Role of the CXCL12-CXCR4 axis in the development of deep rectal endometriosis.

Immunological and angiogenetic factors enhance the implantation of endometrial cells in the peritoneal cavity. The aim of this work was to determine the role of the CXCL12-CXCR4 axis in the attraction and the peritoneal implantation of endometriotic stromal cells in deep infiltrating endometriosis (DIE). Biopsies of DIE nodules were obtained from 14 patients undergoing surgical treatment for DIE with low rectal involvement and from 12 patients without macroscopic endometriosis undergoing laparoscopy. CXCR4 expression was evaluated by Western blot analysis and flow cytometry in eutopic endometrial cells and DIE stromal cells in primary cultures derived from the biopsies. CXCL12-induced migration of DIE eutopic endometrial stromal cells was evaluated by transwell migration. CXCL12 was assayed in peritoneal fluids by ELISA. CXCR4 expression was higher in eutopic endometrial stromal cells than in control endometrial cells (p<0.05) and in DIE stromal cells (p<0.05). Eutopic endometrial stromal cells were more attracted by CXCL12 than control cells (p<0.01). CXCL12 was higher in DIE peritoneal fluids than in controls (p<0.05). CXCR4 was down-regulated in deep infiltrating endometriotic stromal cells. The CXCL12-CXCR4 axis plays a role in the attraction of eutopic endometrial cells into the peritoneal cavity, and the down-regulation of CXCR4 in resident endometriotic cells could cause their arrest in situ.

[Sebaceous carcinoma of the parotid gland]. / Carcinome sébacé de la parotide.

Sebaceous carcinoma is a rare tumor, from the adnexal epithélium of the sebaceous glands. Usually, lesions arise in meibonian glands of the eyelid. However, extraocular lesions within head and neck have been reported. We report a case of recurrent sebaceous carcinoma of the parotid gland without metastases.

[Arrhythmogenic right ventricular dysplasia and cardiomyopathy. Clinical and anatomic-pathologic aspects, nosologic approach]. / Dysplasie et cardiomyopathie ventriculaire droite arythmogènes. Aspects cliniques et anatomo-pathologiques, abord nosologique.

Arrhythmogenic right ventricular dysplasia is a polymorphous clinical entity. Its diagnosis is difficult in incomplete forms or at the onset of the disease. The diagnosis is based on the association of clinical, electrocardiographic and electrophysiologic signs which are the result of a specific pathological structure, consisting of fibromuscular bundles isolated from each other by fatty tissue resulting from apoptosis and/or the basic dysplastic phenomenon. These fibers are oriented in a parallel direction and connected at their extremities with normal myocardium. These fibromyocyte bundles seem to constitute a tissue with preferential conduction, which could explain reentry phenomena, and therefore the basis for the pathogenesis of ventricular arrhythmias. The various clinical aspects of ARVD have similar morphological patterns, but a completely different prognosis and outcome.

[Carcinosarcoma of the submaxillary gland]. / Carcinosarcome de la glande sous-maxillaire.

Salivary gland carcinosarcoma is a rare neoplasm, with a poor prognosis, that should not be confused with the more common carcinoma ex-pleomorphic adenoma, in which the epithelial component alone is malignant. The authors report one case of carcinosarcoma of the submandibular gland, with no previous history of pre-existent tumor. The tumor exhibited two intermingled and very atypical cellular components, one undifferentiated and the other with a chondroid pattern. Immunostaining with epithelial markers in the undifferentiated area allowed to distinguish this tumor from salivary gland sarcomas. In addition, the positivity for EMA, vimentin, and S100 protein in the two predominant components suggested a common origin for the different tumoral cell types, and led to discuss the nomenclature and the still unclarified cellular origin of these tumors.

[Neuroendocrine carcinoma of the larynx with secretion of calcitonin: primary tumor or metastasis of the medullary thyroid carcinoma?]. / Carcinome neuroendocrine laryngé avec sécrétion de calcitonine: cancer primitif ou métastase d'un cancer médullaire de la thyroïde?

Neuroendocrine carcinomas of the larynx are rare and their links with thyroid neoplastic lesions are not specified in most reported cases. We report such a case secondary to medullary thyroid carcinoma. In a 63-year-old man, a supra glottic laryngeal carcinoma confirmed by biopsy was initially treated by chemotherapy. A second biopsy of the laryngeal lesion after incomplete remission displayed a neuroendocrine carcinoma with calcitonin in neoplastic cells. Laryngectomy, cervical bilateral neck dissection and thyroid isthmic adenoma dissection were performed. Numerous neoplastic cells from these tissues contained calcitonin revealed by immunohistochemical method. Calcitoninemia was highly increased and multiple bone metastases were discovered. Secondary total thyroidectomy was not possible and the patient died 6 months after. In this case the neuroendocrine laryngeal carcinoma was probably secondary to a latent medullary thyroid carcinoma. Medullary thyroid carcinoma is most often unknown in similar previously reported cases of neuroendocrine laryngeal carcinoma. Thus a neuroendocrine tumour of the larynx should require search for extra thyroid and over all thyroid neuroendocrine carcinoma, even limited to a small and latent lesion.

