[Sebotropic drug eruption after ingestion of bee pollen]. / Éruption induite à tropisme sébacé après consommation de pollen d'abeille.

INTRODUCTION: The medical literature contains five cases of exanthema with sebaceous tropism induced by consumption of kava-kava extract filed under the name of sebotropic drug reaction. Herein we report a new case following consumption of bee pollen. PATIENTS AND METHODS: A 37-year-old man consulted for erythemato-papular and fixed plaques of the face, upper trunk and shoulders present for 3 days. Standard blood tests were normal except for neutrophil leukocytosis at 9.8 G/l and eosinophilia at 1.4 G/l. Cutaneous biopsy of a facial plaque revealed folliculocentric lesions with necrosis of sebocytes in the sebaceous gland, associated with an eosinophil-rich infiltrate. The patient had begun consuming bee-pollen granules 3 weeks before the onset of symptoms. The rash regressed within 3 weeks of cessation of pollen consumption. Patch tests (ICDRG battery, propolis 1% Vaseline dilution and bee pollen provided by the patient, both pure and in a 30% dilution in Vaseline) were negative at 48 and 72h. DISCUSSION: The clinical-pathological correlation was consistent with a diagnosis of sebotropic drug reaction induced by the consumption of bee pollen. The diagnosis was based on papular exanthema of the seborrheic zones occurring 2 to 3 weeks after initial intake of the offending substance, with histological evidence of inflammatory necrosis of the sebaceous glands. CONCLUSION: We report what is to our knowledge the first case of sebotropic drug reaction following ingestion of bee pollen.

[High-resolution ultrasonography for differential diagnosis between nodular basal carcinoma and sebaceous hyperplasia of the face: A pilot study]. / Échographie cutanée haute résolution dans le diagnostic différentiel entre carcinome basocellulaire nodulaire et hyperplasie sébacée du visage: une étude pilote.

BACKGROUND: Clinical differential diagnosis between incipient nodular basal carcinoma (NBC) and sebaceous hyperplasia (SH) of the face is difficult in some cases. A comparative histological analysis of these two entities led us to the hypothesis that 20MHz high-resolution ultrasonography (HRUS) may enable differentiation between NBC and SH. PATIENTS AND METHODS: Seventy-seven facial tumours requiring histological confirmation to distinguish between NBC and SH were scanned using HRUS before excision. No other imaging technique was used. The ultrasound scans were submitted to two blinded reviewers who were asked to classify the ultrasound pictures of the tumours as either hypoechoic or isoechoic/hyperechoic. Hypoechogenicity was defined as a diagnostic criterion for NBC. RESULTS: Reviewer response reproducibility for 2 images of the same tumour was 90%. Both reviewers agreed regarding the echogenicity classification of an image in 87.4% of cases. The sensitivity of the procedure was 90.9% for detection of NBC and 89.4% for detection of malignant lesions. Specificity was 69.6% for detection of basal cell carcinomas and 78.8% for detection of malignant lesions. DISCUSSION: HRUS is a non-invasive examination technique with excellent sensitivity for the detection of NBC in differential diagnosis with SH. Hypoechogenicity is not specific to NBC. The sensitivity of HRUS in our study suffered as a result of ultrasonography difficulties regarding unexpected differential diagnoses of NBC as well as tumour localisation in seborrhoeic areas.

[Atypical eruptive collagenoma: two cases]. / Collagénomes éruptifs atypiques: deux cas.

BACKGROUND: Eruptive collagenoma is a rare cutaneous lesion seen in young adults. It consists of asymptomatic, flesh-coloured papules that are usually localised on the trunk and the root of the upper limbs. Herein we report two cases on account of the atypical topography of the lesions and the advanced age of the patients. CASE REPORTS: Case n 1: a 69-year-old man consulted for firm, whitish papules on the wrists, elbows, popliteal fossae and groin without associated signs, and which first appeared several years earlier. The standard laboratory assessment and ocular fundus test were normal. Case no 2: a 69-year-old woman had very firm, flesh-coloured papules on the trunk and the root of the limbs, which appeared after the age of 40. The results of ocular fundus, cardiovascular investigation and laboratory examinations were normal. The histology of papules was similar in both cases and revealed a nodular zone in the reticular dermis, comprising disorganized collagen bundles and excessive quantities of elastic fibres, without elastorrhexis. This histology was consistent with collagenoma. DISCUSSION: We report two singular cases that were atypical in terms of patient age and localisation in the flexion folds. Histological analysis of a papule enables a diagnosis of collagenoma to be made. Such analysis usually reveals a hamartoma in which the amount of collagen is increased, with variable quantities of elastic tissue, though often decreased. The principal differential diagnoses are elastoma and pseudoxanthoma elasticum.

