Biomedical subjects
Publications and source records attributed to F Capron.
The author presents a quick review of the pulmonary lesions due to ARC, mainly the pulmonary lymphoid hyperplasias. The most frequent pulmonary complications of the disease are summarised (opportunistic infections and Kaposi sarcoma) the practical conditions of their pathological diagnosis are illustrated.
Actinomycosis of the lung is rare and difficult to diagnose. Its good prognosis after medical treatment contrasts with the high frequency of surgical excision, due to the fact that pre-operative diagnosis is exceptional. Following a review of the recent bacteriological, radiological and therapeutic data available in the literature, 4 personal cases are presented. In all 4 cases actinomycosis was diagnosed post-operatively on the presence of yellow grains in the histological specimens. In 2 cases surgical excision proved impossible, but an almost complete radiological recovery could be obtained after prolonged treatment with co-trimoxazole. This shows how important it is to be aware of the disease, to improve its diagnostic approach and to remember its sensitivity to antibacterial agents, even in well organized forms.
The authors present the results of a histopathological study on the lymph-nodes taken from 45 subjects suffering from either an AIDS or from a chronic adenopathy corresponding to the definition of AIDS related complex (ARC). The various aspects observed were classed as type I to type IV. The lymph-node modifications observed in the 29 patients with an ARC could be divided into three principle groups: an extensive follicular hyperplasia associated with other elementary lesions or type IA (25 lymph-nodes from 23 patients); changes resembling a multicentric Castleman syndrome or type IB (1 case); angioimmunoblastic-like (AIL) lesions or type II (2 cases) and an association of lesions of type II (7 lymph-nodes from 6 patients). During AIDS, the adenopathy usually disappears, and the small lymph-nodes removed, especially on autopsy, show an extensive lymphoid depletion (type III) with systematic sclerosis (15 lymph-nodes from 14 patients). When adenopathy persists, it is due to infections complications (tuberculosis, cryptococcosis, avian mycobacteriosis and Whipple's disease like lesions). Of the 10 patients in whom a Kaposi's sarcoma was observed, only 6 showed lymph-node involvement, or type IV. The different histopathological lesions seem to appear according to an evolving succession, proven by certain association of lesions and by successive biopsies. In our series, 17% of subjects with an ARC evolved to AIDS. Lymph-node biopsy allows a possible ARC to be implicated on the association of the following simple lesions: follicular hyperplasia with partial or total destruction of the perifollicular lymphocytic cisterna, infiltration of the germinative centres by streams of small lymphocytes, evolving to an aspect of a "burst" germinative centre and various sinusal reactions with, in particular, the presence of neutrophilic polynuclear cells. The biopsy also allows the forms with bad prognosis to be recognized: those with AIL-like aspect or multicentric Castleman-like syndrome, which seems to represent a particular evolutive form. Finally, it also detects, in certain cases, the localization of a Kaposi syndrome, signalling the passage to AIDS. The immunopathological studies present a double interest. Firstly, they offer arguments in favour of the diagnosis: increase in the number of T8 lymphocytes in the germinative centres with the formation of small clusters and disruption of the network of dendritic reticular cells, and the inversion of the T4/T8 ratio in the extra-follicular cortical regions, by either a decrease in T4 lymphocytes or by an increase in T8 lymphocytes.(ABSTRACT TRUNCATED AT 400 WORDS)
A case of lymphomatoid granulomatosis arising in a patient with a long history of dysimmunity is reported. The autopsy reviewed the final evolution into a high grade malignant lymphoma with IgM K immunoglobulin production and discovered in deep lymph nodes modifications similar to angio-immunoblastic lymphadenopathy.
5 cases of angiolymphoid hyperplasia with eosinophilia of the skin are reported. This rare condition was initially described in 1969 by Wells and Whimster. The microscopical pattern is characterised by an atypical vascular proliferation associated with an eosinophilic and lymphoplasmocytic granuloma. In our series, immunohistological study demonstrated the polyclonality of the plasmacytoid component. Electron microscopy performed in one case shows endothelial features even in cells forming clusters without well-defined lumen. These results support the endothelial origin of angiolymphoid hyperplasia with eosinophilia.
Kartagener syndrome, identified 40 years ago, is an obstructive bronchopulmonary condition of early onset which rapidly becomes chronic and linked to immobility of the bronchial cilia. This clinical entity is based upon a kinetic problem secondary to ultrastructural abnormalities of the cilia. Current techniques for the study of ciliary movement and electron microscopy in particular are sufficiently accurate to be able to link certain ciliary abnormalities to particular clinical manifestations. Although it is a frequent neonatal condition, Kartagener syndrome may be compatible with prolonged survival. The authors report a case in an adult, with a favorable course, and give an updated review of the condition.
A case report is presented of a patient with a pleural effusion subsequently shown to have a localised immunoblastic lymphoma of the bronchus of non-Hodgkin's type. The development of this lymphoma in a patient with mycosis fungoides underlines the potential for the transformation of a T cell epidermoid lymphoma of low grade malignancy to a lymphoma of high grade malignancy.
