Sebaceous glands in the uterine cervix: two new cases.

The authors report on two new cases of sebaceous glands in the uterine cervix. This extremely rare histological observation was found on biopsy specimens of the uterine cervix because of unclear colposcopic findings and of recurrent CIN II. The etiology of this entity is discussed including a brief review of the medical literature.

[Necrotic eosinophilic angiitis with ileal perforation and peritonitis secondary to abdominal angiostrongyliasis]. / Angéite nécrosante à éosinophiles avec perforation iléale et péritonite secondaire à une angiostrongylose abdominale.

INTRODUCTION: Abdominal angiostrongyliasis caused by the filiform nematode Angiostrongylus costaricensis, is an endemic disease in Central and South America. A case of necrotic eosinophilic angeitis with ileum perforation and peritonitis due to abdominal angiostrongyliasis is reported. OBSERVATION: A 32 year-old man, living in a Paris suburb, underwent segmentary resection of the ileum with end to end anastomosis for perforation with generalized peritonitis. The anatomopathological examination revealed eosinophilic necrotic lesions with thrombosis on the borders of the ileum perforation. The discovery of a section of A. costaricensis in the lumen of a nearby muscular artery initiated an epidemiological survey, revealing that the patient had visited French Guyana 2 months earlier. DISCUSSION: Angiostrongylus costaricensis is a nematode parisiting certain forest rodents that become its permanent host. The intermediate hosts are earth molluscs or slugs of the same family. Humans are accidentally infected following ingestion of vegetables infested with L3 larvae or slugs carrying the disease. The clinical symptomatology is unspecific: prolonged fever, anorexia, and right iliac fossa pain with eosinophilia of the blood. Often benign, the progression of abdominal angiostrongylosis is punctuated by complications: occlusive syndrome, generalised peritonitis due to intestinal perforation and mass syndrome. Hemorrhage, infarct, pseudo-tumoural fibrosis and ulcers represent the surgical or macroscopic rearrangements. In the tissue, 4 lesions characterize abdominal angiostrongylosis: eosinophilic necrotic angeitis, foreign body granulomas, eosinophilia in the digestive wall, and the presence of A. costaricensis in the lumen of the vessels. There is presently no medical treatment and surgery is the only therapeutic option.

Primary squamous cell carcinoma of the endometrium: case history, pathologic findings, and discussion.

Primary squamous cell carcinoma of the endometrium (PSCCE) is an exceedingly rare tumor. Rarely are cytological criteria discussed. We report our experience in the cytological diagnosis of a case. A postmenopausal, 64-yr-old woman suffered from pyometria. An endometrial Pap smear displayed some malignant squamous cells. Curettage of the cervix and the uterine cavity only recovered some fragments of atypical squamous epithelium whose origin could not be precisely identified. A hysterectomy with bilateral adnexectomy was decided upon. Pathological study evidenced a primary squamous cell carcinoma in the uterine cavity while the cervix was tumor-free and the lymph nodes were devoid of metastases (pT1, pN0, pM0). The patient died 46 mo PO with multiple pulmonary and renal metastases. The histological feature of PSCCE is identical to that of any tumor of a similar nature, whatever the site, especially the cervix. Confirmation of the primary endometrial nature is only possible on the hysterectomy specimen.

[Multiple jejunal strictures caused by gastric heterotopia]. / Sténoses étagées du jéjunum par hétérotopie gastrique.

A case of gastric heterotopia was discovered incidentally on a jejunal resection specimen in a 42-year-old patient operated for Koenig's syndrome present for 10 years. This anomaly was responsible for seven chronic ulcers with strictures at multiple levels. Gastric heterotopia, especially in the jejunum, is a rare anomaly, except in intestinal duplications and Meckel's diverticulum. The various complications are a direct result of the activity of the gastric glands: hemorrhage, Helicobacter pylori enteritis, perforation, chronic ulcer and obstructive syndrome; malignant adenocarcinomatous degeneration has also been reported.

