[Diabetic mastopathy with epithelioid fibroblasts :differential diagnosis from an infiltrating lobular carcinoma of the breast. Report of two cases]. / Mastopathie diabétique avec fibroblastes épithélioïdes: piège diagnostique avec un carcinome lobulaire infiltrant du sein. A propos de deux cas.

Two cases of diabetic mastopathy are reported. The patients presented with a rapidly increasing mammary mass. The pathologic findings of diabetic mastopathy usually consist of a lymphocytic lobulitis, a dense stromal fibrosis and prominent epithelioid fibroblasts. In our two cases, the latter findings were initially misinterpreted as malignant cells of an invasive lobular carcinoma. These lesions were first described in longstanding insulin dependent diabetics but recent reports showed that they could also occur in patients with other auto-immune disorders (systemic lupus erythematous, hypothyroidism). Diabetic mastopathy may reoccur locally and the treatment remains to be determined.

Localization of thrombospondin, CD36 and CD51 during prenatal development of the human mammary gland.

Thrombospondin (TSP) is a 450 kDa extracellular matrix glycoprotein expressed in normal, hyperplastic, and neoplastic human breast. In this study, the patterns of expression of TSP were determined during development of the human fetal mammary gland between the 15th and the 39th week of gestation. Using immunohistochemistry, TSP is found in the dense mesenchyme immediately adjacent to the mammary bud, and at the membrane of budding epithelial cells invading the surrounding mesenchyme. As formation of the ductal tree system occurs, TSP is deposited at the myoepithelial-stromal junction of mammary ducts. Such an immunolocalization of TSP in buds and ducts of the fetal mammary gland has been confirmed at the mRNA level using in situ hybridization. Presence of TSP transcripts in nascent breast tissue has been also demonstrated by polymerase chain reaction assay. Comparison of TSP immunolocalization with that of two known TSP cell surface receptors, CD36 and CD51, reveals no codistribution of TSP with these receptors during mammary gland development. As opposed to TSP, CD36 is strongly expressed at the membrane of preadipocytes present in the fat pad tissue, but absent from budding epithelial cells. CD51 is only weakly expressed by malpighian epithelial cells and does not colocalize with TSP. In lactating ducts of a newborn, TSP disappears from the myoepithelial-stromal junction of ducts and is synthesized at the apices of secretory epithelial cells of lactating ducts together with CD36. In conclusion, our findings support the existence of an important role for TSP during development of the human fetal mammary gland.(ABSTRACT TRUNCATED AT 250 WORDS)

[Melanosis of the prostate. A new case and review of the literature]. / Mélanose de la prostate. Un nouveau cas et revue de la littérature.

Melanin may be found within fibromuscular prostatic stroma and/or in prostatic epithelium. An example of prostatic melanosis, with histochemical and immunohistochemical studies is reported. The pathologic description and the histogenesis of this rare entity are discussed.

[Ectopic deposits of Tamm-Horsfall protein. A psuedo-tumoral lesion]. / Dépôts ectopiques de protéine de Tamm-Horsfall. Lésion pseudo-tumorale.

Three cases of unusual deposits of Tamm-Horsfall protein in peripelvic and perirenal fat tissue are reported. A renal tubular rupture leads to the deposition of this protein. In the first case, the association of the deposits with epithelial structures, raised the possibility of a bladder carcinoma infiltration. These deposits simulated on the X-ray examination, a pelvis neoplasm in our second patient and a tuberculosis in the third case. However the particular microscopic appearance of Tamm-Horsfall protein, its intense staining with the periodic-acid-Schiff, and its positivity with a specific antibody led to the diagnosis.

[The endometrium under the effects of hormone replacement therapy in menopause with percutaneous estradiol and low-dose micronized progesterone]. / L'endomètre sous traitement hormonal substitutif de la ménopause par estradiol percutané et progestérone micronisée à faible dose.

