Splitting bone marrow trephines into frozen and fixed fragments allows parallel histological and molecular detection of B cell malignant infiltrates.

Clonality analysis of the immunoglobulin heavy chain (IgH) gene is helpful in identifying malignant B cell infiltrates in the bone marrow and is usually carried out on separate aspirates or on the same formalin-fixed decalcified bone marrow specimen. To determine whether the removal of the decalcification step would improve the molecular analysis, we first studied 12 bone marrow specimens with lymphoma infiltration split into a fixed and a small frozen fragment. Both the detection rate of IgH gene monoclonality and DNA quality were found to be superior in the frozen part than in the fixed part. Conversely, to evaluate whether the split would compromise histological analysis, we selected a series of 134 bone marrow specimens obtained from patients with small B cell lymphoma and showing IgH monoclonality on the frozen part. The histological detection rate of infiltrated or suspicious infiltrates (95%) on the fixed part was not altered by saving a frozen part.

Bone loss in hypothyroidism with hormone replacement. A histomorphometric study.

To determine the influences of hormone replacement on bone tissue in primary hypothyroidism, a histomorphometric study on undecalcified transiliac bone specimens was performed before treatment in ten patients, during the first month of treatment in 16 patients, and after more than six months of treatment in 15 patients. There were no obvious clinical or biologic signs of excessive replacement therapy. Before treatment, trabecular resorption surfaces were lower and bone cortical thickness was increased. From as early as the first month of treatment, trabecular resorption surfaces and cortical porosity were higher than normal but cortical thickness was still increased. After more than six months of treatment there was a significant loss of trabecular (decreased trabecular bone volume) and cortical (normal mean cortical width; increased porosity) bone with hyperremodeling (increased trabecular resorption surfaces and trabecular osteoid surfaces). This osteoporosis is similar to that observed in hyperthyroidism.

Gastric large cell lymphoma expressing cytokeratin but no leukocyte common antigen. A diagnostic dilemma.

A case of undifferentiated malignant tumor of the stomach is reported. The immunohistochemistry of biopsy specimens pointed to a diagnosis of carcinoma, the tumor cells being cytokeratin positive and leukocyte common antigen (LCA) negative. After resection, however, histopathologic results showed that the tumor was a large cell lymphoma with plasmablastic differentiation. A new immunohistologic study confirmed, on the one hand, the diagnosis of lymphoma with its monotypic character IgA kappa and, on the other, positivity with three different cytokeratins of the lymphoma cells and their negativity with LCA. The aberrant immunophenotyping of this lymphoma is exceptional and must not undermine the recognized usefulness of LCA and cytokeratin, which both are basic antibody markers of immunohistochemistry in undifferentiated malignant neoplasms.

Chromosomal analysis of colonic adenomatous polyps.

Chromosomal analysis of 25 colonic adenomatous polyps was performed by a direct method similar to that used in prenatal diagnosis of chromosomal aberration on chorionic villi. Fourteen lesions showed an abnormal karyotype. Two changes were recurrent: trisomy 7 (observed in eight cases) and trisomy 13 (observed in seven cases). No monosomy of the short arm of chromosome 17 was observed even at the level of two polyps with in situ carcinoma lesions.

Chromosome analysis of adenomatous polyps of the colon: possible existence of two differently evolving cytogenetic groups.

A chromosomal study of 42 colonic adenomatous polyps was performed using a technique of direct chromosome analysis derived from the prenatal procedure for diagnosing chromosomal alterations from chorionic villi sampling. Abnormal karyotypes were found in 22 cases. Trisomy 7, the most frequently found alteration, was found in 13 cases, followed by trisomy 13 (nine cases). Monosomy 18 was observed in two cases; in one of these, that of a polyp which had degenerated into an intra-mucosal adenocarcinoma, it was associated with 17p monosomy. Interestingly, these two types of alterations (trisomy 7 versus 18 and 17p monosomy) were not found together in the same lesion. This suggests that there could be two distinct chromosomal behaviors which might be related to the two cytogenetic groups described for colorectal adenocarcinoma. However, the respective frequencies of such cytogenetic groups varied inversely between adenomas and adenocarcinomas, thus suggesting that they evolve differently.

Primary cardiac lymphoma in an immunocompetent woman.

We report a fatal primary cardiac non-Hodgkin's lymphoma in a 62 years old immunocompetent woman presenting with tamponade and complete atrioventricular block. CT-scan, echocardiography and autopsy examination showed a tumor largely infiltrating the heart without extracardiac involvement. A surgical biopsy revealed high grade B-cell non-Hodgkin's lymphoma with a misleading myelomonocytic CD68 (KPI) expression. Polymerase Chain Reaction analysis revealed a clonal rearrangement of the immunoglobulin heavy chain gene and confirmed the B-cell origin of the lymphoma. Our report also emphasizes the role of immunohistochemical and molecular techniques in the diagnosis.

Radiohistology as a new diagnostic method for barium granuloma.

