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Fibrosis Pulmonar Idiopática/diagnóstico , Fibrosis Pulmonar Idiopática/terapia , Neumología/métodos , Neumología/tendencias , Algoritmos , Biopsia , Diagnóstico Diferencial , Práctica Clínica Basada en la Evidencia/normas , Práctica Clínica Basada en la Evidencia/tendencias , Francia , Humanos , Pulmón/patología , Neumología/normas , Radiografía Torácica , Tomografía Computarizada por Rayos XAsunto(s)
Fibrosis Pulmonar Idiopática/diagnóstico , Fibrosis Pulmonar Idiopática/terapia , Neumología/métodos , Neumología/tendencias , Algoritmos , Biopsia , Lavado Broncoalveolar , Diagnóstico Diferencial , Práctica Clínica Basada en la Evidencia/normas , Práctica Clínica Basada en la Evidencia/tendencias , Francia , Humanos , Pulmón/patología , Neumología/normas , Radiografía Torácica , Tomografía Computarizada por Rayos XAsunto(s)
Fibrosis Pulmonar Idiopática/diagnóstico , Fibrosis Pulmonar Idiopática/terapia , Neumología/métodos , Neumología/tendencias , Algoritmos , Biopsia , Lavado Broncoalveolar , Diagnóstico Diferencial , Práctica Clínica Basada en la Evidencia/normas , Práctica Clínica Basada en la Evidencia/tendencias , Francia , Humanos , Pulmón/patología , Neumología/normas , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
This report describes the case of a 44-year-old man with pulmonary nodules whose histological analysis initially suggested tuberculosis. The Mycobacterium tuberculosis (MT) culture was negative and a questionnaire revealed a professional activity of brushing and polishing surgical instruments without any protection for 7 years. A mineralogical analysis by optical and electron microscopy was performed on both a healthy lung tissue biopsy and a lung nodule in a paraffin block. Electron microscopy analysis revealed the presence of metal particles (iron oxide, titanium oxide, aluminum oxide and steel) in both samples. This study suggests that mineralogical analysis combined with a questionnaire on dust exposure could help redirect the diagnosis of a dust-related disease.
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Polvo , Granuloma del Sistema Respiratorio/inducido químicamente , Metales/efectos adversos , Nódulos Pulmonares Múltiples/inducido químicamente , Enfermedades Profesionales/inducido químicamente , Salud Laboral , Ocupaciones , Sarcoidosis Pulmonar/inducido químicamente , Instrumentos Quirúrgicos/efectos adversos , Adulto , Biopsia , Diagnóstico Diferencial , Polvo/análisis , Diseño de Equipo , Compuestos Férricos/efectos adversos , Granuloma del Sistema Respiratorio/diagnóstico , Humanos , Exposición por Inhalación/efectos adversos , Masculino , Metales/análisis , Microscopía Electrónica , Nódulos Pulmonares Múltiples/diagnóstico , Enfermedades Profesionales/diagnóstico , Exposición Profesional/efectos adversos , Valor Predictivo de las Pruebas , Sarcoidosis Pulmonar/diagnóstico , Acero/efectos adversos , Titanio/efectos adversosRESUMEN
AIM: To generate a national biobank made up of samples of the highest quality for the purpose of inciting basic research on gestational trophoblastic diseases (GTD). MATERIAL AND METHODS: Three priority axes of research were defined to optimize the nature, method of collection, and storage of the samples. These are: to enhance our understanding of GTD, develop new diagnostic tests, and identify new therapeutic targets. The protocol for patient inclusion and sample processing was determined after extensive literature review and collaboration with international experts in the field of GTD. RESULTS: For each patient with a GTD and for control patients (legally induced abortions), chorionic villi, decidua and tumor samples (fresh, immersed in RNA-protective solution and fixed in formaldehyde), blood (serum, plasma, RNA, and peripheral blood mononuclear cells), urine (supernatant), and cell cultures of villous cytotrophoblasts are prospectively collected. Associations are then made between the collected samples and numerous clinical and biological data, such as human chorionic gonadotropic plasma levels following curettage in the case of a hydatidiform mole. CONCLUSION: Such a collection of high quality samples and their associated data open up new perspectives for both national and international collaborative research projects.
