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Les adenocarcinomes de l’intestin grele sont des tumeurs rares qui surviennent le plus souvent sur un terrain favorisant tel que la polypose de Peutz-Jeghers, la maladie cœliaque ou la maladie de Crohn. Les signes fonctionnels d’appel sont aspecifiques a type de douleurs, alteration de l’etat general, syndrome occlusif ou hemorragie digestive. Le transit baryte de l’intestin grele est le plus souvent pathologique.

Hamartomas are non-malignant malformations or inborn errors of tissue development. In the head and neck region, especially in the nasal cavity and the ethmoid sinuses, they are relatively rare.A case of respiratory epithelial adenomatoid hamartoma of the ethmoid sinus and a review of literature are reported in order to describe the diagnostic and therapeutic management of this tumour.A 74-year-old man complaining for unilateral nasal obstruction for years was referred to our institution. Clinical and radiological studies revealed a large intra-nasal tumour, osteolytic in nature, arising from the right ethmoidal sinus. Fifteen months after a complete excision of the tumour using an endoscopic procedure, the nasal cavity was free of tumour.Very rare and classified as non-malignant tumours, hamartomas are composed of excessive proliferation of one or more cellular components specific to a given tissue. They can grow out of any part of the body for example the surface epithelium, seromucous glands and vessels. Hamartomas commonly originate from the lung, kidney and intestine. Their localisation in the nasal cavity, especially in the ethmoid sinus, is unusual, but it is really important to be known to distinguish hamartomas from papillomas and adenocarcinomas not to perform useless and destructive surgery.

AimTo assess the effect of laparoscopy on circulating tumor cell (CTC) detection in case of carcinosis.Material and methodsWe compared laparoscopy versus laparotomy on tumor cell blood release in an animal model of ovarian carcinosis obtained by intraperitoneal inoculation of IGR-OV1 cells in nude rats. Animals were randomly assigned to one of the following groups: CO2 laparoscopy (L), gasless laparoscopy (GL), midline laparotomy (ML), or general anesthesia as control (C). A 0.5 ml blood sample was taken in each case before and after experiment and tested with a novel assay, ISET (isolation by size of epithelial tumor cells), which isolates CTC by filtration on account of their size. Statistics were performed with the Fisher's and the Chi-square tests.ResultsTen rats were included in each group. We did not find any significant difference in CTC prevalence before and after surgery (2/14 versus 3/19, respectively, P = 1). Similarly, the three surgical accesses were equivalent with one postexperiment detection per group: 1/5 for L, 1/7 for ML, 1/7 for GL, and 1/6 for C (P = 0.9).ConclusionThis trial did not show any deleterious effect of laparoscopy on CTC when compared to laparotomy.

Sebaceous carcinoma is a rare tumor, from the adnexal epithélium of the sebaceous glands. Usually, lesions arise in meibonian glands of the eyelid. However, extraocular lesions within head and neck have been reported. We report a case of recurrent sebaceous carcinoma of the parotid gland without metastases.

The histological examination of the salivary gland tumors is a very important step in the diagnostic approach of the lesions, on which depends the success of therapeutic outcome. Some surprises may occur; four examples were reported. In one case the lesion was not a tumor but a tuberculous lymphadenitis; another showed a Destombes Rosai Dorfman syndrome. Two other cases were found to be unusual tumors: a carcinosarcoma of the submandibular gland and a metastasis of a Merkel carcinoma in the submandibular gland.

This retrospective pathological study, based on twenty-nine glomus tumors, was conducted in order to define the histological or immunohistochemical diagnostic criteria in cases with atypical morphology. The immunohistochemical phenotype of glomus tumors was defined by means of identification of glomus cells, vessels and associated nerve fibres.

Among a series of 520 parotidectomies performed between 1975 and 1995, we observed 88 cases of malignancy (17%). For this study, we excluded skin cancers which had invaded the parotid and glandular metastases of squamous cell carcinoma, malignant melanoma or kidney cancers, retaining only tumors with a glandular origin and lymphomas. Thus defined, our series comprised 60 patients, i.e. 12% of the operated parodids (31 confirmed cancers, 18 tumors with intermediary malignancy, including several in which the pathology report confirmed malignancy, and 11 lymphomas). We examined therapeutic management by histology and compared the outcomes. Relation with the facial nerve are discussed. Prognosis depends on histology, tumor stage and treatment.

