Lymph node infection by Trichomonas tenax: report of a case with co-infection by Mycobacterium tuberculosis.

In an 82-year-old woman, presenting with fever and asthenia, cervical adenopathy was noted. Clinical and radiological investigations were fruitless. Laboratory examinations detected a refractory anemia. The lymph node was excised and showed numerous trichomonads on touch preparations. Histologically, the node showed caseous necrosis and macrophagic reaction. Diagnosis of lymph node infection by Trichomonas tenax was made. Three weeks later, culture of the node showed Mycobacterium tuberculosis and let us conclude co-infection. T tenax is usually regarded as a harmless saprophyte of the oral cavity. This exceptional observation shows for the first time an invasive potential of T tenax. It raises questions about links with tuberculosis and refractory anemia.

Salivary trichomoniasis. A case report of infestation of a submaxillary gland by Trichomonas tenax.

A tumor was suspected after detection of an asymptomatic submaxillary swelling in an 85-year-old woman. Clinical, radiologic, and biologic investigations were fruitless. Transcutaneous needle aspiration revealed numerous trichomonads and led to the conclusion that a salivary duct was infested by Trichomonas tenax. The patient recovered following treatment with metronidazole, and there has been no recurrence after 2 years. This case sheds new light on the pathogenic properties of trichomonads. Peculiar features of this previously unreported location are discussed. Trichomonas tenax is often unrecognized by pathologists, and surely such cases are often misdiagnosed.

Testicular fibroma of gonadal stromal origin with minor sex cord elements: clinicopathologic and immunohistochemical study of 2 cases.

OBJECTIVE: To report the histologic and immunohistochemical features of 2 cases of intratesticular fibromatous tumors. RESULTS: Microscopically, these tumors were composed of short, randomly interweaving fascicles of spindle cells dispersed within a fibrocollagenous stroma. A sex cord component was detected in one case by microscopic examination and in both cases by immunohistochemical study using MIC2 and anti-inhibin antibodies. CONCLUSIONS: The presence of minor sex cord elements, morphologically or by immunohistochemistry, suggests that these fibromatous tumors are related to and are a subset of sex cord-stromal tumors. Intratesticular fibromatous tumors, of which 11 other cases lacking sex cord elements have been reported, could be considered as the testicular equivalent of ovarian fibroma. These tumors could then be referred to as testicular fibroma of gonadal stromal origin, with or without minor sex cord component.

[Familial form of bulbo-spinal amyotrophy in the adult]. / Forme familiale d'amyotrophie bulbo-spinale de l'adulte.

Three siblings, a male and two females, respectively 47, 51 and 60 years-old, were investigated, since they had, like their father, labioglossopharyngeal paralysis, fasciculations and predominant cervico-facial muscular atrophy. No pyramidal signs were present. The disorder was fatal within 9, 5 and 14 months. In two cases the pathological examination showed a selective involvement of the peripheral motor neuron whereas the central motor neuron was normal. The main abnormalities consisted of abundant chromatolytic neurons and cell loss and were mostly present in the brain stem motor neurons. Immunocytochemical studies with antibodies against neurofilaments and protein-tau, and electron microscopic technics were performed on cervical motor neurons. Neurogenic muscular atrophy was massive in the tongue, less predominant in the diaphragm and psoas and were similar to lesions present in the peroneus brevis muscle. Transmission was autosomal dominant. We suggest that this clinico-pathological syndrome should be considered as a variety of the adult bulbo-spinal muscular atrophies.

[Creutzfeldt-Jakob disease of 34 month's development in a 26-year-old woman]. / Maladie de Creutzfeldt-Jakob ayant évolué 34 mois chez une femme de 26 ans.

A clinico-pathological case of C. J. disease which occured in a 26 year old patient and evolved over 34 months is reported. Published cases of patients dead before 30 y.o. are briefly reviewed. The average length of evolution was 28 months. Concerning the french cases it appears that this average length was significantly longer when C. J. disease had started before 50 y.o., than when it had begun after 75 y.o. However the general survey of the published cases does not show any correlation between the starting age of the disease and the duration of evolution.

[Association of Castleman's disease and Hodgkin's disease. Eight cases and review of the literature]. / Association de maladie de Castleman et de maladie de Hodgkin. A propos de huit cas et revue de la littérature.

