Arbutus Unedo Honey and Propolis Ameliorate Acute Kidney Injury, Acute Liver Injury, and Proteinuria via Hypoglycemic and Antioxidant Activity in Streptozotocin-Treated Rats.

BACKGROUND/AIMS: Honey and propolis have biological and therapeutic effects in various pathological and clinical conditions such as hyperglycemia and diabetes. However, the combined use of honey and propolis has not been reported. The study evaluated the protective effect of Arbutus unedo honey, propolis and their combination in streptozotocin (STR)-induced hyperglycemia, acute kidney injury (AKI), liver injury, dyslipidemia, and proteinuria in male Wistar rats. METHODS: The study identified physicochemical characteristics, mineral and antioxidant content, and antioxidant activity in honey and propolis. Rats were assigned to five groups, with five rats in each group; control, STR-treated, STR-treated + honey (1g/kg/day), STR-treated + propolis (100 mg/day), and STR-treated + honey and propolis. On day 15, blood glucose, insulin, HBA1c, kidney function tests, liver enzymes, lipid profile, hemoglobin, and urine protein, creatinine, glucose, and electrolytes were analyzed. Liver, pancreas, and kidney tissues were studied histologically. The mineral component in honey and propolis was determined by atomic absorption spectrometry. Honey analysis was performed by HPLC. Chemical characterization of propolis was performed by LC/DAD/ESI-MSn . Measurement of blood and urine parameters was carried out with an automated analyzer (Architect c8000) and XT-1800i Automated Hematology Analyzer. Insulin concentration was determined by Elisa and insulin resistance was estimated by using HOMA-IR. RESULTS: Honey and propolis contain a high quantity of antioxidants and exhibit in vitro antioxidant activity. In STR-treated rats, blood glucose, HBA1c, creatinine, blood urea, liver enzymes, and urine protein significantly increased compared to the control group (P<0.05), while insulin, hemoglobin, and body weight significantly decreased. Histological changes were evident in the pancreas, kidney, and liver tissues. These results indicated AKI, liver injury, and pancreatic injury, which was evident with reducing the number of the island of Langerhans and marked hyperglycemia. The use of honey and propolis significantly (P<0.05) attenuated liver and kidney injury, and proteinuria, and improved level of hemoglobin, HBA1c, and insulin toward the normal range. The combination of honey and propolis was more effective than honey or propolis individually (P<0.05). CONCLUSION: the combination of propolis and honey can prevent STR-induced AKI, liver injury, proteinuria, dyslipidemia, anemia, hyperglycemia, and body weight loss, most likely by their hypoglycemic and antioxidant activities.

The expression of MDM2 in gastrointestinal stromal tumors: immunohistochemical analysis of 35 cases.

BACKGROUND: Gastrointestinal stromal tumors (GIST) are the most common primary mesenchymal tumors of the digestive system. The assessment of their biological behavior still remains a scientific challenge. To date, there are no well-established biological prognostic markers of GIST. Our aim is to study the expression of the MDM2 oncoprotein in GIST through an immunohistochemical analysis. METHODS: It was a retrospective study of 35 cases of GIST diagnosed from 2009 to 2012 in the department of pathology of Hassan II university hospital, Fès, Morocco. MDM2 immunohistochemical staining was performed on archival paraffin-embedded and formalin-fixed specimens (with a threshold of nuclear positivity > 10%). Analysis of correlations between MDM2 immunoexpression and clinicopathological features of GIST has been performed. RESULTS: The mean age was 55.23 years (range 25-84 years) with a male predominance (sex ratio = 1.5). The stomach was the main site of GIST, with 17 cases (48.57%) followed by the small bowel (9 cases, 25.71%). The spindle cell type GIST was the most frequent morphological variant (29 cases, 82.85%). Tumor necrosis was present in 8 cases (22.85%). Two patients (5.71%) had very low risk GIST, 5 (14.28%) had low risk GIST, 7 patients (20%) had intermediate risk tumors. The remaining 21 cases (60%) had high risk GIST. At the time of diagnosis, 9 patients (25.71%) had metastatic tumors. At immunohistochemical analysis, 40% of cases (14 patients) stained positive for MDM2. Of these MDMD2-positive tumors, 11/14 (78.57%) had high risk tumors and 8/14 cases (57.14%) presented with metastatic GIST. MDM2 positivity was significantly associated with the metastatic status (p = 0.001). CONCLUSION: The current study suggests that MDM2 immunohistochemical expression is a negative histoprognostic factor in GIST with a statistically significant correlation with metastasis.