AIM: The aim of our study is to evaluate the effects of a new combined association of percutaneous estradiol with oral micronized progesterone during 25 days/month and to confirm that a low dose of progesterone (100 mg/day) can adequately counteract endometrial proliferation induced by estradiol. METHODS: 78 endometrial tissue samples were obtained in a multicenter study on the effects of hormonal replacement therapy of the menopause. Endometrial biopsies were performed on average at the 6.6 month of the hormonal substitution (range: 5-13 months) after 12 days minimum exposure to progesterone. The morphological evaluation was performed blindly. RESULTS: All endometria are only slightly developed, without hyperplasia. Four groups were individualized: subatrophic endometrium (3), quiescent endometrium (48), slightly active endometrium (18), and endometrium with marginal secretion (6). Rare mitosis images have only been found in slightly active endometria. Their number is always very much below the normal proliferative phase with only 3 cases between less than 3 and 6 mitoses per 1000 glandular epithelial cells. CONCLUSION: A low micronized progesterone dose (100 mg/day) over a long period (25 days per month) allows to efficiently control the estrogen-induced endometrial proliferation. This adequate endometrial response is responsible for a high incidence of amenorrhea, often asked by patients, and for rare spottings.

[Oncocytic presentation of a primary epithelioid leiomyosarcoma of the liver]. / Présentation oncocytaire d'un léiomyosarcome épithélioïde primitif du foie.

We report an epithelioid leiomyosarcoma of the liver with oncocytic differentiation. Initially misdiagnosed as an oncocytic endocrine tumor, analysis of the whole liver after transplantation permits rectification of the diagnosis. This observation outlines the fact that oncocytic differentiation is not restricted to epithelial cells but can also be encountered in cells of mesenchymal lineage.

Focal myositis: a pseudotumoral form of polymyositis.

The authors report a case of pseudotumoral focal myositis found in a 55 year-old man, in the anteroexternal area of the right leg. The diagnosis was based on the pathological findings, the absence of any further clinical signs or laboratory findings, and no further development over time. They compare their patient's characteristics with cases found in the literature (24 cases during the past 20 years). Diagnostic certainty confirms the benign character of this pathology, which contrasts with the gravity of the classical form of polymyositis.

[Extra-abdominal desmoid tumors. Therapeutic indications. Apropos of 28 cases]. / Tumeurs desmoïdes extra-abdominales. Indications thérapeutiques. A propos de 28 cas.

Between 1965 and 1989, 46 desmoid tumors were observed in the hospitals of Lyon. Twenty-eight patients with an extra-abdominal tumor, with a follow-up of at least 6 months were observed. In this group, there were 12 males and 16 females with an average of 26.7 years. Surgical treatment was performed in 26 cases (in one case no treatment was given and in another case isolated chemotherapy was given). In 21 cases (80%) a recurrence of the tumor was seen after the first excision, incomplete in 6 cases. The highest rate of recurrence was seen in the neck, the girdles and the lower limbs; at the end of our review, 9 patients still had a tumor. No primary amputation were performed but two late amputations, one of which was major, were necessary. One tumor evolved into a sarcoma and in another case, lung metastases were seen. Associated radiotherapy was given in 9 cases with resolution in 55%. Tamoxifen was used in 5 cases with stabilization of the tumor. The risk of recurrence was higher in males (p = 0.0147). Age less than 30 years, and incomplete removal of the tumor were the other predictive factors for recurrence (the difference was not significant).

In vitro study of effects of 1,25 dihydroxyvitamin D3 on the morphology of human breast cancer cell line BT.20.

The morphological effect induced by 1,25 dihydroxycholecalciferol - 1,25(OH)2VitD3 - on the malignant human breast cell line BT.20 was studied. This cell line is devoid of oestrogen (ER) and progesterone (PGR) receptors. This effect, which requires treatment for at least 3 days, was evidenced by an increase in the cell projection surface, assessed on scanning electron microscopy (SEM) and by quantimetric analysis, for optimal final concentrations of 1.25(OH)2VitD3 in the medium of the order of 10(-11)M. The cells became more spread out and rounded with many junctional systems; there was occlusion of the intercellular space, but hardly any cells overlapped. The cytoskeleton was considerably developed, with microtubules running parallel to the cell surfaces associated with microfilaments. This positive action on cell differentiation was very similar to that noted regarding the reduction in growth under 1,25(OH)2VitD3 treatment. The two actions were, however, observed at different times and with different concentrations of 1,25(OH)2VitD3 in the medium.

Storage and degradation of secretory proteins in adenomatous and secondary hyperplastic parathyroid cells. An immunoelectron microscope study.

