[Laryngeal Tuberculosis Diagnosed in a Pathological Laboratory in Senegal (2011-2015)]. / La tuberculose laryngée diagnostiquée dans un laboratoire d'anatomie pathologique du Sénégal (2011­2015).

Laryngeal tuberculosis (LT) is a rare disease. The therapy for LT is easy but the diagnosis remains a challenge for the pathologist and the laryngologist because of the absence of specific signs. The objective was to analyze the epidemiological and pathological profiles of LT cases in Dakar (Senegal) with a view to better understand this pathology. This study was a retrospective and descriptive of LT cases diagnosed in pathology laboratories in Senegal during five years (2011-2015). The LT was found in 9 cases. The mean age at diagnosis was 41.9 years (18/58) without sex predominance (sex-ratio = 0.8). Tobacco intoxication (3/9), tuberculosis contagion (1/9), HIV immunodepression (2/9), and diabetes (1/9) were the various risk factors found. Dysphonia was a constant symptom (9/9) associated with dysphagia (2/9) and cervical adenopathy (1/9). The macroscopic presentation was tumoral-like (7/9) and erythematosus and fibrinoid (2/9). The LT was of glottic seat in all the cases (9/9) with participation on top-glottic in two of the cases. The biopsy was performed in all patients. It reported tuberculous granuloma in four cases (4/9), tuberculoid granuloma in one case (1/9), and chronic lymphocytic laryngitis in four cases (4/9). CT-scan of the lungs was pathological in five patients (5/9). Evolution was favorable in all cases under "conventional tuberculosis treatment" over a period of six months. The diagnosis of LT requires a high collaboration between the laryngologist and the pathologist.

La tuberculose laryngée (TL) est une affection rare de diagnostic difficile à cause de l'absence de signes spécifiques. L'objectif de cette étude rétrospective était d'analyser les profils épidémiocliniques et anatomopathologiques des cas de TL diagnostiqués dans un laboratoire d'anatomie pathologique du Sénégal. Il s'agissait d'une étude rétrospective et descriptive des cas de TL sur cinq ans (2011­2015). La TL a été retrouvée dans neuf cas. L'âge moyen au diagnostic était de 41,9 ans (18/58) sans prédominance de sexe (sex-ratio = 0,8). Le tabagisme (3/9), le contage tuberculeux (1/9), l'immunodépression au VIH (2/9) et le diabète (1/9) étaient les différents facteurs de risque retrouvés. La dysphonie était un symptôme constant (9/9), accompagnée d'une dysphagie (2/9) et d'adénopathies cervicales (1/9). L'aspect macroscopique était pseudotumoral (7/9) et érythématoblanchâtre (2/9). La TL était de siège glottique dans tous les cas (9/9), avec participation sus-glottique dans deux cas. La biopsie systématique notait un granulome tuberculeux dans quatre cas (4/9), un granulome tuberculoïde dans un cas (1/9) et une laryngite chronique lymphocytaire dans quatre cas. L'évolution était favorable dans tous les cas sous traitement médical. Le diagnostic de la TL nécessite une collaboration parfaite et étroite entre l'otorhinolaryngologue et le pathologiste.

[Undifferentiated Carcinoma of the Nasopharynx in Dakar, an Area Supposed to be Non-Endemic: about 13 Cases]. / Carcinomes indifférenciés du nasopharynx à Dakar, une zone supposée non endémique : à propos de 13 cas.

Undifferentiated carcinoma of the nasopharynx (UCNT) has variable incidence throughout the world. Senegal is supposed to be a non-endemic zone. There is a constant connection with the Epstein-Barr virus. In this work, the authors study and discuss the pathological aspects of undifferentiated carcinoma of the nasopharynx in 13 cases. They also seek to make the link between this cancer and the presence of an Epstein-Barr virus infection in these patients. This is a retrospective series of cases involving patients with UCNT, diagnosed on histological basis in Dakar and confirmed by immunohistochemistry. An EBV search was performed on these cases through in situ hybridization by the EBER probe. 15 cases diagnosed on histological basis were able to benefit from immunohistochemistry, and 13 cases were confirmed, ie 87%. The mean age was 28.37 years with extremes of 5 and 56 years. The male sex predominated, with a sex ratio of 8/3. The macroscopic lesions were of ulcerous-budding type for cases revealed by a mass of the cavum. The histological aspect resulted in a proliferation of atypical undifferentiated cells, with large, clear, strongly nucleated nuclei, with eosinophilic cytoplasm, scarcely abundant. The stroma was of the lymphoid type. In situ hybridization with the EBER probe showed moderate or intense diffuse scarring of the tumor cells for 10 cases, ie 77%. The number of cases noted in our study taking into account the period of 10 years considered, is indicative of the rare nature of this type of cancer in Dakar. While globally, Epstein-Barr Virus is consistently associated with UCNT, for some of our cases we have not been able to highlight EBV, suggesting the possible involvement of other risk factors, such as HPV.

