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Salari GR, Peny MO, Stadt JVD, Donckier V, Zalcman M, Gelin M. Late Liver Metastases of Small Bowel Leiomyoma. The Difficulty in Assessing Malignancy in Gastro-intestinal Smooth Muscle Tumours. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. R. Salari
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. O. Peny
- Departments of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J. Van de Stadt
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - V. Donckier
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Zalcman
- Departments of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Gelin
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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2
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Delaunoit T, Peny MO, Mignon M, Dili A. Splenic metastasis from gastrointestinal neoplasms: a review. Acta Gastroenterol Belg 2012; 75:3-4. [PMID: 22567739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Spleen metastases from solid tumours are rather exceptional, especially for those located in the digestive tract. Although these lesions are usually associated with multivisceral disease at terminal stage, several cases of isolated lesions have also been described in the literature. Diagnosis of spleen lesions associated with multivisceral disease rarely influences patient's outcome. On the other hand, isolated, only-splenic lesions could be curatively treated, allowing physicians to obtain better patient's survival. The aim of this article is therefore to review and summarize a systematic search of all the literature in English based on a Medline search (Pubmed) carried out from January 2000 to February 2011, focusing on only-spleen lesions secondary to digestive tract cancers, and pointing out diagnostic and treatment challenges medical oncologists have to face in their clinical practice.
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Affiliation(s)
- T Delaunoit
- Medical Oncology Department, Jolimont Hospital, Haine-Saint-Paul, Belgium.
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De Vroey B, Schapira M, Peny MO, Ghilain JM. Macroscopic endoscopic lesions in microscopic collagenous colitis: double case report and review of the literature. Acta Gastroenterol Belg 2011; 74:454-461. [PMID: 22103054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Collagenous colitis is a cause of chronic diarrhea of incompletely elucidated origin, defined by normal laboratory tests, a normal endoscopic appearance of colonic mucosa and specific microscopic inflammatory features on colonic biopsies. We report two cases of macroscopic endoscopic lesions observed in patients suffering from chronic diarrhea, whose biopsies confirmed a diagnosis of collagenous colitis and who were successfully treated in that setting, achieving clinical and endoscopic remissions. By means of a literature review, we summarize what is known about collagenous colitis. We particularly discuss macroscopic findings in that context, drawing attention on the so called "microscopic colitis" in the differential diagnosis of that type of lesions.
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Affiliation(s)
- B De Vroey
- Department of Internal Medicine, Gastroenterology, Centre Hospitalier Jolimont-Lobbes, Haine-Saint-Paul, Belgium.
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Delaunoit T, Peny MO, Mignon M, Dili A. Metachronous splenic metastasis in an anal squamous cell carcinoma. Acta Gastroenterol Belg 2011; 74:99-100. [PMID: 21563664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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5
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Brenard R, Dumortier P, Del Natale M, Honhon B, Van Den Berghe M, Bataille C, Rickaert F, Henrion J, Peny MO, Rahier J. Black pigments in the liver related to gold and titanium deposits. A report of four cases. Liver Int 2007; 27:408-13. [PMID: 17355464 DOI: 10.1111/j.1478-3231.2006.01431.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Black pigments are rarely described in the liver. We report four patients with chronic cholestasis and black pigments described on liver histological examination. Energy-dispersive X-ray analysis identified these black pigments as gold particles in the first three patients and titanium particles in the fourth. The origin of the gold deposits was unknown in this first patient and related to gold salts therapy in the two others. Titanium deposits was associated with hepatic granulomas and related to total knee replacement.
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Affiliation(s)
- R Brenard
- Hepato-Gastroenterology, Hôpital St Joseph, Gilly, Belgium.
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6
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Van Laethem JL, Jagodzinski R, Peny MO, Cremer M, Devière J. Argon plasma coagulation in the treatment of Barrett's high-grade dysplasia and in situ adenocarcinoma. Endoscopy 2001; 33:257-61. [PMID: 11293760 DOI: 10.1055/s-2001-12803] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic therapy of high-grade dysplasia (HGD) and superficial adenocarcinoma associated with Barrett's esophagus (BE), using Nd:YAG laser, KTP laser, or photodynamic therapy (PDT), has been reported to be effective in a curative role. Argon plasma coagulation (APC) appears to be effective in the eradication of nondysplastic Barrett's mucosa, but no results are available in the management of early neoplasms complicating BE. We report our initial experience in the application of APC in this indication. PATIENTS AND METHODS Ten patients (mean age 74.2) with histologically proven HGD (n = 7) or in situ adenocarcinoma (n = 3) associated with BE (mean length 6 cm) and unfit for surgery were treated using APC and high-dose omeprazole (40 mg daily) until squamous re-epithelialization or complete eradication of the initially apparent lesions. Endoscopic follow-up was maintained at every 3 months. RESULTS Complete eradication of HGD and in situ adenocarcinoma was achieved after a mean number of 3.3+/-1.5 APC sessions in 8/10 patients (80%). The eight patients with complete clearance of the neoplastic areas did not show any evidence of local recurrence during a median follow-up of 24 months (range 12-36 months). One patient with initial HGD had persistence of HGD 30 months after initial diagnosis, and one patient progressed to invasive adenocarcinoma after failure of APC and PDT. CONCLUSIONS APC is safe and effective in the management of HGD and in situ adenocarcinoma associated with BE, and might represent an interesting alternative in selected patients who are not candidates for surgery.
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Affiliation(s)
- J L Van Laethem
- Dept. of Gastroenterology, Erasme University Hospital, Brussels, Belgium.
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7
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Thiriar S, Deroux E, Dourov N, Evrard L, Peny MO, Simon P, Parent D. Granulomatous vulvitis, granulomatous cheilitis: a single diagnosis? Dermatology 2000; 196:455-8. [PMID: 9669130 DOI: 10.1159/000017948] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report two cases of labial swelling (oral and vulvar) with a granulomatous histology in patients with a history of Crohn's disease. The differential diagnosis of granulomatous vulvitis and cheilitis, as well as the symptomatology and treatment of vulvar and oral Crohn's disease are further discussed. To our knowledge, reported cases of vulvar and oral Crohn's disease are quite scarce in the literature, but the disease might be underdiagnosed. We hope to contribute to an earlier recognition and a better management of the vulvar and oral mucocutaneous lesions of Crohn's disease.
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Affiliation(s)
- S Thiriar
- Department of Dermatology, Erasmus Hospital, Belgium
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Abstract
We report a case of localized jejunal amyloidosis occurring in a 74-year-old man who experienced an episode of digestive bleeding while he was receiving oral anticoagulation. It illustrates a rare entity, characterized by an endoscopic aspect of polypoid, pseudotumoral formations. Histologically, submucosal connective tissues, muscularis mucosae, and blood vessel walls are massively infiltrated by amyloid, giving a typical red/green birefringence under polarized light.
