The Erice 58 Charter on 'The health of migrants. An equity challenge for the public health system'.

Abstract: The Erice 58 Charter titled "The Health of Migrants: a Challenge of Equity for the Public Health System", was unanimously approved at the conclusion of the 58th Residential Course of the School of Epidemiology and Preventive Medicine 'Giuseppe D'Alessandro' entitled "The Health of Migrants: a Challenge of Equity for the Public Health System. Epidemiological, clinical-relational, regulatory, organisational, training and public communication aspects at international, national and local level', which took place from 28 March to 2 April 2022 in Erice (Sicily, Italy), at the 'Ettore Majorana' Foundation and Centre for Scientific Culture. The Course was promoted by the Italian Society of Migration Medicine (S.I.M.M.) and the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), with the collaboration and patronage of the Istituto Superiore di Sanità (ISS). 72 learners participated (mainly resident doctors in 'Hygiene and Preventive Medicine' but also other health service professionals), whose average age was 37 years; on the basis of territorial origin, 13 of the 20 Italian regions were represented. During the intense learning experience, which consisted of 18 frontal lessons (with 20 lecturers from the bio-medical, socio-anthropological and journalistic fields) and 7 working group sessions (supported by 4 classroom tutors in addition to the lecturers) in 'blended learning' mode, the various dimensions and critical issues related to the possibility of guaranteeing truly inclusive health policies for foreigners/migrants, throughout the country, were identified and discussed from an 'Health Equity' perspective. This enabled a small editorial group to draw up the basic document that, in the last session of the Course, was discussed and modified by all participants into the version of the 'Erice 58 Charter' presented here.

[Necrotic eosinophilic angiitis with ileal perforation and peritonitis secondary to abdominal angiostrongyliasis]. / Angéite nécrosante à éosinophiles avec perforation iléale et péritonite secondaire à une angiostrongylose abdominale.

INTRODUCTION: Abdominal angiostrongyliasis caused by the filiform nematode Angiostrongylus costaricensis, is an endemic disease in Central and South America. A case of necrotic eosinophilic angeitis with ileum perforation and peritonitis due to abdominal angiostrongyliasis is reported. OBSERVATION: A 32 year-old man, living in a Paris suburb, underwent segmentary resection of the ileum with end to end anastomosis for perforation with generalized peritonitis. The anatomopathological examination revealed eosinophilic necrotic lesions with thrombosis on the borders of the ileum perforation. The discovery of a section of A. costaricensis in the lumen of a nearby muscular artery initiated an epidemiological survey, revealing that the patient had visited French Guyana 2 months earlier. DISCUSSION: Angiostrongylus costaricensis is a nematode parisiting certain forest rodents that become its permanent host. The intermediate hosts are earth molluscs or slugs of the same family. Humans are accidentally infected following ingestion of vegetables infested with L3 larvae or slugs carrying the disease. The clinical symptomatology is unspecific: prolonged fever, anorexia, and right iliac fossa pain with eosinophilia of the blood. Often benign, the progression of abdominal angiostrongylosis is punctuated by complications: occlusive syndrome, generalised peritonitis due to intestinal perforation and mass syndrome. Hemorrhage, infarct, pseudo-tumoural fibrosis and ulcers represent the surgical or macroscopic rearrangements. In the tissue, 4 lesions characterize abdominal angiostrongylosis: eosinophilic necrotic angeitis, foreign body granulomas, eosinophilia in the digestive wall, and the presence of A. costaricensis in the lumen of the vessels. There is presently no medical treatment and surgery is the only therapeutic option.

Primary squamous cell carcinoma of the endometrium: case history, pathologic findings, and discussion.

Primary squamous cell carcinoma of the endometrium (PSCCE) is an exceedingly rare tumor. Rarely are cytological criteria discussed. We report our experience in the cytological diagnosis of a case. A postmenopausal, 64-yr-old woman suffered from pyometria. An endometrial Pap smear displayed some malignant squamous cells. Curettage of the cervix and the uterine cavity only recovered some fragments of atypical squamous epithelium whose origin could not be precisely identified. A hysterectomy with bilateral adnexectomy was decided upon. Pathological study evidenced a primary squamous cell carcinoma in the uterine cavity while the cervix was tumor-free and the lymph nodes were devoid of metastases (pT1, pN0, pM0). The patient died 46 mo PO with multiple pulmonary and renal metastases. The histological feature of PSCCE is identical to that of any tumor of a similar nature, whatever the site, especially the cervix. Confirmation of the primary endometrial nature is only possible on the hysterectomy specimen.

Localization of the endothelin system in aldosterone-producing adenomas.

