Prognostic interest in discriminating muscularis mucosa invasion (T1a vs T1b) in nonmuscle invasive bladder carcinoma: French national multicenter study with central pathology review.

PURPOSE: Predictive factors of T1 nonmuscle invasive bladder cancer evolution that could guide treatment decision making are lacking. We assessed the prognostic value of muscularis mucosa invasion in nonmuscle invasive bladder cancer. MATERIALS AND METHODS: In a national multicenter study patients with primary T1 nonmuscle invasive bladder cancer were recruited from 6 French hospitals. All patients had undergone transurethral resection of bladder tumor. All T1 tumors were substaged according to muscularis mucosa invasion as T1a-no invasion beyond the muscularis mucosa or T1b-invasion beyond the muscularis mucosa with muscle preservation. Subsequent central pathology review was then done by a single referent uropathologist. Muscularis mucosa invasion was tested as a prognostic factor for survival on univariate and multivariate analysis. RESULTS: A total of 587 patients were enrolled in the study, including 388 (66%) with T1a and 199 (34%) with T1b tumors. Median followup after transurethral resection of bladder tumor was 35 months (IQR 14-54). There was no significant difference between groups T1a and T1b except high tumor grade in T1b cases (p <0.0001). After central review, initial pathological substaging was confirmed in 84% of cases. On multivariate analysis muscularis mucosa invasion (T1b substage) was significantly associated with recurrence-free (p = 0.03), progression-free (p = 0.0002) and cancer specific (p = 0.02) survival. The main study limitation was absent systematic subsequent transurethral resection of bladder tumor. CONCLUSIONS: Muscularis mucosa invasion appears to be highly predictive of T1 nonmuscle invasive bladder cancer behavior. Consequently, systematic T1a vs T1b discrimination should be highly advocated by urologists and pathologists. We believe that it could aid in crucial decision making when choosing between conservative management and radical cystectomy remains a moot point.

[Endometrial and endocervical lesions associated with pseudomyxoma peritonei: a case report]. / Lésions endométriale et endocervicale associées au pseudomyxome péritonéal : à propos d'une observation.

The association of a pseudomyxoma peritonei with a mucinous tumor of the appendix and/or the ovary is regularly reported in the literature. However, in this context, endometrial or endocervical lesions remain exceptional. We report the case of a 57-year-old patient, with pseudomyxoma peritonei associated with a low-grade mucinous neoplasia of appendix and both ovaries. The systematic sampling of endometrium and endocervix showed small segments of intestinal epithelium admixed with native epithelium. Histological and immunohistochemical characteristics of this epithelium were quite comparable to those observed in the appendix and ovaries. The endocervical and endometrial lesions might represent an implantation of mucinous epithelium from appendix, emphasizing the capacity of this epithelium to implant at a distance from the original lesion.

Transient global amnesia caused by painless aortic dissection.

Neurological syndromes secondary to acute aortic dissection (AAD) are uncommon and usually consist of focal deficits after an embolic cerebral infarction. This article reports the observation of an AAD with the chief complaint of transient acute memory impairment-that is, a non-usual stroke-like symptom.

[Atypical carcinoid of the arytenoid: report of six cases]. / Carcinoïde atypique de l'aryténoïde: à propos de six observations.

In order to illustrate the clinical and histological presentations of laryngeal atypical carcinoids and their potential course, we report six cases. We evaluated the factors predictive of local recurrence and metastatic diffusion. For each case, we noted the mitotic index, the quality of the resection, the limits of the tumor and the presence of necrosis. An immunohistochemical study was carried out with a series of antibodies (cytokeratins; D(2)40; CD31; MIB1; P53; P16; TTF1...). The clinical presentation we observed was quite similar to that reported in the literature. These tumors are CK7+, CK8+, CK19+, CK5-6-, CK14- and CK20-. P16 is constantly positive. Only the mitotic index and the lymphatic presence of embolus were correlated with the time course. The tumor is more aggressive when the mitotic index is high and an unfavorable course is observed when there are lymphatic emboli or when the Ki67 index is higher than 5%.

Very-high-frequency ultrasound corneal imaging as a new tool for early diagnosis of ocular surface toxicity in rabbits treated with a preserved glaucoma drug.

