[Differential diagnosis of basal cell carcinoma of the face: Dermatologist advice may avoid surgery]. / Diagnostics différentiels d'un carcinome basocellulaire de la face : l'avis du dermatologue pour éviter la chirurgie.

INTRODUCTION: Basal cell carcinoma (BCC) is the most common skin cancer in France. It is commonly diagnosed in front of a papule or nodule of the face. The surgeon should be able to question the diagnosis of BCC when nodular lesions are untypical, keeping in mind that some differential diagnoses require only medical treatment. OBSERVATIONS: The authors successively describe three non infectious entities mimicking BCC of the face, requiring purely medical treatment: facial granuloma described by Lever, cutaneous pseudolymphoma, sarcoidosis. DISCUSSION: In front of a non-typical skin nodule CBC, a dermatological expert advice may be quite helpful. The value of this collaboration is to guide or otherwise to suspend surgical excision.

[Head to head comparison of two currently used nomograms predicting the risk of side specific extra capsular extension to indicate nerve sparing during radical prostatectomy for treatment of prostate cancer]. / Validation externe des nomogrammes de prédiction de l'extension extra-prostatique spécifiquement au côté pour des patients atteints de cancer de prostate traités par prostatectomie totale.

OBJECTIVE: To perform a head to head comparison of these two nomograms by an external validation combined with an identification of probability cut-offs when to indicate NS. METHODS: The full models of the nomograms of Ohori et al. and Steuber et al. were used to calculate the risk of ECE based on PSA and side specific information on clinical stage, biopsy Gleason score, % positive cores, and % cancer in cores. A dataset of 968 prostate half lobes was used retrospectively for analysis. All patients underwent laparoscopic robot-assisted or open radical prostatectomy for localized prostate cancer. RESULTS: The predictive accuracy of the Ohori nomogram was at 0.80 and for the Steuber Nomogram at 0.78 (comparison P > 0.05). In the calibration plot, the Ohori nomogram showed less departures from ideal predictions than the Steuber nomogram. The best probability cut-off to allow NS for the Ohori nomogram seemed to be ≤ 10%, permitting NS in 59.7% of all cases and being associated with a false negative rate of 10%. The best cut-off for the Steuber nomogram seemed to be ≤ 8%, permitting NS in 44% and associated with a false negative rate 12.5%. CONCLUSIONS: The Ohori et al. and the Steuber et al. nomograms allow highly accurate and comparable predictions of the risk of side specific ECE. LEVEL OF EVIDENCE: 4.

Triple negative breast carcinoma EGFR amplification is not associated with EGFR, Kras or ALK mutations.

BACKGROUND: The amplification of epidermal growth factor receptor (EGFR) in triple negative breast carcinomas (TNBC) suggests its potential therapeutic application, as for HER-2, using standardised methods of measurement. In this regard, we aimed to compare several methods for evaluating EGFR amplification along with potential mutations for suitability in clinical practice. METHODS: Tissue sections of 138 TNBCs were used (1) to compare EGFR amplification and expression by silver in situ hybridisation (SISH) to qPCR and immunohistochemistry (IHC) and (2) to search for EGFR mutations, along with Kras, PI3K, Braf and HER-2 mutations and echinoderm microtubule associated protein like 4-anaplastic lymphoma kinase (EML4-ALK) translocation. RESULTS: (1) Amplification of EGFR was observed in well-characterised TNBCs (up to 92%); (2) qPCR correlated with SISH with 94% specificity and 75.6% sensitivity; (3) IHC correlated with SISH with 97% sensitivity and 78% specificity; (4) no EGFR, Kras mutations or EML4-ALK translocations were found, but PI3K and Braf mutations were observed in 26% of cases; and (5) small, acentric circular extrachromosomal DNA similar to 'double minutes' in glioblastomas was observed in 18% of SISH sections. CONCLUSIONS: SISH and IHC are methods that are suitable in clinical practice to screen for EGFR amplification and overexpression, which are frequently observed in TNBC. Patients with TNBC are potential candidates for EGFR-targeted therapy combined with PI3K and Braf inhibitors.

'Green Apple' Heart Failure.

We report here the clinical case of an Afro-Caribbean patient referred for complete atrioventricular block for whom a diagnosis of hereditary cardiac amyloidosis was eventually confirmed. Hereditary cardiac amyloidosis is an emerging threat in the Caribbean, and the main goal of this report is to raise the awareness of the disease among physicians.

[Pelvic kystic schwannoma evoking a tumor of the right seminal vesicle]. / Schwannome kystique pelvien évoquant une tumeur de la vésicule séminale droite.

We present the case of a pelvic schwannoma in a 36 year old man. It was discovered by chance during the medical assessment of a prostatitis. A computed tomography scan and magnetic resonance imaging revealed a 8 centimeters cystic pelvic tumor, closed to the right seminal vesicle. The patient underwent a transrectal ultrasound-guided biopsy, which showed a proliferation of neural peripheric cells with nuclear abnormalities. A tumorectomy was performed by laparotomy. The histological study diagnosed a benign cystic schwannoma. The patient was free of disease 12 months postoperatively.