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Resume Propos Description clinique de patients presentant un lymphome associe a des manifestations renales. Methodes Nous avons identifie les cas de lymphomes accompagnes de manifestations renales, avec documentation histologique renale, pris en charge sur le CHU de Bordeaux entre 1996 et 2004. Resultats Nous rapportons une serie de quatre observations. Il s'agit de quatre patients ayant presente un lymphome non hodgkinien B. L'atteinte renale s'est manifestee initialement par un syndrome nephrotique chez deux patients et par une atteinte tumorale renale dans deux cas. L'histologie renale a permis le diagnostic de lymphome chez trois patients. Conclusion L'atteinte renale au cours des lymphomes peut correspondre a une atteinte directe par la proliferation maligne ou aux consequences immunologiques du processus lymphomateux. Certaines formes histologiques particulieres telles que le lymphome intravasculaire et le lymphome primitif renal sont a l'origine de difficultes diagnostiques.

Resume Introduction Le xanthome verruciforme est une lesion rare, principalement muqueuse meme si des localisations cutanees ont ete rapportees. Cette tumeur est classiquement unique et survient en general en l’absence de pathologie concomitante. Des facteurs declenchants ou favorisants ont cependant ete decrits comme une immunodepression sous-jacente ou une dermatose inflammatoire associee. Nous rapportons la premiere observation, a notre connaissance, de xanthomes verruciformes multiples buccaux chez un malade suivi pour une maladie du greffon contre l’hote avec localisations orales. Observation Un homme de 57 ans etait traite depuis 8 ans pour une leucemie myeloide chronique, ayant necessite une allogreffe de moelle. Si le malade etait considere en remission complete depuis 7 ans pour son hemopathie, il avait une maladie du greffon contre l’hote avec localisations cutanees et buccales (atteinte lichenoide, ulcerations) requerant un traitement immunosuppresseur au long cours. Dans ce contexte, deux lesions gingivales superieures apparaissaient progressivement, d’aspect verruqueux et jaunâtre. Les examens histologiques et immunohistochimiques confirmaient le diagnostic de xanthomes verruciformes multiples. Discussion La survenue chez ce malade d’une double localisation de cette tumeur rare n’est probablement pas fortuite. L’immunodepression sous-jacente associee a des lesions inflammatoires buccales chroniques sont certainement impliquees dans la pathogenese de ces deux xanthomes verruciformes, par exemple par irritation locale chronique des cellules epitheliales et/ou depletion associee en cellules de Langerhans. La recherche systematique de facteurs favorisants apparait utile lors du diagnostic de xanthome verruciforme.

A 58-year-old man presented with fever and a rapidly progressive glomerulonephritis. An infective endocarditis due to Streptococcus parasanguis was diagnosed. A renal biopsy revealed type III pauci-immune crescentic glomerulonephritis. As first-line therapy, antibiotics were administered alone. Faced to the unsuccessful anti-infective approach, corticosteroid therapy was added as a second-line therapy. Finally, plasmapheresis introduced as the third-line therapy, significantly improved renal function. This case is an original type III rapidly progressive glomerulonephritis, since ANCA were repeatedly found negative. In very few cases, plasmapheresis was successfully used for the treatment of infective endocarditis-induced crescentic glomerulonephritis. The pathophysiology and the potential efficiency of plasmapheresis are discussed.

