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Biomedical subjects

B Cavelier-Balloy

Publications and source records attributed to B Cavelier-Balloy.

At least 19 recordsLinked to original sources

[Thalidomide and thrombosis].

BACKGROUND: Teratogenicity and neuropathy are the well known serious side effects induced by thalidomide. We describe 5 cases of thrombotic events occurring within a brief delay after the onset of thalidomide in a manner that suggests that thalidomide could have acted as a precipiting or as a starting factor in these events. OBSERVATIONS: Five patients including 4 patients with lupus erythematosus (1 discoid lupus, 1 subacute lupus and 2 systemic lupus erythematosus) and one patient with a severe atopic dermatitis, all without previous history of vascular events, developed an arterial thrombosis (2 cases) or a venous thrombosis (3 cases), severe in 4 cases, few days or weeks after the onset of thalidomide treatment (50 to 100 mg daily). DISCUSSION: All the patients had risk factors of thrombosis: the presence of antiphospholipids and/or anticardiolipin antibodies in lupus erythematosus patients and a trauma in the atopic case. However the absence of a previous story of thrombosis, its rapid occurrence after the onset of thalidomide and its severity are intriguing. In addition, recent studies demonstrate that thalidomide has various effects that would act, among other things, on angiogenesis. Thus, we think that a doubt exists on a negative effect of thalidomide in thrombosis risk factors patients and that this hypothesis has to be confirmed.

Adult↗

Analysis of alterations adjacent to invasive vulvar carcinoma and their relationship with the associated carcinoma: a study of 67 cases.

A retrospective analysis of histological lesions adjacent to 67 invasive vulvar squamous cell carcinomas (SCC) was undertaken to analyse their nature, as well as their relationship to SCC. Patient age, clinical presentation and histological type of carcinoma, ISSVD classification of its adjacent lesions, disease-free and overall survival were reviewed. Severe undifferentiated vulvar intra-epithelial neoplasia (VIN3) was found in 19.4% of cases and vulvar lichen sclerosus (VLS) in 76.1% of cases. All VLS, except 2 cases, were associated with squamous cell hyperplasia (SCH), and a concomitant differentiated VIN was found in 76.6% of cases. Undifferentiated VIN3 was never associated with VLS. VLS was significantly associated with a keratinizing, well-differentiated SCC (98% of cases), while undifferentiated VIN3, was linked preferentially to 2 other types of SCC: in 77% of cases, a moderately-differentiated SCC with the same histological features as the so-called basaloid carcinoma and, in 23% of cases, a well-differentiated SCC with a variable extent of koilocytic atypia, similar to the so-called warty carcinoma. Carcinoma of the fourchette was more often associated with undifferentiated VIN3. Disease-free and overall survival were significantly better for carcinoma associated with undifferentiated VIN3 (p < 0.01 and p < 0.05, respectively). These findings suggest invasive vulvar SCC occurs on 2 distinct types of vulvar lesions: differentiated VIN and/or SCH associated with VLS and undifferentiated VIN3. Furthermore, the histological type of the carcinoma seems to differ according to adjacent lesions.

Adult↗

Failure of isotretinoin and interferon-alpha combination therapy for HPV-linked severe vulvar dysplasia. A report of two cases.

BACKGROUND: Retinoids (RA) and interferon (IFN) have been reported to be active against a variety of tumors and human papillomavirus (HPV)-related lesions. Because chronic and recurrent HPV-linked vulvar intraepithelial neoplasia 3 (VIN 3) have a high risk of invasion, we evaluated combined therapy of IFN-alpha with 13-cis-retinoic acid (13 cRA) in the treatment of two VIN 3 cases of this type. CASE: Two patients with chronic and recurrent VIN 3 were treated with combined therapy of IFN-alpha (4.5 x 10(6) five times a week) and 13 cRA (1 mg/kg/d) for six months. Clinical regression was observed at the end of treatment in both cases, but histologic features of VIN 3 were still present. CONCLUSION: These data demonstrate the ineffectiveness of the combined regimen of IFN-alpha and 13 cRA with this schedule for a period of six months in recurrent and chronic VIN 3.

