Primary low-grade B-cell lymphoma of the mucosa-associated lymphoid tissue arising in the gallbladder.
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Biomedical subjects
Publications and source records attributed to F Potet.
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The authors report a new case of primary renin-secreting renal carcinoma in a pregnant woman. The clinical, radiological and pathological findings mimicked an oncocytoma and the diagnosis was confirmed by immunohistochemical study.
The occurrence of elastic tissue abnormalities in the digestive tract is not common. There are sometimes observed in genetically transmitted connective tissue diseases in which numerous systemic complications are associated as in Ehlers-Danlos and in Grönblad-Strandberg syndromes. We report 7 cases of an unusual lesion localized in the colon in which abnormally increased amounts of elastic tissue were observed. This elastosis raises many nosological and diagnostic difficulties. We propose the term "colonic elastoma" to describe this lesion. The review of the literature allows to consider several etiopathogenetic possibilities.
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A 41-year-old woman with a myelodysplastic syndrome complained of diarrhea with malabsorption and protein-losing enteropathy after splenectomy. No cause was found and various therapeutic regimens were not effective. Pathological examination of biopsies from stomach, small intestine, and large bowel showed infiltrations interpreted as inflammatory on routine technics. Blast cell infiltration was found on electron microscopy. Treatment by citarabine induced normalization of leukocytosis, and diarrhea disappeared. Six months after the onset of illness, she developed acute myeloblastic leukemia and died of infectious pneumonia. Blastic infiltration of the lamina propria could be responsible for the determinism of symptoms, because of the lack of another etiology, the intensity of the blastic infiltration and the effect of cytotoxic therapy, even in the absence of new biopsies.
Adenocarcinoma of the esophagus is a well-known complication of Barrett's esophagus. This report describes five patients (three men and two women) with Barrett's esophagus and squamous carcinoma of the esophagus. All patients had hiatal hernia, and three had a history of tobacco and alcohol use. The tumors were located in the Barrett's mucosa in one case, at the squamocolumnar junction in two cases, and in the squamous-lined mucosa above the Barrett's mucosa in two cases. One patient also had focal adenocarcinoma associated with the squamous carcinoma of the esophagus. Review of the literature identified 11 previously reported cases. Occurrence of esophageal squamous carcinoma in Barrett's esophagus patients suggests a possible relationship between these two conditions, and the need for a careful evaluation of the squamous esophageal mucosa and the squamocolumnar junction at the time of endoscopy.
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We report 3 cases of poorly differentiated tumors of the small bowel with histological, immunohistochemical, and ultrastructural studies. The patients were male, aged 45, 57, and 63. In all 3 cases, histological features of spindle cell, epithelioid cell and giant cell areas favoured a diagnosis of carcinoma, although a malignant stromal tumor could not be firmly excluded. Immunohistochemistry demonstrated in the 3 cases a strong expression of both "epithelial" (cytokeratin) and "stromal" (vimentin) markers; one tumor expressed the epithelial membrane antigen, and another one desmin. Electron microscopy showed no specific features in one case. The case positive for desmin demonstrated intracytoplasmic lumina, allowing the diagnosis of carcinoma. In spite of a non-specific immunohistochemical pattern, we finally considered these 3 tumors as of epithelial origin, corresponding to the rare and recently described pleomorphic carcinoma of the small bowel. This report emphasizes the difficult diagnosis of some poorly differentiated tumors, particularly in the gastro-intestinal tract. Such problems had until recently been resolved by ultrastructural and mostly by immunohistochemical studies. However, an increasing number of reports, together with our 3 cases, show unexpected reactivity of tumors with theoretically specific immunoreactions, such as those directed against intermediate filaments. Coexpression of intermediate filaments could be due to cross reactivity of molecules bearing common epitopes, or to the presence of different filaments in the same cell type; recent immunoblotting studies favour this latter hypothesis.
A case of Fabry's disease in a renal transplant recipient with a follow-up period of 11 years is reported. The patient suffered from renal, skin, peripheral nerve lesions, and asymptomatic cardiomegaly. Fabry's disease symptoms disappeared after transplantation. Improvement of renal function was rapidly observed, and it remained satisfactory during the whole posttransplantation period. The patient died of a severe, uncontrolled infection and of biliary peritonitis. Autopsy showed a polyvisceral accumulation of sphingolipids deposits. The engrafted kidney was histologically free of disease. Ultrastructurally, it revealed numerous sphingolipid inclusions in the endothelial cells of capillaries. The explanation of this complication could be attributed to: (1) high circulating levels of plasma substrates locally overwhelming the enzymatic capability of the graft endothelial cells; and (2) the endothelial cells originated from the recipient but not from the donor, an occurrence that has been described after transplantation. Rejection and the newly formed deposits in the endothelial cells may lead to the loss of the engrafted organ. As a consequence of the increasing possibility of organ transplantation, this complication should be detected by studying the blood vessels ultrastructurally in order to evaluate the condition of the transplant.