Resume Introduction La survenue de tumeurs plasmocytaires chez les patients de moins de 40 ans etait rare avant l'infection a VIH. Moins frequentes que le lymphome, il existe cependant une augmentation d'incidence de ces maladies chez les patients seropositifs. Sur ce terrain, outre l'âge de survenue plus jeune, la presentation clinique est differente avec une grande frequence de plasmocytomes extramedullaires dont les localisations peuvent etre surprenantes. Ex'egese Nous rapportons ainsi le cas d'une patiente de 29 ans infectee par le VIH chez laquelle ont ete diagnostique des plasmocytomes occipitaux, parotidiens, sphenoidaux, epiduraux et uterins pour lesquels un traitement par chimiotherapie (trois cures de VAD) et une radiotherapie epidurale ont permis d'obtenir une bonne reponse. L'augmentation de l'incidence des tumeurs plasmocytaires chez les patients infectes par le VIH pourrait etre favorisee par la coinfection par le virus d'Epstein-Barr, la stimulation antigenique chronique due au VIH, la secretion d'interleukine 6 par les lymphocytes infectes. Conclusion Les tumeurs plasmocytaires font partie de la liste des neoplasies dont l'incidence est favorisee par le VIH; leur pronostic actuellement mediocre devrait s'ameliorer grâce a l'apport des traitements antiretroviraux hautement actifs autorisant une intensification chimiotherapique avec eventuelle autogreffe.

An unusual case of acinic cell tumour of the vallecula is presented. Acinic cell carcinoma occurs usually in the major salivary glands. Minor salivary gland location is unusual and vallecular origin exceptional. This peculiar histologic tumour should now be classified as an low grade carcinoma and adequate treatment has to be initiated. The patient, a 9-year-old girl, had undergone a suprahyoid access for total tumor removal with a bilateral neck exploration. Postsurgical radiotherapy has to be done in case with perineural invasion, invaded margins, node invasion or high grade tumor. The clinical and histopathological findings are discussed in the light of the literature.

Resume Le syndrome de Kikuchi-Fujimoto est une lymphadenite histiocytaire necrosante qui s'observe a tous les âges, mais preferentiellement chez l'adulte jeune. Le sex-ratio est de 4: 1 en faveur de la femme. Il se traduit cliniquement par des adenopathies principalement cervicales dans un contexte febrile et d'asthenie. Il existe parfois une leucopenie transitoire et un syndrome inflammatoire modere. L'evolution est favorable spontanement en 1 a 3 mois mais des rechutes sont possibles. L'histologie ganglionnaire peut etre confondue avec celle d'un lymphome malin d'ou l'interet des immunomarquages (anticorps anti-Ki-MIP ou KP1). L'etiologie est inconnue mais une origine infectieuse a ete suspectee (toxoplasmose, virus d'Epstein-Barr). Son association avec un lupus a deja ete decrite, faisant ainsi discuter la physiopathologie de ce syndrome. Nous rapportons deux nouveaux cas de syndrome de Kikuchi dont un est probablement secondaire a une primo-infection a EBV et l'autre associe a un lupus.

The primary angiosarcoma of the kidney is a rare tumor. We report a case of angiosarcoma of the right kidney in a man of 60 years. The CT-scan appearance is the one of a solid tumor compatible with renal cell carcinoma. Histological examination of the piece of nephrectomy straightens diagnosis and reveals the angiosarcomatous nature. In this patient with bone and lung synchronous metastasis, evolution has been a lightning death in less than three months. The literature review confirms the high potential of malignancy of these tumors (metastases almost constant and very short survival in spite of local and systemic treatment).

Analysing periprostatic tissue (PPT) thickness after retropubic (RP) or laparoscopic (LP) prostatectomy.From January to December 2007, 114 consecutives prostatectomies were performed in our institution (38 RP, 76 LP). Clinical data were prospectively collected in a database. Gardner et al.'s (1988) procedure was used for pathological analysis. PPT thickness was measured on pathological specimens by a single observer on a single microscope. The observer had no knowledge of either clinical data or surgical approach. Four levels were chosen (at the base, the proximal part, the distal part, the apex) and 12 standardized measures were performed on each level, 48 measures: a prostate. We compared PPT thickness and surgical margins according to surgical approach and clinical data.Comparative analysis confirmed that LP and RP groups were similar as far as it concerns preoperative and pathological findings. Positive margin rate was also similar in LP and RP groups (4% versus 5.3%; P=0,37). Overall PPT thickness was thinner after LP than after RP except at the apex and the anterior face. Nevertheless, in the "complete preservation" group, PPT thickness was thinner at the apex in the RP group, thinner at the base in the LP group.Measuring PPT thickness was an original objective and reproducible way to compare different techniques and new technologies for radical prostatectomy. PPT sparing was different but not better with the laparoscopic approach.

