[Cancer of the testis, sarcoidosis and neurinoma]. / Cancer du testicule, sarcoïdose et neurinome.

The association of testicular cancer, sarcoidosis and neuroma is reported. Review of the literature revealed the rarity of the association of testicular cancer and sarcoidosis which is probably a chance association, but which is important in the context of staging, as overstaging may lead to useless or even dangerous treatment.

[Ewing's sarcoma and peripheral neuroectodermal tumors. Report of a case with laterothoracic localization]. / Sarcomes d'Ewing et tumeurs neuroectodermiques périphériques. A propos d'un cas de localisation latéro-thoracique.

The authors report the case of a 20-year old male patient presenting with a lateral thoracic tumour which at pathological examination looked like an extra-osseous Ewing's sarcoma. Strongly positive NSE immunolabeling suggested a recently described variant of this lesion: Askin's tumour. In 1979, F. B. Askin described a tumour made of round small cells, located on the side of the thorax and possibly derived from differentiated neuroectodermal tissue. Since that time, the ever wider use of electron microscopy and immunohistochemical methods has made it possible to demonstrate the existence of peripheral neuroectodermal tumours (PNETs) distinct from neuroblastomas. Askin's tumour being only, as it turned out, one of their clinical forms. Following a brief presentation of the clinical, pathological and therapeutic features of PNETs, the authors underline the great similarity between these tumours and Ewing's sarcoma. Owing to the successive discoveries of a cytogenetic abnormality common to these tumour--t(11;22)(q24;q12)--, of a similar expression of proto-oncogens and of identical neuroenzymatic characteristics, Ewing's syndrome can now be regarded as the most undifferentiated of all PNETs, probably arising from the postganglionic neuron of the parasympathetic system.

[Advanced testicular seminoma: treatment of residual masses after chemotherapy. A review of 3 cases]. / Séminomes testiculaires évolués: traitement des masses résiduelles après chimiothérapie. Réflexions à partir de 3 observations.

Based on 3 cases of advanced testicular seminoma classified as stage IIC, the treatment of residual masses after chemotherapy is discussed. The excellent therapeutic response confirmed by histological study of the residual masses, which show a fibrotic or necrotic appearance, allows the adoption of a strategy using imaging techniques: either there is persistence of a gland mass syndrome and resection needs to be carried our or retroperitoneal fibrosis is visualised and careful follow up would appear to be sufficient.

[Exeresis of residual masses of germinal tumors of the testis after chemotherapy]. / L'exérèse des masses résiduelles des tumeurs germinales du testicule après chimiothérapie.

Between 1978 and 1988, amongst the 184 patients treated at the Hôpital du Val de Grâce for a testicular germ cell tumour, 47 patients underwent resection of residual masses after chemotherapy: 27 patients were classified as stage II and 20 were classified as stage III. The chemotherapy, administered for 3 to 6 cycles, used three types of protocols: VAB 6, PVeBV or BEP. Resection of residual masses was only undertaken after return to normal of the biological markers with persistently abnormal medical imaging. Histology of the testicular tumour revealed 3 seminomas and 44 non-seminomatous germ cell tumours. The histology of the residual masses after retroperitoneal lymphadenectomy (42 operations), thoracotomy (9 operations) or craniotomy (1 operation) revealed 22 cases of fibrosis or necrosis (47%), 10 cases of teratoma (21%), 8 cases of cancer (17%) and 7 normal cases (15%). The progression towards fibrosis, necrosis or nature teratoma is synonymous with cure, but the persistence of cancer cells corresponds to a very poor prognosis even after salvage treatment.

[Aneurysmal bone cyst of the ethmoid. Apropos of a case]. / Kyste osseux anévrysmal de l'ethmoïde. A propos d'un cas.

Repeated epistaxis in a 12 year old child revealed an aneurysmal bone cyst of ethmoid, an exceptional localization for this lesion. Modern imaging techniques (CT scan, NMR) provided precise data on its extent, primordial for decision as to surgical approach. NMR imaging was more effective than the CT scan for diagnosis, since blood lakes were identified, and for determination of extent, since tumoral elements were distinguished from sinusal retentions.