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Affiliation(s)
- M O Peny
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
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Closset J, Veys I, Peny MO, Braude P, Van Gansbeke D, Lambilliotte JP, Gelin M. Retrospective analysis of 29 patients surgically treated for hepatocellular adenoma or focal nodular hyperplasia. Hepatogastroenterology 2000; 47:1382-4. [PMID: 11100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND/AIMS Hepatocellular adenoma resection and focal nodular hyperplasia supervision are widely recognized as the best management when these benign liver tumors are diagnosed. Differential diagnosis is thus mandatory. METHODOLOGY Twenty-nine patients with a presumed benign liver tumor were retrospectively analyzed. RESULTS Histopathological analysis of these resected liver tumors demonstrated hepatocellular adenoma in 16 patients and focal nodular hyperplasia in 13. One hepatocellular carcinoma was disclosed into a hepatocellular adenoma and 2 hepatocellular adenoma showed foci of liver-cell dysplasia. Seven patients with hepatocellular adenoma (43%) had evidence of intratumoral hemorrhage, among which 3 patients were admitted with intraperitoneal tumoral rupture. Computed tomography, performed in 26 patients, was the most reliable examination to characterize these presumed benign liver tumors. Magnetic resonance imaging concerned only 5 patients but 3 hepatocellular adenoma and 1 focal nodular hyperplasia were diagnosed. The indications of focal nodular hyperplasia surgical resection were chronic pain (4 pts), hepatocellular adenoma diagnosis (4 pts), undeterminate liver mass (2 pts), a liver mass of unknown origin in patients with a neoplastic history (3 pts). A diagnosis of focal nodular hyperplasia assumed by the imaging work-up was always histologically confirmed. All the patients underwent hepatic resection with no mortality. CONCLUSIONS This report underlines the risk of hemorrhage or malignant transformation of hepatocellular adenoma that justifies a safety surgical resection. An imaging work-up in favor of focal nodular hyperplasia allows radiological observation.
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Affiliation(s)
- J Closset
- Medicosurgical Department of Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Belgium
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10
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Anaf V, Simon P, El Nakadi I, Fayt I, Buxant F, Simonart T, Peny MO, Noel JC. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod 2000; 15:1744-50. [PMID: 10920097 DOI: 10.1093/humrep/15.8.1744] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The histological relationships between fibrotic tissue, endometriotic foci and nerves in the rectovaginal septum endometriotic or adenomyotic nodule were studied. This is considered to be one of the most severe forms of deep endometriosis. Masson's trichrome staining for fibrosis detection and immunohistochemistry with the S100 monoclonal antibody for nerve detection were performed in 28 rectovaginal endometriotic nodules from patients presenting with severe dysmenorrhoea and deep dyspareunia (23 patients with no other endometriotic location or potential cause of pain at laparoscopy and ultrasonography; five patients with multiple pelvic endometriotic localizations and other potential causes of pain at laparoscopy). Patients were allocated to two groups on the basis of their preoperative pain scores for pelvic pain, dysmenorrhoea and deep dyspareunia (group 1, score >7; group 2, score < or =7). For each symptom, the mean number of nerves and endometriotic lesions per high-power field and the mean largest diameter of the lesions were not statistically different in groups 1 and 2. The mean percentages of nerves located within the fibrosis of the nodule and within endometriotic lesions were significantly higher in group 1 than in group 2. Among nerves located within endometriotic lesions, there was a significantly higher proportion showing intraneurial and perineurial invasion by endometriosis in group 1 than in group 2. In rectovaginal endometriotic nodules, there was a close histological relationship between nerves and endometriotic foci, and between nerves and the fibrotic component of the nodule. We postulate that such topographical relationships could at least partially explain the strong association between this lesion and pain.
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Affiliation(s)
- V Anaf
- Departments of Gynaecology, Pathology and Digestive Surgery, Hospital Erasme, Université Libre de Bruxelles (ULB), Belgium.
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11
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Abstract
In-vitro fertilization (IVF) and ovarian stimulation are frequently performed in patients with endometriosis. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low. We report four cases of severe digestive complications due to the rapid growth of sigmoid endometriosis under ovarian stimulation. In three patients, sigmoid endometriosis was diagnosed at laparoscopy for sterility. Because of the absence of digestive symptoms or repercussion on the bowel, no bowel resection was performed before ovarian stimulation. All patients experienced severe digestive symptoms during ovarian stimulation, and a segmental sigmoid resection had to be performed. Analysis of endoscopic and radiological data demonstrated that bowel lesions of small size may rapidly enlarge and become highly symptomatic under ovarian stimulation. At immunohistochemistry, these infiltrating lesions displayed high populations of steroid receptors and a high proliferative index (Ki-67 activity), suggesting a strong dependence on circulating ovarian hormones and a potential for rapid growth under supraphysiological oestrogen concentrations. Clinicians should be aware of this rare but severe digestive complication of ovarian stimulation. The early diagnosis of such lesions may help the patients to avoid months of morbidity falsely attributed to ovarian stimulation side effects. Further experience is necessary to determine the optimal attitude when diagnosing a small and asymptomatic endometriotic bowel lesion before ovarian stimulation.
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Affiliation(s)
- V Anaf
- Department of Gynaecology, Hospital Erasme, Universite Libre de Bruxelles (ULB), Brussels, Belgium
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12
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Abstract
BACKGROUND Eradication of Barrett's mucosa by thermal or photoablation combined with high doses of proton pump inhibitors is a potentially attractive strategy in the management of this preneoplastic condition. However, major concerns of this method are the persistence of residual metaplastic glands beneath the new squamous epithelium and the absence of any knowledge of its impact on long term outcome. CASE REPORT The case of an intramucosal adenocarcinoma diagnosed 18 months after apparently complete squamous re-epithelialisation achieved using argon plasma coagulation and high dose omeprazole (40 mg/daily) is reported in a 68 year old patient presenting initially with a Barrett's oesophagus without dysplasia. Intramucosal adenocarcinoma was located under the new squamous layer and presented as a bulging area covered by the squamous epithelium. It probably originates from residual metaplastic glands after therapy although a pre-existing tumour cannot be definitely excluded. CONCLUSION This observation might question future application of this experimental endotherapy in non-dysplastic Barrett's oesophagus. It suggests that the residual glands might still be premalignant and that the early diagnosis of neoplastic changes might be compromised by the squamous re-epithelialisation.
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Affiliation(s)
- J L Van Laethem
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
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13
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Lambot MA, Haot J, Peny MO, Fayt I, Noël JC. Evaluation of the role of human papillomavirus in oesophageal squamous cell carcinoma in Belgium. Acta Gastroenterol Belg 2000; 63:154-6. [PMID: 10925450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
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.
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Affiliation(s)
- M A Lambot
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
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Lambot MA, Peny MO, Fayt I, Haot J, Noël JC. Overexpression of 27-kDa heat shock protein relates to poor histological differentiation in human oesophageal squamous cell carcinoma. Histopathology 2000; 36:326-30. [PMID: 10759946 DOI: 10.1046/j.1365-2559.2000.00858.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- M A Lambot
- Department of Pathology, Erasme University Hospital, Brussels, Belgium.