Immunohistochemistry evaluation of the expression of degeneration and proliferation markers of the benign form of Schneiderian inverted papillomas in the ORL sphere, in the nondysplastic, dysplastic and degenerated forms. Seeking out an expression profile with a prognostic value.44 surgical specimens were analyzed in two groups: A= 33 benign and B= 11 degenerated. Group A included: 10 dysplastic lesions, 4 septal lesions and 2 isolated sphenoidal lesions. A simultaneous bipolar localization belonged to the two groups (nasal, benign and otologic malignant). A control group consisted often biopsies of healthy mucous membranes harvested during septoplasties. The carcinoembryonic antigen (CEA), the ulex europaeus agglutinin I (UEA-I) and the monoclonal antibody Ki-67 were revealed by immunoreaction with peroxidase and enhanced by streptavidine-biotine.There was a significant difference in the marking of the CEA between the control group and groups A (p0.023) and B (p0.045). This expression was fulfilled only in the superficial layers in 84.1% of cases. There was no difference in expression between groups A and B, the dysplastic and non-dysplastic inverted papillomas and between the various degrees of dysplasias. There was no significant statistical difference in expression of UEA-I between all the groups and the sub-groups. The expression of Ki-67 was significantly increased in groups A (p0.00023) and B (p0.05) when compared to the control group. But, no difference existed between groups A and B, the various sub-groups and the benign specific localizations. This expression was present in the basal cells. An expression encompassing all the thickness of the epithelium was generally associated with a degenerated or dysplastic lesion, without being systematic.It was not possible using this specimen and for these three glycoproteins to extricate immunohistochemistry profiles of expression associated to the studied clinical and histological forms. However the expression of Ki-67 in more than 50% of the cells involving the full epithelium thickness would seem to suggest a particular cellular behavior Whereas the expression of the protein remains generally confined to the basal and suprabasal layers, a more significant population of Ki-67+ cells disseminated in the epithelium, would signify a tendency of the epithelium to escape the regulation mechanisms. This cellular behavior could constitute a prognostic histological marker but it would require a broader study to be confirmed.

ANCA; immune complex-mediated glom- At admission, she presented with bilateral pretibialerulonephritis; infectious diseases; shunt nephritis oedema and a pattern of anaemia. Her temperaturewas normal. Blood pressure was 150/80 mmHg.Clinical examination showed no neurologic, cardiac,pulmonary or cutaneous abnormalities. Laboratory

Most cancers of the oral cavity are epidermoid carcinomas. The prognosis is made on the patient's general health status and the tumoral stage. The UICC TNM staging classification system is one of the most important factors taken in consideration for the prognosis. But this classification in oral epidermoid carcinomas does not include the tumor thickness (except for T4 tumors). Several studies demonstrated that tumor thickness could influence the prognosis in epidermoid carcinoma and other types of cancers. The aim of our retrospective study was to assess the prognostic value of tumor thickness in oral epidermoid carcinoma.The study included patients with mouth floor or mobile tongue epidermoid carcinoma classified T1N0, T2N0 and T3N0 between 1985 and 2005. All patients were treated with a curative intention. A pathologist analysed the tumor thickness and cervical lymph nodes. All the slides were examined to measure tumor thickness in millimetres.Three hundred and five patient files were reviewed and 124 patients were included, with 94 men (75.8%), and a mean age of 59.3 years (17-93). The mean and median tumor thickness were respectively 7.7 and 6.5 mm (0.4-30). The median tumor thickness was chosen for the study. There was a statistically significant link between the five-year probability of global survival and the initial tumor thickness and between neck node invasion and tumor thickness (p0.05).This study suggests that tumor thickness should be taken in consideration in T1N0, T2N0 and T3N0 mouth floor and mobile tongue epidermoid carcinomas. In the future, the clinical evaluation of tumor thickness will help determine the therapeutic management.