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Enfermedad Trofoblástica Gestacional , Bancos de Tejidos , Adulto , Femenino , Humanos , EmbarazoRESUMEN
INTRODUCTION: Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease affecting mainly young women. BACKGROUND: The respiratory manifestations are characterized by a progressive cystic destruction of the lung parenchyma. Extrapulmonary involvement includes benign renal tumours called angiomyolipomas and abdominal lymphatic masses called lymphangioleiomyomas. At the pathological level, the cellular proliferation found in LAM is in part due to the presence of mutations in the tumour suppressor genes TSC1 and TSC2 (Tuberous Sclerosis Complex). These mutations lead to the activation of the mTOR pathway, which is currently the main therapeutic target. mTOR inhibitors such as sirolimus or everolimus have shown a beneficial effect on the decline in pulmonary function and a reduction of angiomyolipoma size, but are necessary in only some patients. PERSPECTIVES: LAM cells have migratory properties mediated by the formation of new lymphatic vessels. They are also able to secrete metalloproteases, which enhance their invasiveness. Moreover, the expression of estrogen and progesterone receptors by LAM cells suggests a possible role for sex hormones in the pathogenesis of the disease. CONCLUSION: A better understanding of mTOR-independent mechanisms would allow the development of novel therapeutic approaches.
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Neoplasias Pulmonares , Linfangioleiomiomatosis , Adulto , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/terapia , Linfangioleiomiomatosis/diagnóstico , Linfangioleiomiomatosis/epidemiología , Linfangioleiomiomatosis/etiología , Linfangioleiomiomatosis/terapiaRESUMEN
BACKGROUND: Pulmonary sarcomatoid carcinomas (SC) are tumors characterized by poor prognosis and resistance to conventional platinum-based chemotherapy. This study sought to describe the mutational profile of SC using high-throughput genotyping technology. PATIENTS AND METHODS: We used mass spectrometry to test 114 surgical biopsies from 81 patients with SC for 214 mutations affecting 26 oncogenes and tumor suppressor genes. RESULTS: In total, 75 (92.6%) patients were smokers. Within the total 81 tumors, 67 distinct somatic alterations were identified, with 56 tumors (69.1%) harboring at least one mutation. The most frequent mutations were KRAS (27.2%), EGFR (22.2%), TP53 (22.2%), STK11 (7.4%), NOTCH1 (4.9%), NRAS (4.9%), and PI3KCA (4.9%). The EGFR mutations were almost always rare mutations (89%). In 32 tumors (39.5%), two or more mutations co-existed, with up to four mutations in a single case. In six different cases, comparative genetic analysis of different histological areas from the same tumor (giant, spindle, or epithelial component) revealed a 61% concordance rate for all the mutations with a 10% detection threshold, compared with 91.7% with a 20% detection threshold. CONCLUSION: Our results demonstrated a high mutation rate and frequent co-mutations. Despite SC tumors exhibiting a high histological heterogeneity, some intratumoral molecular homogeneity was found. Now with newly developed targeted therapies, SC patients may be eligible for new target mutations, and can now therefore be screened for clinical trials.
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Carcinoma de Células Gigantes/genética , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinosarcoma/genética , Neoplasias Pulmonares/genética , Quinasas de la Proteína-Quinasa Activada por el AMP , Adulto , Anciano , Carcinoma/genética , Estudios de Cohortes , Receptores ErbB/genética , Femenino , GTP Fosfohidrolasas/genética , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , Proteínas de la Membrana/genética , Persona de Mediana Edad , Mutación , Proteínas Nucleares/genética , Proteínas Serina-Treonina Quinasas/genética , Proteínas Proto-Oncogénicas p21(ras)/genética , Receptor Notch1/genética , Estudios Retrospectivos , Factores de Transcripción/genética , Proteína p53 Supresora de Tumor/genéticaRESUMEN
Mesothelioma is a rare disease less than 0.3% of cancers in France, very aggressive and resistant to the majority of conventional therapies. Asbestos exposure is nearly the only recognized cause of mesothelioma in men observed in 80% of case. In 1990, the projections based on mortality predicted a raise of incidence in mesothelioma for the next three decades. Nowadays, the diagnosis of this cancer is based on pathology, but the histological presentation frequently heterogeneous, is responsible for numerous pitfalls and major problems of early detection toward effective therapy. Facing such a diagnostic, epidemiological and medico-legal context, a national and international multidisciplinary network has been progressively set up in order to answer to epidemiological survey, translational or academic research questions. Moreover, in response to the action of the French Cancer Program (action 23.1) a network of pathologists was organized for expert pathological second opinion using a standardized procedure of certification for mesothelioma diagnosis. We describe the network organization and show the results during this last 15years period of time from 1998-2013. These results show the major impact on patient's management, and confirm the interest of this second opinion to provide accuracy of epidemiological data, quality of medico-legal acknowledgement and accuracy of clinical diagnostic for the benefit of patients. We also show the impact of these collaborative efforts for creating a high quality clinicobiological, epidemiological and therapeutic data collection for improvement of the knowledge of this dramatic disease.
