[Analysis of positive margins risk factors and long term recurrence in the conservative treatment of breast cancer]

INTRODUCTION

breast conserving therapy remains the first choice in breast cancer care for the early stages. Adequate surgical margins are essential to reduce the risk of locoregional recurrence. This study aims to identify risk factors of positive margins and locoregional recurrence.

MATERIALS AND METHODS

437 patients who underwent a lumpectomy for invasive breast carcinoma or ductal carcinoma in situ have been included. Age, surgical margins, size, type, grade and number of tumor foci, the presence of ductal carcinoma in situ, lymph node status, expression of hormone receptors and HER-2 gene were assessed as risk factors for positive margins and locoregional recurrence.

RESULTS

The disease-free survival is 94 % at 10 years. Patients with positive margins have lower survival (92 %) than those with negative margins (96 %) (p £ 0.05). Lobular and multifocal tumors are at risk of positive margins. Tumors with positive margins, T2, grade III, triple negative and HER-2 positive neoplasms are at risk of locoregional recurrence while the expression of hormone receptors is a protective factor for local recurrence.

CONCLUSION

It appears in our study that invasive lobular and multifocal tumors may present positive surgical margins. Studies on pre- operative work-up are needed. Biological factors of the tumor seem to play a fundamental role in the locoregional recurrence or persistence of the tumor.

[Post operative complications after neoadjuvant systemic therapy in primary breast cancer treatment - Case-control study]

The use of neoadjuvant systemic therapy (NST) for the primary breast cancer treatment has constantly increased. Initially used to improve breast-conserving surgery (BCS) rate as well as for patients with inflammatory or inoperable locally advanced breast cancer, today, NST is used as a test of chemosensitivity and predictive factor by assessing pathologic complete response. With the increasing use of NST, it is fundamental to establish if NST increases postoperative morbidity.. In our study, the postoperative complications associated with NST were examined. We analyzed the data obtained from patients undergoing treatment for breast cancer in a University Hospital between 2003-2014 in a case-control study. We selected 286 patients attributed to two groups according to the surgery type: Group A, 150 patients undergoing breast conserving surgery with axillary node dissection (75 cases after NST and 75 controls with surgery alone) and group B, 136 patients undergoing mastectomy with axillary node dissection (68 cases after NST and 68 controls). There was no statistically significant difference between both groups in post-operative recovery or the rates of complications: use of antibiotics, re-operation, hematoma, blood transfusion, healing problems, wound infection, lymphocele and lymphoedema. Our study supports the safety of NST and suggests that it is not associated with increased morbidity in the patients undergoing breast surgery as BSC or mastectomy with axillary node dissection.

Multiple epitheloid plexiform tumourlet leiomyoma of the uterus with focal vascular invasion

We report the first case of multiple plexiform tumourlets showing focal vascular invasion suggesting that, unlike what the common and accepted opinion would advocate, these tumours may have a more aggressive behaviour. However, the prognosis of this variant of epithelioid leiomyoma remains unknown, due to its rarity. The main differential diagnosis of this entity are discussed, including endometrial stromal sarcoma exhibiting epitheloid cytomorphology, intravenous leiomyomatosis of epitheloid variant.

Glucocorticoid receptor expression in cervical intraepithelial neoplasia and invasive squamous cell carcinoma of the cervix

OBJECTIVES

Glucocorticoids (GCs) are used in cancer treatment to cause programmed cell death in transformed cells of the hematopoietic system and to lessen side-effects as nausea, vomiting, edema formation and allergies to specific chemotherapeutic agents. GCs act also as cofactor with human papillomaviruses in the etiology of cervical cancer. Moreover, recently GCs were described as inhibitors of some chemotherapy or radiation-induced apoptosis. The presence or not of a glucocorticoid receptor (GR) in normal and abnormal exocervices is thus interesting.

METHODS

To clarify the issue, we tested by immunohistochemistry the expression status of GR in normal cervix epithelium (n = 30), in low-grade cervical intraepithelial neoplasia (LSIL) (n = 30), in high-grade cervical intraepithelial neoplasia (HSIL) (n = 30) and in invasive squamous cell carcinoma (ISCC) (n = 30). All the patients with these lesions have a corresponding liquid-based cytology and were proved to be HPV-positive by using hybrid capture 2 methodology with probes against high-risk oncogenic HPVs. The evaluation of GR expression was performed by using the H-score system and an H-score > 50 was considered positive.

RESULT

GR expression was observed in normal epithelium, LSIL, HSIL and ISCC. No statistically significant difference concerning this expression was observed.

