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Lymph node metastasis is an important prognostic factor in prostate cancer (PC). The aim of this prospective study was to validate, through laparoscopic surgery, the accuracy of the isotopic sentinel lymph node (SLN) technique correlated with hyperextensive pelvic resection (extended pelvic lymphadenectomy dissection) in patients with localized PC, candidates for local curative treatment. Methods: A transrectal ultrasound-guided injection of 99mTc-sulfur rhenium colloid (0.3 mL/100 MBq) in each prostatic lobe was performed the day before surgery. Detection was performed intraoperatively with a laparoscopic probe, followed by extensive resection. SLN counts were performed in vivo and confirmed ex vivo. Histologic analysis was performed by hematoxylin-phloxine-safran staining, followed by immunohistochemistry if the SLN was free of metastasis. Results: Two hundred three patients with PC at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 96% (195/203). Thirty-five patients had lymph node metastases, 19 only in the SLN. The false-negative rate was 8.5% (3/35). Unilateral surgical SLN detection did not validate bilateral pelvic lymph node status, and extended pelvic lymphadenectomy dissection was necessary on the opposite side of detection to minimize the false-negative rate (2.8% [1/35]). A significant metastatic sentinel invasion in the common iliac region existed (9.3%) but was always associated with other metastatic node areas. The internal iliac region was the primary metastatic site (40.7%). Finally, this series invalidated any justification for a standard or limited dissection, which would have missed 51.9% and 74.1% of lymph node metastases, respectively. Conclusion: The radioisotope SLN identification method up to the common iliac region is successful to identify sentinel nodes during laparoscopic surgery per hemipelvis to be acceptably considered as an isolated procedure and should be validated for intermediate- and high-risk patients.

Resume Objectifs L’atteinte ganglionnaire metastatique est un facteur pronostique important dans le cancer de la prostate (PC). Le but de cette etude prospective etait d’evaluer la pertinence de la technique du ganglion sentinelle par voie laparoscopique dans la stadification locoregionale chez les patients avec PC cliniquement localise. Patients et methodes Une injection par voie transrectale echoguidee de 0,3 mL/100 MBq de 99mTc-sulfure de rhenium colloidal dans chaque lobe prostatique a ete realisee la veille de l’intervention. La radiodetection peroperatoire etait realisee avec une sonde laparoscopique (Clerad® Gamma Sup) suivie d’un curage extensif. Les comptages des GS etaient realises in vivo et confirmes ex vivo. L’analyse anatomopathologique etait realisee par hematoxyline-phloxine-safran et suivie d’un immunomarquage si GS indemnes. Resultats Soixante-dix patients ayant d’un cancer de la prostate a risque intermediaire ou eleve de metastases ganglionnaires ont ete inclus. Le taux de detection peroperatoire etait de 68/70 (97,0 %). Quatorze patients avaient des metastases ganglionnaires, six uniquement dans les GS. Le taux de faux-negatifs etait de 2/14 (14,0 %). La region iliaque interne etait le premier site metastatique (40,9 %). Une atteinte sentinelle metastatique de la region iliaque commune au-dela du croisement ureteral etait presente dans 18,2 %. Un curage limite ou standard aurait ignore respectivement 72,7 % et 59,0 % des metastases ganglionnaires. Conclusion La voie laparoscopique etait adaptee a un large reperage des GS et un curage cible de ces ganglions limitait significativement le risque chirurgical du curage etendu tout en maintenant la precision de l’information.

Resume Objectifs Le curage standard est actuellement remis en question dans la prise en charge du cancer de la prostate. Le but de cette etude prospective est d’evaluer les performances de la technique du ganglion sentinelle (GS) par cœlioscopie chez des patients porteurs d’un cancer localise de prostate candidats a un traitement local. Patients et methodes Les patients etaient injectes par voie transrectale echoguidee avec 0,3 mL/100MBq de 99 m Tc-sulfure de rhenium colloidal dans chaque lobe prostatique la veille de l’intervention. Une lymphoscintigraphie etait realisee deux heures apres. La radiodetection peroperatoire etait realisee avec une sonde cœlioscopique (Clerad ® Gamma Sup) suivie d’un curage extensif. Les comptages des GS etaient realises in vivo et confirmes ex vivo. L’analyse anatomopathologique etait realisee par HPS, suivie d’un immunomarquage si GS indemnes. Resultats Soixante-dix patients, porteurs d’un cancer de la prostate a risque intermediaire ou eleve de metastases ganglionnaires (D’Amico), PSA median 9,5 ng/mL [6–130] ont ete inclus dans l’etude. Le taux de detection lymphoscintigraphique a ete de 94,2 % (66/70) et peroperatoire de 97,0 % (68/70). Quatorze patients presentaient des metastases ganglionnaires, six uniquement dans les GS. Le taux de faux negatifs etait de 2/14 (14,0 %). La region iliaque interne est le premier site metastatique (40,9 %). Un curage limite ou standard aurait ignore respectivement 72,7 % et 59,0 % des metastases ganglionnaires. Conclusion La voie cœlioscopique est adaptee a un large reperage des GS et un curage cible de ces ganglions limiterait significativement le risque chirurgical du curage etendu tout en maintenant la precision de l’information.