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Mesotelioma , Neoplasias Pleurales , Francia , Humanos , Mesotelioma/patología , Patología Clínica , Neoplasias Pleurales/patología , Derivación y Consulta , Sociedades Médicas , Factores de TiempoAsunto(s)
Fibrosis Pulmonar Idiopática/diagnóstico , Fibrosis Pulmonar Idiopática/terapia , Acetilcisteína/uso terapéutico , Corticoesteroides/uso terapéutico , Anticuerpos/uso terapéutico , Anticoagulantes/uso terapéutico , Colchicina/uso terapéutico , Técnicas de Diagnóstico del Sistema Respiratorio , Francia , Pruebas Genéticas , Humanos , Fibrosis Pulmonar Idiopática/genética , Comunicación Interdisciplinaria , Grupo de Atención al Paciente , VacunaciónRESUMEN
INTRODUCTION: Bronchiolo-alveolar carcinoma is a controversial indication for lung transplantation because of the risk of recurrence. We report three cases and propose some risk factors for recurrence. CASE REPORTS: Our study concerns three patients transplanted at the Louis-Pradel Hospital between 1991 and 2010. The first patient relapsed 86 months after transplantation, benefited from surgical treatment, then died of renal failure. A second patient died of infection, without recurrence, 72 months after transplantation. The third had an early recurrence at 7 months and died 27 months after transplantation. The risk factors for recurrence appear to be: clinically "aggressive" presentation and histological stromal pulmonary invasion by the carcinoma. CONCLUSION: Diffuse bronchiolo-alveolar carcinoma is a possible indication of lung transplantation. The risk of recurrence imposes some requirements: a precise histological diagnosis and a slow clinical course.
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Adenocarcinoma Bronquioloalveolar/cirugía , Neoplasias Pulmonares/cirugía , Trasplante de Pulmón , Adenocarcinoma Bronquioloalveolar/patología , Adulto , Resultado Fatal , Femenino , Humanos , Neoplasias Pulmonares/patología , Trasplante de Pulmón/mortalidad , Trasplante de Pulmón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/etiología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Factores de RiesgoRESUMEN
UNLABELLED: A 71 year-old man with primary Sjögren's syndrome developed pulmonary opacities within two years of the diagnosis. Videothoracoscopic lung biopsy demonstrated high grade, B-cell, CD20+, large-cell lymphoma, associated with Epstein-Barr virus (RNA EBERs of the virus were expressed by the lymphoma cells). The condition initially improved with rituximab-CHOP treatment, but recurrence of the lymphoma was fatal. CONCLUSION: High-grade B-cell lymphoma associated with EBV can occur in Sjögren's syndrome in the absence of long-term immunosuppressive therapy.
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Infecciones por Virus de Epstein-Barr/complicaciones , Neoplasias Pulmonares/virología , Linfoma de Células B/virología , Síndrome de Sjögren/complicaciones , Anciano , Humanos , MasculinoAsunto(s)
Bronquiectasia/etiología , Crioglobulinemia/etiología , Insuficiencia Respiratoria/etiología , Macroglobulinemia de Waldenström/diagnóstico , Bronquiectasia/patología , Bronquiectasia/fisiopatología , Femenino , Humanos , Inmunoglobulina M/metabolismo , Cadenas kappa de Inmunoglobulina/metabolismo , Persona de Mediana Edad , Macroglobulinemia de Waldenström/complicaciones , Macroglobulinemia de Waldenström/fisiopatologíaRESUMEN
Ovine pulmonary adenocarcinoma (OPA) is a lung cancer strikingly similar to the pneumonic-type mixed invasive adenocarcinoma with a predominant bronchioloalveolar component in humans. Telomerase activity in OPA and the potential involvement of the kinase Akt in telomerase activation and regulation of cell proliferation were investigated. Lung tissues were collected from sheep with a histopathological diagnosis of OPA or controls. Epithelial cell cultures were derived in vitro from lung tissues. Telomerase activity was evaluated using the telomeric repeat amplification protocol method. Phosphorylation of Akt was detected by Western blotting. Telomerase activity was significantly higher in OPA lung tissues compared to control lung tissues. A high telomerase activity was detected in eight out of 12 (67%) primary cell cultures derived from tumours. A high level of expression of phosphorylated Akt was found in 10 out of 27 (37%) tumours, with abolition of Akt activation in response to epidermal growth factor stimulation demonstrated in primary cell cultures derived from tumours. Telomerase activation takes place in ovine pulmonary adenocarcinoma tumour cells and may be partly attributable to Akt activation. Telomerase may inhibit cellular senescence and contribute to the accumulation of tumour cells in mixed adenocarcinoma with a bronchioloalveolar component. Further work is necessary to identify alternative signalling pathways of telomerase activation in tumours.
