Gastric Duplication Cyst with Respiratory Epithelium: a Rare Entity.

Gastric duplication cyst is an uncommon entity and management is principally surgical. Diagnosis is often delayed because of the non-specific nature of symptoms. The authors report one case of gastric duplication cyst incidentally diagnosed in a 23-year-old man. He had no specific symptoms but follow up of the unknown retro gastric mass showed an increase in size and cholelithiasis. Magnetic resonance imaging (MRI) was not useful for diagnosis but an endoscopic ultrasound suggested a GIST. The growing size of the mass led to a laparoscopic resection. Histopathology showed a gastric duplication cyst boarded with gastric and respiratory ciliated epithelium. This respiratory differenciation is extremely rare. Our patient is the 25th case reported in the literature. The embryologic origin, diagnosis tools and treatment of those rare cysts are briefly reviewed.

[Cardiac amyloidosis]. / Le cas clinique du mois. Amyloïdose cardiaque de type AL: a propos d'un cas.

We present a case of a 54-year-old female presenting with renal failure and, two years later, heart failure, both due to primary systemic amyloidosis. The case gives us the opportunity to review the litterature on the topic.

Endemic alveolar echinococcosis in Southern Belgium?

Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis. However it was recently demonstrated by necropsy series that, in some parts of southern Belgium (Wallonia), up to 51% of the red foxes (Vulpes vulpes) may be infected by E. multilocaris. The authors, working in a university hospital in southern Belgium, described in 2002 the first autochthonous Belgian case of hepatic alveolar echinococcosis. More importantly, in 2004, they diagnosed three other patients with alveolar echinococcosis. One underwent surgical resection, but two others had bilateral pulmonary involvement at time of definite diagnosis. Palliative albendazole therapy was initiated. These patients had been diagnosed with hepatic mass from unknown origin for several months. The previous experience with the first case allowed the authors to consider and to confirm alveolar echinococcosis diagnosis, made by pathology and/or serological tests and imaging. These four patients with alveolar echinococcosis were living either in the Liege or the Luxembourg province. Considering the high prevalence of E. multilocaris infection of red foxes and the recent increase of the fox population due to rabies vaccination in southern Belgium, and also the presence of E. multilocaris infection of red foxes in northern Belgium, it is likely that not only Wallonia, but also maybe the whole Belgium, may face endemic alveolar echinococcosis in the next years.

Histologic characterization of carotid plaques.

From January 1988 to December 1989, we performed a total of 278 carotid thromboendarterectomies. The plaque was systematically prepared for anatomicopathological analysis by standard light microscopic techniques. We sought to correlate the histology of the endarterectomy specimen with the clinical data. Twenty-eight plaques were not suitable for analysis and classification. The remaining 250 plaques were subdivided as 216 (86%) complicated plaques and 34 (14%) simple fibrous plaques. In the complicated plaques, one or more of the following pathologic characteristics were described: organized intraplaque hematoma (observed in 115 plaques), fresh thrombus (50), ulceration (92), and recent intraplaque hemorrhage (168). Fifty-three percent of these complicated plaques were symptomatic with corresponding neurologic deficit (amaurosis, transient ischemic attacks, reversible ischemic neurologic deficit, or stroke), compared with 21% of the simple plaques (p < 0.001). With regard (o plaque characteristics, the only significant clinicopathologic correlation was found for plaques with fresh thrombus, which were symptomatic in 70% of cases, and for ulcerated plaques (symptomatic in 66% of cases). This comparative study provides no significant evidence of increased predisposition to neurologic deficit for the other morphological aspects (intraplaque hemorrhage, healed ulceration, organized hematoma). We conclude that plaque morphology, rather than luminal narrowing, plays a primary role in cerebral ischemic disease.

Pathologic aspects of carotid plaques: surgical and clinical significance.

From January 1988 to December 1989, we performed a total of 278 carotid thromboendarterectomies. The endarterectomized plaque was systematically confined for anatomopathological analysis by standard light microscopic techniques. The authors looked for clinicopathologic correlation of the histology of the endarterectomy specimen with the clinical data. Twenty eight plaques were not suitable for analysis and classification. The remaining 250 plaques were subdivided in 216 (36%) complicated plaques and 34 (14%) simple fibrous plaques. In the complicated plaques, the pathologist described one or more of the following pathologic characteristics: organized intraplaque hematoma (observed in 115 plaques), fresh thrombus (50), ulceration (92), and recent intraplaque hemorrhage (168). More than one anatomopathologic aspect were observed in most of the complicated plaques. Fifty three percent of these complicated plaques were symptomatic with corresponding neurologic deficit (amaurosis, TIA, RIND or stroke), versus 21% of the simple plaques (p < 0.001). For plaque characteristics the only significant clinicopathologic correlation was found in plaques with fresh thrombus which were symptomatic in 70% of cases, and ulcerated plaques (symptomatic in 66% of cases). This comparative study yielded no significant evidence of increased predisposition to neurologic deficit for the other morphological aspects (intraplaque hemorrhage, healed ulceration, organized hematoma). The histology of the endarterectomy specimen was compared with the preoperative echopattern of 154 plaques. Thirty four ultrasound images were of poor quality. The 120 adequate echographies revealed 22 dense hyperechogenic homogenous plaques, 28 soft hypoechogenic homogenous plaques, 53 inhomogenous plaques, and 13 mixed plaques. According to the surface, lesions were subdivided as smooth (N. = 63) or irregular (N. = 57). Echography recognized fibrous plaques (dense homogenous hyperechogenous lesions), with a specificity of 87% and a sensitivity of 56%. Recent intraplaque hemorrhage is echographically apparent as a hypoechogenic area in 88% of cases, what corresponds to a specificity of 79% and a sensitivity of 75%. Echography proved to be more accurate than angiography in determining the presence or absence of ulceration. The study evidenced that plaque morphology rather than luminal narrowing plays a primary role in cerebral ischemic disease. The ability to characterize the pathology of carotid atheroma by duplex scan makes the clinicopathologic correlation of carotid plaques of practical importance.

