Parasites and malignancies, a review, with emphasis on digestive cancer induced by Cryptosporidium parvum (Alveolata: Apicomplexa).

The International Agency for Research on Cancer (IARC) identifies ten infectious agents (viruses, bacteria, parasites) able to induce cancer disease in humans. Among parasites, a carcinogenic role is currently recognized to the digenetic trematodes Schistosoma haematobium, leading to bladder cancer, and to Clonorchis sinensis or Opisthorchis viverrini, which cause cholangiocarcinoma. Furthermore, several reports suspected the potential association of other parasitic infections (due to Protozoan or Metazoan parasites) with the development of neoplastic changes in the host tissues. The present work shortly reviewed available data on the involvement of parasites in neoplastic processes in humans or animals, and especially focused on the carcinogenic power of Cryptosporidium parvum infection. On the whole, infection seems to play a crucial role in the etiology of cancer.

Eosinophil counts in upper digestive mucosa of Western European children: variations with age, organs, symptoms, Helicobacter pylori status, and pathological findings.

AIM: The aim of the study was to measure the number of eosinophils per high-power field (eos/HPF) according to age, organs, and clinical symptoms and to compare the results to histological characteristics of the upper digestive tract mucosa in children. PATIENTS AND METHODS: A systematic prospective assessment of 284 esophagus, 342 antrum, 453 corpus, and 167 duodenum biopsies was carried out in 316 girls and 366 boys referred for endoscopy (median age 9 months), eos/HPF, and histological analysis. RESULTS: Counts (mean-max SD) were as follows: esophagus 1.73 to 50 eos/HPF (5.35), antrum 3.27 to 40 (4.7), corpus 2.11 to 38 (3.76), and duodenum 4.80 to 46 (7.7). Counts >15 eos/HPF were found in 2.8% esophagi, 3.5% corpora, 4.9% antra, and 10.7% duodena. Duodenal eos/HPF were significantly higher than those of esophageal, corporeal, and antral. Mucosal eos/HPF increased with age in esophagus and antrum. The highest esophageal eos/HPF were significantly associated with recurrent abdominal pain, and with anemia in antrum, corpus, and duodenum. Major and/or minor histological features of eosinophilic esophagitis were seen in 9 of 10 esophagi with 5 to 15 eos/HPF and 7 of 8 esophagi with >15 eos/HPF. Eosinophils per high-power field were significantly correlated with histological antral and corporeal gastric inflammation. Helicobacter pylori-positive children had higher eosinophils per high-power field than H pylori negative ones both in esophagus and in antrum. CONCLUSIONS: The present study shows that in a western European country mucosal hypereosinophilia is rare. Mucosal eosinophil counts increase from esophagus to duodenum, and also with age in esophagus and antrum. The highest eos/HPF in the esophagus are associated with recurrent abdominal pain and in the corpus, antrum, and duodenum with anemia. Features of eosinophilic esophagitis are rare but detectable in association with counts as low as 6 eos/HPF.

In French children, primary gastritis is more frequent than Helicobacter pylori gastritis.

The aim of this study was to analyze the histological characteristics according to the updated Sydney classification (intensity of gastritis, degree of activity, gastric atrophy, intestinal metaplasia, and Helicobacter pylori) in symptomatic children referred for upper gastrointestinal endoscopy. A 4-year retrospective descriptive study was carried out in 619 children (282 females and 337 males), median age 3.75 years (15 days to 17.3 years) referred for endoscopy. Six gastric biopsies were done (three antrum and three corpus) for histological analysis (n = 4), direct examination and H. pylori culture (n = 2). H. pylori status was considered positive if at least two out of three tests were positive and negative if all three tests were negative. The results showed that only 66 children (10.66%) were H. pylori positive. Histological antral and corpus gastritis was detected in, respectively, 53.95% and 59.12% of all cases, most of them of mild grade 1. Antral and corpus activity was grade 1 in 18.57% and 20.03% of cases. H. pylori-positive versus H. pylori-negative children did differ in terms of moderate and marked histological gastritis and grade 2 or 3 activities. One girl had moderate gastric atrophy and another one moderate intestinal metaplasia, both being H. pylori negative. The findings indicate that primary antrum and corpus gastritis is 5.3 and 6.9 times, respectively, more frequent than H. pylori gastritis in French children, with usually mild histological gastritis and activity. Gastric atrophy and intestinal metaplasia are rare.

