Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2020
BACKGROUND The majority of hindquarter amputation defects can be reconstructed with local anterio... more BACKGROUND The majority of hindquarter amputation defects can be reconstructed with local anterior or posterior thigh flaps. Less than 5% of soft tissue defects require free flap reconstruction after tumour resection. Lower extremity fillet flap is described for reconstructing such defects, but the majority of publications are case reports or short single institutional series. There is a lack of data regarding the oncological outcomes of this highly selected patient group. METHODS Three tertiary sarcoma units treated twelve patients with hindquarter amputation or hip disarticulation for oncological indications with a free flap reconstruction of the soft tissue defect. RESULTS The median age of patients was 60 (range 12-76) years. Bone resection was carried out through the SI-joint in six patients and through the sacrum in five patients, with one patient undergoing hip disarticulation. Nine patients had R0 resection margin and three had R1 resection. The median surgical time and flap...
Introduction Le traitement chirurgical de reference des tumeurs osseuses malignes est la resectio... more Introduction Le traitement chirurgical de reference des tumeurs osseuses malignes est la resection carcinologique et le pronostic depend notamment de la marge de resection. Au niveau du bassin, cet imperatif peut entrainer des difficultes pour la fermeture du site operatoire. Nous decrivons sept cas de patients presentant une tumeur osseuse maligne localisee au niveau du bassin ou de l’extremite superieure du femur avec une extension locale, dont la resection carcinologique impose une desarticulation inter-ilio-abdominale ou coxofemorale entrainant un defaut de couverture en fin d’intervention et necessitant un lambeau libre comportant les masses musculaires de la jambe du membre ampute. Le but de ce travail est d’evaluer la fiabilite de cette technique et d’en preciser les indications. Materiel et methodes Sept patients ont ete operes dans 3 centres de references : six desarticulations inter-ilio abdominales et une desarticulation coxofemorale. Le lambeau etait constitue dans trois...
BackgroundSurgical margins of melanoma vary from 5 mm to 1 or 2 cm depending on histology thickne... more BackgroundSurgical margins of melanoma vary from 5 mm to 1 or 2 cm depending on histology thickness (Breslow). This approach usually requires two surgical steps: excisional biopsy and further reexcision according to histology thickness. A previous systematic review showed that measuring melanoma thickness with high-resolution ultrasound imaging equipment correlates well with histological measurement of melanoma thickness. Therefore, we routinely determined tumour sonographic thickness in order to perform surgery as a single step.ObjectivesTo determine the proportion of patients who receive onestep surgery with adequate margins based on sonographic measurement of melanoma thickness and identify the reasons for differences between these two measurements.Materials & MethodsA retrospective series of patients with melanoma, in which thickness was measured by ultrasound (20 MHz) from April 2007 to December 2015 prior to surgery.ResultsNinety-nine melanomas were treated, of which 78 were removed in a single step with surgical margins based on sonometric thickness measurements; 71 of these (91%, 95% CI: 82-96) did not require reexcision, five had excessive margins, and two had insufficient margins. The correlation between the histometric and sonometric measurements was good; r=0.88. Significant absolute difference between sonometric and histometric measurementswas associated with thickness, ulceration, and size of tumours, based on bivariate analysis. Thickness remained the only significant factor based on multivariate analysis.ConclusionsMeasuring the thickness of melanoma with high-resolution ultrasound imaging equipment makes it possible to remove the melanoma in a single step with adequate margins in at least 82% of the cases in routine care.
Angiosarcoma is most frequently occurring in patients treated for a previous cancer with radiatio... more Angiosarcoma is most frequently occurring in patients treated for a previous cancer with radiation therapy. Our aim was to measure the time between the first signs found by the patient and the first biopsy, and the time before the final diagnosis of radiation-associated angiosarcoma (RAAS) and to analyse the reasons for delayed diagnosis. Four patients met the inclusion criteria. Three had cutaneous RAAS and one had suprapubic cutaneous RAAS after treatment for cancer. The intervals between the first cutaneous sign recorded by the patient and the diagnosis of RAAS were 9 to 37 months. The initial diagnosis by the non-specialist pathologist was a benign vascular lesion. Review of the initial biopsy was consistent with RAAS in 3 cases and with AVL in 1 case. Clinicians should alert pathogists when a vascular lesion is larger than 5 mm in the context of irradiated skin. Histology review by an expert should be recommended.
