[Autoimmune bullous diseases with gingival expression: A proposed non-iatrogenic gingival biopsy technique]. / Maladies bulleuses auto-immunes à expression gingivale : proposition d'une technique de biopsie gingivale non iatrogène.

BACKGROUND: Gingival expression of autoimmune bullous diseases (AIBD) may be inaugural, exclusive or dominant (mucous membrane pemphigoid, pemphigus vulgaris). Histology and direct immunofluorescence are essential to diagnosis. The location of the biopsy and the surgical technique determine the histological quality of the tissue sample. However, gingival tissue is often considered fragile and easily impaired during biopsy. We suggest an original biopsy protocol for the gingival papillae that is simple to perform, non-iatrogenic, and readily accessible to all practitioners who usually treat AIBD patients presenting isolated gingival expression (dermatologists, stomatologists, odontology specialists, ENT specialists). PATIENTS AND METHODS: We conducted a retrospective study from 2012 to 2017 identifying all patients presenting AIBD with gingival expression for whom we performed papillary gingival biopsy for diagnostic ends. Our main objective was to determine the diagnostic efficacy and safety of this surgical technique. RESULTS: Over the study period, 34 papillary gingival biopsies were taken from 19 patients : 15 for histopathological examination and 19 for direct immunofluorescence. Of the 34 biopsies, only one could not be properly analyzed due to lack of epithelium and a second tissue sample was therefore necessary. No short- or long-term complications occurred during post-operative follow-up. CONCLUSION: Gingival papilla biopsy is perfectly suited to the histopathological and immunohistochemical examinations needed for diagnosis of AIBD with isolated gingival expression. This surgical technique shows great efficacy and very good safety. However, additional studies are necessary to confirm our preliminary results, in particular the absence of iatrogenic effects.

Tuberculoma of the cavernous sinus mimicking a meningioma: case report and review of the literature.

Cavernous sinus involvement of tuberculosis is rare; only seven cases have been reported in the literature to date. Many factors make the diagnosis difficult in this location, necessitating a surgical procedure. We report the case of a 45-year-old man who presented with a left cavernous sinus syndrome clinically. The lesion mimicked a meningioma of the cavernous sinus in radiological examinations. It was entirely excised through a subtemporal approach. Histopathological examination revealed caseating granuloma and the diagnosis of tuberculoma was established. Postoperative antituberculous drugs completed the treatment and led to complete resolution of neurological symptoms. In our paper, we emphasize the rarity of the lesion in this location, we review all the cases previously published underlining the main epidemiological, clinical, radiological, therapeutic and prognostic features.

Multiple infected cerebral hydatid cysts.

We report an unusual patient with multiple infected cerebral hydatid cysts. A 20-year-old man presented with a 2-month history of headache and progressive left-sided hempiparesis. A cerebral CT scan showed a large and heterogeneous parieto-occipital lesion. During surgery an infected hydatid cyst was discovered with multiple daughter vesicles. Post-operatively the patient was treated with albendazol, cefotaxime and metronidazole. The clinical course was good with total recovery of the hemiparesis. A follow-up CT scan showed persistence of some small deep-seated cysts. Multiple infected cerebral hydatid cyst is uncommon and can be confused with other cystic brain lesions. The aim of surgery is to remove the cyst unruptured and this should be followed by antihelminthic and antibiotic treatment in order to avoid recurrences.

[Infected cervical epidural Ewing's sarcoma (case report)]. / Sarcome d'Ewing épidural cervical infecté (à propos d'un cas).

INTRODUCTION: Ewing's sarcoma is a relatively rare osseous malignant tumour. The age of onset is generally in the youth. Epidural localisation of the malignant osseous tumour Ewing's sarcoma is exceptional. Only 29 cases were reported in surgical literature including only one infected case. OBSERVATION: We report a case of a 24 years old patient who displayed a complete flaccid tétraplégia with T1 sensitive level. Spinal cord MRI documented a cervical posterior epidural process with peripheric gadolinium enhancement. Patient was operated in emergency. A C6 and C7 laminectomy allowed complete tumour resection with its purulent intratumoural collection revealed during the operation. A total tumour removal was performed. The immediate postsurgical evolution was remarkable, with a quasi complete recovery in the upper limbs. DISCUSSION: Firstly described by James Ewing in 1921, the spinal epidural locations of the Ewing's sarcoma are rare without specific clinical signs generally presenting as a radiculo-medullary compression. Our case is the second infected epidural Ewing sarcoma reported in the literature. However the cause remains unexplained. For this spinal epidural extraosseous tumour, X-ray radiography failed to show any osseous lesions. On MRI, the usually found aspect is a T1 and T2 isosignal with gadolinium enhancement. CONCLUSION: Through our observation, we underlined the scarcity of this pathology in the cervical epidural localization and the association with infection. We also emphasized on the complete removal, in order to give the best functional and vital outcome.

[Double localization of a cerebral germinoma. Case report]. / Double localisation d'un germinome cérébral. A propos d'un cas.

