This thesis focuses on gynecopathology. It consists of a collection of seven papers published in pathology journals with impact factor. Introduction section contains selection of examples showing scientific application of molecular genetic methods. Further on the aims of individual research projects are described. The first project comprises histomophologic study of skin endometriosis addressing "mullerian" differentiation. A case report of a rare tumor namely borderline papillary serous tumor of the fimbriated end of the fallopian tube follows with molecular genetic analysis of KRAS, BRAF and p53 gene mutation status. Prospective longitudinal study on high grade squamous dysplasia (HSIL) of the cervix in HPV vaccinated women, so called DAV (dysplasia after vaccination), aims to elucidate pathogenesis of this phenomenon. Two other studies focus on incidence of fumarate hydratase deficient leiomyomas of the uterus and hereditary leiomyomatosis and renal cell carcinoma syndrome (HLRCC). The aim of those studies is to improve our diagnostic capability and increase detection rate of the patients with HLRCC syndrome. Finally a new subtype of HSIL namely bizarre cell dysplasia is described in two separate studies. Conclusion remarks contemplate the role of molecular genetics in surgical pathology.

Introdução: A síndrome SPOAN é uma doença neurodegenerativa, de transmissão genética autossômica recessiva, até o momento reconhecida apenas no Brasil, que caracteriza-se por: paraplegia espástica, de início nos primeiros anos de vida e caráter progressivo; atrofia óptica congênita; neuropatia periférica sensitivo-motora axonal, de início a partir da primeira década de vida; sobressaltos à estimulação sonora, disartria, deformidades de coluna e pés e sinais extra piramidais. A sua caracterização foi feita por nosso grupo, que avaliou clinicamente 71 indivíduos, originários do Rio Grande do Norte. Estudo de ligação mapeou o locus responsável pela síndrome SPOAN em uma região de 2 Mb no cromossomo 11q13. O gene responsável pela síndrome SPOAN permanece desconhecido. A síndrome SPOAN é considerada uma forma complicada de paraplegia espástica. A associação entre neuropatia e paraplegia espástica está relacionada à perda progressiva de axônios longos e tem sido relatada em algumas formas complicadas de neuropatias e paraplegias espásticas hereditárias. Casuística e métodos: Foi realizada a avaliação de 27 pacientes, 20 mulheres, com idade variando entre 4 e 58 anos. Todos os indivíduos compartilhavam o mesmo fenótipo (paraplegia espástica, atrofia de nervo óptico e neuropatia periférica) e tinham o mesmo haplótipo 11q13. Pacientes com história de diabetes mellitus ou alcoolismo foram excluídos do estudo. A avaliação neurológica incluiu a pesquisa dos escores modificados de sintomas e comprometimento neuropáticos. A força muscular foi testada e graduada conforme a escala MRC (Medical Research Council). Foi realizada a pesquisa da sensibilidade dolorosa, térmica, tátil, vibratória e artrestésica. O trofismo foi avaliado pela presença de deformidades na coluna e atrofia nos membros inferiores. Os reflexos profundos e o cutâneo plantar também foram analisados. Os estudos da condução nervosa foram realizados em um aparelho portátil Nicolet - Viking Quest, (Viasys, USA). Para os estudos de condução motora foram analisados os nervos axillar, mediano, ulnar, femoral, tibial e fibular direito. A condução sensitiva foi analisada nos nervos mediano, ulnar, radial, sural e fibular direito. O reflexo H e as ondas F foram avaliados com técnicas padrão. Alguns testes não puderam ser realizados devido à intensa atrofia e deformidades esqueléticas. O coeficiente de correlação de Pearson foi calculado entre a idade e os parâmetros, velocidade de condução, latência e amplitude. Valores de P < 0,05 foram considerados estatisticamente significantes. Resultados: Avaliação clínica: Todos os pacientes obtiveram escore de sinais neuropáticos graves e demonstraram déficit de força e atrofia distal. Deformidades dos pés estavam presentes em todos os pacientes e deformidades na coluna, em 58%. Os reflexos profundos dos membros superiores estavam exaltados em 92% dos casos e o reflexo patelar, em 63%. O reflexo Aquileu estava ausente em todos os pacientes. Todas as modalidades de sensibilidade foram afetadas, principalmente nos membros inferiores. Os dados do exame de sensibilidade na paciente de 4 anos foram desconsiderados. Estudo da condução nervosa sensitiva: Os SNAPs dos nervos mediano, sural e fibular estavam ausentes em todos os pacientes. SNAPs do nervo ulnar estavam ausentes em 96% da amostra