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Adenocarcinoma Bronquioloalveolar/genética , Adenocarcinoma/genética , Modelos Animales de Enfermedad , Retrovirus Ovino Jaagsiekte/genética , Neoplasias Pulmonares/genética , Adenomatosis Pulmonar Ovina/genética , Telomerasa/genética , Adenocarcinoma Bronquioloalveolar/patología , Animales , División Celular/genética , Transformación Celular Neoplásica/genética , Transformación Celular Neoplásica/patología , Senescencia Celular/genética , Activación Enzimática/genética , Regulación de la Expresión Génica/genética , Humanos , Pulmón/patología , Proteínas Proto-Oncogénicas c-akt/genética , Alveolos Pulmonares/patología , Ovinos , Transducción de Señal/genética , Células Tumorales Cultivadas/patologíaRESUMEN
BACKGROUND: Genes and mechanisms of action involved in human acute rejection after allogeneic heart transplantation remain to be elucidated. The use of a murine allograft model in tandem with cDNA arrays and quantitative real-time polymerase chain reaction (Q-PCR) can greatly help in identifying key genes implicated in human heart acute rejection. METHODS AND RESULTS: Hearts from Balb/c mice were either not transplanted or transplanted heterotopically in the abdomen of Balb/c (isografts) and C57BL/6 (allografts) mice. Histological analysis showed acute rejection only in allografts. Total RNA was extracted from isografts (n=3), allografts (n=4), and not transplanted hearts (n=4); reverse transcribed; and labeled with P32. Each probe was hybridized to cDNA macroarrays. Eight genes were overexpressed and 7 genes were underexpressed in allografts compared with isografts. Macrophage inflammatory protein-1beta (MIP-1beta), an overexpressed gene, and VE-cadherin, an underexpressed gene, were validated by immunohistochemistry and Q-PCR in the murine models. Genes of interest, validated in the 3 murine groups, were then investigated in human heart tissues. Immunohistochemistry and Q-PCR performed on endomyocardial biopsies after heart transplantation showing no rejection (n=10) or grade IB (n=10) or IIIA (n=10) rejection, according to International Society of Heart and Lung Transplantation criteria, confirmed the results obtained from the murine model. CONCLUSIONS: We have demonstrated that the upregulation of MIP-1beta and downregulation of VE-cadherin may strongly participate in human acute heart rejection.
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Cadherinas/genética , Rechazo de Injerto/genética , Trasplante de Corazón/efectos adversos , Proteínas Inflamatorias de Macrófagos/genética , Animales , Antígenos CD , Cadherinas/análisis , Quimiocina CCL4 , Perfilación de la Expresión Génica , Humanos , Inmunohistoquímica , Proteínas Inflamatorias de Macrófagos/análisis , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Modelos Animales , Análisis de Secuencia por Matrices de Oligonucleótidos , Trasplante Homólogo , Trasplante Isogénico , Regulación hacia ArribaRESUMEN
To develop an MRI method for the evaluation of contrast enhancement in early atherosclerotic plaque development in the abdominal aorta of a mouse model. Male apoE-/- mice from three groups, respectively 4 (n = 6), 8 (n = 11) and 16 (n = 4) weeks were included. Axial T1 spin echo images of the abdominal aorta were obtained above and below the renal arteries (90 microm spatial resolution) before and over 1 h after the injection of a macromolecular contrast agent. Signal enhancement was measured in the vessel wall and compared to histological features. Maximal arterial wall signal enhancement was obtained from 16 to 32 min post injection. During this time, the signal-to-noise ratio increased by a factor up to 1.7 in 16 week mice and 2.7 and 2.4 in 8 and 4 weeks mice, respectively. The enhancement of the arterial wall appeared less pronounced in the oldest mice, 16 weeks old, exhibiting more advanced lesions. Using a macromolecular gadolinium agent, contrast uptake in atherogenesis varies with lesion stage and may be related to vessel-wall permeability. Dynamic contrast-enhanced MRI may be useful to evaluate the atherosclerotic plaque activity in mice.
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Apolipoproteínas E/deficiencia , Arteriosclerosis/diagnóstico , Medios de Contraste , Modelos Animales de Enfermedad , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Compuestos Organometálicos , Animales , Arteriosclerosis/metabolismo , Arteriosclerosis/patología , Interpretación de Imagen Asistida por Computador/métodos , Magnetismo , Ratones , Ratones Noqueados , Ratones Transgénicos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
Myocardial dysfunction is common in grafted hearts from brain-dead donors, but the mechanisms involved remain unclear, although apoptosis has been suggested to play an important role. In this study, we investigated the presence of apoptotic myocardial cells in donor hearts as compared to control hearts to determine whether pre-existing apoptosis can predict donor heart dysfunction. Apoptosis was studied by in situ DNA fragmentation assay and by Western Blotting for caspase-3, the pivotal executive caspase of the apoptotic pathway. We show that brain-death induced myocardial apoptosis was not predictive of myocardial dysfunction in transplanted hearts.