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We report a 69-year-old adult case with a monoclonal gammopathy incidentally discovered, associated with a moderate thrombocytopenia of 90 G/L. Study of blood smear revealed the presence of tumor cells presenting Auer rod-like inclusions, although there were not blast cells. Blood cytology as well as immunophenotyping allowed us to make the diagnosis of malignant hemopathy. more...

We report the case of a 61-year-old man with a pulmonary nodule discovered while staging the metastasis of a squamous cell carcinoma. No primary cancer was found. Histological examination of the resected specimen (lingula) was in favor of IgG4-related inflammatory pseudotumor. Histological criteria were described in 2012, combining a dense lymphoplasmacitic infiltrate rich in IgG4-positive plasma cell, storiform fibrosis and obliterative phlebitis. IgG4/IgG plama cell ratio>40 % is mandatory for histological diagnosis of IgG4-related disease. This is a rare and often underdiagnosed disease. Diagnostic criteria are now defined and consensual, combining clinical signs, biology and histology. more...

BACKGROUND Taking into consideration the known overexpression of p16INK4a in histologically demonstrated high-grade urothelial malignancies, the objective of the current study was to examine the value of p16INK4a overexpression and of p16/Ki-67 dual labeling versus urinary cytology in the detection of urothelial lesions. METHODS Immunolabeling was performed on demounted and destained Papanicolaou slides after liquid-based ThinPrep processing. Actual diagnoses were ascertained by cystoscopy controls and histopathology. Negative cases, papillary urothelial neoplasia of low malignant potential/low-grade tumor, and high-grade lesions were considered separately. RESULTS A total of 216 urine samples were collected from new patients with symptoms who were referred for cystoscopy (92 cases) or patients who were being followed after conservative treatment for lesions involving the bladder (117 cases) or the upper urinary tract (7 cases). p16INK4a positivity was assessed in 171 of the 216 cases (79.2%) and in 93 of 99 high-grade cases with positive cytology (93.9%). Coexpression of p16/Ki-67 in the same cells was observed in 119 of 216 cases (55.1%) and was noted in 18 of 51 cases of negative or papillary urothelial neoplasia of low malignant potential/low-grade tumor (35.3%) and in 80 of 101 high-grade tumors (79.2%) (P more...

La physiopathologie des prolapsus genitaux n’est a ce jour qu’incompletement elucidee. Le deficit en muscle lisse de la paroi vaginale a ete demontre. Il est possible que les caracteristiques de la paroi vaginale soient differentes chez les patientes ayant un prolapsus recidive. L’objectif de cette etude est de comparer la proportion de muscle lisse de la paroi vaginale anterieure chez des patientes ayant une cystocele recidivee ou operee pour la premiere fois par rapport a un groupe temoin sans prolapsus. Des echantillons du cul-de-sac vaginal anterieur ont ete preleves chez 11 patientes ayant une cystocele et huit patientes operees d’une hysterectomie sans prolapsus. Une deuxieme analyse a compare cinq cystoceles recidivees et six cystoceles operees pour la premiere fois. Une coloration trichrome de Masson a ete utilisee pour determiner la distribution du collagene dans la matrice extracellulaire de la musculeuse vaginale et pour quantifier le collagene. Une etude immunohistochimique utilisant des anticorps anti-alpha actine a ete utilisee pour identifier les cellules musculaires lisses. Une analyse morphometrique a ete realisee pour determiner la proportion relative de muscle lisse et de vaisseaux. La proportion de muscle lisse chez les patientes ayant une cystocele etait significativement diminuee par rapport au groupe temoin (41,9 vs 61,9 %, p = 0,0005 [IC 95 %: 10,8–28,9]). La proportion de collagene etait significativement augmentee (56,8 vs 35 %, p = 0,0002 [IC 95 %: 12,9–30,8]). La proportion de vaisseaux sanguins etait comparable (2,2 vs 3,4 %, p = 0,09 [IC 95 %: −2,8–0,3]). Il n’existait pas de difference des proportions de muscle lisse, de collagene et de vaisseaux chez les patientes ayant une cystocele recidivee ou operee pour la premiere fois (respectivement 40 vs 44 %, p = 0,62 [IC 95 %: −22,7–14,33], 59,6 vs 53,4 %, p = 0,46 [IC 95 %: −12,1–24,4] et 2,1 vs 2,3 %, p = 0,69 [IC 95 %: −1,6–1,1]). Les alterations morphometriques de la paroi vaginale anterieure retrouvees chez les patientes ayant un prolapsus sont en faveur des reparations prothetiques. Des etudes ulterieures sur la reversibilite de ces anomalies seraient necessaires afin d’orienter le choix du type de prothese, resorbable ou non. En revanche, l’histologie vaginale ne semble pas predictive du caractere recidive ou non du prolapsus. La morphometrie du tissu vaginal anterieur est considerablement alteree chez les patientes ayant un prolapsus par rapport alteree chez les patientes ayant un prolapsus par rapport au groupe temoin. La proportion de muscle lisse est comparable chez des patientes ayant un prolapsus recidive ou opere pour la premiere fois. more...

