[Recommendations for reforming prostatic specimens. Les Membres du Sous-Comité Prostate du Comité de Cancerologie de l'Association Française d'Urologie]. / Recommandations pratiques pour les prélèvements prostatiques. Les Membres du Sous-Comité Prostate du Comité de Cancerologie de l'Association Française d'Urologie.

The purpose of these recommendations proposed by the members of the <>, is to provide an informative report for the clinician and the pathologist, in the management of patients with prostate cancer. These recommendations are common to the ADSAP and UICC recommendations on prostate cancer. Standardized forms are recommended to be included in every report.

[How to research oligohydramnios?]. / Que rechercher dans un contexte d'oligoamnios?

When an oligohydramnios has been clinically detected, the fetoplacental study has to find the cause of this syndrome: malformations, infectious or environmental anomalies, and to study the consequences of this syndrome in the fetus. A careful and complete study allows us to indicate some genic syndromes such as polycystic kidney disease, Meckel syndrome, familial renal tubular dysgenesis, Vacterl-Hydrocephaly sequence, or Fraser syndrome inducing the genetic counseling and a familial study. The other pathologies, such as maternal diseases, infections or sporadic malformations must be followed by cautious maternal care for subsequent pregnancies.

Renal chromophobe cell carcinoma and oncocytoma. A comparative morphologic, histochemical, and immunohistochemical study of 124 cases.

BACKGROUND: Renal oncocytoma has several features that overlap with other renal neoplasms, including the eosinophilic subtype of chromophobe cell carcinoma. In fact, strict criteria for renal oncocytoma have not been well defined and remain a matter of controversy. Ultrastructural studies or sophisticated methods such as flow cytometry and cytogenetic techniques can be of great use in distinguishing the two tumors, but are difficult to propose as routine methods because of their limited availability. OBJECTIVE: To further characterize the histologic criteria of these tumors, we undertook a retrospective study to define the utility of routinely available histochemical and immunohistochemical techniques. DESIGN AND SETTING: Twenty-one cases of chromophobe cell carcinoma, eosinophilic subtype, and 103 cases of oncocytoma were tested with histochemical (Perls, periodic acid-Schiff, and Hale's colloidal iron) and immunohistochemical (peanut agglutinin antigen and UEA-1 for lectins; cytokeratin KL1, epithelial membrane antigen, vimentin, S100 protein, and lysozyme) staining. RESULTS: The antibodies tested and the histochemical staining using Hale's colloidal iron allowed eosinophilic chromophobe cell carcinoma to be distinguished by its characteristic reaction pattern. Seventy-six percent of the chromophobe cell carcinomas showed a microvacuolated pattern, and 89% of the renal oncocytomas showed an apical positivity with Hale's colloidal iron staining (P < .01). Peripheral cell accentuation reactivity for cytokeratin KL1 was observed in 66% of the chromophobe cell carcinoma cases, and apical cytoplasmic positivity was observed in 37% of the renal oncocytoma cases (P = .01). Significant patterns were observed with anti-epithelial membrane antigen and anti-peanut agglutinin antigen antibodies (P = .05 and P = .01, respectively). Positive reactions for vimentin, S100 protein, lysozyme, and UEA-1 were not significant characteristics. CONCLUSION: Our study demonstrated that a precise morphologic description associated with simple histochemical and immunohistochemical techniques provides sufficient criteria for a high level of discrimination between the eosinophilic subtype of chromophobe cell carcinoma and renal oncocytoma.

Langerhans' cells are depleted in chronic graft versus host disease.

AIMS: To measure Langerhans' cells in skin of patients treated by bone marrow transplantation who developed chronic graft versus host disease (GvHD); to determine whether the reduction in Langerhans' cells resulted directly from the GvHD or from other factors, such as the immunosuppressive regimens used in bone marrow transplant patients. PATIENTS AND METHODS: Lesional and nonlesional skin specimens from nine patients with lichen planus-like lesions and three patients with sclerodermoid lesions were studied. Control skin specimens were taken from three patients undergoing breast reduction surgery. The number of Langerhans' cells/mm2 and the area of Langerhans' cells as a percentage of total epidermis were measured by counting cells labelled with antihuman CD1a. RESULTS: A significant reduction in Langerhans' cell area and number were found in specimens with lesions (area 3.5%; number 507/mm2) compared with specimens without lesions (8.42%; 2375/mm2). In contrast, Langerhans' cell area and number in skin without lesions were similar to controls (10.26%; 2968/mm2). CONCLUSIONS: Langerhans' cells were significantly reduced in skin with lesions of chronic GvHD but not in skin without lesions from the same patient, suggesting that the reduction is a direct consequence of GvHD and not linked to immunosuppressive drugs or late effects of conditioning regimens. In long term bone marrow transplant recipients, Langerhans' cells are derived mainly from the donor cells; therefore, this result suggests the occurrence of autoreactive phenomenon in chronic GvHD.