Resume Objectifs Decrire et tester sur une serie de patients operes d’un cancer de la prostate et repondant aux criteres de surveillance active du SurAcaP, des signes IRM predictifs d’une tumeur significative. Patients et methodes Les dossiers de 681 patients consecutifs operes d’un cancer de la prostate entre 2002 et 2007 ont ete retrospectivement colliges. Tous les patients ont eu une IRM endorectale a 1,5 Tesla avec antenne pelvienne combinee (1,5 T er IRM PPA). Soixante et un patients (8,9 %) ont reuni les criteres du protocole SurAcaP. Les donnees preoperatoires ont ete comparees a l’analyse anatomopathologique de la piece de prostatectomie. Resultats 85,3 % des patients du groupe SurAcaP ont eu une tumeur significative sur la piece de prostatectomie totale (8,2 % de pT3, 39,2 % de score de Gleason > 6). Le signe T3IRM ± NSP > 1 a ete teste dans la recherche de ces tumeurs significatives (« T3IRM ± NSP >1 » = Extension extraprostatique a l’IRM et/ou plus d’un sextant atteint a l’IRM et/ou sur les biopsies). Les sensibilite, specificite, VPP, VPN du signe T3IRM ± NSP > 1 dans la detection d’une tumeur significative ont ete, respectivement : 77 %, 33 %, 86 %, 20 %. L’ajout de ce critere de selection permettrait d’obtenir un taux de pT3 nul, et un taux de score de Gleason superieur a 6 de 20 %. Conclusion L’IRM endorectale a 1,5 Tesla-PPA a eu un interet dans la selection des patients en vue d’une surveillance active. Le critere T3IRM ± NSP > 1 pourrait representer un critere d’exclusion en detectant les tumeurs significatives (pT3 et score de Gleason > 6).

Introduction Les femmes vivant avec le VIH (FvVIH) ont un taux d’acquisition de l’infection par un Papillomavirus , notamment a haut risque oncogene (HPVhr), superieur aux femmes VIH negatives ; le risque est accru de persistance virale, de lesions precancereuses et de cancers cervicaux. Les recommandations francaises preconisent un frottis cervico-uterin (FCU) annuel et une detection des HPVhr limitee aux cas d’atypies cellulaires indeterminees (ASCUS) au frottis. Le rythme et les modalites de ce depistage chez les FvVIH doivent s’appuyer sur des donnees observationnelles pour faire evoluer les pratiques. Materiels et methodes Cette etude monocentrique, observationnelle prospective a ete realisee chez les FvVIH suivies dans le service d’infectiologie. A chaque consultation gynecologique, les FvVIH beneficiaient sur un meme FCU d’un examen cytologique [classe comme non pathologique (NP), cellules squameuses atypiques (ASCUS) et lesions intraepitheliales de bas ou haut grade (L/HSIL/ASCH)] et d’une recherche de HPVhr. Resultats De septembre 2012 a janvier 2018, 363 FvVIH ont ete incluses dans l’etude : âge median 38 ans, 96 % sous ARV, mediane de CD4 : 568/mm 3 . A l’inclusion (V1), 29 % des FCU sont HPVhr+, la cytologie est NP pour 81 % des FCU (20 % HPVhr+), ASCUS pour 6 % (22 % HPVhr+) et L/ASCH/HSIL pour 13 % (89 % HPVhr+). En analyse multivariee, la consommation de tabac, un frottis pathologique, un taux plus faible de CD4 et une charge virale VIH plus elevee sont associes au risque d’etre HPVhr+. L’analyse semi-quantitative de la charge virale HPV rapportee au nombre de cellules cervicales a V1, montre une valeur significativement superieure dans les FCU P vs NP ( p −5 ). Cent quatorze femmes ont eu 3 FCU sur une duree mediane de 29 mois. Le taux d’acquisition de l’infection HPV entre V1 et V2 et entre V2 et V3 est respectivement de 5,4 % et 6,4 %, la clairance virale respectivement de 31 % et 44 %. Chez les 67 FvVIH suivies a V3, avecun FCU NP HPVhr− a V1, aucune n’a progresse vers des lesions cytologiques ≥ LSIL ; par contre, chez les 23 FvVIH avec un FCU NP HPVhr+ a V1, 12 ont presente une persistance virale a V3 (52 %), avec l’apparition de lesions cytologiques ≥ LSILpour 3 d’entre elles (13 %). Conclusion Apres un suivi de 29 mois, chez les FvVIH ayant un FCU NP HPVhr−, aucune anomalie cytologique n’est apparue alors que des lesions LSIL sont apparues chez 13 % des FvVIH en cas d’HPVhr+. Ces resultats sont en faveur d’un suivi personnalise des FvVIH sur la base d’un bilan initial associant le FCU et la recherche systematique d’HPVhr, ce qui permettrait de definir un rythme de suivi adapte au risque de progression des lesions.

