Biomedical subjects
Publications and source records attributed to M Lecomte-Houcke.
A case of malignant melanoma of the quadriceps tendon is reported. This is an uncommon soft tissue sarcoma of melanocytic origin. The appearance on MRI depends on its melanin content. The microscopic appearance is distinctive and prognosis is poor. This tumor should be kept in mind when a nodular lesion is detected in specific tendon or aponeurosis.
BACKGROUND: Tufted angioma belongs to the family of vascular skin proliferations. Clustered capillaries is the characteristic histological feature. Classically, tufted angioma is an acquired disease observed in children or young adults with lesions predominating on the neck, the shoulders and the upper trunk. CASE REPORTS: Four children were seen for flat skin lesions which were either initially or secondarily erythematous. The lesions were observed at birth or within the first weeks of life. In all 4 cases, the lesions progressed by infiltration, leading to sclerous plaques within a few weeks. The hip area was involved in case n(o) 2 and the thigh in the other cases. Pathology reported tufted angioma. A repeated biopsy 4 years after the first biopsy demonstrated the progressive nature of the fibrosis in case n(o) 2. Magnetic resonance imaging, performed in 3 of the 4 cases, demonstrated deep penetration of the vascular proliferation. The lesions were in contact with bony structures in case n(o) 2, reached the hypodermis in case n(o) 3 and infiltrated between the adducter muscles in case n(o) 4. DISCUSSION: Among tufted angiomas, there is a clinical variant characterized by very early discovery (congenital or within the first months of life), preferential localization on the lower limbs and progression to sclerosis. Although non-specific, hypersudation and lanuginous hypertrichosis are also highly suggestive signs. The main clinical and histological differential diagnosis is angio-eccrine hamartoma and, to a lesser degree, Kaposi hemangioendothelioma which does not predominate on the lower limbs. This particular clinical presentation of tufted angioma should lead to wide and sufficiently deep biopsy to allow precise diagnosis prior to initiating therapy. The possibility of spontaneous involution would allow abstention with regular surveillance to detect reactivation and progression or functional impairment. Such unfavorable progression has lead certain authors to propose high-dose systemic corticosteroid therapy or alpha-interferon.
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Bacillus Calmette Guérin (BCG) is an attenuated strain of Mycobacterium bovis that is currently used as a live vaccine for human tuberculosis. Disseminated BCG infection may rarely occur following vaccination of children. In half of the cases, regarded as idiopathic, no well-defined immunodeficiency condition can account for the infection. However, the high rates of parental consanguinity and familial forms and the associated opportunistic infections with Salmonella suggest that these idiopathic BCG infections result from one or several new type(s) of inherited immune disorder(s). As an approach to the description and understanding of this newly described condition, the associated lesions were examined. Samples from 14 patients collected from a French national retrospective study were analysed. Pathological data from 22 cases reported in the world literature were also reviewed. Two types of granuloma were found. The first type (type I, tuberculoid) consisted of well-circumscribed and well-differentiated granulomas, with epithelioid and multinucleated giant cells containing very few acid-fast rods, surrounded by lymphocytes and fibrosis and occasionally with central caseous necrosis. The second type (type II, lepromatous-like) consisted of ill-defined and poorly differentiated granulomas, with few if any giant cells and lymphocytes but widespread macrophages loaded with acid-fast bacilli. Most children displayed a single type of granuloma. One half displayed type 1 lesions and the other half displayed type II lesions. There was a strong correlation between the type of granuloma and the clinical outcome. Tuberculoid lesions were associated with survival, whilst lepromatous-like lesions correlated with death. Correlation of granuloma structure with clinical outcome defines two types of idiopathic disseminated BCG infection. The phenotypic heterogeneity of the course of BCG infection reflects distinct pathogenic mechanisms and probably results from a genotypic heterogeneity of the underlying inherited immune disorder.
