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1.
Gynecol Obstet Fertil ; 42(2): 84-91, 2014 Feb.
Article in French | MEDLINE | ID: mdl-22306097

ABSTRACT

OBJECTIVES: To propose a therapeutic approach and follow-up of patients with atypical polypoid adenomyoma (APA) wishing to remain fertile. PATIENTS AND METHOD: We are presenting a retrospective study of eight APA cases. RESULTS: Two patients immediately received radical treatment, and one patient had an endometrial thermocoagulation. The remaining five patients received a conservative treatment with ultrasound and hysteroscopic monitoring. Among them, two had full-term pregnancies, one is being treated for infertility, in one case, the APA disappeared after three hysteroscopy-curettages and macroprogestative treatment. Lastly, one of our patients died from an aggressive endometrioid ovarian bilateral tumour associated with an endometrial adenocarcinoma. DISCUSSION AND CONCLUSION: Radical treatment is necessary for cases of APA in women no longer wishing to remain fertile. For those wishing to remain fertile, we can offer a conservative treatment once they have been informed regarding the associated risk of relapse, degeneration, and ovarian lesions which necessitate stricter follow-up.


Subject(s)
Adenomyoma/therapy , Endometrial Neoplasms/therapy , Adenomyoma/pathology , Adenomyoma/surgery , Adult , Endometrial Neoplasms/pathology , Endometrial Neoplasms/surgery , Fatal Outcome , Female , Fertility Preservation , Humans , Hysteroscopy , Middle Aged , Pregnancy , Progestins/therapeutic use , Retrospective Studies , Risk Factors
2.
Article in French | MEDLINE | ID: mdl-21112160

ABSTRACT

OBJECTIVES: Twenty-two uterine carcinosarcomas were treated and followed in two centers over 10 years. We wanted to describe them and review the literature on the subject. PATIENTS AND METHODS: We describe all uterine carcinosarcomas treated in Lille, over 10 years, both in department of gynecology, Hospital Jeanne-de-Flandre (11 patients), and in department of gynecologic oncology of Centre Oscar-Lambret (11 patients). RESULTS: For the 22 patients included, we give age at time of diagnosis, body mass index, pre and post surgical histology, details of surgical treatment, adjuvant treatment and evolution of the pathology. Mean age at time of diagnosis was 69.6. Sixty-eight percent of patients had overweight or obesity. Revealing symptoms were in 91% of cases post-menopausal meno- or metrorrhagias. Preoperatively, histology had an important number of false negative and, 57% of diagnoses were ignored in our study. All patients had first intention surgery, only 54% were yet at an early stage. Sixteen had association radiotherapy, eight of chemotherapy, two declined any adjuvant treatment. Ten patients died with a mean survival of 12.9 months, eight had a good evolution still at 35 months, two had recent pelvic relapse, two were lost to follow-up. CONCLUSION: Uterine carcinosarcomas are rare, aggressive, yet not very well known tumors. First line treatment will be surgery with peritoneal cytology, hysterectomy, bilateral adnexectomy, pelvic and sometimes lumbo-aortic lymphadenectomy, omentectomy, peritoneal biopsies. Adjuvant chemotherapy has shown its interest in this type of tumor. Radiotherapy is still debated.


Subject(s)
Carcinosarcoma , Uterine Neoplasms , Aged , Carcinosarcoma/diagnosis , Carcinosarcoma/therapy , Female , Humans , Middle Aged , Retrospective Studies , Uterine Neoplasms/diagnosis , Uterine Neoplasms/therapy
3.
Gynecol Obstet Fertil ; 37(4): 307-12, 2009 Apr.
Article in French | MEDLINE | ID: mdl-19359207

ABSTRACT

OBJECTIVE: Fluorescence diagnosis is still undeveloped in gynaecology. In order to diagnose and localize squamous intraepithelial lesion (SIL) of the cervix, a new method improving the low specificity of colposcopy would be useful. The goal of this study was to assess the feasibility and safety of colposcopic fluorescence diagnosis of SIL after topically application of methyl aminolevulinate (MAL). PATIENTS AND METHODS: Patients with histologic proved cervical intraepithelial neoplasia (CIN) and planned for loop electrosurgical excision procedure (LEEP) under general anesthesia were included in a prospective study. Before general anesthesia, a thick layer of MAL (Metvix-160 mg/mL cream) was applied on the cervix for 35-150 min. Fluorescent colposcopic inspection of the cervix was performed using a rigid 10-mm laparoscope inserted in the vaginal cavity and connected to D-light AF system (Karl Storz Endoskope, Tuttlingen Germany). In order to confirm neoplasic status, fluorescent foci underwent directed punch biopsy(ies). RESULTS: Fourteen patients were included in the study. Colposcopic fluorescence imaging revealed red fluorescent foci in 71.4% of cases (10/14) (neoplasic status of fluorescent foci was confirmed in 80%). Concerning MAL, the mean of application time was 73 min (35-150). Two cases presented a false-positive fluorescence and four cases of false-negative fluorescence. For all cases of false-negative fluorescence, application time of MAL was less than 60 min. We observed no systemic or local toxicity of MAL application in any group. DISCUSSION AND CONCLUSION: Using topical application of MAL to the cervix, we demonstrated that fluorescence diagnosis of SIL is feasible. This study justifies the further development of fluorescence imaging that combines classical white light colposcopy with the use of a photosensitizer.


