[Evaluation of the follow-up of women aged 50-74 years after cervical cytological Ascus abnormalities in cancer screening: adherence to clinical practice guidelines in Isere, France; 1991-2000]. / Evaluation de la prise en charge des femmes de 50 à 74 ans après frottis du col de l'utérus répondu Ascus dans un dépistage organisé en Isère 1991-2000 : application de la conduite à tenir de l'Agence nationale d'accréditation et d'évaluation en santé.

OBJECTIVES: The aim of this study is to compare to the guideline (1998 and 2001) the follow-up of Ascus cytological abnormalities among women aged 50-74 years who have participated at the combined breast, cervical and colorectal cancer screening programme from 1991 to 2000 in Isère, France. PATIENTS AND METHODS: The follow-up of 1154 women with Ascus smear was analysed. A woman was defined according follow-up if she have made a colposcopy or biopsy less than four months after one positive smear or if she has repeated three smears: 3-7 months and 10-14 months after the positive smear and 1 year after the last negative smear. RESULTS: The follow-up was according to guidelines for 28.4% of the 1154 women (150 women are unknowns), 58.6% had a follow-up with too long delay and 17.2% had an uncompleted follow-up. The follow-up did not differ before 1998. It did not differ from women age. Women who were treated by gynaecologist (548) had a better follow-up (according: 35.4%) than the women who were treated by a general practitioner (595). DISCUSSION AND CONCLUSION: The follow-up of Ascus cytological abnormalities is not according to guideline. The follow-up in the screening program will be intensified.

[Contribution of ultrasonography-guided microbiopsy in breast diseases]. / Apport de la micro-biopsie échoguidée dans la pathologie mammaire.

OBJECTIVE: To assess the usefulness of core biopsy under ultrasonography (CBUS). MATERIALS AND METHODS: 165 US guided breast lesions biopsies were reviewed. Forty-eight underwent surgery and the 117 remaining cases were followed up for at least one year. Forty-four lesions were malignant and 89 were no palpable. Lesion size ranged from 3 to 35 mm (mean 14.8 mm). Core biopsy was performed with an automatic device with a 18 Gauge needle using a long-throw (2.2 cm excursion). Needle length was 10 cm. At least two passes were performed. RESULTS: Five false negatives were obtained which were all explained. All the infiltrative carcinomas without microcalcifications as mammographic sign were correctly diagnosed. A resolutive hematoma was the only complication to occur. None of the lesions with follow up showed any evolution. With CBUS, sensitivity for malignancy was 91% and specificity 100%. This is in agreement with previous studies. CONCLUSION: Methodology and indications of such core biopsies are peculiar. Actually, the lesion must be seen with ultrasonography and should not be superficial, be correlated with microcalcifications, or be a cyst even with a thick content. This method is safe and comfortable. It is not expensive when compared with surgery or stereotaxy. It should avoid useless surgical open biopsies as it allows histologic diagnosis with Scarff and Bloom grading and hormonal receptor status. So, US guided core-biopsy should contribute to increase the predictive positive value of surgical biopsy in senologic screening.

Quantification of cellular adhesion molecules on malignant B cells from non-Hodgkin's lymphoma.

The expression of five cellular adhesion molecules (CAMs), CD54, CD58, CD11a, CD29 and CD49d, was studied in 113 B cell non-Hodgkin's lymphomas (NHL) and in normal B cells from 12 control lymph nodes. Rather than reporting the percentage of positive cells, which does not discriminate between NHL subtypes, we quantified the intensity of CAM expression using flow cytometry. Apart from CD49d the expression of all these CAMs was statistically different among the NHL subtypes as defined by the REAL classification. Low grade NHL-small lymphocytic, follicular and mantle cell lymphoma--which are derived from quiescent cells and show an indolent disease course, expressed low levels of CAMs. Conversely, high grade NHL-diffuse large cell lymphoma--which are derived from proliferating cells and are clinically aggressive, expressed high levels of CAMs. These results indicate that in malignant NHL B cell tumour growth and clinical aggressiveness may be related to the adhesive capacities of the tumour cells.

[Diagnostic difficulties in infiltrating lobular breast cancer: value of ultrasonography. 33 cases]. / Difficultés du diagnostic du carcinome lobulaire infiltrant du sein: apport de l'échographie. A propos de 33 observations.

Thirty three invasive lobular carcinoma (ILC) were submitted to mammography, ultrasonography and finally surgery. The type of tumor proliferation and the absence of microcalcifications within the invasive tissue led to 15% of false negative responses in the mammographic analysis. Ultrasonography disclosed only 12% of false negatives. Sonographic appearance, especially fine needle aspirations or microbiopsy under ultrasonographic control, allows modification of mammographic and clinical diagnosis errors. Thus, this method appears of importance in diagnosis of ILC.

Schwannoma of the bulbar conjunctiva.

