[Blastomycosis in Morocco: imported mycosis]. / La blastomycose au Maroc: une mycose d'importation.

Blastomycosis is a rare case. We report a first Moroccan case. A 41-year-old male presented with a 6-month history of dyspnea, fever and significant chest pain associated with night sweats and weight loss. The physical examination disclosed a firm painful paravertebral mass. The chest radiograph demonstrated a left apical opacity. The thoracic scan showed parenchymal infiltration of the apico-dorsal segment of the left upper lobe with vertebral and costal lytic lesions. Surgical biopsy showed granulomatous inflammation with giant-cell intracytoplasmic inclusions. Fungal studies yielded Blastomyces dermatitidis which responded excellently to ketoconazole. Outcome has been excellent at 3.5 years months follow-up. The clinical and radiographic presentation of blastomycosis is non-specific and can be mistaken for a neoplasm. Delay in diagnosis is common.

[Intracranial hydatid cysts in children: a report of 9 cases]. / Kystes hydatiques cérébraux de l'enfant (à propos de 9 cas).

PURPOSE: To illustrate the value of cross-sectional imaging (CT, MRI) for the diagnosis and follow-up of intracranial hydatid cysts in children. MATERIALS AND METHODS: Retrospective study of 9 cases of intracranial hydatid cysts in children seen over a period of 8 years. Precontrast and postcontrast 5 mm thick axial CT images were obtained in 7 cases. Noncontrast sagittal, axial and coronal T1W and T2W images were obtained in 2 cases. RESULTS: Mean patient age was 7.5 years. Intracranial hypertension was the main presenting clinical symptom. A single supratentorial cyst with significant mass effect upon the ventricular system and midline structures was observed in all cases. All patients underwent surgery with good outcome in all cases. CONCLUSION: CT is the imaging modality of choice for diagnosis and postoperative follow-up of intracranial hydatid cysts in children. MRI is most helpful for further characterization when multiple or atypical cysts are present to optimize management.

[High-resolution CT of temporal bone trauma: review of 38 cases]. / L'apport du scanner dans les traumatismes du rocher: à propos de 38 cas.

PURPOSE: Temporal bone trauma is frequent but difficult to assess due to the diversity of clinical presentations and complex anatomy. We have sought to assess the different types of fractures and complications on high-resolution CT. Materials and methods. Descriptive retrospective study over a 24 month period performed in the ENT radiology section of the Mohammed VI university medical center in Marrakech. A total of 38 cases of temporal bone trauma were reviewed. All patients underwent ENT evaluation and high-resolution CT of the temporal bone using 1mm axial and coronal sections. RESULTS: Mean patient age was 33 years (range: 14-55 years) with male predominance (sex ratio: 36/2). Clinical symptoms were mainly otorrhagia and conductive hearing loss. Oblique extra-labyrinthine fractures were most frequent. Two cases of pneumolabyrinth were noted. Management was conservative in most cases with deafness in 3 cases. CONCLUSION: High-resolution CT of the temporal bone provides accurate depiction of lesions explaining the clinical symptoms and helps guide management. MRI is complimentary to further assess the labyrinth and VII-VIII nerve complex.

[Paratesticular desmoplastic small round cell tumour: case report with literature review]. / La tumeur desmoplastique à petites cellules rondes paratesticulaire: à propos d'une observation avec revue de la littérature.

Desmoplastic small round cell tumors are rare aggressive cancers of adolescence and early adulthood. It has recently been separated from other small round cell tumors because of its pathological characteristics and clinical features. They are usually intra-abdominal tumors affecting young people and have classically been associated with a bad prognosis. However, in recent years there have been reports on desmoplastic small round cell tumors affecting other body regions, including the paratesticular area. We report the case of a 27-year-old male who consulted on a progressive enlargement of the right hemiscrotum. He referred no previous urological symptoms and had no systemic symptomatology. Physical examination revealed a round elastic firm 1-cm mass of the epididymis, which was excised. A computed tomography scan showed a para-aortic mass of 1cm. Histological and immunohistochemical diagnosis confirmed a desmoplastic small round cell tumor. The patient received chemotherapy. Today, 6 months after diagnosis the patient remains well and free of disease. Recent reviews on desmoplastic small round cell tumors affecting the paratesticular area have shown a better prognosis for tumors of this origin compared to abdominal ones. We should include this lesion among the differential diagnosis of paratesticular tumors, mainly in children and adolescents.

