Virilizing adrenal ganglioneuroma containing Leydig cells.

An adrenal medullary ganglioneuroma containing Leydig cells and revealed by a virilizing syndrome in a 56-year old woman is presented. The syndrome, associating with masculinization an elevated serum testosterone level and a normal urinary 17 ketosteroids, is uncommon in adrenal tumours. The tumour was located by computed tomographic (CT) scan and treated by right adrenalectomy. Microscopic examination showed typical features of an adrenal medullary ganglioneuroma containing Leydig cells with Reinke crystalloids. Positive immunohistochemical study confirmed the testosterone secreting nature of the cells. The presence of Leydig cells in the adrenal gland is discussed according embryogenic studies: 1. the common origin of the gonad and the adrenal cortex from the coelomic epithelium, 2. the vicinity of adrenocortical gland and gonad during embryogenesis, 3. the thecal metaplasia of mesenchymal cells, 4. the development of Leydig cells from Schwann cells. Fourth case published in the world literature.

[Difficult diagnosis of a biliary cyst. A case report]. / Kyste biliaire de diagnostic difficile. A propos d'un cas.

A 26 year-old man presented a hepatic cyst complicated by intracystic bleeding. Clinical and biological features (chronic pancreatitis), ultrasound and computed tomography findings apparent hepatic and splenic location), macroscopic aspects (inflammatory changes, brown-colored fluid) as well as microscopic characteristics (thickened cyst-wall, absence of epithelium) of both cysts suggested the diagnosis of pancreatic pseudocysts. The diagnosis of hepatic cyst was carried out on histological examination showing Meyenburg and neuro-fibrillar complexes. Occurrence of complications (bleeding, size enlargement) may modify typical histological aspect of hepatic cyst.

[Association of a secreting oncocytic tumor of the kidney and a parathyroid adenoma]. / Association d'une tumeur oncocytaire sécrétante du rein et d'un adénome parathyroïdien.

An unusual association of a secreting renal oncocytoma and a parathyroid adenoma is described. The high level of hypercalcemia and of blood parathormone (PTH 44-68), partially reduced by nephrectomy and totally normalized by parathyroidectomy, as well as the renal tumor PTH evaluation and the ultrastructural features showing secretory granules in oncocytic cells of kidney, advocate for a double site of PTH secretion. Removal of both tumors permits a complete recovering.

[Pancreatic metastasis of naso-sinusal epithelioma. Apropos of a case]. / Métastase pancréatique d'un épithélioma naso-sinusien. A propos d'un cas.

The authors report a pancreatic metastasis of sinusal squamous cell carcinoma in a 69 year-old man, 18 years after the first excision of the primary neoplasm. The metastases appearing in a patients having previously presented several tumors, was detected by a rising CA 19-9 level and a pancreas head enlargement at the CT. The diagnosis was identified at laparotomy by tumor biopsy. The vascular involvement of the tumor obliged to perform double bypass. 103 cases of pancreatic metastases, published in the literature from 1983 to 1991, are reviewed. Generally the pancreatic mass is visualized by CT but the diagnosis is only carried out on microscopy. Treatment depends on anatomical and pathological characteristics of primary and secondary tumours. Solitary metastasis of renal carcinoma origin have the best prognosis after radical surgery. In other cases palliative procedures are widely used. First case of pancreatic metastasis originated from recurrent sinusal squamous cell carcinoma with poly-tumoral clinical presentation.