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Background Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may even worsen. The aim of the present study was to identify possible predictors of functional failure after VMR. Methods Data of all consecutive patients who had VMR for the treatment of rectal prolapse and/or obstructed defecation between January 2017 and December 2020 in three different pelvic floor surgical centres in Italy were analysed to identify possible predictors of functional failure, intended as persistence, worsening or new onset of constipation or faecal incontinence. Symptom severity was assessed pre- and postoperatively with the Wexner Constipation score and Obstructed Defecation Syndrome score. Quality of life was assessed, also before and after treatment, with the Patients Assessment of Constipation Quality of Life questionnaire, the Pelvic Floor Disability Index and the Pelvic Floor Impact Questionnaire. Faecal incontinence was evaluated with the Cleveland Clinic Incontinence Score. The functional outcomes before and after surgery were compared. Results Sixty-one patients were included (M:F ratio 3:60, median age 64 years [range 33–88 years]). Forty-two patients (68.9%) had obstructed defecation syndrome, 12(19.7%) had faecal incontinence and 7 patients (11.5%) had both. A statistically significant reduction between pre- and postoperative Obstructed Defecation Syndrome and Wexner scores was reported (p p = 0.004 and p p = 0.034) may reduce the risk of postoperative constipation. Conclusions VMR is a safe and effective intervention for correcting the anatomical defect of rectal prolapse. The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. Postoperative rehabilitation treatment may reduce this risk.

Purpose To prospectively assess the clinical impact of expert review of lymphoma diagnosis in France. Materials and Methods From January 2010 to December 2013, 42,145 samples from patients with newly diagnosed or suspected lymphomas were reviewed, according to the 2008 WHO classification, in real time by experts through the Lymphopath Network. Changes in diagnosis between referral and expert review were classified as major or minor according to their potential impact on patient care. Results The 42,145 reviewed samples comprised 36,920 newly diagnosed mature lymphomas, 321 precursor lymphoid neoplasms, 314 myeloid disorders, and 200 nonhematopoietic neoplasms, with 4,390 benign lesions. There were 4,352 cutaneous and 32,568 noncutaneous lymphomas. The most common mature noncutaneous lymphomas were diffuse large B-cell lymphomas (32.4%), follicular lymphomas (15.3%), classic Hodgkin lymphomas (13%), peripheral T-cell lymphomas (6.3%) of which angioimmunoblastic T-cell lymphomas (2.3%) were the most frequent, and mucosa-associated lymphoid tissue lymphomas (5.8%). A diagnostic change between referral and expert review occurred in 19.7% of patients, with an estimated impact on patient care for 17.4% of patients. This rate was significantly higher for patients sent with a provisional diagnosis seeking expert second opinion (37.8%) than for patients sent with a formal diagnosis (3.7%). The most frequent discrepancies were misclassifications in lymphoma subtype (41.3%), with 12.3% being misclassifications among small B-cell lymphoma entities. Fewer than 2% of changes were between benign and malignant lymphoid conditions. Minor changes (2.3%) mostly consisted of follicular lymphoma misgrading and diffuse large B-cell lymphoma subtype misclassification. Conclusion To our knowledge, this study provides the largest ever description of the distribution of lymphoma entities in a western country and highlights how expert review significantly contributes to a precise lymphoma diagnosis and optimal clinical management in a proportion of patients.

Background Our aim was to evaluate whether the cell of origin (COO) as defined by the Hans algorithm and MYC/BCL2 coexpression, which are the two main biological risk factors in elderly patients treated with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone (R-CHOP), maintain their prognostic value in a large prospective clinical trial. Patients and methods We evaluated 285 paraffin-embedded samples from patients (60–80years of age) enrolled in the Lymphoma Study Association trial LNH03-6B who were treated with R-CHOP. We correlated the COO defined by the transcriptome according to the Wright algorithm with that defined by the Hans algorithm in a subset of 62 tumors with available frozen tissue samples. Results The non-germinal center B-cell-like phenotype according to the Hans algorithm and BCL2 expression (but not MYC and BCL2 coexpression) predicted worse progression-free survival [hazard ratio (HR)=1.78, P = 0.003 and HR = 1.79, P = 0.003, respectively] and overall survival (HR = 1.85, P = 0.005 and HR = 1.67, P = 0.02, respectively) independently of the International Prognostic Index. The correlation between the Hans algorithm and the Wright algorithm was 91%, with an almost perfect concordance according to a kappa test (0.81). Conclusions Our results suggest that immunohistochemically defined COO remains a useful tool for predicting prognosis in diffuse large B-cell lymphoma when performed under optimized standardized conditions and that BCL2 expression may help to identify elderly patients at risk for relapse and who could potentially respond to anti-BCL2 targeted agents. In this prospective phase III trial, the coexpression of MYC and BCL2 does not appear to predict worse survival. Clinical trial Number NCT00144755

