High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020.

BACKGROUND: Elderly people in nursing homes are particularly vulnerable to COVID-19 due to their age, the presence of comorbidities, and community living. On March 14, 2020, at the beginning of the first epidemic wave of COVID-19 in France, a cluster was reported in a nursing home in the Nouvelle-Aquitaine region. We monitored the outbreak as well as the infection prevention and control (IPC) measures implemented. METHODS: A confirmed case was defined as laboratory-confirmed COVID-19 in a resident or staff member present in the nursing home between March 7 and May 1, 2020; and a probable case as a person presenting an acute respiratory illness after contact with a confirmed case. Symptomatic inpatient residents and symptomatic staff members were systematically tested for SARS-CoV-2. In addition, two screening sessions were held on site. RESULTS: We identified 109 cases (98 confirmed, 11 probable). The attack rate was 66% among residents and 45% among staff. Half of all cases were identified during the screening sessions. One-quarter of cases had minor symptoms or were asymptomatic. The case fatality rate among residents was 29%. IPC measures were rapidly implemented such as the quarantine of residents, the reinforcement of staff personal protective equipment, and home quarantine of staff testing positive, which were supplemented in April by systematic controls at the entrance of the nursing home and the creation of additional staff break rooms. CONCLUSIONS: This outbreak confirmed the considerable health impact of SARS-CoV-2 transmission in a nursing home. In addition to the implementation of IPC measures, the early detection of cases through the screening of residents and staff is essential to identify asymptomatic and pre-symptomatic cases and limit the spread of the virus.

Extended versus involved fields irradiation combined with MOPP chemotherapy in early clinical stages of Hodgkin's disease.

From 1976 to 1981, 335 patients with untreated Hodgkin's disease, clinical stages I, II, and IIIA, have been treated by MOPP (nitrogen mustard, vincristine, procarbazine, prednisone) chemotherapy, three to six cycles according to the prognostic factors, combined with radiotherapy. Irradiation was always performed after the first three cycles of chemotherapy, and was randomized between extensive radiotherapy, ie, mantle and paraaortic areas for supradiaphragmatic presentations, and radiotherapy restricted to the involved areas. No significant difference was observed between the two randomized branches for the disease-free survival (86% after six years in the involved field branch v 90% in the extended field branch), and none for the overall survival. Most of the relapses occurred in nonirradiated areas in the first group, and in irradiated areas in the second. Relapses were especially frequent in the IIE stages with pulmonary extension; extranodal relapses occurred with osseous and cutaneous localizations. Two cases of secondary leukemia were observed after three- or six-cycle MOPP plus radiotherapy limited to the involved areas.

Defective cell migration in an ovarian cancer cell line is associated with impaired urokinase-induced tyrosine phosphorylation.

The urokinase receptor (u-PAR), a protein anchored to cell membrane by a glycosyl phosphatidylinositol, plays a central role in cancer cell invasion and metastasis by binding urokinase plasminogen activator (u-PA), thereby facilitating plasminogen activation. Plasmin can promote cell migration either directly or by activating metalloproteinases that degrade some of the components of the extra cellular matrix. However, the IGR-OV1-Adria cell line contains the u-PAR but does not migrate even in the presence of exogenous u-PA, although the parental IGR-OV1 cell line migrates normally in the presence of u-PA. We therefore investigated the role of cell signalling for u-PA induced cell locomotion. We show that cell migration induced by u-PA-u-PAR complex is always associated with tyrosine kinase activation for the following reasons: (1) the blockade of the u-PAR by a chimeric molecule (albumin-ATF) inhibits not only the u-PA-induced cell migration, but also the signalling in IGR-OV1 line; (2) the binding of u-PA to u-PAR on non-migrating IGR-OV1-Adria cells was not associated with tyrosine kinase activation; (3) the inhibition of tyrosine kinase also blocked cell migration of IGR-OV1. Therefore tyrosine kinase activation seems to be essential for the u-PA-induced cell locomotion possibly by the formation of a complex u-PAR-u-PA with a protein whose transmembrane domain can ensure cell signalling. Thus, IGR-OV1 and IGR-OV1-Adria cell lines represent a good model for the analysis of the mechanism of u-PA-u-PAR-induced cell locomotion.

