Aggressive maxillary squamous odontogenic tumour in a child: histological dilemma and adaptative surgical behaviour

A case of a maxillary osteolytic tumour is described in a 9-year-old boy. Histological analysis led to an initial diagnosis of benign squamous odontogenic tumour, although this was not straightforward due to swelling, and cellular pseudo-malignant and non-specific signs. Because of the young age of the patient, a local surgical tumourectomy was first chosen with respect to the mixed dentition. For 10 months, the evolution was satisfactory. Then, a very aggressive tumoural recurrence with lip and palate infiltration led to doubts as to the histologic nature of the tumour. Efficient collaboration between several specialized pathologist teams finally confirmed that this was a squamous odontogenic tumour but in a very aggressive form. Radical surgery was then carried out.

Facial malignant peripheral nerve sheath tumors

BACKGROUND/PURPOSE

Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, only sporadically reported involving the maxillo-mandibular region (ten cases with CT or MR data). We present here five additional cases with CT and MR findings along with an extensive review of the literature.

RESULTS

Accurate diagnosis of MPNSTs is difficult because pathological like radiological criteria are often non specific. Radiological features display a large spectrum of abnormalities from a well-delineated heterogeneous appearance simulating benign schwannoma to extensive erosive patterns. Their development along the mandibular nerve, the absence of any target or central dot sign, their strong predominant peripheral enhancement must suggest the diagnosis of MPNSTs while irregular bone destruction or the detection of poorly defined margins with muscular infiltration are the most reliable criteria of malignancy. Unfortunately, MPNSTs also display a considerably varied histology. Careful clinical and radiological correlation should bring pathologists to examining large samples of the lesion to better evaluate the overall organisation of the lesion and detect some evocative criteria often only present in some areas of the sample as the peculiar curlicue or whorled arrangement of the spindle cells or the alternation of densely cellular fascicles with hypocellular, myxoid zones. Focal, limited immunostaining for S-100 protein is one of the most important additional criterion.

CONCLUSION

If accurate early diagnosis often remains difficult, careful correlation of clinical, pathological and radiological data should in most cases suggest a diagnosis of MPNSTs which display a poor prognosis and requires early and adapted treatment.

Design strategy for a simultaneous nitrification/denitrification of a slaughterhouse wastewater in a Sequencing Batch Reactor: ASM2d modeling and verification

Sequencing Batch Reactor (SBR) was used to treat slaughterhouse wastewater which contains average Chemical Oxygen Demand (COD) concentration of 5000 mg l(-1) and ammonium of 360 mgN l(-1). Nitrification/denitrification process was conducted for nitrogen removal. The influent wastewater as internal carbon source and sodium acetate as an external one was used for completing denitrification to achieve the simultaneous organic matter removal (95-96%) and nitrogen removal (95-97%). In addition, the dynamic SBR simulation model for biological nitrogen removal based on the Activated Sludge Model No. 2d (ASM2d) and GPS-X software is presented. The experimental study for the calibration and validation of the model was carried out using laboratory SBR. The study showed that the model provides a powerful tool to reduce the experimental expenditure and time to find the optimum strategy.

Treatment of slaughterhouse wastewater in a sequencing batch reactor: simulation vs experimental studies

In wastewater treatment, the objective of process optimization is primarily to obtain a good treatment efficiency of a specific pollutant. The operational objective of increased productivity has also to be met. This includes a sufficient reduction in the duration of a batch process through batch scheduling. The aim of this paper is thus to find the best cycles for simultaneous carbon, nitrogen and phosphorus (CNP) removal from slaughterhouse wastewater in a sequencing batch reactor (SBR) using GPS-X software and ASM2d model. Simulations with different aeration strategies, residence time, sludge age and feed strategies were carried out to determine the best system performance. The simulation results showed best performance with a system comprised of two equal feeds operated at 48 h hydraulic retention time (HRT) and 20 d solids retention time (SRT). Simulation also showed that addition of metal salts was necessary to reduce the level of phosphorus (P) to meet the requirement (P<1 mg l(-1)). The addition of acetate was also necessary to complete the denitrification process. The simulated results were compared against the experimental results obtained from laboratory SBR. The simulated results of COD, nitrates/nitrites and ammonia removal were very close to the experimental results. A diference of 2-4% between the simulated COD and the experimental COD was observed and that could be attributed to the error in evaluation of the inert COD. For ammonia removal, the simulated (99.9%) and experimental (93-100%) results were practically identical. However, a notable difference in o-PO4 concentration was observed (38% removal by simulation against 78% removal through experiments). After metallic salts addition, P removal efficiency was 98% or 1% less than that observed through experimental results.

Evaluation of combinations of titanium, zirconia, and alumina implants with 2 bone fillers in the dog

The quality of the tissue-implant interface was evaluated using light and scanning electron microscopy with morphometric analysis. Nine dogs were implanted with 3 types of dental implants (titanium, zirconia, or alumina). A total of 24 dental implants was placed in mandibular bone previously filled with coral carbonate calcium (corail) or hydroxyapatite. The study results in breaking the concept of osseointegration into 2 phases: "osseocoaptation," which concerns only the interface (physical contact between the implants and the bone without interpenetration process), and "osseocoalescence," which relies on an interpenetration of the bioactive material, which almost entirely disappears, being substituted by newly formed bone. There was no significant statistical difference between the 3 types of implants. Both fillings showed good ossecoalescence properties. However, hydroxyapatite led to fibrous encystment, preventing osseocoaptation of implants. In contrast with calcium carbonate filling.

