Showing papers in "Annales De Pathologie in 1990"

Identification immunohistochimique des Aspergillus par l'anticorps monoclonal EB-A1

Abstract: We have developed a new monoclonal antibody EB-A1 that recognizes Aspergillus sp. by immunoassay and in formalin fixed tissues. The sensitivity of this antibody is excellent and its specificity appears correct as many human tissues and several fungi other than Aspergillus sp. are not revealed.

Malignant mesothelioma of the pleura. Analysis of its immunohistochemical aspects

Abstract: To evaluate the usefulness of immunohistochemistry in the diagnostic distinction between pleural mesothelioma and metastatic adenocarcinoma to the pleura, the authors studied formalin-fixed paraffin-embedded tissue sections from 14 pleural mesotheliomas and 20 primary adenocarcinomas of the lung, stomach, ovary and breast by using 16 commercially available antibodies to cytokeratin (KL1), vimentin, EMA, CEA, CA19.9, CA125, Egp 34 (detected by HEA 125), secretory component, S100 protein, SP1-beta 1, Leu M1, alpha-1-AT, alpha-1-ACT, lysozyme, desmin and factor VIII. Keratin positivity was found in all mesotheliomas and adenocarcinomas. A coexpression of keratin and vimentin was present in 8/14 (57%) mesotheliomas but only in 2/20 (10%) adenocarcinomas. CEA and CA 19.9 were detected in 80% and 65% of the adenocarcinomas respectively, but not in any of the mesotheliomas. Interestingly, two adenocarcinomas (of the ovary and the stomach) that failed to stain for CEA, were immunoreactive to anti-CA 19.9 antibody. Thus, the combined use of anti-CEA and anti-CA 19.9 antibodies results in staining 90% of the adenocarcinomas. S100 protein, SP1-beta and Leu M1 were also absent in mesotheliomas but present only in less than half of the adenocarcinomas. Adenocarcinomas and mesotheliomas did not significantly vary in reaction to the remaining above mentioned antibodies. The authors conclude that the coexpression of keratin and vimentin and the absence of CEA and CA 19.9 might be the best criteria in the distinction of mesothelioma from metastatic non mucosecreting adenocarcinoma.

[Dna ploidy in adenocarcinoma of Barrett's esophagus].

Abstract: We have studied by flow cytometry the ADN-ploidy of 23 adenocarcinomas developed on Barrett's oesophagus operated at hospital Beaujon between 1982 and 1988. This retrospective study was done on formalin-fixed and paraffin-embedded material. Non dysplastic Barrett's mucosa was diploid in all of the 11 studied cases. Dysplastic mucosa was aneuploid in the 4 studied cases, as were the carcinomas in the same patients. Seven tumors were diploid, and 16 aneuploid. There was no relationship between the aneuploidy and the degree of tumor differentiation. Fourteen of the 15 tumors which invaded the adventitia and only 2 of the 8 tumors which were limited to the muscularis propria were aneuploid. Thirteen of 16 aneuploid and only 2 of 7 diploid tumors had lymph node invasion. Six of the 7 patients with diploid tumor were well 12 to 52 months after surgery. Eleven of the 16 patients with aneuploid tumor died, the remaining 5 were well 12 to 18 months after surgery. The ratio of aneuploid adenocarcinomas developed on Barrett's oesophagus is similar to the ratio observed in other types of solid tumors. The prognosis of adenocarcinoma in Barrett's oesophagus is poor. According to our results, the prognosis of diploid tumors seems to be better than that of aneuploid tumors. In order to determine the value of ADN-ploidy as an independent prognostic criterion, it would be of interest to study a greater number of patients with longer follow-up.

[Intra-scrotal supernumerary spleen. A long silent case of discontinuous spleno-gonadal fusion].

Abstract: The presence of a supernumerary spleen in the scrotum, situated around or near a more or less atrophic testicle, or replacing a missing testicle in cryptorchidism, represents the most common result of a rare congenital anomaly called splenogonadal fusion. A new case discovered in a 81-year-old patient is reported. The different clinical expressions, the different anatomic varieties and the macroscopic and histologic pattern are described and discussed.

