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A case of Hodgkin's disease beginning in the skin of the face with local lymph node involvement is reported. This was a lymphogranulomatous form without characteristic Reed-Sternberg cells in skin biopsy specimens, rendering the diagnosis difficult. There was a combination of granulomatous inflammation, plaques of necrosis and lesions of fibrinoid necrosis in the vessel walls. This form entered the classification of clinical Stage IV, with its associated serious prognosis.

In a series of 331 minor salivary gland tumors (malignant in about 55,3% of cases), mucoepidermoid tumors, after cystic adenoïd carcinomas, are the most frequent malignant tumors (21,5% of cases). They are much more common in women than in men. The average age of patients at presentation (52,2 years) is higher than that of pleomorphic adenomas. They occur more frequently in buccal floor, tongue and gums. By a half-quantitative study of 71 mucoepidermoid tumors, these neoplasms are ranged in 3 main groups : differentiated epidermoid or glandular tumors, intermediate cell tumors with predominant oncocytic, clear glycogenic or basophilic cells and rare adenosquamous carcinomas. These 3 groups are well demonstrated by histoenzymological investigations, which show high level of oxydative enzymes activity in oncocytic cells and high level of ATPase and alkaline phosphatase activities around basophilic sheets. Besides, an ultrastructural study shows, in addition to well differentiated glandular or epidermoid cells, 3 forms of intermediate cells : young basophilic ribosome-rich cells and more differentiated oncocytic or glycogenic cells. The various structural features of mucoepidermoid tumors are positively correlated with clinical course and behaviour, after long term follow-up studies. Differentiated forms and intermediate clear or oxyphilic cell tumors are of low grade malignancy. Intermediate basophilic cell tumors grow rapidly or metastasize and a lethal course is often noted in these cases.

The histoenzymological and ultrastructural study of a haemangipericytoma with the clinical and histological characteristics of malignancy led to the identification within the tumour, in addition to pericytes and more differentiated cells, fibroblastic or muscular, of younger cells. The latter, arranged in cords undergo multiple appearances of transformation to result in a double maturation, at one and the same time pericytic and angio-endothelial, rarely seen up to the present in haemangipericytomas.

The authors report a case of malignant melanoma of the parotid occurring in a 22-year-old man, followed by two local recurrences after surgical excision, radiotherapy and chemotherapy. The primary parotid nature of the tumour was confirmed by the absence of tumour in other sites and by the histological characteristics.

One case of myoepithelioma of the submandibular gland is reported. The tumor was composed of mixed spindle-shaped and plasmacytoid cells. The electron microscopy showed intracytoplasmic myofilaments, with variations in number and in repartition from one cell to another. Histoenzymologically, ATPasic and alkaline phosphatase activities could not be demonstrated in these poor differentiated myoid cells. Usually, the tumor has a good behavior. It represents a rare tumor (7 cases - 0,8% - in a retrospective study of 850 salivary gland tumors). Without demonstration of myofilaments by ultrastructural analysis, the diagnosis of such a tumor is very difficult. Taking into consideration new concepts about the myoepithelial cell, the histogenesis of this neoplasm is discussed.

The authors report on a case of isolated mandibular localization of polyvinyl-pyrrolidine thesaurismosis. The patient, a man of 38, had been treated with injections of posterior pituitary extract, for a period of eighteen months, 10 year ago. Localization in the mandible is extremely rare, making diagnosis difficult unless a detailed anamnesis is available.

A 65-year-old man who had lived in several tropical countries, particularly in Brazil, is observed for an ulcerative lesion of the mouth that appeared two months ago. The biopsy reveals polymorphic granuloma with numerous giant cells. PAS and Gomori-Grocott stains show very numerous roundish structures of variable size (3 microns to 15 microns). There are multiple buds like in paracoccidioidomycosis but culture reveals Histoplasma capsulatum. These abnormal forms have been described in large necrotic zones and especially in endocarditis (intravascular proliferations). To our knowledge, it is the first description of these forms in primary infestation. This case shows the necessity to control histological diagnosis of mycosis. Culture and biological identification are absolutely necessary for specific diagnosis.