Subject(s)
Pregnancy Complications, Neoplastic/surgery , Uterine Cervical Dysplasia/pathology , Uterine Cervical Dysplasia/surgery , Biopsy , Colposcopy/methods , Electrosurgery/methods , Female , Humans , Microscopy, Fluorescence , Pregnancy , Pregnancy Complications, Neoplastic/pathology
4.
Lasers Surg Med ; 40(5): 332-41, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18563777

ABSTRACT

OBJECTIVE: Accurate dosimetry was shown to be critical to achieve effective photodynamic therapy (PDT). This study aimed to assess the reliability of in vivo protoporphyrin IX (PpIX) fluorescence photobleaching as a predictive tool of the hexaminolevulinate PDT (HAL-PDT) response in a rat model of advanced ovarian cancer. MATERIALS AND METHODS: Intraperitoneal 10(6) NuTu 19 cells were injected in 26 female rats Fisher 344. Peritoneal carcinomatosis was obtained 26 days post-tumor induction. Four hours post-intraperitoneal HAL (Photocure ASA, Oslo, Norway) injection, a laparoscopic procedure (D-light AutoFluorescence system, Karl Storz endoscope, Tuttlingen, Germany) and a fluorescence examination were made for 22 rats. The first group (LASER group, n=26) was illuminated with laser light using a 532 nm KTP laser (Laser Quantum, Stockport, UK) on 1 cm(2) surface at 45 J/cm(2). The second group (NO LASER group, n=26) served as controls. Biopsies were taken 24 hours after PDT. Semi-quantitative histology was performed and necrosis value was determined: 0--no necrosis to 4--full necrosis. Fluorescence was monitored before and after illumination on complete responders (NV=3-4; n=20) and non-responders (NV=0-2; n=6). RESULTS: High PpIX photobleaching corresponded with complete responders whereas low photobleaching corresponded with non-responders (P<0.05). A direct linear correlation was shown between photobleaching and necrosis (R(2)=0.89). CONCLUSION: In vivo PpIX fluorescence photobleaching is useful to predict the tissue response to HAL-PDT.


Subject(s)
Adenocarcinoma/drug therapy , Aminolevulinic Acid/analogs & derivatives , Ovarian Neoplasms/drug therapy , Photobleaching , Photochemotherapy , Photosensitizing Agents/therapeutic use , Protoporphyrins , Adenocarcinoma/pathology , Aminolevulinic Acid/therapeutic use , Animals , Female , Microscopy, Fluorescence , Ovarian Neoplasms/pathology , Predictive Value of Tests , Rats , Rats, Inbred F344 , Reproducibility of Results
6.
Photodiagnosis Photodyn Ther ; 4(4): 254-60, 2007 Dec.
Article in English | MEDLINE | ID: mdl-25047562

ABSTRACT

OBJECTIVE: This study aimed to evaluate aminolevulinic acid-photodynamic therapy (ALA-PDT) in an experimental tumor model to expand the use of PDT in the treatment of ovarian cancer with peritoneal carcinosis. MATERIALS AND METHODS: 5-Aminolevulinic acid (ALA) (Photocure ASA, Norway) 60mg/kg was injected in the peritoneum cavity of 45 female rats Fisher with induced peritoneal metastases of ovarian cancer. ALA-PDT was performed 4h later with two different lasers: (1) laser diode (Diomed, Cambridge, UK), at 630nm, 100mW/cm(2), or (2) KTP laser (Laser Quantum, Stockport, UK), 532nm, 30mW/cm(2). The animals were divided into five groups: LASER ALONE group, CTRL group (no cancer), NO LASER group, 1 DOSE group (PDT during 1s) and 1.5 DOSE group (PDT during 1.5s). Biopsies were taken 24h after treatment. A semi-quantitative score called necrosis value (NV) was assigned to each sample that reflected the depth of the peritoneal necrosis. RESULTS: In the first two groups, the peritoneum remained intact irrespective of the wavelength. In the 1 DOSE group, necrosis was observed for 532nm and 630nm. In the 1.5 DOSE group, necrosis was observed for 532nm (NV: 3.22±0.83) and 630nm (NV: 2.67±1.00) (p<0.05). The mesothelium strongly thinned out in the diffuse shape of the tumor. CONCLUSION: Only ALA-PDT induces tumor necrosis with either 532nm and 630nm and should be considered an effective therapy for micrometastasis of ovarian cancer. This preliminary study deserves further experiments.

