[Small cell carcinoma of the ovary of the hypercalcemic type revealed by a severe acute pancreatitis: about one case]. / Carcinome à petites cellules de l'ovaire hypercalcémiant révélé par un épisode de pancréatite aiguë: à propos d'un cas.

Small cell carcinoma of the ovary of the hypercalcemic type is a rare tumour, usually lethal and occurring almost exclusively in young patients. In the majority of described cases, signs of this lesion were revealed by the associated hypercalcemia or by virtue of the physical tumour bulk alone. We report the first case of ovarian small cell carcinoma of the hypercalcemic revealed by a severe acute pancreatitis in a 19-year-old patient.

Epithelioid sarcoma of the tongue.

A case of epithelioid sarcoma in the tongue is reported. The patient, a 35 year old woman, presented with a non-ulcerated painful lesion of the tongue. Microscopically, the tumour was characterised by multiple coalescent nodules with central geographic necrosis infiltrating the lingual muscle. The tumour cells were epithelioid with abundant eosinophilic cytoplasm and atypical nuclei. Immunohistochemically, the tumour cells stained for vimentin, keratin, and epithelial membrane antigen. These morphological and immunohistochemical appearances led to the diagnosis of epithelioid sarcoma of the tongue. Seven years later, the patient died with metastatic dissemination to the scalp, lungs, and brain. No case of epithelioid sarcoma arising in the tongue has been described previously.

Surgical implications of sentinel node with micrometastatic disease in invasive breast cancer.

AIM: To assess the rate of positive axillary clearance (AC) when the sentinel node biopsy (SNB) contains micrometastatic disease in invasive breast cancer and to evaluate the factors that could predict positivity. PATIENTS AND METHODS: This is a prospective study carried out on 542 successive women undergoing SNB for unifocal T0-T1 N0 invasive breast cancer without previous treatment. RESULTS: Five hundred and twenty-five sentinel nodes (SN) were found, 142 contained metastases. Fifty-five of the positive SN contained micrometastatic disease only. Of them, 40 patients underwent completion of AC. Six out of 40 patients who had micrometastatic SN had a positive AC, five for micrometastasis between 0.2 and 2 mm (5/34), one for isolated cells in the SN (1/6). None of the studied factors (age, histological tumour size, histological grade, estradiol receptor (ER), histological tumour type, size and method of micrometastasis detection) could significantly predict the status of the AC. CONCLUSION: As long as the results of ongoing prospective randomised studies are unknown, it remains necessary to perform AC when the SNB contains micrometastatic disease, whatever the size or the detection mode of the metastasis.

[Partial breast irradiation: high dose rate peroperative brachytherapy technique using the MammoSite]. / Irradiation partielle du sein: technique de curiethérapie de haut débit de dose après l'implantation peropératoire du dispositif MammoSite.

In the conservative management of breast cancer, radiation therapy delivering 45 to 50 Gy to the whole breast, in 4.5 to 5 weeks, followed by a booster dose of 10 to 20 Gy is the standard of care. Based on the numerous studies which have reported that the local recurrences occurs within and surrounding the primary tumor site and in order to decrease the treatment duration and its morbidity, partial breast irradiation using several techniques has been developed. Partial irradiation may be considered as an alternative local adjuvant treatment for selected patients with favorable prognostic factors. Using external beam radiation therapy, the 3D-conformal technique is appropriate to deliver the whole dose to a limited volume. In UK, an intraoperative technique using a miniature beam of low energy of x-ray (50 Kv) has been developed (Targit). Milan's team have developed an intraoperative electrons beam radiotherapy using a dedicated linear accelerator in the operative room. In USA and Canada the MammoSite has been advised for clinical use in per-operative brachytherapy of the breast. These two last techniques are currently compared in phase III randomised studies to the standard whole breast irradiation followed by a tumour bed booster dose. In this review we will focus on the MammoSite technique and will describe the per-operative implantation procedure, radiological controls ad dosimetric aspects.

[Pancreatic tumor revealed by metastatic bilateral ovarian tumor with virilisation syndrome]. / A propos d'une tumeur métastatique ovarienne bilatérale et virilisante révélant une tumeur pancréatique.

