Sequential immunopathologic study of oral lichen planus treated with tretinoin and etretinate.

Twenty-five patients with oral lichen planus confirmed by histologic examination were divided into three groups: 10 patients received topical treatment with tretinoin, 10 received systemic treatment with etretinate, and the five remaining patients, who received no treatment, served as a control group. An immunopathologic study with the use of monoclonal antibodies was carried out before and after the 3-month course of treatment and showed a variation in the distribution and phenotype of inflammatory cells. No difference between the two types of treatment was observed, but treated patients had a shorter evolution of the disease when compared with control patients.

Different patterns of spleen involvement in systemic and malignant mastocytosis. A histological and immunohistochemical study of three cases.

Three cases of splenic involvement in three different types of generalized mastocytosis (systemic mast cell disease) are reported. The macroscopic, histological and ultrastructural modifications of the spleen are described. Each case exhibited a different morphological pattern. Giemsa staining, fluorescence after acridine orange staining and naphthol ASD chloracetate esterase reaction are shown to be valuable for diagnosis. By comparison, immunohistochemistry seemed not to be very useful, because no specific antigens are expressed. These findings are compared to previously published cases. Their value for the diagnosis and the prognosis are discussed.

[Ongoing clinical study of oral lichen planus (OLP) treated with retinoids: one used locally, (tretinoin) the other orally (etretinate)]. / Etude clinique évolutive du lichen plan buccal (LPB) sous rétinoîdes: l'un à usage local (trétinoîne), l'autre employé per os (étrétinate).

Twenty patients with oral lichen planus (OLP) were divided into two groups. The first group (8 reticulated OLP, 2 hyperkeratotic OLP) was treated with topical tretinoin. The second group (4 reticulated OLP, 6 eroding OLP) was treated with oral etretinate. All patients were regularly followed in order to observe over a period of five years the evolution of the lesions under treatment, the side-effects and recurrences when the treatment was discontinued.

Eosinophilic cellulitis (Wells' syndrome): ultrastructural study of a case with circulating immune complexes.

A 42-year-old woman was observed during 3 bouts of eosinophilic cellulitis over a 6-year-period. Skin biopsies were taken at each relapse and processed for histological, immunofluorescent and ultrastructural studies. Histologically the eosinophilic infiltrate extended to the deep dermis and the subcutaneous fat. High levels of circulating immune complexes, and complement and IgG deposits around the vessels were detected for as long as the cutaneous lesions lasted. Under the electron microscope eosinophils were numerous, half of them degranulated and some granules had a double cristal core. No injury to the vessel walls was observed. The 3 recurrences occurred respectively after lincomycin, nesdonal, acetyl salicylic acid and pholcodin ingestion and responded to sulfone and steroid therapy.

[Mucocutaneous lentiginosis, ephelides and cardiac myxoma]. / Lentiginose cutanéo-muqueuse, éphélides et myxome cardiaque.

Abnormalities of skin pigmentation are known to be associated sometimes with cardiovascular diseases. Such cases have been reported first in 1954 (14), then in 1962 (16) and 1966 (11), leading to the individualization of the leopard syndrome. In 1973 Rees et al. (21) described a lentiginosis, cardiac myxoma association, and this in turn resulted, in 1985, in a new syndrome (4) supported by several similar findings. We report here a new case with this association.

Interstitial pneumonitis and hepatitis after transfer of bone marrow cells bearing the lpr gene to irradiated recipients: a disease due to large granular leucocytes?

Mice bearing the 'auto-immune' lpr gene develop a lympho-proliferative disease associated with the production of various antibodies. Lethally irradiated recipients were grafted with bone marrow cells (BMC) from syngeneic mice with or without the lpr gene. After 6 months, the survivors were 0/24 and 16/20 for the recipients of lpr and normal BMC respectively. The mortality rate was independent of the presence of T lymphocytes among the BMC. Histological evaluation showed that hepatitis, interstitial pneumonitis, and sclerosis of lymphohaemopoietic organs were the major causes of death for the recipients of lpr BMC. Hepatitis was associated with an increase in the number of liver interstitial cells (LIC) from about 2 X 10(6) up to about 10(7) cells per liver. The LIC associated with the hepatitis were composed of polymorphonuclear leucocytes and large mononuclear leucocytes, showing phenotypic (i.e. Thy.1+, asialo GM1, presence of cytoplasmic granules) and functional (i.e. non-phagocytic and cytolytic) properties of NK cells. The disease can be distinguished both from the spontaneous disease of the lpr mice (by the absence of 'lpr cells' and of anti-DNA antibodies) and from graft versus host disease by the absence of cutaneous and intestinal lesions. It may represent a model of tissue injury mediated by large granular leucocytes.

