[Epithelial-myoepithelial carcinoma of the salivary glands: report of a case]. / Carcinome épithélial-myoépithélial des glandes salivaries. Etude à propos d'un cas.

Epithelial-myoepithelial carcinoma (E.M.C.) is a rare lowgrade salivary gland neoplasm that occurs in both major and minor salivary glands. It is characterized by tubular and solid growth pattern with a dual cell population including an inner layer of epithelial cells which are peripherically bounded by a layer of clear myoepithelial cells. This differentiation is confirmed by electron microscopic and immunohistochemical studies. The differential diagnosis included clear cell tumor of the salivary gland and metastatic renal carcinoma. The majority of these tumours arise in the parotid in women with a peak incidence from the 6th to the 8th decade. We report a case of parotidic E.M.C. in a 33 year old man.

Comparison of the prognostic value of Scarff-Bloom-Richardson and Nottingham histological grades in a series of 825 cases of breast cancer: major importance of the mitotic count as a component of both grading systems.

The most commonly used system in Europe for breast carcinoma was developed by Scarff, Bloom and Richardson (SBR). It was recently modified by Elston and Ellis and significant improvement in reproducibility has been shown by using precise grading guidelines. This study investigated whether the use of this new grade (defined as the Nottingham grade, NG) would improve the prognostic stratification of patients. The respective prognostic value of the two grading schemes was compared in a retrospective series of 825 patients uniformly treated for a small invasive breast carcinoma and followed for a median of 6 years. Univariate and multivariate analysis showed that both histological grades were strongly correlated to overall and metastasis free survival. We have separately analysed the prognostic value of each of the three components used to assess the two grading systems and found that the mitotic index was the only significant prognostic factor for 5 year survival. Univariate analysis showed the count to be more discriminant in the NG scheme (p = 0.0006) than in the SBR scheme (p = 0.04). However, in univariate and multivariate analysis, the prognostic value of the global NG was not significantly better than SBR grade. This may be related, in part, to an uneven distribution of cases reflected by a much lower number of cases with a high mitotic index in the NG system (2%) than in the SBR system (10%). Our study emphasizes the importance of the mitotic count in assessing the prognosis of breast cancers and indicates that the factors which condition this count (tissue processing, microscopic observation, threshold) must be well standardized and controlled.

No significant predictive value of c-erbB-2 or p53 expression regarding sensitivity to primary chemotherapy or radiotherapy in breast cancer.

To document whether c-erbB-2 over-expression or p53 accumulation in tumour cells was predictive of response to chemo- or radiotherapy, we analyzed a population of patients with breast cancer assigned to neo-adjuvant therapy (median follow-up: 54 months). T2/T3-N0N1b-M0 tumours (329 cases) were treated either by FAC chemotherapy or by radiotherapy before surgery, and the clinical response was classified as complete or incomplete. Expression of c-erbB-2 and p53 was retrospectively evaluated by immunohistochemistry. Proliferation rate was assessed by means of MIB-1 antibody and by S-phase fraction. A complete response to chemotherapy was observed in 38/167 patients (23%). Complete response rate was 20% in c-erbB-2-negative tumours, and rose to 31% in tumours with c-erbB-2 over-expression, but this trend was not statistically significant. There was no correlation between p53 staining and response to treatment, whereas chemosensitivity was found correlated with histological grade and S-phase. A complete response to radiotherapy was observed in 64 of the 156 evaluable patients (41%). Complete response rate was 41% in c-erbB-2- or p53-negative tumours, 54% in tumours with c-erb-B-2 over-expression, and 44% in tumours with p53 accumulation. There was no correlation between response to radiotherapy and histological grade or proliferative rate. No prognostic value was found for c-erbB-2 or p53 expression, whereas the 5-year survival rate was 85% for patients presenting a tumour with a low proliferating index (MIB-1 < 10%), and 68% for patients presenting a tumour with a high proliferative index. In multivariate analysis, node status (RR = 2), MIB-1 immunostaining (RR = 2), and tumour size (RR = 1.8) were found to be associated with survival. These results indicate that c-erbB-2 or p53 expression is not significantly associated with tumour response to neo-adjuvant chemo/radiotherapy in our series of breast cancers.

Sclerosing lymphocytic lobulitis in the male breast.

Sclerosing lymphocytic lobulitis is an inflammatory disorder of the breast that is well recognised in women. It has only been reported previously in two men; two further men with the condition are described here. Both presented with a breast mass, and one was an insulin dependent diabetic. Biopsy specimens from both patients showed circumscribed perivascular and, to a lesser extent, periductal collections of B and T lymphocytes. Sclerosing lymphocytic lobulitis in the female breast shows predominantly perilobular inflammation. The predominantly perivascular distribution in men is consistent with the relative paucity of epithelium in the male breast. Interlobular fibrosis with epithelioid fibroblasts was also present.

Flow cytometry versus urinary cytology in the diagnosis and follow-up of bladder tumors: critical review of a 5-year experience.

The authors report the results of a 5-year experience with flow cytometry (FCM) in the diagnosis and evaluation of bladder tumors. FCM was applied to 400 patients (225 without a urinary tumor and 175 with a past or recent bladder tumor). For the patients without a tumor, bladder-irrigation-fluid FCM was positive in 22% of samples vs 1% of those tested with conventional cytology. The high rate of false-positive results may have been due to an imperfect quality of the samples, to the staining procedure and to the high amount of squamous cells. For 72 selected tumors in which the bladder washing was performed under specific requirements, the detection rate of FCM was lower than that of conventional cytology, including G1-grade tumors. A comparison between bladder-irrigation-fluid FCM and disaggregated-biopsy FCM revealed a 22% rate of discordant results. From these data it does not seem desirable tu use bladder-irrigation FCM instead of conventional cytology in routine urologic examinations. The use of this technique must be more selective in bladder tumor evaluation.

Urticarial vasculitis progressing to systemic lupus erythematosus.

We encountered a patient with urticarial vasculitis. The lesions were urticarial target-shaped, lasting approximately 48 to 72 hours, accompanied by burning, photophobia, fever, and arthralgia. Initially, all studies for thyroid disease and lupus erythematosus were negative. However, after 20 months of follow-up, the patient developed autoimmune thyroidosis and systemic lupus erythematosus. We describe an unusual progression of this disease.

Multicentric reticulohistiocytosis: assessment of pulmonary disease by gallium-67 scintigraphy.

We present a case of multicentric reticulohistiocytosis with pulmonary involvement. Scintigraphic evaluation with gallium-67 citrate demonstrated bilateral hilar uptake on 2 occasions. Possible mechanisms for gallium avidity are discussed. Gallium scintigraphy has a potential role for assessing systemic involvement in this disease.