[Uncommon tumor and pseudotumor lesions of the submandibular fossa]. / Lésions pseudo-tumorales ou tumorales inhabituelles de la loge sous-mandibulaire.

The histological examination of the salivary gland tumors is a very important step in the diagnostic approach of the lesions, on which depends the success of therapeutic outcome. Some surprises may occur; four examples were reported. In one case the lesion was not a tumor but a tuberculous lymphadenitis; another showed a Destombes Rosai Dorfman syndrome. Two other cases were found to be unusual tumors: a carcinosarcoma of the submandibular gland and a metastasis of a Merkel carcinoma in the submandibular gland.

[Glomus tumors. Clinical, histological and immunohistochemical study. Apropos of 29 cases]. / Tumeurs glomiques. Etude clinique, histologique et immunohistochimique. A propos de vingt-neuf cas.

This retrospective pathological study, based on twenty-nine glomus tumors, was conducted in order to define the histological or immunohistochemical diagnostic criteria in cases with atypical morphology. The immunohistochemical phenotype of glomus tumors was defined by means of identification of glomus cells, vessels and associated nerve fibres.

[Modified subcutaneous mastectomy. Apropos of 916 cases]. / Les mammectomies sous-cutanées modifiées. A propos de 916 observations.

Modified subcutaneous mastectomy was described by one of us in 1968; its approach, the dissection of the gland, plastic reconstruction of shape and volume are completely different from the subcutaneous mastectomy performed by plastic surgeons. 3 different time periods were studied to explain clearly evolution in the technic and indications. During many years retrospective studies made it possible to build a procedure according to the new diagnostic means for infraclinical breast cancer and to the constant improving prosthetic material. Therefore our indications for modified subcutaneous mastectomy are as following: suspicious mastopathies are the best indications with a performing choice of the radiologic images which require histologic control some evolutive or evoluated mastopathies some small infiltrating tumors developing in a highly dystrophic glandular surrounding. The numerous in situ cancers accompanying them argue for this choice. some big phyllod tumors or phyllod's recurrences.

[Elastofibroma dorsi. Apropos of 5 cases]. / Elastofibrome dorsal. A propos de cinq observations.

Elastofibroma is a rare tumor mainly found under the scapula. Based on a recent study of five cases, we would like to stress the importance of making the diagnosis of elastofibroma, as this lesion simply consists of dysplasia of the elastic fibres and is not malignant as could be suggested by clinical examination.

[Immunohistochemical study of cytosolic estrogen receptor-bound protein in breast cancer. Correlation with a biochemical study. Apropos of 107 surgical specimens]. / Etude immunohistochimique d'une protéine liée aux récepteurs cytosoliques aux oestrogènes dans le cancer du sein. Corrélation avec l'étude biochimique. A propos de cent sept pièces d'exérèse.

One hundred and seven breast cancers were studied by immunohistochemistry with a monoclonal antibody revealing a protein bound to cytosolic estrogen receptors ERD5 on paraffin embedded tissue. Seventy seven per cent of the cancers were positive with a variable intensity. In half of the cases, the estrogen cytosolic receptors were also determined by biochemistry. The results were similar in 74% of cases. Estrogen receptors were detected by immunohistochemistry in 18.5% of the cancers which were negative on biochemistry. As is well known, the presence of estrogen in 18.5% of the cancers which were negative on biochemistry. As is well known, the presence of estrogen receptors is an important prognostic factor in breast cancer. Our results, together with the simplicity of the immunohistochemical method, should encourage pathologists to include this analysis in the study of surgical specimens of breast cancers.

[Pseudotumoral salivary localization of Destombes-Rosai-Dorfman syndrome. Hemophagocytic histiocytosis. Diagnosed by bilateral submandibular and parotid involvement]. / Localisation salivaire pseudo-tumorale du syndrome de Destombes-Rosai-Dorfman Histiocytose hémophagocytaire. Atteinte révélatrice sous-maxillaire et parotidienne bilatérale.

We report one case of pseudotumoral salivary location of the Rosai-Dorfman syndrome, with a favorable outcome, occurring in a 32-year-old man from Guadeloupe. The clinical, biological and clinicopathological features of this syndrome, as well as the pathogenetic hypotheses, are summed up. In this case, no bacterial, fungal, parasitic or viral agent was discovered. The subject presented with no immune abnormality likely to account for the persistence and intensity of the histiocytic infiltration with lymphophagocytosis associated to the lymphoplasmocytic infiltration. The rarity of ENT, and more specifically salivary, locations is emphasized. The importance of the detection of possible immune abnormalities in such patients is demonstrated by the outcome of the syndrome being more often unfavorable when such abnormalities are present.

[Subclinical identification of cancer of the breast. Radiologic progress, proposition for treatment]. / Reconnaissance infraclinique du cancer du sein. Progrès radiologiques, proposition de traitement.

