[Viruses involved in allograft recipients'cutaneous carcinomas]. / Virus impliqués dans les carcinomes cutanés des greffés rénaux.

BACKGROUND: Cutaneous carcinomas are frequent in renal allograft recipients. Their treatment can be difficult especially in cases of multiple carcinomas. The aim of this study was to determine whether human papillomavirus are more frequent in patients group with multiple cutaneous carcinomas and whether other viruses such as Epstein-Barr virus, cytomegalovirus, and herpes simplex might be associated in this kind of tumour. PATIENTS AND METHODS: Forty-three patients were included. Twenty-two had a single carcinoma (group 1) and 21 had multiple cutaneous carcinomas (group 2). Histologic analysis and in situ hybridization were used to search for Epstein-Barr virus, human papillomavirus, herpes simplex virus and cytomegalovirus latency genes. RESULTS: In both groups, epidermoid carcinomas were more frequent than basal cell carcinomas and delay between graft and first carcinoma was similar (5 years). In situ hybridization was more often positive in group 2 (41/50) than in group 1 (13/22). Human papillomavirus DNA was detected more frequently in the group with multiple carcinomas (26/50) than in the group with a single carcinoma (6/22). Moreover, cytomegalovirus was more frequent in group 2. CONCLUSION: This study shows a higher prevalence of human papillomavirus DNA in the carcinomas of the multiple carcinoma population. Moreover, for the first time, cytomegalovirus DNA was detected in carcinomas of renal allograft recipients with a higher frequency in the patients with multiple carcinomas.

[Primary cutaneous cryptococcosis in HIV-seronegative subjects]. / Cryptococcoses cutanées primitives chez des sujets séronégatifs pour le VIH.

BACKGROUND: Primary cutaneous cryptococcosis is an uncommon clinical entity characterized by direct skin inoculation without systemic involvement. We report four cases of this affection in HIV-negative patients seen between 1990 and 1999 in Nantes Dermatological Clinic. CASE REPORTS: Patients mean age was seventy. Three patients had recent exposure to soil or birds, and two remembered a trauma before the lesion appeared. In three cases the lesion was on the hand. In two cases the lesion was an ulcerated nodule, in another an abscess and in the last a cellulitis. Two subjects were treated by fludarabin and systemic corticosteroids for respectively chronic lymphocytic leukemia and Waldenstrom's macroglobulinemia. The third had a CD4 lymphopenia. Cultural examination confirmed the diagnosis. Treatment, with fluconazole in 3 cases and ketoconazole and itraconazole in 1 case, resulted in healing of the skin lesion in a few months. DISCUSSION: Recognition of primary cutaneous cryptococcosis as a clinical entity has long been debated. An altered immunological status is an important factor for developing this disease. There is often a clear history of trauma or exposure to soil or birds preceding the development of the lesion. Clinically it often looks like a papule or an ulcerated nodule. The lesion is confined to the skin without systemic involvement. The prognosis is excellent thanks to the use of oral antifungal imidazoles.

Primary cutaneous B-cell lymphomas of the lower limbs: a study of integrin expression in 11 cases.

Primary cutaneous B-cell lymphoma is a rare disease. Among the cutaneous B lymphomas, B-cell lymphomas of the lower limbs appear as a special subgroup with a prognosis that is possibly worse than that of primary cutaneous B-cell lymphomas located on the trunk, arms or head, with more frequent relapses. In addition, some recent studies indicate that the level of expression of integrins on tumour cells could be related to the clinical course of the disease. This study reports on 14 cases of primary cutaneous B-cell lymphomas of the lower limbs and their clinical course. A study of integrin expression by tumour cells was performed in 11 of these cases. With a mean follow-up of 31 months, the study confirmed the worse prognosis of lymphomas with a predominance of centroblasts and immunoblasts (3 deaths) compared with lymphomas with a predominance of centrocytes, as well as their higher rate of recurrence (7/11). A correlation was confirmed between the course of the disease and the level of expression of lymphocyte function-associated antigen-1, intercellular adhesion molecule-1 and very late antigen-4 by tumour cells.

[IgM kappa lymphoma with antisulfatide antibodies revealed by cervical motor neuropathy simulating amyotrophic lateral sclerosis]. / Lymphome à IgM kappa avec anticorps antisulfatides révélé par une neuropathie motrice cervicale simulant une sclérose latérale amyotrophique.

INTRODUCTION: It is well known that polyneuropathy is associated with monoclonal IgM kappa. EXEGESIS: We report the case of a 79-year-old man with lymphoma and motor neuron disease at cervical level simulating amyotrophic lateral sclerosis (ALS). Neurological deficit with inflammatory process evolved within 4 months. Electrophysiological findings showed increased and enlarged muscular potentials with neurogenic patterns. Nerve conduction velocities were normal, with neither multifocal neuropathy nor persistent conduction blocks. Besides mixed cryoglobulinemia type II, antisulfatide antibodies issued from monoclonal IgM were found. They were directed against myelin glycosphingolipids. No antiganglioside GM1 antibodies could be detected. This not only evoked ALS but also proximal motor axonopathy related with monoclonal IgM. CONCLUSIONS: This case suggests that antisulfatide antibodies often present in sensitive demyelinating polyneuropathy could also be involved in lower motor neuron syndrome.