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15
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Louis H, Le Moine A, Quertinmont E, Peny MO, Geerts A, Goldman M, Le Moine O, Devière J. Repeated concanavalin A challenge in mice induces an interleukin 10-producing phenotype and liver fibrosis. Hepatology 2000; 31:381-90. [PMID: 10655261 DOI: 10.1002/hep.510310218] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Weekly injections of Concanavalin A (Con A) were performed in BALB/c mice to evaluate the pattern of cytokine production and liver injury. High serum levels of tumor necrosis factor alpha (TNF-alpha), interleukin 2 (IL-2), IL-4, and interferon gamma (IFN-gamma) were found in the serum after the first 2 injections of Con A but rapidly decreased from the third injection. Conversely, IL-10 serum levels after repeated Con A challenge increased by 7 times from week 1 to 20. In vivo depletion studies indicated that CD4(+) T cells are essential in IL-10 production. Hepatocyte necrosis was only observed after the first injections of Con A whereas centrilobular inflammatory infiltrates persisted up to 20 weeks. Perisinusoidal liver fibrosis was also increasingly detected in BALB/c mice, whereas no fibrous change was observed in nude mice after 6 weeks of Con A challenge. The number of stellate cells, detected by immunostaining, increased after 20 weeks of Con A injections. Liver cytokine messenger RNA (mRNA) expression after 20 weeks showed expression of transforming growth factor beta1 (TGF-beta1), IL-10, and IL-4 whereas IL-2 was no more expressed. The present study shows that mice repeatedly injected with Con A develop liver fibrosis. The cytokine-release pattern observed after 1 injection of Con A is rapidly shifted towards an immunomodulatory phenotype characterized by the systemic production of large amounts of IL-10.
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Affiliation(s)
- H Louis
- Laboratories of Experimental Gastroenterology, Faculty of Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Lambot MA, Peny MO, Vangeertruyden J, Noel JC. [Unilateral gynecomastia in an adolescent]. Ann Pathol 1999; 19:329-30. [PMID: 10544771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- M A Lambot
- Service d'Anatomie Pathologique, Hôpital Erasme, Bruxelles, Belgique
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Peny MO, Donckier V, Gelin M, Haot J, Noel JC. Sporadic carcinoid of the stomach: a highly proliferative disease with a probable role for p53 protein dysregulation. Eur J Gastroenterol Hepatol 1999; 11:677-9. [PMID: 10418942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We describe here one case of sporadic carcinoid of the stomach, occurring in a 65-year-old man. It is a rare, recently recognized entity, with only few cases reported in the literature. We were able to detect strong MIB-1 and p53 expression in this tumour, with 86 and 80% of tumoral cells positive, respectively. These data suggest that gastric sporadic carcinoids are a highly proliferative entity probably induced by dysregulation of p53 function.
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Affiliation(s)
- M O Peny
- Department of Pathology, Erasmus University Hospital, Brussels, Belgium
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Simonart T, Decaux G, Gourdin JM, Peny MO, Noel JC, Leclercq-Smekens M, De Dobbeleer G. [Hyperpigmentation induced by busulfan: a case with ultrastructure examination]. Ann Dermatol Venereol 1999; 126:439-40. [PMID: 10434109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- T Simonart
- Service de Dermatologie, Hôpital Universitaire Erasme, Bruxelles
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Lambot MA, Noël JC, Peny MO, Rodesch F, Haot J. Fetal parvovirus B19 infection associated with myocardial necrosis. Prenat Diagn 1999; 19:389. [PMID: 10327150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
BACKGROUND/AIMS The objective of this study was to validate, with an independent prospective cohort of patients, our previous data indicating that the proliferating cell nuclear antigen-labeling index (PCNA-LI) reflects the liver functional reserve in human cirrhosis and might have prognostic significance for patient survival. We also examined how this proliferative index is related to the expression of transforming growth factor beta1 (TGFbeta1) as a possible correlate of hepatocyte proliferative activity. METHODS The present group (n=70 patients) was similar in composition to our previous group regarding age, sex and severity of liver cirrhosis. PCNA and TGFbeta1 immunostaining were analyzed on methanol-fixed, paraffin-embedded liver biopsies. RESULTS Our data show that PCNA-LI declined significantly with worsening Child class and was negatively correlated with the Pugh score. Twenty-five patients died and 10 underwent liver transplantation during the observation period. Liver function, hepatic venous pressure gradient and hepatocyte PCNA-LI were significantly different in survivors and non-survivors. At a mean follow-up of 356 days, the patients with a PCNA-LI higher than 4.4% (the previously determined best cut-off value) had a significantly higher probability of survival than those with a PCNA-LI < or = 4.4% (0.87 vs 0.48, p=0.0009). TGFbeta1 expression in liver parenchyma correlated negatively with PCNA-LI, suggesting that this cytokine could be involved in the impaired regeneration observed in worsened liver cirrhosis. CONCLUSIONS This prospective study strengthens our previous observation that, in cirrhosis, hepatocyte proliferative activity, as evaluated by the PCNA-LI, provides information on liver functional reserve as well as on the patient's prognosis.
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Affiliation(s)
- M Delhaye
- Department of Gastroenterology, Erasme Hospital, Brussels, Belgium
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21
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Zhang H, Smail N, Cabral A, Cherkaoui S, Peny MO, Vincent JL. Hepato-splanchnic blood flow and oxygen extraction capabilities during experimental tamponade: effects of endotoxin. J Surg Res 1999; 81:129-38. [PMID: 9927531 DOI: 10.1006/jsre.1998.5450] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We studied the hepato-splanchnic vascular response and changes in O2 extraction capabilities to a reduction in blood flow following endotoxemia. Fourteen anesthetized and mechanically ventilated dogs were divided into two groups of seven each. Group 1 received 2 mg/kg of E. coli endotoxin, and group 2 served as a control. After initial fluid resuscitation following endotoxic shock, regional blood flow estimated by an ultrasonic technique increased similarly in the hepatic artery, portal vein, and mesenteric artery, but microvascular blood flow estimated by a laser Doppler technique was lower in the liver than in the intestinal mucosa. When blood flow was reduced by cardiac tamponade, endotoxin-treated animals had greater whole body and regional critical O2 delivery (DO2crit) and lower whole body, liver, and intestinal critical O2 extraction ratios (O2ERcrit). DO2crit was higher in the liver than in intestine but O2ERcrit was similar in the two organs. Whole body DO2crit at the onset of organ O2 supply dependency was similar under control (9.4 +/- 1.9 mL/kg. min for whole body, 10.3 +/- 4.7 mL/kg. min for liver, and 10.0 +/- 2.6 mL/kg. min for intestine) and endotoxic conditions (13.6 +/- 3.2 mL/kg. min for whole body, 15.6 +/- 2.7 mL/kg. min for liver, and 15.4 +/- 8.7 mL/kg. min for intestine). We conclude that fluid-resuscitated endotoxic shock in dogs is characterized by blood flow redistribution within the liver and intestine. Microvascular depression may be more severe in the liver than in the intestinal mucosa, although the whole body, the liver, and the intestine became O2 supply-dependent simultaneously.
