A competitive enzyme-linked immunosorbent assay for quantification of tetrastatin in body fluids and tumor extracts.

Basement membrane collagens or derived fragments are measured in biological fluids such as blood and urine of patients and appear to be useful for diagnosis, prognostication, or treatment monitoring as proposed for endostatin, a fragment of collagen XVIII, or tumstatin, a fragment of collagen IV. Tetrastatin, the NC1 alpha 4 collagen IV domain, was previously reported to inhibit tumor growth and angiogenesis. The aim of this study was to develop and validate a method to measure tetrastatin concentrations in human fluids. We developed a competitive enzyme-linked immunosorbent assay (ELISA). It allowed measuring tetrastatin levels in human serum, bronchial aspiration and bronchoalveolar lavage fluids, and lung tissue extracts. The tetrastatin level was significantly higher in tumor tissues than in healthy lung tissues. Tetrastatin competitive ELISA could be useful to quantify tetrastatin in tissues and biological fluids for the diagnosis or prognostication of diseases in which basement membrane metabolism may be altered, especially tumor progression.

Increased risk of colonic neoplasia in patients with sporadic duodenal adenoma.

BACKGROUND: Recent studies have shown an increased risk of colorectal neoplasia in patients with duodenal neoplasia. The aim of this retrospective case-control study was to confirm this risk. PATIENTS AND METHODS: Rate of colorectal neoplasia in 29 patients with one or more duodenal adenomas were compared with controls matched for gender and age, but without duodenal adenomas (one case to two controls). Patients with neoplasia of the ampulla, familial adenomatous polyposis or other known hereditary conditions of the digestive tract were excluded. Indications for upper and lower gastrointestinal endoscopy in controls were abdominal pain or changes in bowel habits. Controls with anemia or digestive bleeding were not included. Neoplastic lesions found at colonoscopy were classified as adenomas, advanced adenomas (size > or =10 mm, villous component, high-grade dysplasia), cancers and advanced neoplasia (cancers and advanced adenomas). Comparison between groups was by Fisher's exact test or Student's t test. Odds-ratios (OR) and 95% confidence intervals were calculated, if the difference was significant. RESULTS: Mean age of the 29 cases (seven women, 22 men) was 63.2 years and that of the 58 controls (14 women, 44 men) was 62.5 years. First-degree family history of colorectal cancer was present in four cases (13.8%) and eight controls (13.8%) (NS). Colonoscopy showed at least one adenoma in 15 cases (51.7%) and 11 controls (19%) (P=0.0027; OR 1.87, 1.0-3.49), advanced adenomas in four cases (13.8%) and three controls (5.2%) (NS), and colonic adenocarcinoma in three cases (10.3%) and no controls (0%) (P=0.03). Advanced neoplasia was present in seven cases (24.1%) and three controls (5.2%) (P=0.014; OR 2.86, 0.96-8.52). Results were not significantly modified after the exclusion of patients with a family history of colorectal cancer. CONCLUSION: Although lacking in statistical power, these results confirm that patients with sporadic duodenal adenoma are at high risk of colonic adenoma and advanced neoplasia, warranting systematic colonoscopy.

[Endometriomas of the abdominal wall: Imaging findings]. / Endométriomes de la paroi abdominale: apport de l'imagerie.

Endometrioma of the abdominal wall is a not well-recognized disease and usually develops after pelvic surgery. The most common presentation is a mass of the abdominal wall associated with pain during menstruation. We report six cases of parietal endometriomas studied with ultrasonography, CT, and in one case with MRI. Our results are compared with recent findings in the literature. The purpose of this study was to describe the clinical and imaging findings in abdominal wall endometriomas that can help reach a presurgical diagnosis.

Metastatic calcification in the thyroid gland demonstrated on bone scan in a patient with primary hyperparathyroidism.

Bone scanning agents are known to accumulate in extraskeletal sites. We report the case of a patient with primary hyperparathyroidism whose bone scan performed with [99mTc]HMDP revealed not only the classic pattern described in hyperparathyroidism, but also a striking visceral uptake in the lungs, heart, stomach, and thyroid gland. Metastatic calcification was found on histologic examination of the thyroid.

