Long-term outcome in idiopathic granulomatous mastitis: a western multicentre study.

AIM: To investigate the presentation, disease course and long-term outcome of a western cohort of idiopathic granulomatous mastitis (IGM) and to analyse the impact of different therapeutic strategies. METHODS: Multicentre retrospective study of 23 women followed over an extended period. Patients were recruited in nine French internal medicine departments. RESULTS: The median follow-up was 6 years. IGM presented commonly as a single inflammatory unilateral extra-areolar lump of varying size. Clinical course was heterogeneous and frequently remitting/relapsing. Most patients had at least one recurrence (18/23, 78%). The mean number of recurrences was 1.3 ± 1.5. Seven women had a bilateral evolution. Twelve women received steroids (corticosteroids). Only two of these did not respond to corticosteroids, whereas six relapsed when dose was tapered off. Nine patients received colchicine and/or hydroxychloroquine. First-line treatment consisted of excisional surgery in eight cases. At the date of last interview, 91% of the patients declared to be healed, 15 being free of treatment. However, 12/21 (57%) reported significant sequelae (unsightly scars: eight and/or lasting pain: six). Unsightly scars were not more prevalent in patients who had received steroids whereas they tended to be more frequent after breast excisional surgery. In addition, we found that excisional surgery did not prevent recurrences more successfully than a conservative approach. CONCLUSIONS: Despite its retrospective nature, this Caucasian series provides novel information regarding long-term outcomes in IGM and argues in favour of conservative approaches. The value of immunomodulatory drugs such as colchicine or hydroxychloroquine deserves further investigation.

[Standards, options, and recommendations for initial management of patients with malignant ovarian epithelial tumors]. / Standards, options et recommandations pour la prise en charge initiale des patientes atteintes de tumeurs épithéliales malignes de l'ovaire.

UNLABELLED: Suprapubic and transvaginal pelvic ultrasound exploration is indicated for suspected ovarian tumor (standard). Diagnosis and search for extension require surgery and pathology examination. Systematic preoperative computed tomography is not recommended (standard). Surgery for cancer of the ovary is a specialized procedure requiring skill in cancer, gynecology, visceral surgery and laparoscopic surgery. If the patient is referred to a specialized center after a primary procedure considered to be inadequate, a new procedure is recommended for staging. Residual tumor volume after the primary procedure has prognostic value. Systematic second look procedures are not recommended for routine practice (standard). For patients with grade IA G1 tumors, there is no indication for complementary treatment (standard). For patients with grade IA G2-3 or clear cell tumors, IB, IC, IIA, there is no standard. OPTIONS: no complementary treatment, complementary chemotherapy using platinum, complementary external abdominopelvic radiotherapy. A complementary treatment is recommended for grades IC and IIA. Complementary treatment for grades IIB (no residual tissue), IIC (with residual tissue), III (no residual tissue), is based on: complementary chemotherapy with platinium, complementary external abdominopelvic radiotherapy (options). Complementary treatment for advanced forms (IIB (with residual tissue), IIC (with residual tissue), III (with residual tissue) and IV) is based on polychemotherapy with platinium (standard). OPTIONS: platinium combined with paclitaxel (intravenous), platinium combined with cyclophosphamide and/or doxorubicin (intravenous) or intraperitoneal cisplatin combined with cyclophosphamide (intravenous). The chemotherapy work-up includes physical examination, assay of serum markers (particularly CA125) and abdominopelvic computed tomography (proof level B) (standard). Physical examination is recommended for monitoring patients in complete remission with no sign of suspected recurrence (standard). This document was reviewed in April 1977. The working group again validated the Standards, OPTIONS and Recommendations, without modifications in June 1999.

[Borderline lesions of the breast: clinical and radiological study of 20 cases]. / Les lésions frontières du sein: étude clinique et radiologique de 20 cas.

We describe the clinical and mammographic signs observed in 20 patients with atypical hyperplasia of the breast. The clinical signs include abnormalities noted at palpation (tumefaction, masses, clusters of nodules) and nipple discharge. The mammographic signs include rounded, clearly delineated opacities with benign appearances, or spiculated masses possibly associated with microcalcifications, stellate opacities, and isolated foci of microcalcifications. Galactography may visualize milk ducts dilatation. Both the clinical and mammographic signs are non-specific and even equivocal and do not allow pre-operative diagnosis of non-specific lesions.

Histological correlation of 17 prospective immunoscintigraphies of recurrences of colorectal carcinomas using indium-111-labeled anti-cea and(or) 19-9 monoclonal antibodies.