Epidermal lesions of the GVHR: evaluation of the role of different MHC and non MHC loci and of the Ly-2+ and L3T4+ T lymphocytes.

Irradiated mice (750 rad) were injected with T-depleted bone marrow cells (BMC) and T lymphocytes in various combinations of T/host incompatibility. The epidermis was examined histologically and the incidence of two basic epidermal lesions of graft-vs-host disease (GVHD), the epidermal cell necrosis (ECN) and the lichenoid hyperplastic reaction (LR), were evaluated by a semi-quantitative evaluation. During the acute phase of GVH reaction (GVHR) (days 15 to 25), there was an obvious increase in ECN in reactions elicited by minor loci, whole major histocompatability complex (MHC) differences, or a MHC class I or II difference only. Allogeneic effect without T lymphocyte/epidermis incompatibility did not induce a significant incidence of ECN. Neither depletion of the Ly-2+ nor that of the L3T4+ T lymphocyte subset by treatment with monoclonal antibody (performed in vitro, before injection or also by treatment of the recipient) did prevent the occurrence of ECN, indicating that both T lymphocyte subsets are capable of initiating the epidermal cell damage. The LR was due mainly to the T lymphocytes of the L3T4+, Ly-2- helper phenotype. During chronic GVHR (after 35 days) elicited by either Ly-2+ or L3T4+ lymphocytes, ECN and LR were no longer evident, but the number of epidermal cells and especially the number of replicating cells among the epidermal cells were markedly reduced.

Systemic evaluation of Sjögren-like syndrome after bone marrow transplantation in man.

A systematic evaluation of Sjögren-like syndrome (SLS) was performed in 68 bone marrow transplant (BMT) recipients (60 allogeneic and 8 syngeneic recipients). At day 100, the patients underwent clinical evaluation, functional salivary scintigraphy, and lip biopsy. If any findings were abnormal, the examinations were repeated annually for 3 years. Twenty-two patients with SLS and extensive chronic graft-versus-host disease (CGVHD) had abnormal scintiscan and lip biopsy at day 100. Marked keratoconjunctivitis sicca and xerostomia developed between 12 and 24 months after BMT and, thereafter, progressively decreased. Twenty-seven irradiated recipients (7 syngeneic and 20 allogeneic recipients without CGVHD) had isolated xerostomia and disturbed scintiscan but normal biopsy. Seven other patients with limited CGVHD had a lymphocytic infiltrate on lip biopsy but no SLS and a normal scintiscan. Schirmer's test, functional salivary scintigraphy, and lip biopsy allowed us to distinguish SLS from radiotherapy sequelae. As early as day 100, these 3 tests have a predictive value for SLS, one of the criteria for extensive CGVHD.

Bladder tumors: when to do and what to expect from random mucosal biopsies with reference to blood group cell surface antigens.

Routine random biopsies of normal looking bladder mucosa in the evaluation of bladder tumors demonstrated a high occurrence of anomalies ranging from dysplasia to carcinoma in situ (CIS). 75 patients with a urothelial bladder tumor were submitted to 165 endoscopic procedures under anesthesia including transurethral resection of any bladder tumor and random mucosal biopsies in the 4 quadrants of the bladder. The frequency and severity of mucosal anomalies rise with the tumor grade and stage: in stage 0.Ta, the percentage of anomalies rises from 15% in grade-1 lesions to 53% in grade-3 tumors. 80% of the stage A (T1) B and C (T2, T3) tumors are associated with anomalies of the normal looking bladder mucosa characterized by CIS in 50% of the cases. These lesions which may persist in the absence of any visible tumor respond dramatically to endovesical bacillus Calmette-Guérin therapy. Simultaneous determinations of blood group antigens fail to demonstrate a clear correlation between the antigenic status of the tumor and that of random biopsies. These results may help to clarify the indications of random mucosal biopsies which should be reserved to the treatment and surveillance of grade 3-tumors, irrespective of their stage.

[Bone and joint Actinomyces meyeri infections. Cervicofacial localizations excluded. Apropos of 3 cases]. / Infections osseuses et articulaires à Actinomyces meyeri. Localisations cervico-faciales exclues. A propos de 3 cas.