[A pseudotumoral cutaneous form of sarcoidosis associated with non-Hodgkin lymphoma]. / Sarcoïdose cutanée pseudotumorale associée à un lymphome malin non hodgkinien.

BACKGROUND: Sarcoidosis may be revealed by a variety of cutaneous signs, occasionally atypical. It may also be associated with a lymphoma. Herein we report an original case of pseudotumoral cutaneous sarcoidosis associated with malignant non-Hodgkin's lymphoma (MNHL). PATIENTS AND METHODS: A 64-year-old man was hospitalised for follicular and diffuse large B-cell MNHL localised in the cervical, subclavicular and inguinal lymph nodes. The skin examination revealed a bulky, erythematous, purple, infiltrated mass in the right lumbar region and two similar but smaller plaques in the dorsal region. The lesions were asymptomatic, present for six years, and stable. Histological examination of a skin biopsy sample revealed an epithelioid giant-cell granuloma without caseous necrosis. Bacteriological and mycobacteriological samples were sterile. Mediastinal adenopathies and pulmonary micronodules were found on CAT scan. A diagnosis of cutaneous and pulmonary sarcoidosis associated with the lymphoma was made. Polychemotherapy using CHOP combined with rituximab resulted in remission of the lymphoma but was ineffective against the sarcoidosis. COMMENTS: Pseudotumoral forms of sarcoidosis are rare and have a misleading clinical aspect. In our case, the cutaneous mass was evocative of a secondary lymphoma site. The diagnosis of sarcoidosis was based on clinical and laboratory findings and after elimination of other potential causes of granuloma. The appearance of a lymphoma in a patient with a history of sarcoidosis is rare but not fortuitous, since the notion of "sarcoidosis-lymphoma syndrome" exists. The incidence of lymphomas is 5.5-fold higher in patients presenting sarcoidosis than among the general population. Their time to onset is around 7 years after the discovery of sarcoidosis. The most common forms involve Hodgkin's disease. The efficacy of therapy on the blood disease underlying the sarcoidosis is variable.

Colonic obstruction and perforation related to heavy Trichuris trichiura infestation.

Heavy Trichuris trichiura infestation is rare in developed countries, and complications requiring surgical intervention have been described rarely in human trichuriasis. A case of colonic obstruction and perforation related to heavy whip-worm infection is described in an 84 year old woman. The woman was admitted to hospital because of a chest infection. Two days after admission she suffered nausea and vomiting followed a day later by bowel stoppage. Laparotomy indicated intestinal obstruction by a tumour. A partial right sided ileocolectomy was performed. Pathological examination of the resected bowel revealed heavy infestation with T trichiura causing a pseudotumour following a proliferative inflammatory response.

Morphological and ultrastructural methods for Pneumocystis.

Pneumocystis is a eukaryotic unicellular microorganism with marked fungal affinities. All known life cycle stages of this parasite were observed in the lung of mammals. The cystic forms of this microorganism may be observed microscopically by using stains with affinity for the components of their relatively thick cell wall. However, about 100 years ago they were observed for the first time thanks to panoptic stains which do not stain their cell wall. Methanol-Giemsa technique as well as Giemsa-like rapid stainings are often used to reveal vegetative or cystic forms of this parasite on air dried smears of clinical or experimental samples. For many years, hypotheses on its life cycle, which remains unknown, were based on transmission electron microscopy (TEM) studies. However, only for the last years progresses in the quality of fixation for TEM led to a better understanding of the Pneumocystis cell structure. In this chapter, strategies to reveal Pneumocystis organisms in clinical or experimental specimens by using light microscopy, as well as techniques allowing a good preparation of parasitic samples for TEM, are given and shortly discussed.

