Biomedical subjects
Publications and source records attributed to J Amouroux.
A case of sarcoidosis with iterative spontaneous increase and decrease of thoracic lymphadenopathy is described. No condition such as infectious disease, particular environmental exposure or medication could explain this unusual course of thoracic sarcoidosis.
In 1980 was described for the first time a disease which seemed unknown until then. From that time three cases have been published. The current study summarizes their common characteristic, combining joint involvements to nodular-type involvements to systemic involvement, i.e. a specific histology. This entity has been named fibroblastic rheumatism. Nosologically, it is situated between juvenile fibroblastoses without joint involvement and with nodules, and adult sclerodermis with joint and systemic involvement without nodules.
A 32-year-old patient with a history of surgery for left gynecomastia four years previously presented with right gynecomastia; a tumor in the left testis proved to be a Leydig cell tumor. Preoperative investigations showed elevated but variable levels of plasma estradiol (E2) and estrone (E1), and reduced serum LH and FSH and plasma testosterone (T). After hCG stimulation, E2 response was increased and abnormally prolonged; T reached normal values, which has predictive value for a return to normal of post-operative T level. After left orchiectomy, gynecomastia regressed within a few days, gonadotropins increased by day 2, estrogens dropped by day 2 and were normal at day 7, T and 5 alpha-dihydrotestosterone dropped at day 2 but reached normal levels at day 16. Pathophysiology of these hormonal data are discussed. An incubation procedure with 3H testosterone showed an aromatase activity 21 times greater in the tumor than in normal peritumoral tissue, while the percentage of the volume occupied by Leydig cells was 34 times higher. This suggests that the aromatase activity of a single tumor cell is very similar to that of a normal Leydig cell. Furthermore, evidence of juxtatumoral Leydig cell hyperplasia in areas where the tumor was well encapsulated suggests the existence of a factor stimulating Leydig cell multiplication.
Two patients, aged 32 and 35 years, presented with gynaecomastia and a unilateral testicular tumour which proved to be a Leydig cell tumour. Pre-operative samples taken at 08.00 h on different days showed marked elevation of plasma oestradiol in the first patient, and very slight irregular oestradiol elevation in the second, plasma oestrone within the normal range in both patients, reduced plasma testosterone in the first patient and reduced or normal testosterone in the second, and low or low-normal serum LH and FSH in both patients. One of the patients received an oral dose of 100 mg of clomiphene citrate for 3 consecutive days which induced a rise in LH and FSH and a decrease in the 17-hydroxyprogesterone/androstenedione ratio. These data suggest the inhibiting effect of endogenous hyperoestrogenism on testicular steroidogenesis owing to both the reduction of gonadotropin secretion and a direct local negative effect on C 17,20-lyase. After human chorionic gonadotropin stimulation, oestradiol response was increased and abnormally prolonged, a finding which may be helpful when diagnosing a feminizing Leydig cell tumour; testosterone reached normal values. After removal of the tumoural testis, gynaecomastia regressed within a few days, gonadotropins increased, oestrogens dropped, testosterone and 5 alpha-dihydrotestosterone normalized in one patient but remained low in the other at day 30. The Leydig cells outside the tumour appeared morphologically normal, but the count gave evidence of juxtatumoural Leydig cell hyperplasia in areas where the tumour was well encapsulated while showing a significant reduction at a distance from the tumour and in the contralateral testis by comparison with control testes.(ABSTRACT TRUNCATED AT 250 WORDS)
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The pulmonary manifestations of varicella are observed more frequently in adults than in children. They make present according to 3 modes: acute, subacute or chronic. The authors report 2 cases of chronic pulmonary manifestations in the form of diffuse, partially calcified micronodular lesions of both lung fields observed in the course of varicella in adults.
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The authors present the case of a hypertensive patient with a thrombosis of a saccular microaneurysm (SMA) and underlying cerebral (pontine) lacunae. This SMA lay at the junction between the main vessel and two small feeding arteries penetrating into the necrotic territory. Microhemorrhages were observed in and outside the aneurysmal wall. Very sinuous narrow channels of recanalization crossed the thrombosis between the upstream and downstream vessels. The anatomical relationship between the SMA and the lacunae has been histologically demonstrated.
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Myocardial failure may complicate hyperthyroidism. Some authors consider that preexisting myocardial lesions are necessary for its development. We studied a case of myocardial failure, presenting as a dilated cardiomyopathy, complicating hyperthyroidism in a 57 year old woman. She had a bio-clinical evaluation and a haemodynamic study with endomyocardial biopsy of the left ventricule. No valvular or coronary disease were noted. The light and ultra-microscopic aspects of the myocardium were within normal limits. We conclude that preexisting myocardial lesions are not essential to the development of myocardial failure complicating hyperthyroidism.
14 cases of mammary hamartomas are reported. The WHO describes the mammary hamartoma, as a pseudo-tumor made of ducts and lobules, with fibrosis or adipose connective tissue. The mammogram consists in a well circumscribed tumor generally surrounded by a defined zone of less attenuation. Surgically, the hamartoma can usually be enucleated. Microscopy reveals lobules always but inconstant adipose tissue. Confrontation between gross and histologic features are necessary for the diagnosis. The embryologic development of the mammary gland could help to explain the origin of such a lesion, malformative rather than tumorous.
Two cases of lymphoid interstitial pneumonia, diagnosed according to Liebow's criteria, are reported. In both cases an extra-thoracic lymphoma developed 3 and 6 years respectively after the interstitial pneumonia was diagnosed. Simultaneously, the radiological images of the lungs became more pronounced. Only a few similar cases have been published. This raises the question of whether lymphoid interstitial pneumonia and lymphomas are distinct entities, especially since the histological and immunopathological discriminating criteria seem to be discussed.
Squamous cell lung carcinomas from 10 untreated patients were examined for the state of the oncogene c-myc. Blot hybridization experiments have demonstrated the amplification of the oncogene of about six fold in only one tumor. The oncogene amplification was not detected in normal tissues of patients. The analysis of RNA by Northern blot revealed the presence in the seven tumors examined of a 2.4 kb c-myc RNA band. The level of c-myc expression evaluated by dot blot analysis was 5 to 14 fold greater in tumors than that of histologically normal lung of the same patients.
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A 59 year-old male developed the nephrotic syndrome in the course of squamous-cell lung carcinoma with metastases. Renal biopsy disclosed amyloid deposits. Immunofluorescence was positive with an anti-SAA antiserum. Amyloidosis complicates exceptionally lung tumors, despite extremely high serum levels of SAA in this type of malignancy. This infrequency shows that determinants other than high SAA serum levels are necessary to create tissue amyloid deposits.
The authors report a case of combined mesenteric and retroperitoneal fibrosis resulting in vascular and digestive compressions. Diagnosis was established by laparoscopy and biopsy. No etiologic factors were found. Such an association is exceptional and suggests that the disease is systemic. The possibility of fibrosis arising far from the mesenterium (mediastinum, extrahepatic biliary tract, thyroid, orbit) has led some authors to suggest that this condition be termed Idiopathic Systemic Fibrosis. An immunologic origin has been speculated in the literature.