Les auteurs étudient et discutent les aspects anatomopathologiques du carcinome indifférencié du nasopharynx (UCNT) au Sénégal à propos de 13 cas. Ils recherchent par ailleurs à faire le lien entre ce cancer et la présence d'une infection par le virus d'Epstein-Barr (EBV) chez ces patients. Il s'agit d'une série rétrospective de patients porteurs d'UCNT, diagnostiqués sur base histologique à Dakar sur 10 ans, et confirmés par l'immunohistochimie. Une recherche d'EBV a été effectuée sur ces cas en hybridation in situ par la sonde EBER. Quinze cas diagnostiqués sur base histologique ont pu bénéficier de l'immunohistochimie et 13 cas ont été confirmés, soit 87 %. L'âge moyen était de 28,37 ans avec des extrêmes de 5 et 56 ans. Le sexe masculin prédominait, avec un sex-ratio de 8/3. Les lésions macroscopiques étaient de type ulcéro-bourgeonnant pour les cas se révélant par une masse du cavum. L'aspect histologique se traduisait par une prolifération de cellules indifférenciées atypiques, aux noyaux volumineux, clairs, fortement nucléolés, aux cytoplasmes éosinophiles, peu abondants. Le stroma était de type lymphoïde. L'hybridation in situ avec la sonde EBER montrait un marquage diffus modéré ou intense des cellules tumorales pour 10 cas, soit 77 %. Le nombre de cas notés dans notre étude, tenant compte de la période de 10 ans considérée, est révélateur du caractère rare de ce type de cancer à Dakar. Si à l'échelle mondiale, le virus d'Epstein-Barr est constamment associé à l'UCNT, pour certains de nos cas nous n'avons pas pu mettre en évidence EBV, suggérant l'implication possible d'autres facteurs de risque, tel que le papillomavirus humain (HPV).

Pathological overview of chronic gastritis in Senegal: results of upper gastrointestinal tract endoscopies.

The aim of this study was to determine the prevalence of gastritis in upper endoscopies performed for clinical signs suggestive of gastritis among 100 patients in a tropical country. Chronic gastritis (CG) was present among 81%, including CG due to Helicobacter pylori (n = 61, 75.3%), reactive CG (n = 14), and autoimmune CG (n = 6). The gastritis was located in the stomach antrum (55.7%, n = 40), fundus (3.3%, n = 2), or both (41% n = 25). Median age at diagnosis was 35 years (14/80). This CG was associated with signs of stomach activity (27.9%, n = 17), atrophy (13.1%, n = 8), metaplasia (9.8%, n = 6), and dysplasia (8.2%, n = 5). The 14 patients with reactive CG had a mean age of 31 years and all were coffee-drinkers. This CG was not associated with precancerous lesions. Autoimmune CG, present in 6% of the population, was diagnosed at a mean age of 55 years (range: 45; 67). These involved fundal atrophy with metaplasia and were associated with dysplastic lesions (66.7% n = 4).

[Pathological profiles of retinoblastoma in Senegal]. / Aspects anatomopathologiques du rétinoblastome au Sénégal.

OBJECTIVES: Describe the macroscopic and microscopic profiles of retinoblastoma (RB) in Senegal and correlate histological criteria with progression to establish severity factors. METHODOLOGY: We realized a retrospective study over 10 years (January 2005-December 2014). Only patients (n=67) who underwent histological analysis of the enucleation specimen (n=68) were followed until the end of the study. RESULTS: The tumor measured an average of 3.8cm (2/4.5). Endophytic tumor development was observed in 55 cases (80.8%), exophytic in 6 cases (8.9%) and mixed in 7 cases (10.3%). Retinal detachment was present in 13 cases (19.2%). The RB was well differentiated in 11 cases (16.2%), moderately differentiated in 31 cases (45.6%) and undifferentiated in 26 cases. Optic nerve (ON) invasion was present in 18 cases (26.5%). The tumor was extraretinal in 37 cases (54.4%). The anterior chamber was invaded in 6 cases (8.8%). The global survival at 2 years was 84% and 70% at 5 years. On multivariate analysis, well differentiated tumors and stage pT1 were associated with remission. Retrolaminar ON invasion, massive choroidal invasion and stage pT3 were risk factors for recurrence. Poor tumor differentiation, invasion of the ON resection margin, tumor invasion through the sclera, and stage pT4 were predictive of death. CONCLUSION: The pathologist is a principal actor in the management of RB because his account guide the post-surgical management strategy.

[Human papilloma viruses: other risk factor of head and neck carcinoma]. / Les papillomavirus humains : un autre facteur de risque des carcinomes des voies aérodigestives supérieures.