The Antioxidant Content and Protective Effect of Argan Oil and Syzygium aromaticum Essential Oil in Hydrogen Peroxide-Induced Biochemical and Histological Changes.

Oxidative stress is an important etiology of chronic diseases and many studies have shown that natural products might alleviate oxidative stress-induced pathogenesis. The study aims to evaluate the effect of Argan oil and Syzygium aromaticum essential oil on hydrogen peroxide (H2O2)-induced liver, brain and kidney tissue toxicity as well as biochemical changes in wistar rats. The antioxidant content of Argan oil and Syzygium aromaticum essential oil was studied with the use of gas chromatography. The animals received daily by gavage, for 21 days, either distilled water, Syzygium aromaticum essential oil, Argan oil, H2O2 alone, H2O2 and Syzygium aromaticum essential oil, or H2O2 and Argan oil. Blood samples were withdrawn on day 21 for the biochemical blood tests, and the kidney, liver and brain tissue samples were prepared for histopathology examination. The results showed that the content of antioxidant compounds in Syzygium aromaticum essential oil is higher than that found in Argan oil. H2O2 increased level of blood urea, liver enzymes, total cholesterol, Low Density Lipoprotein (LDL-C), Triglycerides (TG) and Very Low Density Lipoprotein (VLDL), and decreased the total protein, albumin and High Density Lipoprotein-cholesterol (HDL-C). There was no significant effect on blood electrolyte or serum creatinine. The histopathology examination demonstrated that H2O2 induces dilatation in the central vein, inflammation and binucleation in the liver, congestion and hemorrhage in the brain, and congestion in the kidney. The H2O2-induced histopathological and biochemical changes have been significantly alleviated by Syzygium aromaticum essential oil or Argan oil. It is concluded that the Argan oil and especially the mixture of Argan oil with Syzygium aromaticum essential oil can reduce the oxidative damage caused by H2O2, and this will pave the way to investigate the protective effects of these natural substances in the diseases attributed to the high oxidative stress.

The diagnostic value of the bronchoalveolar lavage in interstitial lung diseases.

OBJECTIVE: Bronchoalveolar lavage (BAL) is a diagnostic tool often used during the management of interstitial lung diseases (ILD). However, its diagnostic value in discrimination between entities comprising the very heterogenous group of ILD, is still a controversial issue. The objective of our study is to assess the diagnostic value of BAL in the management of ILD, by comparing the cytological findings in BAL fluid among the different diseases of this group. METHODS: It was a retrospective, observational study of 151 patients between January 2012 and December 2015. BAL fluid cytology was performed to analyse the distribution of leucocytes population subsets in patients with ILD. RESULTS: The mean age was 52.78 years; 74.83% were women. The analysis of the following main groups of diseases was performed : sarcoïdosis (n = 30), idiopathic pulmonary fibrosis (IPF; n = 22), other idiopathic interstitial pneumonia (non specific interstitial pneumonia, cryptogenic organising pneumonia and respiratory bronchiolitis interstitial lung disease; n = 20) and connective tissue disease (n = 14). Overall, out of 141 patients, 22% had sarcoïdosis, 15.6% had idiopathic pulmonary fibrosis (IPF), 14.18% had other idiopathic interstitial pneumonia (IIP) and 9.9% had connective tissue disease (CTD). Mixed alveolitis was common in the 4 groups, sarcoïdosis had higher proportion of lymphocytes and IPF had higher neutrophils count. However, there was no significant statistical difference of BAL cellular count among these diseases (p > 0.05). Also, the prevalence of studied diseases did not change with variation of BAL cellular count (p > 0.05). CONCLUSION: Alone, the BAL cytological analysis has a limited value to provide substantial information that could lead to discriminate between diseases that form ILD. Thus, it must be always associated with other diagnostic methods.

