[First cases of squamous cell carcinoma associated with cosmetic use of bleaching compounds]. / Premiers cas de carcinomes épidermoïdes sur terrain de dépigmentation artificielle.

INTRODUCTION: We report two cases of squamous cell carcinoma (SCC) in two black women (phenotype VI) using bleaching compounds for cosmetic purposes over a period of 15 years. CASE REPORTS: Two women (aged 45 and 47 years) with a long history of cosmetic use of bleaching compounds consulted at a dermatology unit for skin tumours. A diagnosis of SCC was confirmed by histological examination of tumour biopsies. One patient was HIV-positive. Surgical treatment was performed in both cases: simple postoperative complications were seen in one patient but the other died at home following recurrence of carcinoma in the year following diagnosis. DISCUSSION: To our knowledge, theses two cases represent the first description of SCC occurring after prolonged cosmetic use of bleaching compounds. Carcinoma occurred in both cases in skin exposed to sun. In our patients, the mechanism of carcinogenesis may have involved melanin destruction, solar exposure and corticosteroid-induced immunosuppression. A direct carcinogenic effect of hydroquinone or other unidentified compounds is another possibility; the carcinogenicity of hydroquinone is well established in rodents. While these observations do not provide formal proof of any implication of depigmentation products in SCC, they emphasize the need for monitoring of dark-skinned women using skin lighteners.

[Bilateral gestational macromastia: case report]. / La gigantomastie gravidique bilatérale: à propos d'un cas.

PURPOSE: We report a case of bilateral gestationnal macromastia in order to discuss the pathogeny, the diagnosis and the treatment. METHODOLOGY: It was a case of a 33-year-old woman, admitted for a bilateral massive hypertrophy of the breast occurring on pregnancy and with progressive evolution. She had three pregnancies and one born-infant. Biological exams have shown a hyperprolactinemia. Pathological exam of the mammary biopsy had shown a benign hyperplasia. RESULTS: Medical treatment of our patient by bromocriptin was inefficient. She has had a bilateral mastectomy. She is waiting for mammary plastic surgery. CONCLUSION: Gravidic macromastia is a rare pathology whose etiology and treatment are much debated. Frequent recurrence after mammary reduction justify the mastectomy followed by prothesis.

[Gynaecological and breast cancers at the Dakar Cancer Institute]. / Les cancers gynécologiques et mammaires à l'Institut du cancer de Dakar.

OBJECTIVE: To determine the frequency of gynaecological and breast cancers among women and to study their risk factors and diagnostic aspects at the Institut Curie of Dakar. PATIENTS AND METHOD: This retrospective study included all cancers seen at the Institute in 2001. Epidemiological and clinical variables were collected from the patients' medical records and analysed. RESULTS: This study showed that of all 786 cancers in women, 507 were gynaecological or breast cancers. Cancer of the uterine cervix accounted for 240 cases (47.3%), followed by 213 cancers of the breast (42%), 35 of the ovaries (6.9%), 10 of the corpus uteri (2%) and 7 of the vulva (1.4%). Mean age was 49.9 years old. There was a statistically significant (p<0.05) between primary tumour sites and all of the following: age at menarche, age at first sexual relations, and number of sexual partners. Mean time until consultation for all patients was 8.24 months and 96% had clinical signs before diagnosis. The histological confirmation rate was 73%. Local or regional tissue involvement was noted in 60% of cases. CONCLUSION: Gynaecological and breast cancers are frequent in Dakar and have the characteristics common to cancers in developing countries. Further efforts are needed to study their risk factors and effective screening for them.

[Vulval bilharziasis]. / Localisation vulvaire de la bilharziose.

Vulvar localisation of schistosomiasis is a rare presentation. We report a case of a woman of 20 years old hospitalised for a vulvar mass of six months. That mass progressively increased in volume and was tender. It was accompanied by frequency and dysuria. The patient had a history of swimming in fresh water and hematuria when she was eight years old. Initial clinical examination found a good general state, there was a mass involving the clitoris and the small lips. This painless mass had a cauliflower appearance and was soft with a large implantation. Pathology exam of the mass revealed a vulvar schistosomiasis with an important amount of living eggs. A tumour removal with a plasty of small lips was performed. Additionally, praziquantel was administered orally. Vulvar localisation of schistosomiasis might suggest a malignant tumour. Only pathological examination can assess the diagnosis.

[Giant compressive mediastinal lipoma: a case report]. / Lipome géant compressif du médiastin: a propos d'un cas.