CONCLUSION

Because GCs could play a positive role in the progression of cancer, our demonstration of GR persistence in cervix cancer cells raises concern about the widespread combined use of GCs with antineoplastic drugs or agents in the clinical management of cervix cancer in women.

Primary mammary tuberculosis presenting as a voluminous abscess

We present a case of primary mammary tuberculosis (MT), an extremely uncommon pathology, revealed by a voluminous tubercular abscess mimicking a recurrent pyogenic abscess. It was correctly diagnosed after a while because of partial response to antibiotics with a disappearance of the diffuse inflammatory components explained by the effect held concurrently by some antibiotic on a probable staphylococcic superinfection and its bactericidal effect against BK. This is the most common presentation of the mammary forms of the MT and the diagnosis particularly makes sense in this case matching several risk factors: female gender, lactation, young age, and origin from an endemic area. Furthermore the persistence of an abscess after a well driven medical treatment should always make search the presence of BK.

Pl6 expression in Paget's disease of the breast

BACKGROUND

Paget's disease of the nipple is generally associated with an underlying invasive cancer or an underlying ductal carcinoma in situ. Epidermotropic theory maintains that Paget's cells are derived from an underlying mammary in situ adenocarcinoma. Because p16 protein plays a major role in cell-cycle control and in tumoral cell mobility, we analyzed p16 expression in Paget's disease of the nipple and in associated underlying ductal carcinoma in situ.

METHODS

The expression of p16 protein was analyzed by immunohistochemistry in eight cases of Paget's disease of the nipple with associated underlying ductal carcinoma in situ. The Student's t-test (2-tailed) was used to establish the equality of means.

RESULTS

The expression of p16 protein was observed in 87.5% (7/8 cases) both in the nipple disease and in the associated underlying ductal carcinoma in situ. The difference between the two populations was not statistically significant. In normal breast tissue, no expression of the protein was observed.

CONCLUSION

The positive p16 expression in Paget's disease of the nipple and the underlined ductal carcinoma in situ and its role in cell motility lead us to propose a role of p16 in the spread of this disease.

Does preoperative magnetic resonance imaging modify breast cancer surgery?

AIMS

To determine the impact of preoperative use of breast magnetic resonance imaging (MRI) in therapeutic surgical approach in women with breast cancer.

MATERIALS AND METHODS

Preoperative contrast-enhanced MRI of the breast was performed in 105 patients with suspected breast carcinomas. MRI findings were correlated with mammography (MMG) and ultrasonography (US).

RESULTS

Histopathologic analysis revealed 144 breast carcinomas. The results of the MRI lead to a change in 17.1% of the planned surgical procedure. MRI imaging alone revealed 16 multifocal or multicentric tumors and four contralateral carcinomas.

CONCLUSION

Breast MRI could be recommended as a pre-surgical diagnostic procedure in patients allocated to breast conservation surgery. Nevertheless, further studies are needed to determine if preoperative breast MRI leads to a decrease in tumor recurrence and in overall survival.

[Anti-HPV vaccination against cervical cancer]

The aim of this review is to present a new light about the HPV infections, their spontaneous evolutions, and their consequences on the transformation of the target tissues. It enlightens the need for vaccination both as a preventive tool and therapeutic agent and the progresses reached so far. HPV infection is often transient and spontaneously reversible. HR HPV persistence is the major cause of cancerous transformation of several tissues. Preventive vaccination has already demonstrated a remarkable efficiency against the development of risk HPV ano-genital infections. Therapeutic vaccination is now also developed to cure the pre existing lesions. Some new screening protocol can be derived from these experiments. Both preventive and therapeutic HPV vaccinations will probably change within the next few years our approach for the screening and therapy of HPV related diseases. Mass vaccination of adolescent female should lower the frequency of these very frequently lethal affections.

Bilateral extensive vascular calcification of the breast associated with coagulative necrosis: a calciphylaxis-like syndrome

A case of asynchronous bilateral breast necrosis in a 40-year-old woman with untreated chronic hypercholesteraemia is described. Mastectomies were performed, and histological examination revealed bilateral breast calciphylaxis characterized by extensive vascular calcification with coagulative necrosis. Breast calciphylaxis is a rare disease clinically characterized by progressive tissular necrosis with secondary cutaneous ulceration and by vascular calcification and thrombosis. However, the nature of the vascular calcification has remained poorly understood up to now, owing to the absence of any precise mineralogical examination. In this case the mineral deposits were analysed for the first time: only hydroxyapatite was found. The etiology is discussed, and the high cholesterol rate of the patient is implicated.

