[Lightning strike and lesions outside the brain: Clinical cases and a review of the literature]. / Les atteintes extra-cérébrales de la foudre : vignettes cliniques et revue de la littérature.

INTRODUCTION: Every year, 240,000 people are struck by lightning worldwide, causing injuries leading to significant handicaps. Most of the symptoms involve brain lesions; neuromuscular sequelae and myelopathy are less common. OBSERVATIONS: We describe five cases of patients struck by lightning with various clinical presentations. The first patient presented painful paresthesias in both upper limbs that disappeared 18 months later; the injury was a plexopathy. The second patient developed proximal weakness in the upper-left limb due to a myopathy. Two patients presented with various motor weaknesses in the lower limbs due to motor neuron disease and myelopathy. The last patient had a transient tetraplegy, which resolved in 5minutes; the diagnosis was keraunoparalysis. DISCUSSION: Lightning injuries can have many consequences depending on the different mechanisms involved. The clinical presentation is often due to a very focal lesion without any secondary extension. Motor neuron disease probably results from post-traumatic myelopathy. We discuss the ALS-electrocution association, frequently described in the literature. CONCLUSION: Various peripheral nerve and spinal cord lesions can be seen in lightning strike victims involving myelopathy, motor neuron, muscle and plexus. Clinical syndromes are often atypical but outcome is often favorable.

[Primary urethral carcinoma. Epidemiology, diagnosis and pathology. Guidelines from the French Urological Association Cancer committee]. / Tumeurs primitives de l'urètre. Epidémiologie, diagnostic et anatomopathologie. Recommandations du comité de cancérologie de l'Association française d'urologie.

Primary urethral carcinomas are unusual. The most frequent histology is the epidermoid carcinoma in both sex, followed by the urothelial carcinoma in men and adenocarcinoma in women. The diagnosis is often late. It is based on a clinical examination under anesthesia and biopsies. MRI is the best imaging modality for the local stadification.

[Facial diplegia as the presenting feature of Lyme disease]. / Diplégie faciale révélatrice d'une maladie de Lyme.

INTRODUCTION: Diagnosis of neuroborreliosis may be difficult. Neuroborreliosis mainly results in lymphocytic meningitis and in meningoradiculitis (67-83% of cases). CASE REPORT: We report the case of a patient who developed a sudden facial diplegia, revealing neuroborreliosis proved by positive blood and cerebrospinal fluid serology. The patient had no previous history of tick bite and migrans erythema. The patient was given ceftriaxone therapy (2 g/day for 21 days), leading to resolution of all clinical symptoms. CONCLUSION: Our report underscores that neuroborreliosis should be considered in patients exhibiting facial diplegia. Thus, Lyme serology should be performed systematically in these patients. Altogether, early management is crucial, before the onset of neurological manifestations at late stage, leading to disabling sequelae despite antibiotic therapy.

Variability of immunohistochemical reactivity on stored paraffin slides.

AIMS: To investigate the effects of slide storage on immunohistochemical staining, since recent reports have indicated that storage of unstained paraffin slides for up to 12 weeks may lead to false negative immunostaining of tumour markers. METHODS: 11 antibodies (anti-cytokeratin, epithelial membrane antigen (EMA), vimentin, smooth muscle actin, PS100, chromogranin, CD45, CD20, CD3, CD30, and oestrogen receptor (OR) were tested on unstained paraffin slides of breast carcinomas, lymphomas, and neuroendocrine tumours that had been stored for three to 10 years. All the paraffin blocks were recut less than one week before immunostaining. Immunostainings of years old slides were compared with those of recent slides in at least five cases for each antibody. For three antibodies (antichromogranin, anti-CD3, and anti-OR) we also tested one year old and three months old slides. RESULTS: Intensity of staining on years old slides was strikingly reduced for chromogranin and CD3 in several cases and was slightly stronger for vimentin. In some cases a significant decrease of OR positivity was observed after three months storage, and a complete loss of OR immunostaining after 12 months. No significant difference was noted with the other antibodies. CONCLUSIONS: Immunohistochemical detection of some antigens located either in the nucleus, in the cytoplasm, or on the cytoplasmic membrane could be impaired by storage of paraffin slides as short a time as three months. One should be cautious of doing retrospective immunohistochemical studies on stored unstained slides.