Mediastinal lipoma is a rare mesenchymatous fatty tumor in child. Usually asymptomatic, it can cause asphyxiation. The authors report the case of an 18 month-baby-girl referred to us by the pediatric department for asphyxiation. The chest X ray was evocative of a mediastinal tumor. A sudden cardiorespiratory failure leads us to perform thoracotomy. A fatty tumor was found compressing the heart and the left lung. It was easily extirpated. The postoperative recovery was uneventful. Light microscopy showed a lipoma. This compressive form shows the severity of the mediastinal lipoma when it reaches a large size. The literature on this rare pathology is reviewed.

Translocation (6;16) in a case of granulosa cell tumor of the ovary.

We performed a cytogenetic study of an ovarian granulosa cell tumor (GCT). Tumor cells showed a translocation (6;16); the full karyotype was 45,XX-6,dic(6;16)(q11;q22)/44,XX,-6,-22,dic(6;16)(q11;q22),-22/46,XX,- 6,dic(6;16)(q11;q22), +dic(6;16)(q11;q22). This is the second case of GCT with structural changes of chromosome 6 leading to loss of 6q material.

Concomitant sickle cell disease and skeletal fluorosis.

Skeletal fluorosis typically manifests as a diffuse increase in bone density, whereas avascular necrosis of the epiphyses and diaphyseal marrow are the main skeletal manifestations of sickle cell disease. The diagnostic and therapeutic challenges raised when both disorders are present are illustrated by two cases in Senegalese patients from an area characterized by high fluoride contents in the water and soil. Both had SS sickle cell disease. Skeletal fluorosis was diagnosed during evaluation for avascular necrosis in one patient and in the wake of septic arthritis in the other. Femoral head necrosis is difficult to identify in a patient with skeletal fluorosis. The bone lesions due to sickle cell disease and those due to fluorosis can mimic other bone diseases, most notably metastases. The combination of sickle cell disease and fluorosis results in significant medullary canal narrowing due to cortical thickening and to accumulation of necrotic bone. When performing hip replacement surgery, careful reaming of the medullary canal may reduce the risk of iatrogenic femoral fracture and inappropriate stem placement.

[Xeroderma pigmentosum: report of 6 cases in Dakar]. / Xeroderma pigmentosum: à propos de 6 cas observés à Dakar.

We report 6 cases of black Senegalese boys with xeroderma pigmentosum. They were between 2 and 16 year-old and presented features of hypersensitivity to UV (keratosis, lentigines, poikilodermia and photophobia). Our cases were remarkable by the early occurrence of squamous cell and basal cell carcinoma located in photoexposed sites causing the death of 5 of them. Xeroderma pigmentosum must be considered as the first preneoplastic genodermatosis.

[Left ventricular aneurysm in human immunodeficiency virus infection: a case report]. / Anévrisme ventriculaire gauche au cours de l'infection par le virus de l'immuno-déficience humaine. A propos d'une observation.

The authors report the case of a 30 year old man with a left ventricular aneurysm who was seropositive to HIV 1 and HIV 2. The patient was stage IVC 1 (AIDS related complex) by the "Center for Disease Control" classification. The clinical presentation was pyrexia, loss of weight, micropolyadenopathy and cardiac failure. The electrocardiogramme showed low voltage in the peripheral leads with a QS morphology in S2, S3 and aVF and abrasion, of the R wave in the precordial leads. Doppler echocardiography demonstrated a large left ventricular aneurysm with a wide neck. Despite treatment with a diuretic, angiotensin converting enzyme inhibitor and anticoagulants, the patient died suddenly. Autopsy confirmed the wide necked left ventricular aneurysm. This would appear to be the first report of this form of cardiac disease during HIV infection. However, a simple coincidence of the two pathologies cannot be excluded.

[Non-Hodgkin's lymphoma in Dakar: study of 107 cases diagnosed between 1986 and 1998]. / Les lymphomes non hodgkiniens à Dakar: étude réalisée sur 107 cas diagnostiqués entre 1986 et 1998.