Mesenchymal chondrosarcoma of the jaws. Report of four cases

Mesenchymal chondrosarcoma (MCS), described in 1959 by Lichtenstein & Bernstein, is a very rare malignant tumour. Only 46 cases have been previously reported in the jaws. Over a period of 30 years, four chondrosarcomas of mesenchymal type (of which one has already been published in 1987 with a three-month follow up) were treated in our department. Two patients have been followed for more than 17 years, of whom one has died of an intracranial extension and the other is still alive after surgical treatment of numerous recurrences and metastases. The two others are tumour-free with a follow up of 18 months and 11 years respectively. Histological, epidemiological and clinical features and treatment of MCS are discussed relevant to the data published in the literature.

[Intra-mandibular adenoid cystic carcinoma]

A case of mandibular cystic adenoid carcinoma was observed in a 49-year-old man. After slow progression, the diagnosis was directed to mandibular pseudocystic tumor. The treatment was enucleoresection. Histological findings in this exceptionnal lesion led to a discussion of the radioclinical diagnosis and etiopathogenic features of adenoide cystic carcinoma. The origin of this tumor is hypothesized to be heterotopic salivary inclusion although no histologicaly proof can be provided.

[Paradental cyst]

The paradental cyst is an odontogenic inflammatory cyst (WHO classification, 1992). It has been rarely described in the french literature and includes: The inflammatory paradental cyst which occurs on the buccal or distal aspects of an erupted third mandibular molar or of a canine (first description by Main in 1970); the mandibular infected buccal cyst which occurs on the buccal surface of the mandibular second or first molar in children around 6-8 years of age with an associated history of inflammatory signs (Stoneman and North, 1993). The histological features are the same as those of the radicular cyst. Prognosis is excellent after enucleation. This paper present an additional case report of a paradental cyst located on a second mandibular molar.

[The value of biopsy of the accessory labial salivary glands for the diagnosis of amylosis]

Diagnosis of amyloidosis depends on the demonstration of amyloid deposits in biopsies using specific stains. Recently, in addition to classical biopsies (kidney, liver, gum, skin, rectal mucosa), labial salivary gland biopsy has been recommended as safe diagnostic method. In our recruitment, it allowed the fortuitous discovery of amyloidosis in three patients suffering from rheumatoid polyarthritis or spondylarthritis. In five other patients (2 cases of familial amyloidosis, 1 dysglobulinemia, 2 primary cardiac amyloidosis), biopsy was performed for systematic search of amyloidosis. In five of these eight cases, a sicca syndrome was associated with the salivary deposits. These deposits were stained with congo red viewed in polarized light and with T thioflavine. Besides, Wright's method allowed to know the AL or AA type of amyloidosis and thus to guide the treatment. On the whole, labial salivary gland biopsy is a highly sensitive method for diagnosis of primary and secondary amyloidosis.

A pathologic analysis of the outcome following heart-lung transplantation: an autopsy study of 22 recipients

Between 1987 and 1989, twenty-two patients who received combined heart-lung transplantation were autopsied at La Pitie Salpetriere Hospital in Paris. With the exception of two recipients who survived for 2 months and 4 months, respectively, the majority of the patients died in the early postoperative period (the mean survival was 20.1 days). At autopsy, five patients showed acute cardiac rejection of a minor grade. Perivascular and peribronchiolar mononuclear cell infiltrates suggesting acute pulmonary rejection were seen in three patients. Obliterating bronchiolitis, which might be indicative of chronic rejection, was observed in four patients who had longer survival rates, and one of these four had died of obliterating bronchiolitis. Rather than allograft rejection, the major causes of death were (1) perioperative hemorrhage, (2) infections (mainly respiratory infections and occasionally mediastinitis), (3) diffuse alveolar damage (the so-called adult respiratory distress syndrome and/or pulmonary organizing edema), and (4) multiple organ failure. The present study suggested some of the reasons why the survival rate following heart-lung transplantation is much poorer than after isolated heart transplantation. Hemodynamic or respiratory problems causing perioperative multiple organ failure as well as pre-existing complications of the recipients, such as "cardiac cirrhosis," may play an important role in the prognosis of heart-lung transplantation.

An immunohistochemical study of the distribution of lysozyme, lactoferrin, alpha 1-antitrypsin and alpha 1-antichymotrypsin in salivary adenoid cystic carcinoma

The immunohistochemical expression of lysozyme (Ly), lactoferrin (La), alpha 1-antitrypsin (alpha 1-AT), and alpha 1-antichymotrypsin (alpha 1-Ach) was described, and their distributions were compared to each other in 28 cases of adenoid cystic carcinoma (ACC) of the salivary glands. ACC materials were obtained from the parotid gland (7), the submandibular gland (4), the sublingual gland (8), and minor oral salivary glands (9). Histopathologically, ACC was classified into cribriform (14), tubular (3), and basaloid or solid patterns (11). Positive staining for Ly was found in 1 case of solid ACC in the sublingual gland; La was found in 4 cases (2 cribriform, 1 tubular, 1 basaloid) in the sublinguals (3) and parotid glands (1); alpha 1-AT was found in 6 cases and alpha 1-Ach in 17 cases. The immunohistochemical localization of Ly and La was usually confined to luminal tumor cells of tubulo-ductal structures, irrespective of the pathologic types. Positive staining for alpha 1-AT and alpha 1-Ach appeared in tumor cells of cribriform, tubular and solid ACC. Tumor cells with positive La staining coincided with a positive reaction to alpha 1-AT and alpha 1-Ach, and tumor cells with alpha 1-AT positive deposition were also positive for alpha 1-Ach. The contents of pseudocysts in the cribriform pattern showed a positive reaction to La, alpha 1-AT, and alpha 1-Ach. Of the 28 cases of ACC, positive expressions for Ly, La, alpha 1-AT and alpha 1-Ach were found with a high frequency of alpha 1-Ach staining (17 in 28 cases were positive). In sublingual ACC (8), 7 cases were positive for immunohistochemical reactions. Co-expression or simultaneous expression for Ly, La, alpha 1-AT, and alpha 1-Ach in ACC suggest that tumor cells are protected from proteolysis or degradation.

