National multicentric evaluation of quality of pathology reports for rectal cancer in France in 2016.

The quality of pathologic assessment of rectal cancer specimens is crucial for treatment efficiency and survival. The Royal College of Pathologists (RCP) recommends evaluating the quality of the pathology report in routine practice using three quality indicators (QIs): the number of lymph nodes (LNs) analyzed (≥ 12), the rate of venous invasion (VI ≥ 30%), and peritoneal involvement (pT4a ≥ 10%). In this study, we evaluated the three QIs of the French national pathology reports and compared them with British guidelines and assessed the influence of neoadjuvant radiochemotherapy on QIs. From January 1 to December 31, 2016, all pathology reports for rectal adenocarcinoma were collected from French departments. Neoadjuvant radiochemotherapy included long-course radiotherapy with concomitant 5-FU-based chemotherapy. A total of 983 rectal cancer pathology reports were evaluated. A median of 15 LNs were analyzed and 81% of centers had ≥ 12 LNs. The rate of VI was 30% and 41% of centers had ≥ 30% VI. The rate of pT4a was 4% and 18% of centers reported ≥ 10% pT4a. None of the centers reached the threshold for the three QIs. All three QIs were lower after radiochemotherapy compared to surgery alone. In conclusion, in French routine practice, the values of two of the three QIs (LNs analyzed and VI) were globally in line with RCP guidelines. However, the rate of pT4a was very low, particularly after radiochemotherapy, suggesting its low value in rectal cancer.

[Paraganglioma of the cavernous sinus. Case report]. / Paragangliome du sinus caverneux. A propos d'un cas.

A case of paraganglioma arising from the cavernous area is presented. A 51-year-old woman presented with a parasellar mass causing decreased visual acuity, oculomotor nerve paresis and retro-orbital headaches without endocrinological dysfunction. Diagnosis was confirmed by histological appearance and electron microscopy. The patient was treated with surgery followed by radiation therapy consisting of 45 Gy. The clinicopathological features and the possible pathogenesis are discussed.

[Cellular neurothekeoma, a rare cutaneous tumor. Anatomo-clinical and immunohistochemical study of 2 cases]. / Le neurothécome cellulaire, une tumeur cutanée rare. Etude anatomo-clinique et immunohistochimique de deux observations.

Cellular neurothekeoma is an unusual cutaneous tumor described in 1986. We report two new cases in 14-year-old girls. Both tumors measured less than one centimeter and were located on the forearm and the shoulder. They had a plexiform architecture and were developed in the dermis and the dermo-hypodermic junction. Spindle and epithelioid tumor cells were immunoreactive for vimentin, NKI-C3, NSE, CD68 and smooth muscle actin. There was no recurrence 2 and 7 months after the operation. Cellular neurothekeoma is a benign tumor. Its histogenesis is still unknown. Histological and immunohistochemical features, with positivity of the tumor cells for NKI-C3, a non specific melanocytic marker, and negativity for S-100 protein and HMB-45, allow to differentiate cellular neurothekeoma from myxoid neurothekeoma and melanocytic tumors.

[Mesothelial cyst of the adrenal gland]. / Kyste surrénalien d'origine mésothéliale.

We report a case of a mesothelial adrenal cyst which was incidentally discovered in a 38-year old woman. The diagnosis was confirmed by an immunohistochemistry study. Adrenal cysts are rare. They occur more commonly in female patients during the 4th and 5th decades and are usually asymptomatic. Adrenal cysts are divided into four groups : parasitic, epithelial, endothelial cysts and pseudocysts. The management is still discussed : follow-up, surgical resection or fine-needle aspiration.

[Pigmented pemphigoid]. / Pemphigoïde pigmentée.

BACKGROUND: Pigmented bullous pemphigoid has many clinical manifestations. We report a pigmented erythematous form with disseminated bullae. CASE REPORT: A 70-year-old woman with a history of breast adenocarcinoma developed an eruption of pigmented macules on the trunk and members of 72 hour duration. At five days, there was an eruption of tight bullae. The diagnosis of bullous pemphigoid was retained because of the association of infraepidermic bullae, linear deposits of C3 along the basal membrane and the presence of the 180 kDa minor bullous pemphigoid antigen on immunoblotting. DISCUSSION: The initial pigmented aspect of this bullous pemphigoid suggested disseminated pigmented bullous erythema, but histology data with immunotransfer corrected the diagnosis. This very atypical presentation led us to look for a particular etiology. There was no argument in favor of a malignancy in this patient in complete remission after treatment of her breast adenocarcinoma. The fact that the patient was phototype IV would probably explain the pigmented nature of the initial lesions.