Non-Hodgkin's Lymphomas (NHL) are the most prevalent malignant hemopathies in Senegal. In this study we have investigated the epidemiological aspects considering the HIV infection pandemic, and evaluated the diagnosis means and evolutive features of this disease in Dakar. Between 1986 and 1998 (13 years), we collected 107 cases of NHL, all histologically confirmed. Average age of patients was 31.4 years (2-85 years) and sex ratio was 21. HIV infection was found in three out of 62 patients tested (4.8%). At moment of diagnosis, 72% of patients were in stage III or IV according to the Ann Arbor Staging System. Large cell lymphomas were predominant (67.2%), followed by small lymphocyte lymphomas (24.2%) and follicular lymphoma with 8.4% of cases. Localization of lymphomas was exclusively nodal (30.8%) or extra nodal (31.7%) or mixed (37.3%). In therapeutical field, 21.5% of patients were treated with only symptomatical means. Chemotherapy was used in 54 patients (78.2% of treated patients), surgery was performed in 6 patients (8.6%), association of radiotherapy and chemotherapy in 5 patients (7.2%) and 4 patients (5.7%) were treated with surgery + chemotherapy. The average survival time was 344 days. Four patients (3.7%) were alive 3 years after diagnosis and only 2 patients (1.8%) after 5 years.

[Multicentric reticulohistiocytosis with a 20-year follow-up ]. / Evolution sur 20 ans d'une réticulohistiocytose multicentrique.

INTRODUCTION: Multicentric reticulo-histiocytosis also known as lipoid dermoarthritis is a rare systemic disease leading to a massive osteoarticular destruction and systemic complications. EXEGESIS: This case report is a 44 year old black woman who was first seen with a rheumatoid arthritis clinical presentation associated with the presence of rheumatoïd factor. Five years later the diagnosis has been reconsidered after skin nodules histological examination. After that the patient has been lost from the follow up clinic. After a twenty years evolution she presented a complex clinical picture including: a cutaneous syndrome with a non pruriginous and hyperchromic papulonodular rash on the arms and fore-arms; a very destructive polyarthritis with major handicap; and systemic manifestations like cardiomyopathy with heart failure. The heart failure treatment associated first corticosteroids and secondary chloroquine was successful. CONCLUSION: The rheumatoid factor presence should not avoid to consider the possibility of multicentric reticulohistiocytosis in case of polyarthritis associated with a papulonodular rash. Then skin biopsy must be performed. The severity of osteoarticular and systemic lesions require an early prescription of a treatment for which there is so far no compromise.

[Localized benign pleural mesothelioma observed at the Dakar University Hospital]. / Mésotheliomes pleuraux bénins localisés observés au C.H.U. de Dakar.

We report two cases of localized benign pleural mesothelioma with different clinical features. Neuropsychiatric symptoms, including coma, hemiplegia, seizures and misbehavior predominated in the first case, associated with hypoglycemia. The symptoms in the second case were essentially respiratory (cough, dyspnea, and chest pain). Treatment consisted in thoracotomy and complete surgical resection. Histopathology revealed fusiform cells and collagen stroma. These two cases illustrate the diversity of clinical expression of benign localized pleural mesothelioma and confirm their complete resolution after surgical treatment.

[Sebaceous cutaneous carcinoma. Value of early cytological test]. / Carcinome sébacé cutané. Intérêt de l'examen cytologique précoce.

Sebaceous carcinoma is a skin tumour which frequently metastases to the visceral organs. Needle biopsy is needed for rapid diagnosis. We observed a case in a 65-year-old patient who had a tumour formation below the right maxillary angle and homolateral justamandibular lymph node enlargement. Cytology of the needle biopsy showed a double cell population: small anaplastic cells and an agglutinated cell mass with peripheral maturation and sebaceous differenciation. Treatment was surgical with homolateral node dissection and secondary plasty. The tumour was large, non-encapsulated with local infiltration. On light microscopy, two cell populations were seen. Evident sebaceous differentiation was confirmed by histochemical staining. Immunolabelling confirmed the epithelial nature of the tumour. The clinical diagnosis of sebaceous carcinoma is difficult. Early cytology is needed to identify the two cell components when other cytological signs do not allow a positive diagnosis.

[Tumoral mycetoma of the buttock]. / Mycétome tumoral de la fesse.

BACKGROUND: Mycetomas are actinomycosic or fungal infections where the infectious agent produces grains. We report an atypical case of fungal mycetoma presenting as a tumoral formation on the buttock. CASE REPORT: A 56-year-old unemployed man from the Diourbel region of central Senegal consulted in February 1997 for a fistulalized tumor of the right buttock which had developed spontaneously and progressed for 5 years. The patient's general health remained satisfactory. Physical examination showed a voluminous 25 cm tumefaction extending from the right buttock to the perineum. The tumor showed a few areas of fistualization which discharged black grains under pressure. There was a 1.5 cm right inguinal node which did not appear to be inflammatory. The remainder of the physical examination was normal. Pathology reported inflammatory connective tissue surrounding a brownish polycyclic grain composed of spores and mycele filaments. The diagnosis of fungal mycetoma was retained and surgical excision under general anesthesia was performed. DISCUSSION: This is an atypical case of fungal mycetoma because of its tumoral form and gluteal localization. The differential diagnosis was cutaneous neurofibroma, myoma, or Darier-Ferrand dermatofibrosarcoma. The frequency of extrapodal red grain mycetomas has been pointed out by several authors from Senegal, but extrapodal black grain forms as seen in our case are more exceptional.