Endothelin-1 (ET-1) could play a role in the regulation of aldosterone secretion of the human adrenal gland. The presence of the endothelin-converting enzyme 1 (ECE-1) and ET-1 suggests that there is a local ET system in the adrenal cortex, but the in situ synthesis of ET-1 remains to be confirmed. The cellular distribution of the whole ET system was evaluated in 20 cases of aldosterone-producing adenomas. Polymerase chain reaction studies gave strong signals for ECE-1 mRNA and the mRNAs for endothelin type A (ET(A)) and B (ET(B)) receptors and faint signals for prepro-ET-1 mRNA. In situ hybridization showed ET(A) receptors scattered throughout the adenoma, in both secretory cells and vascular structures (score, +). There were more ET(B) receptors (score, ++), but they were restricted mainly to the endothelium. ECE-1 mRNA and protein were ubiquitous and abundant in secretory cells (score, +++) and vascular structures (score, ++); the enzyme was active on big ET-1. There was no prepro-ET-1 mRNA in the cortex, except in the thickened precapillary arterioles present in only 30% of the aldosterone-producing adenomas studied. ET-1 immunoreactivity was detected in vascular structures (score, +), probably bound to receptors, suggesting that ET-1 has an endocrine action. The low concentrations of ET-1 could also indicate that it acts in a paracrine-autocrine fashion to control adrenal blood flow. The discrepancy between the concentrations of ECE-1 and its substrate suggests that ECE-1 has another role in the adrenal secretory cells. Our data indicate that ET probably is not a primary cause of the development or maintenance of the adenoma.

[Leg ulcers and cancer. 6 case reports]. / Ulcères de jambe et cancer. A propos de 6 observations.

OBJECTIVE: It is estimated that 1 leg ulcer out of 300 is a carcinoma. In the literature ulceration of skin cancer is distinguished from chronic leg ulcers although this later category remains a subject of debate. We examined the clinical features of suspected malignant leg ulcers and discuss the notion of secondary malignant transformation of leg ulcers. PATIENTS AND METHODS: This study included patients attending the Vascular Clinic at the Saint-Joseph Hospital in Paris between 1991 and 1999 who were referred for leg ulcers and whose final diagnosis was cancerous ulceration. RESULTS: There were six patients, mean age 77 years who had squamous cell carcinomas (4 cases) and basocellular carcinomas (2 cases). We observed two distinct situations: leg carcinomas that ulcerated from onset (2 cases) and malignant transformation of a cicatrix, known as Marjolin's ulcer (4 cases). There were no cases of malignant transformation of chronic leg ulcers in this series. The clinical elements suggestive of a cancerous leg ulcer were the absence of a vascular etiology, the red, budding aspect of the ulcer with hard borders, and its development on a cicatrix. CONCLUSION: Malignant transformation of a vascular leg ulcer was not observed in our series, but has been reported in the literature although a critical analysis of reported data is only significant for squamous cell carcinoma. The frequency is probably overestimated. Our series enabled us to identify the clinical circumstances leading to an early diagnosis of carcinoma of the lower limbs. There are three essential criteria: analysis of the vascular status of the patient, the clinical characteristics of the leg ulcer, and its development on a cicatrix.

[Erosive lichen of the scalp]. / Lichen érosif du cuir chevelu.

BACKGROUND: We report an exceptional clinical presentation of erosive lichen planus of the scalp associated with hepatitis C and idiopathic CD4 lymphocytopenia. CASE REPORT: A 90-year-old woman was hospitalized in May 1995 for erosive dermatosis of the scalp and alopecia, associated with ungual lesions. Histology of the scalp lesions demonstrated lichen and the serology tests were positive for hepatitis C. The patient also had severe CD4 lymphocytopenia (290/mm3). The lesions regressed with clobetasol and occlusion and growth of scalp hair turned. DISCUSSION: Erosive lichen planus of the scalp has, to our knowledge, not been reported previously. The causal effect of drugs taken by this patient (tetrazepam and clorazepam) was not retained. Seropositivity for hepatitis C (with no evidence of active disease) was however probably not fortuitous. The association with CD4 lymphocytopenia merits discussion.

[Osteoarticular amyloidosis and dysglobulinemia: apropos of 2 cases]. / Amylose ostéoarticulaire et dysglobulinémie: à propos de deux cas.

We report two cases of bone and joint amyloidosis involvement related to plasma cell dyscrasia. The radiographic appearances mimic numerous benign or malignant diseases. MR imaging shows a diffuse low signal in T1 and an heterogeneous low or mild low signal in T2 weighted spin-echo sequence.

[Malignant synovial "chondromatosis" or chondrosarcomatous transformation of synovial chondromatosis of the knee?]. / "Chondromatose" synoviale maligne d'emblée ou évolution chondrosarcomateuse d'une chondromatose synoviale du genou?

A case of chondrosarcoma of the knee with clinical and histopathological features of malignant chondromatosis in a 40-year-old white man is reported. Malignant transformation of true chondromatosis is uncommon and has important implication of diagnosis and surgical treatment.

[Digitization and image reconstruction: application to iconography of surgical pathology specimens]. / Numérisation et traitement informatique de l'image: application à l'iconographie des pièces opératoires en anatomie pathologique.

A simple method for obtaining imaging documents of surgical specimens is reported. the method uses a scanner and a personal computer with printer. It provides rapid, low-cost high-quality images on paper or transparencies. The document can be used to illustrate a pathology report or discussion between clinicians and pathologists. The computers facilities already present in most Pathology laboratories is sufficient. The scanner with software cost slightly more than a camera.