[Indolent firm reddish papules. Cutaneous Rosai-Dorfman disease]. / Beschwerdefreie derbe, rotbraune Papeln. Rein kutane Sinushistiozytose.

Sinus histiocytosis with massive lymphadenopathy (SHML) is generally characterized by severe illness and massive cervical lymphadenopathy. Sinus histiocytosis limited to the skin is now recognized as a rare distinct entity called cutaneous Rosai-Dorfman disease (CRD). We report CRD in a 57-year-old male patient presenting with disseminated firm red-brown papules. Histology revealed a dermal infiltrate with CD1a-, CD68+, S100+ multinuclear giant cells. Some of these histiocytes showed hemophagocytosis (emperipolesis). We achieved a good therapeutic result with topical clobetasol propionate.

[Hepatic splenosis: a rare etiology of hepatic nodules]. / Splénose hépatique: une étiologie rare de nodules hépatiques.

Splenosis is the autotransplantation of splenic tissue, generally after traumatic splenic rupture. Usually, the peritoneal surface is affected. The viscera are rarely involved in this graft. We report a case of intrahepatic splenosis, which presented as a liver tumour on imagery in a 55-year-old man followed for lung carcinoma and chronic hepatitis C and who had undergone a splenectomy for trauma 22 years before. The different characteristics and diagnostic methods of 16 cases of hepatic splenosis are presented from the literature. These different reports emphasize the necessity of considering splenosis in the differential diagnosis of hepatic tumours.

[Benign pulmonary metastases from a leiomyoma]. / Métastases pulmonaires bénignes d'un léiomyome.

INTRODUCTION: Benign metastasizing leiomyoma (BML) is a rare cause of pulmonary nodules. They can occur in women of reproductive age who have undergone hysterectomy for uterine leiomyoma. OBSERVATION: We report the case of a 46-year-old women, who was incidentally found to have bilateral pulmonary cavitating nodules. Pathology exam was consistent with BML. CONCLUSION: Although BML is a rare cause of pulmonary nodules, it should be considered as one of the possibilities especially in young women with a history of hysterectomy for leiomyoma.

Minimally invasive management of insulinomas. A case report.

BACKGROUND: Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are. CASE REPORT: The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome. Tumor location was possible with endoscopic ultrasonography, which detected a hypoechoic 10 x 10-mm mass in the pancreatic tail. Tumor enucleation was accomplished laparoscopically. CONCLUSIONS: Insulinomas may be managed with videolaparoscopy, but this approach, which is not applicable for multiple or malignant tumors, must be contraindicated also in single insulinomas located on the posterior wall or deeply in the head of the pancreas. The disadvantages of the laparoscopic approach, as compared with conventional surgery, are the absence of palpation and difficulty exploring the whole pancreas, which is partly overcome, but not completely eliminated, by EUS. The advantages are the absence of a parietal incision and good postoperative comfort. The reported low-invasive EUS laparoscopy sequence may be successful in selected cases of pancreatic insulinomas. However, it seems this treatment could be proposed for many patients affected by this benign disease.

[Use of fast neutrons in the treatment of tumors of the salivary glands: rationale, review of the literature and experience in Orleans]. / Utilisation des neutrons rapides dans le traitement des tumeurs des glandes salivaires: rationnel, revue de la littérature et expérience d'Orléans.

If low LET radiation therapy (photons, electrons), following radical microscopically and complete surgery can improve results in term of local control from 34 to 74% for salivary gland tumors, local control is more difficult to achieve in advanced tumors and only palliative treatment is usually attempted. In this survey, all the patient series treated worldwide were reviewed. They show an overall control rate of 31% with photon vs 64% with neutron therapy. A prospective randomised trial sponsored by the RTOG and the MRC published in 1988 and reviewed in 1993 showed an overall locoregional complete tumor clearance of 67% for neutrons and 17% for photons (P < 0.005), with 68% and 25% survival at two years for neutrons and photons respectively. This study was closed for ethical reasons. In Orleans, since 1987, 59 patients have been treated. At five years the persistent local control probability was 69.5%, the five-year crude survival probability 66% and the five-year tumor free survival probability was 64.5%. This review provides evidence that surgical treatment for salivary gland tumors should be limited to patients presenting a high likelihood of negative surgical margin and a small risk of facial nerve damage. Others patients should receive neutron radiation therapy alone as definitive treatment.

[Post-vaccination granuloma due to aluminium hydroxide]. / Granulome post-vaccinal lié à l'hydroxyde d'aluminium.

