[Squamous cell carcinoma of the lip: a report of 30 cases]. / Carcinome épidermoïde des lèvres: A propos de 30 cas.

BACKGROUND: Squamous cell carcinoma (SCC) is one of the most common malignant tumors of the lips (90%). The prognosis of these SCC seems to be poor thus here periorificial localization. AIM: To present the epidemiological, clinical, pathological, therapeutic features and out come of SCC of the lips. METHODS: we conducted a retrospective study performed in the dermatology department of the La Rabta hospital of Tunis over a 11-year-period [2000-2010] recording patients with histologically confirmed SCC of lips. RESULTS: Thirty patients were included (26 men and 4 women) with an average age of 63 years. The most frequent risk factors were smoking and chronic sunlight exposure. The occurrence of the labial SCC on a precursor lesion was noted in 11 cases. It occurred more frequently on the lower lip (80%). Tumor was ulcero-vegetant in 21 patients. Twenty patients had a commune SCC, 19 of them were well-differentiated. Surgery was indicated in 18 cases and 10 patients were treated by exclusive radiotherapy. Lymph nodes metastases were noted in 2 cases. No visceral metastasis was observed. During the period of follow-up (20.12 months), two patients died. CONCLUSION: The diagnosis of SCC of the lips is late and the treatment often mutilating. The improvement of the prognosis depends not only on the early diagnosis and the treatment of the precursors, but also on the photo protection and alcohol and smoking eviction.

Multiple myeloma and cutaneous anaplastic large T-cell lymphoma in the same patient: is there a causal relation?

Synchronous occurrence of lymphomatous proliferations of B and T lineage in the same patient is a very rare event and still poorly understood. All the cases reported in the English language literature are described as single case reports. We report a case of 49-year-old man, with 2-year history of multiple myeloma, presented with a raised, erythematous and ulcerated nodule in the anterior aspect of his right thigh. Histologic examination of biopsy specimen showed a dense dermic infiltrate made of large balastic cells displaying anaplastic morphology with no epidermotropism. Immunohistochemical study showed that tumor cells stained positive with CD30, EMA and CD4, and negative for CD3, CD8, CD5, CD20, CD79a, CD138 and anaplastic lymphoma kinase 1 (ALK or Ki-1).

[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.

Hidradenitis suppurativa: a disease with male predominance in Tunisia.

BACKGROUND: hidradenitis suppurativa (HS) is a chronic inflammatory, suppurating, fistulizing, and scar-producing disease of apocrine gland-bearing skin. The diagnosis is primarily clinical, based on the presence of both sinus tracts and abscesses with a characteristic distribution. OBJECTIVE: Review of epidemiological, clinical, and prognostic characteristics of HS and discussion of the etiopathogenic aspects of this chronic problem. PATIENTS AND METHODS: We retrospectively report all cases of HS followed at the Department of Dermatology between January 1985 and December 2008. RESULTS: Eleven patients (10 male and 1 female), with a mean age of 35.2 years (range 21 dash, vertical53 years) at HS diagnosis were followed for HS. The average age of disease onset was 23.9 years. The median delay between onset of symptoms and diagnosis was 144 months (range 1 dash, vertical408 months). Clinical features showed inflamed discharging papules or nodules, painful tender erythematous nodules, and double-ended comedones. The disease mainly affected the axillary, anal, perineal, and genital areas. Histologically, dermal features showed active folliculitis or abscess, sinus tract formation, fibrosis, and granuloma formation. Pathological associations (Darier's disease and Down syndrome) were noted in two patients. Treatment consisted of antibiotics in eight patients, retinoids (1 mg/kg/ day) in three patients, and surgery in three patients. The mean follow-up was 13 months (range 2 dash, vertical30 months). Recurrence of lesions was observed in all patients approximately 1 month after treatment withdrawal. The Down syndrome patient developed vaginal hydrocele of the testis as a complication of his staphylococcic ulcers. In all cases healing occurred with substantial scarring. DISCUSSION: An obvious male predominance was noted in our patients as well as a delay in the diagnosis of HS, which could be explained by non-recognition of the disease by non-specialists that see the patients at the primary-care level.

