[Breast carcinoma and bone chondrosarcoma: a new syndrome?]. / Cancer du sein et chondrosarcome osseux: un nouveau syndrome?

We report the case of a fifty three years old woman who has developed in the same time a breast carcinoma and a bone chondrosarcoma. The mean of this article is to underline the strong link (statistical and phenotype) between those two cancers and to discuss the possibility of a syndrome associating breast carcinoma and bone chondrosarcoma.

Immunohistochemical study of cell cycle regulatory proteins in intraductal breast carcinomas--a preliminary study.

The aim of this study was to assess the levels of cell cycle regulatory proteins p21waf1 (p21), p53, Cyclin A, Cyclin D1 and Ki-67 to see whether they correlated with recurrence-free survival (RFS). From 1982 to 1996, 50 patients aged less than 51 years underwent lumpectomy followed by radiotherapy for a pure ductal carcinoma in situ (DCIS). For each case, the following immunohistochemical stains were carried out: Ki-67, Cyclin A, Cyclin D1, p53 and p21waf1 (p21). The percentage of positive nuclei was assessed. Multiple combinations of these factors were performed; in particular, we called the sum of Ki-67 and Cyclin A a global proliferation factor (GPF). Correlations with classical clinicopathological data were assessed. After a multivariate analysis, only GPF, Van Nuys Prognostic Index (VNPI) grade and mitotic index were independent predictive factors of recurrence in the whole population. In the population with close surgical margins, when the GPF level was less than the 25th percentile or more than the 75th percentile recurrence was low. In this preliminary study, GPF seems to be of interest to help in the decision process in the post-surgical management of the patient.

Double immunohistochemical labeling technique applied to different types of cytokeratins in epithelial proliferations of the breast.

The double labeling technique using peroxidase and alkaline phosphatase for immunohistochemistry is well known, but must be adapted according to the antibodies used, fixation, and technical conditions. The technique allows identification on one slide of two antigens that are localized in the same or different cells of the same lesion. The aim of this paper is to describe the adaptation of this technique to cytokeratins of normal mammary tissue and proliferative lesions of the breast.

[The use of histo-scintigraphic correlations in the detection of osteomedullary metastases secondary to visceral neoplasms (author's transl)]. / Intérêt des confrontations histo-scintigraphiques dans le dépistage des localisations osseuses secondaires des cancers viscéraux.

Disagreement has been observed between the results of bone scan using technetium polyphosphate interpreted quantitatively by local counting and the results of bone-marrow biopsy. This led us to demonstrate the possibility of rare "false-negatives" on histopathological examination related to faulty technique in histological preparations. These "false-negatives" (5 cases ot of 166 biopsies examined) would not appear to require a need for exhaustive examination of all specimens. We therefore suggest that the results of isotopic bone scan should be taken into account in the determination of the technique which should be used in the preparation of sections for histological examination of the biopsy. If the quantitative scan is doubtful or positive, the first four levels of sectins taken every 100 microns in the mounting block should be examined first. If these first four levels are negative, the whole of the remainder of the block is examined and sections are taken every 100 microns (i.e. 15 to 20 sections per case). When quantitative scan is negative, the standard technique of examination of 3 to 4 levels of sections distributed throughout the block seems to be adequate.

[Multidisciplinary treatment of soft tissue sarcomas: an improvement in prognosis (author's transl)]. / Sarcomes des tissus mous: progrès thérapeutiques par l'application d'un protocole pluridisciplinaire.

The results obtained in the treatment of 45 cases of soft tissue sarcomas are presented. All cases were reviewed and classified according to the modern criteria of malignancy. The treatment schedule comprised: (1) preoperative irradiation: 2 sessions of 6.50 Gy in 48 hours, target volume: whole limb segment; (2) surgical excision 48 hours later with systematic intraoperative histologic verification, until healthy tissue margins are obtained; (3) postoperative irradiation: 3 weeks later delivering a cumulative total dose of 50.00 Gy to the preoperative volume and 60.00 - 70.00 Gy to a reduced volume encompassing the surgical region with protection of vascular axes where possible; (4) chemotherapy: Actinomycin D 0.3 mg/m2 half and hour before the first 5 sessions of postoperative irradiation; (5) bilateral lung irradiation: 4 sessions of 3.75 Gy in 7 days to the whole chest. The results were as follows: local recurrence rate was 9.5 per cent at 5 years. In 21 cases in whom surgical excision was deemed histologically adequate, no recurrences was seen at 3 years (minimum follow-up). Survival at 5 years was 77 per cent. Deaths were due to metastatic spread, especially to the lungs. These results show an improvement as compared with historical series. New progress should be sought in combining a more aggressive type of chemotherapy for cases with high metastatic risk.