Objectives Testicular metastases of prostate cancer are rare, usually clinically silent and present in the late stage of disease. We present the case of a patient with a solitary right testicular metastasis of a prostate cancer Gleason score 5 detected by 18 F Choline PET/CT, 16 yrs after total prostatectomy and 6 yrs after surgery of a left testicular metastasis. Material and methods A 80-year-old patient was directed to our department with a biochemically relapse of a prostate carcinoma. He had a laparoscopic prostatectomy in 2000, at age 65. Two 2 mm microcarcinomas of prostate cancer at the right base and apex and a left middle carcinoma of 8 mm were found. The Gleason score was 5. There was an extracapsular extension and the tumor was classified pT3a. Eight month after surgery the PSA was 0.08 ng/ml. In 2004 a rising PSA was observed, 0.48 ng/ml, and a salvage prostate bed radiotherapy was performed, with PSA nadir 0.24 ng/ml. The patient was then treated with intermittent hormonal therapy until July 2010, when he presented with a large left testicle. The PSA was 2.35 ng/ml. The ultrasonography found multiples left testicular nodules. Surgery was performed and histopathology confirmed a 6 × 4-cm testicular metastasis of the prostate carcinoma with extension to the rete testis and to the epididymis and with lymphatic emboli. Post-surgery the PSA dropped at 0.59 ng/ml and 10 months later it was 0.28, with a nadir of 0.21 in November 2011. The patient did not have additional treatment. A new biochemically relapse was diagnosed in March 2016, PSA 5.25 ng/ml, PSA DT 3.89 months, velocity 4.03 ng/ml/year, and the patient was addressed to our department. F Choline TEP/CT was performed after injection of 165 MBq 18 F Choline, 2.9 MBq/kg, with a dynamic phase of 10 minutes at the pelvis level, followed by an acquisition from the upper thigh to the base of skull. Results The 18 F Choline TEP/CT detected a high uptake on the right testicle, SUV max = 8, without other suspect lesions. Surgery was performed and the histology confirmed a new 4 cm testicular metastasis of the known prostate carcinoma. Post-surgery the PSA level was undetectable. Conclusion TEP F Choline is highly reliable in the detection of prostate carcinoma recurrence as in the case we present of a rarely solitary testicular metastasis of prostate cancer Gleason score 5. The testicles have to be well included on PET/CT field of view in order not to overlook such atypical metastases.

International audience; Aim In intermediate- or high-risk prostate cancer (PC) patients, to avoid extended pelvic lymph node dissection (ePLND), the updated Briganti nomogram is recommended with the cost of missing 1.5 % of patients with lymph node invasion (LNI). Is it possible to reduce the percentage of unexpected LNI patients (nomogram false negative)? We used the isotopic sentinel lymph node (SLN) technique systematically associated with laparoscopic ePLND to assess the potential value of isotopic SLN method to adress this point. Methods Two hundred and two consecutive patients had procedures with isotopic SLN detection associated with laparoscopic ePLND for high or intermediate risk of PC. The area under the curve (AUC) of the receiver operating characteristics (ROC) analysis was used to quantify the accuracy of different models as: the updated Brigantinomogram, the percentage of positive cores, and an equation of the best predictors of LNI. We tested the model cutoffs associated with an optimal negative predictive value (NPV) and the best cutoff associated with avoiding false negative SLN detection, in order to assist the clinician’s decision of when to spare ePLND. Results LNI was detected in 35 patients (17.2 %). Based on preoperative primary Gleason grade and percentage of positive cores, a bivariate model was built to calculate acombined score reflecting the risk of LNI. For the Briganti nomogram, the 5 % probability cutoff avoided ePLND in 53 % (108/202) of patients, missing three LNI patients (8.6 %), but all were detected by the SLN technique. For our bivariate model, the best cutoff was