[Iris metastasis from lung cancer]. / Métastases iriennes d'un adénocarcinome bronchique.

A 47-year-old man with a history of lung adenocarcinoma presented a red and painful right eye with loss of visual acuity after the 5th course of chemotherapy. The ophthalmologic exam showed visual acuity at 3/10 and diffuse iris nodular lesions in the same eye. The fundus was not visible. The controlateral eye was normal. The ocular scan showed iris tumors without choroidal metastasis. Systemic medical evaluation demonstrated no other metastases. The patient died 1 year later.

[Idiopathic granulomatous mastitis: apropos of 8 cases and review of the literature]. / Mastite granulomateuse idiopathique: à propos de huit cas avec revue de la littérature.

AIM OF THE STUDY: The authors report eight cases of idiopathic granulomatous mastitis in which the epidemiological, clinical, diagnostic, therapeutic and prognostic features are discussed. MATERIAL AND METHODS: Retrospective study of eight cases registered among 2,000 breast anatomopathological study during 5-years period. RESULTS: The mead age was 44.3 years. Breast lump measuring 2.5 to 15 cm in size was noted at clinical examination. Mammography noted nodular opacities and ultrasonography showed hypoechoic nodules. Histological findings were consistent on granulomatous inflammation centred on mammary lobules. The inflammatory infiltrate was including leukocytes, lymphocytes, plasma cells as well as epithelioid and giant cells without caseous necrosis in the granuloma. DISCUSSION AND CONCLUSION: Idiopathic granulomatous mastitis is a rare entity. This entity can clinically mimic other breast mastitis disease. Diagnosis is assessed by histological analysis This disease can be treated with drugs and surgical excision of the lump. The prognostic of this chronic disease is favourable.

[Chondrosarcoma of the hand. Diagnostic and therapeutic discussion (three case reports)]. / Le chondrosarcome de la main. Discussion diagnostique et thérapeutique (à propos de trois cas).

Chondrosarcoma of the hand is very rare. We report three observations which enable us to make a review of its pathology. There were two men and one woman aged 72, 38 and 63 years respectively. Localisation was phalangeal in two cases and metacarpal in one case. Two cases were central and one peripheral. Radiographs were characterised by the presence of lytic areas with intralesional calcifications and soft tissue extension. Histological diagnosis was made by biopsy in two cases and after amputation of the finger for lesional spread in one case. Treatment consisted of amputation of the finger in two cases. In the case of metacarpal localisation, wide resection of two rays was followed by recurrence after ten months which required amputation of the hand. We agree with other authors who believe that chondrosarcoma in the hand is due to malignant change in a pre-existing chondroma. Conservative treatment is difficult due to the small size of the hand which allows easy spread of the tumour from compartment to compartment.

[Solitary osteochondroma of the limbs. Clinical review of 76 cases and pathogenic hypothesis]. / L'exostose ostéogénique solitaire des membres. Revue clinique de 76 cas et hypothèse pathogénique.

The authors report a retrospective study of 76 solitary osteochondromas of the appendicular skeleton treated between 1981 and 1995. The ages of the patients ranged from 13 to 55 years with a mean of 21 years. The male/female-ratio was 1.37. Tumefaction with or without associated pain was the reason for consultation in 68 cases (89%). In 62 cases the osteochondroma was localized in the distal part of the femur or the proximal part of the tibia. All lesions were surgically resected; the resection was complete in all cases. Six patients were lost to follow-up; the other 70 were seen on a regular basis over a time period ranging from 1 to 12 years. The result from surgical treatment was assessed based on pain, joint motion, cosmetic consequences, nerve compression and recurrence of osteochondroma. The results were good in 68 cases and fair in two cases. Based on a review of previous experimental studies, the authors suggest a hypothesis to explain the rotation of a fragment of the growth plate which is needed for the development of osteochondroma. This rotation occurs as a result of the mechanical action from the periosteum under tension.