[Are lymphocytic and collagenous colitis two forms of a single disease? Arguments taken from a biopsy quantitative study]. / La colite lymphocytaire et la colite collagène sont-elles une seule et même maladie? Arguments tirés d'une étude quantitative sur biopsie.

Collagenous colitis and lymphocytic colitis are defined by a clinicopathologic syndrome with chronic watery diarrhea, microscopic lesions of colonic biopsies, and normal barium enema and colonoscopy. A histopathological study was performed on multiple colorectal biopsies to compare 12 cases of collagenous colitis (defined by a subepithelial collagen thicker than 10 microns) and 7 cases of lymphocytic colitis (defined by a number of intraepithelial lymphocytes more than 20 per 100 epithelial cells at least in one biopsied site). The study included a semiquantitative analysis of inflammatory infiltrate in the lamina propria, crypts distortion and epithelial detachment. The number of intraepithelial lymphocytes per 100 epithelial cells was determined in surface epithelium and crypts. The subepithelial collagen thickening was studied by computerised morphometry. The intraepithelial lymphocytes, villous atrophy and thickness of the subepithelial collagen were also determined in gastric and duodenal biopsies. In collagenous colitis, the subepithelial collagenous thickness ranged from 10 to 40 microns in the colon (median 20.99 microns). In 4 cases of collagenous colitis, no thickening of the collagen plate was seen in the rectum. We found constant epithelial detachment and mucosal distortion. In lymphocytic colitis, the thickness of the subepithelial collagen ranged from 6 to 10 microns in 4 cases and was less than 6 microns in 3 cases (median 6.24 microns). The median number of intraepithelial lymphocytes in surface epithelium was 22.35 (range 18.2 to 40) in lymphocytic colitis versus 12.22 (range 4.6 to 24.4) in collagenous colitis. In conclusion, we observed an overlap of both the collagenous plate thickness and the number of intraepithelial lymphocytes in collagenous colitis and lymphocytic colitis. This result favours a unified histogenesis for these two entities.

Improved detection of human papillomavirus infection in genital intraepithelial neoplasia in human immunodeficiency virus positive (HIV +) women by polymerase chain reaction-in situ hybridization.

The prevalence of genital human papillomavirus (HPV) infection was evaluated in 30 consecutive human immunodeficiency virus (HIV) + women by polymerase chain reaction (PCR)-in situ hybridization (ISH) on paraffin-embedded tissue sections and compared with that found with standard ISH. Biopsies were removed from normal or neoplastic areas in the cervix, vagina, and vulva, and ISH was performed with biotinylated or fluorescein isothiocyanate genomic DNA probes. One probe was used for HPV screening and others for HPV typing (types 6, 11, 16, 18, 31, and 33). Sequences were amplified by the "hot-start" PCR method and followed by standard ISH. Among the 30 HIV + women, 90% scored HPV + in one or several locations by PCR-ISH, whereas only 67% were positive by ISH. Oncogenic HPV types were found in 63% by PCR-ISH and in only 43% by ISH. The same HPV types detected by standard ISH were also recognized by PCR-ISH, but with the latter the signal was amplified. Moreover, some HPV types were found with PCR-ISH but not by ISH. We conclude that PCR-ISH is a valuable and sensitive method for specific detection of HPV.

[Role of biological and anatomo-pathologic criteria in the prognosis evaluation of patients before and after radical prostatectomy]. / Place des critères biologiques et anatomo-pathologiques dans l'évaluation pronostique des patients avant et après prostatectomie radicale.