Resume Introduction Le lymphome a grandes cellules B intravasculaire est une proliferation de cellules tumorales aboutissant a l’occlusion de la lumiere des petits vaisseaux. Il s’agit d’une hemopathie maligne rare et de diagnostic difficile en raison d’une presentation clinique polymorphe. Observation Nous rapportons ici l’observation d’un patient atteint d’un lymphome intravasculaire revele par un syndrome d’activation macrophagique. Cette association est tres souvent marquee par une plus grande severite clinique et impose une prise en charge therapeutique precoce et adaptee. Conclusion En raison du caractere polymorphe et de la presentation systemique du lymphome a grandes cellules B intravasculaire, l’interniste peut etre confronte a cette pathologie, plus grave encore lorsqu’elle s’associe a un syndrome d’activation macrophagique. Il faut donc savoir l’evoquer d’autant que le pronostic depend de la rapidite de la prise en charge avec notamment la mise en route precoce d’une polychimiotherapie associee au rituximab.

Background Plasmablastic lymphoma (PBL), initially described in 1997 in the oral cavity of HIV positive patients, is now recognized as a distinct aggressive and rare entity of diffuse large B-cells lymphoma by the World Health Organization (WHO) classification. Since the original description, others cases have been reported. However, these are largely derived from case reports or small series limiting any definitive conclusions on clinical characteristics and outcome. Patients and methods The clinical, biological, pathological features and outcome of a cohort including 135 patients with PBL, from LYSA centers in France and Belgium, were reported and analyzed. Results The median age was 58 years, with a male predominance. The cohort was divided into 56 HIV-positive patients, 17 post-transplant patients and 62 HIV-negative/non-transplanted patients. Within HIV-negative/non-transplanted, a relative immunosuppression was found in most cases (systemic inflammatory disease, history of cancer, increased age associated with weakened immune system). We have also described a new subtype, PBL arising in a chronic localized inflammatory site, without any sign of immunosuppression. At presentation, 19% of patients showed oral involvement. Immunophenotype showed CD138 positivity in 88% of cases and CD20 negativity in 90% of cases. Chemotherapy was administered to 80% of patients, with a complete response (CR) rate of 55%. The median overall survival (OS) was 32 months. In univariate analysis, HIV positive status showed better OS when compared with HIV negative status. In multivariate analysis, International Prognostic Index score, chemotherapy and CR were associated with survival benefit. Conclusion(s) This cohort, the largest reported to date, increases the spectrum of knowledge on PBL, rarely described. However, specific guidelines to clarify treatment are lacking, and may improve the poor prognosis of this rare disease.

Introduction L’infection par le virus de l’immunodeficience humaine (VIH) touche pres de 30 millions d’individus au monde. Non controlee elle mene au syndrome d’immunodeficience acquise (sida). L’emergence des antiretroviraux (ARV) depuis les annees 1990 a transforme le pronostic de cette infection. Des cas d’amylose, notamment de type AA et AL, sont decrits precocement dans cette population. Notre objectif etait de decrire leur type, la relation aux infections opportunistes et au degre d’immunodepression. Patients et methodes Une revue de la litterature des cas publies entre 1947 et 2018 a ete realisee ainsi qu’une etude retrospective des cas francais repertories via le Centre national de reference des amyloses inflammatoires. Resultats Vingt-trois cas ont ete inclus dont 20 de la litterature internationale et 3 nouveaux cas francais. Il s’agissait d’amyloses AA (n = 12), AL (n = 8) et non typees (n = 3). Le diagnostic d’infection VIH etait anterieur ou concomitant a celui de l’amylose. Pour les amyloses AA (n = 12) il y avait 3 hommes pour 1 femme et un âge median de 35 ans (extremes [28–75 ans]). La presentation initiale etait ; un syndrome nephrotique (n = 11) et une atteinte digestive. Le delai median entre les diagnostics d’infection VIH et celui d’amylose etait de 6 ans. Quarante pour cent des patients etaient sous ARV bien suivi, avec un taux de CD4 3 moyen de 86/mm3 et cinq patients classes stade sida du Centers for Disease Control (CDC). Une infection chronique etait retrouvee chez un tiers des cas. Il n’existait pas d’autre cause d’amylose AA retrouve. Pour les cas d’amylose AL (n = 8), il y avait 5 hommes pour 3 femmes avec un âge median au diagnostic de 49 ans (extremes [19–60 ans]). Les formes locales constituaient 75 % des cas avec une atteinte ORL (n = 3), digestive (n = 2) ou vulvaire (n = 1). La decouverte etait fortuite pour les formes buccales et vulvaires, liee a une dysphonie pour une amylose laryngee et de signes digestifs dans les cas d’amylose intestinale (diarrhee chroniques isolee et tableau sub-occlusif avec rectorragies). Les deux cas avec atteinte digestive etaient associes a une gammapathie monoclonale. L’infection VIH etait pour 60 % des cas controlee et un seul cas etait stade sida. Les lesions intrabuccales (n = 2) ont ete spontanement resolutives, sous antiretroviraux la forme laryngee est restee stable de meme que la forme vulvaire. Trois amyloses non typees ont ete decrites, une amylose cardiaque dont la presentation clinique evoque une amylose a transthyretine mutee et deux formes mediastino-pulmonaires. Discussion Cette etude constitue la plus grande serie ecrivant des cas d’amylose associee au VIH. Elle montre une majorite d’amylose AA avec comme revelation une atteinte renale chez des patients dont l’infection VIH est non controlee. Dans 2/3 des cas la seule infection chronique est celle liee au VIH qui pourrait constituer une cause d’amylose AA. Des etudes appuient ces donnees dont une montrant l’augmentation du taux de la proteine serum amyloide A (SAA) chez les patients VIH [1] . Parmi les amyloses AL, il y a une predominance des formes localisees ce qui suggere une proliferation locale lymphoplasmocytaire. La localisation frequente a la sphere ORL fait discuter le role d’une co-infection par l’Epstein-Barr virus. Conclusion Des amyloses peuvent compliquer une infection par le VIH de type AA plus frequemment. La survenue d’un syndrome nephrotique chez un patient VIH peut reveler une amylose AA qui constitue une cause rare de glomerulopathie au cours du VIH. Un examen clinique buccal regulier doit etre realise chez ces patients afin de depister l’apparition de lesions amyloides localisees souvent asymptomatiques.