e do nervo radial, em 80%. Estudo da condução nervosa motora: As latências motoras dos nervos axilar e femoral estavam normais em todos os pacientes. As amplitudes dos CMAPs estavam reduzidas em 15 e 52% da amostra nos nervos mediano e ulnar, respectivamente. Velocidades de condução estavam reduzidas em 50 e 41% desta casuística nos nervos mediano e ulnar, respectivamente. Velocidades de condução estavam acima de 80% do limite inferior da normalidade, em todos os nervos, exceto em 1 paciente que apresentou redução de 27% no nervo ulnar. Entretanto, este mesmo paciente apresentou amplitude menor que 2mV. Ondas F apresentavam aumento da latência, de acordo com a altura, em 100% dos casos. CMAPs estavam ausentes em 93 e 84% da amostra nos nervos fibular e tibial, respectivamente. Reflexo H estava ausente em 88% dos pacientes. Não houve correlação entre idade e a velocidade de condução, latência e amplitude dos nervos mediano e ulnar. Discussão: O estudo da condução nervosa neste grupo preencheu critérios para uma neuropatia primária axonal. Nenhum paciente apresentou bloqueio de condução ou dispersão temporal. As alterações encontradas na velocidade de condução provavelmente se devem à perda de fibras nervosas de condução rápida. Fenótipos SPOAN-like foram descritos em famílias com mutações nos genes C12orf65, TFG e OPA1. No entanto, não existem detalhes sobre a condução nervosa nestes pacientes. Neuropatia axonal de início tardio foi relacionada à SPG55 e DOA (dominant optic atrophy), enquanto neuropatia axonal e desmielinizante com leve comprometimento sensitivo foi descrita na família com mutação no gene TFG. Conclusão: Os pacientes com a síndrome SPOAN apresentam uma acentuada neuropatia axonal, sensitivo motora. As alterações encontradas na condução nervosa dos pacientes com síndrome SPOAN não são específicas, no entanto, resultados normais excluem esta condição em adultos. A paciente mais jovem desta casuística já apresentava alterações ao exame, o que pode sugerir um início precoce da neuropatia. Entretanto, não temos dados suficientes para afirmar que este seja um achado comum a todos os pacientes SPOAN / Introduction: SPOAN syndrome (Spastic Paraplegia, Optic Atrophy and Neuropathy) is a progressive neurodegenerative disorder of autosomal recessive inheritance described by our group in a large inbred family from Northeastern Brazil. The clinical picture is characterized by non-progressive congenital optic atrophy, progressive spastic paraplegia, axonal neuropathy, auditory startles, dysarthria, spinal and foot deformities and also extrapyramidal signs. Linkage studies mapped the responsible locus for the syndrome to a 2Mb region on chromosome 11q13. The gene responsible for SPOAN syndrome remains elusive. Materials and Methods: This is a cross sectional study which was conducted from 2009 to 2011. We evaluated 27 patients (20 females), with a0ges ranging from 4 to 58 years. All patients shared the same phenotype (spastic paraplegia, optic atrophy and peripheral neuropathy) and had the same 11q13 haplotype in homozygosis. Patients with history of diabetes mellitus or alcoholism were excluded from this study. All patients were evaluated by the same clinical researcher (SA). Neurological evaluation included determination of modified neuropathy symptoms (NSS) and neuropathy disability (NDS) scores. Motor strength was assessed using MRC scale. Sensibility assessment included small-fiber (pain and temperature) and large-fiber modalities (vibration-128Hz diapason, 10g monofilament and joint position sense). Spine deformities and atrophy in the lower limbs were observed. We also evaluated osteotendineous reflexes and cutaneous plantar reflexes. Nerve conduction studies were performed using a portable Nicolet - Viking Quest, (Viasys,USA). Motor conduction studies included axillary, median, ulnar, femoral, tibial and fibular nerves on the right side. Sensory nerve action potentials of median, ulnar, sural and superficial fibular nerves were recorded using a bar electrode of 3 cm and standard fixed distances. Tibial H-reflex was evaluated with standard technique. Minimal F wave latencies were obtained from ulnar and tibial nerves. A few tests could not be done in every patient due to severe deformities. We calculated Pearson\'s correlation coefficients between age and nerve conduction parameters, including velocities, latencies and amplitudes. P values <0.05 were considered statistically significant. Results: Clinical data: Neuropathic symptoms such as pain and paresthesias were rare. All patients had signs of severe neuropathy. All subjects demonstrated weakness