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Biomedical subjects

Alain Claudy

Publications and source records attributed to Alain Claudy.

At least 19 recordsLinked to original sources
PubMed2006

Clinicopathologic monitoring of the skin and oral mucosa of the first human face allograft: Report on the first eight months.

BACKGROUND: The first human face allograft was performed in France on November 27, 2005. We report herein the clinicopathologic findings from the skin and oral mucosa of this allograft during the first eight months. METHODS: Sequential biopsies were taken from the facial skin (n = 3), oral mucosa (n = 20), and sentinel skin graft (n = 11) from day 3 to day 220 postgraft and examined (immuno)histologically, using a pathological score previously proposed for evaluation of rejection in composite tissue (hand) transplantation. RESULTS: The patient developed clinically rejection episodes at day 20 and during the eighth month postgraft, manifesting with redness and edema of the facial skin, oral mucosa, and sentinel graft skin. Pathologically, changes suggestive of rejection grades 0, I, II, and III were seen in 1, 1, 1, and 0 biopsies of facial skin, 7, 2, 1, and 1 biopsies of sentinel skin graft and 3, 5, 8, and 4 biopsies of oral mucosa, respectively. Pathological changes were generally more severe in the oral mucosa than in facial and sentinel graft skin (mean scores 1.85, 0.64, and 1, respectively). CONCLUSIONS: As it happens with other composite tissue allografts, close clinicopathologic monitoring of the skin (and oral mucosa) seems to be the most reliable way to detect rejection in the setting of human facial tissue allotransplantation. Apart from these rejection episodes, the skin and mucosa maintained a normal microscopic structure, paralleling functional recovery.

Adult↗
PubMed2006

Subsequent skin cancers in kidney and heart transplant recipients after the first squamous cell carcinoma.

BACKGROUND: The increased incidence of skin cancers in transplant patients is well documented; however, few data exist on the risk of subsequent skin tumors in a given patient after the first skin cancer. The aim of this study was to compare the individual rate of subsequent skin cancers in kidney (KTR) and heart transplant recipients (HTR) after the first squamous cell carcinoma (SCC) and to assess risk factors for tumor multiplicity. METHODS: In all, 188 patients (121 KTR/67 HTR) were studied for up to 5 years. The cumulative number of SCC, basal cell carcinomas, Bowen's diseases, premalignant keratoses, and keratoacanthomas was recorded yearly after the first SCC. RESULTS: Overall, 71% of patients developed 757 new skin tumors. At 5 years, 100% of HTR and 88% of KTR had presented new tumors. However, the mean number of all tumors was significantly higher in KTR (3.4 vs. 2.0, 4.8 vs. 2.6, 6.6 vs. 2.9, 8.5 vs. 3.5, and 9.7 vs. 4.6 at 1, 2, 3, 4, and 5 years, respectively). Transplantation before 1984, multiple tumors at first consultation, eye and hair color, and skin type were predictive of multiple tumors. Early minimization of immunosuppression and of sun exposure tended to be associated with a reduced rate of all tumors and of SCC, respectively. CONCLUSIONS: Although the proportion of HTR developing new tumors is greater as compared with KTR, the mean number of tumors per patient is higher in KTR. This could be due to a longer immunosuppression in patients younger at transplantation.

Adult↗
PubMed2006

Merkel cell carcinoma in organ-transplant recipients: report of two cases with unusual histological features and literature review.

BACKGROUND: Non-melanoma skin cancers are the commonest malignancies after organ transplantation and are often associated with human papillomavirus (HPV). Merkel cell carcinoma is an uncommon neuroendocrine skin tumor, of which 67 cases have been reported up till now, usually briefly, in organ transplant patients. METHODS: Among a cohort of 2340 organ-transplant recipients, two patients (one renal, one heart) developed cutaneous Merkel cell carcinomas 5 and 12 years of post graft, respectively. These were studied histologically and immunohistochemically, as well as virologically for the presence of HPV. A thorough literature review of all reported cases of Merkel cell carcinoma following solid organ transplantation was performed. RESULTS: Despite a typical immunophenotype, the tumors showed unusual histological features: both were epidermotropic, and one was intermingled with a bowenoid squamous cell carcinoma. Search for HPV by immunohistochemistry and PCR proved negative in both cases. CONCLUSION: In the setting of organ transplantation, Merkel cell carcinoma is much rarer than other non melanoma skin cancers but may show unusual histologic features. HPV do not seem to be involved in its pathogenesis.

