Chemotherapy-induced differentiation to cure botryoid rhabdomyosarcoma: a case report and review of the literature.

Rhabdomyosarcoma (RMS) occurs rarely in adults and constitutes 2-6% of all uterine neoplasms. The authors report the case of a 26-year-old woman diagnosed with botryoid RMS that presented discordant progression results on follow up imaging and cytodifferentiation on pathologic control. This case showed that radiological evaluation could be misleading as the tumor demonstrated chemotherapy-induced differentiation without volume reduction. This case illustrates the limitations of using the imaging anatomical dimensions of sarcomas for treatment planning and highlights the potential role of functional imaging to assess the response to treatment.

Epidemiological Study of Thyroid Pathology in a University Hospital.

OBJECTIVES: The incidence of papillary thyroid carcinoma increased in several countries. The purpose of this study was to quantify the changes in thyroid carcinomas in our University Hospital. STUDY DESIGN: Retrospective study. METHODS: All 1.927 thyroidectomy cases studied in the Pathology Department of Hotel-Dieu de France Hospital (Beirut, Lebanon), between 2003 and 2013, were included. RESULTS: The Female/Male Sex Ratio of the studied population was 3.7/1. The mean age of female patients was significantly lower than that of male patients. The most frequent diagnoses were multinodular goiter (78%) and papillary-carcinoma (26%). 337 cases had a single lesion on gross examination. 21 of them were diagnosed with follicular carcinoma and 59 with follicular adenoma. A statistically significant correlation was found between the unicity of the lesion on gross examination and the final diagnosis of a follicular neoplasm. Thyroid carcinoma was multifocal in 33% of the cases and bilateral in 24%. A statistically significant increase in thyroid carcinoma proportion (from 15% in 2003 to 44% in 2013) was found. Among all thyroid carcinomas, the proportion of papillary type increased from 65% in 2003 to 94% in 2013 ; this increase remained statistically significant after the exclusion of papillary micro-carcinomas, whose proportion was stable throughout the 11 years. CONCLUSIONS: In this study, we noted a statistically significant increase in the frequency of thyroid carcinoma, especially of the papillary type. The unicity of the lesion on gross examination is significantly associated with a follicular neoplasm.

Differentiated thyroid carcinoma in early adulthood patients.

BACKGROUND: This paper reviews the clinico-pathologic features and outcomes of differentiated thyroid -carcinoma in early adulthood patients. STUDY DESIGN: Retrospective study. MATERIAL: From january 2000 to december 2012, 71 patients aged between 20 and 44 years who underwent thyroidectomy for differentiated thyroid carcinoma were included. The following parameters were recorded : age, gender, pre-operative symptoms and diagnosis, thyroid hormonal status, substernal extension, operative details, preoperative and postoperative calcium and phosphorous values, perioperative complications, length of hospital stay, final histology, survival and disease progression. RESULTS: There were 59 females (83%) and 12 males with a median age of 29 years (20-44 years). None had a previous neck irradiation. Total thyroidectomy was performed on 65 patients (92%). There were 66 papillary (93%) and 5 follicular carcinomas. Extrathyroidal invasion and lymph node involvement were present in 44% and 37% of cases respectively. Transient hypocalcemia and dysphonia occurred in 15% and 4 % of cases respectively. Permanent hypocalcemia and vocal cord paralysis occurred in 1% and 0% of cases respectively. Adjuvant radioactive I(131) therapy was given to 50 patients. There were 7 cases (10%) of lymph node recurrences but no disease-related deaths. The only statistical differences between this group and all ages group were the extracapsular invasion (44% vs 20% p = 0,0014) and lymph node metastasis (37% vs 18% p = 0,0091). CONCLUSIONS: Differentiated thyroid carcinoma has a good prognosis in early adulthood patients. Although death from this condition is rare, recurrence is frequent and long term follow up is mandatory.

Reactive Angioendotheliomatosis in Association with Ulcerative Colitis.

Reactive angioendotheliomatosis (RAE) is a rare benign skin condition characterized histologically by the proliferation of dermal vessels and endothelial cells that occurs secondary to an underlying disease such as infections or lymphoproliferative disorders. To our knowledge, no previous cases of RAE associated with ulcerative colitis (UC) were reported in the literature. Therefore, we report the case of a 46-year-old man with a history of UC presenting with RAE confirmed on histopathology and immunostaining.

