Biomedical subjects
Publications and source records attributed to C Micheau.
Embryoma is the name applied by Vawter and Tefft to congenital tumors of the parotid gland. These tumors are highly uncommon, and they must not be confused with malignant tumors--i.e., cylindroma, embryonal carcinoma, or teratoma. Alone, complete surgical exeresis is necessary without radiation or chemotherapy. Two observations of embryoma are reported because of the diagnostic and therapeutic problems involved.
Four cases of Malignant Synovioma of the head and neck are reported. It is a rare tumour with only 76 published cases in the world literature. Study of these 76 cases allows identification of the clinical features of this tumour and also highlights the problems of histological diagnosis. The study shows that the most effective treatment is radical primary surgery in association with post-operative radiotherapy and chemotherapy.
The immunoperoxidase localization of epithelial antigen (keratin, epithelial membrane antigen) was identified in 18 cases of sarcomatoid carcinomas localized in the upper aero-digestive tract. These tumors are an association of a differentiated squamous cell carcinomatous component and of spindle, or pleomorphic cells component. The anti-keratin monoclonal antibody KL1 stained the sarcomatoid component in 4 cases. A continuous staining between differentiated squamous cells and spindle cells in observed in two cases. The identification of cytokeratin is better with KL1 than with the polyclonal anti-keratin antiserum KT. The monoclonal antibody HMFG2 is not retained. These results suggest the dedifferentiation of epithelial cells in sarcomatoid component. They confirm the heterogeneity of these tumors, which has been previously found in ultrastructural studies. These immunostaining are helpful in recognizing sarcomatoid carcinoma, when they are only represented by the sarcomatoid component.
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A total of 102 cases of undifferentiated carcinoma of nasopharyngeal type (UCNT) were reviewed to attempt their classification into histologic forms of different prognosis. Each slide reviewed was evaluated for predominant tumoral tissue architecture, and the quality, amount and topography of the stroma. Immunoperoxidase studies in 80 cases allowed definition of the immunologic profile of the lymphoplasmocytic stroma. For equivalent clinical stages, the different histologic types are defined as a function of the architecture: cordonal or diffuse, compact or fragmented; these forms, when combined with cytologic characteristics and quality of stroma distinguished 3 microscopic groups of different evolution. The fragmented diffuse forms appear to have the best prognosis (85.5% survival at 5 years), the compact cordonal forms the worse prognosis (13.2% survival at 5 years): the intermediate or diffuse compact forms were of fair prognosis (42.8% survival at 5 years). Application of histology to determine prognosis of UCNT should allow future adaptation of treatment (radiotherapy and/or chemotherapy) to each case.
The authors report on 19 cases of Inverted Papilloma collected over ten years at the Institut Gustave-Roussy. The Inverted Papillomas are rare tumors affecting predominantly adult males. This slow progressing tumor is usually revealed by unilateral nasal obstruction (68%). Its loco-regional extension is best appreciated by radiologic and tomodensitometric scanning. After limited surgical resection, the tumor may either recur (11 out of 19 cases) or show malignant evolution (9 out of 19 cases). Histopathologic criterias of this latter possibility are discussed. A radical surgical treatment such as paralateronasal rhinotomy may prevent the malignant transformation of this benign tumor.
The role in tumor spread and the prognostic value of metastasis in a prelaryngeal node were investigated in 124 cases of laryngeal and hypopharyngeal carcinoma selected from about 900 total laryngectomies and pharyngolaryngectomies. Metastasis in a prelaryngeal node was noted in 26 cases: 22 without capsular rupture (N+) and 4 with capsular rupture (N+R+). Vascular embolism (E+) was never noted. Patients with a metastatic prelaryngeal node had a tumor of the piriform sinus in 13 cases (50%), a transglottic tumor in 6, glotto-subglottic in 3, glottic in 2 and supraglottic in 2. They also more frequently had involvement of the cervical nodes (81%) and of the thyroid gland. The 5-year survival in these patients is very poor: only 3 patients (11.5%) were alive and free of disease. These data demonstrate the role of prelaryngeal nodes in tumors that affect the hypopharynx and the antero-inferior portion of the larynx and that directly reach this node through the anterior lymphatic peduncle.
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To evaluate the usefulness of immunocytochemistry in the differential diagnosis of nasopharyngeal tumours, 35 undifferentiated nasal carcinomas were examined with a panel of monoclonal antibodies against a wide variety of epithelial and non-epithelial antigens. The results were compared with those obtained from a series of nasopharyngeal tumours comprising three squamous cell carcinomas, six lymphomas, one rhabdomyosarcoma, and one yolk sac tumour. All of the carcinomas were positive with at least one of the antiepithelial markers and negative for the leucocyte common antigen and were clearly distinguishable from the nasopharyngeal lymphomas, which gave the opposite staining pattern. It was concluded that such a panel of monoclonal antibodies would be extremely useful for the differential diagnosis of nasopharyngeal tumours, particularly with small or technically inadequate biopsies.
A patient with a nasal chondroma and Ollier's disease treated at the Institut Gustave-Roussy, Villejuif, had a long past medical history of over 10 years, starting with a nasal lesion diagnosed as a myxoma. Follow up clinical and radiologic examinations failed to detect recurrences. The discovery, ten years after excision of tumor, of multiple skeletal enchondromas raised the hypothesis of Ollier's disease, this being responsible for the myxoid chondroma of the nasal cavities. A past medical history of surgery to the left lower limb presenting a valgus deformity, and of a left suborbital angioma treated by curietherapy confirmed the diagnosis of Ollier's disease and suggested that of a Maffuci syndrome. Prognosis of the disease is dominated by the risk of onset of chondrosarcoma.