Mycetoma in a non-endemic area: a diagnostic challenge.

BACKGROUND: Mycetoma is a chronic granulomatous infectious disease caused by filamentous bacteria or by fungi. The disease is endemic in certain tropical and subtropical areas of the world but can be found elsewhere posing sometimes a diagnostic challenge for clinicians. CASE PRESENTATION: A 65-year- old man presented with a right foot swelling evolving for 25 years. During that time, several diagnosis and treatments have been made without any improvement. The disease spread to bones, and misdiagnosed as Kaposi's sarcoma. Transtibial amputation has been performed, and the histopathological examination revealed finally the diagnosis of eumycotic mycetoma. The patient recovered well after surgery and orthopedic prosthesis was prescribed for him. CONCLUSION: Mycetoma in non endemic areas is usually misdiagnosed and mismanaged leading to unnecessary and inappropriate surgery. Health practitioners should be aware of that fact in order to provide an accurate management.

Lymphoepithelial carcinoma: a case report of a rare tumor of the larynx.

BACKGROUND: Lymphoepithelial carcinoma is a tumor mostly diagnosed in the nasopharynx, but it has also been described in a variety of nonnasopharyngeal sites. It is extremely rare in the larynx and should be distinguished from squamous cell carcinoma. Therefore, it must be known by clinicians, pathologists and oncologists. In this case report, we discuss its etiopathogeny, its epidemiological, clinical, pathological and therapeutic aspects, and its outcome. CASE PRESENTATION: An 81-year-old Morrocan man, smoker for 40 years, presented with a 1 year history of dysphonia, dyspnea and dysphagia. Laryngoscopy showed a mass occupying supraglottic, glottic and subglottic levels of the larynx. Cervico-thoracic computed tomography scan showed a laryngeal wall thickening with cervical lymphadenopathy. Laryngeal biopsy was performed. Microscopic analysis and immunohistochemistry confirmed the diagnosis of laryngeal lymphoepithelial carcinoma. Immunostaining for LMP1 was negative. CONCLUSION: Laryngeal lymphoepithelial carcinoma is an extremely rare and an aggressive tumor. It is rarely associated with the EBV. It must be regarded as a distinct entity. Radiotherapy is advisable as the unique therapy for local tumor. A correct diagnosis and a close collaboration between the pathologist and clinicians is mandatory for an optimal treatment strategy.

Bone pathologic fracture revealing an unusual association: coexistence of Langerhans cell histiocytosis with Rosai-Dorfman disease.

BACKGROUND: The coexistence of Rosai-Dorfman disease (RDD) with Langerhans cell histiocytosis (LCH) is very rare, as to date only 17 cases have been reported in the english literature. The pathophysiology of this uncommon co-occurrence still remains enigmatic and a subject of various speculations. CASE PRESENTATION: We report a case of a 30-year-old female patient who presented with a pathologic fracture of the left proximal femur. Her medical history was unremarkable, there were no fever, skin lesions, lymphadenopathy or other organomegaly at physical examination. X-ray radiograph of the fractured femur showed an isolated and ill-defined osteolytic lesion. The histopathological analysis of biopsies from this lesion were consistent with a combined RDD-LCH of the bone. CONCLUSION: Combined RDD-LCH is a very rare phenomenon, whose pathophysiology still remains unclear and a subject of various speculations.

Basal cell carcinomas of the areola-nipple complex: Case report and review of the literature.