Fatal hemoptysis during bronchial aspergillosis with multiple pulmonary artery aneurysms

Abstract: Aspergillosis with fatal outcome are usually pulmonary invasive aspergillosis with or without dissemination, developed in patients with severe immunosuppression. We report a fatal case of bronchial necrotizing aspergillosis in a young woman with diabetes mellitus, who developed similar lesions to "Semi-invasive Aspergillosis", so-called "Chronic Necrotizing Pulmonary Aspergillosis". This aspergillosis was complicated by large pulmonary artery aneurysms requiring an hemostatic lobectomy. These aneurysms, secondary to the bronchial lesions, contrast with infectious aneurysms (so-called mycotic) secondary to septic embols. They differ from Rasmussen's aneurysms, due to tuberculosis, by their size, fusiform shape and extent. Lesions of vessels' walls and parietal fungal invasion in the vicinity of an endo-bronchial aspergilloma explain the vascular rupture. The multiplicity of these aneurysms, showed on C T Scan, is responsible for death by post-surgical recurrence of hemoptysis.

[A case of liver angiosarcoma arising in a pre-existing cavernous hemangioma].

Abstract: A 36-year-old woman presented with a solitary hepatic tumor. Macroscopically, the tumor measured 9 cm in greatest diameter, and was well encapsulated; it was reddish, and showed multiple foci of hemorrhage. Microscopic examination revealed two different patterns: a peripheral angiosarcoma surrounding a centrally located cavernous haemangioma. To our knowledge, such an entity has not been reported up to now. Possible pathomechanisms, radiological and pathological findings of this angiosarcoma of liver arising within a cavernous haemangioma are commented.

[The association of neuro-endocrine carcinoma of the skin and Bowen's disease. Review of the literature apropos of 4 cases].

Abstract: Four cases of neuroendocrine carcinoma following Bowen's disease are presented. An immunohistochemical study was performed. The four patients, 3 men and a woman, ranging from seventy to eighty-seven years of age, developed a nodular tumor on a preexisting cutaneous lesion. In one of those cases the diagnosis of Bowen's disease was confirmed histologically before the apparition of the nodular tumor. The tumors were localized on the scalp, thorax, dorsum of the hand, and the scrotum. The four tumors were immunohistologically typical of neuro-endocrine carcinoma: there was a positivity for neurofilaments, cytokeratins and neurone-specific enolase. The clinico-pathological characteristics of those 4 neuro-endocrine carcinomas associated with a Bowen's disease, when compared with the 15 similar described in the literature, are identical to the isolated neuroendocrine carcinoma, from a clinical, morphological and evolutional point of view. The majority are seen in patients older than 60 years old and one third of the cases described survived at least 5 years. The coexistence of Bowen's disease and neuroendocrine carcinoma, the association of neuroendocrine and epidermoid cells in other cutaneous tumors, reactivate the controversy concerning the histogenesis of the so-called Merkel cell carcinoma. In fact, the histogenesis of the tumor is still not fully understood.

Cardiac lesions in acquired immunodeficiency syndrome (AIDS). Apropos of an autopsy series of 25 cases

Abstract: The pathologic study of the cardiac lesions in 25 persons who died of AIDS were studied from autopsies. Most of these patients were intravenous drug abusers (14 cases). Heart failure was symptomatic and lead to death in 4 cases. This study showed histological abnormalities in 76% of the cases. We observed 12 myocarditis. In 6 cases, pathogenes were found: Toxoplasma gondii (2), Cryptococcus neoformans (2), Candida (1), Aspergillus (1). A lymphocytic myocarditis was observed in 6 hearts. By immunohistochemical technique, we could distinguish 2 toxoplasmic myocarditis, and in 4 cases, solitary cysts in the myocardium without inflammation. The remaining lesions comprised respectively: 3 lymphocytic pericarditis, 2 marastic endocarditis and 1 dilated myocardiopathy.