Barium granulomas are rare complications of the barium enema. They pose diagnostic problems to the gastroenterologist, who may suspect a carcinoma, and to the pathologist, who may have difficulty in determining the precise nature of the foreign body. From four cases we suggest a simple and quick diagnostic method: paraffin-block roentgenography.

An adult atypical fibromyxoid tumor of the urinary bladder.

A case of atypical fibromyxoid tumor of the urinary bladder in a 32-year-old woman is reported. The patient had never complained of urinary symptoms, and bladder tumefaction was revealed fortuitously at pelvic ultrasound. Cystoscopy revealed a peanut-sized mass. Microscopically, the lesion was composed of strap- and tadpole-shaped cells resembling rhabdomyoblasts. For this reason, the tumor was initially diagnosed as embryonal rhabdomyosarcoma. However, immuno-histochemical study was negative for muscle origin, and the tumor has subsequently proved benign. The reported case illustrates the value of immuno-histochemical study in the evaluation of the true type of bizarre stroma cells in this pseudo-sarcomatous lesion. Their recognition is important, because the therapeutic consequences of misinterpreting this tumor as a sarcoma are great.

Cytologic findings in a neovagina created with Vecchietti's technique for treating vaginal aplasia.

OBJECTIVE: To report long-term cytologic findings after treatment of congenital vaginal aplasia or Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) using progressive traction of the vulvar tissues, or Vecchietti's technique (VT). STUDY DESIGN: In eight women with MRKH, neovaginal smears stained by the Harris-Schorr technique were collected 2-12 years after VT. RESULTS: Eosinophilic superficial cells observed in all cases indicate that the neovaginal epithelium responds to hormonal variations. The presence of Döderlein bacilli (seven cases) suggests that the regional environment of the neovagina is almost the same as that of the normal vagina. Gardnerella vaginalis (one case) and human papilloma virus infection (low grade squamous intraepithelial lesions) (one case) were also observed. CONCLUSION: Neovaginal smears taken after the cicatrization period following construction of a neovagina by VT show a remarkable resemblance to those from normal vaginal mucosa and suggest that these neovaginas are almost the same as normal vaginas.

[Histological types of 876 breast cancers according to the 1981 WHO classification]. / Types histologiques de 876 cancers du sein selon la classification de l'OMS 1981.

This work presents the results of the classification by histological types of 876 cancers, operated on between November 1979 and December 1982, according to the new WHO's classification of 1981. Noninfiltrating cancers represent 6.5 per cent of the total. Among the infiltrating cancers (93.5%), the individualization of the type "infiltrating duct carcinoma with a marked intraductal component" (14.5%) is interesting for this form justifies a special treatment in consideration of its multicentric and sometimes bilateral character. Its purely quantitative criteria of definition is subject to criticism and discussion.

[Primary choriocarcinoma of the stomach. Immunohistochemistry study of a case and review of the literature]. / Choriocarcinome primitif de l'estomac. Etude immunohistochimique d'un cas et revue de la littérature.

A rare tumor, primary choriocarcinoma of the stomach occurred in a 68 year-old man. Histologic examination of the tumor revealed two components, choriocarcinoma and adenocarcinoma. The liver metastasis displayed only choriocarcinoma, the lymph nodes metastasis only adenocarcinoma. The diagnosis was confirmed by demonstration of beta HcG in serum and urines by radioimmunoassay and within syncytiotrophoblast cells by immunoperoxidase staining. A review of the literature is done. The pathogenesis is discussed with hypothesis that this tumor represents a form of retro-differentiation of a preexisting carcinoma. However, this diagnosis will only be certain when a metastasis of a non gestational, non gonadal choriocarcinoma will be eliminated.

[Colo-rectal spirochetosis: is it an anatomo-pathologic entity?]. / La spirochétose colo-rectale: une entité anatomo-pathologique?

Nineteen colorectal biopsy specimens, stained by Hematein-Eosin-Safran (HES), were examined by light microscopy and showed a thick, blue and fuzzy brush border. Without any further microbiologic investigation, this histologic feature is considered strongly suggestive of colorectal spirochetosis. Our study concerned 19 male patients aged between 35 and 68 years, who had no risk factor for HIV infection, but who belonged to these three groups: (a) those suffering from chronic diarrhea; (b) those without intestinal symptoms; (c) those who had a colonic tumor removed. Rectal biopsy specimens were also taken from a control group of 35 patients seropositive for HIV-1. This thickening, which measured 3-7 microns, showed some variation within the same patient but did not depend on the site of the biopsy. It appeared as a blue fuzzy band on HES stain, was purple on Periodic-Acid-Schiff stain and basophilic after Giemsa stain. Silver stain by Warthin-Starry method confirmed the presence in three cases of numerous spirochetes attached to the epithelial surface. Two of the three patients had no symptom. In the control group, a thickening of the brush border, was observed in only one case, but no spirochete by silver stain was seen. The thickened blue, fuzzy brush border of the colonic mucosa is not a specific criterion. The pathologist must be aware of the possible presence of spirochetes that can only be confirmed by a silver stain. The pathogenicity of spirochetosis remains to be defined.

