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Palich R, Wakim Y, Itani O, Paccoud O, Boussouar S, Lévy-Soussan M, Soulie C, Godefroy N, Bleibtreu A. Clinical, biological and radiological features, 4-week outcomes and prognostic factors in COVID-19 elderly inpatients. Infect Dis Now 2021; 51:368-373. [PMID: 33495763 PMCID: PMC7816947 DOI: 10.1016/j.idnow.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
Objective To describe clinical, biological, radiological presentation and W4 status in COVID-19 elderly patients. Patients and methods All patients ≥ 70 years with confirmed SARS-CoV-2 infection and hospitalized in the Infectious Diseases department of the Pitié-Salpêtrière hospital, Paris, France, from March 1st to April 15th 2020 were included. The primary outcome was death four weeks after hospital admission. Data on demographics, clinical features, laboratory tests, CT-scan findings, therapeutic management and complications were collected. Results All in all, 100 patients were analyzed, including 49 patients ≥ 80 years. Seventy percent had ≥2 comorbidities. Respiratory features were often severe as 48% needed oxygen support upon admission. Twenty-eight out of 43 patients (65%) with a CT-scan had mild to severe parenchymal impairment, and 38/43 (88%) had bilateral impairment. Thirty-two patients presented respiratory distress requiring oxygen support ≥ 6 liters/minute. Twenty-four deaths occurred, including 21 during hospitalization in our unit, 2 among the 8 patients transferred to ICU, and one at home after discharge from hospital, leading to a global mortality rate of 24% at W4. Age, acute renal failure and respiratory distress were associated with mortality at W4. Conclusion A substantial proportion of elderly COVID-19 patients with several comorbidities and severe clinical features survived, a finding that could provide arguments against transferring the most fragile patients to ICU.
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Affiliation(s)
- R Palich
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France.
| | - Y Wakim
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - O Itani
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - O Paccoud
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - S Boussouar
- Sorbonne Université, LIB-Laboratoire d'imagerie biomédicale, Inserm, CNRS, ICAN Institute of CardioMetabolism and Nutrition, ACTION Study Group, Cardiothoracic Imaging Unit, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - M Lévy-Soussan
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Palliative Care, 75013 Paris, France
| | - C Soulie
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, 75013 Paris, France
| | - N Godefroy
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - A Bleibtreu
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
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Brin C, Godefroy N, Simon A, Robert J, Bebear C, Agher R, Monsel G, Palich R, Caumes E. Caractères épidémiologiques cliniques et thérapeutiques des infections à Mycoplasma genitalium dans un centre parisien. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Delorme C, Paccoud O, Kas A, Hesters A, Bombois S, Shambrook P, Boullet A, Doukhi D, Le Guennec L, Godefroy N, Maatoug R, Fossati P, Millet B, Navarro V, Bruneteau G, Demeret S, Pourcher V. COVID-19-related encephalopathy: a case series with brain FDG-positron-emission tomography/computed tomography findings. Eur J Neurol 2020; 27:2651-2657. [PMID: 32881133 PMCID: PMC7461074 DOI: 10.1111/ene.14478] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/11/2020] [Indexed: 12/27/2022]
Abstract
Aim The aim of this paper is to describe the clinical features of COVID‐19‐related encephalopathy and their metabolic correlates using brain 2‐desoxy‐2‐fluoro‐D‐glucose (FDG)‐positron‐emission tomography (PET)/computed tomography (CT) imaging. Background and purpose A variety of neurological manifestations have been reported in association with COVID‐19. COVID‐19‐related encephalopathy has seldom been reported and studied. Methods We report four cases of COVID‐19‐related encephalopathy. The diagnosis was made in patients with confirmed COVID‐19 who presented with new‐onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2‐desoxy‐2‐fluoro‐D‐glucose (FDG)‐positron‐emission tomography (PET)/computed tomography (CT) (FDG‐PET/CT). Results The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID‐19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS‐CoV‐2 RT‐PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG‐PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy. Conclusions Despite varied clinical presentations, all patients presented with a consistent FDG‐PET pattern, which may reflect an immune mechanism.