Cervical response to vaccination against HPV16 E7 in case of severe dysplasia

OBJECTIVE

To evaluate the tolerance to vaccination against human papillomavirus (HPV)16 E7 (in SB adjuvant ASO2B) and its histological and immunohistological effects on HPV16 associated high-grade cervical dysplasias associated with HPV16.

STUDY DESIGN

Five patients with histologically demonstrated severe cervical dysplasia (CIN3) HPV16 positive were injected three times before conization was performed 2 months after the first injection. We studied cytological, histological, proliferative pattern and immune profile before and after vaccination. The slides were compared with those obtained from non-injected patients.

RESULTS

The injections were well tolerated and the specimens displayed a limited regression of the lesions. Nevertheless, massive CD4 and CD8 T cell lymphocytic infiltration was noticed after vaccination.

DISCUSSION

We conclude that the vaccination we used provides an obvious immune histological reaction in the HPV infected cervix and that the 2 months delay before the final step (conization) is done is probably too short.

[The pathology department]

The evolution of the Laboratory of Pathology at Erasmus Hospital is directly related to the morphological diagnosis integration in the medico-surgical organization of the Hospital. Such integration is based on the creation of links between the Laboratory of Pathology and the clinical departments and necessitates permanent adaptations to new complementary technology. Immunohistochemical methods were gradually included in the surgical morphological diagnosis. Currently, new markers from molecular biology are needed to obtain accurate pathological diagnosis. We observe an increasing hyperspecialization of the morphological classification with complete integration of such biological markers leading to the necessity of carrying out collegial diagnosis. The development of the telepathology technology permits international collegial diagnosis. According to its central position the Laboratory of Pathology plays an important part in the development of the clinical and fundamental research. The research subjects of the Laboratory of Pathology concern diagnostic and prognostic evaluation in colic cancers, sarcomas, brain tumors and HPV related tumors endometriosis.

Multiple HPV-positive basal cell carcinomas on the abdomen in a young pregnant woman

Basal cell carcinoma (BCC) is the most common malignant skin tumour. In the last few years, the incidence of multiple BCC has also increased in young patients. We describe the clinical case of a young 29-year-old woman who developed 7 BCC on her abdomen during her first pregnancy and 4 other similar tumours 2 years later during her second pregnancy, all located on the abdomen. Polymerase chain reaction revealed the presence of numerous human papillomavirus DNA sequences. To our knowledge, such a clinical presentation has not been previously reported. Different physiopathological considerations are discussed.

Ki-67 immunostaining activity is higher in positive axillary lymph nodes than in the primary breast tumor

BACKGROUND

The monoclonal antibody Ki-67 allows to investigate the proliferative activity of tumor and is a clinically useful marker to characterize breast cancer. In this study, we have compared Ki-67 activity in 38 primary breast tumors and in their respective positive axillary lymph nodes (ALNs).

METHODS

Immunohistochemistry with the monoclonal antibody against Ki-67 was performed in 38 nodes positive breast carcinomas and in their respective positive ALNs. Statistical analysis was performed with the Student's t-test (2-tailed) for equality of means.

RESULTS

The proliferation index measured by Ki-67 expression was significatively higher (p < 0.02) in ALN than in the primary tumor (29.8% v.s. 21.8%).

CONCLUSION

These results strongly suggest a higher proliferation and perhaps aggressivity of metastatic neoplastic cells when compared with their respective primary tumor. Perhaps, in the future, these differences in proliferation behavior might be taken into account when considering the choice of the adjuvant therapy.

Warty carcinoma of the anus: a variant of squamous cell carcinoma associated with anal intraepithelial neoplasia and human papillomavirus infection

Warty carcinoma (WC) is a rare variant of squamous cell carcinoma primarily described in the vulva in younger women and classically associated with human papillomavirus (HPV) infection. The gross findings are similar to those of verrucous carcinoma with large, exophytic tumors with a papillomatous surface. Microscopically, the tumor is papillated and contains fibrovascular cores covered by hyperkeratotic epithelium showing presence of koilocytes. We report a case of anal squamous cell carcinoma showing similar features, occurring in a young immunosuppressed male patient with a history of multifocal anal intraepithelial neoplasia (AIN). HPV-16 has been demonstrated both in the WC and in adjacent AIN, but the HPV status appears different in the two lesions: integrated in WC and episomal in AIN lesions. We also have demonstrated by immunohistochemistry that both WC and AIN are highly proliferative entities sharing the same MIB-1 pattern, and that WAF1/CIP1 protein expression is common in the two lesions irrespective of p53 protein expression.