Objectifs Le statut du ganglion sentinelle (GS) est pronostique du curage ganglionnaire loco-regional dans le cancer de la prostate mais ce statut a-t-il un impact sur l’evolution clinique des patients ? Le but de cette etude est d’analyser les donnees de survie de patients ayant beneficies d’une prostatectomie radicale cœlioscopique avec reperage des GS et curage pelvien extensif. Methodes De juin 2008 a decembre 2014, 227 patients consecutifs ont ete inclus, dont 49 patients (21,58 %) porteurs de metastases ganglionnaires. Le suivi median etait de 3,94 ans [3,72–4,23]. La survie sans recidive (SSR) et la survie globale (SG) ont ete analysees selon Kaplan–Meier et differents parametres histopathologiques par analyse uni- et multivariee (analyse par Cox regression). Resultats Une moyenne de 26,4 ± 10,5 ganglions retires lors du curage extensif, dont 5,72 ± 3,75 GS. Au dernier suivi, 24,9 % (62/227) des patients avaient recidive et 2 etaient decedes specifiquement du cancer prostatique. En analyse univariee, le stade clinique, le score de Gleason, le % biopsies positives et les marges chirurgicales affectaient significativement la SSR ( p −4 a 10 −6 ). En cas d’atteinte ganglionnaire metastatique, les donnees les plus significatives etaient le nombre total de ganglions metastatiques (GS et non GS) et la presence de macro-metastases ganglionnaires dans le GS ( p −12 a 10 −15 ). En analyse multivariee, la presence de micro- ou de macrometastases dans les GS (quelque soit l’atteinte non GS) etait le critere pronostique le plus pejoratif de la SSR, avec un hazard ratio de 5,25 [95 % CI : 2,83–9,74] ( p −6 ). Conclusion Le GS dans le cancer de la prostate localise semble etre porteur d’informations decisives de l’evolution clinique des patients puisqu’une atteinte metastatique GS a un impact important sur la SSR. Ceci souleve la question d’un traitement adjuvant plus precoce pour les patients avec atteinte metastatique des GS1.

The lymph node metastasis is an important prognostic factor in prostatic cancer. The aim of this prospective study was to evaluate the relevance of the sentinel lymph node biopsy by laparoscopy in staging locoregional patients with clinically localized PC.A transrectal ultrasound-guided injection by 0.3 mL/100 MBq (99m)Tc-sulfur rhenium colloid in each prostatic lobe was performed the day before surgery. The detection was realized intraoperatively with a laparoscopic probe (Clerad(®) Gamma Sup) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by hematoxyline-phloxine-safran staining and followed by immunochemistry if SLN is free.Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 68/70 (97%). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14%). The internal iliac region was the first metastatic site (40.9%). A metastatic sentinel node in common iliac region beyond the ureteral junction was present in 18.2%. A non-negligible sentinel metastatic region was the common iliac area (18.2%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59% of lymph node metastases.The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limited the risk of surgical extended dissection while maintaining the accuracy of the information.

NK and LAK cells which are able to lyse tumor target cells in an MHC-unrestricted manner are not equally effective against targets of the same nature. In the case of colorectal tumors, some cells are highly sensitive, whereas others are resistant to NK and can even be quite resistant to LAK-mediated lysis. In the present paper, we tried to correlate the stage of differentiation of 17 human colorectal tumor cell lines with their NK- or LAK-cell susceptibility. It was observed that NK cells killed colorectal target cells independently from their stage of differentiation defined according to histopathological criteria from xenografting in nude mice. NK susceptibility was not correlated either with in vitro-defined criteria of differentiation, such as cell polarity and morphology, brush-border enzyme expression and CEA production. A LAK-resistant HT-29 sub-line (HT-29 LAK) was selected which could not be distinguished from HT-29 in terms of features of differentiation. It was further observed that HT-29 Glc-/+ cell line, a highly differentiated enterocytic-like variant of HT-29, obtained after glucose starvation, was killed by LAK cells as efficiently as the moderately differentiated parental HT-29, and that Caco-2 cells, which differentiate spontaneously after confluence in standard culture conditions, were equally sensitive to NK-mediated lysis whatever their stage of differentiation. In contrast, HT29 MTX10(-5), a highly differentiated mucus-secreting variant of HT29 obtained by methotrexate selection, was much more resistant to LAK cells than parental HT29 cells.