Aged↗
PubMed2005

[Pathological and clinical correlations in primary cutaneous B-cell lymphomas: a series of 44 cases].

AIMS: histological and clinical relationship study of 44 cases of primary cutaneous B cell lymphoma, classified according to WHO classification. MATERIALS AND METHODS: histological, immunological and molecular analysis was correlated with clinical data. RESULTS: 33 cases (75%) were marginal zone B-cell lymphomas (MZL), with head and trunk predominance (median age = 54 years). Relapses in other mucosa-related sites occurred in 3 patients. Histological transformation implied a more aggressive treatment in 3 cases. A favorable outcome was observed in most cases. 9 (20%) diffuse large B-cell lymphomas (DLBCL) appeared as a unique nodule, with female predominance (median age = 74 years) and 4 lymphoma-related deaths which seemed age-related (> 70 years) with only one lower limb localization. Histological aggressive features were present in 3 patients with a fatal outcome. 2 (5%) WHO grade 3 follicular lymphomas (FL) had an heterogeneous phenotype, with head localization, cutaneous relapses and good outcome. CONCLUSIONS: MZL, the predominant type, has a good prognosis, although transformation can occur, needing a more aggressive treatment. DLBCL, observed in older patients, has clinical and histological prognostic factors identical to extra-cutaneous lymphomas. FL appears rare and has an heterogeneous phenotype. Relationships with its nodal counterpart remains unclear.

Adult↗
PubMed2005

Fucosidosis with angiokeratoma. Immunohistochemical & electronmicroscopic study of a new case and literature review.

Fucosidosis is a rare lysosomal storage disease due to alpha-L-fucosidase deficiency. It presents clinically with neurological, skeletal, and cutaneous findings, including mainly angiokeratoma corporis diffusum. Electronmicroscopic examination reveals characteristic electron-lucent cytoplasmic vacuolization present in several cell types of the skin and other tissues. We present here a new patient suffering from fucosidosis with angiokeratoma, whose normal and diseased skin was studied by lightmicroscopy and electronmicroscopy. The salient clinicopathological features of this disease are briefly reviewed.

Adolescent↗
PubMed2004

Successful match-unrelated donor bone marrow transplantation for congenital erythropoietic porphyria (Günther disease).

UNLABELLED: Congenital erythropoietic porphyria (CEP; Gunther disease; OMIM 263700) is a rare autosomal recessive disorder caused by a deficiency of uroporphyrinogen III synthase (UROS). The deficiency of this enzyme is associated with lifelong overproduction of series I porphyrins which circulate and are deposited in many tissues, causing light-sensitisation and severe damage to skin beginning in childhood. Blistering and scarring of exposed areas may lead to mutilating deformities. We describe two cases: a 4-year-old boy and his first cousin who were cured of CEP by matched unrelated donor bone marrow transplants. Both are alive and disease-free 3 and 2 years post-transplant, respectively. Cutaneous lesions improved dramatically. The correction of the enzyme deficiency was confirmed by measuring erythrocyte UROS activity and urinary porphyrin excretion. Chimerism was complete for both children. Both patients were homoallelic for a novel mutation of the UROS gene, the missense mutation A69T. CONCLUSION: Considering the severity of the disease, if HLA-matched sibling donor is not available, haematopoietic stem cell transplantation using a matched unrelated donor should be strongly considered for treating congenital erythropoietic porphyria since this is currently the only known curative therapy.