[Histological changes after chemotherapy of soft tissue sarcomas in the adult]. / Modifications histologiques après chimiothérapie des sarcomes des tissus mous de l'adulte.

The variations of histologic patterns inside the primary tumor have been studied in 15 patients with locally advanced soft tissue sarcomas who were given induction (neo adjuvant) chemotherapy. Increase of tumor necrosis and decrease of tumor cellularity were the predominant aspects identified. The mitosis count tend to be lower, while the nuclear atypies and the number of giant malignant cells tend to increase. In 2 cases, a better tumor differentiation, attributable to the induction chemotherapy was noted. In 10/15 cases, it was concluded to a tumoricidal effect of the chemotherapy. According to tumor grade, 6 among 10 patients with grade III tumor presented a histological response (greater than 50 p. cent of tumor destruction) while none among 5 lesions of grade I or II exhibited a response of such a level. So, the histological study allows an evaluation of the response to chemotherapy which usefully completes the clinical appreciation, and that may be useful for the selection of postoperative adjuvant treatment, as it is in osteosarcomas.

[Intra-abdominal pseudotumorous panniculitis. CAT scan aspects of a case localized in the greater omentum]. / La panniculite pseudo-tumorale intra-abdominale. Aspect TDM à partir d'un cas localisé sur le grand épiploon.

Intra-abdominal panniculitis is an inflammatory and necrotic reaction to local, general or undetermined aggressions to intra- or retro-peritoneal fatty tissue. A case localized to the greater omentum is described and findings on CT scan imaging reported: encapsulated, heterogeneous mass of fatty density with fibrous bands and with fascial thickenings. Diagnosis is based mainly on histopathology, the CT scan being incapable, despite the clinical context, of formally rejecting a diagnosis of liposarcoma.

[Isolated necrotizing angiitis of the cervix uteri. Apropos of a case]. / Angéite nécrosante isolée du col utérin. A propos d'un cas.

A necrotizing arteritis isolated to the uterine cervix without multisystem disease was fortuitously discovered in a 52-year old woman after hysterectomy for uterine leiomyomas. This rare lesion discovered by routine histopathological examination was cured by surgery. The aetiology and pathogenesis of this arteritis are unknown.

[Non-Hodgkin's lymphoma associated with human immunodeficiency virus infection. Bordeaux experience with 26 cases]. / Lymphomes non hodgkiniens associés à l'infection par le virus de l'immunodéficience humaine. Expérience bordelaise de 26 cas.

We describe the clinical and histologic features of non-Hodgkin's lymphoma in 26 patients with human immunodeficiency virus 1 (HIV) infection. These represent 10 per cent of AIDS cases recorded in the Bordeaux area. Mean age was 42. Contamination was mostly related to homosexuality (50 per cent) and blood transfusion (27 per cent) with 5 female cases. The initial presentation of lymphoma was extranodal (69 per cent). Lymphoma spread was diffuse (65 per cent), involving the bone marrow (38 per cent), lymph nodes (35 per cent), central nervous system (27 per cent), oral and digestive mucosae (23 per cent), liver (19 per cent) and genital tract (12 per cent). Histologic types were of intermediate or high grade malignancy (88 per cent) with 38 per cent large, non cleaved-cell (centroblastic) subtype. Median survival was 4 months. Lymphoma caused death in 65 per cent of patients and opportunistic infection in 18 per cent. Lymphoma was the first manifestation of HIV infection in 10 patients (38 per cent) and was responsible for AIDS in 14 (54 per cent). Diagnosis of lymphoma could be established at an early stage on extranodal biopsy. In these patients a prolonged disease-free survival was obtained after chemotherapy alone or associated with radiotherapy.

[Prostatic osteocondensing metastases and osteomalacia. Value of histomorphometric study. Preliminary results]. / Métastases ostéocondensantes prostatiques et ostéomalacie. Intérêt de l'étude histomorphométrique. Résultats préliminaires.

A clinical, biochemical and histomorphometric study of non-decalcified bone with measurement of calcification rate was carried out in 10 patients with sclerotic bone metastases from prostatic carcinoma. The patients were under oestrogen therapy, and a change of treatment was being considered. The histomorphometric study showed that 3 patients had osteomalacia. These patients differed from the others in that the pain they experienced in bones was stronger, more diffuse and more often permanent. All three had fracture of the femoral neck. They had hypocalcaemia, hypophosphataemia, hypocalciuria and increased serum alkaline phosphatase, but only phosphataemia was significantly lower than in non-osteomalacia patients. Osteomalacia was cured by vitamin D and calcium in one patient. Osteomalacia can only be reliably diagnosed in these patients by histomorphometry. This examination may be proposed to patients with sclerotic bone metastasis of prostatic origin, under hormonal therapy, presenting with diffuse skeletal pain or bone fragility without osteolysis, and with hypocalcaemia or hypophosphataemia.