Objectifs L’objectif de cette etude prospective est de tester 3 differents nomogrammes, Briganti [1] , Cagiannos [2] et Roach [3] et de developper un modele simple d’evaluation de la probabilite d’atteinte ganglionnaire metastatique pour des patients a risque intermediaire ou eleve traites par curage pelvien extensif et detection isotopique sentinelle. Methodes Au total, 202 patients consecutifs ont ete inclus. Une analyse multivariee a recherche un ou des facteurs predictifs d’une atteinte ganglionnaire metastatique (N+). L’exactitude des differents nomogrammes, parametres predictifs isoles et d’un modele combinant les parametres predictifs, a ete realisee par une analyse de l’aire sous les courbes Receiver Operating Characteristics (ROC). Nous avons determine, pour les meilleurs outils, les meilleurs seuils associes a la valeur predictive negative (VPN) optimale associee a une absence de faux negatifs en technique isotopique sentinelle pour aider le clinicien a decider de la realisation ou non du curage extensif. Resultats Trente-cinq patients N+ (17,2 %) et nombre median de 5 SLN retires [3–8]. Le premier chiffre de Gleason et le pourcentage de biopsies positives etaient des facteurs predictifs du statut ganglionnaire N+ conduisant a un modele predictif a 2 variables. Les meilleures exactitudes (courbes ROC) etaient de 81,39 et 81,80 % pour le nomogramme de Briganti1 et notre modele respectivement. Pour le nomogramme de Briganti1, le seuil avec la meilleure VPN etait Conclusion La technique du ganglion sentinelle permet de pallier « aux cas oublies » par le nomogramme de Briganti1 ou notre modele predictif avec un nombre limite de ganglions preleves (sentinelles).

To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French "SurAcaP" protocol.The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T erMR PPA). Sixty-one patients (8.9%) fulfilled "SurAcaP" protocol criteria. Preoperative data (MR+core biopsy) were assessed by comparison to whole-mount step section pathology.85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD)=8.2%, Gleason sum score6=39.2%). A new exclusion criterion has been assessed: T3MRI±NPS1 as a predictor tool of significant tumor. ("T3MRI±NPS1"=Non OCD at MR±number of positive sextants involved in tumor at MR and/or Core Biopsyto 1). Sensitivity, specificity, PPV, NPV of the criterion "T3MRI±NPS1" in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the "SurAcaP" protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score6 rates (20%).Endorectal MR at 1.5 Tesla with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called "T3MR±NSP1" may represent an exclusion citeria due to its ability to predict significant tumor.

Objectifs Etudier la faisabilite, la securite et l’efficacite de la prostatectomie totale laparoscopique (PT) de rattrapage de la recidive du cancer de prostate (CaP) apres traitement focal par phototherapie dynamique (VTP) ou HIFU avec Focal One. Methodes Cinq patients ont ete operes par PT pour recidive de cancer de prostate confirme par biopsie apres traitement focal (un VTP et 4 HIFU). La duree operatoire, les pertes sanguines, le taux de transfusion, la duree de sondage, les resultats fonctionnels, et les resultats oncologiques a court terme ont ete rapportes. Resultats L’âge median etait de 61 ans. Le PSA median avant traitement etait de 2,7 ng/mL (0,65–5,85). Le delai median entre le traitement focal et la PT etait de 11 mois. Le temps operatoire median etait de 120 min. La duree mediane d’hospitalisation etait de 9 jours, la duree mediane de sondage urinaire etait de 11 jours. Apres un suivi median de 8 mois, Le PSA postoperatoire etait indetectable et le stade etait pT2c pour tous les patients, le score de Gleason etait 3 + 3 et 3 + 4 pour 1 et 4 patients, respectivement. Un patient presentait une marge positive focale et aucun n’a eu de traitement adjuvant. A 6 mois, tous les patients etaient continents, pour les deux patients avec IIEF > 17 en preoperatoire, le score IIEF etait superieur a 17. Conclusion Dans notre experience, la PT laparoscopique est faisable, sure et efficace en traitement de rattrapage du traitement focal du cancer de prostate localise. Les resultats oncologiques et fonctionnels a court terme sont prometteurs, des etudes complementaires sont necessaires.