[Descriptive epidemiology of extrapulmonary hydatid cysts: a report of 265 Tunisian cases]. / Profil epidémiologique descriptif des kystes hydatiques extra pulmonaires: a propos d'une série tunisienne de 265 cas.

BACKGROUND: Hydatidosis is a parasitic endemic disease in Tunisia. The liver and lung are the most common sites of involvement; however, it can develop anywhere in the body. AIM: The aim of the present study was to analyse the epidemiological features of extrapulmonary hydatid cysts and compare our results with those reported in literature. METHODS: A retrospective study of 265 extrapulmonary hydatid cysts collected over the 18-year period from 1990 to 2007 was undertaken. RESULTS: There were 101 male and 164 female patients (sex ratio M/F = 0.61) ranging in age from 2 to 84 years (mean age = 38.7). In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%). The other less frequent sites included the peritoneum (n = 9), heart (n = 9), bone (n = 6), adrenal gland (n = 4), epiploon (n = 4), orbit (n = 4), ovary (n = 3), prostate (n = 2), bladder (n = 2), breast (n = 2), Douglas' cul-de-sac (n = 2), diaphragm (n = 1), testis (n = 1), broad ligament (n = 1), mediastinum (n = 1), nasal cavity (n = 1), soft tissue (n = 1), abdominal wall (n = 1), parotid gland (n = 1), psoas muscle (n = 1), synovia (n = 1), thymus (n = 1) et le pancreas (n = 1). CONCLUSION: In contrast to literature, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which occupies the 3rd rank.

[Central nervous system dysgerminoma: a clinicopathological study of 3 cases]. / Dysgerminomes du système nerveux central: étude anatomo-clinique de 3 cas.

BACKGROUND: Intracranial germ cell tumors are rarely seen and typically localize in the pineal or suprasellar region. The largest category of germ cell tumors is dysgerminoma. AIM: to describe clinicopathological features and immunohistochemical profile of dysgerminomas. CASE REPORT: We report three cases of central nervous system dysgerminomas. There were two young women and a man who were 6, 11 and 23-year-old. They presented with symptoms of insipidus diabetes (n=3) with association to visual field defects in the third case. Radiological findings showed a supra seller lesion in two cases. Double localization in the pineal and suprasellar regions was seen in the third case. Histologic examination and immunohistochemical study of surgical specimen were consistent with primary central nervous system dysgerminoma.

Descriptive epidemiology of childhood central nervous system tumours in Tunisia. experience of a single institution over a 15-year period (1990-2004).

INTRODUCTION: Central nervous system tumours represent 20% of all childhood cancers, and are the second most common group of neoplasms after leukaemias. OBJECTIVE: To describe epidemiological characteristics of central nervous system tumours in a paediatric Tunisian population. PATIENTS AND METHODS: A retrospective study of 492 childhood central nervous system tumours operated between 1990 and 2004 was undertaken. We investigated the age-related location, gender distribution and the histology of all tumours, and adopted the latest WHO classification (2007) in grouping all the tumours. RESULTS: There were 488 primary and 4 secondary tumours; 426 (86.6%) were intracranial and 66 (13.4%) were intraspinal. Of the 426 intracranial tumours, 214 (50.24%) were supratentorial and 212 (49.76%) were infratentorial. The median age at diagnosis was 8 years, with a male:female ratio of 1.14:1. Low-grade tumours (WHO I/II) constituted 67.3% of all lesions and the rest (32.7%) were high-grade tumours (WHO III/IV). The most common tumour found in our series was astrocytoma (38%), followed by medulloblastoma (16.2%), then ependymoma (6.9%), cystic tumours (6.3%) and craniopharyngioma (5.3%). The overall 5-year survival rate was 45% with a mean follow-up period of 36 months. CONCLUSION: In our patient population, the incidence and distribution of central nervous system tumours were similar to those reported in literature. Overall survival rates varied according to tumour location and histopathology.

Infantile desmoplastic fibroma of the maxilla.