and atrophy that were more significant distally than proximally. Foot deformities were present in all patients and spine deformities were seen in 58%. Upper limb deep tendon reflexes were exalted in 92% and patelar reflex in 63%. Ankle reflex was absent in all patients. In one patient, who was 4 years-old, sensory evaluation was inconsistent and the results were not considered. In all the other ones, sensory modalities were affected and occurred predominantly in the lower limbs. Electrodiagnostic data: Sensory nerve conduction: Median nerve SNAP was absent in all 27 patients. Ulnar nerve SNAPs were absent in 96%, whereas radial nerve SNPAs were absent in 80%. Superficial fibular and sural SNAPs were absent in all patients. Motor nerve conduction: The motor latencies of axillary and femoral nerves were normal in all patients. CMAP amplitudes were reduced in 15% of the median nerves and in 52% of the ulnar nerves. Conduction velocities (CV) were reduced in 50% of the median nerves and in 41% of the ulnar nerves. CV was above 80% of the lower normal limit for all nerves, except for one patient who showed a 27% reduction of ulnar CV, but had also a CMAP amplitude of less than 2 mV. F waves were prolonged according to the height in 100%. Only one patient who presented significant motor CV reduction of the ulnar nerve. CMAPs were absent in 93% of the fibular nerves and in 84% of the tibial nerves. A single fibular nerve showed more than 20% of CV reduction, but also had severely reduced CMAP amplitude. H reflex was absent in 88% of the patients. There was no correlation between age and neurophysiological parameters, such as median or ulnar CV, latencies or CMAP amplitudes. Discussion: Nerve conduction studies in this group fulfill criteria for primary axonal neuropathy. No patient showed conduction block or temporal dispersion. Abnormalities seen in CV and F waves are probably related to loss of fast conduction fiber nerves. We could not demonstrate correlation between age and nerve conduction parameters, including velocities, latencies and amplitudes. SPOAN-like phenotype has been found in families with mutations in C12orf65, TFG and OPA1 genes, however there is no detailed report on nerve conduction studies in these conditions. Axonal neuropathy is also described in SPG55 and DOA plus, but usually with a later onset than on SPOAN syndrome. Peripheral neuropathy is also described in the family with mutation in TFG gene, but this presents a different pattern characterized as a mixed axonal demyelinating neuropathy with mild sensory involvement. Although the nerve conduction abnormalities seen in SPOAN syndrome are not specific, normal results seem to rule out this condition, at least in adult patients. The younger patient in our series was 4-years-old, and her neurophysiological study was severely abnormal, suggesting an early-onset neuropathy. However, we do not have a comprehensive study of several young patients to support that this feature is

Les ciliopathies rétiniennes sont un groupe de maladies rares causés par des mutations de gènes ciliaires. Les défauts des gènes ciliaires peuvent causer des défauts de trafic de protéines et induit l'apoptose des cellules photoréceptrices causés par le stress du réticulum endoplasmique (RE). On a étudié ciliopathies rétiniennes par modèle mourin, amaurose congénitale de Leber, rétinopathie pigmentaire liée à l’X, syndrome de Bardet-Biedl, syndrome d’Alström. Les souris Bbs1-/- , Bbs10-/- et CEP290-/- ont monté une diminution de la fonction rétinienne et sont causée par ER stress. Les souris Rd9/y et Alms1foz/foz présentent une apparition tardive et avec un faible taux de dégénérescence rétinienne et ils pourrait être causée par d'autres mécanismes. Le traitement GV-Ret basé sur le stress du RE pourrait sauver à la fois la fonction de et la morphologie de la rétine dans souris BBS. / Retinal ciliopathies are a group of rare diseases caused by mutations of ciliary genes. Defects in ciliary genes can cause defects in proteins traffics and induces apoptosis of photoreceptor cells caused by stress of the endoplasmic reticulum (ER) .We studied retinal ciliopathies by mice models, Leber congenital amaurosis, Xlinked retinitis pigmentosa, Bardet-Biedl syndrome and Alström Syndrome. The Bbs1-/-, Bbs10-/- and CEP290-/- mice exhibited a decrease in retinal function caused by ER stress. Rd9/y and Alms1foz/foz mice showed a late onset and a low rate of retinal degeneration and they could be caused by other mechanisms. The GV-Ret treatment based on ER stress could save both the function and morphology of the retina in BBS mice .