We have recorded 8 patients presenting a Hodgkin's disease associated with Castleman's disease. Four men and 4 women with a 44 years mean age (15-60), presented as a solitary mass (2/7) or as a multicentric tumoral disease (5/7). One of our patients was HIV. Histological studies showed typical features of Castleman's disease. Nodular sclerosing Hodgkin's disease with numerous lacunar cells were present in 3 cases, interfollicular Hodgkin's disease in 4 cases and nodular paragranuloma in one case. Hodgkins' and Reed Sternberg cells were positive for CD15 (4/7), CD30 (5/7), EMA (3/6) and LMP-1 (4/5). In situ hybridization on tissue sections demonstrate presence of EBV DNA in one case and EBER1-RNA in 2 of 4 cases. The difficulty in making the diagnosis of Hodgkin's disease the relation between both diseases, and the role of IL-6 are discussed.

[Pre-leukemic granulocytic sarcoma of the uterus. Report of a case]. / Sarcome granulocytaire pré-leucémique de l'utérus. A propos d'un cas.

A case of pre-leukemic granulocytic sarcoma (GS) of the uterus was found in a 73-year old woman. The diagnosis was suggested by vaginal cytology and the green color of the gross lesions, then confirmed by naphthol AS-D chloro acetate esterase stain and immunohistochemistry on fixed tissue with the anti-lysozyme, anti-myeloperoxidase, CD 43 and CD15 antibodies. At the time of GS discovery, the patient presented no evident leukemia but myelogram contained 20% of blast cells. She developed acute myeloid leukemia 2 months later. Cytogenetic study of the bone marrow revealed chromosome 21 trisomy. GS is frequently mistaken for malignant lymphoma since it expresses some of the leukocytic antigens (leukocyte common antigen, CD 45 RO (UCHL1), MB2). Therefore, the use of a large panel of antibodies, including anti-myeloperoxidase, anti-lysozyme and CD15, is recommended. Precise diagnosis is essential because all GS must be treated as acute myeloid leukemias.

[Fulminant streptococcal gangrene of the lower limbs]. / Gangrène streptococcique fulminante des membres inférieurs.

A 58 year old woman with Cushing's disease was admitted to hospital for acute ischaemia of the lower limbs due to fulminant streptococcal gangrene (necrosing fasciitis). A group A beta-haemolytic Streptococcus was isolated from the cutaneous lesions and the blood cultures. Despite antibiotic therapy and medical resuscitation, the patient died within 12 hours of her admission in a state of irreversible collapse. This gangrenous cellulitis, in which a hypersensitivity reaction plays a part in the pathophysiology, is a rare disease which is fatal in one half of cases. The diagnosis is based on a very marked alteration in the general state, the characteristics of the cutaneous lesions and, most importantly, the isolation of group A haemolytic Streptococci, which should be performed early so as to allow wide surgical excision, which remains the principal therapeutic measure, as rapidly as possible.

[Angiokeratoma and fucosidosis. Immunohistochemical and ultrastructural study]. / Angiokératomes et fucosidose. Etude immunohistochimique et ultrastructurale.

INTRODUCTION: Angiokeratoma can lead to diagnoses other than Fabry's disease. We report a case of angiokeratoma in a child with fucosidosis. CASE REPORT: A 7-year-old child with psychomotor retardation presented angiokeratoma located on the penis. Uptake of type I Ulex Europaeus Agglutinin antilectin antiserum was intense in the endothelial structure. This antibody is specific for alpha-L-fucose residues which were thus found in large quantities in the vacuoles of the ultrastructure. The patient also had a major deficiency in leukocyte, serum and fibroblast alpha-fucosidase. COMMENTS: This is a typical case of fucosidosis, a rare hereditary disease with autosomal recessive transmission due to generalized deficiency in alpha-L-fucosidase. Diffuse angiokeratosis should suggest, other than Fabry's disease, fucosidase and other enzyme deficiencies including sialidase, GM1 gangliosidase as well as Kanzaki's disease.

[Detection of human papillomavirus in cutaneous extragenital Bowen's disease in immunocompetent patients]. / Détection de papillomavirus humains dans la maladie de Bowen cutanée extragénitale chez le sujet immunocompétent.