7.
Clin Exp Pathol ; 47(2): 81-7, 1999.
Article in French | MEDLINE | ID: mdl-10398579

ABSTRACT

The study evaluated the feasibility of a thinlayer technique on a routine basis for cervical smears and compared 473 ThinPrep preparations to the matched conventional Papsmears. The interpretation was double-blind and performed according to the Bethesda system. A consensus was established in discordant cases. The technique was easily mastered by gynecologists and technicians. Main advantages of the thinlayer technique were: a low number (1%) of unsatisfactory samples; a constant quality; homogeneity of cell distribution; the disappearance of problems of interpretation due to fixation or smear artifacts, red cells, polymorphs; a more precise interpretation, a firmer diagnosis; less visual fatigue; a shorter time of interpretation; the possibility of preparing more slides and performing special techniques on the same specimen. Main disadvantages were a higher cost and a necessary period of learning for cytologists.


Subject(s)
Cytodiagnosis/methods , Papanicolaou Test , Vaginal Smears , Adult , Double-Blind Method , Female , Humans , Middle Aged
8.
Ann Pathol ; 19(1): 42-5, 1999 Mar.
Article in French | MEDLINE | ID: mdl-10320912

ABSTRACT

A primary serous papillary cystadenocarcinoma of the rectovaginal septum was diagnosed in a 35-year-old woman. There were invasive microfoci in peritoneum and lymph node micrometastasis as well as a small superficial non invasive tumor focus in the left ovary. Diagnosis was based on morphological, immunohistochemical and ultrastructural features of tumor tissue. The patient had surgery and post-operative chemotherapy. Progression of peritoneal disease was found six months after surgery. In this very rare location of serous carcinoma, tumor might have developed from peritoneal inclusions in the rectovaginal septum.


Subject(s)
Cystadenocarcinoma, Papillary/pathology , Perineum/pathology , Rectal Neoplasms/pathology , Vaginal Neoplasms/pathology , Adult , Female , Humans
9.
Ann Pathol ; 18(3): 172-7, 1998 Jul.
Article in French | MEDLINE | ID: mdl-9706342

ABSTRACT

The morphological criteria for the diagnosis of endocervical atypia and dysplasia are variably defined. Diagnosis is difficult. MIB-1 (Ki-67) cell proliferation-associated antigen was detected retrospectively by immunohistochemistry in 230 cervical cone specimens. The percentage of MIB-1 positive cells was 1 to 25% (median 2%) and limited to small hot spots in normal and subnormal glands (140 cases). It was 1 to 30% (median 4%) in endometrioid metaplasia and microglandular hyperplasia (55 cases); 30 to 60 (median 40%) and limited to 1-3 glands in atypia (24 cases); 45 to 60% (median 50%) and diffusely distributed in dysplasia (5 cases). In situ (3 cases) and invasive (3 cases) adenocarcinomas were characterized by a high% (> 60) of MIB-1 positive cells.


Subject(s)
Ki-67 Antigen/analysis , Uterine Cervical Dysplasia/immunology , Adenocarcinoma/diagnosis , Adenocarcinoma/immunology , Adult , Carcinoma in Situ/diagnosis , Carcinoma in Situ/immunology , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Predictive Value of Tests , Retrospective Studies , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/immunology
11.
Ann Pathol ; 18(6): 497-501, 1998 Dec.
Article in French | MEDLINE | ID: mdl-10051919

ABSTRACT

Occurrence of mucinous tumors is favored by Peutz-Jeghers syndrome (PJS). A case of bilateral ovarian mucinous tumor associated with ovarian mature teratoma occurring in a 22-year-old woman with PJS was reported. Tumor cells included 5 cell types: tall columnar mucinous pale cells with neutral mucins; goblet cells with acidic nonsulfated mucins; non mucinous columnar cells; mucinous cuboidal cells lining small glands; endocrine cells. Expression of the MUC2, MUC3, MUC5AC and MUC6 genes was demonstrated by in situ hybridization according to cell type. Some atypia and numerous mitotic figures were observed in basal glands. Diagnosis was ovarian borderline mucinous tumor with gastric and intestinal phenotype associated with PJS.


