[Peritoneal mesothelioma revealed by episodes of recurrent spontaneous peritonitis]. / Mésothéliome péritonéal révélé par des épisodes de péritonite spontanée à répétition.

A case of a malignant peritoneal mesothelioma revealed by recurrent episodes of peritonitis is reported. This presentation had never been described. A 54 year-old man presented successive episodes of appendicitis, cholecystitis and sigmoiditis associated with purulent aseptic peritonitis. There were no signs of immunodepression or vasculitis. Initial analysis of peritoneal biopsies showed non specific inflammation. Because of long-term asbestos exposure, these biopsies were reviewed. A diagnosis of peritoneal mesothelioma was made on subserous infiltration by mesothelioma cells, and confirmed by immunohistochemistry. The patient died ten months after the diagnosis of mesothelioma despite chemotherapy (cisplatine+interferon).

[The Cordeliers University Center. A short guide for a visitor]. / Centre Universitaire des Cordeliers. Quelques lignes pour un passant.

The history of the Pierre and Marie Curie University Cordeliers Center is summarized. A few traces of the history of this part of the latin quarter still remain. The oldest souvenir is the plain but impressive Refectory of the Cordeliers. This Refectory is all that is left of the great Convent of the Cordeliers, and it is a reminder of the important position that theologians of the Order of Saint-Francis held in Paris. Marat's body was laid in state in the Convent Church, which used to be a royal burial place. In the hall stands the statue of Aesculapius as a reminder of the important medical reforms that took place here: the Ecole de Santé de Paris created by the Convention: the Hôpital des Cliniques with its lecturing chairs; Dissection School; School of Practical Work of the Paris Medical Faculty.

Time-course development of differentiated hepatocarcinoma and lung metastasis in transgenic mice.

A precise targeting of the SV40 T early region expression in the liver of transgenic mice was obtained using 700 bp of the antithrombin III regulatory sequences to control oncogene expression. In the strain expressing the highest level of large T antigen (Tag), the incidence of hepatocarcinoma was 100%. The evolution was reproducible and characterized by a marked cytolysis occurring as early as 4 weeks, when no morphological and histological modifications were visible, a preneoplastic state marked by a progression from hyperplasia to proliferative nodules composed of highly differentiated cells exhibiting a high Tag expression, which elicited tumor formation in nude mice and could proliferate in vitro, and hepatocellular carcinoma associated, in 10% of the cases, with lung metastasis. These transgenic mice constituted a useful model for therapeutic assays and fundamental studies on carcinogenesis.

Bone allografts sterilised by irradiation. Biological properties, procurement and results of 150 massive allografts.

Massive bone allografts from cadavers have been sterilised by gamma-radiation from radioactive cobalt at a dose of 25,000 gray (Gy). The biological effects of radiation are discussed. Human cortical bone showed an acceptable 20% decrease in strength on bending tests after 27,000 Gy irradiation, but higher doses are more damaging and should be avoided. The procurement protocol used at the Cochin Hospital is described, and the importance of dosimetry and record-keeping emphasised. The clinical results of 150 massive bone allografts are reported. The infection rate was low. The evolution of the graft in each type of reconstruction is analysed and appears to be comparable to nonirradiated allografts. Very few complications occurred after composite reconstructions in the lower limb. Pelvic reconstructions had the highest complication rate, but most were not related to the use of the allograft.

Castleman's disease of the leptomeninges. Report of three cases.

Castleman's disease is a rare, benign lymphoproliferative disorder that usually arises in lymph nodes, most commonly in the mediastinum. The authors report the clinical and pathological features of three patients with localized Castleman's disease of the leptomeninges. There were two women, aged 63 and 82 years, and one 25-year-old man. Two patients had progressive focal motor seizures of 3 and 24 months' duration, and the third patient presented acutely with generalized seizures. The clinical diagnosis was meningioma in each case, based on computerized tomography scans, cerebral arteriography, and the operative findings. All three lesions arose in the leptomeninges, compressed the underlying cerebral cortex, and infiltrated the overlying dura to a variable extent. Surgical excision of the tumor resulted in marked clinical improvement in all three patients. Histologically, two cases were classified as the hyaline-vascular type and one as the plasma cell type. Immunohistochemical stains of the latter case revealed a monoclonal population of mature plasma cells. Only a few scattered polyclonal plasma cells were seen in the other two cases. The authors conclude that Castleman's disease involving the leptomeninges is a rare disorder that may mimic meningioma clinically and radiographically.

