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Biomedical subjects

G Belleannée

Publications and source records attributed to G Belleannée.

At least 19 recordsLinked to original sources

Hepatic porphyrin concentration and uroporphyrinogen decarboxylase activity in hepatitis C virus infection.

Previous studies have shown a high prevalence of hepatitis C virus (HCV) infection in patients with porphyria cutanea tarda (PCT). The aim of this study was to assess hepatic porphyrin concentrations (HPC) and hepatic uroporphyrinogen decarboxylase (UROD) activity in HCV-infected patients free of PCT. Thirty-two HCV-infected patients (20 M, 12 F, mean age 51 years) and seven control patients (4 M, 3 F, mean age 59 years) free of liver disease, were studied. Knodell's score was determined on liver biopsy by two independent anatomopathologists. Measurement of HPC and hepatic UROD activity levels were carried out on liver biopsy. Relative to controls, HCV-infected patients had high HPC levels (mean +/- SD: 47 +/- 20 vs. 17 +/- 6 pmol/mg protein, P < 0.001) and low hepatic UROD activity levels (514 +/- 95 vs. 619 +/- 125 pmol Copro/h/mg protein, P < 0.05). HPC was not correlated with hepatic UROD activity and the increase was due to coproporphyrin accumulation. No correlation was observed between HPC or hepatic UROD activity values and HCV-RNA concentrations, Knodell's score, hepatic fibrosis, periportal necrosis, periportal inflammation or hepatic iron content in HCV-infected patients. Hepatocellular necrosis was significantly correlated with HPC value (P < 0.005). Hence, in HCV-infected patients, HPC is significantly increased and hepatic UROD activity is very slightly decreased as compared to controls. HPC values and UROD activity are not correlated with HCV-RNA concentrations, hepatic iron content and hepatic fibrosis. The small increase in HPC values in hepatitis C infection is linked with hepatic injury and not with a direct effect on hepatic UROD enzyme.

Adult↗

[Conservative treatment of adenocarcinomas of the anorectal junction by preoperative radiotherapy and intersphincteral resection].

AIM: Adenocarcinomas of the anorectal junction, especially T3 lesions, are usually treated by abdominoperineal resection. The aim of this study was to evaluate oncologic and functional results following conservative radiosurgical treatment of cancers of the anorectal junction. METHODS: From 1990 to 1999, among 395 patients with rectal carcinoma, 31 had sphincter-saving resection for a tumour located between 2 to 4.5 cm (mean 3.6) from the anal verge. There were 16 men and 15 women, mean age 62 years (range 30-86). There were 5 T2, 23 T3 and 3 T4 tumours; 17 were N1 and 3 were M1. Preoperative radiotherapy was performed in 26 patients (dose: 46 Gy, range: 36-54), with concomitant chemotherapy in 14 cases. Intersphincteric resection was performed six weeks after neoadjuvant treatment. Coloanal anastomoses were associated with a colonic pouch in 22 cases and with a protecting stoma in all cases. RESULTS: There was no postoperative mortality. Seven complications occurred: 3 anastomotic fistulas, 3 pelvic haemorrhages and 1 acute pancreatitis. Three patients had a definitive stoma. After preoperative radiotherapy, down-staging (pT0-2 N0) occurred in 46% of cases (12/26). Distal margin was 2.2 cm (range: 1-3) and was microscopically safe in all cases. Lateral margin was safe (> or = 1 mm) in 97% of cases. With a mean follow-up of 36 months, no local recurrence was suspected. Twenty-six patients (84%) were alive, 23 free of disease. Half of the patients had perfect continence, whereas the other half had occasional minor soiling. Functional results were better in patients with a colonic pouch. CONCLUSION: Conservative treatment of carcinomas of the anorectal junction is possible without compromising pelvic control and patient survival. Pelvic control was probably achieved by using preoperative radiotherapy with intersphincteric resection, ensuring safe distal and lateral margins.

Adenocarcinoma↗

Familial non-medullary thyroid carcinoma: pathology review in 27 affected cases from 13 French families.

BACKGROUND AND OBJECTIVES: When familial non-medullary thyroid cancer (FNMTC) develops with no obvious associated pathogenetic factor, an inherited predisposition may underlie the process. The present study was conducted because detailed pathological findings are lacking in most series of FNMTC. PATIENTS AND METHODS: Thirteen families comprising 27 cases of FNMTC were included (1.8% of differentiated thyroid carcinoma). The family relationship (20 F, 7 M; age 46 +/- 16 years; mean +/- SD) was 'siblings' in eight families, 'parent and child' in four and 'aunt and niece' in one. Careful pathological review of the thyroid tumours (papillary/follicular: 25/2, size: 16 +/- 11 mm) was performed. RESULTS: Initial staging according to extension was as follows: grade I (n = 16), II (n = 2), III (n = 6), IV (n = 3). Fourteen tumours were papillary microcarcinomas (size: 8 +/- 2 mm). No tumour phenotype that may be considered specific for FNMTC was found when considering either age, pathological findings or tumour aggressiveness. Although rare events were found in both relatives of some families suggesting a putative 'familial' phenotype of FNMTC, this may be fortuitous. CONCLUSION: Micro familial non-medullary thyroid cancers are more common than previously reported and further studies are required to be able to distinguish this subgroup from sporadic papillary microcarcinomas. The careful pathological review of the familial non-medullary thyroid cancer in this study does not seem to point to a distinct subgroup of familial differentiated thyroid carcinoma although the data are intriguing. Genetic studies are now required to investigate this issue.