Acinic cell carcinomas of salivary glands histoprognosis. Value of NORs stained with AgNOR technique and examined with semi-automatic image analysis

Twenty one patients surgically treated for acinar cell salivary gland carcinomas were studied retrospectively. Four cases were excluded from the results because of an inadequate follow-up time (less than 5 years). The rest was classified into two groups: eleven patients with a favorable outcome were still alive without any recurrence after a mean follow-up period greater than 10 years; in six other patients, recurrences and metastases occurred followed by death in four cases. Previously for such tumors a high degree of histological undifferentiation usually gave rise to a poor prognosis, although some exceptions were noted. Thus, in an attempt to find a more reliable prognosis criterion, we evaluated by semi-quantitative image analysis nucleolar organizer regions by means of AgNOR count and mean area in all these cases. Our results significantly correlated with the clinical prognosis: a high count (more than 3) and a small mean area were always found in tumors with an unfavorable outcome whereas lower counts and larger mean areas were found in tumors with a favourable clinical course. Thus, this method showed promise as establishing the prognosis of acinar cell tumours.

Immunohistochemical localization of MAM-3 and MAM-6 antigens in adenoid cystic carcinoma

MAM-3 and MAM-6 antigens were detected immunohistochemically in 34 cases of adenoid cystic carcinomas (ACC) of the salivary glands and these patterns were compared to these of epithelial membrane antigen (EMA) and laminin. ACC was histologically divided into three types; the cribriform pattern, the tubular and trabecular pattern, and the solid cluster pattern. Immunostaining of EMA and MAM-6 antigen had a similar distributions in the luminal borders of luminal tumor cells, whereas the MAM-3 antigen was slight or negative in luminal borders. Myoepithelial derived tumor cells of ACC accompanying hyaline stroma demonstrated positive staining for the MAM-6 antigen (whole cell positive type), and luminal tumor cells of microcysts showed strong staining for the MAM-3 antigen. Laminin staining was confined to the basement membrane and surface borders in pseudocyst cavities. In salivary gland ACC, laminin staining can be used as a marker of pseudocyst surfaces and immunostaining of EMA and the MAM-6 antigen as a marker of luminal borders of cyst. These two histochemical markers were useful for discriminating pseudocyst and cyst.

Heterogeneity and co-expression of intermediate filament proteins in adenoid cystic carcinoma of salivary glands

Among a series of 76 adenoid cystic carcinomas (ACC), 51 cases with cibriform or trabecular patterns were selected for an immunohistochemical study. These tumors were composed of three types of cells: basaloid, myoepithelial and ductal luminal acinous or tubular cells with a variable amount of each cell type from one case to another. Monoclonal antibodies (MoAb) against keratins (PKK1, KL1, K8.12, K8.13, K4.62 anti-cytokeratins antibodies) and against vimentin were used. Tubular cells were characteristically marked by anti-cytokeratins MoAb, but with a great heterogeneity of keratin distribution. In myoepithelial cells, keratin was absent or slightly positive and vimentin was present, with co-expression of the two types of filaments in some cells. Like myoepithelial cells, basaloid cells were positive to anti-vimentin antibody and negative or slightly positive to anti-keratin antibodies, with sometimes a co-expression of vimentin and keratin filaments in the same cell. Histogenesis of adenoid cystic carcinomas was discussed. Progenitor intercalated duct reserve cells may change into ductal luminal and myoepithelial tumor cells. Otherwise, basaloid cells, arising also from intercalated duct reserve cells, are able to acquire some secretory organites.

Basaloid carcinoma of salivary glands, a variety of undifferentiated adenocarcinoma. Immunohistochemical study of intermediate filament proteins in 24 cases

Among adenoid cystic carcinomas of salivary glands (ACCs), the solid basaloid type has a poor prognosis similar to that of undifferentiated adenocarcinomas. We studied 24 cases in immunohistochemistry using antibodies reactive with keratins of various molecular weights, vimentin, S-100 protein, and its A and B subunits. Our findings were correlated with the histological pattern and with the variable degree of differentiation of these carcinomas. In comparison with other types of ACC, intermediate filament proteins in this group were weakly expressed. The co-expression of cytokeratin and vimentin was noted in some cases. Additional features noted were the presence of cribriform cavities associated with solid lobules and areas of necrosis giving a comedocarcinomatous pattern. In these two variants, cells characterized by the dual expression of cytokeratin and S-100 protein were seen. In the highly malignant anaplastic variety, only a few cells were weakly positive with antisera to cytokeratin and vimentin. This group shows similarities to undifferentiated adenocarcinomas of salivary glands. Such similarities could be explained by the common origin of these tumours from intercalated ducts.

