[Münchausen syndrome with forgery on biologic results. A case report]. / Pseudoleucémie par falsification d'examens biologiques: genèse d'un syndrome de Münchausen.

Münchausen syndrome is a disorder defined by the following: acute factitious symptoms leading to inappropriate investigation and therapy, a restless journey from hospital to hospital and autobiographical falsification. We report here a 20-year-old woman who presented at our hospital consultation of internal medicine with laboratory-test results suggesting the diagnosis of leukemia. A new complete blood cells count and a medullogram by sternal puncture did not show any abnormality. Comparative examination of laboratory-test sheets lead to the diagnosis of Münchausen syndrome as some results had been falsified. With unlimited access to information through internet and word or image processing softwares, laboratory results have become easy to falsify nowadays, particularly for patients with Münchausen syndrome, who may then be quite difficult to diagnose accurately in the context of medical consultation.

[Surveillance and prognosis of "Ta" superficial tumors of the bladder. Homogeneous series of 138 cases followed for 1 to 18 years]. / Surveillance et pronostic des tumeurs superficielles "Ta" de vessie. Une série homogène de 138 cas suivis de 1 à 18 ans.

OBJECTIVE: To identify prognostic factors (risk of recurrence and risk of progression) and define the rules for the surveillance of stage Ta superficial bladder cancers, based on the follow-up of a homogeneous patient series. MATERIAL AND METHOD: 138 Ta bladder cancers were recruited from 1975 to 1995 and regularly followed by the same urologist. The follow-up was 1 to 18 years with a mean of 66 months and a median of 60 months. RESULTS: 30% of patients developed no recurrence (mean follow-up: 52 months). 70% developed one or several recurrences (mean follow-up: 80 months): 46% of Ta recurrences without progression and 24% of T > or = 1, with 10% of T > 1 recurrencesed. 13/138 patients died from bladder cancer, including 11 patients in less than 10 years. The risk of recurrence and the risk of progression were significantly correlated with: the macroscopic appearance of the cancer: size, number and extent of implantations, sessile or pedunculated nature, its site: slightly more serious on the fixed part of the organ, its clinical course assessed over the first 12 months: in patients without recurrence at 12 months: the risk of recurrence decreased from 70% to 35% the risk of deterioration decreased from 24% to 10%. However, this risk persisted in the long term: after more than 5 years without recurrence, 2 patients developed fatal recurrences, 11 and 15 years after the initial treatment. CONCLUSION: Although superficial, Ta bladder cancers are serious cancers. The risk of recurrence and progression justify close surveillance in the year following diagnosis. Subsequently, the frequency of follow-up can be adapted to the specific course of each case, but, regardless of these modalities, long-term (indefinite?) surveillance is recommended.

[Surveillance and prognosis of "T1" superficial tumors of the bladder. Homogeneous series of 88 cases followed for 1 to 22 years]. / Surveillance et pronostic des tumeurs superficielles "T1" de vessie. Une série homogène de 88 cas suivis de 1 à 22 ans.

OBJECTIVE: Define the prognostic factors (risk of recurrence and risk of progression) and the rules for surveillance of stage T1 papillary bladder tumours based on the clinical course of a homogeneous patient series. MATERIAL AND METHOD: 88 T1 bladder tumours recruited from 1975 to 1995 and regularly followed by the same urologist. The follow-up ranged from 1 to 22 years with a mean of 52 months and a median of 48 months. RESULTS: 26% patients relapsed (mean follow-up: 71 months) 74% developed one or more recurrences (mean follow-up: 48 months) with recurrences staged > T1 in 35% of cases. 29/88 patients died from invasive bladder cancer, 14 before 3 years, 19 before 5 years, 28 before 10 years. The risk of recurrence and progression was statistically significantly related to the macroscopic appearance of the tumour; size, number and extent of implantations; its rate of progression assessed by the frequency of recurrence. In patients with no recurrence at 12 months, the risk of recurrence decreased from 74% to 50% and the risk of progression decreased from 35% to 20%. In this cohort, neither histological grading of the initial tumour, nor the degree of invasion of the submucosal lamina propria appeared to modify the prognosis. CONCLUSION: Stage T1 papillary bladder tumours, generally considered to be a superficial tumours regardless of their histological grade, have a serious prognosis and warrant close endoscopic surveillance during the year following the diagnosis. The subsequent frequency of follow-up can then be adapted to the specific mode of progression of each case, but, regardless of this mode of progression, the authors recommend long-term (life-long?) surveillance.

MR and CT findings in a case of hibernoma of the thigh extending into the pelvis.