[Histogenesis of subependymal glioma in Bourneville's tuberous sclerosis].

Abstract: The phenotypic characteristics of 7 subependymal giant cell astrocytomas (GSECG) (6 of these being associated with tuberous sclerosis) are studied using morphological and immunohistochemical methods with antiserums against vimentine, glial fibrillary acid protein (GFA), S100 protein, and neurofilaments. The glycoproteic secretion of the tumor cells was also analyzed after exposure to Concanavalin A (CON A) by a direct fluorescent method. Our results suggest that some GSECG originate from specialized ependyma (circum-ventricular organs). They have the same location (foramen of Monro), present some common ultrastructural features (cytoplasm with lumen containing cilia), are positive with certain immunohistochemical markers (staining with S100 protein in 4 cases, with vimentin in 3 cases) and show a strong glycoproteic secretion (positive with CON A). Therefore, some GSECG might be considered hamartomas of specialized ependyma, with a reduced evolutivity potential.

[Eosinophilic myocarditis and pulmonary hypertension in a drug-addict. Anatomo-clinical study and brief review of the literature].

Abstract: We report the clinical and pathological findings in a young female patient who was a chronic drug addict for over eight years. In 1984, she presented with tricuspid endocarditis and three years later, was found to have irreversible pulmonary hypertension. Post-mortem examination revealed not only persistent tricuspid endocarditis and evidence of repeated pulmonary thromboembolism explaining her pulmonary hypertension but also a diffuse eosinophilic myocarditis, with myocardial fibre degeneration. The combined pulmonary and myocardial lesions have rarely been documented in the same drug addict. The relationship of these various pathological findings are discussed in the light of the existing literature.

[Whipple's disease. Involvement of the small intestine with submucosal presentation].

Abstract: An unusual case of Whipple's disease is described; the involvement was restricted to the sub-mucosa of the large and small intestine, but the mucosa was spared. The involvement was characterized by the presence of large eosinophilic PAS positive histiocytic cells in the sub-mucosa. A Ziehl-Neelsen stain allowed to rule out an atypical mycobacterial infection. In the axillary lymph node removed previously, a retrospective survey demonstrated the presence of large histiocytic cells containing granular PAS positive material. The diagnosis of Whipple's disease of the large and small intestine with lymph node involvement was confirmed by the response to therapy followed by a new biopsy control. It appears from our observation that in Whipple's disease, an attentive examination of the sub-mucosal tissue may allow to discover more cases of this condition, even when the mucosa appears normal.

An isolated intestinal form of infantile myofibromatosis

Abstract: Infantile myofibromatosis is the most common form of fibromatosis in children. It can be solitary, mainly affecting the bone or soft tissues, or multicentric with the possibility of visceral involvement. Solitary forms of visceral localization are exceedingly rare. The authors report the observation of a newborn female infant, with solitary jejunal infantile myofibromatosis which after reviewing relevant litterature on the subject appears to be the sixth case of its kind. This form must be considered in the differential diagnosis of the neonatal intestinal obstruction.

Muscle and brain biopsy in a case of mitochondrial encephalomyopathy. Demonstration of a mitochondrial vasculopathy

Abstract: The authors report the case of a 14-year-old boy who presented with shunted growth and low weight gain, asthenia with fatiguability on effort, clinical signs of myopathy, ataxia, epilepsy, deafness, loss of visual acuity and reduced intellectual capacities. Muscle biopsy revealed numerous ragged-red fibres and mitochondrial anomalies at ultrastructural examination. Cerebral biopsy showed spongiform changes. Both muscular and cerebral biopsies showed vascular lesions: swollen endothelial cells. Mitochondria increased in number with concentric whorls of cristae were observed in pericytes and smooth muscle cells. This mitochondrial vasculopathy could explain the neurological symptoms.

[Colo-rectal spirochetosis: is it an anatomo-pathologic entity?]