Revue de Chirurgie Orthopédique et Traumatologique
Resume Introduction La resection carcinologique est le traitement de reference des sarcomes des t... more Resume Introduction La resection carcinologique est le traitement de reference des sarcomes des tissus mous et osseux. Au bassin, cet imperatif peut necessiter une hemipelvectomie pouvant compromettre la fermeture cutanee de premiere intention. L’utilisation de lambeaux est indispensable, mais la vascularisation des potentiels lambeaux pedicules peut avoir ete resequee lors de l’exerese. Le recours aux tissus sains du membre ampute comme lambeau libre peut constituer une excellente solution de couverture. Hypothese Le lambeau libre de jambe banque est une technique de couverture simple et fiable apres hemipelvectomie ou desarticulation de hanche. Materiel et methodes Sept patients ont ete operes dans 3 centres de references : six desarticulations inter-ilio-abdominales et une desarticulation coxo-femorale. Le lambeau etait constitue dans trois cas de la loge posterieure superficielle du mollet et pour les autres cas de toutes les loges de la jambe avec la fibula non deperiostee. Les differentes complications ont ete analysees. Resultats Pour tous les patients, les marges etaient saines (R0). Le recul moyen lors de la derniere evaluation etait de 13 mois (de 6,5 a 21 mois). Au total, six patients ont une complication sur le lambeau avec une seule perte du lambeau. Quatre patients ont pu etre appareilles. Discussion Le lambeau libre de jambe banque est une technique fiable (86 %) pour la couverture apres hemipelvectomie ou desarticulation de hanche. Dans la litterature, aucun echec de cicatrisation n’est decrit pour les 16 cas rapportes. Les lambeaux locaux sont souvent trop fragiles et avec un matelassage musculaire insatisfaisant. Ce lambeau libre est a privilegier en premiere intention car il permet d’economiser les autres lambeaux libres potentiels en cas de faillite sans augmenter la morbidite d’un geste deja important. Cette technique doit faire partie des solutions de couverture apres hemipelvectomie. Niveau de preuve IV, etude retrospective.
Revue de stomatologie, de chirurgie maxillo-faciale et de chirurgie orale, 2016
The sacrifice of inferior alveolar nerve (IAN) is usual in case of resection of mandibular tumors... more The sacrifice of inferior alveolar nerve (IAN) is usual in case of resection of mandibular tumors and is responsible for disabling sensory disorders, drooling and lip incompetence. We report the case of a reconstruction of the IAN by means of an autologous nerve graft after segmental resection of the mandible. A 27-year-old man presented with a recurrence of mandibular ameloblastoma. Treatment consisted in segmental mandibulectomy with resection of the IAN. Bone reconstruction was performed with a fibula free flap and IAN reconstruction was obtained by mean of a 7-cm nerve graft obtained from the greater auricular nerve (GAN). At the 6th postoperative month, the patient had recovered a normal sensitivity of his lower lip and chin. Latency of somatosensory evoked potentials was similar for both sides. The repair of the IAN by nerve autograft is a simple procedure that allows for good sensitive rehabilitation. The use of the GAN is well suited from its anatomy and from the moderate ea...
