Secreting interstitial cell (Leydig cell) tumors are rare. In adults, the clinical picture and steroid levels are variable.
This paper presents a case of left testicular tumor, showing azoospermia ...with normal serum level of total testosterone, collapsed FSH and LH, and high delta4 androstenedione. Histopathological investigation revealed a Leydig cell tumor. TESE allowed spermatozoa extraction and freezing. Testicular histology found hypospermatogenesis and germ-cell aplasia with interstitial fibrosis. Surgical resection of the tumor resulted in normalization of gonadotropins and fall in serum delta4 androstenedione to subnormal levels in the postoperative period confirming that the tumor was secreting delta4 androstenedione. It was hypothesized that high delta4 androstenedione resulted in intra tumoral 17 β-HSD overtaken by delta4 androstenedione or that 17 β-HSD activity in the tumor was different from that of normal Leydig cells. Three months after surgery sperm analysis found a complete recovery of spermatogenesis. A spontaneous pregnancy occurred 3 months after surgery and a girl was born.
In this case, the diagnosis of testicular Leydig cell tumor secreting delta4 androstenedione was made in a context of azoospermia.
To study the somatic embryogenesis of Brassica oleracea var. botrytis L., hypocotyls were placed on Murashige and Skoog's medium (1962) with 1 mg.l
of 2,4-dichlorophenoxyacetic acid and 1 mg.l
of ...kinetin to induce callogenesis. After transfer of the calli to the maturation medium, somatic embryos appeared. They developed into plantlets and the potential of regeneration of the calli was maintained for more than 8 months. Thirty-five plantlets were produced after 2 months of culture, then transplanted into soil. Inter-simple sequence repeat markers generated by trinucleotidic and tetranucleotidic primers were tested for their ability to characterise genomic variations in the obtained plants. The absence of polymorphism between different regenerants from the same cultivar indicates the conformity of the regeneration protocol.
The H19 gene is transcribed in an mRNA-like noncoding RNA. When tumors of various organs or cell types are considered, H19 oncogene or tumor-suppressor status remains controversial. To address the ...potential regulation of H19 gene expression by an androgen steroid hormone (DHT: dihydrotestosterone) or by a peptidic hormone (PRL: prolactin), we performed experiments in rats systemically treated with chemical mediators. This range of in vivo experiments demonstrated that chronic hyperprolactinemia upregulated the H19 expression in epithelial and stromal cells whereas DHT downregulated the gene. PRL and DHT appeared to be opposite mediators in the H19 RNA synthesis. We investigated these hormonal effects in three human prostate epithelial cell lines. In LNCaP cancer cells, the opposite effect of PRL and DHT was corroborated. However, in normal cells (PNT1A), H19 remained insensitive to the hormones in fetal calf serum (FCS) medium but became responsive in a serum-stripped medium. In the DU-145 cancer cell line, tested for its androgen-independence and aggressiveness, the hormones had no effect on H19 expression whatever the culture conditions. Finally, we demonstrated that PRL upregulated the H19 expression in LNCaP cells by the JAK2-STAT5 transduction pathway. We conclude that H19 expression is regulated by both a peptidic and a male steroid hormone.
Testicular parenchyma abnormalities and testis cancers are more frequent in infertile men, hence the guidelines recommending a systematic scrotal ultrasound.
A retrospective review of all patients ...treated with total or partial orchidectomy, from January, 2000 to July, 2010, for a testicular lesion discovered during an infertility evaluation work-up. Physical, examination data, type of surgery and pathological results were reported.
Forty-five patients were treated. The majority of tumors (80%) were non palpable, and incidentally discovered with scrotal ultrasonography. Eight cases were partial orchidectomies, and 37 cases were radical orchidectomies. A frozen section examination was performed in 13 cases, and led to two radical orchidectomies. Standard histological examination revealed 33 (73.3%) benign lesions (11 Leydig cell hyperplasias, 17 Leydig cell tumors, five Sertoli cell tumors) and 10 (22.2%) malignant lesions (nine seminomas and one teratoma). Ten patients had a Klinefelter syndrome, for whom all the lesions were benign.
The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men were benign tumors. Conservative management in this context appears to be an option, to preserve the endocrine function and the fertility of these patients, while being ontologically safe.
To assess long term biochemical recurrence free survival after radical prostatectomy according to open, laparoscopic and robot-assisted surgical approach and clinicopathological stage.
A cohort study ...of 1313 consecutive patients treated by radical prostatectomy for localized or locally advanced prostate cancer between 2000 and 2013. Open surgery (63.7%), laparoscopy (10%) and robot-assisted laparoscopy (26.4%) were performed. Biochemical recurrence was defined by PSA>0,1ng/mL. The biochemical recurrence free survival was described by Kaplan Meier method and prognostic factors were analysed by multivariable Cox regression.
Median follow-up was 57 months (IQR: 31-90). Ten years biochemical recurrence free survival was 88.5%, 71.6% and 53.5% respectively for low, intermediate and high-risk D'Amico groups. On multivariable analysis, the worse prognostic factor was Gleason score (P<0.001). Positive surgical margins rate was 53% in pT3 tumours and 24% in pT2 tumours (P<0.001). Biochemical recurrence free survival (P=0.06) and positive surgical margins rate (P=0.87) were not statistically different between the three surgical approaches.