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Affiliation(s)
- H Zhang
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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Van Laethem JL, Cremer M, Peny MO, Delhaye M, Devière J. Eradication of Barrett's mucosa with argon plasma coagulation and acid suppression: immediate and mid term results. Gut 1998; 43:747-51. [PMID: 9824599 PMCID: PMC1727342 DOI: 10.1136/gut.43.6.747] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intestinal metaplastic mucosa in Barrett's oesophagus can be replaced by squamous epithelium after mucosal thermal ablation associated with acid suppression therapy. AIMS To assess whether restoration of squamous epithelium can be obtained after ablation of Barrett's oesophagus using argon plasma coagulation (APC) associated with proton pump inhibitor (PPI) therapy. METHODS Thirty one patients with Barrett's oesophagus received APC. Omeprazole (40 mg/day) was given from the first APC application to one month after completion of the treatment, then given symptomatically. Twenty four hour pH-metry was performed during endotherapy. RESULTS Complete re-epithelialisation was visualised at endoscopy in 25/31 patients (81%) after a mean number of 2.4 APC sessions (range 1-4). Only partial squamous re-epithelialisation was observed in three patients and three others had no eradication. At histological assessment, eradication of Barrett's oesophagus was only confirmed in 19/31 patients (61%) due to the presence of a few residual Barrett's glands under the new squamous epithelium. Complete eradication was related to a Barrett's oesophagus segment length of less than 4 cm and the absence of circumferential extension but not to the normalisation of oesophageal acid exposure under PPI therapy. Seventeen patients with apparently complete endoscopic and histological eradication of Barrett's oesophagus were re-evaluated at one year; eight (47%) disclosed relapsing islands of Barrett metaplasia despite continuous omeprazole therapy (10-40 mg/day). CONCLUSIONS APC combined with 40 mg omeprazole daily can eradicate Barrett's mucosa with apparent squamous re-epithelialisation in the majority of patients even in the absence of normalisation of oesophageal acid exposure. However, one year after endotherapy for Barrett's oesophagus, relapse is frequent but limited in extent.
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Affiliation(s)
- J L Van Laethem
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
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Blanpain C, Knoop C, Delforge ML, Antoine M, Peny MO, Liesnard C, Vereerstraeten P, Cogan E, Adler M, Abramowicz D. Reactivation of hepatitis B after transplantation in patients with pre-existing anti-hepatitis B surface antigen antibodies: report on three cases and review of the literature. Transplantation 1998; 66:883-6. [PMID: 9798698 DOI: 10.1097/00007890-199810150-00012] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients who have been exposed to the hepatitis B virus (HBV) and who were able to clear the hepatitis B surface antigen from the serum and to develop anti-hepatitis B surface antigen (anti-HBs) antibodies are not considered at risk for HBV reactivation after solid organ transplantation. METHODS AND RESULTS We, however, observed three solid organ transplant recipients who demonstrated clinically significant HBV reactivation after transplantation. All patients presented normal liver enzymes and serological stigmates of healed HBV infection at the time of transplantation, as indicated by the absence of hepatitis B surface antigen and the presence of anti-HBs and anti-hepatitis B core antibodies in the serum. Patient 1, a renal transplant recipient, presented HBV reactivation 3 years after transplantation and developed chronic HBV hepatitis. Patient 2 developed HBV reactivation 7 months after a second cadaveric renal graft and died of cirrhosis four and a half years after transplantation. Patient 3, a heart-lung transplant recipient, developed HBV reactivation within months after transplantation, but died of unrelated causes. HBV reactivation in the presence of anti-HBs antibodies has been previously reported in other settings of immunosuppression, mainly in patients with acquired immunodeficiency syndrome and after bone marrow transplantation, and may lead to fatal liver disease. Data from our renal transplant recipients suggest that the incidence of HBV reactivation among patients with anti-HBs and anti-hepatitis B core antibodies is about 5%. CONCLUSIONS Transplant physicians should be aware of the risk of HBV reactivation in patients presenting with healed HBV infection before transplantation.
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Affiliation(s)
- C Blanpain
- Department of Nephrology, Hôpital Erasme, Brussels, Belgium
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Galle C, Cavenaile JC, Hoang AD, Minh TL, Peny MO, Braudé P, Dehon P, Ferreira J, Motte S, Wautrecht JC, Dereume JP. Adventitial cystic disease of the popliteal artery communicating with the knee joint. A case report. J Vasc Surg 1998; 28:738-41. [PMID: 9786275 DOI: 10.1016/s0741-5214(98)70105-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe the case of a patient with adventitial cystic disease of the popliteal artery in which a direct anatomic communication between the cysts and the nearby knee joint was demonstrated by magnetic resonance imaging and confirmed by surgery. This unusual observation could shed some light on the much debated question of the cause, the pathogenesis, and the management of the affection. Moreover, it emphasizes the importance and the role of magnetic resonance imaging in the diagnosis of adventitial cystic disease of the popliteal artery.
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Affiliation(s)
- C Galle
- Department of Vascular Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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26
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Tannouri F, Lalmand B, Zalcman M, Peny MO, Van Gossum A, Van Gansbeke D, Gevenois PA, Struyven J. Role of the double-contrast barium enema in rectal stenosis due to suppositories containing paracetamol and acetylsalicylic acid. Eur Radiol 1998; 8:1217-20. [PMID: 9724442 DOI: 10.1007/s003300050538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Self-treatment of chronic headache with suppositories containing paracetamol and acetylsalicylic acid may lead to serious complications. We report the radiological features of five cases of rectal stenosis following the use of such suppositories. The role of the double-contrast barium enema in suggesting the diagnosis of this complication of a chronic and often unrecognized self-treatment is emphasized.
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Affiliation(s)
- F Tannouri
- Department of Radiology, Hôpital Erasme, University of Brussels, Route de Lennik, B-1070 Brussels, Belgium
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27
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Salari GR, Peny MO, Van de Stadt J, Donckier V, Zalcman M, Gelin M. Late liver metastases of small bowel leiomyoma. The difficulty in assessing malignancy in gastro-intestinal smooth muscle tumours. Acta Chir Belg 1998; 98:107-9. [PMID: 9689967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection.
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Affiliation(s)
- G R Salari
- Department of Digestive Surgery, Université Libre de Bruxelles, Belgium
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28
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Eskinazi R, Resibois A, Svoboda M, Peny MO, Adler M, Robberecht P, Van Laethem JL. Expression of transforming growth factor beta receptors in normal human colon and sporadic adenocarcinomas. Gastroenterology 1998; 114:1211-20. [PMID: 9609758 DOI: 10.1016/s0016-5085(98)70427-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS An absence or a presence of mutated transforming growth factor (TGF)-beta receptors is a possible hypothesis explaining the resistance of cancer cells to the growth-inhibitory effect of TGF-beta. Mutations involving microsatellite-like regions of the type II TGF-beta receptor have been described in subgroups of colorectal cancers. The aim of this study was to investigate the expression and distribution of TGF-beta receptors in sporadic colorectal cancers and normal tissues. METHODS Thirty-three sporadic colorectal cancers and 20 normal colonic tissues were explored by immunohistochemistry for the expression of type I and type II TGF-beta receptors. Eighteen tumor and 20 normal samples were used for radioactive thermocycling and sequencing of the two microsatellite-like regions of the type II receptor. RESULTS Both receptors were overexpressed in tumors compared with normal samples. There was a relationship between the abundance of type II receptor expression and the degree of differentiation of the tumors but not the Dukes' staging or the localization of the neoplasias. No mutation was observed in the microsatellite-like regions of receptor II in any of the samples. CONCLUSIONS Sporadic colorectal cancers do not show an absence or a presence of mutated TGF-beta receptors that could explain a resistance to TGF-beta-mediated growth inhibition. The pathways to tumorigenesis of sporadic colorectal cancers may be different from those of some hereditary ones.