The purpose of this study was to compare smooth muscle content of anterior vaginal wall in women with pelvic organ prolapse (POP) and control subjects. Specimens were taken in the midline from the apex of anterior vaginal cuff from eleven women with POP and eight control subjects operated for hysterectomy without prolapse. Masson's trichrome stain was used to determine the distribution of collagen in the extracellular matrix of the vaginal muscularis and to quantify the collagen in area of interest. Slides of alpha smooth muscle actin were detected using antibodies. Morphometric analysis was used to compare and to quantify the smooth muscle content of the vaginal muscularis. Fractional area of nonvascular vaginal smooth muscle of women with POP was significantly decreased in comparison to control subjects (41.9 vs 61.9%, p = 0.005). Fractional area of connective tissue was significantly increased (56.8 vs 35%, p = 0.004). Fractional area of blood vessels was similar (2.2 vs 3.4%, p = 0.20). more...

Gastrointestinal adenocarcinoma with a choriocarcinomatous component (GACC) is an extremely rare and highly malignant human chorionic gonadotrophin-producing neoplasm. The development of this tumour from dedifferentiation or trans-differentiation of adenocarcinomatous cells is the most likely mechanism. 102 of the 120 cases reviewed in the literature presented enough clinicopathological information to be analysed. This tumour can be purely choriocarcinomatous or associated with an adenocarcinoma as in half of the observations. It is usually found in the stomach although it may be found throughout the digestive tract. The diagnosis of GACC should only be retained after having clearly eliminated a metastasis from a choriocarcinoma in particular in the gonads. The prognosis is very poor in particular in the gastric forms of this disease, with death observed within 12 months following diagnosis in 2/3 of the patients. There is no treatment consensus, and it is decided on a case-by-case basis. more...

AIMS The goal of this work was to assess the validity of Mohs Micrographic Surgery (MMS) for basal cell carcinoma (BCC) in a routine clinical setting. MATERIAL AND METHODS Our adaptation of the technique described by Mohs and coll allows intraoperative histological examination of all surgical edges of the resection. Sixteen men and 4 women were selected. RESULTS Average operative time was 2 hours 30 minutes. No false results were noted. The cosmetetic and functional outcomes were good. CONCLUSION MMS is a safe and reproducible surgical technique made possible by solid team work. It is adapted for the treatment of BCC with a high risk of recurrence. The cosmetetic and functional results are quite satisfactory. The recurrence rate at 5 years is 10 times less than with other methods of treatment. The additional time required for this surgery be put in balance with the number of tumors for which a second intervention would have been necessary if conventional surgery had been used. All procedures were performed under local anesthesia, and none or the patients required a second intervention. more...

Maintenance of epithelial cell shape and polarity determines many vital cell functions, including the appropriate response to external stimuli. Murine hepatocytes cultured in a three-dimensional Matrigel matrix formed highly polarized organoids characterized by specific localization of an ERM (ezrin/radixin/moesin) protein, radixin, at microvillus-lined membrane domains. These apical domains surrounded a lumen and were bordered by tight junctions. The hepatocyte organoids were functional as judged by the high level of albumin secretion and accumulation of bilirubin. Stimulation of the Fas/CD95 death receptor, which is highly hepatotoxic in vivo, was a strong inducer of apoptosis in the polarized organoids. This was in sharp contrast to the monolayer hepatocyte cultures, which were protected from death by exacerbated NF-κB signalling following engagement of the death receptors. Thus, hepatocytes in polarized, functional organoids modulate an intracellular signal transduction pathway, allowing the recapitulation of their physiological response to an apoptotic stimulus. more...

Resume Nous rapportons un cas exceptionnel d’angiosarcome mammaire primitif developpe chez un homme âge de 58 ans. L’angiosarcome mammaire est une tumeur tres rare (0,04 % des tumeurs du sein), dont le diagnostic peut etre difficile. Le traitement est actuellement standardise et se limite a une mastectomie avec chimiotherapie adjuvante dans les grades III ou peu differencies. Le pronostic depend de la taille de la tumeur et du grade histologique. Il est necessaire de diagnostiquer ce type de tumeur precocement, car la survie a 10 ans peut atteindre 80 % pour les bas grades, mais ne depasse pas les 20 % dans les grades les plus eleves. more...

