[Endometriosis with massive hemorrhagic ascites: a case report and review of the literature]. / Endométriose et ascite hémorragique massive récidivante: cas clinique et revue de la littérature.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It generally involves the peritoneum, ovaries and rectovaginal septum. Its characteristic symptoms include dysmenorrhea, pelvic pain, deep dyspareunia and infertility. It may also involve the gastrointestinal tract, urinary tract or extra abdominal sites, giving rise to a wide variety of clinical symptoms such as bloody stools, renal haemorrhage, hemoptysis and pleural effusion during menstruation. Recurrent hemorrhagic ascites secondary to endometriosis is an unusual occurrence, 41 cases have been reported since 1954. Here we report an additional case, in order to draw attention to this condition. A 28 years-old black nulligravida woman was seen for the first time in april 2000 with a chief complaint of infertility. Her past medical history was unremarkable. She had regular menses but associated with severe dysmenorrhea. She also recalled abdominal and pelvic pain for several years. She underwent an ovulation induction with gonadotrophin, which resulted in a progressive increase of pelvic pain. A first laparoscopy was performed, revealing voluminous ascites (10 I). Two years later the ascites recurred spontaneously. Ultrasound examination revealed suspect "para uterine masses". A second exploratory laparoscopy showed a voluminous bloody ascites (71), and extensive adhesions. On histologic examination all specimens (peritoneal biopsies) were compatible with endometriosis and ruled out malignancy. Treatment with Gn RH analog was performed and full remission was obtained after 6 months. One year later the ascites recurred again spontaneously, leading to a third laparoscopy in an other medical institution. Histologic examination showed endometrial stromal tissue and fibrous proliferation. Later she became pregnant after in vitro fertilization. In the first trimester of pregnancy, the pelvic ultrasound showed only a small effusion in the pouch of Douglas. Still, the ascites did not progress during pregnancy. The patient was hospitalized from 27 to 33 weeks of gestational age for threatened labor, but she finally had a normal vaginal delivery at 36 weeks of gestational age. Four months later, she had no complaint, but the pelvic ultrasound showed the recurrence of the ascites. She will have a drainage. The future treatement will consists of GnRH analog for about six months, which will be relayed by a long term progestative therapy. A diagnosis of endometriosis should always be considered in middle-age women who presents with bloody ascites. Long follow-up is advisable for patients who undergo conservative treatment because of thehigh risk of recurrence.

Hashimoto's thyroiditis associated with Riedel's thyroiditis and retroperitoneal fibrosis.

This article describe the case of a 38-year-old woman with simultaneous involvement of the thyroid by Hashimoto's thyroiditis and Riedels's disease, associated with retroperitoneal fibrosis and lipidic endarteritis. According to a large review of the literature on the occurrence of this rare condition the difficulty in sharply defining the two thyroid processes is discussed. The chronology of the events is analyzed, and etiopathogenic hypotheses are listed with emphasis on the relationship between the vascular lesions and the onset of the fibrosing process.

[Results of endorectal MRI in local staging of prostatic cancer. Correlation with specimens from prostatectomy. Apropos of 47 cases]. / Résultats de l'IRM endo-rectale dans la stadification locale du cancer de la prostate. Corrélation avec les pièces de prostatectomie. A propos de 47 cas.

Endorectal surface coil magnetic resonance imaging (MRI) was used in the local staging of prostate cancer in 47 patients. We used an 1.5 Tesla General Electric magnet. Fast spin echo sequences were acquired in all cases. All pathological specimen were reviewed by one pathologist. Pathological study showed that 19 patients had a locally confined cancer of the prostate (pT2), and 28 had an extraglandular extension (pT3). MRI correctly predicted a pT3 tumor in 15 of 28 cases, and a pT2 tumor in 18 of 19 patients. MRI was 70% accurate in the differenciation of stage pT2 from stage pT3 cancer. One case was overestimated and 13 cases were underestimated. The latter 13 patients had microscopic extracapsular invasion only.

[Tumor of the spermatic cord and the gonadal stroma of the testis. Apropos of a case in a 19-year old man]. / Tumeur du cordon et du stroma du testicule. A propos d'un cas chez un jeune homme de 19 ans.

A Sertoli cell mesenchymal tumour was observed in a 19-year-old male. The prognosis of this rare tumour is good.

[Epidermoid cyst of the testis. Apropos of a case]. / Kyste épidermoïde du testicule. A propos d'un cas.

The epidermoid cyst of the testis, a rare and benign tumour, continues to create problems. Its definitive diagnosis remains a histopathological one and alters the prognosis and therapy. Based on their case report and a literature review, the authors discuss the different diagnostic, prognostic and therapeutic aspects of this lesion.

[Retroperitoneal benign schwannoma]. / Schwannome bénin rétropéritonéal.