We report a case of a 38-year-old patient presenting with both pancreatic and a bilateral ovarian tumor revealed by a virilization syndrome. Clinically, both tumors were conceivably distinct. However, on histological examination, they were found to be morphologically similar, with neuroendocrine features, suggesting that pancreatic tumor was a primitive neoplasm and the ovarian one a metastatic spread of that lesion. The virilization syndrome was due to the functional status of the ovarian tumors that was confirmed by immunohistochemical detection of inhibin.

[Lymphatic metastasis revealing a calcitonin-secreting extrathyroid carcinoma]. / Métastases ganglionnaires révélatrices d'un carcinome extra-thyroïdien à calcitonine.

We report a case of right sus-clavicular lymph nodes metastasis which revealed a calcitonin secreting carcinoma in a 36 years old woman. Any tumor has been noted in the completely included thyroid gland. There was many lymph nodes metastasis in the right mediastinal removal. A pulmonary origin neuroendocrine carcinoma hyposthesis has been evoked. The outcome proved to be quickly fatal with cerebral metastasis occurrence. Extrathyroid calcitonin secreting carcinomas are rare. Then the discussion was founded on the diagnosis process in the face of hypercalcitoninemia, and on the calcitonin secretion by neuroendocrine cells and neoplasms of the lung.

[Immunohistochemical demonstration of ceruloplasmin and lactoferrin in a series of 59 thyroid tumors]. / Détection immunohistochimique de la céruloplasmine et de la lactoferrine sur une série de 59 tumeurs thyroïdiennes.

Fifty-nine thyroid tumors were re-examined and studied using immunohistochemistry to detect the presence of ceruloplasmin (CP), lactoferrin (LF), thyroglobulin, thyrocalcitonin, carcinoembryonic antigen and ferritin. In an attempt to study the contribution of the immunodetection of CP and LF in the diagnosis of malignant versus benign tumors, specially in follicular tumors, we compared our results of immunodetection with those of Tuccari and Barresi, and carried out our own studies on the usefulness of these immunolabelling. Concerning CP and LF staining, we have found the following data: 1) little (in contrast to Tuccari and Barresi) or no staining in normal thyroid and benign adenomas; 2) diffuse and intense staining in papillary and follicular carcinomas (as noted by the previous authors); 3) diffuse and weak staining for medullary carcinomas (in contrast to Tuccari and Barresi who found none). Our findings suggest that a diffuse and intense cytoplasmic staining with CP and LF concerning more than one third of all cells is a criterion of malignancy, whereas a weak paranuclear staining of a few cells is more in favor of a benign process.

[Stromal luteoma of the ovary. Differential diagnosis of steroid cell tumors]. / Le lutéome du stroma ovarien. Diagnostic différentiel des tumeurs à cellules stéroïdes.

An observation of a stromal luteoma of the ovary is reported. It is a rare tumor (only about thirty cases of it have been published yet), occurring mostly in post menopausal women. Endocrine symptoms and sometimes virilizing signs may be observed. Abnormal vaginal bleeding is the most frequent clinical manifestation. This macroscopically observed tumor is surrounded by ovarian stroma and entirely composed of luteinized cells devoid of crystals of Reinke. Hyperthecosis of ovarian stroma is often observed. Its evolution is always benign. The authors recalled the place of stromal luteoma of the ovary among steroid (lipid) cell tumors and the elements of a differential diagnosis. These tumor might derive from ovarian stromal cells.

[Endometrial cancer: what's new?]. / Controverses et nouveautés dans l'adénocarcinome de l'endomètre.

OBJECTIVES: New and much debated data of the endometrial cancer concerning the preoperative assessment of myometrial invasion, the surgical staging, and the adjuvant treatment. PATIENTS AND METHODS: Medline (1998-2002): searching for "endometrial carcinoma". RESULTS: The pap smears are useful when it is difficult to have a transvaginal ultrasonography or an MRI. We can perform the pap smears and the endometrial biopsy in the clinic. If a patient has pap smears with malignant cells or elevated preoperative CA 125, it probably is a cancer with poor prognostic factors. Surgical staging with abdominal and node evaluation is necessary. The MRI seems to be the best preoperative imaging because we have information about adnexal and abdominal metastases, pelvic or aortic nodes and the invasion of the myometrium. So it gives us information on the surgical route, and provides indication for a lymphadenectomy. The surgical staging is a part of the treatment of the endometrial cancer: an exploration of the peritoneal cavity, a pelvic lymphadenectomy, a para-aortic lymphadenectomy if the pelvic nodes are positive or if there are factors of bad prognosis (deep stage IC, grade 3, adnexal or abdominal involvement, serous carcinoma of the endometrium). It can be performed if technical conditions are correct. The adjuvant teletherapy in the documented stage IpN0 (surgical staging with pelvic lymphadenectomy) does not seem to be necessary. But we can perform an adjuvant brachytherapy (high-dose rate if it is possible) in patients with a high local recurrence (stage IC, stage I with grade 3, stage IB grade 2). CONCLUSION: The preoperative MRI is useful choosing the surgical approach, and the depth of the myometrial invasion, which can be an indication for a pelvic lymphadenectomy. The surgical staging must be a part of the treatment of the endometrial cancer. So the adjuvant teletherapy in patients with stage IpN0 documented should not be used.