[Intimal muscular fibrodysplasia responsible for an ischemic gastric ulcer in a patient with a von Recklinghausen's disease: a case report]. / Fibrodysplasie musculaire artérielle intimale responsable d'un ulcère gastrique ischémique chez une patiente ayant une maladie de von Recklinghausen: un cas.

A 78 year-old woman, suffering from a von Recklinghausen's disease sought medical assistance for hematemesis with anemia. This patient had previously experienced an amputation of the right arm for gangrene. Gastric fibroscopy unveiled a deep chronic ulcus developed in the antrum, highly suspect of malignancy. Multiple biopsies of the ulcer showed mainly interstitial gastritis. The persistence of the hematemesis imposed a subtotal gastrectomy. Pathological examination of the operative specimen evidenced an ischemic ulcer caused by arterial intimal muscular fibrodysplasia with associated neurofibromatosis in the neighboring sub-mucosal layer. This case report highlights the frequent association of phacomatosis especially von Recklinghausen's disease, with vascular lesions whose clinical expression mainly depends on the involved vascular area.

[Kaposiform angiodermatitis (Bluefarb-Stewart syndrome) caused by a superficial arteriovenous malformation of the trochanter area: a case report]. / Angiodermite kaposiforme (syndrome de Bluefarb-Stewart) secondaire à une malformation artério-veineuse superficielle de la région trochanterienne: à propos d'un cas.

We reported a case of kaposiform angiodermatitis (Bluefarb-Stewart syndrome) complicating a superficial arterio-venous malformation of the skin and the sub-cutaneous tissue of the right trochanter area of a 28 year-old-man. This lesion resulted from large arterio-venous shunts occurring over a one-year period inside the vascular malformation, which remained stable for 27 years. This case report underlines that any vascular malformation may take an uncertain turn and needs an attentive follow-up with adequate treatment.

[Pathology of gestational trophoblastic tumors]. / Pathologie des tumeurs trophoblastiques gestationnelles.

Gestational trophoblastic tumours result from an abnormal proliferation of different types of trophoblasts. The morphological pattern, together with the immunohistochemical aspect, the cytogenetic data and the clinical profile, helps identify each pathological entity. Hydatiform moles represent malformed placentas caused by genetic aberrations of the villous trophoblast. A complete hydatiform mole displays an hydropic degeneration of all the chorionic villi with a more or less marked proliferation of trophoblasts. A partial hydatiform mole is made up of molar vesicles interspersed with normal chorionic villi. In an invasive hydatiform mole or chorioma destruens, molar vesicles penetrate the myometrium giving rise to a mass distorting the uterine wall. A choriocarcinoma is a malignant proliferation of atypical villous trophoblasts without villi formation. Necrosis, haemorrhage, vascular invasion and distant metastases strongly compromise its outcome. A trophoblastic implantation site tumor, clearly less frequent, results from a proliferation of extravillous trophoblasts, particular for their secretion of human placental lactogen hormone (hPL). This tumour, exceptionally malignant, should be differentiated from the exaggerated placental site and its variants. Except for the placental site trophoblastic tumour, and whatever the outcome (benign or malignant), all gestational trophoblastic tumours secrete the beta-subunit of the chorionic gonadotropic hormone (beta-hCG) more or less abundantly. The serum or urinary level of this unit is proportional to the tumour volume and represents a fundamental basis for the follow-up of these tumours. Multidisciplinary care of high-risk cases allows us to cure the disease, and helps the patient recover her reproductive uterine function.

[Arterial fibromuscular dysplasia unveiled by a traumatic false aneurysm: a case report]. / Fibroplastie musculaire artérielle révélée par un faux anévrisme traumatique: un cas.

An inadvertent puncture of the brachio-cubital artery during an intravenous perfusion provoked a false aneurysm in a 59-year-old woman. The angiographic check-up disclosed a "pile of dishes" pattern on the humeral artery. Pathological examination of the resected false aneurysm confirmed the presence of an extensive medial fibromuscular dysplasia distant from the rupture area. This clinical case underlines the importance of a systematic study of all traumatic vascular specimens in order to find any possible occult disease responsible for the weakening of the vessel (J Mal Vasc 1999; 24: 377-380).