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Affiliation(s)
- C Delorme
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - O Paccoud
- Department of Infectious and Tropical diseases, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - A Kas
- Nuclear Medicine and LIB Department, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, INSERM U1146, Paris, France
| | - A Hesters
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - S Bombois
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - P Shambrook
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - A Boullet
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - D Doukhi
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - L Le Guennec
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - N Godefroy
- Department of Infectious and Tropical diseases, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - R Maatoug
- Department of adult Psychiatry, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - P Fossati
- Department of adult Psychiatry, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - B Millet
- Department of adult Psychiatry, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - V Navarro
- Department of Neurophysiology, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France
| | - G Bruneteau
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - S Demeret
- Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospitals - Pitié-Salpêtrière Charles Foix, Paris, France
| | - V Pourcher
- Department of Infectious and Tropical diseases, Sorbonne University, AP-HP, University Hospitals Pitié-Salpêtrière Charles Foix, Paris, France.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, INSERM 1136, Paris, France
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Palich R, Wakim Y, Itani O, Paccoud O, Boussouar S, Levy-Soussan M, Soulie C, Godefroy N, Bleibtreu A. « Cent nuances de COVID » : étude descriptive monocentrique des infections à SARS-CoV-2 de 100 patients âgés de plus de 70 ans. Med Mal Infect 2020. [PMCID: PMC7442126 DOI: 10.1016/j.medmal.2020.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Castandet L, Danton E, Bernard F, Oger K, Breger I, Tamames C, Boutolleau D, Caumes E, Godefroy N, Klement-frutos E. AMBUCOV : description d’un système de dépistage hospitalier en ambulatoire en réponse à l’épidémie de CoViD-19. Med Mal Infect 2020. [PMCID: PMC7441949 DOI: 10.1016/j.medmal.2020.06.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Suite à la déclaration d’épidémie de pneumopathies au nouveau coronavirus CoViD-19 en Chine en décembre 2019, 11 patients ont été confirmés infectés en France du 20/01 au 10/02/2020 dont 5 en Île-de-France. Devant l’afflux de personnes nécessitant un dépistage et le manque de place en unité d’isolement dans les établissements de soins référent (ESR), un système dégradé d’accueil pour le dépistage des cas suspects de CoViD-19 a été élaboré. En concertation avec les autorités sanitaires françaises et la direction de l’hôpital, le département des maladies infectieuses a développé le projet AmbuCoV pour pouvoir accueillir au mieux et sans délais toutes les personnes qui lui étaient adressées. Matériels et méthodes Mise en place d’une unité dédiée pour la prise en charge des personnes nécessitant un dépistage pour le CoViD-19 et ne justifiant pas d’une hospitalisation. L’unité AmbuCoV, ouverte 24 h/24 et 7j/7, a fonctionné avec le personnel minimum et respecté un parcours patient développé par l’équipe pluridisciplinaire du service pour le dépistage et l’isolement au sein de l’établissement. Le laboratoire de virologie procédait à deux séries de PCR par jour, avec un rendu des résultats vers 13 h pour les prélèvements envoyés avant 8 h, et 19 h pour ceux envoyés avant 14 h. Une évaluation interne a été menée afin