[Capecitabine-induced subacute cutaneous lupus: a case report]. / Lupus cutané subaigu induit par la capécitabine : un cas.

BACKGROUND: More than 100 drugs have been registered as inducing subacute cutaneous lupus erythematosus (SCLE). Recently, some types of chemotherapy have also been incriminated. If SCLE develops in a setting of neoplasia, two possibilities should be considered: it is either a paraneoplastic syndrome or it is caused by the chemotherapy, thus calling for important decisions on the benefit/risk of stopping potentially effective medication. We report a case of SCLE induced by Xeloda (capecitabine). PATIENTS AND METHODS: A 50-year-old female patient consulted with an annular erythematosquamous and pruriginous eruption, predominantly on areas of the body exposed to sunlight, occurring 4 months after the initiation of capecitabine for advanced colon cancer. She had presented systemic lupus erythematosus (SLE) for many years, which was not treated, was not progressive and had no cutaneous manifestations. The appearance of the cutaneous lesions, positivity for anti-SSA antibodies and the histological aspect led to diagnosis of SCLE. The lesions were resistant to treatment with hydroxychloroquine and systemic corticosteroids, but disappeared after discontinuation of capecitabine, suggesting chemotherapy-induced SCLE. DISCUSSION: Some types of chemotherapy such as capecitabine may reveal or induce SCLE lesions, whether or not there is a previous history of SLE. Cases of chemotherapy-induced cutaneous lupus reported to the French pharmacovigilance agency are rare, but this side effect must be recognised due to the constantly rising use of this type of anticancer agent.

[Cerium-induced granulomatous dermatitis]. / Granulomatose cutanée au cérium.

BACKGROUND: The presence of inorganic foreign bodies in granulomatous cutaneous lesions is not infrequent. In this paper, we describe the first case of cerium-induced cutaneous granulomatous dermatitis. CASE REPORT: A 57-year-old woman seriously burned four years ago presented with papulonodular lesions affecting only the burned areas treated with topical cerium nitrate-silver sulfadiazine cream (Flammacérium). Biopsies revealed sarcoidal granuloma associated with exogenous particles. Electron probe X-ray microanalysis demonstrated a high cerium content. Screening for systemic sarcoidosis was negative. The patient was treated with hydroxychloroquine. After four months of follow-up, clinical and histological evidence of decreased infiltrate was noted. DISCUSSION: Cerium nitrate-silver sulfadiazine cream (Flammacérium) is widely used for the topical treatment of burns. The main effect of cerium is to create superficial calcification, which decreases wound colonization and prevents the formation of granulation tissue (no hypertrophic scar formation) in burns. Prior to our case, no cutaneous side-effects of cerium had been encountered. Inoculation of foreign matter may or may not induce granuloma formation or sarcoidosis in different subjects, according to their immunologic status. The favorable outcome in this case could in fact be due to a change in the pattern of cytokinin production (TH1=> TH2) rather than the effects of hydroxychloroquine therapy.

[Neutrophilic dermatosis of the hands. A localized subset of Sweet's syndrome: 3 cases]. / Dermatose neutrophilique des mains: une forme régionale du syndrome de Sweet: 3 observations.

INTRODUCTION: The term "pustular vasculitis of the hands" described by Strutton for an acute eruption of the hands was recently revisited. "Neutrophilic dermatosis of the hands" has been preferred. We observed 3 new cases. OBSERVATIONS: Two women and a man, without notable past history, consulted for an acute and painful eruption of both hands with fever. Clinical examination showed erythematous papular or nodular or bullous lesions developed on thenar and hypothenar eminences, and on the finger. Histological findings were predominantly neutrophilic infiltration in the dermis, papillary dermal edema, with or without the presence of leukocytoclastic vasculitis. Diagnosis was Sweet's syndrome. No disease was associated. With indometacine (50-100 mg per day), all the lesions disappeared rapidly without relapse. DISCUSSION: These 3 cases add to 19 other cases (review of literature) which confirm the existence of a homogenous entity that we think it a localized subset of Sweet's Syndrome, with a fast healing. Our observations are specific by the first localization on thenar and hypothenar eminences and by the excellent response to treatment with a non steroidal antiinflammatory agents such indometacine (50-100 mg per day). This treatment could be proposed as a first line therapy.

[Giant hydropic fibroma: a case report]. / Fibrome hydropique géant: à propos d'un cas.

Hydropic degeneration of a uterine leiomyoma is common. Giant forms are uncommon. Positive diagnosis may be challenging because the differential diagnosis includes other rare uterine tumors such as leiomyosarcoma. Uterine localization, the leiomyoma volume, margins with adjacent structures are best evaluated at MRI. Final diagnosis requires gross and microscopic examination. We describe such a diagnostic challenge in a 46-year-old woman with a giant hydropic leiomyoma.

[Infectious crystalline keratopathy: a case report]. / Kératopathie cristalline infectieuse: à propos d'une observation.