Head and neck carcinoma (HNC) occupy the sixth place as the most frequent type of cancer worldwide. Next to alcohol and tobacco intoxication, other risk factors (RF) are suspected, including the human papilloma viruses (HPVs). The aim of this study was to highlight the prevalence of HPVs and histo-epidemiological characteristics of HNC HPV+ in Senegal. This is a prospective, multicenter preliminary study of 18 months (January 1, 2012-June 30, 2014). The cases of HNC histologically confirmed in Senegal were then sent to the bio-pathology department of the Curie Institute in Paris to search HPVs. In the 90 included cases, the PCR technique was successful in 54 cases (60%). HPVs were found in seven cases, that is, a prevalence of 13%. HPVs were associated with 5 cases of hypopharyngeal carcinoma and 2 cases of carcinoma of the oral cavity. Patients with HNC HPV+ had a median age of 42 years against 49 years for HPV-patients. Three patients (42.8%) with HPV+ carcinomas were smokers. Of the 47 HPV-patients, 40 patients (87.1%) had alcohol intoxication and/or smoking. The concept of oral sex was refuted by all our patients. Squamous cell carcinoma was the only histological type found. HPV+ cell carcinoma showed no specific histological appearance. HPVs are another certain RF of HNC in Senegal. The major therapeutic and prognostic impact of HPVinduced cancers requires the systematic search of the viruses by the PCR technique.

[NK/T-cell Lymphoma of nasal-type: A rare affection with a poor prognosis]. / Lymphome T/NK de type nasal : une pathologie rare de mauvais pronostic.

INTRODUCTION: NK/T cell lymphoma of nasal-type was described in 1933 as a malignant midfacial granuloma. The diagnosis of this rare affection is clinical and immunohistopathological. We report a case of NK/T cell lymphoma diagnosed at an advanced stage. OBSERVATION: A 60-year-old man with no particular medical history presented since seven months with a left nasal obstruction associated with a purulent and fetid rhinorrhea followed by a centrifugal midfacial necrosis. Blood tests showed an inflammatory syndrome. The CT-scan of the face showed a filling of the nose and sinus by a tissular process and a lysis of the bone walls. Three series of biopsies (le last being performed under general anesthesia) were necessary to get the diagnosis of NK/T cell lymphoma. The standard histology showed a malignant proliferation made of round and spindle-shaped lymphoid-like cells and angiocentric arrangement. The cells were CD 2+, CD 3+, CD 5+ and CD 56+. The spontaneous evolution was fatal one month after diagnosis in a context of septic shock. CONCLUSION: NK/T cell lymphoma of nasal-type is a rare disease but should be evocated in patient with midfacial necrosis of centrifugal evolution. The diagnosis certainty is made on immunohistopathological analysis. Multiple biopsies, made at distance from necrotic areas and under general anesthesia may be necessary.

Discoveries about tubercolosis from autopsies: topographical and morphological profiles of lesions in dakar (Senegal).

Tuberculosis is endemic in Senegal. It is rate of increase and high mortality rate make it a major public health problem. The aim of this study was to describe the topographic, macroscopic, and microscopic aspects of tuberculosis lesions responsible for deaths in Dakar. This is a retrospective study of 158 autopsy reports, collected over 10 years, of deaths due to tuberculosis. The diagnosis of tuberculosis was essentially macroscopic; only equivocal cases had histological analysis. The average age at death was 47 years, and nearly all patients were men (all but 5). The largest percentage of deaths were in the 56-60 year old age group (21.6%, n = 34). Cachexia (70.3%), pallor (44.3%), and hemoptysis (20.9%) were found in the external examination of these corpses. Autopsy of the viscera showed pulmonary disease in 98.7% of cases (n = 156), both bilateral and extensive. Renal and pericardial disease were rare, found in respectively 3.8% and 2.5% of cases. Macroscopic aspects of tuberculosis were various and often related. Miliary tuberculosis (81%), small nodule tuberculosis (76.6%), and tuberculomas (62%) were the lesions most commonly encountered. Histologic analysis showed these lesions were of different ages. Tubercles (Koster follicles) were found consistently. Caseous necrosis was pathognomonic. Tuberculosis remains a deadly disease in Dakar, it mainly affects men and older individuals.

[Inflammatory pseudo-tumor of the bladder expelled through the urethral meatus in a girl]. / Pseudo-tumeur inflammatoire vésicale expulsée par le méat urétral chez une fillette.

Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence.

Diabetes Burden in Urban and Rural Senegalese Populations: A Cross-Sectional Study in 2012.