Three patients with typical histological signs of arrhythmogenic right ventricular dysplasia progressed to fulminating heart failure in 1 case and unexplained sudden death in the other two. There were signs of superacute myocarditis in the first case, previous healed pericarditis in the second and chronic myocarditis in the third case. These cases suggested the presence of an inflammatory process complicating the substrate of the dysplasia. Arrhythmogenic right ventricular dysplasia seems to be a developmental defect which is complicated in 50 to 70% of patients, according to a review of 74 cases reported in the literature, by a varying degree of myocarditis suggesting particular susceptibility of these patients to infection and explaining the presence of unusual amounts of fibrous tissue in some and the so called "progressive" nature of the disease in other patients.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends on the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

Modified subcutaneous mastectomy was described by one of us in 1968; its approach, the dissection of the gland, plastic reconstruction of shape and volume are completely different from the subcutaneous mastectomy performed by plastic surgeons. 3 different time periods were studied to explain clearly evolution in the technic and indications. During many years retrospective studies made it possible to build a procedure according to the new diagnostic means for infraclinical breast cancer and to the constant improving prosthetic material. Therefore our indications for modified subcutaneous mastectomy are as following: suspicious mastopathies are the best indications with a performing choice of the radiologic images which require histologic control some evolutive or evoluated mastopathies some small infiltrating tumors developing in a highly dystrophic glandular surrounding. The numerous in situ cancers accompanying them argue for this choice. some big phyllod tumors or phyllod's recurrences.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends of the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial histological diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

Pelvic actinomycosis is uncommon and usually represents a complication of an intrauterine device (IUD). This organism is very difficult to culture, and most actinomyces is actually identified by histologic features in pathologic specimens or by cytologic features on Papanicolaou smears. A specific fluorescent antibody stain is also available. Tubo ovarian abscess is usually polymicrobial with a preponderance of anaerobic organisms and the exact role of actinomyces in abscess formation remains unclear.The case is described of a 43-year-old women who developed tubo-ovarian actinomycosis while using an IUD. The patient was hospitalized with right abdominal pain and fever. She had a history of appendectomy and right pulmonary lobectomy for tuberculosis. A pelvic mass about 8 cm in diameter was observed on examination. Emergency laparoscopy and laparotomy were performed. In the course of the laparotomy a voluminous, very irregular, necrotic ovarian tumor was observed. The contralateral tube was highly inflamed and had numerous adhesions. An annexectomy was performed, and the diagnosis of tubo-ovarian abscess was made during histological examination. The woman was placed on antibiotic therapy with penicillin, gentalline, and flagyl, and the postoperative course was uneventful. Bacteriological examination of the IUD showed a group of streptococci, rare colonies of a staphylococcus, and absence of strict anaerobic germs. Macroscopic examination showed the ovary to be almost destroyed by yellowish necrotic masses. The tube was swollen. Actinomycosis is a rare cause of tubo-ovarian abscess and usually is found in women using IUDs. 80% of cases of pelvic actinomycosis in IUD users have been reported in women not changing IUDs for at least 3 years. It is more common in plastic IUDs. Most cases are diagnosed histologically by identification of an actinomycotic grain in the center of the abscess or by cytologic features on Papanicolaou smears. A fluorescent antibody stain is also available. The exact role of actinomyces in tubo-ovarian abscess formation is unclear, since such abscesses are usually polymicrobial. Actinomyces should always be systematically ruled out in the event of serious genital tract infection. Treatment consists of high-dose antibiotics over a sufficiently long period.

The inoculation of a temperature-sensitive mutant of Salmonella typhimurium induced a long-lasting infection in susceptible (C57BL/6) and resistant (A/J) mice. During week 1 of infection, the number of bacteria in the spleens was similar in both mouse strains. Then, the decrease of bacteria was more rapid in the resistant strain. Splenomegaly and granulomatous hepatitis were more severe in the susceptible strain. The immune response induced by this infection was studied. In both mouse strains delayed-type hypersensitivity to Salmonella antigens was present, and resistance to reinfection with a virulent strain of S. typhimurium or with Listeria monocytogenes appeared with the same kinetics. Thus, it does not seem that the gene(s) controlling natural resistance to S. typhimurium act(s) on acquired immunity.

