Biomedical subjects
Publications and source records attributed to B Pasquier.
In a 39-year-old patient with tibial productive osteitis, Propionibacterium acnes was identified in a surgical specimen of the bone lesion. Similar cases have been reported by others. The possibility that P. acnes may play in a pathogenic role in the SAPHO syndrome by causing inflammatory or infectious changes is discussed.
A 39-year-old female was admitted to the hospital because of a sudden meningeal syndrome followed by diplopia, cervical, dorsal and sciatic nerve pains, and right peripheral facial palsy. Cerebrospinal fluid obtained by lumbar puncture showed a protein level at 23 g/l. Myelography and magnetic resonance imaging (MRI) were in favor of a lumbar arachnoiditis. A meningeal biopsy revealed a tumour infiltration with foci of cells that were stained with anti-glial fibrillary acidic protein antibody. Cerebral MRI was performed to search for a central nervous system (CNS) primary tumour, and disclosed a pineal mass. Five months after the onset of the disease, the patient worsened her clinical state and died. Necropsy confirmed the presence of a pineocytoma with astrocytic differentiation and diffuse leptomeningeal spread. This exceptional occurrence leads us to discuss about primary tumours of the CNS with leptomeningeal spread.
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A 52-year-old male presented with an anterior mediastinal tumor associated with a 2-year history of myasthenia gravis. The patient underwent thymectomy and a 185-g, 10 X 8 X 3.5 cm, well-delineated tumor was resected. On histologic examination the tumor proved to be a thymolipoma composed of mature adipose elements containing cords and nests of thymic tissue. The latter consisted mainly of cortical areas, the thymocytes of which displayed an immunohistochemical profile of cortical cells, i.e., CD 1+, CD 4+, CD 8+, and frequently Ki 67+. Ultrastructural study confirmed the predominant cortical differentiation of the thymic component. No germinal centers, dendritic reticulum cells, or myoid cells were detected by histologic, immunohistochemical, and ultrastructural studies. The association of thymolipoma with myasthenia gravis is rare; this case is the 10th reported. Our findings lead us to believe that (a) the cortical differentiation of the thymic component and the active thymocyte proliferation could represent a factor leading to myasthenia gravis; and (b) thymolipoma could be a peculiar form of thymoma rather than a mixed tumor of mesenchymal and entodermal origin, a lipoma, or a hamartoma of the thymic gland. The reported association of thymolipomas with other immune disturbances or with neoplastic conditions usually associated with true thymomas support these findings.
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A 36-year-old female presented with vertigo and worsening of a right hearing loss with tinnitus. Clinical and radiologic investigations revealed a tumor of the right internal acoustic meatus, first diagnosed as a neuroma. Histologic study of surgical samples led to a final diagnosis of lipoma. Cranial nerve lipomas are rare and usually located in the cerebellopontine angle. Lipomas confined to the internal acoustic meatus are much rarer. The review of the literature however, shows that their histologic characteristics and their behavior are identical to those of cerebellopontine angle lipomas, and that a minimal surgical resection is therefore advised.
Gliomas involving the brain stem represent 10% of pediatric central nervous system neoplasms. They result in multiple cranial nerve involvement, long tracts signs, cerebellar signs, usually with no evidence of raising in intracranial pressure. The diagnosis is established by computed tomographic scan and magnetic resonance imaging. Classic management consists in conventional radiation therapy but the prognosis is very dismal with a five year survival rate about 30%.
Primary intra-cranial germ-cell tumors are a rare and heterogeneous group of neoplasms, identical to germ-cell tumors of gonads and other organs. These tumors arise along the midline, from the supra-sellar cistern to the pineal gland, and have neurological, ophthalmological, and endocrinological expression. The diagnosis is established by detection of increased levels of tumoral markers and/or by histological examination. The treatment includes chemotherapy, radiotherapy and surgery.
The authors report an uncommon soft tissue tumor, a diffuse giant cell tumor of tendon sheath. The location is uncommon too, the ankle, behind tibial shaft and forward achilleus tendon. The primary diagnosis of ankle and leg lymphoedema, has been for a long time. But CT Scan and MRI allowing the discovery of a firm and multinodular mass, have permitted surgical excision and histological diagnosis. This case agrees with the literature review. The pigmented villonodular synovitis is rather uncommon in comparison to localized form. Young people and lower extremities are more affected; symptoms are of relatively long duration. Histological examination gives diagnosis but surgical excision has to remove the tumor completely as possible because of local recurrence rate of about 50%.
We report a case of primary malignant melanoma of the cerebellopontine angle. This tumour showed RMI features that were totally different from those reported for secondary melanomas, and therefore its nature could not be suspected before surgery. Intracranial primary melanomas are so rare that no other published case is available for comparison, and our tentative explanations for the atypical RMI signals cannot be supported by evidence from the literature.
Twenty-seven patients who had a relapse of astrocytomas or supra-tentorial malignant gliomas, previously treated by radio-surgical combination or exclusive irradiation, underwent a combination of 3 courses of 5-FU, cis-platyl and hypofractionated irradiation. No objective response was observed, but there was a progression of the tumor in 33% of the cases, and no change in 67%. Overall median survival was 7 +/- 1.5 months. The 20 patients with grade III or IV astrocytomas had a lower median rate than the 7 patients with grade II astrocytomas or oligodendrogliomas: 6 +/- 1.8 months versus 18 +/- 3.2 (P = 0.16). Median survival was 14 +/- 2.7 months for neurological responders and 6 +/- 2.1 months for non-responders (P = 0.017).
A 67-year-old woman presenting with a 9-month history of polymyositis, suddenly worsened her clinical state and died. An autopsy was performed, finding a tumor measuring 8 x 6 x 1 cm, located in the left pulmonary hilum. The thyroid gland, of normal volume, was firm. The histological analysis of the tumor, the thyroid gland and several skeletal muscles led to the following diagnoses: thymic carcinoma, Hashimoto's thyroiditis and polymyositis. The aim of the discussion is this thymic carcinoma, the originality of which are firstly its ectopic location, secondly its association with immune diseases usually described during the course of thymomas rather than thymic carcinomas.
The authors present four cases of osteoid osteoma of the spine and review the usual clinical and paraclinical data leading to its diagnosis. The value of radionuclide bone scanning is emphasized: it supersedes the often disappointing radio-tomography and guides computerized tomography which, with modern scanners, virtually always demonstrates the lesion and locates it with accuracy. In the author's experience, spinal and spinal cord arteriography plays an important role: it identifies the radiculospinal vessels preoperatively and provides additional aetiological arguments based on the usual hypervascularity of osteoid osteomas and on the pain induced by injection of the feeding vessels. Data from the literature concerning the vascularization of the nidus suggest that treatment by embolization alone can be envisaged but must be demonstrated.
Paragangliomas of the carotid body are uncommon tumours usually regarded as benign or locally malignant. Metastasis occurs in 5 to 25% of the cases, involving mainly the liver, lung and bones. A case of carotid body tumour without histological evidence of malignancy but with local invasion and, subsequently, multiple spinal metastases is reported. Since the histological prognosis of the initial tumour is impossible to make in most cases, the authors underline the importance of signs of local invasion which is predictive of metastasis and requires regular monitoring with radionuclide bone scanning and MRI.
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