d’évaluer quantitativement et qualitativement ce dispositif. Résultats AmbuCoV a été ouvert le 31 janvier 2020 et comprenait 22 lits répartis en 16 chambres. Une infirmière effectuait le prélèvement nasopharyngé et la prise des constantes dans le box dédié en pression négative de l’unite d’isolement. Les personnes sans ATCD et paucisymptomatiques (constantes normales, t < 38 °C, absence de dyspnée et de toux) étaient accompagnées pour être isolées dans l’unité AmbuCoV jusqu’à réception des résultats. Ces patients ne nécessitant pas de soins infirmiers, une aide-soignante présente dans l’unité en permanence répondait à leurs besoins et assurait le lien avec les infirmières et médecins du service. En cas d’infection CoViD-19 confirmée les patients devaient être hospitalisés dans l’unité d’isolement. Les deux premières semaines, 15 personnes de 10 à 48 ans ont été admises dans AmbuCov soit 20 % des personnes admises pour dépistage du CoViD-19 dans notre ESR. Nous présentons en photos et à l’aide de figures la procédure et le parcours des personnes prises en charge. Aucune personne suspecte d’infection à CoViD-19 ne s’est vue refusée l’admission pour dépistage dans notre ESR. Les usagers et le personnel soignant se sont montrés satisfaits de ce programme. La principale limitation à l’utilisation de l’unité AmbuCoV était l’absence de pression négative dans les chambres qui contre-indiquait la prise en charge des personnes présentant une toux ou des signes broncho-pulmonaires. Un système de recyclage de l’air par appareil mobile (Plasmair) est à l’essai. Conclusion Nous avons mis en place une stratégie de dépistage ambulatoire d’une infection virale émergente pour faire face à l’augmentation de patients et de cas suspects en contexte épidémique. Cette unité baptisée AmbuCoV nous a permis de faire face rapidement et efficacement à l’afflux de personnes et pourra être réutilisée à l’avenir en cas de nouvelle épidémie. Nous souhaitons partager notre expérience, ainsi que son évaluation en termes de points forts et difficultés rencontrées, afin qu’elle puisse servir à d’autres personnels de santé.
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Godefroy N, Meloni C, Junot H, Drieux L, Luyt C, Bleibtreu A. Évaluation de l’incidence des colites à Clostridioides difficile après un traitement par ceftazidime/avibactam ou ceftolozane/tazobactam dans un GH. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stahl JP, Bru JP, Gehanno JF, Herrmann JL, Castan B, Deffontaines G, Sotto A, Lepelletier D, Tattevin P, Godefroy N, Haddad E, Mailles A, Lavigne JP. Guidelines for the management of accidental exposure to Brucella in a country with no case of brucellosis in ruminant animals. Med Mal Infect 2020; 50:480-485. [PMID: 32442670 DOI: 10.1016/j.medmal.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- J P Stahl
- Infectiologie, CHU Grenoble-Alpes, 38043 Grenoble, France.
| | - J P Bru
- Infectiologie, centre hospitalier Annecy-Genevois, Annecy, France.
| | - J F Gehanno
- Médecine du travail, CHU de Rouen, Rouen, France.
| | | | - B Castan
- Infectiologie, centre hospitalier Périgueux, Périgueux, France.
| | - G Deffontaines
- Médecine du travail, mutualité sociale agricole, France.
| | - A Sotto
- Infectiologie, CHU de Nîmes, Nîmes, France; Centre national de référence Brucella, microbiologie, CHU de Nîmes, Nîmes, France.
| | | | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, Rennes, France.
| | - N Godefroy
- Infectiologie, CHU Pitié-Salpêtrière, Paris, France.
| | - E Haddad
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, Rennes, France.
| | - A Mailles
- Direction des maladies infectieuses, santé publique France, Saint-Maurice, France.
| | - J P Lavigne
- Centre national de référence Brucella, microbiologie, CHU de Nîmes, Nîmes, France.