Resume Ce travail est fonde sur l'analyse clinique, histologique et evolutive de 105 cancers du sein, suivis durant une periode de 9 ans, et traites par l'association cobaltotherapie-chirurgie. La confrontation des documents histologiques et des donnees cliniques et evolutives montre, a doses d'irradiation egales, l'inegalite des cancers du sein devant l'action des rayons. Le plus souvent, dans 4 cas sur 5 environ, les rayons donnes a doses elevees, ou modifient plus ou moins profondement le volume et l'image histologique de la tumeur, ou ne semblent pas l'alterer, ou n'empechent pas une reprise evolutive. Le pourcentage de survie de 5 ans, dans ce groupe, compte tenu qu'il selectionne des formes frequemment volumineuses ou evolutives, est de 47%. Dans un faible nombre de cas (1 cas sur 5 environ), la cobaltotherapie, quel que soit l'âge de la malade, le stade clinique, et le volume initial de la tumeur, determine la disparition histologique du cancer. Ce groupe a un pronostic nettement meilleur puisque le taux de survie de 5 ans est de 86%. Il semble qu'il existe un lien entre la radiosensibilite d'un cancer et son pronostic. Enfin, l'association cobaltotherapie-chirurgie diminue, de facon significative, la frequence des recidives loco-regionales (9% dans la serie actuelle).

Seemingly spontaneous subcutaneous ruptures of the flexor tendons of the hand are not frequently encountered. The case studied is that of a young man whose deep flexor tendon of the third finger snapped during a slight effort. The histological and immunohistochemical analysis led to the conclusion that there was localization of an intra-tendinous neurofibroma, which would seem to be a so-far undescribed phenomenon. The patient presented neurofibromas elsewhere and had pigmented spots on the body, which enabled Von Recklinghausen's disease to be diagnosed.

In the case of breast cancer with no clinical signs, radiological signs are the decisive factors to indicate surgery, histological studies or treatment. Foci of microcalcifications currently are the feature to identify as a rule. However, they reveal canalicular carcinoma in only 1 case out of 3. We propose a radiological technique allowing the selection of the microcalcifications to be operated by means of the digitization of a mammographic film and of a software-controlled morphometric analysis. 10,000 microcalcifications have been studied in this way. The most reliable of the 12 parameters that were distinguished is compacity. 100 files were studied with conventional mammography and a morphometric and histological analysis. Any microcalcification less compact than 0.35 is highly suspicious, since this parameter is the only one having a significant difference, with a confidence interval of 95%. The patients are now selected in this way. Differences in the age of the lesions, multiple foci and sometimes lesions with multiple centers lead us to automatically propose the exeresis of the gland, followed by immediate reconstruction of its shape and volume. According to a retrospective study we carried out on 111 subclinical intracanalicular carcinomas after a 5 to 20-year time interval, recurrence is observe in only 4.5% of all cases.

The authors report three cases of tuberculosis affecting the liver and hematopoietic system. The difficulty in diagnosing the chronic progressive forms of the disease and the severity of the acute forms is stressed. Liver biopsy is considered to be the most effective examination for confirming the nature of the disease. Acute and chronic forms can also be distinguished histologically, as the former produce nectotic lesions rich in tubercle bacillus but with only slight surrounding cellular reaction, while the latter lesions are productive and are rich in epithelioid histocytic cells.

A sixty-four year-old woman was admitted for chronic diarrhea with severe weight loss. Investigations showed hepatomegaly, positive serologic tests for syphilis, and nephrotic syndrome with proteinuria. Anasarca occurred and the patient died shortly after admission. Necropsy showed sclero-gummatous hepatic syphilis, generalized amyloïdosis and ulcerative colitis. These last two manifestations and their association with tertiary stage syphilis are discussed.