Multiple endocrine neoplasia (MEN) type II b: report of a case observed at autopsy with immunohistochemical study of mucosal neuromas.

A case of multiple endocrine neoplasia (MEN) II b syndrome was studied in a 28-year-old Colombian woman. The patient presented initially with medullary carcinoma of the thyroid (MTC), an unusual habitus, numerous mucosal neuromas, and intestinal ganglioneuromatosis. Recurrent medullary carcinoma in the mediastinum produced compression. The tumor mass could not be removed surgically, and the patient died of post-operative complications. At autopsy metastatic MTC was present in the liver, lymph nodes, and lungs. In addition, multiple mucosal neuromas were present in the mouth, nasopharynx, larynx, digestive tract, peri-adrenal fat, and hepatic portal spaces. There was no evidence of pheochromocytoma. Immunofluorescence study of mucosal neuromas showed hyperplasia and hypertrophy of nerves, without evidence of tumor. Kindred screening was negative.

Renal chromophobe cell carcinoma and oncocytoma. A comparative morphologic, histochemical, and immunohistochemical study of 124 cases.

BACKGROUND: Renal oncocytoma has several features that overlap with other renal neoplasms, including the eosinophilic subtype of chromophobe cell carcinoma. In fact, strict criteria for renal oncocytoma have not been well defined and remain a matter of controversy. Ultrastructural studies or sophisticated methods such as flow cytometry and cytogenetic techniques can be of great use in distinguishing the two tumors, but are difficult to propose as routine methods because of their limited availability. OBJECTIVE: To further characterize the histologic criteria of these tumors, we undertook a retrospective study to define the utility of routinely available histochemical and immunohistochemical techniques. DESIGN AND SETTING: Twenty-one cases of chromophobe cell carcinoma, eosinophilic subtype, and 103 cases of oncocytoma were tested with histochemical (Perls, periodic acid-Schiff, and Hale's colloidal iron) and immunohistochemical (peanut agglutinin antigen and UEA-1 for lectins; cytokeratin KL1, epithelial membrane antigen, vimentin, S100 protein, and lysozyme) staining. RESULTS: The antibodies tested and the histochemical staining using Hale's colloidal iron allowed eosinophilic chromophobe cell carcinoma to be distinguished by its characteristic reaction pattern. Seventy-six percent of the chromophobe cell carcinomas showed a microvacuolated pattern, and 89% of the renal oncocytomas showed an apical positivity with Hale's colloidal iron staining (P < .01). Peripheral cell accentuation reactivity for cytokeratin KL1 was observed in 66% of the chromophobe cell carcinoma cases, and apical cytoplasmic positivity was observed in 37% of the renal oncocytoma cases (P = .01). Significant patterns were observed with anti-epithelial membrane antigen and anti-peanut agglutinin antigen antibodies (P = .05 and P = .01, respectively). Positive reactions for vimentin, S100 protein, lysozyme, and UEA-1 were not significant characteristics. CONCLUSION: Our study demonstrated that a precise morphologic description associated with simple histochemical and immunohistochemical techniques provides sufficient criteria for a high level of discrimination between the eosinophilic subtype of chromophobe cell carcinoma and renal oncocytoma.

[Protocol for the pathologic examination of cystectomy and cystoprostatectomy specimens. Proposal for a standardized form]. / Protocole d'étude anatomopathologique des pièces de cystectomie et de cystoprostatectomie.

We present practice guidelines for the examination of bladder specimens removed for bladder cancer and propose an example of standardized form for their reporting. This approach takes place in looking for better quality and facilitates use of the morphologic data.

[Clear cell carcinoma of the thyroid; diagnostic difficulties]. / Carcinome à cellules claires de la thyroïde, difficultés diagnostiques.