Phase II double-blind, placebo-controlled study of the safety and efficacy of cidofovir topical gel for the treatment of patients with human papillomavirus infection

Genital condylomata acuminata are nonmalignant human papillomavirus (HPV)-induced tumors in which HPV types 6 and 11 are most commonly found. Usual treatments for condylomata acuminata are nonspecific and are based on the destruction or removal of infected tissue. These procedures are often painful and are characterized by a high relapse rate. We report here what is to our knowledge the first double-blind, placebo-controlled study of the use of cidofovir, a nucleotide analogue, for the treatment of genital papillomavirus infections. Thirty patients were enrolled in the study; 19 received cidofovir, and 11 received placebo. The median number of warts and the median baseline wart area were comparable for both groups. Nine (47%) of 19 patients in the cidofovir group had a complete response (total healing), compared with 0 of the patients in the placebo group (P=.006). None of the patients in the cidofovir group experienced progression of the disease, compared with 5 (45%) of 11 patients in the placebo group. The side effects recorded for both groups were comparable.

A first case of Streptococcus bovis bacteremia and peritonitis from endometrial cancer origin

BACKGROUND

The most important clinical infections caused by Streptococcus Bovis are bacteremia and endocarditis. Usually, Streptococcus Bovis bacteremia has been described in association with bowel pathology.

CASE REPORT

A 67-year-old woman with an history of endometrial cancer Ic was admitted with the suspicion of peritonitis at examination. At exploratory laparotomy, a total hysterectomy was performed and the abdomen was drained. Histology revealed an uterine adenocarcinoma staged IIIa with intramyometrial cocci accumulation. Streptococcus Bovis was isolated from the peritoneal fluid cultures and three haemocultures.

CONCLUSION

Because we excluded bowel pathology and endocarditis, this is the first case of Streptococcus Bovis bacteremia from endometrial cancer origin.

Ki-67 immunostaining of normal human epidermis: comparison with 3H-thymidine labelling and PCNA immunostaining

BACKGROUND

The size of the germinative growth fraction (i.e. the number of actively proliferating germinative cells) of normal human epidermis is still a subject of debate. Ki-67 antigen and PCNA, an auxiliary protein of d-polymerase, are considered as markers of the growth fraction when used under optimal conditions.

METHOD

In the present work, we have compared Ki-67 expression (detected with MIB1 antibody) with PCNA expression (detected with PC10 antibody) in biopsies of normal human epidermis fixed in neutral formalin and using antigen retrieval by microwave processing. To obtain additional information, such as the percentage of cells in S phase, biopsies were also incubated in 3H-thymidine before immunostaining.

RESULTS

Before microwave treatment, 8% of the basal cells were positive for MIB1 antibody and 7.8% were positive for PC10 antibody. The 3H-thymidine labelling index was 2.8%. The proportion of MIB1-positive cells rose to 19% after antigen retrieval by microwave processing. In the same way, the 3H labelling index rose to 9%. In contrast, PC10 became positive in all epidermal nuclei.

CONCLUSION

These results suggest that the growth fraction of the germinative cell population of normal human epidermis is not larger than 20% and is composed of cells with a short cell cycle time.

Evaluation of the role of genital human papillomavirus in the pathogenesis of ungual squamous cell carcinoma

Human papillomaviruses (HPV), and particularly HPV 16, have been associated with ungual squamous cell carcinoma (USCC). But their role in tumor development remains unclear. In genital carcinoma, where the oncogenic role of HPV is well established, integration of HPV DNA into the host cell genome seems to be important for malignant transformation. To clarify the issue, we have studied the physical state of HPV 16 in 3 cases of in situ USCC by the polymerase chain reaction and by in situ hybridization. HPV DNA was integrated into the human genome in 2 cases and episomal in 1 case. This particular physical state of HPV 16 in USCC, similar to those encountered in anogenital SCC, confirms the probable role of this kind of virus in the pathogenesis of USCC.

Evaluation of the role of human papillomavirus in oesophageal squamous cell carcinoma in Belgium

OBJECTIVE

To evaluate the putative role of human papillomavirus (HPV) in the aetiology of oesophageal squamous cell carcinoma (OSCC) in Belgium.