Immunohistochemical studies of S-100 protein alpha and beta subunits in adenoid cystic carcinoma of salivary glands

Immunohistochemical studies were performed to explore the distribution of S-100 protein and its alpha, beta subunits in 76 adenoid cystic carcinomas (ACC) of the salivary glands. Histopathologically. ACC was divided into cribriform, tubular, basaloid and trabecular types which could be mixed in the same tumor. S-100 protein was usually positive in tumor cells forming cribriform structures; foci of strongly positive tumor cells were also distributed in the luminal layer of tubular structures, and in areas transitional between cribriform and tubular patterns. S-100 alpha staining was confined to some tumor cells in cribriform areas, to luminal tumor cells in tubular structures and to few tumor cells in basaloid structures. S-100 beta reaction was usually localized to luminal surfaces in a fine granular pattern in tubular and microtubular structures in a distribution somewhat similar to that in the normal salivary gland. Great heterogeneity in the immunohistochemical distribution of S-100, S-100 alpha and S-100 beta proteins was found in the various histologic types of ACC and the pattern was different from that seen in pleomorphic adenomas. It is possible that the ACC tumor cells positive for S-100 protein may be closely related to true or modified myoepithelial cells.

[Intermediate and late changes in human cardiac graft]

Chronic rejection, the most serious complication in long-term survivors of cardiac transplantation, was studied in 5 cardiac grafts obtained at retransplantation and in 15 post-mortem studies of patients who had survived 3 months to 10 years after transplantation. The usual clinical presentation was cardiac failure. Coronary angiography was performed in several cases and showed narrowing and non-opacification of small arteries often accompanied by thrombosis. Histology showed three types of vascular rejection: the most characteristic one, usually observed after the 6th month, was a stenosing fibrous endarteritis; another type of rejection, occurring earlier, was associated with acute myocardial rejection and presented as an inflammatory arteritis; the third type of vascular rejection was accompanied by widespread atheromatous lesions. The significance and pathogenesis of these lesions are discussed with respect to the clinical context with electron microscopic and immuno-histochemical data.

Proteoglycans detected by monoclonal antibodies in adenoid cystic carcinoma of salivary glands

Thirty-two cases of adenoid cystic carcinoma (ACC) of the salivary glands were examined immunohistochemically by monoclonal antibodies to proteoglycans (PG) such as chondroitin 6 sulfate (C6SPG), chondrotin 4 sulfate (C4SPG), dermatan sulfate (DSPG), heparan sulfate (HSPG) and keratan sulfate (KSPG) in conjunction with specific enzymatic digestion. The cribriform structure of ACC consisted of basaloid, myoepithelium-derived, and luminal tumor cells. The myoepithelial tumor cells were positive for PG, whereas luminal tumor cells were unstained. Occasional pseudocysts also gave positive staining for PG. Tubular structures consisting of modified myoepithelial cells indicated a high intensity reaction for C6SPG and C4SPG, and a slight one for DSPG, HSPG, and KSPG. Immunodepositions in solid and cluster structures were comparatively light in terms of PG. Basement membrane in ACC stained strongly for C4SPG, slightly for C6SPG, and very slightly for DSPG, HSPG, and KSPG. In ACC, immunohistochemical staining of PG was regularly positive in myoepithelium-derived tumor cells, but was irregular in other types of tumor cells.

[Pathology of degenerative aortic valve insufficiency]

The authors studies 154 cases of degenerative aortic regurgitation which presented macroscopically with atrophic changes of the valve and sometimes with hypertrophy and calcification. Histologically, the essential abnormality was the finding of mucopolysaccharide deposits dissociating the corpus spongiosa from the corpus fibrosa. Depending on the importance of these lesions, three degrees of severity can be defined, the most extensive (84% of our patient population) appearing to be typical of the disease. In addition, mild mitral valve prolapse (5%) and medial necrosis of the aortic wall (80% of patients undergoing aortic biopsy) were observed. These morphological features are on the whole quite different to those of other aortic valve pathologies (rheumatic, endocarditis). However, the border line with other pathologies with a similar anatomopathological substratum is less clearly defined: genetic abnormalities (Marfan's syndrome, Lobstein's disease, etc...) or age-related degenerative disease. The pathogenesis is not clearly understood but could be related to regional disturbances in collagen metabolism with collagenolysis predominating.

Stromal changes in early invasive breast carcinoma. An immunohistochemical, histoenzymological and ultrastructural study

The purpose of this work was to detect in periductal connective tissue of breast carcinoma in situ changes induced by intraductal tumor cells before any dehiscence in basement membrane. Histological, electron microscopic, immunohistochemical and histoenzymological methods were used in 3 carcinomas in situ, 4 microinvasive carcinomas and 13 control invasive carcinomas. We could demonstrate a high functional activity of fibroblasts with secretion of mucopolysaccharides and type III collagen around intraductal carcinomas. These changes occurred simultaneously to those of the basement membrane which was either thinning or thickening. Any dehiscence in basement membrane secondarily induced in this periductal stroma the usual changes seen in invasive stroma, peculiarly numerous vascular pedicles, myofibroblasts, elastic material. These periductal stromal changes are interpreted according to recent concepts about the possible influence of tumor cells upon their environment: stimulation of mitotic and metabolic activity of fibroblasts: stimulation of angiogenesis by means of an angiogenic factor.

[Buccal lymphomatoid granulomatosis]

A 57 year old man was referred to us with multiple long-standing, recurring and refractory mouth ulcers involving the palate, the intermaxillary folds, the inner side of the cheeks, the frenum of the tongue, a tonsil, the pharynx, the gums and a lower lip. Multiple biopsies had excluded a lymphoma, a carcinoma and infection. A new biopsy showed a polymorphous granuloma with up to 40% of atypical lymphoid cells. No angiitis was present, but an angiocentric pattern was present in the granuloma. The atypical cells stained positively with OKT3 and OKT4 antisera. The patient also had cardiac rhythm disturbances with defects on the myocardial scan and a proteinuria. Thus, we suspected the diagnosis of lymphomatoid granulomatosis, although there were no pulmonary nodules. Cyclophosphamide and prednisone were given with immediate success. As the doses were gradually decreased, a small relapse occurred. It was controlled by increasing the cyclophosphamide dosage for six months. The patient is now in complete remission more than four years after having discontinued the treatment. Thus, lymphomatoid granulomatosis can be diagnosed on the basis of a biopsy of buccal ulcers and in the absence of the classical pulmonary nodules. We found no evidence that the atypical cells were lymphomatous; rather, the very good response to the treatment points to a curable granulomatosis.