Objectifs Evaluer de facon prospective les resultats des biopsies prostatiques systematisees(BS) et dirigees(BD) apres fusion echo-IRM avec realisation d’une cartographie 3D complete des biopsies. Methodes De mars 2013 a fevrier 2014, 250 patients presentant une indication de biopsies prostatiques (PSA > 4 et/ou anomalie au toucher rectal) ont ete inclus prospectivement. Il s’agissait d’une premiere serie de biopsies dans 207 cas, d’une serie iterative dans 49 cas. Une IRM multiparametrique puis des biopsies selon le schema etendu de 12 biopsies completees par 4 biopsies anterieures ont ete realisees. En cas de lesion suspecte en IRM (score ≥ 3), 2 a 4 BD etaient realisees a la place des biopsies du secteur systematise correspondant. Toutes les biopsies ont ete realisees avec un guidage par la fusion echographie-IRM permettant la realisation d’une cartographie 3D. Resultats Les biopsies etaient positives dans 59,6 % des cas et 51,3 % en cas d’anomalie sur l’IRM. Le nombre moyen des biopsies positives etait de 4,8 par patient avec une longueur moyenne 7,3 mm pour la plus grande biopsie. Les biopsies dirigees etaient les plus grandes dans 69 % des cas et les seules positives chez 32 patients (17,3 %). Le taux moyen de BD positives etait de 49,6 % en cas de 1re serie et 57 % 2e ou 3e serie. Conclusion La realisation d’une cartographie 3D permettant la realisation de biopsies ciblees en cas d’anomalie a l’IRM, parallelement aux biopsies systematisees ameliore significativement la reconnaissance du cancer de la prostate, notamment en cas de premieres series negatives, et permet la mise en place des strategies de traitement focalise, par les donnees topographiques obtenues.

Objectifs Evaluer le traitement par HIFU focalise du cancer de prostate localise avec des lesions visualisees en IRM et des biopsies de prostate ciblees positives (procede de fusion echographie-IRM) apres 6 mois de suivi. Methodes Une etude prospective monocentrique a ete realisee de fevrier a mai 2014 avec pour criteres d’inclusion : stade T1c ou T2, PSA

Familial papillary thyroid carcinoma (PTC) is a well recognized disease. However, genetic predisposition to familial PTC is rare and the molecular alterations at the origin of the pathology are unknown. The association between PTC and lymphocytic thyroiditis (LT) has been reported recently. We communicate here 6 cases of PTC associated with LT in 2 unrelated families. PTC was diagnosed on classical nuclear and architectural criteria. It was bilateral in 5 cases. Architecture was equally distributed between typical PTC and its follicular variant. LT was present in variable degrees, including in 4 cases, oncocytic metaplasia. Using the RT-PCR technique, we observed a RET/PTC rearrangement in the carcinomatous areas of patients of both families: PTC1 in family 1 and PTC3 in family 2 and a RET/PTC rearrangement in non-malignant thyroid tissue with LT in family 2. The RET/PTC band was weaker or absent in pure LT areas. Furthermore, using a polyclonal ret antibody, an apical or a diffuse cytoplasmic ret onc protein immunolabelling was observed in the three patients with RET/PTC1 rearrangement and in the three patients with RET/PTC3 rearrangement. In conclusion our data: (1) show the presence of a RET/PTC 1 or 3 rearrangement (depending on the family) together with a variable expression of ret protein in all the PTCs; (2) suggest that the molecular event at the origin of the PTCs seems to be particular to each one of the studied families; and (3) confirm that the ret proto-oncogene activating rearrangement(s) is an early event in the thyroid tumorigenic process and that it can be observed in association with LT. © 2001 Cancer Research Campaign http://www.bjcancer.com

A retrospective study was conducted in a series of 86 patients (51 men and 35 women; mean age 63.4 years) treated from 1979 to 1995 for linitis plastica of the stomach (LP). The mean interval between the first manifestations and surgery was 3.5 months. The most frequent clinical sign was epigastric pain which occurred in 80.4% of cases. Biopsies were positive in 75.6% of cases. Typical features of LP were found in only 46% of esogastric barium enemas and 11.8% of upper gastrofiberscopic examinations. Seventy-four patients had surgical excision (51 total and 23 partial gastrectomies). There were 6 (7%) postoperative deaths and 10 (11.6%) surgical complications. Node involvement was found in 54 (72.9%) patients. Overall actuarial survival (n = 86) was 50% at 12 months, 40% at 18 months and 7.5% at 84 months. Survival did not depend on the delay in diagnosis, histological analysis of the extremities of the excised piece, associated tissue differentiation, node involvement or the type of surgical excision. The prognosis differed according to tumor height (P0.01) and involvement of the deep stomach wall (P0.001). No independent prognostic factor was found in multivariate analysis. Surgery remains the sole possibility for curative therapy in these patients.