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Affiliation(s)
- R Eskinazi
- Laboratoire de Chimie Biologique et de la Nutrition, Faculté de Médicine, Hôpital Erasme, Université Libre de Bruxelles, Belgium
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Peny MO, Noel JC, Haot J, Sokolow Y, Zalcman M, Houben JJ, Vanderwinden JM, Finne R, Adler M. [Cap polyposis: a rare syndrome]. Gastroenterol Clin Biol 1998; 22:349-52. [PMID: 9762222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We report a case of inflammatory cap polyposis of the colon, a rare syndrome, affecting the rectosigmoid. It was observed in a context of mucous diarrhea. Endoscopic and radiological features consisted of elevated and umbilicated nodular lesions. Histology revealed polypoid lesions containing elongated crypts with superficial abrasions, covered by inflammatory and fibrinoid material. Etiopathogenesis of this new syndrome is unknown.
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Affiliation(s)
- M O Peny
- Service d'Anatomie Pathologique, Hôpital Universitaire Erasme, Bruxelles. Belgique
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Abstract
Lymphocytic colitis is a rare inflammatory colonic disease of unknown etiology accompanied by watery diarrhea. Diagnosis is based upon pathological examination of colonic biopsies. Treatment essentially involves antiinflammatory agents such as sulfasalazine/5-ASA or corticosteroids if necessary. We report the case of a female patient suffering from severe lymphocytic colitis who remained unresponsive after 5-ASA therapy but who improved dramatically after oral budesonide administration.
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Affiliation(s)
- A Van Gossum
- Department of Gastroenterology, Erasme Hospital, Free University of Brussels, Belgium
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31
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Zlotta AR, Djavan B, Matos C, Noel JC, Peny MO, Silverman DE, Marberger M, Schulman CC. Percutaneous transperineal radiofrequency ablation of prostate tumour: safety, feasibility and pathological effects on human prostate cancer. Br J Urol 1998; 81:265-75. [PMID: 9488071 DOI: 10.1046/j.1464-410x.1998.00504.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the safety of radiofrequency (RF) energy delivered interstitially in patients with prostate cancer scheduled for radical prostatectomy and to correlate the proposed theoretical lesion size with the pathological findings. PATIENTS AND METHODS Radiofrequency interstitial tumour ablation (RITA) was performed in 15 patients with localized prostate cancer before radical surgery. RF energy was delivered to the prostate by active needle electrodes (monopolar or bipolar) placed transperineally under transrectal ultrasonography guidance. Needle electrodes were used with different configurations and in some cases were covered by retractable shields to vary the length and circumference of the thermal lesions created. In eight patients, the procedure was performed immediately before radical prostatectomy, in six RITA was performed under spinal anaesthesia 1 week before surgery and in one patient, no surgery was performed but the patient was followed by serial determinations of prostate specific antigen (PSA). At least two lesions were created in each prostate, including both capsule and peripheral zones. NADPH and haematoxylin & eosin (H&E) staining were used to assess the extent of the necrotic lesion in the radical prostatectomy specimen. RESULTS The mean energy delivered was 10.5 kJ, with central temperatures reaching up to 105 degrees C during 12 min of ablation; rectal temperature remained at < 38 degrees C. There were no complications. Macroscopic examination showed well-demarcated lesions including the prostatic capsule, up to 2.2 x 1.5 x 4.5 cm. With monopolar energy, the observed lesion size was comparable to the predicted 2 x 2 x 2 cm lesion, while with bipolar energy, lesion size was related to interneedle distance and uncovered needle length. Microscopic examination showed clearly delineated lesions both with NADPH (in prostates immediately removed after surgery) and H&E (at 1 week after RITA) staining. The lesion size observed on pathological analysis correlated with the predicted lesion size. In one patient, no residual cancer was found in the specimen. In the patient whose entire prostate was targeted and followed by serial PSA measurements, the latter were undetectable at 3 months of follow-up. CONCLUSION Transperineally delivered RF energy is capable of safely creating extensive coagulative necrotic lesions in prostate cancer tissue, in a reproducible and controlled manner. The results presented here provide basic information for the potential future application of this form of energy for localized prostate cancer.
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Affiliation(s)
- A R Zlotta
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Belgium
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Tannouri F, Rypens F, Peny MO, Noël JC, Donner C, Struyven J, Avni F. Fetal endocardial fibroelastosis: ultrasonographic findings in two cases. J Ultrasound Med 1998; 17:63-66. [PMID: 9440110 DOI: 10.7863/jum.1998.17.1.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
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.
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Affiliation(s)
- F Tannouri
- Department of Radiology, Hospital Erasme, Brussels, Belgium
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33
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Zhang H, Rogiers P, Smail N, Cabral A, Preiser JC, Peny MO, Vincent JL. Effects of nitric oxide on blood flow distribution and O2 extraction capabilities during endotoxic shock. J Appl Physiol (1985) 1997; 83:1164-73. [PMID: 9338425 DOI: 10.1152/jappl.1997.83.4.1164] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The effects of the nitric oxide (NO) synthase inhibitor NG-monomethyl-L-arginine (L-NMMA) and the NO donor 3-morpholinosydnonimine (SIN-1) were tested in 18 endotoxic dogs. L-NMMA infusion (10 mg . kg-1 . h-1) increased arterial and pulmonary artery pressures and systemic and pulmonary vascular resistances but decreased cardiac index, left ventricular stroke work index, and blood flow to the hepatic, portal, mesenteric, and renal beds. SIN-1 infusion (2 microg . kg-1 . min-1) increased cardiac index; left ventricular stroke work index; and hepatic, portal, and mesenteric blood flow. It did not significantly influence arterial and pulmonary artery pressures but decreased renal blood flow. The critical O2 delivery was similar in the L-NMMA group and in the control group (13.3 +/- 1.6 vs. 12.8 +/- 3.3 ml . kg-1 . min-1) but lower in the SIN-1 group (9.1 +/- 1.8 ml . kg-1 . min-1, both P < 0.05). The critical O2 extraction ratio was also higher in the SIN-1 group than in the other groups (58.7 +/- 10.6 vs. 42.2 +/- 7.6% in controls, P < 0.05; 43.0 +/- 15.5% in L-NMMA group, P = not significant). We conclude that NO is not implicated in the alterations in O2 extraction capabilities observed early after endotoxin administration.