Lambert-Eaton Myasthenic Syndrome (LEMS) is an autoimmune channelopathy in which patients produce autoantibodies directed against voltage-gated calcium channels. LEMS is paraneoplastic in 50% of patients, most frequently associated with small cell lung carcinoma. We describe a case of paraneoplastic LEMS associated with a vocal cord carcinoma.A 64-year-old man developed in five months muscle weakness affecting gait. Clinical examination showed proximal muscular deficiency, areflexia and dysphonia. Electrophysiologic study showed potentiation greater than 500% after post exercise facilitation and 76 percent increment response at high-rate repetitive nerve stimulation (20Hz). Diagnosis of LEMS was confirmed by electrophysiologic study and anti-voltage gated calcium channel antibodies (90pM, positive value greater or equal to 70pM). Left vocal cord lesion histology showed epidermoid carcinoma. A combination of vocal cord tumor removal by endoscopy and treatment by pyridostigmine, 3-4 diaminopyridine and intravenous human immunoglobulin improved neurological symptoms.Paraneoplastic syndromes in association with cancers of the larynx and hypopharynx are unusual. Only two cases are reported with LEMS associated with larynx carcinoma. We describe an unusual case of LEMS associated with a left vocal cord carcinoma.

Verruciform xanthoma is an uncommon lesion that occurs primarily on the mucous membranes and more rarely on the skin. A few authors have reported the extremely rare occurrence of multiple lesions. Triggering or enhancing factors have been occasionally described such as an underlying immunosuppression or associated inflammatory mucous or skin diseases. We report, to the best of our knowledge, the first case report of multiple verruciform xanthomas of the oral mucosa in a patient with graft-versus-host disease with specific oral lesions.A 57 year-old man presented with an 8-year history of chronic myeloid leukemia. He was considered in complete remission for leukemia after allogenic bone marrow transplantation. Nevertheless, he was still treated with immunosuppressive drugs for oral and cutaneous lesions of chronic graft-versus-host disease. In this context, the patient presented two symmetric lesions of the gingiva. These lesions had progressed over several months. The clinical presentation was similar, with a yellowish and verrucous aspect and a sessile base. Histologic and immunohistochemical analysis led to the diagnosis of multiple verruciform xanthomas.The occurrence of multiple lesions of this rare tumour in our patient was probably not fortuitous. Immunosuppression associated with oral chronic inflammatory lesions are certainly involved in the pathogenesis of these two verruciform xanthomas, for example following degeneration of epithelial cells after local chronic irritation and/or reduction of Langerhans cells. Systematic research of enhancing or triggering factors seems essential in verruciform xanthoma.

To present a comprehensive description of the clinical features of patients with renal manifestations during lymphoma.Retrospective review of medical records from all patients diagnosed with lymphoma associated with kidney involvement in our hospital between 1996 to 2004. Four cases were identified and analysed.Four patients presented a non-Hodgkin's lymphoma. One patient showed intravascular large B-cell lymphoma, revealed by proteinuria. Another patient had a nephrotic syndrome, and two had a renal mass. Renal histology allowed diagnosis of lymphoma in 3 cases.The diagnosis of lymphoma associated with renal involvement is rather difficult, and more specifically in case of intravascular large B-cell lymphoma, or even primary renal lymphoma. We present here a comprehensive review of the literature and we discuss pathogenesis of these conditions.