The authors report two cases of ulnar nerve compression at the wrist due to arthrosynovial cysts arising from the hamatotriquetral joint. The absence of strict parallelism between the type of neurological deficit observed, the site of the cyst and the site of compression requires ulnar nerve release as far as its division in the pisi-unciform hiatus, where the section of the hypothenar fibrous arcade and pisi-unciform ligament is essential. Complete recovery of these 2 patients confirmed the favourable prognosis of this form of compression provided surgical treatment is performed early and rigorously.
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The case is reported of a 66-year-old woman who presented with endoscopic and histological features of multiple lipid deposits in the mucosa of the sigmoid colon associated with an adenoma. Associated clinical features were abdominal pain and diarrhea. Colectomy led to the complete resolution of symptoms. Biochemical analysis disclosed the presence of glycerides in the mucosa. The pathogenesis of lipid deposits and the possible link with the formation of an adenoma is discussed.
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Pseudoxanthoma elasticum (PXE) is a rare inherited connective tissue disorder which is characterized by elastic tissue degeneration involving the skin, eyes and arteries. We describe the case of a hypercholesterolemic 25 year-old woman with typical genetic dominant form of PXE revealed by distal limb artery involvement after a pregnancy. In young adults with arterial disease, a non atheromatous cause should always be sought for, even if risk factors for atherosclerosis are present.
Giant cell tumors of bone are uncommon in the vertebrae above the sacrum. We report the case of a giant cell tumor of the third lumbar vertebra, revealed by lumbar and radicular pain. X ray, computed tomography and magnetic resonance imaging showed osteolysis of the body and vertebral arch of L3. Histologic evaluation gave a conclusion of a giant cell tumor, grade 2. Spondylectomy of L3 was performed using a combined approach (anterior and posterior) in two stages. The patient had a good functional result without recurrence at three years and six months. A review of the literature indicates that the radiological appearance is nonspecific but shows the extent of the tumor. Diagnosis can be based only on histological features. Radiotherapy could induce malignant transformation. Radical resection limits the risk of recurrence. Total spondylectomy is recommended for giant cell tumors when both the body and arch are involved.
AIM OF THE STUDY: Evaluation of frequency and outcome of loco-regional persistance and recurrences of differentiated thyroid carcinomas after surgery. MATERIAL AND METHODS: from 1964 to December 1990, we operated and followed up more than 5 years (from 5 to 31 years): 589 thyroid cancers (309 papillary, 262 follicullar et 18 Hürthle cells); 145 patients were lost to follow-up (24%), 33% of them were microcarcinomas. Surgery consisted ultimately in 411 total thyroidectomies, 51 sub-total thyroidectomies, 113 lobectomies with isthmusectomies, 9 isthmusectomies or tumorectomies and 4 tracheotomies. Neck dissection was not routinely performed but rather selectively (n = 137). All Patients were put under suppressive hormone therapy. After total thyroidectomy, ablative 131 iodine was almost routinely done. All patients have been controlled by clinical examination, radio-iodine scanning and, since 1983, by sequential thyroglobulin assays. We have analysed the course of patients according to L. J. Degroot's staging (Stage I: Patient with intrathyroidal disease. Stage II: Patient with cervical node involvement. Stage III: Patient with extra-thyroidal neck invasive disease. Stage IV: Distant metastasis). RESULTS: Stage I, n = 383, Stage II, n = 96. Total = 479. Local recurrences in the bed of total thyroidectomy were exceptional: n = 2/323 (0.6%). Recurrences in the thyroid remnant after non total thyroidectomy were rare: n = 3/156 (2%). Cervical nodal recurrences were also rare: n = 7/479 (1.5%). Stage III (n = 73): 34/306 papillary, 9/78, well differentiated follicular, 25/175 poorly differentiated follicular. 2/9 follicular of other type and 3/18 hurtle cell. In 67 patients, the loco-regional sterilization was achieved, 5 of which were reoperated for nodal cervical metastasis. 6 patients died from continuing loco-regional disease and 10 presented distant metastases. 4 of which died from. Among opered patients are still alive (52/73 = 71,2%) no loco-regional recurrence persisted. CONCLUSION: The true problem is not recurrence but the persistance after surgery in stage III patients, despite the application of 1131. The determining factor of the persistance and recurrence is the initial stage of the carninomatous disease at the time of treatment.
