Successful surgical removal of occult metastases of medullary thyroid carcinoma recurrences with the help of immunoscintigraphy and radioimmunoguided surgery.

Patients with recurrent or metastatic medullary thyroid carcinoma (MTC) were referred for pretargeted immunoscintigraphy (Affinity Enhancement System; AES) and radioimmunoguided surgery (RIGS). Data collected from 13 patients establish that whole-body AES immunoscintigraphy revealed metastases < 360 mg and RIGS detected micrometastases (5-15 mg). All tissue samples removed by the surgeon were diagnosed by histology and immunohistochemistry of calcitonin to check the accuracy of IS and RIGS results. AES immunoscintigraphy is very sensitive. Of 34 metastases or recurrences detected, 22 had escaped physical examination or conventional imaging. The accuracy of RIGS was 86%, its sensitivity 75%, and its specificity was 90% (n = 208). IS and RIGS detected occult tumors that would have escaped surgery, clearly demonstrating clinical benefit. Serum calcitonin (normal, 10 pg/ml) and carcinoembryonic antigen (normal, 5 ng/ml) of two patients were restored to normal. In patients whose tumors were discovered, progression of their disease was slowed, as evidenced by the large decrease in serum calcitonin and carcinoembryonic antigen, an important prognostic factor. Surgery was canceled in one case where IS detected distant metastases out of surgical reach. Thus, AES immunoscintigraphy and RIGS might be of valuable help for the surgical management of medullary thyroid carcinoma.

[Anaplastic carcinoma of the thyroid]. / Carcinome anaplasique de la thyroïde.

Anaplastic carcinoma of the thyroid, also called undifferentiated carcinoma, is a rare variety of thyroid carcinoma observed in elderly subjects, usually female. This tumour presents in the form of a cervical mass and is rapidly fatal, usually within several months. Histologically, anaplastic carcinoma consists of a proliferation of spindle and/or giant cells, more rarely squamous cells, rich in cytonuclear abnormalities and mitotic figures with areas of necrosis. Immunohistochemistry confirms the epithelial nature of the proliferation, as tumour cells are generally labelled by low molecular weight cytokeratins; cytokeratin-vimentin coexpression is not rare. Anaplastic carcinoma can occur de novo or secondary to a pre-existing thyroid lesion, particularly well differentiated papillary or follicular carcinoma; in this latter case, study of p53 can be useful to detect the appearance of anaplastic transformation.

Variability of immunohistochemical reactivity on stored paraffin slides.

AIMS: To investigate the effects of slide storage on immunohistochemical staining, since recent reports have indicated that storage of unstained paraffin slides for up to 12 weeks may lead to false negative immunostaining of tumour markers. METHODS: 11 antibodies (anti-cytokeratin, epithelial membrane antigen (EMA), vimentin, smooth muscle actin, PS100, chromogranin, CD45, CD20, CD3, CD30, and oestrogen receptor (OR) were tested on unstained paraffin slides of breast carcinomas, lymphomas, and neuroendocrine tumours that had been stored for three to 10 years. All the paraffin blocks were recut less than one week before immunostaining. Immunostainings of years old slides were compared with those of recent slides in at least five cases for each antibody. For three antibodies (antichromogranin, anti-CD3, and anti-OR) we also tested one year old and three months old slides. RESULTS: Intensity of staining on years old slides was strikingly reduced for chromogranin and CD3 in several cases and was slightly stronger for vimentin. In some cases a significant decrease of OR positivity was observed after three months storage, and a complete loss of OR immunostaining after 12 months. No significant difference was noted with the other antibodies. CONCLUSIONS: Immunohistochemical detection of some antigens located either in the nucleus, in the cytoplasm, or on the cytoplasmic membrane could be impaired by storage of paraffin slides as short a time as three months. One should be cautious of doing retrospective immunohistochemical studies on stored unstained slides.

[Carcinosarcoma of the submaxillary gland]. / Carcinosarcome de la glande sous-maxillaire.

Salivary gland carcinosarcoma is a rare neoplasm, with a poor prognosis, that should not be confused with the more common carcinoma ex-pleomorphic adenoma, in which the epithelial component alone is malignant. The authors report one case of carcinosarcoma of the submandibular gland, with no previous history of pre-existent tumor. The tumor exhibited two intermingled and very atypical cellular components, one undifferentiated and the other with a chondroid pattern. Immunostaining with epithelial markers in the undifferentiated area allowed to distinguish this tumor from salivary gland sarcomas. In addition, the positivity for EMA, vimentin, and S100 protein in the two predominant components suggested a common origin for the different tumoral cell types, and led to discuss the nomenclature and the still unclarified cellular origin of these tumors.