On the basis of a critical analysis of the literature, the authors review the various respiratory lesions imputed to the inhalation of hair lacquers. Pulmonary thesaurismosis is alleged to result from accumulation in the pulmonary parenchyma of non-biodegradable macro-molecules, such as PVP. Only isolated cases have been published and the true existence of this disease remains to be confirmed, in the absence of convincing epidemiological data as well as the lack of experimental reproducibility. Chronic inhalation of hair lacquers may, however, be responsible for bronchial irritative manifestations and obstruction of the small airways, in particular in hairdressers. Increase in the relative risk of bronchopulmonary carcinoma has not been proven.
An immunoelectronmicroscopic method using Fab fragment of anti human IgG (H + L) has been employed to study the localization of cytoplasmic immunoglobulins in the tumoral cells of 12 B non Hodgkin's malignant lymphomas (B-M.L.). A comparison with normal homologous B lymphoid cells was performed on 10 non tumoral reactive lymph nodes. Immunostaining was observed in PNC, RER and Golgi complex. The criterions of differentiation were discussed in the different B-M.L.. Because of a granular hyaloplasmic immunostaining in normal and tumoral centroblasts and immunoblasts, monospecific antibodies against gamma, mu, alpha heavy chains were used to rule out a non specific uptake. Presence of mu heavy chain was discussed as an argument for immunoglobulin free ribosomal synthesis.
The authors report the case of a malignant hemangioendothelioma of the choroid occurred in a 62 years old man. Clinically the lesion simulated a malignant melanoma but the histological examination showed an unpigmented tumour consisting of nests of large, pleomorphic cells proliferating inside reticular sheaths. The immunohistochemical identification of Factor VIII Related Antigen by the peroxidase-antiperoxidase method of Sternberger permitted the identification of their endothelial nature. This case which seems to be the first described in the literature, is distinguished from benign hemangioendothelioma and from neoplastic angioendotheliomatosis.
A case of severe diffuse interstitial pneumonia is reported in a 69 year old after 5 weeks treatment with gold salts. Regression of symptoms on withdrawal of gold salts and under steroid therapy, the similarity with previously published cases, the absence of another cause lead us to incriminate the gold salts. The case is documented with optical and electronic microscopic studies of transbronchial biopsy and repeated examination of bronchoalveolar lavage fluid. A general review of the literature is included with a critical discussion of the physiopathogenic mechanisms. The results of the examination of the bronchoalveolar lavage fluid are further evidence in favour of cell-mediated hypersensitivity reaction.
The authors studied the ultrastructural morphology of the lung in one case of Bourneville's tuberous sclerosis with pulmonary involvement. The observations in this report are similar to those previously reported in pulmonary lymphangioleiomyomatosis and further emphasize the striking resemblance between the two diseases.
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To study indicators of disease activity in sarcoidosis, bronchoalveolar lavage (BAL) and serum angiotensin-converting enzyme (SACE) measurement were performed in 39 patients with active sarcoidosis and in 13 patients with inactive sarcoidosis. All patients were non-smokers. Results were compared to those from 9 non-smoking controls and 20 patients with non-granulomatous interstitial lung disease. Lymphocyte counts, IgG concentrations and the IgG/K ratio were high in BAL fluid specimens from patients with active sarcoidosis, indicating a relationship between cellular and humoral immunity. Conversely, specimens from inactive sarcoidosis patients showed supranormal lymphocyte counts with IgG levels and a IgG/K ratio that did not differ significantly from those in controls or patients with interstitial lung disease (p greater than 0,05). Patients with active sarcoidosis that abated after 6 to 12 months had an initial lymphocytosis of 28.7% and a IgG/K ratio under 170 mg/mmol. We conclude that IgG concentrations and the IgG/K ratio are better discriminators between active and non-active or nearly resolved disease than lymphocyte counts. SACE assay is not sufficiently discriminative.
3 cases of hairy cell leukaemia were studied with ultrastructural immunocytochemical methods using an anti human Ig HRPO-Fab fragment. Ig were detected on the cell surface, in the perinuclear cisterna and endoplasmic reticulum of hairy cells. Evidence of Ig in these sites demonstrates a B-lymphoid differentiation of the leukaemic cells.
We observed a patient with Lennert's lymphoma. Immunocytochemical study of paraffin sections by the immunoperoxidase technique and immunologic study of viable cell suspension by monoclonal antibodies confirmed the T-cell nature of the neoplastic lymphoid cells. Subtyping showed a predominance of helper T lymphocytes. The histiocytic nature of the epithelioid-cell component of Lennert's lymphoma was also shown by immunostaining.
Amyloidosis of the lower respiratory tract is a rare condition. We report three new cases and we review the literature. Tracheobronchial amyloidosis is the most frequent form. The diagnostic is made by fiberoscopy and biopsies with a risk of bleeding. Our patients were usually treated with intermittent bronchoscopic resections. In one of the three cases reported, desobstruction of the large airway was performed with laser. Nodular pulmonary amyloidosis is usually asymptomatic, and surgical resection results in cure in all cases. Diffuse pulmonary amyloidosis is very unusual and fatal.
A case of generalised scleroderma is reported in a dental technician exposed to the risk of silicosis. A study of the occupational toxic risks in this patient showed pulmonary overload with silica and metallic particles composed of chromium, cobalt and tungsten. The job also involved the handling of vinyl chloride and its stable polymer. This chemical is known to give rise to scleroderma-type skin disease. The relationship between these occupational factors leads to a difficult physio-pathological problem and justifies preventative measures, even though they may be costly and demanding.