METHODS

The frequency of HPV infection was determined using HPV DNA PCRamplification with L1 consensus primers MY09-MY11, able to recognise about 40 different HPV types, on twenty-one formalin-fixed and paraffin-embedded oesophageal squamous cells carcinomas. Nineteen samples of histologically normal epithelium from the surgical margins of the OSCC specimens and five samples from normal oesophagus obtained at autopsy served as negative controls.

RESULTS

We found only one HPV positive tumour (4.8%) out of the 21 OSCC cases. All the normal epithelium controls remained negative.

CONCLUSIONS

Our data are in agreement with those previously published, suggesting that HPV infection only plays a minor role in the pathogenesis of oesophageal squamous cells carcinoma in West-European countries.

Overexpression of 27-kDa heat shock protein relates to poor histological differentiation in human oesophageal squamous cell carcinoma

AIMS

Various stress conditions such as heat, chemical and mechanical stresses are known to play a major role in oesophageal squamous cell carcinoma development. Our goal was to evaluate whether changes in stress-induced 27-kDa heat shock protein (HSP27) expression could be demonstrated during oesophageal carcinogenesis.

METHODS AND RESULTS

HSP27 expression was studied using immunohistochemistry on formalin-fixed, paraffin-embedded tissue sections from 21 oesophageal squamous cell carcinomas occurring in smokers and/or alcohol abusers. Oesophagus from healthy patients (controls) (five), chemical (eight) and infectious oesophagitis (six) were also included in the study. In normal oesophagus, the protein is present only in the upper epithelial layers. In contrast, in chemical or infectious oesophagitis its expression is strong and occurs in all the epithelial layers including the basal layer. In non-tumoral oesophageal mucosa from smoking and/or drinking patients adjacent to invasive carcinoma, the distribution of the protein is patchy and irregular. In malignant areas, HSP27 protein expression increases drastically from dysplastic lesions to invasive carcinoma, being highest in the less differentiated areas.

CONCLUSIONS

In human oesophagus, HSP27 expression is induced by various stresses but alcohol and tobacco generate focal perturbations in the stress response. Tumour immunoreactivity for this protein increases with the anaplasia of the tumour, as in some other tumours in which it is considered to play a role in drug resistance. To our knowledge, these data have not been previously described for oesophageal squamous cell carcinoma.

Does prostaglandin E1 therapy modify the intracavernous musculature?

PURPOSE

Intracavernous injection of prostaglandin E1 in patients with erectile dysfunction has become widespread. However, to our knowledge long-term side effects on the penile smooth muscles in man have not been documented. We evaluated the histological changes of intracavernous smooth muscle after long-term treatment with prostaglandin E1.

MATERIALS AND METHODS

A total of 10 patients with a mean age of 56.5 years (range 46 to 69) underwent biopsy of the corpora before (5) and after (10 in both corpora) prostaglandin E1 treatment. Between 150 and 250 injections during 3 years were performed, and the dosage varied from 5 to 20 microg. Only 1 patient injected prostaglandin E1 on both sides. Staining with hematoxylin and eosin, and immunohistochemical staining with actin anti-actin of intracavernous smooth muscle and its quantification with computerized image analysis were performed.

RESULTS

No histological difference was observed with classic staining. A reduction was noted in the percentage of intracavernous smooth muscle after treatment in 2 of 5 patients on the side of injection (before 35% and 41%, and after 19% and 30%, respectively) but there was no difference with the other corpus cavernosum. No difference was observed in the percentage of intracavernous smooth muscle between both corpora in the 5 patients with biopsies performed only after treatment.

CONCLUSIONS

Prostaglandin E1 does not seem to alter intracavernous structures.

IL-5 mediates eosinophilic rejection of MHC class II-disparate skin allografts in mice

CD4 T cells play a crucial role in the acute rejection of MHC class II-disparate skin allografts, mainly by Fas/Fas ligand-mediated cytotoxicity. Because recent observations indicate that eosinophils may be found within allografts rejected by CD4 T cells, we evaluated the role played by IL-5, the main eosinophil growth factor, and by eosinophils in the rejection of MHC class II-disparate skin grafts. C57BL/6 mice rapidly rejected MHC class II-disparate bm12 skin grafts. Rejected skins contained a dense, aggressive eosinophil infiltrate. Lymphocytes isolated from lymph nodes draining rejected bm12 skin were primed for IL-5 secretion, and IL-5 mRNA was present within rejected grafts. The IL-5/eosinophil pathway played an effector role in allograft destruction, because the rejection of bm12 skin was significantly delayed in IL-5-deficient mice as compared with wild-type animals. The role of the IL-5/eosinophil pathway was further investigated in MHC class II-disparate donor-recipient strains unable to establish Fas/Fas ligand interactions. Fas ligand-deficient gld/gld mice rejected bm12 skins, and bm12 mice rejected Fas-deficient lpr/lpr C57BL/6 skins. Neutralization of IL-5 prevented acute rejection in both combinations. We conclude that MHC class II-disparate skin allografts trigger an IL-5-dependent infiltration of eosinophils that is sufficient to result in acute graft destruction.

