Impact of cytopathologist expert on diagnosis and treatment of pancreatic lesions in current clinical practice. A series of 106 endoscopic ultrasound-guided fine needle aspirations.

OBJECTIVES: To evaluate the role of a cytopathologist expert in interpreting difficult pancreatic endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in terms of impact on diagnostic yield and therapy in current clinical practice. METHODS: Retrospective study of 106 EUS-FNA performed between January 2002 and September 2004. Forty-seven cases of difficult interpretation by the local cytopathologist were mailed to an expert cytopathologist. The final diagnosis was established by histology obtained by either surgery (n=30), non-equivocal FNA (n=40) or core (n=8) biopsies, or by a mean follow-up of 14 months (n=28). RESULTS: EUS-FNA involved 68 solid lesions (SL). Specimens collected were adequate in 63%. The overall sensitivity of EUS-FNA for the diagnosis of malignancy of SL was 88% versus 72% for local cytopathologist and 89% for expert. EUS-FNA with the reevaluation by expert of 39 SL gave a therapeutic impact in 47% of SL. Thirty-eight cystic lesions (CL) were evaluated. Specimens collected were adequate for cytology in 84% of cases and for biochemistry in 79%. The sensitivity of imaging+EUS-FNA+/-biochemistry for the diagnosis of a surgical CL was 58% with a therapeutic impact in 39.5%. CONCLUSION: Pancreatic EUS-FNA is an easy technique for experienced endosonographers, which can be safely performed on an outpatient basis. The possibility of mailing difficult cases to an expert cytopathologist increases the diagnostic yield. In these circumstances, EUS-FNA has a therapeutic impact in current practice in nearly one out of two pancreatic lesions.

[Intraepithelial capillary hemangioma?]. / Hémangiome capillaire intra-épithélial?

INTRODUCTION: Histological examination of a biopsy of a lesion of the glans penis revealed blood capillaries within the malpighian epithelium. CASE REPORT: A 66 year-old man exhibited two circumscribed red plaques of the glans penis following posthectomy. Their histological examination revealed blood capillaries within the epithelium without basal membrane and pericytes between the endothelial cells and keratinocytes. Further evolution was towards lichen planus of the genital mucous membranes. In spite of a verrucous carcinoma which had been surgically removed, the evolution within a follow-up time of 6 years was favorable. DISCUSSION: Blood capillaries ascending in the epithelium of the genital mucous membranes have been observed in a special variant of Zoon's balanitis, the lichenoid, telangiectatic and purpuric balanitis described by Jonquières in 1971. In our patient exhibiting a lichen planus of the glans penis, the occurrence of blood vessels in the malpighian layer of the epithelium may be interpreted as the consequence of an unusual epithelial and vascular regeneration of an erosive lichenoid lesion. It may also be interpreted as an original neoplasia, and could therefore be considered as a genital intraepithelial capillary hemangioma.

[Hereditary progressive mucinous histiocytosis]. / Histiocytose mucineuse héréditaire progressive.

BACKGROUND: Hereditary progressive mucinous histiocytosis is an uncommon condition which to date has only been observed in women. The disease is a non-Langerhans histiocytosis with a stereotypic clinical presentation limited to the skin. The clinical, histological and genetic features of this disease differ considerably from other types of histiocytoses and overload diseases. We report the first case observed in France. CASE REPORT: A 49-year-old woman consulted for asymptomatic papules on the dorsal aspect of the hands known since childhood. The lesions had progressively spread to other regions of the body. The woman's mother and two sisters had the same condition but her two sons and her brother and nephews did not. Standard semi-thin slices and electron microscope histology demonstrated dense cellular infiltration of the reticular dermis with interstitial mucinous overload, voluminous histiocytes with characteristic toluidine blue positive granulations, and a cytoplasm rich in myelin and Zebra bodies respectively. The observed clinical, histological and genetic features were characteristic of progressive hereditary progressive mucinous histiocytosis. DISCUSSION: The pedigree in our case and in those reported in the literature suggest a dominant hereditary condition. The fact that only female cases have been reported to date would suggest X-linked transmission with early death of male fetuses. An autosomal dominant transmission limited to woman as a result of mitochondrial heredity or hormone-related phenomena cannot be ruled out. The progressive extension with age without a tendency for spontaneous regression and the electron microscopy aspect suggest a phospholipid deposit disorder similar to that observed in lysosomial diseases. However, primary macrophage proliferation in response to an unknown stimulus cannot be excluded.

[Olfactory esthesioneuroma (esthesioneuroblastoma). A pathologic study of 7 cases]. / Les esthésioneuromes (esthésioneuroblastomes) olfactifs. Etude anatomopathologique à propos de 7 observations.

With an histological, immunohistochemical study of 7 cases of olfactory esthesioneuromas (4 of them had an ultrastructural study), our purpose was to revise the problem of the too often ambiguous terminology and of the different histological lower classes classifications of these tumors. Our own results and the literature demonstrate that they are polymorphic. In standard histology, they are often right diagnosed but an immunohistochemical study can be useful and an ultrastructural study absolutely necessary for a reliable diagnosis. For an easier nomenclature, we advise to use only one terminology for these tumors = olfactory esthesioneuroma. But, because of their important polymorphism, we keep to an histological lower classes classification according to their degree of differentiation in light microscopy: well differentiated tumors (old esthesioneuroepitheliomas), moderately differentiated tumors (old esthesioneurocytomas), poorly differentiated tumors (old esthesioneuroblastomas and so on described as neuro-endocrine carcinomas by Silva and al).

[Histological and immunohistochemical diagnosis of bone marrow metastases of neuroblastomas]. / Diagnostic histologique et immunohistochimique des métastases ostéomédullaires des neuroblastomes.

A retrospective, morphological and immunochemical study was performed on 60 bone marrow biopsies (BOM) and 12 tumor specimens surgically excised, from 9 patients with neuroblastoma (NB). Immunochemistry concerned "neuron-specific enolase" (NSE), chromogranin A (CGA) and synaptophysin (SP). The results of immunochemical stains and the study of reticulin network on the argentic stain were compared to the results of morphological evaluation on the routine stain. NSE, CGA and SP staining of tumor cells (part or all of them) was obtained from all surgical specimens. 17/75 BOM (20%) were discarded because of poor material. NB cells were observed in 24 BOM from 3 patients. Tumor cells formed large strands (1 patient) or nests (2 patients) associated with segregated cells. Diagnosis of metastatic BM involvement was negative or doubtful for 6 BOM (3 obtained at the same time, 2 patients), in which NB cells were clearly demonstrated by immunochemical staining of NSE and/or CGA. Reticulin and/or collagen myelofibrosis was present in 32/35 BOM from the 3 patients metastatic in bone marrow (BM+) even if NB cells could not be demonstrated in these samples.