Henri Noël

Benign osteochondromas and exostotic chondrosarcomas: evaluation of cartilage cap thickness by ultrasound.

Ultrasonography (US) enables accurate assessment of the cartilage cap of exostoses. The cartilage cap appears as a hypoechoic layer covering the hyperechoic surface of the calcified part. Measurements of cap thickness with US were compared with measurements performed on pathological specimens in 22 resected exostoses and 2 exostotic chondrosarcomas. The US measurements proved to be very accurate, with a mean measurement error of less than 2 mm for cartilage caps less than 2 cm thick. The detection rate and measurement accuracy of US were higher than with computed tomography (CT) and comparable to magnetic resonance imaging (MRI), which were available in 14 and 10 cases, respectively. US appears to be a good procedure for evaluating the cartilage cap, which is usually thin for a benign exostosis and thick for a malignancy. In addition, other complications — such as bursa formation — are easily recognizable. The sole limitation is that US cannot visualize the cartilage cap when it is inwardly orientated or deeply located in soft tissues, which are both, however, relatively uncommon situations.

BCL3 rearrangement and t(14;19)(q32;q13) in lymphoproliferative disorders

Translocation t(14;19)(q32;q13) is a rare but recurrent abnormality in chronic lymphocytic leukemia and small cell lymphoma. It has been associated with rearrangements of the BCL3 gene, which is located at the breakpoint on chromosome 19 and is juxtaposed to the immunoglobulin heavy chain locus on chromosome 14 as a result of the translocation. This results in transcriptional up‐regulation of the BCL3 gene, which encodes a transcription coactivator, an 1‐κB protein, probably contributing to disease progression. We found, among 4,487 cytogenetic analyses of lymphoproliferative disorders, six cases with a t(14;19)(q32;q13), five of which showed the classical t(14;19)(q32;q13) and one of which showed a three‐way translocation t(7;19;14)(q21;q13;q32). The 14;19 translocation never occurred as a single abnormality; additional aberrations included trisomy 12 and several structural abnormalities. The cytogenetic examination was supplemented by molecular analysis using available probes for the BCL3 locus (pα1.4P and pα5B) in 1,150 of the 4,487 patients. Rearrangements of BCL3 involvement could only be confirmed using long‐range restriction mapping, indicating that, with the usually available BCL3 probes, rearrangements of this locus may be missed. Genes Chromosom Cancer 14:00–00 (1995).

Breast cancer detection by Fourier transform infrared spectrometry

Fourier transform infrared spectra of 75 biopsies from 55 cases of breast carcinoma were studied in comparison with histo-morphometry. The spectra of carcinomatous tissues are very different from those of normal tissues. There are evident correlations between the intensity of some infrared absorption bands and the volume density of malignant cells measured by optical microscopy [7]. Very high correlation coefficients are observed for phosphate monoester and phosphodiester bands; significant correlation coefficients are also observed for amide I and II bands.

Antacid-induced osteomalacia.

SummaryThe case of a 49-year-old woman suffering from generalized skeletal pain and multiple fractures accompanied by severe hypophosphataemia and low urinary phosphorus excretion is reported. She had been taking large amounts of antacids containing aluminum hydroxide for many years. A diagnosis of antacid-induced osteomalacia was made. It was confirmed by biological work-up, radiographs and bone biopsy. A dramatic biological, osteodensitometric, and clinical improvement was achieved by withdrawal of antacids and phosphorus administration. The literature concerning this unusual condition has been reviewed.

1,25-Dihydroxyvitamin D-related hypercalcemia in lymphoma: two case reports.

SummaryWe report two patients with non-Hodgkins lymphoma in whom hypercalcemia and elevated 1,25 dihydroxyvitamin D (1,25-(OH)2D3) levels developed in the absence of any lytic bone lesions. Hypercalcemia responded only transiently to glucocorticoids which were ill tolerated. Intravenous APD administration was needed to circumvene hypercalcemia. Humoral hypercalcemia of malignancy is discussed. Our cases confirm that hypercalcemia associated with elevated 1,25-(OH)2D3 may occur in malignant lymphoma.

Systemic Lupus-erythematosus and Concomitant Malignant-lymphoma - a Case-report

SummaryWe report the case of a woman who suffered Irom systemic lupus erythematosus and who subsequently developed a malignant lymphoma, not induced by immunosuppressive therapy. We discuss this rare association.

Localisation cæcale d’un sarcome myéloïde a-leucémique : un diagnostic difficile

Myeloid sarcoma is a malignant neoplasia composed of abnormal myeloid or monocytic cells, often localized in bones, but also rarely in extra-medullary sites such as lymph nodes, skin and soft tissue. We report a case of caecal myeloid sarcoma, diagnosed in a 60 year old woman who complained from abdominal pain and weight loss, in absence of any medullary disorder. Initially misdiagnosed as a B lymphoma because of a weak positivity for CD79a, the diagnosis of primitive caecal myeloid sarcoma was eventually established after further investigations showing a positivity for lysozyme and myeloperoxidase. This report of such a rare clinical and pathological presentation of a myeloid sarcoma underlines a difficult differential diagnosis for which adequate immunohistochemistry, including lysozyme and myeloperoxydase is mandatory.

Cutaneous mucinosis associated with multiple frozen joints and bony heterotopic deposits around the hips

SummaryA 43-year-old man suffered from migrating then additive arthralgias associated with macroscopic and microscopic cutaneous lesions compatible at first sight with reticular erythematous mucinosis. After nine months, the cutaneous picture evolved into a papular mucinosis. The patient developed ”multiple frozen joints” with heterotopic bony deposits around the hips. To our knowledge, such articular problems have not yet been described in this condition. Severe systemic complications prompted the authors to treat the patient with plasma exchange and melphalan.

Paget's sarcoma — with two illustrative cases

SummaryTwo cases of Pagets sarcoma of bone are described. The first one is mainly characterized by the almost simultaneous degeneration of the only two existing locations of the underlying Pagets disease. The second case is one of monostotic Pagets disease of the scapula disclosed by the malignant degeneration.

Osteopenia, bone fragility and reflex sympathetic dystrophy syndrome in a man with ureterosigmoidostomy.

A 68-year-old man is presented with a reflex sympathetic dystrophy syndrome (RSDS) of the right ankle diagnosed by radiography, magnetic resonance imaging and bone scintiscan. Investigations, including blood tests and bone biopsy, revealed a diagnosis of metabolic acidosis and osteomalacia. These appeared to result from a ureterosigmoidostomy performed 9 years previously for a transitional carcinoma of the bladder. Correction of the metabolic acidosis coincided with improvement in ankle pain. RSDS may be the initial presentation of osteomalacia, which in turn may be caused by the metabolic acidosis resulting from a ureterosigmoidostomy.