[Laparoscopic sentinel lymph node (SLN) dissection for clinically localized prostate carcinoma: results obtained in the first 70 patients]. / Détection laparoscopique des ganglions sentinelles dans le cancer localisé de la prostate: résultats obtenus chez 70 premiers patients.

OBJECTIVES: The lymph node metastasis is an important prognostic factor in prostatic cancer. The aim of this prospective study was to evaluate the relevance of the sentinel lymph node biopsy by laparoscopy in staging locoregional patients with clinically localized PC. PATIENTS AND METHODS: A transrectal ultrasound-guided injection by 0.3 mL/100 MBq (99m)Tc-sulfur rhenium colloid in each prostatic lobe was performed the day before surgery. The detection was realized intraoperatively with a laparoscopic probe (Clerad(®) Gamma Sup) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by hematoxyline-phloxine-safran staining and followed by immunochemistry if SLN is free. RESULTS: Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 68/70 (97%). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14%). The internal iliac region was the first metastatic site (40.9%). A metastatic sentinel node in common iliac region beyond the ureteral junction was present in 18.2%. A non-negligible sentinel metastatic region was the common iliac area (18.2%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59% of lymph node metastases. CONCLUSION: The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limited the risk of surgical extended dissection while maintaining the accuracy of the information.

[Active surveillance for prostate cancer: usefulness of endorectal MR at 1.5 Tesla with pelvic phased array coil in detecting significant tumors]. / Cancer de la prostate localisé: l'IRM endorectale à 1,5 Tesla améliore-t-elle la sélection des patients en vue d'une surveillance active?

PURPOSE: To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French "SurAcaP" protocol. PATIENTS AND METHODS: The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T erMR PPA). Sixty-one patients (8.9%) fulfilled "SurAcaP" protocol criteria. Preoperative data (MR+core biopsy) were assessed by comparison to whole-mount step section pathology. RESULTS: 85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD)=8.2%, Gleason sum score>6=39.2%). A new exclusion criterion has been assessed: T3MRI±NPS>1 as a predictor tool of significant tumor. ("T3MRI±NPS>1"=Non OCD at MR±number of positive sextants involved in tumor at MR and/or Core Biopsy > to 1). Sensitivity, specificity, PPV, NPV of the criterion "T3MRI±NPS>1" in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the "SurAcaP" protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score>6 rates (20%). CONCLUSION: Endorectal MR at 1.5 Tesla with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called "T3MR±NSP>1" may represent an exclusion citeria due to its ability to predict significant tumor.

Papillary thyroid carcinoma: 6 cases from 2 families with associated lymphocytic thyroiditis harbouring RET/PTC rearrangements.

Familial papillary thyroid carcinoma (PTC) is a well recognized disease. However, genetic predisposition to familial PTC is rare and the molecular alterations at the origin of the pathology are unknown. The association between PTC and lymphocytic thyroiditis (LT) has been reported recently. We communicate here 6 cases of PTC associated with LT in 2 unrelated families. PTC was diagnosed on classical nuclear and architectural criteria. It was bilateral in 5 cases. Architecture was equally distributed between typical PTC and its follicular variant. LT was present in variable degrees, including in 4 cases, oncocytic metaplasia. Using the RT-PCR technique, we observed a RET/PTC rearrangement in the carcinomatous areas of patients of both families: PTC1 in family 1 and PTC3 in family 2 and a RET/PTC rearrangement in non-malignant thyroid tissue with LT in family 2. The RET/PTC band was weaker or absent in pure LT areas. Furthermore, using a polyclonal ret antibody, an apical or a diffuse cytoplasmic ret onc protein immunolabelling was observed in the three patients with RET/PTC1 rearrangement and in the three patients with RET/PTC3 rearrangement. In conclusion our data: (1) show the presence of a RET/PTC 1 or 3 rearrangement (depending on the family) together with a variable expression of ret protein in all the PTCs; (2) suggest that the molecular event at the origin of the PTCs seems to be particular to each one of the studied families; and (3) confirm that the ret proto-oncogene activating rearrangement(s) is an early event in the thyroid tumorigenic process and that it can be observed in association with LT.