In the case of breast cancer with no clinical signs, radiological signs are the decisive factors to indicate surgery, histological studies or treatment. Foci of microcalcifications currently are the feature to identify as a rule. However, they reveal canalicular carcinoma in only 1 case out of 3. We propose a radiological technique allowing the selection of the microcalcifications to be operated by means of the digitization of a mammographic film and of a software-controlled morphometric analysis. 10,000 microcalcifications have been studied in this way. The most reliable of the 12 parameters that were distinguished is compacity. 100 files were studied with conventional mammography and a morphometric and histological analysis. Any microcalcification less compact than 0.35 is highly suspicious, since this parameter is the only one having a significant difference, with a confidence interval of 95%. The patients are now selected in this way. Differences in the age of the lesions, multiple foci and sometimes lesions with multiple centers lead us to automatically propose the exeresis of the gland, followed by immediate reconstruction of its shape and volume. According to a retrospective study we carried out on 111 subclinical intracanalicular carcinomas after a 5 to 20-year time interval, recurrence is observe in only 4.5% of all cases.

[Spontaneous rupture of the flexor tendon of the hand disclosing the presence of Recklinghausen's disease]. / Rupture spontanée d'un tendon fléchisseur de la main révélatrice d'une localisation de la maladie de Recklinghausen.

Seemingly spontaneous subcutaneous ruptures of the flexor tendons of the hand are not frequently encountered. The case studied is that of a young man whose deep flexor tendon of the third finger snapped during a slight effort. The histological and immunohistochemical analysis led to the conclusion that there was localization of an intra-tendinous neurofibroma, which would seem to be a so-far undescribed phenomenon. The patient presented neurofibromas elsewhere and had pigmented spots on the body, which enabled Von Recklinghausen's disease to be diagnosed.

[Echography in studying the hyothyroepiglottic space. Normal image. Pathologic aspects. Histologic correlations]. / Apport de l'échographie dans l'étude de la loge hyo-thyro-épiglottique. Image normale. Aspects pathologiques. Confrontations histologiques.

Invasion of the hyothyroepiglottic (HTE) space, or pre-epiglottic space, constitutes an important element in selecting the type of therapy in cancer of the larynx (functional surgery, radiotherapy), the oropharynx and the hypopharynx. Clinical examination and standard X-ray films provide insufficient information. High frequency real time ultrasonography offers a reliable means for exploring the pre-epiglottic space, as evidenced by this study carried on 34 histologically-confirmed cases taken among 77 cases of carcinoma of the upper digestive and respiratory tracts. Advantages presented by this method over CT-scanning and MR imaging in this particular pathological are simplicity, rapidity and low cost, combined with good performance.

[Breast lesions associated with cancer of the breast. Study of 200 excision specimens]. / Lésions mammaires associées au cancer du sein. Etude de deux cents pièces d'exérèse.

Two hundred cases of breast carcinoma were studied, with particular attention to adjacent non-malignant modifications considered by some authors as preneoplastic changes. Diverse proliferative lesions were recognized in 82% of cases. Atypical hyperplasia was present in 51.5% of cases and was more often ductal (83/200) than lobular (40/200). Microscopic cysts were noted in 72% of cases. Calcifications, easily identified by mammography were present in 20% of cases and were associated with atypical hyperplasia in 4/5 of cases. The mean of patients was 58 years. For comparative studies of histologic lesions the following age categories were evaluated: category I less than 50 years (57 patients), category II greater than or equal to 50 years (143 patients). Atypical lobular hyperplasia, adenosis, and, to a lesser degree, sclerosing adenosis and macroscopic cysts were more frequently associated with breast cancer in women younger than 50. Fibro-atrophic or lipomatous changes were more often found in the older group of women, as expected. Sclerosing adenosis was significantly more frequent in breasts with multifocal infiltrating carcinoma. Such changes must be considered as risk factors by pathologists when present in mammary specimens without carcinomatous lesions, and careful study should be undertaken to locate a possible in situ microscopic carcinoma. No differences appeared in lesions associated with breast cancer in women with or without a familial history of breast cancer.

[Fatal pneumopathy linked to subcutaneous injections of liquid silicone into soft tissue]. / Pneumopathie mortelle liée à l'injection sous-cutanée de silicone liquide dans les parties molles.

The case of a 23-year old transsexual male who developed a lethal lung disease 48 hr after a 1 l subcutaneous silicone fluid injection is reported. Histologic examination showed optically empty oil red O negative vacuoles in several specimens, and particularly in the lungs; refractile particles of silicium were also found. We identified the material as silicium, and evaluated its quantity in tissues by atomic absorption and spectrometric and toxicological analysis. Experimental studies and rare human accidents suggest that silicone fluid is transported by migrating phagocytes, thereby explaining lymph node, spleen, liver, adrenal and lung deposits. In our patient's report, we added gradual blood contamination to explain the progressive development of respiratory failure with the severity of the respiratory disorder linked to the massive dose injected. Massive silicone blood embolization could be excluded because of the interval between the injection and emergence of the first clinical signs.