Basal cell carcinoma of the areola-nipple complex poses diagnostic and therapeutic challenges due to its rarity and unique anatomical location. This subtype of basal cell carcinoma necessitates meticulous management to address potential recurrence and metastasis. Surgical excision with clear margins remains the cornerstone treatment for basal cell carcinoma of the areola-nipple complex, while alternative modalities such as radiation therapy, Mohs surgery, and systemic therapies may be considered in specific cases. However, optimal management strategies remain contentious, with varying opinions on the necessity of aggressive surgical intervention to minimize recurrence and metastasis risks. Additionally, the absence of standardized diagnostic criteria and treatment guidelines complicates clinical decision-making. Herein, we present a rare case of basal cell carcinoma of the areola-nipple complex in a 47-year-old woman with a notable medical history of hypertension, type 2 diabetes, and untreated psychosis, alongside a family history of breast cancer in her aunt. The patient exhibited a non-regressing ulceration on the right areolar region of the breast, persisting for approximately 10 years and progressively extending over time. Following surgical excision, a favorable post-therapeutic course was observed during follow-up. This case underscores the diagnostic challenges and nuanced management considerations inherent in basal cell carcinoma of the areola-nipple complex, underscoring the imperative for tailored treatment approaches.

Using imaging to diagnose renal tumors beyond nephroblastoma.

Wilm's tumor (WT) accounted for the vast majority of renal tumors in children (92%). However, there are many atypical or rare forms of kidney cancer, and it is certainly useful to have a diagnostic orientation in imaging to differentiate between the different diagnoses, guiding that way the therapeutic management. We report the cases of 3 patients who were initially diagnosed with nephroblastoma on the basis of radiological data (via PACS search), underwent pre-operative chemotherapy and then nephrectomy, and whose anatomopathological evidence came back in favor of benign renal tumors. Nephroblastoma is the most common renal tumor in children, but other benign tumors should not be neglected, radiological signs that may point to this entity should be taken into account, so that neoadjuvant chemotherapy with its enfeebling side effects can be avoided.

Secretory Breast Carcinoma: Report of Two Cases and Literature Review.

Secretory Breast Carcinoma (SBC) is a rare subtype of breast cancer, predominantly affecting young women, and characterized by hormone receptor-negative and HER2-negative tumors with distinctive histological features, including secretory droplets within tumor cells. This article presents 2 unique cases of SBC, Case 1 involving a 42-year-old woman with triple-negative mammary carcinoma later diagnosed with triple-negative secretory carcinoma, and Case 2 featuring a 48-year-old woman with poorly differentiated adenocarcinoma subsequently identified as invasive mammary carcinoma of secretory type. Both cases received diverse treatment regimens, incorporating surgery, chemotherapy, radiotherapy, and hormone therapy. The importance of accurate diagnosis and the need for further research to optimize the management of this rare breast cancer subtype are emphasized. Raising awareness of SBC and reporting additional cases can enhance understanding and improve patient outcomes. Additionally, the integration of clinical, radiological, and histopathological findings, alongside specific molecular markers like S-100 and mammaglobin, is crucial for accurate SBC diagnosis. Given the lack of established guidelines for SBC management, collecting additional cases can aid in defining a more effective strategy for diagnosis, monitoring, and treatment, ultimately contributing to advancements in the field. Herein, we report 2 cases of this rare disease that were diagnosed and treated in our institution.

Malignant Melanocytic Matricoma: A Rare Skin Tumor That Can Clinically Mimic Melanoma.

Malignant melanocytic matricoma (MMM) is an extremely rare skin malignant neoplasm composed of epithelial cells with matrical differentiation and dendritic melanocytes. We found only 11 cases reported in the literature to date according to the databases consulted (PubMed/Medline, Scopus, and Web of Science). Here, we report a case of MMM in an 86-year-old woman. A histological examination showed a dermal tumor with a deep infiltrative pattern, without an epidermal connection. On immunohistochemical staining, tumor cells were positive for cytokeratin AE1/AE3, p63, and beta-catenin (nuclear and cytoplasmic staining) and negative for HMB45, Melan-A, S-100 protein, and androgen receptor. Melanic antibodies highlighted scattered dendritic melanocytes in tumor sheets. The findings did not support the diagnosis of melanoma, poorly differentiated sebaceous carcinoma, and basal cell carcinoma, but supported the diagnosis of MMM.

