Prognostic value of thoracic recurrent nerve nodal involvement in esophageal squamous cell carcinoma.

BACKGROUND: The determination of a simple and reliable prognostic factor that allows identification of patients at high risk of early cancer recurrence and subsequent death after resection of esophageal carcinoma should contribute to more accurate management of patients suffering from this disease. STUDY DESIGN: The aim of this study was to assess the prognostic value of thoracic recurrent nerve nodal involvement after curative resection of esophageal squamous cell carcinoma. The prognostic importance of gender, age, tumor penetration, and extent of lymph node involvement was evaluated in 55 patients after curative resection of esophageal squamous cell carcinoma. RESULTS: Thirty-four of 55 patients (62%) had nodal metastases and 10 of 55 (18%) had thoracic recurrent nerve nodes involved. The median overall survival was 28 months. By univariate analysis, survival was higher in association with the absence of adventitial invasion (p = 0.04), of nodal involvement (p = 0.03), and of thoracic recurrent nerve nodal involvement (p = 0.0001). In a Cox proportional hazards regression model, thoracic recurrent nerve nodal involvement appeared the strongest predictive factor (adjusted hazard ratio 8.4 (3.0-23.7)). CONCLUSIONS: Assessment of thoracic recurrent nerve nodes is appropriate to identify patients who are at high risk of disease-related death after surgical resection.

Colonic ischemia reveals thromboangiitis obliterans (Buerger's disease).

Two years before the appearance of distal peripheral manifestations of thromboangiitis obliterans (Buerger's disease), a young man had acute peritonitis attributable to an ischemic perforation of the sigmoid colon. Only the histological examination of excised tissue was able to differentially diagnose this entity unambiguously.

[Vestigial retrorectal cystic formations in adults. Apropos of 3 cases]. / Les formations kystiques vestigiales rétro-rectales de l'adulte. A propos de trois cas.

Primary retro-rectal cystic lesions of the adult are malignant or benign congenital lesions, with a female predominance. In this report, we present 3 cases and try to specify the embryologic origin of these lesions and propose an anatomopathological classification. The various diagnostic methods are studied. Because of infection and risk of malignancy, early complete excision is recommended. We suggest the use of a perineal retro-anorectal approach for low situated, small cysts.

[Imaging of hepatic tuberculoma]. / Imagerie du tuberculome hépatique.

We describe a case of localized macronodular tuberculosis of the liver, the so-called hepatic tuberculoma. Liver US scan demonstrated an hypoechoic well-delineated lesion of the left liver lobe. Liver CT scan demonstrated a hypodense lesion before and after contrast enhancement. Liver MR scan demonstrated a lesion hypointense to liver on T1-weighted images and isointense to liver on T2-weighted images.

Benign lymphoid polyposis of the colon. Report of a case in an adult.

A new case of benign lymphoid polyposis of the colon in an adult is presented. Relatively frequent in childhood, this disease remains exceptional in adults. The main concern is differentiation from adenomatous polyposis; the differential diagnosis can be particularly difficult for complex forms of polyposis with coexistent adenomatous and lymphoid polyps. Benign lymphoid polyposis of the colon does not appear to have any propensity for malignant degeneration, and major surgical resection is not indicated.

[From embryogenesis to female phenotype in subjects with XY karyotype]. / De l'embryogénèse au phénotype féminin de sujets à caryotype XY.

On the basis of the findings of their investigation of the embryogenesis of the female genital tract, the authors advance a hypothesis concerning the origin of ambiguities between the genetic sex and the gonophoric sex which determine primary sexual characteristics observed in Morris' syndrome and in gonadoblastoma. According to the authors, in gonadoblastoma there is dysgenesis or even agenesis of the gonads, with a total absence of Sertoli cells and, therefore, no secretion of anti-Müller substance and this explains the development of the Müller canals into uterus and Fallopian tubes and the presence of a vagina in an XY subject. In the syndrome of the feminizing testis, XY subjects have testes containing Sertoli cells which have produced anti-Müller substance. However, the initiation of the production of this substance is delayed and it is this delay which has permitted the tendency towards feminization of the uro-genital sinus with the formation of a vagina. The authors thus refute the theory which holds that the Müller cells are involved in the genesis of the vagina.

[A classification of uterine tumors based on embryogenesis]. / Une classification des tumeurs de l'utérus basée sur l'embryogenèse.

On the basis of their results of studies of human embryos and foetuses, the authors believe that the myometrium is derived from the primitive mesenchyme, while the endometrium is derived from the coelomic mesothelium. The myometrium is the site of non-specific tumours common to all soft tissues (of other organs): leiomyoma, lipoleiomyoma, leiomyoblastoma, leiomyosarcoma; vascular tumours: angioma, haemangiopericytoma. The endometrium is the site of tumours derived either from the epithelial contingent (of glandular tubules): adenoma, adenocarcinoma; or from the epithelio-connective tissue contingents: mullerian dysplasia, carcinosarcoma (homologous mixed mesodermal tumour). The authors classify heterologous mixed mesodermal tumours in a separate group; they believe that they constitute true mixed mesodermal tumours derived from two cell clones: one of mullerian origin and the other derived from the primitive mesenchyme.

[The reality and usefulness of Halban's fascia]. / Réalité et utilité du fascia de Halban.