Background The distally based medial hemisoleus (MHS) flap was found useful for repairing soft-ti... more Background The distally based medial hemisoleus (MHS) flap was found useful for repairing soft-tissue defects of the lower third of the leg; however, its reliability is controversial. We used a combination of static and dynamic techniques to investigate the vascular supply of distally based MHS muscle flaps to better establish their use in repair of lower-third leg defects. Methods We performed an anatomic study of 18 cadaver legs. For 6 legs, we performed dynamic angiography, which allowed for obtaining MHS muscle radiographs after pulsed injection of contrast medium in distal pedicles. Results The mean length of MHS muscle was 25.4 cm, the mean width was 6.9 cm, and the mean surface area was 87.5 cm2. A mean of 3 distal posterior tibial vascular pedicles was directly connected to this medial subunit. These pedicles were present in all 18 cadaver legs. We observed complete opacification of the 6 MHS muscles through distal pedicles. Radiography revealed opacification of a vascular path from 1 distal pedicle to 1 proximal vascular pedicle of the MHS muscle. The mean level of this main distal pedicle was 14.5 cm to the tip of the medial malleolus. The level was at 38.2%, on average, from the bottom of the entire tibia. Conclusions The distally based MHS muscle flap has constant blood supply, so it could be a useful flap to repair soft-tissue defects of the lower third of the leg. Moreover, knowledge of the average location of the main distal pedicle can help in increasing the use of the distally based MHS flap.
Introduction Le dermatofibrosarcome protuberant de Darier-Ferrand (DFSP) est une tumeur cutanee m... more Introduction Le dermatofibrosarcome protuberant de Darier-Ferrand (DFSP) est une tumeur cutanee mal limitee, qui infiltre localement lateralement et en profondeur. Les marges chirurgicales doivent etre larges (laterales > 2 cm) et en profondeur (exerese du fascia) pour eviter les recidives locales. Les marges peuvent etre reduites avec un controle histologique exhaustif des marges. L’imagerie preoperatoire des DFSP vise a preciser l’extension tumorale locale. Quelques etudes sont disponibles en echographie conventionnelle 7–15 MHz, scanner ou IRM. L’echographie cutanee haute resolution (EHR) a 20 MHz, visualise l’extension dermique ou hypodermique des tumeurs cutanees mais aucune etude n’a ete a ce jour consacree au DFSP. Notre objectif etait de decrire les images echographiques et d’observer l’extension laterale et profonde des DFSP. Materiel et methodes Serie retrospective de tous les DFSP adresses pour planifier le traitement, et qui ont eu une imagerie EHR puis une exerese entre le 1/6/2007 au 1/6/2016. Resultats Dix patients (dont 5 femmes) âges de 35 a 78 ans ont ete inclus. Il s’agissait dans 2 cas d’une recidive locale apres exerese incomplete 5 et 15 ans auparavant. Le delai median entre la survenue de la lesion et l’exerese etait de 4 ans (extremes 1–10). Dans un cas a croissance rapide, il existait un contingent plus agressif de fibrosarcome. Les tumeurs etaient toutes bien visibles en EHR, stereotypees, hypoechogenes contenant des structures hyperechogenes. La delimitation laterale avec le derme ou l’hypoderme etait progressive mais bien visible. Le niveau maximal d’invasion (derme, hypoderme, fascia) a pu etre mesure dans les 5 cas dont l’epaisseur maximale etait inferieure a la fenetre d’exploration de la sonde (15 mm de large, 7,5 mm de profondeur). Discussion Il s’agit de la premiere etude en EHR, et qui montre des images assez caracteristiques, tres differentes des images de carcinomes, melanomes ou histiocytofibromes, qui pourraient avoir un interet diagnostique du DFSP, mais ceci est a confirmer par une etude en aveugle du diagnostic clinique, et histologique. Le DFSP est une tumeur mal limitee au plan histologique, avec des travees cellulaires qui infiltrent les structures adjacentes. L’EHR n’a pas la resolution a l’echelle de la cellule, mais permet de voir grossierement les limites laterales entre tissu sain et tumoral. L’extension en profondeur, pour les tumeurs Conclusion Les DFSP en echographie haute resolution ont une echostructure tres particuliere. La visualisation de l’extension laterale et profonde pour les tumeurs d’epaisseur
Merkel cell carcinoma (MCC) is an aggressive skin cancer frequently caused by the Merkel cell pol... more Merkel cell carcinoma (MCC) is an aggressive skin cancer frequently caused by the Merkel cell polyomavirus (MCPyV). It is still under discussion, in which cells viral integration and MCC development occurs. Recently, we demonstrated that a virus-positive MCC derived from a trichoblastoma, an epithelial neoplasia bearing Merkel cell (MC) differentiation potential. Accordingly, we hypothesized that MC progenitors may represent an origin of MCPyV-positive MCC. To sustain this hypothesis, phenotypic comparison of trichoblastomas and physiologic human MC progenitors was conducted revealing GLI family zinc finger 1 (GLI1), Keratin 17 (KRT 17), and SRY-box transcription factor 9 (SOX9) expressions in both subsets. Furthermore, GLI1 expression in keratinocytes induced transcription of the MC marker SOX2 supporting a role of GLI1 in human MC differentiation. To assess a possible contribution of the MCPyV T antigens (TA) to the development of an MC-like phenotype, human keratinocytes were tra...