Critical roles for IL-4, IL-5, and eosinophils in chronic skin allograft rejection

C57BL/6 mice injected with the 145-2C11 anti-CD3 mAb and grafted with MHC class II disparate bm12 skin develop a chronic rejection characterized by interstitial dermal fibrosis, a marked eosinophil infiltrate, and an obliterative intimal vasculopathy. Because these changes occur in the absence of alloreactive antibodies, we examined the contribution of cytokines in their pathogenesis. Chronically rejected grafts showed a marked accumulation of both IL-4 and IL-5 mRNA. Mixed lymphocyte reaction experiments established that mice undergoing chronic rejection were primed for IL-4, IL-5, and IL-10 secretion. In vivo administration of anti-IL-4 mAb completely prevented allograft vasculopathy as well as graft eosinophil infiltration and dermal fibrosis. Injection of anti-IL-5 mAb or the use of IL-5-deficient mice as recipients also resulted in the lack of eosinophil infiltration or dermal fibrosis, but these mice did develop allograft vasculopathy. Administration of anti-IL-10 mAb did not influence any histologic parameter of chronic rejection. Thus, in this model, IL-4- and IL-5-mediated tissue allograft eosinophil infiltration is associated with interstitial fibrosis. IL-4, but not eosinophils, is also required for the development of obliterative graft arteriolopathy.

Chronic rejection of major histocompatibility complex class II-disparate skin grafts after anti-CD3 therapy: a model of antibody-independent transplant vasculopathy

BACKGROUND

Chronic rejection remains a leading cause of allograft loss. Histologically, it is characterized by arterial intimal thickening and parenchymal fibrosis. The immune mechanisms triggering chronic rejection are still uncompletely understood.

METHODS

We performed major histocompatibility complex (MHC) class H-incompatible skin grafts from C-H2bm12 (bm12, H2bm12) into C57BL/6 (C57BL/6, H2b) recipients immunosuppressed with a short course of anti-CD3 monoclonal antibodies to prevent acute rejection.

RESULTS

More than 80% of grafts survived for prolonged periods, but eventually all displayed macroscopic and microscopic evidence of chronic rejection. At histology, there was a progressive arterial intimal thickening as well as intense dermal fibrosis. This was accompanied by an inflammatory infiltrate consisting of lymphocytes and macrophages, but also of a considerable number of eosinophils. Mice with chronic rejection were unable to generate anti-donor MHC class II cytotoxic T lymphocyte activity at either 20 or 60 days after transplant. Furthermore, transplantation of bm12 skins on C57BL/6-congenic, Ig knock-out mice was associated with the development of a chronic rejection that was identical to that occurring in wild-type C57BL/6 animals, indicating that alloantibodies are not necessary in this model.

CONCLUSIONS

(1) Skin grafts may undergo chronic rejection with the characteristic lesions of vasculopathy and fibrosis; (2) chronic rejection of MHC class II-disparate skins may occur in the absence of direct cytotoxic T lymphocyte activity or alloantibodies.

Detection and identification of human papilloma viral DNA, types 16, 18, and 33, by a combination of polymerase chain reaction and a colorimetric solid phase capture hybridisation assay

A colorimetric microplate hybridization assay was developed previously to simplify detection procedures of DNA fragments resulting from polymerase chain reactions (PCR). This format has now been adapted for the simultaneous detection and identification of three human papillomavirus (HPV), types 16, 18 and 33, associated frequently with cervical cancer. This post-PCR detection system uses three type-specific capture oligonucleotides linked covalently to a single microplate well and three type-specific multibiotinylated oligonucleotidic probes for detection. It therefore offers a double specificity; the first is conferred by pairs of primers, specific of each type of virus tested, and the second, by the sets of capture and detection probes which are complementary to internal regions of the amplified DNA fragments. The detection format outperformed agarose gel electrophoresis of amplified DNA products in sensitivity and specificity. The rapidity and simplicity of this hybridisation system would justify its use in routine diagnostic examination of cervical specimens (smears and biopsies).