We describe a conjunctival tumor that occurred in the limbic region of the left eye in a 37-year-old man. The mass was located beneath the conjunctival epithelium. It consisted of a well-demarcated proliferation of fusiform cells arranged in bundles in a fibrous stroma. Tumor cells strongly expressed S-100 protein. On ultrastructural analysis, the tumor was composed of Schwann cells surrounded by a continuous basal lamina. These data led to the rare diagnosis of conjunctival schwannoma.

Coexistence of plasma cell granulomas of lung and central nervous system.

A rare case of concurrent plasma cell granulomas (PCG) of the lung and the central nervous system (CNS) is reported. A 30-year-old man was presented with recurrent left headaches lasting for two years. Computerized tomographic (CT) scan and magnetic resonance imaging (MRI) of the head disclosed a process extending from the lateral aspect of the left cavernous sinus to the tentorium cerebelli and the infratemporal fossa through the foramen ovale. At the same time, chest-X ray and CT scan showed three symptomless masses of the pulmonary right lower lobe. Histological examination of cerebral samples and of one of the pulmonary nodules revealed the presence of a fibrous tissue containing numerous lymphocytes and plasma cells as well as remnants of vascular and respiratory structures. Immunohistochemical study proved these cells to be polyclonal. Ultrastructural analysis confirmed the presence of lymphoid cells and failed to disclose any argument for meningioma or histiocytosis X. The differential diagnostic problems of PCG are discussed as well as considerations about clinicopathological features, histogenesis and pathogenesis of inflammatory pseudotumours (IPT).

Intracranial plasma cell granuloma: a report of four cases.

Inflammatory pseudotumors (IPT) are rare lesions composed of inflammatory cells admixed with collagen tissue. Although IPT are ubiquitous, intracranial locations are rare. In this study, four intracranial IPT of the plasma-cell-granuloma (PCG) type are reported. Four patients presented with lesions located, respectively, in the right cavernous sinus, the left cavernous sinus with extension to the tentorium cerebelli, the vermis cerebelli, and the pituitary stalk. All patients were operated on, but complete resection could not be achieved in cases 1 and 2. Follow-up was favorable in all cases, although case 1 still complained of headaches 2 years after operation. All cases were studied on histologic and immunohistochemical bases, and ultrastructural analysis was performed on two cases. In cases 1, 2, and 4, IPT were made up of plasma cells admixed with lymphocytes and rare histiocytes in a fibrous tissue-the density of which varied from case to case. In case 3, the mass was composed of plasma cells associated with numerous foamy histiocytes and polymorphonuclear cells. No light chain restriction could be demonstrated when immunohistochemistry was performed, and ultrastructural study did not disclose features reminiscent of meningioma or histiocytosis X. Intracranial IPT should not be confused with other diseases such as meningioma, lymphoproliferative disorders, or histiocytosis X. Although intracranial locations are much rarer than pulmonary ones, histology is identical in both sites and shows different patterns in its evolution. This is in agreement with the inflammatory origin of this lesion.

Carcinoid tumour complicating inflammatory bowel disease. A study of two cases with review of the literature.

Two cases of carcinoid tumour complicating inflammatory bowel disease (IBD) are presented. Both tumours were located in the appendiceal tip. The first case occurred in a man with Crohn's disease (CD), and the second one in a woman suffering from ulcerative colitis (UC). Histochemical and immunohistochemical studies were not allowed on case 1 because the tumour was not still present on serial sections of the appendix. On case 2, tumour cells were not reactive with Grimelius and Masson-Fontana stainings, but were strongly stained with anti-keratin and anti-chromogranin monoclonal antibodies (MAb), and faintly expressed neuron specific enolase (NSE), and Leu-7. Both cases occurred in inflammatory or damaged mucosa which exhibited Paneth cell metaplasia and hyperplasia and areas indefinite for dysplasia. Along with these lesions, hyperplasia of enteroendocrine cells was pointed out in the neighbouring appendiceal and colonic mucosa by means of anti-chromogranin MAb. These data suggest that the association of carcinoid tumour with IBD, albeit rare, is not coincidental and is the result of hyperplastic and dysplastic troubles that may involve enteroendocrine cells as well as such other derivatives of digestive stem cells as columnar cells, goblet cells and Paneth cells.

[Bacillary angiomatosis related to Rochalimaea quintana. Anatomoclinical and ultrastructural study of cutaneous localizations in AIDS]. / Angiomatose bacillaire liée à Rochalimaea quintana. Etude anatomoclinique et ultrastructurale de localisations cutanées au cours d'un SIDA.