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Affiliation(s)
- H Zhang
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, B-1070 Brussels, Belgium
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Zlotta AR, Wildschutz T, Raviv G, Peny MO, van Gansbeke D, Noel JC, Schulman CC. Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol 1997; 11:251-8. [PMID: 9376843 DOI: 10.1089/end.1997.11.251] [Citation(s) in RCA: 267] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Small renal tumors are increasingly diagnosed and are frequently treated by nephron-sparing surgery. Tumors can be ablated by radiofrequency (RF) energy, which allows the operator to create very localized necrotic lesions. Radiofrequency interstitial tumor ablation (RITA) has been used in human kidneys in an ex vivo experiment to assess the necrotic lesions produced in a model close to physiologic conditions and then in three patients with localized renal cancer prior to radical nephrectomy. In the ex vivo model, four freshly removed kidneys were treated. Bipolar RF energy was delivered by a generator connected to two needles introduced parallel to each other into the renal parenchyma. A thermocouple was inserted between the two active electrodes. The renal artery at physiologic conditions was maintained at a constant temperature of perfusion of 37 degrees C by a computer-assisted Hot-line monitor. Two lesions were produced in each pole of each kidney including the cortex and the medulla. In an initial human study focusing on safety, feasibility, and pathology, three patients were treated by RITA with bipolar and monopolar energy. One patient with a peripheral 2-cm upper-pole tumor was treated percutaneously under ultrasound guidance with local anesthesia only 1 week prior to surgery. The other patients, with 3- and 5-cm tumors, were treated during surgery under general anesthesia just before nephrectomy. Ex vivo, the maximum temperature at the active needles ranged from 84 degrees C to 130 degrees C with 10 to 14 W applied during 10 to 14 minutes. Lesions were on average 2.2 x 3 x 2.5 cm.3 Microscopic examination showed stromal edema with intensive pyknosis. No damage was seen to adjacent untreated tissue. In the in vivo procedure, tolerance of RTA as an anesthesia-free procedure was excellent. The size of the observed lesions was comparable to the forecast size depending on the needle deployment. No side effects were noted, and no adjacent structures were affected by the RF ablation. These preliminary studies demonstrate the ability of RITA to produce localized extensive necrosis in kidney parenchyma and tumors safely under local anesthesia. Further studies could evaluate this new minimally invasive treatment in small kidney tumors considered for nephron-sparing surgery.
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Affiliation(s)
- A R Zlotta
- Department of Urology, University Clinics of Brussels, Belgium
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el Nawar A, Le Moine O, Nouar E, Bourgeois V, Peny MO, Adler M, Bourgeois N, Devière J. Increased transaminases in psychiatry: a case report. Acta Gastroenterol Belg 1997; 60:243-5. [PMID: 9396184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report the case of a patient admitted to the hospital with psychiatric troubles. Soon after admission, he presented severe hepatitis of unknown origin. Careful review of the charts, transvenous liver biopsy, right heart and hepatic pressure measurements, negative toxicologic and viral screenings were highly suggestive of hypoxic hepatitis. Indeed, the patient had previously been treated for a decompensated cardiomyopathy and medications stopped prior to the current admission. Without clear clinical evidence of heart failure he presented a brief malaise two days before the increase in liver enzymes. Holter heart recording showed afterwards bouts of ventricular tachycardia. Treatment with Dobutamine and antiarrythmics led to a rapid decrease of transaminase levels and recovery in liver function. Unfortunately, he died three weeks later from his cardiomyopathy. This case illustrates the need for cardiovascular work-up in the context of hepatitis from unknown origin.
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Affiliation(s)
- A el Nawar
- Department of Gastroenterology, Université Libre de Bruxelles, Hopital Erasme, Belgium
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Abstract
Experimental T-cell-mediated hepatitis induced by concanavalin A (Con A) involves the production of proinflammatory cytokines. Because interleukin (IL)-10 is a potent anti-inflammatory cytokine derived from macrophages and T cells and is produced within the liver, we investigated the role of IL-10 in modulating the hepatotoxicity and the secretion of cytokines following in vivo injection of Con A. IL-10 is produced early in the serum after Con A challenge. Neutralization of endogenous IL-10 by monoclonal antibodies (mAbs) increases the secretion of tumor necrosis factor alpha (TNF-alpha) (+111%), interferon gamma (IFN-gamma) (+92%), and IL-12 (+730%) 8 hours after Con A injection, and increases the hepatotoxicity, assessed by serum alanine transaminase (ALT) (+174%) measurement and by histology, 24 hours after induction of hepatitis. Conversely, preadministration of recombinant IL-10 reduces the production of these proinflammatory cytokines (-47%, -80%, and -47% for TNF-alpha, IL-12, and IFN-gamma, respectively), and decreases neutrophil infiltration and ALT serum concentration (-74%) 8 hours after Con A challenge. We conclude that IL-10, either endogenously produced or exogenously added, has a hepatoprotective role in Con A-induced hepatitis, through its suppressive property on proinflammatory cytokine production, and that it might be of therapeutic relevance in human liver diseases involving activated T cells.
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Affiliation(s)
- H Louis
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Brussels, Belgium
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Van Gossum A, Peny MO, Zalcman M. Giant fibrous polyp of the anal canal. Acta Gastroenterol Belg 1997; 60:184. [PMID: 9260334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Zlotta AR, Raviv G, Peny MO, Noel JC, Haot J, Schulman CC. Possible mechanisms of action of transurethral needle ablation of the prostate on benign prostatic hyperplasia symptoms: a neurohistochemical study. J Urol 1997; 157:894-9. [PMID: 9072594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Transurethral needle ablation of benign prostatic hypertrophy (BPH) is a rapid, anesthesia-free outpatient procedure using low level radiofrequency energy that produces coagulative necrosis lesions at temperatures of approximately 100C. Clinically, significant improvement in objective and subjective parameters has been observed in BPH patients. Transurethral needle ablation has also been shown to be effective in relieving urinary retention. However, the precise mechanism of action of this procedure remains to be clarified. Ablation could produce its action on the dynamic component of the infravesical outlet obstruction. We analyzed the possible effects of transurethral needle ablation on the intraprostatic innervation. MATERIALS AND METHODS Histological sections from 10 open prostatectomy specimens (BPH) recovered 1 to 46 days after transurethral needle ablation were stained with hematoxylin and eosin and an immunohistochemical technique, using antibodies against S100 proteins and nonspecific enolase as specific nerve markers, and against anti-prostate specific antigen and anti-desmin for glandular and muscle cells, respectively. We used 5 BPH specimens as controls. RESULTS Microscopic examination of the treated areas showed necrotic lesions affecting epithelial and smooth muscle cells in the transition zone at a depth of 0.3 to 1.0 cm, from the preserved urethra. Nerve fibers in the control specimens and untreated prostatic areas were predominant in the urethral submucosal layer and in the stroma surrounding the epithelial nodules. No staining of any axon or isolated nerve cell was observed in any specimen treated by transurethral needle ablation, and there was a sharp and clear delineation between treated and untreated areas. CONCLUSIONS Our study demonstrated severe thermal damage to intraprostatic nerve fibers caused by transurethral needle ablation. A long-term denervation of alpha-receptors and/or sensory nerves could explain the clinical effects of transurethral needle ablation of the prostate. Theoretically, the best location to produce necrotic lesions should include submucosal and subcapsular nerve endings. Differences in the distribution of the adrenoreceptors and morphometry of the prostate transition zone could partly explain differences in clinical outcome observed after transurethral needle ablation of the prostate.