BACKGROUND: Infantile desmoplastic fibromatoses are benign fibrous tissue tumours, non-metastasizing but locally aggressive and with high likelihood of recurrence. Many cases occur in young children between 18 months and 3 years and commonly present as painless mass of the submandibular region. The maxilla is rarely involved. AIM: Through this report and a review of literature, we are going to study clinical, pathological and prognostic characteristics of this affection. CASE REPORT: We report here a case of an aggressive desmoplastic fibroma arising in a 20-months-old infant originating in the left anterior maxillary wall. Clinical examination of the face revealed a non tender, firm, expansion of the left maxilla of 2.5 cm of diameter. The diagnosis of DF of the maxilla was made on the basis of histological features on biopsy specimen. No other location of the fibromatosis was found. The child had a favourable course. CONCLUSION: DF is an intraosseous, non metastasizing and locally aggressive fibrous tumour. Although its benignity, it could engage vital prognosis since it can extend into vital organs.

[Carcinosarcoma of the urinary bladder. Report of three cases]. / Carcinosarcome de la vessie: a propos de trois cas.

BACKGROUND: Carcinosarcoma of the urinary bladder is a very rare neoplasm accounting for less than 0,05% of urothelial tumours is a biphasic malignant neoplasm with only 79 cases reported in the English literature. Histologically, it exhibits morphologic and/or immunohistochemical evidence of epithelial and mesenchymal differentiation with the presence or absence of heterologous elements. It usually involves aged adults after 60 years and it has a poor prognosis. AIM: We report three cases with an emphasis on unusual histologic features. CASES: Three male patients age 76 to 86 years were found to have polypoid masses in the urinary bladder. In all cases, microscopic examination revealed biphasic neoplasms with distinct mesenchymal and epithelial components. The two first cases were remarkable respectively by the presence of chondrosarcomatous and osteosarcomatous components.

[Endometrial adenosarcoma with rhabdomyoblastic differenciation]. / Adenosarcome endometrial avec differenciation rhabdomyoblastique.

BACKGROUND: Mixed mullerian tumours are uncommon endometrial neoplasms that are composed by a combination of mesencymal elements and epithelial elements. They own their denomination to the mullerian origin of their components wich derive from the paramesonephric ducts. According to the benignity or the malignity of each component, four types of mixed mullerian tumours are individualised. Adenosarcoma is composed of benign glandular elements and sarcomatous, usually low-grade, stromal elements. AIM: We report a case of an endometrial adenosarcoma in a 59-year-old woman. Clinicopathological caracteristics and the etiopathogeny of this uncommun neoplasm will be discussed. CASE: A 59-year-old women complained metrorrhagia assearated pair since three months. Vaginal examination showed an incresed valure. Copathological U.S and abdominer CT showed an important. No ather turner were detected hysterrchomy with dilated annexetny werre performed. Pathological examan concluded to tummor with animation of mesenchynal and le pthel elements

[Salivary gland biopsy : experience of La Rabta Hospital's pathology departement]. / Biopsie des glandes salivaires accessoires : experience du laboratoire d'anatomie pathologique de l'hopital la Rabta de tunis.

BACKGROUND: The minor salivary glands biopsy is a very common diagnostic procedure in oral medicine rather its efficiency has not been statistically proved. AIM: Assessment of Rabta pathologic department experience METHODS: 297 biopsies have been studied with special attention to the suspected diagnosis before biopsy and the final histologic result. RESULTS: The minor salivary gland biopsy confirmed the initial diagnosis in 78 cases. Although if the minor salivary gland biopsy is in most cases not contributively, it is a very simple procedure which gives the diagnosis of Gougerot-Sjogren disease, amylosis and sarcoidosis.

[Nevus lipomatosus cutaneous superficialis: a clinico-pathological study of 13 cases]. / Naevus lipomateux cutane superficiel : étude anatomoclinique de 13 cas.

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare hamartomatous skin lesion histologically characterised by the presence of mature fat tissue within the dermis. Clinically, two types of NLCS can be distinguished: a multiple type of Hoffmann-Zurhelle and a solitary type. We report a retrospective study of 13 cases of NLCS seen in the Anatomopathological department of La Rabta hospital of Tunis during a period of 12 years (1992-2004). Two clinical forms were distinguished: the solitary form (11 cases) consisting of a unique papulo-nodular lesion and the multiple form (2 cases). Histologically, the tumor consisted in all cases on mature fat tissue.