Adult↗

[Clear cell adenoma of the parathyroid gland: a rare and misleading lesion].

Parathyroid adenomas are common lesions and are considered to be the cause of most of the primary hyperparathyroidism cases. We report the case of a 73 year-old man who presented with a primary hyperparathyroidism. Clinical and histological explorations revealed the presence of an isolated parathyroid tumor containing exclusively clear cells and devoid of malignancy. This is the second reported case of clear cell parathyroid adenoma. Thus, in spite of its low occurrence, this diagnosis must be considered after rejection of the most frequent parathyroid clear cell hyperplasia and parathyroid carcinoma, or depending of the location, clear cell thyroid tumor and clear cell renal carcinoma metastasis.

Adenoma↗

[Transthoracic aspiration. Evaluation of cytologic and histologic diagnosis in a pulmonary nodule by retrospective comparison of 2 series of 267 cytoaspirations and 292 coaxial needle aspirations].

Percutaneous fine-needle aspiration is a well established method for the diagnosis of peripheral lung lesion. In order to compare different methods of aspiration, we analyze retrospectively two different series: 267 fine needle aspirations (FNA) compared with the histological diagnosis on surgical specimens and 292 lung biopsies using a coaxial technique with comparison between cytological diagnosis--smears and imprints--and histological diagnosis simultaneously obtained on the same specimen. The sensitivity (91%), the specificity (90%) and the overall typing accuracy related to the histological types obtained by FNAB are equivalent to those of the literature. The low rate of pneumothorax in the series (6%) is related to the use of immediate interpretation of the specimen. Automated biopsy with a coaxial cutting needle provide cytological specimens--smears and imprint--with a high rate of sensibility (95.3%) and of sensibility (98%). The overall sensitivity of the cytological methods alone is better than biopsy (95.3% vs. 92.9%), but the typing accuracy is not as good as biopsy alone (98% vs. 100%). False-positive and false-negative diagnoses are the same in both series. In conclusion the percutaneous aspiration method choose to establish a morphological diagnosis in lung lesion depends now on the habits of the radiologist and the pathologist.

Biopsy, Needle↗

[Role of cytology and frozen sections in the intraoperative examination of the thyroid: comparison of two experiences].

Two experiences of peroperative diagnosis in thyroid surgery are reported. In Bordeaux (France), frozen sections are supplemented by touch smears. Imprints alone give results similar to frozen but are not suitable in differentiating follicular adenoma from carcinoma; they appear more accurate for recognising the follicular presentation of papillary carcinoma. Touch smear is a rapid cost-effective alternative to frozen section. In Brussels (Belgium), a more conventional attitude results in 185 frozen. A false negative ends in a follicular carcinoma. Eleven follicular proliferations will be signed out adenoma (8 cases) or carcinoma (3 cases) and three papillary carcinomas will only be detected after embedding. Six false negative derive from frozen section, no false positive is noted. An immediate change in the surgical procedure is justified twice. These observations argue for the free choice by the pathologist of the best technical procedure in peroperative diagnosis.

Adenoma↗

Low prevalence of monoclonal B cells in Helicobacter pylori gastritis patients with duodenal ulcer.

We have studied the prevalence of B-cell clonality among a large group of 320 patients with Helicobacter pylori gastritis and duodenal ulcer. These patients underwent endoscopic examination with multiple gastric biopsies at diagnosis and were followed 2 and 12 months after therapy. Histopathologic examination of 809 sets of biopsy specimens showed lymphoid gastritis with lymphoid aggregates or follicles, but without lymphoepithelial lesion, in 302 samples corresponding to initial biopsy specimens (n=130) or to posttreatment biopsy specimens (n=172). DNA extracted from fresh antral specimens allowed the amplification of Helicobacter pylori DNA in all cases before therapy. The arrangement of the immunoglobulin heavy chain gene was studied by polymerase chain reaction (PCR) in the 302 selected lymphoid gastritis samples. Single or dominant bands were seen only in four specimens from three patients (1.3%), whereas a polyclonal pattern was seen in the other 298 samples. The detection threshold of our PCR technique was approximately 3% of clonal B cells diluted in a polyclonal population. This threshold appeared to be a reliable cutoff between polyclonal gastritis and clonal MALT lymphoma. In our experience, Helicobacter pylori lymphoid gastritis appeared mainly as a benign polyclonal condition.