[Immunohistochemical evaluation of estrogen and progesterone receptors on paraffin sections of breast carcinomas. Practical thoughts based on the study of 368 cases]. / Evaluation immunohistochimique des récepteurs aux estrogènes et à la progestérone sur coupes en paraffine de carcinomes mammaires. Réflexions pratiques suscitées par l'étude de 368 cas.

368 formalin-fixed and paraffin-embedded carcinomas of the breast were studied by immunohistochemistry using antibodies to estrogen and progesterone receptors. The results, which are comparable to the results published in the literature, are discussed with particular emphasis on quality assurance parameters.

[Computer-assisted rescreening of cervicovaginal smears stained by the Papanicolaou method. Evaluation of the PAPNET system apropos of 225 cases]. / Relecture assistée par ordinateur des frottis cervico-vaginaux colorés par la méthode de Papanicolaou. Evaluation du système PAPNET à propos de 225 cas.

The risk of false-negative smears is currently the main criticism of conventional cytological diagnosis of cervical cancer. None of the palliative methods (rescreening of a certain number of smears, external and internal laboratory controls, screener's training, European recommendations for Quality Assurance ...) are completely accurate. This explains the attempt to use automated screening of smears. The PAPNET screening system which allows recognition of possibly abnormal smears appears to be sufficiently effective. In this study, the authors report their personal experience based on a series of 225 cases. Moreover, when used wisely, this system may represent a useful teaching tool as well as a means of cytopathology Quality Assurance.

[Small intestinal tumors with skeinoid fibers. Report of 3 cases with immunohistochemical and ultrastructural study]. / Tumeurs de l'intestin grêle avec fibres en écheveau. 3 observations avec étude immunohistochimique et ultrastructurale.

Three cases of small intestinal stromal tumors with skeinoid fibers are presented and are confronted to the 15 cases found in the literature. These tumors are characterized by the presence of intercellular eosinophilic globules that stain positively on periodic acid-Schiff stain. Ultrastructurally, these structures are composed of tangles of curved banded (45 nm) fibers simulating an appearance of skeins. By immunohistochemistry, tumor cells express vimentin only. These tumors seem to be derived from the enteric plexus.

Neuroendocrine carcinoma (Merkel cell tumor?) presenting as a subcutaneous tumor. An ultrastructural and immunohistochemical study of three cases.

The clinical and pathological features of three unusual soft tissue tumors are presented. They occurred in the groin of elderly patients in the subcutaneous tissue. In Case 1, the inguino-crural tumor coexisted with a second mass in the pelvis. The tumors had a tendency to recur locally and to invade the regional lymph nodes. Metastatic dissemination of the disease resulted in the death of the patient in Case 3. Histologically, the tumors appeared composed of small round cells with scanty cytoplasms, arranged in diffuse, poorly cohesive or solid sheets. In places, a trabecular pattern was noted. Mitotic figures were numerous. Some cells exhibited argyrophil granules. The ultrastructural study revealed compact whorls of intermediate filaments and neurosecretory granules. All three cases displayed a paranuclear dot-like positive reaction with antibodies to cytokeratins and neurofilaments. A diffuse cytoplasmic immunostaining for neuron-specific enolase was present in Cases 1 and 2. Protein S-100, vimentin and leucocyte common antigen could not be demonstrated. All these characteristics, except for the subcutaneous location, are shared with neuroendocrine (Merkel cell) tumors of the skin.

[Accessory spleen on the left ovary. Discussion on its pathogenesis]. / Rate accessoire sur l'ovaire gauche. Discussion pathogénique.

The authors report a case of an accessory spleen attached to the left ovary, discovered in a hysterectomy and bilateral adnexectomy specimen obtained for leiomyoma. This is an exceptional congenital anomaly as only seven cases have been reported in the medical literature. It may be classified as a type of spleno-gonadal fusion. It is always localized to the left side. This anomaly may be manifest as an inguinal tumefaction or by an intestinal occlusion requiring exploratory laparotomy. It is caused by fusion of the spleen to the left urogenital bud during the 5th to 8th weeks of fetal development.

Distinction between hepatocellular carcinoma, cholangiocarcinoma, and metastatic carcinoma based on immunohistochemical staining for carcinoembryonic antigen and for cytokeratin 19 on paraffin sections.

An antiserum to carcinoembryonic antigen (CEA) and a monoclonal antibody to cytokeratin 19 (CK 19) were studied for their suitability as diagnostic reagents for the differential diagnosis of primary and secondary malignant epithelial tumours of the liver, on paraffin sections. With the antiserum to CEA, positive bile canalicular structures were found in 60 per cent of the hepatocellular carcinomas. All the cholangiocarcinomas and 66.6 per cent of the metastatic carcinomas were positive for CEA, without displaying a canalicular staining pattern. All the hepatocellular carcinomas were negative for CK 19. All the cholangiocellular carcinomas and the metastatic carcinomas were positive for CK 19. This staining profile may prove helpful in difficult diagnostic cases.