Techniques for treating trigonocephaly and anterior plagiocephaly have evolved from the initial s... more Techniques for treating trigonocephaly and anterior plagiocephaly have evolved from the initial suturectomy technique to frontal cranioplasty. The authors evaluated the suturectomy technique in adolescent patients with these craniosynostoses, by carrying out a retrospective, long-term assessment at the end of growth. Patients with anterior plagiocephaly or trigonocephaly were included. All had undergone coronal or metopic suturectomy with bilateral orbitofrontal bandeau resection between 1997 and 2005. The primary endpoint was the Whitaker classification. The secondary endpoints were anthropometric measurement, assessments of the bone defects on computed tomography scan, and the comments of patients and their relatives concerning the final skull outcome. Patients with anterior plagiocephaly also attended an ophthalmological consultation. Seventeen patients were included in the study: 8 with anterior plagiocephaly and 9 with trigonocephaly. Mean age at the time of surgery was 6.91 months. Mean age at the time of craniofacial consultation was 14 years. Fourteen patients (82%) were classified as Whitaker Class III and IV, corresponding to poor esthetic results and persistent bone defects. Seven patients requested further surgery. This study shows that suturectomy seems to yield poor esthetic results in the long term and patients should be followed up throughout adolescence to correct any craniofacial deformities.
Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2020
BACKGROUND The majority of hindquarter amputation defects can be reconstructed with local anterio... more BACKGROUND The majority of hindquarter amputation defects can be reconstructed with local anterior or posterior thigh flaps. Less than 5% of soft tissue defects require free flap reconstruction after tumour resection. Lower extremity fillet flap is described for reconstructing such defects, but the majority of publications are case reports or short single institutional series. There is a lack of data regarding the oncological outcomes of this highly selected patient group. METHODS Three tertiary sarcoma units treated twelve patients with hindquarter amputation or hip disarticulation for oncological indications with a free flap reconstruction of the soft tissue defect. RESULTS The median age of patients was 60 (range 12-76) years. Bone resection was carried out through the SI-joint in six patients and through the sacrum in five patients, with one patient undergoing hip disarticulation. Nine patients had R0 resection margin and three had R1 resection. The median surgical time and flap...
Introduction Le traitement chirurgical de reference des tumeurs osseuses malignes est la resectio... more Introduction Le traitement chirurgical de reference des tumeurs osseuses malignes est la resection carcinologique et le pronostic depend notamment de la marge de resection. Au niveau du bassin, cet imperatif peut entrainer des difficultes pour la fermeture du site operatoire. Nous decrivons sept cas de patients presentant une tumeur osseuse maligne localisee au niveau du bassin ou de l’extremite superieure du femur avec une extension locale, dont la resection carcinologique impose une desarticulation inter-ilio-abdominale ou coxofemorale entrainant un defaut de couverture en fin d’intervention et necessitant un lambeau libre comportant les masses musculaires de la jambe du membre ampute. Le but de ce travail est d’evaluer la fiabilite de cette technique et d’en preciser les indications. Materiel et methodes Sept patients ont ete operes dans 3 centres de references : six desarticulations inter-ilio abdominales et une desarticulation coxofemorale. Le lambeau etait constitue dans trois...