[Evaluation of predictive factors, particularly the Van Nuys index, of local recurrence in ductal carcinoma in situ of the breast: study of 166 cases with conservative treatment and review of the literature]. / In process citation.

Ductal carcinoma in situ (DCIS), a non metastazing lesion of the breast is more frequently observed due to the improvement of mammography and widespread use of screening. The most important risk of this disease is local recurrence. In about half of cases, it occurs as an infiltrating carcinoma. In a series of 166 DCIS treated by lumpectomy plus radiotherapy, we have studied clinico-pathological factors for the prognosis of local recurrences and particularly the Van Nuys Index criteria (nuclear grade, necrosis, size, margin width). After median follow up of 75 months, 21 recurrences were observed with 10 corresponding to an infiltrating carcinoma and one of them died. The size of DCIS evaluated on pathological documents (histological slides and shames), the Van Nuys Prognostic Index (VNPI) and the mitotic index were the main prognostic factors of local recurrence. We discuss these results and confront them to a review of the literature focalised on the delicate problem of the decision of conservative treatment. A multidisciplinary approach (Breast : Surgeon, Radiologist, Pathologist and Radiotherapist), a standardisation of pathological criteria (size, margin width) and the continuation of randomised trials are necessary to fine the best attitude of conservative therapy.

[Atypical prostatic leiomyoma: a new case with cytodensitometric analysis]. / Léiomyome à cellules bizarres de la prostate: un nouveau cas avec étude cytométrique.

Atypical prostatic leiomyoma is a very rare benign tumor. We report here a new case with a cytodensitometric analysis. The result of cytodensitometry is a polyploid tumor that is well correlated with the morphology of nuclear multilobulated cells of this tumor. The differential diagnosis is essentially the leiomyosarcoma which is characterized by the absence of mitotic activity.

[Non-parasitic cysts of the spleen: report on two cases and ultrastructural findings in one of them (author's transl)]. / Kystes non parasitaires de la rate. A propos de deux observations dont une avec étude ultra-structurale.

Two cases are reported of non-parasitic cysts of the spleen of the simple epithelial type. The pathogenic mechanism of such cysts is discussed and illustrated by ultrastructural findings in one of the cases. The wall of this cyst was mesothelial in nature. This observation is in favour of the inclusion of mesothelial tissue in the spleen, a hypothesis suggested in the published literature by several authors.

Lymphocyte-rich classical Hodgkin lymphoma (LRCHL): clinico-pathological characteristics and outcome of a rare entity.

BACKGROUND: To investigate the proportion, clinical characteristics and outcome of lymphocyte-rich classical Hodgkin lymphoma (LRCHL) in relation to nodular lymphocyte predominant HL (NLPHL) and classical HL (cHL). PATIENTS AND METHODS: A series of 2743 HL patients of all stages enrolled into three EORTC trials (H7, H8, H34) conducted between 1988 and 2000 and forming an unbiased series of HL patients was studied. RESULTS: Detailed histological classification after panel review was available in 96% of the cases to allow selection of all cases with features potentially compatible with the WHO-definition of LRCHL for this study. Cases with dominance of lymphocytic infiltrate and relative paucity of eosinophils and fibrosis could be selected for re-classification. Twenty-one (0.8%) LRCHL cases were identified of which three were originally classified as NLPHL, seven as nodular sclerosis HL (NSHL) and 11 as mixed cellularity (MCHL), indicating that LRCHL is a rare disease. CONCLUSIONS: Clinical evaluation of the unselected series of patients (n = 2743) showed that LRCHL and NLPHL cases more often presented with favorable features. Clinical outcome adjusted on ab initio patient prognosis did not differ between the three histological entities. These results strongly suggest that LRCHL corresponds to an early stage in the spectrum of cHL rather than a biologically different disease entity.