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Godefroy N, Jauréguiberry S, Monsel G, Haddad E, Jaffré J, Caumes E, Pourcher V. Caractéristiques épidémiologiques, cliniques, microbiologiques et radiologiques chez 473 patients suivis pour tuberculose. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- N Godefroy
- Laboratoire de Génétique et Biologie Cellulaire (CNRS UMR8159), Université de Versailles Saint-Quentin-en-Yvelines, 45 Avenue des Etats-Unis, 78035, Versailles Cedex, France
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Godefroy N, Lemaire C, Renaud F, Rincheval V, Perez S, Parvu-Ferecatu I, Mignotte B, Vayssière JL. p53 can promote mitochondria- and caspase-independent apoptosis. Cell Death Differ 2005; 11:785-7. [PMID: 15002037 DOI: 10.1038/sj.cdd.4401398] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Delanoue R, Legent K, Godefroy N, Flagiello D, Dutriaux A, Vaudin P, Becker JL, Silber J. The Drosophila wing differentiation factor Vestigial–Scalloped is required for cell proliferation and cell survival at the dorso-ventral boundary of the wing imaginal disc. Cell Death Differ 2003; 11:110-22. [PMID: 14526388 DOI: 10.1038/sj.cdd.4401321] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Links between genes involved in development, proliferation and apoptosis have been difficult to establish. In the Drosophila wing disc, the vestigial (vg) and the scalloped (sd) gene products dimerize to form a functional transcription factor. Ectopic expression of vg in other imaginal discs induces outgrowth and wing tissue specification. We investigated the role of the VG-SD dimer in proliferation and showed that vg antagonizes the effect of dacapo, the cyclin-cdk inhibitor. Moreover, ectopic vg drives cell cycle progression and in HeLa cultured cells, the VG-SD dimer induces cell proliferation per se. In Drosophila, ectopic vg induces expression of dE2F1 and its targets dRNR2 and string. In addition vg, but not dE2F1, interacts with and induces expression of dihydrofolate reductase (DHFR). Moreover, a decrease in VG or addition of aminopterin, a specific DHFR inhibitor, shift the dorso-ventral boundary cells of the disc to a cell death sensitive state that is correlated with reaper induction and DIAP1 downregulation. This indicates that vg in interaction with dE2F1 and DHFR is a critical player for both cell proliferation and cell survival in the presumptive wing margin area.
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Affiliation(s)
- R Delanoue
- Institut Jacques Monod, Tour 43, 2, Place Jussieu, 75251 Paris, France
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Cosnard C, Godefroy N. [Cancer and the quality of life. Home care services]. Soins 1997:30-35. [PMID: 9239095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- C Cosnard
- Hôpital de Montfermeil, Aulnay-sous-Bois
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Vacher-Lavenu MC, Le Tourneau A, Duvillard P, Godefroy N, Pinel MC. Pathological classification and grading of primary ovarian carcinoma: experience of the ARTAC ovarian study group. Bull Cancer 1993; 80:135-41. [PMID: 8173164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
One hundred and fifty-seven cases of high stage ovarian carcinomas (FIGO stage III and IV) have been selected for therapeutic protocol under the aegis of ARTAC. One hundred and forty-six cases have been reviewed, of which 15 were peritoneal tumors: eight ovarian tumors were excluded. One hundred and twenty-three primary ovarian carcinomas have been graded and classified. The slides were reviewed independently by three pathologists with a perfect correlation and no significant difference was observed with the initial diagnosis. The World Health Organisation classification of ovarian epithelial tumors was used as a basis for the study (98 serous types, three mucinous tumors, five endometrioid tumors, two clear cell tumors, five mixed epithelial tumors, seven undifferentiated tumors and three unclassified). The adopted grading associates the degree of architecture differentiation and the cytological features using Broder's classification. The architecture grading or degree of differentiation includes well differentiated, moderately differentiated, poorly differentiated and undifferentiated patterns. The nuclear grading is based on pleomorphism of size and form, hyperchromatism, nucleoli, mitotic figures. The proposed grading based on well-known criterions is simple to use and easily reproducible. Grade 1 (6.5%) are well differentiated tumors with no atypia. Grade 2 (17.89%) are moderately well differentiated tumors without nuclear atypia. Grade 3 (32.52%) correspond to moderately well differentiated tumors with nuclear atypia. Grade 4 (43.09%) are poorly differentiated or undifferentiated tumors with nuclear atypia. The authors consider the different correlations between grade, histological type, stage and prognosis. The implications of these findings are discussed and the results are compared to those of the literature.
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