Subject(s)
Adenocarcinoma, Mucinous/genetics , In Situ Hybridization , Mucins/genetics , Ovarian Neoplasms/genetics , Peutz-Jeghers Syndrome/complications , RNA, Messenger/analysis , Adenocarcinoma, Mucinous/complications , Adenocarcinoma, Mucinous/pathology , Adult , Biomarkers, Tumor , Female , Humans , Intestinal Neoplasms , Mucin 5AC , Mucin-2 , Mucin-3 , Mucin-6 , Ovarian Neoplasms/complications , Ovarian Neoplasms/pathology , Stomach Neoplasms
13.
Pediatr Radiol ; 13(4): 219-26, 1983.
Article in English | MEDLINE | ID: mdl-6888994

ABSTRACT

This report describes the symptoms, clinical course and radiological features in three cases of idiopathic carpotarsal osteolysis. Before signs of extensive osteolysis were noted, one of our patients showed flattening, loss of harmonious curvature and minimal osteoporosis of carpal and tarsal bones, all early radiological signs which have not been described previously. We discuss the findings, classification and our ideas as to the cause of the disorder.


Subject(s)
Bone Resorption/diagnostic imaging , Carpal Bones/diagnostic imaging , Osteolysis/diagnostic imaging , Tarsal Bones/diagnostic imaging , Bone Resorption/etiology , Bone Resorption/pathology , Carpal Bones/pathology , Child , Child, Preschool , Female , Humans , Kidney Diseases/complications , Male , Osteolysis/etiology , Osteolysis/pathology , Radiography , Tarsal Bones/pathology
14.
Article in French | MEDLINE | ID: mdl-7175117

ABSTRACT

The condition is extremely rare, since acardia is only found in 1% of monozygotic twin pregnancies. A case was discovered and observed using ultrasound and was then studied anatomically and pathologically. The histopathology and the physiopathology of the malformation is described. The aetiology that has been most usually accepted is that there is an anastomosis between the two umbilical cords of the two "twins" and that this leads to an inversion of the direction of the circulation in the affected fetus. The failure of the myocardium to develop would follow this vascular abnormality because of failure of the allantoid vessels to fuse. The interest in this kind of observation lies in the possibility of making the diagnosis very early in pregnancy using ultrasound, and of following the evolution and the regression of the acardiac fetus throughout the pregnancy, and with the possibility of comparing the views obtained by ultrasound with the anatomo-pathological features that can be diagnosed after birth.


Subject(s)
Abnormalities, Severe Teratoid/embryology , Diseases in Twins , Fetal Heart/abnormalities , Ultrasonography , Abnormalities, Severe Teratoid/pathology , Adult , Female , Humans , Pregnancy , Twins, Monozygotic , Umbilical Cord/pathology
15.
Sem Hop ; 58(3): 171-6, 1982 Jan 21.
Article in French | MEDLINE | ID: mdl-6278625

ABSTRACT

Three congenital fibromatosis are studied. Six years later, the subcutaneous and skeletal lesions of the first patient have disappeared with no recurrence. Regression was also observed in the second one, a generalized fibromatosis with skeletal, subcutaneous and almost certainly pulmonary and laryngeal lesions. The last case is now progressing (vertebral lesion) with a vascular invasion, the prognostic of which is unknown. A review is made about microscopical appearance, origin and difficulties in diagnosis.


Subject(s)
Fibroma/congenital , Diagnosis, Differential , Female , Fibroma/pathology , Fibrosarcoma/pathology , Humans , Infant, Newborn , Male , Neurofibromatosis 1/pathology
17.
J Chir (Paris) ; 117(11): 635-8, 1980 Nov.
Article in French | MEDLINE | ID: mdl-7451577

ABSTRACT

Results of a retrospective study of 674 frozen sections in thyroid surgery, demonstrated on over all reliability of 98.2%, when compared with final pathological findings, with 651 confirmation in 674 cases. False negatives of malignancy represented 1.6% of lesions thought to be benign, while false positives were obtained in 4.8% of lesions thought to be malignant on frozen sections. Prior to frozen sections, 221 patients had needle punctures and cytological smears studies of the thyroid lesion. When comparing the results after using the two methods, no false positive for malignancy, assessed by cytology, was found on frozen sections, which also corrected but two false negatives of malignancy given by the 177 smears affirmative of benignancy, but reduced the number of equivocal results of cytology from 36 to 1. Both pre-operative cytological examination by needle puncture and intra-operative frozen sections appear, therefore, to be very reliable methods for studying thyroid lesions. Frozen sections are complementary to cytological studies. These results suggest that, in surgical thyroid diseases, frozen sections, need perhaps not to be systematically conducted, but should be selective and reserved for cases in which pre-operative needle cytology affirms malignancy, or raises suspicion.


Subject(s)
Thyroid Neoplasms/pathology , Biopsy, Needle , False Negative Reactions , False Positive Reactions , Frozen Sections , Humans , Preoperative Care , Retrospective Studies , Thyroid Neoplasms/surgery
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