Study of survival and prognostic factors in patients undergoing resection for gastric linitis plastica: a review of 86 cases.

A retrospective study was conducted in a series of 86 patients (51 men and 35 women; mean age 63.4 years) treated from 1979 to 1995 for linitis plastica of the stomach (LP). The mean interval between the first manifestations and surgery was 3.5 months. The most frequent clinical sign was epigastric pain which occurred in 80.4% of cases. Biopsies were positive in 75.6% of cases. Typical features of LP were found in only 46% of esogastric barium enemas and 11.8% of upper gastrofiberscopic examinations. Seventy-four patients had surgical excision (51 total and 23 partial gastrectomies). There were 6 (7%) postoperative deaths and 10 (11.6%) surgical complications. Node involvement was found in 54 (72.9%) patients. Overall actuarial survival (n = 86) was 50% at 12 months, 40% at 18 months and 7.5% at 84 months. Survival did not depend on the delay in diagnosis, histological analysis of the extremities of the excised piece, associated tissue differentiation, node involvement or the type of surgical excision. The prognosis differed according to tumor height (P<0.01) and involvement of the deep stomach wall (P<0.001). No independent prognostic factor was found in multivariate analysis. Surgery remains the sole possibility for curative therapy in these patients.

[Breast metastasis from a "tall cell variant" of papillary thyroid carcinoma]. / Métastase mammaire d'un carcinome papillaire à cellules hautes de la thyroïde.

The authors report a case of breast metastasis from a "tall cell" variant of papillary thyroid carcinoma in a 59-year-old woman. This metastasis was discovered two months after the diagnosis of an inextirpable thyroid tumor. Tall cell variant of papillary thyroid carcinoma is a sub-type of papillary carcinoma with an aggressive course and frequent metastases (in patients over 50 years of age). No mammary metastasis of this tumor type has been reported so far.

Radioimmunodetection of medullary thyroid cancer using a bispecific anti-CEA/anti-indium-DTPA antibody and an indium-111-labeled DTPA dimer.

Two-step radioimmunotargeting using a bispecific anti-CEA/anti-in-DTPA monoclonal antibody and an 111In-labeled DTPA dimer (diDTPA-TL) was evaluated nine times in eight patients with medullary thyroid cancer (MTC). Immunoscintigraphy was performed 5 and 24 hr after injection of 111In-diDTPA-TL. For five patients, radioimmunoguided surgery (RIGS) was performed using a hand-held gamma probe (sodium iodine), and a biodistribution study was performed 48 hr (four times) and 24 hr (one time) after injection of 111In-diDTPA-TL. Mean tumor uptake (%ID/kg in tumor) was 39 (range 2.75-139). In these five patients, immunoscintigraphy visualized all known tumors and detected unknown foci (US and CT were negative) in the neck (once) and neck and liver (once). Immunoscintigraphy, performed four times in search of a recurrence, detected unknown localizations in the mediastinum and neck (twice) and was negative twice. There were no false-positives. In three of five patients who had surgery, RIGS localized tumor foci not detected by the surgeon. RIGS failed to detect two small lesions (10 x 10 mm) corresponding to sites of fibrosis and microscopic cancer infiltration. Bispecific anti-CEA/anti-In-DTPA mediated targeting of 111In-diDTPA-TL provided elevated tumor uptake and tumor-to-normal tissue ratios. Radioimmunodetection of small MTC lesions is thus possible even when morphological imaging techniques prove negative.

Analysis of the relationship between stage of differentiation and NK/LAK susceptibility of colon carcinoma cells.