[Biological markers and germinal tumors of the testis. Value and limitations of the assay of chorionic gonadotrophin hormone and alpha-fetoprotein]. / Marqueurs biologiques et tumeurs germinales du testicule. Intérêts et limites du dosage de l'hormone chorionique gonadotrope (HCG) et de l'alpha-foeto-protéine (AFP).

Between 1978 and 1985, 128 patients with germinal tumors of the testes were treated at the Val-de-Grâce Hospital; biological market levels--beta HCG and AFP--were determined before and after orchidectomy in the peripheral blood and during orchidectomy in testicular blood in 76 patients. HCG levels were elevated in 13% of seminomas and HCG and/or AFP levels were elevated in 76% of non seminomas; the sensitivity of the determination was greater in testicular blood. However, in our study, there was no parallelism between marker levels before orchidectomy and tumor stage or prognosis. The change in HCG and/or AFP levels appears to an index of the response to therapy: 4 patients with high HCG and/or AFP levels during chemotherapy died. The diagnosis of recurrence is not always documented by elevated marker levels and monitoring must always documented by elevated marker levels and monitoring must always include both determination of marker levels and imaging.

[Blue tympanic membrane. Apropos of 3 cases]. / Tympans bleus. A propos de trois observations.

A CT scan allowed simple diagnosis of the affection in three patients with the blue tympanic membrane syndrome. Lesions included prolapse of the internal jugular vein sinus into the tympanic cavity, an aberrant trajectory of the internal carotid artery in the middle ear and a tympano-jugular glomus tumor. Angiographic investigation of the latter lesion was performed more as a pre-treatment procedure rather than for diagnostic purposes, since it served as a guide to surgery, consisting usually of embolization.

[Advanced non-seminoma germinal tumors of the testicle. Therapeutic strategy and method of action of chemotherapy]. / Tumeurs germinales non séminomes du testicule évoluées. Stratégie thérapeutique et mode d'action de la chimiothérapie.

Among 39 patients with advanced non-seminoma germinal cell tumors of the testicle treated between 1978 and 1985 at the Val de Grâce Army Hospital, 27 previously untreated patients had chemotherapy followed in every case by surgical removal of residual growths; 23 of these patients (85%) are in complete remission; the remaining four had progression of their disease, with a fatal outcome in three. The subsequent therapy depends upon the results of histologic examination of the residual growths: simple monitoring, or a second course of chemotherapy, the modalities of which are controversial. In addition, on the basis of evidence found upon histologic studies, one can speculate as to the part played by chemotherapy in the histologic transformation of residual growths.

[Do inguinal lymph node metastases of germinal tumors of the testis exist?]. / Les métastases ganglionnaires inguinales des tumeurs germinales du testicule existent-elles?

Abdomino-aortic glands are usually involved by regional extension of germinal tumors of testis. Inguinal gland extension may occur from alteration of lymphatic circulation due to inguinoscrotal surgery and post-orchidectomy scrotal contamination. Among 140 patients treated in Val-de-Grâce Army Hospital between 1978 and 1985, only one patient with a pure non-seminoma germinal tumor developed inguinal gland metastases. Causes of inguinal gland extension are analyzed based on past history of this patient, involving repair of inguinal hernia and orchidopexy. Proposed therapy includes inguinoscrotal radiotherapy for seminoma, surveillance or chemotherapy for a pure non-seminoma germinal tumor.

[X-ray computed tomographic detection of foraminal neurinoma. Apropos of a case]. / Dépistage scanographique du neurinome foraminal. A propos d'un cas.

About the case of the vertebral neurilemmoma diagnosed at the very beginning, purely inside the foramen, precursor of the classical "hourglass Tumor", the authors remain the clinical evolution and the anatomy of the intervertebral foramen's neurilemmoma. They insist on the insufficiency of the conventional radiology in early diagnosis. They also exposed the C.T. technic and his results; the neurilemmoma can be diagnosed before his extension over the limits of the intervertebral foramen, but only if a precis neurological level is known.

[Primary esophageal localization of non-Hodgkin's lymphoma. Apropos of a case]. / Localisation oesophagienne primitive de lymphome non hodgkinien. A propos d'un cas.

Authors present a case of primary oesophageal lymphoma, in view of the great rarity of the neoplasm in this place.