Splenic marginal zone lymphoma with or without plasmacytic differentiation.

We report a series of 31 cases of splenic marginal zone lymphomas with an enlarged spleen and a multimicronodular macroscopic pattern. Two groups, A and B, were distinguished based on the presence (A) or absence (B) of a lymphoplasmacytic component with monoclonal immunoglobulin expression in the cytoplasm. There were no differences between the groups as far as age, sex, spleen weight, and progression. The only difference was the presence in group A of a monoclonal serum component and autoimmune disorders, particularly autoimmune hemolytic anemia. In most cases in which a liver and/or bone marrow biopsy was performed, lymphomatous infiltration was detected. Seven cases had a seric monoclonal IgM of 5 g/L or more and liver or bone marrow infiltration, corresponding to the definition of Waldenstrom's macroglobulinemia. Lymphoma cells had a monocytoid, centrocytoid and, in group A, lymphoplasmacytic morphology. The lymphomatous cells were positive for CD20, CD45 RA, and bcl-2. They expressed IgD in 9 cases, partially in 6, and were negative for IgD in 9 of the 24 cases studied. Progression seems to be slow, with a long survival. Three patients presented with transformation into a large B-cell lymphoma, which was responsible for death in two patients.

A new set of monoclonal antibodies against acute lymphoblastic leukemia.

Six monoclonal antibodies produced by immunization of Balb/c mice with common acute lymphoblastic leukemia (cALL) cells were tested against various types of normal and malignant tissues. ALB1 and ALB2 are directed to the cALL antigen (CALLA gp100); ALB6 recognizes a determinant of p24; ALB7, ALB8 and ALB9 have a pattern of reactivity similar to Ba1. None of these antibodies specifically identify cALL but they should be useful tools for diagnosis or depletion of bone marrow in autologous therapy in transplantation. In addition, the example of ALB6 which acts as a platelet aggregating agent, suggests that the study of other cell systems expressing the antigens associated with cALL may shed light on the function of these antigens and subsequently on the physiopathology of the leukemic cells.

Detection of binding sites for spiroperidol on leukemic cells: its value for the phenotype characterization of lymphoid leukemias.

The specific binding of the dopamine antagonist spiroperidol was studied in leukemic cell samples of various phenotypes. Among these only B-cell samples from chronic lymphocytic leukemias (7/7) and some "null" cell samples from acute lymphoblastic leukemias (2/7) showed specific binding. B cells from a prolymphocytic leukemia were negative as were also T-lymphoïd and non-lymphoïd leukemic cells at different stages of maturation. This pattern can be clearly correlated with the previous results obtained with normal blood cells and on cell lines. Moreover, it suggests that the detection of spiroperidol binding sites could provide a new means of distinguishing different phenotypes among B cells and early lymphoïd cells. Our results open the way to further studies which might show a correlation between spiroperidol binding sites and the new immunological markers defining subsets among non-T lymphoïd cells, as well as defining their physiological meaning.

Full-term pregnancy with embryos from donated oocytes in a 36-year-old woman allografted for chronic myeloid leukemia.

We report the first case of full-term pregnancy arising from donated oocytes in a 36-year-old woman with chronic myeloid leukemia (CML), 6 years after allogeneic bone marrow transplantation (BMT) following total body irradiation (TBI) (12 Gy) and cyclophosphamide 120 mg/kg. The first attempt at implantation with her own cryopreserved ovocytes was unsuccessful. Thereafter, she became pregnant after donated oocyte implantation using estradiol and progesterone support replacing the defective ovarian function. The baby was normal. Unfortunately, 6 months later, she relapsed in chronic phase of CML.

Mediastinal infusion of epirubicin and 5-fluorouracil. A complication of totally implantable central venous systems. Report of a case.