Any set of finitely presented left modules defines a relative purity for left modules and also apurity for right modules. Purities defined by various classes are compared and investigated,especially in the contexts of modules over semiperfect rings and over tame hereditary, andmore general, finite-dimensional algebras. Connections between the indecomposable relativelypure-injective modules and closure in the full support topology (a refinement of theZiegler spectrum) are described.Duality between left and right modules is used to define the concept of a class of leftmodules and a class of right modules forming an almost dual pair. Definability of suchclasses is investigated, especially in the case that one class is the closure of a set of finitelypresented modules under direct limits. Elementary duality plays an important role here.Given a set of finitely presented modules, the corresponding proper class of relativelypure-exact sequences can be used to define a relative notion of cotorsion pair, which weinvestigate.The results of this thesis unify and extend a wide range of results in the literature.

Para otimizar um modelo experimental para o estudo do desbalanço redox em porfirias relacionadas ao acúmulo de ácido 5-aminolevulínico-(ALA), via inibição da ALA desidratase-(ALA-D), ratos foram tratados com o éster metílico de succinilacetona-(SAME), um catabólito da tirosina que inibe fortemente a ALA-O, mimetízando o estado metabólico observado nos portadores de portirias e tirosinemias. Estabeleceram-se modelos de tratamento agudo por 36 e 18 h. No primeiro, os animais receberam 3 injeções de SAME (10, 40 ou 80 mg/kg, grupos Ali-IV). No segundo, os animais receberam 3 injeções de 40 mg/kg de SAME, ALA ou éster metílico de ALA (grupos BII-IV), ALA:SAME (30: 10 mg/kg, grupo BV), ou 10 mg/kg SAME (grupo BVI). Paralelamente, avaliou-se se os sintomas neurológicos característicos das portirias decorriam de danos oxidativos mitocondriais. Para isso, aplicou-se uma tecnologia óptica para medidas da difusão da depressão cortical que determinou a oxigenação e o estado redox do cit c em mitocôndrias do córtex cerebral de ratos submetidos ao tratamento crônico com ALA (40 mg/kg), SAME (10 e 40 mg/kg) e ALA:SAME (30: 1O mg/kg), a cada 48 h, durante 30 dias. Tratamento agudo/36 h: Os níveis de ALA no plasma, fígado, cérebro e urina e o clearance renal do ALA aumentaram nos grupos tratados. A atividade de ALA-D e a coproporfirina urinária reduziram. A marcação para proteínas carboniladas, ferro e ferritina aumentou no fígado e cérebro dos grupos tratados, especialmente no All. Os níveis de malondialdeído hepático aumentaram no grupo AIV. A razão GSH/GSH+GSSG e a atividade de GPx cerebrais aumentaram nos grupos AIV e AIII, respectivamente. Consistentemente com estes dados indicando um desbalanço oxidativo induzido pelo SAME, alterações mitocondriais e citosólicas ultraestruturais foram reveladas, especialmente no fígado. Tratamento agudo/18 h: Os níveis de ALA plasmáticos aumentaram nos grupos tratados, exceto em BIV. O grupo BII mostrou aumento dos níveis hepáticos de ALA. Interessantemente, a inibição da atividade de ALA-D não foi evidenciada. O conteúdo de ferro plasmático aumentou no grupo BII. Para os grupos tratados com 10 e 40 mg SAME/kg, a atividade de SOD hepática reduziu ~50% com a extensão do tratamento de 18 para 36 h, sugerindo que este último é mais efetivo em promover danos oxidativos induzidos pelo ALA. Tratamento crônico/30 dias: Embora nenhuma alteração tenha sido evidenciada no estado redox dos animais tratados, o tratamento com ALA reduziu o fluxo sanguíneo cerebral (CBF) e o consumo de