[Metastatic cancers of the thyroid gland. Diagnostic difficulties]. / Cancers métastatiques de la glande thyroïde. Difficultés diagnostiques.

Metastatic carcinoma of the thyroid is uncommon in surgical pathology and may masquerade as primary thyroid cancer. We studied 6 cases of biopsied and/or surgically resected metastatic carcinoma of the thyroid and their corresponding primary carcinoma, with emphasis on the differential diagnosis. There were 4 men and 2 women patients aged 44 to 77. The primary carcinoma was a breast infiltrating duct carcinoma (3 cases), a colorectal adenocarcinoma (2 cases) and a bronchial oat-cell carcinoma (1 case). The interval between primary carcinoma and secondary thyroid carcinoma was 2 to 9 years in 4 cases; 2 other cases showed simultaneous occurrence. Five patients died with widespread metastases 1 to 14 months following the diagnosis of secondary carcinoma of the thyroid; 1 patient was alive after 24 months. The histological differentiation of secondary from primary thyroid cancer may be difficult in the following situations: clear-cell, Hürthle-cell and signet ring cell changes; positivity of mucins stains; production of melanin; epidermoid differentiation; very rare miscellaneous tumours ("columnar cell carcinoma" and primary thymoma of the thyroid). Immunoperoxidase methods and mucin histochemistry may help.

[Reproducibility of histological criteria of dysplasia in Barrett mucosa]. / Reproductibilité des critères histologiques de dysplasie sur muqueuse de Barrett.

Barrett's mucosa is a precancerous condition. The goal of endoscopic surveillance for patients with Barrett's esophagus is to grade dysplasia. The diagnosis of dysplasia is difficult. The aim of this study was to determine the observer variation in diagnosis of dysplasia. Thirty-seven biopsies selected from Barrett's mucosa reported as having dysplasia between 1987 and 1988 were reviewed by 4 pathologists. The biopsies were classified according to the method of Riddell, as no dysplasia, indefinite for dysplasia, low-grade dysplasia and high-grade dysplasia. Each pathologist reviewed the biopsies alone and then together. There was a total agreement between the 4 pathologists in 20 out of 37 biopsies (54%). The pair-wise agreement varied between 65 and 84%. It was 84% when the pathologists belonged to the same institution. Of 222 double reviews made by 6 pairs of pathologists (37 biopsies x 6 pairs of pathologists), there were 58 disagreements: 19 low grade/high grade dysplasia, 2 high grade/indefinite for dysplasia, 1 high grade/no dysplasia, 18 low grade/indefinite for dysplasia, 2 low grade/no dysplasia, 16 indefinite for dysplasia/no dysplasia. At the second review when the pathologists evaluated the biopsies together, the agreement was 92%; there were 3 biopsies on which there was total disagreement: twice between high grade and low grade dysplasia, once between low grade dysplasia, indefinite for dysplasia and no dysplasia. This retrospective study has shown that disagreement between pathologists was rarely found on the biopsies diagnosed as having high grade dysplasia, more often on those diagnosed as having low grade dysplasia or indefinite for dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lymphocytic ascites revealing systemic mastocytosis]. / Ascite lymphocytaire révélatrice d'une mastocytose systémique.

Systemic mastocytosis is a chronic disease with proliferation of mastocytes in organs separate from skin. We report the case of a systemic mastocytosis revealed by a lymphocytic ascites in the absence of cutaneous involvement. The diagnosis was established by the ultrastructural examination of the bone marrow. Identification of few mastocytes in ascites suggested a mast cell infiltration of the peritoneum. A treatment by alpha-2b interferon was unsuccessful, and death rapidly occurred.

[Partial regression of Barret esophagus with high grade dysplasia and adenocarcinoma after photocoagulation and endocurietherapy under antisecretory treatment]. / Régression partielle d'un endobrachyoesophage en dysplasie de haut grade avec adénocarcinome après photocoagulation et endocuriethérapie sous traitement antisécrétoire.