[Implants of fired ceramics in the dog. Preliminary study. Morphology of bone coaptation after 3 and 7 months]

An experimental study of biocompatibility for ceramic material was undertaken in dogs. We used 8 implants and 1 filling-up material in the alveolar bone. A regular radiographic control of the good coaptation and tolerance of these implants was done after various intervals. The sacrifice was performed at 3 and 7 months after the implantation. The good coaptation between alveolar bone and implant was demonstrated by means of different morphological methods. Thus, microradiographs of anatomical specimens, routine histological study following decalcification, analysis of some specimens without decalcification showed the tight coaptation between implant and alveolar bone, without any foreign-body granuloma or allergic reaction. Besides, by transmission and scanning electron microscopy, we could identify the various types of cells (macrophages, fibroblasts and osteoblasts) noted at the interface of the implant matrix at various intervals after the operation. By histoenzymological methods, we also tested the functional activity of these cells, peculiarly their possible osteogenic ability (alkaline phosphatase and ATPase highly positives in some of these cells).

Cherubism. Histo-enzymological and ultrastructural study

The 3 cases of cherubism reported affected the mandible. They were all studied by means of histo-enzymological and ultrastructural methods. This study demonstrated 3 stages in the morphological evolution of the disease, corroborated by clinical data. The 1st stage was characterized by an osteolytic granuloma with round, fusiform and giant-cells and a high level of activity of acid phosphatase. The 2nd stage showed repair with proliferation of highly active fibroblasts (increase in activity of leucine aminopeptidase). The 3rd stage exhibited an osteogenesis with high activity of alkaline phosphatase and ATPase. The pathogenesis of this rare osteodysplasia is discussed.

Chronic rejection in human heart transplantation

The more prevalent complication in patients with a long survival rate after heart transplantation is chronic rejection, which was studied in a series of 80 necropsies and five cardiac grafts surgically removed for retransplantation after chronic rejection. In the material obtained at necropsy, 11 of 14 patients with a survival rate of more than 6 months died from chronic rejection. Clinically, the usual manifestation was heart failure. Anatomic angiograms were performed in several cases. They demonstrated narrowing and nonopacification of small coronary arteries, often accompanied by thrombosis and ischemic complications. The histologic study detected three types of rejection. (1) The more typical rejection is observed after 6 months. It is characterized by a stenosing fibrous endarteritis. (2) Another type of rejection occurs earlier and is associated with acute rejection; its anatomic substratum is an inflammatory panarteritis. (3) This type of rejection is accompanied by large atheromatous deposits. The significance and pathogenesis of these lesions are discussed in correlation with their clinical context and with the electron microscopic observations.

[Cells in the normal human periodontal ligament. An ultrastructural, histo-enzymological and immunocytochemical study on in vitro cultures]

Four cellular cultures from explants of human periodontal ligament were studied. In these cultures, cells were fusiform or stellate with a high percentage (5 to 10%) of round mitotic cells. The scanning electron microscope confirmed the simultaneous presence of flat cells in interphase and cells in prophase with microvilli and long filipodes and of round mitotic cells with microvilli and blebs. Histoenzymology disclosed in these cells high activities in oxidative enzymes and leucine aminopeptidase. Furthermore some cells showed an alkaline phosphatase activity. Immunocytochemistry detected in most of these cells intermediate vimentin filaments and the presence of type I and III collagen irregularly distributed among these cells. In transmission electron microscopy the elongated cells presented a clear nucleus, numerous endocytosic vesicles, ribosomes and longitudinal filaments. Variations were noted, especially in the quantity and quality of cell secretions, the fibroblasts secreting either the two type I and III collagen or only type I. The rare cells assuming alkaline phosphatase activity were atypical in possibly being provided with osteogenic potential.

[Effect of the soft laser on gingival connective tissue. II--Effect on wound healing. Optical microscopy, histoenzymology and electron microscopy studies]

The effect of soft-laser upon cicatrization of the gum was studied in 14 patients. After the initial biopsy, control biopsies were performed on the same patients in non-irradiated gums. In the absence of inflammation, cicatrization took place in a similar manner in the irradiated and control tissues. After an early vascular growth, connective cylinders occurred, accompanied by an increase of enzymatic activity) (oxidative enzymes, leucine aminopeptidase, alkaline phosphatase). Then, the scar was formed of longitudinal bundles. The laser induced an earlier cicatrization (14th day) than in the controls (21st day). The presence of inflammation in the gum delayed cicatrization and often promoted cheloid scars with abnormal anastomosing connective bundles. In this case also, irradiation by soft-laser was followed by a quicker and better cicatrization.