BackgroundSurgical margins of melanoma vary from 5 mm to 1 or 2 cm depending on histology thickne... more BackgroundSurgical margins of melanoma vary from 5 mm to 1 or 2 cm depending on histology thickness (Breslow). This approach usually requires two surgical steps: excisional biopsy and further reexcision according to histology thickness. A previous systematic review showed that measuring melanoma thickness with high-resolution ultrasound imaging equipment correlates well with histological measurement of melanoma thickness. Therefore, we routinely determined tumour sonographic thickness in order to perform surgery as a single step.ObjectivesTo determine the proportion of patients who receive onestep surgery with adequate margins based on sonographic measurement of melanoma thickness and identify the reasons for differences between these two measurements.Materials & MethodsA retrospective series of patients with melanoma, in which thickness was measured by ultrasound (20 MHz) from April 2007 to December 2015 prior to surgery.ResultsNinety-nine melanomas were treated, of which 78 were removed in a single step with surgical margins based on sonometric thickness measurements; 71 of these (91%, 95% CI: 82-96) did not require reexcision, five had excessive margins, and two had insufficient margins. The correlation between the histometric and sonometric measurements was good; r=0.88. Significant absolute difference between sonometric and histometric measurementswas associated with thickness, ulceration, and size of tumours, based on bivariate analysis. Thickness remained the only significant factor based on multivariate analysis.ConclusionsMeasuring the thickness of melanoma with high-resolution ultrasound imaging equipment makes it possible to remove the melanoma in a single step with adequate margins in at least 82% of the cases in routine care.
Angiosarcoma is most frequently occurring in patients treated for a previous cancer with radiatio... more Angiosarcoma is most frequently occurring in patients treated for a previous cancer with radiation therapy. Our aim was to measure the time between the first signs found by the patient and the first biopsy, and the time before the final diagnosis of radiation-associated angiosarcoma (RAAS) and to analyse the reasons for delayed diagnosis. Four patients met the inclusion criteria. Three had cutaneous RAAS and one had suprapubic cutaneous RAAS after treatment for cancer. The intervals between the first cutaneous sign recorded by the patient and the diagnosis of RAAS were 9 to 37 months. The initial diagnosis by the non-specialist pathologist was a benign vascular lesion. Review of the initial biopsy was consistent with RAAS in 3 cases and with AVL in 1 case. Clinicians should alert pathogists when a vascular lesion is larger than 5 mm in the context of irradiated skin. Histology review by an expert should be recommended.
Revue de Chirurgie Orthopédique et Traumatologique
Resume Introduction La resection carcinologique est le traitement de reference des sarcomes des t... more Resume Introduction La resection carcinologique est le traitement de reference des sarcomes des tissus mous et osseux. Au bassin, cet imperatif peut necessiter une hemipelvectomie pouvant compromettre la fermeture cutanee de premiere intention. L’utilisation de lambeaux est indispensable, mais la vascularisation des potentiels lambeaux pedicules peut avoir ete resequee lors de l’exerese. Le recours aux tissus sains du membre ampute comme lambeau libre peut constituer une excellente solution de couverture. Hypothese Le lambeau libre de jambe banque est une technique de couverture simple et fiable apres hemipelvectomie ou desarticulation de hanche. Materiel et methodes Sept patients ont ete operes dans 3 centres de references : six desarticulations inter-ilio-abdominales et une desarticulation coxo-femorale. Le lambeau etait constitue dans trois cas de la loge posterieure superficielle du mollet et pour les autres cas de toutes les loges de la jambe avec la fibula non deperiostee. Les differentes complications ont ete analysees. Resultats Pour tous les patients, les marges etaient saines (R0). Le recul moyen lors de la derniere evaluation etait de 13 mois (de 6,5 a 21 mois). Au total, six patients ont une complication sur le lambeau avec une seule perte du lambeau. Quatre patients ont pu etre appareilles. Discussion Le lambeau libre de jambe banque est une technique fiable (86 %) pour la couverture apres hemipelvectomie ou desarticulation de hanche. Dans la litterature, aucun echec de cicatrisation n’est decrit pour les 16 cas rapportes. Les lambeaux locaux sont souvent trop fragiles et avec un matelassage musculaire insatisfaisant. Ce lambeau libre est a privilegier en premiere intention car il permet d’economiser les autres lambeaux libres potentiels en cas de faillite sans augmenter la morbidite d’un geste deja important. Cette technique doit faire partie des solutions de couverture apres hemipelvectomie. Niveau de preuve IV, etude retrospective.
