¿Carcinoma de mama o carcinoma de glándula sudorípara? Presentación de dos casos y análisis de la literatura

Primary apocrine carcinoma of the sweat gland is a neoplasm with a very low incidence that may represent a clinical and histological diagnostic challenge, as well as for adequate local, adjuvant, and advanced disease management. The average age of patients is around 67 years with no gender preference. This cancer develops primarily at the axillary and scalp levels and is clinically characterized by slow growth, but can progress aggressively with local, nodal, and metastatic involvement (primarily lung, liver, and bone). The recommended management, once the histology is established, consists of a wide local resection with a clear margin of 1 to 2 cm and regional lymphadenectomy if clinically positive nodes are detected. The adjuvant treatment (radiotherapy or chemotherapy) and for the advanced disease is not established.We report here the cases of two female patients initially diagnosed with breast cancer who were finally diagnosed with apocrine carcinoma of the sweat gland.     

Hombre de 18 años con síndrome verrugoso tropical: ¿leishmaniasis o esporotricosis?

The tropical verrucous syndrome includes infectious, chronic, and granulomatous skin conditions appearing with plaques, nodules, or ulcers with a warty surface which gives name to the syndrome. It includes forms of chromoblastomycosis, sporotrichosis, paracoccidioidomycosis, lobomycosis, leishmaniasis, and tuberculosis verrucosa cutis with ample distribution in tropical and subtropical areas. The diagnoses may be difficult and confused among them, especially between sporotrichosis and leishmaniasis.Clinical, epidemiologic, intradermal reactions, direct smears, skin biopsies, cultures, immunofluorescence, and PCR are used to differentiate them, although several of these methods are not commonly used.We present an 18-year-old man with extensive verrucous plaques in one knee interpreted by clinic, epidemiology, and biopsy as verrucous cutaneous leishmaniasis. He was treated with Glucantime® for 20 days without improvement. A new biopsy was made that was also interpreted as cutaneous leishmaniasis. The revision of both biopsies showed inflammation with abscessed granulomas and asteroid sporotrichotic bodies at the center of the granulomas that led to the diagnosis of sporotrichosis later confirmed by the fungus culture. The patient responded to the treatment with itraconazole. As clinical and epidemiological findings of leishmaniasis and sporotrichosis can be similar, skin biopsy and other paraclinical studies are necessary to establish a proper diagnosis. The asteroid sporotrichotic body is pathognomonic of this mycosis. We review here the essential concepts of leishmaniasis and sporotrichosis and the criteria to differentiate them.     

La lymphoscintigraphie dans la prise en charge thérapeutique des œdèmes des membres par les soins de santé en Belgique

Limbedemas of lymphatic origin, either primary, or secondary, represent a chronic disease sometimes heavy to bear by patients who suffer from them. These lymphedemas imply specific care by physical therapists trained to the use of different therapeutic approaches. Until a few years, only the treatments of secondary lymphedemas after radiotherapy and/or complete nodal dissection for cancer were reimbursed by the national health insurance system in Belgium. The introduction of the primary congenital lymphedemas as a disease also reimbursed raised several problems and led to a redefinition of these situations and of their cares. The definition and classification of the lymphedemas in view of the reimbursement of their treatments by the national health insurance system are now officially based (not only on the sole clinical history but) mainly on their clinical severity and/or also on the result of their lymphoscintigraphic investigation (according to a methodological protocol and to diagnostic criteria adopted at the national level). The reimbursements of the treatments by the physical therapists were also adapted and improved. The lymphocintigraphic investigations of the limbedemas became so essential in the management of the lymphedematous situations and in the reimbursement of their physical treatments in Belgium.     

Quantification de l’activité dopaminergique striatale en TEP à la 18F-DOPA : quels paramètres choisir en routine ?

