[Prognostic value of extensive lymph node excision in curative resections of stomach cancers. Apropos of a series of 100 patients]. / Valeur pronostique du curage ganglionnaire élargi (R2) dans les résections curatives des cancers de l'estomac. A propos d'une série de 100 patients.

UNLABELLED: The aim of this work was to determine the frequency and localization of lymph node involvement and the prognostic value of extensive node dissection on survival in patients with cancer of the stomach. TYPE OF STUDY: Prospective study from 1981 to 1991 evaluating node dissection in adenocarcinoma of the stomach. PATIENTS: There were 179 gastrectomies during the 10-years study period including 100 performed as a curative treatment. The tumour was located in the lower part of the stomach in 48 cases, in the upper part in 25 cases in the middle part in 22 cases and involved the entire organs in 5 cases. METHODS: Distal subtotal gastrectomy (DSG) was performed in 45 cases, total gastrectomy (TG) in 16 and total gastrectomy extended beyond the stomach (TGE) in 33 cases. Polar gastrectomy (PG) was used in 6 cases. Type R2 node dissection was done for 90 patients and R1 dissection for 10. RESULTS: The tumour extended to the mucosa-submucosa (T1) in 17 cases, the musculosa (T2) in 22 cases, the serous membrane (T3) in 45 cases and to adjacent organs (T4) in 16 cases. A mean 18 nodes was examined per surgical specimen and node involvement was found in 59. The localizations showed that the coronary and hepatic chains (n. 7 and 8) were invaded at a rate comparable with the perigastric nodes (n. 3 and 6). The splenic chain was invaded in 1 patient out of 5 with localizations in the mid and upper portions. Corrected overall survival was 49% at 5 years. Survival depended on the node extension (p < 0.0002): survival reached 73% when no metastasis was found and fell to 48% with perigastric node involvement and 30% when the pedicular nodes were invaded. Survival was also a function of tumour stage (p < 0.0002): for T1 tumours it was 89%, for T2 86% and for T3 32%. Multivariance analysis (Cox) showed that parietal extension and node involvement were risk factors with a relative risk of 3.53 and 1.44 respectively. CONCLUSION: Extensive node dissection of the pedicular chains should improve survival without increasing morbidity or mortality in the treatment of cancer of the stomach.

[Neurinomas of the cochlear nerve]. / Neurinomes du nerf cochléaire.

Usually, schwannomas of the eight nerve arise from the vestibular nerve. Yet, the authors have operated from September 1993 to September 1995 three neuromas whose origin is certainly the cochlear nerve. Surgery was performed by retro-sigmoid approach magnified by endoscopic procedure of the cerebello-pontine angle before and after removing the tumor. We report here the cases and the literature is documented. Similar cases of observing cochlear neuromas at the moment of the procedure are exceptional. Because of more and more early diagnosis of these tumors, advances of microsurgery in ponto-cerebellar angle and endoscopic improvements in this area, observation of this kind of pathology could be more and more frequent.

PCR analysis of hepatitis B virus DNA in paraffin-embedded liver tissue from patients with chronic liver disease.

We described a nested polymerase chain reaction protocol to detect hepatitis B viral DNA in paraffin-embedded liver tissue and tried to determine whether this virus was associated with non-B chronic liver disease. Fifty-five samples were obtained from 28 patients with B, and 27 patients with non-B chronic liver disease (35 cirrhosis, 4 hepatocellular carcinoma and 16 chronic hepatitis). The two sets of primers amplify a sequence located in a conserved polymerase/surface region of the viral genome. Reaction products were analysed using a nonisotopic hybridization method. None of the 27 (0%) seronegative samples and 20 of the 28 (71%) seropositive specimens were positive for hepatitis B virus DNA. There were 4 false negatives in which beta-globin PCR was positive. Although its sensitivity is reduced in formalin-fixed paraffin-embedded tissue, nested PCR allows rapid detection of HBV DNA sequences and can be a useful tool if no frozen tissue is available.