Review of the literature shows no report of hibernoma of the thigh extending into the pelvis. Herein we report a case of hibernoma which appeared on CT and MR as a well-defined pelvic mass with contrast enhancement extending through the obturator foramen into the thigh. Fat was demonstrated by CT, whereas MR, using multiplanar sections, better analyzes the extension of the mass. This case demonstrates that hibernoma as liposarcoma can extend through the obturator foramen. However, no definite diagnosis could be made by CT or MR and the tumor must be considered as a "potential" malignant liposarcoma.

Hepatic lesions of vascular origin in multicentric Castleman's disease, plasma cell type: report of one case with peliosis hepatis and another with perisinusoidal fibrosis and nodular regenerative hyperplasia.

We report two cases of multicentric Castleman's disease, plasma cell type, associated with three different liver lesions. Peliosis hepatis was observed in one case and perisinusoidal fibrosis with nodular regenerative hyperplasia in the other. These observations give some evidence that Castleman's disease, per se, may be involved in these three presumably interrelated liver vascular lesions. These changes, already described in monoclonal lymphoproliferations such as myeloma and Waldenström's disease, may also be recorded in a disease characterized by a strong polyclonal plasma cell hyperplasia.

An unusual epithelial pleomorphic giant cell tumour of the pancreas with osteoclast-type cells.

A case of giant cell tumour of the pancreas with a mixture of pleomorphic giant cells and osteoclast-like cells is described. This association is rare and its histogenesis has been debated. The presence of a small differentiated adenocarcinomatous area at the periphery of the tumour indicates an epithelial origin. Moreover, some pleomorphic cells were positive for keratin (KL1). The osteoclast-like cells strongly expressed CD68 (a marker of histiomonocytic lineage) and did not show proliferative activity. They probably correspond to an unusual reaction of the stroma. Their clinical importance in this type of tumour remains unknown.

[Giant cell tumors of the pancreas. Clinical presentation]. / Tumeurs à cellules géantes du pancréas. Présentation clinique.

The authors report the case of a large tumor located at the tail of pancreas. Despite extensive surgery and absence of synchronous metastasis, death occurred after a short period of survival. The authors stress the lack of major clinical features of carcinoma of left pancreas and outline the high malignancy of giant cell type.

Proopiomelanocortin gene expression in normal and tumoral human lung.

Proopiomelanocortin (POMC) gene expression is not restricted to the pituitary corticotroph cell, but also takes place in many normal and tumoral nonpituitary tissues. In contrast, the ectopic ACTH syndrome is a rare event. Because it is most often associated with lung tumors, we specifically studied this tissue, analyzing the different forms of POMC RNAs in normal specimens as well as in various types of tumors. The endocrine nature of the tumors was assessed by both histological examination and measurements of secretogranin-I fragments in the tissue extracts. POMC RNA was first detected by Northern blot analysis; its absolute amounts and its various molecular forms were more precisely quantified and discriminated by S1 mapping studies using a single stranded DNA probe located at the 5' end of exon 3. In five bronchial carcinoid tumors associated with the ectopic ACTH syndrome, a highly predominant, if not single, POMC RNA identical to the 1200-nucleotide (nt) pituitary message was present, the high amounts of which were correlated with those of POMC peptides in the same tissues. In five bronchial carcinoid tumors not associated with the ectopic ACTH syndrome, the same message was detected (four of five), with a second, often predominant, short RNA of about 800 nt (five of five), and the overall amounts of POMC RNAs were low. Similar patterns of POMC RNAs were observed in squamous cell tumors, adenocarcinomas, and normal lung, where the short 800-nt RNA tended to be predominant. These results show that POMC gene expression can be demonstrated in normal lung tissue and in all types of lung tumors. The ectopic ACTH syndrome only occurs with tumors capable of generating high amounts of the pituitary-like message, a phenomenon that seems to be restricted to an occasional tumor with features of neuroendocrine differentiation.

[Cerebral cysticercosis. Apropos of a case treated with praziquantel]. / Cysticercose cérébrale. A propos d'une observation traitée par praziquantel.

The authors report a case of cerebral cysticercosis in a 17 year-old adolescent. Partial seizures and moderate functional signs of intracranial hypertension were the presenting symptoms. Treatment with Praziquantel under corticosteroid therapy was successful with almost complete disappearance of radiologic abnormalities on the computerised tomographic examination performed 7 months after the end of treatment.

[Calcinosis of childhood dermatomyositis. Apropos of 10 cases]. / Les calcinoses des dermatomyosites infantiles. A propos de 10 cas.

Twenty-eight children were diagnosed as having dermatomyositis (DM) on the basis of the criteria of Bohan and Peter. Ten of the 28 children developed calcinosis. Calcium deposits mainly occurred in DM with gradual onset of symptoms and with a chronic course. Calcinosis always appeared insidiously and early during the active stage of the disease. It persisted for a long time beyond the remission of the active muscle symptoms without tendency to spontaneous resolution. Long-term follow-up data substantiate calcinosis as the most frequent and the most serious sequela in this series of childhood DM.