Primary neuroendocrine carcinoma of the fallopian tube: A case report.

► This case is an exceptionally rare primary neuroendocrine carcinoma of the fallopian tube, with a clinical presentation as torsion. ► TTF1 immunoreactivity can be found in neuroendocrine carcinomas originating from the fallopian tube.

[Isolated late-onset plexiform neurofibroma in the absence of neurofibromatosis]. / Neurofibrome plexiforme isolé de survenue tardive, en dehors d'un contexte de neurofibromatose.

BACKGROUND: Plexiform neurofibroma (NFP) is a benign nervous tumour typically involving the head and neck region due to the rich innervation of the latter. It is considered pathognomonic of neurofibromatosis type 1(NF1). This report describes an unusual case of neurofibroma and discusses its singular presentation, namely an isolated cutaneous tumour of late onset and with myofibroblastic histology. CASE REPORT: A 85-year-old man presented swelling of the cutaneous part of the lower palpebral region which had been present for several months. The lesion was relapsing after repeated incomplete excisions and had grown slowly to become firm and suspect. It was decided to perform a large excision with a frontal rotation flap. Initial histological examinations performed on each excision suggested fibrosis and scarring, leading to diagnosis of fibrocytic change and post-surgical neuroma. The final histological analysis indicated diffuse plexiform neurofibroma with a myofibroblastic component. This was a solitary lesion in a patient without any stigmata or familial history of NF1. DISCUSSION: This case is original in terms of its characteristics: a single cutaneous tumour of late onset in a patient with no stigmata of NF1 (in most cases of plexiform neurofibroma, NF1 is either multiple or else isolated at a mucous site). The histological findings for this tumour with a myofibroblastic component have never previously been described. Plexiform neurofibroma classically involves the head-and-neck region as in our case, with deep invasion of subcutaneous tissues making excision difficult and leading to frequent recurrence.

[Giant vascular tumour in an adult: tufted angioma or kaposiform hemangioendothelioma]. / Tumeur vasculaire géante de l'adulte: angiome en touffe ou hémangioendothéliome kaposiforme.

INTRODUCTION: Tufted angioma and kaposiform hemangioendothelioma are two rare benign but aggressive vascular tumours that occur mainly in children. OBSERVATION: A 72 year-old man consulted for a 50 cm wide vascular tumour of the right shoulder which was increasing for 10 years. On histological examination there were features of tufted angioma and kaposiform hemangioendothelioma. DISCUSSION: The tumour of this patient was atypical because of its big size never described before. The histological association of aspects which could correspond to tufted angioma and kaposiform hemangioendothelioma seems to confirm recent publications which support the hypothesis that these two tumours are two evolutive stages of one and only entity.

High negative predictive value of slow lymphatic drainage on metastatic node spread detection in malignant limb and trunk cutaneous melanoma.

AIM: Harvesting of the "sentinel lymph node" (SLN) as identified by lymphoscintigraphy (LSG) is becoming increasingly important in the staging of patients with malignant melanoma. The purpose of the current study was to determine whether the appearance time of the LSG had a prognostic value in predicting metastasis dissemination in thick cutaneous malignant melanoma. METHODS: Between July 1999 and July 2003, 88 consecutive patients with histologically proven melanoma with a Breslow's thickness > 1 mm, without clinical or radiological evidence of lymph node involvement or metastasis, prospectively underwent lymphoscintigraphy with 32 Mbq Tc 99m sulfur colloid prior to sentinel lymphadenectomy with sentinel lymph node (SLN) histological examination. RESULTS: LSG was performed in 88 patients with limb and trunk melanoma and identified a total of 149 sentinel nodes. Pathological examination revealed lymph node involvement in 21 patients (24%). All positive SLNs were imaged with a scintigraphic appearance time of less than 30 min. With a scintigraphic appearance time greater than 30 min, the negative predictive value (NPV) of spread in the SLN was 100% (27/27)(CI 87-100%). CONCLUSION: The strong NPV of LSG in identifying "slow" sentinel lymph nodes in patients with no clinical evidence of lymph node involvement suggests that patients could be spared sentinel lymph node biopsy when LSG detects "slow" sentinel lymph nodes. Another prospective study will be required to confirm that the scintigraphic appearance time of sentinel lymph nodes is an important predictive parameter of metastatic disease in sentinel lymph nodes and consequently might reduce the number of sentinel lymph node biopsies.

Endometrial biopsy during outpatient hysteroscopy: evaluation and comparison of two devices.