Resume Le lymphome nasal T/NK est une entite clinicopathologique aujourd'hui bien reconnue. Elle etait anciennement denommee : granulome malin centrofacial. Depuis les progres de l'anatomie pathologique et l'arrivee de l'immunohistochimie en pratique courante, le diagnostic de lymphome nasal T/NK a pu etre reconnu par l'OMS en 2001. Ce lymphome provoque une destruction centrofaciale debutant par la cavite nasale. L'evolution est spontanement fatale. Son principal diagnostic differentiel est la maladie de Wegener. L'imagerie comprend le scanner des sinus de la face et l'imagerie par resonance magnetique. Elle permet de faire le bilan precis des destructions. Le traitement repose sur la radiotherapie et la chimiotherapie. Leurs modalites sont discutees au cas par cas. Le pronostic reste globalement mauvais.

Background Data are still conflicting on the indication of front-line autologous stem-cell transplantation (ASCT) as consolidation for aggressive lymphoma. To assess the therapeutic effect of ASCT among different aggressive lymphoma subtypes, we conducted a matched-control analysis by pooling the data from two Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Patients and methods Between October 1987 and September 1998, 330 patients received ASCT after achieving complete remission with the ACBVP induction regimen. The histological slides showed: B aggressive non-Hodgkin's lymphoma (B-NHL) in 249 patients (75%), T-NHL in 52 patients (15%) (including 23 T anaplastic) and non-classified NHL in 29 patients. The age-adjusted International Prognostic Index (aaIPI) was 2 or 3 in 66%. Patients were matched with controls from the same GELA database but treated with chemotherapy only. Results ASCT did not benefit non-anaplastic T-NHL patients [5-year overall survival (OS) 44% (chemotherapy) versus 49% (ASCT), P=0.87; disease-free survival (DFS) 38% versus 45%, P=0.89] in comparison with B-NHL [5-year OS 77% (chemotherapy) versus 79% (ASCT), P=0.64; DFS 67% versus 72%, P=0.13]. However, for B-NHL patients with aaIPI score 2 or 3, the benefit of ASCT was significant. Conclusions This cohort study confirms the high efficacy of front-line ASCT in responding aggressive B-NHL patients with adverse prognostic factors.

Purpose Improved survival has been observed in aggressive non-Hodgkin's lymphoma (NHL) patients with adverse prognostic factors when autotransplantation (ASCT) was performed after complete remission. However, there is no agreement on the prognostic factors for patients treated with ASCT. We aimed to estimate the prognostic effect of clinical and biologic variables on relapse and survival rates by pooling the data from two trials. Patients and Methods Of the patients treated in the LNH87 and LNH93 trials, 330 under age 60 years achieved complete remission after high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone, and received consolidative ASCT; 16% of patients had T-cell NHL. The International Prognostic Index (IPI) score was 0 for 11%, 1 for 23%, 2 for 51%, and 3 for 15%. Univariate and Cox multivariate survival analyses were retrospectively performed on this population. Results Overall survival was 75 ± 5% at 5 years and disease-free survival (DFS) 67 ± 5%. For T-cell NHL, these scores were 54% and 44%, respectively. The IPI score had no prognostic value and only the following parameters adversely affected overall survival and DFS (P < .05): marrow involvement; more than one extranodal site; histology (nonanaplastic T-cell v others); and type of anthracycline (mitoxantrone v doxorubicin, for DFS only). Conclusion These results suggest that ASCT can prevent relapse in patients with adverse IPI factors. However, patients presenting with a nonanaplastic T-cell phenotype, more than one extranodal site, or marrow involvement still have a higher risk of relapse. These factors should be taken into account when designing post-ASCT maintenance studies.