Adenoid cystic (cylindromatous) carcinoma associated with squamous cell carcinoma of the cervix uteri: cytologic presentation of a case with histologic and ultrastructural correlations.

BACKGROUND: Adenoid cystic (cylindromatous) carcinoma is a rare tumor. It accounts for approximately < 1-3% of primary adenocarcinomas of the cervix uteri. Its origin is debatable. It has a higher incidence in postmenopausal women but can develop in patients under 40. An association of adenoid cystic carcinoma with squamous cell carcinoma has been reported. CASE: A case of invasive adenoid cystic (cylindromatous) carcinoma associated with an in situ squamous cell carcinoma of the cervix detected on Papanicolaou smears is reported. Ultrastructural studies provided findings that confirmed that the hyaline material corresponded to the remnants of the lamina densa of the basement membrane of malignant cells. CONCLUSION: The concurrence of these two tumors supports the hypothesis that adenoid cystic carcinoma of the cervix may develop from multipotent reserve cells.

[Adenoid cystic carcinoma (cylindroma) of the uterine cervix. Histology, immunohistochemistry, ultrastructure in a case, with review of the medical literature]. / Carcinome adénoïde kystique (cylindrome) du col utérin. Histologie, immunohistochimie, ultrastructure d'un cas avec revue de la littérature médicale.

The authors report a case of adenoid cystic (cylindromatous) carcinoma of the endocervical canal associated with an intraepithelial squamous cell carcinoma of the cervical os in a 60-year-old woman suffering from metrorrhagia. Immunohistochemical study demonstrated labeling of cylindromatous cells with anti-actin, anti-vimentin and anti-keratin antibodies. Ultrastructural study provided significant findings to confirm that the hyaline material surrounded by tumor cells was derived from the remnants of the lamina densa of the basement membrane of tumor lobules. These morphological data are similar to those observed in adenoid cystic carcinomas (cylindromas) of salivary glands. They support the hypothesis that adenoid cystic carcinoma of the cervix may develop from the multipotent reserve cells.

Adult-type rhabdomyoma of the palate. Cytologic presentation of two cases with histologic and immunologic study.

The cytologic presentations of two adult-type rhabdomyomas of the soft palate are reported. Fine needle aspiration smears of the lesions contained globular tumor cells that had striations and intracytoplasmic rod-shaped inclusions. These inclusions, corresponding to hypertrophied Z bands, were pathognomonic of rhabdomyoma tissue. The cytologic diagnosis was confirmed by histologic and immunologic studies in both cases. The cytologic preparations fixed in alcohol or air dried did not show the "spiderweb cells" observed in the histologic sections of tissue fragments fixed in formaldehyde; this clearly illustrates that the morphology of the cells of this tumor depends primarily on the specimen preparation technique used. These cases suggest that aspiration cytology can establish the diagnosis of this benign tumor of striated muscle, for which total surgical removal is usually sufficient to effect a cure. The differential diagnosis is discussed in detail.

Pseudotumoral organization of a twisted epiploic fringe or 'hard-boiled egg' in the peritoneal cavity.

A freely moving pseudotumoral formation resembling a peeled "hard-boiled egg" was discovered in the abdominal cavity of an 82-year-old male patient during exploratory laparotomy for assessment of hepatocarcinoma in the left lobe of the liver. The formation involved a twisted epiploic fringe, which was necrotic, sclerotic, and calcified. The absence of any attachment and the avascular aspect of this pseudotumor suggest a possibly self-sustaining mechanism for the laminar sclerosis organized around the necrotic adipose tissue.

[Adult type rhabdomyoma of the soft palate: pathology of 2 cases with review of the medical literature]. / Rhabdomyome de type adulte du palais mou: anatomie pathologique. A propos de deux cas avec revue de la littérature médicale.