We report the case of a 61-year-old man with a pulmonary nodule discovered while staging the metastasis of a squamous cell carcinoma. No primary cancer was found. Histological examination of the resected specimen (lingula) was in favor of IgG4-related inflammatory pseudotumor. Histological criteria were described in 2012, combining a dense lymphoplasmacitic infiltrate rich in IgG4-positive plasma cell, storiform fibrosis and obliterative phlebitis. IgG4/IgG plama cell ratio40 % is mandatory for histological diagnosis of IgG4-related disease. This is a rare and often underdiagnosed disease. Diagnostic criteria are now defined and consensual, combining clinical signs, biology and histology. more...

Taking into consideration the known overexpression of p16(INK4a) in histologically demonstrated high-grade urothelial malignancies, the objective of the current study was to examine the value of p16(INK4a) overexpression and of p16/Ki-67 dual labeling versus urinary cytology in the detection of urothelial lesions.Immunolabeling was performed on demounted and destained Papanicolaou slides after liquid-based ThinPrep processing. Actual diagnoses were ascertained by cystoscopy controls and histopathology. Negative cases, papillary urothelial neoplasia of low malignant potential/low-grade tumor, and high-grade lesions were considered separately.A total of 216 urine samples were collected from new patients with symptoms who were referred for cystoscopy (92 cases) or patients who were being followed after conservative treatment for lesions involving the bladder (117 cases) or the upper urinary tract (7 cases). p16(INK4a) positivity was assessed in 171 of the 216 cases (79.2%) and in 93 of 99 high-grade cases with positive cytology (93.9%). Coexpression of p16/Ki-67 in the same cells was observed in 119 of 216 cases (55.1%) and was noted in 18 of 51 cases of negative or papillary urothelial neoplasia of low malignant potential/low-grade tumor (35.3%) and in 80 of 101 high-grade tumors (79.2%) (P.0001). Thirteen of 14 high-grade intraurothelial lesions (92.8%) were dual labeled. When high-grade tumors, disease progression (increased grade, muscle infiltration, and extension into the upper urinary tract), and cancer-related death were grouped together as an endpoint, dual labeling demonstrated a sensitivity that was slightly higher than that of urinary cytology (82.5% vs 80.8%; P = .8), with 94.9% overall specificity.When applied to the search for high-grade and aggressive disease, p16/Ki-67 dual labeling and urinary cytology appear to demonstrate comparable performance. more...

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Gastrointestinal adenocarcinoma with a choriocarcinomatous component (GACC) is an extremely rare and highly malignant human chorionic gonadotrophin-producing neoplasm. The development of this tumour from dedifferentiation or trans-differentiation of adenocarcinomatous cells is the most likely mechanism. 102 of the 120 cases reviewed in the literature presented enough clinicopathological information to be analysed. This tumour can be purely choriocarcinomatous or associated with an adenocarcinoma as in half of the observations. It is usually found in the stomach although it may be found throughout the digestive tract. The diagnosis of GACC should only be retained after having clearly eliminated a metastasis from a choriocarcinoma in particular in the gonads. The prognosis is very poor in particular in the gastric forms of this disease, with death observed within 12 months following diagnosis in 2/3 of the patients. There is no treatment consensus, and it is decided on a case-by-case basis. more...

The goal of this work was to assess the validity of Mohs Micrographic Surgery (MMS) for basal cell carcinoma (BCC) in a routine clinical setting.Our adaptation of the technique described by Mohs and coll allows intraoperative histological examination of all surgical edges of the resection. Sixteen men and 4 women were selected.Average operative time was 2 hours 30 minutes. No false results were noted. The cosmetetic and functional outcomes were good.MMS is a safe and reproducible surgical technique made possible by solid team work. It is adapted for the treatment of BCC with a high risk of recurrence. The cosmetetic and functional results are quite satisfactory. The recurrence rate at 5 years is 10 times less than with other methods of treatment. The additional time required for this surgery be put in balance with the number of tumors for which a second intervention would have been necessary if conventional surgery had been used. All procedures were performed under local anesthesia, and none or the patients required a second intervention. more...

We report an exceptional case of primary breast angiosarcoma in a 58-year-old man. This is a very rare breast tumor (0.04% of breast tumors) which may be difficult to diagnose. Treatment is now standardized: radical mastectomy associated with adjuvant chemotherapy for grade III or poorly differentiated tumors. Prognosis is variable, depending on tumor size and histological grade. Diagnosis should be established as early as possible because the 10-year overall survival rate is 80% for low grade tumors and only 20% for high grade tumors. more...