[Deep onchocerciasis of the left thigh. An unusual case]. / Onchocercome profond de la cuisse gauche. A propos d'un cas isolé.

INTRODUCTION: Commonly onchocercoma has been presented as superficial and multiple nodules. When it's unique and deeply situated, its clinical diagnosis is difficult. An uncommon form of onchocercoma is reported. CASE REPORT: A 37 years old man presented a big tumor at the inferior third of the left thigh like lipoma or liposarcoma because of microcalcifications. The tumor was removed. It was a cyst containing a liquid like an "mango juice". The histological examination was performed. Degenerated microfilariae of Onchocerca volvulus was found. DISCUSSION: A big and deep onchocerma of the thigh is uncommon and diagnosis before operation is very difficult. Histological examination have eliminate filarial infections like Dracunculus medinensis and have given the right diagnosis. Radiological microcalcifications and absence of microfilariae at the parasilogical and ophthalmological examinations recall an "aged" onchocercoma. For this reason, we didn't realise a chemotherapy. CONCLUSION: This tumor in Sahel areas is very difficult to diagnose before operation. The histological examination is very important in this case. We don't use chemotherapy because this onchocercoma looks old without alive microfilariae.

[Histoepidemiologic profile of 375 primary bowel cancers at the University Hospital Center in Brazzaville, Congo]. / Profil histo-epidemiologique de 375 cancers digestifs primitifs au CHU de Brazzaville.

This retrospective study was undertaken to determine the histoepidemiologic profile of primary digestive tract cancer based on analysis of 375 of the 2558 cases diagnosed in the Cytopathology Department of the the University Hospital Center in Brazzaville, Congo from January 1992 to December 2001. Incidence was 14.6%. The sex ratio was 1:5. Age ranged from 39 to 49 years. The liver (40.2%) was the most frequent location followed by the colon/rectum (30.2%), stomach (26.2%), and esophagus 2.1%. Predisposing factors included low-fiber diet, heavy consumption of smoked foods, and history of hepatitis B and C virus infection. The most frequent histological entity accounting for 57% of cases was adenocarcinoma that was observed in the esophagus, stomach, colon, rectum, and pancreas. Systematic screening and treatment of precancerous lesions in high-risk patients is necessary to reduce the incidence of digestive tract cancer.

[Frequency of Helicobacter pylori infection in symptomatic patients in Senegal]. / Fréquence de l'infection à Helicobacter pylori chez des sujets symptomatiques au Sénégal.

This prospective study was carried out in Dakar, Senegal, to assess the prevalence of Helicobacter pylori infection in symptomatic patients undergoing endoscopy and to evaluate the factors of risk for infection by this type of bacteria in the population. From October to December 1995, 134 patients were included in this study and replied to a standardized questionnaire designed to determine socioeconomic level and living conditions. Diagnosis of Helicobacter pylori infection was based on the combined results of the urea breath test (Clo-test) and histological findings. Helicobacter pylori infection was detected in 82.8% of patients with no significant difference according to sex, age, ethnic group, or living environment (urban or rural). The incidence of infection was also the same in all socioeconomic groups. It was already high in the age group between 11 and 20 years (90.9%). Helicobacter pylori was identified in 76.2% of patients with normal endoscopic findings and in 100% presenting ulcers, erosions, or gastritis. This study shows that the incidence of Helicobacter pylori infection is extremely high regardless of socioeconomic level and that infection begins at a young age. These findings are consistent with the poor hygiene of most people in Senegal.

[Care management of lower gastric tumors at Dakar. Preliminary study of 60 cases]. / Prise en charge des tumeurs gastriques distales a Dakar. etude préliminaire a propos de 60 cas.