[Pseudomyxoma peritonei secondary to a teratoma of the omentum with a mucinous component of borderline malignancy]. / Pseudomyxome péritonéal secondaire à un tératome épiploïque à composante mucineuse de malignité frontière.

A mature cystic teratoma of the omentum occurred in a 37 years old woman who had an appendicectomy at the age of 8. This extragonadal teratoma contained a predominant mucinous glandular pattern of borderline malignancy, responsible for pseudomyxoma peritonei. Ovarian biopsies had only shown surface mucinous deposits at the time of the first laparotomy but two years later ovarian mucinous cystadenomas of borderline malignancy appeared. The patient developed intestinal obstruction, surround by mucinous retractile material and died four years and an half after initial diagnosis. This case is, to our knowledge, the first pseudomyxoma peritonei occurring from an extragonadal teratoma, the events chronology suggesting the secondary nature of the ovarian tumors.

[Value of MRI in symptomatic patients treated with tamoxifen]. / Apport de l'IRM chez les patientes symptomatiques traitées par tamoxifène.

PURPOSE: To assess the MR imaging (MRI) findings in symptomatic tamoxifen treated-women with abnormal transvaginal sonography. PATIENTS AND METHODS: From january 1997 to june 2000, 32 consecutive symptomatic tamoxifen treated-women with abnormal transvaginal sonography were prospectively studied by MRI. T1-weighted, T2-weighted, post-contrast T1-weighted and dynamic gradient-echo T1-weighted sequences were used. All patients underwent uterine sampling within one month of MRI. RESULTS: Endometrial thickness at sonography ranged from 5 to 48 mm (mean thickness 19 mm), and on T2-weighted imaging ranged from 3 to 50 mm (mean=25 mm). Three MRI patterns were found. Pattern 1 (13 patients) was defined as homogeneous high signal intensity of the endometrium on T2W images, and signal void in the lumen on gadolinium-enhanced images. Pattern 2 (8 patients) was defined as heterogeneous endometrial signal on T2W images, and latticelike enhancement traversing the endometrial canal on gadolinium-enhanced images. Pattern 3 (11 patients) was defined as heterogeneous signal on T2W images with masses or nodules which were better seen on dynamic gadolinium-enhanced images. In pattern 1 we found 13 atrophic endometrium, in addition there were 4 polypoid glandulo-cystic proliferation (PGCP), and 1 adenomyosis. In pattern 2 we found 3 PGCP, 4 atrophy and 1 polyp without hyperplasia. The 2 carcinomas and the polyps with hyperplasia were found in pattern 3 (11 patients). CONCLUSION: In our experience MRI allows differentiation of lesions which may require surgery from other lesions in which noninvasive follow-up is possible.

[Computed tomography-guided transthoracic biopsy after negative fiber-optic endoscopy; apropos of 134 patients]. / Biopsies transthoraciques sous contrôle tomodensitométrique après fibroscopie négative; à propos de 134 patients.

PURPOSE: To evaluate the diagnostic accuracy of transthoracic needle biopsy (TNB) in patients being treated for cancer in order to compare results from small and large pulmonary nodules and to study the efficiency of pathology versus cytology analysis. PATIENTS AND METHODS: 141 consecutive CT-guided TNBs were performed in 134 patients. Cancer had been diagnosed in all cases. From the CT images, nodules were classified as small (< or = 15 mm) (n = 63; 47%) or large (> 15 mm) (n = 71; 53%). RESULTS: There were 16 benign and 118 malignant lesions (92 metastasis, 18 primary, 8 unspecified). There was no statistically significant difference for sensitivity and for prevalence of pneumothorax between small or large nodules. For the 107 true-positive and 16 true-negative results, the cytology examination was positive alone in 41 cases (33.3%), the pathology examination in 24 cases (19.5%) and both in 58 cases (47.2%). CONCLUSION: The diagnostic efficiency of CT-guided transthoracic needle biopsy is as good for small pulmonary nodules (> or = 15 mm) as for larger lesions. This technique is particularly useful in the diagnosis of secondary lesions and does not increase the risk of complications, even in case of small nodules. Ordering both pathology and cytology examinations improves the efficacy of TNB.