Aim of the studyFunctional assessment of the nigrostriatal dopaminergic pathway (NSDP) is still largely dominated by SPECT imaging of presynaptic dopamine transporters. Because of greater performance characteristics and a potential medico-economic added value, 18F-DOPA PET may advantageously replace SPECT procedures. Clinical analysis of 18F-DOPA PET images is mainly based on visual assessment, a parameter which may be empirically affected by a low reproducibility. We assessed several reproducible semi-quantitative parameters applicable in clinical routine.Material and methodsSeventy-two patients (18 control subjects, 55.2 ± 13.4 years; 54 patients without confirmed Parkinson's disease (no-PD patients): 74.0 ± 9.9 years) were prospectively referred for a 18F-DOPA PET brain study. 18F-DOPA striatal uptake, which reflects the activity level of L-DOPA decarboxylase (DDC), was quantified using calculation methods of SUV in several striatal VOI. Background activity in occipital VOI (non specific uptake) was taken into consideration to assess specific uptake.ResultsDespite the absence of standard of truth regarding the medical status of no-PD patients, the most effective quantitative parameter to assess specific striatal dopaminergic activity was the putamen-to-occipital ratio. According to our data, activity level of DCC might decrease with age.ConclusionAn accurate and early in-vivo detection of NSDP alteration is a critical issue at the earliest stages of PD. Despite limits of this preliminary study, simple semi-quantitative parameters appear to be valuable tools to address problems of classification reproducibility in clinical practice.     

La cicatrisation cryptalgaire des diastèmes en tantqu'indicateur paléogéographique: Exemple de la Lettenkohle

Lettenkohle's lagoonal sediments of eastern Franceshow cryptalgal laminites close to diastems between two types of sequences: fluviolacustrine or «mediolittoral (french terminology, Pérès, 1966).The transition between inferior marine and middlenon-marine formations coincided with the development of stromatolitic structures, which molded and preserved the dessicated gypsiferous dolomicrites of inferior Lettenkohle.This phenomena is repeated with an inverse trend,by the way marking transition from middle to upper Lettenkohle, prior to the installation of variegated clays of inferior Keuper.     

Caractéristiques géométriques de la séquence Hα?Cα?N?H de l'isoquinuclidone-3 examinée dans différents etats physiques influence sur la constante de couplage vicinal J

The X-ray structure analysis of a crystalline sample of 2-azabicyclo-[2,2,2]-octanone-3 or 3-isoquinuclidone shows that the molecules of this compound are associated in centrosymmetrical dimers stabilized by two N? H? O?C hydrogen bonds in which the N,H,O atoms are nearly collinear. As a consequence of this interaction, the H atom is shifted from its usual position and the C^α? N? H angle is increased to 125°. Using infrared spectroscopy (ν_N–H frequency range), it is possible to demonstrate that 3-isoquinuclidone is mainly in a dimeric form when dissolved in an inert solvent such as CCl₄ and to observe the dimer-monomer equilibrium on dilution from saturation to a low concentration (0.005 mole/l.). On the contrary, dimers are broken off when operating in a polar medium (acetonitrile, deuterochloroform). In the same experimental conditions, measurements of the J vicinal coupling constant, by nuclear magnetic resonance spectroscopy, afford a concentration-dependent result in the case of CCl₄ solutions (increasing from 5.4 to 5.7 Hz when diluting from 0.5 to 0.005 mole/l.) and a constant one (5.8 Hz) in the case of CH₃CN or CDCl₃ solutions. Then the 0.4-Hz difference can be attributed to geometrical changes in the H^α? C^α? N? H system when dimers are broken off and the valence angle C^α? N? H consequently decreases from 125° to its standard value (about 115°). This experimental observation is consistent with the result of a theoretical analysis performed by the INDO method. Then it seems that the use of the formulas proposed by Karplus to account for the valence angle distorsions in ethane-like systems, in the case of the H^α? C^α? N? H sequence, could yield overstimated corrections.     