Revue de stomatologie, de chirurgie maxillo-faciale et de chirurgie orale, 2016
The sacrifice of inferior alveolar nerve (IAN) is usual in case of resection of mandibular tumors... more The sacrifice of inferior alveolar nerve (IAN) is usual in case of resection of mandibular tumors and is responsible for disabling sensory disorders, drooling and lip incompetence. We report the case of a reconstruction of the IAN by means of an autologous nerve graft after segmental resection of the mandible. A 27-year-old man presented with a recurrence of mandibular ameloblastoma. Treatment consisted in segmental mandibulectomy with resection of the IAN. Bone reconstruction was performed with a fibula free flap and IAN reconstruction was obtained by mean of a 7-cm nerve graft obtained from the greater auricular nerve (GAN). At the 6th postoperative month, the patient had recovered a normal sensitivity of his lower lip and chin. Latency of somatosensory evoked potentials was similar for both sides. The repair of the IAN by nerve autograft is a simple procedure that allows for good sensitive rehabilitation. The use of the GAN is well suited from its anatomy and from the moderate ea...
Background The distally based medial hemisoleus (MHS) flap was found useful for repairing soft-ti... more Background The distally based medial hemisoleus (MHS) flap was found useful for repairing soft-tissue defects of the lower third of the leg; however, its reliability is controversial. We used a combination of static and dynamic techniques to investigate the vascular supply of distally based MHS muscle flaps to better establish their use in repair of lower-third leg defects. Methods We performed an anatomic study of 18 cadaver legs. For 6 legs, we performed dynamic angiography, which allowed for obtaining MHS muscle radiographs after pulsed injection of contrast medium in distal pedicles. Results The mean length of MHS muscle was 25.4 cm, the mean width was 6.9 cm, and the mean surface area was 87.5 cm2. A mean of 3 distal posterior tibial vascular pedicles was directly connected to this medial subunit. These pedicles were present in all 18 cadaver legs. We observed complete opacification of the 6 MHS muscles through distal pedicles. Radiography revealed opacification of a vascular path from 1 distal pedicle to 1 proximal vascular pedicle of the MHS muscle. The mean level of this main distal pedicle was 14.5 cm to the tip of the medial malleolus. The level was at 38.2%, on average, from the bottom of the entire tibia. Conclusions The distally based MHS muscle flap has constant blood supply, so it could be a useful flap to repair soft-tissue defects of the lower third of the leg. Moreover, knowledge of the average location of the main distal pedicle can help in increasing the use of the distally based MHS flap.