We report a case of perforated infectious crystalline keratopathy in a 88-year-old woman. Corneal surgery like keratoplasty and topical corticosteroids are the main causative factors present in the rare reported cases. Clinically, the anterior layers of cornea exhibit slowly progressive stellate infiltrates. "Viridans streptococci" are the most common micro-organisms involved but their culture for identification is difficult. As compared to cultures, histologic examination is more sensitive for diagnosis, by showing clusters of bacteria in the corneal stroma with no inflammatory response.

[Bronchial mucoepidermoid carcinoma: apropos of 3 cases]. / Carcinome muco-épidermoïde bronchique: à propos de 3 observations.

We report three cases of bronchial mucoepidermoid carcinoma (BMEC) of low-grade malignancy with a relafase-free follow up. BMEC are rare tumors. The microscopic findings distinguish low-grade tumors which occur in children and young adults and high-grade tumors concerning older patients; this grading is based on the study of the epidermoid component. If possible, conservative therapy is appropriate in low-grade tumors. The prognosis of high-grade tumors is poor.

[Hamartomatous adiposity of the thyroid]. / Adipose hamartomateuse de la thyroïde.

Report of one case of hamartomatous adiposity of the thyroid gland. Only eight cases have been reported. The lesion is composed of thyroid tissue and mature adipose elements. Previously reported cases are reviewed and the pathogenesis is discussed.

[Appendicular pseudo-tumors: unusual diagnosis]. / Pseudo-tumeurs appendiculaires: diagnostics inhabituels.

The discovery of a tumour mass of the appendix, in an acute or chronic context, raises the problem of its benign or malignant, inflammatory or infectious nature. We report five cases of patients operated by the same surgical team between June 1991 and September 1996, who presented macroscopically and histologically with unusual appendicular pseudotumours: appendicular diverticulosis (n = 1), Crohn's disease localized to the appendix (n = 2), yersiniosis (n = 1), actinomycosis (n = 1). The preoperative diagnosis was acute appendicitis (n = 2) or tumour (n = 3). The postoperative course was uneventful in every case, and specific medical treatment was prescribed in two cases (yersiniosis and actinomycosis). These differential diagnoses must be considered in all appendicular diseases, but they are extremely difficult to confirm preoperatively.

[Retroperitoneal ectopic pregnancy: report of a case]. / Grossesse ectopique rétropéritonéale: à propos d'un cas.

Retroperitoneal space is an exceptional location of extrauterine pregnancy (four cases have been previously reported). The authors report a case of retroperitoneal ectopic pregnancy. Pathogenesis is discussed.

[Helminth diagnosis in pathologic anatomy]. / Le diagnostic des helminthes en anatomie pathologique.

Most publications devoted to diagnosis of helminths emphasize characteristic parasitological features. Histological feature are seldom described in detail. The purpose of this study was to propose a diagnostic method suitable for use by histologists who, unlike parasitologists, do not visualize the whole worm but rather pieces randomly scattered over a slide. It is relatively easy to distinguish helminths which have smooth muscle, no respiratory or circulatory system, and no coelom from arthropods which have striated muscle, both respiratory and circulatory systems, and coelom. At the adult stage, roundworms or nemathelminths present an external cuticle that may have patterned markings. The visceral cavity is empty. Adults can dwell either in the intestine in which case they are oviparous (oxyuris, ascaris, Ancylostoma, Strongyloides stercoralis, Trichuris...) or in tissue in which case they are viviparous (filaria). Larva of some species can be found in tissues. Adult tape-worms are devoid of cuticle and have a mesenchymatous visceral cavity. Cestodes which are segmented and have no digestive tract (taenias) are readily distinguishable from trematodes which are not segmented and have a digestive tract (faciolasis) Some cestodes unable thrive in man can cause cyst formation (hydatidosis, sparganosis, cysticercosis, coenurosis). On the basis of symptoms and histological features, it is usually possible to diagnose the genus and even the species of the offending helminth provided that the parasite has not been excessively damaged and that a sufficient number of sections are available.

Desmoid tumour of the breast.

We describe the clinical and pathological features of a case of desmoid tumour of the breast. The lesion was approximately 3.0 cm in greatest dimension. Histologically, it had infiltrating borders and extended to the pectoral muscle. The differential diagnosis is discussed.

[Cutaneous metastatic Crohn disease. Apropos of a case]. / Maladie de Crohn cutanée métastatique. A propos d'une observation.

The authors report the case of a 54-year old man suffering from facial papulonodular eruption. He has Crohn's disease which was diagnosed 36 years ago. There were no clinical symptoms of the disease when the cutaneous manifestations occurred. The biopsy of a cutaneous lesion showed cutaneous granuloma at skin's level. Having no other etiology, we shall diagnose it as a cutaneous metastatic Crohn's disease. Derived sulfasalazine (Pentasa) healed all lesions in 1 month. This observation reminded us to that it is essential to biopsy all atypical cutaneous lesions occurring in a Crohn's disease case.