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Biomedical subjects

A Croue

Publications and source records attributed to A Croue.

16 recordsLinked to original sources

[Malignant nodular hidradenoma and multiple nodular hidradenomas in a hypogonadic patient].

BACKGROUND: We report a case of multiple benign nodular hidradenomas associated with malignant nodular hidradenoma in a hypogonadic patient. CASE-REPORT: A 49 year-old man presented 11 benign nodular hidradenomas in the pectoral region. A malignant nodular hidradenoma had recently appeared in this region some distance from the pre-existing benign modular hidradenomas. This patient had peripheral hypogonadism associated with congenital bilateral cryptorchidia responsible for gynecomastia due to "relative hyperestrogenism". Large numbers of estrogen receptors were demonstrated in each of the benign nodular hidradenomas. The malignant nodular hidradenoma mass was unavailable and screening for these receptors was not possible. DISCUSSION: Cases of multiple nodular hidradenoma are extremely rare: we have seen only two. To the best of our knowledge, there have been no reports to date of combined malignant nodular hidradenoma and multiple benign nodular hidradenoma. However, there is histological evidence of transition forms. The coexistence of endocrine anomalies associated with this type of tumour has never been reported. However, the presence of estrogen receptors has occasionally been demonstrated in benign nodular hidradenomas. Our patient's endocrine disease may have played a role in the presentation of multiple hidradenomas, but this cannot be demonstrated.

Adenoma, Sweat Gland↗

Chronic ischemic gastritis: case report of a difficult diagnosis and review of the literature.

Chronic ischemic gastritis is an unusual entity that is rarely distinguished from other forms of intestinal ischemia. On the basis of a case encountered and a subsequent review of the literature, the main features of this rare condition are described here. A better understanding and awareness of the disease should improve the diagnosis and ultimately also the prognosis.

Chronic Disease↗

[Malignant tumors arising in extra-ovarian endometriosis: a case report].

We report a case of degenerative extra-ovarian endometriosis. This is a rare complication of endometriosis, the frequency of which is estimated at 0.9%. In more than 50% of the cases, the diagnosis is made following investigation for abdominal pain. If the degeneration is of the same histological type as the endometriosis, it can be said to have arisen from the endometriosis. First-line treatment is surgery, removing as much endometriosis as possible, staging at this point is also necessary. Second-line treatment, with chemotherapy, radiotherapy and even hormonotherapy may be needed. Prognosis for this tumor is variable, from 10 to 100% five-year survival, depending on histological type and localization of the disease.

Abdominal Pain↗

[Cutaneous polyarteritis nodosa following hepatitis B vaccination].

INTRODUCTION: We report the original case of cutaneous periarteritis nodosa that occurred one month following vaccination against hepatitis B. OBSERVATION: A 37 year-old woman, without notable past history, taking no medication, presented with a livedo that had appeared one month after the first injection of a hepatitis B vaccination and had slowly extended over the past 7 years. She did not complain of any other symptom. The histological examination of the livedo showed a necrotic vasculitis. The clinical picture, the histological image and the slow 7-year progression led to the diagnosis of cutaneous periarteritis nodosa. Treatment with hydroxychloroquine (Plaquenil) followed by colchicine had no effect on the livedo. DISCUSSION: Cutaneous periarteritis nodosa is a rare disease of unknown physiopathology. It can be distinguished from systemic periarteritis nodosa by the absence of systemic involvement and benign but prolonged progression. The association of systemic periarteritis nodosa and hepatitis B has been demonstrated. Conversely, only one case of cutaneous periarteritis nodosa associated with hepatitis B viral infection has been described. The vaccination against hepatitis B is frequently prescribed. Following vaccination, a few cases of vasculitis have been reported. The responsibility of the vaccine in the onset of vasculitis has never been formally demonstrated, nevertheless if a cause to effect exists, the physiopathological mechanism might jeopardize the circulating immune complexes containing Ag HBs.

Adult↗

[Congenital adipose plantar nodules persisting in a 28 year-old woman].

INTRODUCTION: Congenital adipose plantar warts, a recently individualized entity, have an unknown long term evolution. Our patient, seen again aged 28 years represents the longest follow-up of the affection in the literature. OBSERVATION: A young woman presented with congenital plantar nodules. She was seen again at the age of 28: the lesions were still present and made it difficult for her to walk. DISCUSSION: Congenital adipose plantar warts are characterized by a bilateral, asymptomatic, plantar nodule of the heel, present at birth, corresponding histologically to a normal hypodermis, occasionally with interlobular fibrosis. The follow-up of published cases has only covered childhood. Our observation suggests the persistence of the affection into adulthood. It also emphasizes the possible functional problem created when walking.