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Affiliation(s)
- A R Zlotta
- Department of Urology, Erasme University Hospital, Brussels, Belgium
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Louis H, Le Moine O, Peny MO, Gulbis B, Nisol F, Goldman M, Devière J. Hepatoprotective role of interleukin 10 in galactosamine/lipopolysaccharide mouse liver injury. Gastroenterology 1997; 112:935-42. [PMID: 9041256 DOI: 10.1053/gast.1997.v112.pm9041256] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND & AIMS Interleukin (IL)-10 is a potent anti-inflammatory cytokine. Its role in modulating liver injury induced by galactosamine and lipopolysaccharide (Gal/LPS) was investigated. METHODS The effects of recombinant IL-10 (rIL-10), anti-IL-10 monoclonal antibodies, or gadolinium chloride (GdCl3) pretreatment were studied in mice challenged with Gal/LPS. Tumor necrosis factor (TNF) alpha and IL-10 serum concentrations were measured and liver injury was assessed by alanine aminotransferase (ALT) serum concentrations and by histology. RESULTS (1) IL-10 is produced early and together with TNF-alpha after Gal/LPS challenge. (2) Anti-IL-10 pretreatment increases TNF-alpha (+443%, P = 0.04), ALT (+160%, P = 0.04) serum levels, and the percentage of severe necrosis compared with control monoclonal antibodies. (3) Administration of rIL-10 30 minutes before Gal/LPS decreases TNF-alpha (-67%, P = 0.02), ALT (-94%, P = 0.01) serum concentrations, and the proportion of severe necrosis. The hepatoprotective effect is still observed when rIL-10 is injected 30 or 120 minutes after Gal/LPS. (4) GdCl3 pretreatment protects against hepatotoxicity, decreases TNF-alpha, but increases IL-10 serum concentrations. CONCLUSIONS These results indicate that IL-10 protects the liver in the Gal/LPS mouse model. Increased IL-10 and decreased TNF-alpha secretion are potentially involved in the hepatoprotection observed after GdCl3 pretreatment.
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Affiliation(s)
- H Louis
- Laboratory of Experimental Immunology, Department of Gastroenterology and Hepatopancreatology, Universite Libre de Bruxelles, Brussels, Belgium
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40
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Noel JC, Andre J, Hermans P, Fayt I, Peny MO, De Thier F, Haot J, Burny A. Kaposi's sarcoma: evaluation of the role of human papillomaviruses. A study using the high sensitivity hot-start polymerase chain reaction detection method and a review of the literature. Arch Dermatol Res 1996; 288:786-8. [PMID: 8950462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J C Noel
- Department of Pathology, Erasme University Hospital, Free University of Brussels, Belgium
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Van Laethem JL, Resibois A, Adler M, Peny MO, Ohtani H, Robberecht P. Localization of transforming growth factor-beta 1 precursor and latent TGF-beta 1 binding protein in colorectal adenomas. Dig Dis Sci 1996; 41:1741-8. [PMID: 8794788 DOI: 10.1007/bf02088739] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transforming growth factor-beta 1 (TGF-beta 1) is a multifunctional cytokine and is thought to be involved in colorectal tumorigenesis as a regulator of cell growth and differentiation. This role is mainly supported by in vitro studies while its role in vivo remains unclear. The aim of the present study was to investigate whether the TGF-beta 1 precursor (beta 1-LAP) and the latent TGF-beta 1 binding protein (LTBP) are expressed in colorectal adenomas, the presumed precursors of most of colorectal adenocarcinomas. TGF-beta 1 precursor and LTBP were examined in 35 adenomas and 10 normal colonic mucosa specimens by immunohistochemistry, using specific polyclonal antibodies. In normal colonic mucosa, beta 1-LAP was moderately expressed in epithelial crypt cells and in the stromal cells in the lamina propria. In adenomas, beta 1-LAP was localized in epithelial cells with an heterogeneous pattern and was also present in stromal cells around the adenomatous glands. LTBP was not detected in epithelial cells but was observed in stromal cells and in the extracellular matrix (ECM). beta 1-LAP expression in epithelial cells did not correlate with the grade of dysplasia, while LTBP localized in stromal cells and ECM appeared to be closely associated with areas of higher grade of dysplasia. This study is the first demonstration of both beta 1-LAP and LTBP in colorectal adenomas with different dysplasia grades. Our results suggest that TGF-beta 1 might be involved in the mechanisms controlling in vivo colorectal tumorigenesis and support a role for the stromal-associated TGF-beta 1.
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Affiliation(s)
- J L Van Laethem
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Université Libre de Bruxelles, Belgium
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Zlotta AR, Raviv G, Peny MO, Vanegas JP, Schulman CC. [A new method of cancer treatment: the use of radiofrequencies in urological tumors]. Acta Urol Belg 1996; 64:1-5. [PMID: 8659329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study reports our preliminary experience with interstitial radiofrequencies in the treatment of urological malignancies. Bipolar radiofrequency was interstitially delivered in four freshly removed human kidneys in an ex-vivo model. The kidney was perfused ex-vivo with 37 degrees C saline in order to mimic physiological conditions. Large reproducible and controlled lesions (hypereosinophilia and pyknosis) were observed in the parenchyma between the active needles. Further animal and human clinical studies are planned to precise the place of bipolar RF in the treatment or urological malignancies, and especially in kidney tumors.
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Affiliation(s)
- A R Zlotta
- Service d'Urologie, Hôpital Universitaire Erasme, Bruxelles, Belgique
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Zlotta AR, Peny MO, Matos C, Schulman CC. Transurethral needle ablation of the prostate: clinical experience in patients in urinary acute retention. Br J Urol 1996; 77:391-7. [PMID: 8814844 DOI: 10.1046/j.1464-410x.1996.91112.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical outcome of patients in urinary retention due to benign prostatic enlargement (BPE) treated using transurethral needle ablation (TUNA), an outpatient procedure requiring only local intra-urethral anaesthesia and intravenous sedoanalgesia. PATIENTS AND METHODS The TUNA technique was used in 38 patients in acute retention due to BPE, 34 of whom were a poor surgical risk. A special cytoscopic catheter device delivered low-level radiofrequency (RF) energy interstitially to a localized area of the prostate, producing necrotic lesions within the prostatic parenchyma. After treatment, all men were evaluated using urinary flow rates, residual urine volume, the International Prostate Symptom Score and quality of life score at 1, 3 and 6 months. RESULTS The mean prostate size was 43.1 g (range 18-90). Tolerance of the procedure when using topical anaesthetic and intravenous sedation was excellent. Of the 38 patients treated using TUNA, 30 (79%) resumed voiding within a mean of 8.7 days (range 2-27). After 6 months, the sustained mean peak flow rate was 10.4 +/- 3.4 mL/s and the mean residual volume was 76 +/- 45 mL. Five of the patients who did not resume voiding after TUNA underwent retropubic prostatectomy and one patient underwent TURP. The mean prostate size in these patients was 55.7 g. Failure to void was associated with the treatment of too few areas of the prostate for its volume. CONCLUSION This study demonstrated that TUNA is highly effective in relieving patients in urinary retention due to BPE and seems particularly suitable for treating patients who are at greater risk during surgery.
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Affiliation(s)
- A R Zlotta
- Department of Urology, Erasme University Hospital, Brussels, Belgium
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Abstract
BACKGROUND Verrucous carcinoma is a rare variant of well-differentiated squamous cell carcinoma which is characterized by a marked local aggressivity and a poor metastatic potential. Until now, little has been known about the oncogenic mechanisms of this tumor. Recently, extensive investigations have shown that p53 protein, a nuclear protein with oncogene-suppressing activity, may play a crucial role in cell transformation and immunoreactivity for this protein is found in a wide variety of cancers. OBJECTIVE AND METHODS The aim of the present study is to examine the frequency of immunohistochemically detectable p53 protein by using two monoclonal antibodies (D07 and BP53-12) in 8 cases of formalin-fixed and paraffin-embedded specimens of verrucous skin carcinoma. RESULTS Overexpression of p53 protein was detected in 6 (75%) of the cases examined with the D07 antibody and in 5 (62.5%) cases with BP53-12. The p53 positivity was shown in a peripheral distribution affecting mainly the basal cell layers of tumoral islands. CONCLUSION In a high percentage of verrucous carcinoma, p53 immunoreactivity has not been previously described in the literature and our findings suggest that abnormal expression of p53 tumor suppressor protein is a common event in the pathogenesis of this tumor.