Introduction Une femme de 78 ans d’origine caucasienne, etait adressee pour le diagnostic etiologique d’une amylose digestive sans atteinte renale. Ses antecedents medicaux comportaient une hypertension arterielle, d’une fibrillation auriculaire paroxystique et de l’arthrose des genoux. Elle n’avait aucun antecedent familial. Elle prenait du paracetamol pour des douleurs des hanches attribuees a l’arthrose. Depuis 18 mois, elle se plaignait d’asthenie, d’anorexie, d’amaigrissement (5 kgs) et de diarrhee. Elle avait ete exploree en nephrologie pour « d’oedemes » des membres inferieurs et diarrhee chronique. Observation Les premieres explorations sanguines avaient revele une anemie a 10,5 g/dL, aregenerative, microcytaires (VGM 78) et une elevation de la CRP a 50 mg/L. Il n’y avait dans un premier temps, aucune explication evidente pour les oedemes des membres inferieurs : fonctions hepatique et renale normales, absence de proteinurie. L’echocardiographie n’avait pas revele de dysfonctionnement cardiaque. Afin d’expliquer l’alteration de l’etat general, un scanner thoraco-abdomino-pelvien avait ete realise montrant plusieurs adenopathies profondes et peripheriques. Un 18-FDG Pet scanner montrait une adenopathie axillaire hypermetabolique de 2 cm de diametre qui avait ete biopsiee, revelant une inflammation aspecifique. A cause de la diarrhee et l’anorexie, des endoscopies digestives ont ete effectuees. L’aspect macroscopique etait normal mais une biopsie duodenale systematique a revele la presence de depots perivasculaires colores par le rouge congo, donc amyloides. Ces depots n’avaient pas ete types. La premiere hypothese etait amylose AL en raison de l’alteration de l’etat general chez une femme âgee avec anemie, syndrome inflammatoire ainsi que polyadenopathie, mais elle n’avait pas d’argument biologique pour une hemopathie et il n’y avait pas de gammapathie monoclonale. Une biopsie de moelle osseuse n’avait retrouve ni hemopathie ni amylose. La deuxieme hypothese etait l’amylose AA a cause du syndrome inflammatoire et l’anemie. Mais il n’y avait pas d’atteinte renale et elle n’avait pas de maladie inflammatoire chronique sous-jacente connue. Le typage de l’amylose duodenale par immunohistochimie a montre qu’il s’agissait en fait d’une amylose AA. A l’examen clinique de la patiente, nous avons ete frappes par ses poignets qui etaient gonfles. Parmi les causes les plus frequentes d’amylose AA de la femme caucasienne d’âge mur, figure au premier plan la polyarthrite rhumatoide, nous l’avons donc interroge sur ses douleurs. Elle a admis avoir des douleurs chroniques de poignets quotidiens et d’horaire inflammatoire ainsi que des douleurs cervicales depuis quelques annees, mais avait estime qu’il etait de l’arthrose, qu’elle soignait par automedication avec du paracetamol tous les jours. Les radiographies des poignets et des mains ont montre une carpite severe bilaterale et l’atteinte de toutes les metacarpophalangiennes et des articulations interphalangiennes proximales. Une IRM cervicale a montre une inflammation C1-C2 avec panniculite de l’odontoide. Un taux tres eleve d’anticorps anti-CCP ainsi que du facteur rhumatoide a permis de poser le diagnostic de polyarthrite rhumatoide. Les œdemes des jambes etaient en fait un du lymphoedeme chronique. Elle a ete traitee par corticotherapie a faible dose (10 mg/jour) rapidement diminuee associe a du methotrexate (15 mg/semaine) et du tocilizumab (anticorps anti-IL-6) pour l’amylose AA associee. Son etat clinique s’est ameliore de facon spectaculaire et le syndrome inflammatoire a disparu moins d’une semaine apres l’introduction du tocilizumab. Conclusion Il s’agit donc d’une presentation tres rare d’une maladie frequente la polyarthrite rhumatoide, revelee par une amylose AA digestive. La presence d’adenopathies multiples dans la polyarthrite rhumatoide et l’absence d’atteinte renale dans une amylose AA sont des situations rares. A noter que l’amylose AA peut se developper sur plusieurs annees avant l’apparition des symptomes qui sont pour la plupart aspecifique. C’est pourquoi nous pensons que la coloration par le rouge Congo sur des echantillons de biopsie doit etre faite dans un grand nombre de situations. Ce cas illustre egalement l’utilite d’avoir des pathologistes experimentes, dans le typage de l’amylose car c’est indispensable pour le diagnostic etiologique et le traitement. La cle du diagnostic etait egalement l’inspection clinique car c’est le gonflement des poignets qui nous a tout de suite fait evoquer le diagnostic de polyarthrite rhumatoide apres pres de 2 ans d’errance diagnostique.