Adipose Tissue↗

[Papular mucinosis associated with myopathy].

BACKGROUND: Papular mucinosis is an uncommon condition sometimes associated with myopathy as in our case. CASE REPORT: A 54-year-old woman presented several disseminated pruriginous papules that spread progressively. Histopathology of a skin biopsy showed mucine deposits and fibroblasts in the derma. Serum monoclonal lambda IgG was evidenced. The patient complained of weakness of the proximal muscles and dysphagia. Serum creatine phosphokinase was moderately elevated and the electromyography showed a typical myogenic pattern. Histopathology of a muscle biopsy disclosed a polymyositis aspect without mucine deposits. The patient was given prednisone. The skin lesions regressed totally with no modification of the muscle deficit. DISCUSSION: Myopathy associated with papulous mucinosis generally presents as a proximal deficit with dysphagia. Myalgia and amyotrophy are exceptional. Moderate serum myolysis is often evidenced. The electromyogram shows a myogenic pattern. The pathophysiology of this condition remains unclear, but the association with papulous mucinosis does not appear to be fortuitous due to its frequency. No standard treatment has been established. General corticosteroid therapy is generally effective and methotrexate, melphalan, isotretinoine and D-penicillamine have given good results in a few cases.

Biopsy↗

Endoscopic detection of early esophageal cancer in a high-risk population: does Lugol staining improve videoendoscopy?

BACKGROUND: The aim of this study was to prospectively compare the diagnostic accuracy of videoendoscopy, with and without Lugol staining, for the detection of esophageal cancer in alcoholic or smoking patients older than 40 years. METHODS: Daily alcohol and tobacco consumption and overt and latent symptoms were noted. The 158 patients included were examined by videoendoscopy and with Lugol dye. RESULTS: The mean consumption of alcohol and tobacco was 86 +/- 49 gm/day for 26 +/- 11 years, and 30 +/- 18 pack-years, respectively. Twenty-five patients had no symptoms. Before Lugol staining, 12 patients had endoscopically identified cancerous lesions. After Lugol staining, 13 patients had 17 esophageal cancers, 3 of which were high-grade dysplasia. The prevalence of esophageal cancer was 8.2%: 95% CI [4,14]. Dye-free surfaces were significantly larger than the endoscopic patterns observed before Lugol staining (11.6 +/- 9.2 cm2 vs 1.4 +/- 1.7 cm2; p < 0.02). CONCLUSIONS: In an alcoholic smoking population, the prevalence of esophageal cancer detected by endoscopy is high and not related to symptoms described by patients. Lugol staining only moderately improves the diagnostic accuracy of videoendoscopy; its main advantage is the assessment of the mucosal extension of esophageal cancer.

Adult↗

Golgi autoantibodies and autoantigens.

Autoantibodies directed against cellular constituents rarely react with antigens localized in the Golgi apparatus and little information is available regarding these particular antibodies. Although thousands of samples have been examined for autoantibodies in our laboratory on a routine basis, only three human sera with anti-Golgi antibodies could be studied. Using pre-embedding immunoelectron microscopy we have demonstrated that these sera have antibodies reacting with antigens located in the Golgi apparatus. The reaction product was exclusively located on cisternal and vesicular Golgi membranes. No intraluminal staining was seen and some saccules were negative. No specificity for a peculiar tissue or cell line was noted, suggesting that the targets or these autoantibodies are evolutionarily conserved. The F(ab')2 fragments retained full binding capacity in indirect immunofluorescence experiments, confirming true antibody activity. When tested by immunoblotting, the three sera reacted with different antigens with relative molecular weights of respectively 230, 150 and 80 kDa. The antigens recognized by anti-Golgi antibodies in two of the three sera were insensitive to trypsin degradation. Together, these results suggest that a set of different autoantigens are recognized by sera from various patients.

Animals↗

[Diffuse sclerosing papillary carcinoma of the thyroid gland. Apropos of a pediatric case of association of an unilateral tumor with diffuse lymphocytic thyroiditis].

