[Standards, options, and recommendation for external radiotherapy of prostatic cancer: evaluation of the effect of dosage]. / Standards, Options et Recommandations pour la radiothérapie externe des patients atteints de cancer de la prostate: évaluation de l'effet dose.

CONTEXT: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical speciality societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. OBJECTIVES: Produce clinical practice guidelines for the radiotherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. METHODS: The FNCLCC and the French Urology Association (AFU) designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers. RESULTS: The main recommendations are: 1/ a minimal dose of 70 Gy must be used, whatever the prognostic factors; 2/ it appeared that patients with favourable prognostic indicators (stage T1-2, PSA < or = 10 micrograms/L and Gleason score < or = 6) do not benefit from a dose escalation effect for doses over 70-74 Gy; 3/ patients with intermediate prognosis are the ones who benefit most from the dose escalation effect over 74 Gy, provided they receive exclusive radiation therapy; 4/ whenever possible, patients should be included in controlled trials designed to assess the effects of dose escalation and hormonotherapy.

[Standards, Options, and Recommendations for brachytherapy in patients with prostate cancer: efficacy and toxicity]. / Standards, Options et Recommandations pour la curiethérapie des patients atteints de cancer de la prostate: efficacité et toxicité.

CONTEXT: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by a critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. OBJECTIVES: Produce clinical practice guidelines for the brachytherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. METHODS: The FNCLCC and the French Urology Association (AFU) first designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers. RESULTS: The main recommendations are: 1/Brachytherapy with permanent seeds alone is a possible curative treatment for prostate cancer patients with the following prognosis factors: tumour stage T1 or T2a (TNM 1992), Gleason score < or = 6 and PSA < 10 micrograms/L. 2/Combined treatment with brachytherapy and hormonal therapy could be more efficient than brachytherapy alone for prostate cancer patients with Gleason score > 7 and/or PSA > 10.3/Combination of brachytherapy and external beam radiation therapy can be proposed to prostate cancer patients with intermediate prognosis. 4/Before and after seed implantation, risks of infection must be prevented by appropriate antibiotic therapy (recommendation). 5/Brachytherapy must not be performed within 2 months of transurethral prostate resection. 6/The height of the urethra receiving more than 200% of the prescribed dose must be reported. The portion of the rectum receiving 100 and 120% of the prescribed dose must be limited to 10 and 5 mm length, respectively.

[Granulomatous mastitis and corynebacteria infection. Two case reports]. / Mastites granulomateuses et corynébactéries. A propos de deux observations.

Diagnosis of granulomatous mastitis must be based on a multidisciplinary approach. First, it's necessary to eliminate carcinomatous mastitis. Usually, the diagnosis is unknown except for tuberculous and sarcoidosis granulomatous mastitis. On observations in two cases of Corynebacterium granulomatous mastitis, we discussed the diagnosis and therapeutic approach. When there is a clinical suspicion of granulomatous mastitis, surgical biopsy with immediate histological analysis and bacteriological culture of mammary tissue should be performed. This multidisiplinary approach should reduce the number of idiopathic granulomatous mastitis observed. Antibiotic treatment is required after biopsy or surgical excision of granuloma.

[Prostate cancer: anatomo-pathological correlation and MRI]. / Cancer prostatique: corrélation anatomo-pathologique et IRM.

In our study, 50 patients had a prostatic carcinoma stade B. Before the radical prostatectomy we have realised a MRImaging of the prostate. After a precise histopathologic correlation we tried to appreciate the MRI performance for the detection of neoplasic nodes in the peripheral zone and for the loco-regional staging of the carcinoma. In detection of the pathologic nodes, MRImaging is more sensitive from the apex (22.5%) to the base of the prostate (91%), but it is at the same time specificless (apex: 90%, base: 40%). The accurate diagnostic for loco-regional staging in our study is 70%. Extracapsular extension is often underestimated because of the very small size of the invasion. On the other hand the specificity of MRI in seminal vesicles extension is satisfactory (87.5%).

[Breast micro-opacities of lead origin mimicking microcalcifications]. / Micro-opacités mammaires d'origine saturnine mimant des microcalcifications.

After a surgical excision of focal mammary "microcalcification" we noticed that in fact they represented fine lead deposits (mean diameter: 100 microns) resulting from an attempted suicide (22 long rifle) 10 years previously. The leaded nature of these foreign microbodies was demonstrated by a micro-analysis by energy dispersion on histological slides.

