Medullary thyroid microcarcinoma: a clinicopathologic retrospective study of 38 patients with no prior familial disease.

Thirty-eight patients (25 women, 13 men; mean age, 57.8 [32 to 91]) showing one or more medullary thyroid microcarcinomas (ie, < 1 cm), with no prior MEN II or medullary thyroid carcinoma history in their family, were reviewed. Follow-up was available for 29 patients (mean, 53.6 months [1 to 147]). 21 patients (72.4%) are alive and free of disease, four patients (13.8%) died during follow-up without disease, 2 patients are alive with disease (local recurrence and persistent hypercalcitoninemia) after 80 and 99 months, respectively, and 2 patients died of disease after 24 and 46 months. Most tumors were incidental pathological findings (19 of 38) or were discovered by systematic blood calcitonin measurement for a nodular thyroid disease (15 of 38). Only the four patients who had an unfavorable outcome were symptomatic cases (palpable micro-MTC, diarrhea, cervical lymph node metastasis and pulmonary metastatic disease). The two patients with metastatic disease at diagnosis died during follow-up. In univariate analysis, a symptomatic medullary thyroid carcinoma was a strong predictor of an unfavourable outcome (p < .00008), as were the preoperative calcitonin level (P = .007) and an elevated postoperative calcitonin level (P = .004). Among 30 histopathological criteria, only the presence of amyloid correlated with an unfavorable outcome (P = .018).

[Environment of invasive breast carcinoma. Morphological and epidemiological study]. / Environnement des carcinomes invasifs du sein. Etude morphologique et épidémiologique.

In a retrospective study, the authors have observed different types among 180 breast invasive carcinomas, their environment and their epidemiology. Tumors consisted in 158 invasive ductal carcinomas, 11 invasive lobular carcinomas and 11 special forms. The benign environment was divided in 3 groups: no epithelial lesion (1/5 cases), "mastosis simple" (3/5) (elementary lesions more or less associated, exceptionally isolated, diffuse or focal), the last, 1/5, corresponded to a "mastosis complex" defined as the significant association of the same elementary lesions (minimum 3 to 4), diffuse, with some degree of dysplasia and always an intraductal hyperplasia, of any type. The confrontation of these environments with carcinoma types and grades and with some epidemiological data allowed: 1) To opposite intraductal hyperplasias, mainly "mastosis complex", to other environments; 2) to discuss a) "mastosis complex" position in relation to cancer, b) an eventual lobular origin for precancerous lesions and c) individualization of epidemiological factors in relation to development of malignant tumors.

[Prognostic value of Fürhman's grade in renal cell carcinoma. A study of 170 cases]. / Valeur pronostique du grade de Führman dans le carcinome à cellules rénales.

In order to evaluate the prognostic value of the anatomical stage (pTNM 1992) and of the histological factors (Führman's grade, cellular and architectural types), 170 renal cell carcinoma diagnosed between 1971 and 1991 were reviewed. In univariate analysis, the prognosis was correlated with the anatomical stage and Führman's grade: for the 125 patients without metastasis, grades 1 and 2 had a good prognosis, whereas grades 3 and 4 did poorly. The cellular type was not related to survival. Among architectural types, only the pseudo-sarcomatous type was correlated with prognosis. Multivariate analysis revealed that grade and metastasis at diagnosis were two independent predictors of survival; the grade was prognostically superior to metastasis. Führman's grade is essential in determining prognosis; its statistical value is superior to anatomical stage in multivariate analysis.

[Apropos of 1 case of paratesticular papillary serous cystadenocarcinoma]. / A propos d'un cas de cystadénocarcinome papillaire séreux paratesticulaire.

The occurrence within the testis or paratesticular tissue of serous tumors, similar to ovarian tumors, is rare. This article reports a primary serous paratesticular cystadenocarcinoma in a 39 year-old man. From data of the literature, we offer guidelines for diagnosis, histogenesis and treatment of this rare tumor.

[Pelvic malignant ectomesenchymoma: a case report]. / Ectomésenchymome malin pelvien. A propos d'un cas.

We report the case of a 19 month old boy referred to our institution because of a pelvic tumor initially identified as an embryonal rhabdomyosarcoma and treated with surgery and chemotherapy. Eight years after the initial surgery, a local tumor recurrence with bone metastasis was found. Histological examination and immunohistochemistry showed a double differentiation with both muscular and neuronal cells. This double differentiation was retrospectively found in the initial tumor, then allowing the diagnosis of malignant ectomesenchymoma also called gangliorhabdomyosarcoma. This rare tumor, occurring mainly during childhood, is composed of neuroblasts and / or ganglion cells and of malignant mesenchymal cells (usually rhabdomyosarcomatous cells).