OBJECTIVE: Association of office hysteroscopy with outpatient endometrial biopsy is interesting to evaluate correctly endometrium. Purpose of this study was to evaluate and compare two endometrial biopsy devices during outpatient hysteroscopy, based on effectiveness and tolerance of the procedure. STUDY DESIGN: A single blind, randomised prospective study. RESULTS: 200 patients were randomised into two groups following outpatient hysteroscopy: 100 were biopsied with Vacurette and 100 biopsed with Pipelle. Pipelle was less painful compared to Vacurette (1.1+0.2 versus 1.6+0.3; P<0.001), no matter hormonal status (1+0.3 versus 2+0.6; P<0.001 in premenopausal subgroup and 1+0.3 versus 1.4+0.3; P<0.001 in postmenopausal subgroup). Vacurette was more effective than Pipelle (64/100 versus 48/100; P=0.02), in case of normal or hypertrophic endometrium (56/72 (77%) versus 40/65 (61%); P=0.04) but not in case of atrophic endometrium (8/28 (29%) versus 8/35 (23%); P=0.6). Among the 112 patients with adequate sample, histologic results were normal, except for three cases of endometrial hyperplasia. Among the 88 patients with inadequate sample, 47 (53%) presented an atrophic endometrial aspect at hysteroscopy, whereas 41 (47%) were considered as normal. CONCLUSIONS: Vacurette was more effective though more painful than Pipelle. Both instruments were, however, well tolerated. Both instruments were not very effective in case of atrophic endometrium. Outpatient hysteroscopy combined with endometrial biopsy may help avoid further investigations.

[Value of endocervical margin examination of conization specimens. Prospective study conducted on 150 patients]. / Intérêt de l'examen extemporané de la limite supérieure d'exérèse des pièces de conisation. Etude prospective portant sur 150 patientes.

OBJECTIVE: To assess the usefulness of frozen sections (FS) on endocervical margin in surgical conization or loop electrosurgical specimens. MATERIAL AND METHODS: In a prospective study, 150 patients were treated from October 1995 to December 1997: 69 cases without FS, 81 cases with FS. CIN on frozen section resulted in an immediate additional resection. RESULTS: In the group without FS, 13 patients had involved endocervical margin by high-grade CIN (18.8%). Frozen section was impossible in a conization specimen that was too short. FS revealed 64 normal glandular epitheliums, seven squamous metaplasias in which two lesions were under-evaluated (being in fact CIN on permanent sections), eight high-grade CIN followed by additional resection in six cases and two invasive carcinomas. Endocervical margin on additionals section were always free of disease. The rate of failure was 2.6% among 77 cases. This rate corresponded to two under-evaluations. Invasive carcinoma and CIN without additional resection were excluded because frozen section only allowed a peroperative diagnosis. The average height of the cone and the rate of complications were similar. Repeat surgery was necessary in nine cases in the group without frozen section, in which five showed residual lesions, absent in the other group. CONCLUSION: The ultimate histological interpretation was never difficult after frozen section. This method permits reduction of cases with involved cone margin and residual lesions and, despite some limitations, it may be useful for surgical management.

[Evaluation of two methods for endometrial sampling during diagnostic hysteroscopy]. / Evaluation de deux méthodes de prélèvement endométrial au cours de l'hystéroscopie diagnostique.

OBJECTIVE: To compare two endometrial sampling devices, pipelle and vacurette, performed during hysteroscopy, based on the quality of material obtained and pain during the sampling. PATIENTS AND METHODS: During the period from 01.03.96 to 01.12.97, 200 patients were consecutively randomized in a single blind prospective study. Efficacity was evaluated on the quality of material obtained and pain was graded on a scale of 0 to 5. RESULTS: On the average the Vacurette was more painful (1.6 vs 1.1, p = 0.01). Vacurette biopsy was more effective than pipelle biopsy (64% vs 48%, p = 0.05). There was a significative difference of efficacity in the post-menopausal group (34% vs 13%, p = 0.05), but not in the pre-menopausal group (76% vs 64%, p > 0.05). When hysteroscopy diagnosed endometrial atrophy, there was no significative difference of efficacity (29% vs 23%, p > 0.05), whereas vacurette was significatively more effective when there was an other hysteroscopy diagnosis (78% vs 62%, p = 0.05). Both procedures were less effective in post-menopausal women (p = 0.001), and in case of endometrial atrophy (p = 0.001). CONCLUSION: Both procedures were acceptable during ambulatory hysteroscopy. In our study, vacurette was more painful than pipelle. Vacurette was more effective but insufficient tissue for histologic evaluation was important in both procedures. This might be explained by the population included and the histologic method used.

[Anetoderma during antiphospholipid syndrome. 3 cases]. / L'anétodermie au cours du syndrome des antiphospholipides. Trois cas.

INTRODUCTION: Anetoderma is a skin disease of unknown etiology sometimes encountered in patients with a lupus syndrome. We report a clinical and pathology analysis of 3 selected cases of anetoderma associated with systemic lupus erythematosus and/or antiphospholipid syndrome. CASE REPORTS: Three patients had skin lesions typical of anetoderma. Antiphospholipid antibodies were present in all three (anticardiolipin in 3, circulating lupus anticoagulants in 3, anti-beta 2GP1 in 2). One patient with systemic lupus erythematosus had signs of antiphospholipid syndrome, the two others had primary antiphospholipid syndrome. DISCUSSION: The analysis of our cases and a review of the literature suggest that anetoderma is a disease which develops in the immunological environment of lupus, and is apparently more related to the presence of antiphospholipids than lupus itself. Thus anetoderma could be another cutaneous sign of the antiphospholipid syndrome.