A radiolabelled iodobenzamide for malignant melanoma staging.

123I-N-(di-ethylamino-2-ethyl) 4 iodobenzamide (I-BZA) has been put forward by the Clermont-Ferrand INSERM U71 group (France) as a tracer for malignant melanoma. We report on the clinical results obtained in 56 studies performed on 48 patients. Whole body scans along with spot views were obtained after injection of 185 MBq of I-BZA. The scans were read by three independent observers and correlated to the clinical findings and the other imaging modalities available, taking into account all lesions larger than 1 cm. Patients were classified into two groups on the basis of a post-treatment survey of patients: group I, in complete remission (24 scans); group II: documented metastases (32 scans). In group 1, 21 studies were truly negative. However, three studies showed positive results. Only one turned out to be a false positive (specificity 95%), the other two revealed unknown lesions and modified the patients' management. In group II, 73% of the known metastases were detected with higher sensitivities (> 80%) for eye and orbit, lung and abdomen. One false positive was reported and four new lesions were detected. I-BZA scintigraphy has the same sensitivity as immunoscintigraphy with higher specificity and without the risk of xenoimmunization. It is a useful tool for staging malignant melanoma which can improve patient management.

Disseminated pagetoid reticulosis associated with mycosis fungoides: immunomorphologic study.

We report a 77-year-old woman with erythrosquamous plaques on the legs for 10 years. Biopsies taken 4 years ago revealed a pagetoid reticulosis with a massive epidermal cell infiltrate. She has now also developed a typical tumor of mycosis fungoides. The epidermal infiltrate of the two types of lesions bore the surface membrane marker for T lymphocytes rich in both T helper and T cytotoxic-suppressor subsets (ratio, 1.8). Both lesions also showed dendritic OKT6-positive Langerhans cells, and staining of the intercellular material with the DR locus of human lymphocyte antigen was positive. A dense dermal infiltrate was evident only in the mycosis fungoides lesions, and it was similar to that in the epidermis. Electron microscopy of the two lesions showed the atypical cells described in mycosis fungoides and the Sézary syndrome. These observations suggest that disseminated pagetoid reticulosis probably is a variant of mycosis fungoides.

In vitro study of the cell populations in two cases of Kaposi's sarcoma.

Despite numerous studies, the histogenesis of Kaposi's sarcoma remains unclear. In connection with the culture of two Kaposi's sarcomas, the morphological, ultrastructural, and immunological properties of the various cell types observed are discussed. Cloning in agar, loss of contact inhibition, and karyotyping were used to determine which cells had undergone malignant transformation. Findings for both cases revealed that endothelial cells had undergone neoplastic transformation. Fibroblastic cell lines were isolated from both sarcoma fragments; although their growth characteristics distinguished them from normal fibroblasts (increased growth and possibility of culture in soft agar), cytogenetic investigations on both lines confirmed that they were genetically normal, and occurred along with malignant cells as a accessory compartment within lesions. Endothelial cells appear to be the sole origin of Kaposi's sarcoma, and may release factors which alter fibroblastic growth.

[Cutaneous apudoma. Apropos of a case and review of the literature]. / Les apudomes cutanés. A propos d'un cas et revue de la littérature.

It has been suggested that Merkel Ranvier cells, generally considered as belonging to the Apud system, may be the origin of extremely rare skin tumors. The authors analyse the characteristics of an apudoma in connexion with a case, and compare their findings with those of 58 other cases reported in the literature. With light microscopy techniques, the differential diagnosis is essentially one of a non-differentiated primary or secondary carcinoma, or of a lymphosarcoma. Detection by electron microscopy of neurosecretory granules in the cell cytoplasm, the neuron-specific enolase activity, when this is detectable, the possibility of ectopic polypeptide secretions, and the evolution potential of the tumor, are all features warranting inclusion of this type of tumor in the category of apudomas.

[Cutaneous neuroendocrine carcinoma : apropos of a case]. / Les carcinomes neuro-endocrines cutanés : à propos d'un cas.

A case of neuroendocrine carcinoma (Merkel cell tumor) of the skin in a 76 years old woman is reported. The lesion, an erythematous nodule, 2 to 3 cm in diameter occurred on the face. Light microscopic examination showed sheets of indifferentiated cells that had a uniform round nucleus and scanty cytoplasm containing argyrophil granules. An ultrastructural study demonstrated neurosecretory type granules in the cytoplasm of the tumor cells. Immunocytochemical analysis was strongly positive for neuron specific enolase, but negative for Met-Enkephalin. This case is discussed in the light of a review of 73 cases already published in the literature. The origin of the cells involved in this tumor is still discussed. Several authors have suggested that this tumor is an Apudoma possibly arising from Merkel cells. In most cases, the lesion is an erythematous nodule. The most common localization is the face (45 p. 100). The tumor can be diagnosed by routine histology, but silver staining and electron microscopic study are often helpful. Removal of the tumor should be performed. This tumor appears to be of a low grade malignancy. Local recurrences or metastases have been reported in a few cases.

[Erythema gyratum repens and primary bronchial cancer. Disappearance of the dermatosis under general corticoid therapy]. / Erythema gyratum repens et cancer bronchique primitif. Disparition de la dermatose sous corticothérapie générale.

A case of Erythema Gyratum Repens in a 76 year old man with bronchiolar carcinoma is reported. The onset of the dermatosis preceded the discovery of the neoplasm. Oral corticosteroids induced the disappearance of the skin lesions. No recurrence was observed after discontinuation of the treatment. The patient died 7 months after the onset of the dermatosis.

[Epidemic aspect of parasite pruriginous dermatitis of Pyemotes zwoelferi type (author's transl)]. / Une épidémie de dermatite prurigineuse parasitaire à Pyemotes zwoelferi.

The responsibility of the Pyemotes in the genesis of certain parasite prurigo is known since the middle of the 19th century. The epidemic that we are describing owes its originality to the species Pyemotes zwoelferi sent in a bunch of dried flowers coming from Yugoslavia. The affection of man by these Pyemotes is essentially due to two factors: one of them is of an ecological nature due to the violent change of the conditions under which the acarian population grew and developed, and the other one linked to the species and the belonging to the ventricosus group. The varieties of the ventricosus group have a host specificity which is by far less narrow than that of the scolity group and they are also the most pathogenic to man.

Cutaneous T-cell lymphoma in association with a monoclonal gammopathy.

Monoclonal gammopathies and other abnormalities of immunoglobulin production may characterize or frequently be associated with B-cell lymphoproliferative disorders. We describe a patient with a T-cell cutaneous lymphoma, expressed clinically as Sézary's syndrome, in association with an immunoglobulin A type kappa M-component monoclonal gammopathy. No evidence for the coincident presence of a malignant plasma dyscrasia was found. This clinical association may lend clinical support to the concept that Sézary's syndrome is a T-helper-cell malignant proliferation. A colonic carcinoma was also present, possibly representing a second manifestation of a functionally abnormal cellular immune system.