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Vedolizumab is a humanized monoclonal antibody that binds to the human a4β7 integrin and is approved for use in inflammatory bowel diseases. We describe a patient with severe, refractory erosive gingivostomatitis, which appeared a few days after the first dose of vedolizumab and resolved after discontinuation of the drug. We believe the gingivostomatitis to be a direct side effect of vedolizumab, rather than an extraintestinal manifestation of the underlying inflammatory bowel diseases. The clinicians need to be aware of this adverse event, which could be mistakenly considered as an extraintestinal manifestation of inflammatory bowel diseases.

Vedolizumab is a humanized monoclonal antibody that binds to the human a4β7 integrin and is approved for use in inflammatory bowel diseases. We describe a patient with severe, refractory erosive gingivostomatitis, which appeared a few days after the first dose of vedolizumab and resolved after discontinuation of the drug. We believe the gingivostomatitis to be a direct side effect of vedolizumab, rather than an extraintestinal manifestation of the underlying inflammatory bowel diseases. The clinicians need to be aware of this adverse event, which could be mistakenly considered as an extraintestinal manifestation of inflammatory bowel diseases.

Introduction Le vedolizumab (VDZ) est un anticorps monoclonal humanise qui se fixe sur l’integrine α4β7, utilise dans le traitement des maladies inflammatoires chroniques intestinales (MICI). Nous decrivons le cas d’un patient atteint d’une gingivostomatite stomatite severe, apparue quelques jours apres la premiere dose de VDZ et qui a regresse apres l’arret du traitement. Observations Un homme âge de 31 ans traite par VDZ en 6e ligne de traitement pour une rectocolite hemorragique (RCH) severe, presentait cinq jours apres la premiere injection de VDZ, des lesions de la muqueuse buccale. Elles se s’aggravaient ( Fig. 1a ) apres la poursuite du traitement par VDZ, avec extension aux gencives et a la langue. Les corticoides topiques, per os et mesalazine etaient inefficaces. Les symptomes gastro-intestinaux du patient s’amelioraient. Les prelevements locaux bacteriologiques et viraux etaient negatifs. La biopsie de la muqueuse buccale montrait un infiltrat inflammatoire avec de nombreux polynucleaires neutrophiles et eosinophiles dans la lamina propria, et quelques cellules inflammatoires dans l’epiderme. Aucun granulome n’etait present. L’immunofluorescence directe ne montrait pas de depots immuns dans l’epithelium ou la membrane basale. Les anticorps anti-peau etaient tous negatifs, excluant les maladies bulleuses auto-immunes. Le VDZ etait implique et arrete. Les lesions buccales commencaient a s’ameliorer et avaient completement disparu dans les deux mois suivant la derniere injection de VDZ ( Fig. 1b ). Discussion Des ulcerations de la muqueuse buccale sont decrites chez des patients traites par anti-TNF et VDZ. Dubinski et al., dans Inflamm Bowel Dis en 2018, ont rapporte une incidence de la stomatite aphteuse trois fois plus elevee chez les patients traites par VDZ que par traitement par anti-TNF alpha, et l’ont decrite comme une manifestation extra-intestinale (MEI), au meme titre que le syndrome de Sweet, l’erytheme noueux ou la cholangite sclerosante. Dans notre cas, les lesions sont apparues quelques jours apres la premiere injection de VDZ et se sont aggravees dans les semaines qui ont suivi, malgre l’amelioration des symptomes de la maladie sous-jacente. Nous avons exclu les infections et les maladies bulleuses auto-immunes. Il n’y avait aucun antecedent de lesions buccales similaires chez ce patient. Plusieurs traitements, y compris les corticoides systemiques a forte dose, n’ont pas ameliore la stomatite. En revanche, c’est apres l’arret du VDZ que l’affection buccale a completement gueri. Au vu de l’evolution, nous pensons que la gingivostomatite est un effet secondaire direct du VDZ, plutot qu’une manifestation extra-intestinale de la maladie sous-jacente. Conclusion La gingivostomatite est un effet secondaire rare direct du VDZ, plutot qu’une MEI des MICI sous-jacentes. Les cliniciens doivent etre conscients de cet evenement indesirable, qui pourrait etre considere a tort comme une MEI des MICI.