A germinoma located in both the pineal and suprasellar regions remains rare. The clinical expression can be polymorphic, although brain imaging reveals specific signs. We report the case of a 16-year-old boy who presented with diabetes insipidus of six months' standing, associated with visual loss and Parinaud's syndrome. Brain MRI showed a tumor in both the pineal and suprasellar regions. A stereotaxic biopsy targeting the infundibular growth confirmed the diagnosis of ectopic germinoma, which was successfully treated by radiotherapy and chemotherapy. The incidence of bifocal germinoma, its clinical and radiological characteristics as well as the therapeutic strategies to adopt are discussed.

[Multiple intracranial ganglioglioma. Case report]. / Gangliogliomes multiples intracrâniens. A propos d'un cas.

Multiple intracranial ganglioglioma (GG) is an extremely rare condition, generally associated with van Recklinghausen neurofibromatosis. We report the case of a 26-year-old woman who presented with progressive tetraparesis, raised intracranial pressure and visual loss. The neuroradiologic workup demonstrated a multiple lesion involving the temporal lobe, the diencephalomesencephalon and the optical pathways. Computed tomography-guided stereotactic biopsy of a right temporal lesion led to the diagnosis of GG. In light of this case and the literature review, we discuss morphologic aspects, differential diagnosis and therapeutic options of GG. In patients with multiple cerebral tumors, search for multiple ganglioglioma is particularly important because of the therapeutic implications and the good prognosis of this tumor.

[Late cervicodorsal metastasis of thyroid adenocarcinoma treated by anterior cervicotomy]. / Métastase cervico-dorsale tardive d'un adénocarcinome thyroïdien opérée par cervicotomie antérieure.

Metastasis from a thyroid adenocarcinoma is a rare entity with high mortality. We describe an unusual case in a woman displaying tetraparesis due to a late cervico-dorsal metastasis operated on via a simple anterior cervicotomy. Outcome was good at eighteen months follow-up. The histological diagnosis was follicular adenocarcinoma. The development of a vertebral metastasis from a thyroid adenocarcinoma 11 years after the treatment of the primitive cancer is rare. The anterior cervico-dorsal location in this patient required decompression via an anterior approach. Surgical treatment of the tumor and spinal stabilization were possible via a simple anterior cervicotomy which allowed adequate access to the third thoracic vertebra, without sternotomy or thoracotomy.

Tumor-like tuberculosis of the sacrum.

Isolated tuberculosis of the sacrum in a 43-year-old woman manifested as functional impairment of the right lower limb. Sacral tuberculosis is rare in patients with no history of tuberculosis. Another unusual feature was the tumor-like aspect of the lesion, with diffuse, ill-defined osteolysis of a large part of the sacrum and extension to the presacral soft tissues responsible for rectal displacement.

[Intraspinal neuro-enteric cyst without associated abnormalities. Apropos of a case]. / Kystes neuro-entériques intra-rachidiens sans malformation associée. A propos d'un cas.

The authors report a case of dorsal extramedullary neuro enteric cyst without any associated dysraphic lesion. The clinical and radiological aspects are presented. Discussions on the embryogenesis and pathogenesis of this rare lesion are reviewed.

[Behcet's disease with multiple intracranial arterial aneurysms. Report of a case]. / Maladie de Behçet avec anévrismes artériels intracrâniens multiples. A propos d'un cas.

Behçet disease is a rare condition in central Europe but more common in Morocco. A case of multiple intracranial arterial aneurysms occurring in a 44 year-old Moroccan patient with 2-years history of Behçet's disease is reported. CT-scan showed an infarction in the right middle cerebral artery territory. Panangiography showed sacciform aneurysms of the bifurcation of the right and left middle cerebral arteries. The draining veins and sinuses were normal. The two aneurysms were successfully clipped by two microsurgical frontotemporal approach in one surgical time. There have been only eight reports of intracranial arterial aneurysms associated to Behçet disease in the literature.

[Hydatidosis of the cranial vault. Two case reports]. / L'hydatidose de la voûte crânienne. A propos de deux cas.

The authors report 2 cases of echinococcosis of the cranial vault, an extremely rare localization of hydatid disease. The parietal bone was involved in one case and the occipital bone in the other. The authors discuss the mechanism and classification of cranial vault echinococcosis. The clinical signs of the disease as well as its radiological appearances and especially its very characteristic CT scan appearances are studied in relation to the literature.

[Non-surgical treatment of extradural hematoma. Apropos of 3 cases]. / Hématome extra-dural non opéré. A propos de 3 observations.

The authors report 3 cases of extradural hematoma treated conservatively with good outcome. They discuss the factors for the enlargement on the hematoma and state the importance of the interval between the initial CT scan and the trauma, in the conservative policy.

[Anatomic configuration of the circle of Willis in the adult studied by injection technics. Apropos of 100 brains]. / Configuration anatomique du polygone de Willis de l'adulte, étudié par les techniques d'injection. A propos de 100 cerveaux.