oxigênio-(CMRO2), sugerindo uma vasoconstrição mediada pelo ALA, efeito este confirmado por ensaios de reatividade vascular conduzidos em anéis de aorta de ratos incubados com ALA. O tratamento com ALA:SAME restaurou os níveis de CBF e CMRO2. Interessantemente, a disponibilidade do radical superóxido-(O2&#8226;-) estava reduzida nos anéis de aorta incubados com ALA. Juntos, estes dados: a)validam o modelo de tratamento agudo/36 h para o estudo bioquímico e dos possíveis efeitos fisiológicos induzidos pelo ALA, e b)sugerem que as alterações mediadas pelo ALA exógeno levam à vasoconstrição. / To optimize an experimental model for studying redox imbalance in porphyrias related to 5-aminolevulinic acid (ALA) accumulation through the inhibition of ALA dehydratase (ALA-D), rats were treated with methyl ester of succinylacetone (SAME), a tyrosine catabolite that strongly inhibits ALA-D, what mimics the metabolic state observed in patients suffering from porphyrías and tyrosinemias. Models of acute treatment were established during 36 and 18 h. In the first model, animals received 3 injections of SAME (10, 40 or 80 mg/kg, groups Ali-IV). In the second model, animals received 3 injections of 40 mg/kg SAME, ALA or methyl ester of ALA (groups BII-IV), ALA:SAME (30:10 mg/kg, group BV), or 10 mg/kg SAME (group BVI). Concomitantly, we evaluated if the neurologic symptoms characteristics of porphyrias were a consequence of the oxidative mitochondrial impairment. For this, an optical technology for the measurement of cortical spreading depression was applied. This techonology determined the cerebral oxygenation and the redox state of cit c in mitochondria of the cerebral cortex of rats submitted to a chronic treatment with ALA (40 mg/kg), SAME (10 and 40 mg/kg) and ALASAME (30:10 mg/kg), alternate days, during 30 days. Acute treatment/36 h: ALA levels in plasma, liver and urine and clearance of renal ALA increased in treated groups. ALA-D activities and urinary coproporphyrin were found to be decreased. Liver and brain proteins carbonyl, iron and ferritin were higher in the liver of treated groups, especially in All. Liver malondialdehyde levels were higher in group AIV. Cerebral GSH/GSH+GSSG ratio and GPx activities increased in groups AIV and AIII, respectively. Consistently with these data indicating SAME-induced oxidative imbalance, mitochondrial and cytosolic ultrastructural changes were revealed, especially in the liver. Acute treatment/18 h: Plasma ALA levels increased in all treated groups but BIV. Group BII showed increased hepatic ALA levels. Interestingly, inhibition in ALA-D activities was not evidenced. Plasma iron content increased in group BII. For the groups treated with 10 and 40 mg SAME/kg, liver SOD activities reduced ~50% by extending the treatment from 18 to 36 h, suggesting that the latter is more effective in ALA-induced oxidative damage. Chronic treatment /30 days: Despite no changes in the redox state of treated animals were observed, the treatment with ALA reduced the cerebral blood flow (CBF) and the consumption of oxygen (CMRO2), suggesting a vasoconstriction mediated by ALA. This effetc was confirmed by vascular reactivity assay performed in aortic rings of rats incubated with ALA. The treatment with ALA:SAME recovered the CBF and CMRO2 levels. Interestingly, the availability of superoxide radical (O2&#8226;-) was reduced in the aortic rings incubated with ALA. Altogether, these data a) validate the model of acute treatment/36 h for studying biochemical and possibly physiological effects induced by ALA, and b)suggest that the changes mediated by exogenous ALA lead to vasoconstriction.