Seventeen patients (mean age 55 years) with suspected recurrence in previously operated and histologically confirmed colorectal adenocarcinomas were explored by immunoscintography (IS) associating planar and emission computed tomography (ECT) and using the 111In-labeled anti carcinoembryonic antigen (CEA) and(or) 19-9 monoclonal antibodies (MoAbs). The results of IS were compared blind with those of computed tomography (CT) and ultrasonography (US). The final diagnosis of recurrence and(or) metastasis was done in 16 cases by second-look surgery and in another patient by rectal biopsy. Overall per-patient sensitivity for the pelvis and extrahepatic abdomen was 69% for IS and 31% and 25% respectively for computed tomography and ultrasonography. No false positive of IS, as well as US and CT, for the pelvis and the extrahepatic abdomen was seen. Based on the number of anatomical sites tested, sensitivity of IS was 91% in the pelvis. In our series, scintigraphic computer subtraction did not allow adequate resolution of the problem of intense liver uptake of 111In-labeled MoAbs. It is concluded that IS using 111In-labeled anti CEA and(or) 19-9 MoAbs should be carried out prospectively in patients at high risk of recurrence of colorectal cancer.

[An unusual clinical form of intraductal breast carcinoma: an inflammatory syndrome. Apropos of 5 cases]. / Une forme clinique inhabituelle des carcinomes mammaires intracanalaires: le syndrome inflammatoire. A propos de cinq observations.

The authors report 5 cases of in situ intraductal breast carcinoma (IDC) revealed or complicated by a clinical inflammatory syndrome. These cases showed some common features with other IDCs, such as mammographic signs and histologic forms of epitheliamatous proliferation, but were also characterized by clinical inflammatory signs different from those of rapidly developing "inflammatory" cancer, frequent nipple discharge, frequent positive results in bacteriologic examinations of nipple discharge and the role of cytologic studies of discharge in determining a definite diagnosis of carcinoma. Some hypotheses as to etiology are also discussed.

[Granulomatous lesions of the breast. Their role in inflammatory breast pathology and their relations to lobular granulomatous mastitis]. / Les lésions granulomateuses du sein. Leur place dans la pathologie inflammatoire mammaire et leurs relations avec la mastite granulomateuse lobulaire.

The authors summarise the clinical notes and histological findings of 17 patients who had inflammatory changes in their breasts and in whom biopsies showed epithelioid granulation tissues with giant cells. Three separate histological tables have been prepared as well as a review of the literature. The paper shows that mixed granulomatous conditions exist, with the sites of the changes being both in the canals and in the lobules. This gives rise to a discussion about the separateness of the condition, which is presumed to be of an autoimmune origin. It is pointed out that there can be an infectious element present.

[Outcome, treatment and prognosis of Horton's disease]. / Evolution, traitement et pronostic de la maladie de Horton.

Precise information was obtained by a computerized analysis of the treatment, prognosis and clinical outcome of 108 representative cases selected from a series of 160 patients with Horton's disease (HD) diagnosed between 1970 and 1981. At the end of the study, 18 patients had died (16,6 p. 100), the commonest cause of death being a cerebrovascular accident. Death occurred during the first two years of the illness in half these cases. Despite these early complications of the disease, from a statistical point of view, the patients did not die of HD or the complications of its treatment. The 5 years survival rate 80,1 p. 100 (actuarial analysis). Most deaths were from natural causes; an intercurrent disease was often implicated; the lower probability of survival for men (69,9 p. cent at 5 years, compared to 85,4 p. cent for women) is compatible with the lower life expectancy which is well established. The roles of intercurrent disease and sex were statistically significant. On the other hand, there was no difference in the probability of 5 year survival when the different presenting of the disease, the terrain (HLA-DR4) and choice of corticosteroid therapy were compared. The initial dose of prednisone or prednisolone should exceed 0,5 mg/kg/day, if relapse is to be avoided. No additional benefits were observed with doses in excess of 1 mg/kg/day except in cases with complications from the onset (ocular, coronary insufficiency, stenosis of the main large arteries, without being able to prejudge their mechanism).(ABSTRACT TRUNCATED AT 250 WORDS)

[Ulcerative colitis associated with chronic atrophic polychondritis. One case (author's transl)]. / Recto-colite hémorragique associée à une polychondrite chronique atrophiante. Une observation.

A male patient has developed ulcerative colitis at the age of 70. Signs of chronic atrophic polychondritis appeared 9 months after the first attack. Subsequently, during the course of the disease each attack of ulcerative colitis was preceded by an exacerbation of polychondritis, which suggests a causal relationship rather than a chance association between the two conditions. The clinical response of polychondritis to sulfones in daily doses of 200 mg was satisfactory, but this dosage, which at present seems appropriate requires to be confirmed by further observations.