A case clinically and morphologically typical angio-immunoblastic lymphadenopathy in a 64-year old man is reported. A sicca syndrome was discovered with histological localization in the labial accessory salivary glands. Death occurred after a course of a few months. The autopsy showed an association of angio-immunoblastic lymphadenopathy lesions of the bone marrow and the lymph node and of typical multivisceral localizations of Kaposi's sarcoma (lymph node, liver, thyroïdd gland) without skin involvement. This association of two diseases characterized by severe dysimmunity with B lymphocytes hyperplasia is discussed, and compared to the others diseases which could be associated with Kaposi's sarcoma.

A 56-year-old woman developed diffuse interstitial pulmonary amyloidosis and died two years after the onset of dyspneic symptoms. Lung biopsy confirmed the amyloid nature of the reticulonodular lesions, which were at the origin of the mixed restrictive and obstructive ventilatory deficiency. Investigations showed an obvious hypogamma globulinemia but the etiology of the affection remained unknown. Pathological examination revealed massive infiltration of amyloid material in the lungs, no involvement of the heart, what was unexpected, and minimal deposits in the mediastinal lymph nodes kidneys, and spleen. An immunofluorescence study of the pulmonary amyloid deposits was performed. The authors emphasize the rarity of such diffuse interstitial pulmonary amyloid lesions which differ greatly from nodular amyloidosis and upper respiratory tract amyloid infections.

This is an analysis of 4 patients with suspicion of centro-facial granulomatosis. Diagnosis is difficult, mainly based upon clinical data, without precise histopathological presentation. The main differential diagnosis is Wegener's granulomatosis. The etiology of centrofacial granulomatosis is still unknown but multiple theories have been proposed: systemic disease, lymphoma. In one case, the initial histopathological diagnosis was undifferentiated carcinoma and the patient received chemotherapy (i.e., Adriamycin, Vincristine, Bleomycin and Steroids). A complete response was achieved. The interest of chemotherapy in the treatment of centro-facial granulomatosis is discussed.

The lesions seen in chronic familial granulomatosis are variable and seen in varied combinations: granulomas, often disseminated, pseudotuberculous lesions, histiocytes with a high content in lipofuscins seen in the liver, lymph nodes, spleen and lungs in particular. These lesions may be explained at least in part by a congenital defect in leucocytes, which is peculiar to this hereditary disease, and which concernes bactericidal functions.

This report describes a case of adult respiratory distress syndrome (ARDS) after massive subcutaneous injections of silicone. The patient, a 23 year-old transsexual man, treated with mechanical ventilation, died on the 12th day of hospital, in septic shock and refractory hypoxemia. Autopsy findings revealed empty vacuoles surrounded by macrophages in various organs, especially in lung tissue. Toxicological analysis by emission by high frequency induced plasma showed silicone in the organs with histological lesions. The pathophysiology of this ARDS is considered.

The authors report a case of endobronchial non-Hodgkin lymphoma, in a 48-year-old woman. This is an exceptional localization. When it reveals the disease, as was the case in the index patient, clinical presentation is usually atelectasis with fever. Diagnosis was established upon bronchoscopy. Histologic examination of biopsy specimens showed an immunoblastic lymphosarcoma. Total pneumonectomy and chemotherapy failed to prevent rapid deterioration with a fatal outcome 7 months after onset. A selective total IgA deficiency and a familial history of malignant tumors were recorded. Immunoblastic sarcoma has a poor prognosis. It often follows a disease whose mechanism is ascribed to an immunological disorder. Lymphoma arising in a patients with prior immune disease should suggest the diagnosis of immunoblastic sarcoma.

Two hundred cases of breast carcinoma were studied, with particular attention to adjacent non-malignant modifications considered by some authors as preneoplastic changes. Diverse proliferative lesions were recognized in 82% of cases. Atypical hyperplasia was present in 51.5% of cases and was more often ductal (83/200) than lobular (40/200). Microscopic cysts were noted in 72% of cases. Calcifications, easily identified by mammography were present in 20% of cases and were associated with atypical hyperplasia in 4/5 of cases. The mean of patients was 58 years. For comparative studies of histologic lesions the following age categories were evaluated: category I less than 50 years (57 patients), category II greater than or equal to 50 years (143 patients). Atypical lobular hyperplasia, adenosis, and, to a lesser degree, sclerosing adenosis and macroscopic cysts were more frequently associated with breast cancer in women younger than 50. Fibro-atrophic or lipomatous changes were more often found in the older group of women, as expected. Sclerosing adenosis was significantly more frequent in breasts with multifocal infiltrating carcinoma. Such changes must be considered as risk factors by pathologists when present in mammary specimens without carcinomatous lesions, and careful study should be undertaken to locate a possible in situ microscopic carcinoma. No differences appeared in lesions associated with breast cancer in women with or without a familial history of breast cancer.