NK and LAK cells which are able to lyse tumor target cells in an MHC-unrestricted manner are not equally effective against targets of the same nature. In the case of colorectal tumors, some cells are highly sensitive, whereas others are resistant to NK and can even be quite resistant to LAK-mediated lysis. In the present paper, we tried to correlate the stage of differentiation of 17 human colorectal tumor cell lines with their NK- or LAK-cell susceptibility. It was observed that NK cells killed colorectal target cells independently from their stage of differentiation defined according to histopathological criteria from xenografting in nude mice. NK susceptibility was not correlated either with in vitro-defined criteria of differentiation, such as cell polarity and morphology, brush-border enzyme expression and CEA production. A LAK-resistant HT-29 sub-line (HT-29 LAK) was selected which could not be distinguished from HT-29 in terms of features of differentiation. It was further observed that HT-29 Glc-/+ cell line, a highly differentiated enterocytic-like variant of HT-29, obtained after glucose starvation, was killed by LAK cells as efficiently as the moderately differentiated parental HT-29, and that Caco-2 cells, which differentiate spontaneously after confluence in standard culture conditions, were equally sensitive to NK-mediated lysis whatever their stage of differentiation. In contrast, HT29 MTX10(-5), a highly differentiated mucus-secreting variant of HT29 obtained by methotrexate selection, was much more resistant to LAK cells than parental HT29 cells.

[Linitis plastica of the stomach. Factors influencing prognosis]. / Linite plastique de l'estomac. Facteurs influençant le pronostic.

The authors make a retrospective study of a series of 57 patients aged 63 years in average, followed up from 1979 to 1989 for linitis plastica of the stomach. Surgical exeresis was performed in 49 patients (34 total gastrectomies and 15 partial gastrectomies, including five 2/3 gastrectomies, two 3/4 gastrectomies, four 4/5 gastrectomies and four upper polar esogastrectomies). The overall actuarial survival rate (n = 57) was 62.5% at 1 year, 40% at 2 years and 12.5% at 5 years. The prognosis did not vary with the delay of diagnosis, the invasion of the area of resection, the associated tissue differentiation and the invasion of lymph nodes. It did very according to the height of the tumor: 22% survival at 5 years for tumors under 6 cm, against 0% for tumors exceeding 6 cm (p < 0.001).

[Desmoid tumors: diagnostic and therapeutic difficulties. Apropos of an unusual case]. / Les tumeurs desmoïdes: un diagnostic et une thérapeutique difficiles. Réflexions à propos d'une observation exceptionnelle.

This observation has been previously reported as a multifocal and recidivant desmoid tumor. The first time, the patient was operated on for a desmoid tumor situated on his left thigh. He was reoperated on fourteen years later for a recurrent tumor implanted on the same place and a new one on the right arm. Recently bilateral pulmonary tumors were discovered. As far as this evolution was concerned, its exceptional pattern induced a new analysis of the microscopic data and the diagnosis of fibrohistiocytic sarcoma was established. This observation suggest to the authors some comments about the difficulty of diagnosis and therapy of such soft tissue tumors.

[Fracture of the femoral neck complicating algodystrophy of the hip during pregnancy. Apropos of 2 cases]. / Fracture du col du fémur compliquant une algodystrophie de hance au cours de la grossesse. A propos de 2 observations.

The authors report 2 cases of fracture of the femoral neck in pregnant women. This is a serious complication of a poorly understood disease, algodystrophy of the hip during pregnancy (transient osteoporosis of the hip of pregnancy, as referred by Anglo-saxon practitioners), whose main clinical, paraclinical and course characteristics are reported. The risk of subcapital fracture is maximal during the period of term, justifying recumbency in painful forms. In spite of the phantom appearance of the femoral head and neck, this type of fractures should not be confused with tumoral osteolysis, since they always unite within usual intervals.

[Experimental model for metastasis of cecal origin]. / Modèle expérimental de métastases à point de départ caecal.