[Effect of the soft laser on gingival connective tissue. I--Effect on fibroblasts. Histoenzymology and electron microscopy study]

The effect of soft-laser upon human gingival fibroblasts was studied after an initial biopsy followed by irradiation and numerous biopsies performed 5 mn, 15 mn, 1 hour and 24 hours after irradiation. In addition, control biopsies were performed in the same way on a non-irradiated gingival area. One hour after irradiation and up to 24 hours later, the enzymatic activities of the fibroblasts were obvious: oxidative enzymes, leucine aminopeptidase, and considerable Brachet's test highly positive (RNA). By transmission electron microscopy were changes were found in these fibroblasts. They were more numerous and their cytoplasmic organelles were increased (mitochondria, rough endoplasmic reticulum). An abundant granular material as well as collagen fibrils were accumulated along their cytoplasmic membrane. On the whole, from the 1st hour on following irradiation by soft-laser a stimulation of metabolic activity of the fibroblasts (oxidative activities, proteic synthesis) was observed with increased production of collagen.

[Odontogenic myxoma. A histoenzymologic and ultrastructural study. Apropos of 5 cases]

The myxoma of the jaws represent 8% of the odontogenic tumours in our series (324 cases). The 5 cases described here were studied by histoenzymological and electron microscopic methods. The first method demonstrated in the majority of tumoral cells a high level of activity of alkaline phosphatases and ATPases similar to that noted in odontoblasts of the dental pulp. In addition, an acid phosphatase activity was also present in numerous cells but usually at a low intensity. Ultrastructurally, the tumour was composed of 3 main cellular types: young round cells with numerous ribosomes; stellate secretory cells with well-developed granular ergastoplasma and Golgi apparatus; fusiform cells with characteristics of fibroblasts. Some macrophages and myofibroblasts were also present. The intercellular substance was granulofilamentous and in one of our cases calcifications were obvious upon some collagen fibers. All these results seem to corroborate the hypothesis of odontogenic nature of the tumour. Early odontogenic induction induces the transformation of fibroblasts into cells with enzymatic activities similar to those of odontoblasts and the calcification of collagen fibers seen in one of our cases would express an early mineralization.

Effects of estradiol and promegestone on human breast cell cultures. An ultrastructural study

Effects of estradiol (E2) and promegestone (R 5020) were tested on primary cultures of epithelial human breast cells prepared from surgical specimens of reduction mammoplasty. Comparative morphological studies were performed by means of transmission and scanning electron microscopy in cells without any hormonal adjunction and in those previously treated with E2 or E2 + R 5020. The results were as follows: In basal medium used as control the majority of epithelial cells, although well-differentiated, remained flat with few microvilli, well-developed Golgi apparatus and rough endoplasmic reticulum, was obvious. R 5020 added with E2 increased differentiation of epithelial cells covered with scarce long and branched microvilli, but reduced the turn-over of young cells. E2 seemed to generate more active proliferation of cells. R 5020 inhibited this effect and induced a higher differentiation of mammary epithelial cells.

Scanning electron microscopy in oral cytology

Sixty-three cell smears from oral mucosa were studied by scanning electron microscopy. Among them, smears from ten healthy controls showed three kinds of cells: flat (superficial) cells with linear anastomosing microridges and microvilli; polygonal (intermediate) cells with well-defined crests between their faces and numerous microvilli; and round (parabasal) cells entirely covered by microvilli. Twenty-five smears from patients with untreated squamous-cell carcinoma showed enlarged polymorphous cells (round, globular, and elongated); microvilli, variable in their dimensions, were irregularly distributed on their surfaces. Eighteen smears from patients with severe epithelial dysplasia showed polymorphous cells with discontinuous but obvious edges separating their faces and with irregular microvilli and ridges. Nine smears were also performed in patients with various other mucosal lesions (lichen planus, leukoplakia, white sponge naevus, pemphigus vulgaris, and herpes). All of these smears were studied comparatively between examination of smears and biopsies by light microscopy. The smears were truly reliable, particularly for distinguishing between dysplastic and tumoral cells.

Histoenzymological features of epithelial cells in lesions of oral mucosa in cysts and ameloblastomas of jaws

A histoenzymological study was carried out on 41 tissue specimens removed at biopsy and for surgical operations of the following lesions: benign hyperkeratosis, lichen planus, severe epithelial dysplasia, carcinoma in situ, epidermoid carcinoma, radicular cyst, odontogenic keratocyst and ameloblastoma. The purpose of this study was to study some possibly significant variations in levels of activities of oxidative enzymes, diaphorases, acid phosphatases and Naphthol esterases in such lesions (normal oral mucosa and epidermis serving as controls). In the lesions of the oral mucosa, these histoenzymological variations were not sufficiently characteristic to contribute to histological diagnosis. In lichen planus, some vacuolated or necrotic basal cells lacked enzyme activities, whereas in the upper layers, enzyme activities were irregularly present. Benign hyperkeratosis showed enzymatic activities similar to those of the normal epidermis, namely high oxidative activities particularly prominent in basal cells and in granular layer, and esterase activity beneath the keratinized layer. In severe epithelial dysplasia, carcinoma in situ and epidermoid carcinoma, numerous variations of activities of oxidative enzymes, esterases and acid phosphatase were seen from one cell to the other. In cystic diseases of jaws, enzymatic activities were equally nonspecific in the epithelial lining of the radicular cyst and the odontogenic keratocyst (activities similar to those of normal oral epithelium and epidermis, respectively). But in common ameloblastoma, there was diffuse uniformly low oxidative enzymatic activities in the epithelium and high widespread activity of alkaline phosphatase in the stroma. The latter may be useful in differentiating the cystic acanthomatous variety of ameloblastoma from odontogenic keratocysts of the jaws.