In this paper, the authors report two cases of adult type rhabdomyomas of the soft palate. This tumor is composed of striated muscle cells containing striations and intracytoplasmic rod-shaped inclusions. In specimens already fixed in aqueous fixators (formalin...), some tumor cells presented a fixation artefact and displayed the morphology of so-called "spiderweb cells". Adult type rhabdomyoma is a real tumor. Total surgical removal is sufficient to cure the patient of this tumor in most cases.

Pseudotumoral tuberculosis of the uterine cervix. Cytologic presentation.

The cytologic presentation of a case of pseudotumoral tuberculosis of the uterine cervix is described. The presence in cervicovaginal smears of epithelioid cells arranged in clusters mixed with Langhans' giant cells was highly suggestive of tuberculosis. This diagnosis was confirmed by the detection of acid-fast bacilli in histologic preparations and cultures from biopsy specimens.

[Primary malignant melanoma of the parotid gland: anatomico-clinical study. Apropos of a case and review of the medical literature]. / Mélanome malin primitif de la parotide: étude anatomo-clinique. A propos d'une observation avec revue de la littérature médicale.

A 62 yo man presented with an enlargement of the parotid gland that had accentuated over the past ten months. Results of a needle aspiration cytology were interpreted as consistent with an adenocarcinoma. A surgical investigation was decided. Frozen and paraffin sections of superficial parotidectomy specimen disclosed a malignant melanoma. This specimen also contained an intraparotid lymph node which was free of tumor. Cervical lymph node dissection yielded 4 metastatic adenopathies among 15 lymph nodes. A retrospective search for an anterior melanocytic lesion was negative. The final diagnosis was primary malignant melanoma of the parotid gland. Cervical radiotherapy was applied. 7 months later, the patient died of diffuse metastatic involvement in the skin, brain, lungs and liver. No local recurrence occurred. Review of the medical literature revealed the rarity of malignant melanomas of the parotid gland (0.68%). No significant differences concerning clinical data and pathological aspects were noted in so called primary malignant melanoma and secondary malignant melanoma of the parotid gland. Nevertheless, primary malignant melanoma of the parotid gland is a controversial entity. Pathogenesis is discussed on the light of modern concepts of diffuse neuro-endocrine system. Prognosis remains poor, due to a late diagnosis and to an inherent aggressiveness of this type of tumor.

[Clear cell ductal adenocarcinoma or epithelio-myoepithelial carcinoma of the salivary glands. Apropos of 2 cases with review of the literature]. / Adénocarcinome canalaire à cellules claires ou carcinome épithélio-myoépithélial des glandes salivaires. A propos de deux observations avec revue de la littérature.

The authors reported two cases of epithelial myoepithelial carcinoma or clear cell adenocarcinoma of salivary intercalated duct with medical literature review. This rare tumor discovered in adults and old patients is frequently localized in parotid gland. Histologically it is composed of two types of cells: epithelial cylindrical cells bordering ductal lumen, clear myoepithelial cells rich in glycogen. This tumor is particular for its local recurrencies but is capable of metastasizing. Its prognosis is uncertain and its treatment is not yet codified.

[Detection of endometrial stromal sarcoma using endometrial cytology. Apropos of a case]. / Dépistage du sarcome du chorion cytogène par la cytologie endométriale. A propos d'une observation.

The authors report a case of endometrial stromal sarcoma which was detected by endometrial cytology. The tumour originates either in the stroma of the endometrium or in foci of myometrial adenomyosis. It occurs most frequently in patients who are more than 60 years of age. It appears as an intra-uterine polypoid mass and causes bleeding and pelvic pain. Its incidence is difficult to establish. Endometrial cytology is highly suggestive of stromal sarcoma when smears harbour numerous atypical sarcomatous cells mixed with regular endometrial cells. Biopsies of the endometrium show decidua-like arrangements of malignant cells. Stromal sarcoma constitutes the homologous form of mesenchymal tumours of the uterus. The prognosis depends on whether local recurrences occur and on the sites of metastases in which the sarcomatous component seems to be latent with lesions that resemble adenocarcinomata . The five years salvage rate is approximately 26 to 28%. Treatment is surgical with or without irradiation.