Vascular sarcomas (haemangio-endotheliomas) are tumours which are very rarely encountered in the facial mass. Only 10 cases have been found in the literature. Two cases are described: the first patient was operated on in 1968 for a localization in the left side of the ethmoid and presented 9 year later with a recurrence on the right side symmetrical with the first which remained apparently cured; a year later, there was a recurrence on the right then diffuse pulmonary metastases. The second case was that of a patient with an ethmoid localization cured by radiotherapy and surgery 20 years before, but presenting with a recurrence in the ganglia 10 years later and a parapharyngeal recurrence developing over the past 6 years. In connection with these two cases, the diagnostic difficulties involved in distinguishing these tumours from epitheliomas and sarcomas of the facial mass, which sometimes show considerable vascularization, from other vascular tumours, benign haemangioendotheliomas, glomus tumours and, in particular, haemangio-pericytomas, are described. The possibility of a long survival should be noted for some rare facial localizations: this is in contrast with the usually very rapid development of vascular sarcomas in other localizations.

The case of a 23-year old transsexual male who developed a lethal lung disease 48 hr after a 1 l subcutaneous silicone fluid injection is reported. Histologic examination showed optically empty oil red O negative vacuoles in several specimens, and particularly in the lungs; refractile particles of silicium were also found. We identified the material as silicium, and evaluated its quantity in tissues by atomic absorption and spectrometric and toxicological analysis. Experimental studies and rare human accidents suggest that silicone fluid is transported by migrating phagocytes, thereby explaining lymph node, spleen, liver, adrenal and lung deposits. In our patient's report, we added gradual blood contamination to explain the progressive development of respiratory failure with the severity of the respiratory disorder linked to the massive dose injected. Massive silicone blood embolization could be excluded because of the interval between the injection and emergence of the first clinical signs.

Limited resection in partial surgery for carcinoma of the larynx leads to discussion of three surgical attitudes: total surgical resection as a matter of principle, additional treatment by radiotherapy, or waiting, with the need for strict surveillance. The present study reports the results of this latter attitude adopted in 23 cases out of 24 of limited resection in a group involving 119 partial laryngectomies (vertical or horizontal) consisting of: 57 cordectomies, 20 hemilaryngectomies, 42 supraglottal laryngectomies. Results of analysis show that there was no recurrence and patients were well with a 3 year follow-up in 19 cases of limited resection out of 24. Overall survival following limited resection was identical to that seen after satisfactory resection, but there was a marked difference with insufficient resection (X2 significant) Following partial laryngeal surgery involving a limit resection, it is felt to be legitimate to temporise as long as the patient can be seen regularly. Such an approach would not seem to modify the overall survival in these patients.

A case is reported of dissection of the aorta in a lady of 35. The condition was complicated first by myocardial infarction and secondly by severe aortic incompetence which led, 20 years after the onset of the dissection, to the death of the patient from intractable heart failure. At post-mortem, an extensive dissection was found to involve the whole of the aorta and several of its branches, but did not involve the coronary arteries, which were normal except for the trunk of the left coronary; this was dilated. The natural history of dissections of the aorta is reviewed. The incidence, course and etiology of coronary aneurysms are also discussed.

The authors stress the difficulty of diagnosis of a neuroblastoma in its undifferentiated when the demonstration of nervous differentiation is necessary. The factors which may play a role in the prognosis of these tumours are analysed. In this series are included the age of the child, the location of the tumour, the existence of certain early metastases (bone), the possibility of complete surgical removal and alterations in the tumour secondary to chemotherapy and radiotherapy. Histoenzymatic study of histio and organotypic cultures as well as chromosomal analysis were possible in a number of cases.