Barrett's oesophagus is a premalignant condition. The possibility of eradicating at least partially the metaplastic epithelium has been reported recently. In this case report, a patient with Barrett's oesophagus complicated by high grade dysplasia and focal adenocarcinoma was treated by Nd:Yag laser then high dose rate intraluminal irradiation while on omeprazole 40 mg/day. A partial eradication of Barrett's oesophagus and a transient tumoural regression were obtained. Histologically, residual specialized-type glandular tissue was observed beneath regenerative squamous epithelium. Four months after intraluminal irradiation, a local tumoural recurrence was detected while the area of restored squamous epithelium was unchanged on omeprazole 40 mg/day. This indicates that physical destruction of Barrett's oesophagus associated with potent antisecretory treatment can induce a regression of the metaplastic epithelium, even in presence of high grade dysplasia. The persistence of specialized-type glands beneath the squamous epithelium raises important issues about its potential malignant degeneration.

[Primary leiomyosarcoma of the liver 37 years after successful treatment of hereditary retinoblastoma]. / Léiomyosarcome primitif du foie survenu 37 ans après traitement curatif d'un rétinoblastome héréditaire.

In patients successfully treated for hereditary retinoblastoma, the risk of developing a second non-ocular tumor has been reported. We report the first case of primary hepatic leiomyosarcoma in a 39 year-old woman who has been treated 37 years before for hereditary retinoblastoma of the left eye. The patient presented with right upper quadrant abdominal pain and fever. Histological diagnosis was made by liver biopsy. As surgical resection was impossible, chemotherapy with epirubicin, then ifosfamide, etoposide and cisplatin was performed. The patient died 22 months after diagnosis. Genetic abnormalities observed in hereditary retinoblastoma, which probably resulted in a predisposition to the development of hepatic cancer in this patient, were not investigated.

[Rectal leiomyosarcoma. 4 new cases]. / Léiomyosarcome du rectum. Quatre nouvelles observations.

We report four cases of leiomyosarcoma of the rectum suspected by endoscopic ultrasonography. Three patients were treated by local excision and one by abdominoperineal resection. An excision of the mass via a Kraske's approach was used. Leiomyosarcoma confined to the rectum wall can be treated by local excision. Endosonography can provide exact estimation of the lesion and is of great value in selecting the appropriate treatment. The treatment is surgical excision with wide margins. The histological stage and the presence or absence of metastases determine the therapeutic. Two patients in our series underwent radiation therapy. Chemotherapeutic agents including doxorubicin have had beneficial effect on recurrence or survival, only for higher grade sarcomas.

[Diclofenac-induced colitis complicated by Klebsiella oxytoca infection]. / Colite induite par le diclofénac et compliquée d'une infection à Klebsiella oxytoca.

A 25-year-old man presented with abdominal pain and bloody diarrhea. Colonoscopy showed hemorrhagic proctocolitis with superficial erosions. Histology was consistent with the diagnosis of ulcerative colitis and biopsy cultures were negative. Despite treatment with prednisolone (40 mg/day), his clinical condition deteriorated and he was referred to our institution. On repeated questioning, the patient reported self-medication with diclofenac (200 mg/day) for 6 weeks to treat tendinitis prior to the beginning of digestive symptoms. Rectosigmoidoscopy confirmed bleeding colitis and repeated biopsy cultures showed Klebsiella oxytoca. Corticosteroids were stopped and ofloxacin (400 mg/day) was prescribed for 14 days. Diarrhea quickly resolved. Colonoscopy 8 weeks later showed only patchy erythematous mucosa without bleeding or erosions. Two years later, the patient remains asymptomatic with normal total colonoscopy. The definitive diagnosis was de novo NSAID-induced colitis subsequently complicated by Klebsiella oxytoca infection.

[Overexpression of protein p53 and Barrett esophagus. A frequent and early event in the course of carcinogenesis]. / Surexpression de la protéine p53 et endobrachyoesophage. Un événement fréquent et précoce au cours de la carcinogenèse.