Biochemical recurrence free survival in our study does not differ according to surgical approach and is similar to published series. Ten years biochemical recurrence free survival for high-risk tumours without hormone therapy is 54% justifying the role of surgery in the therapeutic conversations in this group of tumours.
3.
To delineate the histopathological characteristics of nasal mucosa in refractory chronic rhinosinusitis with nasal polyps (CRSwNP) in order to demonstrate subtypes of nasal polyps and their potential ...relation with lower airway comorbidity.
Clinical- and pathological-based cross-sectional study Methods: Nasal polyp specimens were prospectively collected from patients with refractory CRSwNP referred to our institution for endoscopic sinus surgery. Oral and topical steroids were stopped 1 month before surgery. The pathological analysis was conducted by 2 independent reviewers with light microscopy on Hematoxylin-Eosin-Saffron stained slides. Each observer fulfilled a standardized protocol with cell count and stromal characterization on the most representative field. Mean grading scores were established. Morphological aspects were compared with the cell distribution and the clinical conditions.
Among 36 patients, three subtypes of nasal polyps were depicted: eosinophilic edematous (64%), fibrous (9%) and intermediate with mixed edematous and collagen stromal structure (27%). Basement membrane thickening and seromucous gland hyperplasia were observed in the fibrosis sub-type (p<0.03). Eosinophilic mucosal infiltrate was significantly increased (p=0.026) in patients with concomitant pulmonary disease (n=21). Nasal polyp distribution was not influenced by asthma, allergy, previous surgery and smoking.
Our 3-subtype classification of refractory CRSwNP in Caucasian population shows a predominant edematous structure whatever the clinical conditions may have been. Eosinophilia as a major factor of adaptive immune response in nasal inflammation is a feature of concomitant pulmonary disease. Further studies concerning mucosal remodelling and outcome assessment after sinus surgery are required to evaluate the impact of our classification on a daily basis.
Les TNE rénales sont rares, de spectre histologique étendu, de pronostic mal déterminé Nous en rapportons un cas d’exérèse complète, mais cependant évolutif. Une femme de 39 ans, sans antécédent, ...mère d’un enfant, consulte pour douleurs abdominales. Echographie, scanner et IRM montrent une lésion tissulaire bien limitée (45 × 50 × 43 mm), du côté droit d’un rein en fer à cheval, comprimant l’uretère, sans envahissement à distance. La pièce d’hémi-néphrectomie correspond à une TNE de 6 cm comportant nécrose et emboles vasculaires, marquée par la chromogranine A et la synaptophysine (Ki6710 % ; 13 mitoses/10 champs), classée G2 (OMS 2010–TNE digestives) ou carcinome neuroendocrine à grandes cellules (OMS 1999–TNE pulmonaires), stade pT1b pNx R0 (TNM 2010). Curieusement, une hypertrophie thymique, captant physiologiquement en PET-FDG est constatée comparativement au scanner préopératoire, mais l’imagerie et les dosages post-opératoires des marqueurs neuro-endocrines sont normaux. La neurone-specific enolase (NSE) initialement à 18 μg/L (N < 17) augmente progressivement à 44, 32 puis 38 respectivement 1, 2 et 3 ans plus tard, avec ascension borderline des 5HIAA. Des images hépatiques infracentimétriques fixant en octréoscan* apparaissent 1 an après l’intervention, dont 1 traitée par radiofréquence en association à la somatostatine, puis par tumorectomie en raison de la majoration de leur nombre à 5, avec évaluation morphologique et biologique normale 3 mois plus tard. Moins de 100 cas de TNE rénales sont rapportées, fréquemment sur rein en fer à cheval, nécessitant d’éliminer une métastase rénale d’une autre tumeur. Les facteurs pronostiques anatomocliniques et la conduite thérapeutique restent mal codifiés.
Abstract Aim To assess correlation between necrosis on imaging and pathology reports and prognostic value of tumour necrosis in chromophobe renal cell carcinoma (CRCC). Methods Cases were extracted ...from a prospective renal cancer registry set up in January 2000 containing 470 patients who had surgery for renal cancer in our institution. We reported the outcome of this series and assessed prognostic significance of clinical and pathologic characteristics. Retrospectively, imaging results and histologic slides of CRCC were analyzed and looked for presence and extent of any tumour necrosis and histologic subtype (eosinophilic versus clear variant). Agreement between necrosis diagnosed by CT-scan and histologic necrosis was given by the kappa coefficient. Results Of the 470 patients from the database, 21 (4.5%) had CRCC. Their mean age (±SD) was 56.4 ± 11.4 years (range 34–73). Mean tumour size (±SD) was 5.6 ± 4.2 cm. After a mean follow-up of 22.5 months (range 1–80), 4 patients (19%) developed metastases. Tumour size, Fuhrman nuclear grade and presence of necrosis on imaging and on histology were significant prognostic factors for disease progression of CRCC ( P ≤ 0.01). The histologic subtype was not a prognostic factor. Necrosis assessed preoperatively by spiral CT-scan agreed well with histologic coagulative necrosis (kappa = 0.88). Necrosis extent on imaging and on pathology was not a prognostic factor for disease progression. Conclusion Preoperative detection of tumour necrosis is possible. Tumour necrosis on imaging and on pathology provides a clinically useful information for the clinician to distinguish aggressive variant of CRCC.
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