The authors report a rare case of a histologically proven intraosseous ganglion found in the calcaneus. A 59 year old carpenter was referred to our institution because of progressive talalgia with swelling of the hindfoot, increasing with prolonged standing and walking at job. X rays showed a multilobular radiolucent cyst developed in the anterior part of the left calcaneus, outlined by a rim of sclerotic bone. A lateral cortical split revealed by CT was deemed to be a traumatic communication with the soft tissue. At biopsy, a gelatinous and hematic content was noted but pathologic examination of the cyst walls failed to reveal the diagnosis; there were no malignant cells. 5 weeks later, the cyst and its contents were excised through lateral approach and the defect filled with cancellous bone graft. At pathological examination, a final diagnosis of ganglion cyst was determined. One year after surgery, the patient was asymptomatic; no sign of recurrence was observed. Intraosseous ganglia are benign subchondral cysts which rarely involve foot bones. When pain becomes consistent and swelling occurs because of overlooked fracture, malignant bone tumors should be ruled out. Histological examination is mandatory to confirm the diagnosis. Excision of the cyst and bone grafting are effective; recurrence is infrequent.
This is a retrospective pathological and immunohistochemical study of 38 cases of dermatofibrosarcoma protuberans. It is a rare dermal and subcutaneous spindle cell tumor which may be difficult to diagnose. We tested the value of the CD34 antibody and compared this series with 15 fibrous histiocytomas and II neurofibromas. Thirty-one dermatofibrosarcoma protuberans were positive for CD34 and 7 were negative. All the fibrous histiocytomas were negative. Nine neurofibromas were positive with variable expression of CD34 antigen. The CD34 antibody seems to be a sensitive marker to differentiate dermatofibrosarcoma protuberans from fibrous histiocytoma. It is specific for the dermatofibrosarcoma protuberans in the context of differential diagnosis between these two tumors. The role of immunohistochemical staining remains useful within the anatomoclinical context.
An ileal tumor was detected in a patient with monoclonal plasmocytosis of the bone marrow (IgA Kappa). The pathological examination showed a carcinoid tumor with amyloid stroma. Immunotyping of the amyloidosis showed that it was stained with the antibody directed against light chain kappa, though the amyloidosis was located within a carcinoid tumor.
The in vitro tests on cell viability reveal a favorable position for steel and hydroxyapatite (HA)? However, the roughness induces a negative effect on cell proliferation. Sandblasting of the stainless steel considerably decreased cell number compared with the polished substrate. HA showed a better percentage of proliferation in spite of the surface effect compared with controls. For in vivo biocompatibility, intramuscular implants revealed localized inflammatory reactions for the HA treated stainless steel but nor for the untreated alloy.
OBJECTIVE: Assess the sensitivity of MIBI-Tc for the detection of parathyroid lesions and define the threshold of detection by evaluating contrast uptake at 20 minutes and 2 hours. METHODS: Fifty-five operated and cured patients were studied. Image acquisitions were made 20 minutes and 2 hours after injection of 555 MBq MIBI-Tc then 2 hours after injection of 5.55 MBq iodine 123. RESULTS: A total of 87 pathological glands were found including 47 adenomas (80 to 8820 mg) and 40 hyperplasias (44 to 2175 mg). Detection sensitivity was 81% for adenomas and 30% for hyperplasia, but the cell type did not appear to be a determining factor. CONCLUSION: Scintigraphic visualization of parathyroid lesions is more frequent when there is a single lesion. At least one lesion was seen in 80% of the patients. The threshold of detection was 225 mg. Enhancement of parathyroid uptake with MIBI-Tc compared with the thyroid between 20 minutes and 2 hours was not a constant and of unknown origin.