Histopathologic and Molecular Features of Cutaneous Melanoma in a Moroccan Population.

Background Cutaneous cancer is the most common malignancy type, among which melanomas are considered the most aggressive and lethal. In Morocco, skin melanoma is the 25th most common cancer. To our knowledge, this is the first and largest Moroccan study specifically describing cutaneous melanoma.  Materials and methods We obtained data for 100 patients diagnosed with cutaneous melanoma in the Department of Pathology of Hassan II University Hospital, Morocco. Clinical, histopathological, molecular, and follow-up data were recorded from pathology request forms and the patient's medical records.  Results The mean age of our patients was 65 years old. Histologically, the most prevalent were the nodular (48%) and acro-lentiginous (38%) melanoma subtypes. A total of 66% of the patients had a Breslow thickness of >4 mm. The presence of ulceration was noted in 46% of cases. The average mitoses was 9/1 mm². A total of 44% of patients had metastatic melanoma at the time of diagnosis. The BRAF V600E mutation was found in six cases, and the C-KIT mutation in five cases. The five-year overall survival and metastasis-free survival were 85% and 15%, respectively. There was a significant correlation between Breslow thickness and Clark's level (p<0.001), histologic subtype (p=0.012), and presence of metastasis (p=0.002). There was a significant difference between the head and neck melanomas and those of the feet, particularly in the histological subtype and the presence of ulceration. BRAF V600E mutation was found in six cases of metastatic melanomas of the head and neck, of which three cases were positive for this mutation, as compared with the 23 cases of acral melanomas, which tested negative for the same mutation.  Conclusion The results of our study showed that cutaneous melanomas were characterized by advanced age at diagnosis and late-stage diagnosis with a high Breslow index. The lower limbs were the most affected sites, especially in the plantar region. The acral lentiginous subtype was the most common. The presence of BRAF V600E mutation was associated with a better prognosis.

Primary Cutaneous Malignant Perivascular Epithelioïd Cell Tumor (PEComa): Case Report With Review of the Literature.

Perivascular epithelioïd cell tumor (PEComa) is a mesenchymal neoplasm with epithelioïd or spindled morphology with numerous thin-walled capillaries between tumor cells. They co-express markers of both melanocytic and smooth muscle differentiation. PEComas are rare, presenting in numerous anatomic sites including lung, kidney, liver, genitourinary tract, soft tissue, and skin. Primary cutaneous PEComas are very rare entity, and malignant ones are even more uncommon. Herein, we report the case of a 92-year-old female which was presenting with 7 cm exophytic, ulcerated, hemorrhagic nodular tumor, and rapidly growing for 8 months over the right thigh. On histologic examination, we found a dermal neoplasm formed by an atypical clear cell tumor with numerous branching capillaries between tumor cells. The mitotic count was found 6 mitotic figures/10 HPF. On immunohistochemistry, tumor cells co-expressed smooth muscle and melanocytic markers, CD10, and CD68. Based on these findings, the diagnosis of primary cutaneous malignant perivascular epithelioïd cell tumor (PEComa) was made. The large size (7 cm), the count of mitoses (6 mitotic figures/10 HPF), and the nuclear pleomorphism argued for malignancy. The absence of soft tissue or visceral localization argued for the cutaneous primitive origin. Adjuvant radiotherapy and targeted therapy with mTOR inhibitor (nab-sirolimus) was indicated. To the best of our knowledge, this is only the eighth case of a primary cutaneous malignant PEComa reported in the literature to date.

Prognostic Impact of Tumor Budding on Moroccan Gastric Cancer Patients.

