[Skin shrinkage study for skin oncologic surgery. Clinical study of 79 cases]. / Étude de la rétraction cutanée en chirurgie carcinologique cutanée. Étude clinique de 79 cas.

BACKGROUND: Skin tumors surgery is common and well established. There is discrepancy between recommendations on macroscopic margins to apply and therapeutic decisions taken on histological margins. The purpose of this study is to examine skin shrinkage upon exeresis, then in formalin, to understand the anatomo-clinical discrepancy, which is often found. MATERIAL AND METHODS: It was a prospective study, lasting a month, including patients receiving skin surgery. For each tumor, the surgeon carried out 4 margins measurements before and after exeresis ; margins measured again in histology. The evaluation criterion was the difference between preoperative, postoperative and histological margins measurement. These data was weighting according to factors linked to the patient and the tumor. RESULTS: Seventy-nine tumors for 61 patients had been studied. The study showed a significant shrinkage between preoperative measurements and postoperative, from 0.4 to 0.6mm. It is correlated with no one tested factors. Significant shrinkage between 0.4 and 0.5mm was also established between preoperative and histological measurements. However, there is a significant augmentation between postoperative and histological measurements. CONCLUSION: This last result could be linked to the inflammatory peri-wound skin that surgeon consider as tumoral process so exclude of his margin, while histology could show a healthy area. In front of these results, an expert committee leading a more important study could include histological margins recommendations to the actual clinical recommendations.

[Hepatic MALT lymphoma disclosing a nodal extension]. / Lymphome du MALT hépatique avec extension ganglionnaire révélatrice.

We report a case of a 50-year-old man with chronic viral hepatitis B presenting with a primary hepatic lymphoma of mucosa-associated lymphoid tissue, revealed clinically by a pedicular nodal mass. The liver biopsy showed an active chronic hepatitis and a dense portal lymphoid infiltrate with centrocyte-like cells inducing typical biliary lympho-epithelial lesions. The lymph-node biopsy revealed a marginal zone lymphoma pattern. A monoclonal rearrangement of the immunoglobulin heavy chain gene was detected in the lymph node by polymerase chain reaction. This case of primary hepatic mucosa-associated lymphoid tissue lymphoma confirms that the liver also contains mucosa-associated lymphoid tissue, in which low grade lymphoma can arise.

Superficial gastric carcinoma developed on localized hypertrophic lymphocytic gastritis: a variant of localized Ménétrier's disease?

Ménétrier's disease is a rare premalignant condition that usually involves the entire stomach. Only few cases of localized disease have been reported, rarely with cancer. Lymphocytic gastritis is a newly described entity that may share a common pathogenesis with Ménétrier's disease. The authors report the case of a 62 year old woman with known liver cirrhosis in whom endoscopic examination of the stomach showed an antral tumor. Examination of the surgical specimen showed a superficial gastric adenocarcinoma developed on an hypertrophic gastropathy with both Ménétrier's disease and lymphocytic gastritis features. This observation strengthens the hypothesis of a common mechanism between Ménétrier's disease and lymphocytic gastritis, which may be part of the same disease spectrum. This disease could also correspond to the "hypertrophic lymphocytic gastritis" recently described.

Variation in the histological pattern of nodal involvement by gamma/delta T-cell lymphoma.

AIMS: Gamma-delta (gammadelta) T-cell non-Hodgkin's lymphomas (NHLs) usually present with liver, spleen and marrow infiltration. Lymph node involvement by gammadelta T-cell NHL has been rarely documented so far; its histological pattern needs to be further defined. METHODS AND RESULTS: Two cases of nodal gammadelta T-cell NHL are reported: case 1, a 44-year-old man, presented with cytomegalovirus retinitis and superficial lymphadenopathies. Histological analysis of an inguinal lymph node showed complete destruction by a diffuse pleomorphic lymphoid proliferation, which was positive for CD2, CD3, CD43, CD45, TIA-1 and granzyme B, and displayed a gammadelta phenotype (deltaTCR1+, Vdelta1+, Vdelta2-, Vdelta3-, betaF1-). Bone marrow was normal. Case 2, a male 24-year-old patient with a history of renal transplantation, presented with hepatosplenomegaly and supraclavicular lymph node enlargement. Lymph node architecture was globally preserved. Peripheral sinuses contained scattered nests of medium-sized irregular lymphoid cells. Bone-marrow was infiltrated. Phenotype showed positivity for CD2, CD3, CD45 and TIA1 and expression of gammadelta TCR (deltaTCR1+, deltaV1+, deltaV2-, deltaV3-, betaF1-). Both patients died a short time after diagnosis. CONCLUSIONS: These observations suggest that at least two forms of nodal gammadelta T-cell NHL may be encountered: one mimicking classical alphabeta T-cell NHL, with diffuse pleomorphic cell proliferation, and one displaying sinusoidal neoplastic infiltration suggesting a close relationship with hepatosplenic gammadelta T-cell NHL.

Reduced number of Langerhans cells in oesophageal mucosa from AIDS patients.