The authors report a case of breast metastasis from a "tall cell" variant of papillary thyroid carcinoma in a 59-year-old woman. This metastasis was discovered two months after the diagnosis of an inextirpable thyroid tumor. Tall cell variant of papillary thyroid carcinoma is a sub-type of papillary carcinoma with an aggressive course and frequent metastases (in patients over 50 years of age). No mammary metastasis of this tumor type has been reported so far.

e14082 Background: Brain metastases associated with colorectal cancer are relatively rare, but a frequent cause of death. The aim of our study was to analyze brain metastases from colorectal tumor,...

The authors report 2 cases of fracture of the femoral neck in pregnant women. This is a serious complication of a poorly understood disease, algodystrophy of the hip during pregnancy (transient osteoporosis of the hip of pregnancy, as referred by Anglo-saxon practitioners), whose main clinical, paraclinical and course characteristics are reported. The risk of subcapital fracture is maximal during the period of term, justifying recumbency in painful forms. In spite of the phantom appearance of the femoral head and neck, this type of fractures should not be confused with tumoral osteolysis, since they always unite within usual intervals.

The authors make a retrospective study of a series of 57 patients aged 63 years in average, followed up from 1979 to 1989 for linitis plastica of the stomach. Surgical exeresis was performed in 49 patients (34 total gastrectomies and 15 partial gastrectomies, including five 2/3 gastrectomies, two 3/4 gastrectomies, four 4/5 gastrectomies and four upper polar esogastrectomies). The overall actuarial survival rate (n = 57) was 62.5% at 1 year, 40% at 2 years and 12.5% at 5 years. The prognosis did not vary with the delay of diagnosis, the invasion of the area of resection, the associated tissue differentiation and the invasion of lymph nodes. It did very according to the height of the tumor: 22% survival at 5 years for tumors under 6 cm, against 0% for tumors exceeding 6 cm (p0.001).

This observation has been previously reported as a multifocal and recidivant desmoid tumor. The first time, the patient was operated on for a desmoid tumor situated on his left thigh. He was reoperated on fourteen years later for a recurrent tumor implanted on the same place and a new one on the right arm. Recently bilateral pulmonary tumors were discovered. As far as this evolution was concerned, its exceptional pattern induced a new analysis of the microscopic data and the diagnosis of fibrohistiocytic sarcoma was established. This observation suggest to the authors some comments about the difficulty of diagnosis and therapy of such soft tissue tumors.

The pre-selected tumor cells injection in the cecal wall of rat, seems to be a intermediate model between spontaneous evolution of a colon tumor and intrasplenic or direct intraportal injections. From rhabdomyosarcoma cells (RMS S4-MH-) which present the advantage to prudce up lymphatic, pulmonary and hepatic metastases after subcutaneously injection, first subcutaneously (S.C.), intrasplenic (I.S.) and intracecal sites were compared: In the I.C. model, tumor was obtained in 80% of case and the survival was nearly similar to S.C. model's one. The lymphatic metastases were more and more distal as the evolution and the liver metastases were rarely observed. The I.S. model increased quickly and there were always liver metastases; In the two cases, pulmonary metastases were rarely observed (0 and 2/5). With adenocarcinoma colonic cells (Pro b) I.C. injection in the rat, tumor were obtained in 48% of cases without peritoneal dissemination; lymphatic nodes metastases were observed in 80% of cases; liver metastases was obtained in one animal from metastasis pulmonary selection cell lines. The I.C. model allows to estimate the liver and lymphatic nodes part; improved, it would be used to test adjuvant therapies and immunoscintigraphy.