[An unknown cause of deep lymphadenopathies: polyethylene histiocytosis related to a joint prosthesis]. / Une cause méconnue d'adénopathies profondes: histiocytose ganglionnaire au polyéthylène, satellite de prothèse articulaire.

A case of deep seated lomboaortic lymph node enlargement, due to a storage hitiocytosis by fragments of polyethylene, draining the site of hip joint prosthesis is reported. These lymph node enlargement, made visible by tomodensitometry, were satellites of an ovarian adenocarcinoma. The artificial hip joint operation had taken place 17 years before and 10 years later the patient underwent a secondary operation to replace the prosthesis of the right hip. To the knowledge of the authors this is the first recorded case of lymph node enlargement due to a storage histiocytosis in response to debris shed from hip prosthesis being made visible by way of a radiological examination.

[Abdominal desmoid tumors and Gardner's syndrome. Report of a complete case]. / Tumeurs desmoïdes abdominales et syndrome de Gardner. Une observation complète.

The authors report a case of patient with a complete Gardner's syndrome. This case is characterized by the association of desmoid tumor of the thoraco-abdominal wall, mesenteric fibromatosis, gastric and duodenal polyposis and a rectal adenocarcinoma. They present a brief review of the syndrome which raises problems of clinical classification and therapeutic difficulties.

[Granulomatous lesions of the breast. Their role in inflammatory breast pathology and their relations to lobular granulomatous mastitis]. / Les lésions granulomateuses du sein. Leur place dans la pathologie inflammatoire mammaire et leurs relations avec la mastite granulomateuse lobulaire.

The authors summarise the clinical notes and histological findings of 17 patients who had inflammatory changes in their breasts and in whom biopsies showed epithelioid granulation tissues with giant cells. Three separate histological tables have been prepared as well as a review of the literature. The paper shows that mixed granulomatous conditions exist, with the sites of the changes being both in the canals and in the lobules. This gives rise to a discussion about the separateness of the condition, which is presumed to be of an autoimmune origin. It is pointed out that there can be an infectious element present.

[Breast carcinoma with giant cell stromal reaction. First male case]. / Carcinome mammaire a stroma-réaction giganto-cellulaire. Premier cas masculin.

We report here the first case, to our knowledge, of mammary carcinoma with giant-cell stromal reaction occurring in a man. Review of literature allows to consider this carcinoma as a distinctive morphological entity. Ultrastructural cytochemical and immunohistochemical studies show that giant cells also present in metastases are non tumorous cells coming from mononuclear phagocytes cells system. This entity is peculiar by presence of inusually high titers of receptors to progesterone. Clinical evolution is still not well known.

[Breast carcinoma with multinucleated reactive stromal giant cells (author's transl)]. / Le carcinoma mammaire à stroma-réaction giganto-cellulaire.l Etude cytologique, histologique, ultrastructurale et immunocytochimique 2 deux observations.

Breast carcinoma with multinucleated reactive stromal giant cells is a rare histological type. The number of published cases, to which we add two new cases, is too small for it to be possible to reach a conclusion as to whether this type of complaint, for which the authors put forward morphological criteria, should or should not be considered as an anatomoclinical entity. The diagnosis can be made as soon as cytological examination has shown a large number of multinucleated giant cells associated with carcinomatous cells. Ultrastructural study confirms the macrophagic origin of the giant cells but does not show any macrophagic activity.

[beta2-Microglobulin in cancer patients (author's transl)]. / La beta2-Microglobulineen pathologie cancéreuse.

Cancerembryonic antigen (CEA) and beta2-microglobulin (beta2m) have been measured in cancer patients and patients with benign diseases. Of 168 patients with intestinal cancer, almost 90% had increasing concentrations of either CEA or beta2m or both. In 29 patients at different stages of pancreatic cancer there was a high incidence of increased values in the more severe cases. In 60 patients with histologically classified colorectal cancer the TNomegaMomega group of 19 patients had 47% and 42% of elevated beta2m and CEA respectively. A significant correlation of beta2m or CEA to extension of disease was noted. In benign intestinal disease like cirrhosis and pancreatitis both beta2m and CEA is commonly elevated. Of 26 breast cancer patients, seven had elevated CEA and five had elevated beta2m values before treatment. In the patients with extraganglionary metastasis almost 90% had high beta2m or CEA or both. Of 40 patients with uterine cancer, 26 were found to have increased values of beta2m or CEA or both. Finally, 140 colorectal cancer patients, 62 patients with breast cancer and 10 patients with uterine cancer have been followed longitudinally.