We report a case of bacillary angiomatosis in a 53-year-old homosexual man with acquired immunodeficiency syndrome (AIDS). Pathological and bacteriological studies of cutaneous nodules led to the identification of a rickettsia: Rochalimaea quintana. This observation prompted us to relate the clinical presentation of cutaneous and visceral forms of this disease. Histopathological patterns are also considered. They usually consist in a lobular proliferation of capillaries with plump and sometimes epithelioid endothelial cells. Polymorphonuclear cells, histiocytes and necrotic areas may be present. The most characteristic feature is the presence of interstitial, granular and amorphous clusters of bacteria. Diagnostic problems can be raised with Kaposi's angiosarcoma which can be associated with bacillary angiomatosis. Two types of Rochalimaea have so far been isolated in this disease i.e., R. henselae which is the most frequently involved, and R. quintana. The usefulness of making such a diagnosis resides in the sensitivity of bacillary angiomatosis to antibiotics, emphasing the need to carefully look for the presence of bacterial clusters when atypical angioproliferative lesion appears in patients with AIDS.

[Neurothekeoma. General review apropos of an anatomoclinical case with immunohistochemical and ultrastructural study]. / Le neurothécome. Revue générale à propos d'une observation anatomoclinique avec étude immunohistochimique et ultrastructurale.

The authors report a case of neurothekeoma in a 16-year-old woman. The tumor was located in the dermis of the chin and exhibited a plexiform and multinodular architecture with dense lobules admixed with myxoid areas. Tumor cells were pleomorphic and few atypias and mitoses were seen. On immunohistochemical study, intracytoplasmic staining was observed with anti-vimentin antibody, and, to a lesser extent, with KP1 antibody. Few elements expressed S100 protein. Ultrastructural analysis showed undifferentiated mesenchymal cells. A review of 156 cases (of which 123 cases are reported in two main series) shows that neurothekeoma preferentially affects dermis in cervicofacial areas and shoulders in young women. It has a benign course and recurrence is not seen provided excision is complete. Two main histological varieties are described, i.e. cellular and myxoid, the latter being referred to as nerve sheath myxoma. Diagnostic problems can be raised with other nerve sheath tumors and melanocytic and fibrohistiocytic proliferations. Transition forms between neurothekeoma and neurinoma or neurofibroma are described. Despite confusing immunohistochemical and ultrastructural data, most authors admit that neurothekeoma can express schwannian or perineurial differentiations, and may also be derive from an undifferentiated mesenchymal cell of neural crest origin.

t(11;18)(q21;q21) may delineate a spectrum of diffuse small B-cell lymphoma with extranodal involvement.

We describe a patient with stage IV non-Hodgkin's lymphoma (NHL) and a t(11;18)(q21;q21) translocation. He presented with a gastric small B-cell lymphocytic lymphoma, expressing IgAL immunoglobulins without expression of CD10, CD5, and CD23 antigens. The lymphoma was the final development of a 6-year history of a monoclonal IgAL increase complicated by severe renal failure due to membranoproliferative glomerulonephritis. The clinical, histological, immunologic, and cytogenetic features of this patient are very similar to those observed in the five other patients with t(11;18) reported to date. This translocation therefore seems to delineate a new subtype of diffuse small B-cell lymphoma with involvement of mucosal sites. Involvement of the BCL2 oncogene on 18q21 could not be detected using molecular techniques with 5' as well as 3' BCL2 probes, indicating that other, so far unknown, genes relevant to lymphoid differentiation could be located in 18q21 and 11q21.

Double monoclonal cryoglobulinemia, glomerulonephritis and lymphoma.

We present a case of monoclonal cryoglobulinemia with double monoclonal component IgA lambda-IgG lambda, without complement activation, membranoproliferative glomerulonephritis (MPGN) with deposits of IgA, IgG and lambda chains and lymphocytic IgA-lambda-chain-secreting lymphoma. This case emphasizes the possibility that double monoclonal cryoglobulins could behave differently compared to type I cryoglobulins, determining a MPGN-like type II cryoglobulins do, but without activating the complement cascade.

[Spinal leptomeningeal tumor spread disclosing a pineocytoma]. / Essaimage tumour leptomeninge spinal révélateur d'un pineocytome.

A 39-year-old female was admitted to the hospital because of a sudden meningeal syndrome followed by diplopia, cervical, dorsal and sciatic nerve pains, and right peripheral facial palsy. Cerebrospinal fluid obtained by lumbar puncture showed a protein level at 23 g/l. Myelography and magnetic resonance imaging (MRI) were in favor of a lumbar arachnoiditis. A meningeal biopsy revealed a tumour infiltration with foci of cells that were stained with anti-glial fibrillary acidic protein antibody. Cerebral MRI was performed to search for a central nervous system (CNS) primary tumour, and disclosed a pineal mass. Five months after the onset of the disease, the patient worsened her clinical state and died. Necropsy confirmed the presence of a pineocytoma with astrocytic differentiation and diffuse leptomeningeal spread. This exceptional occurrence leads us to discuss about primary tumours of the CNS with leptomeningeal spread.