Lymphocytic gastritis is a form of gastric inflammation characterised by a pronounced increase in lymphocytes in gastric surface and foveolar epithelium. Lymphocytic gastritis is often associated with endoscopic evidence of 'varioliform gastritis'. Lymphocytic gastritis has recently been reported to be associated with other forms of hypertrophic gastropathies. We present a case of hypertrophic gastropathy with gastric adenocarcinoma, with both Menetrier's disease and lymphocyte gastritis. Immunohistochemical studies showed that the intraepithelial lymphocytes were predominantly alpha/beta T cells as in the normal stomach and not gamma/delta T cells as in coeliac sprue. This case together with the six recently published cases suggests that Menetrier's disease and lymphocytic gastritis may be part of the same disease spectrum.
Only a few reports have established the importance of chronic gastritis and Helicobacter pylori infection in Africa. The aim of this study was to ascertain the prevalence of chronic gastritis and Helicobacter pylori infection in a symptomatic population in Abidjan, Côte-d'Ivoire. The study included 277 consecutive patients referred for gastroscopy. Two hundred nine patients complained of abdominal pain without gastroduodenal ulcer or cancer: 26 had a duodenal ulcer, 23 had a gastric ulcer, and 6 had gastric cancer. The remaining 14 patients underwent gastroscopy for various other reasons. Chronic gastritis was present in 89 percent of cases, of which 96 percent showed signs of activity. There were four cases of lymphocytic gastritis. Patients with antral chronic gastritis were older (39.43 +/- 14.3 years) than those with normal antral mucosa (33.7 +/- 12 years, P less than 0.05). Helicobacter pylori was present in 91.3 percent of cases, representing all patients with active chronic gastritis, and 60 percent of the patients with normal gastric mucosa. Chronic gastritis was present in 86 percent of patients with abdominal pain, in 100 percent of those with duodenal of gastric ulcer, and Helicobacter pylori were observed in 90, 100, and 91 percent of the same patient groups, respectively. This study demonstrates the high prevalence of chronic gastritis and the very high level of Helicobacter pylori infection in Ivorian patients complaining of various gastrointestinal symptoms. The usefulness and feasibility of therapeutic trials still have to be investigated.
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This report describes adenocarcinoma in patients with Barrett's esophagus (BE) and adenocarcinoma of the esophagogastric junction (EGJ) and the gastric cardia. Definitions, frequency, and general features of both conditions are described. The macroscopic features and microscopic findings are detailed for invasive adenocarcinoma and superficial (early) adenocarcinoma. Prognosis and follow-up are evaluated using flow cytometry as a factor of prognosis. Precancerous conditions and etiological factors are discussed. In addition, primary adenocarcinoma of the lower esophagus not associated with BE is considered. The precancerous lesions and precancerous markers in BE and in the cardia are examined, including type of dysplasia, histochemical study, and other lines of research.
We report the diagnostic, prognostic and therapeutic features of non-Hodgkin's lymphoma in eight patients in whom the disease was seen as a primary tumor of the liver. This series illustrates the variety of situations in which lymphoma might be diagnosed: (a) abdominal pain and hepatomegaly (three cases), (b) incidental finding at evaluation of a patient with cirrhosis (two cases), (c) secondary neoplasm after treatment for Hodgkin's disease (one case) and (d) complication of AIDS (two cases). In most cases, clinical and/or radiological features were nonspecific. However, the combination of the following features must be considered as suggestive: occurrence of an apparently primary hepatic tumor in an immunocompromised patient, absence of the usual serum tumor markers and increased serum lactic dehydrogenase activity. The final diagnosis was based on histological examination of specimens obtained by ultrasonically guided liver biopsies or at surgery. All cases belonged to unfavorable histological subtypes. Immunohistochemical findings on paraffin-embedded sections demonstrated the B-lymphocyte lineage of the seven tumors available for study. In the three patients without coexisting disease, complete remission was obtained by surgery alone or combined with chemotherapy. In the two patients with coexisting cirrhosis, outcome was rapidly unfavorable, with death occurring less than 3 mo after diagnosis. Among the three immunocompromised patients, two experienced a rapid unfavorable outcome, and the remaining one was in complete remission after surgery and chemotherapy. In conclusion, primary non-Hodgkin's lymphoma of the liver arising in patients without coexisting disease has a slow progression and might be successfully treated by surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Superficial adenocarcinoma of the oesophagus is defined as carcinoma limited to the mucosa or submucosa regardless of lymph node status. Columnar epithelium lined lower oesophagus, now generally referred to as Barrett's oesophagus, is probably the main cause of adenocarcinoma in the lower oesophagus. Twelve cases of superficial adenocarcinoma arising in Barrett's oesophagus are presented. They were observed over a 6 year period and taken from a series of 50 cases of patients with Barrett's oesophagus and adenocarcinoma, a prevalence of 24%. Endoscopic diagnosis of malignancy was made in six patients. The initial biopsies showed an adenocarcinoma in six patients and some degrees of dysplasia in the other six patients. Prior to surgery, a histological diagnosis of adenocarcinoma was made in all twelve patients. In four patients the adenocarcinoma was confined to the mucosa, and in eight it extended to the submucosa. One patient had a metastatic lymph node. Ten patients are alive without evidence of tumour spread after a mean follow-up of 30 months.