Why pesticides could be a common cause of prostate and breast cancers in the French Caribbean Island, Martinique. An overview on key mechanisms of pesticide-induced cancer.

Prostate and breast cancers have become very frequent in Martinique. We previously conducted a multifactorial analysis in the French Caribbean Island, Martinique, in order to elucidate the aetiology of prostate cancer. Using a linear regression analysis, we found that the growth curves of incidence rates for Martinique and metropolitan France have been significantly diverging since 1983. Although a Caribbean genetic susceptibility factor may be involved in prostate carcinogenesis: this factor, because it could not have changed during the observation period, cannot per se account for the growing incidence of this cancer in the island. We therefore suggested that among possible environmental factors, the intensive and prolonged exposure to Carcinogenic, Mutagenic and/or Reprotoxic (CMR) or presumed CMR pesticides may account for the observed growing incidence of prostate cancer and thus may be involved in prostate carcinogenesis. In this study, we further attempt to show that due to their carcinogenic properties, pesticides and especially organochlorine pesticides may in fact be causally implicated in the growing incidence of prostate cancer in Martinique. Also, we suggest that CMR or presumed CMR pesticides may be causally involved in the growing incidence of breast cancer through a common endocrine disruption mechanism. We therefore propose that protective medical recommendations should be immediately set up and carried out by general practitioners, paediatricians, obstetricians, gynaecologists and urologists; and that public health measures of primary precaution and prevention should be urgently taken in close collaboration with health professionals in order to protect population, more especially pregnant women and children, with the final objective perhaps that these medical recommendations and public health measures will stop Martinique's cancer epidemic.

[Spinal cord histoplasmoma. A case report]. / Histoplasmome médullaire. A propos d'un cas.

Over a period of 2 months, a 60-year-old man, a chicken breeder, experienced low back pain, lower limb weakness predominant on the right side, and urinary difficulties, leading progressively to a flaccid paraplegia with sphincter impairment. Concomitant poor cognitive performances were noted. MRI showed enlargement of the conus terminalis, with a low-intensity signal on T1-weighted images, high-intensity signal on T2-weighted images, and areas of intramedullar contrast enhancement. A biopsy of the lesion showed macrophages containing yeast cells, with PAS and Grocott staining aspects compatible with the presence of Histoplasma capsulatum (Hc). A brain MRI showed multiple localizations in the brain stem and in both hemispheres with associated edema. Disseminated histoplasmosis was confirmed by a biopsy of a sub-maxillary ganglion demonstrating a necrotic tuberculoid lymphadenitis containing yeast cells resembling Hc. Immune tests disclosed the presence of HTLV1 anti-bodies without immunodeficiency nor HIV co-infection. An anti-micotic treatment was started 2 weeks after surgery, with intra-venous amphotericin B, for 21 days, followed by itraconazole, orally for 90 days. Cognitive functions improved significantly in 5 weeks while paraplegia and sphincter impairment remained unchanged. Seven months later, cerebral MR aspects dramatically improved while the conus medullaris lesion diminished, and the edematous component disappeared in all areas. Even though histoplasmosis is endemic in our region, CNS localization is rare, generally in disseminated forms associated with immunodeficiency. Brain granulomas are well-known, but spinal cord histoplasmomas are exceptional: only four cases have been evaluated by MRI. Unlike our case, spinal cord forms generally improve, due to surgery associated with antifungus medication, or sometimes due to specific medical treatment alone but with sufficient dosage.

[Epidermoid cyst of the third ventricle. Report of a case]. / Kyste épidermoïde du troisième ventricule. Une observation.

We report a case of epidermal (or epidermoid) cyst, in a 36-year-old man which developed in the third ventricle. Clinical manifestations were headaches and memory disturbances. On CT scan the tumor occupied the entire third ventricle but was mainly developed on the left side. On CT reconstructed images, the floor of the third ventricle was clearly visible. Using a trans-ventricular approach, the tumor, closely related to the left part of hypothalamus, was totally removed. Later on, because of persistent hydrocephalus, a ventricular shunt was inserted. An aseptic meningitis occurred and resolved spontaneously. The patient exhibited a postoperative transitory Korsakoff's syndrome. Postoperative endocrine investigations showed hypopituitarism. Some intra-ventricular epidermal cysts have been reported, especially involving the fourth ventricle. Their development into the third ventricle is unusual, and in early reports their precise origin appears doubtful. Although they have no characteristic radiological features, the location of epidermal cysts is clearly defined by the CT scan and especially MRI. It would be possible to totally remove epidermal cysts of the third ventricle, avoiding the risk of recurrence.

[Symptomatic spinal intra-dural arachnoid cyst. Apropos of a case with magnetic resonance imaging]. / Kyste arachnoïdien intra-dural dorsal symptomatique. A propos d'un cas avec Imagerie par Résonance Magnétique.

The authors report a case of intradural posterolateral spinal arachnoid cyst diagnosed by Magnetic Resonance Imaging (MRI) in a 59-year-old woman. Ten years before, she started to suffer from burning sensation of the left lower limb aggravated by head movements. Physical examination was normal except a sensory dissociation below T10. A myelography was considered as normal. Three years later, motor disturbances occur with progressive weakness. Examination showed asymmetrical spastic paraparesis with a right predominance. On MRI, the spinal cord was displaced at T6-T7 level by a posterior intradural mass with a similar signal than CSF; furthermore, at this level, there was an intramedullary hyposignal on T1 weighted sections. The diagnosis of spinal intradural arachnoid cyst was confirmed at surgery. Microscopic examination of the cyst wall showed fibrous tissue with mild lymphocytic infiltration. Rapid recovery of legs weakness followed, but abnormalities of spinothalamic functions persisted. The clinical characteristics and the MRI data are discussed. The authors conclude that this arachnoid cyst had an inflammatory origin.