Yves Le Charpentier

Clear-cell chondrosarcoma A report of five cases including ultrastructural study

Five cases of clear‐cell variant of chondrosarcoma (Unni et al.16) are reported. The tumors occurred in the epiphyseal region of long bones; three in the femoral head. Roentgenographically, the lesion was usually a well‐defined and benign appearing one, either purely lytic (3 cases) or with central radiodensity (2 cases). Histologically, all five cases had areas of conventional chondrosarcoma; however, the greater portion of the tumor was made up of sheets of clearcells intermixed with nonneoplastic bone trabeculae but devoid of chondroid matrix. Electron microscopic studies showed that these clear‐cells possess cytoplasmic microvilli, abundant glycogen particles and prominent golgi complexes, like normal or tumorous chondroid cells usually have. In our experience, the best treatment seemed to be en bloc resection with joint replacement; indeed, despite the fact that they are true chondrosarcomas, these tumors usually have a very slow rate of growth. Cancer 44:622‐629, 1979.

Serotonin‐secreting and insulin‐secreting ileal carcinoid tumor and the use of in vitro culture of tumoral cells

The authors report the case of a patient with a typical carcinoid syndrome and a severe hypoglycemia due to hyperinsulinism. He was found to have an ileal carcinoid tumor with hepatic metastasis and no evidence of pancreatic insulinoma at surgery and autopsy. By assaying serotonin and insulin in the tumor and in the supernatants of the culture derived from hepatic metastasis, the authors have been able to show that both hormones were produced by the carcinoid tissue. Cultured cells also synthesized minute amounts of gastrin and thyrocalcitonin.

A pathologic analysis of the outcome following heart-lung transplantation: an autopsy study of 22 recipients

SummaryBetween 1987 and 1989, twenty-two patients who received combined heart-lung transplantation were autopsied at La Pitie Salpetriere Hospital in Paris. With the exception of two recipients who survived for 2 months and 4 months, respectively, the majority of the patients died in the early post-operative period (the mean survival was 20.1 days). At autopsy, five patients showed acute cardiac rejection of a minor grade. Perivascular and peribronchiolar mononuclear cell infiltrates suggesting acute pulmonary rejection were seen in three patients. Obliterating bronchiolitis, which might be indicative of chronic rejection, was observed in four patients who had longer survival rates, and one of these four had died of obliterating bronchiolitis. Rather than allograft rejection, the major causes of death were (1) perioperative hemorrhage, (2) infections (mainly respiratory infections and occasionally mediastinitis), (3) diffuse alveolar damage (the so-called adult respiratory distress syndrome and/or pulmonary organizing edema), and (4) multiple organ failure.The present study suggested some of the reasons why the survival rate following heart-lung transplantation is much poorer than after isolated heart transplantation. Hemodynamic or respiratory problems causing perioperative multiple organ failure as well as pre-existing complications of the recipients, such as “cardiac cirrhosis,” may play an important role in the prognosis of heart-lung transplantation.