Background: Tumor budding (TB) has been defined as an independent prognostic factor in many carcinomas like colon adenocarcinoma, but its prognostic impact on gastric cancer patients remains not well established. In the present study, we aimed to highlight the correlation of tumor budding with clinicopathological features and predict its survival outcomes in gastric cancer patients for the first time in the Moroccan population. Methods: This study was conducted on 83 patients who underwent surgery for gastric adenocarcinoma from 2014 to 2020. The patient's clinico-pathological characteristics were obtained from the pathological and clinical records of each patient. Tumor budding was assessed on HES slides, according to the 2016 International Tumor Budding Consensus Conference criteria. The association of tumor budding grades with categorical and continuous variables were respectively assessed by the χ2-test and the unpaired t-test. Survival analysis was performed by the Kaplan-Meier method, the log-rank test. Results: Patients consisted of 65.1% of men and 34.9% of women with a median age of 61.2 years. Histologically, the majority of the tumors were adenocarcinoma (65.1%). Among all cases, 18.1% were classified as Bud1 (15/83), (27/83) 32.5% as Bud 2, and 49.4% (41/83) as Bud 3 grades. High-grade tumor budding (BUD 3) was found to be significantly associated with special clinicopathological features including older age (P = .02), unradical resection (R1/R2) (P = .03), and the presence of vascular invasion (P = .05), and perineural invasion (P = .04). Furthermore, tumors with high-grade tumor budding were significantly associated with a low rate of resected lymph nodes (P = .04) and advanced TNM stage (P = .02). Among all stages, high-grade tumor budding was correlated with shorter overall survival in univariate and multivariate analysis (P = .04). Patients with high-tumor budding had worse relapse-free survival compared with patients with low-tumor budding grade (P = .01). Conclusion: According to our study, the high-tumor budding grade was correlated with unfavorable clinicopathological features and poorer survival. The present study findings suggest that tumor budding should be considered in the treatment and prognosis of gastric cancer patients.

Clear Cell Carcinoma of Minor Salivary Glands: The Nasopharynx, an Uncommon Site of Origin.

Clear cell carcinoma is a rare minor salivary gland neoplasm. Its occurrence in the nasopharynx is uncommon. A limited number of cases are reported in the literature. Here, we report an additional case of clear cell carcinoma of the nasopharynx managed by induction chemotherapy followed by chemoradiotherapy, and we describe the clinical presentation, pathological features, and outcome. A 63-year-old man presented with an exophytic, ulcerative, and easily hemorrhagic tumor on the left side of the nasopharynx. A diagnosis of primary, cT4N0M0, clear cell carcinoma of the minor salivary gland was confirmed by a core needle biopsy through nasopharyngoscopy and staging procedures. The patient was treated by induction chemotherapy followed by concomitant chemoradiotherapy with clinical benefit and disease stabilization. Primary salivary gland clear cell carcinoma of the nasopharynx is uncommon. A definitive diagnosis requires an appropriate workup. The optimal treatment is unclear. Chemoradiotherapy might be a good option to manage such cases.

Clear-Cell Sarcoma With an Unusual Presentation Mimicking Metastatic Melanoma.

Clear-cell sarcoma (CCS) was first described in 1968. It partly overlaps morphologically, immunohistochemically, and ultrastructurally with malignant melanoma (MM), hence its name "soft tissue melanoma." Nevertheless, there are sufficient cytogenetic differences between cutaneous melanoma and clear-cell sarcoma to consider clear-cell sarcoma as a separate entity. Clear-cell sarcoma of soft tissue is different from clear-cell sarcoma of the kidney. It is classified as a tumor of uncertain differentiation in the WHO 2020 classification of soft tissue tumors. It is an aggressive, rare malignant tumor that is involved in the deep soft tissues of the extremities and trunk. We report a case of primary clear-cell sarcoma of unusual presentation in a 31-year-old young man, mimicking metastatic melanoma. A 31-year-old man presented with a heel mass of 2.5 cm. Histologically, it was a dermal and hypodermal nodular proliferation of spindle cells of 23 mm with a grenz zone under the epidermis. There was no necrosis area or lymphovascular invasion. Surgical margins were free. There were no clinically suspicious lymph nodes. The tumor cells were stained for S100 protein, MELAN A, and HMB45, which led to an initial diagnosis of metastatic malignant melanoma. However, analysis by fluorescence in situ hybridization (FISH) found a rearrangement of the Ewing sarcoma region 1 (EWSR1) gene, which led to a diagnosis of primary clear cell sarcoma in the skin. This case highlights the importance of considering the diagnosis of a clear-cell sarcoma in front of any dermal lesions with morphological and immunohistochemical melanocytic features that do not have an in situ component and of atypical presentation, especially in young patients, hence the interest in performing fluorescence in situ hybridization for EWSR1, which remains the key to the diagnosis of cutaneous clear-cell sarcoma.

