[Spontaneous pneumoperitoneum in scleroderma]

A spontaneous and asymptomatic pneumoperitoneum was observed in two women presenting with pseudoileus resulting from severe gastrointestinal involvement in progressive systemic sclerosis. In the first case, pneumoperitoneum was associated with pneumatosis cystoides intestinalis and remained unchanged during 3 years. As obstruction resisted to medical management, surgery was performed; however at laparotomy neither perforation nor obstruction of the bowel could be found; the patient died during the postoperative course. In the second case, pneumoperitoneum disappeared after medical management of low-grade intestinal ileus but the patient died 6 months later because of cardiac failure. Autopsy revealed major distention of the bowel but failed to show any signs of perforation. These findings show that, in progressive systemic sclerosis, pneumoperitoneum can occur in the absence of digestive perforation and that surgery is not required. However this complication seems to carry a very poor prognosis.

[Light chain deposit disease: an anatomopathological entity]

The light chain deposition disease was recently identified as a systemic clinicopathological entity characterized by amorphous extracellular deposits which differ from the amyloid substance. Various organs may be involved, notably the kidney, the liver, the myocardium and the skin. The histopathological aspects were investigated in 3 cases. By immunofluorescence using frozen sections the deposits were shown to contain monoclonal light kappa or lambda chains. By electron microscopy they appeared to be granular and usually located close to epithelial and/or vascular basal lamina. There was in every case a monoclonal lymphoplasmacytoid proliferation. In one case amyloid deposits were associated in small vessels. In another one, follow-up study after chemotherapy showed improvement of hepatomegaly, stabilization of renal function, and regression of light chain deposits in skin biopsy specimens.