Radical prostatectomy is the treatment of choice for organ-confined prostatic cancers (T1-T2). However, it has been reported to improve the long-term survival of patients and achieve its oncological objectives in only one half of patients despite a serious morbidity. Based on a consecutive series of one hundred patients, the authors performed univariate statistical analysis to determine the predictive value of eight preoperative criteria for biological progression and capsular effraction: clinical stage, PSA (using a highly sensitive test derived from the Yang Proscheck and lowering the limit of detection to 0.1 ng/ml), PSA density (PSAD), percentage and topography of positive biopsies, capsular effraction, perineural spaces and Gleason's score. The predictive value for progression of five postoperative histological criteria (Gleason's score, capsule, perineural spaces, seminal vesicles and resection margins) was also studied in the same group of patients. The presence of capsular effraction on the biopsy was shown to have a positive predictive value of 90%. The three preoperative criteria most closely correlated with tumour progression were PSA, PSAD and percentage of positive biopsies (p < 0.001). Analysis of the combined predictive value of PSAD, percentage of positive biopsies and capsular effraction revealed that progression was always present when two of these criteria were positive. Seminal vesicle invasion on the operative specimen is the most pejorative element for progression. In conclusion, analysis of the histological features of biopsies associated with PSA and PSAD allows a more accurate selection of patients with a high risk of progression and seminal vesicle invasion is so pejorative that it could be detected in subjects with a preoperative PSA greater than 25 ng/ml.

Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistent/recurrent detectable PSA after radical prostatectomy.

OBJECTIVES: To determine if methodic analysis of systematic echo-guided biopsies associated with prostatic-specific antigen (PSA) and PSA density can accurately predict the actual pathologic stage of prostate cancer (Ca P). METHODS: One hundred patients with clinically localized (T1, T2) Ca P who underwent radical prostatectomy (RP) were preoperatively staged by digital rectal examination (DRE), measurement of serum PSA (Yang Pros-check) and PSA density (PSAD), and transrectal echo-guided systematic biopsies (three in each lobe aiming to sample prostatic capsule) to evaluate T stage, Gleason grade, number of positive biopsies, and presence of cancer in the periprostatic tissues. Radical prostatectomy specimens were processed following the McNeal method. The PSA levels were measured every month for 2 years. RESULTS: Extracapsular disease was detected on the specimen in 45% of the patients, persistent/recurrent detectable PSA in 47% (mean follow-up 18 months). Clinical stage T2 B, presence of Gleason grade 4, PSA > 25 ng/mL, PSAD > 0.6, number of positive biopsies > 66% of the total number of cores taken had a positive predictive value (PPV), respectively, of 72%, 66%, 80%, and 87%. Periprostatic tissue was evaluable on the core biopsies in 77% of the cases. Presence of cancer in the periprostatic fat on the core biopsies had a PPV of 94% for extracapsular disease/biological recurrence. CONCLUSIONS: The presence of extracapsular cancerous tissue on prostatic core biopsies accurately predicts extracapsular extension of Ca P. Therefore, care should be taken when performing prostate biopsies to sample the prostate capsule and surrounding tissues to obtain a more accurate staging of the disease. The second best predictor of extracapsular disease is the percentage of positive biopsies.

Predictive value of pathological features for progression after radical prostatectomy.

OBJECTIVE: 10-30% of patients with T1/T2 prostate cancer submitted to radical prostatectomy ultimately fail. It may be important to detect failure as early as possible in order to evaluate the extent of recurrent/residual disease and initiate adjuvant therapy. SUBJECTS AND METHODS: 100 consecutive patients with localized prostate cancer treated by radical prostatectomy have been monitored using the hypersensitive Pros-check prostate-specific antigen (PSA) assay (detection level 0.1 ng/ml). The predictive value of positive surgical margins, involvement of seminal vesicles and perineural spaces as well as Gleason's score for biological failure (persistent or recurrent detectable PSA) has been retrospectively evaluated. RESULTS: Overall 40% of the patients had biological failure (defined as persistence of a detectable or rising PSA after undetectability) and 38% had positive surgical margins. The three main predictive criteria of biological failure were capsular perforation, involvement of seminal vesicles and/or positive margins. All patients in whom these criteria were positive progressed. Seminal vesicle invasion was associated with biological failure in 95% of the cases. 66.7% of the patients with extracapsular disease but no seminal vesicle invasion progressed. 15% of pT2 patients experienced a persistent/recurrent postoperative PSA and were upstaged to pT3 after reevaluation of the specimen. CONCLUSION: Efforts should be made to increase the preoperative evaluation of seminal vesicle and pericapsular status by a more sophisticated technique of prostate biopsy in order to avoid noncurative surgery.

[Neuroendocrine cancers of the prostate]. / Les cancers neuro-endocrines de la prostate.