[Subcutaneous infection spread by Scytalidium (Neoscytalidium) dimidiatum]. / Infection sous-cutanée disséminée par Scytalidium (Neoscytalidium) dimidiatum.

INTRODUCTION: S. dimidiatum (recently reclassified as N. dimidiatum) is a fungus that causes nail and/or superficial skin infection. It may also cause subcutaneous and deep infection, chiefly in immunocompromised patients. CASE REPORT: An 87-year-old male treated with oral corticosteroids for sarcoidosis consulted for violaceous cutaneous nodules on the back of his hands. Histopathological examination revealed epithelioid cell granulomas with numerous mycelial filaments and multiple spores. Culture of a biopsy sample resulted in growth of numerous colonies of S. dimidiatum and the patient was treated with intravenous amphotericin B. DISCUSSION: This organism is transmitted by direct or indirect contact with contaminated soil or plants. It mainly causes superficial skin and nail infections, and may result in deeper infections on rare occasions. We report a case of subcutaneous infection with S. dimidiatum in an immunocompromised patient (due to general steroid therapy) that was successfully treated using amphotericin B.

[Histological types of 876 breast cancers according to the 1981 WHO classification]. / Types histologiques de 876 cancers du sein selon la classification de l'OMS 1981.

This work presents the results of the classification by histological types of 876 cancers, operated on between November 1979 and December 1982, according to the new WHO's classification of 1981. Noninfiltrating cancers represent 6.5 per cent of the total. Among the infiltrating cancers (93.5%), the individualization of the type "infiltrating duct carcinoma with a marked intraductal component" (14.5%) is interesting for this form justifies a special treatment in consideration of its multicentric and sometimes bilateral character. Its purely quantitative criteria of definition is subject to criticism and discussion.

[Axillary lymph nodes in breast cancer. Comparison of standard histological analytical technics and macroscopic serial sections]. / Ganglions axillaires dans les cancers du sein. Comparaison des techniques d'analyse histologique standard et en coupes macroscopiquement sériées.

Lymph nodes in breast cancer have been examined by two histological techniques in 324 patients who underwent axillary node dissection. A routine pathologic examination consisted in the examination of only one pathological section while in the other, the lymph nodes were macroscopically serially sectioned. With the latter, an increase of 18.8 per cent in the number of detected metastases was noted. However this increase can be considered of prognostic and therapeutic importance only in 8.6 per cent of cases: half corresponding to those cases in which more than the initial threshold number of three lymph nodes were found, the other half corresponding to those cases in which one lymph node was found while the initial examination was negative. In the latter case, the increase of lymph node involvement was mainly due to "clandestine" metastases, i.e. lymphatic embolisation of micrometastases.

[Imaging aspect of a case of fibrodysplasia ossificans progressiva]. / Aspect en imagerie d'un cas de fibrodysplasie ossifiante progressive.

Fibrodysplasia ossificans progressiva is a rare congenital disease that affects children under the age of five years. Soft tissue swelling of the cervical and dorsal regions with local pain, warmth and low grade fever are the early clinical manifestations, usually associated with hallux valgus and microdactily of the fingers and toes. Calcifications of the fascias and muscles cause muscular contractures leading to progressive disability and restrictive lung disease. In the early stage, CT shows edema of the soft tissues and later on, calcifications of muscular fascia. The association of these radiographic and CT findings is specific and should avoid muscular biopsies which are known to be an aggravating factor in this disease.

[Epidermoid carcinoma developing in a chronic anal fistula]. / Carcinome épidermoïde développé sur fistule anale chronique.

BACKGROUND: Malignant degeneration of anal fistula is a rare occurrence in the course of a common disease. Abdominoperineal resection offers the only hope of cure. CASE REPORT: A 41-year-old patient who was operated 14 years earlier for anal fistula presented recurrence treated by fistulectomy. Histology revealed a well-differentiated squamous-cell carcinoma. Radiotherapy (45 Gy) was added postoperatively. Five months later, local recurrence was treated by chemotherapy and abdominoperineal resection. Two months later the patient died from cachexia with local recurrence. DISCUSSION: Biopsies of anal fistula tract and histology of all fistulectomies are required for early diagnosis of possible carcinoma. Abdominoperineal resection offers the only hope of cure.