OBJECTIVES AND METHODS: In Barrett's oesophagus, the risk of malignancy is evaluated histologically with the presence of dysplasia. The abnormal expression of p53 protein could represent a useful new marker. The aim of this study was evaluate the abnormal expression of p53 protein in a series of 52 oesophagectomy specimens with Barrett's oesophagus, either non-dysplastic (n = 3), dysplastic (n = 8), or malignant (n = 41). The immunohistochemical study was made on deparaffinized sections with the monoclonal anti-p53 antibody DO7. RESULTS: The 3 non-dysplastic cases were p53 negative; 1 case of low-grade dysplasia in 5 was positive, as were the 3 cases of high grade dysplasia and 33 of 41 cancers (80%), including 13 superficial cancers in 14 (93%) and 20 invasive cancers in 27 (74%). A common feature was the presence of rare p53 positive crypts in low grade dysplastic areas and non-dysplastic specialized mucosa that surrounded high grade dysplasia and cancers. CONCLUSIONS: Our results confirm the high frequency of the abnormal expression of p53 protein in cancer developed in Barrett's oesophagus. This expression is a consequence of alterations of the TP53 gene, and has an important role in the carcinogenesis of Barrett's mucosa; it is likely to represent an early event. Prospective studies are needed to evaluate its interest in the surveillance of patients with Barrett's oesophagus.

[Protective effect of appendectomy on the development of ulcerative colitis. A case-control study]. / Effet protecteur de l'appendicectomie contre la rectocolite hémorragique.

AIMS: To examine by a case-control study the relationship between appendectomy and subsequent ulcerative colitis development in a French population. METHODS: A total of 150 patients with ulcerative colitis were matched for age (+/- 5 years) and sex, with 150 controls recruited in a preventive medicine center. The following data were collected from medical records and by standardised questionnaire in consultation or by phone: appendectomy and tonsillectomy before the onset of ulcerative colitis, smoking habits and area of residence. RESULTS: The rate of previous appendectomy in patients with ulcerative colitis was 8% (12/150) compared with 30.6% (46/150) in the control group (P=0.001). There was no significant association between ulcerative colitis and tonsillectomy (25.3 and 27.3% in the control and the ulcerative colitis groups, respectively). Smoking was more frequent in the control group (36%) than in the ulcerative colitis group (25.3%) but the difference was not significant (P=0.07). In multivariate analysis, the risk of developing ulcerative colitis was significantly lower after previous appendectomy (odds ratio=0.26; 95% confidence interval: 0.13-0.55; P=7 x 10(-4)). CONCLUSION: Our study confirms the inverse association between appendectomy and subsequent ulcerative colitis, in a French population, after adjusting on smoking.

[Laparoscopic diagnosis of stenosing eosinophilic jejuno-ileitis]. / Diagnostic coelioscopique d'une jéjuno-iléite sténosante à éosinophiles.

INTRODUCTION: Eosinophilic gastroenteritis of unknown origin could be isolated or integrated in idiopathic hypereosinophilic syndrome. Clinical expression is variable since the lesion may affect any area of the gastrointestinal tract and any layer of the wall. EXEGESIS: A 25-year-old male patient had digestive symptoms such as peritoneal, obstructive and diarrheal signs, associated with blood eosinophilia, giving evidence for eosinophilic jejuno-ileitis. Computer tomography revealed an extensive obstruction of the jejuno-ileum and thickening of the intestinal wall. The diagnosis was obtained using laparoscopy and controlled wedge biopsy, which showed a predominantly external infiltration of the intestinal wall by eosinophils. The disease evolution was favorable with corticosteroid therapy. CONCLUSION: Worrying and persistent digestive symptomatology, associated with blood eosinophilia, particularly when intestinal wall infiltration is revealed by computer tomography, should lead one to perform a laparoscopy to guide a surgical biopsy of the intestinal wall.

[Cutaneous mucormycosis in a diabetic woman. Diagnostic and therapeutic problems]. / Mucormycose cutanée chez une diabétique. Problèmes diagnostiques et thérapeutiques.

We report a new case of cutaneous mucormycosis in a diabetic woman. The major favouring circumstances are found in this patient: ketoacidosis diabetes, use of bandages, local corticosteroid applications, renal insufficiency. The diagnosis, rarely made on the clinical aspect, is based on the histological and mycological data. A trial of treatment by ketoconazole has been carried out, but without success. The usual treatment by intravenous amphotericine B has been successful.