This study has been realized on one hundred Moroccan brains taken from medico-legal autopsies. Its aim is a morphological study of the arterial circle of the base and frequency of the malformations of the cerebral vasculoris. Those investigations have been realized with the help of a synthetical resin injection, which allowed us to get into the following conclusions. 15 types of Willis' polygonals have been identified among which 14 would be assimilated to the polygonals already described by G. Lazorthes. The 15th is original and seems proper to our series. At the same time the systematic research of the aneurysms at the brain base level has allowed us to identify a case situated at the level of the internal carotide at the origin of the anterior cerebral artery. The few brains injected did not permit us to get into sound statistical conclusions. Even though they incit further searches in practical clinics. Our actual results are just preliminary and we contemplate doing more complete studies in order to find a new approach of classification and systematisation of the Willis' polygonal, as well as the frequency of the malformations of the cerebral vasculoris.

[Spondylodiscitis in subacute bacterial endocarditis. Apropos of a case]. / Spondylodiscite oslérienne. A propos d'un cas.

Occurring of spondylodiscitis as first manifestation of bacterial endocarditis in an uncommon condition. About fifty cases are reported in the literature. Such association makes imperious the regular examination of the heart of patients with spondylodiscitis and spine radiography when a vertebral pain is found to be present in patients with bacterial endocarditis. An additional case is her by reported.

[Extracranial primary meningioma. Apropos of a case]. / Méningiome primitif extracranien. A propos d'un cas.

The authors report a case of a primary extracranial meningioma at the vertex a rare localization which represents less than 2% of all meningiomas. Reviewing the literature they discuss pathogenesis, pathophysiology and histopathology of this lesion.

[Cerebellar primary germinoma. Case report]. / Le germinome cérébelleux primitif.

Germinoma cell tumors account for 1% of all primary cerebral tumors. They occur in pineal and in supra-sellar regions, and rarely, in basal ganglia and thalami. Germinoma cell tumors originating in the posterior fossa are very rare. We report a case of primary germinoma found in the cerebellar hemisphere in a 45-year-old immunocompetent man presented with intracranial hypertension and cerebellar ataxia. The CT scan revealed a heterogeneous mass in the cerebellar right hemisphere with a cystic component. Intense and heterogeneous enhancement after contrast infusion was observed. Two other nodules were identified in the frontal and occipital lobe. The pineal region was normal. Total resection was performed. The histological finding were a germinoma. Extensive systemic examination indicated that the intracranial lesion had not metastasized from a primary extracranial tumor.

[Spinal cord lipoma. Apropos of 3 cases]. / Lipomes intramédullaires. A propos de trois observations.

Intramedullary lipomas are rare, benign tumors of the spinal cord. (1% of all primitive intramedullary tumors). Three cases are reported in this work. The clinical presentation and neuroradiological findings, specially C.T. scan have led in the three cases to a diagnostic of compressive myelopathy secondary to hypodense process situated intradurally in the cervico-thoracic region. The surgery was limited to decompression with biopsy (in 2 cases) and a partial removal in one case. The histologic examination showed a mature lipoma in the three cases. The evolution was good. The literature review allowed us to know that the opinions about surgical management of these tumors are very different. The operation which is always recommended in the evolving clinical cases is more controversial in other cases. It must be conservative, limited to a partial excision of the tumor, and even to a decompression biopsy when the anatomical conditions make it necessary.

[Double localization of intracranial germinoma. Apropos of a case]. / Double localisation d'un germinome intracrânien. A propos d'un cas.

The authors report a case of a double localization of an intracranial germinoma in the pineal and suprasellar regions, which represents only 2 to 7% of all germinomas. Reviewing the literature, they discuss the pathogenesis, histopathology, biology and treatment of these tumours.

[Metastatic and hemorrhagic brain arteriovenous fistulae due to a choriocarcinoma. Case report]. / Fistule artérioveineuse cérébrale métastatique hémorragique d'origine choriocarcinomateuse.

Brain metastasis of choriocarinoma is uncommon. These tumors develop in women of childbearing age and commonly produce signs and symptoms of subarachnoid hemorrhage, intracerebral hemorrhage, or brain tumor. Diagnosis can be established by histologic study of operative swabs and bioassay of the patient's blood, urine and cerebrospinal fluid for chorionic gonadotropin. This condition is highly chemo- and radiosensitive. We report the case of a 36-year-old woman with intracranial neoplastic fistulae. Rupture occurred 3 days after spontaneous abortion at 3 months of pregnancy. The patient presented with hemiplegia, aphasia and unclear consciousness. Left fronto-parietal hematoma was diagnosed on the CT scan, and cerebral angiography showed an arteriovenous intracranial fistulae. The hematoma and angioma were surgically removed successfully. The histological examination showed a metastatic choriocarcinoma. Surgery was followed by chemotherapy and radiotherapy. After 6 years of follow-up, complete remission has been obtained.

Understanding cerebellar liponeurocytomas: case report and literature review.

Cerebellar liponeurocytomas were recognized in the 2000 WHO 3rd edition of CNS tumors as a distinct grade I pathological entity, a tumor with a more favorable prognosis than medulloblastoma. But reports of long-term recurrences and some possible aggressive behavior led to an upgrade on the latest WHO 4th edition of CNS tumors. The case of a 64-year-old female patient is reported in this paper. More than 30 cases of this lately recognized pathological entity have been reported to date. The diagnostic, radiological, and pathological features associated with this tumor are discussed through a literature review.