Plurifocal testicular hamartomas and testicular feminization syndrome

We report the case of a 14-year-old girl with a testicular feminization syndrome. The inguinal cryptorchid testis contained plurifocal hamartomas ranging from 0.5 to 1 cm. They were composed of tubules lined by cylindrical Sertoli cells immunoreactive for alpha-inhibin and p30/32(MIC2). The stroma contained few Leydig cells. Ultrastructural study showed tubules with immature Sertoli cells. The testicular feminization syndrome is caused by mutations of the androgen receptor gene. Patients with male genotype 46, XY have a female morphotype with external sexual organs without ambiguity. They have neither uterus nor ovary but two cryptorchid testis in which sex-cord stromal tumors can develop. Their malignant transformation is rare but requires preventive bilateral orchidectomy.     

Cellular angiofibroma. A rare vulvar tumor. Report of a case

Cellular angiofibroma is a rare tumor. We report a vulvar case in a 37 year old woman. This nodular, well circonscribed tumor consists of bland spindle cells, numerous thin or thick often hyalinized vessels and adipocytes. The stromal cells are positive for vimentin and negative for CD34, protein S100, smooth muscle actin, desmin, epithelial membrane antigen and cytokeratin. Cellular angiofibroma is a benign tumor that has to be differentiated from aggressive angiomyxoma, angiomyofibroblastoma, glomangiopericytoma, spindle cell lipoma, solitary fibrous tumor and perineurioma.     

Serodiagnosis of tuberculosis: comparison of immunoglobulin A (IgA) response to sulfolipid I with IgG and IgM responses to 2,3-diacyltrehalose, 2,3,6-triacyltrehalose,and cord factor antigens

Nonpeptidic antigens from the Mycobacterium tuberculosis cell wall are the focus of extensive studies to determine their potential role as protective antigens or serological markers of tuberculous disease. Regarding this latter role and using an enzyme-linked immunosorbent assay, we have made a comparative study of the immunoglobulin G (IgG), IgM, and IgA antibody responses to four trehalose-containing glycolipids purified from M. tuberculosis: diacyltrehaloses, triacyltrehaloses, cord factor, and sulfolipid I (SL-I). Sera from 92 tuberculosis patients (taken before starting antituberculosis treatment) and a wide group of control individuals (84 sera from healthy donors, including purified protein derivative-negative, -positive, healed, and vaccinated individuals, and 52 sera from nontuberculous pneumonia patients), all from Spain, were studied. The results indicated a significantly elevated IgG and IgA antibody response in tuberculosis patients, compared with controls, with all the antigens used. SL-I was the best antigen studied, showing test sensitivities and specificities for IgG of 81 and 77.6%, respectively, and of 66 and 87.5% for IgA. Using this antigen and combining IgA and IgG antibody detection, high test specificity was achieved (93.7%) with a sensitivity of 67.5%. Currently, it is widely accepted that it is not possible to achieve sensitivities above 80% in tuberculosis serodiagnosis when using one antigen alone. Thus, we conclude that SL-I, in combination with other antigenic molecules, could be a useful antigen for tuberculosis serodiagnosis.     

Angiomyofibroblastoma of the male genital tract. Pathological and immunohistochemical study of three cases

Angiomyofibroblastoma of the male genital tract is a rare tumor with only 20 cases reported in the literature to date. We report three cases in males aged from 23 to 44 years. They presented with painless inguinal, scrotal and perineal masses, ranging from 3 to 8 cm in diameter. On microscopic examination the tumors were composed of small spindle cells without atypia in a fibrous and myxoid stroma. There were scattered mononuclear inflammatory cells around capillaries. Immunohistochemical studies showed positive staining of the tumor cells for vimentin, and weak reactivity for CD34, bcl-2, CD99, EMA and CD117. Some tumor cells expressed estrogen receptors in all three cases, and progesterone receptors in only one case. There was no recurrence with a follow-up ranging form 12 to 21 months. Angiomyofibroblastoma of the male genital tract is a benign often hormone-dependent tumor. Its histogenesis is still unclear. It has to be distinguished from aggressive angiomyxoma and myxofibrosarcoma.     

Results of the tension-free vaginal tape technique in the elderly

OBJECTIVES: To assess the results of the Tension-Free Vaginal Tape (TVT) technique for the treatment of stress urinary incontinence (SUI) in the elderly. PATIENTS AND METHODS: Between March 1998 and February 2001, 76 consecutive women more than 70 years old (median 76) and presenting with SUI were operated with the TVT technique. 28.9% (22/76) of the patients had previous surgery for SUI. 31% (24/76) of the patients had an overactive bladder and 4 patients had detrusor instability controlled by anticholinergic therapy. All patients had preoperative multichanel urodynamic evaluation. RESULTS: No serious complication was noted intra- or postoperatively. At a mean follow up of 24.6 months (range 16-49 months), 67% of the patients were cured (51/76). Among the failures, 10 patients (13.7%) had persistent SUI, 14 patients (18.4%) had urge incontinence and 2 patients were lost to follow up. De novo urgency without incontinence was noticed in 21% of the patients but preoperative urgency symptoms were cured in 46% of the patients. Overall 82% of the patients were satisfied with the result of the surgery, 14% considered the result as incomplete and 4% considered they were worsened by surgery. CONCLUSION: The TVT procedure is safe and efficient to treat SUI in the elderly population even if the rate of de novo urgency appeared to be significant.     

Hallux valgus : mise au point sur l’analyse radiographique et la planification opératoire

The management of hallux valgus (bunions) has seen significant changes over the last 20 years. The first stage, in the early 1990s, saw the introduction of the scarf osteotomy, allowing the reduction of the metatarsus varus, derotation of the epiphysis and a shortening. The second stage, in 2002, was the SOFCOT round table, emphasising the importance of the DMAA and its radiological evaluation. Alongside this, GRECMIP brought experience in percutaneous surgery to France, through the experience of Ischam and De Prado. Surgical planning finally became reproducible, with the aim of recentering the M1 head under the sesamoids, shortening of the 1st ray in cases of articular incongruity of the MP of the hallux or an oversized hallux and correction of the DMAA. The pre- and intraoperative use of the DM2AA angle allows the calculation of the derotation to be applied to the distal articular surface of the M1. When it comes to the choice of treatment, this is guided by the patient??s radiographic analysis, functional problems and co-morbidity. The choice of final treatment is not restricted to a typical operation to treat all types of hallux valgus. A metatarsus varus below 20° allows surgery with an osteotomy site that can depend on the preferences of the surgeon. However, a metatarsus varus greater than 20° can only be reduced by osteotomy of the base (or Lapidus procedure) with intraoperative verification of the new DM2AA. A non-reduced DM2AA means considering an additional distal osteotomy of the M1. Finally, percutaneous surgery must be restricted to specific cases: a congenital hallux with a metatarsus varus below 16°. Its extension can be achieved by experienced surgeons who are able, using forceps, to increase the translation capacity of percutaneous osteotomies.