Epithelioid haemangioendotheliomas are rare tumours of endothelial origin. They can develop in any tissue but occur principally in the lung and liver. Their usual course is a slow progression, so that they can be treated by surgery. In aggressive forms, no treatment has proved efficient to date. This study, describes a case of bilateral pleural epithelioid haemangioendothelioma that extended to the peritoneum. The histological diagnosis was confirmed by both conventional examination and immunohistochemistry. After six courses of carboplatine plus etoposide, a complete response was obtained. The complete remission is still lasting at 18 months after the diagnosis and the patient is healthy. Eur Respir J 1999; 14: 237±238. Epithelioid haemangioendothelioma (EHE) is a rare form of cancer initially described by DAIL and LIEBOW [1] in 1975. This tumour can be found in any organ but is most often found in the liver and lung. Usually, its evolution is slow, but aggressive forms have been described. This study presents a case of a pleural EHE with peritoneal extension characterized firstly by a rapid and aggressive progression and secondly by a high chemosensitivity with complete response to chemotherapy. Case reportA 50-yr-old female was admitted for a spontaneous right pleural effusion revealed by a routine chest radiograph. The only associated disease was a maturity onset diabetes treated by oral sulphamide. Extrapulmonary physical examination was normal and she had not lost weight recently. The thoracocentesis revealed a serosanguineous exudative effusion. Cytological examination of the pleural fluid showed a high cellularity with many malignant cells. A cerebral and thoracoabdominal computed tomography (CT) scan was performed together with a bone scintigraphy to evaluate the disease extension. In addition to the right pleuritis, a minimal contralateral pleural effusion and a peritoneal effusion were found. A right thoracoscopy for pleural biopsies and pleurodesis was performed. Reddish nodules were found on the parietal pleura; the visceral pleura and the lung were macroscopically normal. Histological examination of the pleural biopsy showed some large cells with cytoplasmic vacuolization and multiple, voluminous, irregular, and sometimes atypical nuclei, with numerous mitotic figures. An inflammatory reaction consisting essentially of lymphocytes and polymorphonuclear cells was present. A cellular, fibrous and inflammatory stroma surrounded the tumour cells. The presence of a lot of small well-formed vessels was also noticed ( fig. 1). Staining of the tumoral tissue was positive for the anti-vimentin and antifactor VIII polyclonal antibodies (Dako, Copenhagen, Denmark) ( fig. 2) and for BNH9 monoclonal antibody (Dako) ( fig. 3). Staining with the anti-cytokeratin antibodies were negative, which excludes the diagnosis of a metastatic carcinoma or malignant mesothelioma. Hormonal receptors for oestrogen (30% of cells) and progesterone (40% of cells) were present. The diagnosis of EHE was made. Within a fe...

This investigation was undertaken to assess the effectiveness of an enzyme-linked immunosorbent assay (ELISA) using A60 antigen in ascertaining diagnosis in hospitalized patients suspected to have pulmonary tuberculosis (TB) but with negative sputum stains. Cultures were performed to confirm active or inactive disease. IgG and IgM antibody activity was determined by adding a 1:100 dilution of serum to plates coated with A60 antigen. After addition of peroxidase-conjugated antihuman IgG or IgM and color development, optical density (OD) was determined. A total of 83 patients was studied, taking into account their current disease status and prior history. Using as a cutoff value the mean value +/- 2 SD measured in the negative culture, no TB history group, that is, OD = 0.50 for IgG measurements and 0.43 for IgM measurements, the sensitivity, specificity, and positive predictive value of IgG measurements were equal to 48, 71, and 50%, respectively. Using IgM measurements, these parameters were equal to 76, 98, and 95%, respectively. Combining the results of IgG and IgM measurements, sensitivity, specificity, and positive predictive value were equal to 68, 100, and 100%, respectively. Thus, the ELISA described here can greatly facilitate the diagnosis of TB in patients with negative smears.

ABSTRACfTo evaluate whether atopy is a risk factor for systemic reactions to hymenoptera stings, we compared the atopic status of two groups of subjects. Thefirst group included 93 patients (59 males), mean (± SD) age: 42.3 ± 17.2 yrs with a history of anaphylactic reactions to hymenoptera stings. The second was a control group of 712 subjects (379 males), mean (± SD) age: 42.0 ± 9.6 years recruited at a public health care center. The protocol included a standardized questionnaire about symptoms suggestive of atopy, i.e. medical diagnosis of asthma, perennial rhinitis or hay fever, and skin tests to common aeroallergens, i.e. house dust mites, cat danders, and grass pollens. The percentage of subjects with atopic symptoms was comparable in the two groups (32.2% for the patient group and 28.5 %for the control group). Similarly, 22.6% ofpatients and 36.8% of controls exhibited at least one positive skin prick test. Lastly, 15.1% of patients and 18.5% of controls (a nonsignificant difference) had at least one symptom of atopy and at least one positive skin test. These findings show that atopy is not a risk factor for systemic reactions to hymenoptera stings. (Allergy Proc 15:49-52, 1994) S ystemic reactions (SR) to hymenoptera stings (HS) are commonly present in up to 6.6%0 of the general population according to a recent report by our groupl using medical history and skin tests to venoms as criteria. Since these SR are IgE-mediated, atopy is widely considered as a possible risk factor. In previous attempts to establish a connection between atopy and

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Leukocytes from subjects allergic to Dermatophagoides pteronyssinus were incubated for 20 min with a solution of D. pteronyssinus extracts. Histamine release was measured at 0, 3, 10 and 20 min. Simultaneously, samples were treated for electron microscopy in such a way as to correlate histamine release and the morphological aspects of basophil leukocytes. The principal features accompanying histamine release were: a progressive activation of the cytoplasmic membrane which showed long processes, densification of the mitochondria, fusion of granulations, progressive dissolution and exocytosis of the contents of the granulations, short segments of rough endoplasmic reticulum, active Golgi apparatus, and thin membrane-bound granules suggesting resynthesis of mediators.