The aim of this study was to evaluate the short-term results of our therapeutic attitude about the surgical treatment of lower gastric tumours in our departement. It was a prospective study including all patients hospitalized in our department for gastric tumour whose malignancy was strongly presumed by the clinical symptoms, the paraclinical one, the surgical exploration and/or confirmed by histology. Tumours of the cardia were excluded from this study. Laparotomy was carried out among all patients. When the tumour was resecable, we had carried out a lower partial gastrectomy passing at least than five centimeters with the top of the higher limit of the tumour, associated with lymphadenectomy including the first and second relay. This study was undertaken from January 1994 to June 1997 and concerned 39 men and 21 women. Mean age was 57.6 years. The abdominal mass was present in 38.3% of the cases. The histological confirmation for malignancy was obtained in 38.3% of the cases which all were adenocarcinomas. We had proceded to 38% of partial gastrectomy, 54% of gastrojejunostomy and in 8% of the cases no surgical gesture was practised during laparotomy. Morbidity was 13.3% and mortality 21.7%. The average retreat was 12.4 months after partial gastrectomy, 8.3 months after gastrojejunostomy and 3.5 months after laparotomy without gesture. The total rate of surival at one year was 20%. The rate of survival at one year after partial gastrectomy was 39.1%. We recommend partial gastrectomy associated with lymphadenectomy whenever its realization is possible. This surgical attitude associated to early diagnosis could allow a clear improvement of the rate survival in the short and medium term for lower gastric tumors, in our context.

[Uterine leiomyoma at the surgical department of the Teaching Hospital of Dakar. Report of 140 cases operated in two years]. / Les fibromes utérins à la clinique chirurgicale du CHU de Dakar: à propos de 140 cas opérés en deux ans.

Uterine leiomyomas due to complications in particular mechanical and haemorrhagic constitute a frequent motive of consultation to the surgical department at the university hospital of Dakar. To precise its epidemiologic, clinical and therapeutic aspects, a prospective study of two years (1995-1996) was made. Hundred and forty patients operated for uterine leiomyoma in our department were brought together. Uterine leiomyoma represent 58.82% of the gynaecological disorders operated to the surgical department. These gynaecological affection constitute 15% of the whole surgical pathology. The edge of age most concern was the decade 49-59 years old. The infertility and the low parity were found in 55.14% of the cases. The average delay of consultation was 39 months. The clinical symptoms amounted it metrorrhagia (72%) abdominal or pelvic pains (77.1%) and increase of the volume of the belly (96.4%). The overall reoperating rate was 3.5%. The pelvic ultrasonography allowed to confirm the diagnosis in 84.28% of the cases. The under umbilical laparotomy (90.9%) was the main surgical way. The sub-total hysterectomy was carried out in 35.72% of the cases. The average duration of hospitalization was 9 days and the mortality 0.7%. Main postoperative complications were parietal abscess (16 cases), evisceration (2 cases) and eventration (2 cases). Histological examination realized in 48.06% of the cases confirmed the diagnosis of uterine leiomyoma in every case. In 17.82% of the cases leiomyoma were associated to another lesion and in two cases it was a neoplasm of the uterine cervix. Uterine leiomyomas are frequent in Dakar. Their often impressive volume and metrorrhagia dominant their occasion of diagnosis. Their sufficiently early diagnosis have to noticeably reduce their radical surgery indications in this benign pathology whose association with cervix uterine cancer stays very rare in our daily practical experience.

[Feasability of a heart valve bank in Dakar. (Preliminary study of 8 human hearts)]. / Faisabilité d'une banque d'homogreffes valvulaires cardiaque à Dakar. (Etude préliminaire sur 8 prélèvements de coeurs humains)

Authors record a preliminary study led so as to develope techniques of preparation of the cardiac homograft valves. Eight human hearts have been appropriated in the course of medico-legal autopsy. Under sterile hodd, the heart was dissected, aortic and pulmonary valves as well as a mitral valve fragment were collected for a total of 24 valvular levies. After sterlization in an antibiotic solution, valves were preserved at 4 degrees C for the mitral fragment specimen of fresh allograft and to - 196 degrees C in Nitrogen liquidates for the pulmonary and aortic valves. The control of graft quality had consisted in tests of competence during the dissection, to the evaluation of the histological study as well as tests of sterility. Cellular cultures had shown a fibroblast proliferation in 3 cases. It concerned an indeed reliable method but difficult and little sensitivity. Histological tests had shown two types of injurie: the myxoid degeneration (7 times on 8 valves) cryopreserved and a coagulative necrosis whose distribution was identical forthe two modes of conservation. Antibiotic's solution seemed to induce these injuries as do heart ischemia, and the traumatism lihleed to the great cold. The tests of sterility had shown a rate of contamination to 25 % essentially by Pseudomonas. In view of the installation of a behle of allograft bank of quality, we'll need to improve conditions of leavy, to use a freezer adaptation for progressive cryocongelation and the choice of simple method to evaluate valvular viabilty.