Perforation of the wall of the superior vena cava by a central venous catheter is reported. The resultant inadvertent infusion of 5-fluorouracil and epirubicin caused a severe acute inflammatory reaction in the right-lobe bronchus, mediastinal infiltration and pleural and pericardial effusions. The patient recovered but has residual mild oesophageal dysfunction.

Angiofollicular and plasmacytic polyadenopathy: a pseudotumourous syndrome with dysimmunity.

Two cases are reported of an apparently distinct type of immune disorder. Beginning with mild anaemia and widespread massive lymphadenopathy, the disease progressed to a fatal autoimmune type haemolytic anaemia. Serum investigation showed polyclonal hypergamma-globulinaemia and some autoantibodies. Repeat lymph node biopsies in each case showed hyperplasia within B lymphocyte territory (follicular hyperplasia and polyclonal plasmacytosis with IgG predominance) and atrophy of T dependent areas. Dilatation of lymph sinuses, vascular proliferation, and sclerosis were striking features. This appears to be a new entity, and reasons are given for separating this disease from other pseudotumourous lymph node disorders associated with dysimmunity.

Lysosomal localisation of parallel tubular arrays in chronic lymphocytic leukaemia of T cell origin: an ultrastructural cytochemical study.

An ultrastructural cytochemical study of lysosomal acid phosphatase was performed on leukemic cells in a case of chronic lymphocytic leukaemia of T cell origin (T-CLL). The cells showed inclusion bodies known as parallel tubular arrays, which often lay within acid phosphatase-positive, membrane-bound spaces. This suggests their lysosomal location.

Three cases of preleukemic myelodysplastic disorders with the same translocation t(1;3).

The same translocation, t(1;3)(p36;q21), was observed in three patients with a preleukemic syndrome presenting as a myelodysplastic disorder. It was the only chromosomal abnormality in two patients; and the third patient had 12p- and 15q- as additional abnormalities. The three cases evolved into acute nonlymphocytic leukemia.

Peripheral-T-cell lymphoma with hemophagocytic histiocytosis localised to the bone marrow associated with inappropriate secretion of antidiuretic hormone.

A patient with high fever, loss of weight and profound pancytopenia is reported. Peripheral T-cell lymphoma with hemophagocytosis was diagnosed. Bone marrow was the only localisation of the lymphoma. At presentation there were (i) a coagulopathy consistent with hemophagocytic histiocytosis (ii) the features of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). These different abnormalities disappeared after chemotherapy and reappeared during each of the 2 periods of disease progression. The patient died 6 months after diagnosis without ever achieving complete remission. As far as we are aware this is the first case report of T-cell lymphoma with hemophagocytic syndrome localised to the bone marrow and associated with SIADH.

Incubation of monocytes with adriamycin increases secretion of hepatocyte stimulating factor for fibrinogen biosynthesis.

This work provides evidence that the production by monocytes of hepatocyte stimulating factor(s) for fibrinogen biosynthesis was dramatically increased when monocytes were exposed to Adriamycin. This effect was related to an increased production of leukaemia inhibiting factor (LIF), a cytokine known to stimulate fibrinogen biosynthesis by hepatic cells. Adriamycin also induces an increase in membrane-associated urokinase on monocytes. These results are consistent with the clinical observation in patients with ovarian cancer that when the CA-125 tumour marker decreases during chemotherapy, an increased level of D-dimer is a marker of good prognosis.

Large anaplastic cell Ki-1 positive malignant lymphoma with peculiar endocytotic vacuoles.

Unusual intracytoplasmic inclusions are occasionally seen in some variants of malignant lymphoma. We report here a case of large anaplastic cell malignant lymphoma with peculiar vacuoles of probable endocytotic origin. Immunological findings demonstrated the characteristics of activated cells typical of a large anaplastic cell Ki-1 positive lymphoma. The tumour cells exhibited a phenotype of peripheral helper-inducer T-cells. The intracytoplasmic vacuoles were positive with the T surface marker antibodies. Ultrastructurally, these inclusions were closely related to the microvesicle-containing vacuoles reported in signet ring cell lymphomas of B or T cell lineage. The mechanism of cytoplasmic vacuole formation is discussed. An endocytotic origin is possible. The resemblance to the "capping" phenomenon in small lymphocytes is stressed.