Immunohistochemical contribution to the study of morphine metabolism in Calliphoridae larvae and implications in forensic entomotoxicology.

Morphine was detected by immunohistochemistry on sections of third stage larvae of Calliphora vomitoria (Diptera, Calliphoridae) reared on minced beef meat previously treated with morphine hydrochloride. The detection was performed with an avidin-biotin-peroxidase-complex method. Positive specimens showed specific staining of the haemolymph and a more intense immunoreaction in an area located at the limit between exocuticle and endocuticle. These results constitute an evidence of morphine accumulation inside the cuticle of Diptera larvae during their development. During the pupariation, the larval cuticle is transformed into the sclerotized puparium. This study consequently points out the possibilities of analyzing empty pupariae when suitable tissues or living necrophagous insects are absent.

[Primary liposarcoma of the left atrium surgically treated]. / Liposarcome primitif de l'oreillette gauche opéré.

A case of myxoid liposarcoma of the left atrium in a 35-year old man is reported. The tumour, revealed by an atrial flutter, was excised. The patient died 13 months later, with multiple metastases. A review of the literature yielded only 7 cases of primary liposarcoma of the heart, including 4 which were surgically treated. This confirms the extreme rarity of a tumour which has a very poor prognosis due to recurrence in situ or metastatic spread.

[Prevalence of hepatitis C, B and D markers and histopathological aspects in a group of intravenous drug addicts]. / Prévalence des marqueurs des hépatites C, B et D et aspects histopathologiques dans un groupe de toxicomanes intraveineux.

OBJECTIVES: The aim of this study was to assess the prevalence of infection by HCV, HBV, HDV and HIV and their biological and histopathological patterns in 104 intravenous drug users. METHODS AND RESULTS: Seventy-five patients (72%) had anti-HCV antibodies. Transmission was rapid because 33% of those who had been drug users for 6 months or less had anti-HCV antibodies. The contamination rate was very high because 90% of those who had been drug users for 2 years or less had anti-HCV antibodies. Thirty-four (33%) had an HBV marker, and 6 were HBs Ag carriers. None of the patients had anti-HDV antibodies. Only one patient had anti-HIV antibodies. Twenty-five anti-HCV antibody positive drug users underwent liver biopsy. Seven (28%) had normal ALAT levels and 18 (72%) had permanently or intermittently elevated ALAT levels. The mean histological activity on the Knodell index was 4.1 (range: 1-8). CONCLUSIONS: This study indicates that contamination by HCV is almost inevitable after 2 years of intravenous drug use. The low prevalence of HBV, HDV, and HIV infection might be explained by a low endemic state of these viruses in our area.

[Ovarian tumor and Peutz-Jeghers syndrome. A case report]. / Tumeurs ovariennes et syndrome de Peutz-Jeghers. A propos d'un cas.

A case of Peutz-Jeghers syndrome associated with ovarian mucinous cystadenoma and ovarian sex cord tumor with annular tubules is presented. The sec cord tumor with annular tubules was described in 1970 by Scully, who recognized its striking association with the Peutz-Jeghers syndrome. This tumor is an almost constant finding in patients' ovaries with this disorder. Three cases of ovarian mucinous cystadenoma and sex cord tumor with annular tubules associated with Peutz-Jeghers syndrome were found in the literature. Our observation confirms that gynecologic abnormalities are an important manifestation of the syndrome and require careful surveillance.

[Gastric schwannoma. Observations apropos of a case report of an schwannosarcoma with lymph node metastasis]. / Les schwannomes gastriques. Réflexions à propos d'une observation d'une schwannosarcome avec métastase ganglionnaire.

