[Vasculitis in sweet's syndrome]

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. To describe their clinical, pathological and therapeutic characteristics. We report a series of 47 cases of Sweet's syndrome, collected in our institution between 1997 and 2011. 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 predominately of neutrophis. Fibrinoid necrosis and intramural inflammation were observed in 8 cases. The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's diseases which requires careful surveillance

Sugar tumor

Clear cell tumor of the lung is a rare and very unusual benign pulmonary tumor. This tumor is called sugar tumor because of the abundance of glycogen on its cells. To report a case of sugar tumor and discuss clinical, evolutive features and diagnosis difficulties of this tumor. A case of 75 years old woman presenting as a round pulmonary opacity. Computed tomography [CT] scans showed in the left lower lobe a solitary pulmonary solid tumor with central calcifications. The patient underwent tumor resection. Pathologic examination, including immunohistochemical studies, revealed a benign clear cell tumor, so-called [sugar tumor]. It's the second case reported in Tunisia. This very rare tumor of the lung is characterized by some immunohistological features. Its evolution is favourable after surgery

[adult's cryptorchidism: clinical and therapeutic aspects about 100 cases]

Cryptorchidism is a pathological condition defined as the failure of the testis descending into the scrotum. It is a rare condition in adults. To study clinical and therapeutic aspects of cryptorchidism in adults. A retrospective study of a series of 100 adult patients [mean age: 25.1 years; 19-50 years] with cryptorchid testis admitted in an urology department in Tunis. The main reasons for consultation were the finding of an empty purse, inguinal pain and primary sterility. The testicle was palpable in 84 cases. The treatment consisted of an orchidopexy in most cases and in 14 cases orchydectomy. Finding of cryptorchidism in adult is a real diagnostic failure. Surgical treatment is indicated to facilitate surveillance

[Eosinophilic cystitis: review of nine cases]

Eosinophilic cystitis is a rare inflammatory pathology. It remains a poorly understood entity. To report a series of adult cases of eosinophilic cystitis mimicking a bladder tumor. Retrospective study of cases of eosinophilic cystitis collected in an urology department. Diagnosis was established on a spontaneous bladder perforation in one case and on hematuria in the eight other cases. Histopatholgy studies confirmed the diagnosis. Eight patients underwent an endoscopic resection of bladder lesions followed by medical therapy with nonsteroidal anti-inflammatory drugs and cortimoxazole. An ileal bladder enlargement was performed in one case. Regular follow-up didn't reveal any recurrence. Eosinophilic cystitis is a rare disease simulating a tumor of bladder. Its clinical presentation is not specific and final diagnosis is based on pathology. Endoscopic resection will help to pathologic diagnosis. Associated to corticoids and antihistaminic drug endoscopic resection constitute the treatment of choice

[Bellini renal cell carcinoma: diagnosis and treatment. a report of 7 cases]

The Bellini collecting duct carcinoma [CDC] is a very rare form of renal cell carcinoma [1%] associated with an extremely poor prognosis. To study clinical and radiological characteristics of CDC. From 1993 to 2002, 7 patients with CDC were treated at our institution. The diagnosis of CDC was made by a nephrectomy specimen in all cases. Demographic, clinical, pathological and survival data were gathered. They were five men and two women with an average age of 63 years. Lumbar pain and hematuria were the main symptoms. At presentation 2 T1N0M0, 1 T2N0M0, 1 T3N0M0, 1 T3N+M0 and 2 T4N+M+ tumors were seen. All patients underwent a radical nephrectomy. The two patients who had TNM stage I disease survived without evidence of disease at 5 years and 11 years respectively. Patients with a T4N+M+ tumor experienced rapid progression and died respectively at 3 and 5 months after nephretomy. The 3 other patients with T3N+M0, T3N0M0 and T2N0M0 disease; respectively; progressed rapidly and were lost to follow-up after one year. CDC is an aggressive variety of kidney neoplasm that is often associated with nodal and visceral metastases at presentation. It is associated with poor prognosis. For the majority of patients surgical treatment will not result in a cure. Early detection may be the best method for prolonging patient survival

[Gastric MALT lymphoma: anatomo-clinical data and outcome of early stage H.pylori-associated gastric MALT-lymphoma resistant to treatment]

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. 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. 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. 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: about a rare case report]

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 amyloidosis [light chain amyloidosis], localized gastric involvement is a rare finding which can mimick malignancy. To elucidate the clinical, histological and therapeutic features of pseudo tumoral gastric amyloidosis via a rare report along with a review of related literatures. We report the case of 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. We propose that amyloidosis should be considered in the differential diagnosis of gastric tumors

Circumcaval ureter with a synchronous ipsilateral transitional cell carcinoma of the upper urinary tract and the urinary bladder

We report a case of concomitant ureteral transitional cell carcinoma [TCC] developed in a circumcaval ureter associated to an invasive bladder cancer. Diagnosis was made by intravenous urography [IVU] and contrast-enhanced computed tomography [CT] scanner which showed a typical [J] shaped deformity in the dilated proximal ureteric segment with moderate right hydronephrosis and pelvic filling defect associated to bladder filling defect due to a bladder tumor. The patient underwent a radical cystoprostatectomy and nephroureterectomy; no recurrence was detected after a 12 months period of follow-up

[Descriptive epidemiology of extrapulmonary hydatid cysts: a report of 265 Tunisian cases]

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. 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. Aretrospective study of 265 extrapulmonary hydatid cysts collected over the 18-year period from 1990 to 2007 was undertaken. 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]. 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]

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. To describe clinicopathological features and immunohistochemical profile of dysgerminomas. 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