A 11-year-old girl presented in 1990 with bilateral goiter, hypothyroidism and thyroid auto-antibodies and was treated for Hashimoto's thyroiditis. In 1991, a cervical lymph node metastasis revealed diffuse sclerosing papillary carcinoma (DSPC) of the right thyroid lobe and chronic lymphocytic thyroiditis of the left lobe. The patient is in remission in 1993 (total follow-up, 39 months). The review of 60 previously reported cases of DSPC shows a predilection for young people, a high incidence of lymph node and pulmonary metastases; however the mortality rate is quite low, reflecting either the good prognosis linked to a young age in papillary thyroid carcinomas, or the short duration of the follow-up preventing assessment of the behaviour of DSPC.

Carcinoma, Papillary↗

[Place of endorectal ultrasonography in the evaluation of staging of cancer of the rectum: before or after preoperative radiotherapy?].

Of 62 patients with rectal carcinoma, who were examined by endorectal ultrasound (EER) before operation, 15 were examined after preoperative external radiation therapy. The results were compared to histological and surgical findings according to the TNM classification. When preoperative radiation therapy was not applied, the diagnostic value of EER was excellent, as well as for the detection of perirectal fat spread as for lymph node involvement. The diagnostic accuracy was respectively 87.2% (CI: 74-95) and 78.0% (CI: 62-90). After irradiation, the diagnostic value was much lower. The diagnostic accuracy was 60% (CI:33-84) and 40% (CI:18-68) for perirectal fat spread and nodal involvement, respectively. This loss of information was due to a decrease in specificity. Radiation treatment was responsible for the occurrence of hypoechoic nodal images and peritumoral hypoechoic areas resulting in an overestimation of the extent of involvement. After irradiation of a rectal malignant tumor, the classical EER signs are no longer adequate to predict locoregional involvement. Endosonographic semiology must be modified to describe the tumor response to non surgical treatment.

Adult↗

[Histopathologic lesions in erythromelalgia during essential thrombocythemia].

Erythromelalgia is a vascular disorder of the extremities and is sometimes related to myeloproliferative syndrome with thrombocythemia. We report the cutaneous histopathology in case of erythromelalgia that revealed a thrombocythemia vera. Small arteries were occluded by thrombi of different age and narrowing of the lumen occurred by intimal proliferation of smooth muscle cells. There was no involvement of venules or capillaries. These vascular changes are highly suggestive of erythromelalgia and have not to be confused with necrotizing and/or granulomatous angiitis because of absence of fibrinoid necrosis and sparse inflammatory cells.

Erythromelalgia↗

[The tumorous form of bladder malacoplakia. Apropos of 2 cases].

The authors report two rare cases of neoplastic vesical malakoplakia, one with an enterovesical fistula and the other with extravesical pelvic extension. The symptoms are non-specific and the diagnosis remains histological. Medical treatment, based on the suspected infectious physiopathogenesis of the disease, consists of variable combinations of antibiotics, cholinergics and vitamin C. It must be sufficiently prolonged and conservative in view of its usual efficacy, even in neoplastic forms.

Adult↗

Contribution of immunohistochemistry, electron microscopy, and cell culture to the characterization of nonfunctioning pituitary adenomas: a study of 40 cases.

We studied 40 endocrinologically inactive pituitary adenomas by immunohistochemistry, electron microscopy, and cell culture in order to determine the incidence of gonadotropic adenomas and to classify nonfunctioning adenomas. Immunohistochemical studies using a large panel of monoclonal and polyclonal antibodies identified the following nonfunctioning adenomas: 20 gonadotropic adenomas, four silent corticotropic adenomas, one plurihormonal adenoma, and 15 nonsecreting adenomas. Among nonsecreting adenomas, ultrastructural study of 13 cases identified seven null cell adenomas and six oncocytomas. Silent corticotropic adenomas were classified into subtypes I, II, and III according to Kovacs and Horvath. Most often, gonadotropic adenomas displayed a varying number of oncocytic cells, characteristic secretory granules, and a prominent Golgi apparatus. Postembedding immunoelectron microscopy was performed on eight gonadotropic or nonsecreting adenomas, but this technique did not provide any additional information. Six gonadotropic adenomas and 10 so-called nonsecreting adenomas were studied in primary cell cultures. The six gonadotropic adenomas and seven of the 10 nonsecreting adenomas released gonadotropins in the culture medium. The use of in vitro results as a supplementary diagnostic criterion allowed classification of the 40 nonfunctioning adenomas as follows: 27 gonadotropic adenomas, four silent corticotropic adenomas, one plurihormonal adenoma, and eight nonsecreting adenomas. These results demonstrate a high proportion of gonadotropic adenomas among nonfunctioning adenomas (67.5%) and the usefulness of several techniques in characterizing this type of pituitary adenoma.

Adenoma↗