Schwannomas as neurofibromas are neurogenic mesenchymal tumors of the stomach. They arise from the Schwann cells of nerves of th gastric wall and are usually benign. The incidence of malignant schwannomas is uncertain because of the variable pathologic criteria used. Immunohistochemistry is a diagnostic tool used to distinguish between schwannomas and leiomyomas both constituted by spindle-cells. In this issue we report a case of malignant schwannoma with lymph node involvement. The clinical and histological features of gastric schwannomas are discussed with evaluation of their diagnostic and therapeutic modalities.

[Hepatocellular carcinoma in asymptomatic primary biliary cirrhosis]. / Carcinome hépatocellulaire sur cirrhose biliaire primitive asymptomatique.

Hepatocellular carcinoma is an uncommon complication of primary biliary cirrhosis. Hepatocellular carcinoma occurs generally in the end stage of the disease. We report a case of asymptomatic primary biliary cirrhosis complicated by a hepatocellular carcinoma in a 66 year-old man.

[External ionizing radiation on the prosthesis-arterial anastomosis for the prevention of intimal hyperplasia and study of biomechanical resistance. Experiments and results]. / Radiations ionisantes délivrées par voie externe sur l'anastomose prothéto-artérielle pour limiter l'hyperplasie intimale et étude de la résistance biomécanique. Expérimentations et résultats.

PURPOSE: To evaluate the use of external ionizing radiation for the prevention of intimal hyperplasia in anastomosis between PTFE and artery. METHODS: Bypass using a 6 mm PTFE was performed on a swine subrenal aorta with a distal conventional anastomosis (N = 35) associated (test group; N = 17) or not (control group; N = 18) with post-operative external radiation (20 Gy) on this anastomosis. At 45 days, histological studies and morphometric studies were performed on the aorta receiving the anastomosis. Two protocols were performed, the first protocol with standard analysis and the animals were randomly assigned to either group (test group; N = 11 and control group; N = 13) and the second protocol with test of extraction comparing the biomechanical resistance between the irradiated group (N = 6) and the control group (N = 5). RESULTS: Twenty-one animals survived the procedure in the first protocol, 11 in the second. The endothelium was restored in either group. Histological recasting was observed in the media after radiation with fibrosis and areas of necrosis. Intimal thickness was significantly lower after irradiation in the heel (P < 0.01), the head (P < 0.01) and the suture line (P < 0.001) of the artery in the first protocol. The intimal thickness was also significantly lower in the second protocol after radiation in the heel (P < 0.05) and the head of the artery (P < 0.05). There was no difference between the two groups comparing the resistance. CONCLUSION: After external irradiation, the thickness parameter of the intima decreased significantly in comparison with the control group with similar resistance. Media fibrosis and necrosis need to be confirmed by further investigation.

Keratosis lichenoides chronica: report of a new case, with success of PUVA therapy.

Keratosis lichenoides chronica is a rare disorder. It consists of the progressive development of asymptomatic verrucosities on the limbs and the trunk, with a partially linear distribution. We report the case of a 78-year-old woman who presented with keratotic plaques and papules of the trunk and the limbs for several years. A diagnosis of keratosis lichenoides chronica was clinically and histologically evident. PUVA-therapy was started, with excellent results.

[Symmetrical benign lipomatosis of the tongue and Launois-Bensaude lipomatosis]. / Lipomatose bénigne symétrique de la langue et lipomatose de Launois-Bensaude.