Posterior mediastinal teratoma presenting as an abdominal mass in a child: A case report.

We report the case of a 2.5-year-old child admitted for abdominal distension, whose imaging revealed a large posterior mediastinal cystic mass, with a tissue component, a calcification, and a minimal fat component. The ultrasound- guided biopsy led to the diagnosis of a benign extragonadal germ cell tumor, also called mature teratoma or dermoid cyst, whose mediastinal localization is rare, often localized in the anterior mediastinum, and rarely in the posterior mediastinum. The mainstay of treatment is complete surgical excision.

[Unusual localisation of rare primary skin carcinoma: a case report]. / Une localisation inhabituelle d'un carcinome primitif cutané rare: à propos d'un cas.

Adnexal carcinomas are rare, accounting for less than 1% of skin carcinomas. Sclerosus carcinoma of the sweat glands was first described by Goldstein et al. in 1982. We here report the case of a 33-year-old female patient with a retracted perianal skin lesion. Histological examination of perilesional skin biopsy, immunohistochemistry, and negative results of laboratory tests, radiological and endoscopic investigations allowed for the diagnosis of eccrine sclerosus carcinoma. This is a rare tumor, usually characterized by facial localization and slow but aggressive progression. It poses problems in differential diagnosis with benign and malignant tumors; hence the challenge encountered by pathologist of suspecting this carcinoma in patients with any sclerotic and infiltrating skin lesion characterized by slow progression, in a context of preservation of the general state and in the absence of neoplastic history as well as of feeling free to ask for new deep biopsies when in doubt.

Twelve cases of metaplastic carcinoma of the breast: experience of the university hospital of Fez Morocco.

INTRODUCTION: Metaplastic breast carcinoma (MBC) is a distinct invasive breast carcinoma. It is a rare and heterogeneous group of malignancies, generally characterized by hormone receptor and human epidermal growth factor receptor 2 (HER2) negativity. The aim of the study is to evaluate epidemiological aspects, clinical characteristics, pathological features and biological profile of MBC cases diagnosed in our institution. METHODS: All patients with MBC diagnosed and treated in our institution between January 2004 and June 2009 were included. RESULTS: Twelve patients were identified. The median age was 46.5 (range 35-57 years) and the average tumor size was 6.9 cm (3.5-18 cm). Seven cases were purely squamous cell carcinomas, one was an adenosquamous carcinoma and four cases were mixed epithelial and mesenchymal metaplastic carcinomas. Primary treatment was mastectomy in 11 patients and wide local excision in one patient. There was lymph node (LN) involvement in four patients. Three patients were stage IIA, eight were stage III (2 IIIA, 6 IIIB), and one was stage IV. Estrogen and progesterone receptors status and over expression of HER2 were assessed. Eleven tumors had a basal-like phenotype and one tumor had luminal B phenotype. CONCLUSION: This study found a high incidence of MBC compared to Western countries. The tumors occur at an earlier age of onset and are usually diagnosed at a late stage with predominance of squamous cell carcinoma subtype. LN metastases are found in the third case and the tumors are most often basal-like phenotype significantly reducing therapeutic options.