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Resume Objectifs La chirurgie des tumeurs cutanees est courante et bien codifiee. Il existe une discordance entre des recommandations sur les marges macroscopiques a appliquer et les decisions therapeutiques prises sur des marges histologiques. Cette etude a pour vocation d’etudier la retraction cutanee qui survient lors de l’exerese puis dans le formol, pour comprendre la discordance anatomoclinique souvent retrouvee. Patients et methodes Il s’agissait d’une etude prospective, d’un mois, incluant les patients beneficiant d’une chirurgie cutanee. Pour chaque tumeur, le chirurgien effectuait 4 mesures de marges avant puis apres l’exerese ; marges mesurees a nouveau en histologie. Le critere de jugement etait la difference de mesure de marges en preoperatoire, postoperatoire et histologie. Ces donnees etaient ponderees en fonction de facteurs lies au patient et a la tumeur. Resultats Soixante-dix-neuf tumeurs pour 61 patients ont ete etudiees. L’etude a montre une retraction significative entre les mesures preoperatoires et postoperatoires, de 0,4 a 0,6 mm. Elle n’est correlee a aucun des autres facteurs testes. Une retraction significative entre 0,4 et 0,5 mm a egalement ete montree entre les mesures preoperatoires et histologiques. En revanche, il existe une augmentation significative entre les mesures postoperatoires et histologiques. Conclusion Ce dernier resultat pourrait etre lie a la zone peri-lesionnelle inflammatoire que le chirurgien considere comme etant tumoral donc exclut de sa marge alors que l’histologie peut montrer une zone saine. Devant ces resultats, un comite d’expert menant une etude plus importante pourrait inclure des recommandations sur les marges histologiques aux recommandations cliniques actuelles.

Skin tumors surgery is common and well established. There is discrepancy between recommendations on macroscopic margins to apply and therapeutic decisions taken on histological margins. The purpose of this study is to examine skin shrinkage upon exeresis, then in formalin, to understand the anatomo-clinical discrepancy, which is often found.It was a prospective study, lasting a month, including patients receiving skin surgery. For each tumor, the surgeon carried out 4 margins measurements before and after exeresis ; margins measured again in histology. The evaluation criterion was the difference between preoperative, postoperative and histological margins measurement. These data was weighting according to factors linked to the patient and the tumor.Seventy-nine tumors for 61 patients had been studied. The study showed a significant shrinkage between preoperative measurements and postoperative, from 0.4 to 0.6mm. It is correlated with no one tested factors. Significant shrinkage between 0.4 and 0.5mm was also established between preoperative and histological measurements. However, there is a significant augmentation between postoperative and histological measurements.This last result could be linked to the inflammatory peri-wound skin that surgeon consider as tumoral process so exclude of his margin, while histology could show a healthy area. In front of these results, an expert committee leading a more important study could include histological margins recommendations to the actual clinical recommendations.

Aims The oesophageal mucosa is a frequent target of opportunistic infections in human immunodeficiency virus (HIV) infection. Langerhans cells (LC) are known as a target and reservoir of HIV in the skin. The aim of this study was to characterize oesophageal LC in HIV-infected patients. Methods and results Thirty oesophageal biopsies were obtained from 29 patients (median age 35.5), all in stage IV of the HIV Center of Disease Control Classification. We performed histological assessment of the oesophageal mucosa and immunohistochemical detection of oesophageal LC using an anti-CD1a antibody, followed by morphometric analysis. Biopsies from 17 noninfected patients were studied using the same procedure. LC in oesophageal mucosa of the HIV positive patients showed a significantly and dramatically decreased number (LC(N) median = 5.85/mm2) and surface/epithelial surface (LC (S) ratio = 0.09) when compared with HIV-negative controls (LC(N) median = 29.7/mm2, LC(S) ratio = 1.83) with P = 0.003 for LC(N) and P