Abstract: Nineteen colorectal biopsy specimens, stained by Hematein-Eosin-Safran (HES), were examined by light microscopy and showed a thick, blue and fuzzy brush border. Without any further microbiologic investigation, this histologic feature is considered strongly suggestive of colorectal spirochetosis. Our study concerned 19 male patients aged between 35 and 68 years, who had no risk factor for HIV infection, but who belonged to these three groups: (a) those suffering from chronic diarrhea; (b) those without intestinal symptoms; (c) those who had a colonic tumor removed. Rectal biopsy specimens were also taken from a control group of 35 patients seropositive for HIV-1. This thickening, which measured 3-7 microns, showed some variation within the same patient but did not depend on the site of the biopsy. It appeared as a blue fuzzy band on HES stain, was purple on Periodic-Acid-Schiff stain and basophilic after Giemsa stain. Silver stain by Warthin-Starry method confirmed the presence in three cases of numerous spirochetes attached to the epithelial surface. Two of the three patients had no symptom. In the control group, a thickening of the brush border, was observed in only one case, but no spirochete by silver stain was seen. The thickened blue, fuzzy brush border of the colonic mucosa is not a specific criterion. The pathologist must be aware of the possible presence of spirochetes that can only be confirmed by a silver stain. The pathogenicity of spirochetosis remains to be defined.

[Primary malignant non-Hodgkin's lymphoma of the breast. A study of 5 cases].

Abstract: Five cases of primary non-Hodgkin's lymphomas of the breast (stage IE in the Ann Arbor staging system) are described. No clinical or radiological feature has permitted to make the diagnosis before surgery. Histologically, all lymphomas are diffuse and B type. Three cases are high grade lymphomas, one of lymphoblastic type. Two cases are of lymphoplasmacytoid type, one of them associated with an occult invasive ductal carcinoma within the same breast, the other changing in high grade lymphoma at the recurrence time. Three of them reveal histological aspects of lymphoepithelial lesions and appear as mucosa-associated lymphoid tissue lymphomas (MALT). The differential diagnosis with a carcinoma is now easily done by immunohistochemical techniques. The importance of a diagnosis before surgery by cytopunction and drill-biopsy has to be emphasized, to prevent an useless mastectomy.

[Malignant primary non-Hodgkin's lymphoma of the central nervous system. Anatomo-clinical analysis of 35 cases].

Abstract: We have recorded 35 primary central nervous system (C.N.S.) lymphomas from 1982 to 1988 in Bordeaux in order to show their increasing frequency, and clinicopathological features. Mean age was 57 (15-81). Only one patient was immunocompromised. Clinical symptoms consisted mostly of focal neurologic deficits (23 cases) and mental disturbance (16 cases). Diagnosis was made on bioptic material (20 cases mostly stereotaxic), surgery (13 cases) or autopsy (2 cases). Lymphoma was localised in the brain with unifocal (50%), multifocal (30%) or diffuse (20%) involvement at computed tomographic scans. Histopathological features were diffuse infiltration of the cerebral tissue with perivascular clustering. Two particular cases were observed: one with mostly a perivascular pattern affecting the white matter of both cerebral hemisphere; another with amyloidosis deposits. According to Working Formulation, histologic types were of intermediate or high grade of malignancy (66%), with 35% large, non cleaved-cell (centroblastic) subtype. Immunochemistry on paraffin sections with UCHL-1, MB-2, LN-1, L-26 showed that 94% were of B-cell nature and only one probably of T-cell origin.

Digestive amyloidosis with ischemic ulcer of the colon in a chronic hemodialysis patient

Abstract: A 78 year old male patient who had been treated by haemodialysis for 17 years for renal failure, secondary to tuberculosis, is reported. Following severe rectal bleeding, an ischaemic ulcer of the ascending colon was noticed, which required right hemicolectomy. On the surgical specimen, the ulcer showed massive vascular involvement with amyloidosis of the type found in haemodialysed patients, and constituted of beta 2 micro-globulin deposits. These amyloid deposits have certainly played an important part in the development of this ischaemic lesion.