[Primary lymphomas of the breast. 9 case reports]. / Les lymphomes primitifs du sein. A propos de 9 observations.

Between the 1st of January 1974 and the 30th of June 1989, we saw 9 cases of primary lymphoma of the breast at the Oscar Lambret Centre, all occurring in women. This comprised 0.27% of the malignant tumours of the breast and 3.2% of all non-Hodgkin lymphomas. 8 occurred on the right side and 1 on the left. There were multiple tumours in 5 cases. The clinical findings were always suggestive of a malignant condition and so were the mammography findings in 6 cases. Two patients had total mastectomy. In the other cases, the diagnosis was made (twice) by biopsy or by lumpectomy (5 cases). Using Kiel-Lennert's classification: 5 were highly malignant and 4 of low grade malignancy (using the Working Formulation, three were moderate and 4 were intermediate; 1 was very high grade and 1 intermediate or high). Treatment changed a lot during the period under consideration. Five patients are still alive without any recurrence. One died of lymphoma and two died of intercurrent causes and one died of unknown causes.

Trastuzumab-based treatment of HER2-positive breast cancer: an antibody-dependent cellular cytotoxicity mechanism?

This study evaluated by immunohistochemistry (IHC) immune cell response during neoadjuvant primary systemic therapy (PST) with trastuzumab in patients with HER2-positive primary breast cancer. In all, 23 patients with IHC 3+ primary breast cancer were treated with trastuzumab plus docetaxel. Pathological complete and partial responses were documented for nine (39%) and 14 (61%) patients, respectively. Case-matched controls comprised patients treated with docetaxel-based PST without trastuzumab (D; n=23) or PST without docetaxel or trastuzumab (non-taxane, non-trastuzumab, NT-NT; n=23). All surgical specimens were blind-analysed by two independent pathologists, with immunohistochemical evaluation of B and T lymphocytes, macrophages, dendritic cells and natural killer (NK) cells. Potential cytolytic cells were stained for Granzyme B and TiA1. HER2 expression was also evaluated in residual tumour cells. Trastuzumab treatment was associated with significantly increased numbers of tumour-associated NK cells and increased lymphocyte expression of Granzyme B and TiA1 compared with controls. This study supports an in vivo role for immune (particularly NK cell) responses in the mechanism of trastuzumab action in breast cancer. These results suggest that trastuzumab plus taxanes lead to enhanced NK cell activity, which may partially account for the synergistic activity of trastuzumab and docetaxel in breast cancer.

[Phyllodes tumors]. / Les tumeurs phyllodes.

A review of mammary phyllodes tumors is presented. Clinical, radiological and cytological features are treated, with special emphasis on the histopathological grading system and prognostic indicators. Other analytical methods are described: immunohistochemistry, hormonal receptors study, flow cytometry and electron microscopy. A large place is also given to differential diagnosis, clinical course, histogenesis and originality of some phyllodes tumors. The authors stress the importance of wide excision and the contribution of frozen sections in surgical treatment.

[Intraoperative cytology of breast lesions]. / La cytologie extemporanée en pathologie mammaire.

Evaluation of intraoperative cytology and frozen sections for breast lesions is essential to single-stage and cost effective management. The aim of this study is to evaluate the diagnostic accuracy and the potential role of intraoperative cytology. The results of the study undertaken at the René Huguenin Center and the data of the literature suggest that intraoperative cytology may be helpful in some cases, especially as an adjunct to frozen sections. If frozen sections could be avoided any time clear features of benignity or malignancy are offered by both clinical data and macroscopic and cytologic examination, this approach does have limitations. Intraoperative cytology should not be used as an alternative to frozen sections except, in a few cases, when technical conditions required for them are not available or suitable. It can also constitute a good way for continuous education of our cytotechnologists.