Background: Cystic fibrosis (CF) remains the most common fatal monogenic disease in the US, affecting 1 in 3,300 live births. CF is the result of mutations in CFTR, a chloride channel and regulator of other ion channels. The mechanisms by which CFTR mutations cause chronic lung disease in CF are not fully defined, but may include the combined effects of altered ion and water transport across the airway epithelium and aberrant inflammatory and immune responses to pathogens within the airways. We have shown that Cftr-/- mice mount an exaggerated IgE response towards Aspergillus fumigatus (Af) when compared to Cftr+/+ mice. Along with the increased IgE levels, the Cftr-/- mice had higher levels of IL-13 and IL-4, mimicking both the Th-2 biased immune responses and predilection to mounting Af-specifc IgE seen in CF patients. Herein we hypothesize that these immune aberrations are primarily due to the lack of Cftr expression in lymphocytes rather than with Cftr deficiency in the epithelium. Results: Our results indicate that adoptive transfer experiments with Cf splenocytes confer higher IgE response to Af in host mice as compared to hosts receiving wild-type splenocytes. The predilection of Cftr-deficient lymphocytes to mount Th2 responses was confirmed by in vitro antigen recall experiments, where higher levels of IL-13 and IL-4 where seen only in the presence of Cftr-deficient lymphocytes. Conclusive data on this phenomenon were obtained with conditional Cftr knockout mice, where mice lacking Cftr in T-cell lineages developed the higher IgE titers as compared to their wild-type littermate controls. Further analysis of Cftr-deficient lymphocytes revealed an enhanced intracellular Ca 2+ flux in response to T cell receptor activation as compared to normal lymphocytes. This was accompanied by a significant increase in nuclear localization of the calcium-sensitive transcription factor NFAT, which could contribute to the enhanced secretion of IL-13 and other cytokines. Conclusions: In summary, our data identified that CFTR dysfunction in T cells can lead directly to aberrant immune responses. This is the first instance that a CF related phenotype has been entirely modeled in vivo by selectively knocking out CFTR in the immune system. Specifically, Cftr deficient lymphocytes directed skewed responses to Aspergillus fumigatus , leading to a higher than normal IgE response. These findings implicate the lymphocyte population as a potentially important target for therapeutics directed to the treatment of CF lung disease.

The diploma thesis The influence of early diagnosis for family of children with ASD deals with problems with autistic spectrum disorders diagnostics. It is focused on families with ASD children. It also maps the period before the diagnosis. The main aim is to show the preceding situation and consequences after the diagnosis of one of the autistic spectrum disorders in the family. The thesis works with both, the psychic impacts influencing family members, but also many other factors. The acquired information is based on the narrative conversation with parents. It speaks about the first displayed symptoms and the attempt to solve the occurring problems. It also speaks about possible seeing doctors, and if so, what specialists and what approaches and diagnoses they met. Last but not least the thesis is interested in those who informed the family about ASD as the first, when it was diagnosed and the change of family life after the diagnosis.

Les algèbres cellulaires furent introduite par J.J. Graham et G.I. Lehrer en 1996. Elles forment une famille d’algèbres associatives de dimension finie définies en termes de « données cellulaires » satisfaisant certains axiomes. Ces données cellulaires, lorsqu’elles sont identifiées pour une certaine algèbre, permettent une construction explicite de tous ses modules simples, à isomorphisme près, et de leurs couvertures projectives. Dans ce mémoire, nous définissons ces algèbres cellulaires en introduisant progressivement chacun des éléments constitutifs d’une façon axiomatique. Deux autres familles d’algèbres associatives sont discutées, à savoir les algèbres quasihéréditaires et celles dont les modules forment une catégorie de plus haut poids. Ces familles furent introduites durant la même période de temps, au tournant des années quatre-vingtdix. La relation entre ces deux familles ainsi que celle entre elles et les algèbres cellulaires sont prouvées. / Cellular algebras were introduced by J.J. Graham and G.I. Lehrer in 1996. They are a class of finite-dimensional associative algebras defined in terms of a “cellular datum” satisfying some axioms. This cellular datum, when made explicit for a given associative algebra, allows for the explicit construction of all its simple modules, up to isomorphism, and of their projective covers. In this work, we define these cellular algebras by introducing each building block of the cellular datum in a fairly axiomatic fashion. Two other families of associative algebras are discussed, namely the quasi-hereditary algebras and those whose modules form a highest weight category. These families were introduced at about the same period. The relationships between these two, and between them and the cellular ones, are made explicit.