INTRODUCTION: A specific link between human papillomavirus (HPV) types 16, 18, 31, and 33 and genital carcinomas and between HPV type 5 and cutaneous extragenital carcinomas in patients with epidermodysplasia verruciformis and renal transplant has been previously found. The aim of this prospective study was to detect HPV in cases of cutaneous extragenital Bowen's disease (BD) from non-immunosuppressed patients. PATIENTS AND METHODS: Twelve cases of cutaneous extragenital BD or Bowen's carcinoma (BC), seen in the period 1994-1996 and confirmed by histologic examination, were included in the study. Tissue sections were studied by in situ hybridization with a mixture of HPV DNA probes and specific HPV DNA probes. In addition, study on fresh materiel from 1995 included: Southern blot hybridization with various usual HPV probes (6, 11, 16, 18, 31, 33, 35, 39, 42), polymerase chain reaction (PCR) with hybridization using consensus HPV probes and probes specific for HPV types 6, 11, 16, 18 and 33. In positive samples with conventional PCR, in situ PCR with probes specific for HPV types 6/11 and 16 was performed on tissue sections. RESULTS: In situ hybridization was negative in all the cases. Southern blot hybridization was negative in our 9 studied cases. Three cases studied by consensus PCR were positive. PCR with specific HPV probes revealed positivity on two of these cases: HPV 6 in one, and HPV 16 in another. In situ PCR was positive with a mixed 6/11 HPV probe in the third positive consensus PCR case. DISCUSSION: Our study revealed the presence of HPV in 3 out of 12 cases of cutaneous extragenital BD and BC. HPV type 16, found in BC of skull, was the most usually found type in the literature. HPV types 6/11, detected in 2 cases, were rarely found in cutaneous extragenital BD and BC and these results are in favor of the oncogenic effect of these virus types. In our study, in situ hybridization and Southern blot hybridization were negative in all the cases; HPV was only found in 3 cases by conventional PCR and in 1 case by in situ PCR. The low range of detection of HPV in cutaneous extragenital BD may be due to the used methods, to difficulties related to sampling and/or to a low number of copies of the HPV genoma.

[Neuropathological study of incontinentia pigmenti. Anatomical case report (author's transl)]. / Les lésions cérébrales de l'incontinentia pigmenti. A propos d'un cas anatomique

Report of a case of Incontinentia pigmenti (IP) of the Bloch-Sulzberger type, with neurological features, in a 3 month-old deceased infant. The neuropathological examination revealed signs of a destructive process which had occurred in the perinatal period: ulegyria, cavities of white matter and patchy scar softening of the cerebellar cortex. In addition, there was a diffuse inflammatory process involving the pia-arachnoid and brain tissue: perivascular cuffs of lymphocytes, histiocytes and eosinophilic polymorphs, and mononuclear nodules. No prenatal malformations or vascular lesions were found. These findings are discussed in the light of both the relevant literature on neurological abnormalities in IP and the only already reported neuropathological examination by O'Doherty and Norman (1968). Two main hypotheses might account for the frequency of neurological disturbances in IP, 1. a peculiar sensitivity of the brain to anoxia and/or ischemia: 2. its involvement by the specific inflammatory process which occurs both in the skin as other tissues in this genetically determined disease (Perié et al., 1976).

[Pancreatic insulinoma, adenomatosis of the Wirsung's duct and chronic pancreatitis. Apropos of a case]. / Insulinome pancréatique, adénomatose du canal de wirsung et pancréatite chronique. A propos d'un cas.

The clinical investigations carried out in a 58 years woman complaining of malaise led to the discovery of an hypoglycaemia resulting from a secreting pancreatic insulinoma. In addition, a chronic pancreatitis, an endocrine hyperplasia (possible nesidioblastosis) and a villous adenomatosis of the pancreatic duct were diagnosed on two biopsies. The immunohistological tests performed on the insulinoma showed insulin, calcitonin and gastrin labelled cells. Electron microscopy displayed numerous neurosecretory granules. The peritumoral endocrine hyperplasia contained intermingled B, A and D cells respectively labelled by insulin, glucagon and somatostatin. Following the operation, the patient recovered without recurrence of the hypoglycaemia (three year follow-up). Factors which may explain such a rare pathological association are discussed.

Histological demonstration of haemosiderin deposits in lungs and liver from victims of chronic physical child abuse.

In the context of chronic physical child abuse, two entities have been described based on macroscopical and radiological criteria: the battered baby syndrome and the shaken baby syndrome. However, in some autopsy cases, clinico-radiological information may not be available. In these cases, histological examinations are necessary to look for sequelae of repeated haemorrhages, particularly in organs likely to have suffered traumatisms such as the lungs, or in organs belonging to the mononucleated macrophage resorption system, such as the liver and the spleen. We examined a series of 15 young children who died from proven chronic child abuse and compared them with 15 sex and age-matched control subjects who died from natural causes with no history of child abuse. Using Perl's stain for iron, we identified haemosiderin deposits in pulmonary, hepatic and splenic samples and the deposits were evaluated qualitatively and quantitatively. Haemosiderin deposits were significantly (P < 0.001) more abundant in the lungs and liver of the chronic abuse victims than in those of the control subjects. However, they were not significantly more abundant in the spleens of child abuse victims than in controls. We conclude that haemosiderin deposits in lungs and liver could be proposed as a marker for chronic physical child abuse. This study stresses the importance of systematic histological examination to look for pulmonary and hepatic haemosiderin deposits in cases in which chronic child abuse is suspected.