A significant number of patients with small renal tumours may get benefit from in situ thermo‐ablation techniques. Focused ultrasound is a non‐invasive approach which offers excellent flexibility. On the other hand, real time MR thermometry is a valuable tool for monitoring and controlling therapy. In this study, coupling of focused ultrasound with PRF‐based, respiratory‐gated MR thermometry was used to provide temperature feedback control for local hyperthermia in the rabbit kidney. Two heating protocols were initially used in healthy kidneys (medulla and cortex): 1. fixed focal point heating; 2. spiral trajectories of the focal point. Further, five VX2 renal carcinomas were treated with multiple focal point heating in each tumour. Post‐treatment MRI follow up and post mortem histology were performed. The shape and size of the lesions (MRI, histology) were compared to the calculated thermal dose map. The standard deviation of the MR thermometry ranged from 0.5°C to 1°C. The temperature controller matched the objective curve with approximately 1°C precision (fixed focal point mode). Several technical and physiological difficulties for spiral heating could not be overcome with the available setup. Thermal ablation with temperature feedback control in healthy and tumour bearing kidney was demonstrated to be feasible and effective, despite specific challenges (deep seated organ, respiratory motion, high blood perfusion).

The aim of this study was to analyze the status of patients with a successful long-term (or =20 yr) kidney graft. Nineteen (8.1%) of the 234 recipients who received a cadaveric kidney transplant between 1968 and 1978 in our center are still alive 21.7+/-1.6 yr (mean+/-standard error of the mean) later with a functioning allograft. Function, including measurement of the renal functional reserve (RFR), histological status, and morbidity were evaluated. Fourteen patients agreed to participate in this study. Their current immunosuppressive regimens combined prednisone (P)+azathioprine (AZA) (n=9), P+AZA+cyclosporine (CsA) (n=3) or P+CsA (n=2). Although they described their quality of life as good, 10 patients had mild hypertension, 5 developed 10 malignancies (9 cutaneous), 5 had replicative hepatitis, 8 had osteopenia, and 6 had cataracts, but none had diabetes mellitus. Proteinuria was detected in 6 patients, but was always less than 1 g/d. Mean serum creatinine was 1.28+/-0.28 mg/dL and glomerular filtration rate was 54.5+/-5.3 mL/min/1.73 m2. RFR was present for 4 patients with a mean value of +14.8+/-1.9 mL/min. Their functional status was not correlated with the histological lesions observed in concomitant transplant biopsies. Kidney grafts are able to function well even more than 20 yr post-transplantation, with some having a RFR whose significance remains unknown. Morbidity is of minor clinical severity, but could be further reduced with optimized management. Moreover, transplantation is much less costly than hemodialysis.

Acute renal failure can be induced by intravenous administration of immunoglobulins, especially in patients with a predisposition for nephrotoxicity. The onset and resolution of acute renal failure is typically rapid, but in some cases hemodialysis may be needed.We present 2 cases of acute renal failure associated with intravenous immunoglobulin therapy: a 76-year-old man with a history of non-insulin-dependent diabetes mellitus and hypertension and a 77-year-old woman using nonsteroidal antiinflammatory drugs.Intravenous immunoglobulins must be used with precaution in patients with risk factors for acute renal failure. In such patients, renal failure may be avoided by using preparations without sucrose.

The authors report an extremely rare case: a bony giant cell tumour in the temporo-sphenoidal region presenting with hearing loss and vertigo. The main characteristics of these tumours are given, together with a literature review. This is the 5th published case of this tumour in the temporo-sphenoidal region. The treatment of these tumours is essentially surgical, and the authors emphasise the use of Sekhar's approach.

The Kikuchi-Fujimoto's syndrome is an histiocytic necrotizing lymphadenitis which is observed at any ages but preferentially among young adults. The sex ratio is about 4:1 in favour of women. It is clinically characterized by cervical lymph nodes in a context of fever and asthenia. Sometimes, there is transitory leucopenia and an increase of the erythrocyte sedimentation rate. The course of the disease is spontaneously favourable in 1 or 3 months but recurrence is possible. The histology of the lymph node could mimic a malignant lymphoma and the immunohistochemical findings are of a great importance (Ki-M1P or KP1 antibody). The etiology remains unknown but some infectious diseases have been suspected (toxoplamosis, Epstein-Barr virus). Its association with a systemic lupus erythematous had been described and this set the problem of its physiopathology. We report two new cases of Kikuchi-Fujimoto's syndrome which one was attributed to Epstein-Barr virus primo-infection and the other associated with a systemic lupus erythematous.