Hemorrhagic necrosis of the mesenteric lymph nodes in adult celiac disease. Physiopathologic interpretation of 1 case

Abstract: The authors report the case of a 35 year old woman dead of cachexia in the course of a refractory adult coeliac disease. The autopsy revealed multiple lymphadenopathies exclusively found in the small intestinal mesentery; all these lymph nodes were destroyed by an extensive haemorrhagic necrosis. There was neither lymphoma nor cavitation. These original findings are interpreted as the consequence of a localized intravascular coagulation, and probably a step towards cavitation or atrophy.

Human papillomavirus typing by molecular hybridization in situ with biotinylated probes. Optimization of sample preparation and hybridization time

Abstract: In situ hybridization with non radioactive probes is more and more used to detect viral infections, especially human papillomavirus (HPV) infections. The quality of the reaction depends on several factors, such as sample preparation (including fixation and pretreatments). Their importance was evaluated on a model with cell lines including CaSki cells (harboring about 600 copies of HPV 16 DNA per cell) and Hela cells (containing 10-50 copies of HPV 18 DNA per cell). These cell lines were chosen in order to evaluate cytological and histological difficulties. Several parameters were studied: preparation of samples, fixation and hybridization duration. DNAs of biotinylated probes of HPV types 16 and 18 and cells were simultaneously denatured 10 min at 95 degrees C. Hybridization was carried out at 37 degrees C for various periods of time; it was followed by a 3-step reaction for detection of biotinylated DNA-DNA hybrids with immunoenzymatic staining using streptavidin-alkaline phosphatase complex. Typical intranuclear granulations were seen either in cell deposits fixed with acetone, methanol-acetic acid, paraformaldehyde, formaline, Bouin's, Baker's or Carnoy's fixatives; or in cytocentrifuged cells fixed with formaline, Bouin's or Baker's fixatives. The detergent pretreatment was unnecessary. On the contrary, the protease pretreatment was required with formaline, Bouin's or Baker's fixatives. In order to detect constantly HPV 16 in CaSki cells and HPV 18 in HeLa cells, hybridization should be performed for more than 4 h. The sensitivity of the technique could therefore be evaluated to few copies of HPV DNA per cell. This technique is reliable, sensitive and rapid; et can be applied to biopsy specimens fixed with Bouin's or Baker's fixatives and paraffin-embedded; it allows routine detection of HPV infections.

Mycotic infection in immunosuppressed patients. An anatomopathologic study

Abstract: Mycotic infections are a frequent and often severe complication in the immunosuppressed patient. A review of autopsy findings in 54 cases with gross, histologic and mycologic studies was undertaken among immunocompromised patients after chemotherapy or allogenic bone marrow transplantation: fungal infections were either localized especially in lungs and gastrointestinal tract, or disseminated. Fungi were various: principally Candida and Aspergillus, but also Fusarium, Torulopsis and Trichosporon. In acquired immunodeficiency syndrome (11 autopsy cases), mycotic infections appeared different. Oral and esophageal candidiasis could be found, but cryptococcosis and histoplasmosis were the major generalized mycosis. This study suggests that fungal infections are not the same in patients treated by chemotherapy or bone marrow transplantation, and in acquired immunodeficiency syndrome.

Solitary plasmacytoma of the trachea. Apropos of a case

Abstract: A case of solitary plasmacytoma of the trachea is reported. Immunohistochemical study is mandatory to prove a monoclonal immunophenotyping. Research for signs of systemic disease and follow up over a long period of time are indicated. Surgery alone, sometimes followed by irradiation, seem to be the treatment of choice. In most cases, complete resolution is observed.

A method for the histologic study of the entire esophagus

Abstract: The authors describe a method for sampling and embedding of oesophagectomy specimens which permits the study of the entire oesophagus with a minimum number of sections. Good localization of the lesions is achieved, and the simplicity of this method (accordion fold) makes it suitable for routine use.