Gamma-delta (gammadelta) T-cell non-Hodgkin's lymphomas (NHLs) usually present with liver, spleen and marrow infiltration. Lymph node involvement by gammadelta T-cell NHL has been rarely documented so far; its histological pattern needs to be further defined.Two cases of nodal gammadelta T-cell NHL are reported: case 1, a 44-year-old man, presented with cytomegalovirus retinitis and superficial lymphadenopathies. Histological analysis of an inguinal lymph node showed complete destruction by a diffuse pleomorphic lymphoid proliferation, which was positive for CD2, CD3, CD43, CD45, TIA-1 and granzyme B, and displayed a gammadelta phenotype (deltaTCR1+, Vdelta1+, Vdelta2-, Vdelta3-, betaF1-). Bone marrow was normal. Case 2, a male 24-year-old patient with a history of renal transplantation, presented with hepatosplenomegaly and supraclavicular lymph node enlargement. Lymph node architecture was globally preserved. Peripheral sinuses contained scattered nests of medium-sized irregular lymphoid cells. Bone-marrow was infiltrated. Phenotype showed positivity for CD2, CD3, CD45 and TIA1 and expression of gammadelta TCR (deltaTCR1+, deltaV1+, deltaV2-, deltaV3-, betaF1-). Both patients died a short time after diagnosis.These observations suggest that at least two forms of nodal gammadelta T-cell NHL may be encountered: one mimicking classical alphabeta T-cell NHL, with diffuse pleomorphic cell proliferation, and one displaying sinusoidal neoplastic infiltration suggesting a close relationship with hepatosplenic gammadelta T-cell NHL.

The oesophageal mucosa is a frequent target of opportunistic infections in human immunodeficiency virus (HIV) infection. Langerhans cells (LC) are known as a target and reservoir of HIV in the skin. The aim of this study was to characterize oesophageal LC in HIV-infected patients.Thirty oesophageal biopsies were obtained from 29 patients (median age 35.5), all in stage IV of the HIV Center of Disease Control Classification. We performed histological assessment of the oesophageal mucosa and immunohistochemical detection of oesophageal LC using an anti-CD1a antibody, followed by morphometric analysis. Biopsies from 17 noninfected patients were studied using the same procedure. LC in oesophageal mucosa of the HIV positive patients showed a significantly and dramatically decreased number (LC(N) median = 5.85/mm2) and surface/epithelial surface (LC (S) ratio = 0.09) when compared with HIV-negative controls (LC(N) median = 29.7/mm2, LC(S) ratio = 1.83) with P = 0.003 for LC(N) and P0.0001 for LC(S).These data suggest that oesophageal LC are, like their epidermal counterparts, a preferential target for HIV infection. Their alterations may provide a clue to the pathogenesis of the decreased local oesophageal immunity and to the occurrence of opportunistic infections.

The prognostic value of peritumoral vascular invasion (PVI) in node negative breast cancer (N-) is a controversial issue. Considerable debate has focused on how PVI should be defined, and the techniques used to detect them have differed considerably from one study to another.In our study, 167 cases of N- breast cancers were reviewed, with a view to determining whether or not PVI, as defined in the recently published European recommendations, were present.Based on the results of the subsequent statistical study, the presence of PVI was not found to constitute a reliable prognostic index to the outcome of N- breast cancer.Referring each case to the data available in the literature, the difficulties encountered when searching for PVI of this kind are described, the results of various studies on the topic are reviewed and whether it is worth pursuing studies along these lines is discussed.

Malignant non Hodgkin's lymphomas in patients with acquired immunodeficiency syndrome are usually of high grade and have a B-cell phenotype. We describe two cases of rare lymphomas during acquired immunodeficiency syndrome: one case of pleomorphic T cell lymphoma with medium and large cell predominance, of high grade of malignancy, according to the updated Kiel classification, involving mainly the bone-marrow, and one case of low grade monocytoid B-cell lymphoma with bone-marrow extension, which is a rare condition in this type of lymphoma. These lymphomas seem to be a casual event during acquired immunodeficiency syndrome, but the immunodeficiency can be responsible of a more aggressive behavior.

Adverse effects of zidovudine, which mainly result in myopathies and hematological disorders, could be due to multitissular mitochondrial toxicity of the drug. During zidovudine treatment, most cases of lactic acidosis have been attributed to mitochondrial myopathy. We report a case of hepatocellular failure with lactic acidosis in a 33 year-old patient with the human immunodeficiency virus infection and treated with zidovudine for 8 months. Liver biopsy showed massive macrovacuolar steatosis and ultrastructural mitochondrial abnormalities similar to those previously described in the skeletal muscle. This is the second reported case of lactic acidosis and hepatocellular failure which is probably related to hepatic mitochondrial dysfunction caused by zidovudine.