Introduction Les localisations digestives de lymphoproliferations indolentes T (LPI-T) decrites en 2000 par Ranheim et al., sont caracterisees par une colite recurrente, un infiltrat lymphoide T fait de cellules de taille moyenne, un index de proliferation bas et une evolution indolente (a la difference des lymphomes). Nous rapportons un cas avec atteinte buccale et digestive mimant une maladie de Crohn, d’evolution favorable sous traitement par cyclophosphamide. Observations Un homme ne en 1978, sans antecedent de maladie cœliaque, presentait depuis 2007 des ulcerations du palais et des gencives, tres invalidantes, entrainant une perte de poids. En 2008 douleurs abdominales et diarrhee revelaient une pan-colite, dont l’histologie consideree comme une colite ulcereuse conduisait a un traitement par adalimumab et mezalazine sans efficacite. Une nouvelle biopsie buccale realisee en 2014 et la relecture des lames de biopsie digestive et buccales anterieures mettaient en evidence un infiltrat T lymphocytaire fait de cellules monotones, de taille moyenne, CD2+, CD3+, CD5+, CD8+, TiA1+, granzyme B faible, CD56−, hybridation in situ EBER− avec une perte antigenique du CD7, un index de proliferation inferieur a 20 %, un clone T faisant porter le diagnostic de LPI-T. Le bilan ne montrait aucune autre localisation. Le patient etait traite par cyclophosphamide (150 mg/jour) avec une efficacite remarquable : disparition de la symptomatologie buccale et digestive, reprise de poids. Discussion La plus grande serie de LPI-T digestive rapportee dans la litterature comporte 10 cas avec une predominance masculine, un âge moyen au diagnostic de 48 ans, une atteinte predominante du colon et de l’intestin grele, un infiltrat fait de lymphocytes de taille moyenne le plus souvent CD8+ avec un index de proliferation bas, un clone T, et une evolution indolente. L’association a des ulcerations buccales est frequente (3/10 cas) et peut preceder l’atteinte digestive (13 ans dans un cas). Dans cette serie, aucune autre localisation de lymphome n’a ete decrite et sur les 38 mois de suivi moyen, aucune transformation en lymphome de haut grade n’a ete observee. L’errance diagnostique par meconnaissance a conduit a des traitements inadaptes (5 patients consideres comme des lymphomes agressifs et traites par polychimiotherapies, 2 patients ont eu des resections chirurgicales digestives, dont un une colectomie, pour un diagnostic de colite ulcereuse). Conclusion Des ulcerations buccales peuvent reveler une lymphoproliferation T indolente et preceder l’atteinte digestive. Ce tableau ne doit pas etre confondu avec une maladie de Crohn ou un lymphome agressif. Dans notre cas, le cyclophosphamide (150 mg/J) a entraine une disparition des lesions et une amelioration spectaculaire de l’etat general du patient.

Background Diffuse large B-cell lymphomas (DLBCLs) arising in specific extranodal sites have peculiar clinicopathologic features. Patients and methods We analyzed a cohort of 187 primary Waldeyer's ring (WR) DLBCLs retrieved from GELA protocols using anthracyclin-based polychemotherapy. Results Most patients (92%) had stage I–II disease. A germinal center B-cell-like (GCB) immunophenotype was observed in 61%, and BCL2 expression in 55%, of WR DLBCLs. BCL2, BCL6, IRF4 and MYC breakpoints were observed in, respectively, 3 of 42 (7%), 9 of 36 (25%), 2 of 26 (8%) and 4 of 40 (10%) contributive cases. A variable follicular pattern was evidenced in 30 of 68 (44%) large biopsy specimens. The 5-year progression-free survival (PFS) and the overall survival (OS) of 153 WR DLBCL patients with survival information were 69.5% and 77.8%, respectively. The GCB immunophenotype correlated with a better OS (P = 0.0015), while BCL2 expression predicted a worse OS (P = 0.037), an effect overcome by the GCB/non-GCB classification. Compared with matched nodal DLBCLs, WR DLBCLs with no age-adjusted international prognostic index factor disclosed a better 5-year PFS rate (77.5% versus 70.7%; P = 0.03). Conclusions WR DLBCLs display distinct clinicopathologic features compared with conventional DLBCLs, with usual localized-stage disease, common follicular features and a high frequency of GCB immunophenotype contrasting with a low rate of BCL2 rearrangements. In addition, they seem to be associated with a better outcome than their nodal counterpart.