The authors, in this article, have reviewed the different proofs that confirm that Halban's fascia does exist. The authors have been able to find, separate out and use Halban's fascia in a series of 263 vaginal operations for genital prolapse taking the anatomo-surgical approach. From the histological approach, they have shown that Halban's fascia is constituted by fibro-connective tissue strips between which there are large numbers of blood vessels and muscles and nerve endings. From the point of view of embryogenesis, they believe that Halban's fascia comes from the same mesenchyme layer as that which gives rise to the corpus spongiosus of the penis. As far as sexual physiology is concerned, the authors review the various clinical experiments that have been carried out throughout the world medical literature which shows that there is an erogenous zone in the upper anterior part of the vagina and they believe that Halban's facia, which is homologous with the corpus spongiosus, is the site of origin of vaginal orgasm. Finally, as far as physiology and biology of reproduction is concerned, they believe that the vaginal fluid that is secreted by Halban's fascia during intercourse plays an important role for the survival of spermatozoa.

[New findings on the embryogenesis of the uterus]. / Nouvelles acquisitions sur l'embryogénèse de l'utérus.

In this study including twelve embryos, aged 4 to 8 weeks, and twenty-one fetuses between 9 and 25 weeks, and a group of five still-born fetuses between 25 and 40 weeks, the authors used conventional techniques of histological preparations and immuno-chemistry according to the BSA technique (biotin-streptavidin with peroxidase labelling), in order to demonstrate that the uterus presents a "dual embryogenesis". The endometrium with its stroma and the transition zone endometrium-myometrium have a coelomic origin. The myometrium with the common connective tissue derive from primary mesenchyma. According to the authors, the "dual embryology" of the uterus, would permit simplifying the taxonomy of the histogenesis of uterine tumors.

[Histologic study of the gonads in ovarian differentiation during organogenesis]. / Etude histologique de la gonade à différenciation ovarienne au cours de l'organogenèse.

We report the results of a histologic study of the differentiating ovary carried out in human embryos and fetuses. Up to the sixth week, the anlage of the gonad is formed by the proliferation of cells originating from the coelomic mesothelium; this proliferation starts with the migration of the primordial germ cells. Between the sixth and the tenth weeks, the primary mesenchyma invades the epithelial mass and divides it into "cords"; by division, the germ cells contained within the mass become ovocytes. At the tenth week, the gonad takes shape and is separated from the mesonephros. At the twelfth week, the gonad is formed of two zones; an outer zone formed of epithelial clusters arranged in rosettes around the ovocytes; and an inner, mesenchymal, zone that becomes the medulla and separates the outer epithelial zone from the remnants of the mesonephros. At the sixteenth week, the gonad becomes the ovary that contains millions of primordial follicles; each follicle consists of an ovocyte surrounded by a ring of granulosa cells originating from the coelomic epithelium; the follicles are separated from each other by mesenchymal cells that form the cortical stroma. The remnants of the mesonephros are clearly separated from the ovary by the medulla.(ABSTRACT TRUNCATED AT 250 WORDS)

[New findings on the embryogenesis of the vagina]. / Nouvelles acquisitions sur l'embryogenèse du vagin.

The authors have studied a series of twelve embryos between 4 and 8 weeks of age and 21 fetuses between 9 and 25 weeks of gestation. From this material they have made a study of the embryogenesis of the vagina, which shows that the whole of the vagina, and not only the lower third or fifth, is derived from the vaginal plate, this latter is the result of proliferation and fusion of the two sino-vaginal bulbs. This study supports the unitary theory ascribing formation of the vagina to ascension and extension of the vaginal plate which is derived from the cloacal sinus.

[The morphogenesis of vaginal diaphragms. New data]. / Morphogenèse des diaphragmes vaginaux. Nouvelles acquisitions.

The authors have studied seventeen fetuses which were stillborn as a result of late abortion or premature labour due to cervical incompetence. The authors examined the theory that suggests that the vagina is developed from the urogenital sinus and Mullerian duct. That theory holds that it is failure of canalization of the junction of the sinus and the duct that causes transverse septum formation in the vagina. According to the authors of this paper this theory does not explain how septum are formed at different places in the vagina and how it is transverse septa are not formed in the uterus. This study allows them to suggest that the vagina itself is formed by a plaque which is entirely originally from the sinus, and that it is because of a failure of this plaque to break down completely leaving behind vestigial shreds to cause these septa to appear in the vagina.

[Pathologic anatomy of villous tumors]. / Anatomie pathologique des tumeurs villeuses.

After defining a number of essential terms and recalling the great many synonyms used in the literature, the authors discuss the macroscopic and histological appearance of villous tumours. They emphasize the importance of a good methodology, the limitations of biopsies and the fact that the prognosis of a lesion can only be established after examination of all of the specimen.

[Reversible humoral alterations paralleling the course of a recurring meningioma with metastases (author's transl)]. / Perturbations biologiques réversibles, évoluant parallèlement à un méningiome récidivant et avec métastases.

Case report of a recurring meningioma of the posterior fossa, with pulmonary metastases. Humoral alterations (sedimentation rate, fibrinemia, alkalin phosphatases, sideremia, prothrombin, blood proteins and BSP) paralleled the course of the tumor and may be considered as a para-tumoral syndrome. Pathogenesis is unknown.