The authors report about one case of retroperitoneal benign schwannoma located near the right kidney and causing renovascular arterial hypertension. The diagnosis of benign schwannoma, which is unfrequent in the absence of Recklinghausen's disease, was established after the pathological study of the complete specimen including the right kidney.

[Clear cell unilocular and multilocular cystic renal tumors and in situ clear cell intratubular carcinoma]. / Tumeurs rénales kystiques uniloculaires et multiloculaires à cellules claires et carcinome in-situ intratubulaire à cellules claires.

Clear cell cyst can present as: multilocular cyst (mimicking a cystic nephroma), which is just a multicystic variant of clear cell carcinoma, the right diagnosis often being very difficult to make before final pathological examination; unilocular cyst with atypical clinical features, pathological diagnosis often being very difficult by cytology and on frozen sections; unilocular cyst resembling a simple renal cyst, that is usually small, found incidentally in kidneys removed for renal cell carcinoma (mostly clear cell carcinoma) or sometimes for another pathology. The discovery of this not infrequent type of clear cell cystic tumor was made possible only by systematic histological examination of all ordinary-looking renal cysts. A four year experience with a series of 255 kidneys is presented here. A simple histogenetic schema for cystic clear cell tumors is proposed. The new types of clear cell lesions presented here: clear cell cyst and a particular type of in situ intratubular carcinoma, are discussed in reference to multifocal tumors of the kidney.

[Cystic clear cell tumors of the kidney]. / Tumeurs kystiques à cellules claires du rein.

Renal clear cell carcinoma can sometimes present as: unilocular cyst; necrotic pseudocyst; multilocular cyst, resembling cystic nephroma. Diagnosis by cytology and on frozen sections is often difficult, or even impossible.

[Cellular or atypical mesoblastic nephroma of partially cystic form. Apropos of a case in a 27 year old woman]. / Le néphrome mésoblastique cellulaire ou atypique à forme partiellement kystique. A propos d'une observation chez une femme de 27 ans.

A case of partially cystic atypical or cellular variant of mesoblastic nephroma in a 27 year old woman is reported herein. Some of the cysts were like those seen in a cystic nephroma (solitary multilocular cyst) and others resembled ectasic vascular channels. Nephrectomy was the only treatment used. Since her operation our patient has become pregnant and given birth to a healthy daughter. The mother is well and free of disease more than 18 months after nephrectomy. We have only found 7 other reports of adult mesoblastic nephroma. Ours in the first published case of the cellular or atypical variant of mesoblastic nephroma in an adult patient. Difficulty in diagnosis and treatment particular to this type of tumor is stressed upon with reference to pediatric and adult cases described in the literature.

[Unusual renal tumor in a young woman: cellular or atypical mesoblastic nephroma with partially cystic form]. / Tumeur rénale exceptionnelle chez une jeune femme: le néphrome mésoblastique cellulaire ou atypique à forme partiellement kystique.

A case of partially cystic atypical or cellular variant of mesoblastic nephroma in a 27-year old woman is reported. Nephrectomy was the only treatment. Since her operation, our patient has become pregnant and given birth to a healthy daughter. The mother is well and free of disease more than 18 months after nephrectomy. We have only found eight other reports of adult mesoblastic nephroma. Ours is the first published case of the cellular or atypical variant of mesoblastic nephroma in an adult patient.

[Conservative treatment of a recurring retroperitoneal liposarcoma. Apropos of a case followed over 27 years]. / Traitement conservateur d'un liposarcome rétropéritonéal récidivant. A propos d'un cas évoluant depuis 27 ans.

We report about the case of a patient who, over 27 years, presented with seven local recurrences of a retroperitoneal liposarcoma. This evolution seems to characterize differentiated (adult and myxoid) forms of liposarcoma, for which metastatic expansion is less frequent that in the undifferentiated, pleiomorphic or round-cell forms. The treatment of these tumors is mainly surgical. Adjuvant radiation therapy might reduce the frequency of local recurrence.

Genitourinary tumors and HIV1 infection.

4 patients with solid genitourinary tumors and HIV1 infection have been treated in our institution over the last 2 years. Two patients had seminoma, 1 renal adenocarcinoma and 1 renal angiosarcoma. All had deeply impaired immunity with a low CD4 level. 3 had or developed a true AIDS syndrome according to the WHO and CDC criterias of 1988. The remaining patient was seropositive and died less than 3 months following the diagnosis of renal angiosarcoma. He is the first reported case of renal sarcoma in a patient infected with HIV1. 2 patients were homosexuals, and the 2 others were drug addicts. Along with other reported cases, our cases underline the association between the depression of immunity due to HIV and the onset of solid genitourinary tumors.

Immunohistochemical markers defined by monoclonal antibodies and response to bacillus Calmette-Guérin endovesical immunotherapy for superficial bladder tumors.