Child, Preschool↗
PubMed2004

Skin cancers following pediatric organ transplantation.

BACKGROUND: Organ transplant recipients taking immunosuppressants are at increased risk of skin cancer. Although several studies have been devoted to adult transplant patients, few data are available on the long-term skin malignancies following pediatric organ transplantation. OBJECTIVE: The objective of this study was to present the current state of knowledge on skin malignancies in patients who received their graft during childhood. METHODS: This study reviews data from the literature and includes our personal experience. RESULTS: Skin cancer is the most frequent malignancy following pediatric renal transplantation and the second most common after pediatric nonrenal transplantation. Skin cancers mainly include squamous and basal cell carcinomas. The occurrence of skin cancer in transplanted children is an extremely rare event during childhood. By contrast, skin carcinomas develop in early adulthood at an average age of 27 years. Other reported skin malignancies include anogenital carcinomas and melanoma. Cutaneous forms of Kaposi's sarcoma are exceptional in children. CONCLUSION: The increased risk of skin cancer following pediatric transplantation justifies prevention and adequate education of children and their parents concerning sun avoidance and protection.

Adolescent↗
PubMed2004

Immunoreactivity of hepatocyte paraffin 1 monoclonal antibody in cutaneous metastatic tumors.

Hepatocyte paraffin 1 (Hep Par 1), a monoclonal antibody recognizing an antigen thought to be specific for hepatocyte mitochondria, is considered the most specific and sensitive marker of normal and neoplastic hepatocytes and has been used in diagnosing hepatocellular carcinomas. Recent data suggest that the specificity of Hep Par 1 for hepatic neoplasms is not absolute; nonhepatic neoplasms might express this marker. We assessed the value of Hep Par 1 in the diagnosis of cutaneous metastases of visceral tumors by immunostaining 65 biopsy or excision specimens with Hep Par 1. Hepatocarcinomas (primary and metastatic to the skin) showed specific (coarse granular intracytoplasmic) immunoreactivity. A similar reactivity pattern was found in 5 of 10 metastases of bronchial adenocarcinoma. Nonspecific (weak, nongranular) cytoplasmic immunoreactivity was observed in 5 cases of nonhepatic skin metastases. Hep Par 1 seems to be a sensitive marker of hepatocellular carcinomas metastatic to the skin, but its specificity is not absolute because it might be expressed in metastases of nonhepatic tumors, namely bronchial adenocarcinomas. Hep Par 1 should be used with caution in the investigation of cutaneous metastases from an unknown primary site, preferably in conjunction with other markers of neoplastic hepatocytes.

Adenocarcinoma↗
PubMed2003

Clinicopathologic features of graft rejection of the first human hand allograft.

BACKGROUND: The first human hand allograft, performed in Lyon, France, on September 23, 1998, was removed during month 29 posttransplantation as the result of rejection because the patient did not comply with the immunosuppressive treatment. METHODS: The patient was regularly examined from the day of transplantation to amputation. Biopsies were taken from the skin of the allograft and examined immunohistologically. After amputation, various tissue specimens obtained from the allograft (including skin, tendons, bone, muscles, and joints) were studied. RESULTS: From month 15 onward, the allografted skin presented lichenoid papules that progressively spread and coalesced into diffuse erythematous-scaly lesions over the allografted hand. Histologically, these showed an aspect of chronic lichenoid cutaneous graft-versus-host disease. At the time of amputation, erosive and necrotic areas over the skin were present. Pathologic examination of the allograft showed that the most severe changes were found in the skin. Mild inflammation was found in muscles and tendons. Bones (including bone marrow) and joints were spared. CONCLUSIONS: The skin is the main target of rejection in human hand allografts. Close clinicopathologic monitoring of the skin is the most reliable way to detect rejection in human composite tissue allografts.

Adult↗
PubMed2003

Basal cell carcinomas developing in solid organ transplant recipients: clinicopathologic study of 176 cases.