Parathyroid hormone (PTH) and chromogranin A/secretory protein-I (SP-I) have been localized on immunoelectron microscopy in double-fixed tissues from adenomatous and secondary hyperplastic parathyroid glands. Storage organelles, identified on the basis of their consistent labelling, included tow morphologically distinct varieties of granules/vesicles; the mature granules and the progranules. The former consisted of dense, mostly rounded, medium to large-sized bodies which were strongly labelled and predominant in the proximity of the cell membrane. The other variety of body included a spectrum of small pale vesicles/granules which were mainly located in the Golgi area. Because their morphology and their labelling pattern varied other bodies were assumed to be engaged in degradation or cleavage of the secretory proteins. These bodies comprised crinophagic structures, that is to say multivesicular bodies and large Golgi-related vesicles, as well as a number of atypical solid bodies. Whereas most of the granulated cells stored a mature or a maturing population of vesicles/granules, the process of maturation appeared to be either absent or incomplete in a number of cells from some glands. The major defects were frequently associated with an unusual labelling pattern of the Golgi area and selectively affected groups of cells from all the transitional oxyphil cell adenomas. The minor defects concerned individual cells of different types present in both categories of glands. The present data suggest that in hyperfunctioning glands, the type of hormone processing depends on the capacity of each cell in progranule maturation and that the maturation capacity may decrease dramatically in adenomatous or chronically hyperstimulated cells of the transitional oxyphil type.

Calcitonin-like immunoreactivity of amyloid fibrils in medullary thyroid carcinomas. An immunoelectron microscope study.

Using 3 polyclonal antisera directed against synthetic human calcitonin, we investigated at the electron microscope level the intra-or-extra-cellular fibrillar/filamentous aggregates found in 4 amyloid-rich medullary thyroid carcinomas (MTC) and in a number of other endocrine polypeptide tumours with or without demonstrable amyloid deposition. The antisera were applied by the immunogold procedure on ultrathin sections of glutaraldehyde-fixed, usually osmium-postfixed, tissues. In MTC cases, a strong labelling was present over two types of aggregates: one composed of rigid, criss-crossing fibrils 7-10 nm in diameter, suggestive of amyloid, and the other consisting of loosely arranged fibrils, 4-7 nm in width, often wavy or poorly defined. In both cases, the labelling was closely associated with that part of the sectioned fibril exposed to the antiserum. Amorphous material was sometimes present adjacent to the later aggregates, but did not bind the calcitonin antibodies. In contrast, no labelling occurred over the amyloid deposits found in two non-calcitonin-producing endocrine tumours of the pancreas, nor over the cytoskeletal filaments stored in various endocrine polypeptide tumours. The specific value of the labelling for calcitonin-like immunoreactivity was assessed by control tests, such as absorption of the antiserum by excess calcitonin and comparative use of normal serum and antisera directed against human IgG and P component. No immunoreactivity of the MTC amyloid fibrils was found using antibodies directed against katacalcin and human prealbumin. We conclude that in tumour tissues conventionally processed for electron microscopy, MTC amyloid fibrils of varying morphology can be selectively and specifically labelled for calcitonin-like immunoreactivity.

Electron microscope localisation of insulin-like immunoreactivity of conventionally processed human insulinomas.

Localisation of insulin-like immunoreactivity has been studied using the immunogold staining procedure on thin sections of 6 human insulinomas, conventionally processed for electron microscopy. The labelling was restricted to the secretory granules. Depending on their morphology, these either resembled B-cell granules of human adult pancreas or belonged to the atypical (non-diagnostic) group. Within the former group, those with a crystalloid core or an amorphous dense or moderately dense core were strongly immunoreactive, whereas others, filled with a pale material, were poorly labelled. Most granules of this type were stored together within the heavily granulated cells of 3 insulinomas, presenting the classical features of clinical and biological behaviour and a typical light microscopic staining pattern. In contrast, the non-diagnostic granules, characterized by their smaller size, a very dense core and a thin halo, were mainly found within the poorly granulated cells making up the other tumours, and showed a very uneven labelling. Strongly labelled granules were found in one insulinoma that also belonged to the classical type; these were stored together with a few diagnostic granules within the same cells. Only poorly labelled atypical granules were present in two cases revealing a number of unusual features; these included moderate elevation of insulinaemia, uncertain tumour histology, as well as weak immunostaining for insulin/proinsulin and variable argyrophilia of the tumour in paraffin sections. These findings suggest that human insulinomas differ not only in storage capacity but also in their degree of granule maturation. This may involve some deficiency of either the prohormone conversion or the subsequent processing of the cleavage products.

