Elastofibroma dorsi.

Elastofibromas are rare benign soft tissue tumours that are usually located between the scapula and the rib cage deep in the serratus anterior muscle. Their anatomical location, distinctive clinical symptoms and radiological characteristics set them apart from malignant soft tissue tumours. Although they are rare, it is necessary to be aware of this benign tumour to avoid unnecessary biopsies; surgical resection may, however, be recommended to obtain a differential diagnosis from malignant sarcomas. We report three cases of elastofibroma dorsi in a 48-year-old man, a 33-year-old woman and a 42-year-old man.

[Sentinel node in breast cancer. Experience of the Salah-Azaïz Institute of Tunis]. / Le ganglion sentinelle dans le cancer du sein. Expérience de l'institut Salah-Azaïz de Tunis.

INTRODUCTION: Breast cancer screening increased the ratio of small tumours. These tumours have a low lymph node metastatic potential. Sentinel node detection allows detecting axillary lymph node invasion without the morbidity of complete axillary lymph node dissection. OBJECTIVES: In this study we report the results of the learning curve of sentinel node detection in the Institut Salah-Azaïz of Tunis. MATERIALS AND METHODS: It is a prospective study between January 2004 and December 2005 in which 115 patients were included with breast cancer less than 3 cm without antecedents of breast surgery. All these women had sentinel node dissection by a colorimetric method and 30% had a combined method (colorimetric and isotopic). RESULTS: The rate of detection was 97.3% (n = 112). An extemporaneous examination was performed in 91 patients. The rate of negative forgery of the extemporaneous examination was 4.3% and the sensitivity of 95.7%. There are no false positive with the extemporaneous exam. The sentinel lymph node was the only node invaded in 15 patients (44%). In 3 patients, the sentinel node was healthy whereas the axillary dissection was positive, so the false negative rate is about 2.6%. CONCLUSION: Sentinel node dissection is a reliable and feasible technique. It however requires a training of the surgeon, the pathologist and the nuclear doctor. It allows to reduce the morbidity of the treatment of the breast cancer by avoiding "useless" axillary dissection out in patients without node invasion. The increase in the number of the small cancers discovered during screening makes it possible to increase the number of patients who can profit from this technique.

[Typical medullary carcinoma of the breast: a retrospective study about 33 cases]. / Carcinome médullaire typique du sein : étude rétrospective à propos de 33 cas.

OBJECTIVE: Typical medullary carcinoma of the breast is a rare histological form of breast carcinoma. It represents less than 5% of all breast cancer. It is known for its favourable prognosis. Considering the rarity of the series we could retrieve, we aimed at underlining the particularities of this pathology. PATIENTS AND METHODS: Retrospective study about 33 cases of typical medullary carcinoma managed at the Salah-Azaïz Institute during a period of six years between 1994 and 1999. RESULTS: The mean age was 47.5 years. The left breast was concerned in about 55% of cases. Mean tumoral size was 46mm. Sixty-one percent of our patients were treated by radical surgery. Seventy-three percent undergo radiotherapy, 57% chemotherapy and 42% hormonotherapy. The five-year free-disease survival was about 85%. DISCUSSION AND CONCLUSION: Typical medullary carcinoma of the breast is a rare histological form of breast carcinoma. Its treatment is similar to the other breast cancers. Our results agree with the different published studies and confirm its favourable prognosis.

[Benign schwannoma of the breast: about two cases]. / Schwannome mammaire bénin: à propos de deux cas.

Schwannoma is a rare nervous tumor developed on schwan cells. Only 22 cases of breast schwannoma have been published since 2005. It usually appears as a breast lump having clinical and radiological characteristics suggestive of kindness. Its diagnosis is histological. Its treatment is surgical. Through two observations and a review of the literature we would try to remind the characteristics of this tumor.

[Mammary tuberculosis: a retrospective study of 65 cases]. / Tuberculose mammaire: étude rétrospective de 65 cas.

OBJECTIVES: Remember the clinical, morphologic and histological particularities of mammary tuberculosis. Discuss clinical and radiological diagnostic problems caused by this localization, as far as breast cancer is concerned. PATIENTS AND METHODS: This is a retrospective study concerning 65 women suffering from mammary tuberculosis, diagnosed at Salah Azaiez Institute between January 1980 and December 2001. RESULTS: In this series, mammary tuberculosis represents 0.2% of the declared tubercular localizations and 0.3% of the mammary pathologies treated at the institute. The mean age of our patients was 36 years (19 to 79). Clinical findings were misleading. In 60% of cases the aspect was of a malignant tumor, in 24.6% of cases of a benign nodule and in 16.4% of cases of an abscess. The mammography concluded to a malignant lesion in 49% of cases. The fine needle aspiration achieved at 8 patients was negative in 6 cases and brought back the caseum in the 2 others. The diagnosis has been made, for all our patients, after histological study when we found typical tuberculosis lesions on pieces of tumorectomy, or biopsy. The diagnosis of tuberculosis was established; all patients had an anti-tuberculosis medical treatment in a department of infectious diseases out of the institute. DISCUSSION AND CONCLUSION: Clinical and radiological features of mammary tuberculosis are very confusing and cause a diagnostic problem with breast cancers. In front of symptoms evoking tuberculosis, biopsies must be done to eliminate an eventual cancer.