[Detection of buccal cavity cancers with toluidine blue (author's transl)]. / Le dépistage des cancers de la cavité buccale par le bleu de toluidine.

When malignant tumours of the oral cavity are of a small size, they are asymptomatic during a long time, and it is difficult to detect them. A method permitting to discover them more easily during the examination would be a precious rescue. In this aim, we have tested the oral coloration with toluidine-blue in 50 patients with a high risk of malignant tumour. This coloration has allowed to reveal cancer in 3 patients whereas no tumour was found at previous clinical examination.

Autopsy findings in 111 cases of esophageal cancer.

Autopsy findings for 111 cases of esophageal cancer are presented. Residual tumor in the esophagus was present in 75% of the cases. Lymph node metastases were found in 74.5% and visceral metastases in 50% of the cases. Autopsy revealed a second primary tumor in 21% of the cases; 12% of these were oropharyngeal-laryngeal (OPL) carcinomas, and 9% were visceral carcinomas or malignant lymphomas. Nonmalignant disease found in association with esophageal cancer was dominated by conditions related to chronic alcoholism. Autopsy findings thus revealed that the patients bore not only esophageal lesions, but also patterns of other associated malignant and nonmalignant diseases which would seem to correspond to a complex pathologic state occurring in association with chronic alcoholism. The time between onset of symptoms and autopsy averaged 10.6 months and between first consultation and autopsy, 6.3 months. The brevity of survival from onset of symptoms would seem to confirm that by the time esophageal cancer manifests clinically, it is already at a stage of development beyond the scope of treatment.

Prognostic factors in soft tissue sarcomas. A multivariate analysis of 109 cases.

Prognostic factors were evaluated in 109 soft tissue sarcomas of the extremities, walls of the trunk, head, and neck. All lesions were graded according to the systems proposed by the National Cancer Institute (NCI) and the French Federation of Cancer Centers (FNCLCC), and a correlation was found between tumor grade and prognosis. Univariate analysis selected the following variables as unfavorable prognostic factors: invasive tumor margins, extra-compartmental status, deep tumors, tumor diameters over 5 cm, inadequate excision, presence of necrosis, high mitotic count, histologically undifferentiated tumors, and blood vessel invasion. These variables were found to be interdependent. Multivariate analysis selected quality of surgery as the most important variable for predicting local recurrences. The factors selected with regard to overall and metastasis-free survival were tumor size, tumor margins, necrosis, and adequacy of excision. These results permitted classification of patients into four prognostic groups: two with good and two with bad prognosis. Five-year survival for the four groups was 100%, 83%, 53%, and 0%; 5-year metastatic rates were 0%, 12%, 67%, and 100%. Similar groups were obtained when the variables of tumor margins and size were combined with an adaptation of the NCI grading (low-grade tumors/high-grade tumors without necrosis/high-grade tumors with necrosis). Comparative analysis showed that patients with tumors of the same histologic grade or type were not necessarily classed in the same prognostic groups. A better clinicopathologic correlation was obtained using a combination of prognostic factors than with histologic grading or typing alone.

The pathologist's role in a multidisciplinary approach for soft part tissue sarcoma: a reappraisal (39 cases).

A combined treatment modality of radiotherapy, surgery, and monochemotherapy in 39 cases of soft tissue sarcomas is presented. The 39 patients presented initially with local disease only, without evidence of metastases. At the end of the surgical procedure the adequacy of the excision had been evaluated by the pathologist. Surgical procedure was complemented by systematic radiation therapy. The overall recurrence rate was 7.7%; the overall incidence of metastases 31%. In the group in which adequate excision had been obtained, no loco-regional recurrences were obtained, survival was significantly better, and the incidence of metastases was lower than in group in whom adequate excision could not be obtained. The importance of two criteria was stress: the depth and the character of the margins of the tumor which cannot be considered separately. The results suggest that there is a correlation between the general and loco-regional malignancy of soft tissue sarcomas.