Thyroid carcinomas with clear cell change are rare neoplasms, and always bring up the possibility of a metastasis from another primary clear cell carcinoma. We report the case of a 33-year-old woman operated on for a solitary cold thyroid nodule. Histologic and ultrastructural studies showed a clear cell carcinoma with a trabecular and follicular pattern. Neoplastic cells included lipid droplets, glycogen granules and intranuclear cytoplasmic inclusions, and were stained with one of the two antithyroglobulin polyclonal antibodies used. Radiologic investigations then showed a tumor mass of the right kidney. Surgical management proved it to be a benign cyst, and assessed the absence of kidney neoplasm. Thus, this case exemplifies the pitfalls in the diagnosis of clear cell thyroid neoplasms, and points out the fact that immunohistochemical staining for thyroglobulin should be systematically performed.

[Mycotic infection in immunosuppressed patients. An anatomopathologic study]. / Les infections mycosiques chez les immunodéprimés. Etude anatomo-pathologique.

Mycotic infections are a frequent and often severe complication in the immunosuppressed patient. A review of autopsy findings in 54 cases with gross, histologic and mycologic studies was undertaken among immunocompromised patients after chemotherapy or allogenic bone marrow transplantation: fungal infections were either localized especially in lungs and gastrointestinal tract, or disseminated. Fungi were various: principally Candida and Aspergillus, but also Fusarium, Torulopsis and Trichosporon. In acquired immunodeficiency syndrome (11 autopsy cases), mycotic infections appeared different. Oral and esophageal candidiasis could be found, but cryptococcosis and histoplasmosis were the major generalized mycosis. This study suggests that fungal infections are not the same in patients treated by chemotherapy or bone marrow transplantation, and in acquired immunodeficiency syndrome.

[Recommendations for reforming prostatic specimens. Les Membres du Sous-Comité Prostate du Comité de Cancerologie de l'Association Française d'Urologie]. / Recommandations pratiques pour les prélèvements prostatiques. Les Membres du Sous-Comité Prostate du Comité de Cancerologie de l'Association Française d'Urologie.

The purpose of these recommendations proposed by the members of the <>, is to provide an informative report for the clinician and the pathologist, in the management of patients with prostate cancer. These recommendations are common to the ADSAP and UICC recommendations on prostate cancer. Standardized forms are recommended to be included in every report.

[Idiopathic calcinosis of the scrotum. Apropos of 2 cases]. / La calcinose idiopathique du scrotum. A propos de deux observations.

The authors report two cases of idiopathic calcinosis of the scrotum studied between the years 1986-1987 at the Central Histology Laboratory of Hopital St-Louis. These cases presented subcutaneous calcinosis strictly limited to the scrotum and not accompanied by any clinical signs and no abnormal laboratory parameters. The macroscopic and histological appearance of the lesions is typical and should suggest the diagnosis. Numerous authors have tried to attribute a pathogenic interpretation to this lesion, but the various etiologies proposed are still purely hypothetical.

[Carcinosarcoma and spindle cell carcinoma of the bladder. A comparison of 2 cases with an immunohistochemical study]. / Carcinosarcome et carcinome à cellules fusiformes de la vessie. Comparaison de deux observations avec étude immunohistochimique.

These two cases of bladder tumours with an unusual histological appearance were observed at Hôpital Saint-Louis in 1988. They contained two cellular components: the usual epithelial type and a spindle cell type. Immunohistochemistry performed in order to identify the various cell contingents established the diagnoses of carcinosarcoma and spindle cell carcinoma and emphasised the differences and similarities between these two entities, which we believe can be differentiated.

[Detection of cancer of the prostate. A study of 600 cases]. / Dépistage du cancer de la prostate. Etude de 600 cas.