Echographic characterization of carotid plaques.

The histology of the endarterectomy specimen was compared with the preoperative echopattern of 154 plaques. Thirty-four ultrasound images were of poor quality. The 120 adequate echographies revealed 22 dense hyperechogenic homogeneous plaques, 28 soft hypoechogenic homogeneous plaques, 53 inhomogeneous plaques, and 13 mixed plaques. According to the surface, lesions were subdivided as smooth (n = 63) or irregular (n = 57). Echography recognized fibrous plaques (dense homogeneous hyperechogeneous lesions), with a specificity of 87% and a sensitivity of 56%. Recent intraplaque haemorrhage is echographically apparent as a hypoechogenic area in 88% of cases, what corresponds to a specificity of 79% and a sensitivity of 75%. Echography proved to be more accurate than angiography in determining the presence or absence of ulceration. The ability to characterize the pathology of carotid atheroma by duplex scan make the clinicopathologic correlation of carotid plaques of practical importance.

Fundic argyrophil cell hyperplasia in atrophic gastritis: a search for a sensitive diagnostic method.

Hypergastrinemia induces argyrophil cell hyperplasia in oxyntic mucosa (FACH) in patients with non-antral atrophic gastritis, with or without pernicious anemia. This proliferation favours the development of carcinoid tumours. In order to determine the most usual appropriate method to document FACH, we have studied 29 consecutive fundic biopsies from 26 patients with fundic chronic gastritis. The study encompassed gastrinemia levels, standard histology permitting the classification of chronic gastritis, demonstration of FACH by Grimelius stain, immunohistochemical studies using NSE, chromogranin A and by electron microscopy. The FACH was classified for each stain as slight, moderate or severe. The study displayed a relationship between the grade of gastritis and the density of argyrophil endocrine cells in oxyntic mucosa assessed by Grimelius stain (p < 0.0001) and chromogranin A (P < 0.01). There was also a relationship between the serum gastrin level and the density of argyrophil endocrine cells detected by these two stains (p < 0.001). A highly significant correlation was observed between Grimelius stain and chromogranin A (p < 0.0001). On the other hand, no significant correlation was noted with either NSE or electron microscopy. We conclude that Grimelius stain and immunohistochemical studies against chromogranin A were the best methods for the demonstration of FACH in atrophic gastritis. One of these two techniques is sufficient in current practice for defining the patients at risk for subsequent surveillance.

Surgical management of left atrial myxoma.

Although rare, left atrial myxoma is an entity from anatomopathological and clinical aspects. Seven cases of left atrial myxoma operated on the last ten years were reviewed. We also report a rare presentation of right atrial myxoma, where the tumor was responsible of a dramatic hemodynamic shock due to right ventricular inflow obstruction. Six patients were female, with a mean age of 53 years. All but one consulted for exertional dyspnea of recent onset. Two patients with left atrial myxoma and the patient with right atrial myxoma had experienced embolism. Five patients had systemic symptoms. Echocardiography was the most performant diagnostic procedure. All but the patient with right atrial myxoma were operated by the left atrial access. The mitral valve was replaced in two patients. The histological aspect of this benign tumor is illustrated but the lack of frank border between the tumor and the myocardium is emphasized. We conclude that surgical management is primordial. We give anatomopathological rationale for resection of implantation pedicle. The operative mortality was nul in this series of 8 patients; major improvement of cardiac status was constant. No recurrence has occurred during the follow-up period.

A benign tumor of the sciatic nerve: case report and review of the literature.

Tumors arising from the sciatic nerve are a rare occurrence. A case is described of such a tumor developing as a large painless mass in the posterior right midthigh. The preoperative diagnosis was easily achieved by means of ultrasonography and computed tomography. Excision of the tumor, with preservation of the involved nerve, was performed. Microscopic examination showed a neurofibroma with however some features of a schwannoma. Problems of histological diagnosis and treatment are emphasized.

[Anatomo-clinical correlations of carotid plaques]. / La corrélation anatomo-clinique des plaques carotidiennes.

Recently, much attention has been focused on pathologic plaque characteristics and their importance in producing cerebrovascular symptoms. There remains much controversy on the significance of plaque ulceration, mural thrombi, and intraplaque hemorrhage in symptomatic and asymptomatic patients. We investigated 110 plaques, and the only significant correlation with preoperative symptoms was the presence of fresh mural thrombus, mostly intraluminal, associated with stenosis. Exulceration without fresh thrombus, intraplaque hemorrhage with intact endothelium and recanalized thrombus were also found in a considerable number of asymptomatic patients.