[Bronchiolitis: computed tomographic findings]. / Les bronchiolites: signes tomodensitométriques.

Bronchiolitis includes a broad range of conditions with variable clinical, functional and morphological expression. Bronchiolar disease may be a primary or a secondary condition. Non-specific inflammatory changes are observed at the histology examination, involving respiratory and membranous bronchioles with or without extension to the alveoli. CT findings vary from subtle to quite marked abnormalities related to alveolar involvement, including small centrilobular lesions (nodular and branching linear opacities), ground-glass attenuation, and airspace consolidation. All are potentially reversible and treatable. Cicatrization processes may lead to constrictive bronchiolitis, an irreversible condition characterized by circumferential submucosal or periadventitial fibrosis causing an obstruction of the bronchiolar lumen. CT findings include decreased lung attenuation and expiratory air trapping within the areas of bronchiolar obstruction. The contrast with normally ventilated and perfused areas creates a mosaic perfusion pattern.

Respiratory bronchiolitis: radiographic and CT findings in a pathologically proven case.

A small number of cases of cigarette-smoking-associated respiratory bronchiolitis (RB) with positive findings on the chest radiograph have been reported in the literature. High-resolution computed tomography (HRCT) findings are available in even fewer cases. We describe the case of an asymptomatic female smoker presenting with a reticulomicronodular infiltrate on a routine chest radiograph. High-resolution CT was characterized by ground-glass opacities and centrilobular micronodules with an upper lobe predominance. Surgical biopsy revealed peribronchiolar lesions, with accumulation of brown pigmented macrophages in the lumen of alveolar and bronchiolar lumen, consistent with the pathologic diagnosis of RB.

[Cystic pulmonary metastasis simulating a diagnosis of histiocytosis X]. / Métastases pulmonaires kystiques simulant le diagnostic d'une histiocytose X.

A case of cystic pulmonary metastases from a renal origin simulating lung histiocytosis on high-resolution CT is presented. This diagnosis was suggested because of the presence of cystic lung lesions, micronodules and recurrent pneumothoraces in a male smoker. The diagnosis was reviewed after lung biopsy and demonstration of a renal mass.

[Radiological features of thoracic localizations of lymphomas]. / Aspects radiologiques des localisations thoraciques des lymphomes.

This retrospective work aims to analyse the incidence and the radiologic features of initial thoracic involvement of lymphomas, observed in 320 patients selected among 1,153 lymphomas (640 Hodgkin's diseases and 513 non-Hodgkin's lymphomas). Thoracic involvement was not observed in 833 (72%) patients with lymphoma. In Hodgkin's disease (HD) (n = 200) thoracic involvement was observed in 31% (200/640). The mediastinal lymph nodes were noted in 99.5% and predominated in the superior and mid mediastinum in 84.5%. Mediastino-thoracic ratio was superior to 0.33 in 33.5%. Unilateral paratracheal nodes were involved in 26% and the hilar groups in 39.5%. The lung involvement was present in 26.5%, such as nodules in 11% and alveolar infiltration in 6.5%. In the cases with lung involvement, there were concomitant mediastinal lymph nodes. Pleural and pericardial effusions were seen in 23.5% and 4%. Parietal involvement was noted in 1%. In non-Hodgkin's lymphomas (NHL) (n = 120) thoracic involvement was observed in 23% (120/513). The mediastinal lymph nodes were seen in 82.5%, located in superior and mid mediastinum in 60%. Mediastino-thoracic ratio was superior to 0.33 in 47%. Lymph nodes were unilateral paratracheal in 7.5% and hilar in 18%. The posterior mediastinal lymph nodes group was involved in 2%. Lung involvement was noted in 24%, pleural effusion in 48%, pericardial effusion in 4% and parietal involvement in 2.5%. In the cases of thoracic involvement in HD, mediastinal lymph nodes involvement is constant, affecting commonly the anterior mediastinal, paratracheal and hilar groups. Involvement of the posterior mediastinum and paracardiac groups is more common in NHL. Thoracic computed tomography is helpful in the detection of the abnormalities misdiagnosed on the chest X-ray. Computed tomography is valuable in the initial stages of HD because it can modify the treatment in 15%.