This thesis focuses on gynecopathology. It consists of a collection of seven papers published in pathology journals with impact factor. Introduction section contains selection of examples showing scientific application of molecular genetic methods. Further on the aims of individual research projects are described. The first project comprises histomophologic study of skin endometriosis addressing "mullerian" differentiation. A case report of a rare tumor namely borderline papillary serous tumor of the fimbriated end of the fallopian tube follows with molecular genetic analysis of KRAS, BRAF and p53 gene mutation status. Prospective longitudinal study on high grade squamous dysplasia (HSIL) of the cervix in HPV vaccinated women, so called DAV (dysplasia after vaccination), aims to elucidate pathogenesis of this phenomenon. Two other studies focus on incidence of fumarate hydratase deficient leiomyomas of the uterus and hereditary leiomyomatosis and renal cell carcinoma syndrome (HLRCC). The aim of those studies is to improve our diagnostic capability and increase detection rate of the patients with HLRCC syndrome. Finally a new subtype of HSIL namely bizarre cell dysplasia is described in two separate studies. Conclusion remarks contemplate the role of molecular genetics in surgical pathology.

La polyneuropathie sensitivomotrice héréditaire (PNSMH) est une maladie rare qui entraîne un ralentissement du développement moteur et mental, une déficience sensitivomotrice et des syndromes neuropsychiatriques, et qui s’accompagne souvent d’une agénésie du corps calleux. Par ailleurs, plusieurs évaluations rapportent une petite stature ou une masse corporelle anormalement basse chez les patients. La PNSMH est causée par des mutations perte de fonction du cotransporteur K⁺-Cl⁻ de type 3 (KCC3). Des évaluations cliniques détaillées et la caractérisation de souris inactivées pour Kcc3 (Kcc3ᴷᴼ) ont permis d’établir qu’un défaut d’export K⁺-Cl⁻ cause les atteintes neurologiques anatomiques et fonctionnelles dans la maladie. Chez les souris Kcc3ᴷᴼ, des manifestations extraneurologiques ont également été relevées : masse corporelle réduite, pression artérielle (PA) élevée, polydipsie et polyurie. Puisque la physiopathologie des désordres extraneurologiques découlant de la perte de fonction de KCC3 reste incomplètement décrite, mes travaux avaient pour objectif d’en comprendre les mécanismes sous-jacents en utilisant un modèle Kcc3ᴷᴼ. Une caractérisation initiale de notre lignée de souris Kcc3ᴷᴼ constitutive et systémique a montré des anomalies vasculaires et cardiaques accompagnant une élévation de PA diastolique. Cette lignée affichait également une polydipsie et une polyurie isoosmotique, de même qu’une réduction de masse corporelle et d’adiposité sans réduction d’apport alimentaire. Une caractérisation métabolique détaillée de notre modèle a ensuite permis de révéler des réductions de masse grasse et de masse maigre. Cette minceur résulte sûrement en partie des augmentations d’activité locomotrice et de dépense énergétique mesurées. Une nette amélioration de la tolérance au glucose a aussi été trouvée, ainsi que des concentrations réduites de triacylglycérols plasmatiques. Enfin, nous avons noté que notre modèle est résistant à l’obésité induite par une diète hyperlipidique et affiche une élévation concomitante de l’expression d’enzymes lipogéniques et lipolytiques dans le gras viscéral, engendrant potentiellement une dissipation calorique. En revisitant la fonction cardiovasculaire dans notre modèle par des méthodes de pointe, nous n’avons pas observé de changement de PA ni de différence de réactivité artériolaire en conditions basales, mais nous avons noté une élévation de distensibilité artériolaire passive. Chez notre modèle, nous n’avons pas non plus remarqué de sensibilité particulière de la PA au sel alimentaire, mais une excrétion urinaire fortement accrue de solutés sous diète hypersodée ainsi qu’une préférence marquée