A free screening consultation for carcinoma of the prostate was proposed to men over the age of 50 years working in different companies in the areas of Paris. This consultation included a digital rectal examination, a blood test for determination of serum acid phosphatase and prostatic specific antigen, and two dimensional trans-rectal ultrasonography of the prostate. 600 patients were seen. 575 were evaluable. Prostate biopsy was recommended in 152 men. Ninety-three prostate biopsies were performed. Eighteen prostatic cancers and 1 urothelial cancer invading the prostate were detected with an overall incidence of prostate cancer of 3.1%. Radical prostatectomies were performed in 10 of the 18 patients with a prostate cancer. Sensitivity of digital rectal examination ultrasonography and PSA were respectively 42.8%, 47.3% and 68.4% with an abnormal serum PSA level defined as being greater than 5 ng/ml. The predictive value of a positive ultrasonography (18.7%) contrasts with the predictive value of a positive digital rectal examination (30.7%) and serum PSA (30%). Digital rectal examination and determination of serum prostatic specific antigen seem to be the most useful tests for mass screening of prostate cancer. Transrectal ultrasonography is very useful for guided prostatic biopsy and for a better topographic evaluation of the tumor.

[Total extended ++urethrectomy and transureteral continent cystostomy in the treatment of urethral melanoma in women. Report of a case]. / Uréthrectomie totale élargie et cystostomie continente trans-urétérale dans le traitement du mélanome de l'urèthre chez la femme. A propos d'un cas.

Malignant melanoma of the urethra is one of the rare urethral tumours which can be controlled by total urethrectomy with preservation of the bladder. The authors report the first case of melanoma of the urethra treated by total urethrectomy and continent transureteric urinary diversion according to Mitrofanoff's principle.

[The role of endoscopy in the diagnosis and treatment of keratinizing and desquamating malpighian metaplasia of the kidney pelvis]. / Place de l'endoscopie dans le diagnostic et le traitement de la métaplasie malpighienne kératinisée et desquamante du bassinet.

Keratinized squamous cell metaplasia of the renal pelvis (KSMRP) is a rare lesion, difficult to differentiate from urothelial tumour on the basis of the usual morphological examinations. It is therefore usually diagnosed retrospectively, on histological examination of a nephroureterectomy specimen. However, as its benign nature justifies conservative treatment, preoperative recognition of this lesion is essential. Upper urinary tract endoscopy, which allows diagnosis and treatment of this disease, is therefore very important in this context. Endoscopy is indicated when KSMRP is suspected clinically in a doubtful case of urothelial tumour of the upper urinary tract, in a context of passage of soft stones or a history of renal stones or upper urinary tract infection. Ureteroscopy constitutes the first step to confirm the diagnosis. It must be completed by a percutaneous procedure to eradicate any residual lesion, which could be responsible for recurrence. We report a case of KSMRP in a solitary kidney treated by retrograde and percutaneous endoscopic surgery.

[Carcinoma of Bellini's tubules]. / Le carcinome des tubes de Bellini.

Carcinoma of the papillary ducts of Bellini is a rare form of renal cancer. Patients are usually asymptomatic middle-aged men who frequently have metastatic disease at the time of diagnosis. The diagnosis is based on histological examination of the nephrectomy specimen with a precise immunohistochemical examination. Radical nephrectomy is the first-line treatment and adjuvant chemotherapy, recommended by certain authors, does not appear to improve the usually poor prognosis of these tumours.

[Can the prostatic capsule be preserved during cystectomy for bladder tumors: a study of urethral and prostatic involvement in the cystectomy specimens]. / Peut-on préserver la coque prostatique au cours des cystectomies pour tumeur de vessie: étude de l'atteinte urétrale et prostatique sur les pièces de cystectomie.

OBJECTIVES: To evaluate the frequency of urethral and prostatic lesions on cystectomy specimens for bladder tumour. MATERIAL AND METHODS: This retrospective histological study was based on 260 specimens: radical cystectomies performed in 7 operative sites. The prostate and urethra were analysed in 3 planes (upper, middle and lower thirds). The apex was studied separately. Urethral invasion was identified by continuity of the tumour or by the presence of vesical CIS. RESULTS: Urethral involvement is frequent (30.6% cases) essentially due to contiguous invasion (43/80). CIS is the second pathological association (44 urethral CIS/75 bladder CIS). Prostatic adenocarcinoma was present in 17.8% of cases with a Gleason score > 6 for 30% of lesions. CONCLUSION: The high frequency of urethral and prostatic involvement does not justify preservation of the prostate during cystectomy. A serial prospective study should define the precise criteria able to minimize the risk of conservative surgery.