Unusual presentation of sarcoidosis: solitary intracranial mass lesion mimicking an intracranial neoplasm: a case report.

Sarcoidosis is a multisystem disease of unknown cause and with a worldwide distribution. Involvement of the central nervous system occurs in a relatively small number of patients with sarcoidosis. Isolated neurosarcoidosis without signs of systemic disease however is a rare. In this report, we present an unusual case of neurosarcoidosis with intra cranial mass mimicking radiologically a glioma. Pathological examination revealed intraparenchymatous necrotising granulomatous lesions. After clinicopathological correlation, the diagnosis of a necrotizing cerebral granulomatosis (neurosarcoidosis) with atypical systemic involvement was made. Because of its non-specific clinical presentation and neuroradiological imaging characteristics, intracranial neurosarcoidosis remains a very difficult diagnosis, particularly in the absence of systemic signs of the disease.

Ureteral spread of a primary cutaneous diffuse large B-cell lymphoma, leg type.

We report a case of 76-year-old man, with a past medical history of primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), who presented with ureteral tumor diagnosed as urothelial carcinoma on imaging investigations. Histological examination showed an unusual finding. The tumor was a ureteral localization of the PCDLBCL-LT previously diagnosed. To the best of our knowledge, this is the first case of PCDLBCL-LT with ureteral spread described in the literature.

Ischemic colitis revealing polyarteritis nodosa.

Ischemic colitis is one of the most common intestinal ischemic injuries. It results from impaired perfusion of blood to the bowel and is rarely caused by vasculitis. We report a case of ischemic colitis revealing polyarteritis nodosa (PAN) in a 55-year-old man. Histological examination of the resected colon led to the diagnosis of PAN.

Testicular cancer patterns in Tunisian men : diagnosis problems, pathological types and prognosis. About 41 patients.

AIM: To analyze the testicular cancer (TCa) incidence, diagnosis aspects, pathologic grade, stage, and survival in Tunisian men. METHODS: We studied all patients who had histopathologically confirmed TCa treated in La Rabta University-Hospital between 1991 and 2010. Baseline demographic data included age at diagnosis, year of diagnosis, clinical symptoms, stage at diagnosis, histologic type, management strategies and survival were analyzed. RESULTS: The incidence of TCa among Tunisians is very low; we collected only 41 cases over a period of 20 years with an average incidence of 2 new cases per year. Peak age incidence was 30-49 years. Testicular swelling was the principal complaint in 25 patients. 58.5% of tumours were rightsided and 39% were left-sided. There was bilateral involvement in only one case. The mean interval between onset of symptoms and presentation was 16.5 months (1-120). Most patients presented at stages T2 and T3 (63.4% and 26.8% respectively). Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in respectively 11 and 12 patients (association in 5 patients). One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminomas (n=20) and mixed germ cell (n=8). Three patients died within 48 months, while half were lost to follow-up. CONCLUSIONS: The incidence of TCas in Tunisia remains low. Late presentation and treatment are major challenges to management. Better health funding and education regarding testicular self examination is essential.

[Vasculitis in Sweet's Syndrome]. / Vascularite au cours du syndrome de Sweet.

BACKGROUND: Also called acute febrile neutrophilic dermatosis, Sweet's syndrome is non-infective dermatoses that exhibit a predominantly neutrophilic inflammatory infiltrate. Absence of vasculitis is a histologic criterion for diagnosis. However, recent reports suggest that vasculitis should not exclude the diagnosis. AIM: To describe their clinical, pathological and therapeutic characteristics. METHODS: We report a series of 47 cases of Sweet's syndrome, collected in our institution between 1997 and 2011. RESULTS: The patient population consisted of 11 males and 36 females. The mean age was 47 years (28-74). An associated disease process was seen in 10 patients: inflammatory disease (3 cases), inflammatory bowel disease (2 cases), tuberculosis (3 cases) and diabetes (3 cases). One case of pregnancy was observed. In the prodromal phase, functional symptoms were reported in 38 cases (80.8%). Cutaneous lesions consisted of erythematous plaques or nodules. Lesions were located mainly on the upper or lower extremities. All biopsy specimens demonstrated a dermal infiltrate composed predominantly of neutrophils. Fibrinoid necrosis and intramural inflammation were observed in 8 cases. CONCLUSION: The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's diseases which requires careful surveillance.

Vulvar lactating adenoma associated to a fibroadenoma: common neoplasms in an uncommon site.

Ectopic breast tissue is defined as glands located outside of the breast. Ectopic breast tissue should be excised because it may develop benign (fibroadenoma) or malignant pathologic processes. Less than forty cases of fibroadenomas have been reported in the literature. Although lactation changes can occur, lactating adenoma in the vulva are extremely rare. Only four cases have been reported. We report a case of a young woman who presented with vulvar mass during her lactation. The mass was excised, and histology confirmed vulvar lactating adenoma associated with fibroadenoma. This is the first case of vulvar heterotopic breast lesion associating lactating adenoma and fibroadenoma.

[Gastric MALT lymphoma: anatomo-clinical data and outcome of early stage H. pylori-associated gastric MALT-lymphoma resistant to treatment]. / Lymphome du MALT gastrique : Particularités anatomo-cliniques et évolutives des formes résistantes au traitement.

AIM: To describe the clinical, endoscopic and histological particularities of early stage HP associated gastric MALT lymphoma resistant to anti Hp treatment and identify predicting factors of resistance. METHODS: We retrospectively studied 12 patients with primary low grade gastric localized MALT lymphoma treated with anti HP treatment and diagnosed at La Rabta Hospital from 1999 to 2009. RESULTS: The ultrasonography was normal in 5 patients between the 6 responding patients. Perigastric lymph nodes were found in non responders (33.3%). Hp eradication was achieved in 66% of patients not responding while Hp was eradicated in 100% of responders. The two non-responding patients with failure of eradication of Hp had a strain resistant to Clarithromycin Hp. CONCLUSION: Predicting factors of failure of anti HP: HP resistance to antibiotics, the proximal head, and the presence of perigastric lymph nodes. Recently, chromosomal aberrations and immune-histochemical markers have been implicated as factors of non response to anti Hp.

[Pseudo tumoral gastric amyloidosis: a case report]. / Amyloïdose gastrique pseudo tumorale: a propos d'une observation rare.

BACKGROUND: Amyloidosis is an abnormal extracellular deposition of insoluble proteins, which is associated with an involvement of the gastrointestinal tract in 50 to 70% of cases. In primary amyloïdosis (light chain amyloïdosis), localized gastric involvement is a rare finding which can mimick malignancy. AIM: To elucidate the clinical, histological and therapeutic features of pseudo tumoral gastric amyloidosis via a rare report along with a review of related literatures. OBSERVATION: We report the case of a 56-year-old man, admitted with upper digestive outlet obstruction. Linitis plastica with lymph node involvement was suspected by gastroscopy, barium meal and endoscopic ultrasonography but was not confirmed by gastric biopsies. The patient was treated with total gastrectomy with lymph node dissection. Pathological examination demonstrated gastric and lymph nodes amyloidosis and no malignant tumor was found. CONCLUSION: We propose that amyloidosis should be considered in the differential diagnosis of gastric tumors.