The pre-selected tumor cells injection in the cecal wall of rat, seems to be a intermediate model between spontaneous evolution of a colon tumor and intrasplenic or direct intraportal injections. From rhabdomyosarcoma cells (RMS S4-MH-) which present the advantage to prudce up lymphatic, pulmonary and hepatic metastases after subcutaneously injection, first subcutaneously (S.C.), intrasplenic (I.S.) and intracecal sites were compared: In the I.C. model, tumor was obtained in 80% of case and the survival was nearly similar to S.C. model's one. The lymphatic metastases were more and more distal as the evolution and the liver metastases were rarely observed. The I.S. model increased quickly and there were always liver metastases; In the two cases, pulmonary metastases were rarely observed (0 and 2/5). With adenocarcinoma colonic cells (Pro b) I.C. injection in the rat, tumor were obtained in 48% of cases without peritoneal dissemination; lymphatic nodes metastases were observed in 80% of cases; liver metastases was obtained in one animal from metastasis pulmonary selection cell lines. The I.C. model allows to estimate the liver and lymphatic nodes part; improved, it would be used to test adjuvant therapies and immunoscintigraphy.

[Typing of papillomaviruses in cervical dysplasias. Its value in treatment]. / Typage des papillomavirus dans les dysplasies du col. Intérêt pour leur traitement.

The typing fo Human Papillomavirus (HPV) was carried out in cervical lesions in order to decide on the best therapy to carry out in mild and medium dysplasias of the cervix. 131 patients who had an iodo-negative zone or a smear suggesting an HPV infection had microbiopsies carried out under colposcopic control. Every lesion had two biopsies carried out side by side to study the histopathology and the virology. Dysplastic lesions were found in 93 biopsies. A search for the DNA of HPV 6a, 16 and 18 was carried out using a Southern blot technique with 32P following the method of Random multipriming. Hybridization was carried out in strict and non-strict conditions. In 43 cases out of 93 dysplasias a virus was found: 2 HPV 6a, 14 HPV 16, 1 HPV 18 and 26 X HPV's (not typed). The number of HPV's that could be detected increased according to the severity of the dysplasia which was also found in frequency of type 16. Where the biopsies showed no dysplasia type 16 was found in four out of seven viruses. In this study electrophoretic profiles for type 16 were found in four cases suggesting that they were integrated into the chromosome of the cell. The low percentage of HPV found in mild or moderate dysplasias (4 type 16 out of 61 biopsies) shows that at present this test can not be used as an aid in choosing treatment.

[Immunohistochemical study of 6 multiple familial cervical paragangliomas with lymph node metastasis in one case]. / Etude immunohistochimique de six paragangliomes cervicaux multiples et familiaux avec métastase ganglionnaire dans un cas.

Cervical localizations of extra-adrenal paragangliomas are infrequently malignant, especially in their familial forms. An immunohistochemical study was performed on 6 cervical paragangliomas which were detected in 3 sisters at the age of 20 20. One had a lymph node metastasis. This study confirmed the diagnosis of paraganglioma with endocrine chief cells and supratentacular cells. It also enabled the hormonal contents of these cervical paraganglioma to be determined. In addition to catecholamine, these tumors may (like pheochromocytomas) produce serotonin and one or more other peptides.

Feasibility study of radioimmunoguided surgery of colorectal carcinomas using indium-111 CEA-specific monoclonal antibody.

The study was undertaken to define the potential use of indium 111 carcinoembryonic antigen-specific antibody labelled [CEA F(ab')2] for the radioimmuno-detection of colorectal carcinoma using an intraoperative hand-held gamma probe. The use of a linear radioactive source allowed optimization of physical characteristics. The best results regarding sensitivity and resolution were obtained using a 5-mm thick tungsten alloy collimator. A simulation study with a liver phantom (22 MBq or 0.6 mCi) was performed to determine the effect of side scatter as opposed to direct background and showed that it is possible to detect small radioactive targets (3.7 KBq or 0.1 mu Ci) 4 cm from the phantom. A clinical study performed with ten patients showed that tumours with good uptake of CEA-specific antibody could be detected with sufficient contrast in two patients when the probe was used. Results of a biodistribution study performed after tumour fragment or normal tissue countings in a well counter showed high tumour uptake (above 8 x 10(-3) injected dose/g) and tumour-to-normal tissue ratios (between 2.5 and 20) in five patients. Results with the probe showed markedly lower ratios. There was no correlation between absolute tumour uptake and the count rates of tumour measured intraoperatively. This can be attributed to the degradation of depth resolution resulting from the high energy photopeak of gamma-emitting 111In.