The typing fo Human Papillomavirus (HPV) was carried out in cervical lesions in order to decide on the best therapy to carry out in mild and medium dysplasias of the cervix. 131 patients who had an iodo-negative zone or a smear suggesting an HPV infection had microbiopsies carried out under colposcopic control. Every lesion had two biopsies carried out side by side to study the histopathology and the virology. Dysplastic lesions were found in 93 biopsies. A search for the DNA of HPV 6a, 16 and 18 was carried out using a Southern blot technique with 32P following the method of Random multipriming. Hybridization was carried out in strict and non-strict conditions. In 43 cases out of 93 dysplasias a virus was found: 2 HPV 6a, 14 HPV 16, 1 HPV 18 and 26 X HPV's (not typed). The number of HPV's that could be detected increased according to the severity of the dysplasia which was also found in frequency of type 16. Where the biopsies showed no dysplasia type 16 was found in four out of seven viruses. In this study electrophoretic profiles for type 16 were found in four cases suggesting that they were integrated into the chromosome of the cell. The low percentage of HPV found in mild or moderate dysplasias (4 type 16 out of 61 biopsies) shows that at present this test can not be used as an aid in choosing treatment.

Cervical localizations of extra-adrenal paragangliomas are infrequently malignant, especially in their familial forms. An immunohistochemical study was performed on 6 cervical paragangliomas which were detected in 3 sisters at the age of 20 20. One had a lymph node metastasis. This study confirmed the diagnosis of paraganglioma with endocrine chief cells and supratentacular cells. It also enabled the hormonal contents of these cervical paraganglioma to be determined. In addition to catecholamine, these tumors may (like pheochromocytomas) produce serotonin and one or more other peptides.

The study was undertaken to define the potential use of indium 111 carcinoembryonic antigen-specific antibody labelled [CEA F(ab')2] for the radioimmuno-detection of colorectal carcinoma using an intraoperative hand-held gamma probe. The use of a linear radioactive source allowed optimization of physical characteristics. The best results regarding sensitivity and resolution were obtained using a 5-mm thick tungsten alloy collimator. A simulation study with a liver phantom (22 MBq or 0.6 mCi) was performed to determine the effect of side scatter as opposed to direct background and showed that it is possible to detect small radioactive targets (3.7 KBq or 0.1 mu Ci) 4 cm from the phantom. A clinical study performed with ten patients showed that tumours with good uptake of CEA-specific antibody could be detected with sufficient contrast in two patients when the probe was used. Results of a biodistribution study performed after tumour fragment or normal tissue countings in a well counter showed high tumour uptake (above 8 x 10(-3) injected dose/g) and tumour-to-normal tissue ratios (between 2.5 and 20) in five patients. Results with the probe showed markedly lower ratios. There was no correlation between absolute tumour uptake and the count rates of tumour measured intraoperatively. This can be attributed to the degradation of depth resolution resulting from the high energy photopeak of gamma-emitting 111In.

Axillary lymph node involvement is the most important prognostic indicator for breast cancer. Nevertheless, nearly 25% of patients with histologic negative lymph node will develop distant metastasis. Between 1974 and 1985, 201 patients with breast cancer, less than 3 cm, without axillary lymph node involvement were followed in the “Centre Rene Gauducheau”. The aim of our study was to analyse on this population which clinical and histological parameters were correlated with local recurrence or distant metastasis. We realise a multivariate analysis using the Cox model. We showed that hormonal status, age and multifocality were significantly and independently correlated with locai recurrences, and that pathologic grading (SBR), tumor localization in the breast were prognostic factors of distant metastasis. Finally we found that the nuclear grading (MSBR) 4 or 5 permit to determine in the population SBR II, a sub-group of women associated with a high risk of metastatic evolution, in which it will be probably necessary to discuss systemic adjuvant therapy to prevent distant metastasis.

The authros report two cases of pseudo-tumoral hepatic localization of human brucellosis or « brucelloma . These manifestations belong to chronic localized brucellosis. It constitute in the first observation a residual brucellar focus and in the second one, a subacute focal brucellosis.

We report two cases of epithelioid sarcoma (ES), including one with a 32-year follow-up. Difficult diagnostic problems often arise in this infrequent form of soft tissue sarcoma that predominantly involves the extremities and usually affects young individuals. Immunohistochemistry cannot elucidate histogenesis but does provide helpful information for the differential diagnosis.

An isolated swelling of the masseter raises an aetiopathogenic problem which may be encountered by any stomatologist. There are a number of diagnostic possibilities, in particular tumours. The authors report two cases with a special clinical picture: hematic cyst of the masseter. Treatment is surgical: excision via an endobuccal approach. Histological examination of the operative specimen reveals vascular dystrophy.