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Affiliation(s)
- J C Noel
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
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Noel JC, Heenen M, Peny MO, Fayt I, Peny J, De Dobbeleer G, Haot J, Galand P. Proliferating cell nuclear antigen distribution in verrucous carcinoma of the skin. Br J Dermatol 1995; 133:868-73. [PMID: 8547037 DOI: 10.1111/j.1365-2133.1995.tb06918.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Verrucous carcinoma (VC) of the skin is a rare variety of well-differentiated squamous cell carcinoma (SCC) characterized by aggressive local growth and a low metastatic potential. These tumours are known to have histological and virological features similar to classic warts or condylomata. The aim of the present study was to map the proliferative compartment in VC (n = 7) in comparison with warts (n = 10) and typical well-differentiated SCC (n = 10). The proliferating cells were detected by immunostaining of proliferating cell nuclear antigen (PCNA) in formalin-fixed, paraffin-embedded tissue sections, using the commercially available anti-PCNA monoclonal antibody PC10. Normal epidermis served as a positive control and reference. In VC and warts, the PCNA-positive cells were principally located at the periphery of lesions, in the basal layer of the tumour islands. In some warts, however, stronger PCNA expressed was noted in the superficial layers, of the lesions corresponding to virus-infected keratinocytes (koilocytotic cells). In contrast, in SCC, PCNA-positive cells were randomly scattered throughout the tumours. Our findings suggest that, on the basis of mapping of PCNA distribution, VC resembles large warts or condylomata rather than typical SCC. Thus, VC appears to be a distinct clinical entity, intermediate between these two types of lesions, not only because of its clinical entity, intermediate between these two types of lesions, not only because of its clinical and virological features, but also with regard to its proliferative organization.
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Affiliation(s)
- J C Noel
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
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Mboti B, el Nakadi I, Closset J, Mehdi A, Gay F, Peny MO, Zalcman M. Adenocarcinoma of the ileum. A case report, and review of the literature. Acta Chir Belg 1995; 95:298-300. [PMID: 8571725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 47-year-old female presented with intestinal occlusion and a lower abdominal mass. On laparotomy, a 10 cm diameter mass was discovered involving the ileum, jejunum, vagina and the bladder. Pathological studies conclusion was a primary adenocarcinoma of the ileum involving the jejunum. Small bowel carcinoma is rare. It occurs between sixty- and seventy-year-old equally in male and female. It presents most frequently in the duodenum, sometimes in the jejunum, and occasionally in the ileum. The symptoms are not specific and do not point to the diagnosis which must be made radiologically and endoscopically. Currently, for a minority of patients, surgical resection remains the only hope of cure. Palliative resections and bypass procedures can prevent occlusion or subocclusion.
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Affiliation(s)
- B Mboti
- Department of Medicosurgical Gastroenterology, Hôpial Erasmus, U.L.B., Brussels
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Noel JC, Thiry L, Verhest A, Deschepper N, Peny MO, Sattar AA, Schulman CC, Haot J. Transitional cell carcinoma of the bladder: evaluation of the role of human papillomaviruses. Urology 1994; 44:671-5. [PMID: 7974942 DOI: 10.1016/s0090-4295(94)80202-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The study evaluated the conflicting results of the role of human papillomavirus (HPV) in the development of bladder carcinoma. METHODS We analyzed the frequency of HPV types 6, 11, 16, 18, and 33 by using polymerase chain reaction on formalin-fixed, paraffin-embedded specimens, from 75 cases of transitional cell carcinoma (TCC) of the bladder. Fifteen samples of normal urothelium adjacent to TCC (10) or from normal bladder obtained at autopsy (5) served as negative controls. RESULTS HPV type 16 deoxyribonucleic acid (DNA) was detected in 2 (2.7%) of the 75 cases of TCC and in none of the normal urinary bladder cases. The 2 patients with HPV type 16 were immunosuppressed after undergoing renal and cardiac transplantation. CONCLUSIONS These results strongly suggest that HPVs play a minor role in the development of TCC of the bladder in the general population, although they can act as oncogenic agents in predisposed patients, such as those who are immunosuppressed.
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Affiliation(s)
- J C Noel
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
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Noel JC, Peny MO, Mat O, Antoine M, Firket C, Detremmerie O, Thiry L, Verhest A, Vereerstraeten P. Human papillomavirus type 16 associated with multifocal transitional cell carcinomas of the bladder in two transplanted patients. Transpl Int 1994; 7:340-3. [PMID: 7993570 DOI: 10.1007/bf00336709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This report describes two cases of rapidly progressive, multifocal transitional cell carcinomas of the bladder that developed in two patients after renal and cardiac transplantation, respectively. In both cases human papillomavirus (HPV) type 16 DNA was detected using the polymerase chain reaction DNA amplification method. To our knowledge, this HPV type has not been previously described in multifocal bladder transitional cell carcinoma in transplanted patients. Our findings suggest that HPV may play a major role in the development of rapidly progressive, multifocal transitional cell carcinoma in immunosuppressed patients.
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Affiliation(s)
- J C Noel
- Department of Pathology, Erasme Hospital, Free University of Brussels, Belgium
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Peny MO, Van Gossum A, Noel JC, Capelli JA, Lecocq E, Haot J. Two cases of water-melon stomach and a review of the literature. Acta Gastroenterol Belg 1994; 57:166-70. [PMID: 8053302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report two cases of "water-melon stomach", which is a peculiar form of gastric antral vascular ectasia, characterized by a specific and striking endoscopic aspect. It is observed in a context of chronic iron deficiency anemia and gastrointestinal blood loss, particularly in elderly female patients. The clinical endoscopic, histologic, pathogenic and therapeutic aspects are described, with review of the literature.
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Affiliation(s)
- M O Peny
- Department of Pathology, Erasme University Hospital, Brussels, Belgium
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Noel JC, Detremmerie O, Peny MO, Candaele M, Verhest A, Heenen M, De Dobbeleer G. Transformation of common warts into squamous cell carcinoma on sun-exposed areas in an immunosuppressed patient. Dermatology 1994; 189:308-11. [PMID: 7949492 DOI: 10.1159/000246869] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We report one case of renal transplant recipient who developed widespread multiple verrucous skin lesions. Histologic examination revealed typical warts and, only from several sites exposed to sun (hands and face), a development of dysplasia within the warts and a transformation of some of them toward infiltrating squamous cell carcinoma (SCC). Human papillomavirus (HPV) testing for DNA by polymerase chain reaction DNA amplification identified HPV type 1 in both warts and SCC. Our findings suggest that classic warts may progress to high-grade lesions and that, in addition to the oncogenic potential of the virus alone, other factors including the host's immunosuppressed state and ultraviolet radiation seem to be essential to malignant transformation.
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Affiliation(s)
- J C Noel
- Department of Dermatopathology, Erasme Hospital, Free University of Brussels, Belgium
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