[Immature teratoma of the mandible with ameloblastic component]. / Tératome immature de la mandibule à composante améloblastique.

A case of immature teratoma involving mandible in a 56 year old woman is reported. This teratoma is composed of ameloblastoma structures mixed with some usual components of teratoma: osseous and cartilaginous foetal tissue, indifferenciated blastema, neuroblastic structures, acinous glands and melanotic cells. A lymph node is involved by metastatic mature glial tissue. This patient is treated by pelvimandibulectomy and irradiation. Histogenesis of this teratoma unusual by this ameloblastic component and this mandibular localization is reviewed.

Fulminant adenovirus hepatitis after allogeneic bone marrow transplantation.

Adenoviruses may cause severe infections in bone marrow transplant recipients. We report the case of a patient who developed fulminant hepatitis 5 months after bone marrow transplantation. Adenovirus type 2 was cultured from stool and blood samples. The patient died from liver failure. Histologic examination of post-mortem liver samples showed extensive necrosis with nuclear inclusions. Adenovirus was identified in liver cells by electron microscopy and immunohistochemical staining using a monoclonal anti-adenovirus antibody. No other pathogen was identified.

[Nephroblastoma in adults. Apropos of two cases with immunohistochemical study of one case]. / Néphroblastome de l'adulte. A propos de deux cas dont un avec étude immunohistochimique.

The authors report 2 cases of adult Wilm's tumor, one biphasic, the other triphasic, and briefly discuss anatomoclínical features and differential diagnosis with benign tumors such as nephrogenic nephroma.

[Metastasizing pleomorphic adenoma of the parotid. Apropos of a case]. / Adénome pléomorphe métastasiant de la parotide. A propos d'un cas.

A case of metastasizing pleomorphic adenoma of the parotid in which both the primary tumor and metastasis were composed of benign pleomorphic structures is reported in a 55 year-old white woman. The pulmonary metastasis developed nine years after excision of the primary tumor without local recurrence. No mitotic activity or infiltrative growth pattern were present in the primary tumor. By flow cytometry, DNA content was diploid in both the parotid tumor and the pulmonary metastasis. Previously reported cases are reviewed.

MR of cerebral aspergillosis in patients who have had bone marrow transplantation.

PURPOSE: To assess the CT and MR appearance of cerebral aspergillosis in patients who have undergone bone marrow transplantation. METHODS: The imaging and clinical data of five patients with cerebral aspergillosis were reviewed retrospectively and compared with autopsy findings. RESULTS: Lesions are often located in the basal ganglia and demonstrate an intermediate signal intensity within surrounding high-signal areas on long-repetition-time MR scans. The lesions were multiple in four of the five patients and more numerous on MR images than on CT scans. The lesions (which demonstrate no parenchymal enhancement) are consistent with acute infarcts as confirmed at autopsy. In the large lesions, there is early intravascular and meningeal enhancement, as expected in acute infarcts involving an appreciable portion of the territory of a cerebral artery. CONCLUSION: The diagnosis of early cerebral infarction in a patient considered at risk for invasive aspergillosis, even without overt pulmonary disease, is an indication to institute aggressive antifungal therapy.

[Ossifying periostitis (Garrè) and chronic sclerosing osteomyelitis. Diagnostic limits and therapeutic management]. / Périostite ossifiante (Garrè) et ostéomyélite chronique sclérosante. Frontières diagnostiques et conduite thérapeutique.

Periostitis ossificans and sclerosing osteomyelitis are rare subtypes of non suppurative chronic osteomyelitis in which there is, additionally, a proliferation of periosteum leading to bony deposition secondary to a mild chronic infection making their diagnosis difficult. The authors report two clinical cases and try to release criteria helping to discern them because the prognosis and therapeutic management of these affections are different.

[Periosteal osteosarcoma of the jaw. Apropos of 2 cases]. / Ostéosarcome périosté des maxillaires. A propos de deux observations.

The authors report two cases of periosteal osteosarcoma of the jaws, a tumour which is one of the two variants of juxtacortical osteosarcoma. Periosteal osteosarcoma involving the jaw bones is extremely rare. Because of its chondroblastic differentiation, sometimes predominant, this tumour may pose some problems of differential diagnosis with chondrosarcoma or pleomorphic adenoma: immunochemistry may be necessary. This localization does not change the clinical, radiologic, histologic and prognostic features of periosteal osteosarcoma.

