression was based on azathioprine, antilymphocyte globulin cyclosporine and prednisolone. Kidney allograft function remained stable for 5 years until the patient died from multifocal pancreatic metastases. Clinical, biochemical, radiological and histological arguments demonstrated the function of adrenal allograft. To our knowledge, it is the first report of a simultaneous kidney and adrenal gland allotransplantation in a therapeutic intent. An adrenal gland allotransplantation is only justified when the adrenal insufficiency exists with an end stage organ failure requiring transplantation and therefore immunosuppressive drugs.

Vinyl chloride is a DNA-damaging carcinogen which induces liver angiosarcomas in humans and animals. Activation of the Ki-ras 2 gene by a GC--AT transition at the second base of codon 13 in human liver angiosarcomas associated with occupational exposure to vinyl chloride has been reported recently. In order to compare the molecular pathways of carcinogenesis in humans and animals, Sprague-Dawley rats were exposed to vinyl chloride and hepatic tumors, including two hepatocellular carcinomas and five liver angiosarcomas, were investigated for mutations at codons 12, 13 and 61 of the Ha-ras, Ki-ras and N-ras genes. High molecular weight DNA was amplified by the polymerase chain reaction and point mutations were analyzed by allele specific oligonucleotide hybridization, direct sequencing of polymerase chain reaction products and sequencing after cloning. None of the tumors exhibited a mutation in codons 12, 13 and 61 of the Ki-ras gene, nor in codons 12 of the Ha-ras gene or 61 of the N-ras gene. However, an activating AT--TA transversion at base 2 of codon 61 of the Ha-ras gene was detected in the two hepatocellular carcinomas. Mutations involving codon 13 (GGC--GAC) and codon 36 (ATA--CTA) of the N-ras A gene were detected in two liver angiosarcomas, suggesting that the nature of the ras gene affected by a given carcinogen depends on host factors specific to cell types. Several additional base pair substitutions were found in exon 1 of the N-ras B and C sequences. NIH 3T3 transfection assays and Southern blot analysis of DNA from transformed NIH 3T3 cells confirmed the presence of a dominant activated N-ras gene. These results emphasize the differences in the molecular pathways leading to tumors in humans and rats and within a given species between different cell types.

Epithelioid hemangioendothelioma (HEE) is an unusual malignant neoplasm of vasculo-endothelial origin, arising in soft tissues, lung and liver. One case of hepatic HEE is reported in a 32 year-old man wit an isolated multinodular hepatomegaly. The diagnosis was made by the histologic examination of biopsy specimens. At the time of diagnosis, there was evidence of pulmonary metastasis. However, an orthotopic liver transplantation was performed. The tumor cells were immunoreactive with factor VIII-related antigen, BNH9 and vimentin. There was no expression of cytokeratin and epithelial membrane antigen. The patient is alive and well 24 months after. The thoracic X-ray are unchanged. This case is compared with the 84 others cases of the literature. Fourteen experienced a favorable outcome after transplantation. Extra-hepatic dissemination doesn't contra-indicate the graft. But hilar vascular involvement may be correlated with worse prognosis.

Two mediastinal lymphangiomas (KLM) are described, in 36 and 41 year-old women. They presented as an incidental finding on chest radiograph. The mediastinal mass was anterior or posterior, compressing the adjacent vital structures, and cystic on computed tomography. The complete surgical removal was possible, but complicated by the size (12 x 7 x 4 cm and 10 x 7 x 5 cm), the hypervascularization and the infiltrative tendency of the lesions. The patients are well 36 and 30 months after removal. We compare these cases with 109 previously reported. They account for 1 p. 100 of the whole lymphangiomas and for 0.5 to 4.5% of all mediastinal tumours. The congenital or infantile cervico-mediastinal lymphangiomas are more frequent (10%). The general signs, symptoms, pathological findings, treatment and pathogenetic theories are discussed.

Three cases of intra-mandibular salivary tumors are presented. Two patients died (one with local recurrence, the other with metastasis). 69 cases have been reported in the literature. The lesions present as a progressive swelling of the mandible, with a frequent nervous involvement. The histologic diagnosis is difficult. Mucoepidermoid tumors are the more frequent (71%) but all salivary tumors can be found. An aggressive clinical behavior with local recurrences and/or metastasis (more than 30%) justify a radical treatment.