[Hydatid cyst of soft tissues. Radiological aspects]. / Kyste hydatique des parties molles. Aspects radiologiques.

Hydatid disease of the soft tissues is rare, with a frequency between 2.4 and 5.3% of all sites of hydatid disease. We report a retrospective study of 6 cases of hydatid cyst of soft tissues. The mean age of our patients was 36 years (range: 25 and 63 years) and the sex-ratio was 5 females to 1 male. The clinical symptoms consisted in a mass which had been present for a mean of 12 months. Plain X-rays showed a water density mass with no associated bone lesions. Ultrasonography and computed tomography defined the features of the hydatid cysts, which were situated in muscle in 5 cases and in the subcutaneous tissue in 1 case. Their dimensions varied between 1.5 and 25 cm. All types of Gharbi's classification were observed. Secondary hydatid cysts outside of the soft tissues were observed in 2 patients. Medical imaging, essentially ultrasonography, was suggestive of the diagnosis. Computed tomography provided more precise information concerning the number, site and morphology of the lesions and was able to eliminate neoplastic disease.

[Ultrasound signs of pseudoneoplastic forms of hepatic hydatid cysts. A prospective analysis of 50 cases]. / Sémiologie échographique des formes pseudotumorales du kyste hydatique du foie. Etude prospective de 50 cas.

Pseudoneoplastic hydatid cyst of the liver (type IV), still raises diagnostic difficulties on ultrasonography (US), and often leads us to perform computed tomography. We therefore, conducted a prospective study of 50 cases of hepatic hydatid cyst (HHC) type IV in order to define the US and Doppler features allowing easy diagnosis with the best cost-effectiveness ratio. HHC type IV represented 23.7% of all types. The average age was 43.5 years with a female predominance. Many signs were described and their frequency was established. The main signs were daughter cysts (82%), hypo or hyperechoic spirals (66%), and peripheral transonic collarette (54%). At least one of these signs was present in 90% of cases. The Doppler study showed the avascular nature of the lesion in 100% of cases. Hydatid serology using modern immunologic techniques confirmed the diagnosis in 74% of cases. The US-serology combination can establish the positive diagnosis of HHC type IV in 94% of cases. Computed tomography therefore has a small place in this setting.

[Contribution of imaging in malignant non-Hodgkin lymphomas of the small intestine. Apropos of 32 cases]. / Apport de l'imagerie dans les lymphomes malins non hodgkiniens du grêle. A propos de 32 cas.

The authors report a retrospective study concerning 32 cases of non Hodgkin lymphoma of the small intestine, histologically confirmed. All patients underwent digestive opacification. Ultrasonography was performed in 15 cases and CT scan was performed in 6 cases. The average age was 36 years and the sex-ratio was 3.4. The classical radiological signs described in the literature were found in our patients. The diagnosis of lymphoma was easily suggested in the presence of polymorphic and multifocal lesions, and especially the aneurysmal appearance. Abdominal sonography and computed tomography contributed to the diagnosis and also helped to relate an abdominal mass to its digestive origin, by showing a classical "sandwich" appearance.

[Aneurysmal cyst of the pelvis. Apropos of a case]. / Kyste anévrysmal du bassin. A propos d'un cas.

The authors present an aneurysmal bone cyst of the pelvis which was unusual in its radiographic aspects. Its aggressive features made it difficult to distinguish from a malignant lesion. We develop the imaging methods contribution in positive and differential diagnosis and underline the modern methods interest (CT scan, MR imaging). Biopsy is necessary to confirm the diagnosis and recognize possible causal malignant tumor.