Human cardiac transplants. Diagnosis of rejection by endomyocardial biopsy. Causes of death (about 30 autopsies)

1,000 endomyocardial biopsies performed in 110 patients treated by cardiac graft were reviewed. These biopsies permitted early detection of acute rejection after cyclosporin treatment and a good appreciation of its intensity. By this method, almost all rejection episodes were resolved after adequate treatment. Chronic rejection was diagnosed by arteriography used in vivo or in cardiac transplants removed by surgery or necropsy. Rejection provoked an obliterative fibrous endarteritis often complicated by atherosclerosis and its ischaemic consequences. 34 autopsies were performed in patients dead at a variable time after cardiac or cardio-pulmonary transplantation. In early death (14 cases), graft failure and systemic disorders were observed. Acute and chronic rejection was noted less frequently (9 cases). Systemic infections (10 cases) occurred either early (post-surgical complications) or late (bacterial, fungal and parasitic lesions). In one case, death was due to a contemporaneous bladder carcinoma. The complications of cyclosporin treatment are briefly discussed.

Iodine-induced thyrotoxicosis: analysis of eighty-five consecutive cases

Iodine-induced thyrotoxicosis was documented in eighty-five cases. Eighty per cent occur in apparently normal thyroid glands; 60% among them occur in males. Amiodarone accounted for 50% of iodine-induced thyrotoxicosis. Mean thyroid hormone levels at diagnosis were: FT1: 21.7 (normal mean: 7.5, arbitrary units); T3: 4.53 nmol 1(-1) (normal: 2.30 nmol 1(-1). Mean 131I- 24-h uptake was 3.5% (normal range in France 25-45%) and was activated by exogenous TSH (mean 27%). The spontaneous cure in nontreated cases was observed within an average 6 months. A phase of biological hypothyroidism (mean FT1: 3.7, T3: 1.23 nmol 1(-1), TSH: 9.6 microU ml-1 (normal TSH range: 1-7 microU ml-1] preceded the return to euthyroidism. Intrathyroid iodine content measured by X-ray fluorescence was high, then fell gradually. Thyroid tissue study showed a large quantity of intrathyroid iodine and the overiodination of thyroglobulin. Histological and electron microscopic studies are reported. Prednisone and in some cases propylthiouracile were found to be effective.

Histoenzymological features of epithelial cells in epidermoid carcinomas of oral mucosa and in ameloblastomas of jaws

An histoenzymological study comprising oxidative enzymes, diaphorases, acid and alkaline phosphatases, naphtolesterases, referred to 60 biopsy and operation specimens. It showed interesting arguments for diagnosis and understanding of precancerous and cancerous lesions of the oral mucosa and also of ameloblastomas of jaws. The enzymatic activities of precancerous and cancerous oral lesions were compared with those of normal buccal mucosa and epidermis, benign hyperkeratosis (activities similar to those of the epidermis) and lichen planus. In severe dysplasia and epidermoid carcinoma, numerous variations of oxidative, esterase and acid phosphatase activities were seen from one cell to another. But this pattern was non conclusive for the diagnosis, a similar one being found in inflammatory lesions and especially in the lichen planus. In lobules of invasive carcinoma, the strong enzymological activities (particularly acid phosphatases, naphtolesterases) were correlated with a high degree of differentiation of the tumor and these enzymatic methods offered an interesting contribution for the fine evaluation of histoprognosis in malignant epithelial tumors. Among the lesions of jaws, radicular and dentigerous cysts had low enzymatic activities similar to those of normal buccal epithelium. The epidermoid cysts (keratocysts), because of their highly differentiated keratinization, like benign hyperkeratosis, had the same enzymatic activities as epidermis. Peculiar were the enzymatic activities of common ameloblastoma; they differed from those of other lesions of squamous tissues (low oxidative activities without decreasing gradient). Besides, round epithelial clumps, the stroma showed a high and widespread alkaline phosphatase activity. Thus, this peculiar stromal activity may be useful to differentiate ameloblastoma from the other epidermoid cysts of the jaws. In the other hand, such a constatation suggests a low degree of odontogenic induction.

Acinic cell tumors of salivary glands. Frequency and morphological study

Among 873 salivary gland tumors, 15 cases of acinic cell tumors were found (frequency of 1.6%). They occurred approximately evenly in man and women, the mean age being 41 years. They were located principally in the major salivary glands (12 cases in the parotid and 1 case in the submandibular gland) and only twice in accessory glands. Histologically, these tumors were divided into two groups: group I = highly differentiated tumors (less than 20% undifferentiated cells) and group II = poorly differentiated tumors (more than 20% undifferentiated cells). These histological feature seems to play a role in the clinical behaviour of these neoplasms. Thus, the 9 patients with highly differentiated tumors were alive and well 5 to 22 years after the treatment. On the other hand, 5 of the 6 patients with poorly differentiated tumors had local recurrences (4 cases) and lethal metastases to distant lymph nodes and bone (3 cases). The ultrastructural study corroborated the analogy of differentiated tumoral cells with normal acinic cells (numerous secretory granules and ergastoplasmic cisternae). Moreover, the undifferentiated cells had numerous ribosomes and their morphological structure was similar to that of intercalated duct cells. The histogenesis of this rare tumor is discussed. The acinic cell tumor seems more likely to arise from immature cells of intercalated ducts than from adult acinic cells.

Histoenzymological and ultrastructural study of a bifocal calcifying epithelial odontogenic tumor. Characteristics of epithelial cells and histogenesis of amyloid-like material

A calcifying epithelial odontogenic tumor, simultaneously located in the two jaws (maxilla and mandible) was examined by histochemical and electron microscopic methods. Squamous tumor cells without secretory polarity were different from those of common ameloblastoma. High activities of alkaline phosphatase and ATPases were demonstrated by light and electron microscopy on the cytoplasmic membrane, findings similar to those in the stratum intermedium cells of the normal dental germ from which these tumor cells seem to arise. The tumor cells, like preameloblasts of the dental germ, also produce a granulo-filamentous material in intracytoplasmic vesicles and discharge it into the stroma. This "pseudo-amyloid" substance represents an abnormal protein of the enamel matrix and calcification, mainly occurring in that substance, might be an attempt at mineralization.

