Overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis: a retrospective study of 115 cases of autoimmune liver disease

OBJECTIVE

The aim of this retrospective study was to compare clinical, biological, and histological features and treatment response in 115 patients with overlap syndrome (OS), autoimmune hepatitis (AIH) or primary biliary cirrhosis (PBC).

METHODS

Consecutive patients with AIH, PBC or OS followed between 1984 and 2005 in five different centers were included. All data were re-evaluated using current diagnostic criteria of each disease.

RESULTS

Fifteen patients had OS (13 females), 48 AIH (40 females) and 52 PBC (49 females). Patients with OS were significantly younger than patients with PBC (median age: 44 vs 59 years). Jaundice (20%) and pruritus (20%) were the main initial symptoms in OS. Patients with OS had serum transaminase and gammaglobulin levels significantly higher than patients with PBC; serum alkaline phosphatase, gamma-glutamyl-transpeptidase and IgM levels were significantly higher in OS than in patients with AIH. Histological analysis showed moderate or severe piecemeal necrosis in 86% and destructive cholangitis in 93% in OS group. Among 11 patients with OS treated with ursodeoxycholic acid (UDCA) or immunosuppressors alone, only 6 had a complete biochemical response. In contrast, all patients with OS receiving combined therapy, as first or second line, responded, 5 patients to the combination corticosteroids-azathioprine-UDCA and 2 to the combination cyclosporine-UDCA.

CONCLUSION

OS is not rare and accounts for 13.9% of patients with autoimmune liver disease in our series. Combination of immunosuppressors and UDCA appears the most efficient treatment in these patients.

[Progress report on the Bethesda System]

The 2001 Bethesda System is a uniform system of terminology for reporting results of pap smears. It is acknowledged by most cytopathologists worldwide as a standard for cervical cytology reports. In France, several national surveys have confirmed its current utilization. However, more specific analysis have shown that the Bethesda System may be routinely modified by individual laboratories or even individual cytopathologist working within the same department. The aim of this progress report was to emphasize the importance of fully understanding the Bethesda System and applying it in a rigorous and standardized way.

[Skin cancer diagnosis by dermatologists in the region of Champagne-Ardenne: a prospective study]

INTRODUCTION

The exact incidence of skin cancers is not well established in France as in other european countries, except for cutaneous melanoma. It is the same for the part taken by dermatologists in the screening of skin malignancies. We have therefore planned a prospective study in the Champagne-Ardenne region to determine the incidence of the various types of skin cancers diagnosed by dermatologists.

PATIENTS AND METHOD

A prospective study was performed within a 4-month period at the end of 1998 with the participation of the dermatologists of the Champagne-Ardenne and the south of Aisne. The new incident cases of skin cancers confirmed histologically were recorded using a questionnaire including the type of tumour, demographic data of the patient and type of practice of the dermatologist. Parallely, the pathology laboratories of the same region were asked about the number of squamous and basal cell carcinomas and melanomas diagnosed histologically during the same period of time.

RESULTS

The rate of participation of dermatologists was 86 p. 100. During the study period, 898 skin cancers were diagnosed in 794 patients (408 women and 386 men; mean age 70.1 years) including 643 basal cell carcinomas, 123 squamous cell carcinomas, 48 Bowen diseases, 53 melanomas, 7 lymphomas and 24 other tumours. More than 80 p. 100 of patients were primarily seen in private practice. Ten of 13 pathology laboratories of the region replied to the inquiry. From these pathological data, 585 basal cell carcinomas, 125 squamous cell carcinomas and 44 melanomas were recorded during the same period of time.

DISCUSSION

This study shows that the oncologic clinical practice of dermatologists in our region is considerable. Taking into account both participation and exhaustivity rates, one can estimate at more than 3,500 the annual number of skin cancers diagnosed by dermatologists in our region, with an expected distribution of the various types of cancers. The essential role of the dermatologists in screening skin malignancies is confirmed by data provided by pathology laboratories. This role is a french characteristic and cannot by applied to other industrialized countries.

Hepatic angiomyolipoma. A report of four cases with immunohistochemical and DNA-flow cytometric studies

OBJECTIVE

To describe the pathologic features in four cases of hepatic angiomyolipoma, a rare benign mesenchymal tumor of the liver.

DESIGN

Retrospective analysis of surgical specimens from four patients, with immunohistochemical and flow cytometric studies.

RESULTS

None of the patients carried a diagnosis of tuberous sclerosis. All four tumors were large and well circumscribed, and one patient had multiple lesions. The neoplasms were composed of numerous vessels and exhibited a predominance of epithelioid smooth muscle cells. The low amount of fat in these four cases was not sufficient to produce characteristic images that would allow diagnosis of angiomyolipoma before surgical resection. All tumors exhibited strong staining with HMB45 and anti-smooth muscle actin antibodies, whereas no positivity was observed with estrogen and progesterone receptor antibodies. Flow cytometry revealed a diploid DNA pattern in all cases.

CONCLUSIONS

Our four cases demonstrate that it is difficult to differentiate hepatic angiomyolipoma from other liver tumors when the amount of fat is low. HMB45 positivity of smooth muscle cells appears to be very helpful in reaching a pathological diagnosis of hepatic angiomyolipoma. The DNA-diploid pattern observed in all cases could be considered a new argument for the benign nature of hepatic angiomyolipoma.

Pus, deoxyribonucleic acid, and sputum viscosity

On 100 sputum specimens selected from patients suffering from chronic bronchitis, bronchiectasis, asthma, and cystic fibrosis total deoxyribonucleic acid (DNA) content has been related to macroscopic type, to total dry weight yield, and to the apparent viscosity of the secretion at 1350 s-1: since DNA may be present, either as fibres or within cells, in one-third of the specimens the contribution of each form to the apparent viscosity was assessed. The effect on sputum viscosity of the addition of DNA in vitro has also been studied. Whereas between mucoid, mucopurulent, and purulent macroscopic types a significant difference in total DNA and dry weight yield has been found, viscosity was not significantly correlated with purulence. Similarly, the concentration of either cells or fibres correlated significantly with total DNA but not with viscosity. The in vitro addition of DNA to sputum caused a significant increase in its viscosity, and reasons for the differences between the iv vivo and in vitro effect are discussed. Certain constituents of purulent sputum tend to increase viscosity and others to reduce it, and the influence of these varies in the several diseases studied.

Bronchial secretion from normal human airways after inhalation of prostaglandin F2alpha, acetylcholine, histamine, and citric acid

Sputum produced by normal subjects after inhalation of prostaglandin F2alpha, acetylcholine, histamine, and citric acid has been analysed. Prostaglandin F2alpha was the most effective of the drugs in promoting sputum production. The material expectorated after inhalation of prostaglandin F2alpha shows the characteristics of mucoid sputum from patients with chronic bronchitis. The apparent viscosity and the concentration of marker substances for bronchial glycoprotein was in the lower part of the range found in mucoid chronic bronchitic sputum. The concentration of marker substances for serum glycoproteins and tissue fluid transudate were below the range found in chronic bronchitis, indicating that, in disease states, in addition to bronchial mucus there is a marked tissue fluid transudate component. Sputum produced after inhalation of acetylcholine and histamine contained relatively more tissue fluid transudate than sputum produced after inhalation of prostaglandin F2alpha, Sputum produced after inhalation of prostaglandin F2alpha, is of special value in indicating the nature of secretion from normal airways.