Introduction Le dermatofibrosarcome protuberant de Darier-Ferrand (DFSP) est une tumeur cutanee m... more Introduction Le dermatofibrosarcome protuberant de Darier-Ferrand (DFSP) est une tumeur cutanee mal limitee, qui infiltre localement lateralement et en profondeur. Les marges chirurgicales doivent etre larges (laterales > 2 cm) et en profondeur (exerese du fascia) pour eviter les recidives locales. Les marges peuvent etre reduites avec un controle histologique exhaustif des marges. L’imagerie preoperatoire des DFSP vise a preciser l’extension tumorale locale. Quelques etudes sont disponibles en echographie conventionnelle 7–15 MHz, scanner ou IRM. L’echographie cutanee haute resolution (EHR) a 20 MHz, visualise l’extension dermique ou hypodermique des tumeurs cutanees mais aucune etude n’a ete a ce jour consacree au DFSP. Notre objectif etait de decrire les images echographiques et d’observer l’extension laterale et profonde des DFSP. Materiel et methodes Serie retrospective de tous les DFSP adresses pour planifier le traitement, et qui ont eu une imagerie EHR puis une exerese entre le 1/6/2007 au 1/6/2016. Resultats Dix patients (dont 5 femmes) âges de 35 a 78 ans ont ete inclus. Il s’agissait dans 2 cas d’une recidive locale apres exerese incomplete 5 et 15 ans auparavant. Le delai median entre la survenue de la lesion et l’exerese etait de 4 ans (extremes 1–10). Dans un cas a croissance rapide, il existait un contingent plus agressif de fibrosarcome. Les tumeurs etaient toutes bien visibles en EHR, stereotypees, hypoechogenes contenant des structures hyperechogenes. La delimitation laterale avec le derme ou l’hypoderme etait progressive mais bien visible. Le niveau maximal d’invasion (derme, hypoderme, fascia) a pu etre mesure dans les 5 cas dont l’epaisseur maximale etait inferieure a la fenetre d’exploration de la sonde (15 mm de large, 7,5 mm de profondeur). Discussion Il s’agit de la premiere etude en EHR, et qui montre des images assez caracteristiques, tres differentes des images de carcinomes, melanomes ou histiocytofibromes, qui pourraient avoir un interet diagnostique du DFSP, mais ceci est a confirmer par une etude en aveugle du diagnostic clinique, et histologique. Le DFSP est une tumeur mal limitee au plan histologique, avec des travees cellulaires qui infiltrent les structures adjacentes. L’EHR n’a pas la resolution a l’echelle de la cellule, mais permet de voir grossierement les limites laterales entre tissu sain et tumoral. L’extension en profondeur, pour les tumeurs Conclusion Les DFSP en echographie haute resolution ont une echostructure tres particuliere. La visualisation de l’extension laterale et profonde pour les tumeurs d’epaisseur
Merkel cell carcinoma (MCC) is an aggressive skin cancer frequently caused by the Merkel cell pol... more Merkel cell carcinoma (MCC) is an aggressive skin cancer frequently caused by the Merkel cell polyomavirus (MCPyV). It is still under discussion, in which cells viral integration and MCC development occurs. Recently, we demonstrated that a virus-positive MCC derived from a trichoblastoma, an epithelial neoplasia bearing Merkel cell (MC) differentiation potential. Accordingly, we hypothesized that MC progenitors may represent an origin of MCPyV-positive MCC. To sustain this hypothesis, phenotypic comparison of trichoblastomas and physiologic human MC progenitors was conducted revealing GLI family zinc finger 1 (GLI1), Keratin 17 (KRT 17), and SRY-box transcription factor 9 (SOX9) expressions in both subsets. Furthermore, GLI1 expression in keratinocytes induced transcription of the MC marker SOX2 supporting a role of GLI1 in human MC differentiation. To assess a possible contribution of the MCPyV T antigens (TA) to the development of an MC-like phenotype, human keratinocytes were tra...
Techniques for treating trigonocephaly and anterior plagiocephaly have evolved from the initial s... more Techniques for treating trigonocephaly and anterior plagiocephaly have evolved from the initial suturectomy technique to frontal cranioplasty. The authors evaluated the suturectomy technique in adolescent patients with these craniosynostoses, by carrying out a retrospective, long-term assessment at the end of growth. Patients with anterior plagiocephaly or trigonocephaly were included. All had undergone coronal or metopic suturectomy with bilateral orbitofrontal bandeau resection between 1997 and 2005. The primary endpoint was the Whitaker classification. The secondary endpoints were anthropometric measurement, assessments of the bone defects on computed tomography scan, and the comments of patients and their relatives concerning the final skull outcome. Patients with anterior plagiocephaly also attended an ophthalmological consultation. Seventeen patients were included in the study: 8 with anterior plagiocephaly and 9 with trigonocephaly. Mean age at the time of surgery was 6.91 months. Mean age at the time of craniofacial consultation was 14 years. Fourteen patients (82%) were classified as Whitaker Class III and IV, corresponding to poor esthetic results and persistent bone defects. Seven patients requested further surgery. This study shows that suturectomy seems to yield poor esthetic results in the long term and patients should be followed up throughout adolescence to correct any craniofacial deformities.
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