[Uterine metastasis revealing gastric adenocarcinoma]. / Métastase utérine révélatrice d'un adénocarcinome gastrique.

We report a case of metastasis to the uterine corpus revealing a primary gastric adenocarcinoma. A 26-year-old woman suffered from weight loss, vaginal bleeding, abdominal pain. An endometrial curettage showed apparently metastatic adenocarcinoma. The primary site of the tumour was gastric. The upper gastrointestinal endoscopy revealed an ulcus and aspect of linitis plastica in the fundus. Biopsies showed diffuse type adenocarcinoma. Because of extensive disease, laparotomy was not performed and exclusive palliative chemotherapy was started. The patient died 10 months after the diagnosis. Metastasis from primary gastric cancer to the female genital tract are rare and are usually observed in young premenopausal women with diffuse type gastric adenocarcinoma. This case report underlines the interest, for those patients of careful gynaecologic examination at the initial staging and after treatment.

[Necrotizing hepatic granuloma of brucellosis origin. Apropos of a case]. / Granulome nécrosant hépatique d'origine brucellienne. A propos d'un cas.

The authors report on a case of febrile necrotizing brucellosis hepatic granulomatosis in a patient living in brucellosis endemia areas. This hepatic localization of brucellosis is rare: to our knowledge only 28 cases have been described in the literature. The bacteriological diagnosis was not established by blood or abscess pus cultures, but by Brucella serology only. Surgery completed by biantibiotherapy have permitted a complete recovery.

Diffuse choroidal hemangioma: report of a clinicopathological study in a 4-year-old boy.

The authors examined the clinicopathologic features of a 4-year-old boy with a diffuse choroidal hemangioma, yet without any features of the Sturge-Weber syndrome. The tumor occurred as a grayish intraocular mass with an overlying retinal detachment and was highly reflective in the ultrasonic examination. After contrast, the CT scan revealed diffuse thickening of the ocular wall associated with an enhanced irregular orbital mass. The pathologic examination revealed a cavernous hemangioma involving the entire choroid with extrascleral extension. Diffuse choroidal hemangioma occurring in childhood and unrelated to the Sturge-Weber syndrome is a rare condition that should be included in the differential diagnosis of retinoblastoma.

[Hepatic angiomyolipoma. 2 case reports and review of the literature]. / Angiomyolipome hépatique. A propos de deux cas et revue de la littérature.

We report two cases of hepatic angiomyolipoma. The first tumor was disclosed at the time of resection of a cardia carcinoma, and temporarily regarded as a possible metastasis. The second tumor was an enormous necrotic mass of the right liver in a young woman mimicking a sarcoma.

Thyroglobulin in medullary thyroid carcinoma: immunohistochemical study with polyclonal and monoclonal antibodies.

The presence of thyroglobulin (TG) was investigated by immunohistochemistry with one polyclonal and three distinct monoclonal anti-TG antibodies in 19 primary and 15 metastatic medullary thyroid carcinoma (MTC) cases. In two primary tumors possessing a mixed trabecular and follicular growth pattern, a significant number of tumor cells were positive with the four antibodies in all parts of the tumor; these tumors were considered to be genuine mixed follicular and parafollicular tumors. The 17 other primary tumors looked like "classical" (ie, predominantly compact) MTC. Eight contained tubular or microfollicle-like structures that were consistently TG-negative. Eight contained residual entrapped normal follicles positive with the four anti-TG antibodies. In six cases isolated foci of tumor cells reacted with polyclonal antibody or monoclonal antibody 11. In 10 cases circulating TG stained positively with polyclonal antibody in vascular channels, five cases stained positively for TG with monoclonal antibody 11, four cases stained positively for TG with monoclonal antibody 7, and three cases stained positively for TG with monoclonal antibody 1. In metastases TG was found in tumor cells in only one instance, but positive reactions were obtained in vascular channels and macrophages in several cases. We conclude from this study that there is no genuine secretion of TG in classical, compact MTC, which differs morphologically and functionally from mixed follicular and parafollicular tumors secreting both TG and thyrocalcitonin.