Intravascular large B cell lymphoma is a neoplastic cell proliferation leading to the occlusion of the lumen of small vessels. This is a rare haematological malignancy, which is difficult to diagnose because of a heterogeneous clinical presentation.We report a 62-year-old man who presented a macrophage activation syndrome as the presenting manifestation of an intravascular lymphoma. This association is frequently marked by a greater severity and clinical care requires an early and appropriate treatment.Due to the polymorphism and the systemic presentation of intravascular large B cell lymphoma, the internist may be confronted with this disease, which is considered to be more severe if associated with a macrophage activation syndrome. Awareness of the intravascular large B cell lymphoma is important because the prognosis depends on the rapidity of the initiation of chemotherapy associated with rituximab.

Purpose The utility of [18F]fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET-CT) in assessing response at the end of induction therapy is well documented in Hodgkin's and diffuse large B-cell lymphomas, but its role in follicular lymphoma (FL) remains undetermined. We investigated the prognostic significance of PET-CT performed after first-line therapy in patients with FL treated in the prospective Primary Rituximab and Maintenance (PRIMA) study. Patients and Methods Results of PET-CT scans performed after induction immunochemotherapy were recorded retrospectively. Patients went on to either observation or rituximab maintenance per protocol independent of the PET-CT result. Patient characteristics and outcomes were then evaluated. Results Of 122 PET-CT scans performed at the end of the induction immunochemotherapy, 32 (26%) were reported as positive by the local investigator. Initial demographic or disease characteristics did not differ between PET-CT–positive (PET-positive) and PET-CT–negative (PET-negative) patients. PET status correlated with conventional response criteria (P < .001). Patients remaining PET positive had a significantly (P < .001) inferior progression-free survival at 42 months of 32.9% (95% CI, 17.2% to 49.5%) compared with 70.7% (95% CI, 59.3% to 79.4%) in those who became PET negative. PET status, but not conventional response (complete response or complete response unconfirmed v partial response) according to IWC 1999, was an independent predictive factor for lymphoma progression. The risk of death was also increased in PET-positive patients (hazard ratio 7.0; P = .0011). Conclusion [18F]FDG PET-CT status at the end of immunochemotherapy induction in patients with FL is strongly predictive of outcome and should be considered a meaningful clinical end point in future studies.

It has been suggested that liver allografts are less sensitive to lymphocytotoxic antibodies than other organ allografts. In this experimental study in sensitized inbred rat recipients, we have used extracorporeal liver hemoperfusion to study interactions between the liver and lymphocytotoxic antibodies. Donor-specific liver hemoperfusion can delay hyperacute rejection of heart allografts and reduce the level of lymphocytotoxic antibodies. Immunofluorescence examination of the hemoperfused liver revealed deposits of C3 on Kupffer cells and of IgG on sinusoidal cells. In control rats in which a third-party liver, a donor-specific splenic or renal hemoperfusion was performed, heart allograft survival was less prolonged. The decrease in antibody levels was not significant and the deposit of C3 and IgG was much less evident. Similarly, previous blockade of the Kupffer cells of the donor-specific hemoperfused liver by dextran sulfate suppressed the effect of liver hemoperfusion. These results support the hypothesis that resistance of the liver to hyperacute rejection might be due to a massive and nontoxic absorption of lymphocytotoxic antibodies onto nonparenchymal liver cells.

Essential tremor (ET) is the most common movement disorder and betablockers are still considered the first line of treatment. The aim of our study is to report the clinical response to long action propranolol (LAP) of 40 patients diagnosed with essential tremor with no previous treatment.40 patients with ET were evaluated with rating scales for severity of tremor and clinical classification of ET. All patients were evaluated at least twice, at enrollment and one month after starting treatment.thirty-six patients (90%) had type 2 ET and types 3 and 4 occurred in two patients each (10%). Familiar history was positive in 25 patients (62.5%). Mean age at first evaluation was 43.1 years and mean age at onset was 27.4 years. Of all patients, 33 (82.5%) had some degree of benefit and in 52.5 % this benefit was either good or excellent.LAP seems to be a good treatment option for ET in our series of 40 patients.