[Systemic calcific emboli in calcified aortic valve diseases. Apropos of an anatomical case]

Following the death of a patient with calcific aortic stenosis and complete heart block, five days after surgical replacement of the aortic valve, the autopsy demonstrated multiple calcific emboli in the brain, surrounded by hemorrhagic necrosis. Coronary, renal and splenic emboli were also found. This article discusses the incidence and topographical distribution of these emboli as well as the complications to which they may give rise.

[Oncocyte cells in salivary tumors: frequency, histoenzymological and ultrastructural characteristics]

Two types of salivary monomorphic adenomas, the so-called adenolymphoma and oncocytoma (75 cases in a series of 873 salivary gland tumors) were studied. These tumors were almost always located in major salivary glands (essentially in the parotid gland). They were much more common in men (85%) than in women. The oncocyte represented the characteristic cell in these two neoplasms. By electron microscopy, they were seen to contain numerous and abnormal mitochondriae and well-developed lysosomal systems. These findings were correlated with a high level of activity of oxidative enzymes and of acid phosphatases. The histogenesis of these tumors was discussed. They seemed to arise from aberrant striated ducts embedded in heterotopic lymph nodes. The tumoral oncocytes would suffer a primary disturbance of their oxidative metabolism followed by a compensative mitochondrial hypertrophy.

Ameloblastic fibrosarcoma of the jaws--report of three cases. Clinico-pathologic, histoenzymological and ultrastructural study

The ameloblastic fibrosarcoma is a rare variety of neoplasm. Three new cases reported here occurred within preexistent benign odontogenic tumors (ameloblastic fibroma or fibro-odontoma). These large, osteolytic tumors, spreading to adjacent soft parts, recurred after surgical treatment in two cases. One of them had a lethal course, with pleuro-pulmonary, mediastinal lymph node and hepatic metastases. Histologically, these sarcomas show a malignant mesenchymal component and few benign ameloblastic islands, which often disappear after one or several recurrences. Histoenzymologically, a high level of alkaline phosphatase and ATPase activities is always present, a feature not present in common fibrosarcomas. The ultrastructural study demonstrates, in analogy with odontogenic myxomas, clear cells provided with numerous microfilaments, secretory cells and also some fibroblasts and myofibroblast-like cells. In addition to these pleomorphic cells, a great number of peculiar granular cells with numerous lysosomal bodies were also found. The histogenesis of these tumors in unknown. Perhaps the epithelial component, being unable to assume its functions of organization, may initiate the malignant transformation of its odontogenic mesenchyme.

[Malignant histiocytosis. An anatomic study of 6 cases with atypical clinical manifestations]

The six cases of malignant histiocytosis reviewed in this article all presented with unusual manifestations (muscular masses, renal failure, dysenteriform syndrome, neurological symptoms, or isolated splenomegaly). With one exception, correct diagnosis was only made post mortem. In addition to the usual hematological localizations, the autopsy revealed unusual topographical features in each case, explaining the atypical clinical manifestations.

[Diffuse eosinophilic fasciitis (Shulman's syndrome). Apropos of a case disclosed by spinal cord compression]

The case of Shulman's syndrome reported in this article is unusual, because of the topography of the lesions and the lethal course. The perivertebral fasciitis, which was pseudotumoral in appearance, induced a myelomalacia by compression of the cervical spinal cord. In addition, the autopsy revealed severe tissue eosinophilia, cutaneous sclerodermiform sclerosis and pharyngoesophageal lesions unusual in this disease. The pathogenesis of the syndrome is discussed.

[Histoenzymological characteristics of epithelial cells in oral mucosal lesions and jaw cysts. Diagnostic significance]

An histoenzymological study (including oxidative enzymes, diaphorases, acid and alkaline phosphatases and naphtolesterases) of 41 biopsy and operation specimens revealed interesting factors in the diagnosis of some lesions of the buccal mucosa, and also of cysts and ameloblastomas of the jaw. When compared with normal buccal mucosa and epidermis, the enzymatic activities found in the oral lesions, fell into three different types. In non dysplasic leukoplakia, enzymatic activities were found that were similar to those of the epidermis (high oxidative activities, particularly prominent in basal cells and in the granular layer and esterasic activity beneath the keratinised layer). In lichen planus, some vacuolized or necrotic basal cells occurred which lacked enzymatic activity. In the upper layers, the distribution of the enzymes was irregular. In severe dysplasia and epidermoid carcinoma, numerous variations of oxidative, esterasic and acid phosphatase activities were seen from one cell to another. Among the lesions of the jaws, radicular cysts as well as dentigerous cysts, had low enzymatic activities, similar to those of normal buccal epithelium. The epidermoid cysts (keratocysts), because of their highly differentiated keratinization, like leukoplakia, had the same enzymatic activities as epidermis. The enzymatic activities of common ameloblastoma differed from those of malpighian tissues (low oxidative activities without decreasing gradient). Besides round epithelial nests, the stroma showed a high and widespread alkaline phosphatase activity, which indicated a low degree of odontogenic induction. Thus, this peculiar stromal activity may be useful in differentiating between cystic epidermoid varieties of ameloblastoma and the other epidermoid cysts of the jaws.