[Pelvic pseudotumoral actinomycosis with multisegmental lumbosacral root failure. A case report]. / Actinomycose pelvienne pseudotumorale avec atteinte multiradiculaire lombosacrée. A propos d'un cas.

We report a case of pseudotumoral pelvic actinomycosis with lumbosacral spinal involvement in a 21 year-old woman. The radiological work-up showed a pseudotumoral left ovarian lesion extended to sacral spine, which involved the fifth lumbar vertebra. Diagnosis of actinomycosis was established in histopathological examination of the tubo-ovarian mass under laparotomy. After four months of treatment with ofloxacin and rifampicin evolution was marked by improvement of general health and infection, associated to a progressive recovery of motricity of the lower limbs. Early diagnosis of pelvic actinomycosis may prevent the occurrence of rare but severe neurological complications of this disease.

[Metastatic neoplasia in the optic nerve]. / Neuropathie optique métastatique.

INTRODUCTION: Ocular metastasis always involves the uveal tractus, especially the choroid. Papillary metastases have been exceptionally described, and represent only 5 percent of the ocular metastatic locations. We report in this observation a case of papillary metastasis in a patient treated for a metastatic adenocarcinoma. OBSERVATION: A 35-year-old woman was given chemotherapy for four months for metastatic adenocarcinoma involving the pleura and bones. She consulted for significant decline of visual acuity in the left eye associated with headache and vomiting. The fundus examination revealed a yellowish papillary lesion with edema associated with an inferior peripapillary serous retinal detachment. The fluorescein retinal angiography showed a choroidal lesion highly suggestive of choroidal metastasis. Cerebro-orbital CT scan revealed the presence of multiple cerebral metastases. The patient died four months after diagnosis of ocular metastasis and eleven months after diagnosis of adenocarcinoma. CONCLUSION: Presence of a papillary lesion suggests the possible diagnosis of papillary metastasis despite the lack of a history of neoplasia. Carcinomatosis tumors, especially breast and the lung carcinomas are the most frequent causes of papillary metastasis.

[Evaluation of implantable sites in medical oncology in Tunisia. Prospective study of 205 cases]. / Evaluation des sites implantables en cancérologie médicale en Tunisie. Etude prospective à propos de 205 cas.

OBJECTIVE: To evaluate the insertion and use of implantable central venous accesses in medical oncology at the Institute Salah Azaïz. METHODS: From January 1992 to June 2000, 205 patients including 179 adults (118F/61M) and 26 children aged 7 months to 72 years (mean 37 years) required the insertion of an implantable port (IP). Tumoral pathology was dominated by metastatic breast carcinoma (93/179), digestive cancer (42/179) and paediatric cancer (26 cases). RESULTS: Excluding 3 initial failures, we inserted 205 IP for 202 patients. The supraclavicular anatomic way (Yoffa) was used in 156/205 cases and the subclavicular (Aubaniac) for the resting 32 cases with a jugular conversion in 17 cases. Initial complications were represented by 6 arterial puncture (2.9%), 3 pneumothorax (1.5%) and 1 catheter migration in the right pulmonary artery. Median life duration of the material was 210 days (3 to 1460 days) for adults and 185 days (3 to 1460 ays) for children. Mean life duration for the 205 IP was 240 days +/- 239 (3 to 1460 days) with a total of 49,200 IP-days. We explanted 17 IP for infection (8 cases), cutaneous ulceration (8 cases) and actinomycin extravasation (1 case). We observed 6 cases (2.9%) of subclavian and jugular thrombosis treated by anticoagulants and conservation management of the port. Presently, 58 patients are alive with IP in place. CONCLUSION: Implantable ports represent a useful option in medical oncology for patients treated with prolonged chemotherapy and adjuvant treatments such as antibiotics, transfusion. This method allows a good comfort for the patients and also the treating team but requires a prealable training for the nursing team.

[Male secondary breast cancer after treatment for Hodgkin's disease. Case report and review of the literature]. / Cancer du sein secondaire chez l'homme après traitement pour maladie de Hodgkin. A propos d'un cas et revue de la littérature.

Hodgkin's disease is now curable in more than 50% of cases, due to its chemo- and radio-sensitivity. However, treatment exposes to a risk of secondary cancer varying from 1 to 10% depending on chemoradiotherapy doses and schedules. We report a case of secondary breast cancer associated with a secondary thyroid cancer observed in a 24-year-old man treated when he was 13 years old by vinblastin and radiation for stage IIA, a Hodgkin's disease.