Adult↗

Axillary lymphadenectomy prepared by fat and lymph node suction in breast cancer.

AIMS: To describe a new technique of axillary dissection and evaluate the results. METHODS: Axillary lymphadenectomy prepared by fat and lymph node suction was performed on 43 patients with breast cancer and uninvolved axilla on physical examination. The mean follow-up was 18 months (range 12-27). After lipolysis and liposuction of the axilla, lymph node dissection was performed by axilloscopy in patients treated with conservative surgery. For patients undergoing modified radical mastectomy, a mastectomy with open axillary dissection was carried out. The axillary space was drained until less than 20 ml of lymphorrhea was being produced per day. Seventeen modified radical mastectomies (group M) and 26 lumpectomies (group L) were performed. RESULTS: No injury of muscles, vessels or nerves was observed. An average of 13.6 lymph nodes (8-31) were removed. In group L, the mean number of lymph nodes removed by liposuction, axilloscopy and control incision was 2.5, 5.4 and 4.2, respectively. In group M, the mean number of lymph nodes removed was 14. None of the 589 lymph nodes examined showed any pathological trauma. Fourteen patients (32%) had more than one histologically positive node. The mean quantity of lymphorrhea was 390 ml in group M and 275 ml in group L. The mean duration of drainage was 6 days in group M and 5 days in group L. Four patients had seromas which required punctures. Two patients had shoulder restriction (movements < 90 degrees) at 12 months. No arm oedema was seen. CONCLUSIONS: Axillary lymphadenectomy prepared by fat and lymph node suction is a reliable and effective procedure. However, it does not appear to be better than standard dissection as regards post-operative complications, except for arm oedema, but this must be confirmed by further studies.

Adult↗

[Borderline lesions of the thyroid: diagnostic strategy].

Some thyroid neoplasms notoriously cause problems in the histologic diagnosis of their nature (follicular versus papillary for example) or their malignant potential (adenoma versus carcinoma) because of overlapping histologic features. Here, thyroid lesions are presented according to their histologic presentation (vesicular, papillary, trabecular, solid or cystic patterns, fibrosing thyroids and lymphoid infiltrate). For each entity, the most discriminant histologic features are described with emphasis on the diagnostic pitfalls and their histological clues.

Adenoma↗

[Does axillary liposuction modify histologic study of excised lymph nodes?].

OBJECTIVE: To determine the pathological features of lymph nodes removed by axillary liposuction. METHODS: A prospective study of 34 axillary dissections performed from July 1995 to September 1996 in patients with breast cancer N0. After lipolysis, the fat was drained from the axillary cavity by means of liposuction (Karman nozzle ch.8; suction pressure of 1 Bar). The remaining nodes were removed by an endoscopic dissection in conservative treatments. The remaining nodes were removed during modified radical mastectomy in non-conservative treatments. Lymph nodes were fixed in formol and examined by the pathologist. RESULTS: An average of 15 lymph nodes (8-35) were removed. 502 lymph nodes were examined: 458 (91%) were not involved and 44 (9%) were involved, including 21 (4%) with rupture of the capsule. No pathological traumatism was seen. CONCLUSION: Axillary liposuction did not alter the pathological features of lymph nodes in our study.

Adult↗

Adenomatous hyperplasia in cirrhotic livers: histological evaluation, cellular density, and proliferative activity of 35 macronodular lesions in the cirrhotic explants of 10 adult French patients.

We examined 41 consecutive cirrhotic liver explants from French patients for the presence of nodules of adenomatous hyperplasia (AH) and then analyzed these lesions, together with underlying cirrhosis (C) and associated hepatocellular carcinoma (HCC), for various histological parameters, cellular density, and proliferative activity. Thirty-five AHs were identified in 10 livers (prevalence, 24%); seven of 10 were HCV positive. Hepatocellular carcinoma was more frequent in patients with AH than in patients without. The AHs consisted of 17 ordinary (OAH) and 18 atypical (AAH) adenomatous hyperplasia lesions. There was a malignant focus in five of the 18 AAHs. Wide areas of large liver cell dysplasia were frequent in OAH but never found in AAH. Obvious steatosis was frequent in HCC but exceptional in AAH and absent in OAH. There was a significant increase in cellular density in AAH and HCC as compared with C and OAH. Proliferative cell nuclear antigen immunostaining similarly showed an increase in proliferation from OAH or C to AAH and HCC. These data suggest that, in Europe as in Japan, one pathway of hepatocarcinogenesis is a multistep process in which AAH should be considered as a premalignant lesion very close to grade I HCC, while OAH seems to correspond to a regenerative nodule with limited proliferative ability.

Adenoma↗