PCR assay fails to detect molluscum contagiosum virus-related sequences in AIDS-related Kaposi's sarcoma

Previous PCR-based studies have demonstrated the presence of various viral DNA or RNA sequences in Kaposi's sarcoma (KS) tissues. To date, only human herpesvirus 8 (HHV-8) DNA sequences are found consistently in KS. The putative role of this agent in KS pathogenesis remains, however, to be determined; HHV-8 could infect populations endemically and could be reactivated in patients with KS. A close association between AIDS-related KS and molluscum contagiosum occurrence was found and this study was conducted primarily to search for the presence of molluscum contagiosum virus DNA sequences in KS. Frozen KS samples were examined for the presence of both HHV-8 and molluscum contagiosum virus DNA sequences by PCR. Despite a high rate of co-infection, no molluscum contagiosum virus (MCV) DNA sequence could be found in the KS samples whereas HHV-8 was uniformly detected. These results suggest that the high prevalence of MCV in AIDS patients with KS relies on a mode of transmission common for HHV-8 and molluscum contagiosum virus rather than on a multiviral etiology of KS. They may also indicate a particular susceptibility of the host to viral reactivation. If this is so, the failure to detect MCV DNA sequences in KS tissues by PCR indicates that locally produced or released cyotokines are not involved in the latter process.

Verrucous carcinoma of the nail bed

Verrucous carcinoma is a rare, highly keratinizing variant of squamous cell carcinoma of the skin or mucosae characterized by a local aggressiveness but a low potential for metastasis. The plantar form is also known as epithelioma cuniculatum. Fingers and toes are rarely affected, and tumors of the nail bed are exceptional. Clinically, the lesion presents like a wart and is then often misdiagnosed. Treatment of choice is wide surgical excision. A case of verrucous carcinoma of the nail apparatus is presented, and diagnosis is discussed.

Fetal endocardial fibroelastosis: ultrasonographic findings in two cases

EFE is a rare cardiac disorder with poor prognosis and uncertain cause. Primary and secondary forms have been described. Most authors consider that all EFE is secondary--a reactive process set off in the endocardium by stress on the myocardium. We report two cases representing the primary dilated form and the secondary contracted form. The dilated form was associated with intracavitary thrombus of the left ventricle. In both cases, an unusual presence of subendocardial calcifications was noted. The ultrasonographic findings are discussed.

Complete hydatidiform mole and coexisting normal fetuses. A report of two cases with contrasting outcomes

BACKGROUND

Multiple pregnancies consisting of a complete hydatidiform mole and coexisting fetuses are relatively rare but may become more common due to the increasing use of ovulation-induction agents.

CASES

We report on a twin and a triplet pregnancy, conceived using clomiphene citrate, with contrasting outcomes. The twin pregnancy resulted in a term delivery of a healthy singleton and the triplet pregnancy in a termination at 17 weeks followed by the development of choriocarcinoma.

CONCLUSION

The few cases available suggest that a subgroup of complete moles follows a more benign course and can be managed conservatively, allowing the pregnancy to go to term with appropriate follow-up, whereas other cases follow a more aggressive course. Larger case series are needed to develop definitive protocols.

Selective feticide by embolization in twin-twin transfusion syndrome. A report of two cases

BACKGROUND

The early development of complications in twin-twin transfusion syndrome is a poor prognostic sign. For this reason, new techniques for intrauterine therapy are being developed: invasive options, such as selective feticide of one of the twins, have been reported.

CASES

Two cases of twin-twin transfusion syndrome in the late second trimester were treated by selective feticide using vascular embolization to the more severely damaged fetus. In one case the embolized fetus was a hydropic recipient with a normal cotwin; in the other, the donor fetus was affected by bilateral hydrocephalus. These fetuses underwent ultrasound-guided embolization using a bolus of histoacryl injected into the umbilical vein and fetal heart. Both patients went on to deliver healthy singletons in the third trimester.

CONCLUSION

In twin-twin transfusion syndrome of early onset, embolization may help one of the twins survive. This technique is neither time-consuming nor expensive and does not require a general anesthetic.

A unique clonal chromosome 2 deletion in endomyometriosis

The cytogenetic analysis of a short-term culture from a so-called endomyometriosis revealed a unique clonal del(2)(p21). The embryologic origin of this uterine-like mass is controversial. The finding of a clonal chromosome aberration favors the proliferation hypothesis and suggests that endomyometriosis is a true neoplasm and that a somatic mutation might be involved in the etiology of this lesion.