[Diagnosis and prognosis of malignant colonic adenoma: methodologic implications]. / Diagnostic et pronostic des adénomes coliques cancérisés: implications méthodologiques.

The subsequent management of patients with endoscopically removed malignant colorectal polyps depends on the pathologist's diagnosis. According to the correlation with clinical outcome previously published, the histological criteria of potential adverse outcome are: the presence of tumour at or near the resection margins, the invasion of colonic submucosa, the lymphatic invasion and the high grade of malignancy. This article aims at providing guidelines for an adequate examination of the polyp specimen and an unambiguous pathology reporting.

[Intramural pseudo-diverticulosis of the esophagus or cystic esophagitis? Study of an unusual surgical case]. / Pseudo-diverticulose intramurale de l'oesophage ou oesophagite kystique? Etude d'un cas original opéré.

The authors report an unusual case of oesophageal pseudo-diverticulosis. A 63-year-old male patient presented with dysphagia. A preoperative diagnosis of oesophageal intramural tumour was made on radiological and endoscopic abnormalities. The histopathological study of the involved oesophagus showed a pseudocystic dilatation of glandular ducts in the submucosa with a lymphocytic infiltrate. The authors review the relevant literature on oesophageal intramural pseudodiverticulosis and suggest a possible pathogenesis for this rare and benign entity.

[Microscopic vascular study of the colon with the corrosion casting technique]. / Etude vasculaire microscopique du colon par la technique d'injection-corrosion.

The aim of this study is, firstly, to assess the accuracy of vascular casts obtained at various times after death and secondly to describe the mucosal microvascular architecture of the cat colon. Two injections were realized, the first one on a non-embalmed human corpse, 12 days after the death, and the other one on a cat, immediately following euthanasia. Results show that this second cast seems finer and more detailed than the cast stemming from the human corpse; indeed, the finest vessels obtained are about 6 microns while they are about 15 microns on the human corpse. This could be explained by a post-mortem obstruction of microvessels, that prevented the passage of the injected product or by an insufficient amount of product injected. Finally, the vascular cast of the cat colic mucosa presents a regular honeycomb-like network that bounds the colonic mucosal glands, a finding consistent with the results reported previously.

[Bronchial epidermoid carcinoma with unusual disclosure]. / Carcinome épidermoïde bronchique de révélation inhabituelle.

Dissemination has often occurred before the diagnosis of bronchopulmonary cancer. Pancreatic metastases are exceptional and are very rarely the revealing manifestation. The authors report a case of a tumour of the pancreas which led to the discover of an bronchogenic epidermoid carcinoma. The relationship between these two tumours lead to the proposed hypothesis of pancreatic metastasis of a bronchogenic carcinoma. Although this situation is rare, the preoperative work-up for bronchogenic carcinoma should include computed tomography of the pancreas if the abdominal echography does not allow complete visualization of the pancreas in cases with suggestive digestive disorders. If a tumour is observed in the pancreas, scan-guided needle biopsy should be performed to enable the histological examination.

[Colorectal lesions predisposing to cancer]. / Lésions colo-rectales prédisposant au cancer.

Precursors of colorectal carcinoma are adenomatous polyps, sporadic or arising in familial adenomatous polyposis and Lynch syndrome and chronic inflammatory lesions related to ulcerative colitis and Crohn's disease. The adenoma-carcinoma sequence is well established and early detection and removal of colorectal adenomas is thought to prevent colorectal cancer in high risk asymptomatic persons, i.e. subjects over 45 years, with personal or familial history of adenomas and colorectal cancers. The precancerous potential of adenomatous polyps varies according to tissue type, with increased risk with the extent of the villous component, high grade of dysplasia, large size greater than 1 cm and multiple adenomas. The development of de novo colorectal cancer from normal mucosa with flat adenomas has been recently emphasized. The risk of colonic cancer in patients with ulcerative colitis and Crohn's disease is controversed.