BACKGROUND: There are many causes of macroglossia, including fatty infiltration. Unlike unique or multiple lipomas of the tongue, non-encapsulated adipocyte masses develop in the tongue in symmetrical benign lipomatosis. Only six cases have been reported in the literature. CASE REPORT: A 69-year-old man with a history of chronic alcoholism developed a soft tumefied formation on the lateral margins of the tongue. A yellow-colored content was perceived through the thin mucosa. The formation was bilateral and had developed for more than 10 years. The patient also presented Launois-Bensaude lipomatosis localized on the neck, the nuchal region and the shoulders. DISCUSSION: This is, to our knowledge, the first reported case of symmetrical benign lipomatosis associated with Launois-Bensaude lipomatosis. An analogy between these two conditions has been suggested, but the six earlier cases of lipomatosis of the tongue reported in the literature developed in patients without cutaneous lipomatosis.

[Eosinophilic bladder disease]. / Cystopathies à éosinophiles.

The authors present ten cases of eosinophil cystopathy and recall the very varied clinical signs of this disease: pollakiuria, haematuria, dysuria and the findings of complementary investigations: possible dilatation of the upper urinary tract, thickening of the bladder wall. Biopsy is essential and reveals lymphocyte and plasma cell infiltration and numerous eosinophils. The treatment administered was either immunosuppressants or dimethyl sulphoxide.

[Leiomyoma of the bladder]. / Leiomyome de la vessie.

The authors report a case of bladder leiomyoma. They emphasise its rarity and the important role of medical imaging in its preoperative diagnosis, which can only be confirmed with certainty by histological examination. Treatment must be surgical with complete resection and the prognosis is excellent.

[Rheumatoid polyarthritis and interstitial cystopathy]. / Polyarthrite rhumatoïde et cystopathie interstitielle.

The authors report a case of interstitial cystitis occurring in association with very active rheumatoid arthritis. Although the association of immune disorders and rheumatoid arthritis is well known, cases of concomitant vesical lesions have only been reported exceptionally. The diagnosis of interstitial cystitis is based on histology and immunofluorescence studies. The pathogenetic hypothesis remains uncertain: is this a primary bladder disease or a systemic auto-immune disease with a urinary tract expression? The success of immunosuppressant treatment in this case of cystitis is in favour of the second hypothesis.

Structural modifications in the arterial wall during physiological aging and as a result of diabetes mellitus in a mouse model: are the changes comparable?

AIM: Vascular accelerated aging represents the major cause of morbidity and mortality in subjects with diabetes mellitus. In the present study, our aim was to compare premature functional and morphological changes in the arterial wall resulting from streptozotocin (STZ)-induced diabetes mellitus in mice over a short-term period with those that develop during physiological aging. The effect of aminoguanidine (AG) on the prevention of these alterations in the diabetic group was also analyzed. METHODS: The vascular relaxation response to acetylcholine (ACh) in the mouse was tested in isolated segments of phenylephrine (Phe)-precontracted aorta at 2, 4 and 8 weeks (wk) of STZ-induced diabetes and compare to 12- and 84-wk-old mice. Aortic structural changes were investigated, and receptor for AGE (RAGE) aortic expression was quantified by western blot. RESULTS: Compared to the 12-wk control group (76 ± 5%), significant endothelium-dependant relaxation (EDR) impairment was found in the group of 12-wk-old mice, which underwent a 4-wk diabetes-inducing STZ treatment (12wk-4WD) (52 ± 4%; P < 0.01) and was yet more apparent in the group of 16-wk-old mice, which underwent an 8-wk diabetes-inducing STZ treatment (16wk-8WD) (34 ± 4%; P < 0.001). The alteration in EDR was relatively comparable between the diabetic 12wk-4WD group and the 84-wk-old group (52.7 ± 4 vs. 48 ± 4%). Intima/media aortic thickening and aortic structural changes were significantly increased in the diabetic 12wk-4WD group and were even more apparent in the 84-wk group compared to the 12-wk controls. AG treatment in the 12wk-4WD+AG diabetic group significantly improved EDR, decreased RAGE expression and showed an aging preventive effect on the structural changes of the arterial wall. CONCLUSION: Our study compared EDR linked to physiological aging with that observed in the case of STZ-induced diabetes over a short-term period, and demonstrated the beneficial effect of AG.