[Centroblastic and centrocytic centroblastic malignant lymphomas, predominantly splenic (or primary of the spleen). Anatomo-clinical study of 17 cases]. / Les lymphomes malins centroblastiques centrocytiques et centroblastiques à prédominance splénique (ou primitifs de la rate). Etude anatomo-clinique de 17 cas.

Seventeen cases of splenic centroblastic-centrocytic or centroblastic lymphoma are reported. A large splenomegaly is discovered in all these cases as the prominent symptom. For this reason, all these cases can be considered as primary lymphoma of the spleen. Splenectomy is done in 7 cases for diagnosis a period of 2 to 8 months after the discovery of the splenomegaly. In these patients, no bone marrow biopsy was performed before splenectomy. In 8 other cases, the diagnosis of follicular lymphoma is proposed on a bone marrow biopsy performed with the aim to disclose an etiology for the splenomegaly. In 3 of these cases, a lymph node (2 cases) or a tonsil biopsy (1 case) discover a tumoral localization before the splenectomy. In the 2 last cases, the diagnosis is recognized on a lymph node biopsy. The most important clinical and biological data are compared for these 17 patients. The anatomopathological data are described. In 15 cases, a multimicronodular pattern is recognized on the spleen section. The 2 other cases express a multimacronodular pattern. The weight of the spleen is comprised between 450 and 3,350 g, with only 6 spleens weighing less than 1,000 g. The spleens with multimicronodular pattern correspond to a follicular centroblastic centrocytic lymphoma of low grade of malignancy in the Kiel-Lennert classification. The 2 multimacronodular spleens exhibit the histological aspect of a polymorphous centroblastic lymphoma of a high grade of malignancy. The equivalent of these histological types are given in the Working Formulation. The diagnosis with others diseases of the spleen is discussed. For fourteen patients, the follow-up is available. Six patients are alive, with an evolution of many years. Because of the few number of cases, it is not possible to correlate the histological subtypes according to Kiel or to the WF, and the clinical stage with the evolution. To perform such correlation, a multicentric study should be organized.

[Conjunctival in situ carcinoma in a patient with Waldenström's disease]. / Carcinome in situ de la conjonctive chez un patient porteur d'une maladie de Waldenström.

A 73-year-old male patient was treated for conjunctival in situ carcinoma invading the cornea of his right eye. The patient had been previously operated on for two corneoconjunctival lesions on the same eye (one was a pterygium, the other was simple epithelial hyperplasia) and was regularly followed for a systemic lymphoplasmocytic lymphoma (Waldenström's disease). After a corneoconjunctival excision of the tumor, the histological analysis was performed and established the diagnosis of in situ carcinoma. The tumor recurred a few months later and radiation therapy was then given. No recurrence was observed after this latter treatment.

[Peripheral T-cell malignant lymphomas. Clinical, morphologic and developmental features in 22 cases]. / Lymphomes malins T périphériques. Aspects cliniques, morphologiques et évolutifs de 22 cas.

Peripheral T-cell lymphomas (PTCL) represent a new subset of malignant lymphomas, which demonstrates a marked morphological, immunological and clinical diversity. They seem to have a worse prognosis globally than B-cell lymphomas. The main clinical characteristics and outcome of PTCL are analysed in this series of 22 cases. The majority of patients had an advanced disease (stages III and IV; 55 percent) and constitutional symptoms (59 percent) at presentation; extranodal localizations were particularly frequent (41 percent). Three patients presented with isolated or predominant spleen enlargement and fever. According to the updated Kiel classification, there were 7 low-grade PTCL and 15 high-grade PTCL. Phenotypic analysis on fresh frozen tissue was available in 16 cases, showing a predominant helper/inducer phenotype (CD4+, CD8-). The complete remission rate was 76 percent for the whole population, but the median of global survival was only 40 months. The few patients who received radiation therapy and subsequently relapsed did not relapse in the irradiated fields, which suggests that radiotherapy might be included in the therapeutic strategy, the best modalities of which remain to be defined.