La Fibrose Retroperitoneale (FR) est une maladie rare, caracterisee par la presence d’une masse fibreuse et inflammatoire engainant les structures retroperitoneales (ureteres, aorte, veine cave). L’origine est secondaire (medicamenteuse, auto-immune, tumorale : neuroblastome, lymphome…) dans la moitie des cas. Nous rapportons le cas d’un patient de 19 ans qui, un an apres traitement chirurgical d’un volumineux neuroblastome localise surrenalien sans amplification de N-Myc, presente des douleurs lombaires et une insuffisance renale obstructive. Les examens d’imagerie montrent une compression extrinseque de l’uretere par une masse englobant la terminaison aortique, des adenopathies, et une hyperactivite metabolique sur le Pet-Scan. Il n’y a pas de signe de recidive du neuroblastome sur les examens specifiques. Une biopsie chirurgicale et la pose d’une sonde JJ sont realisees. L’examen histologique montre un tissu fibreux. Une corticotherapie est instituee pour les 3 premiers mois, associee a une surveillance des signes de recidive tumorale. La FR est une complication rare mais decrite des neuroblastomes. Le pronostic est vasculo-renal. Ceci peut justifier un traitement medical immunosuppresseur et/ou chirurgical (ureterolyse).

The authors report the case of an 81 year old woman with a Merkel cell tumor (trabecular carcinoma, cutaneous neuroendocrine carcinoma). A review of the literature is used to recall the principal clinical and pathological characteristics of this rare tumor and to define treatment modalities.

Parotidean localization of acute necrotizing sialometaplasia is exceptional. Based on one observation, the authors evoke the diagnostic and physiopathological problems raised by this localization. The association of facial paralysis and a parotidean tumor make the case presented interesting, leading to exploratory surgery which can alone provide a diagnosis.

Objectifs Delivrer le gene rapporteur luciferase (Luc) sous controle du promoteur thermo-inductible humain Hsp70B dans le rein du rat via un vecteur cellulaire. Activer et controler in vivo son expression locale. Materiels et methodes Huit rats ont beneficie d’une injection intra-arterielle renale de cellules gliales C6 genetiquement modifiees presentant le transgene Hsp70B-Luc. Quarante-huit heures apres l’injection, une hyperthermie locale renale etait realisee in vivo par ultrasons focalises controles par IRM (IRM-FUS) selon differents parametres de chauffage. L’activite Luc intra-renale etait recherchee en imagerie de bioluminescence (BLI) 6h apres le chauffage et le signal quantifie par le rapport d’intensites entre region chauffee et region non chauffee. Les reins etaient preleves 48h apres chauffage. Resultats Treize foyers renaux ont ete chauffes et analyses. L’etude histologique a revele 7 zones de necroses limitees ( = 2 mm) et 1 etendue ( > 2 mm). L’expression genique a pu etre detectee et quantifiee dans 9/13 cas, avec un rapport optimal entre niveau d’expression et innocuite pour un protocole de chauffage de 45° pendant 2 min. Conclusion La delivrance et le ciblage intra-renal du transgene via un vecteur cellulaire, son activation par hyperthermie moderee et controlee induite par IRM-FUS, et son suivi en BLI ont ete possibles in vivo dans notre etude.

A preparation of cyclosporine A (CsA) in small liposomes (300 nm) was tested in a rat model of heterotopic cardiac allograft. At a daily dose of 1,5 mg/kg during 14 days, the graft survival rate was 30.4 +/- 2.8 days with a liposome-CsA solution versus 16 +/- 2.3 days with a Cremophore-CsA solution (p less than 0.01). Animals treated with the liposome-CsA preparation exhibited less weight loss than animals treated with cremophore-CsA solution (p less than 0.01). It is likely that the up-take of CsA by macrophages, when incapsulated into liposomes is dramatically enhanced; these cells have been pointed out at targets for IL2 inhibition by CsA.