Most tumors of the ovary presumed benign according to clinical, biological and imaging data are cysts. A cyst is a newly formed cavity lined by epithelium. It tends to enlarge, and can undergo torsion, rupture and haemorrhage. Most prevalent cystic lesions, i.e. inclusion cysts, serous or mucinous cystadenomas, endometriotic cysts, mature teratoma and other cysts are described. Diagnostic methods of cytology and pathology are described and evaluated: intraoperative examination of cystic and peritoneal fluids are not recommended; intraoperative consultation can be performed on solid parts or implants, if the pathologist is familiar with these lesions, or if primary carcinoma is known. The value of intraoperative examination is good in benign and cancer cases, but unsatisfactory in borderline lesions, especially of mucinous type. Cryopreservation of ovarian tissue can be performed to preserve tumoral and normal tissue in Biobank for research protocol, or to maintain fertility through follicle preservation, in aseptic conditions. Transfer of samples towards the pathology laboratory can be performed either and preferably in fresh state, or in vacuum sealed bags at +4°C allowing a 2-day delay, or after immersion in a 15 × volume of 4% formalin. Cytological samples must be collected on citrate and sent immediately to the pathology laboratory, or fixed volume/volume in of absolute alcohol. The pathologist and the surgeon must collaborate to obtain good practice: intact labelled sample, accompanied by clinical information, transfer according to best local conditions, judicious use of intraoperative examination, knowing its possibilities and limitations, no excess delay of pathology report, even in difficult cases requiring expert opinion.

Corneal dystrophies are relatively rare diseases of the young adult. We report a case of a Groenouw type II macular corneal dystrophy. A 34-year-old woman with no prior history was referred by her ophthalmologist for bilateral corneal dystrophy developing for several years. Physical examination revealed decreased visual acuity related to bilateral rounded corneal deposits. The patient underwent penetrating keratoplasty. The diagnosis of Groenouw type II macular corneal dystrophy was confirmed by pathological examination of the recipient cornea. The clinical, pathologic and therapeutic features are discussed.

Most tumors of the ovary presumed benign according to clinical, biological and imaging data are cysts. A cyst is a newly formed cavity lined by epithelium. It tends to enlarge, and can undergo torsion, rupture and haemorrhage. Most prevalent cystic lesions, i.e. inclusion cysts, serous or mucinous cystadenomas, endometriotic cysts, mature teratoma and other cysts are described. Diagnostic methods of cytology and pathology are described and evaluated: intraoperative examination of cystic and peritoneal fluids are not recommended; intraoperative consultation can be performed on solid parts or implants, if the pathologist is familiar with these lesions, or if primary carcinoma is known. The value of intraoperative examination is good in benign and cancer cases, but unsatisfactory in borderline lesions, especially of mucinous type. Cryopreservation of ovarian tissue can be performed to preserve tumoral and normal tissue in Biobank for research protocol, or to maintain fertility through follicle preservation, in aseptic conditions. Transfer of samples towards the pathology laboratory can be performed either and preferably in fresh state, or in vacuum sealed bags at +4°C allowing a 2-day delay, or after immersion in a 15 × volume of 4% formalin. Cytological samples must be collected on citrate and sent immediately to the pathology laboratory, or fixed volume/volume in of absolute alcohol. The pathologist and the surgeon must collaborate to obtain good practice: intact labelled sample, accompanied by clinical information, transfer according to best local conditions, judicious use of intraoperative examination, knowing its possibilities and limitations, no excess delay of pathology report, even in difficult cases requiring expert opinion.

Corneal dystrophies are relatively rare diseases of the young adult. We report a case of a Groenouw type II macular corneal dystrophy. A 34-year-old woman with no prior history was referred by her ophthalmologist for bilateral corneal dystrophy developing for several years. Physical examination revealed decreased visual acuity related to bilateral rounded corneal deposits. The patient underwent penetrating keratoplasty. The diagnosis of Groenouw type II macular corneal dystrophy was confirmed by pathological examination of the recipient cornea. The clinical, pathologic and therapeutic features are discussed.