Adult↗

[Scleroderma-like patch on the thigh in infants after vitamin K injection at birth: six observations].

INTRODUCTION: Texier's disease or pseudosclerodermatous reaction after intramuscular injection of vitamin K1 is well known in adults although only 1 report of a case in a newborn was found in the literature. We report 6 cases. CASE REPORTS: Six infants (4 boys, 2 girls) developed "peau d'orange" skin lesions after the age of 6 months which was localized in the lower third of the medial aspect of the thigh. Initial rapid locoregional extension was followed by stabilization and then regression. In all 6 cases, histology showed lesions of the fascia and/or the deep hypoderma associated with variable mononuclear inflammatory infiltration and hyalin fibrosis. When performed, immunological studies (complement fixation, search for autoantibodies) were always negative or normal. No visceral involvement was found. DISCUSSION: A pseudosclerodermatous lesion of the lower third of the thigh occurred in 6 infants at the site of an intramuscular injection of vitamin K1 administered at birth. The history, clinical manifestations, histology and outcome of these cases are compatible with the diagnosis of Texier's disease. We discuss the role of the solvent in the Roche vitamin K1 injection. The pathogenesis of this side effect remains unknown. CONCLUSION: Texier's disease in infants after injection of vitamin K1 at birth is a stereotypic dermatosis. Diagnosis is based on history and clinical presentation. The causal effect of injectable vitamin K1 should be entertained whenever pseudosclerodermatous lesions are observed in a young child.

Antifibrinolytic Agents↗

Late, painful, subungual hyperkeratosis in incontinentia pigmenti.

The postpubertal appearance of subungual, painful keratotic tumors is a rare feature of incontinentia pigmenti. A patient affected by incontinentia pigmenti developed subungual, painful, nontumoral, hyperkeratotic lesions of the hands at 10 years of age. The mildness of the subungual lesions may be explained by the early stage of the disorder, but it is difficult to correlate the severity of the fingertip pain with the absence of true tumoral swelling. To our knowledge this is the youngest patient reported so far and the only one with a prepubertal expression of this puzzling disorder.

Abnormalities, Multiple↗

[Epithelio-lymphohistiocytic tumor. Apropos of 3 cases].

We report three cases of epithelio-lympho-histiocytic tumour with very original histological features. The patients were young adults presenting with a nodular lesion on the face which had been present for several years. No recurrence was observed after surgical excision. Histologically, the dermal lesion consisted of epithelial pouches edged with a few layers of basal-like cells and filled with lymphocytes and large clear cells. Relations were found between these lobules and hair follicles, and rudiments of piliary differentiation were noted. The stroma was dense and infiltrated by small lymphocytes and large clear cells. An immunohistochemical study showed marking of the large clear cells by the S 100 protein, which suggested that they were Langerhans cells. The lymphocytes were recognized by the common panleucocyte antibody. The KL 1 antibody marked a few isolated cells within the lobules, but not the basal-like cells. These cases seemed to be similar to the 7 cases reported in the literature by Santa-Cruz and Barr who used the term lymphoepithelial tumour of the skin. We felt justified in putting the stress on the histiocytic component of this tumour and calling it epithelio-lympho-histiocytic tumour. We agree with these authors that this is a tumour of the appendages of the skin and in particular the hair.

Adult↗

Subcutaneous eosinophilic necrosis associated with refractory anemia with an excess of myeloblasts.

We followed up over a period of 10 months a Cambodian patient in whom refractory anemia with excess blasts was discovered after the onset of fever and chronic dermatologic involvement. Violaceous, firm, and painful subcutaneous nodules (1-3 cm in diameter) were present on the arms, legs, trunk, scalp, neck, and chin and were associated with violaceous infiltrating plaques on the face and forehead. The microscopic examination of repeated biopsy specimens showed a predominantly lobular panniculitis characterized by an extensive eosinophilic necrosis, leukocytoclasia, and fibrinoid deposits within a few vessels. Such lesions might be the consequence of the immune response against leukemic clones, which have been shown to be present in a steady state in at least some cases involving myelodysplastic syndromes.

Anemia, Refractory, with Excess of Blasts↗