[Bone resorption and remodelling in chondrosarcomas of the limbs and pelvis. Diagnostic value in 84 cases]. / Résorption et remodelage osseux dans les chondrosarcomes des membres et des ceintures. Valeur diagnostique à propos de 84 cas.

Aside well known histological and cytological arguments of malignancy, we have analysed the tumoral growth and invasion in periphery for the skeletal chondrosarcoma diagnosis. This study involves 84 cases of chondrosarcoma of limbs, and pelvic limb selected from 176 cases of chondrosarcoma seen in the Cochin hospital. The following constatations were made: the tumor growth is fast in a chondrosarcoma and the lesions are continuous; in a same case, we can assist to tumoral invasion signs and bone reparation signs. In the reverse, this growth is slow in an enchondroma and the lesions are the more often stabilized by a mature peri-tumoral osteogenesis. The residual bone fragments into the tumor are constant in the chondrosarcoma and more rare in the enchondroma. The peri-tumoral osteogenesis, identical to enchondral bone formation, is the more often immature in chondrosarcoma and always mature in enchondroma. The active bone resorption as well as the actual bone remodelling, are more frequent in the chondrosarcoma borders than the enchondroma those. Lastly, the peri-tumoral fibrosis is the own of enchondroma; its existence in the chondrosarcoma is only the reflection of a residual enchondroma.

[Double mitral orifice. An anatomical case]. / Orifice mitral double. Une observation anatomique.

A double mitral orifice was discovered at autopsy in a 74 year old woman. Death resulted after several episodes of cardiac failure complicating mixed mitral and aortic valve disease. A vertical limbus bridged the mitral annulus separating it into two distinct right and left orifices, with oblique long axes aligned towards the lower part of the limbus perpendicular to each other from the left atrial view. After opening the left ventricle, both orifices were observed to have their own sets of chordae tendinae attached to normal papillary muscles: the right orifice to the posterior and the left to the anterior papillary muscle. The inferior end of the limbus was attached to a supplementary papillary muscle. Echocardiography and CT scanning were performed before dissection. This malformation results from symphysis of the mid parts of the two mitral leaflets during embryonic stages 15 and 16 (8-10 mm vertex-coccyx, 31st-33rd days).

Frequency and diagnostic value of the virus-like filamentous intranuclear inclusions in giant cell tumor of bone, not associated with Paget's disease. A study of 43 cases.

This paper deals with the paramyxovirus-like intranuclear inclusions observed in giant cells tumours of bone (GCTB). Twenty-one (49%) of 43 cases of GCTB (1977-1985), either fresh and/or cultured, show these ultrastructural inclusions. Fifty samples of various bone lesions in which giant cell lesions occurred, including aneurysmal cysts, hyperparathyroidism, osteoblastoma, human and rat osteopetrosis, GCT of tendon sheaths, and non skeletal granuloma were used as controls. These, together with 20 samples of normal bone (osteoclasts) did not contain intranuclear or intracytoplasmic viral inclusions.

Multifocal nonosteogenic fibroma: report of a case with ultrastructural findings.

The case of a patient in whom multiple nonosteogenic fibromas developed is reported. This condition is very unusual and must be differentiated not only from the multiple lesions that occur in association with well-known entities but also from some occasionally multifocal bone tumors. The lesion is characterized by proliferations of spindle cells disposed in storiform patterns, with numerous scattered multinucleated giant cells. Ultrastructural study revealed that the basic cell of this lesion had fine structural features of both fibroblast and myofibroblast cells.

[Hip surgery: local tissue reactions]. / La hanche opérée: réactions tissulaires locales.