[Central neurocytoma. Four patients]. / Neurocytome central. A propos de quatre cas.

We report four cases of central neurocytoma we operated on at our institution, between 1994 and 2002. This uncommon lesion occurred in young patients, was located in the lateral ventricules and was revealed by signs of intracranial hypertension. The tumor was totally removed in three cases and subtotally in one. Immunohistochemistry provided useful information to distinguish neurocytoma from other nervous system tumors. Prognosis was excellent in two patients. One patient developed tumor recurrence seven years after surgery, without any progression on further follow up evaluation. In the last patient, the tumor showed a more aggressive progression requiring the adjunction of radiosurgery.

[Capillarovenous angioma of the maxillary sinus. Apropos of a case with review of the literature]. / Angiome capillaro-veineux du sinus maxillaire. A propos d'un cas avec revue de la littérature.

We report the case of a 30-year-old woman who presented with swelling of the left cheek, related to a capillarovenous angioma (previously known as cavernous osseous hemangioma), located in the left maxillary sinus. The different imaging modalities, histologic appearance and evolution criteria are reported and discussed.

[Venous malformation of the corpus adiposum buccae]. / Malformation veineuse de la boule graisseuse de Bichat.

We report on a venous malformation (previously known as a cavernous angioma) with an unusual location in the corpus adiposum buccae. Diagnosis, histologic classification and management of these rare lesions are discussed.

[Breast carcinoma: evaluation of hormone receptors and pS2, erb-B2, P-glycoprotein and Ki-67 markers]. / Carcinomes mammaires: evaluation des recepteurs hormonaux et des marqueurs pS2, erb-B2, P-glycoproteine, et Ki-67.

The present study was performed on 45 mammary biopsies submitted to the Pathology Department, Hôtel-Dieu de France Hospital, for evaluation of hormonal receptor. Histological typing and grading did not reveal any difference with the literature, but the mean size of tumor at clinical presentation was 4 cm (+/- 1.6) and 83% of patients with known lymph node status, had metastases. Immunohistochemical assay for hormonal receptors on frozen sections disclosed positivity for estrogen and progesterone receptors in 18 cases (43%), similar to other studies. pS2, intracytoplasmic estrogen-induced protein, is positive in 19 out of 32 studied cases (59%), similar to what is reported by others. The latter does not appear to bring more information than hormone receptors considering therapy and prognosis. Oncoprotein C-erb B2 membrane over-expression is noted in 65% with no significant correlation to histological grade, size of tumor or node status. Antigen Ki-67 marker demonstrates high proliferation rates in 19 tumors (48.7%). The markers studied do not seem to be more conclusive than the hormone receptors. The major fact disclosed by the study of this small series is the advanced stage at clinical presentation, urging an adequate medical education of the Lebanese population, and prompting to appropriate self-screening. Nevertheless, new tumor markers are continuously presented in the literature. In this era of marker extravaganza, a "wait-and-see" attitude would be a wise alternative.

[Esophageal Abrikossof tumor: a case report]. / Tumeur d'Abrikossof de l'oesophage: a propos d'un cas.

Systematic eso-gastric endoscopy allowed the discovery of a granular cell tumor. Also known as Abrikossof's tumor, the latter is a benign lesion, usually symptomless, unless it is large in size, or associated with a malignant tumor. Grossly it is a polypoid, submucosal tumor. Diagnosis is microscopic, confirmed by immunohistochemistry, unless biopsies are superficial, and show only the usually associated pseudo-carcinomatous hyperplasia. Therapeutic approach depends on the symptoms, mainly dysphagia, which is related to the size of the tumor.

[Endoscopic evaluation of chronic human immunodeficiency virus-related diarrhea]. / La place de l'endoscopie dans le diagnostic etiologique des diarrhées chroniques des sidéens.

Chronic diarrhea is an important clinical problem in patients infected with HIV. Data assessing the diagnostic yield of upper and lower endoscopy are limited. We reported 10 cases of HIV-infected patient referred to our hospital for chronic diarrhea from March 1995 to June 1999. 60% of the pathogens were identified obviously by stool studies. Cryptosporidium and Mycobacterium avium intracellulare (MAI) were the most common organisms. In this study, endoscopy identified 2 additional cases of MAI and one of 5 cryptosporidia detected in stool. Immunologic test identified a CMV infection in one case. Stool tests and endoscopy identified obviously 80% of the pathogens. Most investigators and us agree that stool studies should be the first diagnostic test. In patients with negative stool studies, lower endoscopy is more cost-effective than upper endoscopy and indicated as an initial exam.

