Supra-sellar granular cell tumor: Report of a case with literature review.

INTRODUCTION AND IMPORTANCE: Granular cell tumor (GCT) originating from the sellar and suprasellar regions, specifically from the neurohypophysis, is a rare neoplasm. Distinguishing GCT from other pituitary tumors, including pituitary adenoma, pituicytoma, and spindle cell oncocytoma, poses significant challenges. Here, we present a rare case of GCT originating from the posterior pituitary in the supra-sellar region. CASE PRESENTATION: A 41-year-old woman, with no past medical history, presented to neurology department with decreased visual acuity and peripheral facial paralysis since 3 months. The MRI showed a well-defined supra-sellar, retrochiasmatic, oblong, hypothalamic expansive process. It was isointense T1-weighted, discretely hypotensive T2-weighted, measuring 19x17x16 mm, suggesting pituicytoma or craniopharyngioma. An endoscopic transsphenoidal surgical resection was performed. Microscopic examination showed a proliferation of diffuse architecture made up of rounded polyhedral cells with granular eosinophilic cytoplasm. On immunohistochemistry, tumor cells expressed diffusely TTF1, S-100 protein and SOX-10 confirming the diagnosis of supra-sellar GCT. DISCUSSION AND CONCLUSION: GCTs are rare neoplasms that predominantly exhibit benign behavior, while the malignancy rate remains at 2 %. Histopathology serves as the definitive diagnostic approach for GCTs. These tumors are resistant to radiotherapy and chemotherapy, necessitating surgical resection as the primary treatment modality. Due to the potential absence of distinct tumor masses and local tissue infiltration by tumor cells, complete excision is crucial, with resection extent extending beyond areas of infiltration.

Calcifying pseudoneoplasm of the neuraxis (CAPNON): Unraveling a rare non-neoplastic calcified central nervous system lesion.

INTRODUCTION AND IMPORTANCE: Calcifying pseudoneoplasms of the neuraxis (CAPNON) are infrequent benign brain tumors. They demonstrate slow growth and are characterized by calcium deposits within the tumor tissue. CAPNONs are observed in the supratentorial compartment of the brain. Due to their rarity, increasing knowledge of CAPNONs is essential for accurate diagnosis and effective management of affected patients. This report describes a case of CAPNON diagnosed in a 56-year-old female and discusses the clinical, imaging, and histopathological findings of this rare entity. CASE PRESENTATION: A 56-year-old female presented with a history of recurrent holocranial headache and dizziness, progressively worsening over the last month. Physical and neurological examinations revealed no evident abnormalities. Brain magnetic resonance imaging revealed a calcified and cystic mass, measuring 40 × 32 mm in the right frontal lobe. Complete excision of the mass was done. Histologically, the lesion was composed of glial tissue with abundant amorphous lamellar calcification and a myxoid matrix in the background. Concentric circular calcifications were observed with osseous metaplasia present in some areas. Palisading spindle to epithelioid cells was noted around the lesion. The final diagnosis was CAPNON. The postoperative course was uneventful, and one year of follow-up revealed no signs of recurrence. DISCUSSION: CAPNON typically occurs in middle-aged adults and can present with variable symptoms depending on its location within the brain, including seizures, headaches, or neurological deficits. Surgical resection is considered the optimal treatment for CAPNON. Raising awareness and understanding of this rare entity is necessary for accurate diagnosis and management of patients affected by this condition.

[Value of intraoperative frozen-section analysis in thyroid surgery]. / Valeur de l'examen extemporané en pathologie thyroïdienne: étude rétrospective de 1534 examens consécutifs.

AIM OF STUDY: To assess the value of intraoperative frozen-section diagnosis in thyroid surgery and determine its limitations. METHODS: This retrospective study examined the results of 1534 frozen sections of thyroid specimens analyzed over the 11-year period from 1995 through 2005 and their correlations with the final histological examination. Deferred responses were not taken into account for statistical calculations. RESULTS: In our series, frozen-section diagnosis was concordant with subsequent histopathological examination in 92% of cases, discordant in 3%, and deferred in 5%. The global specificity of frozen section analysis for all histological subtypes was 99.8% and its sensitivity 67%. Its sensitivity for thyroid cancer was lower in follicular (42%) and papillary carcinoma (64%) than medullary (100%), anaplastic (100%), secondary (100%), mixed (100%), and insular carcinomas (86%). CONCLUSION: In our series, as in the literature, most of the discordances between frozen-section and definitive diagnosis were associated with microfollicular lesions, which explain the low sensitivity of 67%. Our results demonstrate the reliability of intraoperative frozen-section analysis in thyroid surgery. Collaboration between pathologists, radiologists, and clinicians should be emphasized.