Seemingly spontaneous subcutaneous ruptures of the flexor tendons of the hand are not frequently encountered. The case studied is that of a young man whose deep flexor tendon of the third finger snapped during a slight effort. The histological and immunohistochemical analysis led to the conclusion that there was localization of an intra-tendinous neurofibroma, which would seem to be a so-far undescribed phenomenon. The patient presented neurofibromas elsewhere and had pigmented spots on the body, which enabled Von Recklinghausen's disease to be diagnosed.

Results of experiments conducted in dogs are reported, in which the first few centimetres of the ureter were replaced by a prosthesis in silicone elastomer, the upper extremity being intubated by a trans-renal approach into the lower calyx and the upper extremity into the iliolumbar ureter. The one case of failure among the 6 dogs studied was due to a pyonephrosis from a technical error. In the 5 surviving dogs, the by-pass has remained permeable and there is no sign of incrustation. Control I.V.U. examinations after periods ranging from 26 months to 3 years showed normal function. This procedure has now been used in two human cases with good results.

Angio-immunoblastic lymphadenopathy is a recently demarcated clinico-anatomical entity. A new case underlines the importance of this lesion in E.N.T. The lesion often progresses like a neoplasm, even though the clinical, biochemical and histological features make one consider it today to be an expression of an immune disorder. Nevertheless, the relationship with malignant lymphoma is discussed and the histological arguments which show an association or an evolution towards malignancy are exposed. The difficulties of treatment are particularly underlined on the basis of this ambivalence; and especially on the basis of the dilemma posed by the necessity for an effective therapy, justified by the invasive and extensive nature of the lesion, and the risks represented by the use of chemotherapy in a patient whose immunity is already disturbed. A statistical analysis of the therapeutic results, from data collected from the literature, illustrates this difficulty but does not allow a universally acceptable attitude to be defined.

Malignant teratomas of the thyroid in the adult are rare. A personal case is presented. It brings the total number of cases found in the literature to nine, and illustrates the terrible prognosis of these tumours regardless of the treatment used (extensive surgery, radiotherapy, chemotherapy). Teratomas in the adult thus differ from those in the newborn and child. The latter are much more common and recurrences virtually non-existent. The histogenesis of these tumour is discussed. It may dysgenetic heterotypism, but no definite conclusions may be offered.

The authors report a case of probably ectopic secretion of calcitonin in a 35 year old woman suffering from a malignant tumour in a double intra- and extra-spinal form. Hormone levels returned to normal after complete excision of the tumour, in which it was impossible to demonstrate the presence of calcitonin despite a very marked secretory appearance by electron microscopy. Study of the literature concerning the secretion of calcitonin by malignant tumours indicates the high degree of contradiction concerning the origin and the significance of increased radio-immunological levels of this hormone, which it is not possible to use without criticism as a "marker" of carcinomas.

Summary Two cases of interstitial pneumonitis are described which developed after the acute phase of aspiration pneumonitis. Open lung biopsy revealed an interstitial. granulomatous foreign body response induced by foodstuff aspiration. Steroid treatment was administered and both cases then showed a favourable course, with the pulmonary lesion healing within 12 days.

A Case of chordoma of the base of the skull is reported. It had been present with minimal symptoms for six years during which the clinical picture was limited to nasal obstruction and headache. Comparison of initial X-rays and the preoperative assessment revealed progressive destruction of the base of the skull which indicated the likelihood of considerable difficulties in excision. Surgical treatment posed the problem of the approach and emphasised the absence of encapsulation and the incomplete nature of the operation. The development of new symptoms (diplopia, dysphagia) resulted in complementary radiotherapy. The authors take the opportunity to point out the polymorphous clinical nature of these tumours in relation to their site and the criteria of the histological diagnosis. The possibilities of treatment are discussed. Abstention from treatment is formally rejected and, on the contrary, the emphasis is placed upon the need for early treatment. The consequences of excision should be limited by using a minimal surgical technique when possible. Complementary radiotherapy is necessary and may be repeated, up to certain limits, in the case of recurrence if the first irradiation is felt to be effective. There is no parallel between histological appearances and the response to treatment. The possibilities of chemotherapy would appear to be limited.