[Tuberculous lupus. Apropos of a case of tuberculous lupus tumidus]. / Le lupus tuberculeux. A propos d'un cas de lupus tuberculeux tumidus.

Cutaneous tuberculosis is now becoming rare in well developed countries, representing about 0.5% of systemic tuberculosis. The devaluation of social economic level in a country implies the recrudescence of the sickness. We report a case of "lupus tumidus", a form of lupus vulgaris of the face, which has progressed and worsened during the years of the civil strife in Lebanon.

[Vertebral actinomycosis: case report and review of the literature]. / Actinomycose vertébrale: a propos d'un cas et revue de la littérature.

In this article, the case of a 32-year-old man with a paravertebral actinomycosis is discussed. Initially, the diagnosis was not obvious but it was confirmed later with the repetitive radiologic procedures, the elimination of other etiologies (purulent, mycobacterial or mycotic infections and neoplasia) and the biopsy. Treatment with penicillin initially and then with tetracycline for a long term led to a very good outcome at a 3-year follow-up with a radiologic remission. Following the discussion of the case, a review of the literature concerning the paravertebral actinomycosis, its diagnostic clues and treatment is undertaken.

[Mesothelioma--asbestos in Lebanon: a problem to be considered]. / Mésothéliome--asbeste au Liban: un problème à retenir.

To estimate the incidence of pleural mesothelioma and its relationship with the occupational and environmental exposure to asbestos in Chekka region. Between 1991 and 2000, 22 cases of malignant mesothelioma were diagnosed at Hôtel-Dieu de France Hospital. Eighteen cases were epidemiologically investigated. Fifteen among these 18 patients (83%) had a positive exposure history: exposure was occupational in 11 cases and environmental in 4 cases. The tumor was attributable to Eternit Company in 12 cases among the exposed 15 (80%). These 12 cases were secondary to occupational exposures in 8 and to environmental exposure in 4 cases. Mean latency period between exposition and diagnosis was 29 years. Fifteen patients died from the progression of their disease after a median survival of 8 months. The relationship between pleural mesothelioma and Eternit Company with the related occupational and environmental risk in Chekka region is obvious. The assessment of the incidence needs a national cancer registry. Despite the protective measures taken by the government since 1996, an increase in the incidence is suspected in the coming ten years because of the long latency period of the disease.

[Incidentally discovered adrenal tumor: myelolipoma]. / Tumeur surrénalienne de découverte fortuite: le myélolipome.

The wider application of increasingly sensitive ultrasonography and CT scanning has created a new problem for clinical management: the incidental discovery of asymptomatic adrenal lesions. These lesions, also called "incidentalomas" may be due to a large variety of etiologies, and although most of them prove to be benign cortical adenomas, diagnostic confirmation is frequently impossible preoperatively. For this reason, a general approach, based on the relative prevalence of benign and malignant, clinically silent adrenal masses, has been defined. This same approach is usually needed in the case of myelolipoma, a rare form of benign and silent adrenal neoplasms, containing hematopoietic and fatty elements. Actually, computed tomographic aspect of such tumors is very evocative but not pathognomonic, so it doesn't eliminate the possibility of malignant lesions, especially in the presence of heterogeneities. Because of these limitations and awaiting the development of more specific diagnostic procedures, it seems cautious to approach these tumors like incidentalomas in general.

Imaging of an exceptional tumor: myxoid chondrosarcoma of the jugular foramen.

We report on an unusual tumor of the jugular foramen in a 26-year-old male. The lesion showed moderate enhancement on CT scan and a higher signal intensity on T2-weighted MR images than on T1, with a massive enhancement after gadolinium. Tumor was entirely removed surgically and histology was consistent with a low-grade myxoid chondrosarcoma, an exceptional tumor in this location. The differential diagnosis includes paragangliomas, schwannomas, metastases and meningiomas. Radiological and histological features can also mimic chordomas. However, immunohistochemical analysis certifies the diagnosis.