The presence of Epstein-Barr virus (EBV) was studied in 56 gastric carcinomas from Western patients by in-situ hybridization for EBV-encoded RNAs (EBER). EBV-positive and negative carcinomas were compared for various pathological parameters including p53 overexpression.EBERs transcripts were detected in seven cases overall: four cases of 52 conventional carcinomas (7. 7%) and three cases of four gastric carcinomas with lymphoid stroma (75%). EBER positivity was diffuse in five cases and restricted to a localized area of the tumour in two cases of conventional carcinoma. A monoclonal EBV genomic pattern was demonstrated in the case tested by Southern blot analysis. By immunohistochemical analysis, neither EBV latent or lytic cycle proteins nor C3d/EBV receptor were expressed by neoplastic cells. EBER positivity was significantly correlated with prominent lymphoid reaction (P = 0.0002) which was associated with numerous PS100-positive dendritic cells and with HLA-DR expression by tumour cells (P = 0.03). p53 immunoreactivity in more than 30% of tumour cells was detected in 25 out 49 EBV-negative cases and was absent in EBV-positive cases except in one case with focal EBER-positivity.Focal staining for EBER is an unusual finding in the setting of gastric carcinoma and these results suggest that there might be two types of EBV-associated gastric carcinoma in which the viral infection will play a different role. The presence of a stromal lymphoid reaction which is strongly correlated with EBV positivity, is associated with antigen-presenting ability by HLA-DR-positive tumour cells or abundant dendritic cells. The function of p53 appears preserved in all EBV-associated carcinomas except in one case with focal EBER expression whereas the immunohistochemical pattern of p53 is suggestive of a mutational phenomenon in 51% of EBV-negative cases.

A first case is reported from France of a subcutaneous and muscular tissues invasion by proliferative larval forms of Taenia crassiceps in an AIDS-patient with severe immunodeficiency. These larvae usually develop in rodents whereas the adult form of the cestode is commonly found in foxes. Authors emphasize the differential diagnosis from other human subcutaneous metacestodoses such as T. solium cysticercosis, cenurosis and hydatidosis. The proliferative aspect of the larvae, the recurrence of lesions after surgical removal and the possible invasion of other tissues are elements of a poor prognosis.

Interferons (IFNs) are important cytokines which exhibit antiviral, antitumor, anticellular, as well as immunoregulatory activities [1]. Among these multiple activities, IFNs are potent inducers of MHC antigen expression of a great variety of cells [2–4], helper and maturation factors in B-cell antibody production [5], and macrophage function [6]. IFNs may therefore play a critical role in triggering antigen recognition and allograft rejection.

Major histocompatibility complex (MHC) antigens play a major role in the rejection reaction and their increased expression may increase the host response to the foreign graft. Several clinical and experimental studies have demonstrated increased expression of MHC antigens on the different cell components of liver allografts during rejection. However modified expression of MHC antigens may also occur in certain liver diseases, after cholestasis or on a regenerating liver. In this experimental study in inbred rats, we compared the expression of MHC antigens on liver cells during rejection and non-immunological situations (cholestasis, cytolysis, regeneration).

Interferons (IFNs) are important cytokines which exhibit antiviral, antitumor, anticellular, as well as immunoregulatory activities. Among these multiple activities, IFNs are potent inducers of MHC antigen expression of a great variety of cells, helper and maturation factors in B-cell antibody production, and macrophage function. IFNs may therefore play a critical role in triggering antigen recognition and allograft rejection. Cyclosporin A (CyA) is a potent immunosuppressor which selectively inhibits helper T-lymphocyte proliferation in response to alloantigen presentation. CyA has been reported to inhibit interleukin 2 and IFNgamma production by helper T lymphocytes. In addition, CyA may induce monocyte production of prostaglandin E2, which then reduces MHC class II expression on endothelial cells, monocytes, and macrophages. However, the clinical use of CyA is plagued by its toxic (in particular nephrotoxic) side-effects. These toxic effects are clearly dose-related. It may be very important to develop new products which can act synergistically with CyA to inhibit lymphokine production. The aim of this study was to investigate the effects of combined IFN-specific antibodies and low dose CyA on cardiac allografts in inbred strains of rats.

Major histocompatibility complex (MHC) antigens play a major role in the rejection reaction and their increased expression may increase the host response to the foreign graft [1]. Several clinical [2–5] and experimental studies [6, 7] have demonstrated increased expression of MHC antigens on the different cell components of liver allografts during rejection. However modified expression of MHC antigens may also occur in certain liver diseases [8–10], after cholestasis [11] or on a regenerating liver [11]. In this experimental study in inbred rats, we compared the expression of MHC antigens on liver cells during rejection and non-immunological situations (cholestasis, cytolysis, regeneration).