AIMS: The oesophageal mucosa is a frequent target of opportunistic infections in human immunodeficiency virus (HIV) infection. Langerhans cells (LC) are known as a target and reservoir of HIV in the skin. The aim of this study was to characterize oesophageal LC in HIV-infected patients. METHODS AND RESULTS: Thirty oesophageal biopsies were obtained from 29 patients (median age 35.5), all in stage IV of the HIV Center of Disease Control Classification. We performed histological assessment of the oesophageal mucosa and immunohistochemical detection of oesophageal LC using an anti-CD1a antibody, followed by morphometric analysis. Biopsies from 17 noninfected patients were studied using the same procedure. LC in oesophageal mucosa of the HIV positive patients showed a significantly and dramatically decreased number (LC(N) median = 5.85/mm2) and surface/epithelial surface (LC (S) ratio = 0.09) when compared with HIV-negative controls (LC(N) median = 29.7/mm2, LC(S) ratio = 1.83) with P = 0.003 for LC(N) and P < 0.0001 for LC(S). CONCLUSION: These data suggest that oesophageal LC are, like their epidermal counterparts, a preferential target for HIV infection. Their alterations may provide a clue to the pathogenesis of the decreased local oesophageal immunity and to the occurrence of opportunistic infections.

Peritumoral vascular invasion in women with node-negative breast cancer, receiving no adjuvant therapy.

BACKGROUND: The prognostic value of peritumoral vascular invasion (PVI) in node negative breast cancer (N-) is a controversial issue. Considerable debate has focused on how PVI should be defined, and the techniques used to detect them have differed considerably from one study to another. MATERIAL AND METHODS: In our study, 167 cases of N- breast cancers were reviewed, with a view to determining whether or not PVI, as defined in the recently published European recommendations, were present. RESULTS: Based on the results of the subsequent statistical study, the presence of PVI was not found to constitute a reliable prognostic index to the outcome of N- breast cancer. CONCLUSION: Referring each case to the data available in the literature, the difficulties encountered when searching for PVI of this kind are described, the results of various studies on the topic are reviewed and whether it is worth pursuing studies along these lines is discussed.

Analysis of BAX expression in human tissues using the anti-BAX, 4F11 monoclonal antibody on paraffin sections.

BAX, a heterodimer partner of BCL-2, is an apoptosis inducer. We aimed to characterize the distribution of the BAX protein in normal adult human tissues using immunohistochemistry (IHC). The monoclonal antibody anti-BAX 4F11 was used on paraffin sections: immunodetection of BCL-2 was performed simultaneously on serial sections. The specificity of BAX IHC staining was verified by Western blot analysis. IHC positivity was correlated with the detection of a specific 21 kDa band on Western blots. BAX immunostaining was mainly cytosolic and occasionally on the nuclear membrane. Amounts of BAX protein were high in liver, renal tubules, endocrine islets of the pancreas, gastric glands, cardiac muscle, epididymis, lymph node germinal centers, and neurons; intermediate in the colon, stomach, bronchus. Fallopian tube, salivary gland, breast, thymus, spleen, and testis; low or undetectable in the other tissues. BAX IHC positivity correlated with apoptotic features in neurons and germinal center lymphocytes. There was no strict correlation between the IHC profiles of BAX and BCL-2 expression, although a reciprocal pattern of staining was observed in lymph node and colon. This report shows the usefulness the monoclonal antibody anti-BAX 4F11 on paraffin sections and demonstrates that the human BAX tissular distribution is close to, but not similar, to the profile observed in the mouse. The widespread BAX expression suggests that BAX alone is insufficient to trigger cell death in human tissues. BAX may either modulate the role of other regulators of apoptosis or carry out functions unrelated to apoptosis.

[Rare non-Hodgkin's lymphoma in the course of infection with human immunodeficiency virus. Two cases with bone marrow invasion]. / Lymphomes non hodgkiniens inhabituels au cours de l'infection par le virus de l'immunodéficience humaine. Deux cas avec envahissement médullaire.

Malignant non Hodgkin's lymphomas in patients with acquired immunodeficiency syndrome are usually of high grade and have a B-cell phenotype. We describe two cases of rare lymphomas during acquired immunodeficiency syndrome: one case of pleomorphic T cell lymphoma with medium and large cell predominance, of high grade of malignancy, according to the updated Kiel classification, involving mainly the bone-marrow, and one case of low grade monocytoid B-cell lymphoma with bone-marrow extension, which is a rare condition in this type of lymphoma. These lymphomas seem to be a casual event during acquired immunodeficiency syndrome, but the immunodeficiency can be responsible of a more aggressive behavior.

[Lactic acidosis and hepatic mitochondrial changes during a treatment with zidovudine]. / Acidose lactique et altérations mitochondriales hépatiques au cours d'un traitement par zidovudine.

Adverse effects of zidovudine, which mainly result in myopathies and hematological disorders, could be due to multitissular mitochondrial toxicity of the drug. During zidovudine treatment, most cases of lactic acidosis have been attributed to mitochondrial myopathy. We report a case of hepatocellular failure with lactic acidosis in a 33 year-old patient with the human immunodeficiency virus infection and treated with zidovudine for 8 months. Liver biopsy showed massive macrovacuolar steatosis and ultrastructural mitochondrial abnormalities similar to those previously described in the skeletal muscle. This is the second reported case of lactic acidosis and hepatocellular failure which is probably related to hepatic mitochondrial dysfunction caused by zidovudine.