[Adult autopsies in a French university hospital (CHU Amiens) for the period 1975-2005]. / Les autopsies d'adultes au CHU d'Amiens durant la période 1975-2005.

We have reviewed the pathological reports of adult necropsies performed in Amiens hospital during the 1975-2005 period. 1,639 autopsies were performed in 1,049 men and 590 women. We distinguished three periods: 1975-1987 (period 1) with a high number of autopsies (86/year), 1988-1996 (period 2) with a huge decrease of autopsies performed (43/year) and 1997-2005 (period 3) with few autopsies performed (14/year). Patients were younger during period 3, 38% were less than 50 years old versus 26% and 29% during periods 1 and 2. The sex ratio M/F increased during period 3 (2.7 versus 1.7 and 1.9 during periods 1 and 2). Period 3 showed an increase of major diagnoses discovered during autopsies (36% versus 28% of autopsies performed during periods 1 and 2) and showed an increase of autopsies performed after iatrogenic events (20% versus 12% and 13% of autopsies of periods 1 and 2). Period 3 showed an increase of the delay between the death of patients and autopsy and a decrease of the delay of transmission of pathological reports. 2% of autopsies were never answered by the pathologists. In conclusion, our study confirms the major decline of autopsies during the last 30 years. Patients autopsied are currently young men and the autopsies are more frequently performed in potential forensic circumstances. Selection biases explain that major diagnoses are more frequently found at autopsies nowadays than 30 years ago.

[Bladder nephrogenic metaplasia: circumstances of discovery, predisposing factors, and clinical course in 7 cases diagnosed between 1988 and 2000]. / La métaplasie néphrogénique vésicale: circonstances de découverte, facteurs favorisants et évolution de sept cas diagnostiqués entre 1988 et 2000.

INTRODUCTION: Nephrogenic adenoma (NA) or nephrogenic metaplasia is a rare, benign urothelial tumour. MATERIAL AND METHODS: This retrospective study evaluated the circumstances of discovery, predisposing factors, and clinical course of seven patients with nephrogenic adenoma diagnosed between 1988 and 2000. The mean age of these patients was 55.7 years (range: 16 to 88 years). The mean follow-up was 24 months (range: 4 to 108 months). RESULTS: There are no specific endoscopic findings and the lesion was sometimes flat or papillary with an appearance that can be identical to that of bladder tumour. The diagnosis was always based on histological findings. Suggestive clinical signs were nonspecific and comprised: haematuria, dysuria, or urgency. Treatment was surgical with transurethral resection or electrocoagulation of the lesion, combined with elimination of the factors irritating the urothelial mucosa. In our experience, recurrences were observed in 28.5% of patients and occurred during the year following the initial treatment. CONCLUSION: Nephrogenic adenoma is a rare, benign urothelial tumour most frequently situated in the bladder. The presenting clinical signs are completely nonspecific and usually related to predisposing factors (infections, inflammation, bladder tumour). Only histological examination can provide the essential proof of the benign nature of this lesion. Endoscopic resection therefore has two objectives: diagnostic and therapeutic. The clinical course is characterized by recurrences.

Cerebral peritumoral oedema study: does a single dynamic MR sequence assessing perfusion and permeability can help to differentiate glioblastoma from metastasis?

Our purpose was to differentiate glioblastoma from metastasis using a single dynamic MR sequence to assess perfusion and permeability parameters. 24 patients with glioblastoma or cerebral metastasis with peritumoral oedema were recruited and explored with a 3T MR unit. Post processing used DPTools software. Regions of interest were drawn around contrast enhancement to assess relative cerebral blood volume and permeability parameters. Around the contrast enhancement Glioblastoma present high rCBV with modification of the permeability, metastasis present slight modified rCBV without modification of permeability. In conclusion, peritumoral T2 hypersignal exploration associating morphological MR and functional MR parameters can help to differentiate cerebral metastasis from glioblastoma.

Gastric myeloid metaplasia: a case report and review of the literature.

We report a case of gastric myeloid metaplasia in an 89- year-old woman with agnogenic myeloid metaplasia. The lesions were fortuitously discovered on upper endoscopy. The antral mucosa was thickened and polypoid, and on histologic examination contained immature granulocytes, megakaryocytes, and a few erythroblasts without desmoplastic stromal reaction. The granulocytes were positive for CD15, CD68, and myeloperoxidase on immunohistochemistry, and the megakaryocytes showed positive reactivity for factor VIII. Gastric myeloid metaplasia is a very rare event, and to our knowledge only 6 cases have been reported in the literature to date. It usually occurs in patients with advanced myeloproliferative syndrome. Gastric myeloid metaplasia often has a pseudotumoral appearance, leading to digestive symptoms. Histologic diagnosis is straightforward when trilinear hematopoietic elements are identified in gastric biopsies. Immunohistochemistry with anti-factor VIII antibody can be useful to confirm the presence of megakaryocytes.