Nephrogenic nephroma was individualized by A. Pagès in 1980 as a rare renal neoplasia that mainly occurs in adolescents and adults and presents a benign outcome. The tumor is composed of very small tubular, papillary, and glomeruloid structures. Immunohistochemistry and electron microscopy show that the tumor is a proliferation of primitive epithelial cells that mimic the embryonal nephron. This neoplastic entity has often been confused with a nephroblastoma, although it is a benign tumor that is cured by simple resection. Further studies are needed to define its exact incidence and its histogenesis.

The authors report the results of postmortem histopathological studies in 12 patients who had been treated by endoscopic obliteration of esophagogastric varices with Bucrylate (isobutyl-2-cyanoacrylate). All patients had cirrhosis; 11 patients were Pugh classe C. Eleven patients had esophageal injections. Acute esophageal lesions were characterized by ulcerations in obliterated varices and diffusion of Bucrylate into the esophageal wall. Chronic lesions were characterized by disappearance of varices and Bucrylate, extending fibrosis of the esophageal wall and re-epithelialization of the mucosa. In one patient who had received gastric injections only, non ulcerated Bucrylate filled gastric varices were seen. Bucrylate seems to have a dual action on esophageal varices: immediate obliteration and acute necrosis of the vascular endothelium. Necrosis causes diffusion of Bucrylate through the esophageal wall, and later, secondary fibrosis whereas the product is progressively eliminated into the esophageal lumen.

We analyzed 1432 smears in order to check if the usual methods of contraception influence the development of cervical lesions. Several observations have to be made. 1) Given the rarity of certain lesions, a much larger number of samples (x 50) should have been analyzed in order to obtain realistic statistical projections especially for dysplasias and cervical cancers. 2) Significant results could only be obtained when several morphological screening criteria were put together (ectropions, repairs or inflammation) provided that at least 10 cases/sample were observed in order to perform statistical analysis. Therefore, the rate of ectropions observed in a population without contreceptive treatment is 6% higher than in a population taking the pill (correlations coefficient 0.95) and more than 5% repairs are observed in a population using the IUD as compared to oral contraceptives. The rate of clean smears (class 1) and inflammatory smears (class 2 according to Papanicolaou) was found to be the same for all 3 populations studied. Comparing statistical data, it seems to be difficult to provide a correct answer about the influence of contraceptive methods on the development of cervical cancer. Indeed, our work and all other studies present the same difficulty in gathering sufficient samples which are qualitatively equivalent. Volume and present methodology of most of the anatomy and pathological cytology laboratories do not meet the requirements of statistical calculus. However, we think that smears should be routinely done on women taking the pill or wearing an IUD. That is not to say that contraception, regardless of method used, increases the risk of cancer or dysplasia, but that the smears represent a chance for screening and are thus considered preventive medicine. This would also enhance the physician's knowledge about precancerous lesions of the cervix and would, in the near future, boost the number of samples to allow for statistical analysis. (author's)

A joint prospective long term study of gastric biopsies has been undertaken to survey intestinal metaplasia Types I, II, and III in terms of their incidence, distribution and value in the selection of high risk cancer patients. This study is based on protocols agreed between three centres for endoscopy, histological interpretation, and mucin histochemistry. The results on the first 1350 gastric biopsies examined during 1981-1982 are presented. Intestinal metaplasia was found in 267 biopsies (20%), being common in association with carcinoma (71%), less so in benign conditions such as gastric ulcer (39%), and chronic gastritis (24%), but rare in 'normal' (3%). Type I intestinal metaplasia was predominant (73%) in all the biopsies with intestinal metaplasia and was most common in benign conditions, 70% in gastric ulcer and 76% in chronic gastritis. Type III intestinal metaplasia (incomplete sulphomucin-secreting intestinal metaplasia) was recorded in only 9.8% of all the biopsies with intestinal metaplasia and had a higher incidence in carcinoma (35%), than in benign conditions (7%) (p less than 0.0001). These results suggest that intestinal metaplasia types may have different malignant potential and their identification may be useful in screening patients for early detection of cancer.

Hemorrhage has never been described as a complication of gastric heterotopia of the gallbladder. A case of a heterotopic stomach perforated into the Calot's area and causing hematobilia by arteriobiliary fistula in a young man is described. The clinical presentation, radiologic features, operative and histologic findings are presented, as well as the mechanism of hematobilia and the probable embryologic cause. Extensive review of the literature indicates that this case is unique both in its presentation of hematobilia and by the pathologic configuration of the heterotopic gastric tissue.

Patients presenting genital intraepithelial neoplasia and/or flat condyloma were treated with DTrp6-LH-RH (triptorelin) to induce a transitory suppression of estrogens. This treatment led in some cases to a complete clinical and histological regression accompanied by a disappearance of human papillomavirus sequences as detected by molecular hybridization.