pour le sel. Ces observations sont compatibles avec un défaut de réabsorption hydrosodée par le rein pouvant d’ailleurs prévenir les élévations de PA. En somme, nos travaux ont permis de mieux comprendre les atteintes cardiométaboliques qui accompagnent le tableau neurologique d’un modèle murin de PNSMH. Nous avons notamment relevé des bénéfices inattendus dans le métabolisme glucidique et lipidique suivant l’inactivation de Kcc3. Nous soupçonnons également que l’absence de KCC3 dans le rein engendre une fuite ionique urinaire s’accentuant sous diète hypersodée et pouvant influencer la PA en limitant l’expansion volémique. Nos observations d’anomalies pléiotropiques liées à l’inactivation de Kcc3 font de ce gène une nouvelle cible pharmacologique potentielle et justifient la nécessité d’étudier l’anatomophysiologie cardiométabolique des patients atteints de PNSMH de façon plus approfondie. / Hereditary motor and sensory neuropathy (HMSN) is a rare disease that leads to delayed motor and mental development, loss of sensory and motor function and neuropsychiatric syndromes, and that is often accompanied by partial or complete agenesis of the corpus callosum. Additionally, several cases of short stature or low body weight have been reported in patients. HMSN is caused by loss-of-function mutations in K⁺-Cl⁻ cotransporter type 3 (KCC3). Detailed clinical reports and characterizations of mice inactivated for Kcc3 (Kcc3ᴷᴼ) have allowed to establish that defective K⁺-Cl⁻ export causes the anatomical and functional neurologic impairments in the disease. In Kcc3ᴷᴼ mice, extra-neurological abnormalities have also been noted: lower body weight, high blood pressure (BP), polydipsia and polyuria. Because the pathophysiology of extra-neurological traits arising from KCC3 loss of function remains incompletely described, my work aimed at understanding the mechanisms at play using a Kcc3ᴷᴼ model. An initial characterization of a constitutive and systemic Kcc3ᴷᴼ mouse line showed vascular and cardiac abnormalities along with a rise in diastolic BP. This model also showed polydipsia and iso-osmolar polyuria along with reduced body weight and adiposity but no decrease in food intake. A detailed metabolic characterization of our model further revealed reductions in fat and lean body masses. This leanness results certainly in part from increased locomotor activity and energy expenditure as measured. A marked improvement in glucose tolerance was also found in addition to lower plasmatic triglyceride concentrations. Lastly, we also demonstrated that our model is resistant to high-fat-diet-induced obesity and shows concomitant increase in expression of both lipogenic and lipolytic enzymes in visceral fat, thereby potentially generating caloric dissipation. When revisiting the cardiovascular function of our model with cutting-edge methods, we measured normal BP and arteriolar reactivity in baseline conditions. However, we noted an increase in passive arteriolar distensibility. In our model, we did not notice sensitivity of BP to dietary salt but found a marked increase in urinary solute excretion under high-salt diet and a strong preference for salt. These observations are consistent with a defect in hydromineral reabsorption by the nephron that may prevent BP from rising. In short, our work allowed to better understand the cardiometabolic characteristics that accompany the neurologic portrait of an HMSN mouse model. In particular, we noted unexpected benefits in carbohydrate and lipid metabolism upon Kcc3 inactivation. We also suspect that KCC3 ablation in the kidney leads to urinary hydromineral wasting that can be more salient under dietary salt loading and can influence BP by blunting extracellular volume expansion. The pleiotropic abnormalities arising from Kcc3 inactivation identify this gene as a new potential pharmacological target and argue for improving efforts at describing the cardiometabolic features of patients with HMSN.