Post-vaccination granulomas a well-known reaction due to aluminium adsorbed vaccines. We report three cases of children who developed subcutaneous nodules at the site of a previous injection of Tetracoq*vaccine (tetanus, diphtheria, Bordetella pertussis, poliovirus). Histologically, the lesions were characterized by a necrotizing granulomatous reaction with eosinophilic crystalline material. This material stained positively with the solochrome cyanine stain and was pink-purple. This aluminium stain enabled diagnosis of post-immunization injection-site reaction due to aluminium.

[Inguinal pseudotumor: relapse of a pemphigus after 15 years' remission]. / Pseudo-tumeur inguinale. Récidive d'un pemphigus vulgaire en rémission depuis 15 ans.

INTRODUCTION: Pemphigus vegetans (PV) is a rare type of pemphigus vulgaris. We report a patient with pemphigus vulgaris relapsing as an isolated vegetative tumour. CASE REPORT: A 59-year-old man was seen in February 2001 for a tumour on the right groin. He had received systemic corticosteroids and cyclophosphamide for pemphigus vulgaris from 1974 to 1985, and he had been in complete remission since 1985. At the time of evaluation, a 10 x 5 x 5 cm, smooth vegetative tumour was seen on the right groin. Biopsies showed spongiosis, acanthosis and some acantholysis. Direct immunofluorescence showed strong deposition of immunoglobulin G within the intercellular substance of the epidermis. Indirect immunofluorescence revealed anti-intercellular antibodies at a titer of 1/800. Immunoblot analysis showed reactivity with the 130 kD pemphigus vulgaris antigen. PVg was diagnosed. Local corticosteroid treatment was initiated. The patient was disease-free at follow-up three years later. DISCUSSION: Localised forms of pemphigus are very rare. Twenty four other cases have been reported among them just one case of localised PV. Our case report is very unusual because of the variability of the expression of the disease, the high antibody level, the absence of trigger factors, and the efficacy of the local corticosteroid treatment.

[Localized bullous eruption after intravenous injection of aciclovir: toxic or immunoallergic mechanism?]. / Eruption bulleuse localisée après injection intraveineuse d'aciclovir: mécanisme toxique ou immunoallergique?

OBJECTIVE: To report a case of bullous eruption at and far from the site of aciclovir injection. CASE REPORT: A 50-year-old man was treated with intravenous aciclovir for Herpes simplex meningoencephalitis. Ten days after treatment onset, blisters appeared on his right forearm, at and far from the site of aciclovir injection. DISCUSSION: This adverse effect has not been frequently reported. To date, bullous eruptions were considered to result from extravasation of the aciclovir solution. In this case, an immunoallergic pattern was discussed with the presence of a histological leukocytoclastic vasculitis.

[Bone evaluation in ten adults with cutaneous mastocytosis]. / Evaluation de l'état osseux chez dix adultes atteints de mastocytose cutanée.

BACKGROUND: To systematically evaluate the bone status, searching for osteoporosis in patients with cutaneous mastocytosis. PATIENTS AND METHODS: In a prospective study from March 1997 to June 2000, we included all new patients examined for cutaneous signs of mastocytosis. Past history, physical examination, skin biopsy, laboratory tests, bone densitometry, cytology and histopathology of bone marrow and other complementary investigations were performed in all these patients. RESULTS: Ten patients were included. Two patients had osteoporosis. Five others had osteopenia. Four patients had bone marrow involvement due to mastocytosis. One of these four patients had myelodysplasia. DISCUSSION: This study suggests better investigation of bone density and bone marrow in patients who have cutaneous mastocytosis. Systematic histopathology of bone marrow and osteodensitometry help to detect patients with systemic involvement. Bone densitometry is particularly effective for early detection of patients at risk for fracture and is of practical interest since patients with osteoporosis can now be treated with Pamidronate.

[Splenic abscess. A rare pathology requiring a multidisciplinary approach]. / Abcès splénique. Une pathologie rare qui nécessite une approche multidisciplinaire.

The clinical presentation of the splenic abscess is poorly specific. Its natural evolution is often fatal. The three case reports illustrate the difficulty of the diagnosis and management of this disease. Ultra sound and C.T. scan are the procedures of choice for the diagnosis and follow-up. The choice of the treatment depends on the number of abscesses, their volume, and also the presence of extrasplenic involvement. Antibiotherapy and interventional radiology have modified its therapeutical approach. Although the conservative treatment (antibiotherapy, transparietal drainage) is often successful, splenectomy is still indicated as a first line treatment, or as a salvage procedure.