Prostate capsule: computerized morphometric analysis of its components

OBJECTIVES

There is little objective information on what is designated as being the prostate capsule. We have quantified objectively with computerized image analysis the percentage of smooth muscle fibers (SMFs) surrounding the surgical specimens of radical prostatectomies.

METHODS

Ten radical prostatectomy specimens were used. Six different parts from prostate lobe were analyzed. Thirty different fields were examined from each tissue section. For tissue sections, different stains were used: hematoxylin and eosin, Masson's trichrome, and immunohistochemical staining with antiactin for SMFs.

RESULTS

The mean thickness of the prostate capsule was 0.5 to 2 mm. The mean percentages of SMFs in the different regions of the prostate capsule was 30.6%. No difference was noted between the percentage of SMFs in the prostatic capsule compared with that in the prostate parenchyma itself (30.7%).

CONCLUSIONS

This study provides objective evidence to demonstrate that the prostate does not have a true capsule. This capsule represents a fibromuscular band that probably should be considered as the extension of the internal parenchyma.

Proximal deletion of chromosome 21 confirmed by in situ hybridization and molecular studies

Foetal blood sampling was performed at 35 weeks of gestation due to abnormal foetal ultrasound findings. There was apparent monosomy 21 (45,XX,-21) in all mitoses analyzed. The infant died at 37 weeks during delivery. Examination disclosed facial anomalies, clubfeet, hypoplasia of the left urogenital tract, agenesis of corpus callosum, ventricular dilatation, and heterotopias. Reevaluation of the karyotype showed an unbalanced translocation t(1;21) (q44;q22.11) which resulted from a maternal balanced translocation. These findings were confirmed by fluorescence in situ hybridization and molecular studies with chromosome 21 specific markers. The latter showed a proximal deletion of the maternally derived chromosome 21 including all loci from centromere down to the D21S210 locus. This case illustrates the need for complementary cytogenetic and molecular investigations in cases of apparent monosomy 21.

Biochemical diagnosis of a fatal case of Günther's disease in a newborn with hydrops foetalis

The birth of a male baby was induced at 32 weeks. In utero, the child presented, inter alia, signs of hydrops, hepatosplenomegaly and anaemia. Two in utero transfusions for correction of the anaemia were performed at 28 and 29 weeks, respectively. The baby rapidly presented respiratory distress with mixed acidosis. Three hours after birth, pink urine was excreted. Signs of icterus necessitated phototherapy, after which photosensitivity occurred. Erythrocytes were fluorescent under long-wavelength UV light. The baby died 24 hours after birth, displaying severe acidosis, a diffuse haemorrhagic syndrome, and repeated brady-cardia which did not respond to isoprenaline. The analysis of porphyrins in urine, blood and faeces of the baby gave the following results: 1) uroporphyrin (I and III isomeric series) was increased in urine and faeces, with traces in erythrocytes and plasma; 2) heptacarboxyporphyrin I was found mainly in urine and much less in erythrocytes, plasma and faeces; 3) coproporphyrin I was increased in urine, erythrocytes, plasma and faeces, and 4) 5-aminolaevulinic acid and porphobilinogen in urine and plasma were within the reference ranges. Determination of the enzymes of haem biosynthesis in erythrocytes and lymphocytes showed that both parents possessed only 50% of the normal activity of cosynthase. A previously described point mutation in codon 73 was observed in one parent. Fatal cases of neonatal Günther's disease are extremely rare and such an observation, according to our knowledge, is probably one of the first described.

Hepatobiliary cystadenoma with mesenchymal stroma: presentation of one case and review of the literature

We present one case of hepatobiliary cystadenoma with mesenchymal stroma (CMS) which is a very unusual tumor of the biliary tract. These rare neoplasms have been identified as a distinct clinicopathological entity. They occur exclusively in middle-aged women with an average age of 45 years, and are located on the right hepatic lobe. Histologically, CMS are characterized by the presence of a typical dense stroma between an inner epithelial lining and an outer loose connective layer. Malignant transformation may occur and therefore a complete surgical resection of these premalignant neoplasms is indispensable.

Hydrophobic behavior of sciatin and transferrin on a size-exclusion column

Sciatin and transferrin are very similar glycoproteins which differ slightly in their carbohydrate content. In two-dimensional gel electrophoresis, they have one different isoform at pI lower than 5.77. However, highly different elution profiles have been recorded following size-exclusion HPLC. The use of a I-125 silica gel column has thus provided convincing evidence that both proteins do not show exactly the same hydrophobic three-dimensional structure.