Diabetes represents a challenging global health issue in the 21st century. Data from sub-Saharan African populations are scarce and are usually restricted to urban settings. The objective of this study was to compare prevalence and risk factors of diabetes in rural and urban areas in Senegal. Methods. In a community-based survey between January and May 2012, we included 1027 adults aged ≥18 years living in northern Senegal. Sociodemographic, clinical, and biological data were collected during household visits. Multivariate logistic regression was performed to identify factors associated with diabetes. Results. Mean age of participants was 48.0 ± 16.9 years and 65.7% were female. Participants from urban area represented 55.7%. The age-standardized prevalence of diabetes was 7.6% (6.0% in men versus 9.0% in women). Prevalence of diabetes was higher in urban areas (8.1%) compared to rural areas (4.6%). Disease awareness rate was 43%. After multivariate analysis, age (OR = 1.63, p = 0.001), familial history of diabetes (OR = 1.42, p = 0.001), and abdominal obesity (OR = 1.17, p = 0.05) were associated with diabetes. Conclusion. Diabetes is frequent in urban and rural areas in Senegal. Awareness rate is very low among populations. Age, family history of diabetes, and abdominal obesity are the main risk factors identified.

[Appendicitis schistosomiasis: unusual lesion about two cases in Senegal]. / Appendicite bilharzienne: une lésion rare à propos de deux cas au Sénégal.

Appendiceal schistosomiasis is a rare disease of only histopathological diagnosis. Appendectomy should be followed by treatment with praziquantel to avoid complications. We report two cases of appendiceal schistosomiasis while discussing the place of this infection in the pathogenesis of appendicitis. Finally we recommend a routine pathological examination of any part of appendectomy for better care for patients.

Solitary neurofibroma originating from the posterior nasal septum: Transnasal endoscopic resection.

INTRODUCTION: The head and neck region is one of the locations of neurogenic tumors such as neurofibroma. Although mostly associated with neurofibromatosis, it can be solitary. The present study reports a very rare case of solitary neurofibroma originating from the posterior nasal septum. CASE PRESENTATION: A 48-year-old female presented with tumor in the right nasal cavity. The tumor, originating in the posterior nasal septum, extended to the posterior sinuses and nasopharynx. Following endoscopic and radiological assessment, the tumor was resected by transnasal endoscopic surgery. Histological examination showed the tumor to be a neurofibroma. At 14months' follow-up, there was no recurrence. DISCUSSION AND CONCLUSIONS: However rare, solitary neurofibroma must be considered in the differential diagnosis of unilateral benign tumor involving nasal and paranasal sinuses. A transnasal endoscopic approach should be considered for treatment.

[Testicular bilharzioma by Schistosomia haematobium: about two cases]. / Bilharziome testiculaire à Schistosomia haematobium: à propos de deux observations.

Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area.

[Management of prostate cancer in Senegal: what is being done?]. / Cancer de la prostate : quelle prise en charge au Sénégal ?

OBJECTIVE: To evaluate the management of patients with prostate cancer in Senegal. MATERIALS AND METHODS: We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities. RESULTS: We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen. CONCLUSION: The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

[Schistosoma-induced granulomatous panniculitis. An unusual presentation of cutaneous schistosomiasis]. / Panniculite granulomateuse bilharzienne. Une présentation inhabituelle de la bilharziose cutanée.

BACKGROUND: Cutaneous schistosomiasis is extremely rare, even in endemic regions. It usually leads to non-specific papulonodular lesions in the perigenital area. We report a case of cutaneous schistosomiasis presenting as panniculitis. CASE REPORT: An 8-year-old girl was admitted for a large multinodular, indurated plaque over the perineum that gradually spread over a year in a setting of hypereosinophilia. Ultrasonography showed thickening of the bladder and a significant bilateral ureteral hydronephrosis. Histological examination revealed numerous granulomas Schistosoma haematobium ova at their centre and within the hypodermis. Treatment with praziquantel 40 mg/kg resulted in regression of cutaneous lesions within 3 weeks. DISCUSSION: We report a case of Schistosoma-induced granulomatous panniculitis that is noteworthy in terms of its clinical appearance, perineal location, association with severe urinary involvement and rapid regression under treatment. The current extent of endemic schistosomiasis and its severity justify greater awareness of this unusual cutaneous presentation, which to our knowledge has never previously been reported.

[Renal bilharzioma: A case report]. / Bilharziome rénal : à propos d'une observation.

Renal bilharzioma is an exceptional localization that occurs as a complication of urogenital bilharzioma. The authors report the case of a renal bilharzioma, in a 7-year-old patient, being considered as a nephroblastoma. The investigations revealed a large abdominal mass with solid component. She underwent neoadjuvant chemotherapy and radical nephrectomy. The histological examination of the specimen concluded to renal bilharzioma. The authors underline the difficulty of differential diagnosis with nephroblastoma. The diagnosis is often made after surgery by histological examination of the specimen.