[Steatosis in chronic viral hepatitis C: frequency, risk factors and relationship with fibrosis]. / La steatose au cours de l'hepatite chronique virale C: frequence, facteurs de risque et relation avec la fibrose.

AIMS: To evaluate the frequency and the severity of hepatic steatosis in chronic hepatitis C patients, to identify the associated factors with the presence of steatosis and to determine the relationship between the presence of steatosis and severity of hepatic fibrosis. METHODS: Lecture of hepatic biopsies was performed blindly by the same histopathologist, using the METAVIR grading. Hepatic steatosis was graded as macrovacuolar or microvesicular. Steatosis was considered as mild, moderate and severe if involving less than 10%, between 10 and 30% and more than 30% of hepatocytes respectively. RESULTS: One hundred and nine patients were studied. Determination of the virus genotype was performed in 59 patients, with 93% of genotype 1. Significant fibrosis was noted in 72 patients (66%). Hepatic steatosis was detected in 53 cases (49%): Mild in 32 cases (30%), moderate in 9 cases (8%) and severe in 12 cases (11%). In univariate analysis, associated factors with steatosis are age more than 50 years, weight more than 65 kg, body mass index more than 25 kg/m2, ASAT levels more than 80 UI/l and ALAT levels more than 100 UI/l. In multivariate analysis, only body mass index more than 25 kg/m2 is associated with the presence of steatosis (p=0.02 OR [95%CI]: 3.37 [1.19-9.53]). Significant fibrosis was more frequently detected in patients with steatosis compared to patients without steatosis (42/53: 80% vs 30/56: 54%; p=0.004). CONCLUSION: Hepatic steatosis is frequent in chronic viral hepatitis C. In our Tunisian population, steatosis is associated with body mass index and not with virological factors.

[Predictive factors of fibrosis for chronic viral hepatitis C]. / Facteurs predictifs de fibrose au cours de l'hepatite chronique virale C.

AIM: To determine the histological aspects and associated factors to significant or severe fibrosis in patients with chronic viral hepatitis C. METHODS: Consecutive patients recruited between 1999 and 2005 were studied. Lecture of hepatic biopsies was performed by the same histopathologist, using the METAVIR grading. RESULTS: We investigated 109 patients (36 men and 73 women, mean age:49.3 years (19 - 65 years). Activity was graded A0, A1, A2 and A3 in respectively 2, 49, 51 and 7 cases. Fibrosis was graded F0, F1, F2, F3 and F4 in 3, 34, 35, 16 and 21 cases. In univariate analysis, associated factors to fibrosis more than F2 were age, diabetes, levels of ASAT, gamma glutamyl transpeptidase, alkaline phosphatase, prothrombin index and APRI score. In multivariate analysis, only age more than 50 years was associated with fibrosis more than F2 (p=0,006 adjusted OR [CI95%]:5,57[1,63 - 18,9]). Associated factors to fibrosis graded F4 were age, levels of ASAT, ALAT, gamma glutamyl transpeptidase, alkaline phosphatase, leucocytes, platelets, prothrombin index, APRI score and hepatic dysmorphy on ultrasound examination. In multivariate analysis, only APRI score more than 1,5 was associated with fibrosis graded F4 (p=0,04 adjusted OR [CI95%] :4,35 [2,25-6,76]). CONCLUSION: Age and APRI score are important prognosis factors in chronic viral hepatitis C.

[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

[Endometrial actinomycosis. Two case reports]. / Actinomycose endometriale. A propos de deux cas.

Actinomyces is an aerobic, Gram positive bacteria saprophyte of the genital tract. The endometrial involvement is extremely rare. The authors report two cases of pelvic actinomycosis in a 58 and 55 year old women, the second using intrauterine device for 11 years.