Les différentes anomalies de la reproduction masculine sont-elles en augmentation ? Faits et controverses, possibles facteurs en cause: une analyse actualisée des données de la littérature et des registres

In recent decades, numerous observations in wildlife of various anomalies of the male reproductive functions-some being reminiscent of experimental toxicology data-have raised questions about the possible role of environmental pollutants. A number of studies suggest an increased prevalence of reproductive disorders in adult humans in recent decades in many (but not all) Western countries. The best documented data concern testicular cancer, its increasing rate suggesting that environmental factors and/or changes in lifestyle may come into play. However, considerable regional and ethnic differences exist in absolute incidence rates, suggesting in turn the concomitant role of the genetic background. Finally, several studies suggest that semen quality has declined in many countries. In the early 2000’s, Skakkebæk’s group in Copenhagen postulated a common origin to these different abnormalities — the so-called testicular dysgenesis syndrome (TDS) — all possibly related to abnormal testis development during gestation. Is there a causal link between these different conditions and deleterious environmental and/or lifestyle factors? The answer is far from being unequivocal, and the subject, a potential major public health problem, remains a source of hot debate both within the scientific community and in the media. The present review aims to provide an updated synthesis of these complex issues.     

Comment l’imagerie nucléaire modifie-t-elle la prise en charge par radiothérapie des cancers de prostate ?

Using new tracers such as fluorocholine or gallium-PSMA, the definition of localized prostate cancers and tumor relapses is profoundly altered. Moreover, the definition of intra-prostatic tumor volume makes dose-painting radiotherapy technically feasible. In case of local relapse, local aggressive treatments are now routinely offered. In case of oligometastatic disease, irradiation occupies a growing place, which benefits directly from the best targeting offered by these new tracers.     

Recherche des facteurs du maintien de la richesse de la bryoflore terricole en habitats isolés. III — Étude comparée de la richesse en bryophytes d'îlots à chênes sclérophylles,de leurs interfaces avec le vignoble et du vignoble sur la bordure occidentale du massif des Maures (Var,France)

Quantitative analysis based on 93 bryophytoecological relevés and on exhaustive inventories from six forest structures (dense stands of Quercus ilex or Quercus suber) of different surfaces, isolated within the vineyard near Pierrefeu-du-Var, the outlying contact zones I (shrubby vegetation) and i (herbaceous vegetation) and the neighbouring vineyards. The results show that the contact zones take a rather limited reserve part in the maintenance of the global richness in terricolous bryophytes (RGB) of the forest structures, because the former are richer in photophilous and nitratophilous taxa than the latter. For what concerns the richness in terricolous forest bryophytes (RBF), the contact zones at the Défens-du-Bécasson (northern exposure, surface = 77 617 m²) are particularly humid and shady. They house a notable number of hygrosciophilous and xerosciophilous forest bryophytes. Their role in the maintenance of the RBF of the forest zone is consequently more important than in the other studied stations which correspond to islets and hedges of more reduced surface (13 115 to 1 165 m²), located in a dry environment.     

Ciblage des récepteurs de la somatostatine dans les tumeurs neuroendocrines gastroentéropancréatiques (TNE-GEP) : quels radiotraceurs pour quelles tumeurs ?

Topographic and functional imaging hold a key position in endocrine oncology. In vivo somatostatin receptor scintigraphy using Indium-111 labeled DTPA-octreotide, a tracer with preferential affinity for the somatostatin receptor subtype 2 (sst2), is the gold-standard for initial diagnosis of gastroenteropancreatic neuroendocrine tumours (GEPNETs). Due to the detection limits of scintigraphy, other metabolic imaging modalities are required. Positron emission topography (PET) offers whole body scanning, facilitates tumour localization, and assesses the metastasis statement of the tumour. ¹⁸F-FDG is the most frequent radiotracer used in clinical practice because of its availability, but its interest is demonstrated only in undifferentiated GEPNETs. More recently, ¹⁸F-DOPA PET showed a high sensitivity in particular in carcinoid tumours detection. PET using different ⁶⁸Ga-labeled-somatostatin analogs with high affinity for sst2 displayed better results than SRS in GEPNETs primary tumour and metastasis detection, especially when fusion with TDM images was performed. Using similar metabolic targets, peptide receptor radionuclide therapy (PRRT) with ¹⁷⁷Lu-octreotate and ⁹⁰Y-DOTA-TOC, is indicated in disseminated GEPNETs forms with an efficiency of 30 % and a minor toxicity.