OBJECTIVE: To assess the clinicopathologic features of basal cell carcinomas developing in organ transplant recipients. DESIGN: Case series. SETTING: University department of dermatology. PATIENTS: One hundred forty-six (7.2%) of 2029 transplant recipients followed up in our department who developed 176 histologically proven basal cell carcinomas. One hundred fifty-three random samples of basal cell carcinomas excised from nonimmunosuppressed patients served as controls. MAIN OUTCOME MEASURES: Clinical data were gathered from the medical records. Histologic slides were retrospectively reexamined. RESULTS: Basal cell carcinomas developed an average of 6.9 years after transplantation, sooner after heart than kidney transplantation, and showed a relative predilection for heart allograft recipients. The mean age of transplant recipients with basal cell carcinomas was significantly lower than that of controls (54.6 vs 69.8 years), especially for recipients of renal transplants, and a male preponderance was found (male-female ratio, 4.8:1 vs 1.3:1). In both groups, basal cell carcinomas were predominantly found on the head and neck, but extracephalic locations were significantly more frequent in transplant recipients (37.5%) than controls (24.5%). Histologically, superficial basal cell carcinomas were more frequent in transplant recipients than controls (33.6% vs 14.4%). The density of the peritumoral cell infiltrate was lower in tumors from transplant recipients compared with controls. The tumor thickness and the presence of epidermal ulceration did not differ significantly between the 2 groups. CONCLUSIONS: Basal cell carcinomas in transplant recipients show some clinicopathologic differences from their "ordinary" counterparts, namely, a younger age at development, male preponderance, more frequent distribution in extracephalic sites, and higher frequency of superficial subtypes.

Adult↗
PubMed2003

Novel biological immunotherapies for psoriasis.

Psoriasis is a common skin disease affecting 1 - 3% of the white population. Although its physiopathogenesis still remains poorly understood, recent data suggest a key role played by memory T cells in the genesis of skin and joint lesions. Recent developments in the understanding of cellular mechanisms underlying psoriasis and in biotechnologies have given rise to a generation of biological agents that have shown clinical efficacy in treating psoriasis. These agents, including chimeric antibodies, fusion proteins and recombinant interleukins, specifically target the activated memory T cells directly involved in the development of psoriasis lesions and inhibit their action either directly or through inhibition of pro-inflammatory cytokines. Compared with conventional systemic treatments, they show a better safety profile and allow durable remissions. Some of these agents were very recently marketed for the treatment of psoriasis and hopefully others will follow. These biologicals have opened a new era for the management of this disease; they are reviewed in this article, based on data available in the literature.

Animals↗
PubMed2002

[Cutaneous tumors in organ transplant recipients].

THE CONTEXT: With the improvement in transplant in surgery, organ storage techniques and immunosuppressive treatments, the number of organ transplant recipients is regularly increasing. To preserve the activity of the graft, immunosuppressive treatment is required for life in most cases, leading to prolonged immunodeficiency. These patients exhibit an increased risk of cancer, notably of tumors associated with viruses such as carcinomas, Kaposi's sarcoma and lymphomas. THE DIFFERENT CANCERS CONCERNED: Cutaneous cancers, notably squamous cell carcinomas, are the predominant cancers encountered in transplant recipients and affect around half of the patients within 20 years following the transplant. Squamous cell carcinomas tend to be multiple, may be life-threatening, and appear to predict the onset of other cancers. Exposure to UV, immunosuppression, the relatively old age at the time of the transplant, light skinned phototype, genetic factors and papillomavirus infections are all factors of risk. Other photo-induced tumors, such as melanoma, some sarcomas or Merkel cell carcinomas also appear increased and of severe prognosis. MEASURES OF PREVENTION: The prevalence of these tumors could be reduced by educating the patients on strict sun-protection measures following the transplant. The factors enhancing Kaposi's sarcoma associated with the HHV8 virus remain to be defined. The possibility of transmission of the infection through the graft must lead to the systematic search for this virus in the donors.

Carcinoma, Squamous Cell↗