Ventricular tachycardia with left bundle branch block appearance in adults without coronary artery disease may be due to arrhythmogenic right ventricular dysplasia. This condition forms part of a spectrum with the complete form of Uhl's anomaly at one end and arrhythmogenic right ventricular dysplasia at the other. Both conditions have similar histological appearances representing the same congenital defect but the macroscopic appearances are quite different. Arrhythmogenic right ventricular dysplasia seems to be a slowly progressive condition with one or more localisations in the right ventricle where the myocardium is replaced by adipose tissue with progression of lesions from the epicardium towards the endocardium. The subepicardial layers resemble a plexiform structure of partially degenerated myocardial fibres within fibro-adipose tissue. These fibres may be the site of slowing of activation and the anatomical basis of intraventricular reentry phenomena. A similar appearance is also found in UHl's anomaly, but the severe dilatation of the ventricle and almost complete absence of muscle fibres only leaves a few zones with surviving, partially degenerated myocardial fibres. Clinically, a cardiothoracic index of over 0.60 is more common in Uhl's anomaly whilst arrhythmogenic right ventricular dysplasia is usually associated with a normal cardiac silhouette or only slight cardiomegaly. The differential diagnosis is important if surgery is being considered. An appropriate technique must be chosen to avoid supraventricular arrhythmias which can lethal in patients with Uhl's anomaly.

Immunofluorescent study of paraffin sections of 80 lesions of the buccal cavity, for the most part malignant or pre-malignant revealed marked plasmocytosis in premalignant or early malignant cases. This plasmocytosis, easily seen by the use of anti-immunoglobulin sera, is of polyclonal type, with marked preponderance of IgG secretors. In infiltrating carcinomas and in recurrences, the number of plasmocytes decreases and the percentage of IgG secretors falls markedly. By contrast, that of IgA immunocytes remains the same. The significance of these findings is considered and their practical value in the surveillance of cases of leukoplasia is stressed.

A prospective study was conducted to evaluate cardiac effects of scleroderma by means of phonomyography (30 patients) and ultrasound cardiography (18 patients). Clinically silent effusions can be detected by ultrasound cardiography, and 50 p. cent of the patients were found to have pericarditis through this investigative technique. Valvular lesions (mitral prolapsus) were present in a more important number than simply a coincidence. Measurement of myocardial relaxation appears to give the best indication of the specific myocardial lesion in this disease, and even may be of some prognostic value.

A comparative light microscopy, histoenzymological and ultrastructural study enabled the authors, in a case of invasive lobular carcinoma of the breast, to emphasise certain special morphological traits of this tumour type and to make a contribution to the understanding of its histogenesis. By light microscopy, the only special features of the case were the abundance of mucus secreting tumour cells in the perilobular infiltrating zones and in the stromal texture with marked perigalactophoric hyalinosis and active elastic neogenesis. From an ultrastructural standpoint, intralobular malignant zones contained epithelial type cells, rich in microfilaments and with numerous desmosomal junctions. Two other cell types were identified at the periphery of the lobules. On consisted of round cells with intracytoplasmic cavities filled with mucus (signet ring cells). This group, in common with the intralobular cells, contained abundant amounts of alkaline phosphatase. The other consisted of elongated "pseudo-fibroblastic" cells, rich in microfibrils and in granular ergastoplasm with secretion at points of contact of collagen and elastin. These cells showed marked ATPase activity. They no doubt represented "hybrid" cells, intermediate in terms of their morphology and enzyme activity between myoepithelial and epithelial cells. These findings would thus appear to offer arguments in favour of the double cell origin -- duct and myoepithelial -- of lobular carcinoma.

Correlations between surface ECGs, epicardial mapping and histological data in 15 cases of arrhythmogenic right ventricular dysplasia (ARVD) provide information about the possible mechanism of intraventricular conduction defects in about one third of cases. Two cases in this series had complete right bundle branch block and 4 cases showed diffuse intraventricular conduction defects. The other cases had normal ECGs. The point of origin of the activation in 11 cases was situated in the left ventricle, even in 6 of the 9 cases with normal ECGs. The points of latest activation were located over the right ventricular free wall near the atrio-ventricular groove. However, in all cases but one, a normal right ventricular point of origin was observed, suggesting participation of the right bundle within a free wall showing delayed activation. This activation showed very irregular delayed propagation due to the zones of dysplasia. These results suggest that in ARVD, the mechanism of the conduction defects is not disease of the bundle branch itself but a distal block probably situated in the right ventricular wall. This hypothesis is supported by the histological appearances of the dysplastic zones.

The following points become apparent after the study of 200 cases of aortic valve replacement:--Conduction defects are very common after this type of surgery, affecting one in three patients in this series;--Above all, the frequency of conduction defects of the left bundle branch (2/3 cases) must be underlined. They are much more common than complete atrioventricular block, bifascicular block or isolated right bundle branch block;--Diagnosed immediately after operation in almost all cases, regression is common (50%) especially of left anterior hemiblock;--The long term prognosis is good. There was no long or short term mortality due to this cause in this series;--Apart from traumatic lesions which are difficult to avoid when the aortic orifice is calcified, ischaemia of the conduction pathways due to insufficient myocardial protection probably plays a role in the aetiology of these conduction defects.