The phenotypic characteristics of 7 subependymal giant cell astrocytomas (GSECG) (6 of these being associated with tuberous sclerosis) are studied using morphological and immunohistochemical methods with antiserums against vimentine, glial fibrillary acid protein (GFA), S100 protein, and neurofilaments. The glycoproteic secretion of the tumor cells was also analyzed after exposure to Concanavalin A (CON A) by a direct fluorescent method. Our results suggest that some GSECG originate from specialized ependyma (circum-ventricular organs). They have the same location (foramen of Monro), present some common ultrastructural features (cytoplasm with lumen containing cilia), are positive with certain immunohistochemical markers (staining with S100 protein in 4 cases, with vimentin in 3 cases) and show a strong glycoproteic secretion (positive with CON A). Therefore, some GSECG might be considered hamartomas of specialized ependyma, with a reduced evolutivity potential.

Objectifs Evaluer la faisabilite et les complications de la biopsie hepatique par voie percutanee avec embolisation du trajet de ponction (PBHET) chez une population a risque hemorragique. Materiels et methodes Etude retrospective sur 134 PBHET sous controle echographique chez 116 patients (54 patients transplantes) classes en 4 groupes a faible (Gr.l = 23), moyen (Gr.2 = 59) et haut risque hemorragique (Gr.3 = 33) ou presentant des tumeurs hypervas-culaires (Gr.4 = 19). La longueur, la fragmentation et le nombre d’espaces portes ont ete analyses ainsi que les complications du geste. Resultats La qualite du prelevement a ete jugee bonne ou moyenne dans 86 %, de mauvaise qualite (3 a 5 espaces portes) dans 11,5 % ou inadequate (moins de 3 espaces portes) dans 2,5 %. La longueur moyenne du prelevement etait de 13 mm. Quatre complications severes ont ete rapportees : 1 hematome hepatique (conduisant au deces), 1 hemoperitoine et 2 hemothorax (groupes 3 et 4). Conclusion La PBHET est une technique simple, efficace et rapide pouvant dans la majorite des cas remplacer la PBH par voie transjugulaire.

The authors have developed an indirect immunofluorescence technique for histochemical detection of thyroglobulin and have tested it on 66 tissue sections. Fluorescence reflecting the presence of thyroglobulin was elicited in 57 samples of differentiated thyroid tissue, including healthy or hyperfunctional tissue and primary or metastatic papillary or follicular carcinomas. Thyroglobulin was found to be distributed heterogeneously between different areas and different cells. It may occupy the whole cell, the apex, the colloid substance and sometimes extracellular spaces. No fluorescence was present in non-thyroid tissues. This technique could be applied mainly to the diagnosis of thyroid carcinomas, where 25 metastases have been examined by this method, and to clear cell carcinomas. In these two cases, thyroglobulin appeared to be a good marker of tumoral tissue.

6 thyroid gland and 3 cervical lymph node clear-cells carcinomas are investigated by means of indirect immunofluorescence detection of thyroglobulin. Immunofluorescence was positive only in 1 case, which was a primitive thyroid carcinoma. In 7 other cases, its negativity pointed at the metastatic nature of the lesion, from a clear cell carcinoma of kidney (in 4 cases, nephrectomy was very remote, and in 3 cases, the renal lesion was discovered after our examination of the thyroid tumour). One observation showed negative staining reaction, and was a propagation of a parathyroid carcinoma to the thyroid gland. It is concluded that thyroglobulin can be used as an immunohistochemical marker to establish whether a clear cell cervical tumour originates from thyroid gland, or is a metastatic neoplasm.

The authors studied the innervation of the human lumbar spinal ligaments on cadaver or surgical specimens. In the ligaments annexed to the neural arch and in the posterior longitudinal ligament were found free-ending fibers and amyelinic perivascular fibers. In the anterior longitudinal ligament, coexisting with perivascular fibers were found encapsulated corpuscular formations on the ventrolateral aspect of the junction between the intervertebral disc and vertebral body. These findings comfort the role of the anterior longitudinal ligament in proprioception essential both in static and dynamic function of the spine.