Present extent of total hip prostheses, protracted course of first operations lead to pathological studies on local tissue reactions, sign of the failure or of the damaging of the artificial hip. Another pathology, often as intricate, is observed after more conservative surgery: high femoral osteotomies, cup arthroplasties, femoral metallic prostheses. Failure of an high femoral osteotomy shows a running of osteoarthritic lesions the topography of which is always modified by the new orientation of the articular bearing segment. Osteosclerosis, osteoarthritic cysts may develop on a preexisting osteophytosis. Osteonecrosis or bone resorption are sometimes found. Anatomical results in case of a successful osteotomy are scarce. Fibrous layer eventually quoted as a guide to the development of fibrocartilage is more often associated with osteoclast mediated bone loss. Efficient bone remodelling is assumed only, today, by radiological proof. Failures of cup arthroplasties induce femoral bone or acetabular cartilage lesions which are different according to the surgical technic. Some are marked by cartilage destruction of the acetabula or by a cup dislodgement. Bone structure in those cases shows under the cup a good remodelling with a fibrous or fibrocartilaginous mantle originating from the bone marrow spaces and the capsular attachment. In other cases, the femoral head presents areas of superficial or total osteonecrosis, signs of intense osteoclastic activity, cleaving of the fibrous surface and eventually metallic debris or cement induced histiocytic granuloma. A fibrous layer may develop between the cup and the acetabula. Femoral metallic prostheses may damage in some years cartilage of the acetabula. Osteoarthritic bone remodelling is sometimes observed in close contact with the metallic collar. Lesions of capsular tissues are eventually represented by metallic debris or an histiocytic granuloma due to cement anchorage. Material received at the time of surgical revision on total hip arthroplasties concerns chiefly the newly formed capsular and synovial tissues. Their appearance is quite similar to the tissular layers found between prosthetic material and bone or cement. For the pathologist, main inquiries are the rule out of an infection, the extent and course of the macrophage or giant cell response, the nature of wear debris or of the products of corrosion and the histological factors contributing to the loosening of the prosthetic components. It should be stressed that any physiopathological schedule of an artificial hip failure is a topographical and dynamic problem only partly resolved by studying autopsy material.

[Sea-blue histiocyte syndrome. Review of the literature apropos of a case of idiopathic splenomegaly in the adult]. / Le syndrome des histiocytes bleus. Revue de la littérature à propos d'une observation de splénomégalie idiopathique chez l'adulte.

A case of idiopathic splenomegaly with ceroid histiocytosis--the so-called sea-blue histiocytosis--is reported with reference to the literature. The histological, histochemical and ultrastructural features of stained sea-blue and ceroid-containing macrophages are described and their physiopathological significance is discussed. Attention is drawn to the distinctions, between idiopathic and secondary or associated forms, and the practical value of the pathological diagnosis is emphasized.

[Giant fibroma of the pleura. Apropos of 2 cases]. / Fibromes géants de la plèvre. A propos de deux observations.

Two cases are reported of giant pleural fibroma (2.9 and 4.2 kg), of slow growth (both had been present for 17 years), developing in the parietal pleura in a 56-year-old woman and in the triangular ligament of a 35-year-old man respectively, and treated by surgical excision. Findings in these cases and data on those reported in the literature indicate the principal pathologic and clinical characteristics of these very rare benign tumors of the pleura: onset in the absent of any history of exposure to dust (asbestos); usually fortuitous discovery; suggestive radiological appearances (calcification in some cases) that are not pathognomonic however; differentiation from fibrous mesothelioma by the microscopic or particularly gross pathologic appearance; treatment exclusively surgical and of variable difficulty according to the size of and especially the structures related to the tumor, with the need for careful preoperative screening.

[Rheumatoid polyarthritis with Gougerot-Sjögren's syndrome, pulmonary pseudolymphoma and digestive lymphoma. Apropos of a case]. / Polyarthrite rhumatoïde avec syndrome de Gougerot-Sjögren, pseudo-lymphome pulmonaire et lymphome digestif. A propos d'une observation.

The authors report a case of the Gougerot-Sjögren syndrome with rheumatoid arthritis, of particular interest because of lymphocytic proliferation. This was initially confined to the broncho-pulmonary tissues with histological appearances of pseudo-lymphoma, a diagnosis supported by clinical regression with immunosuppressive drugs, over a 5 years period. This difficult diagnosis needs histological, biochemical and clinical confirmation and, the very existence of this entity is debatable. The occurrence of a malignant lymphoma of the small intestine in the same patient a few years later is an argument in favour of the hypothesis that the pseudo-lymphoma was an intermediary pre-malignant stage of B-lymphocytic proliferation.