AIM: To evaluate very-high-frequency (VHF) ultrasound imaging as a new method to detect and quantify early corneal epithelium changes induced by chronic exposure to a benzalkonium-chloride-containing antiglaucoma drug. METHODS: Timolol preserved with 0.01% benzalkonium chloride solution was applied b.i.d. in 1 eye of 10 rabbits for 56 days. Unpreserved timolol solution was used as control. Ocular surface changes were assessed weekly combining clinical examinations, in vivo 60-MHz ultrasound imaging and ex vivo histological analysis. RESULTS: VHF ultrasound imaging allowed quantitative measurement of corneal epithelium thickness and qualitative imaging of toxic epithelial damage. It revealed significantly decreased epithelial thickness in vivo as early as the 21st day of treatment (40.75 +/- 1.72 microm at D0 vs. 39 +/- 2 at D21, vs. 31.9 +/- 2.98 at D56; p = 0.017 and p = 0.005, respectively). The first clinical changes appeared from the 42nd day of treatment (conjunctival redness, conjunctival staining and corneal staining; D56 compared to D0: p = 0.005, 0.01 and 0.004, respectively) and then correlated with VHF ultrasound data. Epithelial thickness measured with VHF ultrasound was correlated with histological epithelial pachymetry (p < 0.001) and with the corneal damage score assessed with scanning electron microscopy (p = 0.038). CONCLUSION: VHF ultrasound imaging provided an early in vivo diagnosis of corneal epithelium pathology induced by chronic exposure to a preserved glaucoma drug, before the first clinical evidence of ocular toxicity. It could be a new reproducible method to detect the toxicity of glaucoma medication so that therapy can then be adapted.

Contractile and relaxant properties of rat-isolated pulmonary veins related to localization and histology.

The aim of this study was to investigate the in vitro vasomotor properties of rat extra-and intralobar pulmonary veins (PVs) related to their localization and to assess the modulatory role of endothelium on these properties. Segments from PVs were mounted in small vessel myograph and stretched at various diameters (D(10), D(20), D(30)) corresponding to intraluminal pressures of 10, 20 or 30 mmHg. At D(10) or D(20), contractile responses to phenylephrine, U46619 and angiotensin II of distal intralobar part of PVs were smaller compared with those of proximal extralobar part, but no longer different when distal part was stretched at D(30). When submitted to an NO donor, sodium nitroprusside, distal part of PV relaxed more strongly when stretched at D(30) compared with D(10). Acetylcholine and bradykinin were devoid of relaxing effect on distal parts stretched at D(10), but in contrast to acetylcholine, bradykinin slightly relaxed preparations stretched at D(30). Isoprenaline strongly relaxed PVs ( approximately 80% of initial precontraction), with the distal part exhibiting a higher sensitivity to the agonist compared with the proximal part. This relaxation was also observed with salbutamol and suppressed with ICI 118551, which is in favour of the involvement of beta(2)-adrenoceptors in this effect. Preincubation of the preparations with N(G)-nitro-l-arginine methyl ester (10(-4) m) and indomethacin (10(-5) m) did not modify the contractile responses to U46619, nor the relaxing response to isoprenaline, which support that endothelium does not appear to play a significant modulatory role in these responses. Histological and electron microscopical examinations of proximal and distal sections of the same vein show that the layers of smooth muscle cells and cardiomyocytes were thicker in the proximal compared with the distal part. This study shows that, because of morphological heterogeneity of the PVs, the site of dissection and the initial condition of tension can play a significant role upon the sensitivity and the magnitude of the responses to both contractile and relaxing agonists.

[Mullerian "inclusions" within an intramammary lymph node]. / "Inclusions" müllériennes dans un ganglion lymphatique intra-mammaire.

We report a case of mullerian "inclusions" within an intra-mammary lymph node. Discovered on a routine mammography, the inclusions appeared in the right breast as a focus of microcalcifications. The 63-year-old patient was asymptomatic. Microcalcifications were associated with benign appearing epithelial formations which were positive for estrogen receptor antibodies and negative for thyroglobulin, calretinin and smooth muscle actin antibodies. Three years later, the patient developed a peritoneal low-grade serous carcinoma. Mullerian inclusions within lymph nodes are rather frequent below the diaphragm but exceptional above. Even in a supra-diaphragmatic localization, they can be associated with a pelvic serous tumor.

[Cysticercosis contracted in metropolitan France]. / Cysticercose contractée en France métropolitaine.

INTRODUCTION: All cases of cysticercosis diagnosed in France are thought to be imported. Our case report concerns a 48-year-old man who has never left Europe, in whom we diagnosed subcutaneous cysticercosis. CASE: Histologic examination of the subcutaneous nodule extracted from this patient's abdominal wall showed cysticercosis. He has never left Europe. Various imaging techniques showed no other localizations of this infection. Neither he nor any members of his family carried adult Taenia solium. DISCUSSION: We present an exceptional case of autochthonous cysticercosis. It is unlikely to be a larva of Taenia solium, since this adult tapeworm has not been seen in mainland France for a very long time. On the other hand, Taenia crassiceps cestodes parasitize the digestive tract of the fox in Auvergne and may occasionally cause cysticercosis in humans.