We report on a cryoglobulinemia revealed in a 73 year old woman by lower limb ischemia, livedo reticularis and end stage renal disease simulating cholesterol embol disease. The diagnosis was made on post-mortem features.

Essential mixed cryoglobulinemia, which can cause hypersensitivity vasculitis, was observed in five patients with peripheral neuropathy. Three cases presented with multifocal neuropathies and two cases with symmetrical polyneuropathy. One had cryoglobulinemia with IgM monoclonal gammopathy and IgG polyclonal gammopathy, and the other four had cryoglobulinemia with polyclonal gammopathy. Biopsies showed perivascular infiltration by mononuclaer cells around medium, and mainly small-sized blood vessels. This was observed in the epineurium (five cases) and muscular fragments (three cases). At ultrastructural examination two cases showed severe damage of most myelinated fibers, which presented acute stages of Wallerian-like degeneration, and the three other cases showed a less widespread destruction of myelinated fibers. Most endoneurial capillaries showed swollen endoneurial cells. Myelino-axonal degeneration of myelinated fibers is probably due mainly to the vasculitis always present in the epineurium. This damage was probably worsened by the modifications of endoneurial capillaries. These lesions and their mechanisms are quite different from those observed in cases of cryoglobulinemia with an isolated monoclonal gammopathy.

Summary When inoculated by the intranasal route with Paramyxovirus Yucaipa, the guinea-pig (Cavia porcellus) (1) produced infectious virus in the nasal specimens, (2) exhibited tracheitis, as well as bronchitis and pneumonia, as shown by anatomopathological observation, and (3) elaborated virusspecific antibodies. We thus concluded that the guinea-pig is susceptible to Paramyxovirus Yucaipa.

Seven years after a cadaver kidney transplantation a 33-year-old man presented with a monoclonal gammopathy secondarily complicated by AL amyloidosis mainly expressed as a sicca syndrome, gammopathy that ultimately developed into multiple myeloma. The mechanisms responsible for the occurrence of monoclonal gammopathy in renal transplant recipients are discussed.

Based on five observations of primary mucosal melanomas recently treated in the department, the authors describe the main features of this very rare condition, and particularly the evolutive aspects in diagnosis and prognosis. Histological diagnosis is sometimes difficult, and must involve specific argentic staining and a search for the presence of the protein S100. Tumor thickness was systematically examined. No prognostic interpretation, however, is possible, given the small number of cases in the series. Evolution is unpredictable; there is very commonly a series of local recurrences which may be well controlled, followed by remote metastases remaining long quiescent, bypassing the cervical ganglion relay. Treatment is surgical whenever possible, with palliative radiotherapy for local recurrences and chemotherapy for metastatic forms. Other therapies have yet to prove their effectiveness.

A 54 year old man with a history of resistant asthma presented with a multiple neuritis of subacute onset and hypereosinophilia. Histology showed necrotizing vasculitis with multinucleated giant cells compatible with Churg and Strauss' syndrome. Ultrastructural examination of nerves and immunopathological tests showed anti IgG serum fixing deposits in the arterial wall. Recovery was complete after corticoid therapy for 20 months. Literature on the Churg and Strauss' syndrome is reviewed and possible clinical, biologic, histopathologic, and physiopathologic relations between allergic granulomatous angiitis and panarteritis nodosa are discussed.

Analysis of this series of cases reveals the following points: complementary investigations (computed tomography, magnetic resonance imaging) sometimes suggest the diagnosis, the oncocytic nature is often a surprise pathological finding, it is difficult to determine whether the lesion is a pure oncocytoma and the exact grade cannot be determined on frozen section, the choice between radical surgery and conservative surgery is made even more difficult, the study of the course of the disease raises the question of whether the term of oncocytoma should not be reserved to low grade tumours.