Synovial lipoma arborescens of the hip.

Lipoma arborescens is a rare intra-articular tumor usually found in the knee joint. The reported lesion involved the inferomedial recess of the right hip synovium, in a 29-year-old male. The clinical findings were nonspecific. Both arthrography and computerized tomography (CT) of the hip disclosed the tumor which, on CT examination, showed an inhomogeneous low density, due to its fat content. The final diagnosis was given by histological examination of the resected mass. No recurrence was observed after one year. The long-term prognosis probably depends more on the underlying disorder of the joint than on the lipoma itself.

[Ruptured adenoma of the liver with severe pulmonary embolism discovered during a cesarean section]. / Adénome rompu du foie avec embolie pulmonaire grave découvert lors d'une césarienne.

A ruptured adenoma of liver was detected during a caesarean in a multipara woman at full term with a severe pulmonary embolus. Therapy for this rare and curious case, with combined internal hemorrhage, severe pulmonary embolism and full term pregnancy in a multipara, is discussed.

Different types of microcalcifications observed in breast pathology. Correlations with histopathological diagnosis and radiological examination of operative specimens.

Microcalcifications taken from 50 systematized mammary excisions were submitted to light microscopic and scanning electron microscope analysis. Microprobe and x-ray diffraction analyses were also performed. Two main types were observed: Type I microcalcifications composed of weddellite crystals. They were observed in benign breast lesions only (11 cases out of 21) or, in lobular carcinomas in situ (L.C.I.S.) of the breast (5 cases out of 6). They were not seen in 3 cases of intraductal carcinoma (I.D.C.) nor in infiltrating (I.C.) carcinomas (20 cases). Type II microcalcifications, non-cristalline in nature, composed of calcium, phosphate, hydroxyapatite or of phosphorus and calcium associated with other elements, were observed in benign lesions (10 cases out of 21) and in all cases of infiltrating carcinomas. The microcalcifications observed on mammography were also found on the radiographs of systematised mammary excisions from the lesion or from its immediate vicinity, but only when using the appropriate technique. Microcalcifications are therefore an excellent marker of breast lesions but they cannot be simply divided into "benign" or "malignant" types. Nevertheless, the presence of a visible crystalline structure on the radiograph of the specimen argues in favour of a benign breast lesion or of a lobular carcinoma in situ.

Keratins in malignant mesotheliomas and pleural adenocarcinomas: comparative immunohistochemical analysis with polyclonal and monoclonal antibodies.

The distribution of intra-cellular keratins was studied in normal pleural mesothelium, malignant mesotheliomas and adenocarcinomas. This study was performed on deparaffinized sections of tissue fixed in Bouin's solution by indirect immunofluorescence with a monoclonal antibody (KL1) and a conventional keratin antiserum (AKS). Discrepancies were detected using one antibody or the other. Cells from normal mesothelium and 18 cases of malignant mesotheliomas (papillary, tubulary, solid epithelial type) were strongly labelled only by KL1. The 2 cases of sarcomatoid type were negative with both antibodies. In contrast 5 metastatic adenocarcinomas and 5 lung adenocarcinomas were weakly positive or negative with both antibodies. These data confirm the presence of cytokeratins in epithelial differentiation process. Although a clear-cut distinction between mesotheliomas and adenocarcinomas was not possible using these keratin antibodies. Our data point out the importance of reactivity pattern of the antibody used in such investigations.

[A case of aneurysmal cyst of the spine. Pathogenic and therapeutic problems]. / A propos d'un cas de kyste anévrysmal du rachis. Problèmes pathogéniques et thérapeutiques.

The diagnosis of aneurysmal bone cyst is facilitated by modern methods and progress in surgical technique allows their excision. A cyst of the spine was found in a 23 year old woman. It was the size of a grapefruit at the level of the 12th thoracic vertebra. It was asymptomatic and discovered after routine radiological examination. It was removed by a thoraco-abdominal approach to avoid neurological impairment. The spine was fixed by internal fixation and grafted. The condition of the patient was satisfactory after 9 months. A review of the literature reveals the frequency of neurological complications and of recurrence. This justified the planned removal of the tumour despite the possibility of a spontaneous healing. Radiotherapy should be considered only in cases where total excision and fixation is not possible.