As bacillus Calmette-Guérin (BCG) immunotherapy is highly effective for most but not all superficial bladder tumors, there is a need to define predictors of response to this mode of treatment. We have investigated a panel of markers defined by monoclonal antibodies, directed against tumor-associated transitional cell carcinoma antigen (G4 and E7), epidermal growth factor receptor, cytokeratin (CK) 18 and blood group antigens A, B and H, using an indirect immunoperoxidase staining on paraffin sections. Twenty superficial bladder tumors (T1) treated with intravesical BCG therapy (10 responders and 10 nonresponders) were tested with this panel. Among the responders, expression of CK18 antigen was positive in 7 and negative in 3, whereas in the nonresponder group it was positive in 2 and negative in 8. The difference was statistically significant (p less than 0.05). Loss of expression of CK18 antigenicity was associated with recurrence or progression of superficial bladder tumors following BCG therapy, indicating that changes in CK patterns should be investigated as potential predictive markers for response to BCG.

[Treatment of epidermoid carcinoma of the penis]. / Traitement du cancer épidermoïde de la verge.

Epidermoid carcinoma of the penis is a rare type of cancer. Treatment of the primary lesion consists of amputation, although curietherapy can be effective in some cases as a conservative treatment. The prognosis is determined by the presence of absence of lymph node invasion, but the therapeutic strategy to be used when invaded lymph nodes are present remains controversial. Lymph node dissection is the only effective treatment of metastatic adenopathy, but its high morbidity rate limits its indications.

[Urogenital tumors and HIV-1 infection]. / Tumeur urogénitale et infection à HIV 1.

Four patients with solid genito-urinary tumors and HIV 1 infection have been treated in our institution over the last 2 years, including 2 with seminoma, 1 with renal adenocarcinoma and 1 with renal angiosarcoma. All had severely impaired immunity with a low CD4 level. Three had or developed a true AIDS syndrome according to the WHO and CDC criteria (1988). The remaining patient was seropositive and died less than 3 months following the diagnosis of renal angiosarcoma, he is the first reported case of renal sarcoma in a patient infected with HIV 1. Two patients were homosexuals and the other 2 were drug addicts. Along with other reported cases, our cases may underline the association between depression of immunity due to HIV and onset of solid genito-urinary tumors.

[Pathological anatomy of adenocarcinoma of the prostate in 1988]. / Anatomie pathologique de l'adénocarcinome de la prostate en 1988.

After going through gross and microscopic features of prostatic adenocarcinoma, the author stresses upon cytological diagnosis on fine-needle (Franzén) aspiration biopsies. Histological or cytological diagnosis may be difficult. And prostatic dysplasia is an especially difficult subject. There are too many definitions of Stage A1 adeno-carcinoma of the prostate. One would be enough! Histoprognosis only has a statistical value. The Gleason classification is the one we would choose. Any other system could be used as a second classification. PSA (prostate specific antigen) is the best marker for the prostate and for prostatic adenocarcinoma. The idea of an "endocrine prostate" is a new contribution for a better histoprognosis. Carcinoid tumor is only one extreme part of the subject. New methods are reviewed, which will probably make diagnosis and prognosis much easier.

[Ultrasonic diagnosis of non-palpable germinal tumors of the testis. Apropos of 2 cases]. / Diagnostic échographique des tumeurs germinales non palpables du testicule. A propos de deux cas.

The germ cell tumors are the most common type of testicular malignant tumors (90%). About 30% are revealed by metastasis usually into the retroperitoneum, with clinically normal testis. Ultrasound reveals a bright echogenic focus into the testis which is typical, considering the clinical presentation, for a regressed germ-cell tumor and guides the side of the orchidectomy which allows to suppress a still active tumoral tissue which will not be eradicated by chemotherapy. Two typical cases with sonographic guidance are reported herein and confronted with the cases previously described in the literature.

Bladder tumors: when to do and what to expect from random mucosal biopsies with reference to blood group cell surface antigens.

Routine random biopsies of normal looking bladder mucosa in the evaluation of bladder tumors demonstrated a high occurrence of anomalies ranging from dysplasia to carcinoma in situ (CIS). 75 patients with a urothelial bladder tumor were submitted to 165 endoscopic procedures under anesthesia including transurethral resection of any bladder tumor and random mucosal biopsies in the 4 quadrants of the bladder. The frequency and severity of mucosal anomalies rise with the tumor grade and stage: in stage 0.Ta, the percentage of anomalies rises from 15% in grade-1 lesions to 53% in grade-3 tumors. 80% of the stage A (T1) B and C (T2, T3) tumors are associated with anomalies of the normal looking bladder mucosa characterized by CIS in 50% of the cases. These lesions which may persist in the absence of any visible tumor respond dramatically to endovesical bacillus Calmette-Guérin therapy. Simultaneous determinations of blood group antigens fail to demonstrate a clear correlation between the antigenic status of the tumor and that of random biopsies. These results may help to clarify the indications of random mucosal biopsies which should be reserved to the treatment and surveillance of grade 3-tumors, irrespective of their stage.