[Maxillo-mandibular fibrous dysplasia in 2 brothers]. / Dysplasie fibreuse maxillo-mandibulaire chez deux frères.

The authors report two cases of maxillo-mandibular fibrous dysplasia showing different form and grow up features affecting two brothers without notion inherited transmission of the lesion. By the way, the diagnostic and the therapeutic management are discussed.

Towards an objective prognostic index of acute graft-versus-host disease.

Acute graft-versus-host disease (AGVHD) is one of the major complications of allogenic non-T-depleted HLA-compatible bone marrow transplantation. It is not yet possible to predict the clinical evolution of the disease at the time of its first manifestation. Twenty patients who initiated the disease with only moderate skin involvement were selected consecutively among those followed between January 1985 and December 1988 in the Bone Marrow Transplantation Unit, Saint Louis Hospital, Paris. A skin biopsy was performed at the onset of the AGVHD for each patient. For each biopsy, one 5-microns thick section was fixed by Bouin's solution, stained with hematoxylin and eosin and studied by image analysis at a final calibration of 7.6 pixels/microns. Ten patients did not exceed grade I (low risk group) and ten developed a more severe grade (high risk group) in the evolution of the disease. The mean and coefficients of variation, skewness and kurtosis of dimension-, form- and texture-related parameters of the nuclei of lymphocytes infiltrating the skin were investigated for their ability to discriminate between the high and low risk groups. The best discrimination was obtained using texture-related variables. An index containing 5 texture-related variables gave the maximum separation between the two groups, with a 100% correct classification. Our results represent a learning-step towards the development of a prognostic index of AGVHD.

[Undifferentiated carcinomas of the thyroid corpus. Apropos of 10 cases]. / Carcinomes indifférenciés du corps thyroïde. A propos de dix cas.

Ten undifferentiated thyroid carcinomas detected between 1976 and 1991, were reviewed by means of immunohistochemical techniques. These tumors were highly aggressive with a mean survival rate of three months after the histological diagnosis. They were predominant in women and always occurred in old people (mean age 63.1 years). Four tumours were composed of differentiated trabecular areas. Another one was included in a microvesicular adenoma and a sixth one occurred as a recurrence of a papillary carcinoma surgically treated four months previously. Six tumours were cytokeratin-positive and two of them showed a cytokeratin-vimentin coexpression. These results, like those of an electron microscopic analysis of 1 case, confirm the epithelial origin of these tumours. Undifferentiated carcinomas must be distinguished from poorly differentiated carcinomas and from malignant non Hodgkin lymphomas which have a better prognosis and a different therapeutic approach. The immunohistochemistry and the electron microscopy are useful to identify undifferentiated thyroid carcinomas.

[Unusual localization of an olfactory esthesioneuroma]. / Localisation exceptionnelle d'un esthésioneurome olfactif.

Olfactory neuroblastoma, a nerve tumour arising in the olfactory mucosa, is a relatively easy diagnosis in the case of a mass centered around the cribriform plate. It is more difficult to diagnose in its exceptional ectopic forms (maxillary sinus) in the absence of any cytological and histochemical arguments (fibrils, olfactory rosettes). Its local malignancy is variable with a 42% 5-year survival for stage C and metastases in 30% of cases (principally cervical nodes, bone and liver). The role of imaging is to define the criteria of a mass syndrome and to perform the preoperative staging in a case of apparently simple sinus obstruction.

[Polymorphous low-grade adenocarcinoma of the minor salivary glands. Seven cases]. / Adénocarcinome polymorphe de faible malignité des glandes salivaires accessoires. Sept observations.

Seven cases of polymorphous low-grade adenocarcinoma of the minor salivary glands are reported. This fairly recently described tumor, which is not exceptional, is characterized by a polymorphous architecture, fairly uniform cytologic features, and a marked tendency to infiltrate neighboring structures with perineural spread in virtually every case. Immunohistochemical and ultrastructural studies reported in the literature have demonstrated that the tumor cells exhibit epithelial and myoepithelial differentiation. These tumors probably arise from reserve cells in terminal ducts. The histologic study should eliminate two other tumors that carry a very different prognosis, i.e., pleiomorphic adenoma and the tubular, cribriform variety of cystic adenoid carcinoma. Low-grade polymorphic adenocarcinomas grow slowly. Recurrences are infrequent. Metastases are rare and involve only regional lymph nodes. The morphologic features and course of these tumors explain the term "low-grade polymorphous adenocarcinoma" used to designate them.