[Hyperthyroidism induced by amiodarone and hyperthyroidism induced by iodine. Histologic, immunohistochemical and ultrastructural aspects]. / Hyperthyroïdies induites par l'amiodarone et hyperthyroïdies induites par l'iode. Aspects histologiques, immunohistochimiques et ultrastructuraux.

Amiodarone is a widely-used anti-arythmic drug that induces an iodine overload and, in 1 to 23% of the patients, a thyrotoxicosis. In a few cases, the thyrotoxicosis may be refractory to conventional pharmacological therapy, thus leading to thyroidectomy. We report the thyroid gland pathology in 5 thyroidectomies that were performed for uncontrolled thyrotoxicosis, induced by amiodarone (4 cases) and by Colchimax, another iodine-rich drug (1 case). Two cases have been studied by electron microscopy. Pathologic findings were: [1] colloid transformation of the parenchyma, [2] areas of follicular disruption with numerous foamy macrophages in the colloid, [3] regenerative areas and [4] a moderate T lymphocytic infiltration. No lysosomal lamellar inclusion body was found by electron microscopy. These lesions may be rather specific of an iodine toxicity. The pathogeny is still misunderstood, and probably complex. It may essentially involve toxic mechanisms, as well as immunologic or allergic mechanisms.

[Histopathology of neuroendocrine tumors]. / Histopathologie des tumeurs neuro-endocrines.

Neuroendocrine (NE) tumors are a heterogeneous group of neoplasms arising in various organs and sharing the features of the NE cell system. The term "neuroendocrine" is used for cells characterized by their secretory products and some cytoplasmic proteins rather than by their localization and embryological derivation. Some tumor types can show a characteristic pattern on conventional histology but, to obtain an accurate diagnosis of many NE tumors it is necessary to employ various special methods, mainly electron microscopy and immuno-histochemistry. The classification of NE tumors in four categories according to Travis et al. is largely used: typical carcinoid and atypical carcinoid are low grade neoplasms; small cell NE carcinoma and large cell NE carcinoma are high grade neoplasms. The size, extension into surrounding tissues, angioinvasion and hormonal function are also important to consider in the prognostic evaluation of some NE tumors. Tumors exhibiting multidirectional differentiation must be classified in carcinoma with interspersed NE cells, carcinoid with interspersed non NE cells, composite tumors and amphricine tumors. Finally, some NE tumors may present features suggesting a Multiple Endocrine Neoplasia, ie. multifocality and association with hyperplasia of endocrine cells.

[Mucinous ductal ectasia. Apropos of 2 cases]. / Ectasie canalaire mucineuse. A propos de 2 cas.

Mucinous ectasia of the pancreas ducts is a recently described cystic lesion which usually occurs in acute pancreatitis. Endoscopic retrograde pancreatography provides diagnosis. Mucinous ductal ectasia is considered to be a precancerous lesion. Surgical exeresis is recommended. Our two cases emphasize the difficulties encountered for differential diagnosis with other cystic lesions of the pancreas.

[Depression in smoking pregnant women: impact on motivation to quit smoking]. / Dépression chez la femme enceinte fumeuse : impact sur la motivation à l'arrêt du tabac.

UNLABELLED: Despite the organization of smoking cessation program, the percentage of pregnant smokers remains too high in France. The knowledge of the factors limiting success of the attempt can help the smoking cessation. AIM: To evaluate the prevalence of depressive disorders in pregnant smokers compared to nonsmokers; assess their impact on motivation stopping smoking; verify their identification can be performed by midwives. MATERIALS AND METHODS: Prospective multicenter survey on 792 women (435 smokers and 357 non-smokers), the assessment of the current depression is made by the Hospital Anxiety Depression scale, and motivation to quit smoking by the Richmond test. RESULTS: Pregnant smokers compared to non-smokers, have more frequent depressive disorders (current: OR=2.4; history: OR=2). These problems do not decrease the motivation to quit, they are associated with a high nicotine dependence and low socioeconomic levels. Their testing can be done by midwives. CONCLUSION: Systematic screening for depression in pregnant women smoking could facilitate smoking cessation.

[Peritoneal serous borderline tumor discovered during a cesarean section. A case report]. / Tumeur séreuse borderline péritonéale découverte lors d'une césarienne. A propos d'un cas.

During a caesarean section performed in a 36-year-old woman, we discovered small granulations on the pelvic peritoneum. Biopsies were performed. The diagnosis of primitive borderline serous tumor was confirmed by pathologists. The patient was operated twice: once for diagnostic evaluation, and again six months later. A radical gesture was then decided for therapeutic purposes. The optimal attitude regarding these borderline peritoneal tumors in young women remains difficult and requires a multidisciplinary workout between pathologists and surgeons.