Fetoplacental malformations and abnormalities. A retrospective analysis of 398 cases.

BACKGROUND: The fetoplacental examination is actually very important and sometimes necessary to confirm or correct prenatal diagnosis. AIM: to deduce a list of indications of fetoplacental examination and to determine the type and frequency of malformations found. METHODS: a retrospective study including 398 consecutive fetoplacental examinations, including abortions, stillbirths and children died perinatally. The cases were referred in the department of pathology of the M. Slim Hospital (North Tunis) from 1992 and 2012. RESULTS: The mean maternal age was 32,58 years. The average gravidity was 2,65 and the average rate was 1,48. Maternal conditions were dominated by preeclampsia. The main indication motivating the request for fetoplacental examination was a spontaneous abortion in 45,73% of cases. The rate of stillbirths was 15,61% and that of children who died in the perinatal period was 13,28%. The sex ratio was 1,4 and the medium term was 19,38 SA. 170 fetuses had abnormalities (43,14%). The most frequent abnormalities were chromosomal aberrations (27,64%), followed by facial abnormalities (25,88%) and central nervous system abnormalities (18,82%). We examined 283 placentas, 49% of them contained abnormalities. Ischemic lesions were the main placental abnormalities (41%). CONCLUSIONS:   An efficient fetopathological examination should be as complete as possible, including examination of placenta. Everything must be integrated into a data collection and complete clinical information.

Chondroid syringoma: report of four cases.

Chondroid syringomas or mixed tumors of the skin are relatively rare adnexal tumors constituting 0.01% to 0.1% of all primary skin tumors. The majority of chondroid syringomas occur at the head and neck region (80%). Their clinical presentation is not specific and the final diagnosis is based on histopathologic examination. The authors report four cases of benign chondroid syringoma in three women and one man aged 26, 45, 50, and 38 years, respectively. They presented with a slow-growing, painless and firm subcutaneous nodule measuring between 1 and 3 cm involving the lower eyelid, the nasogenien groove, the nose, and the chin, respectively. All patients underwent uneventful surgical excision of the nodules. Histologic examination of the surgical specimen was compatible with benign chondroid syringoma in all cases. Chondroid syringomas must be considered in the differential diagnosis of any small subcutaneous nodule in the head and neck region in middle-aged patients. The treatment of choice is total excision, with wide disease-free margins, to rule out malignancy and reduce the risk of recurrence and malignancy in the future.

[Lipoma of the uterus: clinical and ethiopathological approach of 7 cases with immunohistochemical study of histogenesis]. / Approche clinique et éthiopathogénique de sept cas de lésions lipomateuses de l'utérus avec étude immunohistochimique de leur histogenèse.

BACKGROUND: Lipoleiomyoma of the uterus (LLU) is an extremely rare, benign, uterine tumour. This rare disease was unknown for a long time. Their histogenesis remains controversial. AIM: To describe the clinical and pathological aspects of uterine lipoleiomyoma and to try to specify, by an immunohistochemical study, its degenerative or tumoral nature. METHODS: 7 cases of LLU were identified represented by 2 pure Lipoma and 5 Lipoleiomyoma. We performed an immunohistochemical study including anti-vimentin, anti-smooth muscle actin, anti PS-100, anti-desmin, anti-factor VIII and anti-HMB- 45. The results were correlated with the pathogenesis of this lesion. RESULTS: Immunohistochemical analysis showed an expression of PS 100 only in lipocytes whereas leiomyomatous cells express only smooth muscle actin. CONCLUSION: Our study supports the benign tumoral nature of the fatty uterine lesions. Lipoleiomyomatous cells may originate from the transformation of a totipotent mesenchymal cell and not from a degenerative process.

[Inflammatory fibroid polyp of the ileum presenting as intussusception: a case report in an adolescent]. / Polype fibro-inflammatoire de l'intestin grele revele par une invagination intestinale aigue: a propos d'un cas chez une adolescente.

Inflammatory fibroid polyp is an uncommon and benign submucosal lesion of the gastrointestinal tract. The maximal incidence is in the fifth and sixth decades. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils and highly vascularized fibrocystic stroma. We report a case of 15-year-old patient who underwent emergency surgery because of acute intestinal obstruction as a result of an intussusception. The macroscopical study after segmental ileal resection showed a nodular lesion 3x2x2 cm, arising from the submucosa with an ulcerated surface. The pathologic diagnosis was ileal inflammatory fibroid polyp. Immunohistochemically, the cells reacted with vimentin and CD34. It has no malignant potential although extensive infiltration may occur. The etiology is unknown. We discuss the clinical, the pathological aspects and the possible etiological factors of the inflammatory fibroid polyp.