Combination of standard cytology and immunocytology with BL2-10D1 monoclonal antibody for monitoring-treated bladder cancer patients.

Monoclonal antibody BL2-10D1 directed against a tumor-associated antigen of bladder carcinoma was used for monitoring 11 intravesically treated patients. Thirty-three bladder washout specimens were used for standard cytology and immunological staining. Prior to treatment, 9 of 11 cytologic specimens examined with standard cytology were found to be positive. Using BL2-10D1 alone, only 6 were positive but 1 patient negative with standard cytology was positive with the antibody and corresponded to a positive histological control. Thus, before treatment, an increase in positive rate was observed using the combination of the 2 methods from 82 to 91%. At the end of treatment, 9 washout specimens remained positive with standard cytology, whereas 1 case negative in standard cytology was positive in immunocytology. Thus, the positive rate increased from 82 to 91%. One month after the end of treatment, of 11 washout specimens tested, 3 false-negative standard cytologies and 4 false-negative immunocytologies were shown. However, used in combination, the two methods lead to an increase in positive rate from 67 to 89%. In view of these results, BL2-10D1 may be considered as a useful reagent in combination with the standard cytology for the confirmation of the presence of tumor cells before and after immunotherapy.

[Survival after gastrectomy for cancer. 209 cases]. / Survie après gastrectomie pour cancer. 209 observations.

The long-term results of 209 gastrectomies performed for adenocarcinoma, including 117 which were prospectively collected, are presented. Resection was curative in 154 cases (73.6 percent). The TNM distribution of the tumours was: stage I (TxNOMO) 75 cases, stage II (TxN1MO) 46 cases, stage III (TxN2MO) 33 cases and stage IV (TxNxM1) 55 cases. Lymph node involvement was more frequent in the prospective than in the retrospective study. With a more than 5 years' follow-up of 80 percent of the patients operated upon, the actuarial survival rate at 5 years (operative mortality included) was 38 percent for all lesions, 52 percent for curative resection and 2 percent for palliative resection. Following curative resection, the survival rates for tumours of the upper, middle and lower thirds of the stomach were 40, 60 and 55 percent respectively. These rates were 60 percent for stage I tumours, 54 percent for stage II tumours and 25 percent for stage III tumours. The results obtained in this series, where most of the curative gastrectomies included excision of N1 and N2 lymph nodes, show that lymph node involvement has no significant importance for the prognosis when it is proximal (N1) and is not incompatible with prolonged survival when it is pedicular (N2).

[Anatomo-pathology of cholesteatoma]. / Anatomo-pathologie du cholestéatome.

The authors, from their own histopathological studies and from an overview of otological literature focus the controversial problems about the so-called disease cholesteatoma. The history of cholesteatoma has been marked out by pathologic data which, initially caused the cholesteatoma to be identified as a keratinized squamous tumor. This misnomer will however be retained because of it long-established usage. "Skin in the wrong place" in the middle ear summarizes this clinical entity. Electron microscopic observations provide arguments in favour of the migratory theory and the invasion of the epidermis from the bottom of the external ear canal into the middle ear cavity (identical fine morphology between skin and cholesteatoma, presence of Langerhans and Merkel cells, sharp junction between the advancing front of the cholesteatoma and the middle ear mucosa). Recent immunohistological techniques allow consideration of cholesteatoma as a self-induced inflammatory process in response to tissular and cellular conflicts. A cholesteatoma could be merely a non-healing wound process and a disease of epidermal growth control occurring in the middle ear space. The logical principles governing cholesteatoma surgery, suggested by these biological considerations, are: total removal of cholesteatoma matrix, prevention of cholesteatoma recurrence by a careful respect of the barrier separating the middle ear mucosa from the skin-lined bony external ear canal, maintenance of good healing conditions for both mucosa in a closed well-ventilated middle ear and epidermis in a harmonious anatomical external canal.