This article is a transcription of several papers on neuroendocrine cancers of the prostate presented to the Uropathology Club in Angers in 1990. It consists of three parts: Firstly, a study of neuroendocrine cells in various organs of the human body, followed by the demonstration of these cells in the normal and pathological prostate. The second part reports 3 cases of neuroendocrine cancers as they are observed in routine practice. A total of 66 cases of pure neuroendocrine cancers have been reported to date in the English language literature. This type of cancer is characterised by a rapid, hormone-resistant course with the development of multiple metastases, frequently visceral. Periods of remission in response to chemotherapy may be observed in some cases. The third part concerns the systematic demonstration of neuroendocrine cells in prostatic adenocarcinoma. The percentage of neuroendocrine cells demonstrated by various histological techniques is directly correlated to an increasingly severe prognosis of the cancer.

[Sensory fibers sensitive to capsaicin can modulate secretion of the duodenal mucus. A morphometric study in rats]. / Les fibres sensitives sensibles à la capsaïcine peuvent moduler la sécrétion de mucus duodénal. Etude morphométrique chez le rat.

Many in vitro and in vivo models have been used to study the modulation of intestinal mucosecretion. In such studies, quantification of mucus secretion is usually difficult, due to several technical problems. Whether sensory mechanisms participate in the modulation of intestinal mucosecretion remains unknown. The development and assessment of a morphometric method with computer assisted image analysis that allows to detect and quantitate mucin secretion by duodenal goblet cells are reported. Using this method, the secretory effect of pilocarpine on villus and crypt goblet cells was confirmed. We also determined whether sensory neurons can regulate intestinal mucosecretion by using capsaicin, a vegetal neurotoxin specific of a subpopulation of afferent primary sensory neurons. Intravenous capsaicin administration (10 micrograms/kg) increased mucus secretion by the goblet cells of the duodenal crypts. This suggests that sensory neurons may modulate duodenal mucin secretion. The "local effector function" of these neurons might be involved, in part through the release of substance P because exogenous substance P was able to increase mucin excretion by goblets cells of duodenal villi. Substance P, however, did not exactly mimic the capsaicin effects, suggesting that other factors were involved.

[Tubulo-papillary tumors of the kidney. A distinct entity with a discussed prognosis]. / Tumeurs tubulopapillaires du rein. Une entité à part de pronostic discuté.

Tubulopapillary tumors of the kidney represent a group of peculiar interest with specific histological and cytogenetic features. These tumors are distinguished from other renal tumors by their more favorable prognosis.

[Renal adenocarcinoma with secretion of renin, simulating a oncocytoma. Apropos of a case in a pregnant woman with histological and immunohistochemical study]. / Adénocarcinome rénal avec sécrétion de rénine, simulant un oncocytome. A propos d'un cas chez une femme enceinte, avec étude histologique et immunohistochimique.

The authors report a new case of primary renin-secreting renal carcinoma in a pregnant woman. The clinical, radiological and pathological findings mimicked an oncocytoma and the diagnosis was confirmed by immunohistochemical study.

[Prostatic organogenesis and its morphometric characteristics]. / L'organogenèse prostatique et ses aspects morphométriques.

The prostatic organogenesis had been often studied, since 90 years, with the aim of finding an embryologic cause for the adult pathology. But the prostatic anatomy and morphogenesis had been recently reviewed. The author, with personnal results and an analysis of the literature, shows here the prostatic development. It is in agreement, morphometrically, with the general development of the fetus, and the importance of hormonal factors, androgenic as oestrogenic ones, is specified.

[Abnormalities of prostatic morphogenesis]. / Les anomalies de la morphogenèse prostatique.

The author shows here some malformations of the prostatic development, with personal cases and a revue of the literature. Often, these malformations happen with many other regional abnormalities, as Prune-Belly syndrome or Vacterl sequence, or deficiencies of the androgenic receptors.

[Prostatic sarcoma: point of view of the pathologist]. / Les sarcomes de la prostate: point de vue du pathologiste.

The authors describe here briefly the different prostatic sarcomas and insist on the very peculiar entity called inflammatory pseudo- sarcoma or spindle cell post operative nodule.

[Multiple condylomata of the urethra and bladder disclosing HIV infection]. / Condylomes multiples de l'urèthre et de la vessie révélant une infection par HIV.

The authors report the case of a 26 year old man, in whom recurrent hematuria revealed the diagnosis of urethral condylomata with bladder extension, and HIV serology positive. This case reminds us that it is essential to search for immunodeficiency in every case of extensive or recurrent condylomata. The analysis of such cases in the literature allows discussion of the various clinical courses according to the Human Papilloma Virus types found in condylomatous tissues.