We carried out a retrospective study to analyse clinical, paraclinical and therapeutic aspects of acute appendicitis cases as the National University Hospital (CNHU) at Bangui in the Central African Republic. We compared our findings with those for other African countries and for industrialized countries. From September 15 1990 to February 15 1992, 285 patients underwent laparotomy to treat acute appendicitis. We carried out a study of clinical, paraclinical and therapeutic aspects on 57 patients with complete case histories (20% of the patients undergoing surgery). The appendices of these patients were sent to the Laboratory of Pathological Anatomy of the Faculty of Medicine at Marseille, France, for analysis. The frequency of appendectomy among patients undergoing visceral surgery by laparotomy with no acute traumatic abdominal syndrome was 42.3%. The incidence of appendectomy for the city of Bangui in 1991 was 36.5 per 100,000 inhabitants. These cases of appendicitis were diagnosed essentially on clinical grounds. Leukocyte counts exceeded 10,000 per mm3 in 30% of the patients. Histological examination revealed the presence of parasites in 10 cases : Schistosoma mansoni eggs (seven cases) and Ascaris lumbricoides eggs (one case) in patients with acute appendicitis and one case each of Schistosoma mansoni eggs and Ascaris lumbricoides eggs at the time of diagnosis but normal histological results for the removed appendix. Most of the patients consulted late, a mean of four days after the onset of symptoms. The frequency of appendectomy on principle was 12.7% and parenteral antibiotic treatment was prescribed systematically follow- ing surgery. The mean duration of hospital stay after surgery was 7.6 days. No early postoperative complications were noted. However, two late postoperative complications resulting in the death of the patient were observed, giving a mortality rate of 3.5%. These complications were one case of peritonitis after appendectomy involving intestinal resection and one case of occlusive syndrome with septic shock. The frequency of acute appendicitis at the CNHU at Bangui was similar to that reported in another tropical African country (~ 1%). However, the incidence of appendectomies at Bangui is lower than generally reported for western countries (15 to 40%). Positive diagnosis was made on classic data obtained on clinical examination and on associated biological data, if available. Parasites were identified on histological examination in some cases of acute appendicitis, but it is unclear whether these parasites were actually responsible for the appendicitis. Efficient examinations for the exploration of acute nonspecific abdominal pain, such as the measurement of inflammation indicators, particularly serum activated protein C levels, graded-compression ultrasound scans and celioscopy, should be made available in the hospitals of African countries to increase the precision of diagnosis and to decrease the still too high frequency of appendectomies performed on principle. The postoperative mortality rate at the CNHU of Bangui is higher than the low rates (0.1 to 0.25%) reported for industrialized countries but is close to those reported for African countries. This high rate of mortality results partly from the lateness of consultations, because patients in tropical Africa often consult a traditional healer before resorting to modern medicine, and partly from misdiagnoses.

HCV C100-3 non-structural and core proteins have been detected by immunohistochemical methods on paraffin-embedded tissue sections using monoclonal antibodies in 22 cases of chronic hepatitis C. C100-3 protein was detected in cytoplasm and nuclei of hepatocytes whereas core protein was only detected in nuclei. The specificity of the nuclear localization of HCV antigens was discussed in relation to cross-reactivity of the anti core antibody with host-derived GOR antigen.

Immunohistochemical methods have been used to localize an HCV antigen on paraffin embedded liver tissue sections by means of monoclonal antibodies to C100-3 nonstructural protein. Peroxidase-antiperoxidase, alkaline phosphatase-antialkaline phosphatase, biotin-streptavidin-peroxidase and immunogold silver staining methods showed a nuclear staining of the hepatocytes in cases of chronic hepatitis with positive HCV serology, alcoholic liver disease and hepatocarcinoma. No cross reactions were observed with viral hepatitis B and delta antigens. The strongest reaction without background staining was obtained with immunogold silver staining. Nuclear localization was compared to the cytoplasmic staining described in the literature.