The authors report three observations of osseous and/or articular actinomycosis. Osseous localizations, always in contact with abscessed foci of the soft tissues, included the spine and one or several limbs. In one case there was an arthritis of the knee. Culture and typing of the responsible germ: Actinomyces meyeri, were obtained from infectious foci in the three cases. The authors insist on the rare occurrence, at the moment, of osteo-articular actinomycoses outside the maxillo-facial area. Actinomyces meyeri has exceptionally been implicated. The prognosis of osteo-arthritis is similar to that of other localizations. It is usually favorable due to the great sensitivity of the germs to antibiotics, especially penicillin.

Angioimmunoblastic lymphadenopathy with dysproteinaemia (AILD) and sicca syndrome.

We report a case of AILD and sicca syndrome. The patient had presented with renal insufficiency, lymphadenopathy, hepatosplenomegaly, polyclonal hypergammaglobulinaemia, dryness of the eyes and mouth. Lip biopsy specimens showed an unusual cellular infiltrate similar to his kidney lesions. Data from the eight previously reported cases support the hypothesis that the association is a distinct pathological entity differing from pseudolymphoma and malignant lymphoma, which occur in the course of Sjögren's syndrome. The recognition of AILD is important because lymphoproliferation may lead to death after a few months.

[Bladder tumors. Indications for and results of routine biopsies of the macroscopically healthy mucosa (with a study of surface antigens)]. / Tumeurs de vessie. Indications et résultats des biopsies systématiques en muqueuse optiquement saine (avec étude des antigènes de surface).

The routine biopsy of macroscopically normal mucosa has demonstrated the frequency of anomalies (hyperplasia, dysplasia or carcinoma in situ) associated with bladder tumours. 75 patients with urothelial bladder cancer were investigated by a total of 163 endoscopic examinations which, apart from resection of the tumour, included biopsies of macroscopically healthy mucosa. The frequency and severity of the lesions increased with the grade and the stage of the tumour: in cases with stage O/Ta lesions, the percentage of anomalies increased from 15% with grade 1 to 53% with grade 3. At stage A (T1), anomalies were present in 8 out of 10 cases and consisted of carcinoma in situ in one half of cases. Similar figures were obtained for stages B/C (T2, T3). Lesions which may persist in the absence of a visible tumour respond dramatically to intravesical BCG chemotherapy. Analysis of the surface antigens did not reveal any clear correlation between the antigenic status of the tumour and that of the non-tumoural mucosa. These results clarify the indications for biopsies in macroscopically healthy mucosa, which should be limited to follow-up endoscopies and treatment of grade 3 tumours.

[Critical study of methods for the diagnosis of allergic asthma]. / Etude critique des moyens de diagnostic de l'asthme allergique.

A search for an allergic cause in asthma is fundamental to the diagnosis. Typically it is based on: A clinical history. Specific cutaneous and inhaled provocation tests which can produce a possible reaction (early and delayed) which are of great pathophysiological and therapeutic interest. In vitro tests (which enable the different phases of the allergic reaction to be distinguished) to know the serum IgE antibody levels (total IgE, specific IgE and their fixation to cell receptors) cell tests on the degranulation of basophils and the dosage of chemical mediators: histamine, leukotrienes, prostaglandins, P.A.F. in the serum or in the bronchial alveolar lavage liquid, from the study of cells or tissue samples. In this regard the authors stress two recent techniques enabling direct access to bronchial tissue and the pulmonary parenchyma, which are bronchoalveolar lavage and bronchial biopsy, both are possible today by using a fibroscope. The broncho-alveolar lavage still remains in the research area, and is not always well tolerated in asthmatics. It already allows a better definition of the major allergic cytological and biochemical components in asthma (IgE, IgA, albumin, phospholipids, mast cells and eosinophils). Bronchial biopsies with ultra-structural studies, and above all immunopathology (by immunofluorescent techniques and peroxidase stains) enable groups of asthmatics to be uncovered who were considered as non-allergic by the unsuspected intervention of hypersensitivity mechanisms to IgE (the presence of cells carrying IgE); these biopsies enable the importance of inflammatory factors to be confirmed and equally to establish the prognosis in certain asthmatics by the degree of irreversibility of the lesions (fibronectin).(ABSTRACT TRUNCATED AT 250 WORDS)

[Actinomyces meyeri actinomycosis: a case with thoracic and tibial localization]. / Actinomycose à Actinomyces meyeri: un cas avec localisation thoracique et tibiale.

Apart from the rarity of the causal agent, this case is of interest because of the absence of cervico-facial involvement and the presence of multiple cutaneous nodules at a distance from the visceral localisation.