[Hepatic mesenchymal hamartoma in adulthood: a case report with literature review]. / Hamartome mesenchymateux du foie chez l'adulte: a propos d'un cas avec revue de la littérature.

Mesenchymal hamartoma is a rare and benign tumor.. Representing 5 to 8 % of children's hepatic tumors, it is rarely described in adults. Authors report a new case of hepatic mesenchymal hamartoma in a 21-year-old woman, diagnosed after a sudden onser of clinical and biological cholestasis. Abdominal US and CTscan exminations showed a medial liver tumor with cystic formations suggestive of a hydatid cyst. The diagnosis of hepatic mesenchymal hamartoma was based onn hitology of the resected liver specimen. Radiological findings can suggest the diagnosis but only histology can confirm it. Treatment is surgical involving in most of the cases; a wide hepatic resection because of the size of the tumor. Progosis is excellent when complete exeresis is possible.

[Kikuchi disease: an unusual clinico-pathologic presentation]. / La maladie de Kikuchi: présentation clinique inhabituelle et aspects morphologiques.

Histiocytic necrotizing lymphadenitis, also known as KIKUCHI disease is rare self-limited condition of young adults. Manifestations include enlargements of the cervical lymph nodes, sometimes with fever, and can be associated with other non-specific signs. The aetiologie of this affection is still unclear. This is a case report of a 27 year-old man who presented cervical and sus-clavicular lymphadenopathy diagnosed first as lymph nodes tuberculosis before the diagnostic of KIKUCHI disease was made.

A misleading hepatic tumour: epithelioid angiomyolipoma.

Hepatic angiomyolipoma (HAML) is a rare, benign mesenchymal neoplasm composed of varying amounts of smooth muscle cells, adipose tissue, and vessels. Its morphological diversity often poses diagnostic problems. In this paper, the authors report a peculiar case of epithelioid HAML mimicking histologically hepatocellular carcinoma with focal areas resembling inflammatory pseudotumour. A 57 year-old male patient presented with abdominal pain and discomfort. Non enhanced CT scan demonstrated a heterogeneous hypodense mass located in segment II and IV of the liver. Hepatocellular carcinoma was suspected and the patient underwent left lobectomy. Histologically, the tumour was mainly composed of epithelioid cells arranged in trabeculae and sheets (50% of the tumour surface) admixed with mature fat cells (20%) and thick-walled blood vessels. Lymphocytic aggregates and clusters of foamy histiocytes were focally found in the stroma (30%). Most of the epithelioid tumour cells were immunoreactive to homatropine methylbromide 45 (HMB-45) and smooth muscle actin. Morphological pattern and immunophenotype were consistent with epithelioid HAML.

The prognostic value of the immunohistochemical expression and mutational pattern of the key mediator of Wnt signaling: beta-catenin in Tunisian patients with colorectal carcinoma.

Beta-catenin plays a critical role with E-cadherin in cell-cell adhesion and is also a key molecule of the highly conserved Wnt signaling pathway that regulates cell proliferation and differentiation. Abrogation of this pathway is implicated in the carcinogenesis of several malignancies, especially colorectal cancer. The objective of this study was to determine the prognostic value of ß-catenin/E-cadherin complex in Tunisian patients with colorectal cancer. Matched primary tumors from 150 patients with sporadic colorectal adenocarcinomas were stained for ß-catenin and E-cadherin by using immunohistochemistry. Deletion of exon 3 of CTNNB1 gene was performed by polymerase chain reaction. Our results showed that ß-catenin and E-cadherin expressions were related inversely to tumor differentiation. Furthermore, the nuclear expression of ß-catenin was considerably increased in advanced colorectal adenocarcinomas and was highly associated with shorter survival of patients. Deletion of exon 3 of CTNNB1 was identified in 2 cases by using polymerase chain reaction and was significantly related to tumor invasion and aberrant expression of E-cadherin. The major finding of this study is that activation of ß-catenin gene by deletions involving exon 3 may be considered as an advanced event in colorectal tumorigenesis in Tunisian patients, in contrast to some worldwide studies. Moreover, disruption of ß-catenin/E-cadherin complex may be considered as a dependent predictor of disease outcome.