A case of intra medullary ganglioglioma is reported in a 25 year old woman, who had presented an acute poliomyelitis when she was 2 years old. Since 7 years, new neurological signs occurred with spastic paraplegia, sensitive and sphincter disturbances. Cervical and lumbar myelography showed an intra medullary tumor, extending from C2-C3 to T7-T8. Macroscopically, the lesion was well circumscribed, except on the cervico-dorsal junction where it engulfed the anterior spinal artery. Histologically, the tumor was a ganglioglioma, grade I. Two years after surgery, the patient remains paraplegic. This case is compared with the 13 other cases of the literature.

A case of lumbar epiduro-vertebral actinomycosis is related, in a 45 years old man, who was immuno depressed by an evolutive pulmonary sarcoidosis. 72 similar cases are reported in the literature. 50 of them are autopsied++. Clinically our patient looked like a Pott disease. The infection began probably in the kidney. The smear's diagnosis was actinomycosis, confirmed by the routine examination. An atypical mycobacteria, Mycobacterium xenopi was bacteriologically isolated twice in the pus. It was considered as the pathogen agent for 14 months. Actinomycosis was never identified bacteriologically. The patient responded to surgery and penicillin therapy. In view of the pathologic constatations and the therapeutic response, the final diagnostic was epiduro-vertebral actinomycosis. Mycobacterium xenopi acted probably as an "accompaning " germ in this case.

Antibodies raised against glial fibrillary acidic protein (GFA), S-100 protein (S100) and glutamine synthetase (GS) are currently used as glial markers. The distribution of GFA, S100 and GS in the ependyma of the rat subcommissural organ (SCO), as well as in the adjacent nonspecialized ventricular ependyma and neuropil of the periaqueductal grey matter, was studied by use of the immunocytochemical peroxidase-antiperoxidase technique. In the neuropil, GFA, S100 and GS were found in glial elements, i.e., in fibrous (GFA, S100) and protoplasmic astrocytes (S100, GS). The presence of S100 in the majority of the ventricular ependymal cells and tanycytes, and the presence of GFA in a limited number of ventricular ependymal cells and tanycytes confirm the glial nature of these cells. The absence of S100, GFA and GS from the ependymocytes of the SCO, which are considered to be modified ependymal cells, suggests either a non-astrocytic lineage of these cells or an extreme specialization of the SCO-cells as glycoprotein-synthesizing and secreting elements, a process that may have led to the disappearance of the glial markers.

Orthotopic liver transplantation (OLT) for liver cirrhosis in the presence of hepatocellular carcinoma (HCC) is based on tumour number and size. The high incidence of undetected HCC before OLT has been reported previously. The object of this work to report the results of OLT for liver cirrhosis in the presence of incidental and/or undetected HCC and tumour characteristics. From 1985 to 1996, 334 patients received OLT. Two groups of patients were studied; group 1 (G1) where HCC was diagnosed on radiological examination before OLT (n = 13, mean age 53.8 +/- 8.1 years), and group 2 (G2), where HCC was diagnosed on pathological review (n = 13, mean age 53.3 +/- 6.1 years). Indications for OLT were (G1/G2) hepatitis C = 6/8, hepatitis B = 5/2, alcoholic = 2/3. There was no statistically significant difference in alpha-foetoprotein levels between both groups. Pathological review showed 26 and 30 HCC with a mean size of 1.6 +/- 0.8 and 1.6 +/- 1.2 cm (P0.05) in G1 and G2, respectively. Tumour stagings were (G1/G2) stage I = 6/2, stage II = 4/6, stage III = 2/3, stage IVa = 1/2. We had two (G2) hospital and three (G1) later mortalities; none had HCC recurrence. The other patients are alive and recurrence free. Reinforced immunosuppression related to acute or chronic rejection treatment was not associated with HCC recurrence. The 5-year actuarial survival rates were 76% for G1 and 85% for G2 (P0.05). Our study revealed that long-term survival can be achieved with liver transplantation in the presence of HCC in carefully selected patients.