Cytochemical reactions were examined in lymph node imprints from a group of 53 previously untreated patients with histologically proven Hodgkin's disease. In 40 of 51 cases investigated, Reed-Sternberg (R-S) cells, irrespective of the cytologic appearances and the histologic types, showed moderate to strong reactions with acid phosphatase (ACP). In 12 cases ACP activity was present in more than 25% of the R-S cells. The reaction consisted of formation of small- to medium-sized granules, which were located close to the nuclei on a diffusely positive background or irregularly distributed throughout the cytoplasm. In three cases, a coarse granular reaction product with periodic acid-Schiff was present. R-S cells were positive to the naphthol-AS acetate esterase and beta-glucuronidase reactions in four and two cases, respectively. Alkaline phosphatase and naphthol-AS-D-chloroacetate esterase reactions were completely negative. Our results have revealed a pattern of staining in the diagnostic R-S cells similar to that in its morphologic variants; this supports the view that these cells may derive from a common primitive cell. Moreover, the quality and quantity of the ACP reaction product shows that R-S cells differ from both neoplastic histiocytes of malignant histiocytosis and neoplastic lymphocytes of T-cell lymphomas. This study confirms that R-S cells lack definite cytochemical characteristics of each of supposed progenitor cells: histiocytes and T-lymphocytes.
Seventy-six North African patients (most from Algeria) affected with nasopharyngeal carcinoma (NPC) have been studied for their HLA-A, -B, and -DR phenotypes and compared with a control North African population. Antigens HLA-A3, HLA-B5 and HLA-Bw15 were found more frequently in the NPC group than in the control group (30.3% vs 17.6%, 38.2% vs 24.4% and 9.2% vs 0.8%, respectively). HLA-Aw33, HLA-B14 and HLA-DR4 were less frequent in the patients than in the controls (3.9% vs 16.8%, 1.3% vs 16% and 13.2% vs 29.1%, respectively). After correction for the number of specificities tested, these differences were not statistically significant. They were, however, more striking when compared to normal Kabyles (Algerian Berbers), a major ethnical population in Algeria, with lower incidences of the HLA-B5 antigen and of the HLA-Aw33-B14 haplotype. This could suggest, in North Africa, either the existence of MHC-linked genes of resistance or susceptibility to NPC, in Berbers especially, or a preferential occurrence of NPC in non-Berbers. Antibody titers against the Epstein-Barr virus (EBV) associated early antigen (EA) and viral capsid antigen (VCA) have been measured. No correlation was observed between HLA phenotypes and the anti-EBV serological response of the patients.
Advanced ulcerating and infiltration tumors are commonly found in the hypopharynx, whereas early well-defined lesions are rarely diagnosed. The pathologic reports of 242 uniformly studied surgical specimens after total pharyngolaryngectomy for cancer of the hypopharynx were reviewed. The histologic analysis of 26 cancers (10.7%), which were recorded as having an entire or predominant superficial type of spreading, demonstrated that also in the hypopharynx a "superficial extending carcinoma" (SEC) may occur. SEC of hypopharynx was pathologically defined as a poorly or moderately differentiated squamous cell carcinoma, generally located in the pyriform sinus, which spreads superficially. It was limited to the mucosa (2.9%), but more frequently early infiltrated the underlying muscle or gland structures (6.2%), regardless of the presence of lymph node metastases or lymph vessels invasion. Although the concept that SEC of the hypopharynx may be an expression of a generalized disease of the mucosa must be carefully considered in surgical management, it appeared that this carcinoma in its "pure" intramucosal form may be associated with a good prognosis and a long survival.
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Few pathologists have given much thought to the problem of post-chemotherapeutic tumoral regression of upper respiratory and digestive tract carcinoma. In other oncological fields (pediatry: nephroblastoma, embryonic sarcoma, osteosarcoma; gynecology: mammary tumors...) pre- and post-chemotherapy tissue studies have led to histological grading of prognostic value (particularly well known is that of Rosen et al). Numerous specimens were examined following operations for cancer, including pelvimandibulectomy, buccopharyngectomy, facial resection... Possible tumoral changes were evaluated using a conventional scale of regression based on 6 histologic degrees, and findings were of prognostic significance when compared with the initial biopsy results. This evaluation scale may require modification in the near future since recently introduced chemotherapy, particularly cisplatinum, appears to have a more potent and more specific effect on histologie features.
Isolated cervical lymph node metastases from undifferentiated carcinoma of nasopharyngeal type (UCNT) or lymphoepithelioma (LE) pathologically may be mistaken for malignant lymphomas. The case histories of four patients in whom metastatic UCNT in lymph nodes pathologically simulated Hodgkin's disease (HD) and other non epithelial malignancies are reported. Initial lymph node biopsies showed a cellular and architectural context suggestive of HD in three cases. "Lacunar" cells were seen associated with fibrosis and numerous eosinophils in Case 1; cells indistinguishable from diagnostic Reed-Sternberg cells were recognized in Case 4. Case 3 showed some additional features suggestive of malignant histiocytosis. Subsequent biopsies revealed a primary UCNT of the nasopharynx (Case 1) and typical UCNT lymph node metastases (Cases 3 and 4). In Case 2, an immunoblastic lymphoma and a spindle cell sarcoma, respectively, were mimicked by consecutive lymph node metastases. A primary UCNT of palatine tonsil was found five years later. This report emphasizes that deceptive features of metastatic UCNT in lymph nodes may produce serious difficulties in the correct recognition of the tumor on pure histologic grounds. In order to minimize the possibility of misdiagnosis, additional cytochemical, immunohistochemical and serologic studies should be considered, especially when a young patient presents with spinal or infraclavicular lymphadenopathies and no lesion is evident in the nasopharynx.